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Substance Abuse Treatment: For Adults in the Criminal Justice System [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 44.)

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Substance Abuse Treatment: For Adults in the Criminal Justice System [Internet].

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11 Key Issues Related To Program Development

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In This Chapter….

Overview

An important thread running throughout this TIP is the interdependence of criminal justice and substance abuse treatment systems, which influences what program activities are undertaken and how they are implemented. The members of the TIP consensus panel feel strongly that effective collaboration between the criminal justice and substance abuse treatment systems can result in better treatment for offenders and, ultimately, a reduction in crime. When available and effectively implemented, substance abuse treatment programs can reduce recidivism, reduce substance use, and help offenders to change their lives. The guiding notion in this chapter is to provide thoughtful consideration of key issues that frame effective programming and coordination.

This chapter is primarily aimed at program administrators, although counselors will benefit from reading it as well. The chapter presents information on issues such as reconciling the goals of the criminal justice and substance abuse treatment systems; the interdependence of the two systems and how to collaborate effectively; program-level coordination, including barriers to coordination and solutions, and integrating criminal justice and substance abuse treatment; research and evaluation issues; cost issues; and conclusions.

Reconciling Public Safety and Public Health Interests

Any discussion concerning the effectiveness of substance abuse treatment for clients under criminal justice supervision needs to address the historic differences between the criminal justice and public health systems. These differences influence the nature and quality of services provided at both the program and policy levels. A basic difference is the primary focuses of the two fields. The responsibility of the criminal justice system is to protect the public safety, with a focus on activities designed to isolate, and supervise individuals who threaten the lives and well-being of others (Office of the Federal Register 2004). The substance abuse treatment system's focus is on restoring individuals to productive lives and minimizing the consequences of alcohol and drug dependence on people with substance use disorders, their families, and communities.

Because of these differences in focus, the two systems sometimes operate at cross-purposes. The perceived need to “get tough” on crime and the rehabilitation of the offender have fueled the continued debate. Offenders are sometimes viewed as less deserving competitors for scarce substance abuse treatment services compared to nonoffending citizens. For some, punishment is the primary goal; treatment—if available at all—is secondary.

At the same time, security and public safety issues may not be a primary consideration for substance abuse treatment professionals. Counselors may forget that offenders are there because they have committed crimes, sometimes violent ones, and that not all offenders will become law-abiding citizens, even if they are not under the influence of drugs or alcohol. Moreover, some treatment programs may not address the additional needs of criminal justice clients, such as issues underlying criminal activity (e.g., criminal belief systems and criminal peer groups).

Despite these differences, the missions of public health departments and correctional agencies are complementary. An important common ground—a goal that is critically important to both systems—is the reduction of crime. The remainder of this chapter addresses ways to build on that common ground to create systems that habilitate offenders, prevent crime, and protect the public.

The missions of public health departments and correctional agencies are complementary.

“Good treatment is good public safety.”

—Claire McKaskill, former county prosecutor in Missouri

Interdependence of Criminal Justice and Treatment Systems

The criminal justice and substance abuse treatment systems can work together to improve the results of both systems. The Criminal Justice Treatment Planning Chart prepared by the Center for Substance Abuse Treatment (CSAT) might serve as a frame of reference (CSAT 1994b). In the chart (Figure 11-1, pp. 238–239), specific connections between the criminal justice and substance abuse treatment systems are targeted.

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Figure 11-1.

CSAT Criminal Justice Treatment Planning Chart.

It is vitally important that these two systems, and the people who work within them, agree that treatment must be tailored to the particular criminal justice setting and to the client's stage in the recovery process. Steps to promote integration between the criminal justice and the substance abuse treatment systems are discussed below.

Effective Collaboration Between Criminal Justice and Treatment Systems

Several conditions must exist for effective relationships between different groups or systems (Argyris 1970), such as the treatment and criminal justice systems. These conditions include

Investment in the system's effectiveness

Confidence in their own system

Belief in the interdependent nature of the systems

Willingness to accept or develop common goals to link the systems

Willingness to work collaboratively with other systems on joint projects

The consensus panel recommends the following basic principles, which are used to promote change in different organizations and systems but can be applied to the criminal justice and substance abuse treatment systems:

Development of leadership and goals

Endorsement from system leaders

Establishment of common goals and objectives

Identification of stakeholders

The following section describes how these recommended principles can be used to strengthen coordination between criminal justice and substance abuse treatment systems.

Development of leadership and goals

Small groups of individuals who have endorsement of leadership within the criminal justice and substance abuse treatment systems can help develop an agenda for action. Preliminary goals that link the two systems can then be established. It is important that preliminary goals identified are specific and attainable. Building on small successes at the beginning of the process is important.

Endorsement from system leaders

Formal endorsement should be obtained for collaborative projects from both systems' leaders. Endorsement may be implicit if leaders are part of the group or may be obtained from a more formalized process if they are not. This endorsement can take the form of an executive order from the governor, mayor, or commissioner; a legislative declaration for the group's work; or simply a memorandum of understanding from those who hold power in the criminal justice and substance abuse treatment systems. Whoever commissions the collaborative project activities must be kept informed about progress and goals at every stage, preferably in an informal, uncomplicated way. A systems audit may be an effective way to measure the starting point and level of collaboration. This may be conducted internally by project staff or by external evaluators.

Establishment of common goals and objectives

For systems collaboration to be effective, a unifying goal must be identified and pursued. The planning group should set a unifying goal that encompasses the needs of both the substance abuse treatment and criminal justice systems. For example, a goal to reallocate money from current treatment programs in order to treat other groups of offenders may be divisive rather than unifying. However, a goal of finding new funding for offender treatment that focuses on the most dangerous offenders is an example of a superordinate or unifying goal. The process of articulating goals will help to clarify and resolve differences among group members and to expedite project development. As soon as the goals have been determined, objectives should be described. A series of concrete objectives should be accompanied by an action plan to achieve the goals. The objectives should then be assigned to individual group members for followup.

Identification of stakeholders

Everyone has a vested interest in preventing and addressing crime related to substance abuse. As the example of Portland's Regional Drug Initiative (see text box on page 240) demonstrates, when systems and individuals work together the results can be impressive.

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Regional Drug Initiative, Portland, Oregon.

The following groups can be targeted to garner support for initiatives designed to provide substance abuse treatment for offenders.

The public. As taxpayers, voters, and residents, the public can influence what happens at every point along the criminal justice treatment continuum. As such, they are primary stakeholders who should be kept informed of relevant issues. For example, officials might consider releasing an annual community progress report, similar to a corporate annual report that includes facts such as the number of people who have successfully completed a treatment program. When members of the public participate in planning, an ongoing educative process is initiated. Public involvement also can address fears associated with proximity to offenders who use drugs and help the public recognize the benefits of treatment programs (e.g., jobs in the community, reduced crime, etc.).

Victims. Those victimized by a crime include the crime victim and family members—especially children and significant others. Several States have passed constitutional amendments that protect the rights of victims and that usually provide an opportunity for the victim to take part in the criminal justice process. Additionally, community-based victims' rights groups have been established in many communities, and some prosecutors' offices employ victim advocates.

Victims have a variety of interests, depending on the circumstances of their cases. Most victims want to see a combination of punishment, restitution, and protection, while others may be interested in having the offender's substance abuse problem addressed. There are a number of “indirect” victims of drug-related crime who are not readily identified by law enforcement or the courts, such as individuals who live near “crack” houses and whose main goal is to close them down. As stakeholders, these victims should have the opportunity to represent their own interests.

Recovering criminal justice clients. Offenders in recovery are the “consumers” of treatment services. Although their criminal behavior creates public safety problems, often they are also the victims of abuse and other crimes. It is important to include criminal justice clients who are in recovery as stakeholders, since they are well informed about issues related to coordination between the justice and treatment systems. It is also important to reference the statements, writings, achievements, and testimonials of recovering criminal justice clients.

Media. The media play a major role in shaping public attitudes toward the criminal justice system, especially attitudes about how to handle substance-involved offenders. Avenues of communication between the media and the criminal justice and substance abuse treatment systems must be kept open. Continual efforts should be made to communicate to the media a full picture of the multifaceted issues surrounding crime, substance use disorders, and substance abuse treatment. When media representatives are involved in planning, they may begin to see the positive side of joint efforts of the criminal justice and substance abuse treatment systems.

Legislators. Legislators should be consulted and provided up-to-date information about offenders who use substances and are involved with the criminal justice system. It is important that they also become aware of “success” stories, so that the influence of failed cases does not dominate their policy decisions. The political stance of being “tough on crime” and “waging war on drugs” has resulted in legislation requiring mandatory sentences for drug offenses, which must be tempered with information regarding positive treatment outcomes, the availability of effective alternatives to incarceration, and the consequences of punitive approaches for drug offenders. Tough crime bills (e.g., “three strikes” laws) have resulted in high criminal justice expenses that often shift limited funds from social services and education to construction and operation of correctional facilities—actions that tend to exacerbate the crime problem and reduce the availability of needed services for citizens. In some cases, this type of punitive sentencing reform has been developed in reaction to a particularly heinous crime, with inadequate consideration provided to the public policy consequences.

Community organizations. Community groups include local boards, recreational programs, church groups, neighborhood watches, and other community associations that address, either directly or indirectly, the issues of substance abuse and criminal behavior. These groups can play a role in prevention, treatment, and referral. Advocacy groups such as Mothers Against Drunk Driving and other special interest groups also can work effectively at the community level to address prevention issues. Their agendas often are consistent with those of other community groups that can be helped to understand the importance of reaching offenders with effective treatment.

Businesses. Local businesses and business groups, such as Kiwanis, Rotary, and downtown business associations, have a strong interest in preventing crime, since they may be targets, and often take an active role in their communities. Employers also are interested in preventing substance abuse by their employees. Businesses are a vital component of the larger community and should be involved in planning for substance abuse treatment in the criminal justice system. Business leaders can provide invaluable assistance in planning training programs and providing opportunities for job placements. Vocational training is a critical component of the transition and reintegration process for offenders with substance use disorders reentering communities (see also Chapter 8 in TIP 38, Integrating Substance Abuse Treatment and Vocational Services [CSAT 2000c]).

The consensus panel believes that leaders from the criminal justice and substance abuse treatment systems can do the hard work of planning substance abuse treatment for offenders in all parts of the criminal justice system continuum. Policy, procedures, relationships, and shared responsibilities should be developed to operationalize effective substance abuse treatment within the criminal justice system.

Program-Level Coordination

Federal, State, and local policies have a tremendous effect on the quality and availability of substance abuse treatment for offenders, as do policies and procedures within individual programs. The following sections address the barriers to effective program coordination and integrating substance abuse treatment into criminal justice at the program level.

Barriers to Program Coordination

Farabee and colleagues (1999) identified six major barriers that prevent effective implementation of substance abuse treatment in the criminal justice system. These barriers and their suggested solutions are summarized in Figure 11-2.

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Figure 11-2.

Barriers to Effective Treatment.

Program Components

Effective programs include case management along with procedures to coordinate the flow of information and to serve the best interests of the offender.

Case management

Case management is the process of linking the offender with appropriate resources; tracking the offender's participation and progress in the referred programs; reporting this information to the appropriate supervising authority and, when requested, to the court; and monitoring the conditions imposed by the court. Effective case management often requires supplementary funding and reallocation of resources.

Case management activities optimally begin at the pretrial period, continue throughout the treatment process, and provide a means to coordinate the requirements of the justice system with treatment goals and other immediate concerns. Case management activities focus on coordination of services during transitions between different stages of the justice system. When clearly defined, accountability guidelines established across the two systems ensure that information regarding criminal activity, infractions, and other critical incidents are reported in a timely and effective manner.

Procedures to coordinate the flow of information

Information management is the key to identifying treatment needs and can provide treatment and related services more effectively. Basic information gathered about the defendant should follow the offender through subsequent stages of the criminal justice system and substance abuse treatment system. Agencies from both systems should decide what information is necessary and useful and should develop methods for sharing that information. However, the defendant's civil liberties and rights of confidentiality must be considered whenever information is shared.

Procedures to improve information flow include the following:

Establish methods for timely collection and reporting of information.

Implement regular quality control procedures to maximize completeness, accuracy, and consistency of data.

Establish consistent definitions of the data elements between the different participating agencies.

Ensure that information flows in both directions: from treatment providers to criminal justice staff, and from criminal justice staff to treatment providers.

Increase sensitivity to the confidentiality requirements and political concerns of criminal justice agencies and treatment providers.

Create a designated central repository for appropriate client information.

Integrating Public Safety and Treatment at the Program Level

Good substance abuse treatment programs contribute heavily to enhancing safety and security, as program participants usually present the fewest safety and security-related problems (Belenko 2001). Treatment and security can be thought of as two sides of the same coin, rather than as opposites. For example, substance abuse treatment significantly enhances offenders' accountability through additional monitoring and communication with the courts, community supervision, and other criminal justice staff. Accountability also is provided by drug testing and by behavioral and skills-oriented interventions that are provided by treatment.

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Information Sharing: Maricopa County Data Link Project.

The consensus panel believes that the following conceptual model is helpful in understanding how the justice system is strengthened by substance abuse treatment involvement.

Supportive environment with accountability

A key issue for criminal justice programs is how treatment and justice system staff can work together to maintain a positive atmosphere that supports offenders' recovery efforts while confronting and managing offender “games” and manipulative coping strategies. Programs that focus exclusively on either supportive or confrontational approaches generally are not effective within the criminal justice system. Criminal justice treatment programs run smoothly and successfully only when staff employ both supportive and accountability procedures. “Confrontation” as used here does not mean a hard and aggressive verbal interchange, but rather assertively pointing out misbehavior and discrepancies between goals and behavior.

Some programs are successful in implementing only half of this formula. Supportiveness without accountability leads to the appearance that staff are trying to be “friends” with clients, leaving staff vulnerable to offender manipulation. The staff relationship with the client is better represented as that of a teacher and student, with staff modeling adaptive skills, behaviors, and attitudes. Conversely, accountability procedures that are developed in a nonsupportive environment often lead to an atmosphere characterized by hostility and punitiveness. Criminal justice system programs with this type of atmosphere are not typically successful in engaging offenders in treatment recovery.

Justice system programs flourish when all staff contribute to both the supportive environment and accountability of the clients. Keys to success include staff appreciation of the need to set limits supportively and to establish clear personal boundaries with clients. A final point for all staff who are integrating the work of criminal justice staff and treatment staff is that good treatment is good public safety. Treatment staff should demonstrate to justice system staff how their program might enhance safety and security. Substance abuse treatment programs can quickly demonstrate their worth by effectively managing clients' difficult behavior, supporting the work of criminal justice staff, and holding themselves and criminal justice staff accountable for following through with their respective commitments to the program.

Personnel needs

Training and professional and workforce development issues are of paramount concern in implementation of treatment programs with the criminal justice system. Because the criminal justice system affects the environment in which treatment occurs and provides the structure to which the client must respond, substance abuse treatment counselors need to become familiar with the criminal justice system, its unique terminology, and methods of balancing client treatment needs with safety issues. Treatment professionals working with criminal justice clients should be knowledgeable about criminogenic risk factors, the most effective strategies and approaches for use with offender populations, and the need for professional boundaries.

By the same token, criminal justice staff should understand the goals of substance abuse treatment, the effects of frequently abused drugs, and the types of treatment that are available. Treatment knowledge is particularly important for criminal justice staff, since treatment is increasingly affecting all aspects of diversion, community supervision, court monitoring, and incarceration. Cross-training activities can encourage employees to work together. Training is also needed to address the wide variety of “special needs” populations under criminal justice supervision and the impact of managed care systems and tiered placement criteria (e.g., American Society of Addiction Medicine criteria) on publicly funded treatment systems.

Given that the rapid growth of treatment programs within the criminal justice system has not been matched by equal growth in organizational and staff resources, the system has been strained. Staff turnover, burnout, and other occupational hazards can be addressed through efforts to increase professionalism, such as developing

A clear hierarchy of staff positions with increasing responsibilities at each level

Clear requirements for advancement in the hierarchy

Incentives for additional training, made readily available

Incentives for working on units that are considered more difficult or are higher security

Merit pay

Training resources

CSAT launched a network of Addiction Technology Transfer Centers (ATTCs) in 1993 to increase the knowledge and skills of substance abuse treatment professionals; to facilitate access to state-of-the-art research and education; heighten the awareness, knowledge, and skills of all professionals who may be in a position to help people with substance use disorders; and to foster alliances among stakeholders. Information on and links to ATTC's 14 Regional Centers and National Office can be accessed online at http://www.attcnetwork.org.

The ATTCs have extensive resources of value to professionals working with offenders who abuse substances, a few of which are highlighted below:

Working with Criminal Justice Clients. Designed to familiarize substance abuse treatment counselors to work with criminal justice clients, the curriculum includes material on intersystem teamwork and relapse issues.

Training for Professionals Working with MICA (Mentally Ill Chemical Abusing) Offenders. This 1-day course module serves as cross-training for staff in law enforcement, mental health, and substance abuse settings.

Orientation to Therapeutic Community. Developed to introduce administrators and ancillary staff to the history, theory, and current research on the therapeutic community model, this training provides a fundamental framework for therapeutic communities. This training curriculum is not intended for frontline workers.

Therapeutic Community Experiential Training. Intended for frontline staff of startup therapeutic communities, this 5-day intensive experiential training provides participants with the knowledge, expertise, and attitudes that have been used effectively by professionals in the field.

Criminal Justice/Substance Abuse Cross Training: Working Together for Change. This program is designed to help administrators and professionals integrate criminal justice and substance abuse services systems to coordinate treatment and recovery services and overcome barriers to collaboration.

Research and Evaluation

Research and evaluation is a critical dimension of substance abuse treatment programs in the criminal justice system. Evaluations are needed for program monitoring and for decisionmaking by program staff, prison administrators, and policymakers. Evaluations provide accountability, identify strengths and weaknesses, and provide a basis for program revision. In addition, evaluation reports are useful learning tools for others who are interested in developing effective programs. Many treatment programs in the criminal justice system have operated without evaluations for many years, only to find out later that key outcome data are needed to justify program continuation.

Conducting an adequate evaluation requires one to clearly formulate the treatment model and reasonable program goals and specific objectives related to client needs. General goals must be translated into measurable outcomes. The evaluator generally works closely with program administrators to translate their evaluation guidelines into operational components. For example, general goals of helping program participants become drug and crime free can be operationalized into intermediate goals of changing behavior (e.g., reductions in rule infractions and fewer positive drug test results) while in a program.

There are three basic types of evaluations:

1.

Implementation

2.

Process

3.

Outcome

While implementation and process evaluations can begin when the program is initiated, outcome evaluation should not begin until the program has been fully implemented. Outcome evaluations are generally more costly than other types of evaluation and are warranted for programs of longer duration that are aimed at modifying lifestyles (such as therapeutic communities), rather than drug education interventions that are less intensive and less likely to produce long-term effects.

Implementation Evaluation

While programs often look promising in the proposal stage, many fail to materialize as planned in the security-oriented correctional environment. Other programs are rigidly implemented as planned and without adjustments for the realities of prison, often rendering them less effective. Implementation evaluations are aimed at identifying problems and accomplishments during the early phases of program development for feedback to clinical and administrative staff. Such evaluations involve informal and formal interviews with correctional administrators, officers, and inmates to ascertain their degree of satisfaction with the program and their perceptions of problems.

Research and evaluation is a critical dimension of substance abuse treatment programs in the criminal justice system.

In order to initiate an evaluation, in addition to having a clear, detailed proposal that describes the planned program, evaluators will need to know

The model or theory the program is based on

Criteria for participation

Program components

Planned treatment duration

Staff qualifications

Plans for staff orientation and training

The schedule for implementation

These elements provide the basis for assessment. Periodic implementation feedback reports to program and institutional administrators can be very useful in identifying problems and planning corrective measures.

Process Evaluation

Traditionally, process evaluation refers to assessment of the effects of the program on clients while they are in the program, making it possible to assess the institution's intermediary goals. Process evaluation involves analyzing records related to

Type and amount of services provided

Attendance and participation in group meetings

Number of clients who are screened, admitted, reviewed, and discharged

Percentage of clients who favorably complete treatment each month

Percentage of clients who have infractions or rule violations

Number of clients who test positive for substances (this can be compared to urinalysis results for the general prison population)

Effective programs produce positive client changes. These changes initially occur during participation in the program and ideally continue upon release into the community. The areas of potential client change that should be assessed include

Cognitive understanding (e.g., mastery of program curriculum)

Emotional functioning (e.g., anxiety and depression)

Attitudes/values (e.g., honesty, responsibility, and concern for others)

Education and vocational training progress (e.g., achievement tests)

Behavior (e.g., rule infractions and urinalyses results)

Within corrections it is also important to evaluate program impact on the host institution. Well-run treatment programs often generate an array of positive developments affecting the morale and functioning of adjacent cellblocks and entire prisons. Areas to examine include

Inmate behavior. Review the number of rule infractions, the cost of hearings, court litigation expenses, and inmate cooperation in general prison operations.

Staff functioning. Assess stress levels, which may become manifest in the number of sick days taken and the rate of staff turnover. Generally, the better the program, the lower the stress, and the better the attendance, the involvement, and the commitment of staff.

Physical plant. Examine the physical properties of the program. Assess general vandalism apparent in terms of damage to furniture or windows, as well as the presence of graffiti. Assess structural damage, for example, to walls and plumbing.

Institutional impact can be evaluated by comparing the status of the environment before and after program implementation (pre/post comparison), as well as by comparing the current status of similar cellblocks that do not have treatment programs. Careful cost assessment of institutional impact can help provide convincing information regarding program cost benefits to administrators, funding sources, and policymakers.

Outcome Evaluation

Outcome evaluations are more ambitious and expensive than implementation or process evaluations. Outcome evaluations involve quantitative research aimed at assessing the impact of the program on long-term treatment outcomes. Such evaluations are usually carefully designed studies that compare outcomes for a treatment group with outcomes for other less intensive treatments or a no-treatment control group (i.e., a sample of inmates who meet the program admission criteria but who do not receive treatment), complex statistical analyses, and sophisticated report preparation.

Followup data (e.g., drug relapse, recidivism, employment status) are the heart of outcome evaluation. Followup data can be collected from criminal justice and substance abuse treatment agency records or from face-to-face interviews with individuals who participated in prison programs. Studies that use agency records are less expensive than locating former inmates and conducting followup interviews. Outcome evaluations can include cost-effectiveness and cost-benefit information that is important to policymakers.

Because outcome research usually involves a relatively large investment of time and money, as well as the cooperation of a variety of people and agencies, it must be carefully planned. A research design may be very simple and easy to implement or it may be more complex. In the case of more complex studies it is usually advisable to enlist the assistance of an experienced researcher. The kinds of outcome information that might be collected are summarized in Figure 11-3 (next page).

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Figure 11-3.

Outcome Information.

There is a hierarchy of evaluation approaches ranging from simple outcome monitoring to nonrandom or quasi-experimental designs to experimental research studies that use random assignment. The selection of a research design depends on available funding and available comparison groups.

Any claims to a program's effectiveness rest on comparisons that demonstrate it is superior to nontreatment groups or to groups that have received another type of treatment. The power of a research design is related to how defensible study results are against potential criticisms. Although simple outcome monitoring studies are relatively economical to conduct, they lack the comparison groups needed to show the specific effects of a program. While specific program outcomes can be compared with national and State norms or with published outcomes of another program, such comparisons are limited because of the many uncontrolled potential differences between the program group being monitored and the comparison groups.

The defining characteristic of a pure research design is random assignment of inmates to treatment and control groups. Random assignment may be done by using a lottery type procedure that ensures that there are no systematic pretreatment differences between the groups (such as motivation or background characteristics). The concern is that any important preprogram difference in program and control groups may bias the results and compromise any claims for program effectiveness. Random assignment is difficult to implement in prisons because of ethical and legal implications of denying inmates treatment. If a program has a substantial waiting list it may be feasible to implement a lottery procedure as a fair method to control program admission, thus creating a random assignment situation.

Nonrandom assignment is an attempt to approximate the power of the pure experimental design. A popular quasi-experimental design uses a comparison group that is matched to the program group on as many pretreatment factors as possible. Often, statistical methods are employed to control pre-treatment group differences that might influence outcomes.

Locating criminal justice clients for outcome studies is a very difficult and expensive undertaking. Collection of extensive locator information at program intake will assist interviewers in the locating task. Examples of useful locator information include social security number, driver's license number, mother's maiden name, aliases, names and locations of family members and friends, and locations of favorite hangouts.

Large samples are needed in outcome studies to demonstrate significant results and to study the effects of multiple variables. For example, an analysis of the role of ethnicity (African American, Caucasian, and

Hispanic/Latino) reduces group size by a third. When reporting results it is generally best to use less complex statistics such as percentages and averages so that they are clear and understandable to nonstatisticians. Often, showing results in figures and charts is helpful. It is advisable to keep reports concise and clear for policymakers who may have little time or patience to study complex material. Finally, the credibility of outcome studies is often enhanced when conducted by outside researchers who have fewer vested interests in the outcomes.

The consensus panel provided several recommendations for improving evaluation efforts within criminal justice programs:

Management information systems should be coordinated for use by substance abuse treatment and justice system professionals. This can lead to greater sharing of information and ensure that information is available for evaluation purposes.

Quality assurance and quality improvement measures should be applied across all criminal justice program settings.

Monitoring and evaluation should be part of all major treatment initiatives established within the criminal justice system.

Cost Issues

Another critical area in program development is that of program costs, including cost savings and cost-benefit/cost-offset information. Program administrators are routinely required to provide evidence that monies are spent effectively. The literature indicates that treatment has cost benefits in certain settings. Positive cost-offset results (savings down the road) have been demonstrated from treatment through specific approaches, such as drug courts (Belenko 2001). Similar results have been shown for treatment in prison settings (McCollister and French 2001).

Cost analyses (see Figure 11-4 below for definition) are important in determining how to allocate funds within a program and for understanding the relationship between costs and outcomes. Examining costs for the program as a whole (or for parts of it) is a basic form of cost analysis. Cost analyses can be provided as a monthly or quarterly report and costs generally vary over time. Costs provided at several levels include:

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Figure 11-4.

Definition of Terms.

Total cost of the program for the average treatment

Cost of each part of the program each day

Total monthly or annual cost per offender

The major types of cost analyses include “cost,” “cost-effectiveness,” and “cost benefit,” and are described below in Figure 11-4.

Some treatment program evaluations measure direct monetary outcomes, such as a reduction in the use of health services. Other treatment program evaluations can measure indirect costs, such as reduction in crime-related costs, reduced recidivism, and the costs of incarcerating offenders.

Other ways to report the relationship between costs and benefits include

The net benefit of a program can be shown by subtracting the costs of a program from its benefits.

The ratio of benefits to costs is found by dividing total program benefits by total program costs.

The time to return on investment is the time it takes for program benefits to equal program costs.

The present value of benefits takes into account the decreasing value of benefits attained in the distant future.

Because neither net benefits nor cost-benefit ratios indicate the size of the cost (initial investment) required for treatment to yield the observed benefits, it is important to report this as well.

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How Politics and Policy Can Affect Treatment: California's Proposition 36.

Key Goals of SAMHSA

SAMHSA is committed to serving justice-involved populations and shares that responsibility with other agencies. In 2004 SAMHSA began a 2-year action plan to create a strategy to facilitate development and management of mental health and substance abuse prevention, early intervention, clinical treatment, and recovery support policies, programs, strategies, and practices for adults and juveniles in contact with or involved with the justice system. Following are some of the key activities that are underway:

Develop and implement a Recovery Management Framework that will foster resiliency and manage recovery among adults and juveniles involved in the criminal justice system.

Examine the gaps within SAMHSA's criminal and juvenile justice activities and identify key efforts that could be implemented.

Provide training and technical assistance on best practices and evidence-based programs for persons in the criminal justice system.

Support mechanisms that promote science-based policies, programs, and models to ensure that services are provided at all points in the criminal justice system.

Support knowledge synthesis and information dissemination efforts to help change attitudes of and reduce stigma among service providers who work with clients in the justice system.

Engage in targeted collaborations at local, State, and Federal levels to promote effective, integrated systems approaches.

Inform communities, policymakers, and other stakeholders of the importance of substance abuse and mental health services for people in the criminal justice system.

For more information about SAMHSA's efforts regarding substance abuse and mental health services for adults and juveniles in the criminal justice system go to http://www.samhsa.gov.

Conclusions

The consensus panel draws conclusions and makes recommendations as follows:

A goal that is critically important to both the substance abuse treatment and correctional systems is the reduction of crime.

It is vitally important that these two systems recognize that treatment must be tailored to the particular criminal justice setting and to the client's stage in the recovery process.

The following basic principles can be used to promote change in the criminal justice and treatment systems: developing leadership, obtaining endorsement from systems leaders, establishing common goals and objectives, identifying stakeholders, and encouraging collaboration among stakeholders.

Good treatment programs contribute to enhancing safety and security, as program participants usually present the fewest safety and security-related problems.

Substance abuse treatment professionals should be trained in criminal justice issues, and criminal justice personnel should be trained in substance abuse issues. Cross-training activities can encourage employees' willingness to work with each other more and can help personnel manage the wide variety of “special needs” populations under criminal justice supervision as well as the impact of managed care systems and tiered placement criteria.

Research and evaluation are a critical dimension of substance abuse treatment programs in the criminal justice system. Evaluations provide feedback related to key issues and also can identify major problems related to program implementation.

Program costs are another critical area. Cost analyses can help a program determine how to allocate funds and understand the relationship between costs and outcomes.

Copyright Notice

This is an open-access report distributed under the terms of the Creative Commons Public Domain License. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.

Bookshelf ID: NBK572931

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