The present study examined the validity of a screening instrument to identify homeless medical patients in need of psychiatric services. A self-report screening instrument was developed and completed by 64 participants using the medical services offered at a free health clinic. We examined 2 approaches, a statistical deviation approach and a clinical judgment approach, in order to determine the criteria for specifying caseness. Caseness is defined as those participants in need of mental health evaluations. A criterion group composed of clinic medical patients presently using their mental health services was used as the standard to define caseness. Results showed the statistical deviation approach identified 100% of the criterion group, whereas the clinical judgment approach identified only 57% of the criterion group. Both approaches had similar false positive rates of 25%. Our findings support the validity of the client self-report measure as a screening tool to identify patients in need of mental health evaluations.

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