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 KentuckyU. of MD, College Park U. Miami

04/18/23

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

VisionVision

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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.

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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.

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CJ-DATS Center Sites

Nine National Research Centers & a Coordinating Center

Criminal Justice and Correctional Systems across the United States

Surveys UtilizationResearch Dissemination

Program Evaluations

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Organizational Structure for CJ-DATS

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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

CJ-DATSTransitional Case Management Study

Michael Prendergast:

Add slides:

Need for study

(Importance of aftercare

But poor participation)

Strengths case management: rationale and principles

Michael Prendergast:

Add slides:

Need for study

(Importance of aftercare

But poor participation)

Strengths case management: rationale and principles

Supported by NIDA Grant U01DA16211

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Participating Centers

Pacific Coast Research Center (Lead)Integrated Substance Abuse Programs, UCLA

Michael Prendergast, Principal Investigator 

Central States Research CenterCenter on Alcohol and Drug Research, University of Kentucky

Carl Leukefeld, Principal Investigator 

Connecticut Research CenterConnecticut Department of Mental Health and Addiction Services

Linda Frisman, Principal Investigator 

Mid-Atlantic Research CenterCenter for Drug and Alcohol Studies, University of Delaware

James Inciardi, Principal Investigator 

Rocky Mountain Research CenterNational Development and Research Institutes, Inc.

Harry Wexler, Principal Investigator

National Institute on Drug AbuseBennett Fletcher, Collaborative Scientist

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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

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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.

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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.

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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.

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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

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Intervention Overview

Strengths

Assessment

Institution Community

Michael Prendergast:

Need a better figure; include

role of case manager

Michael Prendergast:

Need a better figure; include

role of case manager

Case Conference Call

Strengths

Case Management

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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

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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

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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

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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

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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

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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

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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

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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

Michael Prendergast:

“Standard Referral”: Need

better term

Michael Prendergast:

“Standard Referral”: Need

better term

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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)

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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

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Sources of Data

• Client interviews

• Staff interviews/questionnaires

• Case manager logs

• Program records

• Criminal justice records

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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)

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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

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Baseline and Follow-up Instruments/ Measures: Client Level

Instrument Baseline9 Months

Post-Release

 

   

 

 

 

 

   

Drug Test Results 

Treatment Participation (from treatment programs)  

   

       

* Shortened version of Intake^ Selected items

     

Rearrest, Reincarceration (from CJS records)

Client Satisfaction Questionnaire

Services Received Form

Progress Evaluation Scale

Client Evaluation of Self at Intake

Brief Symptom Inventory

Lifetime Criminality Screening Form

Drug Dependence Assessment

CJ-DATS Intake and Follow-up Form X*

3 Months Post-Release

X*X

X

X

X

X

X X

X

X

X

X

X

X

X

X

X

X^

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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

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1 2 3 4 1 2 3 4 1 2 3 4 1 2

Study Component

Protocol Devel./ApprovalsStaff Hiring/TraningSite Develop./Set-upStudy RecruitmentStrengths AssesssmentCase Conference CallsCommunity Case MangementConference Calls/Site Visits3-Month Follow-upTreatment Participation Data9-Month Follow-upReturn to Custody DataData CleaningPreliminary AnalysesFinal Analyses

Year 1 Year 2 Year 3 Year 4

Project Timeline

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Hypotheses1 (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.

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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.

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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.

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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.

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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.

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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?

bhall: How is data going to be collected on the

systems questions?

Qualitatively?

bhall: How is data going to be collected on the

systems questions?

Qualitatively?

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That’s All.

Questions?

CJ-DATS Website: www.cjdats.orgUCLA Website: www.uclapcrc.org