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