1. 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

2. 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

3. 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
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4. 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).
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5. 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)
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6. 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
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7. 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
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8. 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)
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9. 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
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10. 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
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11. 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
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12. 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
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13. 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
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14. 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
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15. 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
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16. 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
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17. 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
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18. 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
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19. 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
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20. 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
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21. 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
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22. 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
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23. 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
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24. 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
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25. 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
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26. 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)
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27. Questions?
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28. 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 ). Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. National Institute on Drug Abuse. (2007). Drugs, brains, and behaviors: the science of addiction (NIH Pub. No ). Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. 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, , DOI: / 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): , DOI: /j.jsat
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