Providing Effective Substance Abuse Treatment to a Correctional Population Chloe Moore, MSW Corrections Field Supervisor Erin Thorvaldson, MPA Evidence Based Program Manager Training Objectives Understand NIC s Eight Principles of Effective Interventions Understand ways to implement Risk, Need, Responsivity Principle into programming Gain an understanding of the WI Department of Corrections Substance Use Disorder Treatment Standards What is Evidence Based Practice? A progressive, organizational use of direct, current scientific evidence to guide and inform efficient and effective correctional services. The Carey Group, 2008 1
Understanding the Whole Person Behavior Using external influences, punishments, and rewards Cognitive Structure Using internal influences, building on strengths, and increasing internal awareness October 26, 2018 FOR INTERNAL USE ONLY Copyright 2012 Northpointe Inc., its subsidiaries and affiliates. All rights reserved. NIC s 8 Principles of Effective Intervention Risk Principle (Who) RNR Model Prioritize resources for higher risk offenders Need Principle (What) Target interventions to criminogenic needs Responsivity Principle (How) Gender Learning Style Culture Tailor programming/interventions to offender s unique needs Intervention strategy 2
Criminogenic Needs Dynamic as opposed to static Provide ingredients for smarter alignment of interventions Measured over time Can drive major sentencing and correctional policy Criminogenic Needs Exercise Top Four Anti Social Cognition Anti Social Companions Anti Social Personality or Temperament Family and/or Marital Next Four Substance Abuse Employment School Leisure and/or Recreation Reduce anti social cognition, recognize risky thinking and feelings, adopt an alternative identity Reduce association with offenders, enhance contact with prosocial peers Build problem solving, self management, anger management, and coping skills Reduce conflict, build positive relationships and communication, enhance monitoring/supervision Reduce usage, reduce the supports for abuse behavior, enhance alternatives to abuse Provide employment seeking and keeping skills Enhance performance rewards and satisfaction Enhance involvement and satisfaction in pro social activities Source: Andrews, Donald A. (2007), Principles of Effective Correctional Programs, in Motiuk, Laurence L. and Serin, Ralph C. (2007). Compendium 2000 on Effective Correctional Programming. Correctional Service Canada. What about Mental Health? Research suggests correctional clients with an identified mental illness are equally likely to be rearrested, but are more likely to return to prison custody Correctional clients with an identified mental illness have also been found to have more general risk factors for recidivism These risk factors significantly predicted recidivism, with no additional risk found to be associated with mental illness Citation: Skeem, J. L., Winter, E., Kennealy, P. J., Louden, J. E., & Tatar, J. R. (2014). Offenders with mental illness have criminogenic needs, too: Toward recidivism reduction. Law and Human Behavior, 38(3), 212 224. 3
Trauma Articles: Research Hannah Moffat, K. (2005). Criminogenic needs and the transformative risk subject: Hybridizations of risk/need in penalty. Punishment & Society, 7(1), 29 51. Hollin, C.R. & Palmer, E.J. (2006). Criminogenic need and women Offenders: A critique of the literature. Legal and Criminological Psychology, 11(2), 179 195. Comprehensive Programs Six Dimensions of ASAM s Criteria 4
Contingency Management System Essential ingredient for changing offender behavior Incorporate both reinforcers (e.g. rewards) and punishers (e.g. sanctions) Reinforcement is most effective when: Comes immediately after the appropriate behavior and is done consistently Reason for reward is emphasized Aim for a 4:1 Ratio Key Elements Reinforce behavior and thoughts related to criminal conduct Treatment Progress Skill Demonstration Basic system of graduated reinforcers and sanctions (more complex, positive behaviors receive larger rewards) Individual rewards vs. group rewards Supporting Research NIJ Meta Analysis Results HERE https://www.crimesolutions.gov/practicedetails.aspx?id=72 5
Examples of Rewards Rewards should vary and be desirable for the target population Verbal Praise Token or Point System Certificates of Completion Do you use any rewards systems in your program? Available Tools Curricula: Cognitive Behavioral Interventions for Substance Abuse Thinking for a Change Helping Women Recover: A Program for Treating Substance Abuse Tools Skills Cards Change Journals Carey Guides Brief Intervention Tools (BITS) 6
DOC SUD Treatment Standards Screening and Assessment Assessing initial needs and progress towards discharge Risk, Need, and Responsivity Principles Directed Practice Cognitive behavioral approach Incorporating skill training, role playing, and directed practice DOC SUD Treatment Standards Utilizes ASAM Criteria to evaluate the six dimensions using evidence based assessments Establishes Individualized Continuum of Care Plans Identifies group dynamics and levels of care for DCC contracted services Requires monitoring of treatment outcomes Assessments 7
Assessments Risk and Needs Assessment Tool Validated tool generating both risk to recidivate and identified criminogenic needs Examples include: COMPAS, ORAS, LS/CMI, WRNA, STRONG AODA/SUD Assessment Tool Assesses the six domains of the ASAM criteria summarizing the level of need through an actual score or objective criteria Examples include: TAAD 5, SUDDS 5, DAPPER 3, CONTINUUM, SBIRT Clinical Tools, and AUDIT Clinical Case Manager Master s level clinicians licensed to treat mental health and substance abuse ASAM Criteria will be utilized to determine the appropriate level of care Comprehensive mental health assessments will be completed by the Clinical Case Manager Clinical Case Manager will collaborate with communitybased providers and DCC contracted providers to provide wrap around care Citation: https://csgjusticecenter.org/nrrc/community supervision agency/ 8
What does Collaboration Mean? Benefits and difficulties of collaboration Different lenses and at times priorities Additional information for all parties leads to better collaborative case plans Shared goals: Reduce/eliminate substance abuse Improve functional areas of client s life What does Collaboration Mean? Collaboration with treatment providers is an important part of agent s work Increases the possibility of a successful outcomes Offers treatment providers additional tools Allows for client advocacy Provides agents with the opportunity to obtain a clinical recommendation when responding to violations What does an agent need to know? Clinical recommendations Information regarding responsivity needs (e.g., mental health diagnosis) Non compliance with treatment and associated clinical recommendation Treatment progress Violations of supervision Case Examples Jason Jason has recently been convicted of multiple thefts, and has been placed on probation for a period of two years. As a condition of his probation he must complete an AODA assessment and comply with the recommended treatment. During his first appointment with his agent Jason discloses that he committed each of the thefts to obtain money so that he could purchase heroin. When the agent asks about his support network, Jason shares that his father and brother are both currently incarcerated. His mother is supportive, but unfortunately resides in another state. He has one friend from high school who is a positive peer, but he has not talked to this friend in some time as they told him they would only speak to him if he were sober. A UA is taken at the end of the visit which is positive for opiates. In further review of the case, the agent learns that Jason has a criminal history which includes Burglary [Party to a Crime], Operating a Vehicle without Consent as Passenger, and Intent to Deliver Narcotics [Party to a Crime], and Battery. 9
Jason s Bar Chart Contact Information Chloe Moore, MSW Chloe.Moore@Wisconsin.gov 608 622 4780 Erin Thorvaldson, MPA Erin.Thorvaldson@Wisconsin.gov 608 240 5022 10