Download - Robert L. Neri, LMHC, CAP Senior Vice President /Chief Clinical Officer WestCare Foundation, Inc
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“Drug Offender Treatment
Lessons Learned: New Challenges from
Institution to Community”2013 FADAA/FCCMH Annual Conference
Robert L. Neri, LMHC, CAPSenior Vice President /Chief Clinical OfficerWestCare Foundation, Inc.
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Lessons Learned in Corrections
•Learning from the Past•Lessons of the Present•Looking to the Future
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Lessons Learned in CorrectionsTraining Objectives:
Participants will be able to list examples of the many dynamic changes in the field of drug
offender treatmentParticipants will be able to assess their programs’
readiness for future anticipated changesParticipants will be exposed to the significance of
the treatment environment and culture as it relates to outcomes
Participants will leave with several ideas to process and plan with their program staff 21
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Lessons Learned in CorrectionsDo you know that 90% of your brain works without using any words at all?
Just so you know that means there’s only a 10% chance of me making any sense at all
once I start talking 31
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Lessons Learned in Corrections“I kept trying to be
what you wanted, he said- but at a certain point you needed to
stop adding to the list”Ex Offender41
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Lessons Learned in CorrectionsTREATMENT/CORRECTIONS CONTINUUM
TREATMENT
Prev
entio
nIn
terve
ntion
Basic
Outpati
ent
Inten
sive O
utpati
ent
Sobe
r Hou
sing
GPS
Shor
t-term
Res
identi
alDay
Rep
ortin
g Cen
ters
Long-t
erm R
eside
ntial
In Ja
il/In
Priso
n
CORRECTIONS
Civil C
itatio
ns
Pre-tria
l Prog
rams
Basic C
ommun
ity Sup
ervisi
on
House
Arrest
Commun
ity C
ontro
l GPS
Jail: i
n Trea
tmen
t + R
e-entr
y
Prison
: in Trea
tmen
t + R
e-entr
y
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Lessons Learned in CorrectionsTreatment Is Dynamic &
ChangingSeparated vs. Integrated
Relapse (Shame-based) vs. Relapse AnalysisMedication (Shunned) vs. Medication Valued
Harsh Confrontation vs. Motivational Continuum
Recovering Staff vs. Multi-Disciplinary61
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Lessons Learned in CorrectionsTreatment Is Dynamic &
Changing ContinuedInstinct-Based vs. Research- BasedOne Size Fits All vs. Individualized
Supervision vs. Supervision Intermittent
PlannedMust Hit Bottom vs. Coercion Works
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Lessons Learned in CorrectionsCLIENT
JUDGE COUNSELOR
RECOVERY IS
RELATIONAL
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Lessons Learned in Corrections
Client Motivation is Dependent Upon Internal as well as
External Pressures
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Lessons Learned in CorrectionsMotivational Changes in
Treatment
Treatment Dosage
External
Internal
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Lessons Learned in CorrectionsDevelopmental Model
Principles • “It’s a process not an event”• “Treatment is cumulative”•Developmental Psychology
means: “Psychology of Maturation”111
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Lessons Learned in CorrectionsCOMPETENCY BASED
APPROACH TO LEARNINGCompetency Mastery
Requires:• Information knowledge• Implementation knowledge
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Lessons Learned in Corrections
Establish a therapeutic alliance:
build and facilitate trust transfer
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Lessons Learned in Corrections
HHIGH HOPE
LOW HOPE
HIGH PAIN
LOW PAIN
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Lessons Learned in CorrectionsRatio of Rewards to Sanctions and the
Probability of Success
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Lessons Learned in Corrections
Incentives & SanctionsMaximize benefit by
timing of rewards and consequences
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Lessons Learned in CorrectionsFinding a New Vocabulary for
Affirmation and Validation• Pulling Up the Positive to Avoid the
Punitive• Affirm the Small Steps and Progress• Educate- Which Means “Lead Forth”• Learn to Articulate Affirmations• Develop Emotional Literacy….Name it, Claim it, Own it, Change it! 171
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Lessons Learned in Corrections
{Assess / Deprivation Needs}
•Trauma History•Resiliency Factors
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Lessons Learned in Corrections
Programs are:Expectations based- Emphasize relationshipsRules based- Emphasize compliance
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Lessons Learned in Corrections
Compliance is adaptation
Not Treatment
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Lessons Learned in Corrections
Institutionalization requires treatment
Emotional Incarceration211
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Lessons Learned in CorrectionsGender Specific Challenges for Men
Masculinity Demands
Treatment Demands
Being Self-Reliant Seeking Help
Being Stoic Expressing Feelings
Taking Action Becoming Introspective 22
Vs.
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Lessons Learned in CorrectionsGender Specific Challenges for Men
Masculinity Demands
Treatment Demands
Showing Strength Showing Weakness
Experiencing Pride
Experiencing Guilt & Shame
Acting Invincible Acting Vulnerable23
Vs.
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Lessons Learned in CorrectionsFacilitate movement from compliance to
internalization through gradual reduction of structure and insight
work241
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Lessons Learned in Corrections
Create a treatment culture that promotes
“Mistakes as wonderful opportunities to learn”.
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Lessons Learned in Corrections
Teach social network mapping and assist
clients with building a social support network
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Lessons Learned in CorrectionsHow Can Programs Improve Care• Ask and integrate trauma related
questions / practices• Deliver more experiential based
learning• Improve cognitive health approach (teach memory / thinking skills)• Use incentives 4:1 to sanctions 271
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Lessons Learned in CorrectionsHow Can Programs Improve
Care Continued• Insure program cultures are
expectations based vs. rules based• Aftercare can be more of a system
rather than a loose aggregate of diverse providers• Develop a youthful offender track of
services 28
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Lessons Learned in CorrectionsRisk, Need, Responsivity
The Big 8NEED GOAL
Anti-social cognitions Reduce anti-social cognition, recognize risky thinking and feelings, adopt alternatives
Anti-social companions Reduce association with criminals, enhance contact with pro-social friends
Anti-social personalities Build problem-solving, self-imaging, anger awareness, and coping skills 29
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Lessons Learned in CorrectionsRisk, Need, Responsivity
The Big 8NEED GOAL
Family and marital relationships
Reduce conflict, build positive relationships and communication
Substance abuse Reduce usage, reduce the support for abusive behavior, enhance awareness
Employment Provide employment-seeking-and –keeping skills and enhance performance? 30
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Lessons Learned in CorrectionsRisk, Need, Responsivity
The Big 8NEED GOAL
Education Increase performance rewards and satisfaction
Leisure and recreation Enhance pro social activities
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Lessons Learned in Corrections Expectations Reality
Not easy, but worth it32
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Lessons Learned in Corrections
Questions?
Thank you 33