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Reducing  Recidivism  and  Promo1ng   Recovery:  Implemen1ng  Effec1ve   Programming  for  Individuals  with   Substance  Use  Disorders     Alexa  Eggleston,  J.D.   Program  Director,  Substance  Abuse   The  Jus;ce  Center,  Council  of  State  Governments   JMHCP  Conference         February  28th,  2013  


Today’s  Presenta.on    

What  Works:  Developing  Effec.ve  Responses  

CSG  Jus;ce  Center    

Introduc.on        

State  and  Local  Applica.on  

Conclusion    

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3  

CSG  Jus;ce  Center    


CSG  Jus;ce  Center    

Reach  of  the  Criminal  Jus.ce  System    

The  High  Cost  of  Correc;ons  in  America   hJp://www.pewstates.org/research/data-­‐visualiza;ons/the-­‐high-­‐cost-­‐of-­‐correc;ons-­‐ in-­‐america-­‐85899397897    

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CSG  Jus;ce  Center    

Individuals  Incarcerated  for  Drug   Offenses:  1980  and  2010  

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CSG  Jus;ce  Center    

Women  in  Prison:  1980  -­‐  2010  

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CSG  Jus;ce  Center    

Children  of  Incarcerated  Parents    

7   Parents  in  Prison  and  their  Minor  Children,  Bureau  of  Jus;ce  Sta;s;cs  Special  Report,   US  Department  of  Jus;ce,  Office  of  Jus;ce  Programs    2008    


Substance  Abuse  &  Addic.on  in   Criminal  Jus.ce   60  

Percent  of  Popula.on  

50  

47  %  

53  %   44  %  

40   30  

Alcohol  use  disorder   (Includes  alcohol   abuse  and   dependence)   Drug  use  disorder   (Includes  drug  abuse   and  dependence)  

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CSG  Jus;ce  Center    

54  %  

8  %    

10   0  

2  %   Household    

Jail  

Source:    Compton  et  al.,  Am  J  Psychiatry,    2010.    

State  Prison  

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CSG  Jus;ce  Center    

SMI  with  Substance  Abuse/ Dependence  in  Criminal  Jus.ce    

Source:  General  Popula;on  (Kessler  et  al.  1996),  Jail  (Steadman  et  al,  2009),  Prison  (DiJon  1999),  James  (2006)    

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CSG  Jus;ce  Center    

Most  Resources  Spent  on  Prisons    

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Low  U.liza.on  of  EBP’s  in  Criminal   Jus.ce     Mean  EBPs   Adopted  

Adult  Prison  

5.6  

Adult  Jail  

3.9  

Adult  CC  

5  

Juvenile  Res.  

5.7  

Juvenile  CC  

4.8  

Drug  Court  

5.6  

Less  than   1/3rd   Adopted     CSG  Jus;ce  Center    

SeUng  

11   Friedmann,  Taxman,  &  Henderson,  2007:  Young,  Dembo,  &  Henderson,  2007;  Henderson,  Taxman  &  Young,  2008  


Key  Trends:  States  Are  Moving  Towards   Evidence-­‐based  Strategies    

•  Development  of  training  programs  for   proba;on  and  parole  officers   •  Funding  for  community-­‐based  programming   as  ‘alterna;ve  to  incarcera;on’    and/or  post-­‐ release  ‘reentry’    

CSG  Jus;ce  Center    

•  Target  programming  to  individuals  at  high-­‐ moderate  risk  of  reoffending  

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Today’s  Presenta.on    

What  Works:  Developing  Effec.ve  Responses  

CSG  Jus;ce  Center    

Introduc.on        

State  and  Local  Applica.on  

Conclusion    

13  


CSG  Jus;ce  Center    

Combining  Supervision  and  Treatment     Can  Improve  Outcomes  

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•  Use  criminogenic  and  clinical  screening  and  assessment   tools  to  iden;fy  high  RISK  cases  and  focus  resources  on   them   •  Target  criminogenic  NEEDS  an;social  behavior,  substance   abuse,  an;social  agtudes,  and  criminogenic  peers  

CSG  Jus;ce  Center    

The  Cornerstone  of  Effec.ve  CJ   Programming:  Risk-­‐Need-­‐Responsivity  

•  RESPONSIVITY  –  Tailor  the  interven;on  to  learning  style,   mo;va;on,  culture,  demographics,  and  abili;es.    Address   the  issues  that  affect  responsivity  (e.g.  mental  illnesses).    

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•  Criminal  history  (number  of  arrests,  number   of  convic.ons,  type  of  offenses)   •  Current  charges   •  Age  at  first  arrest   •  Current  age   •  Gender  

CSG  Jus;ce  Center    

Sta.c  Risk  Factors  


1.  2.  3.  4.  5.  6.  7.  8. 

An.-­‐social  aUtudes   An.-­‐social  friends  and  peers   An.-­‐social  personality  pabern   Substance  abuse   Family  and/or  marital  factors   Lack  of  educa.on   Poor  employment  history   Lack  of  pro-­‐social  leisure  ac.vi.es    

CSG  Jus;ce  Center    

Dynamic  Risk  Factors  

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Incorpora.ng  Criminogenic  Risk  Factors  in   Sentencing  and  Supervision  Planning   Risk  Factor    

Need  

History  of  An;social  Behavior  

Build  alterna;ve  behaviors  

An;social  Personality  PaJern  

Problem  solving  skills,  anger   management  

An;social  Cogni;on  

Develop  less  risky  thinking  

An;social  Associates  

Reduce  associa;on  with  criminal  others  

Family  and/or  Marital  Discord  

Reduce  conflict,  build  posi;ve   rela;onships  

Poor  school  and/or  work  performance  

Enhance  performance,  rewards  

Few  leisure  or  recrea;on  ac;vi;es  

Enhance  outside  involvement  

Substance  abuse  

Reduce  use  through  integrated  tx  

Source:    Andrews,  2006  

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CSG  Jus;ce  Center    

Following  RNR  Principles  Impacts   Recidivism      

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CSG  Jus;ce  Center    

Framework  for  Criminal  Jus.ce  and   Behavioral  Health    

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Priori.zing  Your  Target  Popula.on  

Low Criminogenic Risk

Medium to High Criminogenic Risk

(low)

(med/high)

Low Severity of Substance Abuse

Substance Dependence (med/high)

(low)

Low Severity of Mental Illness (low)

Serious Mental Illness

Serious Mental Illness

(med/high)

Low Severity of Mental Illness (low)

Group 1 I–L CR: low SA: low MI: low

Group 2 II – L CR: low SA: low MI: med/high

Group 3 III – L CR: low SA: med/high MI: low

Low Severity of Substance Abuse

Substance Dependence (med/high)

(low)

Serious Mental Illness

(med/high)

Low Severity of Mental Illness (low)

(med/high)

Low Severity of Mental Illness (low)

Group 4 IV – L CR: low SA: med/high MI: med/high

Group 5 I–H CR: med/high SA: low MI: low

Group 6 II – H CR: med/high SA: low MI: med/high

Group 7 III – H CR: med/high SA: med/high MI: low

Serious Mental Illness (med/high)

CSG  Jus;ce  Center    

 

Group 8 IV – H CR: med/high SA: med/high MI: med/high

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CSG  Jus;ce  Center    

Mental  Health,  Substance  Use,     Co-­‐occurring  Disorders  and  Risk     Occur  Along  Con.nuum      

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CSG  Jus;ce  Center    

No  Single  Factor  Determines   Addic.on    

23   hJp://www.drugabuse.gov/sites/default/files/sciofaddic;on.pdf    


CSG  Jus;ce  Center    

Length  of  Treatment  is  Important    

24   hJp://www.drugabuse.gov/sites/default/files/cjpolreatment.pdf    


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CSG  Jus;ce  Center    


CSG  Jus;ce  Center    

Relapse  does  not  Equal  Treatment   Failure    

26   hJp://www.drugabuse.gov/sites/default/files/cjpolreatment.pdf    


Key  Elements  of  Effec.ve   Substance  Abuse  Programs   Standardized  substance  abuse  assessment  tool(s)     Standardized  risk  assessment  tool(s)    

Cogni.ve  behavioral/behavioral  modifica.on  techniques     Target  factors  that  are  associated  with  criminal  behavior   Services  that  address  co-­‐occurring  medical  and  mental   health  disorders    

CSG  Jus;ce  Center    

Interven.ons  to  encourage  engagement  and  mo.va.on  

Family  involvement  in  treatment     Treatment  dura.on  of  90  or  more  days     Systems  integra.on  and  a  con.nuum  of  care   Use  of  sanc.ons  and  incen.ves  

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Target  factors  that  are  Associated   with  Criminal  Behavior  

CSG  Jus;ce  Center    

 

28   hJp://www.drugabuse.gov/sites/default/files/cjpolreatment.pdf    


Cogni.ve-­‐Behavioral  Interven.ons      

•  ACTION-­‐ORIENTED…engages   individuals  in  ac;vi;es,  such  as  role   plays  as  part  of  therapeu;c  process.   •  FOCUSED  ON  THE  PRESENT…aimed  at   changing  current  risk  factors  that   impact  behavior.   •  FOCUSED  ON  LEARNING…significant   amount  of  ;me  learning  and  prac;cing   new  ways  to  handle  risky  situa;ons.          

SAMHSA  TIP  41  Group  Therapy  Inservice  Training  and  University  of  Cincinna?  Correc?ons  Ins?tute,   Cogni?ve  Behavioral,  Interven?ons  for  Substance  Abuse    

CSG  Jus;ce  Center    

•  “Well  tested  and  shown  to   demonstrate  a  posi1ve  impact  on  both   addic1on  and  criminality”  

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CSG  Jus;ce  Center    

Systems  Integra.on  Can  Improve   Outcomes  

30  


CSG  Jus;ce  Center    

The  Importance  of  Fidelity    

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32  

CSG  Jus;ce  Center    


Staff   Training   and   Supervision    

Structured   Program   Model  

Right   Dosage  of   Treatment    

Monitoring   and   Evalua.ng   Change    

External   Researcher /Evaluator    

CSG  Jus;ce  Center    

Five  Components  Associated  with   Successful  Program  Implementa.on  

33   Andrews  and  Dowden  (1999)  


Preparatory   Knowledge,  i.e.   ‘ground  school’  

Supervision   and   Coaching  

Monitored   Prac.ce   with   Feedback  

CSG  Jus;ce  Center    

Three  Steps  to  Support  Staff  EBP  Use  &   Fidelity      

34   W.R.  Miller  et  al.  /  Journal  of  Substance  Abuse  Treatment  (2006)  25–39  


Sequen.al  Intercept  Model

CSG  Jus;ce  Center    

 

35  


Today’s  Presenta.on    

What  Works:  Developing  Effec.ve  Responses  

CSG  Jus;ce  Center    

Introduc.on        

State  and  Local  Applica.on  

Conclusion    

36  


Lessons  in  Transforming  Proba.on  

2.      Employ  smart,  tailored   supervision  strategies     3.      Use  incen.ves  and  graduated   sanc.ons  to  respond  promptly   to  behavior     4.      Implement  performance-­‐ driven  personnel   management  prac.ces  that   promote  and  reward   recidivism  reduc.on  

CSG  Jus;ce  Center    

1.  Effec.vely  assess  criminogenic   risk  and  need,  and  strengths  

37  


CSG  Jus;ce  Center    

Travis  County  Supervision  Strategies     Related  to  Assessment  

38  


Travis  County’s  Experience  

•  Felony  technical  revoca;ons  fell  by  48   percent—the  largest  reduc;on  in  the  five   most  populous  coun;es  in  Texas,  and   nearly  10  ;mes  the  statewide  reduc;on  of   5  percent.  

CSG  Jus;ce  Center    

•  Felony  proba;on  revoca;ons  declined  by   20  percent.  

•  The  decreased  number  of  technical  revoca;ons  averted   $4.8  million  in  state  incarcera;on  costs.   •  The  one-­‐year  re-­‐arrest  rate  for  proba;oners  fell  by  17   percent.  

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Lessons  Learned:  Second  Chance  Act   •  Clear  risk/need  criteria  for  program  eligibility   ü     Priori;zing  based  on  risk  and  need   •  Use  of  standardized  curricula  that  incorporate  cogni;ve-­‐ based  approaches     •  Emphasis  on  Con;nuity  of  Care       ü  ü  ü  ü 

Intro  to  post-­‐release  programming  and  what  to  expect     Set  appointment  prior  to  release     Develop  treatment  con;nua;on  plan     ‘Inside  -­‐  Out’  service  delivery    

CSG  Jus;ce  Center    

ü  Engaging  ‘less  mo;vated’  clients      

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Lessons  Learned:  Second  Chance  Act   ü     Family  programming   ü     Co-­‐occurring  capacity   ü     Skype   ü     MAT  access   ü     Peer  support  programs      

•  Supervision  policies  post-­‐release  have    significant   impact  on  transi;on     •  Opportunity  to  strengthen  and  leverage  RSAT   funding  

CSG  Jus;ce  Center    

•  Innova;ons  in  strengthening  use  of  EBP’s  

41  


Today’s  Presenta.on    

What  Works:  Developing  Effec.ve  Responses  

CSG  Jus;ce  Center    

Introduc.on        

State  and  Local  Applica.on  

Conclusion    

42  


In  Summary:  5  Key  Things  to  Improve   Outcomes    

2.      Iden.fy  individuals  who  are  most  in  need,  i.e.  higher/ moderate  risk  and  high  need  target  popula.on   3.  Match  programming  to  criminogenic  risk/need    

CSG  Jus;ce  Center    

1.  Use  valid  and  standardized  screening  and  assessment   processes    

4.  Respond  with  right  type  and  length  of  treatment         5.  Provide  con.nuity  in  services  and  ‘warm  hand-­‐off’   43   Taxman,  F.S.  Journal  of  Substance  Abuse  Treatment,  Special  NCJTP  Issue,  April  2007,   Volume  32(3)  


CSG  Jus;ce  Center    

And  of  course  Fidelity…Staff  Training  and   Support…Data  Collec.on  

44  


CSG  Jus;ce  Center    

Resource:  ‘What  Works’    

45   hJp://na;onalreentryresourcecenter.org/what_works    


CSG  Jus;ce  Center    

Resources:  Health  Reform      

46  


Resource:     A  Checklist  for   Implemen1ng   EBP’s    for  Jus1ce-­‐ involved  with   Behavioral   Health  Disorders                          

  hJp://gainscenter.samhsa.gov/cms-­‐assets/documents/ 73659-­‐994452.ebpchecklistinal.pdf    

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CSG  Jus;ce  Center    

Resource:  

48   hJp://www.ibr.tcu.edu/index.htm    


Alexa  Eggleston   aeggleston@csg.org     For  more  informa1on:   www.jus.cecenter.csg.org  

CSG  Jus;ce  Center    

Thank  you!  

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substance-abuse-ebps