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 Webinar August 19, 2015 This research is supported by NIJ grant #2013-MU-0057

Overview of Presentation Provide background and overview 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

Study background In 2008, Section 102 (a) of the Second Chance Act amended the RSAT program funding legislation to provide aftercare, including case management and other support It also required a study on the use of funds for aftercare services In 2013, BJA removed the 10% cap on treatment services for individuals released from facilities 11/23/2018

What is aftercare? Aftercare services are defined as the treatment and support provided after release from prison/jail (Pelisser et al., 2007) . BJA specifies that “aftercare services must involve the coordination between the correction treatment program and other social service and rehabilitation programs, such as education and job training, parole supervision, halfway houses, self-help, and peer group programs” (BJA, 2008; 2014). 11/23/2018

Importance of aftercare Residential treatment can provide the foundation for recovery- but aftercare is essential for supporting individuals leaving correction settings (NIDA, 2016). The chronic nature of addiction and changes in brain chemistry make relapse likely (NIDA, 2007). Research indicates individuals who complete aftercare have better outcomes (e.g. lower recidivism) than those who complete just in-person treatment or untreated comparison groups. (Pelisser et al., 2007; Olson & Lurigio, 2014) 11/23/2018

RSAT aftercare 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 that use RSAT funds, 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 State Coordinator Inventory- includes all 50 states and 5 territories receiving RSAT funds, N=55 programs Response rate: 87% (n=48) 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

Types of subgrantee programs Setting for RSAT funded services (N=60) Majority of subgrantees were not using RSAT funds for transitional or aftercare services 18% (n=11) serve juveniles 18% (n=11) serve women only Service Setting % (n) Jail/Prison services only 63% (38) Jail/Prison & Post-facility and/or transitional services 18% (11) No facility based services- transitional and/or post-facility services only 11/23/2018

RSAT funded aftercare services This next section focuses only on RSAT funded services and support provided in a community setting A total of 13 programs interviewed spent some RSAT funds on post-facility (jail/prison) services 5 programs spent all of their resources on post-facility services Remaining used 4% to 75% of their RSAT funds Average amount of RSAT funds for programming is 86K, three are below 50K 11/23/2018

Target population and capacity Two programs targeted females only & two males only One program targeted juveniles Average daily enrollment during quarter ranged from 8 to 50 individuals Almost all programs (N=10) reported 75% to 100% of participants were under correctional supervision while receiving program services 11/23/2018

Program referral Ten of the 13 programs provide a linkage from a correctional setting to community service providers Six of these programs link directly from a RSAT prison/jail program For the remaining 3 programs, participants are court mandated to participate 11/23/2018

Aftercare program setting & models 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 8 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

What RSAT funds Programs have been in operation approximately 2-6 years, through one has been in operation for 18 years (a residential program) 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 A little more than 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

Screening and treatment planning Screening/assessment practices among aftercare programs All programs develop written individualized treatment plans- in which participants are actively involved Family members are only involved in treatment planning in 4 of the programs Type of Screening/Assessment % (n) Substance use 100% (13) Risk assessment 92% (12) Mental Health 85% (11) Trauma 46% (6) Half of the programs (n=7) report reassessing participants during the program 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 ten programs Peer support provided by six programs Twelve programs provided wrap-around support, and 8 reported linking clients to educational and vocational services 11/23/2018

Evidence Based Practices (EBP) All 13 programs reported using multiple EBPS 12 provide Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) Four programs provided EBPs that address criminal thinking- including Thinking 4 Change (T4C) and Moral Reconation Therapy (MRT) Four programs identified a trauma-specific EBP- all serve women 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 program funds like Access to Recovery (ATR) to support housing related needs (e.g. security deposit, utilities) Juvenile aftercare used to enrich treatment program by providing supplemental resources 11/23/2018

Innovations/unique features 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 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 analysis 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

Transitional and aftercare- not funded by RSAT Non-RSAT funded transitional supports (N=38) Among RSAT that dedicate all resources to in-facility treatment- majority have transitional supports for RSAT participants Among 47 programs that do not use RSAT funds for aftercare- little more than half – 55% (n=24) reported that RSAT participants receive some type of aftercare funded by other sources Activity % (n) Personnel/ case manger to support transition 95% (36) Written pre-release plan 97% (37) Referral to community SA provider 82% (32) Pre-arranged appointment with SA provider 58% (22) Personal contact with SA provider before exit 34% (13) 11/23/2018

Questions? 11/23/2018

References Department of Justice, Bureau of Justice Assistance FY2014 residential Substance Abuse Treatment (RSAT) for State Prisoners Program Formula grant announcement. (Washington, DC: DOJ, 2013). National Institute on Drug Abuse. (2006). Principles of drug abuse treatment for criminal justice populations: A research-based guide (NIH Pub. No. 06-5316). Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment National Institute on Drug Abuse. (2007). Drugs, brains, and behaviors: the science of addiction (NIH Pub. No. 14-5605). Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. http://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction Olson, D.E & A. J. Lurigio. (2014). The long-term effects of prison based drug treatment and aftercare services on recidivism, Journal of Offender Rehabilitation, 53: 8, 600-619, DOI: 10.1080/10509674.2014.956965 Pelisser, B., N. Jones and T. Cadigan. (2007). Drug treatment aftercare in the criminal justice system: A systematic review. Journal of Substance Abuse Treatment, 32 (3): 311-320, DOI: 10.1016/j.jsat.2006.09.007 11/23/2018