Kristin Stainbrook, PhD The Residential Substance Abuse Treatment (RSAT) Aftercare Study: Early Findings on RSAT funded Aftercare Kristin Stainbrook, PhD RSAT Training and Technical Assistance Workshop New Orleans, LA ◊ July 16, 2015 This research is supported by NIJ grant #2013-MU-0057

Overview of Presentation Provide a description of the RSAT Study Describe the sample of RSAT funded aftercare programs and present preliminary data on services, challenges, and innovations Describe next steps for the analysis Open discussion about challenges to aftercare in your programs/communities

RSAT Study Research Aims Understand how States/Territories and Subgrantees use BJA RSAT funds for treatment and aftercare for offenders transitioning to the community Describe the specific substance abuse treatment and aftercare services that are supported with RSAT funds Describe the challenges, facilitators, and lessons learned 11/23/2018

Study Design and Methods The RSAT State Coordinator Program Inventory- focuses on understanding the role and responsibility of the RSAT Coordinator in funding and administering RSAT program funds. Administered as a web-survey The RSAT Subgrantee Program Inventory- focuses on Subgrantee facilities or agencies funded services with RSAT to understand: program setting and enrollment criteria; screening and assessment procedures; program staffing; the types of services and evidence based practices provided in RSAT programs, pre-release planning activities; aftercare related activities; exemplary practices; barriers and facilitators to aftercare; and lessons learned. Administered as a telephone interview 11/23/2018

Study Sample Coordinator Inventory- includes all 50 states and 5 territories, N=54 programs Response rate: 87% (n=47) Subgrantee Inventory- targeted all RSAT Subgrantees with active programs reporting PMT data in July-Sept 2014 quarter and serving at least 10 individuals during the period, N=77 programs Response rate: 78% (n=60) 11/23/2018

RSAT funded aftercare programs Includes all RSAT funded services and support provided in a community setting A total of 12 programs interviewed spent 20% or more of their funds on post-facility (jail/prison) services Two programs targeted females only & two males only One program targeted juveniles 11/23/2018

Program Referral Nine of the 12 programs provide a linkage from a correctional setting to community service providers Five of these programs link directly from a RSAT prison/jail program For the remaining 3 programs, participants are court mandated to participate Only 9 programs represent “aftercare” that is services provided to support clients following discharge from jail/prison 11/23/2018

Aftercare Program Setting & Model Two General Approaches: Five programs provide RSAT services in a residential treatment facility Two of these consider themselves halfway houses Transitional case managers are the primary service model for the 7 community based programs Average program length 6-months to year Program capacity small Transitional CM programs- average daily 20-50 Residential- average daily is 10-20 11/23/2018

Program Funding Programs have been in operation approximately 2-6 years, through one has been in operation for 18 years (a residential program) Average amount of RSAT funds for programming is 86K, three are below 50K Majority of RSAT funds are spent on staff positions All but one program spend funds on substance abuse counselors/clinicians; most also fund case managers and a small percentage of management/oversight (5-10% of funds) Two programs used RSAT funds principally for non-staff expenses 11/23/2018

Funding (con’t) All programs reported using other financial and in-kind staffing resources to support RSAT programs Most of the funding came from state resources About half use funds for non-staff expenses Training materials, drug testing, etc. Programs that included multi-service agency reported leveraging a broader range of services 11/23/2018

Program Services Main services provided by programs: All programs provide case management Substance abuse individual and group services provided by all but one program Trauma services provided in nine programs Peer support provided by six programs Ten programs provided wrap-around support, and 7 reported linking clients to educational and vocational services 11/23/2018

Evidence Based Practices (EBP) All twelve programs reported providing Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) Two programs reported Thinking 4 Change and Moral Reconation Therapy (MRT) Two identified a trauma specific EBP 11/23/2018

Innovations/Unique Features Funding/leveraging Use of RSAT funds to support Medication Assisted Therapy (MAT) by one site to fill an existing gap in the community One program uses portion of RSAT funds like Access to Recovery (ATR) to support housing related needs (e.g. security deposit, utilities) Juvenile program used to enrich aftercare program by providing supplemental resources 11/23/2018

Innovations/Strengths Outreach/engagement One program reported using peers to conduct in-reach to RSAT program to “sell” the aftercare program and promote the positive impact of the transitional support Among programs focusing on transitional CM - reported that having the same case manager/clinician providing support both in the facility and in community helped with enrollment and retention 11/23/2018

Innovations/Strengths Collaboration Majority of programs report participation in multi-system community boards/committees focused on diversion, re-entry, offender issues Regular opportunities for communication/ interactions around participant needs and progress between community corrections and RSAT case managers One program co-locates staff 11/23/2018

Innovations/Strengths Services Several respondents reported that contracting with a provider for RSAT program helped capitalize on resources available within the organization and its connections to other community providers Individualization of services to promote transition to community, including resources to support basic needs Using peers for groups and mentoring 11/23/2018

Challenges Funding and Resources RSAT funding decreases over the past few years, no longer adequate to support programming Community resources for treatment supports major barrier to long term recovery, no resources to support medication assisted treatment Majority of respondents identified housing and transportation as a barrier to participation in services *One program no longer using RSAT funds for program- taken over with state funds *Another program- used to be one of three in the state- not only one 11/23/2018

Challenges Services/Client Retention For residential programs, having clients with sentences long enough to participate or unanticipated release is a challenge For case manager programs, tracking clients and retaining them is challenging when it is voluntary A few sites mentioned the tension between what in legal interest of participant and interest of recovery 11/23/2018

Next Steps for Study Analyze the staffing, services and support funded by RSAT across all programs types Explore the transitional and aftercare services available to RSAT jail and prison participants that are not funded by RSAT Document the challenges and barriers to aftercare across programs 11/23/2018

Open Discussion What aftercare is available for participants in your RSAT programs? What are the biggest needs for participants transitioning from facility to community? What are the issues/challenges with providing aftercare for RSAT participants? 11/23/2018