robert l. neri, lmhc, cap senior vice president /chief clinical officer westcare foundation, inc

“Drug Offender Treatment

Lessons Learned: New Challenges from

Institution to Community”2013 FADAA/FCCMH Annual Conference

Robert L. Neri, LMHC, CAPSenior Vice President /Chief Clinical OfficerWestCare Foundation, Inc.

Lessons Learned in Corrections

•Learning from the Past•Lessons of the Present•Looking to the Future

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Lessons Learned in CorrectionsTraining Objectives:

Participants will be able to list examples of the many dynamic changes in the field of drug

offender treatmentParticipants will be able to assess their programs’

readiness for future anticipated changesParticipants will be exposed to the significance of

the treatment environment and culture as it relates to outcomes

Participants will leave with several ideas to process and plan with their program staff 21

Lessons Learned in CorrectionsDo you know that 90% of your brain works without using any words at all?

Just so you know that means there’s only a 10% chance of me making any sense at all

once I start talking 31

Lessons Learned in Corrections“I kept trying to be

what you wanted, he said- but at a certain point you needed to

stop adding to the list”Ex Offender41

Lessons Learned in CorrectionsTREATMENT/CORRECTIONS CONTINUUM

TREATMENT

Prev

entio

nIn

terve

ntion

Basic

Outpati

ent

Inten

sive O

utpati

ent

Sobe

r Hou

sing

GPS

Shor

t-term

Res

identi

alDay

Rep

ortin

g Cen

ters

Long-t

erm R

eside

ntial

In Ja

il/In

Priso

n

CORRECTIONS

Civil C

itatio

ns

Pre-tria

l Prog

rams

Basic C

ommun

ity Sup

ervisi

on

House

Arrest

Commun

ity C

ontro

l GPS

Jail: i

n Trea

tmen

t + R

e-entr

y

Prison

: in Trea

tmen

t + R

e-entr

y

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Lessons Learned in CorrectionsTreatment Is Dynamic &

ChangingSeparated vs. Integrated

Relapse (Shame-based) vs. Relapse AnalysisMedication (Shunned) vs. Medication Valued

Harsh Confrontation vs. Motivational Continuum

Recovering Staff vs. Multi-Disciplinary61

Lessons Learned in CorrectionsTreatment Is Dynamic &

Changing ContinuedInstinct-Based vs. Research- BasedOne Size Fits All vs. Individualized

Supervision vs. Supervision Intermittent

PlannedMust Hit Bottom vs. Coercion Works

71

Lessons Learned in CorrectionsCLIENT

JUDGE COUNSELOR

RECOVERY IS

RELATIONAL

8

Lessons Learned in Corrections

Client Motivation is Dependent Upon Internal as well as

External Pressures

91

Lessons Learned in CorrectionsMotivational Changes in

Treatment

Treatment Dosage

External

Internal

101

Lessons Learned in CorrectionsDevelopmental Model

Principles • “It’s a process not an event”• “Treatment is cumulative”•Developmental Psychology

means: “Psychology of Maturation”111

Lessons Learned in CorrectionsCOMPETENCY BASED

APPROACH TO LEARNINGCompetency Mastery

Requires:• Information knowledge• Implementation knowledge

121

Lessons Learned in Corrections

Establish a therapeutic alliance:

build and facilitate trust transfer

131

Lessons Learned in Corrections

HHIGH HOPE

LOW HOPE

HIGH PAIN

LOW PAIN

14

Lessons Learned in CorrectionsRatio of Rewards to Sanctions and the

Probability of Success

15

Lessons Learned in Corrections

Incentives & SanctionsMaximize benefit by

timing of rewards and consequences

161

Lessons Learned in CorrectionsFinding a New Vocabulary for

Affirmation and Validation• Pulling Up the Positive to Avoid the

Punitive• Affirm the Small Steps and Progress• Educate- Which Means “Lead Forth”• Learn to Articulate Affirmations• Develop Emotional Literacy….Name it, Claim it, Own it, Change it! 171

Lessons Learned in Corrections

{Assess / Deprivation Needs}

•Trauma History•Resiliency Factors

181

Lessons Learned in Corrections

Programs are:Expectations based- Emphasize relationshipsRules based- Emphasize compliance

191

Lessons Learned in Corrections

Compliance is adaptation

Not Treatment

201

Lessons Learned in Corrections

Institutionalization requires treatment

Emotional Incarceration211

Lessons Learned in CorrectionsGender Specific Challenges for Men

Masculinity Demands

Treatment Demands

Being Self-Reliant Seeking Help

Being Stoic Expressing Feelings

Taking Action Becoming Introspective 22

Vs.

Lessons Learned in CorrectionsGender Specific Challenges for Men

Masculinity Demands

Treatment Demands

Showing Strength Showing Weakness

Experiencing Pride

Experiencing Guilt & Shame

Acting Invincible Acting Vulnerable23

Vs.

Lessons Learned in CorrectionsFacilitate movement from compliance to

internalization through gradual reduction of structure and insight

work241

Lessons Learned in Corrections

Create a treatment culture that promotes

“Mistakes as wonderful opportunities to learn”.

25

Lessons Learned in Corrections

Teach social network mapping and assist

clients with building a social support network

261

Lessons Learned in CorrectionsHow Can Programs Improve Care• Ask and integrate trauma related

questions / practices• Deliver more experiential based

learning• Improve cognitive health approach (teach memory / thinking skills)• Use incentives 4:1 to sanctions 271

Lessons Learned in CorrectionsHow Can Programs Improve

Care Continued• Insure program cultures are

expectations based vs. rules based• Aftercare can be more of a system

rather than a loose aggregate of diverse providers• Develop a youthful offender track of

services 28

Lessons Learned in CorrectionsRisk, Need, Responsivity

The Big 8NEED GOAL

Anti-social cognitions Reduce anti-social cognition, recognize risky thinking and feelings, adopt alternatives

Anti-social companions Reduce association with criminals, enhance contact with pro-social friends

Anti-social personalities Build problem-solving, self-imaging, anger awareness, and coping skills 29

Lessons Learned in CorrectionsRisk, Need, Responsivity

The Big 8NEED GOAL

Family and marital relationships

Reduce conflict, build positive relationships and communication

Substance abuse Reduce usage, reduce the support for abusive behavior, enhance awareness

Employment Provide employment-seeking-and –keeping skills and enhance performance? 30

Lessons Learned in CorrectionsRisk, Need, Responsivity

The Big 8NEED GOAL

Education Increase performance rewards and satisfaction

Leisure and recreation Enhance pro social activities

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Lessons Learned in Corrections Expectations Reality

Not easy, but worth it32

Lessons Learned in Corrections

Questions?

Thank you 33