collaborating with the criminal justice system

samhsa T e c h n i c a l a s s i s T a n c e P a c k a g e

Collaborating With the Criminal Justice System

I Introduction Contents

I Introduction

II The Intersection of Behavioral Health and the Criminal Justice System

III Drug Courts

IV Engaging Criminal JusticendashInvolved Individuals in ROSCs

V Reentry Into the Community

VI Case StudiesmdashExperiences of ATR Grantees

VII Additional Resources

Goals for SAMHSArsquos Strategic Initiative for Trauma and Justice

bull Address the needs of people with mental disorders substance use disorders co-occurring disorders or a history of trauma in the criminal and juvenile justice systems

bull Develop a comprehensive public health approach to trauma

bull Make screening for trauma and early intervention and treatment common practice

bull Reduce the impact of trauma and violence on children youth and families

bull Reduce the impact of disasters on the behavioral health of individuals families and communities

Substance use disorders are widespread among the criminal justice population but access to and options for treatment are often extremely limited Offenders are an important subpopulation of those needing treatment for such disorders but their needs are rarely met by the criminal justice system (CJS) itself Although CJS-involved individuals have many of the same problems that others in need of treatment face they also present clinical and other factors unique to their involvement in the criminal justice system Along with the specialty needs of these populations another challenge is the coordination and collaboration it takes between state systems to create a partnership that can benefit the clients needing services Formal and informal agreements between systems can support this interaction but positive relationships between the organizations are as important as the good relations between the clients and the services that they need

Research suggests that treatment for substance use disorders works in this population cutting the risk of criminal recidivism by approximately one-third for offenders who receive a sufficient amount of treatshyment These effects have been shown to last for at least 5 years1 Some of the substance abuse treatment can happen inside of the corrections facility but most of it will happen in the community forcing us to recognize the need for good communication with community resources and the services available outside of the criminal justice system These community resources partnered with the criminal justice system can be a critical component for client success in recovery

Whatrsquos in This TA Package This Technical Assistance (TA) package details the issue of substance use among the CJS population and the considerations for working with CJS-involved clients and collaborating with the CJS It lists points

collaborating With the criminal Justice system 1



at which the treatment and criminal justice systems can intersect provides an in-depth look at drug courts and reentry as key opportunities for intervention and describes how the CJS can be incorporated into a broader recovery-oriented system of care The final section presents practical lessons learned and strateshygies for working with the CJS from access to recovery (ATR) programs in Iowa and Indiana

How Should Grantees Use This Information Much of this TA package is a guide for ATR grantees who want to better understand the intersection of substance use treatment recovery and the CJS It can serve as a starting point for conversations with providshyers and State and local stakeholders In addition the information in this TA package can be used to develop educational presentations for staff and providers who may be new to working with CJS-involved individushyals The information is tied to practical application in Section V and in the Iowa and Indiana ATR case studies in Section VI (eg which partners to consider engaging)

Approximately one-third of the individuals served by ATR 1 and ATR 2 grantees were involved with the CJS ATR 3 grantees can play an important role at the intersection of the treatment recovery and criminal justice systems They can open pathways to recovery for CJS-involved individuals experiencing issues with substance use and help bridge the gap between CJS clients and access to an appropriate comprehensive array of options and services needed for recovery

SAMHSArsquos Strategic Initiatives The Substance Abuse and Mental Health Services Administration (SAMHSA) recently set forth eight strategic initiatives to guide its work and focus its resources as it pursues its mission to reduce the impact of substance use and mental illness on Americarsquos comshymunities Two of these initiatives are closely related to collaborating with the CJS to meet the drug treatment and mental health needs of justice-involved populashytions These are Initiatives 2 Trauma and Justice and 4 Recovery Support

bull Trauma and Justice (Initiative 2) Reducing the pervasive harmful and costly health impact of violence and trauma by integrating

trauma-informed approaches throughout health behavioral health and related systems and addressshying the behavioral health needs of people involved in or at risk of involvement in the criminal and juvenile justice systems

bull Recovery Support (Initiative 4) Partnering with people in recovery from mental and substance use disorders to guide the behavioral health system and promote individual- program and system-level approaches that foster health and resilience increase permanent housing employshyment education and other necessary supports and barriers to social inclusion


In the United States on any given day more than 7 million adults are involved in some form of criminal justice supervision2 Most of them are on probation or parole and living in the community Of the more than 2 million who are incarcerated in prisons and jails nearly all of themmdash95 percentmdashwill eventually return to the community Annually more than 700000 indishyviduals are released from prison and 9 million cycle through Americarsquos jails3

Criminal Justice and Substance Abuse Facts and Figures bull

bull

bull

bull

8 million adults are involved in the justice system

Almost 5 million individuals are on probation or under parole supervision

The substance abuse or dependence rates of offenders are more than four times those of the general population

In the juvenile justice system about 56 percent of the boys and 40 percent of the girls tested positive for drug use at the time of their arrest (National Institute of Justice 2003)

Source National Institute on Drug Abuse (2006) ldquoPrinciples of Drug Abuse Treatment for Criminal Justice Populationsrdquo National Institutes of Health US Department of Health and Human Services httpwwwnidanihgovPDFPODAT_CJ PODAT_CJpdf (accessed October 14 2011)



The link between substance use and crime is well recognized The criminal justice population has a disproportionately high rate of substance use disorders (as well as people with co-occurring mental health and substance use disorders) compared with the general population For example the Bureau of Justice Statistics (BJS) estimated that in 2005 between 56 and 66 percent of incarcerated individuals had a substance use disorder and that around 25 percent of incarcerated individuals were convicted of a drug offense In 2006 27 percent of probationers had drug violations as their most serious offense and 37 percent of parolees had served a sentence for a drug offense The boom in the American prison population over the last 25 years was driven largely by drug policy and incarceration for low-level drug offenses (As a point of comparison in 1972 300000 people were in prison in the United States4)

Despite the prevalence of substance use and co-occurshyring disorders among offenders only a small percentage have access to adequate substance use services and few receive treatment BJS found that in 2004 only 148 pershycent of State and 174 percent of Federal prisoners had received drug treatment since becoming incarcerated5

Treatment availability tends to be even more limited in jails and community correctional facilities Even when treatment is provided offenders usually have little choice in the kind of treatment and recovery planning they receive and additional services are often required to meet their needs

Numerous studies have shown that comprehensive treatment for substance use disorders can reduce both substance use and criminal recidivism6

Comprehensive treatment including recovery support services is more effective in decreasing recidivism and substance use than incarceration alone Support with overcoming substance use issues can help CJS-involved individuals with successful reintegration ultimately decreasing prison populations and lowering the high social costs of recidivism drug use and drug-related crime

Working with Drug-Involved Offenders

Providing access to treatment for substance use disorshyders to CJS-involved individuals both in correctional facilities and in the community can have a profound

effect on their trajectory Research suggests that treatment during incarceration increases the chances that an individual will continue treatment in a comshymunity program and offenders who participate in prison-based treatment and then engage in follow-up treatment in the community have the best outcomes Length of time spent in treatment is strongly correshylated to recovery decreased recidivism and sobriety for CJS-involved individuals7 Achieving this however requires planning coordination and the engagement of a number of stakeholders across different systems

As an example in the ldquoWIser Choicerdquo ATR program in Milwaukee Wisconsin which accepts individuals on probation and parolees with substance useaddicshytion treatment needs community reach-in specialists screen potential program participants while they are still in a correctional facility identify a care coordinashytion agency and work with the client to develop a care

HIV and the Criminal Justice System bull One in seven people living with HIV in the United

States passes through the criminal justice system (CJS) each year

bull HIV-infected prisoners with SUDs face many obstacles as they transition back to the community

bull Correctional facilities have a prevalence rate of HIV 3ndash5 times higher than that of surrounding communities

bull Up to 70 percent of HIV-infected prisoners meet criteria for opioid dependence These ongoing and sometimes untreated substance use disorders play a major role in prison recidivism and contribute to poor HIV outcomes after release

Sources

Springer SA Azar MM Altice FL (2011) ldquoHIV alcohol dependence and the criminal justice system A review and call for evidence-based treatment for released prisonersrdquo National Center for Biotechnology Information httpwwwncbinlmnih govpubmed21171933 (accessed October 14 2011)

Meyer JP Chen NE and Springer SA (2011) ldquoHIV treatment in the criminal justice system Critical knowledge and interven-tion gapsrdquo Hindawi Publishing Corporation AIDS Research and Treatment Volume 2011 Article ID 680617 10 pages


plan Once the individual is released the probation

parole agent care coordinator and treatment provider

work together to ensure a successful transition from

jail or prison to effective community-based care8

CJS-involved individuals with substance use disorders

often present a complex array of risks and needs Like

others suffering from such disorders offenders may

need emotional and instrumental recovery services

(such as assistance with housing education job trainshy

ing transportation applying for entitlements forming

pro-social peer networks or parenting classes) in

addition to clinical treatment Unlike clients from the

general population CJS clients have distinct needs and

risks stemming from their involvement in the criminal

justice system Among these is meeting the terms of

their probation or parole while participating in comshy

munity-based treatment ATR grantees treatment and

service providers case managers and care coordinators

should be aware of the different stages of involvement in

the CJS the stage at which their client stands and the

particular legal requirements set forth for their client

by that stage or program Further they must coopershy

ate with law enforcement judges probation and parole

officers attorneys and corrections officials

Criminal Justice Culture and Client Choice

Criminal Justice Culture The CJS has the dual goals of public safety and rehashybilitation In practice these goals can be directly at odds with or at least take a different direction than the goal of treatment for substance use disorders Specifically the CJS has limited strategies for routinely intervening in an individualrsquos treatment and recovery beyond its criminal process functions Further the cultural and structural differences between the drug treatment and criminal justice systems can hinder cooperation and communication However these barrishyers can be overcome

The criminal justice system can become an important part of a larger system that helps deliver recovery support services to CJS-involved individuals with substance use disorders Collaborations between case managers judges treatment providers parole officers attorneys and a variety of other stakeholders can bridge the divide between treatment service provision and the CJS

The worksheet below can be used to initiate discusshysions with key ATR stakeholders on how to enhance collaboration with the CJS

Team Questions Responses

1 What features and benefits of our ATR system should be highlighted with CJS staff

2 What are reciprocal aspects of a collaboration with ATR Why should criminal justice staff collaborate with ATR

3 What opportunities exist for criminal justice and ATR staff education What events or meetings can staff attend to share and learn more about ATR and vice versa

4 What systems and relationships do we have in place that can support greater collaboration with the CJS




Client Choice Client choice a key element of ATR presents two distinct issues for CJS-involved individuals in need of treatment for substance use disorders

bull Difficulty accessing adequate services is often comshypounded by limited choices in treatment options and services provided

Increasing client choice is a key goal of ATR Strong partnerships between the CJS and State and local agencies community providers faith- and commushynity-based organizations and advocacy groups can radically expand options for treatment and recovery support services ATR grantees can increase client choice by expanding and diversifying the provider network (both treatment and recovery service proshyviders) increasing both choice and capacity and by

providing clients with information about the providshyers who meet their level of care helping to ensure choice Grantees and providers should keep in mind that even if treatment is legally mandated ATR can still help ensure that CJS clients have a genuine choice in their treatment and service providers

bull Criminal justice clients may participate in treatment because they are legally mandated to do so or because they have been encouraged through legal pressure

Although having few choices in treatment options can certainly affect non-CJS clients legal mandate is unique to the CJS client population Community treatment may be a condition of release probation (including participation in a drug court) or parole Legal requirements are commonly cited by offenders as reasons for entering substance use treatment

Principles of Drug Treatment for Criminal Justice Populations

The National Institute on Drug Abuse outlines princi-ples of drug treatment for criminal justice populations

1 Drug addiction is a brain disease that affects behavior

2 Recovery from drug addiction requires effective treatment followed by management of the prob-lem over time

3 Treatment must last long enough to produce stable behavioral changes

4 Assessment is the first step in treatment

5 Tailoring services to fit the needs of an individual is an important part of effective drug abuse treat-ment for criminal populations

6 Drug use during treatment should be carefully monitored

7 Treatment should target factors that are associ-ated with criminal behavior

8 Criminal justice supervision should incorporate treatment planning for drug-using offenders and treatment providers should be aware of correc-tional supervision requirements

9 Continuity of care is essential for drug users reen-tering the community

10 A balance of rewards and sanctions encourages pro-social behavior and treatment participation

11 Offenders with co-occurring substance use disor-ders and mental health problems often require an integrated treatment approach

12 Medications are an important part of treatment for many drug-using offenders

13 Treatment planning for drug-using offenders who are living in or reentering the community should include strategies to prevent and treat serious chronic medical conditions such as HIVAIDS hepatitis B and C and tuberculosis

Source National Institute on Drug Abuse (2007) Principles of Drug Abuse Treatment for Criminal Justice Populations A Research-Based Guide (2nd ed) Washington DC National Institute on Drug Abuse National Institutes of Health US Department of Health and Human Services httpdrugabusegovpodat_cj (accessed August 16 2011)



Studies suggest that participation in treatment mandated or not reduces relapse and recidivism In some studies offenders who enter treatment as a result of legal mandate have been shown to do as well as or better than individuals entering with no form of legal requirement9 Thus although a requirement to enter treatment might be a factor in an offenderrsquos pursuit of treatment it is not necesshysarily detrimental and may be beneficial Offenders participating in mandated treatment tend to conshytinue treatment longer and have higher attendance rates both of which are factors associated with good treatment outcomes10

Criminal Justice System as Part of a Recovery-Oriented System of Care

A recovery-oriented system of care (ROSC) promotes self-determination and ownership of the recovery proshycess by the client A ROSC is holistic community based integrated and comprehensive and links substance use

Principles of Drug Treatment for Criminal Justice Populations Melody Heaps director of Treatment Alternatives for Safe Communities in Chicago Illinois and her colleagues outline the following goals of a ROSC working with the CJS

bull Hold clients responsible to both the criminal justice and treatment systems

bull Integrate each clientrsquos recovery into a legal framework and identify the most critical points of intervention to satisfy both community safety and case-processing needs

bull Provide access to evidence-based drug treatment interventions for suitable individual offenders at each stage of their recovery and justice processes

bull Ensure that clients do not receive isolated interven-tions and fragmented care but coherent care that builds cumulatively toward sustained recovery

Source Heaps M M Lurigio A J Rodriguez P Lyons T amp Brookes L (2009) Recovery-Oriented Care for Drug-Abusing Offenders Addiction Science and Clinical Practice 5(1) 31ndash36 httpwwwncbinlmnihgovpmcarticlesPMC2797119

disorder treatment and recovery mental and physical health care providers and ancillary services Including the CJS within a ROSC can open opportunities for recovshyery to an underserved population

Probation parole reentry and drug courts have all served as referral sources for ATR grantee treatshyment providers Drug courts in particular are well recognized in the treatment and criminal justice comshymunities as an effective way to provide a treatment alternative to incarceration for some offendersmdashand they consistently reduce recidivism They are imporshytant mechanisms for integrating offenders into a system of care that supports both recovery and public safety goals by providing accountability sanctions substance use treatment a variety of support and wraparound services case management and a clear model for cross-system coordination among programs and stakeholders

III Drug Courts

Drug courts have the resources to focus on a wide variety of problems associated with supervising and treating offenders with substance use disorders They increase direct supervision of offenders coordinate treatment and other services collaborate with public service providers reduce duplicate services and expedite case process-ing Drug courts that work with ATR have the opportunity to provide wrap-around services to meet the needs of their participants and thus can provide recovery services that many criminal justice programs cannot access with their limited resources

Drug courts are

an alternative to

incarceration that

blends criminal

justice supervision

with substance

use treatment and

recovery

Alternative to Incarceration Approximately 80 percent of adult offenders are under the influence of alcohol during their crime are charged with a drug- or alcohol-related offense or committed their crime to support a drug habit Of that 80 percent just under half (45 percent) are adult inmates who meet the criteria for substance dependency11 The common response to ldquoaddictsrdquo in the CJS has been jail or prison

In the late 1980s many courts in the United States were overwhelmed by drug-related cases In 1989 in an effort



to stem the tide the Dade County Circuit Court system in Miami Florida created an intensive drug treatment program which was monitored by a single judge and multidisciplinary team as an alternative to incarcerashytion The program was called Drug Court

Today drug courts are a widespread initiative to reverse the negative effects of the demand for illicit drugs They reflect the growing understanding among crimishynal justice professionals that the traditional method of incarceration as the sole response to offender behavior has little impact on drug use among criminals or on the prevalence of drug- and alcohol-related crime

Drug courts represent the combined efforts of justice and treatment professionals to actively intervene and break the cycle of substance abuse addiction and crime These special dockets handle cases involving substance-dependent citizens under the adult juvenile family and tribal justice systems In this blending of justice treatment and social service systems the drug court participant undergoes an intensive regimen of treatment case management drug testing supervision and monishytoring and immediate sanctions and incentives while reporting to regularly scheduled status hearings before a judge and drug court team Drug courts increase parshyticipantsrsquo probability of success by providing ancillary services such as mental health treatment trauma and family therapy and job skills training

Good Return on Investment A substantial body of research on drug courts has produced a general consensus that drug courts are cost effective and reduce both drug use and crime Over the past two decades drug court programs have undergone a comprehensive scientific review To date seven indeshypendent meta-analyses have concluded that adult drug courts significantly reduce crime as measured by fewer re-arrests for new offenses and technical violations Recidivism rates for drug court participants average 8 to 26 percentage points lower than those for other justice system programs High-performing drug courts reduce crime by as much as 45 percent over other dispositions12

Drug courts have also proven to be a cost-effective approach One meta-analysis concluded that drug courts produce an average of $421 in direct benefits

to the CJS for every $100 investedmdasha 421 percent return on investment When studies considered long-range cost such as savings from reduced foster care placements and health care service use they found economic benefits ranging from approximately $200 to $2700 for every $100 invested13

Increase Collaborations The Bureau of Justice Assistance and the National Association of Drug Courts established 10 standards that govern drug court programs under the following topics

bull Integration of justice and treatment

bull Non-adversarial approach

bull Early identification

bull Continuum of services

bull Drug testing

bull Coordinated strategy

bull Judicial supervision

bull Monitoring and evaluation

bull Interdisciplinary education

bull Forging partnerships

Drug courts provide an unparalleled approach that supports treatment for substance use disorders and recovery within the CJS The drug court judge serves as the leader of a multidisciplinary team of professhysionals that includes a court coordinator prosecuting attorney defense attorney treatment providers case managers probation officers and representatives from law enforcement

Participants entering drug court programs are nonvioshylent individuals charged with drug-related offenses such as possession of a controlled substance or drug-driven offenses such as forgery or theft committed to support an addiction Drug court programs generally last 12 to 18 months Successful completion requires participants to maintain continuous sobriety for a minimum of 6 months complete treatment goals meet supervision conditions and meet their financial obligashytions (eg fines fees and restitution)



Defining Drug CourtsmdashKey Components 1 Drug courts integrate alcohol and other drug

treatment services with justice system case processing

2 Using a non-adversarial approach prosecution and defense counsel promote public safety while protecting participantsrsquo due process rights

3 Eligible participants are identified early and promptly placed in the drug court program

4 Drug courts provide access to a continuum of alcohol drug and other related treatment and rehabilitation services

5 Abstinence is monitored by frequent alcohol and other drug testing

6 A coordinated strategy governs drug court responses to participantsrsquo compliance

7 Ongoing judicial interaction with each drug court participant is essential

8 Monitoring and evaluation measure the achieve-ment of program goals and gauge effectiveness

9 Continuing interdisciplinary education promotes effective drug court planning implementation and operations

10 Forging partnerships among drug courts public agencies and community-based organizations generates local support and enhances drug court program effectiveness

Source Bureau of Justice Assistance and National Association of Drug Court Professionals Drug Court Standards Committee (2004) Defining Drug Courts The Key Components Washington DC httpwwwojpusdojgovBJAgrant DrugCourtsDefiningDCpdf (accessed August 4 2011)

Drug court programming typically includes weekly

and random drug testing regular status hearings

before the court and intensive treatment Treatment

plans for participants are based on their clinical needs

Drug courts must build collaborations with community

providers to meet the diverse needs of the particishy

pants In addition to partnerships with substance use

treatment providers drug courts seek partnerships

with other community agencies to assist clients with family counseling mental health counseling vocashytional training or counseling housing employment education or medical or dental needs Through the drug courtsrsquo strong collaborations with community stakeholders participants are able to obtain services to assist with their recovery Drug courts use these collaborations to provide comprehensive case manageshyment that is coordinated with other providers thus reducing the overlap in service delivery

As a result of the drug court program design subshystance-dependent individuals remain in treatment for longer periods while under close supervision Keeping participants engaged in treatment and recovery is accomplished through the use of incentives and sancshytions that are based on behavioral research not on traditional criminal justice principles of punishment

Because these courts use sanctions as a ldquocoordinated strategy [that] governs drug court responses to parshyticipantsrsquo compliancerdquo (Key Component 6) their responses to client behavior are for the sole purpose of modifying behavior not applying punishment Drug court responses to client behavior are agreed upon in a pre-case conference with all of the team members This coordinated response allows all team members to offer recommendations and agree on incentives and sanctions in a non-adversarial atmosphere The goal is for drug courts to make court responses therapeutic and supportive of an overall established case plan

Drug courts work with key stakeholders to identify recovery services in the community that can assist program participants Many who enter drug courts have housing education employment and medical problems and other major challenges Drug courts understand that just addressing individualsrsquo substance use problems does not resolve their other complex challenges Drug courts play a major role in case manshyagement to assist offenders with navigating multiple systems to obtain services

Other Specialty Courts

The drug court movement has had a significant impact on the management of drug-related offenses and offenders Its success has led to the development of



other specialty court models (also known as problem-solving courts) such as mental health courts DWI courts veterans treatment courts and reentry drug courts The impetus for the creation of mental health courts was the overrepresentation of individuals with mental illness in the CJS These programs include a court team and mental health professionals who work together to develop a treatment plan and supervise participants in the community

DWI courts are post-conviction programs for alcohol- or substance-dependent repeat offenders or high-bloodshyalcohol-content offenders arrested for driving while impaired Like drug courts DWI courts use criminal justice professionals along with substance use treatshyment and recovery providers to help participants make long-lasting behavior changes

Veterans treatment courts (VTCs) are the newest addition to the problem-solving court family VTCs use a hybrid of drug court and mental health court principles to serve military veterans and some active-duty personnel These programs rely on collaboration between the courts drug treatment and mental health providers the Department of Veterans Affairs health care networks the Veterans Benefits Administration the State departments of veterans affairs volunteer veteran mentors and other organizations that support veterans and their families

Finally reentry drug courts help facilitate the reinteshygration of drug-involved offenders into the community upon their release from local or State correctional facilities These programs use the drug court model as previously outlined


A ROSC that includes the criminal justice system can be difficult to develop but the rewards are great Communities must understand a number of issues in order to develop such a system intervention opporshytunities within each stage of the CJS recovery goals beyond abstinence common needs of those in recovshyery and the role of ATR in these issues

Intervention Opportunities

Intervention opportunities to engage individuals in recovery-oriented services are available at most stages of the CJS as outlined in the chart on the next page

Two of the most common points of intervention for ATR grantees are described below

Point of Intervention Alternatives to Incarceration

Individuals may be referred to substance abuse treatshyment in the community as part of a diversionary program prior to adjudication or as a term of probashytion Referrals at this point of intervention are typically through community corrections programs which include drug courts and other specialty court models

Community corrections are administered by courts or agencies (often probation and parole agencies) with the legal authority to enforce sanctions Individuals who have committed low-level nonviolent crimes are often given the opportunity to participate in comshymunity corrections programs in lieu of incarceration These programs typically include community supervishysion but may also require work release day reporting centers or halfway houses Community corrections can serve as a point for collaboration between CJS and ATR-affiliated treatment and recovery support service providers by establishing a pathway to referral

Through a community corrections program an indishyvidual can enter a traditional adult drug court or other specialty court program at different points in the CJS depending on the model used in the jurisdiction Where a pre-plea dispositional drug court model is used drug courts are a pretrial diversion and individuals enter with the understanding that upon successful compleshytion of the program the charges against them will be dismissed If they fail to complete the program they will be returned to the regular criminal justice sysshytem for adjudication In jurisdictions with a post-plea dispositional drug court model offenders plead guilty or stipulate to the facts of the criminal complaint Post-plea models can be either pre-adjudication or post-adjudication (term of probation) If participants in pre-adjudication programs complete the program their arrest or conviction records are expunged In


Intervention Opportunities in Criminal Justice Systems

Stage Offender Event Participants Intervention Opportunities

Entry Arrest Crime victim police FBI Screening or referral

Prosecution Court pretrial release jail

Crime victim police FBI judge

Diversion programs drug courts community-based treatment TASC

Adjudication Trial Prosecutor defense attor-ney defendant jury judge

NA

Sentencing Fines commu-nity supervision incarceration

Jury judge Drug court terms of incarceration release

conditions

Corrections Probation jail prison Probation officers correctional personnel

Screening and treatment for substance

abuse disorders screening and treatment for other mental illnesses screening and

treatment for other medical disorders

Community

Reentry

Probation parole release

Probation or parole officer family community-based

providers

Drug treatment aftercare housing employment mental health medical care halfway house TASC

Abbreviations FBI Federal Bureau of Investigations NA not applicable TASC Treatment Accountability for Safer Communities

Interventions of the TASC organization are based on a case management model for integrating criminal justice and drug abuse services

Source Chandler R K Fletcher B W amp Volkow N D (2009) Treating Drug Abuse and Addiction in the Criminal Justice System Improving Public Health and Safety JAMA 301(2) 183ndash190 httpjamaama-assnorgcontent3012183long

post-adjudication programs the conviction stands regardless of whether an individual completes the program but individuals can avoid incarceration or reduce their probation obligations through successful participation

Point of Intervention ReentryPost-Incarceration

Reentry drug courts as the name implies come into play at the other end of the CJS when individuals are released from a correctional facility As offenders reenter the community these courts provide treatment and ancillary services through the collaborative multidiscishyplinary drug court model described earlier that includes intensive treatment supervision and drug testing

Individuals who have been incarcerated experience significant obstacles when reentering the community As mentioned in Section II treatment during incarshyceration followed by treatment after release is more

effective than treatment only during incarceration Ideally care would be provided from the time an individual enters a correctional facility through reentry and beyond as the offender reintegrates into society Even if care cannot be seamless comprehensive

Reentry services are

most effective when

planning begins

before an offender

returns to the

community

reentry planning can provide the continuity offenders need when leaving prison or jail and going back into the community Reentry is covered in more detail in Section V

Recovery Goals Beyond Abstinence

The criminal justicendashinvolved population has a prishymary recovery goal beyond abstinence that is not shared by other substance-dependent populations reducing recidivism broadly defined as a return to criminal behavior Most States use validated actushyarial risk and needs assessment tools at one or more




points in the CJS to enhance their ability to rehabilishytate offenders reduce recidivism and increase public safety Two commonly used risk and needs assessment tools are the Level of Service InventoryndashRevisedTM

(LSI-R) and the Correctional Offender Management Profiling for Alternative Sanctions (COMPAS) Both evaluations use questions to elicit offendersrsquo charactershyistics and personal circumstances to help supervising agencies and problem-solving courts create supervision plans and refer offenders to community services based on their probability of reoffending and their individushyalized treatment or recovery needs

Risk and needs assessment tools are based on the risk principle which states that recidivism can be reduced if the level of treatment services provided to an offender is in proportion to the offenderrsquos risk to reoffend That is the most intensive programming should be allocated to moderate- to high-risk offenders whereas low-risk offenders should be given little or no programming Current research suggests that when low-risk offenders are engaged in intensive programshyming that is not warranted based on risk they are more likely to reoffend than if they had received no programming at all14

The most effective programs for high- and medium-risk offenders focus on crime-producing risk factors such as substance use personality characteristics anti-social peers and anti-social attitudes Decreasing such risk factors has been shown to lower recidivism rates However offenders can have other problems that interfere with their ability to engage in treatment These can include low IQ or inability to read If not dealt with such challenges will negatively affect these offendersrsquo ability to complete treatment and thus their potential for recidivism

Common Needs of Those in Recovery

Recovery support services are nonclinical services such as housing employment assistance vocational rehabilitation child care emergency shelter and transportation These services aid in removing barriers and provide resources for those seeking or maintaining recovery Recovery support services can be offered by professionals or nonprofessionals including peers

Women and the Criminal Justice System bull Nationwide law enforcement made an estimated

13687241 arrests (except traffic violations) in 2009 253 percent of arrests were of females

bull 17 percent of arrests of females in the United States were of persons under the age of 18

bull 47 percent of arrests of females were of persons under the age of 15

Source National Criminal Justice Reference Service (adminis-tered by the US Department of Justice) (2011) ldquoWomen amp Girls in the Criminal Justice System mdash Facts and Figuresrdquo https wwwncjrsgovspotlightwgcjsfactshtml (accessed October 14 2011)

and can be offered post-treatment during treatment or instead of treatment

Recovery supports that work best with the criminal jusshytice population integrate instrumental support services and emotional support which builds self-esteem and improves resiliency Integrating instrumental and emoshytional recovery supports will yield the greatest benefit for the client by optimizing the chances for a sustained recovery and decreasing the likelihood of recidivism

Instrumental Recovery Support Services

Instrumental recovery support services vary based on community resources however the following are commonly identified as core services needed by CJS-involved individuals who have substance use disorders

EmploymentEducational Services Unemployment and underemployment are common among individuals involved in the criminal justice system Many in the CJS with substance use disorders have low educational attainment impaired cognitive skills and limited work histories (or work histories with significant gaps) These barriers are compounded by the stigma of having a criminal record Readily available employment and educational resources are vital and should include at minimum

bull Obtaining verification of past employment

bull Obtaining an identification card



bull Job search strategies

bull Resume completion

bull Interviewing strategies

bull Planning for appropriate disclosure of criminal

history

bull GED preparationtesting as needed

bull Referral to vocational rehabilitation agencies

as appropriate

bull Guidance in setting up or maintaining self-

employment using an existing skill set or

vocational background

Organizations such as the National HIRE Network

established by the Legal Action Center provide

clearinghouse informationmdashby Statemdashof resources

available to help CJS-involved individuals find and

maintain employment These resources include Federal

bonding programs workforce development tax credits

and local agencies with a mission of helping this popushy

lation find and keep jobs

Housing Services Studies on the criminal justice population and housshy

ing show that approximately 26 percent of offenders in

jail and 195 percent of offenders incarcerated in State

institutions reported they were homeless 1 year prior

to incarceration Because individuals in the CJS often

live in high-crime areas or with family members who

continue to use drugs and alcohol securing safe and

affordable housing is an important step toward sucshy

cess for those in ATR ATR providers must familiarize

themselves with affordable housing options available

in their communities including supportive living halfshy

way houses and Section 8 HUD housing and Oxford

Houses (self-run self-supported addiction recovery

houses) A recent study found that at 24 months of

follow-up individuals entering Oxford Houses after

substance use disorder treatment had significantly

lower substance use significantly higher monthly

incomes and significantly lower incarceration rates

than those entering usual care

Transportation Services Individuals in the CJS often have lost their driverrsquos licenses because of their criminal offenses do not have access to a vehicle have no financial resources for bus or cab fare and have limited pro-social supshyport to draw upon for transportation Treatment and service organizations should help alleviate transportashytion problems by assisting CJS-involved individuals with driverrsquos license reinstatement efforts or through creative transportation strategies such as purchasing bus tickets and gas cards paying cab fare establishing car pools or developing relationships with community- and faith-based organizations willing to loan their vans In addition vocational rehabilitation agencies can assist with transportation for those who qualify

Emotional Recovery Support Emotional recovery support services cultivate a sense of optimism resiliency and faith in an individualrsquos own capabilities to implement positive lasting change in his or her life These services tend to be less tangishyble than instrumental recovery services but emotional recovery supports lay the foundation for long-term recovery Examples of such services include peer famshyily and faith-based support services

Peer Support Services Formalized peer support services provide individuals with someone often called a peer recovery specialist who can share lessons learned from his or her own journey of recovery and be a role model for wellness Peer recovery specialists help individuals articulate their goals determine holistic steps that will move them toward recovery identify barriers reinforce positive progress increase confidence in the ability to recover and provide an avenue for pro-social support Even if formal peer support services are not available establishing positive role models and encouraging relashytionships with individuals successfully in recovery will increase an individualrsquos chance of staying in recovery and avoiding re-arrest

Family Support Services The impact of substance use disorders on family members is enormous Due to the secrecy associated with substance use disorders family members are often caught off guard which can be devastating to



the entire family system Family involvement is pivotal in recovery because substance use disorders affect the whole family Families have often lived in a world of confusion and unpredictability feeling helpless frustrated and responsible for the family memberrsquos substance use challenges The overwhelming anger and sense of betrayal experienced by family members often cause them to pull away from the one with a substance use disorder further reducing the support available to the individual in recovery Restoration of damaged family bonds often provides stability increases community support and fosters the desire to stay abstinent

Faith-Based Support Services The involvement of faith-based organizations is pivotal in assisting with mentoring support guidance and fulfillment of spiritual needs The faith community has long been an integral component of the transition from prison to the community by providing faith- and char-acter-based programs and emotional and instrumental recovery support services Faith-based organizations teach fundamental values that challenge individuals to change and typically reward change with positive reinshyforcement Faith-based recovery support services can increase confidence pro-social support willingness and community involvement and studies suggest that this effect decreases both substance use and recidivism

Treatment Services Treatment is defined as clinically driven services such as screening brief intervention counseling medical services psychological services and psychiatric services that are targeted at individuals who have substance use disorders The purpose of treatment is for individuals to decrease andor abstain from the use of all mood-altering substances Treatment services are professional in nature and require licensure or certification

Screening and Assessment

Screening and assessment accuracy depends on an individualrsquos ability to be honest Those in the CJS may be reluctant to share openly for fear that the informashytion will be used against them Fear can be escalated if the person has criminal charges pending or is under community supervision and has continued to use alcoshyhol or drugs To elicit the most accurate information

ATR providers should foster an environment of trust and explain the parameters of confidentiality

When working with individuals in the CJS who have substance use disorders it is vital to secure collateral information with informed consent when required including

bull Urine drug screen results

bull Arrest history

bull History from family and other support persons

bull Criminal justice risk and needs assessment

bull Reports from community supervision agencies such as probation parole community corrections problem-solving courts or court alcohol and drug programs

bull Previous treatment records

bull Medical records

Screening tools are used to determine whether a person needs to be referred for a more in-depth assessshyment for a substance use disorder Screening tools are not intended for diagnosis or making referrals to a treatment level of care Open-domain screening tools are easy to obtain are free and require little to no training Commonly used tools include

bull Michigan Alcoholism Screening Test (MAST)

bull Drug Abuse Screening Test (DAST)

bull TCU Drug Screen (TCUDS)

bull Cut Back Annoyed Guilty Eye Opener (CAGE)

Assessments gather information about the negative effects that substances have had on an individualrsquos life identify barriers to treatmentrecovery and provide a blueprint for the treatment level of care intensity and recovery support services an individual needs to be sucshycessful Life domains often included in assessments are

bull Substance use (history motivation for treatment severity frequency detoxification and treatment history)



bull Criminal justice involvement (criminal thinking current offenses prior charges convictions age at first offense type of offense number of arrests incarcerations and history of diagnosis)

bull Health (intoxication infectious disease pregnancy general health and acute conditions)

bull Mental health (suicidality history of treatment past diagnosis treatment outcomes current and past medications acute symptoms and psychopathy)

bull Special considerations (trauma education level readingliteracy language barriers housing disshyabilities family issues etc)

In addition to determining the level of treatment and recovery support services needed assessment outshycomes also affect treatment relapse prevention and continuing care plans

Care Coordination

The assessment sets the stage for care coordination inishytial choice of services and preparation for selecting and entering appropriate services Care coordination is a critical service that assists and advocates for individuals as they make choices and engage with service providshyers based on assessment outcomes Care coordinators can help individuals understand treatment and recovery support services available to them in the community Ideally care coordination is based on a treatment recovery plan that is developed in partnership with the individual seeking services The ultimate goal in assessshyment and throughout an individualrsquos involvement with ATR is to give the individual the maximum opportushynity to direct his or her own recovery For additional information on care coordination see the ATR Care Coordination Technical Assistance Package

Treatment and Recovery Planning

Treatment and recovery planning is developed in partnership with the client and is strengths based The ATR provider and client should review the results of the comprehensive assessment and additional collateral information collected from the supervising criminal justice agency such as results of the risk and needs

assessment family or other support persons past treatment history urinalysis results if applicable and identified client strengths and needs Because no single treatment or recovery support services approach works for all individuals in the CJS ATR providers must help individuals accurately match their recovery goals to an appropriate level of treatment and recovery supports

Treatment and recovery plans should be updated periodically to assess for stabilization in recovery and progress toward personal goals Every effort should be made during the treatment and recovery planning proshycess to obtain releases of confidentiality so that other agencies such the criminal justice supervisory agency can receive progress updates

Strategies to Aid Treatment and Recovery Support Service Providers

Recovery-oriented care is not part of most Statesrsquo criminal justice approach When implementing this change it is important to educate people and once it is available use data to support the work The followshying steps should be taken to prepare for working with individuals who are involved in the CJS

bull Increase understanding of the organizational structure of local criminal justice agencies such as community corrections parole probation problem-solving courts and court alcohol and drug programs Often these agencies work independently of each other and have varying statutes by which they must abide

bull Inquire about reporting processes and requirements for each criminal justice agency and its expected frequency of communication

bull Inquire whether the criminal justice agency requires a memorandum of understanding (MOU) with all providers prior to making referrals or coordinating client care Find out the process for getting an MOU put into place

bull Find out the agencyrsquos philosophy about consumer choice when a court orders a person to obtain treatment If applicable meet with criminal justice professionals and discuss how the difference in



philosophy between court-ordered treatment by a specific provider and consumer choice in ATR can be bridged

bull Become familiar with risk and needs assessments how to read a court order and the difference between misdemeanor and felony charges

bull Become a member of a local problem-solving court team if applicable

bull Volunteer to talk about the ATR philosophy and what the program can offer Most criminal justice agencies welcome training for their staff on various topics

bull Find out whether the agency has an advisory board that is open to the community Inquire about meetshying time and place and ask to be put on the agenda to talk about ATR

Collaborating with the Statersquos Department of Corrections

A Statersquos Department of Corrections is a multilayshyered system with the primary goal of public safety Successfully collaborating with this system requires identifying and understanding the stakeholders such as the commissioner superintendents case managers parole district officers and directors of reentry and substance abuse programming Every State is differshyent so ATR grantees must research the system in their State This research can typically begin online Once stakeholders are identified the challenge becomes effectively making the case that ATR providers can play a vital role in improving public safety and reducshying recidivism through offender care coordination and linkages to treatment and recovery services

ATR grantees can leverage established relationships with the Single State Agency to set up a meeting with the Department of Corrections and explain the conshycept of ROSC Focus on data to demonstrate why ATR is more effective than treatment as usual Anecdotal information is less useful in making the case for ATRrsquos importance Emphasize ATR providersrsquo abilshyity to bridge the gap between correctional facilities and community providers thus ensuring continuity of care for formerly incarcerated individuals This

continuity is best achieved through care coordination that establishes a protocol for information sharing with the correctional facility during pre- and post-release transition planning


Evidence-Based Practices What Works

The most effective approaches to working with CJS-involved individuals with substance use disorders are those that integrate criminal justice supervision evidence-based addiction treatment and a full array of recovery support services tailored to meet individushyalsrsquo needs Evidence-based practices (EBPs) should be part of an integrated approach that includes establishshying therapeutic relationships developing motivation for change treating comorbid psychopathologies establishing abstinence preventingmanaging relapse developing involvement in pro-social activities and moving toward a balanced lifestyle The following practices are recognized by SAMHSA as EBPs and have proven successful with CJS-involved populations

bull Integrated Dual Diagnosis Treatment (IDDT) The IDDT model recognizes the difficulties posed by the interaction of substance use disorders and mental illness and addresses factors like drug interaction relapse and overlapping symptoms Individuals with co-occurring disorders repeatedly cycle through the criminal justice and treatment sysshytems They are likely to experience problems when not taking medication and not in treatment and even small amounts of alcohol or drugs may trigshyger a recurrence of mental health symptoms IDDT focuses on treating individuals as a whole and helps them develop high-quality satisfying functional lives throughout recovery

bull Cognitive Behavioral Therapy (CBT) CBT is based on the belief that changing negative thoughts posishytively influences behavior The cognitive-behavioral approach suggests that criminals think differently than noncriminals either because of a lack of moral reasoning or through dysfunctional information processing Research has shown that improved reasoning and pro-social thinking skills are related


to reduced recidivism Specific therapies based on these concepts such as the Matrix Model have been developed and implemented for correctional populashytions The Matrix Model is available at httpnrepp samhsagovViewInterventionaspxid=87

bull Motivational Interviewing (MI) MI is informed by the fact that not everyone enters treatment ready to change The approach is non-adversarial and non-judgmental and it helps individuals explore their current stage of change This reduces resistance and

SAMHSArsquos National Registry of Evidence-Based Programs and Practices Criminal Justice Related Interventions to Consider

Intervention Title Description

Chestnut Health Systemsndash Bloomington Adolescent Outpatient (OP) and Intensive Outpatient (IOP) Treatment Model

The Chestnut Health SystemsndashBloomington Adolescent Outpatient (OP) and Intensive Outpatient (IOP) Treatment Model is designed for youth between the ages of 12 and 18 who meet the American Society of Addiction Medicinersquos criteria for Level I or Level II treatment placement

Helping Women Recover and Beyond Trauma

Helping Women Recover A Program for Treating Substance Abuse and Beyond Trauma A Healing Journey for Women are manual-driven treatment programs that when combined serve women in criminal justice or correctional settings who have substance use disorders and are likely to have co-occurring trauma histories (ie sexual or physical abuse)

Moral Reconation Therapy (MRT)

Moral Reconation Therapy (MRT) is a systematic treatment strategy that seeks to decrease recidivism among juvenile and adult criminal offenders by increasing moral reasoning Its cognitive-behavioral approach combines elements from a variety of psychological traditions to progressively address ego social moral and positive behavioral growth

Multidimensional Family Therapy (MDFT)

Multidimensional Family Therapy (MDFT) is a comprehensive and multisystemic family-based outpatient or partial hospitalization (day treatment) program for substance-abusing adolescents adolescents with co-occurring substance use and mental disorders and those at high risk for continued substance abuse and other problem behaviors such as conduct disorder and delinquency

Parenting with Love and Limits (PLL)

Parenting with Love and Limits (PLL) combines group therapy and family therapy to treat children and adolescents aged 10ndash18 who have severe emotional and behavioral problems (eg conduct disorder oppositional defiant disorder atten-tion deficithyperactivity disorder) and frequently co-occurring problems such as depression alcohol or drug use chronic truancy destruction of property domes-tic violence or suicidal ideation

TCU (Texas Christian University) Mapping-Enhanced Counseling

TCU (Texas Christian University) Mapping-Enhanced Counseling is a communica-tion and decision-making technique designed to support delivery of treatment services by improving client and counselor interactions through graphic visualiza-tion tools that focus on critical issues and recovery strategies

Trauma Recovery and Empowerment Model (TREM)

The Trauma Recovery and Empowerment Model (TREM) is a fully manualized group-based intervention designed to facilitate trauma recovery among women with histories of exposure to sexual and physical abuse

Source National Registry of Evidence-Based Programs and Practices Available at httpwwwnreppsamhsagov Accessed October 14 2011




allows them to explore consequences as a result of behavior MI is currently used in the mental health and addiction field but it is also taught to probation parole and community corrections officers Studies have shown that MI engages clients in the therapy process and increases retention rates

bull Motivational Enhancement Therapy (MET) with Stages of Change Component MET is a client-centered counseling approach based on principles of cognitive therapy in which the counselor seeks to develop a discrepancy between current behavior and significant personal goals in a clientrsquos percepshytion MET is based on the idea that motivation is a necessary and significant factor in making internal changes that support treatment and recovery efforts Although MET and the Stages of Change approaches were developed separately they are often used together Stages of Change complement the MET approach of finding the gaps between current behavshyiors motivation and goals The Stages of Change are Precontemplation Contemplation Preparation Determination Action Maintenance and Relapse

bull Contingency Management Contingency manageshyment is based on rewarding individuals for meeting treatment milestones or sanctioning them when they do not meet the goals and objectives outlined by the team This approach is recognized by SAMHSA as an EBP and is popular in reentry courts The principle behind contingency management is that if a person is rewarded for a positive behavior the behavior will be reinforced and is more likely to be continued or repeated in the future Numerous studies have demonstrated the effectiveness of this approach with substance users Study particishypants who received positive reinforcement showed improved retention in treatment decreased cocaine use and longer periods of abstinence than individushyals who did not receive positive reinforcement

bull Twelve Steps Facilitation Attending twelve-step support groups has been proven to increase attendance at group and individual counseling appointments improve treatment retention and increase overall rates of abstinence Twelve-step meetings complement cognitive behavioral

interventions for ex-offenders with substance use and co-occurring disorders because they promote pro-social behavior

Continuity of Treatment and Successful Transition

Formerly incarcerated individuals are vulnerable to conshytinued use of drugs and alcohol upon release because most have received only detoxification not addiction treatment Detoxification without access to treatment and recovery support services does not successfully deter people with substance use disorders from engagshying in future criminal activity or alcohol and drug use As a chronic untreated disease addiction is likely to result in continued contact with the CJS and a greater likelihood of re-incarceration A recent study found that 85 percent of drug-abusshying offenders returned to drug use within 1 year of release from prison and 95 percent returned to drug use within 3 years Research also sug-gests that approximately 30 percent of newly released offenders commit a serious crime within 6 months of release15

Formerly incarcerated

individuals are

particularly

vulnerable to relapse

for both drugs and

criminal behavior

in the period

immediately following

release Coordination

between systems and

sharing information

are critical

ATR grantees have the unique opportunity to bridge the gap between correctional facilities and community providers thereby ensuring continuity of care for the formerly incarcerated individual This continuity has been shown to decrease the likelihood of a return to use of alcohol and drugs and the likelihood of reshyarrest As stated above it is best achieved through care coordination that establishes a protocol with the correctional facility for information sharing during pre- and post-release transition planning

For the best reentry outcomes offenders with substance use disorders must be connected to comshymunity-based providers prior to release Although considered a best practice connecting with an offender while incarcerated can be difficult because correcshytional institutions have varying policies for allowing outside providers and volunteers into their facilities ATR grantees must familiarize themselves with State and community policies before proceeding If feasible



ATR grantees should contact the correctional facilishyties with which they want to develop partnerships and set up meetings with leadership to share information about the purpose of ATR and how care coordination can positively affect reentry and reduce recidivism

Pre-Release Planning

ATR providers should offer to meet with offenders 3 to 6 months prior to release to facilitate pre-release planning Meeting with an offender face-to-face can be a source of motivation and support that boosts the offenderrsquos willingness to follow through with recovery once reshyleased To maximize what is achieved during the time with offenders providers should request a summary of their health records correctional transition plans court orders and risk and needs assessments to help offendshyers determine what ongoing treatment and recovery support services they will need upon release

ATR grantees should also consider institutional programming that offenders have completed such as intensive substance abuse counseling a therapeushytic community or a parenting or anger management program If possible offenders transitioning into the community should continue with programming similar to what they received while incarcerated Treatment continuity after release reinforces the skills that ofshyfenders have already gained and decreases anxiety about learning a new approach

If correctional institutions have policies that prohibit providers from meeting with offenders providers should ask to meet with correctional officers or case managers and provide them with information about ATR and other resources available in the community

Strategies for Pre-Release Planning

bull Offer to meet with offenders 3 to 6 months prior to release

bull Request a summary of the individualrsquos health records correctional transition plans court orders and risk and needs assessments

bull Consider institutional programming that offenders have completed

bull Meet with correctional officers or case managers

Post-Release Planning

Post-release planning should incorporate the same strategies outlined for pre-release planning In addishytion if a formerly incarcerated individual is supervised by a criminal justice agency the ATR provider should request consent to receive and release confidential information so that the individualrsquos risk and needs assessment conditions of supervision and other pertinent information can be coordinated Although offenders have the final decision in the services they choose to receive obtaining this additional information will help them make a choice based on all the facts

Post-release planning for individuals with substance use disorders should integrate recovery support services in addition to substance abuse counseling Because every community has different strengths and resources from which to draw recovery support sershyvices will vary

Common Post-Release Services

The most commonly identified post-release ser-vices requested by formerly incarcerated individuals include

bull Determination of eligibility for government benefits


bull Stable supportive housing

bull Vocational rehabilitation aimed at work readiness that includes reading comprehension GED prepa-ration skills building resume development job training and obtaining higher education

bull Reliable transportation

bull Clothing assistance

bull Emergency shelter

bull Food

Environmental Changes and Discrimination

Returning home from incarceration can cause immense anxiety confusion trauma and frustrashytion These feelings can persist long after release Formerly incarcerated individuals who have spent years in correctional institutions may have never



seen a cell phone automatic seat belt computer and other technology that most people take for granted Neighborhoods in which the individual resided prior to incarceration may have undergone significant changes In addition formerly incarcerated individuals are often isolated with little pro-social support ATR providers must take into consideration the number of years the person has spent away from society when preparing to assist with community transition Providers must offer emotional support that fosters hope and resiliency The ATR provider may initially be the only positive conshynection an individual has to the community

In addition to environmental changes individuals may encounter discriminatory policies that complicate reenshytry as they seek housing and employment Significant barriers often prevent them from securing housing ATR providers must be cognizant of housing and employment barriers and be proactive when working with the formerly incarcerated For example within HUD housing statutes and regulations two unequivoshycal lifetime bans on occupancy based on criminal justice involvement require Public Housing Agencies (PHAs) to deny admission to public housing and housshying choice voucher programs for

bull Individuals found to have manufactured or produced methamphetamine on the premises of federally assisted housing

bull Sex offenders subject to lifetime registration requirements under State sex offender registration programs

Also PHAs must have a policy in place to prohibit admission if they determine that a household member is actively using drugs or is a danger to others livshying in the public housing community They also must prohibit admission of an applicant for 3 years from the date of eviction if the applicant was evicted from a home based on illegal activity PHAs often have discreshytion to consider the circumstances of an individualrsquos eviction and subsequent treatment however they may exercise this discretion more or less stringently based on personal preference

Formerly incarcerated individuals have many employshyment obstacles to overcome ATR providers must

understand the laws as well as the protections that exist For example Federal protections exist for people in recoverymdashthe Rehabilitation Act of 1973 and the Americans with Disabilities Act Both laws protect individuals who are in recovery from discriminashytion based on their past drug history when seeking employment education or other services No Federal protections exist for people with criminal histories however discrimination based on a criminal record can be race discrimination in violation of Title VII of the Civil Rights Act of 1964 because minorities are overrepresented in the CJS


ATR programs can learn from current and previous grantees with experience working and collaborating with the CJS Here we include examples from Iowa and Indiana (both ongoing in ATR 3) showing their approaches and implementation strategies

Iowarsquos ATR Experience

Up to 70 percent of the individuals in Iowarsquos publicly funded treatment programs are involved with the CJS Of these individuals the same percentage or higher is likely to have a substance use disorder revealing an obvious need that led to Iowarsquos collaboration with the CJS

Primary Partners and Collaborators

Some of Iowa ATRrsquos recommended CJS contacts include

bull Director of the Department of Corrections bull Department of Corrections Treatment Coordinator bull Regional probation and parole supervisors bull Prison discharge counselors bull Department of Corrections Women Offenders

Subcommittee bull Criminal and Family Drug Court

Successful Strategies of Approach

bull Communicate the message of ATR Iowa ATR staff highlighted key aspects of their ATR program with criminal justice contacts This messhysaging included the background of the initiative and its emphasis on recovery-oriented care and client



choice an overview of the recovery-oriented sershy

vices and supports that are available and program

utilization and outcome data

bull Explore every avenue to get the message out When reaching out to new partners and systems

Iowa ATR connected with contacts at different

levels to be sure of reaching those who were most

receptive to the ATR concept Among their outreach

activities were

mdash Attending regional probationparole meetings

and conferences of corrections staff and presentshy

ing information about ATR

mdashVisiting State prisons to meet with discharge

counselors in an effort to bridge the gaps

between State departments and State and local

connections

bull Increase collaboration through constant communishycation at all levels Guided by the strategies above Iowa ATR was

able to increase collaboration efforts between the

Statersquos Public Health and Corrections departments

Through Iowa ATRrsquos connection with the Women

Offenders Subcommittee staff reached several target

populations including methamphetamine users

parents with child-rearing responsibilities and

women being released from correctional settings

bull Create varied marketing materials Providers are an excellent source of information on

what kinds of materials will reach individuals in their

communities and where to distribute them Iowa

ATR staff sent brochures to the Statersquos Department of

Human Services offices and various drug courts ATR

fact sheets were created to highlight the programrsquos

services and successful results Division of Behavioral

Health staff also developed a monthly Division of

Behavioral Health newsletter in which ATR was often

showcased because one of the newsletterrsquos editors

was on the ATR staff The newsletter is sent to more

than 600 individuals across the State

bull Adjust ATR services to client needs Iowa recognized that individuals in correctional

settings who need psychotropic medication



typically receive no more than a 60-day supply when discharged but booking an appointment with a psychiatrist who could help them continue their recovery could take up to 90 days To reduce the likelihood of an additional offense Iowa initishyated a pilot program that provided medication to these individuals during the interval between the end of their supply and their access to additional assistance Not only did the pilot yield cost-saving results but it also led to the adoption of psychotroshypic medications as one of the approved uses of ATR funds for all ATR 3 grantees

bull Home in on recovery barriers To move forward with their recovery clients may need a variety of vouchers to address specific recovery barriers These could range from providshying transitional housing and meeting transportation needs to providing clothing for job interviews or work settings and providing child care so that clishyents can attend outpatient treatment

bull Initiate implementation where needed Iowa adjusted its implementation plan after discusshysions with the State Department of Corrections The State first initiated ATR within five communities that were selected because individuals were likely to return to these areas once released from prison

Iowa ATRrsquos Lessons Learned When conducting outreach to potential partners remember to keep the ATR message moving through all levels of an organization Expand the contact roster and build relationships as needs and environ-ments change never underestimate the value of each person reached Although communication may be working at a certain level it might not be permeating beyond that level Continual communication could lead outreach efforts to the introduction of new pro-grams and partners

Indianarsquos ATR Experience

With nearly 15000 individuals to be released from the CJS during the first year of Indianarsquos ATR grant ATRrsquos recovery support services were clearly needed in communities The Indiana Department of Correction provides substance use disorder programs for incarcershyated individuals but ATR provides an opportunity to help this population as it faces challenges beyond the prison walls when reentering communities


Some of Indiana ATRrsquos recommended CJS contacts include

bull State Department of Correction bull Judicial Center that oversees problem-solving courts

(eg drug and reentry courts) bull Probation officials bull Parole officers bull Community Corrections


bull Educate CJS staff about ATRrsquos key features and benefits and use ATR as a platform for discussion of recovery-oriented care By funding many of the addiction services that are not typically covered by State funding and focusing on the criminal justice population ATR provided Indiana with an opportunity to bring criminal justice stakeholders together to understand ATRrsquos role in recovery ATRrsquos unique structure requires CJS staff to rethink their approach to treatment and recovery support services Unlike the CJS ATR requires client buy-in and client choice

bull Work toward a shift in attitude Coming to an understanding about ATRrsquos focus on recovery-oriented care is a gradual process unique to each situation Individuals who are used to assignshying acute treatment-as-usual solutions to individuals with substance use disorders may be resistant to changing to a client-focused approach to recovery State buy-in is crucial to achieving buy-in at lower levels Connections made at the State level eased adoption of ATRrsquos approach among the counties Staff attended advisory board meetings or volunteered to



make introductory presentations about ATR and the benefits it offers to agencies It took time but staff eventually saw the evidence of ATRrsquos benefits ATRrsquos client-driven care has led to positive outcomes not only helping the individual in need but also reducing recidivism and decreasing or keeping constant the criminal justice systemrsquos staff workload

bull Ensure care coordination to help individuals reinteshygrate into their communities Once released from incarceration individuals may not know where to turn to continue their recovshyery Indianarsquos recovery consultants offer key care coordination to help these individuals navigate through resources available from ATR and other Federal State and community programs Recovery consultants with strong linkages to the community facilitated understanding among community proshyviders about ATRrsquos unique structure and provided individuals with a framework in which to achieve recovery Because connecting with offenders durshying incarceration is the most effective way to engage them post-incarceration Indianarsquos recovery consulshytants solicited meetings with offenders 3 to 6 months prior to their release to establish relationships and begin outlining a reentry plan The consultants work with individuals at every level of recovery from assisting with the development of recovery plans to serving as their voice liaison and guide

bull Understand that collaboration is reciprocal Just as courts need to understand ATR its client-centered care and its free-form approach to treatment and recovery services ATR staff had to adjust to the court systemrsquos requirements Problem-solving courts cannot mandate that individuals enroll in ATR In Indiana ATR could fund court-required services only if they included at least one ATR provider Court-referred clients in Indiana have some choice but not the full array of choices for every ATR service that a client who is not referred by the court would have For all services that are not court-ordered which includes most recovery supshyport services court clients have the ability to choose from all ATR providers

bull Focus on education to achieve understanding among partners and stakeholders Indiana staff educated Department of Correction case managers and corrections officers on ATRrsquos policies and procedures including eligibility criteria the involved counties and referral development and forms Through contracts with the Judicial Center they scheduled training sessions with probation agencies problem-solving courts and court alcohol and drug programs Additionally recovery consulshytants were tasked with fostering their local criminal justice connections and educating judges and other key leadership about ATR

bull Encourage staff education to facilitate and enhance collaboration To break down barriers and facilitate communicashytion with potential partners and systems Indiana ATR staff became familiar with each agencyrsquos organizational structure tools processes and procedures Within the CJS this included commushynity corrections parole probation problem-solving courts and court alcohol and drug programs Many ATR staff had to learn to understand court orders and the difference between misdemeanor and felony charges They explored each agencyrsquos leadership structure advisory board reporting processes comshymunication practices risk and needs assessments and philosophy on consumer choice when an indishyvidual is ordered to treatment by the court

Indiana ATRrsquos Lessons Learned

Educate grantee staff and potential partners to culti-vate effective collaboration ATR brings new concepts to the treatment-as-usual arena Communicate the benefits of ATR how it showcases recovery-oriented care by promoting client choice and providing recovery support services Realize however that agencies are independent of each other and that ATR staff need to be well versed in the State statutes that govern each one Change is gradual because of each agencyrsquos unique structure and culture but collabora-tion can be achieved through open communication and effective learning



Endnotes

1 Natarajan N Petteruti A Walsh N amp Ziedenberg J (2008) Substance Abuse Treatment and Public Safety httpwwwjusticepolicyorg imagesupload08_01_REP_DrugTx_AC-PSpdf

2 Glaze LE (2010) Correctional Populations in the United States 2009 httpbjsojpusdojgov contentpubpdfcpus09pdf Sabol WJ and West HC (2010) Prisoners in 2009 httpbjs ojpusdojgovindexcfmty=pbdetailampiid=2232 Bonczar T Glaze L (2010) Probation and Parole in the United States 2009 httpbjsojp usdojgovindexcfmty=pbdetailampiid=2233 and Todd MD (2010) Jail Inmates at Midyear 2009 - Statistical Tables httpbjsojpusdojgovindex cfmty=pbdetailampiid=2195

3 National Institute of Justice ldquoReentry Into Societyrdquo httpwwwnijgovtopicscorrectionsreentry welcomehtm


5 Ibid

6 Ibid

7 National Institute on Drug Abuse (2009) Principles of Drug Abuse Treatment for Criminal Justice Populations A Research-Based Guide httpwww nidanihgovPDFPODAT_CJPODAT_CJpdf

8 Greene J and Pranis K (2006) Treatment Instead of Prisons A Roadmap for Sentencing and Correctional Policy Reform in Wisconsin Washington DC Justice Strategies httpwww justicestrategiesorgsitesdefaultfiles publicationsWisconsin_Report_Treatment_ Instead_of_Prisons_Jan_06pdf


10 National Institute on Drug Abuse ldquoFrequently Asked Questionsrdquo httpdrugabusegovpodat_cj faqsfaqs1html

11 Gever M (2007) Prisoner Reentry and Lack of Substance Abuse Treatment Coverage httpwww ncslorgdefaultaspxtabid=14085

12 National Association of Drug Court Professionals ldquoThe Verdict Is Inrdquo httpwwwnadcporglearn facts-and-figures

13 Ibid

14 Lovins B Lowencamp CT amp Latessa EJ (2009) Applying the Risk Principle to Sex Offenders Can Treatment Make Some Sex Offenders Worse Prison Journal 89 (3) 344-357 httpcjonlineucedu article-risk-principle-to-sex-offenders

15 Martin SS Butzin CA Saum CA and Inciardi JA (1999) Three-Year Outcomes of Therapeutic Community Treatment for Drug-Involved Offenders in Delaware Prison Journal 79 (3) 294-320


Gaumond P and Whitter M (2009) Access to Recovery (ATR) Approaches to Recovery-Oriented Systems of Care Three Case Studies HHS Publications No (SMA) 09-4440 Rockville MD Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration Available at httppfrsamhsagovdocsATR_Approaches_to_ ROSCpdf

Heaps MM Lurigio AJ Rodriguez P Lyon T amp Brookes L (2009) Recovery-oriented care for drug-abusing offenders Addiction Science and Clinical Practice 5(1) 31-36 Available at httpwwwncbinlm nihgovpmcarticlesPMC2797119

Moore GE and Mears DP (2002) Voices From the Field Practitioners Identify Key Issues in Corrections-Based Drug Treatment Washington DC Justice Policy Center Urban Institute 2002 Summary availshyable at httpwwwurbanorgpublications410617 html Full report available at httpwwwurbanorg UploadedPDF410617_NIDA2_IntRptpdf



National Institute on Drug Abuse (2006) Principles of Drug Abuse Treatment for Criminal Justice Populations A Research-Based Guide NIJ Publication No 06-5316 Available at httpwwwnidanihgovpodat_cj (PDF available)

Osher F Steadman HJ and Barr H (2002) A Best Practice Approach to Community Re-entry from Jails for Inmates with Co-occurring Disorders The APIC Model Delmar NY The National GAINS Center 2002 Available at httpgainscentersamhsagovpdfs reentryapicpdf

National GAINS Center for People with Co-Occurring Disorders in the Justice System Creating Integrated Service Systems for People with Co-Occurring Disorders Diverted from the Criminal Justice System The King County (Seattle) Experience Delmar NY 2000 Available at httpgainscentersamhsagovtext integratedKingCounty_Fall_2004asp PDF available at httpgainscentersamhsagovpdfsintegrating King_Countypdf

Websites

bull National Institute on Drug Abuse Criminal Justice and Drug Abuse httpdrugabusegovdrugpagescjhtml

bull Prison Policy Initiative Prison Programs Recidivism

Reentry httpwwwprisonpolicyorgresearch prison_programs_recidivism_reentry

bull Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Knowledge Application Program TIPs Series Criminal and Juvenile Justice httpkapsamhsagovproductsmanualstips indexhtmcriminal

bull The Center for Court Innovation Statewide Drug Court Training and Technical Assistance httpwwwdrugcourttaorg

bull The National Association of Drug Court Professionals httpwwwnadcporgnadcp-home

bull Treatment Alternatives for Safer Communities httpwwwtasc-ilorgpreviewindexhtml

Contents

I Introduction

II The Intersection of Behavioral Health and theCriminal Justice System

III Drug Courts

IV Engaging Criminal JusticendashInvolved Individuals inROSCs






at which the treatment and criminal justice systems can intersect provides an in-depth look at drug courts and reentry as key opportunities for intervention and describes how the CJS can be incorporated into a broader recovery-oriented system of care The final section presents practical lessons learned and strateshygies for working with the CJS from access to recovery (ATR) programs in Iowa and Indiana

How Should Grantees Use This Information Much of this TA package is a guide for ATR grantees who want to better understand the intersection of substance use treatment recovery and the CJS It can serve as a starting point for conversations with providshyers and State and local stakeholders In addition the information in this TA package can be used to develop educational presentations for staff and providers who may be new to working with CJS-involved individushyals The information is tied to practical application in Section V and in the Iowa and Indiana ATR case studies in Section VI (eg which partners to consider engaging)

Approximately one-third of the individuals served by ATR 1 and ATR 2 grantees were involved with the CJS ATR 3 grantees can play an important role at the intersection of the treatment recovery and criminal justice systems They can open pathways to recovery for CJS-involved individuals experiencing issues with substance use and help bridge the gap between CJS clients and access to an appropriate comprehensive array of options and services needed for recovery

SAMHSArsquos Strategic Initiatives The Substance Abuse and Mental Health Services Administration (SAMHSA) recently set forth eight strategic initiatives to guide its work and focus its resources as it pursues its mission to reduce the impact of substance use and mental illness on Americarsquos comshymunities Two of these initiatives are closely related to collaborating with the CJS to meet the drug treatment and mental health needs of justice-involved populashytions These are Initiatives 2 Trauma and Justice and 4 Recovery Support

bull Trauma and Justice (Initiative 2) Reducing the pervasive harmful and costly health impact of violence and trauma by integrating

trauma-informed approaches throughout health behavioral health and related systems and addressshying the behavioral health needs of people involved in or at risk of involvement in the criminal and juvenile justice systems

bull Recovery Support (Initiative 4) Partnering with people in recovery from mental and substance use disorders to guide the behavioral health system and promote individual- program and system-level approaches that foster health and resilience increase permanent housing employshyment education and other necessary supports and barriers to social inclusion


In the United States on any given day more than 7 million adults are involved in some form of criminal justice supervision2 Most of them are on probation or parole and living in the community Of the more than 2 million who are incarcerated in prisons and jails nearly all of themmdash95 percentmdashwill eventually return to the community Annually more than 700000 indishyviduals are released from prison and 9 million cycle through Americarsquos jails3

Criminal Justice and Substance Abuse Facts and Figures bull

bull

bull

bull

8 million adults are involved in the justice system

Almost 5 million individuals are on probation or under parole supervision

The substance abuse or dependence rates of offenders are more than four times those of the general population

In the juvenile justice system about 56 percent of the boys and 40 percent of the girls tested positive for drug use at the time of their arrest (National Institute of Justice 2003)

Source National Institute on Drug Abuse (2006) ldquoPrinciples of Drug Abuse Treatment for Criminal Justice Populationsrdquo National Institutes of Health US Department of Health and Human Services httpwwwnidanihgovPDFPODAT_CJ PODAT_CJpdf (accessed October 14 2011)

















Sources











































































III Drug Courts


Drug courts are

an alternative to

incarceration that

blends criminal

justice supervision

with substance

use treatment and

recovery
















bull Drug testing



























































NA



conditions





Community

Reentry



providers











most effective when

planning begins

before an offender

returns to the

community































history



as appropriate













































bull Arrest history




















Care Coordination



























































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts





















Sources











































































III Drug Courts


Drug courts are

an alternative to

incarceration that

blends criminal

justice supervision

with substance

use treatment and

recovery
















bull Drug testing



























































NA



conditions





Community

Reentry



providers











most effective when

planning begins

before an offender

returns to the

community































history



as appropriate













































bull Arrest history




















Care Coordination



























































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts













































































III Drug Courts


Drug courts are

an alternative to

incarceration that

blends criminal

justice supervision

with substance

use treatment and

recovery
















bull Drug testing



























































NA



conditions





Community

Reentry



providers











most effective when

planning begins

before an offender

returns to the

community































history



as appropriate













































bull Arrest history




















Care Coordination



























































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts


















bull Drug testing



























































NA



conditions





Community

Reentry



providers











most effective when

planning begins

before an offender

returns to the

community































history



as appropriate













































bull Arrest history




















Care Coordination



























































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts
























































NA



conditions





Community

Reentry



providers











most effective when

planning begins

before an offender

returns to the

community































history



as appropriate













































bull Arrest history




















Care Coordination



























































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts































history



as appropriate













































bull Arrest history




















Care Coordination



























































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts















bull Arrest history




















Care Coordination



























































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts












Care Coordination



























































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts




















































individuals are

particularly


for both drugs and

criminal behavior

in the period



between systems and

sharing information

are critical



























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts





























bull Food































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts

































activities were







connections

















































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts































Endnotes





5 Ibid

6 Ibid







13 Ibid












Websites








Contents

I Introduction


III Drug Courts










Websites








Contents

I Introduction


III Drug Courts





collaborating with the criminal justice system

Documents