Transcript A National Portrait of Treatment in the CJS

Correctional Policy: Preparing for EBPs
Faye S. Taxman, Ph.D.
University Professor
George Mason University
Advancing Correctional Excellence!
http://gunston.gmu.edu/cebcp/
[email protected]
Acknowledgements: NIDA U01 DA 16213; CJ-DATS is funded by
NIDA in collaboration with: SAMHSA, CDC, NIAAA, and BJA;
NIDA R01 DA017729
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Acknowledgements
• Anne Rhodes, M.S., George Mason University
• Carrie Oser, Ph.D., University of Kentucky
• Craig Henderson, Ph.D., Sam Houston
University
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Business leaders, political leaders, military leaders, entrepreneurs all need to learn
and practice the same fundamental rule of thumb: Ask the last question first. And
that is:
What’s the point of this exercise?
If you do not begin a new campaign, enterprise, military engagement or business
with a clear definition of victory, you’ve set yourself for failure. If you don’t know
what success is, how do you know when you’ve achieved it? If you don’t know if
your strategy and tactics will take you there? If you don’t have a clear
understanding of what you hope to achieve, how will you be able to justify the
time, energy, human and financial resources you commit to the effort?
It’s the lesson that the United States learned in the Vietnam War, in which we
managed to win every battle and still left the country having lost the war. The
critical missing element to that ill-conceived war was a lack of clear definition of
victory.
Alan Webber, founder of Fast Company Magazine, Washington Post, Sun Aug 30, 2009.
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What Works for Offenders?
• ASSESSMENT & CASE PLANNING: Use standard tools to
identify problem severity and link to programming
• TREATMENT:
– Treatment that is multi-dimensional, includes criminogenic
risk factors & criminal thinking
– Address co-occurring disorders, criminogenic factors, etc.
– Skill building, recovery models, not traditional
alcohol/educational programs and outpatient programs
– Dosage (length of treatment) is important through stages:
motivate, change, reinforce
• COMPLIANCE MANAGEMENT: Rewards & Incentives
• WORKING ALLIANCE: Rapport, Relationship
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The Quest of EBPs
• Evidence-based practices are specified systems,
programs, and services that are based on
research on facets that reduce criminal behavior
OR reduce drug use
• EBPs are a tool kit that can be used to advance
actual practice, if the goal is to reduce recidivism
• Significant gaps exist between best practices
identified by research and their implementation
in routine care (Institute of Medicine, 2006).
Is the public or correctional agencies ready for
research-based correctional programs?
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Why EBPs are important….
Opponents
Proponents
• Effect sizes (~ 10%) are too
small to have an huge
impact
• Drastic policy change like
length of incarceration or
probation will have a
greater impact
• Goal is to prevent crime,
not reduce recidivism
• Too hard
• Deterrence is more
important
• Politicians do not support
this movement
• EBPs are a formula for
success
• EBPs can help to
professionalize corrections
• Effects are small because..
– NOT MUCH IMPLEMENTATION
– Existing structures serve a
small number—7% daily
population
• Corrections should be part of
the service system to
improve outcomes
• Human rights
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Source of Data
• Criminal Justice Drug Abuse Treatment
Studies (CJ-DATS) research cooperative
(www.cjdats.org)
• National Criminal Justice Treatment Practices
Survey (NCJTPS) is a stratified cluster sample
of prisons, jails, community corrections, and
substance abuse treatment agencies (n=647)
(Taxman et al., 2007).
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National Surveys: Response Rates
Survey administered via mail
Multi-level (state agency executive, facility administrator, staff, tx providers, drug court
coordinators)
No differences in response rates based on region and facility type
• Criminal Justice Treatment Practices
– N = 1,902
– Adult: 67% Administrators, 75% State Executives
– Juveniles: 54% Administrators, 70% State Executives
• COD Survey (only facility administrators of NCJTP)
–
–
–
–
N = 757
Adult: 63% Administrators
Juvenile: 65% Administrators
Community Treatment Providers: 61%
• Drug Treatment Court Survey
– N = 208
– Drug Court Coordinators: 68%
– Treatment Providers: 75% GMU
Taxman, et al 2007; Melnick, et al 2008; Taxman and Perdoni, in press
Research Questions
• What impact does the perspectives of
administrators have on the adoption of
evidence based practices?
• What impact, if any, does the nature of the
reform have on the adoption of evidencebased practices?
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The Challenge: Using EBPs
•
•
Setting
Mean EBPs
Adopted
•
Adult Prison
5.6
•
Adult Jail
3.9
Adult CC
5
Juvenile Res.
5.7
Juvenile CC
4.8
Drug Court
5.6
•
•
•
•
Standardized risk
assessment
Standardized substance
abuse assessment
Addressing co-occurring
disorders
•
•
•
Systems integration
Use of drug testing in
treatment
Use of techniques to
engage and retain clients
in treatment
Treatment duration of 90 • Assessment of treatment
days or longer
outcomes
Comprehensive Services
•
Use of therapeutic
community/CBT
•
Continuing care or
aftercare
•
Use of graduated
sanctions and incentives
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Friedmann, Taxman, & Henderson, 2007: Young, Dembo, & Henderson, 2007; Henderson, Taxman & Young, 2008
Family involvement in
treatment
Availability of qualified
treatment staff
Developmentally
appropriate treatment
% of Respondents Providing EBPs
% of Agencies
• = Treatment directors were not assessed on this item
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^ = Facility administrators were not assessed on this item
~ = Adult program treatment directors/facility administrators not assessed on this item
Cumulative # EBPs Offered
% of
Agencies
# of EBPs
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Competing Values:
Importance of SUD Treatment to other CJ Services
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SA TX Compared to Other Programs
High Believers: More use of EBPs, County run, in Midwest/Northeast,
stronger belief in rehabilitation
Low Believers: South
Equal/Ambivalence: Marginal use of EBPS, Support Rehabilitation, in South/Northeast
Henderson & Taxman, 2009
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What style of reform do CJ Agencies pursue?
Clinical orientation=focus on treatment such as therapies and working
alliance
CJ Innovators=Focus on punishment (sanctions), drug testing, treatment
None=No clear direction, responsive to
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EBP by Type of CJ Innovators
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Correlates of Latent Class Membership
Clinical vs. CJ System Innovators
Correlate
Coefficient
Standard Error
Pseudo Z Value
Institution vs. Community
2.13
1.13
1.89*
Adult vs. Juvenile
-1.02
0.85
-1.20
Rehabilitation Orientation
-0.05
0.51
-0.10
Need for Training
-0.64
0.37
-1.73*
Internal Support for New Programming
<0.01
0.73
<0.01
Size
0.07
0.18
0.37
* p < .05, ** p < .01, *** p < .001
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Correlates of Latent Class Membership
Clinical Innovators vs. Non-Innovators
Correlate
Coefficient
Standard Error
Pseudo Z Value
Institution vs. Community
0.75
0.47
1.59
Adult vs. Juvenile
-0.05
0.34
-0.14
Rehabilitation Orientation
-1.44
0.37
-3.91***
Need for Training
-0.80
0.36
-2.21**
Internal Support for New Programming
-0.76
0.26
-2.93***
Size
-0.01
0.10
-0.13
* p < .05, ** p < .01, *** p < .001
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Correlates of Latent Class Membership
CJ Innovators vs. Non-Innovators
Correlate
Coefficient
Standard Error
Pseudo Z Value
Institution vs. Community
-1.39
0.98
-1.42
Adult vs. Juvenile
-.97
0.83
1.18
Rehabilitation Orientation
-1.39
0.41
-3.41***
Need for Training
-0.16
0.57
-0.29
Internal Support for New Programming
-0.76
0.72
1.06
Size
-0.08
0.20
-0.40
* p < .05, ** p < .01, *** p < .001
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The Importance of Type of Reform Efforts
1.
Agencies pursue different avenues regarding their adoption of
evidence-based practices
2.
Some focus on a more clinical perspective; others reinforce an
offender management (safety) perspective
3.
Criminal Justice Innovators were more likely than Clinical
Innovators to be a community corrections agency
4.
Clinical Innovators perceived a higher need for training than
Criminal Justice Innovators
5.
Relative to the Non-Innovators:
a)
b)
Clinical Innovators had higher rehabilitation orientations, saw a greater need
for training, and had more internal support for new programming
Criminal Justice Innovators also had higher rehabilitation orientations
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What Matters in Adoption of EBPS?
Organizational
Structure and
Leadership
Community Setting
Administrator:
Organizational
Culture and
Climate
Training
Resources
Physical Facilities
Learning
Internal
Support
•Increased Knowledge of
EBPs
Performance
Training
•Supports Rehabilitation
Quality Tx
Resources
•Human Services
Background
Network
Connections
Integration
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Friedmann, Taxman, & Henderson, 2007: Henderson, Taxman & Young, 2008
Factors to Improve Networkness?
Integration or Boundaryless Processes of SA & CJ Agencies
Most Typical Activities:
 Average Number of Activities
Integrated:
• Share Information with
agencies
• Develop Client Eligibility Across
Agencies
 Drug Court=6.1
• Written Program Programs
 Prison=3.2
• Joint Staffing of Program
 Jails=3.7
 Probation/Parole=4.5
• Modified Program to Meet
Correctional and SA Agencies
 Interagency integration is
associated with more use of
EBPs, more holistic services,
and improved outcomes
• Written MOU between agency
Fletcher, et al 2009; Taxman & Perdoni, 2007
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Unlikely to Reduce Recidivism
•
Too few offenders exposed to treatment
2400000
2200000
2000000
1800000
1600000
1400000
1200000
1000000
800000
600000
400000
200000
0
Need based on SUD
# Exposed to Treatment
524,000
398,000
ED
OP
101,000
IOP
50,000
97,000
Drug Court
Res
◄ Less than 11% can receive tx a year; on any given day, ~7.6% are in
treatment
•
Treatment is inconsistent with needs
– Not multi-dimensional—should address 3+ conditions including criminal values/thinking
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End Goal?
• What should be the content of correctional
reform?
– Volatile environment
– Reducing sentence lengths is only a short term and
does NOT clarify the mission
– Punishment vs. Prosocial Behavior
• Where should we go?
–
–
–
–
Therapeutic Alliance
Working Alliance/Relationship
Get political support through mandating legislation
Focus on Administrators as Leaders AS the means to
advance practice
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The Failure to Define the Mission of
Corrections to include EBPs and Service
Orientation Impacts…..
•
•
•
•
•
•
Use of working relationships with other organizations
Emphasis on recidivism reduction practices
Training of staff
Staff Orientation
Types of Administrators hired
Legitimacy of correctional practice
A renewed focus on viewing corrections as a service
provider (public health) will serve better outcomes
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Useful Resources
TIP 44.
Substance
Abuse
Treatment for
Adults in the
Criminal
Justice System
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Special Edition of Drug and Alcohol Dependence
Fletcher, B. W., Lehman, W. E., Wexler, H. K., Melnick, G., Taxman, F. S., & Young, D. W. (2009). Measuring collaboration and integration
activities in criminal justice and substance abuse treatment agencies. Drug and Alcohol Dependence, 103(Supplement 1), S54-S64.
Henderson, C. E., & Taxman, F. S. (2009). Competing values among criminal justice administrators: The importance of substance abuse
treatment. Drug and Alcohol Dependence, 103(Supplement 1), S7-S16.
Henderson, C. E., Young, D. W., Farrell, J., & Taxman, F. S. (2009). Associations among state and local organizational contexts: Use of
evidence-based practices in the criminal justice system. Drug and Alcohol Dependence, 103(Supplement 1), S23-S32.
Lehman, W. E., FLETCHER, B. W., Wexler, H. K., & Melnick, G. (2009). Organizational factors and collaboration and integration activities in
criminal justice and drug abuse treatment agencies. Drug and Alcohol Dependence, 103(Supplement 1), S65-S72.
McCarty, D., & Chandler, R. K. (2009). Understanding the importance of organizational and system variables on addiction treatment
services within criminal justice settings. Drug and Alcohol Dependence, 103(Supplement 1), S91-S93.
Melnick, G., Ulaszek, W. R., Lin, H., & Wexler, H. K. (2009). When goals diverge: Staff consensus and the organizational climate. Drug and
Alcohol Dependence, 103(Supplement 1), S17-S22.
Oser, C. B., Knudsen, H. K., Staton-Tindall, M., Taxman, F., & Leukefeld, C. (2009). Organizational-level correlates of the provision of
detoxification services and medication-based treatments for substance abuse in correctional institutions. Drug and Alcohol Dependence,
103(Supplement 1), S73-S81.
Oser, C., Knudsen, H., Staton-Tindall, M., & Leukefeld, C. (2009). The adoption of wraparound services among substance abuse treatment
organizations serving criminal offenders: The role of a women-specific program. Drug and Alcohol Dependence, 103(Supplement 1), S82S90.
Taxman, F. S., & Kitsantas, P. (2009). Availability and capacity of substance abuse programs in correctional settings: A classification and
regression tree analysis. Drug and Alcohol Dependence, 103(Supplement 1), S43-S53.
Taxman, F. S., Henderson, C. E., & Belenko, S. (2009). Organizational context, systems change, and adopting treatment delivery systems in
the criminal justice system. Drug and Alcohol Dependence, 103(Supplement 1), S1-S6.
Young, D. W., Farrell, J. L., Henderson, C. E., & Taxman, F. S. (2009). Filling service gaps: Providing intensive treatment services for
offenders. Drug and Alcohol Dependence, 103(Supplement 1), S33-S42.
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