Page 1

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  

2


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    

4


CSG Jus;ce  Center    

Individuals Incarcerated  for  Drug   Offenses:  1980  and  2010  

5


CSG Jus;ce  Center    

Women in  Prison:  1980  -­‐  2010  

6


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)  

20

CSG Jus;ce  Center    

54 %  

8 %    

10 0  

2 %   Household    

Jail

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

State Prison  

8


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)    

9


CSG Jus;ce  Center    

Most Resources  Spent  on  Prisons    

10


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  

12


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  

14


•  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).    

15


•  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  

17


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  

18


CSG Jus;ce  Center    

Following RNR  Principles  Impacts   Recidivism      

19


CSG Jus;ce  Center    

Framework for  Criminal  Jus.ce  and   Behavioral  Health    

20


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

21


CSG Jus;ce  Center    

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

22


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    


25

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  

27


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”  

29


CSG Jus;ce  Center    

Systems Integra.on  Can  Improve   Outcomes  

30


CSG Jus;ce  Center    

The Importance  of  Fidelity    

31


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.  

39


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      

40


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    

47


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!  

49

substance-abuse-ebps