Bay Area Community Resources Jail Treatment Program in Marin County, California

Transcription

1 Bay Area Community Resources Jail Treatment Program in Marin County, California A program to reduce alcohol/drug abuse & recidivism SUPPORTED BY THE MARIN COUNTY SHERIFF S DEPARTMENT & MARIN COUNTY PROBATION DEPARTMENT

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3 Bay Area Community Resources Jail Treatment Program in Marin County, California A program to reduce alcohol/drug abuse & recidivism Bay Area Community Resources 171 Carlos Drive San Rafael, CA phone (415) fax (415) Prepared by José Luis Gomez, Program Coordinator John Haller, Ph.D. December, 2008

4 2008 Bay Area Community Resources Material in this manual may not be reproduced without written permission from Bay Area Community Resources Bay Area Community Resources Marty Weinstein, Executive Director Mary Jo Williams, Co-Executive Director Laura Kantorowski, Ph.D., Director of AOD Programs

5 Contents PREFACE PROGRAM OVERVIEW...7 A. Program Model... 7 B. Evidence-Based Practices C. Our Values D. Goals PROGRAM OPERATIONS...17 A. History and Philosophy B. Program Participants C. Program Schedule D. Program Rules and Policies E. Staff F. How the Marin Criminal Justice System Works G. How To Work Inside The Marin Criminal Justice System TREAT ALCOHOL/DRUG ABUSE & CRIMINALITY I: EDUCATION PROGRAM...41 Week 1: Tobacco Addiction Week 2: Addiction: Use and Abuse Week 3: Denial And Impaired Thinking Week 4: Mind Altering Drugs Week 5: Relapse Prevention Week 6: Violence, Anger & Crime Week 7: Family and Relationships Week 8: Challenge To Change Week 9: Commitment To Change Week 10: Taking Ownership of Change, Part Week 11: Taking Ownership of Change, Part Week 12: Taking Ownership of Change, Part Week 13: Consequences Of Addiction & Criminal Behavior Week 14: Resources for Change Week 15: Motivational Speakers... 98

6 4. TREAT ALCOHOL/DRUG ABUSE & CRIMINALITY II...99 A. Process Group...99 B. 12-Step Book Study Group BUILD A RECOVERY COMMUNITY A. Inmate Volunteer Program B. Inmate Board Meeting SUPPORT THE CRIMINAL JUSTICE SYSTEM A. Alcohol/Drug Assessments B. Case Management APPENDIX A. Other Programs in the Jail B. Community Programs C. Useful Web Sites D. Alcohol/Drug Assessment Forms E. Outcome Evaluation Study

7 Bay Area Community Resources Preface 5 Preface The is an alcohol and drug program operated by Bay Area Community Resources (BACR). Founded in 1976, BACR promotes the healthy development of individuals, families and communities in the San Francisco Bay Area through direct services, volunteerism, and community partnerships. BACR programs address a diversity of issues: alcohol and drug use, mental health, tobacco use, youth development, after school programs, national service, community health, fiscal sponsorship. Purposes of Manual This manual has three purposes. 1. To train new BACR jail treatment program staff, so that we can quickly and effectively get them up to speed about the program. 2. Serve as a reference book for program staff. 3. Inform staff at the Sheriff s Department and the Probation Department about our program, in order to provide them useful information when they need it and hopefully to build their support for our program. Acknowledgements Our first acknowledgement is, of course, to the Marin County Sheriff and the Department for hosting our program in the jail. Their belief in our program s value for their mission and their belief in us as staff make the program possible. Just as important is the Marin Probation Department, who contracts with us to assess alcohol/drug issues among people in the Marin criminal justice system. Special thanks go to Captain David Augustus and Peggy Harrell, Program Director at the Jail, and to Teresa Torrence-Tillman, Director of Adult Services in the Probation Department, for giving generously of their time and knowledge so that this manual would be useful and accurate. We sincerely appreciate everyone s support, and we work diligently to sustain their faith in our program. Jose Luis Gomez, Program Coordinator James Sellers, Counselor Michelle Johnson, Counselor Milton Paul, Counselor Alvenia Foster, Counselor Michael Coleman, Counselor December, 2008

8 Acronyms used in this manual AA AOD BACR F.A.T.H.E.R.S. GED H&I Alcoholics Anonymous Alcohol and other drugs Bay Area Community Resources, the non-profit community organization that operates the jail treatment program Fathers as Teachers: Helping, Encouraging, Reading, Supporting General Educational Development exam; the equivalent of a high school diploma Hospitals and Institutions; refers to AA or NA volunteers who visit people in hospitals and institutions M.O.T.H.E.R.S. Mothers as Teachers: Helping, Encouraging, Reading, Supporting NA STAR Narcotics Anonymous Support and Treatment After Release

9 Bay Area Community Resources 1. Program Overview 7 1. PROGRAM OVERVIEW The mission of the is to reduce alcohol/drug abuse and recidivism among inmates. To accomplish this mission, we provide day treatment services for men in A Pod and women in F Pod. The program services are designed to treat the criminal addict i.e., alcohol/drug addicts who also have a criminal lifestyle. Most inmates have both types of issues, and it is essential to treat both types of behavior. In fact, inmates who have a criminal lifestyle but who do not abuse alcohol/drugs are rare. A. Program Model The program model includes three types of services, and participants are required to be involved in all the services: 1. Services to treat alcohol/drug and criminality issues, in order to foster individual change. 2. Services to build a recovery community in the jail, in order to help inmates understand and become part of a community in a productive way, especially a community which has the culture of supporting recovery. 3. Services to support the criminal justice system, in order to help move people through the system by providing specialized professional skills. Central to our program model is the idea of getting inmates into recovery while they are in jail. Our approach to recovery in jail includes three core strategies: We treat addiction as a disease. Every disease has a treatment and healing process in which people can recover from the disease. This process may involve some relapse. Recovery is defined as: stopping alcohol/drug use; making life more functional in terms of relationships, work, and being a productive member of society; and working to heal the issues which led to the alcohol/drug use. We address the behaviors that put people in jail, and we help them change the values and morals that led to the criminal lifestyle, especially values about how to be a productive member of society. This 3-part concept of recovery in jail shows why it is essential that our program model includes services to build a recovery community i.e., in order to go beyond individual change and create an environment in which inmates learn how to become part of and contribute positively to a community.

10 8 1. Program Overview Bay Area Community Resources Jail Treatment Program Model TREAT ALCOHOL/DRUG & CRIMINALITY ISSUES Foster individual change Education Program Educate inmates about alcohol/drug abuse and criminality and how they can change their values and behavior. Lecture, videos, group discussion, homework. Process Group Create peer pressure for positive change and inspire people by inmates recovery efforts. Discuss personal issues about recovery in a positive group setting. 12-Step Book Study Group Inspire and educate people by powerful recovery stories. Read aloud and reflect on the AA and NA 12-Step books. BUILD A RECOVERY COMMUNITY Foster the values of responsibility and accountability to a community Inmate Volunteer Program Give inmates opportunities to hold positions of responsibility and accountability in which they contribute to a community Inmates serve in 14 volunteer positions that extend programming beyond what staff can do, and get publicly recognized for their accomplishments and positive qualities. Inmate Board Meeting Give all program participants a responsibility they alone are accountable for. Inmates plan and conduct a daily 15-minute meeting with a specific set of activities. SUPPORT THE CRIMINAL JUSTICE SYSTEM Help move people through the system via tasks requiring specialized professional skills Clinical Assessment Support Probation Department and/or the court in decisions about inmate sentencing. Assess alcohol/drug issues and recommend treatment placement before sentencing, when an inmate applies for parole, or when probation supervision begins. Case Management Get inmates and others into the most appropriate community-based alcohol/drug treatment program after incarceration. Locate appropriate programs, get people enrolled, and transport them to the program. Provided for inmates in jail, for people waiting to be sentenced who may or may not be out on bail, and for people who are on parole or about to go on parole.

11 Bay Area Community Resources 1. Program Overview 9 1. Services to treat alcohol/drug and criminality issues These services are intended to foster individual change, and they treat both alcohol/drug issues and criminality issues, which are different. These services are essentially pre-treatment, with the best results occurring when people complete a full treatment program after their jail time. We provide three pre-treatment services: an education program, an inmate support group or process group focused on recovery, and a 12-step book study group. Education Program. The education program is designed to teach inmates about alcohol/drug behavior and criminal behavior, and how that behavior will keep leading them to jail unless they go into recovery. The program entails a lecture and seminar four days a week for 15 weeks. The curriculum addresses every major issue involving alcohol and drugs, violence, criminality, and recovery. In every session inmates are given written homework assignments on the topics for that day which lead them to look at their own lives and help motivate them to change. Process Group. This is a guided support group to give inmates a safe place to discuss their personal views about alcohol/drug use, criminality, and recovery. Inmates who are making strong efforts to change can benefit greatly from talking to each other about it, and they can educate and support others. Those who are beginning the change process can be educated and inspired by other inmates. All the inmates can serve to provide peer pressure for positive change. 12-step Book Study Group. This group studies the AA big book and the NA basic text and follows a similar process as AA or NA book study groups outside of jail. The AA and NA programs are widely recognized as extremely effective in helping addicts become and stay clean and sober, in part because the AA big book and the NA basic text provide powerful stories and insights about recovery. The program includes additional methods that encourage and consolidate recovery and personal change. One key method is to use certificates and graduations to mark major changes and to publicly reward accomplishments. Participants receive a Completion Certificate at the end of 60 days of participation and a Graduation Certificate at the end of 90-days of participation. 2. Services to build a recovery community in the jail Services to build a recovery community are designed to foster values of responsibility, accountability, and integrity and to give inmates the experience of being a productive member of a community. Program participants take on jobs that support recovery and can make them feel like they are a valued member of a community. The goal is to prepare inmates to be productive members of society and to re-integrate into society with new and positive values and skills. We

12 10 1. Program Overview Bay Area Community Resources provide two community building services: an extensive inmate volunteer program and an inmate run daily meeting. Inmate volunteer program. Our program includes 14 types of volunteers who are responsible for assisting with specific activities, ranging from being group facilitators to being members of a welcoming committee. Before inmates can be selected as volunteers, they must prove that they are committed to changing themselves. Inmate Board Meeting. This 15-minute daily meeting is conducted by the inmates under the supervision of the program staff. It requires that every inmate take on leadership and responsibility for some activity in the meeting. 3. Services to support the criminal justice system Services to support the criminal justice system help the Probation Department and Sheriff s Department move people through the system. Since BACR operates the program with registered or certified counselors, we have the skills and expertise to assist the Probation Department and the Sheriff s Department with two services: clinical assessments and case management. Clinical Assessment. Program staff conduct a detailed alcohol/drug assessment and make treatment placement recommendations upon request through a contract with the Probation Department. The assessments are used by the Probation Department and/or courts to make decisions before sentencing, when an inmate applies for parole, or when probation supervision begins. Case Management. Each inmate is assigned a Jail Treatment Program staff member as a case manager to give the inmate personal and individualized support. One part of that case management is to help inmates make careful plans for discharge and reentry, especially getting them enrolled in an appropriate alcohol/drug treatment program in the community, so that they receive the treatment needed to maintain recovery and help prevent recidivism. Case management can also be provided for people waiting to be sentenced who may or may not be out on bail, and for people who are on parole or about to go on parole.

13 Bay Area Community Resources 1. Program Overview 11 B. Evidence-Based Practices Two lines of evidence support the effectiveness of our program: 1. a rigorous program evaluation conducted by an established research organization, and 2. the fact that our program is consistent with practices which national research shows are effective 1. Study of the BACR Jail Treatment Program In 2005, Resource Development Associates conducted a rigorous evaluation study of the BACR jail treatment program (see Appendix E for the entire study). The study included 110 former program participants. Data sources included Marin County arrest and booking data, Probation Department case notes, BACR program data, key informant interviews, and focus groups with current inmates. All the data compare the year after release from the Marin County jail with the year before incarceration in the jail. The key findings were as follows. Drug Use Declined 30% indicated drug use in the year after release, as per Probation Department case notes. The longer that people had been in the BACR Jail Treatment Program, the less likely they were to use drugs. less than one month 60% 1-2 months 36% 2-3 months 22% more than 3 months 15% Recidivism Declined All the data pertain to the year after release from the Marin County jail, compared with the year before incarceration in the jail.

14 12 1. Program Overview Bay Area Community Resources New arrests decreased by a statistically significant amount. Arrest for any crime Felony arrest 81% declined to 44% Misdemeanor arrest 88% declined to 42% Drug-related crime 62% declined to 33% Parole violation 36% declined to 21% Violent crime 33% declined to 10% Theft 31% declined to 17% Driving under the influence 27% declined to 15% Driving without a license 25% declined to 12% Weapons crime 10% declined to 6% 100% of program participants in the prior year, declined to 56% of participants in the year after release The longer that people had been in the BACR Jail Treatment Program, the less likely they were to be arrested for new crimes in the year after release. less than one month in program 71% arrested 1-2 months 47% arrested 2-3 months 64% arrested more than 3 months 40% arrested The average number of arrests per person decreased, by a statistically significant amount. Arrest for any crime 2.7 in prior year declined to 1.2 in the year after release Felony arrest 1.3 declined to.6 Misdemeanor arrest 2.1 declined to.9 The number of days in jail for new crimes decreased an average of 65 days, from 127 in the prior year to 62 (a statistically significant decrease). The longer that people had been in the BACR Jail Treatment Program, the greater was their decrease in jail time for new arrests. less than one month in program 12 day decrease (from 102 days prior year to 90 days) 1-2 months 60 day decrease (108 to 48) 2-3 months 110 day decrease (177 to 67) more than 3 months 100 day decrease (140 to 40) Decreased incarceration yielded an average one-year cost savings of $7,440 per former participant in the BACR Jail Treatment Program. The longer people had been in the BACR Jail Treatment Program, the greater the cost savings. less than one month in program $1,375 cost savings 1-2 months $6,867 cost savings 2-3 months $12,590 cost savings more than 3 months $11,446 cost savings

15 Bay Area Community Resources 1. Program Overview 13 For the 52 former program participants included in the cost savings analysis, the total savings for incarceration for the one study year period was $488,275 (average decrease of 65 days in jail time, times incarceration cost of $ per day, times 52 former participants). These cost savings do not include costs benefits to the community such as increased productivity through employment, increased taxes paid, or decreased health care costs. Former volunteers in the BACR jail treatment program had even better outcomes than regular program participants. a greater decrease in jail days 181 fewer jail days versus 44 less likely to have evidence of drug use 7% versus 37% higher enrollment in drug treatment programs 88% versus 68% more likely to be employed full time 36% versus 9% Stakeholders expressed satisfaction with the program Marin County Jail staff cited: A more manageable inmate population which uses its time productively. Probation staff cited: More informed recommendations to the Parole Board. An in-custody treatment resource for the Parole Board. Support for Probation Officers in their assessment of inmate needs upon release. Residential treatment providers cited: High BACR expertise in placing inmates into a post-release treatment program. A wonderful job of preparing inmates for residential treatment. Inmates cited: The program forced them to get past their denial and acknowledge their addiction. 2. National research on recidivism and drug use Recidivism is a major national and local concern % of released prisoners are rearrested within three years (Bureau of Justice Statistics, 2003; JTO 2005). Re-arrests account for 35 percent of all prison admissions (IDU HIV Prevention, 2001). In Marin County, 67% of male inmates and 52% of female inmates had previously served time in the jail (Marin County Sheriff s Crime Analysis Unit, 2005).

16 14 1. Program Overview Bay Area Community Resources Drug use is highly related to recidivism. The more prior convictions an individual has, the more likely that individual is a drug abuser. Belenko (1998) reported that in state prisons: 81% of inmates with 5 or more convictions used drugs regularly. 63% of inmates with 2 prior convictions used drugs regularly. 41% of first offenders used drugs regularly. In-custody drug treatment has been shown to be successful: Education, training and drug treatment programs within prisons have reduced recidivism by as much as 40% (Brown, 2000). Drug therapy while in prison and under post-incarceration supervision has yielded a 50% reduction in recidivism (Office of National Drug Control Policy, 2001). Women who receive drug treatment in prison have fewer subsequent arrests, less drug use, and greater employment (Hall, et al, 2004). Treatment programs show the best results when adhering to a continuum of care model from institution to community (Hiller, Knight, & Simpson, 1999). Alcohol and drug treatment can save $7 in incarceration costs for every $1 spent, with gains attributable to reduced crime, enhanced workplace productivity, and lower health care costs (Little Hoover Commission, reported in Marks, 2003). Three studies presented in the Autumn Workshop Series Conference, November 2006, showed that jail treatment programs reduce recidivism and alcohol/drug relapse rates. (1) Re-Entry Models from Prison to the Community: an Illinois Model, by Dan Lustig and Kenis Williams. (2) Corrections Voice in America s Drug Problem, by General Barry McCaffrey. (3) From the Institution to the Community, by Gary Field, Ph.D. C. Our Values Ever since the began in 1998, our methods and services have evolved as a result of our experience with the Sheriff s Department and Probation Department and the needs of inmates. However, our essential values have remained the same, because they represent our beliefs and what we bring to the program. Values about Working in the Jail 1. We believe that we must design and operate our program so that it helps the jail accomplish its mission.

17 Bay Area Community Resources 1. Program Overview We believe that we need to stay tuned in to the jail staff s work and help them on a day in, day out basis whenever and however we can. 3. We believe and recognize that the Sheriff s Department staff are the primary experts in maintaining safety in the jail, and therefore we must follow every policy and every instruction they give us. Values about ourselves 1. We believe we can help people change their behavior. 2. We see inmates as our clients. 3. We want inmates and custody staff to see us as advocates for change, but not as somebody to get people out of jail. 4. We believe we can be effective in working with inmates because our staff are in recovery and/or have worked extensively with people in recovery. 5. We believe we can teach inmates tools that will make their lives better. 6. We believe we can help families and the communities at large. 7. We believe we offer hope. 8. We believe that our program offers pre-treatment and that we are preparing people to go on to successful treatment after jail. 9. We believe we should model those values and relationships we want people to have. 10. We believe we should always be professional and reliable. 11. We believe our staff are most effective when we work as a team. 12. We believe we should use evidence-based practices wherever possible, because they have been proven to be effective. Values about Inmates/Clients 1. We believe people can change. 2. We believe people should be accountable and responsible. 3. We believe in recovery and that recovery gives people their life back. 4. We believe people s recovery is inside them and that they can find it. 5. We believe people can be in recovery in jail or prison. 6. We believe some inmates have alcohol/drug issues, some have criminality issues, and most have both. 7. We believe that inmates who work our program consistently want to change. 8. We believe inmates can have skills and good qualities that can and need to be channeled in a positive direction. D. Goals The has specific goals, with activities and structures designed to reach every goal.

18 16 1. Program Overview Bay Area Community Resources Goals of the Program 1. Eliminate alcohol/drug abuse. 2. Eliminate recidivism. 3. Help the custody staff see our program as valuable to them in their job. 4. Honestly assess clients and tell them the truth, even if it is not comfortable. 5. Address alcohol/drug issues, criminality issues, social issues, and responsibility. 6. Re-educate people about a lot of things. 7. Challenge people s values and life, because those values and behaviors got them into trouble. 8. Help people find that internal strength which can move them to a new place. 9. Teach coping mechanisms and tools for self-care. 10. Engage people to be active in self-change. 11. Expose inmates to people who have been where they are and who have changed. 12. Develop a sense of community, because that involves values which most inmates lack. 13. Prepare clients to succeed in treatment when they leave jail. 14. Work with other agencies so our clients can get into continued treatment and recovery. Goals for Personal Change among Inmates 1. Get people to accept their alcohol/drug problems and/or their criminality problems. 2. Get people to eliminate their criminality and recidivism. 3. Get people to understand and eliminate their alcohol/drug abuse. 4. Get people to start taking control and responsibility. 5. Reinforce positive behavior. 6. Get people to see they have choices, and if they change they have even more choices. 7. Get people not to see themselves as bad, but to find their strengths they can use in recovery. 8. Build self esteem. 9. Empower people. 10. Get inmates to take responsibility for program activities, especially by becoming volunteers. 11. Get people to identify their current values, thought patterns, and self-image and understand how those things are stopping them from getting the deeper things they want. 12. Get people to elevate their integrity and help them adopt values that will make them able to live in society. 13. Get people to stop thinking of themselves as victims and not be self-defeating. 14. Reconnect and integrate people into the community and shows it s a good thing. 15. Get inmates to understand that the parole officer is not an enemy but someone who can help them navigate the criminal justice system.

19 Bay Area Community Resources 2. Program Operations PROGRAM OPERATIONS A. History and Philosophy The Bay Area Community Resources (BACR) originated with our work for the Marin County Probation Department. The Department began contracting with BACR to provide clinical assessments of inmates concerning alcohol/drug issues. This work began at the Honor Farm in 1988 through 1994, along with some counseling and some transportation of inmates to treatment programs. The program moved to the Marin County jail in 1994, and in 1998 the Sheriff s Department began funding BACR to provide an intensive program for inmates. The Probation Department continues to contract with BACR to provide clinical assessments. Alcohol/drug addiction and the corresponding dysfunctions were historically treated as moral failings rather than a health and social problem. This led to an emphasis on punishment rather than prevention. Today, the views and responses to alcohol/drug abuse have changed dramatically, and treatment has been considered the most effective response in all spheres of society, including the criminal justice system. Hundreds of county jails and state penitentiaries offer alcohol/drug treatment to the criminal addict. Sheriff departments, courts and probation departments throughout the country are considering more and more the alternative of treatment while the criminal addict is incarcerated and post-release conditions for entry into treatment are more emphasized. Research tells us that most criminal offenders have alcohol or drug problems i.e., they are criminal addicts. Among this population the rate of alcohol/drug relapse and criminal justice recidivism after incarceration is very high. Our program focuses on preparing the criminal addict for post-incarceration treatment, with the goal of improving their chances of completing a recommended treatment program. This goal is grounded in research which shows that inmates who become clean and sober will be less likely to re-offend. One of our program strengths is understanding how people change and their motivation for change, rather than blaming the addict for not being ready to change. Contemplation of action, followed by preparation for and initiation to action are seen as natural, sequential steps toward stable change. The program encourages the counselor to understand the client s present stage of change and to provide counseling that is appropriate for his or her current level of readiness. Inspiring motivation for change becomes part of the counselor s job, rather than waiting for the client to see the light.

20 18 2. Program Operations Bay Area Community Resources The cornerstone of the program is education about recovery and criminality, brought on by the counselor s guidance, by peer pressure, and by activities that foster and reward individual responsibility. The ultimate goal is not only for inmates to abstain from using alcohol/drugs but also to elevate the individual s level of morals, values and integrity, therefore aiming at making the criminal addict more apt to successfully live in and contribute to society. BACR Best Practices The Jail Treatment Program, like all BACR programs, operates in accordance with our best practices. These represent our philosophy about how best to deliver our programs and our recognition of what has made our programs very effective and high quality. We persevere, are dependable and act with integrity. We continually learn stretching, growing and innovating. We act with humility, hopefulness and a sense of humor. We build healthy relationships and are guided by a caring heart. We recognize the needs and strengths of the people we serve and support their development. We work within communities and build alliances to meet community needs. Our services are based on proven models and methods. Our programs are goal-oriented and get results. B. Program Participants Inmates must apply to the program in order to participate. All the male inmates in A pod must participate in the program, and the men in B and C pods and special housing must get screened in order to be assigned to A pod. Of course, the Department can assign any inmates to A pod, such as when B and C are full or for other reasons, but those inmates are mandated to participate. In both A pod and F Pod, inmates must sign up for the program and be accepted. There can be a waiting list for the program in both C and F Pods. A person can get removed from the program or pod for inappropriate behavior and later reapply to return if he/she wants. The average daily census is approximately 60 male participants in A Pod and 20 female participants in F Pod. Dual Diagnosis Clients A key issue during assessments and sentencing is whether the person has a dual diagnosis of both mental health problems and alcohol/drug addiction. Research indicates that a good portion of individuals affected by the disease of alcohol/drug addiction also suffer from mental health problems. The Jail Treatment Program includes people

21 Bay Area Community Resources 2. Program Operations 19 with a dual diagnosis. In order provide effective services for this population, we have designed the following guidelines and criteria for acceptance into the program. 1. During the acceptance interview we ask the candidate if he/she has been diagnosed with any mental or emotional conditions by a physician or therapist and if he/she is taking medication. If the answer is yes, we inform the inmate that we will consult with the mental health department at the jail to see what kind of treatment he/she is following and what medications the potential client is taking. The medical/mental health department staff in the jail must clear the person to enter our program. 2. If accepted into the treatment program, the client will be assigned to a BACR Counselor. The Counselor will write in the client s file the condition and the medications the client is taking, as well as any other information about mental and emotional health status. 3. The client must be able to attend groups and function in program activities. 4. The Process Group is sometimes confrontational. The client should be able to accept confrontation from the counselors and sometimes from the inmates. These confrontations only take place when the counselor is present and under his/her guidance. 5. Placements for these clients will be always be coordinated with the Probation Officer supervising the STAR Program or the mental health case load. 6. The clients are informed that A and F Pods are not established for dual diagnosis individuals and that they must adapt to what the program has to offer. Participant Profile In order to gain a better understanding of program participants, Data Trends in Santa Rosa, California surveyed inmates in The survey included 59 inmates 48 men in A Pod and 11 women in F Pod. Note that for every item, people could give more than one answer. Substance Abuse Addiction % Addicted to This Substance Average Years of addiction Nicotine 58% 15 Alcohol 56% 11 Marijuana 42% 13 Methamphetamine 34% 7 Cocaine 32% 9 Heroin 14% 11 Other 10% 8

22 20 2. Program Operations Bay Area Community Resources Criminal Convictions Percent of Participants Driving under the influence 29% Driving without a license 25% Probation violation 24% Possession of drugs or paraphernalia 20% Assault 15% Fraud 14% Burglary 14% Petty theft 12% Possession for sale 8% Forgery 7% Domestic violence 7% Weapon possession 5% Embezzlement 5% Identity theft 3% Auto theft 3% Rape 2% Child endangerment 2% Post-Incarceration Support Needed Percent of Participants Will need ongoing support for recovery and sobriety 85% Will need ongoing emotional support 61% A sober environment will be a problem 19% Stable housing will be a problem 22% Finances will be problem 22% Childcare will be a problem 8% Emotional Status Percent of Participants Have violent thoughts 67% Have suicidal thoughts 27% Often anxious or nervous 24% Often depressed/or withdrawn 22% Often angry 19%

23 Bay Area Community Resources 2. Program Operations 21 Family History Percent of Participants Substance abuse 66% Emotional abuse 46% Emotional/mental problems 44% Physical abuse 40% Sexual abuse 12% Education Percent of Participants Graduated from high school or got a GED 71% Received job or technical training 41% Have an attention or learning problem 36% C. Program Schedule The current program schedule is shown below. However, this schedule can vary from time to time and is modified as the program evolves or as the overall jail schedule changes. A-Pod Schedule The Process Group, and the 12-step Book Study group and the inmate board meeting occur in three cohorts called the A, B or C group in order to make the group sizes small enough for discussion and for everyone to get a turn. Each cohort is about 15 to 20 people. BACR Program Morning Schedule, Monday to Friday Group A Group B Group C 8:15-9:15 Process Group 12-Step Book Study Free Time 9:15-10:15 Free Time Process Group 12-Step Book Study 10:15-11:15 12-Step Book Study Free Time Process Group

24 22 2. Program Operations Bay Area Community Resources BACR Program Afternoon and Evening Schedule Time Activity Monday 2:15 2:30 Inmate board meeting 2:30-4:00 Education program Tuesday 2:15 2:30 Inmate board meeting 2:30-4:00 Education program 1:00 2:00 p.m. Volunteer/mentor meeting 8:00-10:00 Spirituality meeting Wednesday 12:45-2:00 Over age 40 group 2:15 2:30 Inmate board meeting 2:30-4:00 Education program Thursday 2:15-2:30 Inmate board meeting 2:30-4:00 Education program 8:00-10:00 p.m. Age 25 and under group Friday 2:15-2:30 Inmate board meeting 8:00-10:00 p.m. Age group (men s focus group) Saturday 1:00-2:00 p.m. In-house AA Meeting 3:00-4:00 p.m. In-house Spanish AA Meeting Sunday 10:00-11:00 In-house Spanish NA Meeting 1:00-2:00 In-house NA Meeting 8:00-8:15 p.m. Newcomers welcoming meeting 8:15-9:00 p.m. In-house Bible studies Related Program Activities by other Organizations Day Time Topic Monday 12:45-2:00 Parenting Classes, by Center Force 2:15-2:30 Marin Job Council, 4 th Monday of each month 8:00-10:00 p.m. AA meeting facilitated by H&I volunteers from AA Tuesday 12:45-2:00 General Education (GED), by Marin County Office of Education Wednesday 12:45-2:00 F.A.T.H.E.R.S Group, by Marin Literacy 8:00-10:00 p.m. NA meeting facilitated by H&I volunteers from NA Thursday 12:45-2:00 F.A.T.H.E.R.S Group, by Marin Literacy 8:00-10:00 p.m. Religious service, New Life Christian Center and other organizations Friday 12:45-2:00 Creative writing, by Marin County Office of Education Saturday 2:30-4:00 Domestic violence and anger management class 9:45-11:00 a.m. Spanish class

25 Bay Area Community Resources 2. Program Operations 23 Non-Program Activities Meals Breakfast 6:15-6:45 a.m. Lunch 12:00-12:30 p.m. Dinner 5:00-5:30 p.m. Library Movie Razor Laundry Inspection Visits Mail Commissary Saturday, 9:00-11:00 a.m. Saturday, with soda and popcorn, 8:00-10:00 p.m. Sign up every night, 8:00-10:00 p.m. Tuesdays and Fridays after dinner Wednesday, 7:30 a.m. Monday Friday, 6:00-10:00 p.m. Weekends 9:00-11:00 a.m.; 1:00-4:00 p.m.; 6:00-10:00 p.m. 8:00-10:00 p.m. Turn in the slip by Monday 10:00 p.m.; slips given out Thursday after dinner Other Activities Child support information is provided once a month from 1:00-2:00 p.m. No specific day or time is assigned. GED testing and sign-ups are held once a month. No specific day or time is assigned. County Parole hearings are on Wednesdays mornings. F-Pod Schedule BACR Program Day Time Topic Monday - Thursday 9:00-9:30 12-Step Book Study 9:45-10:45 Process group 2:15-2:30 Inmate board meeting 2:45-4:00 Education program Friday 9:00-9:30 12-Step Book Study 9:45-10:45 Process group Related program activities are conducted by other organizations for all inmates in F Pod. BACR program participants are strongly encouraged to attend as many activities as possible.

26 24 2. Program Operations Bay Area Community Resources Related Program Activities by other Organizations Day Time Topic 8:00-9:00 p.m. AA meeting facilitated by H&I volunteers from AA Tuesday 9:00-10:00 General Education (GED), by Marin County Office of Education 1:00-2:00 Parenting classes, by Center Force M.O.T.H.E.R.S. Group, by Marin Literacy 8:00-9:00 p.m. Religious service, New Life Christian Center and other organizations Wednesday 9:00-10:00 a.m. General Education (GED), by Marin County Office of Education 1:00-2:00 M.O.T.H.E.R.S. Group, by Marin Literacy 8:00-9:00 p.m. NA meeting facilitated by H&I volunteers from NA Thursday 9:00-10:00 General Education (GED), by Marin County Office of Education 1:00-2:00 Literacy program, by Marin County Office of Education Spirituality group, by independent contractor 3:00-4:00 Education about HIV & Hepatitis C (2 nd Thursday of the month), Marin AIDS Project Friday 1:30-2:30 Choir 3:00-4:00 Job information, by Marin Jobs and Career Services Sunday 1:00-2:15 p.m. Religious services, by various organizations Non-Program Activities Meals Breakfast 6:15-6:45 a.m. Lunch 12:00-12:30 p.m. Dinner 5:00-5:30 p.m. Visits Library cart Movie night Commissary Mail Monday Thursday, 1:00 2:00 p.m. and 6:00 10:00 p.m. Friday, afternoons and 6:00 10:00 p.m. Weekends 9:00 11:00 a.m.; 1:00 4:00 p.m.; 6:00 10:00 p.m. Saturday, 10:30 11:00 a.m. Saturday, 8:00 10:00 p.m. Turn in the slip by Monday 10:00 p.m.; slips given out Thursday after dinner 8:00 10:00 p.m.

27 Bay Area Community Resources 2. Program Operations 25 Razor GED testing Sign-outs in morning As needed, by Marin County Office of Education Parole hearings Wednesday mornings, by Marin County Parole Board Inspection Wednesday, 7:30 a.m. D. Program Rules and Policies Inmates will obtain a Certificate of Completion after two months of participation in the program. A Certificate of Graduation will be earned after three months of participation. There will be consequences for breaking the rules and regulations of the program as well as lack of therapeutic progress. These consequences may include a warning, a written assignment, lock down time, or a contract. If a staff member is unable to be present for a group or lecture due to a holiday schedule or staff meeting conflict, then we will provide directions for the group with a video and/or assignment. The group members are aware of the guidelines to follow when a staff person is not present. The facilitator-mentors have the responsibility and duty to end the group when they are finished. The facilitators will set up for group prior to the meeting time. Group members need to be in the group at the start time. The County Parole board often requires completion or graduation from the Jail Treatment Program before being released on County Parole. Our statistics show that inmates who attend the Jail Treatment Program tend to be more successful on County Parole. All participants are encouraged to take advantage of the other programs in the Jail, such as parenting classes, spirituality classes, Bible study, GED preparation and tests, F.A.T.H.E.R.S. or M.O.T.H.E.R.S. classes, general education and family reunification. (See Appendix A for a complete program list). Staff will conduct face-to-face sessions, intakes, probation and parole assessments, and orientation meetings with the inmate-facilitators during other daytime hours. Extracurricular activities such as inmate-led 12-step meetings and other program activities are encouraged.

28 26 2. Program Operations Bay Area Community Resources Process groups are strictly confidential. The 12-Step Book Study group is not the setting to process issues. Participation is required for all. Be on time. No micro-waving, noise, or phone calls (only attorneys or probation, as approved) during groups. The key word is respect. If an inmate is sick, he/she needs the counselor s authorization to skip a session. A counselor from Center Force will be available from 8:00 11:00 a.m. every Tuesday, to help inmates work on family/community reintegration and support. Be respectful to staff and to each other at all times. E. Staff Staff Positions The Jail Treatment Program has five full-time BACR staff the Program Coordinator, three A Pod Counselors, and one F Pod Counselor. The duties and qualifications are as follows. Coordinator Supervised by: BACR Director of AOD Programs Job Purpose: To manage the, including overseeing staff and providing direct services. Administrative Duties Be highly professional and expert serving as the primary liaison with the Sheriff s Department, the Probation Department, other components of the Marin Criminal Justice System. Represent the program and the agency to the general public in a highly professional manner. Act as the leader in recruiting, screening and hiring program staff. Provide a high quality program of professional development for staff, including a pre-service orientation and ongoing training. Provide or arrange for staff to participate in training opportunities which will continually increase their professional skills and knowledge.

29 Bay Area Community Resources 2. Program Operations 27 Provide individual and group supervision for staff, including monitoring all staff activities, conducting staff meetings to manage routine duties, problem solving, and coaching. Manage a program of case conferences among staff to maintain the highest levels of teamwork and collaboration in providing services to clients and funders. Manage all program activities for documenting services, including collecting required data and reporting to the Sheriff s Department, the Probation Department, and BACR. Manage periodic evaluations to collect data and report to stakeholders about program effectiveness. Participate in strategic planning for the program and the agency in order to ensure that the program has a secure, predictable and sustainable future, including seeking opportunities for program improvement and expansion. Specific Program Responsibilities Full-time position counseling inmates with substance-abuse and criminality problems. Manage a caseload of approximately 20 inmates. Maintain positive, professional relationships with Sheriff s Department staff and Probation Department staff. Assess the nature and extent of inmates alcohol/drug problems and make appropriate referrals. Submit written assessments and recommendations when required. Establish positive working relationships with clients. Provide individual, group and/or family counseling. Establish individual treatment plans with client collaboration, monitor participation and progress. Modify treatment plans, at a minimum of every 3 months. Provide case management services that include ongoing needs assessment, coordination of services, identification of barriers, appropriate referrals and follow-up. Help clients get into post-incarceration treatment programs. Provide in-service and educational training to clients, organizations and the community. Maintain positive, professional relationships with service providers. Coordinate services with other treatment facilities, public service agencies, and other service providers. Attend coordination meetings. Participate in substance abuse outreach activities and advocacy for treatment services. Maintain accurate and up-to-date client records. Complete all evaluation and record-keeping paperwork. Provide transportation to clients when part of program requirements. Participate in individual supervision, staff meetings, trainings, events, and conferences. Support the inmate volunteers to encourage them to be accountable and to support other inmates. Skills and Knowledge Skills: At least five years continuous experience working in substance abuse field. Ability to lead a multidisciplinary team, as well as establish rapport with the Sheriff's Department, Probation Department, community treatment providers and other people in the Marin criminal justice system. Education and/or certification commensurate with program position. Experience with substance abuse and criminal justice populations required.

30 28 2. Program Operations Bay Area Community Resources Knowledge: A dedicated staff person with demonstrated knowledge of substance abuse treatment models, assessment skills, and inmate populations. Ability to establish rapport with challenging population. Demonstrated sensitivity to diverse communities within Marin. Knowledge of substance abuse resources preferred. Ability to speak Spanish preferred. Personal Qualities: A commitment to and strong belief in the mission of BACR and the Jail Treatment program. Compliance with procedures and policies. Positive motivation and attitude toward work. Willingness for self-examination and continued learning. Ability to maintain goals and priorities in dealing with varying challenges. Ability to be flexible in working with people and organizations with different viewpoints. This position requires excellent communication and organizational skills. Additional Requirements: Five years of continuous sobriety if in recovery. Clean DMV record. Documentation of vehicle insurance. Ability to obtain jail clearance by: not having prior crimes that involve violence against police, arson, or sex offenses; not having any felony convictions or arrests with the past 5 years; passing a polygraph test; and agreeing to a credit check. The is a program of Bay Area Community Resources (BACR), a well-respected, established agency with excellent reputation throughout the Bay Area. See the BACR website at Case Manager/Counselor (Marin County Jail) Supervised by: Jail Treatment Program Coordinator Job Purpose: To provide assessment, counseling and case management services related to substance abuse and addiction and criminality. Specific Responsibilities Full-time position counseling inmates with substance-abuse and criminality problems. Manage a caseload of approximately 20 inmates. Maintain positive, professional relationships with Sheriff s Department staff and Probation Department staff. Assess the nature and extent of alcohol/drug problems and make appropriate referrals. Submit written assessments and recommendations when required. Establish positive working relationships with clients. Provide individual, group and/or family counseling. Establish individual treatment plans with client collaboration, monitor participation and progress. Modify treatment plans, at a minimum of every 3 months. Provide case management services that include ongoing needs assessment, coordination of services, identification of barriers, appropriate referrals and follow-up. Help clients get into post-incarceration treatment programs.

31 Bay Area Community Resources 2. Program Operations 29 Provide in-service and educational training to clients, organizations and the community. Maintain positive, professional relationships with service providers. Coordinate services with other treatment facilities, public service agencies, and other service providers. Attend coordination meetings. Participate in substance abuse outreach activities and advocacy for treatment services as directed by program coordinator. Maintain accurate and up-to-date client records. Complete all evaluation and record-keeping paperwork. Provide transportation to clients when part of program requirements. Participate in required meetings including individual supervision, staff meetings, trainings, events, and conferences. Support the inmate volunteers to encourage them to be accountable and to support other inmates. Administrative Duties Be highly professional in relating to the Sheriff s Department, the Probation Department, other components of the Marin Criminal Justice System. Collaborate as required in recruiting, screening and hiring program staff. Participate in a high quality program of professional development, including a pre-service orientation and ongoing training. Participate in external training opportunities in order to continually increase professional skills and knowledge. Participate actively in individual and group supervision and staff meetings. Participate in case conferences with other staff to maintain the highest levels of teamwork and collaboration in providing services to clients and funders. Adequately document services as required by the Sheriff s Department, the Probation Department, and BACR. Participate as required in periodic evaluations of program effectiveness. Report as required on program budget expenses. Skills and Knowledge Skills: A dedicated staff person who is open to training and can relate well to this population. At least two years continuous experience working in substance abuse field. Ability to establish rapport with challenging population. Ability to work as part of a multidisciplinary team, as well as with the Sheriff's Department, Probation Department, community treatment providers and other people in the Marin criminal justice system. Education and/or certificate commensurate with program position. Experience with substance abuse and criminal justice populations preferred. Knowledge: Demonstrated knowledge of substance abuse treatment models and assessment skills. Demonstrated sensitivity to diverse communities within Marin. Knowledge of substance abuse resources preferred. Ability to speak Spanish preferred.

32 30 2. Program Operations Bay Area Community Resources Personal Qualities: A commitment to and strong belief in the mission of BACR and the Jail Treatment program. Compliance with procedures and policies. Positive motivation and attitude toward work. Willingness for self-examination and continued learning. Ability to maintain goals and priorities in dealing with varying challenges. Ability to be flexible in working with people and organizations with different viewpoints. This position requires excellent communication and organizational skills. Additional Requirements: Five years of continuous sobriety if in recovery. Clean DMV record. Documentation of vehicle insurance. Ability to obtain jail clearance by: not having prior crimes that involve violence against police, arson, or sex offenses; not having any felony convictions or arrests with the past 5 years; passing a polygraph test; and agreeing to a credit check. The is a program of Bay Area Community Resources (BACR), a well-respected, established agency with excellent reputation throughout the Bay Area. See the BACR website at Professional Development BACR Jail Treatment Program staff go through a structured professional development program that includes training and supervision. The staff trainings include four components: 1. Each new staff member receives an intensive pre-service training from the Program Coordinator and from the BACR Director of AOD Programs. The training addresses all aspects of their service activities and administrative duties. 2. All staff receive ongoing trainings throughout the year. Some trainings occur when speakers are brought into staff meetings or when the Program Coordinator provides a special training. Staff also attend the 3-4 trainings per year conducted or organized by the BACR Director of AOD Programs. These trainings address technical and clinical issues about alcohol/drug services. 3. All staff participate in outside trainings three times per year on average. The BACR Director of AOD Programs alerts all staff to relevant outside trainings, and Jail Treatment Program staff sign up for and attend the trainings that will be most helpful to them. The Marin Probation Department also provides trainings helpful to our staff. 4. New staff participate in a structured process of on-the-job training. When first hired, new staff must wait for written full clearance to work in the jail. During this time they shadow the Program Coordinator and/or other staff to learn about the alcohol/drug assessments we conduct for the Probation Department and the assessments conducted in the jail. New

33 Bay Area Community Resources 2. Program Operations 31 staff are, of course, experienced counselors who already know the basics of counseling and working in jails. The Program Coordinator trains the staff person about the specific procedures used for the assessments and all aspects of the program. The new staff member will also review all the education program materials and watch the videos in order to prepare for that program. The person will sit in to observe groups on a one-day clearance. After the person receives full clearance to work in the jail, he/she shadows the Program Coordinator and other staff for one week to one month, and the Program Coordinator observes his/her first solo assessment. Both the Program Coordinator and the BACR Director of AOD Programs review that first solo assessment and give feedback. All BACR staff receive regular supervision. All staff receive individual supervision once a month from the Program Coordinator that includes case consultation as well as monitoring of difficult cases. Staff receive group supervision at weekly staff meetings which last one to two hours. The group reviews assessments completed during the week and makes decisions about program issues. For example, the group might make a decision about how to ask an person during an assessment about their motivation concerning alcohol/drug use, or the group might do a role play about a situation that occurred in a process group or education group. Mandated Reporting of Potential Harm to Self or Others BACR Jail Treatment program staff are legally mandated reporters of individuals who might be a harm to themselves or others. If an inmate states that he/she intends to harm him/herself or another person, BACR staff are legally required to report that person immediately to custody staff. We are also required to report immediately if we believe a person s behavior indicates such harm might be imminent. The report should be written and coordinated with the Program Coordinator. All BACR staff are also legally mandated child protective services (CPS) reporters. If an inmate reveals that a child is being abused or molested, then the counselor must immediately file a written report with Child Protective Services. This report should be coordinated with the Program Coordinator. Safety And Ethics Safety is the chief concern in the jail, and staff must understand and follow all the Department s safety rules. These issues are described more fully in the sections in Chapter 2 on how the Marin criminal justice system works and how to work inside the Marin criminal justice system. New staff will also be trained about safety rules and ethics guidelines at the Jail Program Director s orientation.

34 32 2. Program Operations Bay Area Community Resources Dress Code One aspect of safety is the Department s dress code policy, and staff must abide by this dress code. The following is the dress policy adopted June 18, 1997 by the Sheriff s Department for Contract Employees and Volunteers Entering the Marin County Jail : The following policy is made to address the security, health and welfare of the Marin County Jail. Clothing: Slacks or jeans only, no shorts, no spandex or cotton leggings allowed. Dresses and skirts must be of appropriate length and will be worn with stockings or tights (no mini-skirts). If sandals are worn, they will be worn with stockings or socks (no bare feet). Clothing will not be excessively tight. No sleeveless tops or shirts; necklines will not be cut excessively low. Jewelry: Not to excess; necklaces are discouraged for security reasons. Makeup: Should be conservatively applied. Violations of this policy can cause the violator to lose entry privileges into the jail until authorized by the Bureau Commander. F. How the Marin Criminal Justice System Works Sheriff s Department at the Jail It is critical that BACR Jail Treatment Program staff understand and respect the mission and functioning of Marin County Jail. We are guests who have a mission that is different but complementary to that of the custody staff. The Marin County Jail is the facility that manages court ordered confinement for people who have broken the law, as well as for those who are pre-sentenced. As one staff member stated: Prisoners are in jail as a sentence from the legal community for crimes and offenses committed. Another staff member noted that the job of the Sheriff s Department is custody in a professional setting. The jail is not a therapeutic institution. Security is a big issue, and the

35 Bay Area Community Resources 2. Program Operations 33 custody staff are in charge. The custody staff are experts in security, and we are not. Custody staff are very professional about their duties, and BACR staff are expected to be very professional and very respectful in turn. The Marin County Sheriff s Department is very supportive of programs that can help inmates turn their lives around. The large number of programs in the jail operated by community organizations such as BACR reflect the Department s attention to recovery and rehabilitation that are separate from sentencing. The chain of command in the jail begins with the Captain, who manages the Marin County Jail and is responsible for supervising all activities and staff. There are also two lieutenants and a sergeant in the administration department. The Program Director is a civilian, who reports directly to and is supervised by the Captain. Two Sergeants, supervised by the Lieutenants, work on each shift. One Sergeant manages housing duties, and BACR staff have the most contact and relationship with this Sergeant. The other Sergeant manages booking duties. Deputies are supervised by the Sergeants. In turn, the deputies supervise the pods where the prisoners are housed. There is a Medical/Mental Health unit with its own staff. Marin County Jail Regulations and Release Civilians working or volunteering in the jail must agree to the following Department policies and sign the release statement. 1. The Marin County Jail is operated by the Sheriff s Office and is a busy place. If a Sheriff s Deputy asks you to leave, you should leave immediately. 2. If you feel ill, do not come into the facility. Illness spreads rapidly in institutions. Some prisoners may be incarcerated who have infections diseases. 3. Dress simply and conservatively. 4. Do no personal favors for prisoners. Do not share your home telephone number, address or any other person information with the prisoners. Do not deliver correspondence for inmates inside or outside the Jail. 5. Do not bring contraband into the Jail, including but not limited to cigarettes, gum, books, pens, etc. 6. The Sheriff has a no hostage policy. This means that no prisoner will be released from the Jail as a result of taking a hostage, regardless of who the hostage is. It is the policy of the

36 34 2. Program Operations Bay Area Community Resources Sheriff to resolve crises involving hostages without loss of life or injury if at all possible. Force will be used when necessary to rescue hostages. Release I have read and reviewed the foregoing guidelines for conduct in the Marin County Jail. I understand such rules and promise to abide by them. Further, I hereby release the County of Marin, its officers and employees, including but not limited to the Marin County Sheriff, from any and all liability owing to my death or injury which might arise from my inspection of the Marin County Jail. Dated Witness the signature of By Signature Probation Department BACR conducts clinical assessments for the Marin County Probation Department, in order to provide Probation Officers and the courts with current information about people s alcohol/drug issues, as well as a recommendation for an appropriate alcohol/drug treatment placement. The Probation Department requests assessments in three circumstances: before sentencing occurs, when inmates apply for parole and there is not already an assessment, or after sentencing when probation supervision begins. The Department requests assessments on a case by case basis. We work most closely with the Investigation Unit, the County Parole Unit, and the Supervision Unit. We could be requested to do an assessment by any of the units. The Investigations Unit handles work for defendants in court. The County Parole Unit handles cases of inmates applying for parole to the Marin County Parole Board. The Supervision Unit handles people who the court decides can go on local probation. BACR is strictly bound by confidentiality laws concerning anyone we serve, whether in custody or prior to sentencing. In order to have optimal communication, it is important to ensure that Probation staff understand that we are aware of and follow the laws and policies concerning confidentiality.

37 Bay Area Community Resources 2. Program Operations 35 G. How To Work Inside The Marin Criminal Justice System A major reason that the BACR Jail Treatment Program has been operating for 10 years (at this writing) is that our staff have always understood how to work inside the Marin County Criminal Justice system and have done a good job of collaborating with the Jail staff and Probation staff at the same time that they focus on the BACR goal of getting inmates into recovery. It is well worth taking stock of what is important in this collaboration. We spent a great deal of time talking with BACR staff and the Jail Program Director about these issues. There was complete consistency between the views of the Jail Program Director and BACR staff about how to work successfully within the jail. Two general themes emerged how to work with the custody staff and how to work with the inmates. Both take awareness and knowledge to be successful. BACR fully expects that Jail Treatment Program staff will thoroughly understand and follow the principles and guidelines described here. How To Work with Sheriff s Department Staff Nine main principles or themes emerged about how BACR staff can work effectively with the Sheriff s Department staff in the Jail. 1. BACR staff are guests in the jail We are contracted to be here providing professional services to the Sheriff s Department and the Probation Department, but we are still guests. We must make it clear to custody staff that we understand and respect their role and their authority. If we do that and we do our job effectively and professionally, then the custody staff will also understand and respect our role. We want custody staff as allies and want them to see us as allies. And we want our program to continue because we believe it reduces recidivism. 2. BACR and the Jail have different but complementary missions The Sheriff s Department mission in the Jail is essentially to manage in a professional setting the incarceration of people who have broken the law and people those waiting the outcome of their cases. BACR s mission is to get these inmates into recovery, with the belief that recovery is a prerequisite for inmates to stay out of jail in the future. Clearly, these missions are complementary. However, the primary concern of the Jail staff is safety, and the primary concern of BACR staff is personal change. Without safety, our program would not operate at all. Or, as one Deputy put is so succinctly, custody is number one, program is number two.

38 36 2. Program Operations Bay Area Community Resources 3. Be professional Boundaries and professionalism are huge in this environment. People here both custody staff and program staff need to be authentic to make this environment work. This includes professional dress and body language. Follow the dress code. It is there for a reason. We must also maintain a professional demeanor, such as no legs up on a desk or maintaining a professional expression when in the pods. BACR staff cannot do things in our personal life that the criminal justice system would not approve of. 4. Let the custody staff know that we understand and appreciate their role Since the jail is a security area and security is the number one concern, we must learn how this works and learn how to work with jail staff about security. Program staff are never in a situation with an inmate where they cannot be observed by custody staff. Still, we must learn to recognize and be aware of danger. Understand that custody staff are, as one staff person said, in charge, in charge, in charge. One story showed how this works. When a deputy announces lock down, program staff must leave immediately. Recently, a BACR staff person was talking with an inmate when lockdown was declared and the inmate wanted to keep talking. The BACR supervisor needed to tell the counselor, Get out NOW. Inmates might cross a line, but we may never cross a line or break a rule. 5. Show that our program makes the pods more manageable Two things help make the pods more manageable: (1) professional and consistent staff behavior, and (2) changing the behavior of inmates through an effective program. Show Deputies we are here for the right reasons i.e., to provide treatment for inmates, not to get them out of jail. Being extremely consistent with our behavior and program is another key to having our program make the pods more manageable. Another key is to make clear to inmates that the Deputies are not their enemy. The inmates put themselves in jail by their behavior, not the Deputy. Another issue is to solve any problems by going through our direct supervisor and up the chain of command. 6. Be explicit in our communication with Deputies about security We must learn how to prevent interactions with inmates from escalating into violence. Custody staff need to know that we understand this and that we will ask for help if we need it. Also, they need to know that we will never escalate a situation. For example, when interviewing an inmate, we always seat ourselves between the inmate and the door and always ask the Deputy to leave the door unlocked, so there is an out in case of emergency. If we are interviewing a person who is volatile, ask the deputy to stand by. Deputies will probably always take these precautions as a matter of course, but communicating with them shows them we understand the situation and their role and removes any confusion. 7. Build working relationships with Jail staff one person at a time Since BACR and the Jail have different but complementary missions, we also have differences in culture. Our professional training and experience focus on creating personal change in people and communities, while the custody staff receive professional training and experience in security dealing with people convicted of crimes. Their training in the police academy or their experience

39 Bay Area Community Resources 2. Program Operations 37 do not necessarily teach them to trust civilians, and some may even see us as trying to get people out of jail whom the criminal justice system put into jail. We need to find common ground in understanding and working in the jail environment. We must make it clear to each custody staff member that our goal is not to get people out of jail which may be the goal of a public defender or an attorney but our goal is to help inmates get appropriate treatment. We can easily show Deputies or all Jail staff through personal interactions that we value and respect them, and our experience is that it is very possible to develop effective and cordial working relationships with most custody staff. If they come to view our clients as people who are trying to change their ways, that is fine, but it is not essential for us to have good working relationships. 8. New employees should ask questions The attitude of my prior experience already covers this is a big mistake. The situation in the Marin County Jail is unique to here and will have different rules or policies than other places. 9. F Pod is different from A Pod Most men in A Pod are in our program and have chosen to make an effort to go into recovery and to change the behaviors that got them into jail. Since all women housed in jail are in F Pod, there is a mixture of people who want to be in the program and those who do not. There has been a change in how women see the program now that they have to sign up for it and be accepted into the program. Still, some staff in F Pod may see the program as a distraction. The way we manage the program in F Pod must take into account the inmates who do not care about the program. The program in F Pod had been operating successfully for a long time. The issue for BACR staff is to recognize that the environment in F Pod and thus our approach will be somewhat different than in A Pod. How To Work with Inmates Eight principles or themes emerged about how BACR staff can work effectively with inmates in the Jail. 1. Know what our job is and what it is not The job of program staff is to guide, to educate, to be someone who cares, and to hold inmates accountable for their behavior on the way to them learning to hold themselves accountable. Our job is not to be someone s friend or pal. 2. Critically attend to our personal life Since the jail is an intense and emotional environment, we must have our personal life in order for us to work here effectively. This means that taking extraordinarily good care of ourselves, including creating a healthy home and social life. It also means always taking responsibility for ourselves and becoming good at what we do, so that we bring that self-confidence to work. This job is not the place for someone to get their social needs met.

40 38 2. Program Operations Bay Area Community Resources 3. Be ultra-clear about our boundaries It is essential to keep clear boundaries between ourselves and the inmates. We work diligently to role model how people can be in recovery, and this will inevitably lead to divulging some personal information. However, it is not necessary to divulge personal stories to build credibility, and we must be very careful about the limits on self-disclosure. Similarly, we must be authentic with inmates for them to see us as role models. Consequently, it is inevitable and OK that what happens in your personal life does come in here to the job, but there must be clear boundaries there as well. For example, if we are sad or tired, it is OK to acknowledge it to inmates, but it is not OK to try to resolve it or dwell on it here on the job. It is also critical to maintain careful and proper sexual boundaries. We act as guides for all inmates, but never confidants or friends. Once again, inmates can and might cross lines having to do with personal information, but we may never cross those lines. 4. Know that we are on all the time Working in a jail is difficult work, and it can be exhausting. As one staff member put it, inmates are needy beyond measure, and their need is paramount in our program. Moreover, inmates are hyper-vigilant and assess and test staff constantly, especially since it is well-known that people in the early stages of treatment and recovery challenge everything. So program staff are under a microscope. This makes it all the more important to maintain boundaries, be professional, and be consistent and honest. 5. Be aware of danger and know how to prevent escalation It is critical to know how to act so that a situation with inmates does not escalate to violence when things get increasingly serious. While we are never without custody staff, either in the room or watching through glass walls and doors, violence could occur rapidly if we do not know how to prevent it. Staff emphasized constantly taking the temperature around you and understanding the levels of stopping escalation. First, inmates in our program will often selfcorrect if their behavior is wrong, because that is the culture of the program i.e., taking responsibility for one s own behavior. Second, people in the program will often begin to check each other on their behavior or attitudes when they are in the program, and it is often done in a way that does not provoke people. Third, program staff or volunteers may need to correct someone s behavior, and that too can usually be done without making someone angry if a program rule is invoked or an explanation is given. The final step is to get help from a Deputy. If we are losing control of a situation and cannot stop an escalation, get help immediately, saying loudly I need help NOW. It is important that the Deputies understand that we know to do this and know when to do it. 6. Know how to interact with clients This manual cannot begin to summarize the knowledge and professional skill that staff will bring to this program. However, staff did list quite a number of principles they follow in working with people in the program, who are both inmates and clients: Be cheerful. Be flexible.

41 Bay Area Community Resources 2. Program Operations 39 Talk to people not at them. Check in with people. Try to establish rapport. Let them know they are talking to someone who has been where they are. Meet them where they are at, versus expectations that we might bring to the situation. Discussing their triggers for alcohol/drug use, criminal activity, or violence is OK. Get people to be real, not perfect clients. Call them on their attitudes or behavior if it is not OK, but let them know it is OK to have issues or mistakes, that does not mean they are bad clients or bad people. Know when to confront people in group versus individually (timing is everything). Sometimes use a hammer, sometimes be delicate. Use humor to diffuse their anger and misery and make them relax and open up to the process. Find balance between not accepting disrespect and not taking things personally. Let them know we will not take their anger personally. Use all our clinical acumen and then some. Model the behavior we want them to have. Read people and then respond to their needs. For example, if someone is losing it and crying or getting angry, respond to that instead of ignoring it. Show how the lecture material relates to people and is relevant to them. Contract with inmates when that is helpful. Continue to learn what works and what does not. 7. Encourage people to see the program as a community of recovery Since many people in the program are making earnest efforts at recovery, we have the opportunity to present the program as a community. That is a valuable asset, because peer pressure and community norms and values can further shape people s behavior. It is also helpful that staff work as a team and bring complementary skills to the program. The key ingredients to building this community are to emphasize honesty, integrity, accountability and trust. Raising the level of values and integrity among inmates is critical to personal change and recovery. We use many strategies to build this sense of community. For example, the program staff and volunteers must model the behavior we expect of program participants. Participants are expected to keep themselves clean and not make noise at night. All participants are expected to build trust with newcomers by introducing themselves and then letting the newcomer talk. People agree to do interventions with peers when necessary (called pull-ups ) and to respond to interventions from others. We also build community by engaging people as volunteers and helping them serve as leaders. For example, volunteers facilitate the inmate board meeting, and all participants and newcomers see that meeting is serious business.

42 40 2. Program Operations Bay Area Community Resources 8. Support the volunteers Engaging inmates as volunteers in our program is a key element of success. It builds commitment to accountability and recovery among the volunteers, it gives volunteers the experience of being productive members of society contributing to a community, and it shows other inmates that success is possible and desirable. It encourages people to excel. We try to engage and support volunteers at every turn. Staff need to be aware of which inmates might become volunteers and then support those positive qualities they see or channel their values into a positive direction. For example: Some people are natural leaders but not engaged, such as hard core inmates who have seen it all before and know all the jail ropes but they can make people laugh. We need to give them opportunities to see that their knowledge and qualities are valuable if turned to a good purpose. Some people seem very committed to sobriety and recovery, and we need to give them a chance to have volunteering solidify their commitment. Some people may value loyalty and keeping their word, and these values can be encouraged in order to keep them engaged in the program. In all cases, the goal is to use volunteering as a way to help inmates interact in a positive fashion and a way to understand and be part of a community.

43 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I TREAT ALCOHOL/DRUG ABUSE & CRIMINALITY I: EDUCATION PROGRAM The Education Program is one of the three services designed to treat alcohol/drug abuse and criminal lifestyle issues among inmates. Since the Education Program has such a long and detailed curriculum, it occupies its own chapter in this manual, while Chapter 4 presents the other two services the Process Group and 12-Step Book Study Group The education program addresses the program goals of challenging people to change and helping them take ownership of their change. However, the curriculum is constantly evolving and changing as staff develop new ideas for how to present material. The program operates Monday through Thursday. Each day begins with a 30 minute lecture, usually by program staff, but the lecture could be delivered by a volunteer inmate. Following the lecture is a group discussion and then a video on the topic for the day. Finally, inmates are assigned homework every day. The curriculum below also shows the reference materials for each topic that staff draw on as background materials in order to prepare the lecture. e.g. we have added a 5th day for each week on anger mgt. but not shown here because not pilot tested Curriculum Overview Week 1: Tobacco Addiction Week 2: Addiction: Use and Abuse Week 3: Denial and Impaired Thinking Week 4: Mind Altering Drugs Week 5: Relapse Prevention Week 6: Violence, Anger, and Crime Week 7: Family and Relationships Week 8: Challenge to Change Week 9: Commitment to Change Week 10: Taking Ownership of Change, Part 1 Week 11: Taking Ownership of Change, Part 2 Week 12: Taking Ownership of Change, Part 3 Week 13: Consequences of Addiction and Criminal Behavior Week 14: Resources for Change Week 15: Motivational Speakers

44 42 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 1: Tobacco Addiction Week 1, Day 1: The Contents of Cigarettes Goals Help clients understand tobacco manufacturing and the myths and misconceptions about tobacco. Lecture Overview the theme for the week History of tobacco in the U.S. and the world How cigarettes are made Chemical contents of cigarettes The link between tobacco use and recovery from alcohol and other drugs Video Sir Walter Raleigh stand-up comedy routine by Bob Newhart Assignment What I Like about Using Tobacco and What I Like about Being Tobacco-free Reference Materials 1. Tobacco, Biology and Politics. Stanton Glantz, Ph.D., University of California at San Francisco Medical School 2. The Real Bidi, The Dental Health Foundation 3. Smoke and Mirrors: Crack and Nicotine, 4. The African Americanization of Menthol Cigarette Use in the United States. Phillip S. Gardiner, Ph.D., Nicotine and Tobacco Research 5. Addressing Tobacco Use in Substance Abuse Treatment: Summary of Research Findings on Tobacco and Addictions, Policy and Education Project, The Institute for Health and Recovery

45 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 43 Week 1: Tobacco Addiction Week 1, Day 2: Nicotine As An Addiction Goals Help clients understand nicotine as a powerful biochemical addiction Help clients understand realistic strategies for remaining tobacco-free after release Lecture Nicotine the drug we hate to love Neurochemical effects of nicotine Maintaining tobacco-free lives Video Smoking: Truth or Dare, AIMS Multi-media Assignment What I Already Knew and What Has Surprised Me Reference Materials 1. Neurochemical Effects of Nicotine, 2. How Addictive is Nicotine? Jack E. Hennenfield, Ph.D., NIDA 3. Bringing Everyone Along Resource Guide, Tobacco Cessation Leadership Network 4. Quit Smoking for Good: The Take Control Guide, California Smokers Helpline, University of California at San Diego

46 44 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 1: Tobacco Addiction Week 1, Day 3: Second Hand Smoke Goals Help clients understand the dangers of second hand smoke Help clients understand practical tools for prevention Reinforce motivation to remain tobacco-free Lecture Protecting ourselves and our loved ones from second hand smoke Internal motivation versus external pressure for remaining tobacco-free Video One Step, American Lung Association, Colorado Assignment Why I Care About Second Hand Smoke Reference Materials 1. Poisoning Our Children: The Unknown Dangers of Second-Hand Smoke, Prescription for Change, California Medical Association 2. One Step to Protecting Your Kids from Secondhand Smoke, American Lung Association, Colorado

47 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 45 Week 1: Tobacco Addiction Week 1, Day 4: How the Media Targets Addicts Goals Help clients understand media literacy as a stimulus for remaining tobacco-free Reinforce client s preparation for trigger situations after release Lecture Cross-addiction issues. How the tobacco companies target addicts/alcoholics in advertising. What is freedom? Video Selling Cross-Addiction: Marketing Tobacco to Addicts and Alcoholics Assignment My Personal Definition of Freedom Reference Materials 1. Addressing Tobacco Use in Substance Abuse Treatment: Summary of Research Findings on Tobacco and Addictions, Policy and Education Project, Institute for Health and Recovery 2. Magazine Tobacco Ads at and 3. Tobacco Advertising, Federal Trade Commission, 2003

48 46 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 2: Addiction: Use and Abuse Week 2, Day 1: The Disease Concept of Addiction Goals Help clients understand and accept addiction as a disease Lecture Overview of the theme for the week The concept of disease A disease can be treated The disease of addiction Symptoms, signs, consequences Video Understanding Addiction, by GWC Incorporated Assignment Definition of addiction Reference Materials 1. Addiction is a Brain Disease, AI Leshner, Issues in Science and Technology Online, 2. Definition of Addiction, National Council on Alcoholism and Drug Dependence 3. Understanding Addiction, S.F. Grinstead, Addiction Free Pain Management, 4. Addiction: A Neurological Disorder, 5. Who Is An Addict, Narcotics Anonymous 6. Drugs are A Fact of Life, 7. The Disease of Chemical Addiction

49 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 47 Week 2: Addiction: Use and Abuse Week 2, Day 2: Chemical Dependency & Criminal Conduct Goals Help clients understand the connection between chemical dependency and criminal conduct Lecture Who is an addict Who is a criminal The connection between chemical dependency and crime for some, but not necessarily for all Video Disease Concept of Addiction With David Ohlms Assignment Addiction self-assessment Reference Materials 1. The Disease Concept of Addiction 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book) 3. Problem: Progressive Disease of Chemical Addiction, The Process of Addiction, Minireach

50 48 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 2: Addiction: Use and Abuse Week 2, Day 3: The Revolving Door Goals Help clients see how addiction leads to recidivism Lecture The revolving door Recidivism and relapse as the same thing How treatment could become part of the revolving door Video Breaking the Addiction Cycle, Part 1 Assignment Belief system, impaired thinking and unmanageability Reference Materials 1. Breaking the Cycle 2. A Three Headed Dragon, Campobello Chemical Dependency Recovery Center, Recovery Training Materials 3. Chemical Dependency

51 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 49 Week 2: Addiction: Use and Abuse Week 2, Day 4: The Rituals of Alcohol/Drug Use Goals Help clients understand their own rituals of alcohol/drug use and that it is possible to break the cycle of addiction Lecture The rituals of alcohol and drug use It is possible to break an addiction Video Breaking the Addiction Cycle, Part 2 Assignment Describe your rituals of use Reference Materials 1. Breaking the Cycle 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

52 50 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 3: Denial And Impaired Thinking Week 3, Day 1: Denial as a Defense System Goals Help clients understand denial Lecture Overview of the theme for the week Denial is a defense system The 3 stages of denial Video Making Sense of Addiction Assignment What is the main obstacle that addicts find to recover from AOD addiction? Reference Materials 1. How to Get Your Own Way 2. How Denial Grows 3. Denial: I Doubt I Have a Problem 4. A Three Headed Dragon, Campobello Chemical Dependency Recovery Center, Recovery Training Materials

53 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 51 Week 3: Denial And Impaired Thinking Week 3, Day 2: Dealing with Denial Goals Help clients begin to deal with denial Lecture The nature of denial Accepting that a problem exists How to deal with denial Video Denial: Breaking the Defense System Assignment Denial no more (2 pages) Reference Materials 1. Beliefs and Self-Feelings 2. I Had a Rough Childhood

54 52 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 3: Denial And Impaired Thinking Week 3, Day 3: Impaired Thinking Goals Help clients understand how denial involves impaired thinking Lecture Go over the impaired thinking chart Video Brother Earl Street Talk Assignment How do your thoughts and feelings keep you in denial? Reference Materials 1. Impaired thinking chart 2. Thinking Errors Checklist 3. Errors in Thinking and the Entitlement Trap 4. Denial: I Doubt I Have a Problem 5. Errors in Logic and Thinking

55 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 53 Week 3: Denial And Impaired Thinking Week 3, Day 4: The 2 nd & 3 rd Heads of the Dragon Goals Help clients understand the 2 nd and 3 rd heads of the dragon. Lecture Explain the 2 nd head of the dragon (similar to denial) Explain the 3 rd head of the dragon (similar to impaired thinking) Video Resistance and Recovery by Delbert Boone Assignment 20 Questions to check the thoughts against reality Reference Materials 1. A Three Headed Dragon, Campobello Chemical Dependency Recovery Center, Recovery Training Materials 2. Plain Sense,

56 54 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 4: Mind Altering Drugs Week 4, Day 1: How Alcohol/Drugs Affect Thoughts & Actions Goals Help clients understand that alcohol and drugs affect thoughts and actions. Lecture Overview of the theme for the week How alcohol and drugs alter the brain How alcohol and drugs affect thoughts and actions How the criminal-addict way of thinking is just a pattern Video The Hijacked Brain Assignment What is your drug of choice? How does it affect you? Reference Materials 1. Rates of Illicit Drug Abuse in the U.S.,

57 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 55 Week 4: Mind Altering Drugs Week 4, Day 2: Gateway Drugs Goals Help clients understand gateway drugs Lecture Effects of marijuana Effects of alcohol Effects of ecstasy Effects of hallucinogens How these drugs affect the addict and the community Accepting your own usage patterns Video Marijuana by Delbert Boone, or Chalk Talk by Father Martin Assignment Gateway drugs Reference Materials 1. Evidence Accumulates That Long-Term Marijuana Users Experience Withdrawal, NICA Notes, wwww.nida.nih.gov 2. Factline in Gateway Drugs, Indiana Prevention Resource Center, 3. Cannabis 4. Gateway Drugs, Moyers in Addiction, 5. The Dangers of Gateway Drugs, 6. Hallucinogens, Minireach 7. Sedatives/Hypnotics

58 56 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 4: Mind Altering Drugs Week 4, Day 3: Stimulants, Methamphetamines and Cocaine Goals Help clients understand the effects of stimulants, methamphetamines, and cocaine Lecture Effects of stimulants Effects of methamphetamines Effects of cocaine How these drugs affect the addict and the community Accepting your own usage patterns Video Methamphetamines Assignment What are uppers? Reference Materials 1. Cocaine 2. What is Methamphetamine, MIDA, 3. Cocaine, heart attack article 4. Breaking the Cycle 5. Methamphetamine Treatment, A Practitioner s Reference Book, California Department of Alcohol and Drug Programs

59 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 57 Week 4: Mind Altering Drugs Week 4, Day 4: Downers, Heroin & Opiates Goals Help clients understand the effects of depressants, heroin, and opiates Lecture Effects of depressants Effects of heroin Effects of opiates How these drugs affect the addict and the community Accepting your own usage patterns Video Heroin: Chasing the Dragon, Delbert Boone Assignment What are downers? Reference Materials 1. Heroin/Opiates, Alcohol and Other Drug Addiction Services, 2. Narcotics/Analgesics, Minireach 3. Heroin Usage Patterns May Be Shifting, NIDA, 4. How Do We Not Drink / Not Use 5. The Impact of Heroin Addiction on My Family, ABC News,

60 58 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 5: Relapse Prevention Week 5, Day 1: What is Relapse? Goals Help clients understand relapse Lecture Overview of the theme for the week What relapse is Gorky s relapse concepts Remembering the pain of addiction Video Relapse, with David Ohlms Assignment Relapse, what does it mean to you? Reference Materials 1. The Relapse Dynamic 2. Every Day That We Live 3. Relapse Videos for the Provider, Terrence T. Gorky

61 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 59 Week 5: Relapse Prevention Week 5, Day 2: Relapse Warning Signs Goals Help clients develop tools to prevent relapse Lecture Warning signs for relapse What to do when these signs happen Video March Towards Sobriety, by Delbert Boone Assignment Warning signs of relapse; select 5 warning signs from a list Reference Materials 1. Relapse Videos for the Provider, Terrence T. Gorky

62 60 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 5: Relapse Prevention Week 5, Day 3: High Risk Situations Goals Help clients develop tools to prevent relapse Lecture Situations that are high risk for relapse What to do in these situations Former friends and associates Coping with family and peer pressure Video The Lifestyle By Michael Johnson Assignment Is there a situation? Reference Materials 1. Relapse Prevention, 2. List of Symptoms Leading to Relapse 3. Staying Sober

63 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 61 Week 5: Relapse Prevention Week 5, Day 4: How to Have Fun in Recovery Goals Help clients begin to find support for recovery Lecture It is possible to have fun in recovery, and how to do it The importance of getting support for recovery Recovery support groups Video Set-Up for Relapse By Michael Johnson Assignment List three high risk situations Reference Materials 1. Relapse Prevention Support Graph, Terrence T. Gorky

64 62 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 6: Violence, Anger & Crime Week 6, Day 1: Anger Issues Goals Help clients begin to manage anger Lecture Overview of the theme for the week What is anger Criminal conduct and violence at home The connection between these problems and substance abuse Video Rage and Recidivism By Danny Trejo Assignment List 3 angry thoughts that in the past led to violence or criminal conduct Reference Materials 1. Domestic Violence, Men and Women s Anger Management 2. The Power and Control Wheel, 3. Domestic Violence Information and Referral Handbook 4. Risk Factors, South Coast Today, 5. Why Do Men Batter Women? National Coalition Against Domestic Violence, 6. Criminal Conduct and Substance Abuse Treatment Workbook

65 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 63 Week 6: Violence, Anger and Crime Week 6, Day 2: Anger Issues Goals Help clients understand how self-image influences your behavior Help clients understand how passion and love can be a disguise Lecture How self-image influences your behavior How some people use passion and love to control others How passion and love can be a disguise for anger and lead to drama and chaos Video Anger: Creating New Choices I Assignment What is the cost of anger in your life? Reference Materials 1. Criminal Conduct and Substance Abuse Treatment Workbook

66 64 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 6: Violence, Anger and Crime Week 6, Day 3: Excuses to Commit Crimes Goals Help clients understand criminality Lecture How people use excuses to justify committing crimes. How buying or selling drugs contributes to committing crime. How keeping friendship with criminals contributes to committing crime. Video Anger: Creating New Choices II Assignment List highly charged situations that can lead you to anger Reference Materials 1. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book) 2. Criminal Conduct and Substance Abuse Treatment Workbook

67 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 65 Week 6: Violence, Anger and Crime Week 6, Day 4: Where Violence Comes From Goals Help clients understand anger Lecture What is anger What is aggression What is violence How aggression leads to violence Video Anger: Creating New Choices III Assignment Managing highly charged situations Reference Materials 1. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book) 2. Criminal Conduct and Substance Abuse Treatment Workbook

68 66 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 7: Family and Relationships Week 7, Day 1: How Our Addiction Affects Our Family Goals Help clients become aware of how addiction affects the family Lecture Overview of the theme for the week How addiction affects your spouse or partner How addiction affects your children How addiction affects other family members Video Close To Home, from Bill Moyers series on addiction Assignment Letter of apology to your family Reference Materials 1. Alcohol, Tobacco, and Other Drugs and Pregnancy and Parenthood, Domestic Violence Information Packet, Marin Abused Women s Services

69 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 67 Week 7: Family and Relationships Week 7, Day 2: How Family Can Affect the Addict in Recovery Goals Help clients understand the family role in addiction Lecture How the family can be co-dependent How the family can help with recovery Understanding and empathy Understanding the difference between intimate partner and a drinking/using buddy Video Drinking Apart Assignment How has your alcohol/drug use affected your love and personal relationships? Reference Materials 1. Codependency and Addiction,

70 68 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 7: Family and Relationships Week 7, Day 3: How the Addict Relates to the Family Goals Help clients understand how the addict relates to his or her family Lecture How the addict denies the family How the addict confronts the family The but I am the provider excuse Myths and reality about the addict and the family Video My Name is Kate or Under the Influence Assignment Have you ever been confronted by any family member about your alcohol/drug use? Explain. Reference Materials 1. Children of Alcoholics (COA) 2. The Characteristics-Traits, Feelings and Behavior of Children of Alcoholics

71 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 69 Week 7: Family and Relationships Week 7, Day 4: Relationships, Sex & Drug Use Goals Help clients understand how relationships and sex can be related to drug use Lecture How sex can lead to cravings How relationships can be related to drug use Sex as an addiction Video Sex and Drugs Assignment How can obsessive thoughts of sex lead to an alcohol/drug relapse? Reference Materials 1. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

72 70 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 8: Challenge To Change Week 8, Day 1: How Do We Change? Goals Help clients learn about the areas where they are going to make change Lecture Overview the theme for the week Identifying the areas that we need and want to change How thinking and acting fit into self-improvement, self-control and change Video Commitment to Change, Part 1 Assignment Why change? What are the reasons that make you start thinking about the need to change your lifestyle? Reference Materials 1. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book) 2. Tactics: Habits That Block Change, Stanton E. Samenow, Ph.D.

73 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 71 Week 8: Challenge To Change Week 8, Day 2: Building Motivation to change Goals Help clients build their motivation to change Lecture How attitudes, beliefs and thinking patterns control how we act toward people and situations Resisting change Having mixed feelings about changing Moving from being challenged to change to being committed to change to taking ownership of change Video Commitment to Change, Part 2 Assignment List areas you feel you need to change. In which part of these areas do you resist change? Reference Materials 1. Building A Desire and Motivation To Change 2. Criminal Conduct and Substance Abuse Treatment Workbook

74 72 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 8: Challenge To Change Week 8, Day 3: What To Change? Goals Help clients understand the areas in need of change Lecture How to study your patterns of AOD use and abuse and their connection to your criminal conduct The importance of self-assessment How life situations, problems and conditions affect change Video Commitment to Change, Part 3 Assignment Identify an attitude or belief that has led to your use of alcohol or other drug. Identify an attitude or believe that has led you to criminal conduct Reference Materials 1. In-depth Assessment: Looking at the Areas in Need of Change 2. Criminal Conduct and Substance Abuse Treatment Workbook

75 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 73 Week 8: Challenge To Change Week 8, Day 4: Thinking Patterns of the Criminal/Addict Goals Help clients understand how believing in yourself is a motivator to change Lecture The thinking patterns of the criminal/addict Errors in thinking The role of behavior and attitude in self-improvement and change How believing in yourself is a motivator to change How to improve self-esteem and self-confidence Video Going Home to Stay, Part 1 by Delbert Boone Assignment Errors in thinking checklist Reference Materials 1. Phase III Taking Ownership of Change 2. Criminal Conduct and Substance Abuse Treatment Workbook

76 74 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 9: Commitment To Change Week 9, Day 1: How Destructive Tactics Block Change Goals Help the clients understand and identify steps for replacing the habit of using destructive tactics Lecture Overview of the theme for the week Habits that can block changing the addiction and criminality lifestyle Steps for replacing the habit of using destructive tactics Errors in thinking that can be barriers to change Verbal attacks as barriers to change Change is a process and changing a habit is hard but is part of that process Video Commitment to Change, Part IV Assignment Do you have any reason to change? What gets in the way? Reference Materials 1. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book) 2. Tactics: Habits That Block Change, Stanton E. Samenow, Ph.D.

77 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 75 Week 9: Commitment To Change Week 9, Day 2: The Tactic of Diversion Goals Help clients understand Help clients understand Lecture The tactic of diversion How changing the subject shifts the spotlight away from ourselves How using diversion affects others and how it affects us How diversion and other tactics build walls, cut off communication with people who want to help, and prevent us from looking at ourselves Video Commitment to Change, Part V Assignment List at least 5 problems in each of the following sections Reference Materials 1. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book) 2. Tactics: Habits That Block Change, Stanton E. Samenow, Ph.D.

78 76 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 9: Commitment To Change Week 9, Day 3: Taking an Honest Look at Ourselves Goals Help clients understand how taking an honest self-inventory is the beginning of change Help clients understand the tactic of casing people out Lecture Change is possible but not easy How change begins with taking an honest look at ourselves Taking responsibility for our actions The tactic of casing people out and feeding them what they want The difference between temporary compliance and a true desire to change How fears prevent us from changing our lives, especially if we deny the fears Video Commitment to Change, Part VI Assignment For each of the fears listed, answer the questions Reference Materials 1. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book) 2. Tactics: Habits That Block Change, Stanton E. Samenow, Ph.D.

79 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 77 Week 9: Commitment To Change Week 9, Day 4: How Change Is Possible Goals Help clients understand that they must change both thinking and behavior Help clients understand that they have a choice to change old habits and behavior Lecture How criminal/addicts are fighting a battle on two different fronts thinking and behavior Which errors in thinking or tactics prevent people from achieving goals in treatment and recovery. How we have a choice to change, even if it is difficult How change requires sustained motivation and effort How it is possible to unlearn old habits and learn new ones Video Going Home to Stay, Part 2 by Delbert Boone Assignment Errors in thinking check list Reference Materials 1. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book) 2. Tactics: Habits That Block Change, Stanton E. Samenow, Ph.D.

80 78 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 10: Taking Ownership of Change, Part 1 Week 10, Day 1: Getting Out of a Rut Goals Help clients understand their ruts Lecture Overview of the theme for the week What it means to be in a rut Identifying your ruts How ruts affect people Video The Rut, from the Gordon Graham series Assignment What I wish I could do about my ruts Reference Materials 1. A Framework for Recovery, Gordon Graham Series all changed to look like this 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

81 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 79 Week 10: Taking Ownership of Change, Part 1 Week 10, Day 2: What Is Your Current Reality? Goals Help clients understand their current reality Lecture Checking your current reality Your vision for the future The gap between the current reality and the vision What you have to do to bridge the gap Video Denial and Current Reality from the Gordon Graham series Assignment How do I like my current reality? Reference Materials 1. Denial and Current Reality 2. A Framework for Recovery, Gordon Graham Series 3. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

82 80 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 10: Taking Ownership of Change, Part 1 Week 10, Day 3: What Does It Mean To Change in Recovery? Goals Help clients begin to change Lecture What it means to change in recovery A 180 degree turnaround Learning how to let go Video Change from the Gordon Graham series Assignment Where will my decisions lead me? Reference Materials 1. Just One Life: No Matter the Past, You Are Accountable 2. Change, 3. Courage To Change 4. Vision and Current Reality 5. A Framework for Recovery, Gordon Graham Series 6. Flip Charts on Change 7. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

83 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 81 Week 10: Taking Ownership of Change, Part 1 Week 10, Day 4: The Importance of Making The Right Decisions Goals Help clients understand begin to make the right decisions Lecture Common sense Good judgment Utilizing your choices Video Decision Making from the Gordon Graham series Assignment Do my decisions keep me where I am? Reference Materials 1. Decision Making 2. A Framework for Recovery, Gordon Graham Series 3. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

84 82 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 11: Taking Ownership of Change, Part 2 Week 11, Day 1: Obstacles To Change Goals Help clients understand and overcome their own barriers to change Lecture Overview of the theme for the week Barriers to change, such as denial How to overcome barriers Video Barriers To Change, from the Gordon Graham series Assignment Are my beliefs about myself obstacles to change? Reference Materials 1. A Framework for Recovery, Gordon Graham Series 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

85 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 83 Week 11: Taking Ownership of Change, Part 2 Week 11, Day 2: What Roles Our Attitudes Play in Our Recovery Goals Help clients understand how attitudes affect recovery Lecture Understanding attitudes Identifying your own attitudes and how they affect recovery Video Attitudes from the Gordon Graham series Assignment Do my attitudes lead me toward recovery? Reference Materials 1. The Longer I Live 2. A Framework for Recovery, Gordon Graham Series 3. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

86 84 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 11: Taking Ownership of Change, Part 2 Week 11, Day 3: The Comfort Zone Goals Help clients understand addiction and criminality lifestyle as a comfort zone Help clients understand how we get into our comfort zones Help clients understand the idea of doing what is hard Lecture What a comfort zone How we get into our comfort zones How the addict and criminal lifestyles are a comfort zone Doing what is hard for you Video Comfort Zones from the Gordon Graham series Assignment How co my comfort zones keep me where I am? Reference Materials 1. A Framework for Recovery, Gordon Graham Series 2. Changing 3. Comfort Zone Change 4. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

87 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 85 Week 11: Taking Ownership of Change, Part 2 Week 11, Day 4: Mental Traps Goals Help clients understand how errors in thinking are a mental trap Help clients understand the power of self-talk Lecture What is a mental trap The power of negative self-talk Video Mental Traps from the Gordon Graham series Assignment How can I get out of my mental traps? Reference Materials 1. A Framework for Recovery, Gordon Graham Series 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

88 86 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 12: Taking Ownership of Change, Part 3 Week 12, Day 1: Overcoming Barriers to Change Goals Help clients begin to break barriers to change Lecture Overview of the theme for the week Positive self-talk as a tool Video Breaking Barriers, from the Gordon Graham series Assignment How could I overcome my barriers to change? Reference Materials 1. A Framework for Recovery, Gordon Graham Series 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

89 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 87 Week 12: Taking Ownership of Change, Part 3 Week 12, Day 2: The Importance of Motivation in Recovery Goals Help clients increase their motivation to be in recovery Lecture The importance of motivation in recovery Restrictive motivation Constructive motivation as a personal quality Making the transition from restrictive to constructive motivation Video Motivation, from the Gordon Graham series Assignment What is motivating me to consider treatment now? Reference Materials 1. Motivation 2. A Framework for Recovery, Gordon Graham Series 3. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

90 88 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 12: Taking Ownership of Change, Part 3 Week 12, Day 3: How To Be Accountable Goals Help clients improve their principles and values to maintain recovery Lecture Integrity Honesty Accountability Social and moral values Video Goal Setting, from the Gordon Graham series Assignment What could be my goals for self-accountability? Reference Materials 1. A Framework for Recovery, Gordon Graham Series 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

91 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 89 Week 12: Taking Ownership of Change, Part 3 Week 12, Day 4: Making Plans For the Future Goals Help clients begin to have ownership of their own change Lecture Set goals Making plans for the future Vision and affirmations Video Action Plan, from the Gordon Graham series Assignment What actions or affirmations can I do to keep me focused on my vision for recovery? Reference Materials 1. Action Plan 2. A Framework for Recovery, Gordon Graham Series 3. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

92 90 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 13: Consequences Of Addiction & Criminal Behavior Week 13, Day 1: Consequences & Unmanageability Goals Help clients take a close look at their actions and the effect on their lives Lecture Overview of the theme for the week Taking a close look at their actions The effect of their actions on their lives Consequences Unmanageability Video Portrait of an Addict Assignment Which of these areas have you faced consequences in as a result of your drug use and criminal behavior? Explain. Reference Materials 1. Recovery, 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

93 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 91 Week 13: Consequences Of Addiction and Criminal Behavior Week 13, Day 2: Health Goals Help clients understand health issues Lecture Health issues Health risks HIV and hepatitis C Brain damage Video AIDS/FAS Assignment Which of these areas have you faced consequences in as a result of your drug use and criminal behavior? Explain. Reference Materials 1. Recovery, 2. Criminal Conduct and Substance Abuse Treatment, K.W. Wanberg and H.B. Milkman (book)

94 92 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 13: Consequences Of Addiction and Criminal Behavior Week 13, Day 3: Legal Consequences Goals Help clients understand that addiction and criminal behavior will keep them in the criminal justice system Lecture What is a legal consequence, e.g., domestic violence is a crime How people can get used to the criminal justice system Video Hard Time Assignment How are your legal consequences progressing? What are your attitudes that keep you stuck in this path? Reference Materials 1. Criminal Conduct and Behavioral Cycles

95 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 93 Week 13: Consequences Of Addiction and Criminal Behavior Week 13, Day 4: Going to Extremes to Obtain the Substance Goals Help clients understand the seriousness of addiction Lecture People will go to a lot of extremes for their addition, such as crime or prostitution Crime as a consequence of addiction Video Methadonian Assignment Explain some of the possible consequences of long term drug use/abuse Reference Materials 1. Prostitution: Fact Sheet on Human Rights Violations, Prostitution Research and Education, 2. How Prostitution Works, Prostitution Research and Education, 3. Sexuality

96 94 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 14: Resources for Change Week 14, Day 1: Transitioning to Life on Your Own Goals Help clients begin to make the transition to life on their own Lecture Overview of the theme for the week How to think about transitioning from life in the program to life on your own Begin preparing an exit plan Support groups The importance of staying in touch with the program through an alumnus or a sponsor Video Recovery Road to Success Assignment Deep down do you believe Reference Materials 1. Relapse Prevention Support Groups, Terrence T. Gorky 2. Criminal Conduct and Substance Abuse Treatment Workbook

97 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 95 Week 14: Resources for Change Week 14, Day 2: Setting up for a Life in Recovery Goals Help clients plan for a life of recovery on the outside Lecture Housing and jobs in recovery Relationships and family in recovery Education in recovery Leisure time and idle time in recovery Getting high on healthy activities Video Where/How to Live for a New Way of Life Assignment Why do you think the following areas are important to include in your exit plan? Reference Materials 1. Criminal Conduct and Substance Abuse Treatment Workbook

98 96 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 14: Resources for Change Week 14, Day 3: Resources for Employment Goals Help clients prepare to be responsibly employed Lecture How to prepare for and develop good work habits Resources for employment How to prepare a resume How to interview for a job The importance of employment in recovery How to prepare for being self-supporting and independent Video Getting Ready to Work/Working Assignment Name some of the fears and obstacles that you will have to overcome in order to gain and keep successful employment in recovery Reference Materials 1. Why Are You Back Here? Make a Plan 2. Criminal Conduct and Substance Abuse Treatment Workbook

99 Bay Area Community Resources 3. Treat Alcohol/Drug Use & Criminality I 97 Week 14: Resources for Change Week 14, Day 4: How To Maintain Long-term Sobriety Goals Help clients live a life in recovery Lecture How to maintain long term sobriety How to utilize the information provided to maintain successful recovery Traps and pitfalls How to utilize a support system to apply the concepts learned in the program How to recognize vulnerabilities Remember the pain of addiction Video Going Home to Stay, Part II Assignment What are the main commitments I need to make to stay in recovery? At what points in your recovery do you find yourself vulnerable to give up on your personal commitments to selfimprovement? Reference Materials 1. Commitment: A Promise or a Pledge

100 98 3. Treat Alcohol/Drug Use & Criminality I Bay Area Community Resources Week 15: Motivational Speakers Bring in speakers the inmates can identify with but who have a powerful message of recovery. Bring in a mixture of people, so inmates are exposed to a variety of viewpoints and there is a greater chance that everyone will find someone to identify with. Examples are four speakers used recently: A rough ex-gang member who makes it real. A bad guy who will not give an inch to people and comes at inmates from his street knowledge. An extremely professional man from Delancey Street who is a poster child for transformation. An ex-addict and ex-gang member with 15 years in recovery who got a master s degree and is now a director for a youth program and who is very clinical when he speaks. A man in recovery who was not a criminal and was never in jail and had a job all his life, but whose alcoholism led to cirrhosis of the liver that almost killed him. The doctor told him if he took one more drink it would kill him.

101 Bay Area Community Resources 4. Treat Alcohol/Drug Use & Criminality II TREAT ALCOHOL/DRUG ABUSE & CRIMINALITY II The jail treatment program includes three services designed to treat alcohol/drug abuse and criminal lifestyle issues among inmates by fostering individual change. This chapter presents the process group and the 12-step book study group, while the education program is presented in its own chapter (Chapter 3) because the curriculum is so long. A. Process Group The process group is a guided support group to give inmates a safe place to discuss their personal views about alcohol/drug use, criminality, and recovery. In this group inmates are our clients. We use a group process for members to inspire and educate each other and to create peer pressure for positive change. Inmates who are making strong efforts to change can benefit greatly from talking to each other about it and can educate and support others. Those who are beginning the change process can be educated and supported by other inmates. The process group prepares clients to succeed in whatever post-jail treatment program they are placed through County Parole or Supervised Probation. As described in the evidence-based practices discussion in Chapter 1 and in Appendix E, inmates who completed the BACR Jail Treatment Program were more successful in their post-jail treatment program. These former clients said that the Process Group helped them adapt better to outpatient and residential treatment programs, especially those which programs are structured as a therapeutic community. Alcohol/drug use and criminal conduct often go together. The large majority of people in the criminal justice system have alcohol/drug problems. The majority of those locked up for burglary, assault, robbery or domestic violence committed those crimes while under the influence of alcohol or other drugs or to get money for alcohol/drugs. The Process Group is facilitated and guided primarily by the BACR Counselor but secondly by an inmate volunteer designated as a group facilitator. This program of self-improvement and change is built on an approach called cognitive-behavioral therapy. This approach means that we make changes in our actions by changing how we think, what we believe, and how we feel. In this program, we start with some simple questions. What has happened in your life to bring you to where you are at this point now? What problems have been caused by your involvement in alcohol/drug use and criminal behavior? Is your life working? Is change necessary? Who is responsible for what you do? Who is in charge of your future?

102 Treat Alcohol/Drug Use & Criminality II Bay Area Community Resources This service is based on two principles. 1. Challenge the client to change. This part of the program sets the stage for selfimprovement and change. It allows clients to get to know each other through methods such as writing an autobiography or the big brother system. 2. Peer pressure encourages people to be involved in the program. We encourage people to commit to change by helping them improve their motivation. One way to get inmates inspired or motivated to change is to have them give serious thought to whether they need or want to change. Group therapy is a powerful therapeutic tool that is effective in treating substance abuse and criminal conduct. Group members get encouraged to change, and they get inspired by seeing others become committed to change. Group therapy has other advantages besides positive peer pressure: reduction in the client s sense of isolation; help from peers in coping with substance abuse and criminal conduct as well as other life problems and stressors; information and feedback from peers; a substitute family that may be healthier than a client s family of origin; peer confrontation; positive affirmation and encouragement from peers; structure and discipline; and the hope, support, and encouragement to break free from substance abuse and involvement in criminal conduct. The Process Group provides clients with a safe setting to analyze and discuss personal issues that contribute to addiction patterns as well as involvement in criminal conduct. This setting provides the client with the assurance of confidentiality and the proper empathy, which allows the clients to develop the trust and confidence that treatment works. In the group the clients discuss the assignment for the day and get information and feedback from the counselor and their peers. Clients have an opportunity to talk about the issues that are stressors to them and receive feedback to help them cope with the stress. This group is also a good setting to introduce pod newcomers to the modality of treatment we use, including informing them about the program rules and regulations and assigning them a big brother or big sister. The process group is also a perfect setting for clients to confront each other as a way to correct the behaviors conducive to the use of alcohol/drugs, engagement in criminal conduct, or living a dysfunctional life. The group provides clients the opportunity to see that their problems are not unique and that in fact others share their problems, such as anger, shyness, inability to fit into society or other problems that contribute to their alcohol/drug use and criminal conduct. The Process Group helps clients face situations that involve conflict and deep emotion. For example, the group may be appropriate venue for some to finally confront painful realities such as being an abused child or having an abusive spouse. The group could also help them to build a healthier marriage, communicate more effectively, or become a better parent. It can even serve as a place to learn new job skills or to increase employability.

103 Bay Area Community Resources 4. Treat Alcohol/Drug Use & Criminality II 101 B. 12-Step Book Study Group The 12-step Book Study Group is designed to foster individual change by reading and reflecting on powerful stories and insights about recovery. This group studies the AA big book and the NA basic text and follows a similar process to AA and NA book study groups outside of jail, because a second goal is to help the clients to create the habit of attending AA and/or NA meetings as a part of their treatment after incarceration. In A Pod, men are separated into three groups for morning activities (A, B, and C groups), and each group does the book study for one hour each morning Monday through Friday. In F Pod the book study happens Monday through Friday mornings from 9 to 9:30. See the program schedule in Chapter 2 above. One of the biggest problems of addicts is their tendency to isolate. This problem can often become more acute when people are in the first phase of treatment. Criminal addicts, because of their lifestyle, tend to keep to themselves while incarcerated and limit their interaction with other inmates. The limitations they impose on themselves go as far as creating great divides based on race, culture, religion, age, nationalities, or neighborhoods. The Book Study Group like the Process Group can help offset this due to its structure. The group has many benefits: reducing isolation, enabling addicts to witness the recovery of others, and learning from the accomplishments and mistakes of other addicts in treatment. Also like the Process Group, the Book Study Group can support an individual in times of pain or trouble, and can help clients cope with the amount of stress caused by incarceration and by detoxification from drugs and alcohol. The Book Study Group is like a self-help group and is managed by the volunteer Book Study Facilitator. Participation during group meetings is not voluntary, because the Facilitator requests each member to read a chapter of the Big Book. The discussion of the topic however, is voluntary. The group uses the examples in the AA big book and the NA basic text as a way to relate to their own issues. The group focuses on the here-and-now but during meetings group members do not discuss their treatment plans or future plans. The Book Study Group has the main goal of supporting universality, empathy, affective sharing, mutual affirmation and morale building. Psychodynamic techniques are not used in the group. This group is not confidential since it meets in the main room of the pod and one of its requirements is not to discuss personal feelings or issues during the group by avoiding self-disclosure or discussion of any personal subject.

104 Build a Recovery Community Bay Area Community Resources 5. BUILD A RECOVERY COMMUNITY The Jail Treatment Program includes two services designed to build a recovery community in the jail the inmate volunteer program and the inmate board meeting. Both services foster the values of responsibility, integrity and accountability to a community. These values will be essential to become re-integrated into society in a positive way. A. Inmate Volunteer Program The inmate volunteer program gives inmates opportunities to hold positions of responsibility and accountability. Having inmates serve as volunteers is a very effective way to engage people into the recovery community we are working to build in the jail. Engaging people into a community is, of course, one step in helping them reintegrate into society is a positive way. The volunteer positions require responsibility and accountability, which, in turn, support volunteers recovery and personal change. The volunteer program also builds community by publicly recognizing people for their positive behavior and qualities such as personal honesty, self-disclosure and integrity. We ask volunteers to get all their positive qualities together and to be accountable to us and to each other. The program includes 14 volunteer positions in A Pod, with 22 inmates or about one-third of the population serving as volunteers. In F Pod three inmates serve as volunteers. Volunteers are responsible for specific parts of the program. A critical element of this program is that volunteers extend programming beyond what staff can do, not only during the day but also in the evenings and on weekends. For example, inmate volunteers facilitate groups and they conduct activities in the evening after BACR staff hours. Inmates must prove that they are committed to changing themselves before they can be selected as volunteers. The Role and Value of Inmates as Volunteers Inmates serving as volunteers can do some of the work of delivering the program, and volunteering is an integral part of the treatment, both for the volunteers and the other inmates. Volunteers can extend the program s influence by performing some of the functions of program staff, both while the program staff are at the jail and also after the staff s working hours. The volunteer job descriptions below describe the specific roles that inmates can take on as volunteers. For example, volunteers deliver some of the lectures in the commitment to change portion of the education program. They act as facilitators who lead the 12-step book study, the

105 Bay Area Community Resources 5. Build a Recovery Community 103 over-40 group, the under-25 group and other groups. Volunteers run all the components of the afternoon meeting. Just as important, volunteers can serve as role models and as mentors for other inmates. They can serve as a mentor or monitor after the program hours when the program staff are not available, and they can become personal mentors for other inmates. Staff frequently assign a volunteer to work with or mentor a particular inmate, in order to help that inmate get into recovery and in order to help the volunteer expand their own recovery. We often select matches that will require both the volunteer mentor and the mentee to stretch and grow. Benefits for Volunteers and Other Inmates The benefits for inmates who serve as volunteers are clear and measurable. As documented in the effective practices section in Chapter 1 and in Appendix E, the 2005 evaluation study conducted by Resource Development Associates documented that inmate volunteers have better outcomes after release than regular program participants. Specifically, in the year after release from jail, former volunteers had: a greater decrease in jail days 181 fewer jail days versus 44 less likely to have evidence of drug use 7% versus 37% higher enrollment in drug treatment programs 88% versus 68% more likely to be employed full time 36% versus 9% The psychological foundation for this benefit is easy to see. Someone identified positive qualities in them, expressed faith in them, and then had high expectations that they would succeed in taking on a lot of responsibility. Both BACR staff and custody staff have high expectations of volunteers, and for some this may be the first time someone has expected and demanded that they succeed. Those expectations are powerful motivators to follow the right path. Or, as one staff member put it, Volunteers must talk the talk, and volunteering helps them walk the talk. Several Bay Area recovery programs and community service agencies now have staff members who were previously volunteers in our program, including the Salvation Army and Delancey Street. Those inmates and the staff in those programs have said that serving as a volunteer in the Marin County Jail helped prepare them to succeed in treatment after jail. Staff have consistently observed over a period of years that volunteers have increased self-esteem and self-confidence and increased commitment to recovery. Feedback to us is that volunteers help keep the pods in check. The benefits to all inmates are also equally clear. They see inmate volunteers take on positions of responsibility and express their recovery in tangible ways, and this serves as a motivation to succeed in their own recovery. Newcomers typical feel beat down and discouraged, and it helps them to see that inmates are taking responsibility for some of the activities and that volunteers are someone to look up to.

106 Build a Recovery Community Bay Area Community Resources Requirements for Becoming a Volunteer Inmates must earn the right to be a volunteer. The minimum qualification is that a candidate must earn the two certificates offered by the program. The Certificate of Completion is given after phase 1 in the program i.e., a person has completed two months in the program and the education curriculum. The Certificate of Graduation is given after phase 2 at the end of the third month in the program. Beyond that, volunteers must have good behavior in the pod and good performance in program activities. They must participate in all the activities, talk about their personal issues, be committed to recovery, and show that they are exercising self-discipline. Program staff and other volunteers always keep an eye out for volunteer candidates. With the experience of staff and existing volunteers as the judges, inmates must earn volunteer status and cannot manipulate their way into becoming a volunteer. The Program Coordinator formally proposes a person as a volunteer candidate at a staff meeting, and program staff must give their advice and consent. Two unwritten rules are that all volunteers must attend the AA hospitals and institutions (H and I) meeting at least once a month in order to support that activity, and they must attend the 12-step book study meeting at least once a month to support that activity. How We Support Volunteers Our first step in supporting new volunteers is to publicly acknowledge their qualities at the volunteers meeting. Also, new volunteers are introduced at the newcomers meeting, giving them their first chance to show newcomers to the pod that inmates can take on positions or responsibility. The BACR Program Coordinator works with all the volunteers as a caseload, helping them in their role and directly supporting their efforts to be responsible volunteers. He holds a volunteer group meeting each Tuesday from 1-2 p.m. to address issues and solve problems about how the program or the pod is operating or issues affecting the volunteers in their various roles. The goal in the group is to build professionalism among the volunteers. Each week one person is assigned to be the meeting facilitator. That person begins each meeting with a check-in about cares and concerns. Then he makes a presentation he has prepared on a topic, such as trust and change, and then facilitates a group discussion. Other program staff also give volunteers more attention and demand more accountability. Once selected, a volunteer keeps their job unless they do something to lose it. When a volunteer is going to leave the jail, the Program Coordinator asks the volunteer to nominate a replacement. If time permits, the volunteer mentors the new person into that volunteer position.

107 Bay Area Community Resources 5. Build a Recovery Community 105 Volunteer Job Descriptions Volunteer roles are based on needs in the pods. We have 14 volunteer positions in A Pod, and a total of 22 volunteers. More than one person serves in some volunteer positions e.g., there are three Process Group Facilitators, and there are three members of the Conflict Resolution Team. F Pod has volunteer positions: the Process Group Facilitator, the 12-Step Book Study Group Facilitator, and the Inmate Board Meeting Monitor. Pod Facilitator The Pod Facilitator position is filled by one or two inmate(s), usually people who will be in the jail and the program for a lengthy period. This position must be earned and if possible the inmate assuming the position should serve in one or more mentors positions before being promoted to Pod Facilitator. The Pod Facilitator is responsible for maintaining a positive attitude in the Pod and helping keep up the integrity of the Pod. When two inmates are selected as Pod Facilitators, they should be of different races. Responsibilities of the position: Sits in on conflict resolutions as a support to the conflict resolution team. Ensures that all meetings start on time. Facilitates the 2:15 meetings when counselors are not present. Discusses issues regarding the rules to individuals and the community. Facilitates the volunteer meeting on Tuesdays at 1 p.m. if the counselor is not present. Helps volunteers/mentors coordinate meeting times with the Deputies. Writes a weekly report on weekend incidents and gives it to the program staff on Monday morning. Process Group Facilitator The Process Group Facilitators will be selected by the Program Coordinator in collaboration with the counselors and the Pod Facilitator. The Process Group Facilitator is responsible for leading the process group if the counselor is not present. There are actually three facilitators, one from each group A, B and C. Explains the rules and the purpose of the group. Ensures everyone attends the group and arrives on time. Assigns a big brother to newcomers. Ensures the group is run in an orderly fashion and only one person speaks at a time. Stands in for the group co-facilitator when he is absent. Ensures that homework is completed. Homework can be read and discussed when the counselor is not present. Records names and dates of people who join and leave the group. Maintains the daily sign-in sheets. 12-Step Book Study Group Facilitator The Group Facilitator is responsible for running the morning Book Study Group. There are actually three facilitators, one from each group A, B and C.

108 Build a Recovery Community Bay Area Community Resources Ensures everyone participates in the group. Maintains records of attendance, tardy, and no-show. Explains the rules of the group. Ensures only one person speaks at a time and keeps discussions related to the book. No cross talk. Ensures that all group members sign up for at least one assignment in the Inmate Board Meetings during the following week when that group is responsible for the board meeting. Data Entry/Homework Volunteer The Data Entry Volunteer is responsible for the orientation of all newcomers in the pod. Records personal information when people come into the pod. Assigns newcomers into group A, B, or C. Ensures everyone gets homework assignments. Maintains current records of everyone in the pod and submits them to program staff every Monday. Provides a folder and notepads to pod newcomers. Conflict Resolution Team The conflict resolution team is responsible for helping two people or a group of people solve interpersonal problems without verbal threats or physical altercation. We must be careful to refer conflicts that the team cannot handle to the custody staff. The conflict resolution team consists of three members, with one person from each group A, B and C. If an individual is not complying with pod rules, the conflict resolution team can call a meeting with that person, in order to give him an outside perspective and suggestions. The Pod Facilitator sits in as an observer on team meetings. Talks to the people who have a conflict and decides if the problem should be dealt with by the conflict resolution team. Remains neutral and does not side with any one person. Writes a meeting summary for the counselor. Welcoming Committee Team The Welcoming Committee Team meets with newcomers to explain the pod rules. The committee consists of three members, one from each group A, B and C. Meets Friday night or when needed. Describes the rules and the required groups, as well as extracurricular classes and meetings. Explains the dress code, rules about being punctual to groups, and rules about etiquette. Inmate Board Meeting Monitor The Inmate Board Meeting Monitor is responsible for overseeing the final presentation used in the inmate board meeting. Ensures that writing is legible and words are spelled correctly. Ensures that the word and sentence for the day are appropriate and related to recovery.

109 Bay Area Community Resources 5. Build a Recovery Community 107 Ensures that the concept for the day comes from approved list. Ensures that the current event to be presented is positive and uplifting. The article must not include scandalous remarks about law enforcement or judicial departments. Ensures that the skit is uplifting in nature and is summarized. Discusses on Monday mornings the meeting rules with whatever group has been assigned to plan the afternoon meetings for that week. The rules are also discussed in the Process Group. AA Facilitator The AA facilitators is responsible for the in-house AA meetings. Selects a topic, chooses a speaker, or may read from the AA big book. Keeps the meeting environment serious, with no cross talk or war stories. Maintains a record of attendance. Attends AA meetings facilitated by outside H&I people from AA whenever possible. NA Facilitator The NA facilitator is responsible for the in-house NA meetings. Selects a topic, chooses a speaker, or may read from the NA basic text. Keeps the meeting environment serious, with no cross talk or war stories. Maintains a record of attendance. Attends NA meetings facilitated by outside H&I people from NA whenever possible. Spanish AA/NA Facilitator The Spanish AA/NA Facilitator is responsible for providing one book study or speaker discussion meeting per weekend. The meeting is mandatory for all Spanish speaking and bilingual residents in the pod. Meetings are at 3:00 p.m. on Saturdays and at 10:00 a.m. on Sundays. The Sunday meeting is mandatory for all Spanish-speaking and bilingual kitchen workers. Selects a topic, chooses a speaker, or may read from the Spanish AA book. Keeps the meeting environment serious, with no cross talk or war stories. Maintains a record of attendance. 25 And Under Group Facilitator The 25 and Under Group Facilitator is responsible for leading the group and coordinating the time with the Deputy. The group is mandatory for everyone age 25 and younger. The group is not for therapy or for pull-ups. A BACR counselor usually assigns a topic for each week, but if no topic is assigned, the topic will be the weekly topic from the Education Program. Meetings occur Thursdays at 8:00 pm. Ensures that everyone eligible is present. Maintains a record of attendance and no-shows. Ensures that the meeting environment is serious, with no cross talk or war stories.

110 Build a Recovery Community Bay Area Community Resources Men s Focus Group Facilitator (Ages 26-39) The Men s Focus Group Facilitator is responsible for leading the group and coordinating the time with the Deputy. Men ages who have been assigned to the group are required to attend. There should be no more than 15 people in the group. The group is not for therapy or for pull-ups. A BACR counselor usually assigns a topic for each week, but if no topic is assigned, the topic will be the weekly topic from the Education Program. Meetings occur Fridays at 8:00 p.m. Maintains a record of attendance and no-shows. Ensures that the meeting environment is serious, with no cross talk or war stories. Maintains a record of people added to the group and submits it to the BACR counselor. Over 40 Group Facilitator The age Over 40 Group Facilitator is responsible for leading the group and coordinating the time with the Deputy. The group is mandatory for everyone over age 40. The group is not for therapy or for pull-ups. A BACR counselor usually assigns a topic for each week, but if no topic is assigned, the topic will be the weekly topic from the Education Program. Meetings occur Wednesdays at 12:45 pm. Ensures the everyone eligible is present. Maintains a record of attendance and no-shows. Ensures that the meeting environment is serious, with no cross talk or war stories. Charity Bag Volunteer The program maintains a charity bag to provide essential person items to inmates who have no money, especially newcomers to the jail who are homeless or destitute. Inmates need money on the jail s books to purchase personal items at the commissary such as shampoo, cosmetic soap, conditioner, books, or candy. BACR staff and some inmates donate items to the charity bag. Obtain items for the charity bag and maintain the bag. Disburse items to newcomers or other inmates as needed. B. Inmate Board Meeting Inmates plan and conduct a daily 15-minute meeting with a specific set of activities that are written on a large board in the meeting room. Every program participant must take the responsibility for some of the activities, and they are accountable to their peers for doing their activity properly. The meeting is conducted by the inmates under the supervision of the volunteer Inmate Board Meeting Monitor, who in turn is accountable to program staff. Staff attend the meeting as observers. Inmates in A Pod and F Pod entirely run the inmate board meeting. The purpose of the meeting is to give all program participants a clear responsibility that they alone are accountable for, as well as to handle business in the pod. This type of accountability helps support personal change and engages inmates as responsible people in a recovery community.

111 Bay Area Community Resources 5. Build a Recovery Community 109 The meeting lasts 15 minutes every day, usually before the education program session. BACR counselors attend the afternoon meeting but only as observers, although they might make an announcement during the announcement time. The meeting always has the same seven activities: introductions, announcements, word for today, sentence for today, current event, skit, amends. In the A Pod program, inmates are separated into three groups for most program activities i.e., A, B, and C group. A given group, such as B group, takes the lead for a week at a time in planning and conducting the inmate board meeting. The group decides in advance who in the group will serve as the master of ceremonies (MC) each day that week. The MC decides who in the group will be responsible for each activity on the day he/she is the MC. Each evening the MC for the next day writes on a large board each activity, along with the name of the person who will lead that activity. At 9 p.m. each day Sunday through Thursday in both pods, the MC for the next day meets with the Inmate Board Meeting Monitor to review the board and the plan for the next day s meeting. The Monitor is a volunteer accountable to the BACR Program Coordinator that the afternoon meetings are conducted properly. If the Monitor does not believe an activity or some part of the plan is proper, he/she works with the MC to fix the plan. For example, the Monitor ensures that the skit is productive and not a mockery of jail or the criminal justice system or BACR, and he/ she ensures that the board contains nothing improper, such as a gang tag. Meeting Process The process for the meeting is always the same. The meeting room is the same room that will be used for the Education Program. By 2:10 p.m. Monday through Thursday in both pods, everyone in the group should be sitting down. About 5 seconds before 2:15, the group counts down out loud then all clap. This ritual sets the meeting apart from the normal routine and makes the meeting time a special time. The MC runs the meetings and begins by introducing himself/herself. Then the MC introduces newcomers into the group, and announces the activity for the day. Next the MC asks if anyone has any announcements. Anyone can make an announcement. Examples of typical announcements would be: Laundry is happening today at 5 p.m. The H and I meeting will occur tonight in this room from 8 to 10 p.m.

112 Build a Recovery Community Bay Area Community Resources Tonight is the under-25 group here in this room. It was noisy in the pod last night. Let s keep it quiet. In the word for today activity, the MC reads the word from the board. The words are all related to a concept in the program and are chosen to reinforce some aspect of recovery e.g., commitment. Then a person reads the dictionary definition of the word. The sentence for today is similar. Another inmate reads from board the sentence they wrote which includes the word for today. The similar concept for today activity follows. The assigned person reads the concept from the board. Group members may briefly talk about what the concept means to them, but there is no cross talk or discussion. BACR counselors give the Inmate Board Meeting Monitor and the MCs a list of concepts related to recovery, so that the concepts discussed in the meeting are standardized and relevant. In the current event activity, someone talks about a current event. It could be something they saw in the newspaper or something that happened in the program. Next one or more inmates will do some form of skit related to treatment or recovery. This could be a poem or song or role play. In the next activity, those people make amends who have been late to a meeting. There are consequences to being late to the afternoon meeting. The first time someone is late, they must sing and dance either the Hokey Pokey or I m a little teapot song in front of the group. No one may clap or laugh or attempt to humiliate the person. After a second tardy, the inmate must talk with the BACR counselor. After the third tardy, the person must write an essay assigned by the BACR counselor. In the time for amends, the person must read their essay to the group. After essay there is no clapping, but the group shows thumbs up or thumbs down. On Wednesdays during the meeting the BACR Counselors give out graduation certificates to those who have earned them. At the end of the meeting the MC yields the room to whoever will be the lecturer or speaker for that day in the Education Program.

113 Bay Area Community Resources 6. Support the Criminal Justice System SUPPORT THE CRIMINAL JUSTICE SYSTEM The jail treatment program includes two services to support the criminal justice system by helping to move people through critical steps. BACR provides clinical assessments to support the Probation Department and courts, and we provide case management to support the Sheriff s Department. A. Alcohol/Drug Assessments Program staff conduct a detailed alcohol/drug assessment and make treatment placement recommendations upon request through a contract with the Probation Department. The assessments are used by the Department and/or the court to make decisions about inmate sentencing. The Department requests assessments in three circumstances: before sentencing occurs, when an inmate applies for parole and there is not already a current assessment, or after sentencing when probation supervision begins. The Department requests assessments on a case by case basis. An assessment report is delivered to the Probation Officer or other staff person who requested it. Normally, the officer requesting an assessment provides BACR with some prior history on the person being assessed, so that we are not going cold into an assessment. The prior history is very helpful to increase the accuracy of our assessments, especially since inmates and others minimize their offenses, their alcohol/drug abuse, and their past history. This information could be in a presentencing report, a probation report, or information provided on a referral form. Prior alcohol/ drug or mental health assessments by BACR or others may also be included. The information will typically describe the charge(s), the possible punishments for the crime(s), the offenses in prior convictions, victim stories and inmate statements, and social factors or a case history. When we receive a referral for an alcohol/drug assessment, the charge or personal information usually suggests that the person has an alcohol/drug problem. BACR is strictly bound by confidentiality laws concerning anyone we serve, whether in custody or prior to sentencing. In order to have optimal communication, it is important to ensure that Probation Officers and other staff understand that we are aware of and follow the laws and policies concerning confidentiality. Program staff conduct an assessment that includes the person s history of alcohol/drug use, criminal justice involvement, mental health issues, and personal and family issues, as well as a recommendation for an appropriate alcohol/drug treatment placement. The placement recom-

114 Support the Criminal Justice System Bay Area Community Resources mendation could vary considerably, from recommending attendance at AA meetings to recommending placement in a residential treatment program. A residential placement recommendation includes the degree of structure required, whether minimum structure, low structure, structured and or highly structured. The depth of the assessment of the person s issues depends upon the circumstances under which the assessment is being requested. The three assessment guides are in Appendix D. 1. The most detailed assessment occurs after the conviction but before the sentencing when the crime involves an alcohol or drug component. For example, the crime itself may be directly related to alcohol/drugs, the person may have been under the influence of alcohol or drugs when committing the crime, or the crime may have been committed to procure money for drugs. This pre-sentence assessment usually takes hours and uses the Alcohol/Drug Assessment Long Form shown in Appendix D. 2. A less detailed assessment is conducted when an inmate applies for parole, because everyone who goes before the Parole Board must have an alcohol/drug assessment. It could be that an alcohol/drug assessment was not done at the time of sentencing because the crime did not have an alcohol or drug component, or it could be that the presentencing assessment is old enough that the court or Probation Officer believes an updated assessment is appropriate. This pre-parole assessment usually takes about one hour and uses the Alcohol/Drug Assessment Short Form shown in Appendix D. 3. The least detailed assessment occurs after sentencing when probation supervision begins. Many if not most inmates already have had an alcohol/drug assessment by this time. However, an assessment may need to be updated because it is old or because the judge or Probation Officer believes an assessment is appropriate. For example, alcohol/drug treatment may become a condition of probation, or a judge may have found some reason to suggest that alcohol/drug use is an issue, such as an old DUI. At that point the supervising Probation Officer will request the assessment. This pre-probation assessment usually takes a little less than an hour and uses the Alcohol/Drug Assessment Supervision Form shown in Appendix D. B. Case Management Case management services support the Sheriff s Department by getting inmates and others into the most appropriate community-based alcohol/drug or mental health treatment program after incarceration. BACR staff locate appropriate programs, get people enrolled, and transport them to the program. We provide case management for inmates in jail, for people waiting to be sentenced who may or may not be out on bail, and for people who are on parole or about to go on parole.

115 Bay Area Community Resources 6. Support the Criminal Justice System 113 Each inmate is assigned a jail treatment program staff member as a case manager to give the inmate personal and individualized support. One part of that case management is to help inmates make careful plans for discharge and reentry, especially getting them enrolled in an appropriate alcohol/drug treatment program in the community, so that they receive the treatment needed to maintain recovery and help prevent recidivism. Case management can also be provided for people waiting to be sentenced who may or may not be out on bail, and for people who are on parole or about to go on parole. BACR jail treatment program staff provide case management services in order to get people into the most appropriate community-based alcohol/drug treatment program. BACR staff can bring special expertise to this part of the criminal justice process: a comprehensive knowledge of Bay Area treatment programs, knowledge of the person s needs gleaned through assessments, and rapport with inmates who have been participating in the BACR jail treatment program. Case management includes locating appropriate community placements, getting people enrolled into the program, and transporting them to the program for interviews and after sentencing. We provide case management for inmates in jail during their sentence, for people waiting to be sentenced who may or may not be out on bail, or for people who are on parole or about to go on parole. One situation in which we provide case management is when a person is granted parole. After a person is sentenced and applies for parole, BACR will usually be asked to do an alcohol/drug assessment to determine the appropriate treatment placement. If parole is granted, the inmate will see the BACR counselor/case manager to decide what to do about the parole board s provisions. For example, if a provision of parole is that a person must attend a community inpatient or outpatient treatment program, then the BACR counselor/case manager talks to selected community programs to see if they will take the person into treatment. This will involve briefing the program about the client, based upon the BACR assessment and/or the person s performance in the Jail Treatment Program. If the program agrees to accept the client, then BACR will schedule a date for the program to interview the client. Our staff will complete the paperwork and arrange for the inmate to obtain a pass for the interview. Then we will transport the person to the interview, stay during the interview, and take the person back to the jail. If a community program puts a person on a waiting list, the counselor keeps calling the program to find when a bed is available. When a bed becomes available, the person will still be in custody but be released to BACR and our staff will take the person to the program. We do limited case management through treatment planning for people who go into outpatient treatment. For example, if an inmate in our program is granted parole, BACR will make specific recommendations for a treatment plan, such as being on the electronic house arrest ankle bracelet for a set period of time and attendance at three AA meetings per week. We do case management when a supervising probation officer wants an inmate to go directly to a community program after jail and not be released to the community. BACR will do the case management required to make that happen.

116 Support the Criminal Justice System Bay Area Community Resources A limited type of case management occurs when a person needs acceptance into a program when they go to court for sentencing. We would help arrange the program acceptance, but not provide followup unless the court or Probation Department requests it.

117 Bay Area Community Resources Appendix A 115 Other Programs in the Jail APPENDIX A. Other Programs In The Jail BACR s Jail Treatment Program is one of many programs working in a collaborative effort. The Marin County Jail brings in a host of community organizations to provide programs for inmates. The Program Director oversees all the community programs. Community programs in the jail as of October, 2008: Alcoholics Anonymous (AA) Bay Area Community Resources ( drug and alcohol recovery units; pod groups) Bay Marin Community Church (religious service) Bread and Roses (music entertainment by community volunteers) Centerforce Parenting Project (parenting classes; family reunification; information and referral to community agencies) Choir (F Pod) Christian Science Community of Marin (religious service) Communications and Spirituality (Houses of Healing) Detention Ministry-ASF (mass / religious service) Dominican Volunteers (religious service) Holiday Celebrations (Santa Claus, Giant Pumpkins, Easter Rabbit) Marin AIDS Project (education about HIV, HCV, STD, and safe sex) Marin County Family Law Office (court ordered child support arrangements) Marin County Office of Education (G.E.D. preparation and testing; ESL) Marin County Public Defender s Social Work Intern Program Marin Covenant Church (religious service) Marin Jobs and Career Services Marin Literacy Program (library; fathers/mothers program; basic reading and writing; ESL; newsletters; video learning program) Narcotics Anonymous (NA) New Life Christian Church (bible study and religious service) Special Housing Support Group Community Action of Marin (housing assistance) Sufi Women s Organization Prison Program (meditation; stress reduction; breast cancer awareness workshops; poetry workshops)

118 116 Appendix B Bay Area Community Resources Community Programs B. Community Programs At the end of incarceration, we work to get inmates enrolled into inpatient or outpatient alcohol/drug treatment programs. Our program is designed to be pre-treatment that brings people into recovery, but they need continued treatment. The program selected depends on the inmate s needs and the nature of the person s sentence from the court. BACR refers inmates to the following community programs. Adobe House Asian American Recovery Services 2024 Hayes Street, San Francisco Bonita House 1440 Bonita Ave. Berkeley Casa Maria 105 McLain Ave, Brisbane Casa Quetzal 635 Brunswick Streets, San Francisco Center for Recovery 2740 Grant Street, Concord Center Point nd Street, San Rafael inpatient and outpatient Chrysalis House 3837 Telegraph Ave, Berkeley C.U.R.A th Street, Oakland Daytop Villages 2560 Pulgas Ave, East PALO Alto Delancey Street 600 Embarcadero Streets, San Francisco Diablo Valley Ranch Marsh Creek Road, Clayton El Chante Recovery Home 425 Vernon Street, Oakland Freedom from Alcohol and Drugs th Street, San Francisco Friendship House 80 Julian Ave., San Francisco Genesis House 1149 Warren Ave., Vallejo

119 Bay Area Community Resources Appendix B 117 Community Programs Golden Gate for Seniors 637 South Van Ness Ave., San Francisco Harbor House Project 407 Ninth Street, San Francisco Henry O. House North 5394 Nave Dr., Novato Ohlhoff Recovery Programs 601 Steiner Street, San Francisco Jellani House 1601 Quesada Ave., San Francisco Jericho Project 150 North Hill Dr. # 15, San Francisco Jubilee Restoration 2144 Byron Street, Berkeley , ext. 16 Lytton Springs Healdsburg Marin Services for Women 1251 South Eliseo Drive, Greenbrae New Bridge Foundation P.O. Box 524, Berkeley New Life Center 1080 Folsom Street, San Francisco Orchid Women s Recovery Center 1342 east 27 th Street, Oakland Our Family Corporation Napa State Hospital C and D Ward Pine Hurst Project Pride PSG 3387 East Hwy 20, Clearlake Redwood Center 100 Edmonds Road, Redwood City Seton Hall 165 Guerrero Streets, San Francisco Salvation Army Program in San Francisco 500 Valencia Street, San Francisco Salvation Army Program in Oakland 601 Webster Street, Oakland Ujima House 904 Mellus Street, Martinez VA Programs in Menlo Park 795 Willow Road 137 MP, Menlo Park

120 118 Appendix B Bay Area Community Resources Community Programs Walden House 1885 Mission Street, San Francisco Western Addition Recovery San Francisco Women s Empowerment Network 5808 Walnut Street , Oakland Wistar Redemption and Recovery 273 Tunis Rd., Oakland Women s Recovery Association 1450 Chaplin Ave., Burlingame TLC (clean and sober homes) Next Step (clean and sober homes) San Rafael Casa Aztlan 3080 Longview Dr., San Bruno

121 Bay Area Community Resources Appendix C 119 Useful Web Sites C. Useful Web Sites Bay Area Community Resources Describes the agency s mission and programs. Marin County Sheriff s Department Describes programs and information about the Department. Marin County Probation Department Describes programs and information about the Department. Marin County Superior Court Provides useful information about the courts. California Department of Alcohol and Drug Programs A source of articles about addiction and treatment. National Institute on Drug Abuse A source of information on drugs, addiction research, and treatment. U.S. Substance Abuse and Mental health Services Administration. Located within the U.S. Department of Health and Human Services. A source of information about addiction research and government programs. GWC Incorporated A source of education and training videos for the education program. Hazelden A source of articles about addiction treatment, research, and recovery support. The Recovery Zone A guide to 12 step program information on the world wide web.

122 120 Appendix D Bay Area Community Resources Alcohol/Drug Assessment Forms D. Alcohol/Drug Assessment Forms Alcohol/Drug Assessment - Long Form To:, Marin County Probation/Parole Department From: Date: Subject: Purpose: Current Offense: Prior Convictions: Demographic Information: Age: Date Of Birth: Race: Sex: Marital Status: Children Under 18: Family History And Current Living Situation 1. Life as a minor stability, stress and exposure to substance abuse in environment Where were you born and raised? Number of siblings? Intact home? Who had custody? Other parent s involvement?

123 Bay Area Community Resources Appendix # 121 Outcome Evaluation Study 2005 What was home like (close/distant? chaotic/stable) any major family problems violence, mental or physical illness, financial problems, other? Who in family used substances and had problems? 2. Time from living home up to current situation When did you leave home and why? What happened between then and now? Where did you live? Relationships? Marriages? Children? Any major stress in this period? Where do you live now/ for how long? Who do you live with? Is anyone else there using substances?

124 122 Appendix D Bay Area Community Resources Alcohol/Drug Assessment Forms Significant Medical Information 1. History of major illnesses? Disabilities (hearing, vision, movement, etc.)? When and how long? Hospitalizations/surgery/medications? 2. Drug-related injuries/ conditions or concerns (accidents, HEP C, HIV)? Tested? Alcohol blackouts, overdoses or drug related induced seizures, accidents? 3. Current medical concerns? Current medications? For? Name/quantity? For how long? Mental, Physical Or Sexual Abuse 1. Have you ever perpetrated abuse on another person? Who? When? What happened, consequences?

125 Bay Area Community Resources Appendix # 123 Outcome Evaluation Study Have you ever been abused? Who? When? What happened, consequences? Anyone currently at risk? Significant Psychological Problems 1. Ever seen a therapist/counselor/psychologist? Reason? When? How long? Meds.-name 2. Ever hospitalized or visit crisis unit for an emotional problem? Any suicide attempts? What happened? 3. Concern about current emotional state? Getting support? How long? Medication (name/quantity)? Stressful Life Events 1. What incidents in your life would you identify as stressful divorce, illness, abuse, money, death, job loss? What was the impact on you? How did you cope?

126 124 Appendix D Bay Area Community Resources Alcohol/Drug Assessment Forms 2. Any current major stressor? What? How long? How coping now? Employment 1. History of prior employment. How many years in life have you worked? Kinds of jobs? 2. Usual length on jobs and reasons for living? Any substance-use related problems? 3. Currently employed? Doing what? How long? Client s History Of Substance Use 1. What is/are your drug(s) of choice. What else have you used, including tobacco?

127 Bay Area Community Resources Appendix # 125 Outcome Evaluation Study When did you first try alcohol/drugs? What was it? How much? What did you first use on regular basis? When? Describe the progression in chunks of time. (Example: From age client was using alcohol on weekends, usually about 6 beers each night. Client reported being sober for the following 3 years but then returned to drinking more frequently. He reported he began daily drinking (6-10beers) following the loss of his job at age 28 and this pattern continued until his first arrest at age 35 )

128 126 Appendix D Bay Area Community Resources Alcohol/Drug Assessment Forms 3. Do you consider yourself an addict or alcoholic? Current/Last Use Of Alcohol/Drugs 1. What was date of last use? What and how much did you use? Identify all drugs used. 2. If not clean and sober, amount and frequency of drugs used in the last month? Past Treatment Efforts 1. Ever gone to a program for substance abuse? How many? Where? When? Completed? If not, why not? 2. Ever attended 12-Step meetings? When? How long in months or years? How often in times per week or month?

129 Bay Area Community Resources Appendix # 127 Outcome Evaluation Study DDP programs attended/completed? Which one(s)? When? 4. Other treatment for criminal behavior e.g., domestic violence, theft awareness, other? When? Where? How long? Completed? Current Treatment Efforts 1. Alcohol/drug treatment program name? How long attending? 12-Step groups? How many times per week? How long attending? Sponsor? DDP or other program? Which program? Where? How long attending? Origin/Causes Of Substance Abuse 1. How and why did your using became a problem?

130 128 Appendix D Bay Area Community Resources Alcohol/Drug Assessment Forms What other factors may have contributed to your using? Consequences Connected To AOD Use 1. What in your life has been negatively affected by your use? Any DUIs? (chronological order) 2. What do you feel has been the worst consequence? Why? Motivation 1. What do you want to do about using?

131 Bay Area Community Resources Appendix # 129 Outcome Evaluation Study What are your reasons for wanting to change? 3. Therapist adds assessment of client s motivation. Look for conflicting statements or behavior, clarity and detail in responses, level of honesty, commitment, and emotion behind statements. (Example: Based on client s statements and attitude during the assessment, client s level of motivation appears (low, questionable, minimally adequate, good, very positive, etc.). His participation and behavior in the Pod C/F treatment program supports/contradicts his statements related to his motivation for becoming clean and sober.) Treatment Recommendation / Prognosis Make sure you add other possible needs e.g. DDP (if needed and clients intends to drive), other treatment, psychological evaluation (if questions about mental health status). (Example: Based on client s statements and information provided, it is recommended that Mr. X enter and complete an outpatient treatment program such as but not limited to Positive Changes. In addition, he should attend a minimum of 3 AA meetings per week for a period of six months. If relapse occurs, residential treatment would be advised. Prognosis is very positive.)

132 130 Appendix D Bay Area Community Resources Alcohol/Drug Assessment Forms Alcohol/Drug Assessment Short Form To:, Marin County Probation/Parole Department From: Date: Subject: Purpose: Custody Status: Current Offense: Prior Convictions: Demographic Information: Age: Date Of Birth: Race: Sex: Marital Status: Children Under 18: History And Extent Of Alcohol/Drug Use

133 Bay Area Community Resources Appendix # 131 Outcome Evaluation Study 2005 Current Status Of Alcohol/Drug Use Past Treatment Efforts Current Treatment Efforts Significant Medical Information Mental, Physical Or Sexual Abuse

134 132 Appendix D Bay Area Community Resources Alcohol/Drug Assessment Forms Significant Psychological or Emotional Problems Employment History Original Causes Of Substance Abuse Consequences Connected To Alcohol/Drug Use

135 Bay Area Community Resources Appendix # 133 Outcome Evaluation Study 2005 Motivation Treatment Recommendation

136 134 Appendix D Bay Area Community Resources Alcohol/Drug Assessment Forms Alcohol/Drug Assessment - Supervision Form To: (Name Of Supervising DPO) From: (Name Of BACR Assessor) Date: Subject: Purpose: Treatment Recommendation Custody Status: Out Of Custody Demographic Information: Age: Date Of Birth: Race: Sex: Marital Status: Children Under 18: History And Extent Of Alcohol/Drug Use Current Status Of Alcohol/Drug Use

137 Bay Area Community Resources Appendix # 135 Outcome Evaluation Study 2005 Past Treatment Efforts Current Treatment Efforts New Supplemental Information Current Employment Status Original Causes Of Substance Abuse Motivation Treatment Recommendation

138 136 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 E. Outcome Evaluation Study 2005 Bay Area Community Resources Marin County Jail Intensive Day Treatment Evaluation Report January 2005 Prepared by: Pat Reyes, Robert Bennett, Brenda Abrams, Felicia Tripp Resource Development Associates 3685 Mt. Diablo Blvd., Suite 351 Lafayette, CA (925) Reformatted for this manual

139 Bay Area Community Resources Appendix E 137 Outcome Evaluation Study 2005 Table of Contents I. Executive Summary A. Description Of The Program B. Evaluation Approach C. Findings II. Introduction A. Background B. Description Of The Program III. Evaluation Approach A. Design B. Data Sources C. Data Analysis IV. Findings A. Post Release Outcomes (PRISM Notes Dataset) B. Criminal Recidivism (CJIS Data) C. Satisfaction with Program Functioning and Impact V. Discussion A. Results B. Challenges & Recommendations C. Future Evaluation Efforts VI. References VII. Appendices Participant Focus Group Questions Volunteer/Mentor Focus Group Questions Treatment Provider Interview...170

140 138 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 I. Executive Summary A. Description Of The Program The Marin County Jail Intensive Day Treatment Program is a collaboration between Bay Area Community Resources and the Marin County Sheriff s Department designed to address the problem of substance abusing offenders within the Marin County Jail. The program seeks to prepare in-custody offenders to participate effectively in treatment programs when they return to the community and to reduce the cycle of criminal recidivism characteristic of substance abusing offenders. The overarching goals of the program are: Goal 1: Increase access to in-custody substance abuse treatment services in Marin County. Goal 2: Improve participants attitude towards AOD abstinence and increase motivation to maintain sobriety Goal 3: Reduce participants criminal justice involvement. Goal 4: Improve participants well-being. Goal 5: Volunteer-mentors will benefit from their additional involvement in the program. C-Pod (for men) is similar to an intensive 90-day therapeutic community residential treatment program and F-Pod (for women) is similar in structure to an intensive 90-day outpatient treatment program. C-Pod provides six hours of structured activities a day and F-Pod provides for 3 hours. In addition there are twice-weekly AA and NA meetings. Structured activities include group meetings, lectures, book study, and individual counseling sessions. In addition, participants are encouraged to take advantage of the availability of parenting classes, spirituality classes, GED preparation and tests, general education, literacy programs, family reunification, and Marin Abused Women s Services domestic violence classes. Inmates obtain a certificate of completion after two months of participation and a certificate of graduation is earned after three months participation. The program utilizes a peer counseling approach whereby inmates who have completed the program but are fulfilling the remainder of their sentence have the option to become a volunteer-mentor.

141 Bay Area Community Resources Appendix E 139 Outcome Evaluation Study 2005 B. Evaluation Approach Design The evaluation compares outcomes utilizing a one-year pre- post-intervention design. The main analysis group is restricted to those who are released from jail into the community or into a treatment program within one month of termination from the treatment program. Comparisons are made by length of time in the program as well as regular participant vs. volunteer/mentor. Data Sources The evaluation used both quantitative and qualitative sources of data. These include: 1) Marin County Arrest and Booking data from The Criminal Justice Information System (CJIS); 2) Assessments of one-year post-release well-being from abstraction of Probation case notes recorded in the PRISM database; 3) BACR program data including demographics and program entry and termination dates; 4) Focus groups with current program participants; 5) Telephone interviews with community based treatment providers; and 6) Key informant telephone interviews. C. Findings Overall, the evaluation found that the program is well-designed and well-implemented and produces highly positive outcomes for inmates who participate in it. In particular, the evaluation found that the program was effective in reducing days of subsequent incarceration, in promoting enrollment and retention in treatment programs after release, and in reducing substance abuse and increasing employment in the post-release period. The findings also showed that number of post-release felony and misdemeanor arrests decreased as a result of participation, although this finding was not strong enough to attain statistical significance. Results below are based upon analyses of the booking data and probation case notes. Engagement in Treatment Services and Substance Use 70% of clients enrolled in at least one treatment program in the year after release. 30% of all clients in this sample completed a treatment program in the year following release. 40% engaged in 12-Step type support groups. 70% of clients had no indication in probation case notes of drug use during the year postrelease. Housing and Employment Status 12% of clients were homeless at some time during the one-year post-release period. 15% of clients were employed full-time at some point in the post-release year and another 38% had part-time or occasional paid work. Criminal Recidivism 56% had one or more bookings in the year following termination from treatment.

142 140 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 The number of individuals with at least one felony or misdemeanor booking decreased from the pre-treatment period to the post-treatment period. There were also decreases in the number of people with one or more bookings in each charge category. There was a statistically significant average decrease of 65 days in jail from bookings occurring one-year pre-treatment to one-year post-treatment. Additionally, the evaluation found that length of time in the in-custody program was related to post release substance use, treatment program enrollment, employment and justice outcomes with longer periods in the in-custody program being associated with greater improvements in these areas. An analysis of potential cost savings due to averted days in jail from the pre to the post program (post-release) period found savings of those staying longer than one month ranging from $5,492 to $11,215 per person depending upon length of time in the program. Volunteer/mentors had better outcomes than regular participants in many areas. They were more likely to enroll in a treatment program, complete a treatment program, participate in a 12-step support groups, be less likely to have evidence of drug use, were more likely to be employed full time, and had a greater decrease in jail days. They were as likely to be homeless, be employed in any capacity (fulltime, part-time, or occasional), and as likely to be remanded to jail for failure to meet conditions of parole or probation. Satisfaction with the Program Results of Interviews and Focus Groups BACR s in-custody substance abuse treatment program has helped inmates take steps to make significant changes in their lives. The interviews and focus groups attest to the program s effectiveness in motivating clients and readying them for additional treatment upon release. In addition, BACR staff facilitate the client s entry into treatment into the community after leaving the jail. According to interviews conducted as part of this evaluation, Marin County Jail, Probation Department, and treatment providers in the community find direct benefit from this program. The benefits include: a more manageable inmate population which uses its time productively, more informed recommendations to the Parole Board, an in-custody treatment resource for the Parole Board, support for Probation Officers in their assessment of inmate needs upon release, and coordination of enrollment into a treatment program upon release. Treatment programs in the community appreciate the high level of expertise that BACR provides during the referral and placement process. An area agreed on by staff and women participants to be facing difficulty is the women s program. Because there is only one woman s pod in the jail, program participants are housed together with inmates not in treatment. The women do not enjoy the isolation from the general jail population that allows the men s program to create a therapeutic community. This structural issue also limits the total amount of programming time. The jail commander, who is extremely supportive of this program, also stated that he would like to see an intensive all-day program for the women. This would only be possible if they were able to create a women s treatment-only pod. If funds were available to add additional staff and retrofit F-Pod to create a physical barrier separating treatment vs. non-treatment areas for the women, they would be able to create such a

143 Bay Area Community Resources Appendix E 141 Outcome Evaluation Study 2005 program. Participants also reported that supervising deputies are not uniformly supportive of the women s program. Cross-training of jail staff who work in the treatment pods with treatment personnel may be helpful. II. Introduction A. Background Drug Use in the Offender Population A study by the Center on Addiction and Substance Abuse at Columbia University reveals that at least 77 percent of local jail inmates have used an illegal drug regularly (at least weekly for a period of at least one month); been incarcerated for drug selling or possession, driving under the influence of alcohol (DUI) or another alcohol abuse violation; were under the influence of alcohol or drugs when they committed their crime; committed their offense to get money for drugs; have a history of alcohol abuse, or share some combination of these characteristics (Belenko, 1998). Inmates who have abused alcohol or drugs often have special health needs that add expense to their incarceration. These include detoxification programs, mental and physical health care, and AIDS treatment. Recidivism Sixty-to-seventy percent of released prisoners are rearrested within three years (BJS, 2003; JTO 2005). In 1980, re-arrests accounted for 17 percent of all prison admissions. They now make up 35 percent (IDU HIV Prevention, 2001). The Marin County Sheriff s Crime Analysis Unit found that 67% of male inmates and 52% of female inmates had previously served time in the Marin County Jail. As a result both the prison population and jail costs have skyrocketed. The results of these high recidivism rates, including incarceration costs, are so staggering that Congressional leaders are working on legislation that could provide grants for delivering healthcare and other services to ex-offenders. For substance abusers the recidivism rates are even more staggering. Inmates who are alcohol and drug abusers and addicts are the most likely to be re-incarcerated. The more prior convictions an individual has, the more likely that individual is a drug abuser: in state prisons 41 percent of first offenders have used drugs regularly, compared to 63 percent of inmates with two prior convictions and 81 percent of those with five or more convictions. The result has been a steady and substantial rise in the nation's prison population over the past generation (Belenko, 1998). In-Custody Drug Treatment and Successful Reentry Investments in education, training and drug treatment programs within prisons are having a large impact on reducing recidivism, showing reductions in recidivism as high as 40% (Brown, 2000). The Office of National Drug Control Policy has found that a 50% reduction in recidivism can be achieved through drug therapy while in prison and under post-incarceration supervision (Office of National Drug Control Policy, 2001). Women treated in prison also have fewer arrests, less

144 142 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 drug use, and greater employment (Hall, et al, 2004). A report from the Little Hoover Commission reveals that an alcohol and drug treatment can save $7 in incarceration costs for every $1 spent, with gains attributable to reduced crime, enhanced workplace productivity, and lower health care costs (Marks, 2003). Treatment programs show the best results when adhering to a continuum of care model from institution to community (Hiller, Knight, & Simpson, 1999). B. Description Of The Program Bay Area Community Resources designed a program to address the problem of substance involved offenders with the inception of the Marin County Jail Intensive Day Treatment program which is funded by the Marin County Sheriff s Department. The program seeks to prepare incustody offenders to enter and make the most of treatment programs when they enter the community and to reduce the cycle of criminal recidivism characteristic of substance abusing offenders. The overarching goals of the program are: Goal 1: Increase access to in-custody substance abuse treatment services in Marin County. Goal 2: Improve participants attitude towards AOD abstinence and increase motivation to maintain sobriety Goal 3: Reduce participants criminal justice involvement. Goal 4: Improve participants well-being. Goal 5: Volunteer-mentors will benefit from their additional involvement in the program. Approximately 60 men and 50 women are in the program at any one time with participating in the program in a year. The treatment pods house about one-third of the total Marin County Jail population. Inmates are generally eager to enter the treatment program because participation and successful completion of the program appears favorably on their record and can facilitate release or fulfill a condition of parole. Research shows that those coerced to participate in substance abuse treatment have as good or better outcomes than those who volunteer for treatment. When first begun, the program was a simple pre-treatment program but has since grown into a more structured and intensive program. C-Pod (for men) is now similar to an intensive 90-day residential treatment program and F Pod (for women) is similar in structure to an intensive 90- day outpatient treatment program. In time, BACR plans to upgrade F-Pod to a more intensive program. C-Pod provides six hours of structured activities a day and F-Pod provides for 3 hours. In addition there are twice weekly AA and NA meetings. Structured activities include group meetings, lectures, book study, and individual counseling sessions. In addition, participants are encouraged to take advantage of the availability of parenting classes, spirituality classes, GED preparation and tests, general education, literacy programs, family reunification, and Marin Abused Women s Services domestic violence classes. Inmates obtain a certificate of completion

145 Bay Area Community Resources Appendix E 143 Outcome Evaluation Study 2005 after two months of participation and a certificate of graduation is earned after three months participation. These activities are designed to provide the participants with the following: Education about their drug and alcohol addition and their criminal behavior in order to improve their morals and build up their integrity; Opportunities to take responsibility towards seeking treatment; A foundation to be successful in treatment after incarceration or while on County Parole; and The proper tools to become leaders and role models within the recovery community. BACR s Marin County Intensive Day Treatment program utilizes a peer counseling approach. Inmates who have completed the program but are fulfilling the remainder of their sentence have the option to become a volunteer-mentor. The volunteer-mentor position is an essential part of the program and is designed to encourage the inmate/client to be accountable and start giving back to the community. There are up to 18 volunteer-mentors in the two pods at any one time. They aid the program by supporting new members, helping with homework and group facilitation, and being role models to other prisoners. After completing the treatment program, inmates may generally remain in the treatment pod until their sentence at Marin County Jail is finished. Upon release from jail, inmates are discharged to the community with the expectation that they will continue to participate in a residential or outpatient treatment program. To increase this likelihood of this occurring treatment plans are created in preparation for release, BACR arranges bed space for those seeking residential treatment and coordinates interviews with the community program s intake coordinator. If the inmate is on parole, probation, or early release and treatment is a condition of release, BACR staff will drive the participant to the residential treatment program. If the participant is homeless or fearful they will relapse as soon as they get out they may also be transported to the program. Approximately one-third of participants must complete additional jail time beyond treatment completion, are released to state prison, another county jail, or a non-treatment pod within Marin County Jail. The program is culturally competent. There are monolingual Spanish speaking inmates in the men s treatment pod at any one time. The program director is the bilingual staff person. He will conduct the individual counseling sessions with these clients in Spanish. Groups are conducted in English. Mentor-volunteers provide support to monolingual Spanish speaking inmates in understanding group content and homework. Three NA/AA meetings a week are held in Spanish by a bilingual mentor/volunteer. During that time mentors clarify group process, concepts, and answer questions. When BACR staff prepare treatment plans for the participant upon release they will refer the Latino and Asian clients to culturally specific programs.

146 144 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 III. Evaluation Approach A. Design The evaluation compares outcomes utilizing a one-year pre/post intervention design. The main analysis group is restricted to those who are released from jail into the community or into a treatment program within one month of termination from the treatment program. Those participants who upon discharge from the treatment program are released to another in-custody situation (e.g., another Marin County Jail pod, to State prison, or to another county) were not tracked for outcomes because individuals who are still in-custody do not have a comparable opportunity to attain outcomes as do those who are out of custody. Comparisons are made by length of time in the program as well as regular participant vs. volunteer/mentor. BACR s program engages in a process of continual improvement. Thus, outcome findings are a reflection of the effectiveness of the program as it was operating in FY Qualitative data in the form of interviews and client focus groups supplement justice data and provide additional insights into the functioning and impact of the program. B. Data Sources Arrest and Booking Data The Criminal Justice Information System (CJIS) is the source of arrest and booking data in Marin County. A list of clients was submitted by BACR to the Crime Analysis Unit of the Marin County Sheriff s Department. The analyst produced a printout of the booking history for 110 clients. The data from the booking reports was entered into a spreadsheet by BACR staff. This data was transmitted to the evaluator linked only by study identification number. The booking reports with identifiers were then destroyed. Booking data from State and Federal sources is extremely difficult to obtain. Thus the justice data presented in this report reflects only occurrences recorded in Marin County s system. Because of the limitation to offences occurring in Marin County, we excluded those clients who were not residents of Marin County during the year before arrest leading to the jail sentence. Probation Case Notes Marin County probation officers record information for their caseload on the PRISM database. Both case notes and specific data items are entered. The case note files for clients are the primary source of information for the evaluation s one-year post-release follow-up of well-being. Probation provided printouts of the case notes based upon a list of clients provided by BACR. The evaluator developed a data abstraction and recording tool. BACR staff then read through the notes and made determinations on outcomes listed in the abstraction tool. Data quality assessments of the notes were made as well. If there was not enough information in the case notes to make a determination on an item it was left as missing. If the notes appeared to have

147 Bay Area Community Resources Appendix E 145 Outcome Evaluation Study 2005 gaps in information for the period of interest they were not used. Following data abstraction the case notes were destroyed. Data was transmitted to the evaluator linked only by study identification number. BACR Program Records Information at intake and discharge is collected by project staff and entered into a BACR database. BACR provide RDA with data on participants linked by the study identification number. This was the source of demographics, program entry, and termination dates. Participant Focus Groups Bay Area Community Resources arranged for the evaluator to conduct focus groups with participants in the agency s in-custody treatment program in the Marin County Jail. Three groups were facilitated. Each group lasted about one hour and began with a brief explanation of the purpose of the discussion. Participants were advised of their right not to answer questions and that their confidentiality would be protected. Questions provided opportunities for participants to give feedback on program functioning and its impact on their lives. The mentors on C-pod were asked a slightly different set of questions which focused on their role in the program. Focus group questions are included in the Appendix. 1. C-Pod participants - A total of 8 African-American and White men participated in this focus group. They had been in the program for a time ranging from two months to one year. Two of the participants had been in a treatment program previously in the community. 2. C-Pod volunteer/mentors - A total of 9 African-American, White, Latino and Asian men participated in this focus group. All had been in the program for over three months. All of the participants had also been in a treatment program in the community. 3. F-Pod participants and mentors combined - A total of 4 Latina and White women participated in this focus group. They had been in the program for a time ranging from three weeks to two months. For three this was their first treatment episode. One had participated in an in-custody treatment program at another facility. Treatment Provider Interviews Telephone interviews were conducted with four substance abuse treatment providers who have worked with Marin County Jail treatment program participants upon release. These staff are in a unique position to provide feedback on how the program has prepared participants for continued treatment. Programs represented primarily residential men s and women s programs. Question areas included their perceptions of BACR s program, how well they prepare participants for community treatment, and their management of the referral and placement process. Key Informant Interviews Telephone interviews were conducted with individuals who have a perspective on the program of a specialized nature. A core set of questions was developed as well as items specific to their role. Interviews were conducted with the following:

148 146 Appendix E Bay Area Community Resources Outcome Evaluation Study Division Director of Adult Probation, Marin County; 2. Commander of Detention Services Bureau, Marin County Sheriff s Office; and 3. Director of BACR s Marin County Jail Treatment program with input of staff. C. Data Analysis Un-weighted frequencies (counts and percentages) as well as descriptive statistics (average and standard deviation) are provided. Percentages are based on non-missing responses. Chi-square and t-tests are conducted where appropriate. IV. Findings A. Post Release Outcomes (PRISM Notes Dataset) Demographics There are a total of 83 clients for whom we have adequate data quality from the abstraction of probation notes to utilize for this analysis. Almost two-thirds of the sample (64%) is male and 36% are female. The largest ethnic/racial group is White (59%) followed by African-American (22%) (Table 1). The average age was 37 years and ranged from 19 to 63 years of age. Table 1: Ethnic Distribution of Clients in PRISM Dataset (N=83) Race/Ethnicity Number Percent White 49 59% African-American 18 22% Latino 5 6% Asian/Pacific Islander 3 4% Other/Bi- 8 9% Racial/Unknown Total % Engagement in Treatment Services & Substance Use Seventy percent of clients participated in at least one treatment program in the year after release. Time in the BACR in-custody program appears to be related to likelihood of engaging in treatment services post-release with those in the program for less than one month least likely to participate in a program (Chart 1; Table 2). Clients were also engaging in 12-Step type support groups with 40% overall having participated during the post-release year. The association of incustody treatment time and post-release program participation is evidence of a causal connection between program participation and the observed outcome.

149 Bay Area Community Resources Appendix E 147 Outcome Evaluation Study % Chart 1: Enrollment in a Post-Release Treatment Program (N=77) 75% 75% 70% 65% 68% 71% 70% 60% 63% 55% 50% <1 mo 1-2 mo 2-3 mo >3 mo Total Time in BACR In-Custody Program Table 2: Engagement in Treatment Post Release by Time in BACR Average Std. Dev. Number Percent Time in BACR number of programs Enrolling in a tmt. program Enrolling in a tmt. program Less than one % month (n=11) One to two % months (n=25) Two to three % months (n=17) More than three % months (n=24) Total (n=77) % Almost one-third (30%) of all clients in this sample completed a treatment program in the year following release (Table 3). Those who had been in the BACR program for less than a month were least likely to have completed a treatment program once out of custody.

150 148 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Table 3: Completion of a Post Release Program by Time in Program Time in BACR Less than one month (n=9) One to two months (n=23) Two to three months (n=17) More than three months (n=20) Number Completing a program one year post-release Percent Completing a program one year post-release 1 11% 9 39% 4 24% 7 35% Total (n=69) 21 30% Clients enrolled in a variety of treatment programs throughout the Bay Area (Table 4). There were a total of 30 programs attended as listed in probation officer notes. Clients may have enrolled in more than one in the post-release year. The most frequently attended programs are Center Point (10), Salvation Army Oakland (10), Delancey Street (6), Henry Ohloff (5), and CURA (4), and Marin Services for Women (4).

151 Bay Area Community Resources Appendix E 149 Outcome Evaluation Study 2005 Table 4: Treatment Programs Utilized by Clients Post-Release Number Name of Program Enrolling in Program Bonita House 1 Buckelew 1 Casa Maria, Brisbane 1 Center Point 10 Chrysalis House 3 CURA 4 Delancey Street 6 Epiphany House 1 Freedom from Alcohol and Drugs 1 Haight Ashbury 1 Henry Ohloff 5 Kaiser Outpatient 1 Linda Reed Center 1 Marin Services for Women 4 Marin Abused Women s Services 1 Table 4: Treatment Programs Utilized by Clients Post-Release (continued) Number Name of Program Enrolling in Program New Bridges 1 Orchid 1 Ozanam Center 1 Positive Changes 3 Project Aurora 1 PSG 1 Recovery Concepts 1 Saint Anthony s 1 Salvation Army (ARC), Oakland 10 Tam Day Treatment 1 TLC 3 Voyager 1 Walden House 1 Women s Recovery Center 2 Word of Faith 1 Evidence of drug use was indicated by self-report of use or positive urine results. For seventy percent of clients there was no indication in case notes of drug use during the year post-release.

152 150 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Those in the in-custody BACR program the least length of time were most likely to have a relapse in drug use (Table 5). Table 5: Drug Use Post Release by Time in BACR Time in BACR Number with indication of drug use Percent with indication of drug use Less than one 6 60% month (n=10) One to two 9 36% months (n=25) Two to three 4 22% months (n=18) More than three 3 15% months (n=20) Total (n=73) 22 30% Housing Stability Twelve percent of clients were homeless at some time during the one-year post-release period. Table 6: Post Release Homelessness by Time in BACR Time in BACR Number who were homeless Percent who were homeless Less than one 2 20% month (n=10) One to two 3 12% months (n=24) Two to three 1 6% months (n=18) More than three 3 14% months (n=21) Total (n=73) 9 12% Employment Status Fifteen percent of clients overall were employed full-time at some point in the post-release year and another 38% had part-time or occasional paid work (Table 7). Clients who had less than one month in BACR were the most likely to be unemployed.

153 Bay Area Community Resources Appendix E 151 Outcome Evaluation Study 2005 Table 7: Employment in Post Release Year by Time in BACR Part- Time in BACR Full- Time/ None Total Time Occasion al Less than one month 0% (0) 22% (2) 78% (7) 100% (n=9) One to two months 22% (5) 39% (9) 39% (9) 100% n=23 Two to three months 18% (3) 38% (6) 44% (7) 100% (n=16) More than three months 10% (2) 45% (9) 45% (9) 100% (n=20) Total 15% (10) 38% (26) 47% (32) 100% (n=68) Outcomes by Volunteer/Mentor Status There were 17 volunteer/mentors included in the probation notes data. Table 8 below presents the post-release outcomes discussed in the earlier sections by volunteer/mentor status. Percentages are based upon non-missing data for each item. Volunteer/mentors had better outcomes than regular participants in many areas. They were more likely to enroll in a treatment program, complete a treatment program, participate in a 12-step support groups, be less likely to have evidence of drug use, and were more likely to be employed full time. They were as likely to be homeless, be employed in any capacity (full time, part time, or occasional), and as likely to be remanded to jail for failure to meet conditions of parole or probation. Table 8: Probation Outcomes by Volunteer Status (N=83) Volunteer/ Regular Mentors Participant (N=17) (N=66) Outcome Percent Percent Enrolled in a treatment 88% 68% program Completed a treatment 40% 27% program Participated in a 12-Step 50% 37% Evidence of drug use 7% 37% Homeless 13% 12% Employed Full time 36% 9% Part-time/Occasional 14% 43% Remanded 35% 33%

154 152 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 B. Criminal Recidivism (CJIS Data) For this analysis we included individuals who had been released to the community within one month following termination from the BACR program. Of the 110 clients for whom we obtained Marin County booking data, 89 were eventually released to the community or a residential treatment program. However, only 52 met the criteria of being released within one month of termination from the program and are included in the one-year post-release analysis. Demographics Almost three-fourths of the study group is male (73%) and 27% are female. The largest ethnic/racial group is White (71%) followed by African-American (15%) (Table 9). The average age was 38 years and ranged from 19 to 63 years of age. Table 9: Ethnic Distribution of Clients in CJIS Dataset (N=52) Race/Ethnicity Number Percent White 37 71% African-American 8 15% Latino 3 6% Asian/Pacific Islander 1 2% Other/Bi- 3 6% Racial/Unknown Total % Bookings Of the sample of 52, 56% (n=29) had one or more bookings in the year following termination from treatment. After dividing the sample into four groups by length of time in the program we can see that those who were in the program for less than one month were the most likely to have a booking in the following year (Table 10; Chart 2). The group least likely to have a booking was those who were in the program for three or more months. However, that group had the highest average number of bookings. Sub-sample sizes are very small. Future analyses with larger samples will be important to see if the emerging patterns remain.

155 Bay Area Community Resources Appendix E 153 Outcome Evaluation Study % Chart 2: Clients with One or More Bookings One Year Post Release 70% 60% 71% 64% 50% 40% 30% 20% 10% 47% 40% 56% 0% <1 mo 1-2 mo 2-3 mo >3 mo Total Time in Program Time in Program(n) Table 10: Bookings One Year Post Release by Time in Program Number of Number of Clients with bookings: bookings: one or Pre- Post- more Treatment Treatment bookings Avg. (Std. Avg. (Std. Post Dev.) Dev.) Release Less than one month (n=14) 3.36 (2.20) One to two 2.82 months (n=17) (1.98) Two to three 2.45 months (n=11) (1.57) More than three 1.70 months (n=10) (1.25) Total (n=52) 2.67 (1.89) 1.29 (1.38) 0.94 (1.25) 1.09 (1.45) 1.50 (2.01) 1.17 (1.46) Pct. with one or more bookings Post Release 10 71% 8 47% 7 64% 4 40% 29 56% The charges for each booking were described by type (felony or misdemeanor). In addition they were placed into charge categories as described in the table below. Each booking may have multiple charge categories associated with it.

156 154 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Category Violent DUI Drug Theft License Violation Weapons Other DESCRIPTION OF CHARGES INCLUDED battery, domestic violence, threats of violence; violate restraining order driving under the influence of alcohol or other drugs under the influence of AOD (not DUI), manufacture, sale, possession of AOD or paraphernalia burglary, petty theft, robbery, receive or sell stolen property, forgery for financial gain, attempt to defraud, in possession of forged docs driving without a license or with revoked license; in possession of forged driver's license violate conditions of probation; failure to appear before court; while on bail. possession, sale, manufacture of weapons or explosives resist arrest, disorderly conduct, vandalism, not in any other category The number of individuals with at least one felony or misdemeanor booking decreased from the pre-treatment period to the post-treatment period. There were also decreases in the number of people with one or more bookings in each charge category (Chart 3; Table 11). The average number of bookings for the entire group (n=52) decreased as well. These decreases were statistically significant for total bookings, felony and misdemeanor bookings, and bookings with charges that were in the following categories: violent, drug-related, DUI, theft, violation, or other

157 Bay Area Community Resources Appendix E 155 Outcome Evaluation Study 2005 Chart 3: Pre and Post Treatment Comparisons of Jail Booking Types and Charges (N=52) Other Weapon Violation Driver License Theft Drug (not DUI) DUI Violent Misdemeanor Felony Any Booking 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent with any bookings of this type or charge Pre-treatment Post-treatment Table 11: Pre and Post Treatment Comparisons of Booking Types and Charges (N=52) Percent with any bookings of this type or charge Average number of bookings of this type or charge Booking Pre-tm. Post-tmt. Pre-tmt. Post-tmt. Type/Charge Z score Any Booking 100% 56% *** Felony 81% 44% *** Misdemeanor 88% 42% *** Violent 33% 10% ** DUI 27% 15% ** Drug (not 62% 33% ** DUI) Theft 31% 17% * Driver 25% 12% License Violation 36% 21% * Weapon 10% 6%

158 156 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Percent with any bookings of this type or charge Average number of bookings of this type or charge Booking Pre-tm. Post-tmt. Pre-tmt. Post-tmt. Type/Charge Z score Other 52% 23% * Comparisons were made using Wilcoxon signed rank tests, *p<.05 **p<.01 ***p<.001 Days in Jail Table 12 below compares the days in Marin County Jail for bookings occurring one-year pretreatment to one-year post-treatment. If an individual was released to another in-custody institution (for example, state prison or another jurisdiction) or was incarcerated in another county those days are not reflected here. The group as a whole (N=52) saw a statistically significant average decrease of 65 days in jail from bookings occurring one-year pre-treatment to one-year post-treatment (t=2.51; p<.05). Fifty-six percent had one or more jail days in the post-treatment period. Differences in change in days in jail by the length of time in the treatment program showed that those who participated for one month or less had poorer outcomes. However, the number in each group is too small and the variance too large (as measured by the std dev) to determine if these observations are statistically significant. Table 12: Days in Jail for Pre and Post-Treatment Bookings by Time in Program Time in Program(n) Average days in jail pre-tmt. Average days in jail post-tmt. Change in days Avg. (Std Pct. with one or more days of jail post-tmt. Dev) Less than one % month (n=14) (194) One to two % months (n=17) (147) Two to three % months (n=11) (278) More than three % months (n=10) (103) Total (n=52) (187) 56%

159 Bay Area Community Resources Appendix E 157 Outcome Evaluation Study 2005 Volunteer/Mentor Status The resulting sample of 52 contained only 8 participants identified as mentor/volunteers. While findings comparing mentor/volunteers with regular participants are presented here, caution should be taken generalizing to the larger group because of the small sample size. The volunteer/mentors on average had a greater number of bookings and jail days prior to entering the BACR program than did regular participants (Table 13). In the year after release volunteer/mentors still had a somewhat higher number of bookings, though the decrease in the number of bookings was the same. Volunteer/mentors had both fewer jail days post treatment and a greater decrease in jail days than did regular participants. Table 13: Justice Outcomes by Volunteer Status (N=52) Volunteer/Mentors (N=8) Regular Participant (N=44) Outcome Std. Dev. Average Average Std. Dev. Pre Treatment Bookings Post Treatment Bookings Change in Bookings Pre Treatment Days in Jail Post Treatment Days in Jail Change in Jail Days Cost Savings in Jail Days The following is an analysis of potential costs savings due to averted days in jail resulting from program participation. The average reduction in days in jail from pre to post treatment is multiplied by the cost per day in Marin County jail. Because those staying longer in the program had a greater reduction in one-year post-release jail days, the corresponding cost savings was greater as well and ranged from $5,492 to $11, 215 per person (Table 14). Less measurable is the impact that crimes avoided have on the community. Additional social savings beyond those we are able to measure might be expected to arise from longer-term reductions in recidivism, from participation in employment, lower use of public benefits, and reductions in other antisocial behaviors such as family violence.

160 158 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Table 14: Cost Savings Due to Reductions in Jail Days Time in Avg. prepost reduction Pre-post cost differential in jail days* Program(n) in days in jail Less than one 12 $1,375 month (n=14) One to two 60 $6,867 months (n=17) Two to three 110 $12,590 months (n=11) More than three 100 $11,446 months (n=10) Total (n=52) 65 $7,440 * average reduction in jail days X cost per day ($114.46) C. Satisfaction with Program Functioning and Impact The findings in this section are the result of focus groups with current participants, interviews with treatment providers in the community who have had BACR participants enter their program upon release from jail, the Marin County Jail Commander, the Director of Adult Probation in Marin County, and the BACR Program Director. In-Custody Substance Abuse Treatment A Matter of Timing Focus group participants agreed that a treatment program in jail is a good idea, and many wondered why participation is not mandatory. Some suggested that they and others might not be exposed to treatment any other way, and it catches participants at an opportune time. Jail is supposed to provide rehabilitation, not punishment, and this program gives people a chance to learn from their mistakes, to take responsibility for changing their behavior. Even though he is heading for prison, one man finds it is constructive to work on himself and to help others this helps with being in limbo and with the stress of not knowing about his case between court appearances. Another stated that without the program he would never have come to grips with his addiction. The aspect of starting people in treatment when they are the most open and vulnerable is a strength of the program that was seconded by key informant interviewees. These men and women are in jail and don t want to be there. It is a good opportunity to help them connect dots between their actions and behaviors (of drug use and criminal behavior and being in jail). They learn how to improve their life. It is an opportunity to funnel into County Parole to continue treatment on the outside and gets them going in right direction before being sentenced by the court.

161 Bay Area Community Resources Appendix E 159 Outcome Evaluation Study 2005 The immediacy and availability of an in-jail program is a strength described by key informant interviews as well. There is not the problem of lack of available bed space as can occur in treatment in the community. This is also a way to make use of their idle time. Many of the inmates who are not in the treatment pods spend much of their time watching trash television. Focus on Recovery & Personal Growth Many participants credit the program for forcing them to get past their denial and acknowledge their addiction. Instead of believing that being in jail is the problem, participants may begin to understand the problems with the choices they made on the streets. The program has helped them to focus realistically on their lives, and to realize they can do something different. Participants are getting prepared for a program in the community. Everything the program offers is important to recovery and I m grabbing it, was the comment by one participant. Another indicated that she had no idea who she was when she was on the outside, and is committed to staying in the program until she has done her 90 days. In this program participants meet people who have their sobriety and they grasp this as a possibility for themselves. The program helped several people change their belief that they had to be like their parents who used drugs and has given them the tools for recovery and an ideal place to put these into practice. These tools include the communication skills to talk both about what is wrong as well as solutions, and tools to help build on and maintain sobriety. Some people are in the program with others they knew from the streets and feel good about the effort to put positive energy into changing the nature of these interactions. Several participants feel they are slowly learning life skills like discipline and social skills. The program has helped some individuals stop being isolated and to express their feelings, which in turn helps them understand that their problems are common and to not judge others based on appearances. Instead of being dismissed, criticism from others is taken seriously and considered. Their thoughts are constructive and geared toward the positive, and some participants have become more spiritual. Participants know they must take responsibility and be accountable for themselves. People have developed more perseverance as a result of following the routine of the program, especially after cycling through it more than once, and following rules here makes them think it is possible to stop doing crimes on the outside. Motivation for Treatment The primary goal of the in-custody program is to motivate participants to engage in treatment following release from jail. Many of the participants reported they had not thought of entering residential treatment before and intend to enter a program when released into the community. This is the case even for those individuals who will go to prison first. The program has given them tools for recovery and there is a desire to keep learning in residential treatment. For the first time many participants now understand that while they can follow the straight and narrow they cannot do it alone. The focus is no longer on the quickest ticket to the streets but on doing what it takes to recover.

162 160 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Without the treatment pod an inmate couldn t take care of both jail sanction and have treatment simultaneously. As observed by the Adult Division Probation Director the longer a person sits in jail being punished the less likely they are to be motivated to put in extra time for a treatment program upon release. It can feel just like more punishment to them because they feel they have paid the penalty and are less motivated for putting in additional time. As a result they see postrelease treatment as punishment. However, the attitude of the treatment pod participants is different. With the in-custody program they are taking care of a court obligation and doing something that benefits them at the same time. During this time there is opportunity to change their attitude toward treatment. Once they get out of jail they see treatment as a benefit not a punishment. Increased motivation for treatment gives momentum for the Probation Officer to build on when the inmate is released. The PO is not required to convince them to go into treatment. The process is jump-started. Staff of four residential treatment programs that work with BACR clients upon release were asked to discuss participants treatment readiness and motivation for recovery as compared to their other clients. There was general agreement that BACR did a wonderful job of preparing participants for residential treatment upon release. The activities that BACR clients participate in during the program prepare them for similar types of activities they will do in long-term residential treatment. One interviewee commented that the emphasis on taking personal responsibility for their behavior greatly furthers the men s progress with treatment. While treatment staff agreed that clients were extremely motivated all stated that are many individual factors that contribute to motivation and success including: length of stay in jail, number of times in jail, if court-ordered to treatment, presence and severity of a dual diagnosis, and prior treatment experiences. Staff from two programs felt clients from BACR were as likely as others to complete the program and two thought BACR clients were more likely to complete the program once enrolled. One program staff person estimated that 80% of BACR clients referred graduate from their program. The Role of Volunteer/Mentors Overall, the men think it is a good idea to have people with more experience mentor and motivate other participants. It is great to see the responsibility and accountability the mentors demonstrate in the program especially in light of the wrong they did on the outside. Participants acknowledged that some people have a difficult time seeing the mentors as anything but another inmate, as a criminal just like them. Information they would accept from someone in street clothes is dismissed. However, when asked if they want to be a mentor, all members of the focus group replied affirmatively. There has been high turnover on the women s pod so few of the women had a Big Sister and could comment on their role. The participants in the focus group that included only mentors were enthusiastic about the idea that everyone is and should be considered a mentor that they can all be role models to one another. A participant might look up to and learn from a man because of how he acts though he is not a designated mentor. By the same token it is natural that people are drawn to someone they see doing well, giving him no choice but to become a role model. A participant may do what appears to be a little thing, like translating for monolingual Spanish speakers, but soon realizes people need his help and then good things happen and it feels good to be looked up to. When

163 Bay Area Community Resources Appendix E 161 Outcome Evaluation Study 2005 dealing with struggles like court and not knowing their future, these participants welcome the chance to get involved with someone else s problems. It is often when working with or giving advice to someone, they can see the need to take their own advice. This meaningful interaction helps them to stop focusing on the here and now and see light at the end of the tunnel. Finally, the participants agreed that although the best support and advice might come from the senior members of the pod, they will not turn each other down when in need. Program Strengths Several consistent themes surfaced in the focus groups in response to the question of program strengths. Program participants learn they are not alone in their addictions and that they must examine themselves deeply and ask questions about changing their lives. People realize they need help and learn how to ask for and accept support. The importance of helping others and learning what they share in common creates a sense of community. The men emphasized that C- pod is very different from other pods in the jail, asserting that there is no racial tension but positive peer pressure and caring instead. While both the men and women feel they have learned to accept others, the men feel that they can take off their masks and be accepted in spite of their faults. Participants appreciate the counselors personal experiences with addiction and the knowledge they share. The men benefit from male counselors who demonstrate how to be open with others. The counselors are able to find weaknesses and encourage and inspire growth. Participants acknowledged that the counselors are busy but do what they can, including locating resources in the community. The personal experience that the counselors have had with addiction and the justice system was seen by key informants as a strength as well. They know what is going on. However, they clearly have a commitment to the population and believe they are still reachable and can change. With regard to the best parts of the curriculum, participants indicated the program has a lot to offer, including valuable tools to use when released from jail to the community. This is probably one of the most successful programs in a jail, was a response to this question from one of the men. There are also opportunities to learn life skills, educational programs such as GED preparation, NA/AA parenting groups and classes on domestic violence from Marin Abused Women Services (MAWS) for men, and bible study and classes on spirituality. The MAWS classes were described as excellent and valuable even for those never involved in an abusive relationship. Participation during these classes is said to be phenomenal, and comments about a recent exercise included very gripping, everyone was elated, and appreciated it. When asked about the group sessions participants agree that they are helpful for a number of reasons. Groups are where they learn to communicate, can reveal anything, including their faults, get feedback, and begin to see themselves and other people from different perspectives. They know their confidentiality is safe and there is support and camaraderie. In groups, they learn and discuss recovery related information - real information. Participants can see the light bulbs turning on as people get it. Individual counseling is seen as very helpful but difficult to get because there are so many people in the program for the staff to manage.

164 162 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Areas Needing Attention Men s Program C-Pod participants pointed out the need for more accountability and consequences for those people following their lawyer s recommendation but not participating. 1 The men seemed particularly concerned about the negative influence someone can have on everyone else if he promotes gang-related activities or has the standard jail attitude and just wants to beat his case. The men had more specific comments than the women about elements of the program in need of improvement. Though not all are viable they are all listed here and are as follows: more staff, especially Spanish-speaking staff; 2 additional individual counseling (also requested by women); 3 additional programming on the weekends (also requested by the women); 4 updated educational videos; 5 special programming for Latino participants, especially monolingual Spanish-speakers; 6 community outreach to local high schools (this might help some participants to grow); more teachers from Marin Abused Women s Services; less frequent repetition of Stage 1 curriculum; employment and housing services; 7 interaction with the female participants on F-Pod (a chance to hear their perspective); contact visits with children (a chance to use new parenting skills); and more flexible visiting hours. Some men mentioned that it is valuable for the counselors to have experience with issues of criminality. Without this, the little things that happen in jail (the small permissions a participant might give him or herself) are not connected to a person s behavior on the outside. Some topics do not get enough attention or the counselor might change the direction of a discussion in a way that is difficult to follow. In spite of these criticisms, the participants give the counselors credit, and are aware that responding to the demands of so many people could be overwhelming. One participant noted it must be frustrating for the counselors to work with people who keep returning to jail. 1 Footnotes are added for this manual to reflect the program s responses to viable recommendations since the 2005 study. We have increased the number of volunteer positions to 14, with a total of 22 volunteers serving in these positions. Volunteers in A pod are now about one-third of the population. This has increased peer pressure for inmates to participate seriously in the program. 2 Staff job descriptions now include a preference for bilingual Spanish speakers, and we actively seek bilingual staff when recruiting. 3 Each counselor now has a caseload and sees each person on the caseload individually at least once a month. In addition, counselors follow up individually about issues that they see emerge in the group sessions or elsewhere in the program. 4 Programming on weekends has been added. See the program schedule in Chapter 2. 5 Videos are updated regularly. 6 In-house AA meetings and NA meetings in Spanish have been added to the program. See the program schedule in Chapter 2. 7 The Marin Jobs Council now provides an employment program, but rather than being part of our program it occurs through the Jail and is accountable to the Jail Program Director. See the program schedule in chapter 2.

165 Bay Area Community Resources Appendix E 163 Outcome Evaluation Study 2005 Women s Program An area agreed on by staff and women participants to be facing difficulty is the women s program. Because there is only one woman s pod in the jail, program participants are housed together with inmates not in treatment. 8 The women do not enjoy the isolation from the general jail population that allows the men s program to create a therapeutic community. This structural issue also limits the total amount of programming time. One participant put it this way, the number of hours I spent hustling for my fix I should put that much time in my recovery. The jail commander, who is extremely supportive of this program, also stated that he would like to see an intensive all-day program for the women. If funds were available to add additional staff and retrofit F-Pod to create a physical barrier separating treatment vs. non-treatment areas for the women, they would be able to create such a program. Participants also reported that supervising deputies are not uniformly supportive of the women s program. As with the men the women shared that they are concerned about and irritated by participants who have not made treatment their priority. Arriving late for groups, cross-talking or otherwise not paying attention, these were examples of giving oneself small permissions when you are supposed to accept the rules. Those interviewed expressed the belief that lots of the women are here just because their lawyers said being in the program will help their case. Too much program time is spent by people discussing their cases and trying to get legal information. Overall, participants felt that the program in F-Pod could use more structure, and more time dedicated to program activities. Early Participant Impressions of the Program Participants were asked to think back to the first week or two they were in the program, their initial impressions, and what would have helped them during that time. Two of the women recalled noticing the lack of structure and infrequency of program activities within their first weeks on F-Pod. Another woman, in the program for just 3 weeks before this interview, did not think she needed treatment when she started and only agreed because of her lawyer but now understands it is helping her future. One woman remembers being in shock at first and found it comforting to have a forum and opportunity to talk about her addiction or just to listen to the stories others shared. The women indicated that they just got assigned Big Sisters (because the program has been so small) and that having a mentor in the first few weeks of the program would have helped them know what to expect. Two of the women recalled noticing the infrequency of program activities within their first weeks on F-Pod, reflecting a desire for a more intensive program. The evaluators observed that both the men and women participants had negative comments regarding those inmates who are not invested in or working the program. These may be 8 Women in F pod must now apply to be in our treatment program, which has helped create separation from nonprogram inmates in F pod. Support for the program has also increased, due to the institution of the position of Jail Program Director. The Director s advocacy for many programs in the jail has helped change inmates acceptance of our treatment program in F pod. In addition, Deputies now address participants as one of our F pod program activities, and their involvement has further legitimized and separated the program participants from the nonprogram participants.

166 164 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 individuals who initially enter the program because it was suggested by their lawyers or it looks good for their case. These participants can divert energy away from those who are trying to improve themselves. Yet there were many stories shared with the facilitator of individuals who over time realized the relevance of the program to their lives and became positive members of the community. Although they may not have bought into the idea of recovery initially over time they saw its value. Residents for the most part also felt that staff were good at weeding out those who are truly not ready for the program and pose too much of a negative influence. Benefits to Jail Functioning and the Probation Department Jail inmates must meet certain criteria to reside in the men s treatment pod. They are there because they want to be. They also know they can be expelled. The Jail Commander shared that as a result they are very manageable more so than the general population. The intense programming keeps them occupied and thus more easily managed. The focus group facilitator also observed a strong sense of community and interpersonal support which may also be related to better relations among inmates. The women s pod is different because it is not an exclusive program pod. While treatment programming occurs the women in treatment intermix with those who are not. Thus they do not see the same benefits on a group level as with the men in treatment (this is discussed in more detail later). Any time the inmates are spending time productively, whether it be in treatment or other supplementary programming in the jail rather than watching television is seen by supervisory personnel as beneficial. The BACR staff and Department of Probation work together as the time of a participant s release nears. BACR staff provide recommendations to the Probation Officer of the ongoing care and aftercare needed, which often becomes part of the probation requirements. Probation Officers get additional information from BACR staff about what other challenges or issues they may need to address when the inmate is released into the community such as major problems with an exspouse, mental health issues, people they have connected up with who may be a bad influence when they get out, other legal problems in other jurisdictions. They also inform PO s of their strengths or resources they have (family members, a potential job) that will support their sobriety and new lifestyle. BACR will confirm the level of motivation for treatment. Some inmates may declare their motivation but are not ready. BACR staff and Probation see if they are getting the same picture of the person and work together for the benefit of the individual as well as the good of the community. Prior to the BACR program inmates would request of their Parole Officers to get them out of jail and into a treatment program. Without the expertise in substance abuse treatment, the PO would make a determination of the best program, make phone calls and complete a great deal of paperwork, obtain permission from the court, arrange for transportation to the program and often find that the individual never made it to the program or dropped out and disappeared. By providing in-custody treatment BACR has saved the Probation Department a great deal of time. The Parole Board may also utilize BACR in making recommendations. Inmates often request to be paroled in order to enroll in treatment. The Parole Board may require them to complete the jail pod program first. BACR is also called upon by the Parole Board to make recommendations for post-release treatment plans for inmates up for parole.

167 Bay Area Community Resources Appendix E 165 Outcome Evaluation Study 2005 Coordination with Treatment Programs in the Community All community treatment program staff were extremely pleased with BACR s referral and placement process. One program representative was also impressed with the thoroughness of the BACR assessments. One of the programs would like to see BACR staff continue contact with their program and become part of the treatment team for the client. Another commented on a problem that all programs in Marin County face which is the difficulty connecting clients with psychiatric services. V. Discussion A. Results A goal of the Marin County Sheriff s Office as stated in the Jail Mission Statement is: To provide a vast array of educational, literacy, addiction counseling, parenting and other inmate programs that will create opportunities for inmates to make positive changes in their lives and thus become productive members of the communities in which they live. BACR s in-custody substance abuse treatment program has helped inmates take steps to make significant changes in their lives. The interviews and focus groups attest to the program s effectiveness in motivating clients and readying them for additional treatment upon release. In addition, BACR staff match clients to treatment programs and facilitate the client s entry into treatment. Research on treatment in both community and criminal justice settings consistently shows that motivation and readiness for treatment are significant predictors of engagement and retention in treatment and entry into aftercare which has a direct effect on decreased drug use and re-incarceration (Burdon et al, 2004). Data from probation indicates that a large portion of BACR clients (70%) do indeed engage in treatment services upon release from jail. Length of participation in BACR appears inversely related to the likelihood of using drugs post release with those with longer periods in the program being the least likely to have evidence of drug use in the probation notes. This evaluation showed that participation in the program was related to reduced criminal recidivism. Those with the least amount of time in the program were the most likely to have at least one booking in the year post-release. A significant reduction in jail days from pre to post treatment was also enjoyed by those in participating in the program for longer periods of time. Volunteer/mentors also had better outcomes on most indicators. It would appear that participants in the jail program fared better as compared with California Prop 36- SACPA participants state-wide one-year post release. One major difference is that BACR clients were more likely to get into treatment and at a level appropriate to the severity of their problem, which was a reported problem faced by SACPA. BACR clients were more likely to complete treatment and less likely to have a drug-related re-arrest. While about one-quarter (24%) of all SACPA participants completed treatment (Longshore et al, 2004), 30% of BACR clients (regardless of length of time in the program) completed a treatment program. One-half

168 166 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 (50%) of SACPA participants had a drug-related re-arrest compared to 33% of BACR clients. According to interviews conducted as part of this evaluation, Marin County Jail, Probation Department, and treatment providers in the community find direct benefit from this program. The benefits include: a more manageable inmate population which uses it s time productively, informed recommendations to the Parole Board, an in-custody treatment resource for the Parole Board, support for Probation Officers in their assessment of inmate needs upon release, and coordination of enrollment into a treatment program upon release. Treatment programs in the community appreciate the high level of expertise that BACR provides during the referral and placement process. B. Challenges & Recommendations As described in this report the women s program faces some barriers that present challenges to reaching the level of quality achieved by the men s program. Lack of isolation from the general jail population is the primary problem faced. Physically separating the program through architectural strategies may not be feasible at this time. Personnel should explore alternative strategies. Contacting programs in other jurisdictions providing treatment with limited space may yield new approaches for improving program delivery to Marin County Jail s women participants. Cross-training of jail staff who work in the treatment pods with treatment personnel may be helpful. C. Future Evaluation Efforts The results of this evaluation show that the BACR intensive day treatment program in the jail answers a demonstrated need and is meeting its objectives. Particularly interesting is the finding that those who leave the program early (less than one month) have poorer outcomes than those who complete the program. While planning this evaluation we struggled with creating a comparison group. It is unlikely that there is a large enough group in the jail with documented substance abuse problems who did not get into the program. The sub-analyses by length of time in the program conducted in this report may continue to be the best option. It will be important to determine if the trends seen in this report continue as we obtain data for larger numbers of clients. Future analysis could also include demographic factors. There is an additional source of data that may be valuable to include in subsequent evaluations. The program has been collecting extensive assessment data for clients upon program entry. As this data is collected on increasing numbers of clients, selected information may be incorporated both as descriptive information and for predictive purposes. VI. References Belenko, S. (1998). Behind bars: substance abuse and America s prison population. New York: National Center on Addiction and Substance Abuse at Columbia University (CASA).

169 Bay Area Community Resources Appendix E 167 Outcome Evaluation Study 2005 Brown, S.L. (2000). Cost-effective correctional treatment. Forum on Corrections Research. Vol. 12(2). Ottawa. ON: Correctional Service of Canada. Bureau of Justice Statistics. (2003). Reentry Trends in the United States. Bureau of Justice Statistics, U.S. Department of justices. Available Burdon, W., Messina, N., Prendergast, M. The California Treatment Expansion Initiative: Aftercare participation, recidivism, and predictors of outcomes. March The Prison Journal, 84(1), Hall, E., Prendergast, M. et al. Treating drug-abusing women prisoners: an outcomes evaluation of the Forever Free Program. March The Prison Journal, 84(1). Hiller, M.L., Knight, K., & Simpson, D.D. (1999). Prison-based substance treatment, residential aftercare and recidivism. Addiction. Vol. 94(6), IDU HIV Prevention. (2001). Helping inmates return to the community. Department of Health and Human Services. Join Together Online. Recidivism Legislation Could Include Addiction Services. 1/18/ Kassebaum, P. Substance Abuse Treatment for Women Offenders: Guide to Promising Practices. Technical Assistance Publication #23. Substance Abuse and Mental Health Services Administration. U.S. Department of Health and Human Services Publication No. (SMA) , Rockville, MD. Longshore, D. et. al. Evaluation of the Substance Abuse and Crime Prevention Act 2003 Report Integrated Substance Abuse Programs, University of California Los Angeles. Marks, M. (2003) For our health and safety: Joining forces to beat addiction (Report #169). Sacramento, CA: Little Hoover Commission on California State Government Organization and Economy. Office of National Drug Control Policy. (2001). The Economic Costs of Drug Abuse in the United States: Washington, DC. VII. Appendices Participant Focus Group Questions Date of Focus Group: Location: Facilitator:

170 168 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Number of participants: Ages: Gender: Males: Females: Race/Ethnicity: African American: Latino: Asian: White: Other: Go around circle and ask #1 and #2 diagram and use code for answers to subsequent responses. 1. How long (# weeks or # months) have you been in this program? 2. How many of you have been in another treatment program not in the jail? 3. Is it a good idea to have a treatment program in the jail? Why and why not? 4. What are the best parts of this program things that are helping you the most (ask for examples)? 5. What are the worst things areas that need improvement (ask for examples)? 6. Think back to the first week or two you were in the program. a. What did you think of the program then? b. What helped you / would have helped you then? 7. How has the program affected you in your recovery efforts? In what other ways have you changed or grown since you began the program? 8.. How has this program affected your motivation and intention to enter a treatment program after your release? 9. How well does it work to have other inmates work as volunteer/mentors in the program (advantages/disadvantages)? 10. Do you want to be a mentor? Why? Why not? 11. Are the group sessions helpful? Why/why not? Are there enough group sessions? 12. Is the one-on-one counseling time helpful? Why/why not? Enough one-on-one time? 13. Would you recommend this program to other people? Volunteer/Mentor Focus Group Questions Date of Focus Group: Location: Facilitator: Number of participants: Gender: Males: Females: Race/Ethnicity African American: Latino: Asian/PI: White: Other: 1. How many of you have been in another treatment program not in the jail? 2. Is it a good idea to have a treatment program in the jail? Why and why not? 3. Now I want to discuss your role in this program. 4. How long have you been a volunteer/mentor? 5. Tell me about what you do as volunteer/mentors? 6. What are the benefits or advantages both to you and to the other participants of having fellow inmates serve as volunteer/mentors?

171 Bay Area Community Resources Appendix E 169 Outcome Evaluation Study What are the problems or disadvantages of having fellow inmates serve as volunteer/mentors? 8. How has being a volunteer/mentor affected you in your recovery efforts? 9. What are the best parts of the program overall things that have helped you the most (ask for examples)? 10. What are the worst things areas that need improvement (ask for examples)? 11. How has this program affected your motivation and intention to enter a treatment program after your release? 12. Would you recommend this program to others?

172 170 Appendix E Bay Area Community Resources Outcome Evaluation Study 2005 Treatment Provider Interview Interviewee: Agency: Date of Interview: Interviewer: 1. Respondent s role (counselor, clinical supervisor, director, etc.). 2a. How many (and what proportion) of your clients are typically referred from BACR s Marin County Jail program? 2b. Do you have other clients who are coming directly from jail or who are justice involved? 3. How familiar are you with BACR s program in Marin County Jail? What do you see as the goals of this program? 4. What do you see as the strengths of BACR s jail program? 5. In what ways could the program be improved (tmt. svc./administration/ follow-up)? 6. How well does BACR manage the referral and placement process for its clients into your program? How could it be improved? 7. Compared to other clients (general and justice involved) how would you describe the degree of motivation and treatment readiness of participants coming from this program? 8. BACR utilizes inmates who have graduated from their program as volunteer/mentors? Do you know of any of your clients (current or past) who have been in this role? Are you aware of any differences in motivation of participants who were mentor/volunteers while in the BACR jail program? 9. Are your clients who come from BACR s jail program more likely, less likely, or about as likely to complete your program?