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)