Transcript Improving Drug Abuse Services in Criminal Justice Settings

What Works in Corrections:
Strategies to Reduce Recidivism
Faye S. Taxman, Ph.D.
George Mason University
[email protected]
10
9
8
7
6
5
4
3
2
1
0
5,613,739
adults need TX
(4.5M males,
1.1M females)
7.6% receive
TX Each day!
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
In Millions
1:28 adults
Insatiable Appetite:
The Ever Expanding Population
8+M Adults, 650K Juveniles
Year
Probation
Jail
Prison
*Bureau of Justice Statistics, 2005 adjusted
with estimates from Taxman, et al, 2007.
Parole
Juveniles
Other Adult
Substance Use Disorders (Percentages)
80
70
70
60
50
44
40
38
40
30
20
10
4.7
2.6
12
9
0
Lifetime
Adult Justice
Adult General
30 Days
Juvenile Justice
Juvenile General
CJ Populations have 4 times the SA Disorders as the
General Population
STDs (Percentages)
• AIDS/HIV: 2% CJ, <1% general
• TB : 25% CJ, <.01% general
• HEP C: 30% CJ, 1.6% general
20
18
16
14
12
10
8
6
4
2
0
16.3
8.9
5.9
2.8
0.5
Chlamydia
Adult Justice
5.2
3.9
0.6
0.1
Gonorrhea
Adult General
Juvenile Justice
0.01
1.3
0.01
Syphillis
Juvenile General
Co-Occurring Disorders and Mental Health
Disorders (Percentages)
90
80
70
80
75
64
60
50
40
51
26.2
30
20
10
0
8.4
6.3
Co-Occurring Disorders
Adult Justice
25
Adult General
MH Disorders
Juvenile Justice
Juvenile General
Type of SA Services Offered
• Few Offenders Can Access Services on Any Given Day
• Majority are Drug-Alcohol Education
– Adult Prison—74%, 8.8% ADP
– Adult Jail—61%, 4.5% ADP
– Adult CC—53.1%, 15.5% ADP
– Juv Res—88%, 30%ADP
– Juv CC—80.2%, 8.2ADP
•
Low Intensity OP (<4Hrs/Week)
• CBT based therapies are reported in 1 in 5 community
based programs for offenders
Taxman, Perdoni, & Harrison, 2007
% of Adult ADP in Substance Abuse
Treatment Services
50%
Estimates of Needs
(Belenko & Peugh,
2005): Dependent:
31.5% Males,
52.3%Females
% of ADP in SA Tx Services
40%
30%
20%
10%
0%
Drug Alcohol
Education
SA Group
Counseling: up
to 4 hrs/week
Prison ADP
Taxman, Perdoni, Harrison, 2007
SA Group
Counseling: 525 hrs/week
Jail ADP
TC-Segregated
Community ADP
TC-Nonsegregated
What Should We Do?
• Evidence-Based Practices
• Policies to Support Adoption of EBPs
• Increase Programming
What Has Been Tried: CJ Interventions?
Results from Meta-Analysis
• Intensive Supervision
• Boot Camps
• Case Management
• Treatment Accountability for Safer Communities (TASC)
• DTAP (Diversion to TX, 12 Month Residential)
• Tx w/ Sanctions (e.g. Break the Cycle, Seamless System,
etc.)
• Drug Treatment Courts
• In-Prison Tx (TC) with Aftercare
Taxman, 1999; MacKenzie, 2006; Aos, et al, 2006
What Has Been Tried: Clinical?
Results from Meta-Analysis
• Education (Psycho-Social)
• Non-Directive Counseling
• Directive Counseling
• Motivational Interviewing
• Moral Reasoning
• 12 Step with Curriculum
• Cognitive Processing
• Cognitive Behavioral (Social Skills, Behavioral
Management, etc.)
• Therapeutic Communities
• Contingency Management/Token Economies
NIDA, 2006
What Does NOT Work (non-Behavioral)*
• Incarceration—70% return; fairly constant
• Fear and other emotional appeals
• Threatening
• Bibliotherapy
• Talking cures
• Self-Help programs
• Vague unstructured programs
• Fostering self-regard (self-esteem)
• “Punishing smarter”
Latessa, 2003
Reduction of Crime and Cost
Aos, et al 2006
What Have We Learned?
• DOES NOT WORK
Boot camps, intensive
supervision & control-interventions do not change behavior
• WORKS
Clinical component or rehabilitation
• MIXED RESULTS
Positive Results IF:
Negative Results IF:
 Target High Risk Offenders

Unfair Procedures or Processes
 Longer duration of TX (>90 days)

Less than 90 days
 Treatment is CBT or TC and
multidimensional

No clinical component

All sanctions
 Address Compliance issues with
immediate responses

Low risk offenders

Target offense, not behaviors
 Rewards to shape behaviors
Procedural Justice
Treat like all others, Fairness
Responsivity
Diagnosis, Address Behavioral Drivers
Behavioral Management
Shape Behavior, Reinforcers,
Contingency Management
Social Learning Models
#1: Procedural Justice: Fairness & Legitimacy

National Research Council, 2005

Reduced rearrests for DV offenders when
arrestees given clear instructions about the reason
for rearrest (Paternoster, Brame, Bachman, Sherman,
1996)

Police misconduct in high disadvantaged areas
increases violence (Kane, 2005)

Police clear instructions increase compliance in
communities (Tyler, et al., 2000, 2003, 2004)

Relevance to Corrections: legal cyncism, distrust, and
milieu influence outcomes from treatment programs
Impact: Perceived Fairness on Outcomes
When Offenders Believe they have a VOICE,
reductions in negative outcomes occur!
Procedural
Justice by PO
Procedural
Justice by TX
Taxman & Thanner, 2004
-.19*
-.44*
Arrest/VOP
Drug Use at
Follow-up
APA Task Force on Empirically Supported
Therapy Relationships*
• Rapport/Relationship with Counselor
Increase Outcomes: 40% outcomes
• Therapeutic alliance: works with client, not
against
• Goal consensus and collaboration: agree
on goals for client
• Empathy: understands client
*Norcross, 2002
#2: Risk, Need, & Responsivity
• Valid Instruments to Identify Risk Factors and
Criminogenic Needs
• Provide Treatment for Offenders that address
Criminogenic Needs
• Match Offenders to Treatment Programs Designed
to Affect Criminogenic Needs
• Basic Principle: High Risk Offenders should be
placed
Failure to Match Offenders to Appropriate
Services Affects Outcomes
% With New Arrest
60%
44%
50%
43%
41%
40%
26%
30%
Mean
31%
20%
10%
0%
Sanction - No Tx
Criminal Offender
Taxman, Reedy, and Ormond (2003)
Sanction + Tx
Addict Offender
Matching Offenders to Appropriate Services
• Use Risk Tools that are Actuarial in Basis
• Use Needs Tools that Focus on Dynamic
criminogenic factors (e.g. peers, antisocial
personality, criminal thinking, etc.) that are
subject to change
• Screen/assess on key issues of criminogenic
needs and dependency issues
– Offense is not a Proxy for Risk
Focus On “Big Six”
Criminogenic Needs:
1)Anti-Social Values
2) Criminal Peers
3) Low Self-Control
4) Dysfunctional Family Ties
5) Substance Abuse
6) Criminal Personality
Eric Shepardson & Lina Bello, Bureau of Governmental Research 2001, www.bgr.umd.edu.
Impact of Programs Based on Number of
Target Criminogenic Needs Addressed
0.35
0.3
Reduction
in
Recidivism
0.25
0.2
0.15
0.1
0.05
0
Increase in
Recidivism
-0.05
<3 Needs
4+ Needs
Adapted from Latessa, 2003. Original Source is Gendreau, P., French, S.A., and A.Taylor (2002). What Works (What Doesn’t Work) Revised 2002. Invited Submission to
the International Community Corrections Association Monograph Series Project
#3 Behavioral Management Approaches
What is a reinforcer? Anything that will be of value to the offender,
and that will motivate production of good behavior. Goods, Services, $
• Shapes Offender Behavior
– Must be salient; valuable to the recipient
– Must be swift and certain
– Must be withheld when desired behavior does not occur
• Withdrawal of aversive conditions
– Foregoing a urine testing
– Decreasing frequency of meetings with PO
% Retained
Retention in Treatment with Positive
Reinforcers
120
100
80
60
40
20
0
2
4
6
weeks
Standard
Petry et al., 2000
Cont Mgt
8
% Positive for Any Illicit Drug
50
40
30
%
20
10
0
Intake
Standard
Petry et al., 2000
Week 4
Week 8
Cont. Mgt.
Re-Arrest Rates From Maryland PCS
•38% Reduction in Odds of Rearrest Rates
Rearrest Rates*
0
*p<.01
Taxman, 2008
10
20
Non-PCS
30
40
PCS
50
Requests for VOP Warrants (Maryland PCS)
•
40% Reduction in Odds of VOP Warrants
Warrant Rates*
0
*p<.05
Taxman, 2008
5
10
15
Non-PCS
20
25
PCS
30
35
Challenges: Limited Knowledge
and Use of Evidence-Based
Practices
Use of EBPS

Mean
No. of
EBP
0
2
Adult Prison
Adult CC
Juv CC
4
6
8
Adult Jail
Juv Res
Ad Drug Court














Use of techniques to engage and retain
clients in treatment
Addressing co-occurring disorders
Treatment duration of 90 days or longer
Assessment of treatment outcomes
Family involvement in treatment
Availability of qualified treatment staff
Comprehensive Services
Developmentally appropriate treatment
Use of therapeutic community/CBT
Standardized risk assessment
Standardized substance abuse assessment
Continuing care or aftercare
Use of graduated sanctions and incentives
Use of drug testing in treatment
Systems integration
Friedmann, Taxman, & Henderson, 2007: Young, Dembo, & Henderson, 2007
Factors* Associated with the Use of EBPs
in Adult Corrections Systems








Community based programs
Administrators:
- Background human service
- Knowledge about EBP
- Belief in rehabilitation
Performance driven culture
Emphasis on training
Emphasis on internal support
 All factors listed were statistically significant in multivariate analyses.
 Factors not impacting use of EBPs: Physical Plant, Staffing, Leadership
Friedmann, Taxman, & Henderson, 2007; Grella,et al, 2007
State of Practice
• Drug Abusing Offenders are Unlikely to Receive Adequate
Treatment Services—too few offenders to have an impact
on behavior/outcomes
• Risk-need-responsivity model is still “under construction”,
but more in place in prison-based TCs
• System needs strategies to make gains in implementation
– Few knowledge barriers, lack of tools
– Adoption is Affected by policies
– Adoption is Affected by failure to connect to sentencing
• Continue to develop practices to provide for a continuum of
care of similar treatment orientations and philosophies
Unintended Consequences:
Our Current Tx & CJS Practices
• With the majority of offenders in need of
services and the minority receiving services no
one can not “feel” the impact of treatment
• The continual failure to provide access
contributes to an offender’s disbelief and
defiance
• Strides in SA treatment do not carry over into
CJS with the same, inappropriate processes
• Motivational Engagement practices need to
incorporated in CJS actions at all points
Steps to Move Ahead
• Adopt Risk and Need Instruments at Sentencing to Define
the Sentence
– Triage: High Risk Offenders Should Be First Priority for
Programming
– Programs need to be CBT, focused on continuum of care
• Advance the use of Programming to ensure that 50% of
the offenders are involved in educational, vocational, and
treatment programming
• Ensure that programming is evidence-based
• Have Correctional Officers/Supervision Staff be part of
the plan by using motivational strategies (change the tone
of corrections)
Tools of the Trade:
A Guide to Incorporating Science into Practice
http://www.nicic.org/Library/020095
WWW.CJDATS.ORG
“The empirical evidence regarding
intermediate sanctions is decisive.
Without a rehabilitative component,
reductions in recidivism are elusive,”
--as noted by criminologist Joan Petersilia