Exhibit 16 (TCU DSV).pdf
PDF 2 MB Posted
- Solicitation number
- BPM055260
- Issued by
- Baltimore City, Maryland
About this file
This document is the TCU Drug Screen 5 assessment tool, a standardized clinical instrument developed by the TCU Institute of Behavioral Research at Fort Worth, Texas, for use in evaluating substance use disorders in pre-trial and criminal justice settings. The assessment is referenced in solicitation BPM055260 for the DPDS-SUDTS (Pre-Trial) program. The tool contains a comprehensive series of yes/no and multiple-choice questions designed to evaluate an individual's drug use patterns, severity of substance use disorder, treatment history, and readiness for intervention during the 12-month period preceding intake. The instrument collects demographic information including client ID, facility ID, zip code, and administration date, and assesses eleven core diagnostic criteria related to substance use disorder along with detailed frequency-of-use data across eighteen categories of drugs and controlled substances.
The assessment tool is designed to inform clinical decision-making and program placement for individuals entering the pre-trial diversion or substance use disorder treatment system. Questions 1 through 11b evaluate diagnostic criteria consistent with standardized substance use disorder classification, question 12 identifies the primary problematic substance, question 13 provides frequency-of-use metrics across drug categories, and questions 14 through 17 assess treatment history, perceived severity, injection drug use history, and motivation for treatment engagement. The tool serves as both a screening and measurement instrument to establish baseline conditions and guide appropriate intervention levels within the criminal justice and substance abuse treatment program context.
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TCU Drug Screen 5 (v.Sept2020) © Copyright 2020 TCU Institute of Behavioral Research, Fort Worth, Texas. All rights reserved.
Client ID# Today’s Date Facility ID# Zip Code Administration
TCU DRUG SCREEN 5
During the last 12 months (before being locked up, if applicable) –
1. Did you use larger amounts of drugs or use them for a longer time than you planned or intended?
2. Did you try to control or cut down on your drug use but were unable to do it?
3. Did you spend a lot of time getting drugs, using them, or recovering from their use?
4. Did you have a strong desire or urge to use drugs?
5. Did you get so high or sick from using drugs that it kept you from working, going to school, or caring for children?
6. Did you continue using drugs even when it led to social or interpersonal problems? ...
7. Did you spend less time at work, school, or with friends because of your drug use?
8. Did you use drugs that put you or others in physical danger?
9. Did you continue using drugs even when it was causing you physical or psychological problems?
10a. Did you need to increase the amount of a drug you were taking so that you could get the same effects as before?
10b. Did using the same amount of a drug lead to it having less of an effect as it did before?
11a. Did you get sick or have withdrawal symptoms when you quit or missed taking a drug?
11b. Did you ever keep taking a drug to relieve or avoid getting sick or having withdrawal symptoms?
12. Which drug caused the most serious problem during the last 12 months? [CHOOSE ONE]
None Stimulants – Methamphetamine (meth)
Alcohol Synthetic Cathinones (Bath Salts)
Cannaboids – Marijuana (weed) Club Drugs – MDMA/GHB/Rohypnol (Ecstasy)
Cannaboids – Hashish (hash) Dissociative Drugs – Ketamine/PCP (Special K)
Synthetic Marijuana (K2/Spice) Hallucinogens – LSD/Mushrooms (acid)
Natural Opioids – Heroin (smack) Inhalants – Solvents (paint thinner)
Synthetic Opioids – Fentanyl/Iso Prescription Medications – Depressants
Stimulants – Powder Cocaine (coke) Prescription Medications – Stimulants
Stimulants – Crack Cocaine (rock) Prescription Medications – Opioid Pain Relievers
Stimulants – Amphetamines (speed) Other (specify)
Yes No
DPDS-SUDTS (Pre-Trial) Solicitation #: BPM055260 Exhibit 16.
TCU Drug Screen 5 (v.Sept2020)
© Copyright 2020 TCU Institute of Behavioral Research, Fort Worth, Texas. All rights reserved.
Client ID# Today’s Date Facility ID# Zip Code Administration
13. How often did you use each type of drug during the last 12 months?
Only a few Never times
1-3 1-5 times per times per month week Daily
a. Alcohol
b. Cannaboids – Marijuana (weed)
c. Cannaboids – Hashish (hash)
d. Synthetic Marijuana (K2/Spice)
e. Natural Opioids – Heroin (smack)
f. Synthetic Opioids – Fentanyl/Iso
g. Stimulants – Powder cocaine (coke)
h. Stimulants – Crack Cocaine (rock)
i. Stimulants – Amphetamines (speed)
j. Stimulants – Methamphetamine (meth)
k. Synthetic Cathinones (Bath Salts)
l. Club Drugs – MDMA/GHB/Rohypnol (Ecstasy)
m. Dissociative Drugs – Ketamine/PCP (Special K)
n. Hallucinogens – LSD/Mushrooms (acid)
o. Inhalants – Solvents (paint thinner)
p. Prescription Medications – Depressants
q. Prescription Medications – Stimulants
r. Prescription Medications – Opioid Pain Relievers
s. Other (specify)
14. How many times before now have you ever been in a drug treatment program?
[DO NOT INCLUDE AA/NA/CA MEETINGS]
Never 1 time 2 times 3 times 4 or more times
15. How serious do you think your drug problems are?
Not at all Slightly Moderately Considerably Extremely
16. During the last 12 months, how often did you inject drugs with a needle?
Never Only a few times 1-3 times/month 1-5 times per week Daily
17. How important is it for you to get drug treatment now?
Not at all Slightly Moderately Considerably Extremely
DPDS-SUDTS (Pre-Trial) Solicitation # BPM055260 Exhibit 16.
File details come from the government source that posted it. Updated .