Transcript 5.presentation-urda - Association for Criminal Justice Research

UCLA’s Statewide
Evaluation of
Proposition 36
Darren Urada, Ph.D.
UCLA Integrated Substance Abuse Programs
Association for Criminal Justice Research (California)
October 16, 2008
Topics










What is Prop 36?
Show rates
Completion rates
Arrests
Cost
Recommendations for Reducing No-Shows
Employment
Narcotic Replacement Therapy
Incentives & Sanctions
Process Improvement
What is Prop 36?

Passed by California Voters in November 2000

Enacted into law as the Substance Abuse and
Crime Prevention Act (SACPA) of 2000.

If an adult is convicted of a drug offense or
commits a drug related parole violation and
meets other eligibility criteria, the offender is
given the option of receiving supervision with
substance abuse treatment.
Prop 36 Treatment Client
Characteristics






Primary Drug: Meth 57.0%, cocaine/crack 13.1%,
marijuana 12.5%, alcohol 8.2%, opiates 8.0%.
Sex: 73% male
Average age: 34.8
Ethnicity: 43.9% non-Hispanic White, 35.9%
Hispanic, 13.6% African-American.
First time in treatment: 50.4%
Probation: 86.8%, Parole: 13.2%
Prop 36 Offender Pipeline
2006-2007
Referred
Assessed
(Step 1)
(Step 2)
85.6%
48,996
Placed in
Treatment
(Step 3)
Overall Show
Rate:
82.8%
Yes 41,925
No 7,071
Yes 34,702
No 7,223
All categories may include people who “opted out” later
Data Source: SACPA Reporting Information System, adjusted
70.8%
Prop 36 Treatment Clients by Modality
(CADDS), 7/1/05 – 6/30/06
(N = 40,358)
Percent of Prop. 36 treatment clients
100
84.1
80
60
40
20
11.5
2.2
0.9
0.5
0.7
Detox
Residential
< 30 days
Methadone
detox
Methadone
maintenance
0
Outpatient
Drug Free
Residential
> 30 days
Discharge Status by Referral Source
(CADDS admissions 2004-2005)
100%
Percent of clients
80%
60%
40%
32.2%
38.0%
35.0%
Criminal justice nonProp.36
(N = 32,005)
Non-criminal justice
(N = 75,342)
20%
0%
Prop. 36
(N = 31,605)
Note: Requirements may differ - Prop 36 completers spend about 30 days longer in tx.
New Arrests During 42 Months After Offense
Prop 36 Offenders, July 2001 – June 2002
(N =17,519)
Percent of offenders
100
80
61.5
65.1
60
46.9
40
19.6
20
18.5
11.8
6.4
5.9
4.1
0
New drug arrest
Referred but untreated
(N = 6,954)
New property arrest
Entered but did not complete treatment
(N = 7,611)
New violent arrest
Completed treatment
(N = 2,954)
New Arrests During 42 Months After Offense
Prop 36 Year One vs Pre- Prop 36 Comparison Group
Percent of offenders
100
80
55.2
60
48.9
40
20.1
20
14.1
5.6
6.4
0
New drug arrest
Comparison offenders
(N = 42,029)
New property arrest
New violent arrest
Prop. 36 eligible offenders
(N = 40,368)
Crime Trends 2001-2005



Statewide, drug crime arrests rose more in
California than nationally (21% vs 14%).
Statewide, property crime arrests rose more in
California than nationally (6% vs 0%).
Statewide, violent crime arrests dropped more in
California than nationally (12% vs 9%)
Source: FBI Uniform Crime Reports, National Archive of Criminal Justice Data
Cost Analysis by Treatment Status
42 month follow-up
Dollars per offender
$4,000
$2,000
$0
-$2,000
-$4,000
-$6,000
-$8,000
-$10,000
Prison
Jail
Probation
Parole
Arrest
and
Treatment
Health
Total
No treatment
-$4,598
-$2,054
$692
-$226
$1,823
-$403
$729
-$4,037
Some treatment
-$5,694
-$1,749
$736
-$332
$2,799
$1,700
$747
-$1,792
Completed treatment
-$8,425
-$1,723
$727
-$322
$1,161
$2,292
$454
-$5,836
No treatment
Some treatment
Hawken, Longshore, Urada, Fan, & Anglin (2008)
Completed treatment
Cost Analysis:
42 month followup
$3,000
$1,974
$2,000
$1,116
$727
Dollars per offender
$1,000
Prison
Jail
$667
Parole
Total
$0
Probation
-$1,000
-$2,000
-$296
-$1,862
-$3,000
-$4,000
-$4,303
-$5,000
Hawken, Longshore, Urada, Fan, & Anglin (2008)
Arrest and
Conviction
Treatment
Health
-$1,977
Recommendations
Suggestions we hear most often
Funding
Funding
Funding
Funding
Funding
Funding !
“Classic” Recommendations for
Reducing No-Shows




Co-locate assessment units in/near court
Assess in a single visit
Allow walk-in assessments
Incorporate procedures used in drug courts
Employment: Focus Group Ideas
Funding stability
Lower cost suggestions:

“Felon-friendly” job lists

Tap into networks of alumni who can provide job
search assistance, contacts
GED graduation ceremonies

Higher Cost Suggestions:
 Vocational education (regularly, weekly, evenings)

On-site “one-stop shopping” employment services,
professional job counselor
Narcotic Replacement Therapy
 Methadone:
still the “gold standard” to treat
opiate addiction but there is exceptional
resistance
 Trainings
needed, but valid concerns, barriers
exist.
 Suboxone
(Buprenorphine + Naloxone) an
alternative for areas without a methadone clinic.
Sanctions & Incentives

Incentives work and are preferable to sanctions.

Literature: Testing and sanctions programs
implemented with certainty and consistency have
led to reduced drug use, recidivism.


Examples: DC Drug Court Experiment, HOPE
Literature: When sanctions were not delivered
with certainty, the program failed

Example: Maryland’s Break-the-Cycle
Treatment Provider Perceptions – would jail
sanctions improve treatment completion?
80
80%
70
Percent
60
50
40
30
20
10
19%
1%
0
No
Maybe
Yes
Source: UCLA 2007 Proposition 36 Treatment Provider Survey
Process Improvement:
Network for the Improvement of
Addiction Treatment (NIATx)


Designed to help treatment providers improve
their own programs
Goals:




Increase admissions
Reduce waiting times
Reduce no-shows
Increase client continuation in treatment
Key Steps





Conduct a “walk-through” to understand the
processes that facilitate or inhibit treatment goals
from a client’s perspective.
Identify a measurable goal.
Establish a Change Team to select and test changes
to address the problem.
Collect data before, during, after a change to see
whether the change resulted in improvement.
Make adjustments to improve continuously and
sustain changes.
2005-2006 LA County Pilot Project
Change Example
Southern California Alcohol & Drug Programs, Inc.
Normally assessor would call program and whoever
answered phone scheduled intake. Change: When
assessment center called, a Prop. 36 counselor would
talk with the potential client on the phone.
• Counselor introduced self
• Told client about the program
• Asked if client had any specific needs that should be
addressed during treatment
• Motivational interviewing-type strategies used
Tracking Change Results
No-Shows to Assessment
60
57%
Percentage
50
40
33%
30
20
14%
14%
14.4%
11%
10
0
Baseline Mar-06
(Nov 05Jan 06)
Apr-06
May-06
0%
Jun-06
Jul-06
Month of Admission
Average
(Mar-Jul)
Overall Results
No-Shows to Intake/Assessment Appointment
(based on six OP/IOP programs)
40
35
34%
Percentage
30
25
20
15
10
11.2%
7.7%
7.1%
5
6.8%
5.7%
2.4%
0
Baseline Mar-06
Apr-06
May-06 Jun-06
Month of Admission
Jul-06 Average
(MarJul)
For more info
UCLA Prop 36 Reports:
http://www.uclaisap.org/Prop36/html/reports.html
NIATx:
http://www.NIATx.net
Comments / Questions
[email protected]