Module 2: Screening and Assessment

7A. Self-Report Information

Self-report instruments are limited because of their reliance on information reported by the youth. Self-report screening tools work well when the youth is stable, has a good memory, and is willing and able to provide accurate information—not always the case with youth involved with the juvenile justice system who have co-occurring disorders. The MAYSI is an example of a self-report instrument.

Adolescents often underreport or overreport their mental health symptoms and substance use. Some instruments have been designed to address underreporting by including validity scales to assess whether the offender is defensive and minimizing mental health symptoms or substance use. It is also possible that a youth may look worse on a self-report measure when reassessed at a later time. Once youth feel more comfortable in a particular setting or with staff members, disclosure of more accurate information may occur.

Other youth involved with the juvenile justice system may overreport mental health or substance abuse symptoms to receive medication, housing in special quarters, or increased contact with treatment staff.

Difficulty in Obtaining Accurate Mental Health and Substance Abuse Histories

Obtaining an accurate history of a youth’s mental health and substance abuse can be a challenge for the following reasons:

• Youth who have a severe mental illness may be confused or not understand the effects of their substance use
• The youth’s substance use may have gone on for a long enough time that it may be difficult to date the onset of the disorders or find substance-free periods
• Mental health and substance use disorders wax and wane; they may show up in different phases at different points in time
• Disorders often manifest differently depending on age, leading to multiple, conflicting diagnoses over the years
• Previous clinicians may have avoided or neglected to ask about co-occurring disorders
• Records may be incomplete, misleading, or misidentify the cause of a particular symptom
• Youth vary tremendously in the expression of these disorders

In addition, youth who have a mental illness may be more vulnerable to even small amounts of substance use so the threshold for what is considered abuse may be lower. Also, the negative consequences of the resulting substance use may appear different in youth with mental illness. For instance, substance use among youth who have a mental illness may result in the following:

• Paranoia
• Increased aggression
• Depression
• Hyperactivity
• Anxiety/agitation
• Failure to adhere to medication

Improving the Accuracy of Self-Reported Information

The following suggestions will help to obtain the most accurate information possible when interviewing youth:

• Conduct the screening/interview in a private environment where interruption is unlikely
• Develop a calm, nonjudgmental atmosphere that encourages the youth to relax
• Preface the screening with a discussion about what will be done with the results
• Discuss limits of confidentiality and when confidentiality must be breached before beginning the screening
• If possible, have someone the youth knows and trusts conduct the screening

Improving the Usefulness of Self-Reported Information

The following suggestions will help to corroborate self-reported information:

• Examine previous records and other relevant history
• Supplement screening results with observation
• Conduct drug testing (drug testing can enhance the accuracy of self-reported substance use)
• Reassess the youth at a later time with the same instruments
• Supplement screening results with information from collateral sources

Collateral sources include family/caretakers, teachers, friends, treatment staff, arresting officers, case managers, correctional officers, and others who are often able to provide relevant, useful information. When looking for collateral information about a youth, never overlook nonclinical staff. They may be able to help identify juveniles who are experiencing significant withdrawal or psychosocial problems, such as self-destructive behaviors and/or difficulties interacting with other offenders or staff.