2 - Screening questions for employment intervention (Staff)

OMB Control No.: xxxx-xxxx
Expiration Date: xx/xx/201x
2 – Screening Questions for Employment Intervention

This assessment asks some questions about your criminal history, education, employment, family and
social support, alcohol and drug use, and attitudes about various things in your life to determine
whether you are eligible for Cognitive Behavioral Intervention for Justice Involved Individuals Seeking
Employment services. Answering these questions is voluntary. We hope you will answer the questions
to determine if you are eligible for the available program services. The survey is estimated to take about
15 minutes to complete. Your name will not be included in any written reports and your answers will
be kept private to the extent permitted by law.

THE PAPERWORK REDUCTION ACT OF 1995
This collection of information is voluntary and will be used to learn about the effects of parenting and
employment services for fathers. Public reporting burden for this collection of information is estimated to
average 15 minutes per response, including the time for reviewing instructions, gathering and
maintaining the data needed, and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. The OMB number for this information collection is 0970-0XXX and
the expiration date is XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden to Erika Lundquist; 16 E
34th St, MDRC, 19th Floor, New York, NY 10016; (212) 340-8605; Attn: OMB-PRA (XXXX-XXXX).

OHIO RISK ASSESSMENT SYSTEM: COMMUNITY SUPERVISION TOOL (ORAS-CST)
Name:

Date of Assessment:

Case#:

Name of Assessor:

1.0 CRIMINAL HISTORY:
1.1 Most Serious Arrest Under Age 18
0=None
1=Yes, Misdemeanor
2=Yes, Felony
1.2 Number of Prior Adult Felony Convictions
0=None
1=One or Two
2=Three or more
1.3 Prior Sentence as Adult to a Jail or Secure Correctional Facility
0=No
1=Yes
1.4 Received Official Misconduct while Incarcerated as Adult
0=No
1=Yes
1.5 Prior Sentence to Probation as an Adult
0=No
1=Yes
1.6 Community Supervision Ever Been Revoked for Technical Violation as Adult
0=No
1=Yes
Total Score in Criminal History:

2.0 EDUCATION, EMPLOYMENT, AND FINANCIAL SITUATION:
2.1 Highest Education
0= High School Graduate or Higher
1= Less than High School or GED
2.2 Ever Suspended or Expelled From School
0=No
1=Yes
2.3 Employed at the Time of Arrest
0= Yes
1= No
2.4 Currently Employed
0=Yes, Full-time, Disabled, or Retired
1=Not Employed or Employed Part-time
2.5 Better Use of Time
0=No, Most Time Structured
1=Yes, Lots of Free Time
2.6 Current Financial Situation
0=Good
1=Poor
Total Score in Education, Employment, Financial:

51

3.0 FAMILY AND SOCIAL SUPPORT
3.1 Parents have Criminal Record
0= No
1=Yes
3.2 Currently Satisfied with Current Marital or Equivalent Situation
0=Yes
1=No
3.3 Emotional and Personal Support Available from Family or Others
0=Strong Support
1=None or Weak Support
3.4 Level of Satisfaction with Current Level of Support from Family or Others
0=Very Satisfied
1=Not Satisfied
3.5 Stability of Residence
0=Stable
1=Not Stable
Total Score on Family and Social Support:

4.0 NEIGHBORHOOD PROBLEMS
4.1 High Crime Area
0=No
1=Yes
4.2 Drugs Readily Available in Neighborhood
0=No, Generally Not Available
1=Yes, Somewhat Available
2=Yes, Easily Available
Total Score in Neighborhood Problems:

5.0 SUBSTANCE USE
5.1 Age First Began Regularly Using Alcohol
0=17 or older
1=Under Age 17
5.2 Longest Period of Abstinence from Alcohol
0=Six months or Longer
1=Less than Six months
5.3 Offender Ever Used Illegal Drugs
0=No
1=Yes
5.4 Drug Use Caused Legal Problems
0=None
1=One Time
2=Two or More Times
5.5 Drug Use Caused Problems with Employment
0=No
1=Yes
Total Score for Substance Use:

52

6.0 PEER ASSOCIATIONS
6.1 Criminal Friends
0=None
1=Some
2=Majority
6.2 Contact with Criminal Peers
0=No Contact with Criminal Peers
1=At Risk of Contacting Criminal Peers
2=Contact or Actively Seeks Out Criminal Peers
6.3 Gang Membership
0=No, Never
1=Yes, but Not Current
2=Yes, Current
6.4 Criminal Activities
0=Strong Identification with Prosocial Activities
1=Mixture of Pro- and Antisocial Activities
2=Strong Identification with Criminal Activities
Total Score for Peers:

7.0 CRIMINAL ATTITUDES AND BEHAVIORAL PATTERNS
For the Following Items Please Rate the Offender:
7.1 Criminal Pride
0=No Pride in Criminal Behavior
1=Some Pride
2=A Lot of Pride
7.2 Expresses Concern about Others’ Misfortunes
0=Concerned about Others
1=Limited Concern
2=No Real Concern for Others
7.3 Feels Lack of Control Over Events
0=Controls Events
1=Sometimes Lacks Control
2=Generally Lacks Control
7.4 Sees No Problem in Telling Lies
0=No
1=Yes
7.5 Engages in Risk Taking Behavior
0=Rarely Takes Risks
1=Sometimes Takes Risks
2=Generally Takes Risks
7.6 Walks Away from a Fight
0=Yes
1=Sometimes
2=Rarely
7.7 Believes in “Do Unto Others Before They Do Unto You”
0=Disagree
1=Sometimes
2=Agrees
Total Score Criminal Attitudes and Behavioral Patterns:

TOTAL SCORE:

53

Risk Categories for MALES
Scores
0-14
15-23
24-33
34+

Rating
Low
Moderate
High
Very High

Risk Categories for FEMALES
Percent of Failures
9%
34%
58%
70%

Scores
0-14
15-21
22-28
29+

Rating
Low
Moderate
High
Very High

Percent of Failures
7%
23%
40%
50%

Domain Levels
1.0 Criminal History
Score
Failure
Low (0-3)
27%
Med (4-6)
46%
High (7-8)
53%
3.0 Family and Social Support
Score
Failure
Low (0-1)
32%
Med (2-3)
41%
High (4-5)
48%
5.0 Substance Use
Score
Failure
Low (0-2)
27%
Med (3-4)
40%
High (5-6)
45%
7.0 Criminal Attitudes and Behavioral Patterns
Score
Failure
Low (0-3)
24%
Med (4-8)
44%
High (9-13) 59%

2.0 Education, Employment, and Financial Situation
Score
Failure
Low (0-1)
21%
Med (4-6)
37%
High (7-8) 55%
4.0 Neighborhood Problems
Score
Failure
Low (0)
17%
Med (1)
35%
High (2-3) 45%
6.0 Peer Associations
Score
Failure
Low (0-1)
21%
Med (2-4)
43%
High (5-8) 64%

Professional Override:
Reason for Override (note overrides should not be based solely on offense):
Other Areas of Concern. Check all that Apply:
_____Low Intelligence*
_____Physical Handicap
_____Reading and Writing Limitations*
_____Mental Health Issues*
_____No Desire to Change/Participate in Programs*
_____Transportation
_____Child Care
_____Language
_____Ethnicity
_____Cultural Barriers
_____History of Abuse/Neglect
_____Interpersonal Anxiety
_____Other _________________________________________________________
*If these items are checked it is strongly recommended that further assessment be conducted to determine level or
severity.

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