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Screening and Assessment for Alcohol and Other Drug Abuse Among Adults in the Criminal Justice System
Treatment Improvement Protocol (TIP) Series 7

Appendix C -- Screening and Assessment Instruments

This appendix includes several screening and assessment instruments that are readily available, in widespread use, and in the public domain. Two alcohol abuse screening instruments are included -- the CAGE questionnaire and the Short Michigan Alcohol Screening Test. Two instruments designed to screen for drug abuse are included -- the Substance Abuse Screening Instrument and the Offender Profile Index. The Addiction Severity Index, which can facilitate a comprehensive assessment, is also included.

A brief HIV risk assessment is included as part of the Offender Profile Index. For an assessment of HIV risks while incarcerated, the AIDS Initial Assessment Jail Supplement is reproduced here. Information on the costs for training and utilization of these instruments is also included. Additional instruments are discussed in Appendix D, Supplementary Instruments Recommended for the Assessment of Life Domains and Problem Areas of Adult Clients.

The CAGE Questionnaire

The CAGE questionnaire is a self-report screening tool for alcoholism. Among validated instruments, it is perhaps the shortest. It consists of four questions:

  1. Have you felt the need to Cut down on your drinking?
  2. Do you feel Annoyed by people complaining about your drinking?
  3. Do you ever feel Guilty about your drinking?
  4. Do you ever drink an Eye-opener in the morning to relieve the shakes?

Two or more affirmative responses suggest that the client is a problem drinker. A discussion of the CAGE questionnaire and other alcoholism screening techniques appears in the following article: Allen, J.P., Eckardt, M.J., and Wallen, J. Screening for alcoholism: techniques and issues. Public Health Reports 103:586-592, 1988.

Cost: Since the CAGE is in the public domain, there is no cost for its reproduction and use. Furthermore, as a self-report screening tool, there are no interviewing or administration costs.

Short Michigan Alcohol Screening Test

The Short Michigan Alcohol Screening Test is a 13-item questionnaire that requires a 7th grade reading level, and only a few minutes to complete (see next page). It was developed from the Michigan Alcoholism Screening Test. Evaluation data indicate that it is an effective diagnostic instrument, and does not have a tendency for false positives, as does the Michigan Alcoholism Screening Test. Research demonstrates a high degree of reliability with Latino populations, but is useful with all populations.

Administration: Self-administered. All questions are to be answered with "Yes" or "No" answers only.

Scoring: Each "Yes" answer equals one (1) point.

A score of 1 or 2 indicates there is no alcohol problem. A score of 3 indicates a borderline alcohol problem. A score of 4 or more indicates an alcohol problem.

Cost: Since the Short Michigan Alcohol Screening Test is in the public domain, there is no cost for its reproduction and use. Furthermore, as a self-report screening tool, there are no interviewing or administration costs.

Short Michigan Alcohol Screening Test

Answer Yes or No
  1. Do you feel that you are a normal drinker? (By "normal" we mean that you drink less than or as much as most other people.)

______

  1. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking?

______

  1. Do you ever feel guilty about your drinking?

______

  1. Do friends or relatives think you are a normal drinker?

______

  1. Are you able to stop drinking when you want to?

______

  1. Have you ever attended a meeting of Alcoholics Anonymous?

______

  1. Has drinking ever created problems between you and your wife, husband, a parent, or other near relative?

______

  1. Have you ever gotten into trouble at work because of your drinking?

______

  1. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?

______

  1. Have you ever gone to anyone for help about your drinking?

______

  1. Have you ever been in a hospital because of drinking?

______

  1. Have you ever been arrested for driving under the influence of alcoholic beverages?

______

  1. Have you ever been arrested, even for a few hours, because of other drunken behavior?

______

Substance Abuse Screening Instrument

The Substance Abuse Screening Instrument is a questionnaire designed to be used as an initial screen for substance abuse problems among people entering the criminal justice system (see next page). Although it was developed for youths, it is appropriate for other populations as well. The purpose of this screening instrument is to identify people for whom further substance abuse assessment is indicated. The Substance Abuse Screening Instrument is comprised of 15 self-report items. The instrument has been designed to be brief, and should take no more than 5 minutes to implement. The instrument is easy to administer and score, and no specialized clinical skills or lengthy training are required. The instrument is useful, since the information obtained will be immediately useful to the individual administering it.

A manual for this screening instrument is available from the National Center for Juvenile Justice, 701 Forbes Avenue, Pittsburgh, Pennsylvania 15219.

Cost: Since the Substance Abuse Screening Instrument is in the public domain, there is no cost for its reproduction and use. Furthermore, as a self-report screening tool, there are no interviewing or administration costs.

Substance Abuse Screening Instrument

Substance Abuse Screening Insrument
Please Read Carefully and Circle the Appropriate Response
Have you ever done something crazy while high and had to make excuses for your behavior later?YES/NO
Have you ever felt really burnt out for a day after using drugs?________________________________YES/NO
Have you ever gotten out of bed in the morning and really felt wasted? __________________________YES/NO
Did you ever get high in school? ________________________________________________________YES/NO
Have you gotten into a fight while you were high (including drinking)? ___________________________YES/NO
Did you think about getting high a lot of the time? ___________________________________________YES/NO
Have you ever thought about committing suicide when you were high? __________________________YES/NO
Have you run away from home, partly because of an argument over drug use? ___________________YES/NO
Did you ever try to stick to one drug after a bad experience mixing drugs? _______________________YES/NO

Have you gotten into a physical fight during a family argument over drugs? _______________________		YES/NO

Have you ever been suspended because of something you did while high? ______________________		YES/NO

Have you ever had a beer or some booze to get over a hangover? _____________________________		YES/NO

Do you usually keep a supply [of drugs] for emergencies, no matter how small?		YES/NO

Have you ever smoked some pot to get over a hangover? ____________________________________		YES/NO

Have you ever felt nervous or cranky after you stopped using for a while? _______________________		YES/NO
Thank You for Your Cooperation
ID#:________ Age:________ Gender:________ Race:________
Results: #YES:________ #NO:________ Offense(s):_____________________________________________________________
______________________________________________________________________ Comments:_____________________________________________________________
______________________________________________________________________
Referred for Further Assessment? Yes________ No________

Offender Profile Index

The Offender Profile Index (OPI) is not a clinically oriented instrument designed to yield a comprehensive substance abuse treatment plan. Rather, it is a broad "sorting" or classification instrument, appropriate for determining which type of drug abuse treatment intervention should be used: long-term residential, short-term residential, intensive outpatient, regular outpatient, or urine monitoring only. Diagnoses and assessments for comprehensive treatment planning are best accomplished at the particular program to which the client is directed.

Administering the OPI involves a face-to-face interview that can be completed in about 30 minutes. It can be administered by any trained professional with basic interviewing skills. The assessment is essentially self-scoring, and a numerical score corresponds with a specific referral recommendation.

The OPI and its associated service recommendations are based on "stakes in conformity." Research findings have indicated that individuals with high stakes in conformity (as measured by educational attainment, employment history, living arrangements, and arrest history) are less likely to commit crimes than persons with low stakes in conformity. Research also indicates that persons with high stakes who commit crimes are less likely to do so than recidivists or persons with low stakes and, therefore, require less supervision and fewer services than persons with low stakes in conformity.

The specific background data and stake-in-conformity indices included in the OPI are:

  1. Socio-demographic and Offense Characteristics
  2. Drug Severity Index
  3. Family/Support Sub-Index
  4. Educational Stake Sub-Index
  5. School Stake Sub-Index
  6. Work Stake Sub-Index
  7. Home Stake Sub-Index
  8. Criminal Justice History Sub-Index
  9. Psychological Stake Sub-Index
  10. Treatment Stake Sub-Index
  11. HIV Risk Behaviors Sub-Index

A manual on the OPI is available from the National Association of State Alcohol and Drug Abuse Directors, located at 444 North Capitol Street, Washington, D.C. 20001. The instrument and manual also appear in: Inciardi, J.A. Drug Treatment and Criminal Justice. Newbury Park, CA: Sage Publications, 1993.

Cost: Since the OPI is in the public domain, there is no cost for its reproduction and use. Other costs are as follows: Training Cost: $1,000 to $1,500 plus travel expenses for an on-site trainer. A self-training manual is reproduced in James A. Inciardi (ed.), Drug Treatment and Criminal Justice. Newbury Park, CA: Sage Publications, 1993. Further information on the OPI may be obtained from its developers: James A. Inciardi (302-831-6286) or Duane C. McBride (616-471-3576).

Administrative and scoring cost: 1 hour of clinical staff time.

OFFENDER PROFILE INDEX
CASE # _ _ _ _ _ _ _ _
CRIMINAL JUSTICE VERIFICATION
Arrests Verified: ________
Date of Verification: ________
Not Verified: ________
URINALYSIS RESULTS (PRELIMINARY):
Negative for All Drugs: _____

Positive for:
Cocaine_____
Opiates_____
Amphetamines_____
THC_____
Benzodiazepines_____
Barbiturates_____
Phencyclidine_____
Date of Test: ___________
Confirmed: Yes __ No__

PART I: Background Information


Jurisdiction: _____________________

Client's Name: _______________________________
Last, First, Middle

Social Security Number: _ _ _ -_ _ -_ _ _

Date of Birth: _ _ /_ _/_ _

Age:___

Please circle appropriate responses:

Sex:
  1. Male
  2. Female
Ethnicity:
  1. White
  2. Black
  3. Black/Haitian
  4. Black/Other Caribbean
  5. Native American
  6. Asian or Pacific Islander
  7. Hispanic/Mexican
  8. Hispanic/Cuban
  9. Hispanic/Puerto Rican
  10. Hispanic/Other
Type of Client:
  1. Pre-Sentencing
  2. Sentencing
  3. Post-Sentencing
Offenses:
1. ______________
2. _____________
3. _____________
4. _____________

UNCOOPERATIVE/DISORIENTED CliENTS: If client refuses to cooperate or appears too disoriented to provide the information requested, the interview should be terminated and the appropriate indicator circled.

Client was:
  1. Disoriented
  2. Uncooperative
  3. Cooperative, continue interview
_____________________
Interviewer's Signature
_____________________
Date of Interview

PART II: DRUG SEVERITY INDEX

Illegal Drugs and/or Non-Medical Use of Prescription Drugs Age of 1st UseAge of 1st Continued Use CODING FREQUENCY:
3=daily;
2=1/wk or more;
1=less than 1/wk
A.
1. ALCOHOL		_____________________

2. MARIJUANA, kif hashish, etc.		_____________________
B.
3. INHALANTS, glue solvents,etc.		_____________________

4. HALLUCINOGENS LSD, PCP, etc. 		_____________________

5. PILLS, downers, prescribed sedatives, tranquilizers		_____________________
C.
6. PILLS, uppers, speed, crank 		_____________________
7. AMPHETAMINES,
Ice, crystals		_____________________

8. OPIATES, pills, Dilaudid, codeine, T's and Blues		_____________________

9. COCAINE, non-IV, inhalation, snorting 		_____________________

10. CRACK, freebase		_____________________

11. BASUCO, coca paste		_____________________
D.
12. HEROIN, (IV)		_____________________

13. COCAINE, (IV)		_____________________

14. SPEED, (IV)		_____________________

15. OTHER IV NARCOTICS		_____________________

16. COCAINE/HEROIN (IV) speedball		_____________________

17. ILLEGAL METHADONE		_____________________
SCORING:

6 = 0 in A - D OR 1 in A
5 - 2 in A OR 1 in B
4 = 3 in A OR 2 or 3 in only 1 drug in B
3 = 2 or 3 in TWO or more drugs in B OR 1 in C
2 = 2 or 3 in C
1 = 1 in D
0 = 2 or 3 in D		DRUG SEVERITY SCORE________

PART III: STAKE IN CONFORMITY INDEX

A. Family/Support Stake Sub-Index
1. With whom are you currently living?____
a. spouse/sex partner= 2 
b. parents/family= 2 
c. alone/friends= 1 
d. street/institution= 0 
2. If (a) or (b) above, how long have you been living in that arrangement?____
1 year or longer= 2 
6 to 12 months= 1 
less than 6 months= 0
 
3. Has your spouse/sex partner or any of the people with whom you are currently living EVER been incarcerated for 30 days or longer? (1) Yes (2) No____
4. Has your spouse/sex partner or any of the people with whom you are living ever been treated for a drug or alcohol problem or gone through detox? (1) Yes (2) No____
5. How many close friends do or did you have prior to your arrest? (not scored) ____
6. How many of these friends have EVER been incarcerated for 30 days or longer? ____
half or more= 0 
less than half= 1 
none or almost none= 2 
7. How many of these friends have ever been treated for a drug or alcohol problem, or have gone through detox? ____
half or more= 0 
less than half= 1 
none or almost none= 2 
TOTAL COMPOSITE SCORE for questions 1, 2, 6, 7 above:____

Family/Support Stake Sub-Index Scoring

Assign a weight of 0 for a composite score of 0 - 3
Assign a weight of 1 for a composite score of 4 - 5

Assign a weight of 2 for a composite score of 6 or greater

FAMILY/SUPPORT STAKE SCORE (circle the appropriate score): 0 1 2
B. Educational Stake Sub-Index
  1. What is the highest grade in school that you completed?
(If 12 years or more, proceed to scoring below)		_____
  1. If less than 12, did you receive a GED? 2) Yes 1) No
    (If client received GED, proceed to scoring below)
  2. Have you attended any vocational/technical courses? (If no, proceed to scoring)
    2) Yes 1) No
  3. If yes, what courses or training programs did you complete?

Educational Stake Sub-Index Scoring

Assign a weight of 2 for: 12 or more years of schooling, or GED, or
9 or more years + completed skills training

Assign a weight of 1 for: 9 - 11 years without completed skills training
Assign a weight of 0 for: 8 years or less

EDUCATIONAL STAKE SCORE (circle the appropriate score): 0 1 2

C. School Stake Sub-Index
  1. Are you currently attending school? 2) Yes 1) No
  2. If No, score 0 below and go to Work Stake Sub-Index
  3. If Yes, is schooling full- or part-time?
If Full-time, score 2 below
If Part-time, score 1 below
Interviewer: Obtain enrollment verification information below:
1) Not Verified
2)Inaccurate
3)Accurate
Enrollment Verification Information

Name of School:_________________________________
Address:_________________________________________
__________________________________________________
Telephone Number:______________________________

SCHOOL STAKE SCORE (circle the appropriate score): 0 1 2

D. Work Stake Sub-Index
1. How many weeks have you worked outside the home and/or as a homemaker(with responsibility for others) during the past 12 months?____
Assign a weight of 2 for 35 weeks or more
Assign a weight of 1 for 20 - 34 weeks
Assign a weight of 0 for less than 20 weeks		____
2. Are you currently employed outside the home and/or as a homemaker
(with responsibility for others)? 2) Yes 1) No		____
3. If YES, how many hours a week do you typically work?____
Assign a weight of 2 for 35 or more hours/week
Assign a weight of 1 for 15 - 34 hours/week
Assign a weight of 0 for less than 15 hours/week		____
4. If NO, how many hours a week did you work on your last job?____
Assign a weight of 2 for 35 hours or more/week
Assign a weight of 1 for 15 - 34 hours/week
Assign a weight of 0 for less than 15 hours/week		____
INTERVIEWER: Obtain employment verification information below

Employment Verification Number

Name of Employer:_____________________________

Address:______________________________

Telephone Number:__________________________

Supervisor's Name:__________________________
1) Not Verified
2) Inaccurate
3) Accurate
Work Stake Sub-Index Scoring

Sum of Scores (from questions 1 and 3 or 4) =____
Assign a weight of 2 for a composite score of 4
Assign a weight of 1 for a composite score of 2 - 3
Assign a weight of 0 for a composite score of 0 - 1
WORK STAKE SCORE (circle the appropriate score): 0 1 2

E. Home Stake Sub-Index
  1. What is your most recent residence:

    __________________________
    Street
    __________________________
    City
    ______________________
    State
    ______________________
    Zip Code

    Telephone:______________________

  2. Dates you resided there: From_______ to_____

  3. Number of months at that residence:
    (If 12 months or more, proceed to question #5)

  4. How many residences have you had during the past 12 months?
____
  1. During the past 12 months, how much were you contributing to the rent or mortgage of the place(s) you were living?

    1)______none
    2)________some
    3)________all
VERIFICATION

____ place of last residence verified as correct
____ dates of last residence verified as correct
____ place of last residence verified as incorrect
____ dates of last residence verified as incorrect
____ residence not verified
Date of residence check: __________

Name of checker: ________________

Home Stake Sub-Index Scoring
Assign a weight of 0 if the client: made no contribution to the rent of mortgage during the past 12 months or had 6 or more residences, or if most recent residence was false.

Assign a weight of 1 if the client: made some contribution to the rent or mortgage during the past 12 months or had 4 - 5 residences, and most recent residence was verified as correct.

Assign a weight of 2 if the client: made the total contribution to the rent or mortgage, and had less than 4 residences, and the residence was verified as correct.
HOME STAKE SCORE (circle the appropriate score): 0 1 2

F. Criminal Justice History Sub-Index
1. Total arrests in last 5 years:____
2. Total convictions in last 5 years:____
3. Total time served (months) in last 5 years:____

Criminal Justice History Scoring

Assign a weight of 2 if client: no more than 2 arrests and/or 45 days incarcerated in the last 5 years

Assign a weight of 1 if client: 3 to 10 arrests and/or 6 months incarcerated in the last 5 years

Assign a weight of 0 if client: 11 or more arrests and/or more than 6 months incarcerated in the last 5 years

NOTE: In scoring, time incarcerated should weigh more heavily than # of arrests.
CRIMINAL JUSTICE SCORE (circle the appropriate score): 0 1 2

G. Psychological Stake Sub-Index
  1. Have you ever felt if you had acted out of control, or have others told you that you had acted out of control, at any time when you were NOT under the influence of alcohol or drugs? 1) Yes 2) No

    If "YES," how many times in the last year?
____

Score 2 if none
Score 1 if only 1 time
Score 0 if 2 or more times		____
  1. Have you ever attempted suicide? 1) Yes 2) No

    If "NO," have you ever seriously considered suicide?
    1) Yes 2) No

    Score 2 if no to both questions
    Score 1 if yes to considered
    Score O if yesto attempted
____
  1. Have you ever been treated for nervous or mental problems? 1) Yes 2) No

    If "YES," how many times did you receive treatment?
____

Score 2 if never treated
Score 1 if treated once
Score 0 if treated 2 or more times		____

TOTAL COMPOSITE SCORE FOR QUESTIONS 1 - 3 ABOVE:____		____

Psychological Stake Sub-Index Scoring

Assign a weight of 2 for a composite score of 5 - 6
Assign a weight of 1 for a composite score of 2 - 4
Assign a weight of 0 for a composite score of 0 - 1
PSYCHOLOGICAL STAKE SCORE (circle appropriate score): 0 1 2

H. Treatment Stake Sub-Index
1. How many months have you spent in drug abuse treatment during the past 5 years?____

Assign a weight of 2 for 12 months or more
Assign a weight of 0 for less than 12 months
TREATMENT STAKE SCORE (circle the appropriate score): 0 1 2
I. HIV Risk Behaviors Sub-Index
  1. How many sex partners have you had in the last year?
____
  1. What proportion of the time were condoms used?
    1. None
    2. About a quarter
    3. About half
    4. About three-quarters
    5. Almost all


    FOR MALES ONLY

  2. What proportion of your sex partners were prostitutes?
    1. Almost all
    2. About three-quarters
    3. About half
    4. About a quarter
    5. None

  3. What proportion of these sex partners were IV drug users?
    1. Almost all
    2. About three-quarters
    3. About half
    4. About a quarter
    5. None


  4. What proportion of these sex partners were males?
    1. Almost all
    2. About three-quarters
    3. About half
    4. About a quarter
    5. None

  5. If any were males, what proportion of the time did sexual contact involve anal penetration?
    1. Almost all
    2. About three-quarters
    3. About half
    4. About a quarter
    5. None



    FOR FEMALES ONLY

  6. What proportion of your sexual partners were IV drug users?
    1. Almost all
    2. About three-quarters
    3. About half
    4. About a quarter
    5. None
  7. What proportion of the time did sexual intercourse involve anal penetration?
    1. Almost all
    2. About three-quarters
    3. About half
    4. About a quarter
    5. None


    ASK BOTH MALES AND FEMALES (IV DRUG USERS ONLY)

  8. When you had your own works, how often did you share them with others?
    1. More than half the time
    2. About half the time
    3. About a quarter of the time
    4. Almost never

  9. After sharing your works, how often did you clean them before using them yourself?
    1. Almost never
    2. About a quarter of the time
    3. About half the time
    4. More than half the time
    5. Never shared

  10. What do you usually use to clean your works?
    1. Never clean them
    2. Other (specify)________
    3. Water
    4. Alcohol
    5. Bleach

  11. When you did not have your own works, how often did you clean the works you borrowed?
    1. Almost never
    2. About a quarter of the time
    3. About half the time
    4. More than half the time

  12. On these occasions, how did you clean these works?
    1. Never clean them
    2. Other (specify)_________
    3. Water
    4. Alcohol
    5. Bleach
INTERVIEWER: Is client at high risk for HIV infection? Yes No

PART IV:PROFILE SUMMARY
1. Drug Use Severity (from page 3)____
2. Stake in Conformity____
A. Family/Support Score (from page 5)____
B. Educational Stake Score (from page 6) ____
C. School Stake Score (from page 7) ____
D. Work Stake Score (from page 8) ____
E. Home Stake Score (from page 9) ____
F. Criminal Justice Stake Score (from page 10) ____
G. Psychological Stake Score (from page 11) ____
H. Treatment Stake Score (from page 12)____
TOTAL STAKE IN CONFORMITY SCORE____

Profiles( circle one)
1. Long Term Residential Treatment0 or 1 drug severity
2. Short-term Residential Treatment2 in drug severity plus conformity stake of less than 12
3. Intensive Outpatient Treatment (must have contact with client in a therapeutic session of at least one hour's duration, three times/week or more)a) 3 in drug severity plus conformity stake of less than 12
OR
b) 2 in drug severity plus conformity stake of at least 12
4. Outpatient Treatment (must have contact with client in a therapeutic session of at least one hour's duration, no less than one time/week a) 4 in drug severity plus conformity stake of less than 12
OR
b) 3 in drug severity plus conformity stake of at least 12
5. Urine Onlya) 5 or 6 drug severity
OR
b) 4 drug severity plus conformity stake of at least 12
Is AIDS prevention/intervention indicated? Yes No

In completing the interview it has been determined that the client experiences overriding mental health problems and is not suitable for drug intervention. (Circle) Yes No

Addiction Severity Index

The 5th edition of the Addiction Severity Index (ASI) is a 161-item multidimensional clinical and research instrument for diagnostic evaluation and for the assessment of change in client status and treatment outcome. It consists of two parts: 1) identifying personal and family background data, and 2) questions on current status and problems in six life areas or domains. It is based on the premise that treatment for substance abuse should address the "problems which may have contributed to and/or resulted from the chemical abuse."

The ASI is probably the most widely used standardized instrument in the field and is used for client clinical assessment and research purposes. ASI data have been published on many different samples of drug abuse clients.

A "technology transfer" package, which will include a detailed users guide, a 90-minute training videotape, and audiocassettes is currently being developed by NIDA. This will help to familiarize service providers with the use of the ASI for clinical assessment and client treatment planning.

The ASI is unavailable in electronic form as part of TIP 7: Screening and Assessment for Alcohol and Other Drug Abuse Among Adults in the Criminal Justice System.

A copy of the entire TIP containing the ASI can be ordered from the National Clearinghouse of Drug and Alcohol Information (NCADI). The order number for TIP 7: Screening and Assessment for Alcohol and Other Drug Abuse Among Adults in the Criminal Justice System is BKD138. It is free and can be ordered from NCADI's electronic catalog at http://ncadi.samhsa.gov/ or by calling 1-800-729-6686.

Cost: Since the ASI is in the public domain, there is no cost for reproduction and use. Other costs are as follows: Training cost: $1,500 to $3,000 plus travel expenses for an on-site trainer. Self-training tapes and manuals are available from ABT Associates (301-913-0500). Administration and scoring cost: 1 to 1-1/2 hours of clinical staff time.

AIDS Initial Assessment Jail Supplement

The AIDS Initial Assessment Jail Supplement was developed by researchers in the Comprehensive Drug Research Center at the University of Miami School of Medicine. The purpose of the instrument is to elicit information on AIDS risk behaviors in which the client may have participated while incarcerated. Since the instrument does not yield a numerical score, the interviewer or clinician administering this tool must be knowledgeable of the risks for HIV infection. This is necessary in order to make the subjective decision whether a client is in need of AIDS prevention education and/or should be urged to have an AIDS test.

Cost: Since the AIDS Initial Assessment Jail Supplement is in the public domain, there is no cost for its reproduction and use. Since the instrument is self-explanatory, there are no training costs. Administration and scoring cost: 30 to 45 minutes of interviewer or clinical staff time.

AIDS Initial Assessment Jail Supplement*:
Question 1

1. Have you ever committed a crime?
 NO (Skip to Q5)0
 YES1
 DK/UNSURE7
 REFUSED8
 N/A9
2. What was the first crime you ever committed?
(RECORD CODE FROM LIST BELOW) ____ ____
 DK/ UNSURE
77		REFUSED
88		N/A
99
  1. SELL TO DEALERS
  2. MANUFACTURE
    OR SMUGGLE DRUGS
  3. SELL TO USERS
  4. ROBBERY (INCL. DRUGS)
  5. BURGLARY (B & E)
  6. MOTOR VEHICLE THEFT
    (GRAND THEFT AUTO)
  7. THEFT FROM MOTOR VEH.
  1. SHOPLIFTING (INCL. FOR PERSONAL USE)
  2. PROSTITUTION (FOR DRUGS OR MONEY)
  3. PROCURING
  4. PROSTITUTE'S THEFT FROM CLIENTS
  5. CON GAME
  6. PICKPOCKET
  7. BAD PAPER (RX, CHECK, CREDIT CARD)
  1. OTHER THEFT (INCL. DRUGS)
    SPECIFY
    ___________________
  2. STOLEN GOODS
    (SELL, TRADE, OWN, OTHER)
  3. UNARMED ASSAULT
    (WITH ANY OF THE ABOVE)
  4. WEAPON
    (SHOW OR OTHER USE)
  5. OTHER ASSAULT
  6. OTHER CRIME
* The AIDS Initial Assessment Jail Supplement has been retyped for inclusion in this Treatment Improvement Protocol. Those who wish to administer the AIDS Initial Assessment Jail Supplement should obtain a copy of the original for verification. This iteration of the AIDS Initial Assessment Jail Supplement is for general reference purposes only.

AIDS Initial Assessment Jail Supplement:
Question 3


INTERVIEWER: READ ACROSS CHART FOR EACH CRIME.

3. Next, I will read a list of different crimes and ask some questions about each one.

3a. Have you ever _____________________________?
3b. How old were you the first time you _____________________________?
3c. Have you ever _____________________________ regularly (3 or more/week) for at least a month?
3d. How old were you when you started _____________________________ regularly?
 3a
EVER		3b
AGE 1ST TIME		3c
REGULARLY		3d
AGE REG.
 NY NY 
  1. Sold drugs (or conducted other drug business or other activity)
  2. COLSPAN="4" anyone (incl. purse snatch or drug robbery)
  3. Been a prostitute
  4. Done thefts
  5. Assaulted anyone (violence)
01 01 
01 01 
01 01 
01 01 
01 01 

AIDS Initial Assessment Jail Supplement: Questions 4-8

4. Now, please think back to the first time you were arrested:
   DK/ UNSURE REFUSED N/A
4a. What was the offense?
(USE CATEGORIES FROM Q.2) ____ ____
778899

4b.
How old were you when first arrested? ____ ____
778899

4c.
What was the disposition of your case?
 Never prosecuted1   
 Found not guilty2   
 Suspend sentence3   
 Probation4   
 Incarceration:   
 1 year or less5   
 Greater than 1 year6   
 DK/ UNSURE7   
 Refused8   
 N/A9   
   DK/ UNSUREREFUSEDN/A

5.
How many times have you been arrested in your lifetime?
(RECORD EXACT NUMBER OF TIMES)____ ____
778899
6.
Except for the last few days, have you ever been incarcerated?
 NO (TERMINATE INTERVIEW )0
 YES1
 DK/ UNSURE7
 REFUSED8
 N/A9
7. How old were you when you were first incarcerated?
(RECORD EXACT AGE)____ ____
778899
8. Were you incarcerated in the last 6 months?
 NO0
 YES1
 DK/ UNSURE7
 REFUSED8
 N/A9

AIDS Initial Assessment Jail Supplement: Hand Card A

HAND CARD A
CODES

A=Always

B=More than half the time

C=About half the time

D=Less than half the time

E=Never

7=DK/UNSURE

8=REFUSED

9=N/A

AIDS Initial Assessment Jail Supplement: Hand Card B

HAND CARD B
CODES

A=Never/None
B=Less than 4 times per month
C=About 1 time a week
D=2-6 times a week
E=About 1 time a day
F=2-3 times a day, almost every day
G=4 or more times a day, almost every day
7=DK/UNSURE
8=REFUSED
9=N/A

AIDS Initial Assessment Jail Supplement: Question 9

HAND CARD B
9. Next, I will ask some questions about the time when you were incarcerated and your use of drugs.
9a. Have you ever injected _______________________ while incarcerated?
INTERVIEWER: IF NOT INCARCERATED IN LAST 6 MONTHS, DO NOT ASK 9b OR 9c. TERMINATE INTERVIEW AFTER ALL 9a's ARE ASKED.
9b. How often have you injected _______________________
over the past 6 months when you were incarcerated?
9c. How often have you injected _______________________ over the past 5 years when you were incarcerated?
 EVERFREQ. 6 MO.FREQ. 5 yr.
 NY  

A.
Cocaine by itself
0
1		  

B.
Amphetamine/Prescription stimulant by itself
0
1		  

C.
Heroin by itself
0
1		  

D.
Heroin and cocaine mixed together
0
1		  

E.
Nonprescription methadone
0
1		  

F.
Other opiates or narcotics
0
1		  

G.
Barbiturates
0
1		  

H.
Tranquilizers
0
1		  

I
PCP
0
1		  

J.
Hallucinogens/Psychedelics: MDA
0
1		  

K.
Nitrites and poppers
0
1		  

L.
Other drugs (Specify: _____________________________________

  

__________________________________________ )
0
1		  

M.
Other drugs in combination (Specify: _______________________
______________________________________ )

0

1		  

AIDS Initial Assessment Jail Supplement: Questions 10-15

 Last 6 Mo.Last 5 Yrs.
10.Still thinking about the time you were incarcerated, how often did you have your own works?__________
11.How often did you share your works with someone else?__________
12.How often did you clean your works before you used them yourself?__________
12.13. When you cleaned your works, how often did you use any of the following methods?

ENTER CODE FROM BOX
A.
Used bleach or clorox and rinsed with water?		__________
B.
Used alcohol and rinsed with water?		__________
C.
Boiled in water?		__________
D.
Rinsed in water only?		__________
E.
Used some other method I have not mentioned?
(Specify ___________________________________)		__________
14.Did you borrow your works?NO0
 YES1
 DK/UNSURE7
 REFUSED8
 N/A9
14a. How often did you clean works that you borrowed?Last 5 Yrs. __________
Last 6 Mos. _________
15.When you cleaned the works that you borrowed, how often did you use any of the following methods to clean the works before you used them?
ENTER CODE FROM BOXLast 6 Mo.Last 5 Yrs.
A.
Used bleach or clorox and rinsed with water?		__________
B.
Used alcohol and rinsed with water?		__________
C.
Boiled in water?		__________
D.
Rinsed in water only?		__________
E.
Used some other method I have not mentioned?
(Specify ___________________________________)		__________

AIDS Initial Assessment Jail Supplement: Questions 16-17

16.Next, I will ask some questions about your sexual activities, while you were incarcerated. During the time you were incarcerated in the last 6 months, how many people did you have sex with?
DK/UNSUREREFUSEDN/A
____ ____ ____777888999
(RECORD NUMBER)
IF MORE THAN ONE, DK, OR REFUSED, SKIP TO Q.19
ASK IF ONLY ONE PARTNER:
17.Is your sex partner
Male?1
OR Female?
(TERMINATE INTERVIEW)		2
REFUSED8
N/A9

AIDS Initial Assessment Jail Supplement: Question 18

18.Still thinking about the time you were incarcerated in the last 6 months, please tell me how often you've done each kind of sex.
INTERVIEWER:

HAND CARD B
(WATCH SKIP PATTERNS CLOSELY)
18a.ASK ONLY MALE RESPONDENT WITH MALE PARTNERS
 With a Condom?Without a Condom?
 AB
 99

CIRCLE 9 IF COLUMN "a or b" IS NOT APPLICABLE
 ORAL (1) Your penis in your partner's mouth____________
 ANAL (2) Your penis in your partner's anus____________

AIDS Initial Assessment Jail Supplement: Question 19

FOR MORE THAN ONE PARTNER ONLY
19a.How many of these partners were female?
 DK/UNSUREREFUSEDN/A
 ____ ____ ____777888999
 ____ ____ ____777888999
IF NO MALE PARTNERS, TERMINATE INTERVIEW
20.Please tell me how often you've done each kind of sex during the last 6 months while you were incarcerated.

INTERVIEWER:
HAND CARD B
(WATCH SKIP PATTERNS CLOSELY)
20a.ASK ONLY MALE RESPONDENT WITH MALE PARTNERS!
With a Condom?Without a Condom?
AB
99

CIRCLE 9 IF COLUMN "a or b" IS NOT APPLICABLE

ORAL (1) Your penis in your partner's mouth		____________

ANAL (2) Your penis in your partner's anus		____________
 		 



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