TIP 44: Adults in the Criminal Justice System Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
May 07, 2015
Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
TIP 44: Adults in the Criminal Justice System
Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC
Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
Screening and Assessment
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Screening
Purpose◦Screen out offenders who do not need treatment ◦Assess the extent of offenders’ treatment needs ◦Gather information for wrap-around referrals◦Determine eligibility and suitability
Information sources◦Booking records◦Interview◦Instruments◦Correctional records/presentence investigations◦Past treatment records◦Police reports◦Drug Tests
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Screening Areas of Concern
Accuracy of information Continuity and system-wide sharing of
information The importance of re-screening and re-assessing Timing of screening and assessment Drug testing Detoxification needs Readiness for treatment History of trauma PsychopathyRisk for violenceRecidivism
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Diagnosis Pitfalls
StigmaInaccuracy due to withdrawalSA diagnosis may preclude from MH
treatmentSA diagnosis may limit offenders access to
work assignments or vocational training/rehab
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Reasons for Diagnosis
ReimbursementTo support pharmacological interventionsWhen psychiatric concerns emergeClarification of co-occurring disordersResearch/evaluation
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De-stigmatizing Diagnosis
Explain that diagnosis is just short handReview presenting issues and discuss
differential diagnosisNormalize diagnoses
◦Google “Famous people with…”Do an “All About Me” worksheet
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Screening Instruments
Instruments with adequate reliability and validity with incarcerated populations
Reproduced in appendix C of TIP 44◦Addiction Severity Index–Alcohol Use subscale (ASI-
Alcohol)◦ ASI–Drug Use subscale (ASI-Drug)◦Drug Abuse Screening Test (DAST-20) ◦Michigan Alcoholism Screening Test (MAST)
Simple Screening Instrument for Substance Abuse (SSI-SA)—Reproduced in TIP 42 (CSAT 2005)
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Assessment Instruments: ASI
Addictions Severity Index◦reproduced in TIP 38, Integrating (CSAT 2000)◦structured interview format (75 minutes)◦examines the following areas of functioning:
Drug/alcohol use Relationships Employment Legal involvement Physical health Mental health
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Assessment Areas
SA◦Substance use history ◦Motivation◦Severity and frequency of use ◦Detoxification needs◦Treatment history
Criminal Involvement◦Criminal thinking ◦Current and prior offense(s) types and numbers◦Prior successful completion of probation for drug
use offenses ◦Prior involvement in diversionary programs ◦History of diagnosis of any personality disorder
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Assessment Areas cont…
Health◦Intoxication◦Infectious disease◦Pregnancy ◦General health ◦Acute conditions
MH◦Suicidality◦MH diagnosis and treatment history◦Acute symptoms◦Current medications
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Assessment Areas cont…
Special Considerations◦Educational level ◦Reading level/literacy ◦Language/cultural barriers ◦Physical disability ◦Developmental disability ◦Learning/cognitive disability ◦Housing ◦Dependants/family issues ◦History of abuse (victim or perp)
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Triage and Placement
Continuum of services◦Pretreatment (Detoxification)◦Outpatient◦Inpatient
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Triage and Placement cont…
Key staff preparations ◦Develop a treatment resource database◦Define eligibility and suitability for each
program◦Document referral process to each program◦MOU including
information to be shared supervision and treatment responsibilities of each
party evaluate effectiveness of offender matching
(ongoing)
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Placement Strategies
Target offenders with moderate to high risk of recidivism◦Criminal history◦Poor employment history◦Poor support environment◦Homelessness◦Antisocial traits (impulsivity, lack empathy,
anger issues, entitlement)
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Placement Strategies cont…
Moderate to severe substance abuse problems◦Substance dependence◦SA related arrests◦History of SA with or without treatment◦Positive drug tests
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Placement Strategies cont…
Moderate to severe mental health issues◦Suicidal or violent behaviors◦Acute symptoms◦Cognitive impairment (concentration, problem
solving) ◦Social impairment (interpersonal skills,
frustration tolerance
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Offender characteristics
Perceived severity of problems (Readiness for change)
Motivation (SOCRATES*, TIP 35)Prior evidence of attempts to improvePerceived importance of treatment
*Stages of Change, Readiness, and Treatment Eagerness Scale
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Implementing Treatment
Offender involvement in treatment planning
Motivational interviewingCoordination with “team”Plan updates at status changesCommunity based linkages at re-entry
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Implementing Treatment cont…
Outreach and low-intensity interventions◦Provided to all offenders
Entrance As part of daily activities (webcast via TV) Exit/Re-entry
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General CJ Treatment Issues
Components of criminality◦Criminal thinking◦Criminal code (inmate value system)◦Manipulation
Criminal Thinking◦Learned behavior◦Help offenders recognize thinking errors and
understand how they can lead to behavior ◦CBT and Staff/Peer confrontation
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General CJ Treatment Issues cont…
Criminal Code◦Refusal to cooperate with authority◦Refusal to confront negative behavior ◦Participation in treatment viewed as weakness◦“Snitch syndrome”
Manipulation◦Throwing focus◦Team splitting◦Demeaning others (Power plays)
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General CJ Treatment Issues cont…
Addressing manipulation◦ Identifying the primary thinking errors
observed ◦Instructing the client to begin self-monitoring
when these occur (journaling)◦Providing regular feedback to the client, usually
from peers in a treatment group
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General CJ Treatment Issues cont…
Excuse making Blaming Justifying Throwing focus“I think; therefore it is,” permits function
according to what he wants, rather than according to the facts
Lying: commission/omissionMaking Fools Of : pulling the woolBuild-up: focus on positives and bring down others
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General CJ Treatment Issues cont…
Assuming I'm unique / It doesn’t apply to me Ingratiating : phony manipulation Fragmented Personality Behaviors are inconsistent Minimizing / Exaggerating Vagueness / Non-committal Anger Power plays Victim playing Closed channel : unreceptive, undisclosing Ownership / lack of awareness of other’s boundaries Image cowboy or victim
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Addressing Anger and Hostility
Identifying the feeling(s)—other feelings may be involved, such as embarrassment or guilt
Understanding clearly where the feeling is coming from
Identifying the goals the anger is serving (e.g., deflecting attention)
Identifying the goals the anger is undermining (e.g., staying out of jail or keeping a job)
Working toward taking the longer view (e.g., beginning to use a positive/pro-social thought process to manage the anger)
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Barriers to Effective Treatment
Assessment: inaccurate placementsPoor staff trainingStaff transitionOverreliance on institutional sanctions
instead of letting peers pressure for internal controls
Aftercare availability and complianceCoercionTreatment competes with other facility
opportunities
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Sentencing Alternatives
Pretrial Diversion◦Supervision in lieu of detention◦Treatment in lieu of prosecution
Maintain a client’s confidentialityAvoid discussing the client’s criminal casethe client is presumed innocent before trialBe realistic about the responsibilities that a
client is capable of handlingAvoid allowing individuals to be inadvertently
penalized for enrolling in treatmentBe aware that clients may be more focused on
“beating the case” than on recovery
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Drug Courts
10 Components1. Drug courts integrate alcohol and drug treatment
services with justice system case processing. 2. Using a non-adversarial approach, prosecution
and defense counsel promote public safety while protecting participants’ due process.
3. Eligible participants are identified early and promptly placed in the drug court program.
4. Drug courts provide access to a continuum of co-occurring disorders treatment.
5. Abstinence is monitored by drug testing.
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Drug Courts cont…
6. A coordinated strategy governs drug court responses to participants’ compliance.
7. Ongoing judicial interaction with each drug court participant is essential.
8. Monitoring and evaluating achievement of program goals is necessary to gauge effectiveness.
9. Continuing interdisciplinary education promotes effective drug court planning, implementation, and operations.
10.Forging partnerships among drug courts, public agencies and community-based organizations generates local support and enhances drug court program effectiveness.
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Treatment Accountability for Safer Communities (TASC)
TASC programs provide a bridge between treatment providers and the CJ system
Provide a range of services◦Screening and assessment◦Referral to community-based services◦Monitoring of treatment ◦Case management◦Court liaison
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Interventions
Brief (TIP 34)Motivational (TIP 35)Behavior contactsPhased treatmentSubstance abuse educationDetoxificationDay reportingDrug testing
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Interventions cont…
Criminal thinking assessment and treatment (video feedback)
Coping skills trainingRelapse prevention toolsStrengths buildingCommunication skills enhancement
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Wrap Around Services
Vocational ◦Job readiness assessment and preparation ◦Liaison with employer
Literacy assessment and referral Anger management training HIV education/testing/counselingAssistance in accessing public assistanceSelf-help programs
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Treatment Issues in Jails
Most treatment is involuntaryScheduling constraints: treatment or…
something elseGang affiliationConfidentialityTraumaHopelessness (esp. prisons)
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Special Issues: Community Supervision
Therapeutic communityIntensive outpatientHalf-way housesDay reporting
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Special Issues: Women
Mental health issuesAbuse historyHIV positivePoorer employment historiesChild custody issuesLower educational level
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Special Population: Elderly
Many have spent most of their life in and out of “the system”
Prison rules and mores are the normDevelopmental milestones (marriage, raising
children, career, education, etc.) are absent leading to disculturation
Engage them by having them help othersSpecial Issues
◦ Increased health problems◦Slow response to directions◦Physical issues presenting as MH◦Lack of assertiveness allowing them to slip through
the cracks
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Summary
Persons in the CJ system have a unique set of learned behaviors
Consider the drawbacks as well as the benefits to giving up criminality
Work with the clientSet and consistently enforce clear boundaries and
rulesIdentify biopsychosocial issues and their influence
on treatment and recoveryEnsure clients have a seamless transition into the
community