Christine Grella, Ph.D.UCLA Integrated Substance Abuse Programs

American Society of Criminology Los Angeles, CA

November 1, 2006

Funded by Contract No. C98.316 with Office of Substance Abuse Programs/California Department of Corrections & Rehabilitation

Predictors of Return to Prison Predictors of Return to Prison Following Participation in a Re-entry Following Participation in a Re-entry

Program for Substance-Abusing Program for Substance-Abusing Women OffendersWomen Offenders

BackgroundBackground

Increase in incarceration of women Increase in incarceration of women for drug-related crimesfor drug-related crimes

Women offenders have greater Women offenders have greater needs for parenting, mental health, needs for parenting, mental health, and trauma-related servicesand trauma-related services

Development and evaluation of in-Development and evaluation of in-prison and re-entry programs for prison and re-entry programs for women offenders in Californiawomen offenders in California

California Inmate Population California Inmate Population by Gender, 1985 - 2005by Gender, 1985 - 2005

150,000

100,000

50,000

10,000

8,000

6,000

4,000

2,000

47,205

156,573

2,906

11,462

1985 2005 1985 2005Males Females

No. of inmates

Source: CDCR (2006). Historical Trends 1985-2005.

3.3 increase

3.9 increase

Proportion of Offenders in Proportion of Offenders in California Incarcerated for Drug-California Incarcerated for Drug-

Related Offenses by Gender, 1985-Related Offenses by Gender, 1985-20052005

0

10

20

30

40

50

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Pe

rce

nt

Source: CDCR (2006). Historical Trends 1985-2005. SACPA

Females

Males

50

40

30

20

10

0

Growth in the U.S. Female Growth in the U.S. Female Prison Population, 1977-2004Prison Population, 1977-2004

Source: Institute on Women & Criminal Justice, 2006

Research QuestionsResearch Questions

What are correlates of treatment needs What are correlates of treatment needs among substance-abusing women among substance-abusing women offenders prior to their re-entry?offenders prior to their re-entry?

Do treatment needs predict completion of Do treatment needs predict completion of community-based re-entry treatment?community-based re-entry treatment?

Do treatment needs and completion of re-Do treatment needs and completion of re-entry treatment predict return-to-prison?entry treatment predict return-to-prison?

Study DesignStudy Design Participants (N = 1,404) were recruited at admission to in-Participants (N = 1,404) were recruited at admission to in-

prison substance abuse treatment in 5 prisons in California prison substance abuse treatment in 5 prisons in California from September 1998 – January 2004from September 1998 – January 2004

Upon completion of the in-prison program and parole, Upon completion of the in-prison program and parole, participants transferred to community based treatment in participants transferred to community based treatment in the Female Offender Treatment & Employment Project the Female Offender Treatment & Employment Project (FOTEP)(FOTEP)

Participation in prison-based treatment can be mandated; Participation in prison-based treatment can be mandated; participation in FOTEP is voluntary, but encouraged participation in FOTEP is voluntary, but encouraged (SB (SB 1453)1453)

FOTEP TreatmentFOTEP Treatment Residential treatment is provided for 5-15 Residential treatment is provided for 5-15

months in 10 community programs in 8 months in 10 community programs in 8 counties in Californiacounties in California

Core services:Core services:► Case managementCase management► Vocational training/job preparationVocational training/job preparation► Parenting skills training and family servicesParenting skills training and family services► Trauma-related and mental health servicesTrauma-related and mental health services► Co-residence with up to two children (< 12 Co-residence with up to two children (< 12

years old)years old)

Demographics/Background Demographics/Background Characteristics of SampleCharacteristics of Sample

(N = 1,404) (N = 1,404)

Average age: 33.8 (SD = 7)Average age: 33.8 (SD = 7) Ethnicity: Ethnicity:

► African American, 36%African American, 36%► Hispanic, 24%Hispanic, 24%► White, 38% White, 38%

47% had never been married 47% had never been married 80% had minor children80% had minor children 52% had a HS degree or GED52% had a HS degree or GED 50% were employed prior to incarceration50% were employed prior to incarceration 29% had unstable housing prior to incarceration29% had unstable housing prior to incarceration

Substance Use CharacteristicsSubstance Use Characteristics(N = 1,404)(N = 1,404)

Average age 1st drug use: 14.5 (SD = 4)Average age 1st drug use: 14.5 (SD = 4) 83% were drug dependent (DSM-IV criteria) 83% were drug dependent (DSM-IV criteria) 35% were alcohol dependent (DSM-IV criteria)35% were alcohol dependent (DSM-IV criteria) Most frequently used substances:Most frequently used substances:

► Cocaine/crack, 49%Cocaine/crack, 49%► Amphetamines, 41%Amphetamines, 41%► Marijuana, 40%Marijuana, 40%► Opiates, 21%Opiates, 21%► Sedatives, 12%Sedatives, 12%

20% were injecting daily prior to incarceration20% were injecting daily prior to incarceration 77% used tobacco daily77% used tobacco daily

Mental Health StatusMental Health Status(N = 1,404)(N = 1,404)

29% had used prescription meds for psych 29% had used prescription meds for psych problemsproblems

21% had prior suicide attempts 21% had prior suicide attempts 32% were classified with mental health 32% were classified with mental health

problems by criminal justice systemproblems by criminal justice system 44% had a history of physical/sexual abuse44% had a history of physical/sexual abuse

Criminal Justice HistoryCriminal Justice History(N = 1,404)(N = 1,404)

Mean age 1st arrested: 20.1 (SD = 6.7)Mean age 1st arrested: 20.1 (SD = 6.7) Mean no. of lifetime arrests: 15.5 (SD = 25)Mean no. of lifetime arrests: 15.5 (SD = 25) Mean no. of times incarcerated > 30 days: 6.7 (SD Mean no. of times incarcerated > 30 days: 6.7 (SD

= 9.8)= 9.8) Category of most recent offense:Category of most recent offense:

► Drug related, 57%► Property, 24%► Crimes against persons, 8%► Other, 11%

61% were under influence of AOD when committed last offense

61% had volunteered for in-prison treatment

MeasuresMeasures

Baseline assessment was conducted at admission to in-prison treatment

Information on completion of the FOTEP re-entry program was obtained from treatment providers

Data on return to prison was obtained from the state criminal justice administrative data system (OBIS)

AnalysesAnalyses

Multiple regression model predicting Treatment Needs Index

Logistic regression model predicting FOTEP treatment completion

Cox regression model predicting return-to-prison within 12 months after FOTEP discharge

Treatment Needs IndexTreatment Needs Index

Sum of 13 items rating need for treatment at baseline in each area

► (0 = not at all, 4 = extremely) Range: 0-52, Mean = 17.4 (SD =

9.8)

43.240.9

46.7

17.0

41.438.5

0

10

20

30

40

50

Medical Family Social Work Legal MentalHealth

Per

cen

tag

e

1Rated need as “considerable” or “extremely” high

Treatment/Service Needs Among Treatment/Service Needs Among Women Offenders: Social and Health Women Offenders: Social and Health

NeedsNeeds11

33.6

14.9

38.0

18.522.1

25.6

0

10

20

30

40

50

Tobacco Alcohol Heroin/Opiates

Cocaine/Crack

Marijuana Amphetamines

Per

cen

tag

e

1Rated need as “considerable” or “extremely” high

Treatment/Service Needs Among Treatment/Service Needs Among Women Offenders: Substance UseWomen Offenders: Substance Use11

Greater Treatment Needs at Greater Treatment Needs at Admission to In-Prison Admission to In-Prison

Treatment Were Positively Treatment Were Positively Associated With:Associated With:

Unstable housing prior to incarcerationUnstable housing prior to incarceration History of physical/sexual abuseHistory of physical/sexual abuse Mental health disorderMental health disorder Drug or alcohol dependence (vs. abuse or no Drug or alcohol dependence (vs. abuse or no

disorder)disorder) First arrest at less than 19 years oldFirst arrest at less than 19 years old Volunteered for treatment (vs. mandated)Volunteered for treatment (vs. mandated) White (vs. African American or Hispanic)White (vs. African American or Hispanic)

NS variables: age, education, prior legal incomeNS variables: age, education, prior legal income

Treatment CompletionTreatment Completion

FOTEP treatment completion: 39%

Mean (SD) / median days in treatment:

► Completers = 217 (86) /median = 188

► Non-completers = 76 (77) / median = 55

Type of Discharge from Type of Discharge from FOTEPFOTEP

45%39%

10%4%

1% 1%0

20

40

60

80

100

Left againstadvice

Completion Rule violation

Medical/Psychiatric

Parole violation/

arrest

Refer to otherFOTEP program/

Parole DC

%

Predictors of FOTEP Treatment Predictors of FOTEP Treatment CompletionCompletion

1.07*

0.73* 0.73*

0.46***

1.66**

0.82*

0.67**

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

Odds

Education(years)

African American

(vs. White)

Hispanic(vs. White)

Mental HealthStatus

DrugDependence

No. ofIncarcerations

1st Arrest < 19 Years

NS variables: Tx need index, age, legal income, stable housing, any abuse, alcohol dependence, mandated to tx*p < .05, **p < .01, ***p < .001

Return to Prison in 12 Return to Prison in 12 Months Following FOTEP Months Following FOTEP

Discharge Discharge Includes returns due to parole violation

and new commitments Overall RTP: 32.7% FOTEP Completers: 15% vs.

Non-completers: 45% Vs. 36.9% for females who completed

in-prison treatment, but did not transfer to community-based aftercare

Predictors of Return to PrisonPredictors of Return to Prison

0.98** 0.95*

1.28*

1.82***

1.26** 1.25*

0.31***

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Odd

s

Age(years)

Education(years)

AfricanAmerican

(vs. White)

Mental HealthStatus

No. ofIncarcerations

EnteredFOTEP fromcommunity(vs. parole)

CompletedFOTEP

NS variables: Tx need index, Hispanic, legal income, stable housing, any abuse, drug/alcohol dependence, mandated to tx, first arrest < 19 years old, crime of commitment*p < .05, **p < .01, ***p < .001

Time to First Incarceration for Up to 12 Months Time to First Incarceration for Up to 12 Months After FOTEP Discharge by Completion Status After FOTEP Discharge by Completion Status

Conclusion & ImplicationsConclusion & Implications

Completion of community-based re-entry treatment reduces recidivism for women offenders

However, those with co-occurring disorders and more CJS-involvement remain at high risk for recidivism

Treatment providers need to assess for co-occurring disorders and develop treatment plans that address high-severity profiles