Criminal Justice Drug Abuse Treatment Studies

1. Criminal Justice Drug Abuse Treatment Studies A National Network for the Study of Drug Abuse Services for Offenders NIDA Natl. Developmental Res. Inst. (2) CT DMHAS Lifespan Hospitals/Brown/RIDOC Texas Christian U. U. of Cal., Los Angeles U. of Delaware U. of Kentucky U. of MD, College Park U. Miami

2. Vision To improve outcomes for offenders with substance-use disorders by improving the integration of drug abuse treatment within public safety and public health systems.

3. CJ-DATSCooperative Mission • Establish a national research network to test different integrated system-level drug abuse treatment models for the criminal justice-involved population. • Facilitate knowledge development about drug treatment services that can improve offender outcomes.

4. How Will CJ-DATS Provide the Answers? • Conduct rigorous scientific studies of offender populations across multiple settings including jails, prisons, and in the community. • Use multi-site studies to increase knowledge about feasible evidence-based practices. • Develop and test research-based systems-level models that integrate public health and public safety approaches.

5. CJ-DATS Center Sites Nine National Research Centers & a Coordinating Center Criminal Justice and Correctional Systems across the United States Surveys Utilization Research Dissemination Program Evaluations

6. Organizational Structure for CJ-DATS

7. Other CJ-DATS Projects • National CJ Practices Survey • Performance Indicators for Corrections (PIC) • Inmate Pre-Release Assessment (IPASS) • Co-Occurring Disorders Screening Instrument • Targeted Interventions for Corrections (TIC) • Step’n Out: Collaborative Behavioral Management • Three Re-Entry Strategies for Drug-Abusing Juvenile Offenders • Adolescent Offenders' Reintegration from Juvenile Detention to Community Life • HIV/Hepatitis Prevention Study

8. Michael Prendergast: Add slides: Need for study (Importance of aftercare But poor participation) Strengths case management: rationale and principles CJ-DATSTransitional Case Management Study Supported by NIDA Grant U01DA16211

9. Participating Centers • Pacific Coast Research Center (Lead) • Integrated Substance Abuse Programs, UCLA • Michael Prendergast, Principal Investigator • Central States Research Center • Center on Alcohol and Drug Research, University of Kentucky • Carl Leukefeld, Principal Investigator • Connecticut Research Center • Connecticut Department of Mental Health and Addiction Services • Linda Frisman, Principal Investigator • Mid-Atlantic Research Center • Center for Drug and Alcohol Studies, University of Delaware • James Inciardi, Principal Investigator • Rocky Mountain Research Center • National Development and Research Institutes, Inc. • Harry Wexler, Principal Investigator • National Institute on Drug Abuse • Bennett Fletcher, Collaborative Scientist

10. Rationale • Community treatment following prison treatment improves outcomes. • But many parolees do not follow up on referrals to community, even when mandated. • Parolees entering treatment tend to have poor retention. • Improving treatment participation by parolees involves addressing • motivation • self-efficacy • information • needs and goals • social support

11. Specific Aims of TCM Study • Primary Aims • 1. (Client) Assess whether the TCM intervention increases enrollment and retention in community treatment. • 2. (Systems) Assess whether the TCM intervention changes patterns of collaboration among correctional and treatment staff.

12. Specific Aims of TCM Study Secondary Aims 3. (Client) Asses whether the TCM intervention increases access to needed community services. 4. (Client) Assess whether the TCM intervention reduces drug relapse and recidivism. 5. (System) Assess economic issues related to the TCM intervention.

13. Principles of Strengths Case Management 1. Focus on the strengths, not pathology or deficits. 2.  Strong bond between case manager and client. 3.  Needs and goals determined by the client. 4.  Aggressive outreach by case manager. 5.  Case manager assists ability to learn, grow, and change. 6.  Community as a source for formal and informal resources and services.

14. Rationale for Selecting Strengths Case Management • Effectiveness for drug-abuse clients has been shown in two major NIDA-funded studies (Hall; Siegal) • Manuals available • Case manager assumes an active role in assisting the client in early months on parole • Focus on strengths, assets, accomplishments, and goal seeking • Fosters self-sufficiency; discourages dependency • Use of para-professionals

15. Michael Prendergast: Need a better figure; include role of case manager Intervention Overview Strengths Assessment Case Conference Call Strengths Case Management Community Institution

16. Strengths Assessment: Objectives • Increase motivation for entering and participating in community treatment • Identify strengths, assets, and resources • Identify and prioritize goals and community re-entry needs • Initiate a relationship between client and case manager

17. Strengths Assessment: Procedures • Conducted about 2 months before release • Includes client and case manager • Complete Strengths Assessment • 60 minutes • Identify likely participants in case conference call

18. Case Conference Call: Objectives • Increase motivation for entering and participating in community treatment • Confirm information about the program to which the inmate has been referred • Discuss discharge plans for parole generally and treatment specifically • Review expectations and responsibilities of the parolee and transition team members

19. Case Conference Call: Procedures • Conducted about 1 month before release • Includes client, treatment counselor, case manager, parole agent, community provider, family members, others • 30 minutes • Based on community treatment referral, strengths assessment, and discharge plan

20. Strengths Case Management:Objectives • Increase motivation for entering and participating in community treatment • Assist client to use strengths and resources to achieve goals • Reduce barriers to access • Advocate for client

21. Strengths-Based Case Management:Institutional Procedures Case Manager: • “Reaches in” to make contact with client 2-3 months prior to discharge • Assists client in conducting strengths assessment and goal setting • Coordinates case conference call • Encourages client to enter community treatment

22. Strengths-Based Case Management:Community Procedures Case Manager: • Meets weekly with client for 3 months; monthly calls for 3 more months • Assists client to access resources, using his/her strengths and resources to support recovery: • Advocates for client • Provides linkage information • Provides direct support (e.g., accompany client to appointment) • Encourages continued treatment participation

23. Michael Prendergast: “Standard Referral”: Need better term Study Design • Standard Referral vs. Transitional Case Management • Randomized in institution • Sample size: 200 per site; 25% women • Video shown to all participants prior to release • Client interviews at baseline and at 3 and 9 months following release • Program and system impact assessment • Economic analysis

24. Client Eligibility Criteria: Inclusion • Adult inmates (in prison or confined facility) • Have a referral a community-based treatment program • Within 2-3 months of release • Released to the jurisdiction within which transitional case manager operates • Consent to participate in the study (including records review)

25. Client Eligibility Criteria: Exclusion • Inmate referred to community services with case management • Inability to provide informed consent • Registered sex offender • Parole requirements that prevent participation

26. Sources of Data • Client interviews • Staff interviews/questionnaires • Case manager logs • Program records • Criminal justice records

27. Client-Level Measures: Baseline • Demographics • Drug use and treatment history • Criminal history • HIV risk behaviors • Psychological status • Cognitive assessment (motivation, readiness, perceived coercion, self-efficacy)

28. Client-Level Measures: Outcomes • Short-term • Admission • Time to admission • Length of stay • Discharge status • Services received • Long-term • Crime • Drug use • Employment • Psychological status

29. Instrument Baseline 9 Months Post-Release Baseline and Follow-up Instruments/ Measures: Client Level Drug Test Results Treatment Participation (from treatment programs) * Shortened version of Intake ^ Selected items 3 Months Post-Release CJ-DATS Intake and Follow-up Form X X* X* Drug Dependence Assessment X X Lifetime Criminality Screening Form X Brief Symptom Inventory X X Client Evaluation of Self at Intake X X^ Progress Evaluation Scale X X Services Received Form X X Client Satisfaction Questionnaire X X X X Rearrest, Reincarceration (from CJS records) X

30. Design Issues for Multi-Site Study • Variation in intervention protocol • Variation in nature of standard referral • Variation in site of subject recruitment • Variation in referral status (voluntary vs. mandated) • Variation in location of case manager • Departures from protocol during implementation • Identification of “active” ingredients of protocol

31. Project Timeline

32. Hypotheses 1 (Client). To assess whether TCM increases the likelihood that offenders leaving prison (or other supervised setting) with a community treatment referral enroll in treatment soon after release and successfully complete treatment. 1. A larger percentage of participants in the TCM group will enroll in community treatment and other services than will those in the Standard Referral group. 2. Participants in the TCM group will enroll in treatment sooner than will those in the Standard Referral group. 3. Participants in the TCM group will stay in treatment longer than will those in the Standard Referral group. 4. A larger percentage of participants in the TCM group will have a successful treatment discharge than will those in the Standard Referral group.

33. Hypotheses 2 (Systems). To assess whether TCM increases the likelihood that treatment, criminal justice, and community services agency staff change their patterns of contact and collaboration in order to more effectively address the needs of offenders who re-enter local communities. 5. Over time, the TCM intervention will improve the transition process, as carried out by prison and community correctional staff, for substance-abusing offenders released to their communities. 6. Over time, the TCM intervention will increase the level of collaboration between treatment and criminal justice personnel both in the case manager-facilitated transitional planning phase and in later contacts with clients in community.

34. Hypotheses 3 (Client). To assess whether TCM increases access to needed community services by recently release parolees. 7. Participants in the TCM group will be more likely than will those in the Standard Referral group to obtain and utilize appropriate services for needs other than drug abuse problems. 8. Participants in the TCM group will be more likely than those in the Standard Referral group to obtain and utilize appropriate services on their own after the end of case management.

35. Hypotheses 4 (Client). To assess whether TCM reduces drug relapse and recidivism. 9. A smaller percentage of participants in the TCM group than those in the Standard Referral group will have used illicit drugs. 10. Participants in the TCM group will report lower recidivism than those in the Standard Referral group.

36. Hypotheses 5 (System). To assess economic issues related to TCM. 11. The TCM intervention will achieve its primary client-level aims at a favorable benefit-cost ratio.

37. bhall: How is data going to be collected on the systems questions? Qualitatively? System-Level Questions • Has communication improved between criminal justice and treatment staff? • Which services were clients referred to, and which did they actually participate in? • Was the intervention able to remove barriers to receipt of services? • Do study sites plan to continue using the TCM protocol after the end of the study? • What is the cost effectiveness of the TCM protocol?

38. That’s All. Questions? CJ-DATS Website: www.cjdats.org UCLA Website: www.uclapcrc.org