INTERVENING WITH SUBSTANCE USING MEN NEWLY RELEASED FROM JAIL CHALLENGES AND STRATEGIES

1. INTERVENING WITH SUBSTANCE USING MEN NEWLY RELEASED FROM JAIL CHALLENGES AND STRATEGIES Charles Sperling, MS, NCAC-II 1 Antonya Pierce, MPH, CHES 1 Tricia Hall, MPH 1 James Tomlin 1 Samantha P. Williams,Ph.D 2 STAND, Inc.1 Centers for Disease Control and Prevention 2

2. Background • There is considerable evidence regarding association between criminal activity and substance use. • An estimated 7 in 10 local inmates had used drugs regularly or had committed a drug offense (BJS, 2000). • Two-thirds of convicted jail inmates were actively involved with drugs prior to jail admission (BJS, 2000). • 55% of convicted jail inmates were using drugs in the month before the offense; 36% at the time of the offense (BJS, 2000) • Substance use and related activities are likely to continue once the inmate is released and previous behaviors and/or activities are resumed.

3. Background • Consequences of behavioral risk increases with multiple risk: • Substance use  Negative outcomes • sexual risk  such as • criminal activities  STDs • Data suggest that prisoners are a high risk population immediately prior to incarceration (an average of three sexual partners in the 30 days prior to detention with 59% of men indicating a female partner at high risk for STDs) as well as upon release. • Contributors to sexual risk include drug use, which is heavily linked to arrests in approximately 1/3 of parolees and probationers in Georgia • Given the co-morbidity of these factors, an intervention to reduce STD acquisition and transmission, prior to or upon post release would seem the best strategy for improving sexual health in this population.

4. Background • Goal • Describe challenges and strategies of working with substance using men newly release from jail • Context - MISTERS Project • Multi-session, group intervention study with an intent to reduce sexual risk behaviors in men newly released from jail.

5. Suggestions • Speakers’ time: 10-20 mins each • Question/Answer: At end of presentations • Address questions to individual speaker or panel • Enjoy!

6. In the Beginning….. Charles Sperling Principal Investigator - MISTERS Project Executive Director - STAND, Inc.

7. OVERVIEW • Collaboration • Intervening • Intellectual Village • Study Foundation

8. COLLABORATION • Scientists & Community Based Organizations • Challenging • Necessary for effective program development • Key Collaborators • Creates a tangible synergistic effect • Positive outcomes for our participants • Intellectual Village

9. INTERVENING(Research vs. Program) • The development and delivery of efficacious research initiatives require several critical considerations • Avoiding an impasse • Examining ethical constructs • Making research useful to program strategist • MISTERS Project is an illustration of bridging the gap between research and programs • Opportunity to gather and synthesize data specific to this population • Establishes credibility

10. INTERVENING(Research vs. Program) • Benefits • Cross Disciplinary participation enhances researchers opportunity to gain access • Creates an intellectual village • Impetus for sound program development • Environment where researchers and program staff can examine their ethical constructs

11. INTERVENING(Research vs. Program) • Challenges • Bureaucracy • Flexibility • Funding

12. Study Foundation • Logistics • Consultants • Availability of Technical Assistance • Staff Competencies

13. ASSESSMENT Tricia Hall Interview Coordinator

14. SCREENING PROCESS • Sign In Sheet How he heard about the project • Screener Between 18 and 60 Sexually Active Substance Use Read English Hour Availability Atlanta Availability No Sexual Offense HIV Negative

15. Eligible Participants • Informed Consent Form Reason for the study What will be required Benefits Risks/Discomforts Confidentiality • Release of Information Form Authorizes the release of STD results • Locator Form

16. QUESTIONNAIRE Demographic Information Ethnicity Relationship Status Housing Arrangements Education Work status Knowledge STDs Anger Management Skills

17. QUESTIONNAIRE History Incarceration History Substance Use History STD History Sex Partners Number Gender Behaviors

18. QUESTIONNAIRE Associated Factors Perceived Risk Social Networks Vaginal, anal, oral sex behaviors Condom Use & STD Incidence Substance Use Health Care Seeking Behaviors

19. CONDOM SKILL ASSESSMENTS Demo of condom skills • Condom Selection Latex vs. lambskin Not expired vs. Expired • Open package • Roll on outside • Hold the tip • Unroll to base pf penis • When to remove penis • Type of Lubrication Oil vs. Water base • How many times can use one condom

20. COMMUNICATION SKILL ASSESSMENTS Role plays Listening Actively Speaks about himself States Feelings Specific Needs

21. RANDOMIZATION • Colored ball selection - Intervention group - Control group • Groups are separated - What is required - Intervention begins that night

22. BIOLOGICAL SPECIMENS Urine Chlamydia & Gonorrhea Blood Syphilis & HIV

23. ASSESSMENT SCHEDULE

24. RECRUITMENT & INTERVENTION James C. Tomlin Intervention Coordinator

25. RECRUITMENT STRATEGIES • In Jail Presentation (3x per week) • IRB approved script • STAND, Inc. Services • Walk-ins and word of mouth by participants • Flyers, business cards, and other materials • Expanding, to other Locations

26. INTERVENTION DEVELOPMENT • Theory – Based (Fisher & Fisher,1992) • Motivation & Behavioral Skills • Piloted Focus Groups • Target population sample

27. INTERVENTION SESSION Ice Breaker Five Nightly Session Two Hours Days of Week Closure

28. INTERVENTION SESSIONS Session 1: STD Knowledge Session 2: Condom & Negotiation Skills Session 3: Avoiding triggers for drug use Session 4: Anger Management Session 5: Life Skills/Community Resources

29. QUALITY ASSURANCES Evaluator Manual Facilitators Feedback

30. MISTERS GROUP CHALLENGES • Substance use • Relationship Issues • Family Issues • Probation/Parole • Work Schedules • Weather

31. RETENTION SUGGESTIONS / RECOMMENDATONS FOR FUTURE RESEARCH Antonya Pierce MISTERS Project Coordinator

32. RETENTION “First Impression = Lasting Impression” Personable Service Locator Form Baseline Randomization Follow Up

33. TRACKERS DIS Trained 15+ years combined experience Familiar with population and city Face to face recognition Follow up throughout 6 months

34. PROJECT ADHERENCE Housing Employment Physical Legal Recidivism Children / Partners Substance Use

35. Maslow’s Theory Self- actualization Esteem Social Safety Physiological Hierarchy of Needs

36. SUGGESTIONS & RECOMMENDATIONS Recruitment Partnerships Intervention Retention

37. ADDITIONAL INFORMATION • Recruiting and Retaining Substance Using Men Newly Released from Jail: Challenges of the MISTERS STD Intervention (P141) • Examining Risk Perceptions of STDs including HIV/AIDS in African American Men Newly Released from Jail (P051)

38. ACKNOWLEDGEMENTS Centers for Disease Control & Prevention DeKalb County Health Department DeKalb County Jail Georgia Dept. Human Resources, Division of Sexually Transmitted Diseases