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Continuity of Offender Treatment for Substance Use Disorders From Institution to Community
Treatment Improvement Protocol (TIP) Series 30

[Tables and Figures]

Figure 1-1: Criminal Justice System Definitions

Figure 1-1
Criminal Justice System Definitions
Many references to community supervision are made throughout this TIP. The following list of general definitions may help a reader who is not familiar with the criminal justice system. However, the definitions may vary slightly from place to place because jurisdictions organize their supervision systems in different ways.
Probation is typically court-ordered supervision imposed in lieu of jail or prison.
Parole is supervision imposed at the end of a jail or prison sentence, perhaps shortening the period of incarceration. As with probation, parole may be revoked, resulting in the individual being incarcerated.
Postprison supervision is used to describe supervision following a completed period of incarceration. Some States have replaced their parole systems with postprison supervision.
Community supervision is the general category that includes all the terms listed above. There are other forms of community supervision as well, such as courts that have their own supervision systems. In this TIP, community supervision is the most commonly used term. A community supervision agent, then, could be a parole officer.

Figure 1-2: Characteristics of Both Outreach and Reach-in Models

Figure 1-2
Characteristics of Both Outreach and Reach-in Models
  • Early prerelease planning
  • Development of an effective community reentry and relapse prevention plan
  • Establishment of linkages among service systems as designated by the plan
  • Incorporation of continued community treatment plans as a condition of parole or probation where possible
  • Monitoring the offender to ensure that linkages have been made, that transition services are appropriate, and that new issues that have arisen are being addressed
  • Establishment of a standard protocol for this function within the system's infrastructure
  • Contracted third-party services can fit with either model

Figure 2-1: Indicators of Treatment Success

Figure 2-1
Indicators of Treatment Success
  • Reductions in substance use, extended periods of abstinence, substance-free days, crime-free days, reductions in the number of arrests
  • Restoration or establishment of ongoing and recovery-supporting social network
  • Substance-free and crime-free for at least a year
  • Consistent employment
  • Stable housing
  • Bank account with savings
  • Agreed-upon treatment goals met
  • Consistent participation in support groups
  • Correctional obligations (terms and conditions) met
  • Restitution (fines and fees) paid

Figure 2-2: Benefits of AA

Figure 2-2
Benefits of AA
A comprehensive review of the research on AA reveals several important findings:
  • Research shows a strong association between AA participation that occurs during or following professional treatment and both reduced drinking and abstinence.
  • Research suggests a strong association between increased frequency in attending AA meetings and improvements in drinking behavior measures, such as abstinence and decreases in alcohol consumption.
  • Research suggests a modest association between increased participation in and affiliation with AA (such as obtaining or becoming a sponsor) and improvements in drinking behavior measures, such as abstinence, decreased drinking, and decreased relapse.
  • Research suggests modest associations between AA participation and improvements in several areas of psychosocial functioning.
Source: Landry, in press.

Figure 2-3: Commonly Used Sanctions

Figure 2-3
Commonly Used Sanctions
  • Increased number of urinalyses
  • Breathalyzer™
  • More frequent contacts
  • More frequent appointments
  • Curfew
  • Extension of term or time
  • Community service
  • Increased AA and/or NA meetings
  • Withholding of privileges and personal freedoms
  • Day reporting
  • Electronic monitoring
  • Facility transfer
  • Increased intensity of treatment
  • Brief reincarceration
  • Additional reporting with additional charges or costs assessed
  • Return to incarceration, i.e., supervision violation

Figure 4-1: An Example of Effective Partnership

Figure 4-1
An Example of Effective Partnership
An agency has received legislative authority and funding to create a transitional services program for substance-using boot camp graduates who are returning to the community. Through a series of planning and development meetings with key administrators and program officials representing four other participating agencies, agreements were reached to address
  • >Common goals and objectives for the transitional phase
  • Agency responsibilities for offender risk and needs assessment
  • Case management plan development
  • The timing of components of transitional services, some of which begin while offenders are still in boot camp
  • The collection and transmittal of offender-specific data relating to institutional adjustment, treatment involvement and performance, key offender demographic data, and location data (such as home phone numbers)
  • Logistics issues, such as community agency access to the offender population for assessment and case management, the involvement of institutional and community agencies in care planning, what agency pays for what services, and issues related to offender release (such as custody and transportation)
These collaborative meetings were recorded by the lead agency and its clerical staff developed and circulated detailed meeting minutes. The agencies successfully negotiated all program criteria and letters of agreement were signed by all participating agencies.

Figure 4-2: State Level Case Management

Figure 4-2
State Level Case Management
In California, case management programs are funded through the Department of Corrections. The case managers, who are based in the prisons, keep track of the progress of the client, work with the parole officer, and follow the offender through all aspects of the treatment process.

In many States, parole and probation officers have specialized caseloads that include only offenders with substance use disorders. These officers receive specialized training in substance use disorders. It is significant that when Texas implemented its program in 1992, these specialized officers were in addition to, not in replacement of, existing officers.

Figure 4-3: State Legislatures and the Delivery of Transitional Services

Figure 4-3
State Legislatures and the Delivery of Transitional Services
The State can
  • Define who is in charge of the transition process (department of corrections; each prison; parole/probation system; or other third party, including TASC)
  • Pass laws that dictate eligibility criteria for prisons, jails, boot camps, and youth detention facilities (for example, structured sentencing laws)
  • Determine the funding levels and requirements for funding substance use disorder treatment for offenders and specify annual appropriation needs
  • Create policies dictating the process by which transitional issues are addressed (e.g., policy can mandate that State-run boot camp programs include a transitional phase designed in collaboration with community treatment agencies)
  • Specify treatment resources such as residential and substance use disorder programs dedicated to offenders leaving institutional care
  • Earmark funding for research to demonstrate the effectiveness of transition efforts

Figure 4-4: Information on Confidentiality in Other TIPs

Figure 4-4
Information on Confidentiality in Other TIPs
Confidentiality TopicTIP #TIP TitlePages
General Consent12 Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System71-78
Minors8Intensive Outpatient Treatment for Alcohol and Other Drug Abuse83-84
Communication With Others12Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System78-79
Programs in Correctional Settings17Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System81-83
Offenders Changing Treatment Programs12Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System79-80
Patients and Criminal Activity23Treatment Drug Courts: Integrating Substance Abuse Treatment With Legal Case Processing52-55
Research14Developing State Outcomes Monitoring Systems for Alcohol and Other Drug Abuse Treatment58-66
Other Exceptions12Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System82-66

Figure 4-5: Process Evaluation Questions

Figure 4-5
Process Evaluation Questions
Questions to be asked when conducting a process evaluation include
  • What services have been provided and by which agency?
  • How often were services provided?
  • Who received services?
  • Was the program implemented as designed?
  • What are the program's strengths and weaknesses?
  • Was the program changed, and if so, how and why?
  • What were the catalysts for the changes made?
  • How much did the program cost?
  • What were the barriers to implementation?

Figure 4-6: Data Sources for Process Evaluation

Figure 4-6
Data Sources for Process Evaluation
  • Observation
  • Agency budgets and billing information
  • Client attendance records
  • Staff time sheets and duty records
  • Daily schedules and activities
  • Staff surveys and interviews

Figure 4-7: Outcome Evaluation Questions

Figure 4-7
Outcome Evaluation Questions
Examples of the kinds of questions to be asked when conducting an outcome evaluation are
  • Do the transitional services reduce relapse and recidivism among offenders?
  • What are the relapse and recidivism rates of offenders?
  • Do the transitional services assist offenders in successfully reintegrating into the community?
  • Do the transitional services help offenders improve their housing, financial, and employment status?
  • Do the transitional services assist offenders in accessing other necessary services, such as primary medical and mental health services?
  • Are there differences in offender outcome by participation in different services/program components?
  • Which program components are associated with positive outcomes?
  • Based on client profiles, which clients received the most benefit from transitional services?

Figure 4-8: Data Sources for Outcome Evaluation

Figure 4-8
Data Sources for Outcome Evaluation
  • Discharge summaries and status reports (from treatment programs, the criminal justice supervisor[s], and other service providers)
  • Drug test results
  • Arrest and incarceration records
  • Face-to-face followup interviews or client self-reports
  • Program intake and attendance records
  • Probation and parole records

Figure 6-1: A Review of Treatment Programs for Offenders With Coexisting Disorders

Figure 6-1
A Review of Treatment Programs for Offenders With Coexisting Disorders
A recent review of treatment programs for prison inmates with coexisting disorders (Edens et al., 1997) brings attention to efforts currently under way to meet the needs of those with coexisting disorders in prisons. The authors identified seven programs that provide specialized services for this population. Most of these initiatives evolved from the recognition that this population does not respond well to traditional intervention methods.

Transitional or aftercare services in these programs generally begin with placement in a halfway house or other transitional setting, such as work release. Transportation to the aftercare facilities is usually coordinated by the programs. The Turning Point program (see box) contracts with several aftercare programs and provides funds for 2 months of treatment after release. The Substance Abuse Felony Punishment Facilities (TDCJ Estelle II and Hackberry Units) in Texas provide coordination and funding of transitional services through State agencies.

Several programs employ transitional coordinators, who work with case managers to provide linkages to community resources prior to release. In some programs, these coordinators also develop a plan for services and arrange meetings between the offender and the assigned case manager. All programs described in the review provide parole/supervision officers with an aftercare plan for those inmates who are released to community supervision programs.

The common goals of these prison programs, consistent with treatment approaches for those with coexisting disorders in community settings, are
  • The use of staff with training in mental health issues as well as substance use disorders
  • Consideration of both disorders as primary
  • Individualized assessments of skill deficits and symptom severity
  • Use of medication (when necessary)
  • A long-term treatment focus with an emphasis on phases of treatment
  • Appreciation of the integral role of self-help treatment
  • Recognition that treatment must extend beyond the institution and into the community
The authors found significant gaps in service during the transition period because of the expected difficulties in providing a comprehensive range of services for this population. These included a lack of transitional housing options for those in rural settings, a lack of availability or access to mental health services, resistance by community agencies to providing services to offenders, a lack of mental health services and medication monitoring in community programs, lack of cross-training in mental health issues for community supervision officers, and offender resistance to treatment after release.
 



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