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- 10 California’s Correctional Drug Treatment System
William M. Burdon, Michael L. Prendergast, and Harry K. Wexler
- ACKNOWLEDGEMENTS AND DISCLAIMER
This paper was supported by interagency agreements (Contracts C97.355 & C98.346) between the California Department of Corrections and Rehabilitation, Office of Substance Abuse Programs (CDCR-OSAP) and the UCLA Integrated Substance Abuse Programs (ISAP). Opinions and views expressed herein are those of the authors solely. They do not necessarily represent the opinions or views of the California Department of Corrections and Rehabilitation or its employees. Inquiries should be directed to William M. Burdon, Ph.D., UCLA Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025; E-mail address: [email protected].
- ABSTRACT
Since 1997, California has been engaged in the largest expansion of prison-based treatment of its kind in the nation and perhaps even the world. This chapter provides a historical overview of the California correctional drug treatment system, including the current expansion of prison-based treatment programs and the related system of aftercare treatment. Findings from a series of evaluation studies of prison-based treatment programs in California are presented and discussed, as are the findings from continuing analyses that have been performed on data collected from these evaluations. The collective body of findings that have been generated from the California correctional drug treatment system have made a substantial contribution
to the literature on corrections-based treatment. However, there remains much to be learned about how to further enhance the effectiveness of treatment for offenders. To that end, the chapter concludes with a discussion of how the expanding and evolving body of literature can be used to inform and advance corrections-based substance abuse treatment, not only in California, but nationwide.
- INTRODUCTION
Over the past 40 years, therapeutic communities (TCs) have flourished in many states, primarily in community-based settings. However, it has only been in the past decade that they have emerged as the “treatment of choice” for dealing with substance-abusing offenders in prison settings (Inciardi, 1996; Wexler, 1995). Perhaps nowhere has this been more apparent than in California, which, since 1997, has been engaged in the largest expansion of prison-based substance abuse treatment ever undertaken in the United States; perhaps even the world. This chapter documents the story of the California correctional drug treatment system to date.
The story of the California correctional drug treatment system begins with the opening of the Amity TC at the R. J. Donovan Corrections Center in San Diego in 1989. Early evaluations of this and other prison-based TC programs, which showed the benefits of providing in-prison substance abuse treatment using the TC model, formed the foundation for legislation to expand the number of in-prison TC treatment beds in California prisons. This chapter will describe this expansion of prison-based treatment programs in California and the complementary system of aftercare that was developed and implemented to help ensure positive outcomes by providing continuity of care for paroles choosing to continue treatment in the community following release from prison.
Prendergast and Wexler (2004) provided a historical perspective of prison-based substance abuse treatment programs in California. This chapter seeks to supplement and build upon that historical overview by providing details of the outcomes from the evaluation studies that were performed on the California correctional treatment system, as well as findings from continuing research and analyses performed on the treatment database developed from these evaluations, which contains client-level background, treatment participation, and return to prison data on almost 28,000 inmates who participated in prison-based treatment from 1997 to 2004. The chapter closes with a discussion of how to move the initiative forward and ensure its continued viability and success into the future. This includes broadening the scope of in-prison treatment to include modalities other than TC treatment, the adoption and implementation of a system for assessing and referring drug-involved offenders to the appropriate modality and intensity of in-prison treatment, improving the system of in-prison and aftercare treatment by focusing on assessing and improving the quality of existing treatment programs, and the need for more gender-specific treatment.
- Early Prison-Based Treatment in California—The Civil Addict Program
In the 1960s, California pioneered the “civil commitment” approach to the treatment of drug and alcohol addiction among offenders. This approach to treatment allowed judges to designate certain drug-involved offenders facing sentencing before the court as “narcotics addicts” and commit them to serve their sentence at the California Rehabilitation Center,
where they were required to undergo a period of in-prison residential treatment in the newly formed Civil Addict Program (CAP), followed by mandatory community-based treatment after release from prison. Entrance into CAP was voluntary, and offenders could refuse the designation and be sentenced as a felon offender to regular state prison.
At its height, CAP proved to be a relatively successful treatment program for drug-involved offenders. An evaluation of the programs conducted in the mid-1970s (McGlothlin, Anglin, & Wilson, 1977) found that, during the seven years after initial commitment, CAP clients reduced their daily opiate use by 22 percent, whereas comparison clients reduced their daily use by only 7 percent. Similarly, criminal activities among the CAP group were reduced by 19 percent, while the comparison group reported a reduction of only 7 percent.
Despite these positive findings, CAP became a victim of a budget reductions and the antirehabilitation ideology of the late 1970s. In 1976, California passed the Uniform Determinate Sentencing Act, which specified defined lengths of time in prison for specific offenses rather than leaving the decision up to the parole board. This act removed a major incentive for inmates to participate in rehabilitation programs, making it difficult to maintain existing programs (e.g., CAP) or initiate new ones. As a result, CAP eventually became little more than a shell of the initial program, and its value as a treatment tool declined. Apart from the much weakened programming at the California Rehabilitation Center and scattered short-term drug education programs in a few prisons, programming for drug-using inmates within the California prison system virtually disappeared in the late 1970s and the 1980s.
- A Return to Correctional Treatment in California
Between 1983 and 1988, commitments to prison for drug offenses in California increased from 11.1 percent of all new felon admissions to 35.4 percent. Sharp increases were also observed in the number of parolees returned to prison for drug-related offenses. The contribution of drug and alcohol abuse to the increasing number of offenders entering prison and being returned to prison on parole violations was highlighted by a Blue Ribbon Commission on Inmate Population Management (established in 1987). This commission also pointed out that, despite the increase in drug-involved offenders in state prison, there were few drug and alcohol treatment programs available to California prisoners or parolees. The commission urged the Department of Corrections, the Board of Corrections, and local correctional agencies to “immediately develop and implement a state and local corrections substance abuse strategy to systematically and aggressively deal with substance abusing offenders while they are under correctional supervision, because this is perhaps the most significant contributing factor to prison and jail overcrowding” (Blue Ribbon Commission on Inmate Population Management, 1990, p. 7).
Several other developments that were occurring nationally in the late 1980s also contributed to the revival of treatment programs within California’s correctional system. There was growing support nationally for rehabilitation as evidenced by positive reviews of correctional treatment programs (Camp & Camp, 1989; Chaiken, 1989; Gendreau & Ross, 1987), surveys indicating public support for rehabilitation (Cullen, Cullen, & Wozniak, 1988), federal backing of treatment for drug-abusing offenders in Project REFORM (Wexler, Lipton, Blackmore, & Brewington, 1992), and the first National Drug Control Strategy (Office of National Drug Control Policy, 1989).
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lso, in 1987, at the same time that the Blue Ribbon Commission was meeting, a task force on prison-based treatment was formed that reported directly to the director of the California Department of Corrections and Rehabilitation (CDCR).1 At the urging of this task force, CDCR initiated participation in Project REFORM. With the assistance of a grant from the Bureau of Justice Assistance and a technical review of the department’s substance abuse treatment needs (Rupp & Beck, 1989), CDCR submitted a plan to the legislature that included the establishment of a demonstration treatment project at the newly opened R. J. Donovan Correctional Facility near San Diego (Winett, Mullen, Lowe, & Missakian, 1992). The plan called for this demonstration project to utilize the therapeutic community (TC) model of treatment, modified for a prison environment, and it called for the formation of the Office of Substance Abuse Programs (OSAP) within CDCR to oversee and guide the design and implementation of this and other possible treatment programs in prisons throughout the state.
In 1990, OSAP and the Amity Foundation designed and implemented the Amity program at the R. J. Donovan Correctional Facility near San Diego (Amity-RJD), the first prison-based TC treatment program in the California state prison system. Amity-RJD provided TC treatment services to Level III (medium-maximum security) inmates2 who volunteered for treatment, a characteristic of the program that disappeared with the subsequent expansion of prison-based treatment programs throughout the state’s prison system (see below).
As with most prison-based treatment programs that have been implemented in the years since Amity-RJD commenced operations and that use a modified TC treatment model, Amity-RJD utilized a three-phase model. The initial phase (2 to 3 months) included orientation, assessment of needs and problem areas, and planning of treatment goals. During the second phase of treatment (5 to 6 months), residents were provided opportunities to earn positions of increased responsibility by showing greater involvement in the program and by engaging in hard emotional work. Encounter groups and counseling sessions focused on self-discipline, self-worth, self-awareness, respect for authority, and acceptance of guidance for problem areas. During the third reentry phase (1 to 3 months), residents strengthened their planning and decision-making skills and worked with program and parole staff to prepare for their return to the community. Upon release from prison, Amity graduates were given the choice of entering a community-based TC program called Vista for up to one year, also operated by Amity Foundation. The content of the Vista program built on the foundation of the Amity-RJD in-prison TC curriculum and was individualized for each resident based on the progress that was made while in the Amity-RJD program and on individual treatment needs.
1 Previous to 2006 and for most of the period of time covered by the story of the California prison-based treatment initiative, the California Department of Corrections and Rehabilitation (CDCR) was known only as the California Department of Correction (CDCR). However, for simplicity, this chapter will use the new title of the department.
2 Male inmates in the California state prison system are housed at four different levels of security, ranging from Level I (minimum security) to Level IV (maximum security).
The Amity-RJD program was originally designed as a pilot project to determine the effectiveness of a TC within the state’s prison system. Under a NIDA-funded grant to the Center for Therapeutic Community Research at National Development and Research Institutes, Inc., Wexler (Wexler, De Leon, Kressel, & Peters, 1999; Wexler, Melnick, Lowe, & Peters, 1999) conducted a 12-month prospective outcome study of the Amity-RJD program using a treatment-control group design with random assignment. Inmates on a waiting list of
volunteers for the Amity-RJD program were randomly selected and assigned to the treatment condition as beds became available in the program. Those who were still on the waiting list when they had less than nine months to serve on their prison term were removed from the list and became members of the control group. This procedure yielded a final sample for the outcome study that consisted of 715 inmates (425 inmates assigned to the treatment group and 290 assigned to the no-treatment group).
Early unpublished findings from this evaluation, presented at various conferences (Wexler & Graham, 1992, 1993, 1994) and directly to OSAP and policy makers in California (Wexler, Graham, Koronkowski, & Lowe, 1995), found strong support for the effectiveness of the Amity-RJD program. At 12 months postrelease, statistically significant differences in return-to-prison (RTP) rates were found for the treatment and the control subjects (33.9% and 49.7%, respectively).
Subsequent analyses also examined RTP rates at 12, 24, 36, and 60 months among three self-selected subgroups within the treatment group: prison TC dropouts, TC completers, and TC and Vista (aftercare) completers (Wexler, De Leon, et al., 1999; Wexler, Melnick, et al., 1999; Prendergast, Hall, Wexler, Melnick, & Cao, 2004). At 12 months, the RTP rate consistently decreased across these three groups (TC dropouts, 44.9%; TC completers, 40.2%; TC/Vista completers, 8.2%). At 24, 36, and 60 months, the RTP rate for all of the groups increased, but the pattern of results was consistent with the 12-month outcomes (at 60 months: TC dropouts, 87.0%; TC completers, 86.2%; TC/Vista completers, 41.8%).
For inmates who were returned to prison, the published Amity outcome reports also assessed outcomes in terms of the time until return to prison. In general, participation in treatment significantly delayed return to prison compared with no treatment, as did longer exposure to treatment.
In 1991, a year after the Amity program was established, OSAP and Mental Health Systems, Inc., opened California’s first in-prison treatment program for women, the Forever Free program at the California Institution for Women, using funds provided by the federal Office of Treatment Improvement (which later became the Center for Substance Abuse Treatment). Unlike Amity-RJD, the original Forever Free program was not a TC. Instead, this program adopted a cognitive-behavioral approach to treatment, using a psychoeducational curriculum combined with a strong 12-step emphasis to treat women for up to six months. Upon release to parole, graduates from the program volunteered to participate in community residential treatment.
The earliest evaluation of the Forever Free program was a retrospective study conducted by OSAP (Jarman, 1993), which found that 90 percent of Forever Free clients who graduated from the program and attended at least 6 months of aftercare were successful on parole (i.e., successful discharge from parole and/or no returns to prison) compared to only 38 percent of Forever Free clients who did not complete the program. In a subsequent restrospective study, Prendergast, Wellisch, and Wong (1996) found that, at 12 months following release to parole, 68 percent of Forever Free clients who graduated from the program and attended aftercare were successful on parole, compared with 52 percent of Forever Free program graduates who did not attend aftercare, and 27 percent of a no-treatment comparison group. This study also found that increased time in treatment was associated with success on parole. Among those women who stayed in aftercare for five or more months, 86 percent were successful on parole, compared with 58 percent of women who stayed less than five months in aftercare. More recently, Hall, Prendergast, Wellisch, Patten, and Cao (2004)
examined 12-month recidivism (arrests and/or convictions), drug use, and employment among 119 women who participated in the Forever Free program and 96 women who participated in an 8-week (3 hours per day) substance abuse education course. The results showed that the women who participated in the Forever Free program had significantly fewer arrests or convictions, significantly less drug use, and significantly greater employment.
- The Expansion of Prison-Based Treatment
The findings from the early evaluations of the Amity-RJD program, combined with published findings supporting the effectiveness of drug treatment programs in prison settings (Field, 1989; Wexler, 1986; Wexler, Lipton, & Falkin, 1992), laid the foundation for California legislation in 1993 that appropriated funds to build the largest prison dedicated solely to drug treatment program in the world, and for subsequent legislation that embarked California on a large and rapid expansion of TC treatment programs throughout the state’s prison system; an expansion that remains ongoing.
In 1997, the Substance Abuse Treatment Facility (SATF) opened. In addition to five facilities that house various levels of general population inmates, SATF has two self-contained treatment facilities that are specifically designed to provide housing and residential substance abuse treatment for 1,056 minimum-security offenders with substance abuse problems. Each treatment facility has three housing units, each containing four 44-bed treatment clusters.3 Each cluster contains space for inmate housing, treatment-related activities, interviewing, and a staff office. Inmates in these treatment facilities are completely separated from the general prison population. Treatment services were provided by two community-based treatment organizations, under separate contracts with OSAP: Phoenix House and Walden House. However, CDCR retains responsibility for custodial operations at both facilities. Consistent with the Amity and Forever Free programs, graduates of SATF can volunteer for up to six months of residential or outpatient treatment following release to parole (Anglin, Prendergast, & Farabee, 1997).
Shortly after the opening of SATF, two state reports called for the further expansion of prison-based treatment as a way to address the problem of prison overcrowding, reduce the need for enlarging or building new prisons, and enhance public safety and health. In 1997, the Legislative Analyst’s Office issued a report titled Addressing the State’s Long-Term Inmate Population Growth (1997) in which it recommended that substance abuse treatment be provided for 10,000 inmates over a period of seven years. It was estimated that this action would result in significant savings to the state. In 1998, the Little Hoover Commission, an independent state body tasked with improving government efficiency, called for prison-based drug treatment to be greatly expanded, with certain high-level offenders targeted for TC treatment and low-level and medium-level offenders targeted for cognitive-behavioral treatment (Little Hoover Commission, 1998).
3 Although designed for only 1,056 offenders, the SATF is capable of providing treatment to as many as 1,476 Inmates.
This further expansion of prison-based treatment programs commenced in 1998, with a 1,000-bed expansion that added five new TC programs in five prisons. This was followed in 1999 with a 2,000-bed expansion that added nine new TC programs in six prisons,
and subsequent expansions added even more programs and treatment beds. As of 2006, there exist 40 programs totaling 9,557 beds devoted to providing prison-based substance abuse treatment to prisoners throughout California’s network of 32 prisons and 33 fire camps. Combined, participants in these programs include both male and female inmates at all levels of security classification (minimum to maximum).
All of the TC substance abuse programs (SAPs) in the California state prison system provide between 6 and 24 months of treatment at the end of inmates’ prison terms. With few exceptions, participation in these programs is mandatory for inmates who have a documented history of substance use or abuse (based on a review of inmate files) and who do not meet established exclusionary criteria for entrance into a TC SAP (e.g., documented in-prison gang affiliation, being housed in a Secure Housing Unit within the previous 12 months for assault or weapons possession, Immigration and Naturalization Service holds). Also, with the exception of the treatment beds located at the SATF, the TC SAPs are not fully separated from the general inmate populations of the institutions within which they are located. Rather, inmates enrolled in the programs are housed in a normal inmate housing unit that has been designated as a SAP housing unit. Programming activities generally occur in specially constructed trailers that are located within or near to the facility where the TC SAP inmates are housed. Thus, outside of the time that the TC SAP inmates spend in the designated housing units and 20 hours per week of programming activities, they remain integrated with the general population inmates, that is, they dine, work, attend education classes, and share recreation time with general population inmates.
The average size of the in-prison TC programs (approximately 240 beds per program) was the result of efforts to maintain some level of segregation from general population inmates. This was accomplished by selecting a housing unit that existed on the general population facility and designating it as the housing unit for the TC SAP inmates. Housing units in the state prison system house from 100 to 250 inmates, depending on the institution and level of security. Thus, the average size of the TCs was essentially driven by the capacity of the average housing unit in the state prison system.
- Aftercare
As a result of evaluation findings from prison-based TC programs showing the importance of aftercare, the California initiative has included a major aftercare component that allows inmates paroling from the prison-based programs to participate in up to six months of continued treatment (residential or outpatient services) in the community.
The Substance Abuse Services Coordinating Agency (SASCA) network, developed in California in parallel with the expansion of in-prison TC treatment programs, is an aftercare system of interrelated and interdependent components. At the center of this system are four regionally based SASCAs, under contract with OSAP and geographically located in each of the state’s four parole regions. The specific tasks that each SASCA is responsible for can be classified into four main areas (Ossmann, 1999): (1) Capacity development: The SASCAs are responsible for ensuring that sufficient treatment capacity exists within their respective regions to satisfy the expected demand. This is accomplished primarily through contracting with community-based service providers to provide treatment services to graduates from prison-based treatment programs. (2) Liaison: Each SASCA serves as a liaison between the (a) prison-based treatment providers, who are responsible for developing the aftercare plan
for the parolee; (b) CDCR parole division, which is responsible for supervising the parolee; and (c) community-based providers, with whom the SASCA contracts for services and monitors the parolee’s progress through post-release treatment. (3) Transitioning: Each SASCA is responsible for ensuring the smooth, timely, and uninterrupted transition of the parolee from prison to community-based treatment. (4) Monitoring and tracking: Each SASCA is responsible for maintaining contact with graduates of the prison-based treatment programs during their period of eligibility for aftercare (whether they participate in treatment or not), securing access to community-based treatment when necessary during this period, and tracking each parolee’s progress and participation in community-based treatment.
Parolees from the prison-based SAPs are eligible to access and participate in up to 6 months of aftercare through the SASCA network during the first 12 months following their release to parole. For felons, participation in aftercare is voluntary, and failure to enter community-based treatment in accordance with the established aftercare plan is not mandated and does not constitute a parole violation. However, for civil addicts, participation in aftercare is a condition of parole.
The SASCA network is an example of a “Third-Party Coordination” model for ensuring continuity of care for individuals transitioning from prison-based to community-based treatment (CSAT, 1998; Field, 1998). This continuity of care model involves the use of a third party who acts as a broker of services and coordinates the parolee’s release and transition into aftercare. The model is considered most appropriate when there are dispersed services that make it difficult or impractical for the prison, the prison-based treatment provider, or the community-based provider to offer transitional planning or to coordinate continuing care (CSAT, 1998; Field, 1998). These characteristics make this model uniquely suited to ensuring continuity of care within the California correctional drug treatment system, which consists of a large number of prison-based and community-based treatment providers and a large number of clients who will be receiving services over a large geographic region.
Separate from the SASCA system, CDCR also established the Female Offender Treatment and Employment Project (FOTEP) in 1999. Unlike the SASCA system, which was designed to facilitate the transfer of male and female parolees from prison-based to community-based substance abuse treatment, FOTEP was designed to provide actual treatment and employment services to drug-involved female parolees with dependent minor children. The goal of FOTEP is to enable the successful reintegration of women parolees into the community, particularly with regard to reducing criminal behavior, substance use, and welfare dependence, and to strengthen family relationships and vocational education. To be eligible for FOTEP, women must have participated in an in-prison substance abuse treatment program, must have parental rights to at least one child under the age of 18, and must be paroled to a region of the state where a FOTEP program is available. Participants enroll in FOTEP at the time of parole from prison-based treatment. Females who enroll in FOTEP do not need the transitional and case management services offered by the SASCAs, and thus access and participate in aftercare (FOTEP) outside of the SASCA system.
FOTEP services are provided by three not-for-profit community treatment providers (Walden House, Phoenix House, and Mental Health Systems, Inc.), which provide services under separate contracts with CDCR. Over 400 FOTEP slots are currently available in residential FOTEP programs located in eight counties throughout the state. All FOTEP programs provide comprehensive case management, vocational services, and parenting assistance within the context of community-based residential drug treatment, although program design
details vary across the three subcontractors. Planned treatment duration ranges from 6 to 15 months, depending on a participant’s assessed needs. Specific characteristics of the FOTEP programs are as follows: (1) Residential drug treatment services for 6 to 15 months using a TC treatment model. Services provided include comprehensive needs assessment, relapse prevention, life skills training, self-help/support groups, “criminal lifestyles” awareness, literacy assessment and training, and individual and group counseling sessions. (2) Comprehensive case management, referral, and transportation services to link individuals with legal, social, medical/dental, and other needed services. (3) Vocational services, provided in both individual and group sessions, include assessments for vocational readiness and employability and behavioral skills training in job-seeking skills. (4) Parenting and family services, which include parent training groups and classes, on-site child care, family reunification assessment and advocacy, family therapy, pre- and postnatal support and referrals, and supervised child visitation. Some programs also provide live-in accommodations for minor children (within age limitations).
Shortly after the expansion of prison-based TC programs began in 1997, OSAP formed the Policy Advisory Committee (PAC). The mission of the PAC is to identify larger issues and problems relevant to the ongoing growth of the network of prison-based TCs and the SASCA system, develop possible solutions, and advise OSAP on the formation of new policy or revision of existing policy. Since it formed, the PAC has met an average of twice each year. The membership of the PAC consists of senior management from OSAP, executives of the major treatment organizations that are contracted to provide in-prison treatment and SASCA services, UCLA ISAP (the contracted evaluators), and the University of California, San Diego, Center for Criminality and Addiction Research, Training, and Application (CCARTA), which has been contracted to perform training and continuing education for treatment counselors. Beyond these core members, various other stakeholders frequently attend the PAC meetings (e.g., treatment program directors, correctional counselors, parole agents). Identified issues are generally assigned to standing subcommittees or ad hoc subcommittees, which are charged with studying an issue in depth and developing a list of recommended solutions. These are then reported back to the full PAC, which makes final recommendations to OSAP for implementation.
- UCLA RESEARCH ON THE CALIFORNIA PRISON-BASED TREATMENT SYSTEM
- Evaluating the Expansion Initiative
As part of the expansion of prison-based treatment that began in 1997, UCLA Integrated Substance Abuse Programs (ISAP) was contracted by the CDCR’s Office of Substance Abuse Programs to conduct a series of five-year nonexperimental process evaluation studies of 17 TC programs located in 10 institutions and totaling approximately 4,900 beds. At six of these programs, outcome evaluations were also conducted, which assessed return-to-prison rates between inmates who participated in the TC programs and matched comparison groups of inmates who did not receive TC treatment.
- Process Evaluation Findings: Growing Pains.
The main objectives of the process evaluations were to (1) document the goals and objectives of CDCR’s drug treatment
programs and any additional goals and objectives of each provider, (2) assess the degree to which the providers were able to implement these goals and objectives in their programs, (3) determine the degree to which the provider conformed to the therapeutic community model of treatment, and (4) collect descriptive data on treatment participants.
Consistent with these objectives, the process evaluations collected both client- and program-level data. Client-level data consisted of quantitative descriptive and treatment participation data on all inmates participating in the prison-based TC programs that were included in the evaluation studies. These data and the analyses performed on them are discussed in more detail below.
Program-level data was largely qualitative in nature and consisted primarily of data drawn from program documents; observations of programming activities; interviews with program administrators, treatment and corrections staff, and OSAP personnel; and periodic focus groups with treatment staff, custody staff, and inmates. Observations of programming activities and interviews with program administrators, treatment and custody staff, and OSAP personnel occurred during frequent site visits by ISAP research personnel to each of the program sites. Observations also included ISAP staff participation in various regularly scheduled meetings attended by institutional, treatment program, and OSAP personnel, which discussed and addressed issues of import to particular programs and/or the entire treatment initiative (e.g., PAC and various PAC subcommittee meetings).
An additional source of qualitative data came from two waves of focus groups that were conducted at five TC programs located at five different institutions covering both male and female inmates at varying levels of security. The first wave of focus groups was conducted in the winter of 2000. The second wave was conducted in the winter of 2002. At each location, focus groups were held with program clients, treatment staff, and custody staff. Each focus group lasted approximately 90 minutes and was recorded on audiotape. Written transcripts were prepared and content analyzed using qualitative software.
At the program level, the process evaluations revealed a number of system- and treatment-related issues that were relevant to the implementation and ongoing operations of the prison-based TC programs. However, given the nature of these issues, we believe that they are not unique to the California correctional drug treatment system. Many, if not most, states that have established or expanded treatment programs for inmates may have faced or are still dealing with the same or similar issues (Farabee et al., 1999; Harrison & Martin, 2000; Moore & Mears, 2001). Thus, these issues are presented in terms of their importance as key elements in developing and sustaining effective substance abuse treatment programs in correctional environments in general. The first three issues (collaboration and communication, supportive organizational culture, sufficient human resources) represent system-related issues, while the remaining four issues (screening, assessment, and referral; treatment integrity, incentives and rewards; and coerced treatment) represent treatment-related issues.
- Collaboration and Communication.
Corrections-based treatment programs exist within, and are largely subordinate to, the organizational culture of the larger correctional system, which holds a very different philosophy and mission with respect to substance abuse and the way it should be dealt with. Correctional systems are dedicated to public safety and view drug use as a crime, whereas substance abuse treatment systems are rehabilitative and view drug use as a chronic, but treatable disorder (Prendergast & Burdon, 2002). As a result of this organizational reality, the goals and philosophies of treatment programs have
less influence than those of the superordinate correctional system. Because of this, effective and open communication and collaboration between the two systems becomes critical. The separate objectives of ensuring public safety and rehabilitation can coexist, but both systems need to be committed to developing and maintaining an inter-organizational “culture of disclosure” (Prendergast & Burdon, 2002), in which there exists a common set of goals and where system-, program-, and client-level information is shared in an atmosphere of mutual understanding and trust.
- Supportive Organizational Culture.
Most departments of corrections are complex bureaucratic organizations that need to emphasize safety, security, and conformance to established policies and procedures. For the most part, such an organizational culture does not easily facilitate or support the presence of client-oriented substance abuse treatment programs. Yet, in order for substance abuse treatment programs to operate effectively, some degree of meaningful coordination needs to exist between the criminal justice and treatment systems. For this to occur, the organizational culture should facilitate the work of treatment programs, while ensuring the continued safety and security of the inmates, staff, and public. While it is not realistic to expect that correctional treatment programs be exempt from departmental and institutional policies and procedures, it is also not realistic to expect treatment programs to operate effectively in a prison environment that does not support the existence and operation of such programs. Without clear and continuing commitment and support from correctional management, the ability of treatment programs to operate effectively will be impeded. Examples of actions and activities that can facilitate the creation of a supportive organizational culture and the overall effectiveness of treatment programs include the development and incorporation of policies and procedures into existing departmental operations manuals that explicitly recognize and reflect the unique nature of substance abuse treatment programs. Such policies and procedures can address sensitive issues such as behavioral guidelines that cover counselor-client interactions and recognize the importance of developing therapeutic bonds, or establishing guidelines that allow treatment staff to initiate disciplinary actions for infractions of treatment program rules of conduct and behavior, which are distinguished from disciplinary actions that are initiated by custody staff for infractions of institutional rules of conduct and behavior.
- Sufficient Human Resources.
Most discussions of effective treatment systems address the issue of resources (Field, 1998; Greenley, 1992; Rose, Zweben, & Stoffel, 1999; Taxman, 1998). While departments of corrections understandably need to control costs, the commitment of insufficient financial resources, especially for salaries, often prevents the recruitment and retention of experienced and qualified treatment staff, which in turn results in excessive staff turnover.
Qualitative data from the focus groups with treatment staff suggest that paying frontline counselors salaries that are competitive with the local markets is often not sufficient to ensure long-term retention and avoid turnover. Even with previous experience in substance abuse counseling, many individuals who come to work as counselors in prison-based treatment programs are unprepared for the realities of working in a highly structured prison environment, where they are constantly being “tested” by inmates, struggle to establish personal boundaries of interaction, and are closely monitored to ensure that they do not become overly familiar with the inmates. This often results in stressful working conditions
where counselors are likely to “burn-out” and leave within short periods, either as a result of resignation or termination.
- Screening, Assessment, and Referral.
Therapeutic community treatment is the most intensive form of substance abuse treatment available. It is also the most costly to deliver. As such, it should be reserved for inmates with more severe substance abuse or dependence problems. Simply put, not all substance-using offenders are in need of TC treatment. Given the limited amount of treatment bed space in TC programs relative to the number of inmates who are in need of substance abuse treatment, identifying inmates who are most in need of intensive TC treatment requires the use of valid screening procedures.
The “risk principle” (Andrews, Bonta, & Hoge, 1990; Gendreau, Cullen, & Bonta, 1994) states that treatment services are most effective when offenders receive services based on risk level; high-risk offenders require more intensive services, whereas low-risk offenders require less intensive services. (Risk refers to the likelihood of engaging in subsequent criminal behavior.) Several meta-analyses on offender treatment have consistently found that treatment interventions are more effective when delivered to high-risk offenders (Andrews et al., 1990; Bonta, 1997; Lipsey, 1995; see also Lowenkamp & Latessa, 2004). There also exists empirical support for the risk principle (Bonta et al., 2000; Brown, 1996; Lowenkamp & Latessa, 2003). In a study of 53 residential treatment programs for offenders, Lowenkamp and Latessa (2003) found that among low-risk and low/moderate-risk offenders, there was a 4 percent and 1 percent (respectively) increase in the probability of recidivism, whereas among moderate-risk and high-risk offenders, there was a 3 percent and a 8 percent (respectively) decrease in the probability of recidivism. With respect to prison-based substance abuse treatment, Knight, Simpson, and Hiller (1999) found that intensive in-prison TC treatment was most effective for high-severity inmates. Similarly, using data collected from the original sample of inmates in the evaluation of the Amity-RJD program (Graham & Wexler, 1997), Wexler, Melnick, and Cao (2004) found that risk factors predicted return-to-prison rates at three years and that positive treatment effects were more likely among higher risk treatment participants.
However, even when good assessment and referral procedures exist, many correctional systems often base decisions to place inmates into drug treatment programs less on the severity of their substance abuse problem and more on institutional factors such as management and security concerns. Treatment staff often have little control over which inmates are entering the programs. When this occurs, inmates who could or should be placed into these programs (i.e., those with substance abuse disorders and at highest risk for relapse) may be excluded, whereas inmates who may not be amenable to or appropriate for treatment programs may be included (e.g., those who have severe mental illness or are dangerous sex offenders). This, in turn, directly impacts the treatment providers’ ability to provide treatment services to those who are most in need of them.
- Treatment Integrity.
“Community as method” (De Leon, 2000) refers to that portion of TC philosophy that calls for a full immersion of the client into a community environment and culture that is designed to change (rehabilitate) the “whole person.” In correctional environments where treatment programs are not fully segregated from the general inmate population, inmates participating in the treatment curricula remain exposed to the prison subculture and its negative social and environmental forces, which may attenuate treatment
benefits. To counteract the dysfunctional influence of the prison subculture on participants in treatment, it is important that treatment curricula be structured, well-defined, and engaging. Wexler and Williams (1986) highlighted several features that help ensure the effectiveness of prison-based TC programs. Among them is program integrity; the perception that the program is strong, coherent, and autonomous while maintaining cooperative and respectful communications with correctional staff and the administration of the host institution. Related to this is the enforcement of TC program rules by treatment staff in a manner that maintains credibility with custody staff and discipline within the treatment program while keeping the primary focus on treatment. Program integrity is especially important in mandated programs, where problem awareness and motivation for change among many treatment participants may be limited.
- Incentives and Rewards in Treatment.
Correctional environments generally rely on punishment for rule infractions and seldom offer inmates positive reinforcement for engaging in prosocial behaviors (i.e., complying with institutional rules and codes of conduct). Similarly, within the context of prison-based treatment, inmates are seldom reinforced for specific acts of positive behavior (e.g., punctuality, participation, timely completion of tasks). To the extent that they are, the reinforcement “tends to be intermittent and, in contrast to sanctions, less specific, not immediately experienced, and based on a subjective evaluation of a client’s progress in treatment” (Burdon, Roll, Prendergast, & Rawson, 2001, p. 78).
Where participation in prison-based TC treatment programs is mandated, the treatment process needs to counteract the resentment and resistance that inmates initially feel and exhibit as a result of being coerced into treatment. This requires that programs and institutions not only reduce disincentives that may exist, but also incorporate incentives that would serve as meaningful inducements to participating in the treatment process. However, at some institutions, the ability of treatment providers to develop and implement incentive or reward systems is limited by departmental and institutional policies and procedures that severely limit the granting of special privileges, rewards, or other incentives to specific groups of inmates (e.g., those participating in a treatment program).
- Coerced Treatment.
Much of the growth in criminal justice treatment (both in California and nationally) is based on the widely accepted belief that involuntary substance abuse clients tend to do as well as, or even better than, voluntary clients (Farabee, Prendergast, & Anglin, 1998; Leukefeld & Tims, 1988; Simpson & Friend, 1988). However, the studies supporting this position were based on community-based treatment samples. As mentioned above, mandated referral to prison-based treatment programs often breeds a high degree of resentment and resistance among inmates forced into these programs.
One possible strategy to overcome this resentment and resistance, increase engagement in treatment, and facilitate the development of a therapeutic treatment culture would be to limit admissions during a program’s first year or so to a relatively small number of inmates who volunteer for treatment. Ideally, the majority of clients referred to prison-based programs (particularly new programs) should be inmates with at least some desire to change their behavior through the assistance of a treatment program. Once a treatment milieu is established, the presence of involuntary inmates may prove to be less of an impediment to the delivery of effective treatment. Another strategy for overcoming resistance and increasing engagement in treatment is the use of peer mentors for new inmates entering the
program. In TCs, peers act as the primary agents of change through the reinforcement of positive norms, values, and beliefs (De Leon, 2000). In prison-based programs, the recruitment of respected “shot-callers” from the general population into the program and their advancement to the role of peer mentors can lend substantial credibility and respect to the program and the inmates participating in it. Indeed, some California prison-based TCs have started mentor programs that involve recruiting inmates who are serving long sentences into the programs. After successfully completing the full curriculum, rather than being released to parole, these inmates remain involved in the TC as peer mentors to new inmates entering the programs.
- Outcome Evaluations.
Six of the 17 TC programs evaluated by UCLA ISAP were also selected for more in-depth quantitative outcome evaluations; the SATF and five other TC programs located at five different prisons. These six outcome studies included five male programs covering all levels of security (except maximum security) and one female felon program, which included females at varying levels of security.4
The fundamental question addressed by outcome evaluations of prison-based treatment programs, and the one of most interest to policy makers and legislators, is how well a program performed in terms of its ability to reduce criminal recidivism among offenders. Most often this is measured by reincarceration or return-to-prison (RTP) rates.
For these outcome studies, random assignment to treatment and nontreatment conditions was not possible. (Human subjects concerns did not allow inmates to be randomly assigned to a nontreatment condition.) Thus, RTP rates were examined between first admission cohorts of inmates who participated in prison-based TC treatment and a matched comparison group of inmates who did not participate in prison-based TC treatment. To ensure that subjects in the comparison groups were in fact comparable to those in the treatment groups, a one-to-one matching procedure was employed. Lists of similar (nontreatment) inmates were selected from among general population inmates who had not participated in a prison-based TC program. This was accomplished using data from the CDCR Offender-Based Information System (OBIS), which contains demographic, incarceration history and status (i.e., prison admission and release dates, current location, custody level), and conviction offense data on each inmate. Primary matching criteria consisted of age, race/ethnicity, commitment offense, and custody level.
4 In California, male inmates are segregated by level of security (Level 1-Minimum to Level IV-Maximum). However, although they are assigned a security classification level, females are housed together, they are not segregated based on security level.
Overall, these studies found no significant differences in RTP rates between the treatment and matched comparison groups in these six studies. Two important factors likely contributed to this finding. First, each of these outcome studies started collecting data in only the second or third year after the program commenced operations. Many of the system- and treatment-related issues identified in the process evaluations (see above) had not been identified or addressed. As a result, it is likely that these issues were having an impact on the ability of each of these programs to deliver optimal treatment services to inmates, thus stunting the impact they could potentially have on reducing RTP rates. Second, each of these outcome studies used an intent-to-treat method when computing RTP rates; computation of RTP rates
for the treatment group included all inmates who entered a prison-based TC program and agreed to participate in the study. Participation in aftercare was not considered. Analyses of RTP rates among inmates participating in all of the prison-based TC programs (see below) did look at the role of aftercare and highlighted the importance of aftercare in conjunction with prison-based treatment in improving post-treatment outcomes.
UCLA ISAP is currently conducting a further outcome evaluation of RTP rates among successive cohorts of inmates enrolled in the two programs at SATF, which have now been in operation for almost a full decade. It remains to be seen whether the system- and treatment-related issues identified in the process evaluations have been addressed and what if any impact they may still have on RTP rates among inmates now participating in these programs.
- Ongoing Analyses of the UCLA Treatment Database
As part of the process evaluations described above, quantitative data on clients and their participation in treatment (both in prison treatment and aftercare) was collected from three sources. First, client-level data were collected by the treatment providers at the time that inmates entered the prison-based TC treatment programs using an Intake Assessment (IA) instrument. The IA was designed to assess a client’s pretreatment/preincarceration sociodemographic background, criminality, employment, and substance use, abuse, or dependence. Adapted from the Initial Assessment developed at the Institute of Behavioral Research at Texas Christian University (Broome, Knight, Joe, & Simpson, 1996), the IA has been used extensively with criminal justice populations and provides information that is useful for both clinical and evaluation purposes. Second, aftercare participation data (i.e., admission and discharge dates, treatment modality) were collected from the SASCAs, which obtained these data from the community-based treatment providers. Third, return-to-prison (RTP) data were obtained from CDCR’s OBIS database (described above). Data collection started when each of these programs commenced operations (1997–1999) and continued through June 2004.
Collectively, these data were combined into what is perhaps the largest database of prison-based treatment in existence. It contains data on 27,898 inmates (18,676 men and 9,222 women), including individual-level data (i.e., sociodemographics, employment, criminal history, and substance use, abuse, and dependence), treatment participation and retention data relating to both in-prison and community-based treatment, and return-to-prison data and criminal offense history.
Since collection ceased in July 2004, UCLA ISAP has continued to perform quantitative analyses on this treatment database to examine previously unexplored aspects of prison-based treatment. These analyses have generated important findings relating to the influence of aftercare on treatment outcomes, general predictors of outcomes, the need for gender-responsive treatment, and the effectiveness of prison-based TC treatment for maximum security inmates. Some of these findings have been published in peer reviewed journals (cited below). Other findings have been reported in various internal reports submitted to OSAP and/or in response to special requests by OSAP.
- The Influence of Aftercare on Treatment Outcomes.
The most consistent finding to emerge from UCLA ISAP’s quantitative analyses of participation in prison-based TC treatment and its impact on return-to-prison has been the importance of continuing substance abuse treatment in the community following release from prison-based treatment (i.e., aftercare).
W
hile the initial decision to provide funding for an aftercare component to the prison-based treatment initiative in California was based on findings from the early evaluation study of the Amity-RJD program (Wexler, 1996), evaluations of prison-based substance abuse treatment programs since then have consistently demonstrated the importance of aftercare as a means of reinforcing and consolidating the gains made in prison-based treatment, improving clients’ behavior while under parole supervision, and promoting long-term successful outcomes (Burdon, Messina, & Prendergast, 2004; Knight et al., 1999; Martin, Butzin, Saum, & Inciardi, 1999; Prendergast, Wellisch, & Wong, 1996; Prendergast, Hall, & Wellisch, 2002; Wexler, Melnick, et al., 1999). The combined findings of these studies have consistently demonstrated the positive impact that aftercare in combination with prison-based treatment has on reducing relapse to drug use and recidivism. They also highlight the need for making available effective community-based treatment services to parolees exiting prison-based treatment programs and for developing and implementing a structured system to ensure efficient transition from prison- to community-based treatment.
Quantitative analyses of data contained in the treatment database described above further reinforces the robustness of these findings by demonstrating the importance of aftercare for both male and female participants in prison-based treatment and for inmates at all levels of security (minimum to maximum). These analyses have examined two aspects of aftercare treatment: (1) retention or time spent in aftercare and (2) modality of aftercare (residential or outpatient).
These analyses focused on aftercare treatment that occurred subsequent to a subject’s first parole date following his/her first admission into a prison-based TC (i.e., first admission cohorts). Participation in aftercare that followed subsequent incarcerations was not considered. This minimized potential confounding factors associated with previous in-prison residential or TC treatment and postprison aftercare. The dependent variable of interest was 12-month return to prison, which was operationalized as the first return to prison that occurred within 12 months of a subject’s first parole from prison as defined below (retention in aftercare analyses) or within 12 months of a subject’s discharge from his/her first aftercare treatment episode (modality of aftercare analyses).
- Retention in Aftercare.
Analyses were performed to determine the 12-month return-to-prison (RTP) rates based on participation and retention in aftercare for varying lengths of time. In order to be eligible to participate in aftercare in California, parolees must have successfully completed participation in a prison-based TC treatment program or must have been in good standing in a prison-based TC treatment program at the time of their parole from prison. Such parolees are referred to as “TC graduates.”
Among all TC graduates (male and female), the 12-month RTP rate was 39.1 percent. This included TC graduates who chose to enter aftercare and those who chose not to enter aftercare. However, the 12-month RTP rate among TC graduates who chose not to participate in aftercare was 45.1 percent; among those who did participate in aftercare, the RTP rate was 29.1 percent; and among those who participated in more than 90 days of aftercare, the RTP rate was 16.5 percent. While these rates differed substantially between males and females and among males classified at different levels of security (Level I-Minimum to Level IV-Maximum), the noted decreasing trend in RTP rates remained consistent across these groups.
A
lthough this trend reinforces the significant contribution of aftercare to successful postprison outcomes as measured by RTP, it masks an important phenomenon relating to time spent in aftercare and its impact on RTP. The varying groups described above are not mutually exclusive. The RTP statistics reported for TC graduates who participated in any aftercare included those who participated in less than 90 days and those who participated in more than 90 days. Analyses of mutually exclusive groups of TC graduates (i.e., no aftercare, less than 90 days of aftercare, and more than 90 days of aftercare) showed that the highest rate of return to prison occurred among TC graduates who participated in less than 90 days of aftercare (48.8%). This trend was consistent among both genders at all levels of security. While this phenomenon has been noted in other studies of prison-based treatment and aftercare (Knight et al., 1999; Martin et al., 1999; Wexler, De Leon, et al., 1999), it has yet to be explained or subjected to further study.
In any event, the data show that retention in aftercare for more than 90 days significantly improves outcomes as measured by return-to-prison rates. To the extent that aftercare is voluntary, this may be at least partly the result of selection bias, that is, systematic differences between parolees who opted for and remained in aftercare and those who did not, although this statistical trend was consistent among both felons (for whom aftercare is voluntary) and civil addicts (for whom aftercare is a mandated condition of parole).
- Modality of Aftercare.
While research has been consistent in demonstrating the benefits of substance abuse treatment in terms of more time spent in treatment (Condelli & Hubbard, 1994; Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997; Hubbard, Craddock, & Anderson, 2003; Simpson, Joe, & Brown, 1997), it has not consistently demonstrated that more intensive substance abuse treatment produces better outcomes than does less intensive treatment. Numerous studies that have examined differences between clients receiving treatment in different modalities have found significant improvements among all clients across modalities, while finding no significant differences between modalities on dependent measures of interest. (Gottheil, Weinstein, Sterling, Lundy, & Serota, 1998; Hser, Evans, Huang, & Anglin, 2004; McLellan, Hagen, Meyers, Randall, & Durell, 1997; Weinstein, Gottheil, & Sterling, 1997). However, many studies that have shown no effect of treatment modality did not examine which clients within each modality experienced the best outcomes (Gastfriend & McLellan, 1997). The lack of differences between varying modalities may be due to a failure to match clients to the appropriate modality of treatment, resulting in different modalities having a mix of clients—those who were more appropriate for that particular modality and those who were less appropriate—thus masking the true effectiveness of each modality. There is evidence that matching drug-involved individuals to substance abuse treatment programs based on the severity of their substance abuse problem and the level of need for treatment and ancillary services leads to increased retention in treatment and improved outcomes (Friedmann, Hendrickson, Gerstein, & Zhang, 2004; Melnick, De Leon, Thomas, & Kressel, 2001; Moos, 2003; Thornton, Gottheil, Weinskin, & Kerachsky, 1998).
Burdon, Dang, Prendergast, Messina and Farabee (2006) conducted an analysis of the differential effectiveness of community-based residential and outpatient drug treatment on 12-month RTP rates. This analysis found that type of aftercare (i.e., only outpatient versus only residential treatment) was not a significant predictor of 12-month RTP rates, even when subjects were matched to treatment modality based on the severity of their substance
abuse problem. Subjects who were classified as having a drug/alcohol abuse problem or no diagnosable drug/alcohol problem (low severity) benefited equally from outpatient and residential aftercare. Similarly, those who were classified as being drug/alcohol dependent (high severity) also benefited equally from outpatient and residential aftercare.
Although type of aftercare did not predict 12-month RTP, time spent in aftercare was a significant predictor of 12-month RTP rates for both low-severity and high-severity parolees. These results are consistent with previous research highlighting the importance of aftercare in combination with prison-based treatment as a means of ensuring successful treatment outcomes as measured by return-to-prison rates (e.g., Burdon et al., 2004; Knight et al., 1999; Martin et al., 1999; Prendergast et al., 1996; Wexler, De Leon, et al., 1999; Wexler, Melnick, et al., 1999; Prendergast et al., 2004; Wexler, Burdon, & Prendergast, 2006).
The “continuum of care” construct rests on the notion that the transition of parolees from prison-based treatment to community-based treatment be “seamless” (i.e., uninterrupted; Taxman, 1998). Implicit in the concept of a seamless transition is the belief that treatment in the community will pick up where treatment in prison left off. Prior to the California initiative, research demonstrating the importance of aftercare in conjunction with prison-based treatment was largely limited to situations where only one or very few aftercare programs were available for parolees who completed prison-based treatment (Knight et al., 1999; Martin et al., 1999; Wexler, De Leon, et al., 1999; Wexler et al., 1992; Wexler, Melnick, et al., 1999). These continuity of care situations were characterized by well defined and/or contractual relationships between the in-prison and aftercare treatment programs; in some cases (e.g., Amity and Vista), both programs were operated by the same treatment provider. This ensured that clients experienced a relatively smooth transition into aftercare treatment, participated in aftercare with individuals who were in prison-based treatment with them (i.e., progressed through the treatment continuum in cohorts), and received aftercare treatment that was tailored to their needs and that built upon the progress that parolees made in prison-based treatment.
Due largely to its size, both in terms of geography and the number of offenders being served, the California correctional treatment system (inclusive of prison-based treatment, the SASCA network, and aftercare) has not been able to realize many of these characteristics. The rapid expansion of prison-based TC treatment and aftercare after 1997 resulted in a similar rapid growth in the number of community-based programs providing treatment services to individuals paroling from the many prison-based TC programs. In the analyses examining modality of aftercare, 455 different community-based treatment programs (164 outpatient and 291 residential) delivered treatment services to the 4,165 parolees included in the analyses (an average of 9.2 parolees per program).
Most of the community-based treatment programs where parolees receive aftercare are located at great distances from the prisons where they received treatment and are usually operated by community providers that have no direct relationship or contact with the prison-based treatment providers and little or no experience with prison-based treatment. As a result, parolees who choose to enter aftercare often experience difficulties getting to the designated community-based treatment program and seldom participate in treatment with other parolees from the same prison-based treatment programs they attended, or even with other drug-involved individuals under parole supervision. They are also less likely to receive treatment that builds upon the progress that was made in prison-based treatment.
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ny combination of these factors may contribute to increased dissatisfaction with aftercare treatment and increased dropout rates, triggering a perception of failure on behalf of the parolee (who voluntarily entered aftercare treatment), which in turn may lead to a return to criminal activity, drug use, and ultimately reincarceration. In addition, the large number of community-based treatment programs raises the question of variability in the quality of aftercare treatment services provided to parolees by community-based providers, which may also account for the inability of treatment modality to predict outcomes.
In sum, the results of the analyses examining modality of aftercare highlight the need for empirical research that examines more closely the “continuum of care” construct and the assumptions that underlie it and for assessing the quality of community-based treatment services.
- General Predictors of Outcomes.
In an analysis examining general predictors in aftercare and 12-month return-to-prison, Burdon et al. (2004) found that motivation for treatment was a significant predictor of participation in aftercare, which in turn was a significant predictor of 12-month RTP. This finding reinforced the findings of previous research that examined the relationship between motivation, continued participation in aftercare, and return-to-prison (De Leon, Melnick Kressel, & Jainchill, 2000; Melnick et al., 2001).
The most consistent theme that emerged from the results of this study was the importance of duration of time spent in treatment—both in-prison treatment and aftercare. With respect to in-prison treatment, subjects who spent more time in prison-based treatment were significantly more likely to participate in aftercare and significantly less likely to be returned to prison within 12 months. This finding is consistent with previous research that has demonstrated a significant relationship between time spent in treatment and treatment outcomes among substance abusers (Gossop, Marsden, Stewart, & Rolfe, 1999; Lipton, 1995; Westhuis, Gwaltney, & Hayashi, 2001; Wexler, Falkin, & Lipton, 1990). Similarly, with respect to aftercare, subjects who spent more time in aftercare were significantly less likely to be returned to prison within 12 months.
The results also showed that Hispanics were significantly less likely to participate in aftercare, but were also significantly less likely to be returned to prison within 12 months following their release. A possible explanation for this finding is that the social and/or familial support systems for Hispanics are stronger, and that they tend to rely on these support systems to a greater degree and with greater success following release to parole. (A significantly greater percentage of Hispanics reported living with family/relatives or friends prior to being incarcerated.) Previous research has found that social support systems (including familial factors) are important in preventing drug abuse among Hispanics (De La Rosa & White, 2001).
Finally, education was also a significant predictor of 12-month RTP, highlighting the importance of this factor in facilitating the process of post-release reintegration and promoting posttreatment successful outcomes.
In sum, the results of Burdon et al. (2006) were consistent with the findings of previous research. Motivation for treatment was a significant predictor of participation in aftercare, which in turn was a significant predictor of 12-month RTP. However, the most consistent theme that emerged from the results of this study was the importance of duration of time spent in treatment. The findings relating to Hispanics and education highlight the unique
importance of social and/or familial support systems for Hispanics postrelease and the important role that education plays in facilitating postrelease reintegration and ensuring successful outcomes.
- Gender-Responsive Treatment.
Under a separate contract with the CDCR, ISAP conducted an evaluation of the FOTEP programs. An intake assessment was administered upon parole from prison-based treatment and admission into FOTEP treatment, and a follow-up assessment was administered 12 months from the date of parole.
Records-based outcome analyses of RTP rates performed at 12, 24, 36, and 48 months revealed RTP rates of 34 percent at 12 months; 46 percent at 24 months; 50 percent at 36 months, and 54 percent at 48 months. Survival analyses showed that being younger, African American, and a felon offender (versus a civil addict); having a mental disorder; and dropping out of FOTEP treatment were all positively associated with an increased likelihood of being returned to prison.
Longer time in FOTEP treatment significantly reduced the likelihood of RTP; completers averaged significantly more time in treatment than noncompleters (217 versus 128 days, respectively). Women who were older and those who entered into FOTEP immediately upon parole were more likely to complete treatment than their respective counterparts, as were women who had fewer treatment needs in the area of mental health problems (Grella & Greenwell, 2006a). Being African American or Hispanic was associated with lower treatment needs (compared with Whites), but also a lower likelihood of treatment completion (Grella & Greenwell, 2006a).
Additional analyses found direct positive relationships between severe childhood profiles (e.g., adolescent conduct problems and substance abuse) and adult criminal behavior and current psychological distress (Grella, Stein, & Greenwell, 2005), and between exposure to childhood traumatic events and negative health-related outcomes as adults (Messina & Grella, 2006). Risky parental attitudes were found to be indirectly related to self-efficacy, decision-making ability, and social conformity; and directly related to depression and education and being non-White (Grella & Greenwell, 2006b).
The FOTEP programs represent a significant effort and commitment by CDCR to focus resources directly on addressing the unique needs of drug-involved female offenders, albeit in a community treatment setting. In a study that examined differences between men and women offenders entering prison-based TC treatment and the specific treatment needs of drug-involved women offenders, Messina, Burdon, and Prendergast (2003) found that, compared with men, women entering prison-based substance abuse treatment were more likely to have experienced some form of psychological impairment, to be taking prescribed medications, to be using cocaine/crack and heroin on a daily basis, to be poly-drug users prior to their current incarceration, to report being sexually and physically abused as children and as adults, to have less than a high school education; and to be financially dependent on family members and in need of public assistance.
These findings highlight the unique needs and characteristics of female drug-involved offenders (compared to males) and the need to provide gender responsive treatment in both prison- and community-based treatment settings. While the FOTEP programs address this need with respect to community-based treatment, prison-based treatment programs and curricula remain largely male-oriented in their content and approach to treatment.
- T
he Effectiveness of TC Treatment for Maximum Security Inmates.
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Based in large part on the success of Amity TC in the medium security R. J. Donovan prison in San Diego (Wexler, 1996), Amity Foundation was contracted in 1998 to operate a maximum security TC at the California State Prison, Los Angeles County (LAC), located in Lancaster, California (hereinafter referred to as Amity-LAC). Drug treatment programs are rarely found in maximum-security prisons, largely because of the generally harsh prison conditions, which are believed to be not supportive of a treatment culture and which result in low expectations for the inmates housed in these institutions, who tend to have extensive criminal histories. The Amity-LAC program commenced operations as part of the 1,000-bed expansion of prison-based TCs that occurred in 1998 (see above), and was one of the 17 TC programs included in the UCLA ISAP evaluations.
In terms of demographics and background differences, compared with male felons who participated in lower security level TCs, the Amity-LAC TC participants had significantly more severe and violent criminal histories, had greater unemployment, and were more likely to suffer from a mental disorder. Amity-LAC participants were also younger, single, more likely to be Black, and more likely to use opiates and other drugs as opposed to methamphetamine and alcohol.
The most important finding of this study was that inmates who participated in prison-based TC treatment and at least 90 days of aftercare had significant reductions in RTP. Security level was not related to differential outcomes, even when controlling for significant background differences (i.e., criminal history, unemployment, and prevalence of mental illness) between the maximum-security Amity participants and other lower security male TC participants. Although the significance of the background differences between maximum-security TC participants and male TC participants at other levels of security highlight the challenges confronting providers of treatment to maximum-security offenders, the findings of this study lend support to the expansion of treatment efforts to maximum-security prison populations.
- MOVING THE INITIATIVE FORWARD IN CALIFORNIA AND THE NATION
Since 1997, California has been engaged in the largest expansion of prison-based treatment of its kind in the nation and perhaps even the world. In less than a decade, the state has opened 40 in-prison therapeutic community programs totaling more than 9,500 treatment beds. It is important to highlight that it was in fact a limited body of research on prison-based treatment that was relied on in forming the foundation of this rather large and rapid expansion of in-prison TC programs. However, since then a number of studies have contributed greatly to the evolution of and advancement of knowledge regarding the effectiveness of corrections-based treatment. Much of this research was based on data collected from the California treatment initiative. In particular, the process evaluations performed on the prison-based TC programs in California have yielded valuable system and treatment-related findings that are relevant to the implementation and ongoing operations of prison-based treatment programs in general. The question now should focus on how this expanding and evolving body of literature can be used to inform and advance corrections-based substance abuse treatment, not only in California, but nationwide. Several issues are especially important in accomplishing this task: diversifying treatment, assessment and referral, aftercare, treatment quality, and treatment for women.
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iversifying Treatment: Cognitive Behavioral and Educational programs
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Although there exists a variety of approaches to treating substance-abusing inmates, the most common treatment modality still in use in California is the TC as modified for the prison setting. However, a substantial body of research supports the effectiveness of cognitive-behavioral (CB) treatment as a means of reducing criminal recidivism.
Programs that fall under the broad scope of CB treatment have as their underlying theoretical foundation social learning theory (Bandura, 1969), in that they focus on helping clients unlearn behaviors associated with criminal behavior and/or substance abuse through the acquisition of new thinking and acting skills (Langevin, 2001). Research on CB treatment suggests that it is effective at reducing recidivism among offenders. Meta-analyses have concluded that CB treatment programs improve outcomes (Andrews et al., 1990; Garrett, 1985; Izzo & Ross, 1990; Pearson, Lipton, Cleland, & Yee, 2002). Pearson et al. (2002) found that CB treatment approaches have a positive effect on reducing recidivism, with an average effect size (r) of .12.
Since the majority of general offender populations have a substance abuse or dependence disorder, and because of the lower cost of CB programs relative to TC programs, the question of the effectiveness of CB treatment programs in reducing recidivism has significant implications for prison-based substance abuse treatment. CB treatment differs from the modified TC model mainly in terms of the length of time that offenders are engaged in the treatment process and the level of intensity with which treatment services are delivered. And, as mentioned earlier, not all substance-abusing offenders are alike in terms of their characteristics or needs. Depending on the severity of their substance abuse or dependence problem, many drug-involved offenders may benefit equally well or better from less intensive forms of treatment, such as CB treatment.
- Assessment and Referral
Effectively assessing and referring drug-dependent individuals to the most appropriate treatment modality and intensity is believed to be essential to ensuring the optimal effectiveness of treatment (DHHS, 1994). Yet, there remains no consistent and effective means of performing these tasks (Hser, 1995; Moos, 2003; Thornton et al., 1998). This is true in the California state prison system, where the task of identifying and classifying inmates into a one of the existing TC treatment programs utilizes CDCR’s inmate classification system, which was designed to assess the security risk of inmates entering the prison system and place them in the least restrictive (i.e., least costly) security settings based on their tendency to misbehave while incarcerated (CDCR, 1996). Consistent with this, the current process for identifying inmates with substance abuse problems is limited to a review of their “Central Files” for documentation of drug-related offenses and convictions or a history of substance use (not necessarily abuse). Once potential candidates for treatment have been identified, they are subjected to further review using an established set of exclusionary criteria (e.g., documented gang affiliation, time spent in administrative segregation for violence, Immigration and Naturalization Service hold). In short, the primary objective of this process is to ensure that actual placements into substance abuse treatment are consistent with the objective of the classification system to minimize disruptive behavior. There is no formal systematic process that utilizes
validated instrumentation to assess the presence or severity of a substance abuse or dependence disorder and make referrals to treatment based on the results of the assessment.
Similarly, the process of transitioning parolees from prison- to community-based treatment does not include a formal systematic process for assessing parolees’ needs and referring them to appropriate community-based treatment programs or services. For the most part, following conventional wisdom, parolees are most often referred to and attend residential treatment in the community (i.e., the more intensive treatment modality).
The ability to properly assess and refer clients to appropriate treatment services is believed to be a key component of any effective system of care for drug-dependent individuals (Wellisch, Prendergast, & Anglin, 1993) and promotes increased retention in treatment and improved outcomes (Friedmann et al., 2004; Moos, 2003; Thornton et al., 1998). Without effective assessment and referral practices, resource allocation and utilization, and ultimately treatment effectiveness, are not optimized (Hser, 1995).
A number of instruments have been developed to assess substance abuse severity and make referrals to treatment. The matching criteria developed by the American Society of Addiction Medicine (ASAM, 1998; Gastfriend, 2003; Melnick et al., 2001) are designed to refer clients to increasingly intensive treatment modalities based on how they are evaluated along six dimensions: acute intoxication and/or withdrawal potential, biomedical conditions and complications, emotional/behavioral conditions and complications, treatment acceptance or resistance, relapse potential, and recovery environment. However, while recent articles have reported on their predictive validity and psychometric properties (Magura et al., 2003; May, 2004), the ASAM criteria have yet to be empirically validated (Gastfriend & McLellan, 1997; Turner et al., 1999). Another validated instrument that uses objective criteria to match clients to residential or outpatient treatment programs is the Client Matching Protocol (CMP; Melnick et al., 2001). The CMP assesses client risk across four domains (pattern of use, previous long-term abstinence, social factors, and habilitation). Also, unlike the ASAM criteria, the CMP collects data relating to clients’ past criminal behavior and involvement with the criminal justice system. Although designed for use in community-based treatment settings, there has been recent talk of modifying the CMP for use with offender populations and corrections-based treatment.
- Focus on Aftercare
Perhaps no finding has been more consistently reported and supported in the literature on prison-based substance abuse treatment than the impact of aftercare on improving postprison treatment outcomes. So widely accepted is the importance of aftercare, that it forms the foundation of the concept of “continuity of care,” which emphasizes the importance of transitioning individuals from prison-based treatment to continued treatment in the community with minimal or no interruption (i.e., a “seamless” transition). Data collected from the California initiative has further reinforced the importance of participation and retention in aftercare, but it has also highlighted some important issues relating to aftercare and the continuity of care construct. This includes the phenomenon of higher RTP rates among parolees who choose to enter aftercare, but drop out within 90 days. As expected, these rates are higher than those of parolees who remain in aftercare for more than 90 days, but they are also higher than the RTP rates of parolees who never entered aftercare. In addition, the apparent lack of differential effectiveness of residential versus outpatient aftercare needs to be explored further. One
possible explanation for this finding may be a large variance in the quality of programming across the literally hundreds of residential and outpatient community-based programs that parolees have accessed for aftercare services in California.
- Monitoring and Measuring Treatment Quality
Through its Policy Advisory Committee, OSAP has initiated a number of efforts to improve the quality of TC SAP and SASCA programming. The main effort in this regard is the Continuing Quality Improvement (CQI) subcommittee, which consists of a rotating group of representatives from the seven SAP provider organizations, prisons where programs are located, and OSAP. The CQI subcommittee conducts periodic site visits to the prison-based TCs for the purpose of collecting and reporting “best practices” aspects of the individual programs that the CQI group believes contribute to the overall effectiveness of the program and should be shared with other prison-based treatment programs. However, despite the benefits that may be derived from the sharing of best practices, the CQI program does not represent, nor does there exist, a systematic validated process for assessing and ensuring the continuing quality of the prison-based treatment programs.
One means for assessing the quality of corrections-based treatment programs is the Correctional Program Assessment Inventory (CPAI, Gendreau & Andrews, 1996), a validated instrument that assesses how well various aspects of a correctional treatment program correspond with principles of effective programming for offenders (Gendreau & Goggin, 1997). Items on the CPAI cover six domains: program implementation, client pretreatment characteristics, program characteristics, staff characteristics, evaluation and quality assurance procedures, and other. The CPAI has been widely used in Canada to assess program quality and is increasingly being used with correctional programs in the United States.
Of greater concern, however, is the question of variability in the quality of the large number of community-based treatment programs that provide aftercare treatment services provided to parolees from the prison-based treatment programs—a measure that is difficult to capture. In California, residential and nonresidential treatment programs are not required to be certified by the state, which would ensure that the program is delivering a minimal level of service quality (California Department of Alcohol and Drug Programs [CDADP], 2004). Only about 70 percent of licensed residential programs in the state are certified, and there were only 903 nonresidential programs that had been certified as of July 2003; non-residential drug/alcohol programs are not required to be licensed, and so it is not known how many of them are operating in the state (CDADP, 2004).
Related to this (and discussed briefly above) is the type and dosage of treatment parolees receive vis-à-vis the treatment that they received while in prison. For a large percentage of parolees entering aftercare, the treatment programs that they are entering do not build upon the progress made in prison-based treatment. While this hypothesis has not been empirically tested, anecdotal data collected as part of process evaluations suggest that parolees entering community-based treatment programs often feel as though they are not being given credit for the progress that they made in prison-based treatment. Furthermore, the SASCA system, while it represents an efficient model for transferring parolees from the large network of prison-based treatment programs to an even larger network of community-based treatment programs, was not designed to assess or ensure the quality of aftercare treatment
services,5 and it does not ensure that the community-based treatment programs take into account progress that parolees made in prison-based treatment. Nevertheless, given the large number of programs involved, the current state regulations covering licensing and certification for community-based treatment programs, and the costs associated with implementing a comprehensive quality assessment protocol, it is likely that the monitoring of program quality, to the extent that it is possible, will need to be built into the existing SASCA system.
- Gender-Responsive Treatment
Findings that drug-dependent women offenders have higher rates of co-occurring mental disorders compared with males and are at higher risk for recidivism (Grella & Greenwell, 2005, Messina et al., 2003) indicate the need to place greater emphasis on promoting integrated services (e.g., FOTEP) for women transitioning from prison-based treatment to community-based aftercare programs. The lack of access to integrated treatment for individuals with co-occurring disorders may be especially detrimental, since offenders with both mental health and substance abuse disorders have higher rates of recidivism compared to offenders with only substance use disorders (Messina et al., 2004). Once in community treatment, the findings from the FOTEP evaluation highlight the need to improve treatment completion rates by more effectively addressing the needs of the women and engaging them more in the treatment process.
With respect to in-prison treatment, there is a need for a comprehensive diagnostic assessment at intake that will inform treatment staff of the diverse substance use disorders and psychological needs of women. There is also a need for specialized treatment curricula that address issues that arise from sexual and physical abuse and the resulting mental health disorders.
There is also the question of whether programs for female offenders should only be staffed by female counselors in order to promote stronger therapeutic alliances between clients and counselors, provide strong female role models and supportive peer networks, and more effectively address patterns of abuse from childhood to adulthood (Morash, Bynum, & Koons, 1998). Findings regarding education and employment (Messina et al., 2003) suggest that basic education, literary skills, and marketable vocational training are particularly important components of treatment for women, as well as men. In addition, the large percentage of drug-dependent offenders, male and female, who have children suggests that parenting programs should also become a critical part of treatment for both men and women.
- CONCLUSION
During the 1950s and 1960s, California led the nation in the development and evaluation of rehabilitation programs for offenders (Palmer & Petrosino, 2003). During the 1970s,
correctional treatment in California, as in other states, experienced severe cutbacks as the result of budget reductions and an anti-rehabilitation ideology. As the pendulum swung back in the late 1980s to a focus on treatment for offenders, California again led the way and has since developed a comprehensive and still growing system of prison and community treatment for substance-abusing offenders. Research findings were influential in the initiation of prison treatment, as well as in its further expansion. Much still remains to be learned about what works, with whom, and under what conditions in order to enhance the effectiveness of treatment for offenders. Continued collaboration between research centers and correctional agencies, in California and other states, will move the field forward, to the benefit of offenders and society.
5 SASCAs have been known to stop referring clients to community-based treatment programs that they viewed as delivering poor quality services. However, it is not clear how common this was or what criteria were used to determine that the services were of poor quality.
- REFERENCES
American Society of Addiction Medicine (ASAM). (1998). Reviewing ASAM’s goals and accomplishments. Journal of Addictive Diseases, 17(2), 123–128.
Andrews, D. A., Zinger, I., Hoge, R. D., Bonta, J., Gendreau, P., & Cullen, F. T. (1990). Does correctional treatment work? A clinically relevant and psychologically-informed meta-analysis. Criminology, 28(3), 369–404.
Andrews, D. A., Bonta, J., & Hoge, R. D. (1990). Classification for effective rehabilitation—rediscovering psychology. Criminal Justice and Behavior, 17(1), 19–52.
Anglin, M. D., Prendergast, M., & Farabee, D. (1997). First annual report on the substance abuse program at the California Substance Abuse Treatment Facility (SATF) and state prison at corcoran: A report to the California State Legislature. Project Report, California Department of Corrections Contract C97.243. Los Angeles: UCLA Drug Abuse Research Center.
Bandura, A. (1969). Principles of behavior modification. New York: Holt, Rinehart & Winston.
Blue Ribbon Commission on Inmate Population Management. (1990). Final Report. Sacramento, CA: Blue Ribbon Commission on Inmate Population Management.
Bonta, J. (1997). Offender rehabilitation: From research to practice (User Report No. 1997-01). Ottawa: Department of the Solicitor General of Canada.
Bonta, J., Wallace-Capretta, S., & Rooney, J. (2000). A quasi-experimental evaluation of an intensive rehabilitation supervision program. Criminal Justice and Behavior, 27(3), 312–329.
Broome, K. M., Knight, K., Joe, G. W., & Simpson, D. D. (1996). Evaluating the drug-abusing probationer: Clinical interview versus self-administered assessment. Criminal Justice and Behavior, 23(4), 593–606.
Brown, M. (1996). Refining the risk concept: Decision context as a factor mediating the relation between risk and program effectiveness. Crime & Delinquency, 42(3), 435–455.
Burdon, Dang W. M., Messina, N. P., & Prendergast, M. L. (2004). The California treatment expansion initiative: Aftercare participation, recidivism, and predictors of outcomes. The Prison Journal, 84(1), 61–80.
Burdon, W. M., Prendergast, M. L., Messina, N. P., & Farabee, D. (2006). Differential effectiveness of residential versus outpatient aftercare for parolees from prison-based therapeutic community treatment programs. Manuscript submitted for publication.
Burdon, W. M., Roll, J. M., Prendergast, M. L., & Rawson, R. (2001). Drug courts and contingency management. Journal of Drug Issues, 31(1), 73–90.
Bureau of Justice Statistics. (1999a). Substance abuse and treatment, state and federal prisoners, 1997 (NCJ 172871). Washington, DC: Bureau of Justice Statistics, U.S. Department of Justice.
California Department of Alcohol and Drug Programs. (2004). Fact Sheet: Licensing & Certification of Alcoholism or Drug Abuse Recovery or Treatment Programs. Retrieved August 25, 2005 from www.adp.cahwnet.gov/abt_adp.asp#fact
C
alifornia Department of Corrections and Rehabilitation. (1996). A report on the inmate classification system. Sacramento: Offender Information Branch, California Department of Corrections and Rehabilitation.
California Department of Corrections and Rehabilitation. (2005). Prisoners & Parolees 2004.Sacramento: Offender Information Services, California Department of Corrections and Rehabilitation.
California Department of Corrections and Rehabilitation. (2006). Monthly report of population as of December 31, 2005. Retrieved April 2, 2006 from www.corr.ca.gov/ReportsResearch/OffenderInfoServices/Monthly/MonthlyTpop1aArchive.asp
Camp, G. M., & Camp, C. G. (1989). Building on prior experience: Therapeutic communities in prison. South Salem, NY: Criminal Justice Institute.
Center for Substance Abuse Treatment. (1998). Continuity of offender treatment for substance use disorders from institution to community (Treatment Improvement Protocol [TIP] Series 30). Washington, DC: Substance Abuse and Mental Health Services Administration, Department of Health and Human Services.
Chaiken, M. (1989). In-prison programs for drug-involved offenders. Washington, DC: National Institute of Justice, U.S. Department of Justice.
Condelli, W. S., & Hubbard, R. L. (1994). Relationship between time spent in treatment and client outcomes from therapeutic communities. Journal of Substance Abuse Treatment, 11(1), 25–33.
Cullen, F., Cullen, J., & Wozniak, J. (1988), Is rehabilitation dead? The myth of the punitive public. Journal of Criminal Justice, 16(4), 303–317.
De La Rosa, M. R., & White, M. S. (2001). A review of the role of social support systems in the drug use behavior of Hispanics. Journal of Psychoactive Drugs, 33(3), 233–240.
De Leon G. (2000). The therapeutic community: Theory, model and method. New York: Springer.
De Leon, G., Melnick, G., Kressel, D., & Jainchill, N. (2000). Circumstance, motivation, readiness, and suitability (the CMRS scales): Predicting retention in therapeutic community treatment. American Journal of Drug and Alcohol Abuse, 20(4), 495–515.
Department of Health and Human Services. (1994). Treatment for alcohol and other drug abuse: Opportunities for coordination. Technical Assistance Publication Series 11, Publication No. (SMA) 94-2075. Washington, DC: Department of Health and Human Services.
Farabee, D., & Knight, K. (2001). Final report on the Psychometric Properties of the Inmate Pre-Release Assessment (IPASS). Los Angeles: Query Research.
Farabee, D., Prendergast, M. L., & Anglin, M. D. (1998). The effectiveness of coerced treatment for drug-abusing offenders. Federal Probation, 62(1), 3–10.
Farabee, D., Prendergast, M. L., Cartier, J., Wexler, H., Knight, K., & Anglin, M. D. (1999). Barriers to implementing effective correctional treatment programs. The Prison Journal, 79(2), 150–162.
Field, G. (1989). A study of the effects of intensive treatment on reducing the criminal recidivism of addicted offenders. Federal Probation, 53(10), 51–56.
Field, G. (1998). From the institution to the community. Corrections Today, 60(6), 94–97,113.
Friedmann, P. D., Hendrickson, D. C., Gerstein, D. R., & Zhang, Z. W. (2004). The effect of matching comprehensive services to patients’ needs and drug use improvement in addiction treatment. Addiction, 99(8), 962–972.
Garrett, C. J. (1985). Effects of residential treatment of adjudicated delinquents. A meta-analysis. Journal of Research in Crime and Delinquency, 22, 287–308.
Gastfriend, D. R. (Ed.). (2003). Addiction treatment matching: Research Foundation of the American Society of Addiction Medicine (ASAM) criteria. Binghamton, NY: Haworth Medical Press.
Gastfriend, D. R., & McLellan, A. T. (1997). Treatment matching: Theoretical basis and practical implications. Medical Clinics of North America, 81(4), 945–966.
Gendreau, P., & Andrews, D. A. (1996). Correctional Program Assessment Inventory (CPAI) (6th ed.). Saint John: University of New Brunswick.
G
endreau, P., Cullen, F. T., & Bonta, J. (1994). Intensive rehabilitation supervision: The next generation in community corrections. Federal Probation, 58(1), 72–78.
Gendreau, P., & Goggin, C. (1997). Correctional treatment: Accomplishments and realities. In P. Van Voorhis, M. Braswell, & D. Lester (Eds.), Correctional counseling & rehabilitation (3rd ed., pp. 271–279). Cincinnati: Anderson.
Gendreau, P., & Ross, R. (1987). Revivification of rehabilitation: Evidence from the 1980s. Justice Quarterly, 4(3), 349–407.
Gossop, M., Marsden, J., Stewart, D., & Rolfe, A. (1999). Treatment retention and 1-year outcomes for residential programmes in England. Drug and Alcohol Dependence, 57(2), 89–98.
Gottheil, E., Weinstein, S. P., Sterling, R., Lundy, A., & Serota, R. D. (1998). A randomized controlled study of the effectiveness of intensive outpatient treatment for cocaine dependence. Psychiatric Services, 49(6), 782–787.
Graham, W. F., & Wexler, H. K. (1997). The Amity therapeutic community at Donovan prison: Program description and approach. In G. De Leon (Ed.), Community as method: Therapeutic communities for special populations and settings. New York: Praeger.
Greenley, J. R. (1992). Neglected organizational and management issues in mental health systems development. Community Mental Health Journal, 28(5), 371–384.
Grella, C. E., & Greenwell, L. (2006a). Treatment needs and completion of community-based aftercare among substance-abusing women offenders. Manuscript under review.
Grella, C. E., & Greenwell, L. (2006b). Correlates of parental status and attitudes toward parenting among substance-abusing women offenders. The Prison Journal, 86(1), 89–113.
Grella, C. E., Stein, J. A., & Greenwell, L. (2005). Associations among childhood trauma, adolescent problem behaviors, and adverse adult outcomes in substance-abusing women offenders. Psychology of Addictive Behaviors, 19(1), 43–53.
Hall, E. A., Prendergast, M. L., Wellisch, J., Patten, M., & Cao, Y. (2004). Treating drug-abusing women prisoners: An outcomes evaluation of the Forever Free program. The Prison Journal, 84(1), 81–105.
Harrison, L. D., & Martin, S. S. (2000). Residential substance abuse treatment for state prisoners formula grant: Compendium of program implementation and accomplishments. Final report. Newark, DE: Center for Drug and Alcohol Studies, University of Delaware.
Hser, Y. (1995). A referral system that matches drug users to treatment programs: Existing research and relevant issues. The Journal of Drug Issues, 25(1), 209–224.
Hser, Y. I., Evans, E., Huang, D., & Anglin, M. D. (2004). Relationship between drug treatment services, retention, and outcomes. Psychiatric Services, 55(7), 767–774.
Hser, Y. I., Polinsky, M. L., Maglione, M., & Anglin, M. D. (1999). Matching clients’ needs with drug treatment services. Journal of Substance Abuse Treatment, 16(4), 299–305.
Hubbard, R. L., Craddock, S. G., Flynn, P. M., Anderson, J., & Etheridge, R. M. (1997). Overview of 1-year outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behvaiors, 11(4), 261–278.
Hubbard, R. L., Craddock, S. G., & Anderson, J. (2003). Overview of 5-year follow-up outcomes in the drug abuse treatment outcome studies (DATOS). Journal of Substance Abuse Treatment, 25(3), 125–134.
Inciardi, J. A. (1996). The therapeutic community: An effective model for corrections-based drug abuse treatment. Drug treatment behind bars: Prison-based strategies for change (pp. 65–74). Westport, CT: Praeger.
Izzo, R. L., & Ross, R. R. (1990). Meta-analysis of rehabilitation programs for juvenile delinquents. Criminal Justice & Behavior, 17, 134–142.
Jarman, E. (1993). An evaluation of program effectiveness for the Forever Free Substance Abuse Program at the California Institution for Women, Frontera, California. Sacramento: Office of Substance Abuse Programs, California Department of Corrections.
K
night, K., Simpson, D. D., & Hiller, M. L. (1999). Three-year reincarceration outcomes for in-prison therapeutic community treatment in Texas. Prison Journal, 79(3), 337–351.
Langevin, C. M. (2001). An evaluation framework for the Maison decision house substance abuse treatment program. Canadian Journal of Program Evaluation, 16(1), 99–129.
Leukefeld, C. G., & Tims, F. M. (1988). Compulsory treatment of drug abuse: Research and clinical practice (NIDA Research Monograph 86, Department of Health and Human Services Publication No. ADM 89-1578, pp. 236–249). Washington, DC: U.S. Government Printing Office.
Lipsey, M. W. (1995). What do we learn form 400 research studies on the effectiveness of treatment with juvenile delinquents? In J. McGuire (Ed.), What works: Reducing reoffending, Chichester: John Wiley & Sons.
Lipton, D. S. (1995). The effectiveness of treatment for drug abusers under criminal justice supervision (NIJ Research report). Washington, DC: National Institute of Justice, U.S. Department of Justice.
Little Hoover Commission. (1998). Beyond bars: Correctional reforms to lower prison costs and reduce crime. Sacramento: Little Hoover Commission.
Lowenkamp, C. T., & Latessa, E. J. (2003). Increasing the effectiveness of correctional programming through the risk principle: Identifying offenders for residential placement. Retrieved January 25, 2005 from www.uc.edu/criminaljustice/Articles.htm
Lowenkamp, C. T., & Latessa, E. J. (2004). Residential community corrections and the risk principle: Lessons learned in Ohio. In Ohio Corrections Research Compendium, Volume II, Columbus, OH: Ohio Department of Rehabilitation and Correction.
Magura, S., Staines, G., Kosanke, N., Rosenblum, A., Foote, J., DeLuca, A., et al. (2003). Predictive validity of the ASAM patient placement criteria for naturalistically matched vs. mismatched alcoholism patients. The American Journal on Addictions, 12, 386–397. II, Columbus, OH: Ohio Department of Rehabilitation and Correction.
Martin, S. S., Butzin, C. A., Saum, C. A., & Inciardi, J. A. (1999). Three-year outcomes of therapeutic community treatment for drug-involved offenders in Delaware: From prison to work release to aftercare. Prison Journal, 79(3), 294–320.
May, W. W. (2004). A psychometric analysis of the dimension rating system—2nd edition. Journal of Addictive Diseases, 23(4), 85–112.
McGlothlin, W. H., Anglin, M. D., & Wilson, B. D. (1977). An evaluation of the California civil addicts program. (NIDA Services Research Monograph Series, Department of Health and Human Services Publication No. ADM 78-558). Rockville, MD: National Institute on Drug Abuse.
McLellan, A. T., Hagan, T. A., Meyers, K., Randall, M., & Durell, J. (1997). Intensive outpatient substance abuse treatment” Comparisons with traditional outpatient treatment. Journal of Addictive Diseases, 16(2), 57–84.
Melnick, G., De Leon, G., Thomas, G., & Kressel, D. (2001). A client-treatment matching protocol for therapeutic communities: First report. Journal of Substance Abuse Treatment, 21(3), 119–1289.
Messina, N., Burdon, W., Hagopian, G., & Prendergast, M. (2004). One year return to custody rates among co-disordered offenders. Behavioral Sciences and the Law, 22, 503–518.
Messina, N., Burdon, W., & Prendergast, M. (2003). Assessing the needs of women in institutional therapeutic communities. Journal of Offender Rehabilitation, 37(2), 89–106.
Messina, N., & Grella, C. (2006). Childhood trauma and women’s health outcomes in a California prison population. American Journal of Public Health, 96(10), 1842–1848.
Moore, G. E., & Mears, D. P. (2001). Strong science for strong practice: Linking research to drug treatment in the criminal justice system. Views of practitioners. Washington DC: The Urban Institute.
Moos, R. H. (2003). Addictive disorders in context: Principles and puzzles of effective treatment and recovery. Psychology of Addictive Behaviors, 17(1), 3–12.
M
orash, M., Bynum, T., & Koons, B. (1998). Women offenders: Programming needs and promising approaches. Bureau of Justice Statistics Bulletin, Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics.
Office of National Drug Control Policy. (1989). National drug control strategy. Washington, DC: The White House.
Ossmann, J. (1999). Evolution of continuing care in California. Sacramento: Office of Substance Abuse, California Department of Corrections.
Palmer, T., & Petrosino, A. (2003). The “Experimenting Agency”: The California Youth Authority Research Division. Evaluation Review, 27(3), 228–266.
Pearson, F. S., Lipton, D. S., Cleland, C. M., & Yee, D. S. (2002). The effects of behavioral/cognitive-behavioral programs on recidivism. Crime & Delinquency, 48(3), 476–496.
Prendergast, M., & Burdon, W. (2002). Integrated system of care for substance-abusing offenders. In C. Leukefeld, F. Tims, & D. Farabee (Eds.), Clinical and policy responses to drug offenders (pp. 111–127). New York: Springer.
Prendergast, M., Hall, E., & Wellisch, J. (2002). An outcome evaluation of the Forever Free Substance Abuse Treatment Program: One-year post-release outcomes. Final Report, National Institute of Justice Grant 99-RT-VX-K003. Los Angeles: UCLA Drug Abuse Research Center.
Prendergast, M., Hall, E. A., Wexler, H. K., Melnick, G., & Cao, Y. (2004). Amity prison-based therapeutic community: Five-year outcomes. The Prison Journal, 84(1), 36–60.
Prendergast, M. L., Wellisch, J., & Wong, M. (1996). Residential treatment for women parolees following prison-based drug treatment experiences, needs and services outcomes. Prison Journal, 76(3), 253–274.
Prendergast, M., & Wexler, H. K. (2004). Correctional substance abuse treatment programs in california. The Prison Journal, 84(1), 8–35.
Rose, S. J., Zweben, A., & Stoffel, V. (1999). Interfaces between substance abuse treatment and other health and social systems. In B. S. McCrady & E. B. Epstein (Eds.), Addictions: A Comprehensive Guidebook. New York: Oxford UP.
Rupp, L. G., & Beck, A. R. (1989). Invited review: California Department of Corrections substance abuse treatment programming. Washington, DC: Bureau of Justice Assistance, U.S. Department of Justice.
Simpson, D. D., & Friend, H. J. (1988). Legal status and long-term outcomes for addicts in the DARP follow-up project. In C. G. Leukefeld & F. M. Tims (Eds.), Compulsory treatment of drug abuse: Research and clinical practice (NIDA Research Monograph 86, Department of Health and Human Services number (ADM)89-1578, pp. 81–98). Washington DC: U.S. Government Printing Office.
Simpson, D. D., Joe, G. W., & Brown, B. S. (1997). Treatment retention and follow-up outcomes in the drug abuse treatment outcome study (DATOS). Psychology of Addictive Behaviors, 11(4), 294–307.
Taxman, F. S. (1998). Reducing recidivism through a seamless system of care: Components of effective treatment, supervision, and transition services in the community. (Prepared for Office of National Drug Control Policy Treatment and Criminal Justice System Conference). Greenbelt, MD, University of Maryland, College Park.
Thornton, C. C., Gottheil, E., Weinstein, S. P., & Kerachsky, R. S. (1998). Patient-treatment matching in substance abuse: Drug addiction severity. Journal of Substance Abuse Treatment, 15(6), 505–511.
Turner, W. M., Turner, K. H., Reif, S., Gutowski, W. F., & Gastfriend, D. R. (1999). Feasibility of multidimensional substance abuse treatment matching: Automating the ASAM patient placement criteria. Drug and Alcohol Dependence, 55(1–2), 35–43.
Weinstein, S. P., Gottheil, E., & Sterling, R. (1997). Randomized comparison of intensive outpatient vs. individual therapy for cocaine abusers. Journal of Addictive Diseases, 16(2), 41–56.
Wellisch, J., Prendergast, M., & Anglin, M. D. (1993). Criminal justice and drug treatment systems linkage: Federal promotion of interagency collaboration in the 1970s. Contemporary Drug Problems, 20(4), 611–650.
W
esthuis, D. J., Gwaltney, L., & Hayashi, R. (2001). Outpatient cocaine abuse treatment: Predictors of success. Journal of Drug Education, 31(2), 171–183.
Wexler, H. K. (1986). Therapeutic communities within prisons. In G. De Leon & J. T. Ziegenfuss (Eds.), Therapeutic communities for addictions: Readings in theory, research and practice (pp. 227–237). Springfield, IL: Charles C. Thomas, Publishers.
Wexler, H. K. (1995). The success of therapeutic communities for substance abusers in American prisons. Journal of Psychoactive Drugs, 27(1), 57–66.
Wexler, H. K. (1996, November). The Amity prison TC evaluation: Inmate profiles and reincarceration outcomes. Paper presented to the California Department of Corrections, Youth and Adult Correctional Agency, Sacramento, California.
Wexler, H. K., Burdon, W. M., & Prendergast, M. L. (2006). Maximum-security prison therapeutic community and aftercare: First outcomes. Offender Substance Abuse Report, 5(6), 81–82, 91–94.
Wexler, H. K., DeLeon, G., Thomas, G., Kressel, D., & Peters, J. (1999). The Amity prison TC evaluation: Reincarceration outcomes. Criminal Justice and Behavior, 26(2), 147–167.
Wexler, H. K., Falkin, G. P., & Lipton, D. S. (1990). Outcome evaluation of a prison therapeutic community for substance abuse treatment. Criminal Justice and Behavior, 17(1), 71–92.
Wexler, H. K., Falkin, G. P., Lipton, D. S., & Rosenblum, A. B. (1992). Outcome evaluation of a prison therapeutic community for substance abuse treatment. In C. G. Leukefeld & F. M. Tims (Eds.), Drug abuse treatment in prisons and jails (NIDA Research Monograph 118, pp. 156–175). Rockville, MD: National Institute on Drug Abuse.
Wexler, H. K., & Graham, W. F. (1992, October). Evaluation of a prison-based therapeutic community for substance abusers: Preliminary findings. Paper presented at the World Conference of Therapeutic Communities, Venice, Italy.
Wexler, H. K., & Graham, W. F. (1993, October). Evaluation of a prison therapeutic community: Relationship between crime and drug histories, psychological profiles and 6-month outcomes.Paper presented at the American Society of Criminology, Phoenix, Arizona.
Wexler, H. K., & Graham, W. F. (1994, August). Prison-based therapeutic community for substance abusers: Follow-up outcomes. Paper presented at the American Psychological Association, Los Angeles, California.
Wexler, H. K., Graham, W. F., Koronkowski, R., & Lowe, L. (1995). Amity Therapeutic Community Substance Abuse Program preliminary return to custody data: May 1995. Report to the Office of Substance Abuse Programs, California Department of Corrections.
Wexler, H. K., with Lipton, D. S., & Falkin, G. P. (1992). Correctional drug abuse treatment in the United States: An overview. (NIDA Monograph 118, pp. 8–30). Washington DC: National Institute on Drug Abuse.
Wexler, H. K., Lipton, D. S., Blackmore, J., & Brewington, V. (1992) Comprehensive state department of corrections treatment strategy for drug abuse (Project REFORM). A final report to the Bureau of Justice Assistance.
Wexler, H. K., Melnick, G., & Cao, Y. (2004). Risk and prison substance abuse treatment outcomes: A replication and challenge. The Prison Journal, 84(1), 106–120.
Wexler, H. K., Melnick, G., Lowe, L., & Peters, J. (1999). Three-year reincarceration outcomes for Amity in-prison therapeutic community and aftercare in California. Prison Journal, 79(3), 312–336.
Wexler, H. K., & Williams, R. (1986). Therapeutic communities within prisons. In G. De Leon & J. T. Ziegenfuss (Eds.), Therapeutic communities for addictions: Readings in theory, research, and practice (pp. 227–237). Springfiled, IL: Charles C. Thomas.
Winett, D. L., Mullen, R., Lowe, L. L., & Missakian, E. A. (1992). Amity Righturn: A demonstration drug abuse treatment program for inmates and parolees. In C. G. Leukefeld & F. M. Tims (Eds.), Drug abuse treatment in prison and jails (NIDA Research Monograph Series 118, pp. 84–98). Rockville, MD: National Institute on Drug Abuse, U.S. Department of Health and Human Services.