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
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Introduc.on
State and Local Applica.on
Conclusion
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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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Individuals Incarcerated for Drug Offenses: 1980 and 2010
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Women in Prison: 1980 -‐ 2010
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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
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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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54 %
8 %
10 0
2 % Household
Jail
Source: Compton et al., Am J Psychiatry, 2010.
State Prison
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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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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’
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• 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
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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
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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
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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
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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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Following RNR Principles Impacts Recidivism
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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)
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Group 8 IV – H CR: med/high SA: med/high MI: med/high
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Mental Health, Substance Use, Co-‐occurring Disorders and Risk Occur Along Con.nuum
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No Single Factor Determines Addic.on
23 hJp://www.drugabuse.gov/sites/default/files/sciofaddic;on.pdf
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Length of Treatment is Important
24 hJp://www.drugabuse.gov/sites/default/files/cjpolreatment.pdf
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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
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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
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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
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• “Well tested and shown to demonstrate a posi1ve impact on both addic1on and criminality”
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Systems Integra.on Can Improve Outcomes
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The Importance of Fidelity
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Staff Training and Supervision
Structured Program Model
Right Dosage of Treatment
Monitoring and Evalua.ng Change
External Researcher /Evaluator
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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
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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
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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
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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
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1. Effec.vely assess criminogenic risk and need, and strengths
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Travis County Supervision Strategies Related to Assessment
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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.
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• 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
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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
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• Innova;ons in strengthening use of EBP’s
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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
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
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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)
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And of course Fidelity…Staff Training and Support…Data Collec.on
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Resource: ‘What Works’
45 hJp://na;onalreentryresourcecenter.org/what_works
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Resources: Health Reform
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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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Resource:
48 hJp://www.ibr.tcu.edu/index.htm
Alexa Eggleston aeggleston@csg.org For more informa1on: www.jus.cecenter.csg.org
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Thank you!
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