Transcript Slide 1

Client Profiles in the Offender Reentry Program (ORP) and the Need to
Address the Twin Issues of
Trauma and Crime
Michael Dennis, Ph.D. and Vinetha Belur, Ph.D.
Chestnut Health Systems, Normal, IL
Presentation at the Community Corrections
and Offender Reentry Program Grantee
Meeting, May 3, 2011, Denver Colorado
Acknowledgement and
Contact Information
• Data from SAMHSA/CSAT 2004–2009 Young Offender Reentry Program (TI16904, TI16915, TI16928, TI16939,
TI16961, TI16984, TI16992, TI17046, TI17070, TI17071) and
2009-2013 Offender Re-entry Program (TI21580, TI21585,
TI21595, TI21597, TI21624, TI21632, TI21639, TI21682,
TI21688, TI21705, TI21714, TI21748, TI21774, TI21788,
TI21815, TI21948)
• Opinions are those of the author and not official positions
of the Government
• Available from http://www.chestnut.org/li/posters
• Please direct comments to Michael Dennis, Chestnut
Health Systems, 448 Wylie Drive, Normal, IL 61761,
(309) 451-7801, [email protected].
Goals
• To give a profile of the clients seen in
SAMHSA/CSAT’s Offender Re-entry Program (ORP)
and how needs, treatment and outcomes vary
by age
• Examine the high rate of victimization and
demonstrate how it is related to co-occurring
mental health issues, criminal activity and other
presenting problems
Demographics
Adults more likely than
other ages to be female
and White
13%
12%
Female
43%
22%
19%
16%
African American
20%
21%
White
<18 (N=1,734)
50%
40%
44%
Hispanic
21%
16%
14%
11%
Mixed
Other
3%
2%
2%
0%
18-25 (N=811)
26+ (N=421)
Adolescents & Young
Adults more likely to be
Hispanic and Mixed
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Grantee Location & Age of Clients
Years of Use
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
98%
Less than 1
1-2 years
3-4 years
5 or more years
77%
27%
<18
18-25
(N=1,734) (N=811)
26+
(N=421)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Adults (OR=132.5) and
young adults (OR=9.1)
more likely than youth
to have 5 or more
years of use
Weekly Pre-Controlled Environment
Alcohol/Drug Use By Age
71%
74%
72%
Any Drug
57%
Marijuana
Heroin
Other Drug
0%
55%
22%
31%
Alcohol
Crack/Cocaine
Adolescents and
Young adults
more likely to
use marijuana
<18 (N=1,734)
41%
39%
18-25 (N=811)
6%
11%
4%
9%
17%
26+ (N=421)
18%
6%
6%
11%
10%
20%
30%
40%
50%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
60%
70%
80%
90% 100%
Substance Use Severity
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Use
Abuse
Dependence
91%
59%
66%
<18
18-25
(N=1,734) (N=811)
26+
(N=421)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Adults (OR=9.7) and
young adults (OR=1.9)
more likely than
adolescents to have
dependence
Any Violence or Illegal Activity
Any Interpersonal/ Violent Crime
Lifetime Juvenile Justice Involvement
100%
72%
57%
Any Illegal Activity
Other Drug Related Crimes*
90%
80%
Physical Violence
Any Property Crimes
80%
70%
60%
50%
40%
30%
20%
10%
0%
Past-Year Violence & Crime
42%
40%
41%
100%
Current Juvenile Justice involvement
95%
1+/90 days In Controlled Environment
90%
*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
9
Type of Crime by Severity Group
100%
Drug Use
only
90%
80%
Other
Crime*
70%
60%
Odds ratio
50%
(OR) for
Youth (15.6)
40%
and young
30%
adults (3.0)
higher than
20%
adults
10%
Violent
Crime
*Other crime
includes vandalism,
possession of stolen
goods, forgery, and
theft.
54%
28%
7%
0%
Under 18
18-25
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
26+
10
Intensity of Justice System Involvement
Past-Year Illegal
Activity/SA Use .1%
Past Arrest/JJ/CJ Status 2%
Other JJ/CJ Status 2.8%
Other Probation,
Parole, or
Detention 16.3%
In Detention/Jail
30+ Days 51.9%
On Probation/
Parole 14+
Days w/1+Drug
Screens 20%
In Detention/ Jail
14-29 Days 6.6%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
11
Intensity of Justice System Involvement
by Severity Group
100%
90%
Past year illegal activity/
drug use
80%
Past arrest/ JJ/ CJ
status
70%
Other JJ/ CJ status
60%
Other prob/ parole/
detention
50%
40%
68%
30%
20%
46%
56%
On prob/ parole 14+
days w/1+ drug screens
In detention/ jail 14-29
days
In detention/ jail 30+
days
10%
0%
Under 18
18-25
26+
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Adults (OR=1.6) and young adults
(OR=1.5) more likely than
adolescents to be coming from
long term detention
12
Co-Occurring Psychiatric Problems
Any Co-Occurring
Psychiatric
56%
Conduct Disorder
33%
Attention Deficit/
Hyperactivity Disorder
33%
Major Depressive
Disorder
31%
Traumatic Stress
Disorder
23%
General Anxiety
Disorder
13%
0%
10%
20%
30%
40%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
50%
60%
70%
80%
90%
100%
Pattern of Co-morbidity
100%
80%
63%
60%
60%
Adolescents
more likely
than adults40%
to
have only
Externalizing
20%
Disorders
(OR=8.4)
44%
0%
<18
18-25
(N=1,734) (N=811)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
26+
(N=421)
Internalizing
only
Externalizing
only
Both
Adults more likely
than adolescents
to have only
Internalizing
Disorders
(OR=4.4)
Other Psychiatric Issues
Ever Physical, Sexual or Emotional
Victimization
74%
High Severity Victimization (GVS > 3)
56%
Ever Homeless or Runaway
Any Homicidal/ Suicidal Thoughts
Any Self Mutilation
44%
13%
8%
Prior Mental Health Treatment
41%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100
%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
GAIN-I Main Scale Problem Profile
0%
Physical Health Conditions
Current Withdrawal
Financial Problem
Environmental Stress
Personal Sources of Stress
Health Problem Symptoms
Internalizing Disorders Sx
Personality Disorders Sx
HIV Risk Behaviors
Externalizing Disorder Sx
Substance Problem Sx
Crime and Violence Sx
Average No. of High/Mod Prob.
20%
40%
60%
80%
100%
High
Moderate
Low
5.38
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Count of GAIN-I Main Scales Problems
Vast majority
Vast majority
By Age Group
endorse 3 or
endorse one or
more problems
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
more problems
None
1 to 2
3 to 6
7 to 13
57%
26%
34%
<18
(N=1,734)
18-25
(N=811)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
26+
(N=421)
Adults more likely
than adolescents
to report 7 or
more problems
(OR=3.7)
Initial Level of Care
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
39%
62%
10%
<18
58%
6%
43%
18-25
26+
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
OP
IOP
LTR
CC-OP
Adults more
likely than
youth to start
in IOP
Treatment System Involvement
0%
20%
40%
60%
80%
94%
<18 (N=1,734)
96%
97% 18-25 (N=811)
Initiation within
2 wk
Engagement for
6+ wks
26+ (N=421)
79%
79%
14%
64%
Continuing Care
3+mons.
Positive System
Outcome 6+
mons.
100%
75%
75%
39%
54%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
89%
Adults more
likely than youth
to be in phased
program and to
have positive 6
month outcome
(retention/
completion)
Amount of Substance Abuse Treatment
(intake to 3 months)
0
5
10
15
20
25
21.8
Days in Any SA
Treatment
14
14.2
<18 (N=1,072)*
18-25 (N=561)*
7.5
Times in SA OP
4.7
26+ (N=235)*
6.4
13
Days in SA IOP
1.2
Adolescents
received more
“days” of
treatment
3.8
Nights in SA
Residential
Days in other SA Tx
Treatment Satisfaction
Scale (mean)
1.4
9.8
4.1
1.2
1.2
0.4
12.1
13
13.4
*At 3m follow-up
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Young Adults
received more
Residential Tx
Range of Substance Abuse Treatment
Content (Intake to 3 months)
0
2
External Services
Received
Treatment
Received Scale
6
8
10
12
<18 (N=1,072)*
4.8
Direct Services
Received
Family Services
Received
4
3.8
3.15
18-25 (N=561)*
1.4
0.75
0.58
26+ (N=235)*
Adolescents
received a
broader range of
Tx Services
4.01
3.0
2.51
10.21
7.59
6.25
*At 3m follow-up
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Mental Health Treatment Received
(intake to 3 months)
0
10
20
30
40
0.5
Days in Mental
0.3
Health w/o Meds
2
18-25 (N=561)*
9.7
Days in Mental
Health Tx w/ Meds
Times in MH OP
<18 (N=1,072)*
5.4
31.9
26+ (N=235)*
0.4
0.3
1.8
Nights in MH 0.1
0
hospital
0.2
Adults received
more mental
health services
9.8
Days on MH Meds
5.6
32
*At 3m follow-up
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Other Environmental Interventions
Across Systems (intake to 3 months)
0
5
10
20
15
25
30
35
18.09
Days of structured activity without
substance use
<18 (N=1,072)*
25.69
16.5
18-25 (N=561)*
5.79
12.73
11.9
Times urine/breath analysis*
26+ (N=235)*
22.33
20.41
Days in a controlled environment
31.6
13.45
6.08
Days incarcerated
20.1
1.79
Days of self-help
6.40
*At 3m follow-up
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
28.2
Adults more
likely to be
reincarcerated
and to get self
help
Percent of Days Abstinent from AOD
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
6m
3m
Intake
<18 years
18-25 years
26+ years
Precontrolled
environment
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Past Month Abstinence
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
<18 years
18-25 years
26+ years
Intake
3m
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
6m
No Past Month Substance Problems
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
<18 years
18-25 years
26+ years
Intake
3m
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
6m
No Days in a Controlled Environment
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
<18 years
18-25 years
26+ years
Intake
3m
6m
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
12m
In Recovery
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
<18 years
18-25 years
26+ years
Intake
3m
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
6m
No Illegal Activity
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
<18 years
18-25 years
26+ years
Intake
3m
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
6m
General Victimization Scale
58.25%
48%
Ever attacked w/ gun, knife, other weapon
Ever hurt by striking/beating
28%
Abused emotionally
10%
Ever forced sex acts against your will/anyone
65%
Age of 1st abuse < 18
45%
39%
Any with more than one person involved
Any several times or for long time
27%
30%
Was person family member/trusted one
Were you afraid for your life/injury
People you told not believe you/help you
Result in oral, vaginal, anal sex
Curently worried someone attack
Currently worried someone beat/hurt
Currently worried someone abuse emotionally
Currently worried someone force sex acts
13%
9%
13%
9%
6%
1%
0%
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Severity of Victimization by Gender
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Low
Moderate
High
70%
56%
53%
Total
Male
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Female
Odds ratio
(OR) of
Females 2.1
times greater
than Males
Severity of Victimization by Race
62%
58%
64%
63%
White
Hispanic
Mixed
Other
Low
Moderate
High
39%
African
American
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
OR of other
races 2.2 to
2.8 times
greater than
African Am.
Severity of Victimization by Age Group
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Low
Moderate
High
76%
50%
<18
(N=1,734)
59%
18-25
(N=811)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
26+
(N=421)
OR higher for
18-25 (1.4)
and adults
(3.2) than
youth
Type of Crime By
Severity of Victimization
100%
Substance
Use Only
Other Crime
80%
60%
Violent Crime
40%
20%
30%
40%
45%
Low
Severity
Moderate
Severity
High
Severity
0%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
High victimization
group more likely
(OR=1.9) to report
violent crime than
low group
Intensity of Justice System Involvement By
Severity of Victimization
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Past year illegal
activity/ drug use
Past arrest/ JJ/ CJ
status
Other JJ/ CJ status
41%
48%
Low
Severity
Moderate
Severity
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
58%
High
Severity
Other prob/ parole/
detention
On prob/ parole 14+
days w/1+ drug screens
In detention/ jail 14-29
days
In detention/ jail 30+
days
Psychiatric Disorders by
Severity of Victimization
60%
Traumatic
Stress
Disorder
(OR=6.8)
40%
40%
23%
26%
7%
13%
General
Anxiety
Disorder
(OR=5.6)
20%
21%
26%
4%
6%
19%
30%
15%
21%
40%
10%
High
41%
Moderate
34%
50%
Low
0%
Major
Depressive
Disorder
(OR=3.9)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Attention
Deficit/
Hyperactivity
(OR=2.5)
Conduct
Disorder
(OR=2.2)
GAIN-I Main Scales Problem Count By
Severity of Victimization
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
1 to 2
3 to 6
7 to 13
45%
11%
Low Severity
(N=763)
25%
Mod Severity
(N=532)
Source: CSAT 2010 YORP and ORP studies only (N = 2,966)
High Severity
(N=1664)
High
victimization
group more
likely (OR=6.6)
to have 7 to 13
problems than
low group
37