Transcript PowerPoint Poster

Treatment Needs and Treatment Completion as Predictors of Return-to-Prison
Following Community Treatment for Substance-Abusing Female Offenders
Christine Grella, Ph.D. & Lisa Greenwell, Ph.D.
UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience
Introduction
Participant Characteristics
Mental Health Status
• What are correlates of treatment needs among substance-abusing
women offenders?
• 29% had used prescription meds for psych problems
• Do treatment needs predict completion of community-based
aftercare?
• 32% were classified with mental health problems by CJS
Study Design
• Participants (N = 1,404) were recruited at admission to in-prison
substance abuse treatment in 5 prisons in California from 9/98 – 1/04
• Upon completion of the in-prison program and parole, participants
transferred to community based treatment in the Female Offender
Treatment & Employment Project (FOTEP)
• Participation in prison-based treatment can be mandated; FOTEP
participation is encouraged, but voluntary
FOTEP Treatment
• Residential treatment is provided for 5-15 months in 10 community
programs in 8 counties in California
• 21% had prior suicide attempts
• 44% had a history of physical/sexual abuse
50
Criminal Justice History
• Mean age 1st arrested: 20.1 (SD = 6.7)
40
10
• Mean no. of lifetime arrests: 15.5 (SD = 25)
• Mean no. of terms served in jail/prison: 4.2 (SD = 7.1)
0
Medical
• Mean no. of times incarcerated > 30 days: 6.7 (SD = 9.8)
• Category of most recent offense:
►
Drug related, 57%
40
►
Property, 24%
►
Crimes against persons, 8%
►
Other, 11%
30
• 61% were under influence of AOD when committed last offense
• 61% had volunteered for in-prison treatment
20
18.5
14.9
10
0
Tobacco
Variable
Co-residence with up to two children (< 12 years old)
• Baseline assessment was conducted at admission to in-prison
treatment
• Information on completion of the FOTEP aftercare program was
obtained from treatment providers
White, 38%
• 47% had never been married
• 80% had minor children
• 52% had a HS degree or GED
• 50% were employed prior to incarceration
• 29% had unstable housing prior to incarceration
Substance Use
• Average age 1st drug use: 14.5 (SD = 4)
• 83% were drug dependent (DSM-IV criteria)
• 35% were alcohol dependent (DSM-IV criteria)
• Most frequently used substances:
►
Cocaine/crack, 49%, Amphetamines, 41%, Marijuana, 40%,
Opiates, 21%, Sedatives, 12%
• 20% were injecting daily prior to incarceration
• 77% used tobacco daily
Methods
1Rated
Alcohol
Heroin/
Opiates
Cocaine/
Crack
Marijuana
Amphetamines
need as “considerable” or “extremely” high
Multiple Regression Model Predicting Treatment
Needs (N = 1,404)
Parameter Estimate
Standard Error
-0.03
0.04
Education (years)
-0.15
0.12
Any legal income
-0.45
0.48
African American
-1.80
0.54***
Hispanic
-1.42
0.61*
Stable housing
-1.85
0.52***
Any physical/sexual abuse
3.19
0.56***
Mental health status
1.11
0.52*
Analyses
Alcohol dependence
4.08
0.50***
• Multiple regression model predicting Treatment Needs Index
Drug dependence
4.54
0.64***
Number of incarcerations (lifetime)
0.61
0.34
First arrest < 19 years old
1.02
0.51*
• Logistic regression model predicting FOTEP treatment completion
• Cox regression model predicting return-to-prison within 12 months
after FOTEP discharge
Ethnicity (ref = White)
Mandated to treatment (vs. volunteer)
-1.85
0.49***
Intercept
16.29
2.1***
Adjusted
R2
= 0.188
*p < .05, **p < .01, ***p < .001
Dependent Variables
• Treatment Needs Index:
►
►
Logistic Regression Model Predicting FOTEP Treatment
Completion (N = 1,404)
Variable
Odds Ratio
95% CI
Sum of 13 items rating need for treatment at baseline in each
area (0 = not at all, 4 = extremely)
Treatment needs
1.01
0.99, 1.02
Age (years)
1.01
0.99, 1.03
Education (years)
1.07
1.002, 1.14*
Range: 0-52, Mean = 17.4 (SD = 9.8)
Any legal income
0.94
0.74, 1.20
African American
0.73
0.56, 0.97*
Hispanic
0.73
0.54, 0.99*
Stable housing
1.01
0.78, 1.33
Any physical/sexual abuse
0.90
0.68, 1.20
Mental health status
0.46
0.35, 0.61***
Alcohol dependence
1.05
0.81, 1.35
Drug dependence
1.66
1.18, 2.33**
Number of incarcerations (lifetime)
0.82
0.69, 0.98*
First arrest < 19 years old
0.67
0.51, 0.86**
Mandated to treatment (vs. volunteer)
1.17
0.91, 1.50
• FOTEP treatment completion: 39%
►
Mean (SD) / median days in treatment:
►
Completers = 217 (86) / median = 188
►
Non-completers = 76 (77) / median = 55
• Return to prison within 12 months following FOTEP discharge:
32.7%
Ethnicity (ref = White)
*p < .05, **p < .01, ***p < .001
95% Confidence
Interval
Age (years)
0.98
0.96, 0.99*
Education (years)
0.95
0.90, 0.99*
Any legal income
0.88
0.72, 1.08
African American
1.28
1.02, 1.61*
Hispanic
0.89
0.68, 1.16
Stable housing
1.03
0.83, 1.28
Any physical/sexual abuse
0.89
0.70, 1.12
Mental health status
1.82
1.48, 2.23***
Alcohol dependence
1.08
0.88, 1.34
Drug dependence
1.07
0.81, 1.41
Number of incarcerations (lifetime)
1.26
1.09, 1.44**
First arrest < 19 years old
1.15
0.92, 1.43
Mandated to treatment (vs. volunteer)
0.92
0.75, 1.14
Treatment Needs Index
0.99
0.98, 1.004
Felon (vs. civil addict)
1.18
0.91, 1.55
Property
1.08
0.77, 1.52
Drug
1.02
0.73, 1.43
Other
0.72
0.36, 1.44
Entered FOTEP > 2 days from parole
1.25
1.02, 1.54*
Completed FOTEP
0.31
0.23, 0.40***
Model 2 (df = 20) = 243, p < .0001
*p < .05, **p < .01, ***p < .001
Age (years)
• Data on return-to-prison was obtained from the state
administrative data system
Hazard Ratio
Crime of commitment (ref = violent)
22.1
Measures
►
Needs1
25.6
Trauma-related and mental health services
Hispanic, 24%
Mental
Health
33.6
►
►
Legal
38.0
Parenting skills training and family services
African American, 36%
Work
Substance Use Treatment/Service
►
►
Social
50
Vocational training/job preparation
• Ethnicity:
Family
Variable
Ethnicity (ref = White)
17.0
►
• Average age: 33.8 (SD = 7)
40.9
30
Case management
Demographics/Background
43.2
41.4
38.5
►
Participant Characteristics
Cox Regression Model Predicting Return-to-Prison within
12 Months Following FOTEP Discharge (N = 1,270)
46.7
20
• Core services:
►
Results
Social and Health Treatment/Service Needs1
Research Questions
• Do treatment needs and completion of aftercare predict return-toprison?
Results
Summary of Findings
• Substance-abusing women offenders with co-occurring disorders had
higher treatment needs, were half as likely to complete aftercare, and were
nearly twice as likely to return-to-prison compared with others
• African American & Hispanic women had lower perceived treatment needs,
but were less likely to complete aftercare compared with white women;
African-American women were about 30% more likely to return to prison,
compared with white women
• Individuals who were drug dependent had more treatment needs and were
more likely to complete aftercare, but were no more likely to return to
prison compared with others
• Individuals with earlier and/or greater CJS involvement had more treatment
needs, were less likely to complete treatment, and were more likely to
return to prison
• Individuals who had a history of abuse, who had unstable housing prior to
incarceration, and who volunteered for in-prison treatment had more
treatment needs, but were no more likely to complete treatment or to
return-to-prison
• Treatment needs did not predict treatment completion or return-to-prison
• Completion of aftercare treatment reduced the risk of return-to-prison by
about 70%
Conclusion
Completion of community-based aftercare reduces recidivism for women
offenders, but those with co-occurring disorders and more CJSinvolvement remain at high risk for recidivism
Funded by Contract No. C98.316 with Office of Substance Abuse Programs/
California Department of Corrections & Rehabilitation