UCLA’s Statewide Evaluation of Proposition 36 Darren Urada, Ph.D. UCLA Integrated Substance Abuse Programs Association for Criminal Justice Research (California) October 16, 2008

Topics What is Prop 36? What is Prop 36? Show rates Show rates Completion rates Completion rates Arrests Arrests Cost Cost Recommendations for Reducing No-Shows Recommendations for Reducing No-Shows Employment Employment Narcotic Replacement Therapy Narcotic Replacement Therapy Incentives & Sanctions Incentives & Sanctions Process Improvement Process Improvement

What is Prop 36? Passed by California Voters in November 2000 Passed by California Voters in November 2000 Enacted into law as the Substance Abuse and Crime Prevention Act (SACPA) of Enacted into law as the Substance Abuse and Crime Prevention Act (SACPA) of If an adult is convicted of a drug offense or commits a drug related parole violation and meets other eligibility criteria, the offender is given the option of receiving supervision with substance abuse treatment. If an adult is convicted of a drug offense or commits a drug related parole violation and meets other eligibility criteria, the offender is given the option of receiving supervision with substance abuse treatment.

Prop 36 Treatment Client Characteristics Primary Drug: Meth 57.0%, cocaine/crack 13.1%, marijuana 12.5%, alcohol 8.2%, opiates 8.0%. Primary Drug: Meth 57.0%, cocaine/crack 13.1%, marijuana 12.5%, alcohol 8.2%, opiates 8.0%. Sex: 73% male Sex: 73% male Average age: 34.8 Average age: 34.8 Ethnicity: 43.9% non-Hispanic White, 35.9% Hispanic, 13.6% African-American. Ethnicity: 43.9% non-Hispanic White, 35.9% Hispanic, 13.6% African-American. First time in treatment: 50.4% First time in treatment: 50.4% Probation: 86.8%, Parole: 13.2% Probation: 86.8%, Parole: 13.2%

Prop 36 Offender Pipeline Referred Assessed Placed in Treatment (Step 1) (Step 2) (Step 3) 85.6% 82.8% 85.6% 82.8% 48,996 Yes 41,925 Yes 34,702 No 7,071 No 7,223 No 7,071 No 7,223 All categories may include people who “opted out” later Data Source: SACPA Reporting Information System, adjusted Overall Show Rate: 70.8%

Prop 36 Treatment Clients by Modality (CADDS), 7/1/05 – 6/30/06 (N = 40,358)

Discharge Status by Referral Source (CADDS admissions ) Discharge Status by Referral Source (CADDS admissions ) Note: Requirements may differ - Prop 36 completers spend about 30 days longer in tx.

New Arrests During 42 Months After Offense Prop 36 Offenders, July 2001 – June 2002 (N =17,519)

New Arrests During 42 Months After Offense Prop 36 Year One vs Pre- Prop 36 Comparison Group

Crime Trends Source: FBI Uniform Crime Reports, National Archive of Criminal Justice Data Statewide, drug crime arrests rose more in California than nationally (21% vs 14%). Statewide, drug crime arrests rose more in California than nationally (21% vs 14%). Statewide, property crime arrests rose more in California than nationally (6% vs 0%). Statewide, property crime arrests rose more in California than nationally (6% vs 0%). Statewide, violent crime arrests dropped more in California than nationally (12% vs 9%) Statewide, violent crime arrests dropped more in California than nationally (12% vs 9%)

Cost Analysis by Treatment Status 42 month follow-up Hawken, Longshore, Urada, Fan, & Anglin (2008)

Cost Analysis: 42 month followup Hawken, Longshore, Urada, Fan, & Anglin (2008)

Recommendations

Suggestions we hear most often Funding Funding Funding Funding Funding Funding !

“Classic” Recommendations for Reducing No-Shows Co-locate assessment units in/near court Co-locate assessment units in/near court Assess in a single visit Assess in a single visit Allow walk-in assessments Allow walk-in assessments Incorporate procedures used in drug courts Incorporate procedures used in drug courts

Employment: Focus Group Ideas Lower cost suggestions: On-site “one-stop shopping” employment services, professional job counselor On-site “one-stop shopping” employment services, professional job counselor “Felon-friendly” job lists “Felon-friendly” job lists Vocational education (regularly, weekly, evenings) Vocational education (regularly, weekly, evenings) Tap into networks of alumni who can provide job search assistance, contacts Tap into networks of alumni who can provide job search assistance, contacts GED graduation ceremonies GED graduation ceremonies Funding stability Higher Cost Suggestions:

Narcotic Replacement Therapy Methadone: still the “gold standard” to treat opiate addiction but there is exceptional resistance Methadone: still the “gold standard” to treat opiate addiction but there is exceptional resistance Trainings needed, but valid concerns, barriers exist. Trainings needed, but valid concerns, barriers exist. Suboxone (Buprenorphine + Naloxone) an alternative for areas without a methadone clinic. Suboxone (Buprenorphine + Naloxone) an alternative for areas without a methadone clinic.

Sanctions & Incentives Incentives work and are preferable to sanctions. Incentives work and are preferable to sanctions. Literature: Testing and sanctions programs implemented with certainty and consistency have led to reduced drug use, recidivism. Literature: Testing and sanctions programs implemented with certainty and consistency have led to reduced drug use, recidivism. Examples: DC Drug Court Experiment, HOPE Examples: DC Drug Court Experiment, HOPE Literature: When sanctions were not delivered with certainty, the program failed Literature: When sanctions were not delivered with certainty, the program failed Example: Maryland’s Break-the-Cycle Example: Maryland’s Break-the-Cycle

Treatment Provider Perceptions – would jail sanctions improve treatment completion? Source: UCLA 2007 Proposition 36 Treatment Provider Survey

Process Improvement: Network for the Improvement of Addiction Treatment (NIATx) Process Improvement: Network for the Improvement of Addiction Treatment (NIATx) Designed to help treatment providers improve their own programs Designed to help treatment providers improve their own programs Goals: Goals: Increase admissions Increase admissions Reduce waiting times Reduce waiting times Reduce no-shows Reduce no-shows Increase client continuation in treatment Increase client continuation in treatment

Conduct a “walk-through” to understand the processes that facilitate or inhibit treatment goals from a client’s perspective. Conduct a “walk-through” to understand the processes that facilitate or inhibit treatment goals from a client’s perspective. Identify a measurable goal. Identify a measurable goal. Establish a Change Team to select and test changes to address the problem. Establish a Change Team to select and test changes to address the problem. Collect data before, during, after a change to see whether the change resulted in improvement. Collect data before, during, after a change to see whether the change resulted in improvement. Make adjustments to improve continuously and sustain changes. Make adjustments to improve continuously and sustain changes. Key Steps

LA County Pilot Project Change Example Southern California Alcohol & Drug Programs, Inc. Normally assessor would call program and whoever answered phone scheduled intake. Change: When assessment center called, a Prop. 36 counselor would talk with the potential client on the phone. Counselor introduced self Counselor introduced self Told client about the program Told client about the program Asked if client had any specific needs that should be addressed during treatment Asked if client had any specific needs that should be addressed during treatment Motivational interviewing-type strategies used Motivational interviewing-type strategies used

Tracking Change Results

Overall Results

For more info UCLA Prop 36 Reports: NIATx: Comments / Questions