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Center for Substance Abuse Treatment. Continuity of Offender Treatment for Substance Use Disorders from Institution to Community. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1998. (Treatment Improvement Protocol (TIP) Series, No. 30.)

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Chapter 4—Administrative Guidelines

The development and implementation of transitional programming for offenders requires an effective partnership among diverse criminal justice, substance use disorder treatment, and social services agencies. The designated transitional program administrator must be thoroughly knowledgeable of the obstacles inherent in launching such a collaborative effort. As each agency brings its own culture, agenda, and operational differences to the planning process, administrators from each of the participating agencies must work together to establish compatible goals, policies, and procedures. At the outset of the planning process, the need for individual and organizational flexibility and genuine cooperative effort should be emphasized to all participants.

The role of the administrator of a transitional services program is critical. This individual shoulders the responsibility for managing complex interactions among all agencies and institutions involved in criminal justice accountability and service provision. Therefore, the administrator must be thoroughly familiar with the environments in which participating agencies operate and lead the effort to unify policies so that communications with other organizations and with offenders served are consistent. Knowledge of each agency's administrative environment and procedures improves the likelihood of an effective collaboration.

At the beginning of the planning process, the transitional program administrator and the participating agency representatives should focus attention on several issues that, if left unaddressed, will have a serious impact on the success of offender transitions and the transition program itself. Key issues for consideration are discussed below.

Building an Effective Partnership

Selection of Appropriate Representatives From Each Agency

Ideally, each agency's representative should be a senior staff member who has authority to speak for the agency, make commitments on behalf of the agency, and sign agreements or other official documents. Final sign-off authority is extremely important. The transitional services program administrator should resist any attempts to assign staff members who do not have such authority. However, since partial authority is better than none, accepting representatives who can approve some elements of the transitional program may be necessary if that is the only alternative.

Including other stakeholders (e.g., judges, legislators, advocates) may prove beneficial to the success of the program. For example, if legislators become part of the planning process, they may become advocates for funding. Support at this level can be essential to program implementation and long-term funding.

Knowledge of the Partners and Their Histories

Each participating agency should have a working knowledge of every other participating agency's policies, internal dynamics, service capacities, legal responsibilities, and authority in relation to the client. This knowledge is essential for the development of mutual respect among the partners. Additionally, familiarity with the organizational history of each agency, including success in collaborative or partnership efforts is important to the planning process. Agencies that have had difficulty sharing authority or yielding control may need to be treated with special sensitivity and attention.

Awareness of Obvious Conflicts in Operations, Policies, and Procedures

Each agency representative should take responsibility for determining how collaboration on transitional services may affect the internal operations of his agency. Coupled with this analysis is the need to make adjustments to ease service planning and program implementation. For example, an agency headed by a board of directors that must approve changes in operations or policy will need extra time to obtain approval.

Recognition of the Partnership as a Hybrid yet Single Entity

The nature of transitional service programs is complex in that several service providers must function as one. Therefore, the organizational goals and culture of each agency must be blended with the others. Differences will exist in professional jargon, organizational structure (including chain of command and identity of the official invested with authority for various programming issues), and the amount of time each agency will need to obtain approval. To mediate these and other differences, the transitional services program administrator can remind the participating agencies that the goals and objectives for each agency and for the partnership are the same.

Education of the Partners

An educational effort may be required to align the partner agencies in an understanding of client characteristics and the diverse agency planning, processes, and programming that may be at play. Agencies that have not worked with offenders will need training on the kinds of issues these clients bring to service providers and on the community concerns that may surface. They will also need to develop an understanding of criminal justice processes and the operating principles that govern community-based organizations and other groups in the partnership, as well as the political forces that shape each agency's agenda. For example, jails and prisons have been under enormous pressures to reduce their populations through the targeting of specific offender populations for diversion. Identification of these target populations will generally include determinations regarding substance use disorder histories. For planners of transition services, this is an important opportunity, as it provides the political motivation to move offenders from jails and prisons into community programs under a carefully designed transition process.

A delicate balance must be reached in order to reconcile differences in policy and procedures among the partnership agencies. Differences left unaddressed at the organizational level can prevent effective service delivery and undermine the program. Figure 4-1 presents a brief developmental scenario of a successful transitional services program.

Policy and Procedural Issues

Administrative Goals and Objectives

During the planning phase of a transitional service program, it is critical to agree on goals that are acceptable to each participating agency. For example, a treatment provider may see a decrease in substance use as a measure of success. The criminal justice agency, however, may believe that abstinence is the only acceptable outcome. Such issues highlight the underlying philosophies of different systems and must be identified and discussed prior to program implementation. Failure to do so may foster interagency mistrust, inmate manipulation, and dishonesty, and can result in program failure. Partnership goals and objectives must also be compatible with any legal conditions placed on an offender by the releasing or supervisory authority.

Treatment Improvement Protocols (TIPs) 17, Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System (CSAT, 1995c), and 12, Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System (CSAT, 1994c), describe basic differences in the criminal justice and substance use disorder treatment systems, and the use of sanctions in coordination with substance use disorder treatment.

Interagency Agreements

When possible, the results of negotiating the key components of a transitional services program should be documented in an interagency agreement. All policy and procedural decisions reached during planning meetings should be included in this agreement. Such decisions include

  • The development of a shared "vision statement"
  • Goals and objectives of transition programming
  • Each agency's specific roles, expectations, and responsibilities
  • Timing of tasks
  • Monitoring procedures
  • Shared information requirements
  • Client confidentiality
  • Program evaluation needs

These agreements serve as a written reminder of each agency's responsibilities, describing which agency takes the lead and which staff member is responsible for carrying out each task.

It is important to realize, however, that interagency agreements must be renegotiated at least every 2 years, and that multiagency planning requires flexibility -- particularly during initial implementation -- which should be viewed as a period of "testing the theories." A more thorough discussion of the process of building an interagency agreement can be found in TIP 12 (CSAT, 1994c).

Effective Communication

Because transitions involve multiple systems and agencies, policy issues inevitably arise: disagreements about treatment methods, differing philosophies, conflicts about who should take responsibility for resolving problems, and disagreements over roles. To minimize conflict, there should be intersystem and interagency agreements at all levels within the corrections system, the supervising authority, and the treatment system. These agreements should specifically describe roles, responsibilities, confidentiality issues, and policies on the transfer of records, who pays for treatment, the structure of communications, program implementation, and methods for resolving disputes.

A primary goal of such agreements is to help each partner understand the roles of both the criminal justice agencies and the treatment providers by holding these discussions early in the planning process. Policies must be developed at the highest levels, and vigorous efforts must be made to promote and ensure commitment among staff members, including administration, management, and staff.

There are times when effective interagency coordination is less a result of established policies and practices and more a result of good personal working relationships and a vision shared by a few front-line staff. In some instances, when the group membership changes, the interagency coordination may fail if new team members do not support the vision. Therefore, interagency coordination should be institutionalized and maintained by senior administrative personnel. Highly motivated front line staff members who volunteer to take these administrative positions are often invaluable in promoting and sustaining interagency coordination and partnership.

Coordinated public policy

State and local policies related to substance use and its treatment for offenders are often in a state of flux, even in the short term, with leadership from administrative agencies and the different branches of government sometimes following different—and occasionally conflicting -- visions of what is in the public interest. Policies on offender rehabilitation and the impact of treatment are part of this policy debate. Ideally, the vision of offender rehabilitation and treatment should be coordinated at the highest levels of State government, starting with the governor and State legislature. Legislative support is crucial, especially with regard to funding and other critical policies. To enlist legislative support, State decisionmakers and policymakers must be apprised of research demonstrating the impact and cost-effectiveness of offender treatment and the significance of the transition period. (More detail on legislative issues is provided in a later section of this chapter.) Once sufficient agreement among key policymakers is reached, policy statements should be developed that apply to all partners.

For example, resistance to offenders' return to the community should be addressed as a matter of public policy. Upon release, offenders should be able to remain in or go to a different community to participate in treatment, even if the program is not in the county of last commitment or location of last residence. This can be especially important if the last place of residence was a high-risk area for the offender who wants to avoid these risks. Therefore, the Consensus Panel recommends that States, counties, and other jurisdictions develop policies that permit offenders who are being transferred from prison to community treatment to go into a community other than that of last commitment or last residence. A system should also be established that allows the client to move up or down on the treatment intensity scale and to be placed in the least restrictive setting required. That is, a client with a number of positive urine tests could move to a more intense level of treatment rather than automatically being removed from the program and placed back in the general population.

Other offenders, however, may want to return home but the community resists -- a "not in my back yard" syndrome is especially virulent with regard to specialized housing for offenders. Many of these public fears are related to misconceptions about criminality and substance use disorders. Yet research demonstrates that providing treatment and transition services reduces the risk of criminality and substance use disorders among offenders. Providers of transition services should accordingly promote community buy-in for transition efforts. This can be accomplished through public education, public relations, and media campaigns. The general public, community decisionmakers, and politicians should be educated about the fact that most offenders are going to be returned to their home environments or communities and should receive rehabilitation services in order to be successful there.

Clarification of Roles

Unless one individual has been designated as the lead for transitional program planning and administration, the individual and organizational roles and responsibilities within each agency in the partnership must be delineated. These decisions should be made as early as possible in the planning phase. The establishment of a distinct, but interdependent role for each collaborating agency is fundamental to success. Agreement must be reached on specific issues, such as who takes the lead, who will schedule meetings, who records and distributes drafts of meeting minutes, and how meetings will be run.

Since administrative support functions of a transitional services program are critical to its success, decisions about responsibility for these functions should be made carefully. If no one person has been designated as administrator for the program, each partner should participate in determining how staffing should be handled. There may be a position in one of the agencies that can be reassigned to this effort, or tasks may be added to an existing position. In some cases, a new position must be created, which requires a funding commitment and supportive personnel policies.

In addition, because staffing will cross agency lines, agreement on cross-training is strongly recommended to increase the knowledge of all staff members and to foster a comfort level that facilitates communication. Cross-training should focus on the philosophy, goals, semantics, and operations of each partnering agency. Cross-training reduces intra-agency personnel problems, distrust, and the potential for offender manipulation.

Case Management Planning

Case management planning and its implementation are at the heart of effective transitional services. Each participating agency administrator must ensure that the agreements reached among the partners address the timing, methods, and responsibility for case management. Administrators also need to be aware that case management planning for transitional service is unique and influenced by several factors:

  • A team approach to case management planning is often required, since supervision and service delivery will include a variety of community agencies.
  • The releasing agency and the community-based agencies must be invested in the transition process.
  • Cross-training in case management planning should be conducted to ensure that all personnel follow the same planning procedures.
  • Policies or agreements on risk assessment and needs assessment instruments should be made during the case management planning phase. Existing means for assessment must be reviewed to decide their applicability to the transition program (see Chapters 2 and 3 for descriptions of comprehensive assessment).
  • Within the case management plan, policies on postrelease supervision of offenders must include the full range of responses to offender behavior, such as the response to relapse. Will a relapse lead to increased supervision or treatment? At what state will relapse be grounds for parole or probation status violation or revocation? The responses for other offender behaviors could include increased intensity of treatment, community service work, short-term detention, or jail.

Recommended administrative strategies for improving transitions

The National Task Force on Correctional Substance Abuse Strategies (1991) makes the following recommendations on linking corrections and community resources:

  • Cumulative information -- with the offender's consent -- should follow the offender from the earliest impact point throughout the entire process.
  • Assessment and treatment information -- with the offender's consent -- should be shared with all programs providing treatment services to the offender.
  • Continuing care plans should be developed prior to transitions between and from correctional facilities and agencies.
  • Formalized agreements should be developed among State and local agencies in the correctional system and treatment community to detail areas of responsibilities, services provided, and mechanisms for exchanging information.
  • Combined case planning should be accomplished among correctional and treatment agencies when working with the same substance-using offender and when transferring the offender from one agency to another or from one part of the correctional system to another.
  • Cross-training across disciplines and agencies should address a wide array of treatment techniques, case management issues, and criminal justice concerns, and should be conducted on an ongoing basis for professionals and paraprofessionals working with substance-using offenders.
  • A management information system (MIS) should be established and used within and across systems to monitor the delivery of appropriate substance use disorder programming to offenders, collect data for program evaluation, and establish a rationale for additional interventions and staff.

Information Sharing

During the planning phase, types and amounts of information to be shared must be considered a central issue, and the resulting decisions should be clearly defined. The individual(s) responsible for information transfer and the timeframes to which these are bound should be specified for each partner.

During planning discussions, each agency should be prepared to contribute its lists of the types of information (such as databases) that are available for the information sharing process. Every effort should be made to avoid requesting data that are not being collected or asking some agencies to find or create information that is needed for the transitional services program only. Acceptable substitutes should be discussed. For example, if 90 percent of the data needed for the partnership's purposes exists in one agency's client discharge summary, that form may be acceptable even without the additional information. Once existing data have been identified, the partnership should discuss the need to generate "new" data that are not currently being gathered in any system. These plans should include funding for the development of adaptations to each agency's MIS.

One way to generate data for all parties is to use automated MIS, which also are valuable mechanisms for promoting interagency cooperation and increasing the likelihood of successful transfers. These systems can permit all players to have rapid access to the same information, provided the Federal confidentiality regulations limiting access to information about offenders in treatment are followed. They help promote consistent and multi-use forms that can be used by multiple agencies. An MIS can help decrease resource duplication and enhance consistency of information. Also, such systems can have important roles in conducting quality assurance checks. If possible, an automated MIS should be established and used within and across systems to monitor the delivery of appropriate substance use disorder treatment to offenders, collect data for program evaluation, and establish a rationale for additional treatment and staff (National Task Force on Correctional Substance Abuse Strategies, 1991).

Integrated information systems are beginning to be developed to facilitate the ongoing communication, data collection, and evaluation of cross-system programs. A shared data system, with data elements and security issues delivered by the partnership, is developed either using existing data systems or creating a new system that replaces existing systems. One example of this is the Baltimore/Washington High-Intensity Drug Trafficking Area (HIDTA) Project. The Delaware drug court is beginning to design a system to draw data from the courts, Treatment Alternatives for Safe Communities (TASC), and providers into a separate system for use by all, as well as feed new data into the existing systems. This approach comes from a recognition that all involved agencies have a stake in the entire case.

Each partner may have data that cannot be shared. Strict monitoring and oversight responsibilities should be clear to ensure that the information sharing process occurs as originally specified, without compromising client confidentiality or data integrity. This topic is also addressed in the section on confidentiality below.

Information sharing plans should address the following points:

  • Appropriate oversight should be provided to ensure that necessary information is being obtained. A data manager could be designated to handle information on the transitional services program.
  • When existing databases will be used, their data elements, software formats, update schedules, and general availability for use should be determined. The possibility of using a shared MIS across systems should be investigated.
  • Information needed for monitoring program performance and conducting evaluation should be included.
  • The basic process for information sharing and the appropriate conduits for this activity (hard copy, special forms, disks, etc.) must be identified and explained.
  • A method or policy should be developed to ensure that information follows a client to the next provider, especially information on treatment intensity and the extent of clients' program participation.
  • Commitments should be made in writing from each agency in a letter of agreement, interagency agreement, or cooperative agreement describing specific information sharing requirements.

Procedures for Monitoring

Once representatives have agreed on the policies and procedures needed to ensure complete transitional planning and services, they must then agree on the measures by which implementation will be monitored. For example, if agencies agree that offender assessment is to be completed within 30 days of release and that case management plans are to follow within 7 working days, data showing compliance with this agreement must be maintained. Similarly, if agencies agree that positive drug tests will result in program referral and enrollment, data related to these incidents must be tracked. Participating agencies can increase cooperation with contract provisions encouraging the agencies to work together toward improved client outcomes. Mutually beneficial goals and outcomes should be set and agencies held accountable for reaching these goals and outcomes.

Legislative Issues

States have historically legislated policy for correctional programs. In recent years, program policies have increasingly been tied to costs, with delegation of authority placed where legislators see fit. Some lawmakers have advocated alternatives to incarceration for treatment purposes. Other legislatures have created situations that negatively affect the linkages between criminal justice and substance use disorder treatment systems. Legislative attempts to regulate offender substance use disorder behavior have led to the imposition of several new sanctions:

  • New laws mandate subsidiary offender punishment, such as revoking convicted drug felons' rights to receive benefits from entitlement programs such as welfare.
  • Additional penalties are imposed on offenders by agencies other than corrections. For example, public housing authorities may evict a substance-involved tenant who does not provide a copy of her treatment record. Or the child welfare system may be more likely to take away custody of children.
  • With reforms of the welfare and health care systems (e.g., Hatch Amendment), funding for offender treatment and eligibility for public assistance and Medicaid must be monitored for individuals with felony convictions.
  • Other types of sanctions against substance-using offenders have been imposed, including ineligibility for loans, professional licenses, research grants and fellowships, and federal contracts and purchase orders; denial or revocation of passports; and suspension of driver's licenses or occupational licenses (Bureau of Justice Statistics, 1992).
  • The "get-tough" stand is eliminating the treatment alternative for many convicted of a violent offense, those who may have longer substance use disorder histories and greater criminal histories -- those who will need treatment the most.

Legislative mandates on institutional and transitional programming can also be positive, creating the opportunity for offenders to receive treatment or promising service improvement. For example, some legislation requires the creation of separate treatment facilities or programs within the jail or prison system; other regulations require that current institutional treatment programs conduct transition planning and services.

State legislatures have a tremendous capacity to shape policies, organizational structures, resources, and programs related to the transition of offenders from institutional to community-based treatment. For example, New York's Managed Care Law sets an important precedent: Managed care organizations must pay for treatment, up to the limits of the plan, if the court orders such treatment.

Transitional service program administrators should have a keen awareness of how State legislatures can affect their programs or larger policies. Changes in mandatory sentencing or drug laws can have a major impact on who comes into institutions, how long they stay, and the conditions under which they are released. In response to the continually changing legislative climate, a transitional services program administrator must educate the legislature on the necessity for these services, be aware of opportunities to help develop new legislation, and identify the need for changes in existing legislation that presents obstacles to successful offender transition. This can be accomplished in part by working with individual representatives who are interested in or have responsibility for regulating substance use, criminal justice, or health issues. Legislative briefings with all agency partners in attendance are also very effective. The administrator has the responsibility to develop programs that are compatible with current legislative mandates and requirements. Examples of legislative opportunities and obstacles are described in the following sections.

Legislative Opportunities to Support Transitional Services

The three most important legislative opportunities to enhance transitional services programs for offenders result from provisions made in (1) community corrections acts, (2) structured sentencing laws, and (3) truth in sentencing laws.

1. Community Corrections Acts: Increasingly, State legislatures are passing laws that create local planning boards charged with responsibility for comprehensive planning for local corrections systems. Among other objectives, these boards help develop jail-based treatment programs and aftercare. Community corrections acts generally reduce prison admissions for nonviolent offenders, who are instead sentenced to local sanctions and services and have increased opportunities for treatment, often with State subsidies. Such laws may also provide sentencing alternatives, such as "split sentences" that begin with treatment during jail time and continue with community treatment options following release. In Oklahoma, community correction boards must include not only justice representatives, but also treatment and social service agencies and community members at-large.

2. Structured Sentencing Laws: Such laws generally reduce judges' sentencing discretion by mandating prison sentences for some high-risk offenders and community-based sentences for low-risk offenders. Other offenders may not receive prison sentences. These laws may expand the population of offenders for whom community treatment may be expected following a period of incarceration.

3. Truth in Sentencing Laws: These laws provide an opportunity to mandate treatment as a sentence for offenders who commit low-level crimes. Mandated treatment may assist in reserving prison space and allocating more funds for the institutional treatment of serious offenders. In the case of more serious offenders, these laws sometimes mandate that the actual time served in institutions closely approximate the amount of time ordered by a judge. Truth in sentencing laws may compel certain offenders to spend long terms in prison.

Legislative Obstacles to Effective Transitional Services

State legislatures have the authority to determine many issues critical to the successful transition of offenders from institutional to community treatment settings. Legislatures determine which agency is in charge of parole, probation, and community treatment. The legislature may also determine the agency in charge of transition to the community and/or community-based substance use disorder treatment. A transitional services program administrator must be aware of the States' legislative position on these issues and the current structure of these services to effectively navigate the planning and implementation processes. If there are obstacles, the administrator must be able to identify and work with those obstacles. The kinds of legislative obstacles a transitional services program administrator might expect to encounter are described below.

  • Determinant Sentencing Laws: These laws establish absolute terms of offender confinement and abolish early release through parole. Instead of parole, these laws may mandate a term of community supervision. From an administrative perspective, there is a custodial concern that the removal of the motivation provided by early release may lessen offender involvement in institutional treatment and rehabilitative programming. In such situations, there is a stronger need for transitional services following release.
  • Presumptive and Mandatory Minimum Sentencing Laws: Such laws reduce or eliminate judicial sentencing discretion, particularly for substance-related crimes, and compel judges to incarcerate offenders. Transitional services program administrators must be cognizant of the increased incidence of prison admission for certain substance-using offenders and realize that once they are released, this subpopulation will need a higher level of transitional services than other groups of offenders.
  • Legislative Treatment Mandates: State legislators may unwittingly hinder treatment services by mandating the level of treatment and/or creating specific treatment termination criteria (i.e., three dirty urine tests result in termination from treatment). Under such circumstances, treatment is not driven by individual offender needs or treatment progress. Legislators should be educated that regulations of this type negate the effectiveness of treatment and thereby increase the burden of transitional services programs. Supplying cost/benefit information to legislators may help convince them of the overall savings in tax dollars gained from reduced recidivism through effective treatment.

These and other legislative obstacles require the transitional services program administrator (and each partner's administrator) to take responsibility for shaping legislation by providing information on transitional service needs to legislators whenever possible.

Funding Transitional Programs

Agencies involved in planning for transitional programming face the challenge of finding the resources needed to complete the planning process and support ongoing operations, monitoring, and evaluation of the programming once it is implemented. Several specific areas of need were identified by the Consensus Panel and are discussed in the following sections.

Planning Activities

Planning is an intensive and time-consuming activity. If staff members involved in planning are unable to focus on their planning because of other job responsibilities, or lack the expertise to organize, create, and plan transitional programming, it may become necessary to identify new resources to support the planning process.

New funding or resources may be available from Federal, State, or local agencies, or from foundations, which often fund new services or programs. Support for planning activities can also come from reallocation of resources within participating agencies. Reassignment of staff members may facilitate some planning or program development activities.

Operational Activities

Support for ongoing transitional program operations may be generated from reallocation of existing resources within collaborating agencies or the reassignment of personnel. To create the necessary array of supports and services, programs can attempt to combine existing but separate funding streams from welfare, housing, primary medical, substance use disorder, mental health, and justice budgets. Reallocation of funds from these sources may be justified because front-end investment in transitional programming can ultimately produce long-term savings for most of these agencies.

Often, however, transitional services program administrators must identify additional sources of funding for ongoing operations or assist partnership members in doing so. Within the partnership, agencies can work together to seek additional funding from Federal, State, or local government authority. Partnerships of several agencies can leverage State money with Federal or local funding. It is critical that those agencies work collaboratively, rather than competitively, to generate funding in order not to undermine the entire process. Foundations may be willing to support model transitional programming for a demonstration period. Finally, agencies may need to find other, more creative sources of funding; some jurisdictions have tapped into resources recovered from confiscation and forfeiture of offender assets. Consideration should be given to accessing different funding streams for different groups of offenders. For example, offenders in transitional services programs for a certain period of time may become eligible for government benefits, including public assistance.

Evaluation Activities

Existing evaluation resources, brought to the table by each participating agency, can be combined for more efficient use (see the section on evaluation later in this chapter). A partnership can approach Federal, State, and local funding agencies to support evaluation research essential in documenting the effectiveness of transitional programming. Foundations may be interested in supporting the effort to document the efficacy of model programs that can be replicated in other jurisdictions.

Managed Care

Currently, the typical resources for funding transitional service programs are State budgets. Increasingly, however, treatment services and, as a result, transitional services, are funded through managed care organizations and discretionary funding. The obstacles these funding sources pose for transitional services are discussed in Chapter 1 of this TIP. It is essential for administrators to understand how funding streams and managed care initiatives operate within their community and to be involved in planning and contract negotiations of such funds.

Funding Following the Client

Funding identified for offenders having substance use disorders should be driven by client needs and should "follow the client" rather than be preallocated to specific systems or agencies. As population needs change, funding changes should follow. For example, the agency most available to provide transition services should receive the funding. When institutional treatment is available but community-based treatment is not funded, continuity of care cannot occur. Treatment providers often struggle with funding issues in relation to offenders who are mandated to treatment by the courts when there is no funding to support it.

Confidentiality Issues

Confidentiality issues affect the structure and operations of transitional services programs offered by a collaboration or partnership. As always, the central issue is balancing protection of client confidentiality and the offender's right to privacy against the needs of various agencies for information. It is critical to this goal that all partners understand the limitations on sharing of information by substance use disorder providers and the importance of safeguarding any information received from a treatment provider about a client from further disclosure to or sharing with others.

It should be noted that several other TIPs have presented information on a variety of confidentiality issues; some have done so at great length. Therefore, this TIP does not offer comprehensive information on the topic. Instead, this section describes the types of confidentiality issues that must be addressed by a transitional services program administrator and the agencies involved in a transitional program partnership. For more information on many aspects of confidentiality, the Consensus Panel refers the reader to the TIPs listed in Figure 4-4.

Additionally, the CSAT Technical Assistance Publication (TAP) 18, Checklist for Monitoring Alcohol and Other Drug Confidentiality Compliance (CSAT, 1996a), contains valuable information for determining whether confidentiality has been violated after the fact.

Confidentiality Issues for Transitional Services Partnerships

The confidentiality issue of greatest concern to a transitional services partnership is the security of client data within and across all agencies. During the planning process for information sharing, this issue should be addressed in great depth. A full discussion of electronic data confidentiality can be found in TIP 23, Treatment Drug Courts: Integrating Substance Abuse Treatment With Legal Case Processing (CSAT, 1996b).

Other issues that should be brought to light when developing confidentiality procedures for a partnership-based transitional services program are

  • The use of consent forms, including revocable, nonrevocable, limited, and other types of forms (see TIP 23 [CSAT, 1996b])
  • How to handle information that is not protected by confidentiality, as this differs by program type or setting
  • Appropriate confidentiality specifications for conducting program evaluation
  • Procedures and rules for sharing information between service providers in the partnership
  • Methods for handling disclosure of criminal acts (e.g., the variations that exist in different jurisdictions)

Confidentiality Guidelines for Administrators of Transitional Services Programs

For the administrator charged with managing a transitional services program, it is essential both to understand confidentiality regulations and to create methods by which clients are informed of their rights. There should be clear agreements concerning confidentiality within the various components of the criminal justice system and with each of the partnerships' service providers. All staff members involved with transitional services need training on the parameters of client confidentiality. To ease the development of the procedures and forms associated with maintaining confidentiality, the transitional services program administrator needs to

  • Be aware of the differences between terms of consent for offenders who are mandated to treatment by the criminal justice system and those who enter treatment voluntarily
  • Have a clear understanding of information redisclosure issues, the need for separate consent for followup, the right to revoke consent, and the expiration of consent
  • Recognize the need to comply with other programs' consent requirements
  • Have a clear understanding of differences in consent for clinicians, administrators, clerical staff, and other types of service providers
  • Develop a checklist of consent and confidentiality issues (i.e., clarification of what, when, how, to whom information can be given) to review with the partnership members
  • Assign a designated confidentiality expert to the task of preparing materials and procedures
  • Understand the implications of confidentiality as it pertains to case management, including issues of consent that affect the disclosure of information from several agencies, the extent to which disclosure is legal and ethical, the issue of disclosure without consent, and differentiating between case management and qualified service agreements
  • Understand the implications of confidentiality as it pertains to interagency, cooperative, and other agreements

When developing transitional services programs, it is also critical to maintain client confidentiality at all levels of planning and implementation.

Program Evaluation for Transitional Services Programs

Evaluation of transitional services programs is much like that of other programs. There are, however, some unique evaluation issues, because services are provided by different agencies, and each has its interests and concerns to protect. It is essential that the planning process address evaluation issues, including what data will be used; who will be responsible for collecting data; who will assist in data interpretation; and what, how, and to whom data will be reported. In addition, a program evaluator must be identified during the early part of the planning phase. This section provides a basic overview of the evaluation of transitional services. Additionally, the Consensus Panel recommends the in-depth discussion of evaluation and monitoring found in TIP 14, Developing State Outcomes Monitoring Systems for Alcohol and Other Drugs Abuse Treatment (CSAT, 1995a).

Evaluation can be conducted by the participating agencies as a collective effort or by a designated third party. When transitional services in a jurisdiction are provided by many agencies, the Consensus Panel recommends the use of a third-party program evaluator. This person should clearly understand each participating agency and have access to the information necessary to conduct an evaluation.

Participation of the evaluator from the inception of the program lays the foundation for the evaluation effort, because the data elements and issues affecting program evaluation will then be identified and included. The cooperation of all partnership administrators and agency staff involved in the evaluation must also be obtained early in the process because successful program evaluation depends not only on good design and an adequate number of subjects, but also on the cooperation of staff and others involved in the intervention. This cooperation can be expected in a research environment, but in settings such as prisons, jails, probation departments, and community treatment programs, the evaluation can place demands which staff may be reluctant to assume. It is imperative, therefore, that an evaluator gain and maintain the cooperation of program staff. This can be facilitated by explaining the purpose of the study, sharing data collection instruments with staff, listening to concerns about the study, giving the staff feedback, and making them aware of time constraints.

Purposes and Uses of Evaluation Information

There are many uses for the information gathered from a program evaluation. Evaluation not only documents program implementation but helps to guide it. Process and outcome evaluations are also used to improve implementation of subsequent programs by identifying strengths and weaknesses. Evaluation provides data to

  • Justify program costs and identify cost offsets
  • Establish program effectiveness or success
  • Make program adjustments
  • Assist in legislative decisionmaking and fund allocation
  • Serve as a basis for obtaining additional funding
  • Serve as a justification for expanding services

Process Evaluation

Process evaluation examines the implementation procedures and operations of a transitional services program as it compares with the program's stated goals and objectives. Process evaluation can be used to determine whether the people studied actually received program services and measures the intensity and duration of services provided. Unless evaluation describes what happens during a program, its strengths will not be known, and necessary changes in program design will not be identified. A good process evaluation suggests ways in which a program can be improved and serves as a management tool for further program development.

Many treatment efforts have been ineffectual, misunderstood, or misinterpreted because the program was not implemented as it was described in the original design. Process evaluation can be used to assess whether the program that was originally designed is the program that is being tested. A process evaluation can also help interpret the results of an outcome evaluation by providing a description and assessment of the services provided and the population receiving them.

Because several agencies are part of the service delivery continuum, process evaluation of transitional service programs requires a great deal of effort. To conduct a comprehensive process evaluation, the participating agencies must each undertake comparable process assessments, which means they must be willing and able to assess the implementation of their service components.

Outcome Evaluation

Outcome evaluation determines the effectiveness of a program when comparing the group receiving services to a control group receiving no treatment, an alternative program, or standard treatment. Outcome evaluation measures a program's ability to produce expected changes in the clients who are part of the program.

Types of Evaluation Designs

  • Posttest: In a posttest-only design, data are collected from patients at some point following treatment and then analyzed to determine if certain groups of patients have had better outcomes than other groups that did not receive the same services.
  • Pre/Post Intervention: This design balances scientific rigor with practicality in that it allows for a measure of change over a period of time. "Pretest" and "posttest" are analogous to "before" and "after" or "baseline" and "outcome." However, this design is limited because it does not prove a causal relationship between patient outcomes and treatment.
  • Quasi-experimental (comparison group): In this design, patients are randomly assigned to two or more groups. One group receives the conventional treatment, while the other receives the experimental treatment or no treatment at all. This is the strongest type of research design because of its capacity for demonstrating causal relationships between interventions and outcomes.

Of the three types of evaluation designs, the use of a quasi-experimental approach is preferred. Care must be taken to ensure that the comparison group selected is truly comparable to the client population by client profile, risks, and needs, and that data on these characteristics are available. The Consensus Panel suggests the use of a pre/post intervention design if a quasi-experimental design is not possible.

As mentioned, evaluation of transitional services poses unique challenges. First, data from several agencies must be collected. Second, attributing client outcomes to a specific agency is difficult. Third, each agency may focus on a slightly different or very different measure of client success. A consensus on measures of successful outcomes must be reached in consultation with the program evaluator prior to initiation of services. The focus of outcomes measurement should be on behavioral changes, such as reduced substance use or abstinence, stopped or reduced criminal activity, compliance with supervision requirements, and stability within the community.

Evaluation Reporting

The individual selected as the program evaluator will be responsible for coordinating the evaluation effort with each participating agency. Therefore, each agency should The individual selected as the program evaluator will be responsible for coordinating the evaluation effort with each participating agency. Therefore, each agency should designate a staff member to help the evaluator compile that agency's information for the report. As evaluation activities are being planned, agreement should be reached among participating agencies concerning the frequency of evaluation reporting, the data elements required for the report, and those who will receive reports. The format, length, and breadth of detail reported should also be determined. The program evaluator should ensure that the final report addresses any concerns raised by participating agencies and is written in clear and concise language. Ideally, evaluation data should be collected at 3 months, at 1 year, and later, if possible. Since offender clients are often on extended probation or parole, they may be easier to track than traditional clients.


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