Implementation of the TDCJ Rehabilitation Tier Treatment Programs: Progress Report

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1 Implementation of the TDCJ Rehabilitation Tier Treatment Programs: Progress Report Criminal Justice Policy Council April 1998 Tony Fabelo, Ph.D. Executive Director

2 Implementation of the TDCJ Rehabilitation Tier Treatment Programs: Progress Report Criminal Justice Policy Council P.O. Box Austin, Texas (512)

3 Researched and Written By: Michael Eisenberg

4 Note From The Director The 75th Texas Legislature mandated the Texas Department of Criminal Justice (TDCJ) to designate specific correctional facilities for providing programs directed at reducing recidivism. In response, TDCJ is currently operating 6 programs in 19 locations serving close to 7,000 inmates. The facilities housing these programs are commonly referred to as the tier of rehabilitation facilities. The programs provide a variety of interventions, such as substance abuse treatment, vocational training, and sex offender therapy. In adopting the tier policy the legislature recognized the need for a multi-year methodical implementation and evaluation approach to allow these programs to work and be costeffective. The legislature directed the Criminal Justice Policy Council (CJPC) to monitor implementation and measure the performance of these programs. This report examines implementation issues. A later report will review the performance of selected programs. Setting up integrated rehabilitation programs in a correctional setting is challenging as conflictive security, treatment, release, and budgetary goals have to be balanced for successful implementation. TDCJ has made substantial progress in balancing these goals, in particular, for the drug treatment programs started in late However, certain issues such as staff shortages and the toughening of release decisions continue to negatively impact the programs. As prison release policies have become more restrictive, the programs have to draw on a limited number of eligible offenders that meet both treatment and release criteria. For example, the Pre-Release Therapeutic Community (PRTC) program targets offenders with substance abuse and/or vocational training needs who will be released to the Dallas area to take advantage of enhanced post-release services developed for the program. Because of specific program and release criteria, the PRTC has been unable to identify an adequate number of offenders to fill the program as designed. This has resulted in 34% of offenders participating in the program who will not be released to the Dallas area and will not receive post-release services as designed. Similarly, the Pre-Release Substance Abuse Program (PRSAP), designed to select offenders with moderate substance abuse problems for 4 to 6 months of treatment before release, was modified to accept offenders with severe substance abuse problems. This was necessary to fill program capacity. The benefit of mixing offenders of various treatment needs in a 4 to 6 month treatment program is unknown but will be evaluated by the CJPC. No major implementation issues were found with the In-Prison Therapeutic Community (IPTC) or the Substance Abuse Felony Punishment (SAFP) drug treatment program. These programs have been in existence since 1992 and it took program managers between two to three years to resolve major implementation problems. Based on this experience, therefore, the legislature should expect a similar break-in period for the newly created tier of rehabilitation programs. TDCJ needs to concentrate on addressing issues recommended here to continue to improve the operations of the tier programs. Critical areas for improvement are the screening, assessment, and treatment planning and its linkage with the parole process. Tony Fabelo, Ph.D. Executive Director i

5 Acknowledgments The Criminal Justice Policy Council would like to acknowledge the assistance of the Texas Department of Criminal Justice-Research, Evaluation, and Development Unit (TDCJ-RED) and the TDCJ-Programs and Services Division (TDCJ-PS) in providing information for this report. Dimitria Pope, Director of the TDCJ-RED Unit, and TDCJ-RED staff Mickey Neel, Michele Moczygemba, Sly Hughes, and Marty Martin and Cathy McVey and Debbie Roberts, TDCJ-PS Assistant Directors and their staff provided valuable assistance.

6 I. Overview of Tier of Rehabilitation Programs

7 TDCJ Required to Establish Tier of Rehabilitation Programs Which Coordinate Treatment Services and Are Accountable for Reducing Recidivism The 75th Texas Legislature charged the Texas Department of Criminal Justice (TDCJ) with the development of a rehabilitation tier of programs designed to integrate treatment services to rehabilitate offenders and be accountable for reducing recidivism. Many of TDCJ's programs have not been delivered through an integrated delivery system designed to holistically address the treatment needs of offenders. The Criminal Justice Policy Council (CJPC) recommended to the legislature that programs in the rehabilitation tier be evaluated based on their effectiveness in reducing recidivism in a cost-effective manner. Future funding decisions for these programs would be based on their performance in achieving cost-effective reductions in recidivism. These recommendations were adopted into policy by the 75th Legislature in 1997 in House Bill 819. Lieutenant Governor Bob Bullock established the Senate Interim Committee on Criminal Justice and charged the committee to monitor the progress of the rehabilitation tier. This is the initial CJPC report monitoring the implementation of the rehabilitation tier programs in TDCJ. 3

8 All Rehabilitation Tier Programs Were Operational in 1997 Rehabilitation Tier Programs Program Pre-Release Therapeutic Community Sex Offender Treatment Program Faith-Based Pre-Release Program In-Prison Therapeutic Community Substance Abuse Felony Punishment Facilities Pre-Release Substance Abuse Program Start Location Program Budget Offenders in Date FY /97 Beto 1 $985, Program (12/97) 1/96 Ramsey, Estelle, Central $821, /97 Jester II * 84 6/92 Kyle, Henly $15,217, (in-prison phase) 10/92 11 Locations $25,022,000 4,507 (post-release) 2/96 LeBlanc $1,513, TDCJ identified six programs as rehabilitation tier programs to be held accountable for reducing recidivism. The Sex Offender Treatment Program (SOTP) is a 3 phase program located at 3 different prison units. The SOTP budget includes staff to conduct evaluations of sex offenders to determine treatment need. The Faith-Based Pre-Release Program, also known as InnerChange Freedom Initiative, is funded by a two year commitment from Prison Fellowship Ministries (PFM). PFM estimates the value of their non-compensated agreement with TDCJ at $1.2 million for the two year period. The In-Prison Therapeutic Community (IPTC) and Substance Abuse Felony Punishment (SAFP) programs, while distinct programs, share a common budget appropriation. Several of the programs listed above allocate additional resources to post-release treatment. However, the post-release budget for the IPTC and SAFP is the only one noted due to its significant size. 4

9 Rehabilitation Tier Programs: Descriptive Profiles Pre-Release Therapeutic Community (PRTC): Target Population: Primarily mandatory release offenders (parole and discharge cases meeting criteria are also included) with substance abuse problems and/or educational/vocational needs who are within 6 months of release and have a release plan to the Dallas area. Program Approach: Program offers substance abuse treatment, vocational, and educational programs coupled with a life skills training program delivered in a modified therapeutic community. Comments: The program is located at the Beto I unit due to the extensive number of vocational programs available and the units proximity to Dallas. Enhanced post-release services are available to offenders at the Dallas Day Reporting Center. Sex Offender Treatment Program (SOTP): Target Population: Sex offenders volunteering for treatment who are within three years of release. Program Approach: Three phase program involving programming to overcome offense denial, accept responsibility for behavior, intensive group and individual counseling, victim empathy, reintegration and relapse prevention counseling. A complete psychological evaluation is conducted on each offender entering the program. Comments: Phase 1 of the program is approximately 6 months in length and is offered at the Ramsey II Unit. Phase 2 is a 12 to 18 month intensive treatment program at the Estelle Unit utilizing a therapeutic community approach. The reintegration/relapse prevention program is a 6 month program at the Central Unit. Plans are being made to integrate all 3 phases (plus expanded treatment and evaluation services) on two units. Faith-Based Pre-Release Program: Target Population: Offenders within 18 months of release who volunteer for the program. Mandatory supervision cases are the most likely program candidates as they have a release date established within program parameters. Program Approach: The program uses biblical principals to assist offenders in making good moral decisions and applying biblical values to life situations. The program, located at the Jester II unit, provides cognitive skills training, education, vocational training, community service, and volunteer mentoring relationships. Comments: This program is a joint project of TDCJ and Prison Fellowship Ministries (PFM). 5

10 Rehabilitation Tier Programs: Descriptive Profiles (cont.) In-Prison Therapeutic Community (IPTC): Target Population: Offenders with serious substance abuse problems who are within 12 to 14 months of release and who have received a parole vote linking program completion to parole release. Program Approach: The IPTC is a 9 to 12 month in-prison intensive treatment program for substance abusing offenders in TDCJ-ID which utilizes a therapeutic community approach. Offenders' parole release is tied to completion of the in-prison phase of the program. Comments: Offenders completing the in-prison program participate in a 3 month postrelease residential treatment facility program followed by 9 to 12 months of outpatient counseling. Substance Abuse Felony Punishment (SAFP): Target Population: Offenders with substance abuse problems who have been sentenced as a condition or a modification of probation. Program Approach: The SAFP program, like the IPTC program, is a 9 to 12 month intensive treatment program for substance abusing offenders utilizing a therapeutic community approach. Comments: Offenders completing the SAFP facility program participate in a 3 month post-release residential treatment facility program followed by 9 to 12 months of outpatient counseling. Pre-Release Substance Abuse Treatment Program (PRSAP): Target Population: Offenders with substance abuse problems who are within 6 months of release. The majority of offenders selected are scheduled for mandatory release, with some offenders discharging their sentence or approved for parole. Program Approach: PRSAP is a three phase 4 to 6 month substance abuse treatment program using a modified therapeutic community approach. Offenders receive group and individual counseling, anger management, life skills training, drug and alcohol education, and educational and life skills training. Comments: A continuum of care form is used to recommend post-release services to the offender's parole officer. 6

11 The Challenge of Program Implementation is Coordinating Key Program Components The Challenges of Program Implementation Program Delivers Needed Services Post-Release Services Supports Prison Program Staff Qualified and Experienced Offender Ready For Treatment Facility Meets Program Needs Adequate Time for Treatment Coordinated With Prison Operations Aftercare Services Available Providing rehabilitation programs in prison requires addressing a complex number of factors and issues which must be coordinated for effective program delivery. These include: Offender selection issues: Will offender be in prison long enough to complete program? Is offender ready, motivated, and capable of receiving treatment offered or can the program positively change offender's denial of need for treatment? Does offender meet security requirements of program and unit where program offered? Staffing issues: Programs require staff with specialized training and experience with the specific program approach. Programs must be able to attract and retain a sufficient number of qualified staff. 7

12 The Challenge of Program Implementation is Coordinating Key Program Components (cont. 2) Program issues: Program design is supported by research indicating effectiveness in reducing recidivism. Program is implemented as designed. Program matches offender's needs and is appropriate for offender's skills and abilities. Length and intensity of program is sufficient to achieve program goals. Facility issues: Adequate and appropriate space is available to meet program needs. Offenders in the facility, not participating in the program, will not undermine program efforts. Security staff support program efforts and program does not conflict with security mission. Capacity dedicated to the program does not detract from facilities operational needs or efforts to deliver other correctional programming. Post-release service issues: Post-release treatment services are available to provide a continuity of treatment when the offender is released. Post-release services are consistent with institutional programming received and do not duplicate or contradict services already received. Progress achieved in prison and additional treatment needs must be communicated to supervising parole or probation officer to promote continuity of treatment. Solving this Rubik's cube of matching key program components is the key to program success in the rehabilitation tier. 8

13 II. Implementation Issues Common to Rehabilitation Tier Programs 9

14 Parole No Longer an Incentive for Program Participation Program Primary Selection Criteria Program Participation Pre-Release Therapeutic Mandatory Release Involuntary Community Sex Offender Treatment Mandatory Release Voluntary Program Faith-Based Pre-Release Mandatory Release Voluntary Program In-Prison Therapeutic Community Parole Condition of Parole Approval Substance Abuse Felony Condition of Probation Condition of Probation Punishment Facilities Pre-Release Substance Mandatory Release Involuntary Abuse Program Implementation Issue: Historically, participation in rehabilitation programs has been viewed as a positive factor in parole consideration and thus considered an incentive for offenders to enter treatment. As parole rates have hit historic lows in recent years the role of parole as an incentive for program participation has declined. Less than 20% of offenders considered for parole are approved for parole. The inability to coordinate parole selection and release with program completion (with the exception of the IPTC program) has forced programs to select offenders that have a set mandatory release date for program selection to insure adequate time to complete the program before release. Offenders selected because of their proximity to release and not their desire to participate can negatively affect the program. Involuntary program participants may be inappropriate for the program, not ready for treatment, and/or disrupt and delay progress for offenders who could benefit from the program. While involuntary participants may benefit from treatment as much as voluntary participants, research indicates voluntary treatment participants are those most likely to benefit from treatment. Interim Actions: TDCJ-Programs and Services and the Board of Pardons and Paroles (BPP) are working to try improve the selection process. An increasing number of offenders are subject to discretionary mandatory release by the BPP. This group may represent a potential population to try and link release to program participation. The BPP is also working on a new set of parole voting options linked to rehabilitation tier programs. HB 3244 and HB 2918 allow TDCJ to take diligent participation good time credits from offenders refusing to participate in substance abuse programs. TDCJ is exploring alternative sanctions to encourage program participation. 10

15 Staffing Shortages Negatively Impact Some Programs Percent of Staff Postitons Filled in Relation to Offender Capacity 100% 80% 88% 82% 60% 40% 46% 54% Staff 11/97 Offenders 11/97 20% 0% Pre-Release TC Pre-Release Substance Abuse Implementation Issue: Staffing shortages at the Pre-Release Therapeutic Community (PRTC) and the Pre-Release Substance Abuse Program (PRSAP) significantly compromised the programs ability to effectively deliver services. In November 1997 only 46% of the counseling staff positions were filled at the PRTC while the program was at 88% of offender capacity. Similarly, while the PRSAP program was at 82% of capacity 56% of staff positions were filled. Due to TDCJ prison capacity limitations, when a program is allocated prison capacity, that program's bed space must be filled as soon as possible, even if not enough program staff have been hired to work with offenders in the program. Two factors have made it difficult to staff these programs at allocated levels: Labor shortages, especially skilled specialized jobs like substance abuse counselors, have impacted many areas of the state, especially rural areas. Managers have noted the lengthy process necessary to get positions posted and staff hired in TDCJ. Several managers indicated that it had taken over three months to fill vacant positions. Interim Action: TDCJ-Programs and Services has formed a Recruitment Working Group to address the staffing issue. The effort has been particularly effective at the PRTC where the staff positions filled went from 46% to 83% from November 1997 to January The staff positions filled at PRSAP went from 56% to 70%. 11

16 Programs Impacted by Limited Number of Offenders Who Meet Program and Release Criteria 12 Months from Release Minimum Custody Not Targeted For Other Programs Not Mentally or Physically Handicapped Implementation Issue: Program selection and release criteria reduce the number of offenders eligible for specific programs. This makes it difficult to keep programs operating at capacity with offenders appropriate for the program as designed. As an example of how criteria reduce offenders eligible for programs, consider the reduction of offenders eligible for the PRTC program: Of the 140,000 offenders in prison, approximately 88,000 are identified as substance abusers. Of the 88,000 substance abusers, only 2,000 are being released to the Dallas area every 6 months. Of the 2,000 being released to the Dallas area, only 400 meet all program criteria. As a result only 400 of the 600 offenders participating in the PRTC program will be released to the enhanced post-release services in Dallas as the program was designed. Program designs have also been changed for other rehabilitation tier programs due to an inadequate number of offenders meeting program criteria. This may negatively impact the effectiveness of the program. Interim Actions: TDCJ-Programs and Services Division is working to address this issue. The window for identifying offenders for programs has been expanded to increase the eligible populations. Programs that are modified from original design are being reviewed to determine changes necessary to improve services for offenders selected. 12

17 How Much Treatment is Needed and Why Offer Treatment Toward the End of Sentence? Program Program Length Is Program Length Adequate? Pre-Release Therapeutic 6 months No-Need Longer Community Sex Offender Treatment 18 to 24 months No-Need Longer Program Faith-Based Pre-Release 18 months * Program In-Prison Therapeutic Community 9 to 12 months Should be based on client progress Substance Abuse Felony Punishment Facilities 9 to 12 months Should be based on client progress Pre-Release Substance 4 to 6 months No-Need longer Abuse Program * Inadequate time to assess Implementation Issue: Two issues that are linked revolve around the question of the appropriate length of treatment. One issue involves the decision to focus most rehabilitation treatment programs during the last 6 to 12 months of an offender's incarceration and the second issue involves how much time is necessary to provide effective treatment. The chart above reflects staff response to questions regarding adequate length of treatment. Problems cited by staff include: Program length was too short to overcome issues of denial. Substance abusers denying need for treatment or addiction to drugs and sex offenders denying the offense, severity of offense, or reasons for offending create obstacles to treatment and require time to overcome. The therapeutic community (TC) approach takes several months for offenders to understand and incorporate this approach. Additionally, TC's rely heavily on experienced members to teach new members TC concepts. This is difficult to achieve in programs 4 to 6 months in length. Some offenders meeting the criteria for 9 to 12 month treatment programs are placed in the shorter programs. Mixing of clients with varying treatment needs may negatively affect the program. Interim Actions: Efforts to identify offenders eligible for program participation earlier by expanding the selection window will improve the length of stay in program. Additional program experience may assist in delivering programs within current time constraints. Integrating the three-phase sex offender program at two units in close proximity will facilitate time in program and program delivery. Additional focus on appropriate length of program should be examined in relation to available capacity and resources. 13

18 III. Implementation Issues for Specific Programs 14

19 Pre-Release Therapeutic Community (PRTC) The PRTC program design to provide comprehensive services to meet the multiple treatment needs of offenders appears to be sound. Assessment has identified offenders who need various combinations of educational, vocational, and substance abuse programs both prior to and after release. These programs are available at Beto I (prior to release) and Dallas (postrelease). This coordinated approach to offender treatment has not been attempted in TDCJ-ID prior to the PRTC program. Matching offender needs to program and prison capacity has been problematic, as has coordinating program delivery and prison operations. Issue: Coordinating offender selection, programs, prison operations, and treatment delivery presents significant implementation challenges for the PRTC program. The PRTC was allocated 600 beds allowing for 1,200 offenders to be served annually at Beto. This capacity has presented a number of problems related to the original program design. The program's target populations are offenders being released to the Dallas area. However, there are not 1,200 offenders meeting program requirements being released annually to the Dallas area. As a result, offender selection for the program has been forced to take 3rd priority offenders, offenders not being released to the target counties. Approximately 30% of offenders selected will not be released to the Dallas area. These offenders do not receive the enhanced post-release services as designed. To some extent, capacity allocated to the PRTC is driving offender selection rather than program design. Without knowing the combination of treatment needs of incoming offenders, it is difficult to match offender needs to the treatment capacity of the substance abuse, vocational, and educational program capacities allocated for the PRTC. In some cases this results in placement based on program capacity of the different programs at the facility rather than assessed treatment need of the offender. When some programs are at capacity, some offenders are placed in other programs that are available that may not represent the offender's primary treatment needs. Integrating the new PRTC program plan with the existing Windham, vocational, and prison operation schedules has been problematic. Similarly matching program facility needs with existing prison capacity has been less than ideal for operating a therapeutic community. Interim Actions: Pre-selection criteria has been changed to identify eligible offenders who are 8 to 10 months from release, expanding the pool of eligible offenders. Increased staffing of the program has expanded service and program capacity, as well as facilitated program scheduling and coordination. Additional efforts in these areas are still needed. 15

20 Sex Offender Treatment Program (SOTP) The SOTP program is an 18 to 24 month program which provides three phases of treatment to sex offenders volunteering for the program. Each phase of treatment is offered at a different prison facility. In addition to volunteering for the program, offenders must have at least three years remaining on their sentence limiting selection primarily to offenders scheduled for mandatory release. Issue: Adequate time in treatment and resources to achieve program goals represents a challenge to program success. Offenders requiring more time in any phase of treatment than allocated must still progress to the next phase, compromising other phases of treatment. Compounding this problem is the perception that current times allocated for treatment are inadequate for effective treatment. Some staff have indicated that five years of treatment would be more reasonable for some offenders than the current treatment time available. In some cases projected release dates have been inaccurate and offenders do not have three years to participate in the program. Movement from one facility to another to participate in the different phases also consumes significant amounts of time due to the logistics associated with movement (classification review, transportation, cell and schedule assignments, etc.), further aggravating the time in treatment issue. Finally, the prison facilities available for the program were never designed for a sex offender treatment program and the mixing of offenders in the general population and treatment participants is problematic. The TDCJ Board has recently expanded the responsibilities of SOTP by requesting complete psychological evaluations and treatment for all sex offenders, significantly expanding the mission of the program and raising the issue of adequate resources and facilities for the program. Interim Actions: TDCJ has allocated prison capacity at two facilities to facilitate program delivery and provide space for mandatory treatment of all sex offenders. This should mitigate problems associated with fragmented program delivery as well as provide capacity to address expanded program responsibilities. The new locations will provide more appropriate facilities and reduce problems associated with mixing treatment and nontreatment populations. Additionally, TDCJ has significantly increased the SOTP budget to address increased program responsibilities. Further evaluation of the adequacy of resources and facilities to meet new mandates is necessary. 16

21 Faith-Based Pre-Release Program: InnerChange Freedom Initiative Due to the religious nature of the program, offenders must volunteer for participation in this program. Offenders must also be within 18 months of release and must be classified at a security level (minimum security-out) that will allow them to participate in the required community restitution phase of the program which requires work outside the prison facility. Additionally, offenders must have a release plan to the Houston area where extensive volunteer support services are being developed for offenders completing the in-prison phase of the program. Issue: Selection requirements detailed above have slowed down implementation. Due to the selection criteria, the program is having difficulty identifying an adequate number of offenders to fill allocated program capacity. Initial plans proposed selecting 25 offenders 4 times a year to be admitted to the program resulting in 200 offenders admitted to the program in the first two years. Program administrators identify offenders quarterly for the program, but various attrition factors reduce the population to levels lower than planned. A related issue has emerged for offenders selected and participating in the program. Offenders meeting the selection criteria represent good parole candidates. Of the 84 offenders selected for the program in the first year, 27 subsequently were approved for parole and received parole dates that are prior to their program completion dates. Thus a significant number of program participants will be released before completing the program. Unlike the IPTC program, where this issue was resolved by linking parole release to program completion, a parole date cannot be linked to completing a voluntary program that is primarily religious in nature. Interim Actions: TDCJ administrators and Prison Fellowship Ministries are exploring ways to alter the selection process to increase the pool of eligible offenders and to identify offenders most likely to remain in prison long enough to complete the program. 17

22 In-Prison Therapeutic Community (IPTC) Substance Abuse Felony Punishment (SAFP) The IPTC and SAFP programs have been operating since These programs utilize numerous outside vendors for delivering treatment both inside TDCJ-ID and for post-release aftercare treatment. As a result, program and financial accountability issues represent significant responsibilities for TDCJ. Both TDCJ-Program and Services, responsible for institutional program contracting, and TDCJ-Pardons and Paroles Division, responsible for contracting for residential and outpatient counseling services, have developed extensive program and financial accountability monitoring and auditing functions. Issue: The performance of vendors providing post-release treatment services remains unknown. While program performance measures exist for institutional, residential, and outpatient treatment providers, only institutional performance measures are calculated and used to monitor vendor performance. The TDCJ-Substance Abuse Treatment program calculates the percentage of offenders completing the institutional phase of the SAFP and IPTC program by vendor and by overall program, monitors client-counselor caseload ratios, and requires offenders to demonstrate an acceptable level of mastery of program concepts. TDCJ-Parole Division requires residential and outpatient treatment providers to submit monthly program performance reports. However, TDCJ-PD does not have adequate staff to compile, report, and analyze program performance data. As a result: The percent of offenders completing residential treatment, outpatient treatment, and overall program completion rates are unknown by vendor and for the program overall. This data could be used to evaluate vendor and program performance but is not compiled. Results of urinalysis drug tests are reported but rates are not calculated to examine variation in drug use by offenders by treatment provider or for the program as a whole. Interim Action: TDCJ-PD plans to develop a computer system to calculate drug test results by vendor. It is recommended that efforts to calculate program performance measures as reported by treatment vendors be instituted and utilized in reviewing program effectiveness and awarding treatment contracts. 18

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