Post on 14-Dec-2015
Integrating Risk/Needs Assessment Into Drug
Court
Judge Shanta OwensJefferson County Drug Court
Tenth Judicial CircuitBirmingham, AL
Develop understanding of the Risk and Need Principle
Develop understanding of the effective use of ARAS in Drug Court
Develop an understanding of Integrating the Risk/Needs Assessment into Drug court
OBJECTIVES
Presiding Judge, Jefferson County Drug Court Birmingham Division
Drug Court Judge since 2009
Prior Experience
My Bio
338 Active Participants 6 Case Managers Drug Court Team
◦ Judge◦ Case Managers◦ Program Administrator◦ Treatment Coordinator◦ Law Enforcement Officer◦ Peer Specialist◦ Job Placement Program Coordinator◦ Medical Provider◦ Defense Attorneys
Jefferson County Drug Court
Prior to March 2013
Jefferson County Drug Court
What Do We All Know About Drug Court?
Drug Court Works!
Drug Court is a scarce and precious resource that
should be used in a manner that maximizes its benefits to participants and society
in general
We Also Know…
Risk/Needs Assessment
Jefferson County Drug Court
Comprehensive Review of Information related to Substance Use Disorders and Risk for Recidivism. Can examine both psychosocial functioning and risk factors (Risk Assessment)
What Is An Assessment?
RISK AND NEED PRINCIPLE
According to what are known as the Risk Principle and the Need Principle, the most effective and cost-efficient
outcomes are achieved when treatment and supervision services are tailored to
the (1)Prognostic Risk Level and (2) Criminogenic Needs of the Participants
(Andrew & Bonta, 2010; Taxman & Marlowe, 2006)
Characteristics of offenders that predict relatively poorer outcomes in standard rehabilitation programs
Prognostic Risk
Younger age during treatment (especially < 25) Male Gender Early onset of substance abuse or delinquency Prior Felony Convictions Previously unsuccessful treatment attempts Co-Existing Diagnosis of antisocial personality
disorder Familial History of Crime or Addiction Regular Contacts with antisocial or drug-using
peers or associates
Risk Factors
(Marlowe, 2003)
Clinical disorders or functional Impairments that, if treated, significantly reduce the likelihood of future involvement in crime
Criminogenic Needs
Diagnosis of substance dependence or addiction
Major Mental Illness Lack of basic employment skills/poor
employment history Lack of daily living skills Lack of education Collateral Needs
◦ Dual Diagnosis◦ Chronic Medical Conditions (ex. HIV, Diabetes, HCV)
Needs
Belenko, 2006; Simpson & Knight, 2007
Prognostic Risk and Criminogenic Need indicate what level of treatment and supervision are likely to be required to manage an offender, and what consequences should ensue for new instances of alcohol or drug use
Most intensive treatment should be reserved for Higher Risk offenders
Must survey important Risk Factors to produce an accurate measure of Risk
What does Risk Indicate?◦ Level of Supervision
RISK PRINCIPLE
Interventions must be very focused and target the Needs that are related to Risk
Stabilize the Client first. Then, start to treat the addiction
Need Principle
Higher Risk = More Intensive Supervision Services
Higher Need = More Intensive Treatment Services
High Risk/High Need = Typically Require full array of Treatment and Supervision services embodied in 10 Key Components of Drug Court
Low Risk = Less Intensive Supervision Services
Low Need = Less Intensive Treatment Services
Low Risk/Low Need = Typically do not require the full menu of services specified in the 10 Key Components of Drug Court
Providing too much treatment or too much supervision is not merely a potential waste of scarce resources. It can increase crime or substance abuse by exposing individuals to more seriously impaired or antisocial peers, or by interfering with their engagement in productive activities such as work, school, or parenting.
(Lowenkamp & Latessa, 2004; McCord, 2003)
Low Risk Offenders RECIDIVATE at higher rates when placed in residential interventions and/or intensive supervision
High Risk Offenders respond BETTER when placed in a residential intervention and/or intensive supervision
RISK
So…What Did We Do in Our Program?
Jefferson County Drug Court
We figured out DOSAGE MATTERS
Started using ARAS (Alabama Risk Assessment System)
◦Adopted from ORAS (Ohio Risk Assessment System)
Length of time in Drug Court now based on Clients Risk and their Level of Needs
4 Drug Court Tracks with different Requirements and Phases
RISK What level of
supervision services
NEED What level of
treatment services
Where Does the Client Fall ?
Alabama Risk Assessment System
(ARAS)Jefferson County Drug Court
Assessment is done on every client accepted into Drug Court
Time: Approximately 2 hours per client Completed by Case Managers Plea is Taken on Thursday ARAS is scheduled a few days later Based upon score, clients are placed in
Track 1, 2, 3, or 4
Alabama Risk Assessment System
Criminal History Education, Employment, and Finances Family and Social Support Neighborhood Problems Substance Abuse Peer Associations Criminal Attitudes and Behavioral Problems Mental Health Screening Form
ARAS Consists Of:
Overall score does not matter as much as the scores in the individual domains
Moderate to High Score in Substance Abuse, Formal Treatment is required. Therefore, client will be Track 2 or 4, depending on scores in other domains.
Tracks 1 and 3 are clients who do not score Moderate or High in Substance Abuse
ARAS Score
TRACK 4High Risk, High Need12 Months
TRACK 2Low Risk, High Need6 Months
TRACK 3High Risk, Low Need9 Months
TRACK 1Low Risk, Low Need3 Months
Dependent on alcohol or drugs At Risk for failure in standard correctional rehabilitation
programs◦ Using drugs or committing crimes at early age◦ Failed previously in less intensive dispositions◦ Possible diagnosis of antisocial personality disorder
Need all services embodied in the 10 Key Components◦ Should Appear Frequently in Court: No less than Biweekly for
the first few months until stable interval of sobriety or engaged in treatment
◦ Our clients appear Weekly in Phase 1, Biweekly in Phase 2, Monthly in Phase 3, and Noncompliance Calendar in Phase 4
◦ Formal Treatment is Required
High Risk/High Need
Need interventions that focus on remediating “criminal thinking” patterns
Minimum dosage of 200 hours of cognitive behavior services ◦ Lack inclination to engage in productive activities
such as work, school, or parenting◦ Do not attach importance to the assumption of
responsible roles ◦ Endorse antisocial attitudes and values
High Risk/High Need (cont’d)
Deficient in adaptive life skills, such as employability, education, financial management, and homemaking
Adaptive habilitation services are often required to teach vocational skills, address educational deficits, improve daily living skills, and model effective interpersonal problem-solving strategies
High Risk/High Need (cont’d)
Deficient in adaptive life skills, such as employability, education, financial management, and homemaking
Adaptive habilitation services are often required to teach vocational skills, address educational deficits, improve daily living skills, and model effective interpersonal problem-solving strategies
High Risk/High Need (cont’d)
Compliance with the conditions of supervision and treatment is the primary goal
Abstinence is a more difficult goal
The use of appropriately prescribed medications by a qualified addiction psychiatrist constitutes an evidence-based practice for addicted offenders and should be available in appropriate cases (National Institute on Drug Abuse, 2006).
High Risk/High Need (cont’d)
Dependent on drugs or alcohol Do not have substantial prognostic risk factors
that would predict failure in standard Primary focus for this group is Treatment
services Do not require frequent supervision on status
calendar◦ Monthly judicial hearings and then noncompliance
calendar in Phase 2◦ Rather than appear in court interacting with high-risk
antisocial peers, they should focus their energy on Treatment
Low Risk/High Need
Formal Substance Abuse Treatment Required◦ However, research suggests that low-risk
individuals should not be treated in the same groups as high-risk individuals because they may adopt antisocial attitudes or values (Lowenkamp & Latessa, 2004).
Adaptive Habilitation services may be required such as vocational or educational assistance, family therapy, or mental health counseling.
Low Risk/High Need (cont’d)
Consequences should be focused on Treatment◦ Abstinence is still a difficult goal
Use of appropriately prescribed medications by a qualified addiction psychiatrist may be indicated for some addicted offenders
Low Risk/High Need (cont’d)
Non-Dependent substance abusers But have substantial Risk Factors for failure on
standard supervision Emphasis should be on closely monitoring their
behavior, holding them accountable for their conduct, and teaching them pro-social life skills
Should appear in court on a status calendar for judge to review progress◦ Weekly judicial hearings◦ Because they are at risk for failing to comply with
standard supervision requirements
High Risk/Low Need
Better suited for Early Intervention classes that teach about the dangers of drugs and alcohol and activity-scheduling exercises that re-orient their daily activities away from drug-related peers and events
Because High Risk, 200 hours of cognitive behavioral services may be needed to reduce criminal activity
Focus consequences on Abstinence and Supervision
High Risk/Low Need (cont’d)
Unnecessary to expend substantial resources on this group because they have a low probability of recidivism
Noncompliance Calendar Prevention Services such as Early Intervention
classes on an individual basis or in separately stratified groups
Drug and alcohol use are under their voluntary control
Important that this group is NOT mixed with high risk offenders or that they spend lots of time in court
Low Risk/Low Need
Jefferson County Drug Court
Better understanding of client’s circumstances and what level care is needed to treat him/her
You do not want to mix occasional pot smoker with hardcore IV drug user in treatment
Want to use resources wisely and treat the right people◦ Ex: Low Risk, Low Need folk don’t need inpatient
treatment. Without an assessment, this would be a waste of resources
ARAS IS IMPORTANT BECUASE
How Do You Get Reliable Information?
Jefferson County Drug Court
Goal: Information Gathering Environment should be conducive to disclosure
of information Purpose of Assessment should be explained Client should be alone Interviewer should be Patient, Open-Minded, and
Attentive Interviewer should exhibit good listening skills Open-Ended Questions Avoid Close-Ended, Biased, Double-Barreled
questions
ARAS INTERVIEW
Dealing with Inconsistencies◦ Use collateral info/resources◦ Lightly challenge inconsistent info
Dealing with Oppositional Behavior◦ Offer Choices◦ Offer a Break◦ Redirect
The Challenging Interview
QUESTIONS?