1. 1 Therapeutic Community Treatment in Correctional Settings The Call for An Integrated System George De Leon, Ph.D. Center for Therapeutic Community Research at NDRI, Inc. New York City Cite only with permission of the author

2. 2 ABSTRACT Some 20 years of research and clinical experience underscores the necessity for a systems-approach to advance the recovery and re- entry of substance abusers treated in corrections-based therapeutic communities.

3. ABSTRACT (Cont’d.) This presentation reviews a) key research conclusions and implications for integrated systems. b) the state of the current system of aftercare. c) barriers to an integrated system. d) components of a Recovery Oriented Integrated System (ROIS).

4. 4 A. RESEARCH CONCLUSIONS AND IMPLICATIONS FOR INTEGRATED SYSTEMS  A considerable research literature on TC treatment in correctional settings has developed in the past 15 years.

5. 5 A. RESEARCH CONCLUSIONS AND IMPLICATIONS FOR INTEGRATED SYSTEMS  Studies have mainly focused upon the issue of effectiveness and cost effectiveness of Prison TC treatment but have generated other findings that are relevant to the issues of recovery, re-entry and aftercare.

6. 6 A. RESEARCH CONCLUSIONS AND IMPLICATIONS FOR INTEGRATED SYSTEMS (Cont’d.)  The main conclusions from this research are outlined along with key implications for an effective system of aftercare.

7. 7 1. Client Profiles in Correctional Treatment  The substance abusers entering prison-based TC treatment settings (as well as community-based residential TC treatment) reveal severe drug use, deviant social and psychological profiles.

8. 8 1. Client Profiles in Correctional Treatment (Cont’d.)  Thus, an effective treatment and aftercare system must address the cognitive, emotional and behavioral dimensions that define the substance abuse disorder. Moreover, aftercare resources must make available the treatment and social services that promote recovery, not simply manage the disease.

9. 9 2. Treatment Effectiveness and Aftercare  Research documents that the effectiveness of modified prison TC for the treatment of substance abusing offenders is considerably enhanced when treatment continues in TC-oriented aftercare settings.

10. 10 2. Treatment Effectiveness and Aftercare (Cont’d.)  Positive outcomes obtained with clients who complete prison + aftercare reconstitute the time-in- treatment effects universally obtained in community based studies. Namely, duration of treatment involvement is directly related to post treatment success.

11. 11 2. Treatment Effectiveness and Aftercare (cont’d)  Thus, an effective aftercare system must be capable of keeping the individual engaged in treatment and/or social services long enough to assure stability in the recovery process.

12. 12 3. Client Motivation and Treatment  Research has illuminated the role of motivation in substance abuse treatment both in community based and criminal justice populations. Client motivation is a significant predictor of entry into treatment, retention in treatment, engagement in treatment and entry into aftercare.

13. 13 3. Client Motivation and Treatment (cont’d)  Thus, an effective and cost- efficient system of aftercare must be capable of assessing and sustaining client motivation and readiness to constructively utilize treatment and social services to advance their recovery.

14. 14 4. Recovery  Decades of treatment follow up and natural history studies document the fact of recovery in significant numbers of addicts.  Clinical experience, supported by developing research, indicates that recovery unfolds as a process of change which can be described as stages.

15. 15 4. Recovery (cont’d)  Thus, an effective aftercare system must have a common understanding of the process of recovery in order to define its goals and inform the deployment of resources on treatment interventions and social services.

16. 16 B. THE CURRENT TREATMENT AND AFTERCARE SYSTEM The conclusions from 20 years of research and clinical experience underscores the necessity for a systems-approach to advance the recovery and re- entry of substance abusers treated in corrections-based therapeutic communities.

17. 17 B. THE CURRENT TREATMENT AND AFTERCARE SYSTEM (cont’d)  The current system of aftercare consists of a fragmented aggregate of diverse community providers of social and treatment services, or surveillance activities.

18. 18 B. THE CURRENT TREATMENT AND AFTERCARE SYSTEM (cont’d.)  Goals are defined by the provider’s ideology, mission or mandate (e.g., medical, educational, medicational, vocational, housing).

19. 19 B. THE CURRENT TREATMENT AND AFTERCARE SYSTEM (cont’d.)  Service delivery is loosely coordinated or conceptually unrelated. This usually leads to duplication or lack of services, non utilization or poor utilization services, cost inefficiency, professional and agency turf conflicts. Notably, client dropout from aftercare is high.

20. 20 C. THE BARRIERS TO AN INTEGRATED SYSTEMS APPROACH There are inherent barriers to integration which reflect political, pragmatic, and professional features across the major components of the system.

21. 21 C. THE BARRIERS TO AN INTEGRATED SYSTEMS APPROACH (cont’d.)  Differing philosophies regarding substance abuse and treatment and the conflicting goals of those representing the CJS (corrections departments, parole departments, courts, judges, prosecutors) and those representing the treatment system (prison based and community based treatment providers).

22. 22 C. THE BARRIERS TO AN INTEGRATED SYSTEMS APPROACH (cont’d.)  An integrated systems approach to Prison-based TCs and community based aftercare programs must be informed by what is known about the client, the disorder, treatment and recovery.

23. 23 D. A RECOVERY ORIENTED INTEGRATED SYSTEM (ROIS)  ROIS is a paradigm of a systems approach. It emphasizes partnership linkages among community providers and prison-based treatment providers to coordinate transitional and aftercare treatment and services for post release clients.

24. 24 D. A RECOVERY ORIENTED INTEGRATED SYSTEM (ROIS) (cont’d.)  Additional partners in the system are parole/probation officers, judges, and social services agencies. (e.g., education, employment, family, mental health).

25. 25 D. A RECOVERY ORIENTED INTEGRATED SYSTEM (ROIS) (cont’d.)  Key components of ROIS are:  Recovery Stage Framework;  System-wide vernacular;  Uniform assessment protocol;  Coordinated procedures for referral and placement.

26. 26 D. A RECOVERY ORIENTED INTEGRATED SYSTEM (ROIS) (cont’d.)  The integrative ingredient of the system is an overarching framework of recovery.

27. 27 KEY ASSUMPTIONS OF ROIS:  (ROIS) consists of interrelated treatment interventions, surveillance and social services provided in a variety of settings, which is guided by a common perspective on the disorder and recovery.

28. 28 KEY ASSUMPTIONS OF ROIS (cont’d.)  In a ROIS, settings and modalities may change, but their purpose remains the same, to move the individual to the next stage in the process of recovery.

29. 29 KEY ASSUMPTIONS OF ROIS (Cont’d.)  Treatment services, social services and surveillance differ in their contribution to the recovery process.

30. 30 KEY ASSUMPTIONS OF ROIS (Cont’d.)  The optimal utilization of aftercare services in halfway houses, day treatment or outpatient setting depends upon the client’s stage of recovery.

31. 31 KEY ELEMENTS OF ROIS  A Recovery Stage Framework;  System-wide vernacular;  System-wide assessment protocol;  Coordinated procedures for referral and placement.