Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System Treatment Improvement Protocol (TIP) Series12
For alcohol and other drug (AOD) treatment and intermediate sanctions to be combined effectively, the criminal justice system and the AOD abuse treatment system must cooperate and collaborate on two levels.
First, they need to develop and manage joint interventions into the lives of individual offender-clients that respond to the individuals' intertwined problems of criminality and AOD abuse.
Second, to deliver more productive services to their shared clients, they need to create shared programs and procedures that span their respective systems.
The systemic approach to collaboration is a necessary prerequisite to developing a workable programmatic intervention for AOD-abusing offenders.
This chapter explores major issues related to collaboration between the two systems in the development and implementation of effective intermediate sanctions programs.
First, differences in perspectives and goals of the two systems are described.
Then guidelines for forging an effective partnership between agencies are outlined.
Specific problems and needs of the offender-client population are considered next, and strategies for engaging these clients in treatment are presented.
Included also is a discussion of case management, an essential ingredient of effective intermediate sanctions programs.
Combining AOD treatment with intermediate sanctions raises many ethical issues, especially related to the allocation of scarce resources.
These issues are also discussed, as are several major obstacles to the effective use of intermediate sanctions.
As discussed earlier, the criminal justice system and the AOD treatment services system operate with different goals.
In combining treatment and intermediate sanctions, the two systems work toward joint ends with the same group of offender-clients.
Those efforts are far more likely to be successful if the two systems understand and acknowledge their different responsibilities and goals, and work to find common ground that will allow each to be successful in meeting them.
One of the primary differences between the two systems is the focus of responsibility.
The criminal justice system is charged with carrying out justice and maintaining public safety; the AOD abuse treatment system with helping individual clients recover.
The criminal justice system's responsibility for public safety requires supervision and surveillance of offenders; the treatment system attempts to influence or modify clients' behavior in the least restrictive manner possible, consistent with treatment needs.
Such differing responsibilities lead to very different views of and relationships with offender-clients.
The treatment system depends on engaging the client psychologically and developing a therapeutic alliance between the treatment provider and the client.
The criminal justice system's interaction with the offender is bifurcated: On the one hand, this individual must be watched as a potential threat to others; on the other, he or she is a human being in need of help.
The criminal justice system, by making treatment part of the offender's sentence, makes treatment part of sanctioning his or her prior behavior.
To the treatment system, treatment is not punishment, but exists to serve the best interests of the client.
These differences in responsibility and intent can obscure and impede the abilities of the two systems to work together toward common goals.
Their ability to work together successfully is further impeded by old misperceptions and misconceptions that continue to exist among professionals and staff within the two systems.
Although they have been dispelled in some communities through cooperative programs and efforts, it is probably helpful to acknowledge what those are so that we can move forward.
Treatment professionals often believe that the criminal justice system is overly focused on punishment and control to the detriment of considering the client as a whole person, as one who needs rehabilitative treatment for a verifiable disease.
In fact, the criminal justice system and its practitioners have an absolute responsibility to be vigilant about any indication that an offender may pose a threat to the community: A minor infraction may be indicative of an emerging pattern of law-breaking.
It seems to many in the treatment community that criminal justice practitioners lack information about AOD abuse treatment and, therefore, about the cost of treatment.
Treatment requires resources, and the criminal justice system in most jurisdictions lacks the funds needed to provide for all the clients that they mandate to treatment.
Thus, the issue of resource availability is another source of systemic conflict that can potentially impede collaboration.
Some criminal justice professionals seem not to believe that substance abuse is a disease.
Whether because of this disbelief, or their lack of understanding of AOD abuse, especially its physiologic aspects and pattern of relapse, criminal justice practitioners may impose mandates and conditions that have the unintended effect of setting up offender-clients to fail in treatment.
The "piling on" of sanctions or conditions that can conflict with treatment has the effect, in turn, of making the criminal justice system seem uncommitted to the long-term process of treatment, recovery, and rehabilitation.
The "piling on" of sanctions or conditions that can conflict with treatment has the effect of making the criminal justice system seem uncommitted to the long-term process of treatment, recovery, and rehabilitation.
Finally, the criminal justice community may be seen by the treatment community as uninterested in developing working partnerships with the treatment community, as being overreliant on control, and as working according to a military model.
Criminal justice system practitioners, on the other hand, often believe that treatment professionals pamper offenders, that they are uninformed about criminal justice issues, and that they are not concerned about public safety.
In this regard, treatment professionals are also accused of using AOD abuse confidentiality requirements to hide client information vital to the justice system.
Criminal justice system professionals may also believe that the treatment community has little interest in working with offender populations because those populations are more difficult to treat than other groups of AOD abusers, are less compliant with program rules, and represent a greater risk of failure for the treatment providers.
Criminal justice system practitioners perform a difficult job with a difficult group of people.
It is understandable that they believe that others do not want to work with this population.
Treatment professionals are also seen as unwilling or unable to stretch the boundaries of their treatment plans and programs to accommodate the requirements of the criminal justice system and its offender-clients.
For the two systems to work together to address the problems and rehabilitation needs of offender-client populations, perceptual and philosophical differences must be confronted and overcome.
Working collaboratively, the two systems must identify and target priorities, find ways to meet identified priorities, plan programs and services with attention to pooling available resources, and achieve minimum standards for the treatment and supervision of offender-clients.
An agreement or contract between the two systems is one means to begin this collaboration.
Working on such an agreement between the two systems will facilitate, if not mandate, the consideration of their different concerns and practices, and will force discussion of how the two systems can most effectively address the requirements of the offender population in need of treatment.
Given the enormity of the current need for AOD treatment for offenders, developing collaboration between the two systems is both vital and a major challenge.
Combining AOD abuse treatment with intermediate sanctions requires a partnership that is systemic and that integrates the goals and objectives of both systems.
Developing and implementing an agreement to guide their common work is a key step in building this partnership.
The development process can serve to focus the discussion and to record the shared goals, intentions, and responsibilities of the criminal justice and treatment communities.
It is recommended that the two systems finalize their understanding in a formal agreement between the treatment agency and the criminal justice agency.
The suggested components of such an agreement are listed in Exhibit 5-1. These elements are inclusive but not exhaustive, and will necessarily be augmented or modified according to locality.
All participating parties must be represented in the development of the agreement.
In addition to the corrections agency and the treatment provider, judges, prosecutors, and other decisionmakers from every component of the criminal justice system should be involved in the discussions.
If the treatment program will be utilized by more than one corrections or court agency (probation, parole, community corrections, the jail, pretrial services), then each one should be represented in the process of developing an agreement.
If all the members do not participate in the process, the intermediate sanctions programs are less likely to succeed.
The constraints, limitations, or needs of one or more of the involved agencies will inevitably be overlooked or inaccurately considered, and as a result, the intermediate sanctions program may be underutilized or used inappropriately.
This diminishes the credibility of intermediate sanctions and AOD treatment for offenders.
Cross-training is an important step toward making professionals and staff in both systems aware of the constraints, operating procedures, and requirements of the other.
The agreement between the two systems informs the interaction between staff in the two systems and is a basis for cross-training.
AOD treatment and criminal justice system professionals should agree on which behaviors call for criminal justice intervention and which can be handled within the treatment program.
Clarification of this critical issue ensures that there are clear, appropriate, and enforceable consequences of infractions while offenders are in treatment, and that the consequences are consistently and uniformly imposed.
A focus on the behavioral outcomes that both systems want for offender-clients will facilitate decisions about how to respond to noncompliance.
The choice of response can be based on whether it will produce a desired outcome.
Positive change or progress in behavior, rather than avoidance of rule-breaking, should be the joint goal.
Positive change or progress in behavior, rather than avoidance of rule-breaking, should be the joint goal.
For most offender-client infractions, penalties imposed by and within the treatment program are sufficient responses.
More serious infractions require criminal justice sanctions.
The offender signs a client agreement that identifies behavior that constitutes an infraction and outlines the possible responses to those behaviors. (The client agreement is different from the interagency operations agreement and is discussed later in this document.) But first, the two systems have to negotiate and agree on these sanctions and on the occasions when they will be used.
When the behavior in question constitutes a new crime, the criminal justice system will, in all likelihood, respond unilaterally.
In the agreement, treatment providers may want to include an item ensuring that their role in the offender-client's life will be recognized; for example, they may ask to be notified by the criminal justice system if the offender-client is arrested.
However, since there are so many law enforcement channels through which an offender can be apprehended, arrested, and booked, it may be difficult for criminal justice system practitioners to guarantee notification.
It may be helpful for treatment providers to realize that criminal justice agencies themselves have trouble staying informed about actions taken by other agencies or parts of the system against offenders under their supervision.
Few jurisdictions at this point have the kind of integrated information system that tracks all criminal justice activity relative to specific individuals.
To facilitate the collaboration, treatment providers must be responsible for reporting critical incidents to the criminal justice agency supervising the offender-client. (The definition of a "critical incident" will presumably have already been decided through the agreement process outlined earlier.) Failure to do so will undermine the use of treatment and intermediate sanctions.
The criminal justice system, for its part, must understand the importance of treatment continuity and avoid unilateral action that disrupts the hard work of treatment unless such action is absolutely necessary.
For example, a unilateral decision to revoke an offender-client to jail or prison for a so-called technical violation of probation (when the offender fails to comply with the conditions of probation, such as missing an appointment with the probation officer or breaking curfew, but does not commit a new crime) may undermine both the treatment process and the cooperation between the agencies.
To facilitate the collaboration, treatment providers must be responsible for reporting critical incidents to the criminal justice agency supervising the offender-client.
Understanding and supporting treatment continuity does not mean that criminal justice agencies are expected to ignore such violations.
It does mean that they will work with treatment providers and their own colleagues to develop other responses to violation behavior short of revocation to jail or prison.
Such alternative responses are useful and appropriate in many cases and for a variety of violations.
In addition to agreements about when a treatment provider should communicate with the supervising criminal justice agency, the content of that communication should be clarified.
Federal rules regarding client confidentiality must be observed, and some information is not appropriate to communicate to criminal justice agencies. (See Chapter 7 for a full discussion of client confidentiality issues.) Treatment programs usually provide progress reports to other agencies that include minimal therapeutic detail regarding a client's disclosures in treatment, but instead describe general observations about the client's progress in treatment.
The criminal justice system must understand the importance of treatment continuity and avoid unilateral action that disrupts the hard work of treatment unless such action is absolutely necessary.
The content and frequency of treatment programs' reports to criminal justice supervision agencies and the related issues of confidentiality requirements should be covered in the interagency agreement.
These topics should also be included in multi-agency cross-training.
Offender-clients need a diverse array of other services to help them attain and sustain a stable life.
These may include child care, transportation to treatment, job training and placement, health and mental health care, legal assistance, and housing.
Such services are necessary for recovery and can also act as inducements to participate in treatment.
Although there is certainly room for both the criminal justice and treatment systems to provide ancillary services to offender-clients during and after treatment, it is recommended that the treatment provider provide or arrange for these services when possible.
Some probation or parole officers are responsible for managing all aspects of the service delivery plan.
This may present conflicts for treatment professionals who are accustomed to taking responsibility for the client's full treatment plan.
While the situation and the division of responsibilities vary across jurisdictions, probation officers in many areas have caseloads that are too large to coordinate these services effectively.
Treatment programs are typically part of a larger network of human service providers and may be better positioned to access services for offender-clients.
Some have argued, moreover, that the client will be less confused if the surveillance and supervision function is clearly separated from the helping role of providing ancillary services.
However, some probation, parole, and other community corrections officers do not want to limit themselves or their responsibilities to law enforcement, preferring to define themselves as helpers as well.
Cooperation and collaboration will be more fruitful if that role is recognized and those officers are encouraged to take on some of that responsibility.
The offender-client comes to treatment with many internal barriers and obstacles that can inhibit treatment effectiveness and the client's progress.
The characteristics of offenders that serve most often as barriers to treatment include:
A history of failure
Alienation from the social structures and the governmental agencies that typically and repeatedly have a major impact on them
A sense of hopelessness that anything can make a difference in their lives
Cynicism about the opportunities offered by social service agencies
A tendency to manipulate systems that affect them
Unrealistic expectations of treatment,
A culturally supported belief that treatment is for people who are weak
The perception that treatment is punishment or an additional sanction.
Offender-clients typically have had more substantial experience with failure and less experience with success than the voluntary treatment-seeking population.
Therefore, orienting the offender client toward small accomplishments in the treatment process is an important task, particularly during the early stages of treatment.
Treatment programs and corrections agencies should work together to build in small success opportunities for clients so that they gain confidence as they progress through treatment and complete supervision requirements.
These can include making and keeping an appointment, having a negative urine drug test, or completing a homework assignment.
Well-formulated intermediate sanctions programs will build in small structured steps that clients can take successfully with relative ease.
As indicated above, offender-clients bring to treatment both the classic patterns of addiction behavior and the particular experiences of having reached the point of engaging in criminally deviant and destructive (to themselves or others) behavior to maintain their addiction.
Their status as both addicts and offenders who have been forced into treatment and who may yet face severe penalties for their actions may enhance their sense of having little to hope for and their belief that recovery is not worth the hard work needed to achieve it.
They may believe that they are so far down that the treatment will not work for them.
Some offender-clients do not perceive their AOD abuse as a problem or its treatment as a priority.
In the face of all the other problems that they may have, they are often more focused on collateral needs such as those for housing, medical care, and employment.
Even if offender-clients have a desire to strive for recovery, their life experiences may have led them to believe that treatment providers' promises are meaningless and will not be fulfilled.
The typical offender-client has little to show for years spent in school, in training programs, and probably in social service programs.
Frequent past contacts with law enforcement and other criminal justice agencies that resulted in few if any consequences may lead the offender-client to believe that this experience will be like all the others: Nothing that is said is meant, and neither threats nor promises will be kept.
AOD treatment and criminal justice professionals must endeavor to promote client receptivity and engagement with the treatment and recovery processes.
To accomplish this engagement, both groups must work to help the offender-client overcome alienation, hopelessness, and cynicism.
In the same way that treatment and intermediate sanctions programs must build in small steps to make success possible, they must also ensure that promises are kept; that consequences of behavior, both positive and negative, are delivered quickly and consistently; and that the programs promote a sense of self-worth among the offender-clients.
Such goals may make it necessary to adjust the environment and change attitudes of program staff.
In the same way that treatment and intermediate sanctions programs must build in small steps to make success possible, they must also ensure that promises are kept; that consequences of behavior, both positive and negative, are delivered quickly and consistently; and that the programs promote a sense of self-worth among offender clients.
Treatment professionals should be willing to look at the treatment settings to make the physical environment more appealing to clients.
A clean, well-cared-for, attractive facility connotes respect for everyone in it and for what goes on there.
AOD treatment professionals should encourage staff attitudes that also convey respect for clients.
For example, the manner in which clients are addressed should convey respect; clients should be asked rather than told what their needs are and how they will be met.
In this way, the offender-client and the treatment provider are more likely to function as a team to promote the client's recovery.
Treatment for the offender is usually ordered within the context of a criminal proceeding, and, in the case of intermediate sanctions, within a sentencing proceeding.
Thus, the justice system usually communicates to the offender that treatment is punishment.
Indeed, in this context treatment is not voluntary and is part of a sanction.
However, the sanction is intended to benefit the offender.
The major therapeutic challenge to the treatment system is to address offenders' likely resentment that treatment has been imposed on them.
Theoretically, the criminal justice system dispenses punishment to offenders and the treatment system offers help to AOD abusers.
When the two systems work together, the punishment and assistance elements become enmeshed in practice and in the offender's mind.
In the context of intermediate sanctions, no meaningful distinction exists between treatment as a punitive and a nonpunitive measure.
Offender-clients need assistance to clarify and resolve this conflict between the criminal justice sanction and AOD treatment.
Once the offender-client is involved in AOD abuse treatment, treatment professionals, with support from the probation or parole officer, should help the client refocus on the goals of treatment and recovery.
To benefit from treatment, the offender needs to move beyond the fact that it is involuntary and to understand that treatment represents an opportunity to help himself or herself.
The goals of treatment and recovery are likely to vary somewhat among treatment modalities and groups of offender clients but, in general, treatment professionals need to:
Help the offender-client develop the motivation to create an AOD- and crime-free orientation
Help the offender-client solve the ancillary but still pressing problems associated with AOD abuse, which are often a mix of psychosocial, medical, financial, and entitlement problems.
Addicted individuals typically manipulate the people and institutions that surround them.
Offender-addicts generally have been engaged in manipulative behavior for a long time and with many systems.
The treatment and criminal justice systems must accept responsibility for not permitting or facilitating manipulation, either within their own system or through giving different or opposing signals to offender-clients.
Good cross-system case management is critical to dealing with manipulation.
Clear, consistent, and uniform messages and responses from the criminal justice and treatment systems are one way for the two systems to promote recovery and avoid being used against one another.
For similar reasons, it is crucial to establish and enforce effective sanctions for infractions in treatment so that offender-clients know that their behavior will have consequences.
Offenders communicate among themselves, and if the word is out on the street that the treatment program does not deal seriously with rule-breaking, the program will be faced with endless efforts to manipulate its rules.
Offender-clients need to be educated about the treatment process and the expectations for their active role in treatment.
They need to be taught that treatment will not take care of all of their problems, and that passive involvement in treatment will not produce results.
In much the same way that the criminal justice and treatment systems must collaborate to provide treatment services to offender-clients, the collaborative system must forge another relationship, one that makes the offender-client a full participant in the process of his or her own treatment and recovery.
There are several key requirements for bringing the offender-client into a partnership role:
Fully inform clients.
Fully disclose to them the expectations of both systems and the repercussions if expectations are not met.
Clarify what treatment is and is not.
Create and develop a therapeutic alliance with clients to help set recovery goals that are realistic and meaningful to them.
Provide immediate and appropriate responses to positive and negative behavior.
Follow through on commitments to clients.
Empower clients to participate in the recovery process.
Treat clients with respect.
Acknowledge and attempt to address clients' other problems (which may result from or be independent of AOD abuse problems.)
Ensure that representatives of the two systems speak with a single voice on critical issues and that system responses to key incidents are jointly supported.
Create positive and negative incentives for clients.
From the outset, staff in the two systems must present a single message about their common expectations to the offender-client, as well as good, clear information that is as consistent as possible.
One way to achieve both of those objectives is through the use of a client agreement.
The client agreement addresses issues similar to those addressed by the agreement between the treatment and criminal justice systems.
The systems agreement defines the intermediate sanctions program, specifies its goals, and indicates each system's responsibilities to the other and for services.
The client agreement describes the sanction, the treatment program, and the expectations and responsibilities that the intermediate sanctions program places on the offender-client.
Clients are expected to sign this agreement.
The specific information that it is crucial for clients to know may vary according to the jurisdiction, the type of sentence, and the nature of the crime.
The general issues to be covered in the client agreement are shown in Exhibit 5-2.
The client agreement might also include information about the nature of AOD abuse and treatment and describe expectations of treatment participants.
That information might include:
The outcomes that can be expected from treatment
The limitations of treatment
The demands that treatment and recovery place on the participant
A description of recovery as a process
Information about relapse and related behaviors.
The offender-client's signing of this agreement should be considered and treated as a ceremonious affirmation of his or her responsibility and participation.
It is the first step in the process of recovery.
The key elements of this agreement should be summarized in simple language, particularly those that describe behaviors that necessitate criminal justice sanctions.
Accordingly, the client agreement should reference any criminal justice system waivers and consents that are applicable to offender-clients.
Informing clients about treatment is essential not only for engaging clients in the process, but also for keeping them actively involved.
An especially important part of that information is the pivotal role that they themselves play; client participation and input are critical aspects of the treatment plan.
Clients should be told that this is their treatment, and that they are expected to participate in the process.
That the treatment is the client's is one of the primary tenets of voluntary treatment.
Because offender-clients are not voluntary participants, the treatment system may need to find ways to "reframe" its strategy with this group.
A brief document describing the nature and components of AOD abuse treatment can help prepare clients psychologically.
In addition to giving the document to clients, the information should be read to them as well.
The document should define the goals and objectives of treatment, describe the process in which clients are about to participate, and describe what outcomes they can expect.
For offender-clients, it should also include expectations of participation in treatment as a component of an intermediate sanction.
A number of States require treatment programs to provide this kind of information both in writing and orally to potential clients as part of obtaining informed consent from clients for treatment.
Clients should also be educated about the differences between "doing time" and participating in treatment.
Treatment may be more difficult than doing time, because the client has to work and participate actively in creating behavior change.
The treatment professionals should acknowledge that treatment is hard work and help the offender-client define the possible payoffs for the effort.
Treatment may be more difficult than doing time, because the client has to actively work and participate in creating behavior change.
Treatment is dependent on the therapeutic alliance between the offender-client and the counselor.
Bonds must be created early, or the potential for losing the client increases greatly.
The client should feel some personal connection with the processes of entry into and participation in treatment.
Adversarial relationships with clients are counterproductive.
Treatment providers may find it easier to establish this bond if they can identify and focus on issues important to the client, instead of on external or system expectations and requirements.
Such an approach requires framing recovery and the expected behavior changes in a context that is both pragmatic and beneficial to the client.
The alliance will also be more likely if treatment professionals do not impose on clients the system's idea of what their problems are; clients must identify their needs and the problems that they want solved.
The job of the treatment team and the function of the therapeutic alliance is to help clients identify and gain access to solutions for all of their problems.
Culturally sensitive and appropriate interactions with the client are necessary for the alliance.
With individuals from some cultural groups, for example, the extended family should be involved in supporting the treatment plan.
With those from other groups, the treatment provider will have to accept the fact that the client does not believe that the provider can understand his or her needs and problems.
The rate of AOD relapse is high among offender-clients.
Relapse prevention information and activities must be included from the beginning and throughout treatment.
These clients need to learn relapse prevention skills such as refusing AODs, and identifying and managing the triggers of craving.
When relapse occurs, clients must be helped to understand it as part of the recovery process rather than as a personal failure.
They can pick up and go on to success.
In negotiating the intersystem agreement, treatment and criminal justice professionals need to address the issue of the likely relapse of offender-clients.
Both systems should support sanctions along the treatment continuum so that relapse is not punished as if it were an additional criminal offense.
Criminal justice decisionmakers at all levels should be reminded that relapse is a characteristic feature of AOD abuse that needs to be anticipated, prevented, and addressed.
To engage the offender-client in the treatment process, it is most helpful to make use of all available positive incentives for treatment.
These are varied and will depend, naturally, on the values, interests, and needs of the particular group of clients.
To overcome offender-clients' sense of hopelessness, treatment providers and criminal justice system agencies should provide contacts with peers engaged successfully in the therapeutic process.
Such exposure to models of success has been demonstrated to influence individual success in treatment.
In the context of intermediate sanctions, both systems need to realize that successful peers are often lacking in nonresidential treatment environments.
In outpatient settings, therefore, different types of role models for offender-clients should be identified and made available.
Some courts and corrections agencies have had success with group sessions, either in a drug court setting, group supervision sessions, or in separate group court appearances for AOD cases, in which current and former clients who are doing well appear and are congratulated by the judge or agency supervisor.
These clients may be commended for having accomplished even small, but important, goals.
Such an approach is similar to developing peer leadership in residential treatment programs.
Efforts like these help focus criminal justice decisionmakers on evaluating and rewarding of offender clients for small steps accomplished along the way, rather than for total recovery or rehabilitation.
These strategies also help keep offender-clients involved and engaged in treatment and compliant with the intermediate sanction.
Treatment programs often provide other services that can serve as incentives for offender-clients to engage and participate in the program.
Those services can be as basic as a safe, secure, and comfortable place to live (in residential programs); medical care; child care; or referrals for free food (in nonresidential programs).
Treatment professionals should not hesitate to use these other services to sell the client on treatment.
Not only do they help engage clients, they also meet some of the offender-client's critical human needs.
In some cases, successful completion of a treatment program can be used as an incentive to secure a change in the overall sanction facing the offender-client.
Such a change might include less intrusive supervision or a less restrictive curfew, a reduction in the duration of supervision, or a reduction in a community service obligation.
As has already been indicated, there are many important reasons for providing and enforcing clear, consistent consequences for failure to comply with treatment requirements.
For offender-clients, it is also important that the consequences be provided within the treatment continuum before the criminal justice system responds. (These are covered in more detail in Chapter 6, but might include requiring more frequent attendance at Alcoholics Anonymous meetings or more frequent urinalysis.) Every treatment problem encountered should not engender a response from the criminal justice system.
The two systems have the challenge of developing sanctions along the treatment continuum and determining when criminal justice intervention is appropriate.
The two systems have the challenge of developing sanctions along the treatment continuum and determining when criminal justice intervention is appropriate.
The supervising corrections agency typically has considerable discretion in this regard.
In some jurisdictions, the corrections officers themselves have substantial discretion in making violation decisions.
Such discretion can cause problems if the parole or probation officers apply different standards and the treatment program is working with the clients of many different officers.
In the interests of consistency and fairness across the two systems, a set of basic guidelines within which all agencies and officers will operate should be developed.
Such guidelines might specify categories of behavior and a range of responses for each category.
If both systems focus on promoting desired behavior and specific outcomes for each offender-client, then some discretion must be available to both the treatment providers and the criminal justice practitioners.
General guidelines can permit both consistency across cases and flexibility in individual cases.
Exhibits 5-3 describes incentives for treatment and consequences of negative behavior.
When directing offender-clients to treatment, it is essential to realize that different types of AOD abusers require different durations and intensities of treatment.
AOD abuse treatment needs should be determined by the client's category of AOD abuse rather than by offender type. Clients with a chronic AOD abuse history have the most pressing and extensive treatment needs.
Offenders who use drugs casually will not need the same level of treatment.
Generally, there are four categories of AOD abusers among the criminal justice population:
Casual AOD abusers only marginally involved in AOD abuse or crime
Addicted offenders with an established pattern of abuse or dependence
Antisocial offenders for whom AOD abuse is symptomatic of a criminal lifestyle and of criminal values
Mentally ill, chemically dependent offenders.
The congruence of treatment duration and level with the sanction imposed is of great concern to both systems.
On the one hand, the criminal justice system is required to impose a sanction whose length and intrusiveness is limited, if not determined, by factors related to the seriousness of the offense and the offender's criminal history.
On the other hand, a sanction that includes a treatment requirement that is not related to the assessed AOD treatment needs of the offender may be a waste of resources.
With adequate information about each system available to the other, and effective communication between the two, the criminal justice and treatment systems can devise strategies for ensuring congruence between treatment and the sanction imposed.
This approach must begin with a realistic set of expectations on each side.
For example, criminal justice decisionmakers need to realize that recovery is not possible when they order an offender who needs intensive, long-term treatment to an outpatient treatment program for 3 months.
In that situation, however, it may be realistic to expect the offender to become treatment ready, that is, prepared for and wanting treatment.
For its part, the treatment system may need to intensify its services and prepare for the shorter-term sentences of many offender-clients.
In addition to focusing on treatment readiness for such clients, treatment providers may have to concentrate on strategies to attract the client toward longer-term, voluntary treatment services, while criminal justice system decisionmakers support increased funding and availability of such services.
Criminal justice system decisionmakers must also become educated about the pitfalls of the opposite situation: the offender who is assessed as a casual AOD user, but who is ordered by the court to a long-term residential program because the court wants him or her in a structured environment away from the street.
Such an offender-client is bound to become frustrated and difficult for the treatment program to manage, and may fail to complete the sanction (and thus be classified as an even more serious offender by the criminal justice system).
To avoid these cases, treatment providers must be active in reaching out to and educating judges and other decisionmakers in the justice sytem.
Defining and explaining the steps in the recovery process are important parts of educating the criminal justice system about the problems offender-clients face on the road to recovery, and about realistic expectations at various stages of treatment.
The typology of the stages of treatment outlined below, although helpful, is very general; individual AOD abusers in treatment show substantial variation.
Recovering AOD abusers cycle through these phases, perhaps several times, and relapse frequently occurs.
In the first several months, the objective is to engage offender-clients in the process of treatment.
An initial treatment goal is their acknowledgement of the profound problems related to their abuse of AODs.
An additional treatment goal includes recognizing the presence and severity of the AOD abuse problem and their corresponding need for help.
This stage is marked by substantial fluctuations in client progress; the client's commitment to treatment usually vacillates.
Ideally, the client reaches the point of understanding that treatment is important and makes a commitment to it.
Attempts to bargain with the treatment staff are to be expected as the client explores and tests the system.
A number of positive urine tests usually occur during this early phase.
During this early recovery period, with its erratic_if predictable_behavior, primary responsibility for the monitoring of offender-clients is probably best left to treatment providers, who are trained to handle clients' testing and exploring of the recovery process.
The second stage begins when the client becomes engaged in the treatment process.
It is a period of significant growth for AOD abuse treatment clients.
Clients generally come to terms with the other major problems that are related to or have been affected by AOD use, such as relationships and value systems.
Most of the work of treatment is accomplished during this phase.
Clients begin to respond positively to treatment and behave according to the treatment program's requirements and goals.
The duration of this phase varies significantly among individuals_from a few months to a year or more.
In the final stage, clients begin to take responsibility for themselves.
If they are still in a treatment setting, they begin to take responsibility for their leadership role with new people entering the treatment environment.
Clients begin their reentry into the world or refocus on the ordinary business of life outside of treatment.
The treatment focus is on maintenance of recovery after treatment and on assisting clients with the tasks of reentry or reengagement with work, family, and community.
Again, the duration of this phase varies among individuals.
Treatment providers typically want to focus treatment resources during the early recovery phase to help ensure that the client is drawn into and thoroughly engaged in the recovery process.
Treatment programs also emphasize rules at this stage, where behavior problems and infractions usually peak.
Expectations of such problems must be factored into the treatment-intermediate sanctions plan, which should incorporate substantial monitoring and drug testing in the early stage.
At this stage, the treatment system focuses on enhancing offenders' motivation and commitment to treatment to help clients develop accountability for their behavior in the treatment program.
Resistance to treatment and dropping out of the program are highest in the early stage.
Relapse, however, is part of the recovery process and may be anticipated at any point.
The treatment provider must take the lead in developing treatment sanctions for reasonable occurrences of relapse, though the imposition of sanctions in individual cases should be made jointly with the criminal justice system practitioner involved.
Assessment for AOD abuse treatment needs is a several-tiered process that all clients must go through to be placed appropriately.
This subject is covered in detail in another TIP, Screening and Assessment for AOD Abuse Among Adults in the Criminal Justice System, and will be discussed only briefly here.
This initial step by the criminal justice system should screen offenders for two items relative to treatment within intermediate sanctions: 1) likely AOD abuse and 2) eligibility for the jurisdiction's intermediate sanctions programs as designed.
Screening should occur as early in the criminal justice process as possible, prior to sentencing if that is feasible.
Screening might be described as a rough cut, the first step in deciding whether an offender is at all suitable for intermediate sanctions and AOD treatment.
Screening can determine whether an offender meets the agreed-on eligibility requirements and eliminate those that do not.
Eligibility requirements typically cover both the need for AOD abuse treatment and the severity level of sanctions required to make a treatment referral.
The screening process gathers information about the offender and the offense necessary to make a decision about whether he or she should be sentenced to a particular sanction.
The screening process gathers information about the offender and the offense necessary to make a decision about whether he or she should be sentenced to a particular sanction.
Screening for intermediate sanctions must employ the criteria established by a collaborative planning group representing both systems.
Certain categories of offenders constitute the target group or groups, that is, those for whom the intermediate sanctions were developed.
For example, the screening instrument might consider:
The offender's previous criminal history
The offender's level of risk to public safety
The offender's performance in any previous sanctions or periods of pretrial supervision
The offender's previous experience with treatment
The specific nature of the offender's crime that might indicate a more or less appropriate sanction (for example, sentencing a drug dealer to home detention may do nothing to stop his or her dealing activities).
Determining who meets these criteria should be as objective a process as possible.
For example, an objective risk or risk-needs assessment instrument is one way to measure the public safety risk represented by offenders, and the severity of their individual needs in a variety of psychosocial areas.
This correctional assessment may form the basis of a recommendation about the type and duration of the sanction.
A risk-needs assessment can be a useful part of any presentence investigation.
The nature of the offender's AOD involvement, either from a self-report or from a toxicology screen, is also a necessary component of this piece of the process.
The intermediate sanction referral must be matched to necessary treatment; for example, if an offender needs residential AOD abuse treatment and the severity of the offense permits that level of intrusion, then home confinement does not make sense as an intermediate sanction option.
Each jurisdiction must determine who performs the initial screen -- that is, who is the first-level gatekeeper.
Usually, the judge makes the decision or agrees to the use of intermediate sanctions, but there is more flexibility in determining who gathers the information on which the decision is based.
It is usually collected by the probation agency or court assessment unit, or an independent agency.
When screening suggests that an offender may have an AOD problem, the offender should be clinically assessed by a treatment professional.
Screening for communicable diseases (HIV, TB, and sexually transmitted diseases) also needs to be conducted or arranged for at this time.
Actual counseling and testing may be done at any approved public health site as discussed earlier.
Assessment is the process of determining the nature of the offender-client's AOD abuse and placing him or her in the appropriate treatment modality (or recommending such placement).
The criminal justice system also conducts assessments of various sorts, but in the context of AOD abuse treatment, assessment is a comprehensive, clinical addictions assessment.
Assessment is the process of determining the nature of the offender-client's AOD abuse and placing him or her in the appropriate treatment modality (or recommending such placement).
One of the problems with securing proper treatment for the offender-client is that criminal justice screening often substitutes for a complete clinical assessment.
Clinical assessment is absolutely necessary.
Criminal justice screenings or "quick and dirty" assessments are incomplete and insufficient for matching alcohol and other drug abusers to the right level of treatment.
It is recommended that the AOD assessment of offender-clients be conducted by a treatment professional.
If it is not feasible to involve treatment providers at this stage of presentence recommendations, then the criminal justice system should have its own trained addictions personnel to conduct the assessments.
Although it is very difficult to determine the exact rate of AOD abuse (as opposed to AOD use) among the offender population, the National Institute of Justice's Drug Use Forecasting system reported that in 1990, more than 50 percent of a sample of arrestees in 24 urban areas tested positive for at least one drug at the time of their arrest.
Anecdotal reports by criminal justice practitioners put the AOD abuse figure among offenders at 70-80 percent.
In any case, treatment resources simply do not exist that are sufficient to handle either number.
Accordingly, it is not recommended that every potential treatment candidate be routed for an assessment.
In jurisdictions struggling to make the best use of existing resources, or planning their best use, policymakers may want to consider sending for clinical assessment only offenders who meet criteria for intermediate sanctions programs. (On the other hand, an AOD abuse screening of every offender would provide extremely useful data on treatment resource needs for this population in a jurisdiction.)
The collaborative system needs two funnels: one for offenders whose sentence will not include treatment, but who should be referred for voluntary treatment; and another for those who are remanded into custody or who receive an intermediate sanction.
If the criminal justice system screening establishes that the offender is likely to have an AOD abuse problem and meets the criteria for intermediate sanctions, then the clinical assessment should take place as soon as possible -- at the very latest, after a plea or trial.
Certainly, the criminal justice system is taxed, and its processes are often overloaded and rushed.
The court must support the necessity and value of conducting good clinical assessments of eligible offenders for the system to accommodate this additional step in the sentencing process and the additional expense.
The way the client responds to treatment is partly a function of how he or she initially encounters treatment services.
Accordingly, when conducting the clinical assessment, treatment staff should be attentive to their interactions with the client and should try to "invite" him or her into the treatment process.
If, as recommended above, treatment staff conduct the assessment, clinical control can be exerted over the introduction to treatment and the client's perception of and reaction to the process.
Treatment staff can also question the client with protection for the confidentiality of the information provided. (Please refer to Chapter 7 of this document for a fuller treatment of this topic.)
It has been recommended that criminal justice screening be limited to identifying likely AOD abuse among offenders who meet the criteria for the jurisdiction's intermediate sanctions, and directing those so identified to a treatment professional for a thorough assessment.
The treatment professional should then provide the assessment results to the criminal justice system.
One reason for placing the assessment responsibility with a treatment provider is to ensure that a thorough clinical assessment is only conducted once, and that the client does not have to answer evaluative, personal questions over and over.
However, basic demographic and personal history information about the offender is needed by agencies of both the criminal justice and the treatment systems.
Each item of this information should be collected only once, with each office or agency adding only new data items.
This cumulative information sheet should follow the offender-client and be shared among criminal justice and treatment agencies.
The redundancy typically exhibited in the collection of basic information about the offender and the frequent repetition of the same questions are obstacles to establishing positive relationships with the client, as well as a misuse of staff time and resources in both systems.
Early clinical participation with the client is seen as essential by treatment professionals, and having this basic demographic information already available would free time for the treatment staff to begin developing the clinical relationship via the comprehensive AOD abuse assessment.
Policymakers from the two systems need to agree that one point for the integration of the two systems is information collection.
The collaborative system should agree on the nature of the information collected, where it will be collected, and how it will be transmitted between agencies.
To protect the integrity of the information collected, planners of the data collection process should carefully determine where in the criminal justice system the data sheet originates.
Because information will be collected only once, it becomes even more imperative that it be accurate.
It would make sense to assign this responsibility to a stage of the intake process in which there is less pressure to complete the work quickly.
Despite concerted joint efforts by the criminal justice and treatment systems to develop an excellent screening and assessment process, both systems will still be faced with the problem of inadequate treatment resources and the reality of AOD treatment waiting lists.
Too often there are more offenders who fit the criteria for placement than there are slots available.
Although the principle of immediate access to treatment is theoretically sound, the practical reality is that it is not always possible.
However, if waiting lists seem unmanageably long and it is apparent that some clients will never get into programs they have been recommended for, in the absence of increased resources, program entrance criteria may need to be defined more narrowly.
Although the principle of immediate access to treatment is theoretically sound, the practical reality is that it is not always possible.
All other things being equal, waiting lists should be run on a first-come, first-served basis.
Waiting list programming should be established that provides pretreatment services that use minimal resources to keep clients involved until treatment slots become available.
The intermediate sanctions programs themselves may also have to make adjustments because of the lack of available treatment resources; for example, a day reporting program that requires outpatient treatment may have to be redesigned to include waiting-list clients.
Case management is the process of linking the offender with appropriate resources; tracking the offender's participation and progress in the referred programs; reporting this information to the appropriate supervising authority and, when requested, to the court; and monitoring conditions imposed by the court.
Case management is an essential ingredient of successful intermediate sanctions programs.
Such programs are really only additional tools to provide the services, support, and accountability to offenders in the community that together constitute the heart of good case management.
When intermediate sanctions and AOD treatment are combined, the necessity of case management becomes even greater.
Case management for offender-clients should provide the following functions:1
Assessment: determining the client's strengths, weaknesses, and needs; evaluating the client's ability to remain crime free and drug free ensuring development of the overall case plan
Planning: for treatment services and the fulfillment of criminal justice obligations, such as meeting community service and restitution requirements and maintaining regular contacts with the probation officer or other criminal justice officials
Brokering treatment and other services and assuring continuity as the client moves along the criminal justice and treatment continuums
Monitoring and reporting progress
Client support: identifying problems and advocating for the client with legal, treatment, social service, and medical systems in response to client's needs
Monitoring urinalysis, breath analysis, or other chemical testing for AOD use.
Case management is the point at which the implementation of the criminal justice and treatment systems' collaboration is tested.
Successful, joint case management -- whether actually done by one agency or both -- rests on the foundation of the two agreements described earlier.
The client agreement lays out the content of the sanctions, the treatment protocol, the offender-client's obligations, and the repercussions of infractions or failure to comply with the sanction.
This agreement represents a contract between the two systems and the offender.
The client agreement becomes the guiding document for managing offender-clients through the intermediate sanctions and treatment programs.
The second agreement, between the two systems, outlines how the criminal justice system and the treatment system will manage the caseload of offender-clients in the jurisdiction.
This agreement defines some of the overall parameters that are relevant to the collaborative system in the context of case management.
There can be a single case manager, or there may be two -- one from the treatment system and one from the criminal justice system.
If there are two case managers, they must work in tandem and make sure that efforts are coordinated.
Working together, they can encourage a multidisciplinary approach that takes advantage of a wide range of treatment and rehabilitation options.
If there is to be only one case manager, that function should probably be within the treatment system, even though that system may become overloaded with increasing numbers of offender-clients.
Furthermore, if resources permit, it is recommended that the person who does the specific AOD counseling not be the same person who is responsible for the court supervision part of case management.
Jurisdictions vary, however, and some probation and parole officers define their roles as resource providers and resource brokers.
If caseloads permit, these officers can serve equally well as case managers or co-managers.
The number of correctional field officers has not kept up with the growth in probation and parole cases under supervision over the last 15 years.
As a result, the National Institute of Justice reported that the average probation caseload in the United States is now 120 per officer, and in some areas that ratio is much higher.
Such caseload size represents a major impediment to the ability of criminal justice practitioners to either carry out effective case management or participate meaningfully with treatment personnel in managing cases.
Because new and increased resources have been dedicated to law enforcement and prosecution in drug cases, much of the increased caseload volume has come in that area.
With more cases, and no corresponding increase in treatment capacity for offenders, criminal justice practitioners and decisionmakers have difficulty focusing on individual cases.
There are too many of them and too few resources to make intervention seem worthwhile.
Policymakers from both systems must struggle to overcome the cynicism and hopelessness that are unfortunately as common among probation and parole officers in this regard as among clients.
While additional resources, both in officer positions and treatment capacity, will be necessary, enhanced attention and effort by agencies and policymakers from both systems will also be helpful.
Because treatment programs and services are rooted in the traditional client-counselor relationship, the treatment system is particularly attuned to issues of confidentiality in sharing and transmitting information to the criminal justice authorities.
Treatment professionals are bound not only by their own code of ethics, but also by Federal regulations regarding the privacy rights of clients in AOD treatment. (See Chapter 7 of this TIP for a full discussion of those regulations.) Criminal justice practitioners, on the other hand, expect that the court and its officers have the right to all information about the offender.
Their concern about protecting public safety may make them suspicious when any information seems to be withheld from them.
This divergence in attitudes between the treatment and the criminal justice systems can be a source of some friction in handling offender-client cases.
In the intermediate sanctions process, the confidentiality requirements of each system must be examined carefully.
As the two systems design and develop the collaborative agreement, the issue of confidentiality should be resolved by identifying particular types of information that must be communicated to the criminal justice system and the infractions that can be handled with treatment sanctions both with and without notification of the criminal justice system.
The treatment and criminal justice systems differ in regard to the treatment outcomes that they desire.
The differences are a potential source of conflict.
On the one hand, treatment personnel are typically more tolerant than criminal justice practitioners of the relapses and intermittent failures of the offender in recovery.
On the other, their ultimate expectation for that offender is doubtlessly higher: They want to see a sober client whose life is free of AODs and free of the lifestyle that is often part of AOD abuse.
Criminal justice practitioners may wish for such an outcome for individual offenders, but they would be happy with less, that is, with the offender's AOD abuse under enough control for the offender to be able to remain crime-free and meet the other requirements of the sentence or parole.
The treatment provider wants abstinence and full recovery; the criminal justice practitioner hopes for compliance with the law and conditions.
The treatment provider wants abstinence and full recovery; the criminal justice practitioner hopes for compliance with the law and conditions.
Although these differences are subtle, the potential exists for conflicts between the two systems over the level of supervision, expectations about services, and the nature of behavioral requirements.
Treatment programs typically absorb most of the costs incurred by criminal justice clients, even when the clients are ordered into the program by a judge or parole board.
Issues relating to payment are a formidable impediment to developing coordinated care for offender-clients.
Clearly, there is a need for greater resources for treatment generally, but there is also a specific need for the criminal justice system to generate additional resources for offender-clients.
A possible remedy to this dilemma is to divert funds not used for planned jail beds into treatment for offenders as those offenders are diverted from jail into treatment.
These funds, however, may not be available for use to purchase treatment services.
Another potential source of funds are those generated by the forfeiture cases brought by prosecutors in drug cases.
The two systems also need to collaborate and apply jointly for available State and Federal funds and to advocate with a unified voice for the availability of increased funding for treatment.
The argument to be made for adequate funding of treatment for offenders, particularly offenders who meet the criteria for intermediate sanctions, is really a quite powerful one.
Resources are far better spent on confronting and treating the underlying source of criminality than on either just jailing AOD-abusing offenders or simply restricting their movement.
Adequate treatment is more likely to end their criminality.
Meanwhile, payment responsibility for treatment for criminal justice clients needs to be clearly indicated in the system agreement.
The parties may want to add to the agreement their plan for and commitment to seeking additional resources.
Combining AOD treatment with intermediate sanctions raises two sets of ethical issues.
The first has to do with dedicating some portion of scarce and valuable treatment resources to those who have been convicted of crimes.
The second concerns the difficulties of using the apparatus of the criminal justice system to coerce participation in treatment, a supposedly beneficial activity.
If AOD abuse treatment were in unlimited supply, providing such treatment to offenders would not be an issue.
Unfortunately, this is not the case, and it may appear that the criminal justice system and intermediate sanctions programs are taking services away from people who are innocent of crime (other than possession and use of illicit drugs or prescription drugs obtained fraudulently -- "innocent" is a relative term in this arena) by directing a large number of criminal justice offenders into treatment.
In some jurisdictions there are waiting lists for publicly funded treatment programs.
If treatment resources are indeed quite scarce in a community and most services for offender-clients are provided outside the criminal justice system, then the appearance of taking services away from people who have not committed crimes may be reality.
This raises a very significant ethical question: Given limited treatment slots, does someone have to commit a crime to get one?
Given limited treatment slots, does someone have to commit a crime to get one?
Criminal justice and treatment policymakers must confront this issue together.
They should collaborate on common efforts to secure increased treatment capacity and funding.
To create this increased capacity, the two systems may need to pool and reallocate their existing resources and coordinate funding requests.
Even with increased capacity, there will probably never be enough treatment for everyone who needs it.
However, solid reasons remain for giving criminal justice clients some priority when existing treatment resources are allocated.
Criminal justice clients present a high risk for relapse and reoffending.
These clients typically would not otherwise receive treatment.
Studies suggest that offender-clients whose treatment is coerced have better retention rates in treatment than clients who are not coerced.
Accordingly, the offender-client should be viewed as a potentially more responsive client.
Ideally, treatment capacity projections should include estimates for criminal justice clients so that offenders do not take treatment slots from voluntary clients.
In any case, the criminal justice system's policymakers must be aware of the impact of their population on a limited treatment system.
One of the chief difficulties in combining intermediate sanctions and AOD abuse treatment is related to the fundamental divergence in purpose between the two: Intermediate sanctions are one set of tools used by the criminal justice system to enforce the will of the larger society on its members.
The criminal justice system makes use of the power of the State to inflict unpleasantness (deprivation of liberty and property) when individuals refuse to abide by society's behavioral norms.
In fact, this reality is nowhere more evident than in the area of drug use and the definition of some substances (marijuana, for example), but not others (alcohol or tobacco), as illicit and their use as punishable by sanctions of all sorts.
The criminal justice system is based on the power of the State to deprive individuals of liberty and property and on the consequent fear of citizens of violating the law.
AOD abuse treatment exists to help individuals become more fully realized, self-controlling persons.
Its chief aim is individual empowerment through recovery, rehabilitation, and sobriety.
Although treatment also emphasizes client accountability and respect for rules, the purpose is benign for the individual, that is, such an emphasis is aimed at helping the client achieve self-control.
The difficulty in combining these very different approaches -- punishment and self-realization -- and purposes is that as a society we are attempting to use the power of the State (as expressed by the justice system) to force what is supposed to be a beneficial and empowering activity -- treatment -- on the individual.
By coercing treatment, we assume that our judgment of what is in the best interests of the individual surpasses his or her own judgment.
We submerge the interests of the individual to those of the larger community and require the individual to change.
Because treatment is considered a benefit, a good thing for the client (even a gift), it is easy to overlook the element of coercion that is present when the criminal justice system is involved.
It becomes easy over time to want to use even more coercion to force more treatment -- because it is all for the individual's own good.
This rather appealing notion tends to overlook the consequences to the involuntary client when he or she cannot achieve recovery, or perhaps even when he or she simply goes through the inevitable process of denial, resistance, and relapse that characterize the recovery process.
The descriptions that follow explore dimensions of ethical conflicts that can arise from combining treatment and intermediate sanctions.
From the criminal justice perspective, the ethical issues usually derive from violations of any of several basic principles and values of criminal justice:
The government will not intrude on the individual's life unless the individual breaks a law that has been publicly enacted.
The punishment ordered in response to the law-breaking will be proportional to the seriousness of the offense.
When the government does intervene in a person's life, it will seek the least intrusive alternative.
The "net of social control" is the system of requirements and interventions by social institutions, usually related to criminal justice, that reduce individual liberty.
In the implementation of intermediate sanctions, reference is made to both the widening of the net, that is, including ever-larger numbers and types of people, and the tightening of the net, that is, imposing ever-greater restrictions or requirements on those people.
In combining treatment with intermediate sanctions, the concern is that in the name of providing needed services (of treating people who really need it), the two systems will collaborate to use intermediate sanctions inappropriately.
The concern is that such sanctions will be used for people whose offense would suggest a less intrusive response than involuntary AOD abuse treatment, or used to require more intense treatment than the offense would indicate.
The concern is not primarily with the original condition requiring treatment (although that is a concern); the more worrisome issue is the consequences to the individual of relapse or other infractions.
Net-widening can be avoided, but it requires careful planning and monitoring.
First, as the two systems plan their use of treatment in the context of intermediate sanctions, there must be broad-based agreement on the goals of the program or programs.
As pointed out in Chapter 1, the criminal justice system seeks many philosophical and systemic goals and values from sanctions.
These must be stated clearly and explicitly, and relevant parties from both systems must acknowledge and agree to them.
For example, if incapacitation is desired, then security will be an issue; if reducing jail and prison commitments is important, then only certain types of offenders should be allowed into the program.
Second, the target population -- those for whom the intermediate sanctions program is intended -- must be carefully defined.
That definition will include criteria based on a combination of current offense, criminal history, personal characteristics, and treatment needs.
For adequate planning, the number of individuals in the overall offender population (in jail, in prison, and on probation and parole) who meet these criteria must be determined.
Finally, it is essential to monitor intermediate sanction programs regularly to assess how closely the actual population looks like the targeted population and to evaluate how well the programs' stated goals and objectives are being met.
The monitoring will also assist the jurisdiction in looking at the impact of a program on criminal justice resources, treatment resources, and target populations.
In addition to these safeguards to avoid net widening, criminal justice policymakers would be well advised to make training available to probation and parole officers, pretrial agencies, and court assessment personnel on the criteria for intermediate sanctions, on the appropriate use of AOD abuse treatment, and on the identification of voluntary treatment resources for offenders who do not meet the criteria.
Concern about net-widening must be balanced by concern for the treatment needs of those who do not fit the criteria for intermediate sanctions.
The criminal justice system has an obligation to act as an advocate for increased availability of treatment resources in the community to which those offenders could be referred.
Net-tightening refers to the imposing of more restrictive or intrusive sanctions on AOD-abusing offenders because they are AOD abusing.
It reflects the intense desire by some criminal justice decisionmakers and practitioners to help people via the sanctioning process by intervening in major ways in their lives.
Their approach might be summed up by the statements, "If a little is good, a lot is better." and "We've got him, so let's cure him."
The impulse to overload an offender with conditions or requirements or to overintrude in his or her life -- relative to the seriousness of the offense or the risk of harm represented -- arises in many kinds of cases and with many types of offenders.
With offenders who evidence AOD abuse, however, the impulse is particularly strong, often encouraged by treatment providers who are convinced of their own ability to offer real help to the offender.
Offender-clients in treatment are at high risk of relapsing and reoffending.
Treatment is difficult enough for high-functioning clients; offender-clients are struggling with many other issues while they try to achieve recovery.
Their ability to benefit from treatment and to be successful in their first round of treatment is limited.
The need for criminal justice decisionmakers and practitioners to be educated about and aware of the stages of recovery and the likelihood of relapse has been addressed above.
However, they also need to understand that without adequate support for the other, collateral issues and needs in offender-clients' lives, offender-clients are almost certain to fail.
If such failure does occur, subsequent opportunities for treatment should be provided.
Unfortunately, the criminal justice system too often takes the attitude that the offender has already had his or her chance, has already been offered a valuable opportunity, and has bungled it.
To some that means the opportunity should not be offered again.
This outcome is particularly likely with intermediate sanctions offenders, who may be perceived by judges, prosecutors, or probation officers as having been given a double opportunity because they might otherwise have gone to prison.
Unfortunately, the criminal justice system too often takes the attitude that the offender has already had his or her chances, has already been offered a valuable opportunity, and has bungled it.
The criminal justice system has a responsibility to make sure that the offender-client is provided with needed ancillary services, by both the treatment provider and the supervising corrections agency, and to understand that the offender may need several attempts at treatment to achieve recovery. (It is always helpful at this point to realize how many times we or someone close to us has tried to stop smoking before finally succeeding.)
In any collaboration between the criminal justice system and treatment providers, both the program and the offender need to be accountable.
On the one hand, offender-clients represent some risk to the safety of the community if they do not cooperate with treatment and are not appropriately supervised.
Treatment programs provide a much-needed service, but they generally also receive scarce public or charitable dollars to do so.
Program accountability begins with the program's providing a definition of success for its services and a reasonable expectation of how much success it will achieve; defining which services will be delivered, to whom, and how often; and setting the cost.
The treatment providers and criminal justice policymakers should then negotiate around these factors, creating mutually agreed-upon outcome measures, services, and costs and putting in place the means for monitoring them.
Like the agreement both systems enter into with the offender-client, this agreement should also spell out how the two systems will handle the provider's failure to meet the agreed-upon terms.
Licensing programs is one method of providing oversight of service standards.
External, objective evaluators are another tool for monitoring treatment programs.
However, any evaluation efforts will be limited if the programs are not required to keep aggregate data on services, completion rates, and outcomes and to provide these to the criminal justice system or to some third party.
In many jurisdictions, this kind of agreement on accountability will be difficult if not impossible: Treatment services are in short supply, and they constitute, so to speak, a seller's market.
In these jurisdictions, the criminal justice system has a hard time securing any services for its clients.
In still other jurisdictions, a central agency controls the allocation of treatment resources, and that agency may not have any interest in helping criminal justice agencies address concerns about accountability.
If treatment programs are made accountable for offender-client outcome, this may have the unintended effect of making treatment programs limit the types of offender-clients they are willing to take.
Whether that is a problem or not, it is important to have a range of treatment services available in a jurisdiction so that there are programs specifically intended for the more difficult cases, with the accompanying lower expectations for success.
It would be optimal for treatment modalities to be available that meet a range of client needs, value systems, and cultural and psychosocial realities.
Like net widening, this ethical issue is concerned with the problem of trying to match treatment needs with a sanction having a duration and intensity appropriate to the offense and the desired amount of security.
Although this document has already described this matching problem as a barrier to client engagement in treatment, it is also a significant ethical dilemma.
The ethical concerns arise in a number of possible scenarios:
First, a jurisdiction has a very limited array of treatment options available (or available to offender-clients).
This situation occurs frequently in small, rural, or economically depressed communities; either the population or the resources are insufficient to support more varied treatment modalities.
In this case, it is difficult to make the best match of client and treatment needs, and certainly very difficult to match treatment needs and appropriate sanctions.
Second, the court orders a sanction based solely on the offender's assessed treatment needs, without taking into account whether the length and intensity of the sanction is appropriate to the offense.
Third, the court orders a sanction that includes treatment but that is based exclusively on criminal justice goals: punishment, security, or deterrence.
Any one of these situations can result in inappropriate treatment programming, a waste of resources, and an increased likelihood of failure, both in the program and in the offender-client's meeting the conditions of the sanction.
As discussed earlier, inappropriate matching can be in either direction: too little treatment or too much.
With careful planning and a willingness to invest resources, it is possible for the two systems in collaboration to take steps to avoid these problems.
First, the court must put in place a system for conducting an initial screening of offenders that identifies both a potential need for AOD treatment and eligibility for intermediate sanctions.
Second, the court should order an AOD assessment conducted by a trained professional with an accompanying treatment recommendation.
Third, the case should be assessed for the level of punishment, incapacitation, deterrence, or rehabilitation that is required, desired, or deemed appropriate; this can be done using sentencing guidelines, local intermediate sanctions policies or guidelines, a presentence investigation and recommendation by a probation officer, or by the judge's own usual practice.
Fourth, the two recommendations should be integrated, making the best match of treatment and sanction elements.
When very few treatment options are available, the two systems should work together to expand them.
For example, if there is no intensive outpatient treatment available, the criminal justice system might create a day reporting center for offender supervision to which the treatment system might assign counselors to offer treatment and consultation on the creation of other suitable activities.
If the court desires more security for some offenders than a day reporting center can provide, corrections agencies may offer a home confinement option (with or without electronic monitoring) in conjunction with the day center for the time that those offenders are not at the center.
The center can be used in the evening for offenders who require even less intensive treatment (as well as for self-help group meetings) or for those who have steady employment.
In addition to matching offender-clients to the right type of treatment, the sanction needs to match the length of treatment that is required.
For instance, offender-clients can begin with the same treatment services, but there should be flexibility so that those who do well or who do not need extended treatment are not trapped in a court-mandated period of treatment.
Some of these lengths of treatment have become almost standard: The offender is ordered into a certain number of months of treatment (or AA or NA meetings) for a particular kind or level of offense.
Courts should focus on building in success or exit points for offender-clients.
The case can be scheduled on the calendar for periodic review.
If programs are created with care and imagination, and screening and assessment mechanisms are put in place, it is possible to avoid over- or underprogramming.
Providing appropriate treatment and collateral services to particular sociocultural groups and women presents several ethical issues.
While appropriate and culturally sensitive services are always desirable, they are particularly important when treatment is mandated by the court, and treatment failure can have severe repercussions for the individuals involved.
While appropriate and culturally sensitive services are always desirable, they are particularly important when treatment is mandated by the court, and treatment failure can have severe repercussions for the individuals involved.
A major issue in regard to female offender-clients is ensuring that the intermediate sanctions process does not impose restrictions or requirements on them because they are women and mothers rather than because of the offense they committed.
Such requirements often take the form of restrictions related to the woman's pregnancy or requirements that relate to her parenting responsibilities -- even when these have no connection to her offense.
The continuing custody of her own children (or their future custody) may be used as further coercion.
What "works" in treatment for women is often different from what works for men.
Women typically have problems with self-esteem, assertiveness, and the ability to express anger.
They may have experienced persistent and severe physical or sexual abuse at the hands of parents, partners, or relatives.
These issues may require programs to adjust treatment to make it more appropriate for women's empowerment and, therefore, their recovery.
The most pressing problem for women in treatment, however, is child care.
Programs that offer child care -- or even more rarely, that permit children to live with their parents in inpatient treatment -- are usually full.
It is almost impossible for women offender-clients to focus on and attend treatment consistently if they cannot arrange care for their children.
Communities establishing collaborative programs need to assess the feasibility of providing child care services for offender-clients with children.
The costs of such services probably do not approach those of putting the children in foster care, or of revoking the woman to jail or prison.
Certain modalities of treatment will not fit the values of some offender-clients whether for cultural or individual reasons.
Self-help, biopsychosocial, and 12-step approaches may not be consistent with offender-clients' value systems and can therefore contribute to dropout.
Treatment programs should offer different or more eclectic approaches to match offender-client values.
Although matching clients and treatment modalities is in an early stage of development, it is always worthwhile to attempt to provide services consistent with the specific needs of an individual.
Effective programs should be prepared to deal with the language barriers that can impede treatment.
Appendix C provides information about cultural competence, including definitions of stages along the continuum of competence and a checklist for assessing cultural competence.
Many States and the Federal Government have legislated mandatory minimum terms of incarceration for drug offenses, including minor ones.
In those jurisdictions, the discretion of the court has been severely limited with respect to considering intermediate sanctions in drug cases, and the only option that may be open to the judge is to sentence the individual to prison.
If the prosecutor in a given jurisdiction is willing to consider intermediate sanctions in such cases, it is possible to negotiate around this legal barrier.
In some local courts, prosecutors have been willing to dismiss cases or to modify the charge (to move the case out of the mandatory category) if treatment requirements are successfully completed during an agreed-upon period.
There are doubtless other ways to work around legislated prohibitions in these cases if key decisionmakers in the jurisdiction, particularly the prosecutor, are willing to do so.
Little if any outcome data exist on the effectiveness of many of the intermediate sanction options described above in meeting specified objectives for particular subgroups of the offender population.
The lack of outcome data is complicated by the absence in many jurisdictions of objective data about the offender population.
This combination raises the possibility of sanctions being used for the wrong offender subgroup, which may jeopardize public safety and result in ineffective treatment of offender-clients.
These outcomes place all efforts to implement intermediate sanctions at risk.
The public's attitude toward the development of intermediate sanctions programs in a community is critical.
Not only can community opposition hinder the siting of a particular treatment center or facility in an area, it can also affect the willingness of judges and prosecutors to use such intermediate sanctions as sentencing options and of legislators to fund their initial development and ongoing costs.
For intermediate sanctions programs to work, there must be citizen education about the nature of crime in the community and the costs and benefits of various sentencing options and increased collaboration between the justice system, treatment personnel, and the larger community.
Citizens who are well informed about intermediate sanctions programs can provide helpful input about their design and location within the community.
Most intermediate sanctions programs require new funds for start-up and operations.
These costs usually are in addition to those of prison, jail, probation, and other existing options.
Many State and county governments have difficulty finding the necessary funds, especially when other public services may have to be reduced or eliminated to cover these new costs.
A public that has been well informed about the costs and benefits of various sentencing options can be a powerful ally at such times.
The absence of sufficient funding and resources can itself undermine this search for community support.
In the absence of multiple programs, and with only the fixed resources of an existing program, local decisionmakers may overuse the program (sometimes referred to as "loving the program to death.") Stretching this resource in such a manner can dilute treatment to the point that it fails to be effective and can reduce the credibility of the treatment process.
The difficulty in funding intermediate sanctions programs mirrors the larger problem in many communities where continued unemployment, the absence of training opportunities, and inadequate housing and health care make it more difficult for offender-clients to succeed in the community.
The very large caseloads that probation officers carry make it difficult for them to serve as brokers for any available services.
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