evaluating the implementation & impact of a seamless system of care for substance abusing...
TRANSCRIPT
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 1/57
The author(s) shown below used Federal funds provided by the U.S.Department of Justice and prepared the following final report:
Document Title: Evaluating the Implementation & Impact of a
Seamless System of Care for SubstanceAbusing Offenders: The HIDTA Model
Author(s): Faye S. Taxman Ph.D. ; James M. Byrne Ph.D. ;Meridith H. Thanner M.A.
Document No.: 197046
Date Received: October 28, 2002
Award Number: 96-CE-VX-0017
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 2/57
PROPERTY OFNationalCriminal Justice Reference Service (NCJRS)Box6000Rockville,MD 20849-6000 .S@"--
e
University of Maryland Center for Applied Policy Studies
Bureau of Governmental Research
Evaluating the Implementation & Impact of a Seamless System
of Care for Substance Abusing Offenders- The HIDTA Model
By:
Faye S. Taxman, Ph.D.
James M. Byrne, Ph.D.Meridith H. Thanner, M.A.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 3/57
Table of Contents
Executive Summary ........................................................................ i
Introduction and Overview ................................................................. 1
1. The Link Between Drug Treatment and Offender Control: A
Review of the Research ............................................................2
2. The HIDTA Model ................................................................. 6
a. Continuum of Care ......................................................... 8b. Supervision .................................................................. 10
c. Urinalysis Testing ........................................................... 10
d . Com pliance Measures and G raduated Sanctions ...................... 11
3. The HIDTA Demonstration Project .............................................. 12
4. Data and Method ................................................................... 13
5 . A Profile of HIDTA Participants ................................................. 16
6. Assessing Implementation ......................................................... 18
Area 1: Implementing Continuum of Care .............................. 20
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 4/57
Diagram
Diagram 1 : The HIDTA Model............................................................. 13
Tables
Table 1. Twelve HIDTA Sites and Size .................................................. 14
Table 2. Client Descriptive Statistics ..................................................... 17
Table 3. Characteristics of 1997 HlDT A Sample ...................................... 18
Table 4 . Continuum of Care Models in the HIDT A Sites ............................. 21
Table 5.Treatment Duration & Completion of First Phaseof Treatment ........................................................................ 23
Table 6.Drug Testing Protocols .......................................................... 24
Table 7. Dru g Testing Results for Various Jurisdictions .............................. 25
Table 8. Graduated Sanctions Protocol ................................................... 27
Table 9. Comparison of Actual Rearrest Rate at 6 and 12 Month
Follow-up Period .................................................................. 31
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 5/57
EXECUTIVE SUMMARY
Introduction
By the end of th e year 2000, more than 6.5 million adults were under the supervision of the
correctional system, and more than half of these offenders are estimated to have significant
substance abuse problems.
Traditional, boundary -laden treatment and control strategies have been unable to change offend er
drug use and criminal behavior. Amo ng the state probation populations, the proportion of
offenders wh o successfully complete their supervision has dropped from seventy (70) percent to
sixty (60) percent in the past decade, due in large part to offenders’ failure to abide by the
conditions of their release related to abstinence from druglalcohol use and/or participation in
treatment. In 1999 alone, fourteen (14) percent of the probation population (244,700) and forty
two (42 ) percent of the parole population (17 3,800) were retur nea sen t to prison for a rule
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 6/57
0offenders, specifically the formulation of a new m odel of incorporating treatment within the
criminal justice system - he Seamless System of Care. The HIDTA Model was designed to
target hard-core, substance abusing offenders who are both difficult clients for treatment
providers and difficult offenders for com mu nity supervision agents. Part of this demonstration
project was the restructuring of the treatment a nd supervision delivery systems for criminal
justice offenders within the High Intensity Drug Trafficking Areas (HIDT A) program in the
Washington, DC - Baltimore corridor. Each of the 12 participating jurisdictions (VA:
Alexandna City, Arlington County, FairfaxRalls Church, Loudon County, Prince William
County; MD: Baltimore City, Baltimore County, Charles County, Howard County, Montgom ery
County, Prince W illiam County, and the District of Colum bia) developed a seamless system
tailored to their own socio-legal environm ent which included system reforms consistent with the
core components of the HlD TA model.
The HIDTA model is based on the concept of the boundaryless system that “transcend s the
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 7/57
Evaluation Data and Methods
This evaluation report provides a detailed examination of the development, implementation, an d
initial impact of the High Intensity Dru g Trafficking Areas (HIDT A) Model, based on a multi-
0
site (12 jurisdictions) analysis of the program. Using a sim ple pre-post, non-experimental
design, data were collected at each of these twelve sites on the total population of offenders
admitted to the HID TA program in 1997 (N=1,216). By using a non-experimental design to
conduct our initial review, we could prov ide preliminary ou tcome data to jurisdictions while
focusing our evaluation resources on the critical question of level of implementation. Data w ere
collected on the following: (1) demographic and criminal history, (2) treatment placement an d
movem ent through treatment, (3 ) criminal justice supervision and services, (4) drug testing
results, and (5) the use of g raduated sanctions by either the treatment agency or the criminal
justice agency. The integration of records from treatment providers and criminal justice agency
providers w as critical to assessing the im pact of the HlDT A M odel on the offenders included in
e
this study.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 8/57
offender is a low-level drug dealer who deals to support hi sh er addiction to drugs. Th e drug of
choice for these offenders is either crack/cocaine (28.2%) or heroin (19.8%), consum ed by
smoking (39.2%), injection (12.7%), or some other oral means (17.4%). Although th e treatment
histories of H IDTA offenders are often unknown at the time of HIDTA intake, it appears that the
majority of these offenders are addicts who have been in treatment before but w ho remain -
based on their own self-report response - addicted to drugs. In fact, one of every three HID TA
offenders reported daily drug use at the time of their arrest. Clearly, there is significant overlap
between the addiction careers and the criminal careers of these offenders.
e
Level of Program Implementation
Th e purpose of our implementation (or process) evaluation is two-fold: first, to determine the
extent to which th e HIDTA model was implemented as designed; and second, to document
changes in each jurisdiction’s response to offenders during the pre-post comp arison period.
Overall, the HIDTA m odel was not fully implemented in 8 of the 12 jurisdictions. How ever,
a
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 9/57
based treatmenvoutpatient m odel. On ly one jurisdiction (Montgomery Coun ty) developed a
continuum of care system that incorporates all four modalities. Overall, the average successful
completion rate for H D T A treatment participants was 64 percent, which was much higher than
anticipated given the target population selected. The average time in treatment for H D T A
participants w as 20 8 days (range 1 72-265 days).
e
Drug Testing Implementation.Drug testing sched ules varied considerably across the twelve
jurisdictio ns we exam ined: one site used random drug testing; three sites tested offenders three
times per m onth; one site tested offenders w eekly; and seven sites conducted drug tests twice per
week . Thirty-five percent of HIDTA participants tested positive for drugs between the time of
arrest and the time of intake to treatme nt. During this pre-treatment period, the drug of choice
was cracWcocaine ( ll % ) , marijuana (6% ), and heroin (5%). Overall, 18 percent of HIDTA
participants tested positive for drugs during the treatment period. When com pared to the pretest
results, this represents a 49 percen t declin e in the test positive rate (from 35 percent to 18
a
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 10/57
Graduated Sanction Implementation. Each jurisdiction we reviewed had a different graduated
sanction protocol, including both judicial and adm inistrative systems. Overall, jurisdictions had
e
difficulty responding to the first, second, an d third positive drug tests using progressively more
stringent sanctions. It appears that neither certainty (of response) nor progressiveness (of
response) have been im plemented at the test sites.
The Impact of the HIDTA Model on Offending
Th e average re-arrest rate for a new offense is 1 1 percent at a 6-month follow-up and 16percent
at the 12-m onth follow-up (from intake). At the twelve-month follow-up, there is significant
inter-jurisdictional variation in arrest rates, from a low of 6 percent to a high of 32 percent.
Offenders w ere typically arrested for drug offenses including possession, distribution or
possession with intent to distribute. Based on our review of the previous patterns of offending
among HIDT A offenders, th e overall predicted re-arrest rate for these offenders is 52 percent.
This represents a 70 percent reduction from the base rate (52% vs. 16% re-arrested). Estimates
e
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 11/57
Implementation Barriers and Recommendations
During the planning, implemen tation, and evaluation stages of the HIDTA seam less system three
key compon ents of the system were identified as needing to be addressed in order to successfully
implemen t the current and future systemic case management systems. Specifically, the need to
appropriately target the n eeds and risks of offenders and identify what stage in their add ictions
and criminal career they are in , so as to adequ ately meet their treatment and other needs. Second ,
the need to offer various types of high quality treatment prog rams and phases to ad dress specific
needs and to promote longer treatment stays. Need to offer treatment in a convenient and safe
place as a team, for example on location at a parole and probation joint run by supervision and
treatment staff. Und erstand that treatment is a process not an episode and that mo re than one
treatment program or stay may be needed. Important to address whole needs of offender and to
prepare the offender that behavior changes are needed from them. Third, need to develop and
consistently administer joint responses to no ncomp liance in a sw ift and certain w ay. To continue
the impact, more attention is needed on providing a more rigorous application of the san ction and
0
I
a
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 12/57
Future A nalyses: The Need for an Experimental Design
Although these initial findings are promising, we mu st emphasize that they are preliminary, non-
experimental an d in need of further review. W ith such small sample sizes and without a contro l
a
group(s) of non-HIDTA offenders, it is certainly premature to claim that participation in the
HIDTA program w as the primary factor explaining these positive outcomes. Future analyses
stress the importan ce of using a controlled experiment.
Implications
Th e present study has a num ber of potential im plications for theory, research and policy
in the area of dru g use and criminal behavior. First, it does appear that the “boundaryless
system” concept has merit, especially when the target population is the hard-core drug user.
Seco nd, it is certainly possible that the age of the offender, in conjunction with the extent of the
offender’s addiction and crim inal career path to placement in the HIDTA program, may be
at least partially responsible for the findings reported here. Perh aps older addicts are at the state
a
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 13/57
Introduction and Overview
Th e following report provides a detailed examination of the development,
implementation and initial impact of th e W ashing tonB altimo re High Intensity Drug Trafficking
Areas (HIDTA) Model, based on a multi-site analysis of the program. The HIDTA M odel
represents an excellent e xample of the type of intra- and inter-system collaboration that m ost
experts agree is critical to the success of drug treatment and control strategies in this country
(Taxman, 2001,Taxman & Bouffard, 2000). At its core, the HlD TA M odel represents a unique
collaboration between agencies and organizations responsible for the provision of drug treatment
services and the agencies and organizations responsible for the community controZ of offenders.
Th e report begins by providing an overview of the em pirical evidence supporting the key
elements of the HlDT A seamless system of drug treatment and control. The HIDTA M odel is
then described, focusing on the following four program elem ents:
1. continuum of care;
2. offender supervision strategies;3. drug testing protocols; and,
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 14/57
1. The Link Between Drug Treatment and Offender Control: AReview of the Research
In 2000, nearly 6.5 million people were under som e form of correctional control in this
country. About seventy (70) percent of our correctional population was under comm unityi
supervision, while thirty (30) percent were in prison or jail (Bureau of Justice S tatistics, 2001).
It is conservatively estimated that over half of these offenders have significant substance abu se
problems (Drug Policy Strategies, 1997), underscoring the link between addiction careers a nd
criminal careers (Anglin & Hser, 1 990). Am ong state prisoners, it is estimated that 83.9% of the
offenders released from prison in 1999 were alcohol or drug involved at the time of the offense
(Bureau of Justice Statistics, 2000). Am ong the state probation populations, the proportion of
offenders wh o successfully complete their supervision has dropped from seventy (70) percent to
sixty (60) percent in the past decade, due in large part to offenders’ failure to abide by the
conditions of their release related to abstinence from drug/alcohol use and /or participation in
@
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 15/57
within institutional and com mu nity correctional settings appears to be the most ob vious course of
action.
Several emp irical studies have illustrated the positive impac t of drug treatment services
on offender criminal behavior and d rug use (Sim pson, Joe & Brown 1997; Lipton, 1995;
Taxm an, 1998; Simpson, Wexler & Inciardi, 1999). Specifically, these studies demo nstrate that
offenders participating in drug treatmen t services are less likely to be rearrested or return to jail
or prison than similar offenders wh o are not participating in drug treatment services.
Participation in treatment services not only contributes to reductions in the incidence of criminal
behavior but also to increase in th e overall length of crime-free time for offenders. Tax ma n and
Spinner (19 97), in their study of offenders w ho participated in a jail-based treatment prog ram
that included a continuum of care, found that 38.5% of treatment participants were rearrested
within 24 m onths after release from jail com pared to 48.7 % of the comparison group.
Additionally, the average offender participating in jail and co mm unity treatment took an averag e
of 282 days to be rearrested comp ared to 201 days for the compa rison grou p, an almost three
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 16/57
Carlson, 1996), particularly for the criminal justice offender (Duffee & Carlson, 1 996; Falkin,
199 3; Scarpitti, Inciardi & Martin, 1994; Wexler, Lipton & Johnson, 1988). In addition, the
prevailing view by criminal justice agents that offenders are undeserving of treatment and that
drug treatment should not be an integral part of the su pervision sentence further impedes the
development of collaborative efforts between supervision agents and drug treatment service
providers.
For a client on criminal justice supervision required to participate in su bstance abuse
treatment services, collaboration between treatment and control is critical for a variety of
reasons. First, the leverage of the criminal justice system can be an important mean s of reducing
treatment dropou ts by establishing credible punitive contingiencies. Second, supervision and
monitoring can augment treatment by enhancing treatment goals and pursuing long-term
outcomes. Finally, the use of criminal justice sanctions for offenders has been evaluated and
recent results from a drug court evaluation in Washington,DC demons trate that offenders who
receive san ctions are four times less likely to continue drug use than typical supervision clients
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 17/57
e.g., MacK enzie & Souryal, 1994; Cowles, Castellano & Gransky, 199 5), and day reporting
centers (see e.g., Parent et al., 1995).
Despite these findings, program developers often lament the man y difficulties associated
with providing treatment to offenders, particularly drug users under com mu nity supervision.
First, drug users often have a num ber of problems related to physical health and/or men tal health
that make “treatment” planning much m ore difficult. In most instances, it should be recognized
that drug users are “m ultiple problem” offenders w ith a variety of treatment needs. Unless a
comprehensive treatment assessment strategy is developed, it is likely that these offenders will
“fail” in drug treatment. Second, resource constraints often limit drug treatment availability
(resulting in inappropriate treatment placements) having an adverse effect on treatment quality.
A num ber of recent reviews of the drug treatment literature have docum ented such problems as
inadequate service levels (Dennis, 1990), the use of inapp ropriate services (Andrew s et al.,
1990a,b), th e short duration of treatment programs (Pendergast et al., 1994), lack of staff training
(Gustafon, 199 1), and lack of essential program compon ents (Gendreau, 1996). Any discussion
1
0
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 18/57
problems as low statistical power, small sam ple sizes, lack of treatment integrity, and/or poor
implementation of treatment procedures.
a
2. The HIDTA Model
Case managem ent has been promoted as a critical component of any treatment system. It
involves outreach, assessment, case planning, monitoring, reassessment, coordination, treatment Iplanning, brokering services, treatment m onitoring, discharge planning, advocacy, an d o r clinical
interventions (Anglin et al., 1996; Martin & Inciardi, 19 96; Metja et al., 1994). The con text and
nature of case management practices varies considerably (Anglin et al., 1996) with tremend ous
uncertainty as to the actual functions performed by case managers (Shw artz et al., 1997). A series
of studies on the effectiveness of case management have generated inconclusive and occasionally
negative findings (e.g., Anglin et al., 1996; Martin, Inciardi, Scarpitti & Nielsen, in press; Taxman
et al., 1997), due in part to the large variance in se rvices rendered under the category of “case
management.” As it is most often practiced, case management relies on the individual manager to
make informed decisions and scramble for the needed resources and services. Unfortunately, the
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 19/57
justic e sy stem brokered treatment services from the treatment sy stem under the assumption that
the treatment system had unlimited resources. By brokering treatment services in this way, the
crimina l justic e and treatment sy stems offered separate programs and services, and main tained
separate budgets. Under this mod el, the criminal justice system assumed no su pervisory role
while the offender was in treatment.
e
Under the ration ingtriage service delivery model or seamless system, however, service
integration defines the relationship between the criminal justic e and treatment systems. Ro les
are specifically defined for crim inal justice and treatment staff members, as too are jointly
identified goals for offenders under supervision participating in treatment. Joint decisions
regarding treatment selection, placement, monitoring, responses to positive drug tests, and
discharge are predetermined by the supervision agent and treatment provider and serv ices
focusin g specifically on offe nder outcomes are offered by both sy stems. Like many system
reform efforts, systemic case management provides a s tructure to ensure that critical functions
are performed by removing the barriers of coordination and having policy makers restructure
a
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 20/57
and discharge. Th e HIDTA seamless system includes the following components: (1) continuum o f
care, (2) supervision, (3) urinalysis testing, a nd (4) compliance measures and graduated
sanctions. Eac h of the four key system elements is described below:
e
a. Continuum of Care. Research continues to dem onstrate that length of time in
treatment is influential in determining positive outcomes (Conde lli & Hubbard, 1994; Hubbard e t
al., 1989; Simpso n et al., 19 97a). W ith the tendency in the treatment field to provide short-term
services (Etheridge et al., 1997), the continuum of care requires that the offender participate in
tw o levels of care-typically a more intense service followed by aftercare or counseling. The
concept of a continuum is to mo ve the client through the treatment delivery system consistent
with h is he r progress. Underlying the concept of a continuum is that treatment placemen t
decisions should be affected by the offender's risk level to determine the am ount of control and
structure needed to augment treatment and crim inal justice outcom es (Andrews et al., 1990a,b).
For ex ample, higher risk offenders may need a residential setting for six months because of the
propensity to engage in criminal activity. Th e residential setting provides external controls on
Ii
0
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 21/57
treatment is usually four to nine months w ith most programs lasting six months in duration.
Offenders continue in com mu nity treatment after release from the resideritial facility as they
mov e through the different stages of recovery.
a
Intermediate Care follo wed by Outpatient Services. In this model, the offender is placed
in a 28-day treatment program and then in a six-mon th outpatient program. The program within
the intermediate care usually focuses on treatment readiness and preparation for change in the
comm unity. Th e goal of the 28-day residential program is to prepare the offender for change by
using a variety of psychosocial educational modules and to begin the preparation for return to the
community. Part of the discharge planning is to develop action plans that can guide the offender
to change his he r behavior in the community. This model is being implemented in Montgome ry
County M aryland. In the District of Columbia, the Assessme nt Orientation Center (AOC)
provides an intermediate care environment to em phasize developing the offender’s motivation to
change by focusing on pre-contemplation and contemplation phases of recovery. Th e AOC uses
the period of tim e to assess and diagnosis the offender to determine a ppropriate placement in the
i
0
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 22/57
Jail-Based Programming followed by Ou tpatient Services. Many offenders are in jail
prior to release to the com munity. Incarceration provides an opportunity to begin th e recovery
process w ith a focu s on continued treatment after release from the facility. Jail based
progr amm ing includes cognitive skill development and relapse prevention as the two treatment
strategies to address the offender's com mitm ent to recovery. Jail based program min g usually
runs three to six mon ths in duration and the em phasis is on maintaining the offender in treatment
in the com mu nity after release. In some jail-based programs (after release from jail), offenders
are placed in wo rk release programs after release from the jail where treatment services are
continued. In such cases, the work release program emphasizes work ethic and employment as
part of the recovery process.
a
b. Supervision. Mo nitoring and oversight are vital to the man agem ent of offenders in
a the comm unity and remains the primary com pon ent of supervision services. Supervision
facilitates the treatment proces s by enforcing treatment co nditions, and verifying and v alidating
the progress of th e client. Essentially, supervision consists of 1) case managem ent (including
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 23/57
a important that the drug testing information be shared and used to support mutual treatment and
public safety goals. I
d. Compliance Measures and Graduated Sanctions. Both treatment and supervision
agencies share a com mon problem of com pliance with program requirements. S impson et al.,
(1997b) report that over half of the clients do not com plete drug treatment programs and Taxman
and Byrne (1994) estimate that at least half of th e offenders do not comply with basic
/
I
supervision requirements. Not surprisingly, noncom pliance with probation requirements
constitutes on e of the main reasons for new prison admissions each year. Of course, the use and
application of sanctioning (or the leverage of the criminal justice system) tends to vary
considerably in practice, in both the treatment and criminal justice arenas. Recent ad vancements
have promoted the use of b ehavior modification app roaches, referred to as graduated sanctions in
the criminal justice literature, to provide swift, certain, and appropriate responses to com pliance
problems (Harrell et al., 2002;Harrell & Cavanaugh, 1996; Kleiman, 1997). Similar to
contingency management, graduated sanctions ho ld clients accountable for their behavior
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 24/57
3. The HIDTA Demonstration Project
Th e Office of National Drug Control Policy (ONDC P) provides for regional approaches
to drug problems, prim arily drug trafficking issues. Mo st of the HIDTA s are involved in law
enforcement specific activities. Th e Washington-B altimore con ido r was designated as a special
HIDTA in 1994 by the ON DC P (Lee Brown was the Director at this time). ON DC P funde d the
HIDTA initiative to address both d emand and supply issues. On the demand side, the g oal was
to improve the service delivery system for treating chronic substance abusing offenders. Each of
the 12 participating jurisdictions (Virginia: Alexandria C ity, Arlington County, Fairfax/Falls
Church, Loudo un Cou nty, Prince William County; Maryland: Baltimore City, Baltimore Cou nty,
Charles County, Ho ward Cou nty, Mo ntgomery Coun ty, Prince William County, and the District
of Colum bia) developed a seam less system tailored to their own socio-legal environment w ith
th e system reforms co nsistent with the core components, as shown in the following diagram an d
1
system model. Each jurisdiction has d eveloped the supporting policies and procedures to ensure
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 25/57
requires that policies should be developed and put in place to ensure a change in the daily
operations. In order for the model to be developed and implem ented, policies must be developed
and supported by procedures. Th e line staff will then be clear as to the new operational proced ures
and the working relationship among the different agencies.
Diagram 1: The HIDTA Model
e
moliciesPrinciples -
/ Treatment Placement
OoerationsProcedures -
Treatment Transitions Contin uum of
Treatment Discharge
* Graduated SanctionsDrugTesting DrugTesting
-Intra-and Inter-
Graduated
4. Data and Method
Twelve separate jurisdictions agreed to participate in this evaluation, including six
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 26/57
Table 1. Twelve HIDTA Sites and Size
12. Washington, D C
I TOTAL:
Site
1 . Alexandria City
2. Arlington Coun ty3. Fairfax County4. Prince William County
5. Loudoun County
6. Baltimore City
7. Baltimore County
8. Howard County9. Charles Coun ty
10.Mon tgomery County11. Prince G eorge’s County
Target
CohortSize
58
59362822
545
2937
44
5366
276
1,216
It should be noted at this point that both case flow and the total num ber of HlD TA
participants identified at each test site were likely affected by th e availability of funding f or this
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 27/57
years. How ever, since the final decision on eligibility criteria was left up to the individual
jurisdiction, it is not surprising that there is considerable inter-jurisdictional variation in the
instant offense, criminal histories, and drug use patterns of the target population identified here.
e
For each offen der identified as HIDT A-eligible, data were collected to document the offender’s
movem ent through th e “seamless system” described earlier in this report. Regardless of the
offender’s status in the criminal justice system at the time of intake &e., pretrial release,
probation, parole), data were collected on the following: (1)demog raphic and criminal history,
(2) treatment placement and mov eme nt through treatment, (3) criminal justice supervision and
services, (4) rug testing results, and (5) the use of graduated sanctions by either the treatment
agency or the criminal justice agency. Th e University of Maryland has developed an autom ated
tracking database (H ATS ) that allows criminal justice and treatment agencies to enter and share
offender and client information. This information includes progress across various
organizational networks while maintaining all of the federal protections for confidentiality. The
integration of records from treatment providers and criminal justice agency providers is critical
e
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 28/57
implementation level, four of these twelve sites have been selected for participation in a separate,
multi-site randomized field experiment (Baltimore County, Mon tgom ery Coun ty, Prince William
County an d Alexandria City). On e of the problems with field experiments conducted in the past
by criminal justice researchers is that they often jum p the gun, attempting to evaluate the impact
of a program before it has been fully implemented. By using a non-experimental design to
conduct o ur initial review, we can provide preliminary ou tcome data to jurisdictions while
focusing our evaluation resources on the critical question of level of implementation. To the
extent that we can identify an initial link between the level of implementation of the HIDTA
Model an d lower o ffending rates (our impact m easure), there is further justification fo r providing
a more comprehen sive, randomized field experiment on the subgrou p of full implementation
sites. Parenthetically, this is the strategy recomm ended in a recent review of th e research on
drug treatment in criminal justice settings (National Research C ouncil, 2002).
5. A Profile of HIDTA Participants
Th e HIDTA M odel has been designed to target hard-core, substance abusing offenders
II
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 29/57
criminally active for several years: the typical offen der averaged a little over one arrest per year
fo r the past nine years. These offenders are currently in th e criminal justice system becau se of
their drug problem. Nearly 45% of these offenders had a drug charge with half of the ch arges
involving distribution or possession with intent to distribute. It appears that the typical HlDT A
offender is a low-level drug dealer who deals to support hi sh er addiction to drugs. Th e drug of
choice fo r these offenders is either cracWcocaine (28.2%) or heroin (19.8%), consumed by
smoking (39.2%), injection (12.7% ), or some other oral means (17.4%) including inhalation.
Although the treatment histories of HlDTA offenders are often unknown at the time of HlD TA
intake, it app ears that the majority of these offenders are addicts who have been in treatm ent
before but who remain -- based on their ow n self-report response -- addicted to drugs. In fact,
one of every three H D T A offenders reported daily drug use at the time of their arrest. Clearly,
there is significant overlap between the addiction careers and the criminal careers of these
offenders (NOTE: see Table 3 and Appendix A for a site-specific profile of these offenders).
Table 2. Client Descriptive Statistics
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 30/57
Table 3. Characteristicsof 1997 HIDTA Sample
402. Washington, DC 276
Site
1. Alexandria City2. Arlington County3. Fairfax County4. Loudoun County5. Prince William
County6. Baltimore City7. Baltimore County
8. Charles County9. Howard County10. Montgomery
County
11. Prince George’sCounty
81%--
SampleSize
585936
22
285452944
37
53
6685% 20%
Mean
Age
353736
35
3435333434
32
35
18% 1.3
%
Male
82%62%87%
35%
71%71%
70%85%98%
92%
81%
9i
African-American
77%70%49%
45%
36%57%36%39%53%
38%
72%
9%
Employed
44%
24%52%
47%
61%17%14%10%27%
48%
4%
%
PossessionDrug
31%7%
14%
33%
39%23%17%6%
12%
52%
20%
MeanArrests
Per Year
1.oo.81.761.5
1.1
1.51.1
,75.73
1.1
1.2
A%YrS
CriminallyActive
8.l
210.0
7.111.48.15
6.95.2
10.0
5.69.7
9.0
6. Assessing Implementation
Th e purpose of our implementation (or process) evaluation is two-fold: first, to determine
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 31/57
Figure 1highlights impo rtant changes that hav e occurred during the pre-testlpost-test
period at the twelve HID TA sites. In terms of the developm ent of a continuum of care consistent
with the HID TA Mod el, three sites had actually developed such a continuum prior to the
initiation of the HIDTA project. By the time of our post-test review, ten sites had such a system
in place. Only two sites had drug-testing policies in place prior to the initiation of the HlDT A
project, as compared to ten sites at th e time of our post-test review. And finally, only one site
had developed a system of graduated sanctions for either treatment providers or comm unity
correction agents prior to the start of the HID TA project, as compared to nine sites following
implementation of the HID TA system. Although Figure 1highlights the fact that there wa s
considerably less progress in other related areas, it does appear that the HIDTA M odel has
fundamen tally changed the way these jurisdictions respond to hard-core drug users. W e expand
on this finding below, focusing on three imp lementation areas: (1) continuum of care, (2) drug
testing, and (3) graduated sanctions.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 32/57
Figure 1. Progress on Implementing Seamless System Components
11
I 10
nE3
1 1
J
07
10
2
I0I9
0I13
Continuum of Grad uated Graduated Integrated Drug Testing Integrated Formalized Integrated
Treatment Criminal of Graduated SharingCare Sanctions -- Sanctions -- Application Fblicies Service Mix Information Assessment
Justice Sanctions
Re-HIDTA
0 IDTA
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 33/57
0based treatment, etc . It also allows the use of less intensive services as offender’s progress in their
recovery (see Appendix A - TreatmentRrim inal Ju stice Flow C hart Sample Seamless System).
Table 4 highlights the site-specific variations in the development of a comprehensive
continuum of care system. Although our review has identified ten jurisdictions with a clearly
defined con tinuum of care system in place, only one jurisdiction has developed a system that
incorporates all four modalities of treatment (Montgomery County). This finding can be directly
I
linked to the resource constraints faced by program developers at the other eleven sites.
Table 4. Continuum of Care Models in the HZDTA Sites
Models
Resihentiauoutpatient
Intensive Care Facility/Outpatient
Intensive Outpatiendoutpatient
Sites
Montgomery County, M DFairfax County, VAWashington, DCBaltimore City, MDArlington County, VABaltimore County, MDWashington DCMontgomery County, MD
Alexandria City, VAFairfax County, VAPrince William County, VA
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 34/57
concepts: com pletion of the first phase or mo vem ent into another more app ropriate treatment
experience. T he seam less system provides that protocol for the transition based on the
offender’s progress. The continuum is built on the notion that some clients need less intensive
services as the secon d phase, som e need m ore intensive services, and som e can suffice with
aftercare services of self-help groups or vocational education. That is, the system mu st function
to mo ve the offen der into the appropriate level of care. In addition to de termining the
appropriate level of initial treatment, i t is also critically important to assess the progress of the
offender. This needs to be approached from a systemic perspective to determine whether more
treatment is warranted and the type of treatment that is most ap propriate at th e time.
0
/
I
Table 5 illustrates key performance measu res regarding the treatment com pon ent of the
program . Since each jurisdiction has a different planned treatment continuum (as discussed in
Ap pend ix A), the patterns of length of stay vary differently. It should be noted that the
comp letion rates for the first phase of treatment are higher than those reported in DA TO S whe re
forty (40) percent of the clients completed treatm ent similar types of treatment (Simpson, et al.,
0
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 35/57
Table 5. Treatment Duration & Completion of First Phase of Treatment
*Note that successful completion refers to the completion of the expected duration of treatment. Often criminal justice clients, due to the ir status,
may not complete due to a change in legal s ta tus , movement across the legal spectrum, etc. Many offenders transition into other levels of serviceregardless of whether they complete the duration of a particular time frame in a given program. This varies depending on he jurisdictions and
the continuum of care available in that jurisdiction.
The HlDTA protocol has two m ain features that affect the offender’s duration in
treatment. First, the protocol is designed to step treatment up or down based on progress. Even
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 36/57
Area 2: Implementing a System for Drug Testing Offenders
The HIDTA protocol targets the criminally active substance abuser under the co ntrol of
the criminal justic e sys tem. Th e protocol involves drug testing the offender while the offende r is
actively involved in treatment. Drug testing provides an objective measure of whether the
offender is continuing to abu se drugs while involved in treatment. Early in the HIDTA program,iI
ONDCP ma de funds ava ilable to enhance drug testing around the region. During the first two
cohorts of the H lD TA p rogram, direct funding for drug testing was available. In 1997, funds
were removed fro m the HIDTA budget for drug testing. Jurisdictions were asked to continue
drug-testing offenders using av ailable funds in their jurisdiction. Ma ny jurisdictions
implemen ted drug testing on various schedules based on the available funds from either the
criminal justice o r treatment systems. As level funding occurred, many of the program s
attempted to maintain the following schedu le through existing funds. Table 6 shows the 1998
Drug Testing Protocols.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 37/57
are under legal control that serve s to suppress their use of illicit drugs. Of the thirty-five (35)0
Howard
percent that test p ositive for an illicit substance during this pre-treatment period, the drug of
1 5 % 63
choice in the HIDTA jurisdictions based on drug test results are: cocaine/crack (11percent);
marijuana (6 percent); and heroin ( 5 percent). It should be noted that these drugs of choice are
slightly different than the self-reported drug of choice where addicts tend to emphasize their use
of coc aine krac k, heroin, and then marijuana. Table 7 show s the drug test results by jurisdiction.
Table 7. Drug Test ing Results for HIDTA Jurisdictions
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 38/57
constant and con sistent pattern of testing o ffenders results in reduced positive test rates (W ish &
Gropper, 1990).
e
Overall the testing illustrates that treatment contributes to a significant reduction in the
test positive rate. Th e estimate of offenders testing positive at intake is thirty-five (35) percent.
These results illustrate that treatment contributes to a forty-nine (49) percent decline in the test
positive rate-from thirty-five (35) to eighteen (18) percent. It should also be noted that many
offenders are more likely to continue to test positive for marijuana than other illicit drugs such as
cocaine and heroin. Th e change in drug of choice also contributes to reduce non-drug use
criminal behavior because the literature is less clear about the marijuana-crime nexus (as
compared to the cocainek rackhero in nexus).
Area 3: Implementing a System of Sanctions and Rewards
The cornerstone of the HIDTA protocol is enhanced supervision and case mana gem ent of
the offender to include the use of sanctions and rew ards to address offender compliance patterns.
Th e consequence protocol was designed to be specific to each jurisdiction with the jurisdiction
a
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 39/57
goals of reducing drug use and criminal behavior through a purposeful response to negative
behavior. An ad vantage of the approach is that communication with th e offender is more
targeted and focused on outcomes. To facilitate the process, many jurisdictions d eveloped a
behavioral or sanctions contract, which provides a framew ork for commun icating the negative
behavior and expected consequences to the offender. This contract can incorporate both
administrative and judicially ordered sanctions. So me jurisdictions incorporated the sanctions
into the standard practice of treatment and supervision. At th e end of th e 1997 training session it
was realized that more attention was needed to the developm ent and implementation of the
sanction protocol in large part due to philosophical differences between the treatment criminal
justice personnel on the type of sanctions to be used. Sim ilarly, a lack of consensus was also
i
reported in the developm ent of a reward structure.
Table 8. Graduated Sanctions Protocols
Graduated Sanct ions (1997)
Administrative SanctionsFirst Positive Test:
Sites That Implement These Sanct ions
Alexandria City, VA
Arlington County, V A
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 40/57
Figure 2
implementation.
llustrates that the sanction protocol needs further work in terms of the
Th e exhib it shows that there is som e progressive nature’ of the action-as the
nega tive behavior continues , the type of responses is altered. Ye t, it also shows that there is little
variation across the first three positive drug tests. An exam ination of Table 8 illustrates that
eight (8) of the twelve (12 ) jurisdictions are implementing adm inistrative sanctions an d three (3)
jurisdictions are implementing judicial order sanctions and that the concepts of certain and
progressives are not well implemented. So m e jurisdictions like Alexandria City and Prince
William, which developed strict policies and procedures, have translated into clearer practices.
More attention in the other jurisdictions is needed on the development of their policies. Further,
development is also needed on th e training of staff (treatment and criminal justice), supervisors,
and other interested parties. How ever, we should point out one important, unanticipated
consequence of the development of graduated sanctions: increased tolerance by criminal justice
decision-makers for multiple drug test failures. It may be that the reason HlD TA offenders are
staying in treatment longer and com pleting treatment program levels more frequently is that
iI
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 41/57
First
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 42/57
@this evaluation does not represent a test of a specific treatment modality (such as methedone fo r
heroin addicts), but rather a general, system-wide orientation toward im pioving both treatment
quantity and quality. Similarly, the HIDT A Model does not specify a particular supervision
level, drug testing protocol, an d or graduated sanction system. Given the variations we have
already documented in the development and im plementation of the HIDTA Model across twelve
jurisdictions, we anticipated much interjurisdictional variation in our primary outcome measure
- the offending rates of hard-core drug users. However, we did not anticipate either the reduction
in drug use during the post-test period documented in the previous section or the significant,
overall reductions in arrest levels and offending rates we describe below. W hy did these changes
occur in drug use and offending? Perhaps the simplest answer is the most accurate: it is not a
matter of specific program development - it is a matter of general systems development (Taxm an
& Bouffard, 2000).eThe evaluation strategy involved a pre-post design that compares the actual reoffending
rate of the offender with prior offending patterns. Table 9 shows the rearrest rates based on tw o
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 43/57
Table 9. Comparison of Actual Rearrest Rate at 6 and 12 Month
Follow-up Periods
Site
Alexandria CityArlington CountyFa irfM alls ChurchLoudoun Countv
6 Month Arrest
for New Crime (%)12Mon th Arrest for
New Crime (9%)
8% 16%
3 16
17 32
5 10
Prince William County
District of ColumbiaBaltimore CityBaltimore CountyCharles CountyHoward CountyMontgomery CountyPrince George's CountyOverall
Th e evaluation is designed to exam ine the hypothesis about the impact of the HJDTA
treatment protocol on rearrest rates. The base rate or the likelihood that offenders w ill be
rearrested is derived from the average rate of offending for the offender. That is, given the high
11 24
10 225 13
3 30
9 20
11 **0 6
6 11
11 16
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 44/57
Table 9 illustrates that the average rearrest rate was sixteen (16) percent, compared to the
expected fifty-two (52) percent rearrest rate. This is a seventy (70)percent reduction from the
base rate, demonstrating that the HIDTA intervention likely affected the frequency of the
offender offending in the different jurisdictions. It also appears to demonstrate the sustained
effects of the HlDTA initiative, supporting th e strength and utility of the HlDTA approach, and
underscoring th e apparent importance of treatment duration. The average offender is reported to
have participated in 208 days of treatment or over six months in treatment; this is consistent with
m -
B = '
!i2 = -
Y
0 4 -
Y
Ce, 20.
2
researchers that suggest longer duration in treatment as a tool to reduce criminal behavior a nd
c
//
//
/+/4
substance abuse.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 45/57
Table 10. Comparison of Base Rate with Participation in the W B HIDTA
Protocol
Charles CountyHoward CountyMontgomery CountyPrince George’s CountyOverall
.71 .20 -72
.3 3 * *
.60 .06 -90
.49 .ll -77
.53 .16 -70
Although these initial findings are prom ising, we must emphasize that they are
preliminary, non-experimen tal and in need of further review. With such sma ll sample sizes and
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 46/57
System” Model examined in this evaluation attempts to address this problem by focusing on the
development of a coo rdinated, multi-system treatment and control strategy. It is this general,
systemwide model that is the focus of both our process and impact evaluation. Rather than
offering an assessment of a particular treatment modality (e.g., methadone maintenance
programs) we are attemp ting to gauge the implemen tation and impact of a treatmentjcontrol
system for all forms of drug addiction.
Our evaluation un derscored both the d ifficulties inherent in a mu lti-jurisdictional
systemwide change effort (see e.g., Taxm an & Bouffard, 2000 for a more complete review) and
the potential positive effects of this type of systemwide collaborative effort on the cessation of
both the offenders’ addiction and criminal careers. Perhaps most imp ortant is our finding that
HIDT A offenders remained in treatment longer (an average stay of 208 days in treatment) and
had a higher than expected program com pletion rate (sixty-four [64] ercent successfully
completed treatment). The impact of these two basic changes in treatment provision on offen der
behavior are worth considering, despite the preliminary nature of the research: (1)HIDTA
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 47/57
decision-making to make changes in the offender’s life. The question is how much the model
motivated offenders to change. Th is further research is needed to understand th e issues related to
treatment and control and how they are perceived by the offender.
This stu dy has also offered an interesting approach to an often vexing problem fo r
research scientists interested in conducting a controlled, randomized field experiment: Ho w d o
you identify jurisdictions who have fully implemen ted the “treatment” being examined (in this
case, the HlDTA Seamless System)? Far oo often in the area of criminal justice, researchers
have wasted time , money and othe r resources trying to conduc t experiments on “failed”
programs (in terms of implementation lev el, targeting strategies and samp le size). To address
this problem, we have conducted a fairly comprehensive implementation evaluation across
twelve (12) separate jurisdictions in order to identify subgroup of sites that appear to be ready f or
a controlled field experiment. Since the twelve (12) jurisdictions are not only interested in
implementation, but also impact, we have employed a less rigorous and less costly evaluation
design to measure th e prelimin ary effectiveness of this strategy across all sites. As a result of
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 48/57
specific treatment mod alities, and more important to think creatively and decisively about how to
improve the quantity and quality of both crim inal justice supervision and treatment service
delivery systems. The HlDTA “Seam less System” Model evaluated in this report offers an
excellent exam ple of this type of intersystem cooperation and collaboration.
While w e must resist the urge to focus too much attention to the positive (albeit
preliminary) findings we report on the recidivism reduction effects of the HIDTA Model, it does
appear that this approach has the potential for significant system-wide cost savings. In addition,
an equally important implementation finding was that improvements in intra- and intro-system
coordination and treatment resource availability resulted in noticeable increases in both treatment
program co mpletion rates and length of stay in treatment. It should be obvious to even the casual
observer that you are not going to change a “lifetime” of addiction and criminality with any
single, short-term strategy.
The fact that this is a coerced treatment strategy with com pliance monitoring
(via drug testing) and graduated sanctions fo r continued drug use should not be forgotten,
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 49/57
drug use (i.e., marijuana vs. heroin) - epresents an even more fundamental change: a growing
goal consensus between treatment and control staff in such areas as the need fo r proper
assessment, th e importance of treatment protocols, and the recognition that the cessation of an
offender’s addiction career is not going to happen overnight. Stated simply, both treatment and
control appear to now agree: long-term problems require long-term solutions.
a
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 50/57
0 References
Andrew s, D. A ., I. Zinger, R. D. Hoge, J. Bonta, P. Gendreau & F. T. Cullen. 1990a. “D oesCorrectional Treatment W ork? A Clinically Relevant and Psychologically Informed M eta-
Analysis.” Criminology 28: 369-404.
Andrew s, D. A ., I. Zinger, R. D. H oge, J. Bonta, P. G endreau & F. T. Cullen. 1990b. “AHuman Science Approach or More Punishm ent and Pessimism: A Rejoinder to Lab and
Whitehead.” Criminology 28: 4 19-429.
Anglin, M. D. & Y. Hser. 1990. “Treatment of Drug Abuse.” Pp. 393-460 in Drugs and C rime,
edited by M. Tonry and J. Q. Wilson. Chicago,E: niversity of Chica go Press.
Anglin, M. D., D. Longshore, S . Turner, D. McB ride, J. Inciardi & M. Prendergast. 1996.Studies of the Functioning and Effectiveness of Treatment Alternatives to Street C rime (TA SC )
Programs: Final Report. Los Angeles, CA: UCLA Drug Abuse Research Center.
Bureau of Justice Statistics - Special Report. 2001. “Trends in State Parole, 1990-2000. NCJ184735. Washington, DC: U.S. Department of Justice.
Bureau of Justice Statistics. 2000. “ U S . Correctional Population Reaches 6.3 Million Men andWom en, Represents 3.1 Percent of the Adults U S . Population.” NCJ 183508. Wash ington, DC:
U.S. Department of Justice.
Bym e, J. M., A. Lurigio & C. Baird, 1989 . “The Effectiveness of the ‘New’ Intensive
Supervision Programs.” Research in Corrections 5: 1-70.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 51/57
0 Gendreau, P. 1996. “Offender Rehabilitation: W hat We Know and What Needs to Be Done.”
Criminal Justice and Behavior 23: 144-161.
Gerstein, D. R., R. A. Johnson , H. J. Harwoo d, D. Fountain, N. Suter & K. Malloy. 1994.Evaluating Recovery Services: The California Drug and Alcohol Treatment Assessm ent
( C M D A T A ) . Sacramento, CA: State of California, Health and Welfare Agency.
Gustafon, J. S . 1991. “Do Mo re and Do It Better: Staff Related Issues in the Drug Treatm ent
Field that A ffect Quality and Effectiveness of Services.” Pp. 53-62 in Zmproving Drug Abu se
Treatment,edited by R. W . Pickens, C. G . Leukefeld and C. R. Schuster. Rockville, MD:National Institute on Drug A buse Research Monograph Series, No. 106.
Harrell, A. & S . Cavanagh. 1996. Preliminary Resultsfr om the Evaluation of the D C Superior
Cour t Drug Intervention P rogram for Drug Felony Defendants. Washington, DC: National
Institute of Justice.
Harre ll, A., 0.Mitchell, A. Hirst, D. Marlowe& J.
Me rrill. 2002. “Breaking the Cycle of Drugsand Crime: Findings From the Birmingham BTC Demonstration.” Criminology & PubEic Policy
1(2): 189-215
Hubbard, R. L., M. E. Marsden, J. V. Rachal, H. J. Harwood, E. R. Cavanaugh & H. M.
Ginzburg. 1989. Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill, NC:University of North C arolina Press.
Kleiman, M. R. 1997. “Drug Free or Unfree: To Get Heavy Users to Stay Clean, Link Paroleand P robation to A bstinence.’’ Washington Post, February 2:C3.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 52/57
@Approaches to Drug Abuse Trea tment, edited by J. A. Inciardi, F. M. Tims and B. W. Fletcher.
Westport, CT: Greenwood Press.
Metja, C., P. J. Bokos, J. H. Mickenberg & E. M. Maslar. 1994 . “Case Man agement with
Intravenous Drug Users: Implementation Issues and Strategies.” Pp. 97-1 13 in Drug Abuse
Treatment: The Implementation of Innovative Approaches, edited by B . W. F letcher, J. A.
Inciardi and A. M. Horton. We stport, CT: Greenwoo d Press.
National Research Co uncil. 2002. ‘T reatm ent of Drug Users,” Pp. 8-3 in Informing Am erica’s
Policy on Illegal Drugs: Wh at We Don’t Know Keeps Hurting Us. Washington, D.C: National
Academy Press.
Parent, D., J. Bym e, V. T sarfaty, L. Valade & J. Esselman. 1995. Day Reporting Centers.
Washington, DC: National Institute of Justice.
Petersilia, J. & S . Turner. 1993. “Evaluating Intensive Supervision Pr ob ati of lar ol e: Results of
a Nationwide Experiment.” Research in Brie5 Washington, DC: Nation al Institute of Justice.
Peyton, E.A., & R. Gossw eiler. 2000. ‘Treatment Services in Adult Courts: Report on the 1999
National Drug Court Treatment Survey.” Office of N ational Drug C ourt Policy,U.S. Department of Justice, Wa shingto n, DC . NCJ 1822 93: p.1-8
Prendergast, M. L., M. D. Anglin & J. Wellisch. 1994. “Community-Based Treatment forSubstance-Abu sing Offenders: Principles and Practices of Effective Service Delivery.”Presentation at This W orks! Comm unity Sanctions and Services for Special Offenders: A
Research Conference. Internationa l Association of Resid ential and Comm unity Alterna tives.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 53/57
e Simpson, D.D., H.K. Wexler & J.A. Inciardi. 1999. “Drug Treatment Outcomes for CorrectionalSettings, Part 1.” The Prison Journal, 79(3), 291-293.
Taxman, F. S. 1997. Coordination, Collaboration, or Absolute Chaos: Mo ving From B rokerage
to Systemic Processes in Offender Drug Treatment Services. Unpublished Paper, College Park,
MD: Un iversity of Maryland, College Park.
Taxman , F.S. 1998. “Reducing Recidivism Through A Seam less System of Care: Com ponentsof Effective Treatment, Supervision, and Transition Services in the Comm unity.” College Park,
Maryland: Un iversity of Maryland, College Park.
i
Taxman, F. S . & J. Bouffard. 2000. “The Importance of Systems in Improving O ffender
Outcomes: New Frontiers in Treatm ent Integrity.” Justice Research and Policy, Z(2): 37-58.
Taxman, F. S . & J. M. Byme. 1994. “Locating Absconders: Results from a Randomized Field
Experiment.” Federal Probation 58: 13-23.
Taxman, F. S . & D.L. S pinner. 1997. “Jail Addiction Services (JAS) Dem onstration Project inMo ntgomery County, MD: Jail and Commun ity Based Substance Abuse Treatment Program
Mo del.” Rep ort, University of Maryland.
Thanner, M.T. & F. S. Taxman. 2002 (un der review). “The Multiple Career Paths of DrugOffenders.” Paper submitted to the Journal of Research and Delinquency.
Vish er, C. A. 1990 . “Incorporating Dru g Treatment in Criminal Sanctions.” NZJ Reports 221:
a
2-7.
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 54/57
Appendix haracteristics of the Sam ple Per Justification (1997) 0
?rinceWilliam
eounty
:% I
84313
Fairfax
County
(%)
532621
PG
County
( % o )
32
617
Montgomery
County
(%)
14
2858
Howard
County
27
1855
Charles
County
(% I
11
881
10
28
34150
1
16
20
319180
22
26
2
4
4
36280
Baltimore
County
531928
Loudoun
County
[% I
8848
4rlington
County
412039
WashingtonD.C. (%)
32
2939
0
1340
13
0
0
33
BaltimoreCity (%)
175726
PlexandriaCity (%)
452827
Previous
Treatment
YesNo
Unknown
Dru g of
Choice*
Alcohol
Crac k/Cocaine
HeroinMarijuana
PCPOther
Unknown
8
512
370
22
18
34
28141
1
5
3
23
1582
1
49
0
500
50
000
6
5010
20
3
10
7
0
00
0
0
0
100
0
0
0
0
0
0
100
21
57
140
0
0
7
0
0
0
0
0
0
100
0
73
714
0
0
7
Mode ofConsumption*
Injection
Smoking
OralInhalation
Other
Unknown
Freauency ofUse*
No past monthuse
1-3 times in past
month1-2 times in past
week
3-6 times in past
week
DailyUnknownNo t collected
-3
2
798
0
0
11
17
47183
105
533
530
49
7730
70
13
0
0
0
0
0
100
0
0
0
0
0
1000
0
0
0
0
0
100
0
0
0
0
0
100
0
14
2914290
14
0
0
0
0
21
3636
0
0
0
0
0
100
0
0
0
7
17
680
2446
9150
7
0
0
0
0
1000
0
7
63100
0
20
0
0
0
10
47330
27
130
130
47
0
0
10
10
28
450
32
22
6
3
8290
4
2
4
17
712
0
0
0
7
0
930
0
33
9
3
3
20
330
and do not necessarily reflect the official position or policies of the U.S. Department of Justice.been published by the Department. Opinions or points of view expressed are those of the author(s)This document is a research report submitted to the U.S. Department of Justice. This report has not
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 55/57
PROPERTY OFNational CriminalJustice Reference Service (NCJRS)Box 6000
and do not necessarily reflect the official position or policies of the U.S. Department of Justice.been published by the Department. Opinions or points of view expressed are those of the author(s)This document is a research report submitted to the U.S. Department of Justice. This report has not
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 56/57
8/14/2019 Evaluating the Implementation & Impact of a Seamless System of Care for Substance Abusing Offenders: The HIDTA Model
http://slidepdf.com/reader/full/evaluating-the-implementation-impact-of-a-seamless-system-of-care-for-substance 57/57
TREATMENTKRIMINAL JUSTICE FLOW CHART
SAMPLE SEAMLESS SYSTEM
Identify
Screen & SelectEligible Offenders-
Emergency
Criminal JusticeRisk Assessment
1 /. 3.
Assign Risk LevelDevelop
LEGEND
= Criminal Justice Function
= Treatment Function
= Shared Criminal Justice andTreatment Function
0
= Information Sharing
c
Adminster TreatmentDischargereatment