client profiles in the offender re- entry program (orp) and the need to address the twin issues of...
TRANSCRIPT
Client Profiles in the Offender Re-entry Program (ORP) and the Need to
Address the Twin Issues of Trauma and Crime
Michael Dennis, Ph.D. and Vinetha Belur, Ph.D.Chestnut Health Systems, Normal, IL
Presentation at the Community Corrections and Offender Reentry Program Grantee Meeting, May 3, 2011, Denver Colorado
Acknowledgement and Contact Information
• Data from SAMHSA/CSAT 2004-2009 Young Offender Re-entry Program (TI16904, TI16915, TI16928, TI16939, TI16961, TI16984, TI16992, TI17046, TI17070, TI17071) and 2009-2013 Offender Re-entry Program (TI21580, TI21585, TI21595, TI21597, TI21624, TI21632, TI21639, TI21682, TI21688, TI21705, TI21714, TI21748, TI21774, TI21788, TI21815, TI21948)
• Opinions are those of the author and not official positions of the government
• Available from www.chestnut.org/li/posters • Please direct comments to Michael Dennis, Chestnut
Health Systems, 448 Wylie Drive, Normal, IL 61761, 309-451-7801, [email protected] .
Goals
• To give a profile of the clients seen in SAMHSA/CSAT’s Offender Re-entry Program (ORP) and how needs, treatment and outcomes vary by age
• Examine the high rate of victimization and demonstrate how it is related to co-occurring mental health issues, criminal activity and other presenting problems
Demographics
13%
22%
20%
40%
16%
3%
12%
19%
21%
44%
14%
2%
43%
16%
50%
21%
11%
2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Female
African American
White
Hispanic
Mixed
Other
<18 (N=1,734)
18-25 (N=811)
26+ (N=421)
Adults more likely than other ages to be female
and White
Adolescents & Young Adults more likely to be
Hispanic and Mixed
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Grantee Location & Age of Clients
Years of Use
27%
77%98%
0%10%20%30%40%50%60%70%80%90%
100%
<18(N=1,734)
18-25(N=811)
26+(N=421)
Less than 11-2 years3-4 years5 or more years
Adults (OR=132.5) and young adults
(OR=9.1) more likely than youth to have 5 or more years of use
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Weekly Pre-Controlled Environment Alcohol/Drug Use By Age
11%
18%
17%
39%
22%
72%
6%
9%
11%
41%
55%
74%
6%
4%
6%
31%
57%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other Drug
Heroin
Crack/Cocaine
Alcohol
Marijuana
Any Drug
<18 (N=1,734)
18-25 (N=811)
26+ (N=421)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Adolescents and Young adults more likely to use marijuana
71%
Substance Use Severity
59% 66%
91%
0%10%20%30%40%50%60%70%80%90%
100%
<18(N=1,734)
18-25(N=811)
26+(N=421)
UseAbuseDependence
Adults (OR=9.7) and young adults (OR=1.9)
more likely than adolescents to have
dependence
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
9
Past-Year Violence & Crime
80%
90%
95%
100%
40%
57%
72%
42%
41%
0% 10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Any Violence or Illegal Activity
Physical Violence
Any Illegal Activity
Any Property Crimes
Other Drug Related Crimes*
Any Interpersonal/ Violent Crime
Lifetime Juvenile Justice Involvement
Current Juvenile Justice involvement
1+/90 days In Controlled Environment
*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
10
Type of Crime by Severity Group
54%
28%
7%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Under 18 18-25 26+
Drug Useonly
OtherCrime*
ViolentCrime
*Other crime includes vandalism, possession of stolen goods, forgery, and theft.
Odds ratio (OR) for
Youth (15.6) and young adults (3.0) higher than
adults
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
11
Intensity of Justice System Involvement
Past-Year Illegal Activity/SA Use .1%
Past Arrest/JJ/CJ Status 2%
Other JJ/CJ Status 2.8%
Other Probation, Parole, or Detention 16.3%
On Probation/ Parole 14+ Days w/1+Drug Screens 20%
In Detention/ Jail 14-29 Days 6.6%
In Detention/Jail 30+ Days 51.9%
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
12
46%56%
68%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Under 18 18-25 26+
Past year illegal activity/drug use
Past arrest/ JJ/ CJstatus
Other JJ/ CJ status
Other prob/ parole/detention
On prob/ parole 14+days w/1+ drug screens
In detention/ jail 14-29days
In detention/ jail 30+days
Intensity of Justice System Involvement by Severity Group
Adults (OR=1.6) and young adults (OR=1.5) more likely than
adolescents to be coming from long term detention Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
13%
23%
31%
33%
33%
56%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
General AnxietyDisorder
Traumatic StressDisorder
Major DepressiveDisorder
Attention Deficit/Hyperactivity Disorder
Conduct Disorder
Any Co-OccurringPsychiatric
Co-Occurring Psychiatric Problems
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Pattern of Co-morbidity
63%60%
44%
0%
20%
40%
60%
80%
100%
<18(N=1,734)
18-25(N=811)
26+(N=421)
InternalizingonlyExternalizingonlyBoth
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Adolescents more likely
than adults to have only
ExternalizingDisorders (OR=8.4)
Adults more likely than adolescents
to have only Internalizing
Disorders (OR=4.4)
41%
8%
13%
44%
56%
74%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Prior Mental Health Treatment
Any Self Mutilation
Any Homicidal/ Suicidal Thoughts
Ever Homeless or Runaway
High Severity Victimization (GVS > 3)
Ever Physical, Sexual or EmotionalVictimization
Other Psychiatric Issues
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
GAIN-I Main Scale Problem Profile
5.38
0% 20% 40% 60% 80% 100%
Physical Health Conditions
Current Withdrawal
Financial Problem
Environmental Stress
Personal Sources of Stress
Health Problem Symptoms
Internalizing Disorders Sx
Personality Disorders Sx
HIV Risk Behaviors
Externalizing Disorder Sx
Substance Problem Sx
Crime and Violence Sx
Average No. of High/Mod Prob.
0 1 2 3 4 5 6 7 8 9 10 11 12 13
High
Moderate
Low
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Count of GAIN-I Main Scales Problems By Age Group
26% 34%57%
0%10%20%30%40%50%60%70%80%90%
100%
<18 (N=1,734)
18-25 (N=811)
26+ (N=421)
None1 to 23 to 67 to 13
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Vast majority endorse one or more problems
Adults more likely than adolescents
to report 7 or more problems
(OR=3.7)
Vast majority endorse 3 or
more problems
Initial Level of Care
10%6% 43%
62% 58%39%
0%10%20%30%40%50%60%70%80%90%
100%
<18 18-25 26+
OPIOPLTRCC-OP
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Adults more likely than
youth to start in IOP
Treatment System Involvement
94%
79%
64%
39%
97%
75%75%
96%
79%
54%89%
14%
0% 20% 40% 60% 80% 100%
Initiation within 2wk
Engagement for6+ wks
Continuing Care3+mons.
Positive SystemOutcome 6+
mons.
<18 (N=1,734)
18-25 (N=811)
26+ (N=421)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Adults more likely than youth to be in phased program and to have positive 6
month outcome (retention/ completion)
21.8
7.5
13
1.4
1.2
12.1
1.2
13
0.4
13.4
4.7
1.2
9.8
14
4.1
3.8
6.4
14.2
0 5 10 15 20 25
Days in Any SATreatment
Times in SA OP
Days in SA IOP
Nights in SAResidential
Days in other SA Tx
Treatment SatisfactionScale (mean)
<18 (N=1,072)*
18-25 (N=561)*
26+ (N=235)*
Amount of Substance Abuse Treatment (intake to 3 months)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
*At 3m follow-up
Adolescents received more
“days” of treatment
Young Adults received more Residential Tx
Range of Substance Abuse Treatment Content (Intake to 3 months)
4.8
1.4
4.01
10.21
0.75
3.0
7.59
3.8
6.25
2.51
0.58
3.15
0 2 4 6 8 10 12
Direct ServicesReceived
Family ServicesReceived
External ServicesReceived
TreatmentReceived Scale
<18 (N=1,072)*
18-25 (N=561)*
26+ (N=235)*
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
*At 3m follow-up
Adolescents received a
broader range of Tx Services
0.5
9.7
0.4
0.1
9.85.6
32
5.4
0.3
0
0.3
0.2
1.8
31.9
2
0 10 20 30 40
Days in MentalHealth w/o Meds
Days in MentalHealth Tx w/ Meds
Times in MH OP
Nights in MHhospital
Days on MH Meds
<18 (N=1,072)*
18-25 (N=561)*
26+ (N=235)*
Mental Health Treatment Received(intake to 3 months)
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
*At 3m follow-up
Adults received more mental
health services
Other Environmental Interventions Across Systems (intake to 3 months)
18.09
5.79
22.33
13.45
1.79
12.73
20.41
6.08
6.40
25.69
28.2
20.1
31.6
11.9
16.5
0 5 10 15 20 25 30 35
Days of structured activity withoutsubstance use
Times urine/breath analysis*
Days in a controlled environment
Days incarcerated
Days of self-help
<18 (N=1,072)*
18-25 (N=561)*
26+ (N=235)*
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
*At 3m follow-up
Adults more likely to be
reincarcerated and to get self
help
0%10%20%30%40%50%60%70%80%90%
100%Pr
e-co
ntro
lled
envi
ronm
ent
Inta
ke 3m 6m
<18 years18-25 years26+ years
Percent of Days Abstinent from AOD
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Past Month Abstinence
0%10%20%30%40%50%60%70%80%90%
100%
Intake 3m 6m
<18 years 18-25 years 26+ years
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
No Past Month Substance Problems
0%10%20%30%40%50%60%70%80%90%
100%
Intake 3m 6m
<18 years
18-25 years
26+ years
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
No Days in a Controlled Environment
0%10%20%30%40%50%60%70%80%90%
100%
Intake 3m 6m 12m
<18 years18-25 years26+ years
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
In Recovery (no use, abuse or dependence in the past month
while living in the community)
0%10%20%30%40%50%60%70%80%90%
100%
Intake 3m 6m
<18 years18-25 years 26+ years
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
No Illegal Activity
0%10%20%30%40%50%60%70%80%90%
100%
Intake 3m 6m
<18 years18-25 years26+ years
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
General Victimization Scale
48%28%
10%65%
45%39%
27%30%
13%9%
13%9%
6%1%
58%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ever attacked w/ gun, knife, other weapon
Ever hurt by striking/beating
Abused emotionally
Ever forced sex acts against your will/anyone
Age of 1st abuse < 18
Any with more than one person involved
Any several times or for long time
Was person family member/trusted one
Were you afraid for your life/injury
People you told not believe you/help you
Result in oral, vaginal, anal sex
Curently worried someone attack
Currently worried someone beat/hurt
Currently worried someone abuse emotionally
Currently worried someone force sex acts
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Severity of Victimization by Gender
56% 53%70%
0%10%20%30%40%50%60%70%80%90%
100%
Total Male Female
LowModerateHigh
Odds ratio (OR) of
Females 2.1 times greater
than Males
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Severity of Victimization by Race
39%
62% 58% 64% 63%
0%10%20%30%40%50%60%70%80%90%
100%
Afr
ican
Am
eric
an
Whi
te
His
pani
c
Mix
ed
Oth
er
LowModerateHigh
OR of other races 2.2 to
2.8 times greater than African Am.
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Severity of Victimization by Age Group
50% 59%76%
0%10%20%30%40%50%60%70%80%90%
100%
<18(N=1,734)
18-25(N=811)
26+(N=421)
LowModerateHigh
OR higher for 18-25 (1.4) and adults (3.2) than
youth
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Type of Crime By Severity of Victimization
30% 40% 45%
0%
20%
40%
60%
80%
100%
LowSeverity
ModerateSeverity
HighSeverity
SubstanceUse OnlyOther Crime
Violent Crime
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
High victimization group more likely (OR=1.9) to report violent crime than
low group
Intensity of Justice System Involvement By Severity of Victimization
41% 48%58%
0%10%20%30%40%50%60%70%80%90%
100%
LowSeverity
ModerateSeverity
HighSeverity
Past year illegalactivity/ drug usePast arrest/ JJ/ CJstatusOther JJ/ CJ status
Other prob/ parole/detentionOn prob/ parole 14+days w/1+ drug screensIn detention/ jail 14-29daysIn detention/ jail 30+days
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
Psychiatric Disorders by Severity of Victimization4% 7%
15% 21
%
23%
6%
13% 21
% 26%
26%
19%
34% 41
%
40%
40%
0%
10%
20%
30%
40%
50%
60%
GeneralAnxietyDisorder(OR=5.6)
TraumaticStress
Disorder(OR=6.8)
MajorDepressive
Disorder(OR=3.9)
AttentionDeficit/
Hyperactivity(OR=2.5)
ConductDisorder(OR=2.2)
Low Moderate High
Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)
37
GAIN-I Main Scales Problem Count By Severity of Victimization
11%25%
45%
0%10%20%30%40%50%60%70%80%90%
100%
Low Severity (N=763)
Mod Severity (N=532)
High Severity (N=1664)
None1 to 23 to 67 to 13
Source: CSAT 2010 YORP and ORP studies only (N = 2,966)
High victimization group more
likely (OR=6.6) to have 7 to 13 problems than
low group