Send to

Choose Destination
Health Justice. 2018 Apr 7;6(1):7. doi: 10.1186/s40352-018-0065-6.

Evaluating concurrent validity of criminal justice and clinical assessments among women on probation.

Author information

Department of Internal Medicine, Yale New Haven Health, PO Box 208030, New Haven, CT, 06520-8030, USA.
Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Connecticut Judicial Branch, Court Support Services Division, 936 Silas Deane Hwy, Wethersfield, CT, 06109, USA.
Bauman Consulting Group, LLC, 411 W. Loveland Ave., Suite 201-B, Loveland, OH, 45140, USA.
Criminology, Law & Society, George Mason University, 4400 University Drive, 4F4, Fairfax, VA, 22030, USA.
AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.



Women in the criminal justice (CJ) system experience complex and comorbid medical, psychiatric, and substance use disorders, which often contribute to CJ involvement. To identify intersections between CJ and health needs, we calculated Spearman r correlations between concurrent CJ and clinical assessments from women on probation in Connecticut who were enrolled in a clinical trial. We examined longitudinal trends in CJ risk scores over 9 years of observation (2005-2014), modeling time to probation recidivism with shared gamma frailty models and comparing contiguous time points by Wilcoxon matched-pairs signed rank tests.


Women (N = 31) were predominantly white (67.7%) with at least some high school education (58.1%) and mostly unemployed (77.4%) and unstably housed (83.9%). Most met clinical criteria for severe substance use and/or psychiatric disorders. Concurrent measures of substance use, mental health, social support, partnerships, and risk by the Level of Service Inventory-Revised (LSI-R) and clinical assessments were not significantly correlated. The LSI-R personal/emotional sub-score, however, positively correlated with the Addiction Severity Index psychiatric composite score (r = 0.40, 95% CI 0.03-0.68, p = 0.03). After adjusting for age, race and number of previous events, having some high school education versus none marginally decreased the hazard for probation recidivism and having > 5 inpatient psychiatric admissions versus none increased the hazard of probation recidivism 7-fold (HR 7.49, 95% CI 1.33-42.12, p = 0.022). Women with 0-1 recurrent probation terms (n = 16) had a significantly lower mean LSI-R score than those with 2-4 recurrent probation terms (35.9 [SD 6.4] versus 39.2 [SD 3.0], p = 0.019), but repeated LSI-R scores did not change over time, nor vary significantly beyond the group mean.


In this small, quantitative study of women on probation, widely used CJ assessment tools poorly reflected women's comorbid medical, psychiatric, and substance use needs and varied minimally over time. Findings illustrate the limitations of contemporary CJ assessment tools for women with complex needs. The field requires more comprehensive assessments of women's social and health needs to develop individualized targeted case plans that simultaneously improve health and CJ outcomes.


Criminal justice; HIV; Probation; Risk needs assessment; Women

Supplemental Content

Full text links

Icon for Springer Icon for PubMed Central
Loading ...
Support Center