Common Practices in Treatment for Drug Using Offenders : Results from the National Criminal Justice Treatment Practices Survey Faye S. Taxman, Ph.D. [email protected].

Common Practices in Treatment for Common Practices in Treatment for

Drug Using OffendersDrug Using Offenders: : Results from the National Criminal Justice Treatment Practices Survey Results from the National Criminal Justice Treatment Practices Survey

Faye S. Taxman, [email protected]

CJ-DATS Partners (www.cjdats.org)

• National Institute on Drug National Institute on Drug AbuseAbuse

• Virginia Commonwealth Virginia Commonwealth University/University of University/University of Maryland, College ParkMaryland, College Park

• Lifespan University/Brown Lifespan University/Brown University University

• National Development & National Development & Research Institutes, Inc., Research Institutes, Inc., Center for the Integration of Center for the Integration of Research to Practice & Research to Practice & Center for Therapeutic Center for Therapeutic Community Research Community Research

• University of DelawareUniversity of Delaware• Connecticut Department of Connecticut Department of

MH & Addiction ServicesMH & Addiction Services• University of Kentucky University of Kentucky • University of California, Los University of California, Los

AngelesAngeles• University of MiamiUniversity of Miami• Texas Christian UniversityTexas Christian University

• American Correctional American Correctional Association Association

• American Probation and American Probation and Parole Association Parole Association

• American Jail Association American Jail Association • Justice Research and Justice Research and

Statistics AssociationStatistics Association• National Criminal Justice National Criminal Justice

AssociationAssociation• National Drug Court National Drug Court

Professional Professional Association/National Drug Association/National Drug Court InstituteCourt Institute

• Treatment Accountability Treatment Accountability for Safer Communitiesfor Safer Communities

• Council of Juvenile Council of Juvenile Corrections AdministratorsCorrections Administrators

• National Association of National Association of State Drug and Alcohol State Drug and Alcohol DirectorsDirectors

Stakeholder GroupsResearch Partners

Justice-Involved are 4 Times More Likely Justice-Involved are 4 Times More Likely to have a Substance Use Disorder than the to have a Substance Use Disorder than the

General PopulationGeneral Population

21

11

9.3

9.4

8.5

4.5

37.2

34

American Indian

Pacific Islander

Hispanic

Caucasin

African American

Asian

Probationers

Parolees

In 2005, an estimated 22.2 million persons aged 12 or older were classified with substance dependence or abuse in the past year. National Household Survey on Drug Use and Health, 2005.

Severity of Substance Abuse Disorders Severity of Substance Abuse Disorders Among Offender PopulationsAmong Offender Populations

0

10

20

30

40

50

60

70

80

90

100

Adult Males Adult Females Juveniles

Dependent Abusers Users No Use

• 70-80% offenders 70-80% offenders have a substance have a substance abuse disorderabuse disorder

• Adults--31% Male, Adults--31% Male, 50% Female need 50% Female need intensive servicesintensive services

• Juveniles—50% Juveniles—50% need servicesneed services

• Limited, single Limited, single studies on SUD for studies on SUD for juvenilesjuveniles

• Limited, aged Limited, aged studies on SUD for studies on SUD for adultsadults

What substance abuse treatment services What substance abuse treatment services and correctional programs exist?and correctional programs exist?

How easy is it for offenders to access How easy is it for offenders to access substance abuse treatment services and substance abuse treatment services and other correctional programs?other correctional programs?

Are the programs or treatment structured Are the programs or treatment structured to reduce drug use? Recidivism? to reduce drug use? Recidivism?

Are the treatment services integrated Are the treatment services integrated with other agencies?with other agencies?

What structural or organizational What structural or organizational barriers impact the quality of programs?barriers impact the quality of programs?

Topics Explored by NCJTP SurveyTopics Explored by NCJTP SurveyFirst National Survey of Correctional Agencies on First National Survey of Correctional Agencies on

Treatment PracticeTreatment Practice

Survey administered via mailSurvey administered via mail Multi-level Multi-level (Head of state agency, facility administrator, staff)(Head of state agency, facility administrator, staff)

Response Rates from Survey Response Rates from Survey

Analyses found that there was no difference in response by geography, size of Analyses found that there was no difference in response by geography, size of jurisdiction/facility, or type of organizationjurisdiction/facility, or type of organization

37

29

67

54

7570

0

10

20

30

40

50

60

70

80

adults juveniles

Staff Administrator Executives

Per

cen

t o

f R

esp

on

den

ts

0123456789

10

Year

In M

illio

ns

Probation Jail Prison Parole Juveniles Adults in Other Status

Estimated Size of the Correctional Population:

8+m Adults & 650K Juveniles

*Bureau of Justice Statistics, 2005 adjustedwith estimates from Taxman, F. S., Young, D. W., Wiersema, B., Rhodes, A., & Mitchell, S (2007). National criminal justice treatment practices survey: Methods and procedures. Journal of Substance Abuse Treatment 32 (3): 225-238.

253,034 juveniles need TX(198,000 males, 54,000 females)

54,496 juveniles

receive SA Tx (21.5%)

5,613,739 adults need TX(4.5M males, 1.1M females)

424,046 adultsreceive SA TX

(7.6%)

5 Practices to Improve Services

• Use an Actuarial Risk Tool to Screen for High Risk Offenders

• Use a Standardized SA Tool to Screen for Severity of Disorder

• Offer SA Programs that are > 90 days

• Offer Intensive Treatment or TC Programs*

• Provide Appointment to Treatment Services in the Community

*Treatment Orientation should be CBT based

Screening “Practices”

0102030405060708090

100

%SA Tool %Risk Tool

Adult Prison Adult Jail Adult CC Juv Resd Juv CC

% A

dm

inis

trato

rs R

ep

ort

ing

Facilit

y U

se

Taxman, Perdoni & Harrison, 2007; Young, Dembo, & Henderson, 2007

Tx Practices in “Practices”

0

1020

3040

50

6070

8090

100

TherapeuticComm

Intensive OP %Referral wAppointment

%Tx 90days+

Adult Prison Adult Jail Adult CC Juv Resd Juv CC

% A

dm

inis

trato

rs R

ep

ort

ing

Facilit

y U

se

Taxman, Perdoni & Harrison, 2007; Young, Dembo, & Henderson, 2007

Juvenile & adult prisons are more likely to report the use of CBT treatments than facilities in community settings

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 to be provided in a third of the juvenile residential and adult prison programs; only 1 in 5 community based programs report use

0%

10%

20%

30%

40%

50%

Drug AlcoholEducation

SA GroupCounseling: up

to 4 hrs/week

SA GroupCounseling: 5-

25 hrs/week

TC-Segregated TC-Non-segregated

Prison ADP Jail ADP Community ADP

% of Adult ADP in SA Treatment Services (Missed Opportunities)

% o

f A

DP

in

SA

Tx

Ser

vic

es

Estimates of Dependency (Belenko & Peugh, 2005): 31.5% Males,

52.3%Females

Health Related Services Reported Available by

Correctional Administrators

% o

f P

rog

ram

s R

ep

ort

ing

U

se 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

HIV/AIDS Testing TB Screening Hepatitis CScreening

Physical HealthServices

0123456789101112131415

Adult-Prisons Adult-CC Juv-Residential Juv Comm Corr

Elements of Evidence-Based Practice (from Meta-Analysis & Expert Consensus Panels)

System Issues Standardized risk assessment Standardized substance abuse

assessment Use Tx matching strategies Family involvement in treatment Systems integration Use of drug testing in treatment Use of graduated sanctions and

incentives Availability of qualified treatment

staff Assessment of treatment outcomes

Clinical Issues Use of therapeutic community/CBT Treatment duration of 90 days or

longer Continuing care or aftercare Use of techniques to engage and

retain clients in treatment Addressing co-occurring disorders Use of role playing in treatment

sessions Small group treatment size (i.e. small

client to counselor ratio)

Created a Score Based on Availability (N/Y)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Risk Assessment Substance AbuseAssessment

Systems Integration

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

% o

f P

rog

ram

s R

ep

ort

ing

E

BP

sPrevalence of EBPs Reported by Correctional Administrators in National CJDATS Survey

5.6 Adult Prison

4.8 Juvenile Community

5.7 Juvenile Residential

4.7 Adult Community

Mean EBP score

Correctional Administrators: Treatment Directors:

Factors* Associated with the Use of EBPs in Adult Factors* Associated with the Use of EBPs in Adult Correctional & SA Treatment ProgramsCorrectional & SA Treatment Programs

All factors listed were statistically significant in multivariate analyses. Factors not impacting use of EBPs: Physical Plant, Staffing, Leadership

• Community based programs• Administrators: - Background in human service - Knowledge about EBP - Belief in rehabilitation• Performance driven culture• Emphasis on training• Emphasis on internal support

• Larger % of correctional population• Administrators - Years in running programs - Belief in importance of SA in community• Accredited program

Friedmann, Taxman, & Henderson, 2007

Therapeutic Community Cognitive Behavioral Therapy

Factors* Associated with the Use of CBT & TC in Factors* Associated with the Use of CBT & TC in Adult Correctional ProgramsAdult Correctional Programs

All factors listed were statistically significant in multivariate analyses.

• Drug Abuse Treatment Facility• Size of the Program (logged)• Believe in Importance of Community Treatment (p<.1)

• Ranking of Staff Influence on Treatment Improvements• Importance of SA in community• Planned Duration is 90-181 Days• Use of written protocols (p<.1)

Grella, et al, 2007

Implications of Research• Differences in Orientation of TX-- Prison (TC) & Community (CBT)• Affects Discontinuity in Tx Approaches in Prison & Community

Cross sectional survey - does not Cross sectional survey - does not examine historical influence of examine historical influence of factors or casual relationshipsfactors or casual relationships

Self-report by administrators on Self-report by administrators on programs/ services and EBPsprograms/ services and EBPs

May be subject to overreporting of May be subject to overreporting of programs/services due to perceived programs/services due to perceived social desirability of certain answerssocial desirability of certain answers

Familiarity with nomenclature may Familiarity with nomenclature may have affected responses to questionshave affected responses to questions

Limitations of the SurveyLimitations of the Survey

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 procedures within

organizations– Adoption is Affected by System Barriers across

agencies– Adoption is Affected by Staff issues—training,

development, skills

• Continue to develop practices to provide for a continuum of care with community and prison-based programs that have similar treatment orientations and philosophies

WWW.CJDATS.ORG

• Taxman, F. S., Young, D. W., & Fletcher, B (editors). The National Criminal Justice Treatment Practices Survey: An overview of the special edition. (Pages 221-223)

• Taxman, F. S., Young, D. W., Wiersema, B., Rhodes, A., & Mitchell, S. National criminal justice treatment practices survey: Methods and procedures. (Pages 225-238)

• Taxman, F. S., Perdoni, M., & Harrison, L. D. Drug treatment services for adult offenders: The state of the state. (Pages 239-254)

• Young, D. W., Dembo, R., & Henderson, C. E. A national survey of substance abuse treatment for juvenile offenders. (Pages 255-266)

• Friedmann, P. D., Taxman, F. S., & Henderson, C. E. Evidence-based treatment practices for drug-involved adults in the criminal justice system. (Pages 267-277)

• Henderson, C. E., Young, D. W., Jainchill, N., Hawke, J., Farkas, S., & Davis, R. M. Adoption of evidence-based drug abuse treatment practices for juvenile offenders. (Pages 279-290)

• Grella, C., Greenwell, L., Prendergast, M., Farabee, D., Hall, E., Cartier, J., & Burdon, W. Organizational characteristics of community and correctional treatment providers. (Pages 291-300)

• Oser, C., Tindall, M. S., & Leukefeld, C. HIV testing in correctional agencies and community treatment programs: The impact of internal organizational structure. (Pages 301-310)

Journal of Substance Abuse TreatmentSpecial NCJTP Issue, April 2007, Volume 32(3)