Pathways (and Distractors) to SA Treatment for Probationers

Transcription

1 Pathways (and Distractors) to SA Treatment for Probationers Faye S. Taxman, Ph.D. Cynthia Lum, Ph.D. GEORGE MASON UNIVERSITY THIS PROJECT IS FUNDED BY THE NATIONAL INSTITUTE ON DRUG ABUSE,UNDER R01 DA017729

2 Acknowledgements Monique Wilson, Site PI at Friends Research Institute Clinical Team: Joshua Okundaye, Adria Trotman, Jimmie Alston Research Team: Meda Barker, Terry Wilkins, Pam Brown Center for Evidence-Based Crime Policy (GMU): Julie Willis

3 Place: Factors Affecting Success Tendency to focus on individual personality traits and behaviors affect causation, risk factors, or mechanisms for treatment Recent criminology research has focused on place as it affects behavior Concentration of reentry offenders in certain neighborhoods Increased risk of recidivism in these certain neighborhoods Increased health risks also in neighborhoods, i.e. Thomas & Torrone (2006) increased rates of STDs, pregnancy rates, etc. Social capital (positive structures) has been disappearing in neighborhoods where crime and drugs are prevalent Drug-involved offenders, drug-related crime, and drug abuse all concentrate geographically Few studies have examined how characteristics of one s environment can influence success in treatment and probation

4 Treatment Ecology Treatment Ecology : relationship between an offender s living, working, and treatment environs with treatment outcomes. Ecological contexts : Residence: factors such as drug availability, neighborhood disadvantage and strain, community resources, and the restorative qualities of place. Treatment: exposure to treatment options, travel burdens to maintaining attendance at treatment, and other possible place based factors (dangerousness, traffic, etc.) (Jacobson, 2006) Addicts are more likely to participate in treatment closer to their community (Beardsley, et al 2003) Failure to examine micro-structures (places, activity) that affect routine behaviors

5 Manualized Treatment Study Seamless system of treatment and probation supervision where treatment is offered on-site at probation office Randomized clinical trial at 3 sites; blocked by risk level: suburban, urban with concentration of treatment facilities, urban with fewer treatment facilities SOARING Treatment probation officer/treatment provider jointly offer the intervention; use probation officer to reinforce CBT through structured goals (face-to-face) meetings Negative drug tests awarded through reduced sessions CBT and communication skills On-going study, recruitment still occurring Data collected at baseline, 3, 6 and 12 months Treatment Outcomes affected by Individual Factors Probation-System Factors Treatment System Factors Integration of Probation & Treatment Systems Community Factors

6 Parole and Probation Intake Eligibility Screening Informed Consent & Research Intake Battery Clinical Assessment: ASI Random Assignment to: Control Group: Referred for Treatment in the Community (Follow-up at 3, 6, & 12 months) Experimental Group: SOARING at Parole & Probation (Follow-up at 3, 6, & 12 months) Parole and Probation Assessment Induction Session (Clinician, PO, & Offender) Goals Group Check-In Cognitive Behavioral Therapy Social Network Group

7 Offender Characteristics (n=128) Average Age: 34 80% male 55% Caucasian 63% Low to Moderate Criminal Risk Factor; 37% High Risk Used Frequently (at least 2x week within 30 days baseline) Alcohol 25% Marijuana 33% Cocaine 26% Opiates 33% Majority are polysubstance abusers

8 Psychosocial Functioning Area Mean %High Score Problem Recognition % Desire for Help % Treatment Readiness % Hostility % Legal Cynicism % Power Orientation % Criminal Rationalization %

9 Probation and Treatment Accessibility Mean SD Distance to probation office (in miles) % that have public transportation nearby (within reasonable walking distance) Approximate travel time by public transportation to probation office (in minutes) Number of available treatment facilities within a two-mile radius of individual s home 94% 23% Impact on attendance at probation? Treatment? Impact on outcomes?

10 Offender Factors Affecting Accessibility Within 30 days of baseline interview, 30% report severe physical pain 25% report bouts with depression for 2+weeks 36% report anxiety or tension 34% report trouble understanding others 9% report difficulty controlling violent behavior 25% report drug use affects physical health 2.2 mean number of prior hospitalizations for physical ailment.67 mean number of prior hospitalizations for mental health disorder

11 Perspective on Drug Availability 25% Perceive drugs available where they live; 75% do not Two concentrations: --Urban with TX Facilities --Urban w/o TX Facilities No perceived availability in Suburban areas Concentrated in transportation zones

12 Treatment Accessibility In some communities where offenders believe that drugs are a problem, there is a greater concentration of treatment programs (include self-help) Concentrated Neighborhood: 8.7 Tx Centers (in the City) Other Neighborhoods : 3.1 TX centers

13 Distribution of Positive Drug Test Positives Positive drug tests concentrate in key areas at baseline and 3 months Concentrated areas (offenders perceive neighborhoods as having drugs): no difference in baseline vs 3 month drug test positive rates Dispersed areas: more positive rates at baseline (statistically significant) in areas where perceive drugs not to be available

14 Legal Cynicism of Offenders 30% report cynical about the legal system, more likely to occur in lower risk offenders (p<.o5) No correlation between availability and cynicism Cynicism more likely to occur in concentrated areas (available drugs)

15 Personal Irresponsibility 14% score in high levels of personal irresponsibility No correlation with perception of availability Concentrate in neighborhoods w/o treatment facilities

16 Hostility 22% score higher on hostility dimension Positive correlation (.234) with perception of drug availability (p<.o1) More likely to occur in concentrated areas where drugs availability

17 Cold Heartedness 15% report high scores on coldheartedness No correlation with perception of drugs availability Concentrated in areas w/0 treatment facilities

18 Next Steps Current study examines proxies of environment and neighborhood Geographical distance to treatment, other users, social networks, etc. Model Treatment and Probation Outcomes on these Factors of Perception of Offenders, Individual Factors and Characteristics, Treatment/Probation Supervision, and Community/Neighborhood Factors To measure community and environment need: Develop micro-level structural factors and social networks such as level of drug market activity in a community, level of interaction with negative social networks, etc. Integrate Police Calls for Service and Arrest Data into Offender-level data Integrate data on drug markets in the areas Integrate Data on Social Capital (i.e. schools, religious facilities, etc.) and Social Networks