Standards on Substance Use Disorders and Mental Health Conditions: Standard VI. Assessment and treatment matching

Standards adopted by the Supreme Judicial Court, acting on the advice of the Working Group on Substance Use and Mental Health.

Standard VI

When a judge, clerk, or probation officer believes that a substance use disorder, mental health condition, or co-occurring disorder is a contributing factor in a case, and the judge has issued or is considering a court order for treatment where the law authorizes such an order, the judge should consider referring the party to a qualified clinician for a diagnostic assessment to assist in determining which form of evidence-based treatment will be most appropriate and effective.  

Commentary

Assessment. Court-ordered treatment, where authorized by law, should be based on comprehensive information regarding a party's substance use, mental health, or co-occurring disorder needs. A diagnostic assessment should be conducted by a qualified clinician. Where appropriate, assessments should also be ordered to be performed periodically to assess if individual needs have changed. Only qualified health professionals can make determinations about the appropriateness or type of treatment needed. The diagnosis of a substance use, mental health, or co-occurring disorder is a clinical determination, not a legal determination.

A diagnostic assessment is an in-depth clinical process to determine a person's specific treatment needs and takes significantly longer than a screening. Qualified clinicians can conduct diagnostic assessments. In cases involving mental health conditions in addition to substance use disorders, the court should use the court clinic or a DMH-licensed vendor with mental health expertise to conduct the assessment. People with co-occurring disorders respond best to treatment of both disorders in an integrated manner.

Treatment Matching. The objective of matching treatment to a party's treatment needs is to coordinate the intensity of the intervention to the severity of the underlying issue. Treatment matching involves consideration not only of the individual qualities addressed by the assessment, including the severity of the disorder and the support structures available to the person through family, work, school, and peers, but also of the latest available evidence-based information about the effectiveness of treatment programs. Appropriate matching greatly enhances the effectiveness of treatment, is essential in addressing relapse and reducing recidivism, and promotes the efficient use of resources.

Court-ordered and referred treatment should be based on the court-ordered clinical assessment, and the treatment recommendations resulting from the assessment. Where feasible, the treatment recommendations should address the party's related needs, if any, such as psychological or psychiatric services, housing assistance, vocational services or educational assistance, including parenting education. If an assessment is conducted before the issuance of the treatment order,  MPS, with the judge's approval and consistent with existing law, should make all relevant information and recommendations available to the court, the parties, and their attorneys, within a reasonable time prior to the issuance of a treatment order.

Treatment Navigation and Access. Courts should order substance use and mental health treatment through providers licensed by DPH to treat a substance use disorder, licensed by DMH to treat mental health conditions, or jointly licensed by DPH and DMH to treat co-occurring disorders. Subject to established rules of confidentiality, MPS should require providers to communicate regularly and candidly with the court regarding a party's compliance with court-ordered conditions. It is important to obtain signed releases from the party and any treatment provider(s) at all intersection points to comply with HIPAA and other confidentiality regulations, as these releases are necessary for treatment providers to share information with the courts.

In each court location, the effectiveness of responses to substance use disorder, mental health conditions, and co-occurring disorders will be largely dependent on knowledge of treatment and recovery support resources in the local community and the cultivation of relationships with various providers. Probation should identify the specific resources available in the community for the evaluation and treatment of substance use disorders, mental health conditions, and co-occurring disorders, and should establish and maintain relationships with local treatment providers. If community services are lacking, Probation should look beyond the local community to develop relationships with the providers of those services.

Medications for Substance Use Disorders. As noted above, only qualified health professionals can make determinations about the appropriateness or type of medication needed. The diagnosis of a substance use, mental health, or co-occurring disorder is a clinical determination, not a legal determination. In accordance with the Americans with Disabilities Act, MOUD participants shall not be excluded from participation in or denied the benefits of court services, programs, or activities because of their use of properly prescribed MOUD.

Last updated:	November 16, 2023