Re-Entry Modified TC in Community Corrections for Offenders with COD: Crime Outcomes at 12-Months Post-Prison Release

Transcription

1 Re-Entry Modified TC in Community Corrections for Offenders with COD: Crime Outcomes at 12-Months Post-Prison Release Stanley Sacks, PhD Center for the Integration of Research & Practice (CIRP) National Development & Research Institutes, Inc. (NDRI) Karen McKendrick, MPH Center for the Integration of Research & Practice (CIRP) National Development & Research Institutes, Inc. (NDRI) 2011 Addictions Health Services Research: Service Integration Across the Spectrum October 3-5, 2011 Fairfax, VA Supported by The Department of Health and Human Services National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA) grant: 5R01DA

2 Background Offenders have a high prevalence of COD: 42% State prisons & 49% local jails (James & Glaze, 2006) In CJDATS1, 80% of State inmates entering substance abuse treatment had a mental health disorder, 39% considered serious (Sacks et al., 2007a; 2007b) There is an evidence-based for modified therapeutic communities in community based programs and this model can be applied to offenders with COD (Sacks, et al., 2004) The participating site for the current study was a Colorado DOC program 2

3 Prevalence of Severe Mental Disorders in Colorado Prisons is Increasing # of inmates # of inmates with mental disorders ,795 (20%) (3%) 2006 ¾ with COD 3

4 Offenders with COD Study Design Colorado Department of Corrections referral pool Modified TC prison Mental Health prison comparison 4 Modified TC aftercare Regular community services 4

5 Offenders with COD 12 Month Outcomes reincarceration rates MH 33% 10 0 MTC in prison only 16% Total n= 139 n=64 n=32 n=43 MTC in prison + MTC aftercare 5% Sacks, S., Sacks, J., et al. (2004) 5

6 Study Design In-Prison TC N=77 In-Prison Standard Services N=50 Random Assignment Random Assignment E Re-Entry MTC Treatment (RMTC) (N=71) C Parole Supervision Case Management (PCSM) (N=56) 6

7 Re-Entry Modified TC Intervention Components COMMUNITY ENHANCMENT u Morning Meetings o Motivate positive interactions u Community Meetings o Discuss shared concerns u Community Activities o Familiarity with community resources THERAPEUTIC/ EDUCATIVE u Psycho-educational classes o Relapse prevention o Criminal thinking o Triple recovery u Psychotherapeutic groups & counseling o Group/individual o Feelings/anger mgmt o Conflict resolution u Case management assistance o Medication monitoring o Entitlement assistance COMMUNITY & CLINICAL MANAGEMENT u Social learning Self-management of program guidelines 7

8 Sample Male offenders were eligible for the study provided they: 1) Diagnosed with COD; 2) Participated in substance abuse treatment (completers & non-completers); 3) Approved by the Community Corrections Board & Accepted by Provider Agency for placement in a Community Corrections Facility 4) Voluntarily consented to enter the study. 8

9 Reincarceration Rates: 12 months post-prison 50 Percent C PSCM E RMTC

10 Reincarceration Rates: 12 months post-prison for different in-prison / re-entry combinations Percent No MTC Treatment MTC in prison MTC in Re-entry MTC in prison AND re-entry

11 Summary An intent-to-treat analysis 12-months postprison release showed reincarceration to be less likely for E-RMTC participants (19%) than for C PSCM participants (38%), with the greatest reduction in recidivism found for E- RMTC participants who also received MTC treatment while incarcerated. 11

12 Limitations Power to detect group differences limited by sample size In-prison treatment was not randomized The effect of time in treatment 12

13 MTC for Co-Occurring Disorders: A Meta-Analysis of Three Studies (Four Comparisons) Summary of meta-analysis combined study comparisons random effects analysis (differential treatment effects: MTC vs. Comparison) Domain Effect Size Odds Ratio 95% CI p Q (p) I 2 Substance abuse ( ).043* (0.172) Mental health ( ).031* (0.567) Crime ( ).032* (0.462) HIV-risk behavior ( ) (0.381) Employment ( ).000*** (0.096) Housing ( ).030* (0.946) *p<0.05; **p<0.01; ***p<0.001 An odds ratio less than one indicates a greater improvement for clients in the MTC group than in the comparison group. 13 Sacks, S., Banks, S., McKendrick, K, Sacks, J.Y., & Cleland, C. (2008)

14 Modified Therapeutic Community for Persons with Co-Occurring Disorders 14

15 Future Directions for MTC Studies Replications (that also address the limitations noted) Studies of MTC aftercare, including outpatient programs* Studies to determine the relative contribution of MTC residential and aftercare components Implementation studies 15

16 Conclusion Findings point to the effectiveness of the Modified TC in Community Corrections as a stand-alone intervention for offenders in Community Corrections with COD, and provide initial evidence for integrated MTC programs in prison and in aftercare for offenders with COD This study adds to the research base providing evidence for the effectiveness of the modified TC. 16

17 References Sacks, S., Sacks, J.Y., McKendrick, K., Banks, S., & Stommel, J. (2004). Modified TC for MICA offenders: Crime outcomes. Behavioral Sciences & The Law,22(4), DOI: / bsl.599. Sacks, S., Melnick, G., Coen, C., Banks, S., Friedmann, P. D., Grella, C., & Knight, K. (2007a). CJDATS Co-occurring Disorders Screening Instrument (CODSI) for Mental Disorders (MD): A pilot study. The Prison Journal, Special Issue: Criminal Justice Drug Abuse Treatment Studies (CJ-DATS), H.K. Wexler, M. Prendergast, & G. Melnick, Eds.,87(1), DOI: / Sacks, S., Melnick, G., Coen, C., Banks, S., Friedmann, P. D., Grella, C., Knight, K., & Zlotnick, C. (2007b). CJDATS Co-occurring Disorders Screening Instrument (CODSI) for Mental Disorders (MD): A validation study. Criminal Justice & Behavior, Special Issue: Offender Needs & Functioning Assessments, D.D. Simpson, & K. Knight, Eds.,34(9), DOI: / Sacks, S., Banks, S., McKendrick, K., & Sacks, J.Y. (2008). Modified therapeutic community for co-occurring disorders: A summary of four studies. Journal of Substance Abuse Treatment, Special Issue: Recent Advances in Research on the Treatment of Co-Occurring Disorders, S. Sacks, R. Chandler, & J. Gonzales, Eds., 34(1), doi: /j.jsat

18 Contact information: Stan Sacks, PhD Director Center for the Integration of Research & Practice National Development & Research Institutes, Inc. 71 W 23rd Street, 8th Floor New York, NY tel u fax u stansacks@me.com 18