Taking Proven Interventions to Scale: State and National Perspective

1. Taking Proven Interventions to Scale: State and National Perspective Alexa Eggleston. J.D. Substance Abuse and Addiction Project Director Council of State Governments Justice Center National TASC Conference May 4, 2011

2. The Justice Center: Council of State Governments The center serves all states to promote effective data-driven practices�particularly in areas in which the criminal justice system intersects with other disciplines, such as public health�to provide practical solutions to public safety and cross-systems problems. National Reentry Resource Center Justice Reinvestment Consensus Project 2

3. Current Reforms Offer Unprecedented Opportunity for Treatment Expansion Size and cost of corrections system: 1 in 31 adults is under some form of correctional control. From 1987 to 2008, correctional spending grew 303 percent Bi-partisan interest in addressing costs and recidivism Passage of Affordable Care Act and Medicaid Expansion Increasing research and evidence-base about �what works� 3

4. Principles of EffectiveTreatment for Justice-Involved Drug addiction is a brain disease that affects behavior Requires effective treatment and management over time Treatment must last long enough to produce stable behavioral change Assessment is the first step in treatment Tailoring services to fit the needs Drug use should be carefully monitored Target factors that are associated with criminal behavior Supervision should incorporate treatment planning Continuity of care A balance of rewards and sanctions encourages pro-social behavior and treatment participation Co-occurring disorders often require an integrated treatment approach Medications Treatment planning should include strategies to address serious, chronic medical conditions 4

5. Principles of Recidivism Reduction Four Key �What Works� Principles: Focus on Individuals Most Likely to Reoffend Base Programs on Science and Ensure Quality Implement Effective Community Supervision Policies and Practices Apply Place-Based Strategies 5 What are implications of viewing these through lens of health care reform and opportunity it could bring to partner on expanding access to tx for justice involved individuals. What are implications of viewing these through lens of health care reform and opportunity it could bring to partner on expanding access to tx for justice involved individuals.

6. 1. Focus on Individuals Most Likely to Reoffend 6 Matching Supervision and Treatment to Risk and Need How do we adopt framework that triages people across their risk and need? Are there appropriate referral processes that can be put in place to address high risk/high need in corrections setting. Agonists, stimulates the central nervous system (CNS) in the same manner as illegal drugs. For example, methadone is itself an opiate that works similarly to illicit opiates, such as heroin. Buprenorphine, has what are called partial agonist properties because it does not stimulate the CNS to the same degree. Antagonist medications work very differently from agonist medications, in that they do not stimulate the CNS in the same manner as illicit drugs. Rather, they block the effects of illicit drugs while providing no intoxication of their own. For example, a drug called naltrexone binds to opiate receptors in the brain and prevents opiates from getting through to those nerve cells. As a result, the individual can not get high on opiates.Matching Supervision and Treatment to Risk and Need How do we adopt framework that triages people across their risk and need? Are there appropriate referral processes that can be put in place to address high risk/high need in corrections setting. Agonists, stimulates the central nervous system (CNS) in the same manner as illegal drugs. For example, methadone is itself an opiate that works similarly to illicit opiates, such as heroin. Buprenorphine, has what are called partial agonist properties because it does not stimulate the CNS to the same degree. Antagonist medications work very differently from agonist medications, in that they do not stimulate the CNS in the same manner as illicit drugs. Rather, they block the effects of illicit drugs while providing no intoxication of their own. For example, a drug called naltrexone binds to opiate receptors in the brain and prevents opiates from getting through to those nerve cells. As a result, the individual can not get high on opiates.

7. 2. Base Programs on Science and Ensure Quality 7 1st arrow � 6 studies 2nd � 25 studies 3rd � 23 studies 4th � 11 studies1st arrow � 6 studies 2nd � 25 studies 3rd � 23 studies 4th � 11 studies

8. 3. Implement Effective Community Supervision Policies and Practices 8

9. 4. Place-based Strategies Research demonstrates the importance of providing community-based services nearby. 9 Clients who traveled less than 1 mile were 50% more likely to complete treatment than clients who traveled more than 1 mile, after holding constant demographic variables and type of drug problem. Similarly, clients who traveled more than 4 miles were significantly more likely to have a shorter length of stay than clients who traveled less than 1 mile. The greatest reductions in recidivism often occur in programs that are based in the community, not programs based in institutions. Clients who traveled less than 1 mile were 50% more likely to complete treatment than clients who traveled more than 1 mile, after holding constant demographic variables and type of drug problem. Similarly, clients who traveled more than 4 miles were significantly more likely to have a shorter length of stay than clients who traveled less than 1 mile. The greatest reductions in recidivism often occur in programs that are based in the community, not programs based in institutions.

10. A State Approach to Take Interventions to Scale: Justice Reinvestment Analyze state-level data and develop policy options Adopt new policies and put reinvestment strategies into place Measure performance 10 New States coming online soon. New States coming online soon.

11. Texas: Improved Public Safety at Reduced Costs 11 Bottom Line Outcomes: Improved Public Safety at Reduced Costs More Texas Residents but Lower Crime Rate No Growth in Prison Population Increased Diversions to Community Punishments More Probationers but No Increase in Failure Rate More Parole Releases but Fewer FailuresBottom Line Outcomes: Improved Public Safety at Reduced Costs More Texas Residents but Lower Crime Rate No Growth in Prison Population Increased Diversions to Community Punishments More Probationers but No Increase in Failure Rate More Parole Releases but Fewer Failures

12. A National Approach: Second Chance Act 12 First, for those of you who don�t know NRRC�First, for those of you who don�t know NRRC�

13. Second Chance Act Emphasis State and local communities Recidivism reduction Use of risk and need assessments to prioritize services for those most in need Data collection Outcomes and measuring performance Treatment for individuals with co-occurring substance use and mental health disorders and parents with substance use disorders 13

14. Second Chance Act 2010 Grantees 14 And as most of you know these are grant programs we provide TA to CR � $100 for now Pres Budget for 12 asked for $100 for SCAAnd as most of you know these are grant programs we provide TA to CR � $100 for now Pres Budget for 12 asked for $100 for SCA

15. In Summary: Current interest in criminal justice and health reform is unprecedented and provides unique opportunity Increasing emphasis will be placed on demonstrating outcomes and ensuring dollars are being well spent. Opportunities exist on local, state and federal level to implement best practices. 15

16. Thank you! Alexa Eggleston, J.D. Substance Abuse and Addiction Project Director Council of State Governments Justice Center aeggleston@csg.org www.nationalreentryresourcecenter.org www.justicereinvestment.org www.consensusproject.org 16