Part II: The Framework
The model highlights that the heterogeneity of individuals with co-occurring disorders is a critical factor in the development of appropriate individualized interventions and the identification of the relative roles of mental health and addiction providers. In a review of the model’s utility, researchers concluded that the conceptual model has been a helpful planning tool and is in wide use across the country. The model “has informed program and policy discussions at federal, state, and local levels, both within the mental health and substance abuse communities and outside of them, in areas such as the primary healthcare and judicial systems.” 105 Development of this framework created a common language to categorize the needs of individuals with co-occurring disorders, and established shared priorities between mental health and substance abuse treatment systems. The appropriate package of services for quadrant II, III, or IV individuals and the most appropriate settings for service delivery is an ongoing subject of discussion and the focus of research. Still, the mental illness and substance abuse (alcohol and drugs) dimensions of this model have been incorporated into the following proposed framework to help state administrators allocate resources and develop policies for individuals with behavioral disorders in contact with the corrections system. Researchers also have developed tools and practice models in which criminogenic risk and need are used to guide criminal justice professionals in prioritizing and matching treatment services for individuals most likely to commit future crimes. For example, some judges and court officials use the Risk-and-Needs Triage (RANT™) tool to ensure individuals are matched to services and supervision levels based on their criminogenic risk and substance abuse treatment needs.106 Using a 2-by-2 matrix defined by risks and needs, individuals are grouped into one of four quadrants that have direct implications for court dispositions and the appropriate type of behavioral healthcare treatment. Findings showed that high-risk and dependent individuals in treatment programs experienced more positive results,107 with high-risk drug court participants twice as successful as low-risk participants.108 In other models, offenders were also categorized so that the drug-dependent individuals were triaged for more intensive services, and this contributed to reductions in violations and rearrests.109 These models demonstrate that a shared understanding of the needs of populations that are connected to different systems can improve collaborative opportunities, maximize the impact of expended resources, and promote better individual and programmatic outcomes.*
*Dr. Faye Taxman and colleagues at the Center for Advancing Correctional Excellence at George Mason University are currently piloting an RNR Simulation Tool. This decision-support tool uses the risk/need principles to identify the appropriate levels of control and treatment for individuals involved in the criminal justice system. Additionally, the tool has portals that allow local jurisdictions to assess their capacity to provide responsivity interventions and to rate their current programming. Development of the tool is funded by the U.S. Department of Justice, Bureau of Justice Assistance; the Agency for Health Quality Research; the Substance Abuse and Mental Health Services Administration; and the Public Welfare Foundation.