HRID – Phase 3

The GPS of the criminal justice system is screening and assessment. Comprehensive screening and assessment is necessary to identify DUI offenders who have behaviors or disorders that require further intervention. Without the accurate identification of these disorders, practitioners miss an opportunity to address an underlying cause of offending and therefore reduce future recidivism.

Screening and assessment affects release, sentencing, supervision, and treatment decisions. The process should occur early in the criminal justice process, preferably at the pre-trial phase. This ensures that judges have more information available when they make release and sentencing decisions. But it is common for assessment to be done post-conviction when a DUI offender is under community supervision or has entered into a treatment program.

Screening is the first step in the process of determining whether a DUI offender should be referred for treatment. Offenders who may have issues can be sent for a more in-depth assessment. 

Screening tools are simple, meaning pre-trial services staff, probation officers, case managers, counselors, treatment practitioner can administer them. In some cases, clients may complete the screening process themselves and have practitioners score the results. 

Assessment is more in-depth and is administered for offenders who show signs of substance use disorders or mental health issues. Assessment instruments are standardized, comprehensive, and explore individual issues in-depth. The process can take several hours to complete and is typically administered by a trained clinician or professional. It is meant to evaluate not only the presence of a substance use disorder but its extent and severity. 

The results from screening and assessment together should be used to inform sentencing decisions, case management plans, supervision strategies, and treatment referrals and plans. Assessments should be repeated at multiple points of an offender’s involvement in the criminal justice system to identify progress and to inform changes to supervision and treatment plans. 

Risk-Needs-Responsivity (RNR)

Assessments are a guided by risk-needs-responsivity model (Andrews & Bonta, 2007), which consists of three principles: 

• Risk principle – supervision and treatment levels should match the offender’s level of risk, or likelihood to re-offend or fail to adhere to release conditions. Low-risk offenders should not be placed in the same interventions as high-risk offenders as this typically produces poor outcomes. Risk can be “contagious.”
• Need principle – treatment services should target an offender’s needs that, if unaddressed, could cause further criminal behavior. The “big four” factors are history of anti-social behavior; anti-social cognitions; anti-social personality pattern; and anti-social associates. The “moderate four” are family/marital discord; leisure/recreation; substance abuse; and school/work. While mental health and trauma are not identified as criminogenic needs, their presence can have a profound impact on the other factors and cannot be ignored. 
• Responsivity principle – treatment interventions should be tailored to an individual offender’s specific characteristics—cognitive abilities and gender, for example—that may affect program outcomes. Sometimes finding the right program or approach involves trial and error. The more information that practitioners have about individuals, the better they can target treatment referrals.

The more that interventions can be tailored to the individual, the more likely it is that behavior change will occur. 

Assessment Tools

There are two types of assessment instruments: 1) risk assessments and 2) risk and needs assessments. Risk assessments provide practitioners with information about an individual’s probability of committing future offenses or being non-compliant with conditions. Risk and need assessments are actuarial-based tools used to classify offenders into levels of risk (low, medium, and high) and to identify and target interventions to address needs (anti-social cognitions, anti-social peer groups, and more) that are linked to recidivism. Risk assessments are most commonly used to make release and supervision decisions. Risk and needs assessments are used to develop sentencing, supervision, and treatment plans as they provide more information to practitioners.

An offender can fall into one of four categories: high risk/high need; high risk/low need; low risk/high need; and low risk/low need. The majority of repeat impaired drivers as well as polysubstance offenders will be classified as high-risk on account of their propensity to repeatedly engage in dangerous criminal behavior. But being high-risk does not automatically mean that an individual also has high needs. Many repeat DUI offenders are high-risk/low need and benefit from intensive supervision but minimal treatment.

Why DUI Offenders Require Unique Assessment

The assessment tools used to determine a DUI offender’s level of risk and need should be developed with the specific characteristics of DUI offender population in mind. Otherwise, they are likely to be misclassified in the process, and therefore less likely to change their behavior. 

DUI offenders tend to be predominantly male (between 70-80% of those arrested for DUI are men), tend to between ages 20 and 45, are usually Caucasian, and tend to drive at high-BAC levels, which is indicative of binge drinking. They have personality and psychosocial factors that increase their risk of offending such as aggression, irritability, thrill-seeking, impulsiveness, anti-authoritarian attitudes, and a likelihood of blaming others for their lack of control. These individuals tend to attain higher levels of education, maintain higher rates of employment, and, as a result, have higher socio-economic status then their drug court counterparts. This makes them unusual among the justice-involved population, and differ significantly from drug court participants, for example, who are usually classified as high-risk offenders with multiple convictions. As a result of these characteristics and others, DUI offenders tend to be improperly classified as low-risk when using risk assessments that have not been validated specifically for DUI offenders. 

Not all impaired drivers meet the conventional criteria for substance use disorders. However, studies show that many do struggle with addiction:

• Approximately two-thirds of convicted DUI offenders are alcohol dependent (Lapham et al., 2001). 
• 91% of male and 83% of female DUI offenders have met the criteria for alcohol abuse or dependence at some point in their lives (Lapham et al., 2000). 
• Approximately 11-12% of impaired drivers are multiple drug users who report significant involvement with drugs other than alcohol or marijuana (Wanberg et al. 2005). 
• 38% of male and 32% of female DUI offenders have met the criteria for drug abuse or dependence at some point in their lives (Lapham et al., 2001).

Research has shown 45% of repeat DUI offenders had a lifelong major mental disorder in addition to a substance use disorder and nearly 30% had a disorder in the past year. In many instances, these disorders contribute to criminal behavior but easily go undetected. It is logical to assume that a DUI offender has an alcohol or drug problem, particularly if they are a repeat offender. But these may only be surface issues. Like an iceberg, a small portion can be seen on the surface, but there is far more underneath. Therefore, proper assessments must cover mental health disorders, even though such evaluations have historically been lacking.

In short, risk assessment must be tailored for DUI offenders to be accurate for multiple reasons:

• DUI offenders have more pro-social and protective factors than most individuals who are involved in the justice system.
• DUI offenders tend to be employed at higher rates and can function on a daily basis. 
• DUI offenders also tend to have stable social networks. 
• DUI offenders do not view themselves as criminals which can be difficult to address in treatment as it is a blockade to behavior change. 
• DUI offenders often have unique needs, including substance use disorders and mental health issues, and can be highly resistant to change due to limited insight into their behavior.

Assessment tools not designed for or validated among the DUI offender population will lead DUI offenders to be misidentified as low risk due to an absence of criminogenic factors. 

Appropriate Tools for DUI Offenders 

There are many common screening and assessment instruments. Some jurisdictions, like Ohio and Texas, developed and utilize an assessment that is specific to their needs. The Texas Risk Assessment System, unfortunately, has not been validated among DUI offenders, and judges and other criminal justice practitioners report that the TRAS frequently classifies repeat DUI offenders as low risk. The misclassification of DUI offenders is one reason why specialized tools are needed for this population. 

Currently, there are only a few screening/assessment instruments are validated specifically for impaired drivers. These include the Computerized Assessment and Referral System (CARS), the Impaired Driver Assessment (IDA), and the DUI-RANT (Risk and Needs Triage). These were developed based on the recognition that other tools often led to risk misclassification. Agencies using assessment instruments that are not specific to the impaired driving population may be improperly assessing DUI offenders.

Computerized Assessment and Referral System (CARS): Responsibility.org collaborated with the Division on Addiction at Cambridge Health Alliance, a Harvard Medical School teaching hospital, to develop, validate, and implement CARS. The instrument was initially developed with grant funding from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which allowed the Division team to create an assessment that is adapted from the World Health Organization’s (WHO) Composite International Diagnostic Interview (CIDI). The CIDI is a reliable and internationally validated instrument that has the added benefit of being developed for use by lay interviewers. CARS is both a risk and needs assessment and is available in three formats—full assessment, interviewer-administered screener, and self-administered screener. Both the screener and assessment cover 13 different domains including DUI offending, alcohol use disorder, drug use disorder, and major mental health disorders. CARS is a particularly valuable instrument because it provides in-depth information about each of these key pieces needed to inform supervision and treatment plans:

In short, risk assessment must be tailored for DUI offenders to be accurate for multiple reasons:

Unlike traditional paper-and-pencil assessments, CARS combines a standardized substance use and mental health assessment with a user-friendly interface. The tool is operated on free, open source software that generates immediate personalized diagnostic reports that contain information about a client’s mental health profile, a summary of risk factors, and targeted referrals to treatment services within their geographic area that match their individual needs. By including a referral database, CARS can not only identify an impaired driver’s issues, it can also provide them with information on service providers in their area. CARS can be downloaded at www.carstrainingcenter.org. The website also contains training materials and resources for interested parties. To date, CARS is used almost every state and several foreign countries. 

CARS is routinely updated, and the team at the Division collaborates with Responsibility.org to identify ways to enhance the tool based on feedback from practitioners. 

Impaired Driver Assessment: The IDA was developed by the American Probation and Parole Association (APPA) with funding from the National Highway Traffic Safety Administration (NHTSA). The goals of the IDA are four-fold:

• Provide guidelines for identifying effective interventions and supervision approaches that reduce the risk of negative outcomes in treatment and community supervision.
• Provide preliminary guidelines for service needs for DUI clients.
• Estimate the level of responsivity of clients to supervision and to DUI and alcohol/drug education and treatment services.
• Identify the degree to which the client’s DUI has jeopardized traffic safety and to address this in the supervision plan.

The IDA was designed for community corrections practitioners and, as such, it is primarily a risk assessment, although it does examine criminogenic needs. The tool also identifies whether there are substance use and mental health issues present that require further assessment. The tool is comprised of 34 self-report questions and 11 evaluator report questions that, when combined, produces a DUI-risk supervision estimate. The IDA should be used to develop an accurate risk score for impaired driving clients and identify those individuals with substance use or psychosocial issues that require more in-depth assessment. Practitioners must be trained to use the IDA and an online training module is now available. The tool is available free of cost and online training can be accessed here. 

DUI-RANT: The DUI-RANT is a screening/triage tool. The purpose of the instrument is to identify the quadrant of the risk/needs matrix in which an offender fits. This information assists practitioners in identifying which offenders require intensive supervision as well as treatment interventions. This tool was developed by a team of researchers at the Treatment Research Institute (TRI) and it was derived from the Risk and Needs Triage (RANT), which is an empirically based risk and needs triage tool. There are licensing fees associated with its use. Learn more about the RANT and the DUI-RANT here. 

Sometimes agencies will decide to use multiple tools in an effort to develop a more complete picture of each individual impaired driver. This is often referred to as a stacked approach to assessment. For example, in the San Joaquin County DUI Monitoring Court, all repeat DUI offenders are screened using the DUI-RANT to determine if they will be placed in a monitoring or treatment track (high-risk/high needs offenders enter the treatment track). Each offender in the treatment track is then assessed using CARS to determine their specific treatment needs.

Additional Considerations

Practitioners are encouraged to consider several factors when determining what tool is the best fit for their program. Always ask the following questions:

• Which tool is best for your court/agency?
• Is the tool validated through independent research?
• Is the tool validated among the population being targeted (i.e., was it validated among impaired drivers)?
• Is the tool reliable, standardized, and easy to use?
• What level of training is required to administer the tool?
• Who will be responsible for administering the tool?
• Will the tool be administered pre- or post-sentence?
• Will the tool be used with all offenders or repeat offenders?
• Will the tool be useful in assisting decision-making?
• Is the instrument cost-effective?
• What policy changes (if any) are needed prior to administering a new tool?
• What key stakeholders need to be advised?