kenton county detention center mat-pdoa evaluation project
TRANSCRIPT
University of Kentucky Center on Drug and Alcohol Research
JANUARY 3, 2020
Kenton County Detention Center MAT-PDOA Evaluation Project
YEAR 1 ANNUAL REPORT
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Prepared by: The University of Kentucky
Center on Drug and Alcohol Research Lexington, KY 40508
January 3, 2020
Strong Start COR-12 Treatment and Reentry Program
KENTON COUNTY DETENTION CENTER
MEDICATION ASSISTED TREATMENT FOR PRESCRIPTION DRUG AND OPIOID ADDICTION (MAT-PDOA)
Evaluation Annual Report
GRANT YEAR 1
OCTOBER 1, 2018 – SEPTEMBER 30, 2019
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TABLE OF CONTENTS
Grant Identification Information…………………………………………………………………………………….. 3
Project Team.…………………………………………………………………………………………………………………. 4
Executive Summary………………………………………………………………………………………………………… 5
Overview of CSAT Supported Services…………………………………………………………………………….. 7
Evaluation Overview……………………………………………………………………………………………………….. 10
Kenton County MAT Evaluation Snapshot & Project Goals …………………………………………….. 11
Outcome Evaluation Findings
MAT participation…………………………………………………………………………………………………… 12 Participant characteristics………………………………………………………………………………………. 13 Housing status………………………………………………………………………………………………………… 13 Employment…………………………………………………………………………………………………………… 14 Child custody & parenting………………………………………………………………………………………. 15 Physical & mental health………………………………………………………………………………………… 15 Substance use……………………………………………………………………………………………………..…. 17 Recovery supports & services…………………………………………………………………………………. 19 Criminal justice involvement………………………………………………………………………………….. 20
Process Evaluation Findings……………………………………………………………………………………………. 21
Conclusions and Recommendations………………………………………………………………………………… 25
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GRANT IDENTIFICATION INFORMATION
Grantee Federal Identification Number:
TI 081561
Project Name:
Kenton County Detention Center MAT-PDOA
Grantee Organization:
Kenton County Detention Center
Program Director:
Jason Merrick, MSW, CDAC 3000 Decker Crane Ln. Covington, KY, 41017 Phone: (859) 363-2437 E-mail address: [email protected]
Evaluation Team:
Michele Staton, PhD, MSW UK College of Medicine Department of Behavioral Science Center on Drug & Alcohol Research 117 Medical Behavioral Science Building Lexington, KY 40536
Tiffany Howard, MPH
Center on Drug & Alcohol Research 643 Maxwelton Court Lexington, KY 40508
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PROJECT TEAM
Kenton County Detention Center
Jason Merrick, MSW, CDAC, Program Director/Director of Addiction Services
Bethany Ball, MSW, CSW, TCADC, Program Coordinator
Joseph Roberts, BSW, Clinical Navigator
David Wray, BS, Clinical Navigator/SAP Deputy
Rachel Pinnell, Clinical Navigator
Meghann Smith, BSW, Clinical Navigator
Michael Greenwell, Clinical Navigator
Tina Malone, BSW, Clinical Navigator
Life Learning Center
Alecia Webb-Edgington, President
Denise Govan, Managing Director & Director of Education
Robert Venable, Director of Enrollment
Mitch Haralson, MSW, LCSW, Director of Care Continuum & Volunteer Recruitment/Coordination
Ashton Van Gorden, MSW, Data & Job Placement Coordinator
University of Kentucky
Dr. Michele Staton, MSW, PhD, Principal Investigator and Evaluator
Tiffany Howard, MPH, Project Director
Martha Tillson, BSW, Administrative Research Assistant Pr.
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EXECUTIVE SUMMARY
With funding from the Center on Substance Abuse Treatment (CSAT), the Kenton County Detention Center expanded
treatment services offered through its Jail Substance Abuse Program (JSAP) for adults diagnosed with an opioid use
disorder (OUD). This expansion included implementation of Hazelden Betty Ford’s Strong Start Comprehensive
Opioid Response with the 12 Steps (COR-12) Treatment and Reentry Program, offering two “tracks” of medication-
assisted treatment (MAT) for OUD, and enhanced aftercare services provided primarily by the Life Learning Center
(LLC). Through these “tracks,” participants may choose to receive A) no medications (abstinence-only), B) extended-
release injectable naltrexone (e.g., Vivitrol®), or C) 14 days of oral buprenorphine, followed by initiation to injectable
extended-release buprenorphine.
This annual evaluation includes two primary components – a process evaluation and an outcome evaluation. The
purpose of the process evaluation was to assess project implementation using qualitative interviews with project
administrators, project staff, and project participants. Process evaluation findings included the following key themes
from project administrators and staff: (1) KCDC and the JSAP program have had to be adaptable and flexible as they
have navigated challenges related to offering an entirely new model of treatment for correctional facilities in
Kentucky; (2) implementation of treatment “tracks” (buprenorphine, naltrexone, or abstinence) has created a
valuable opportunity for open dialogue and education of staff, community partners, JSAP clients, and other inmates
concerning MAT; (3) partnerships with community organizations to provide wrap-around services have been
invaluable towards the positive outcomes observed during the first grant year; and (4) in the remaining grant years,
staff and administrators agreed that they would like to focus on sustaining positive changes, evaluating and adjusting
existing procedures, and looking for opportunities for future growth. Participants receiving services also participated
in the process evaluation and the following themes emerged from their responses: (1) clients valued the “safety net”
of MAT as an important tool to reduce the chance of relapse after they were released; (2) although access to MAT
options was one important component of treatment, clients also appreciated many other aspects of the JSAP
program; and (3) in addition to these services, clients discussed the desire and willingness to stop using as an
important aspect of successful recovery.
The outcome evaluation included a face-to-face interview at intake (baseline) and at 3-month and 6-month post-
intake (follow-up). The CSAT Government Performance and Results Act (GPRA) instrument was used for data
collection, as well as a few additional measures relevant to the grant goals. During the first year of the project
(October 1, 2018 through September 30, 2019), 101 participants received services under the CSAT Kenton County
Detention Center MAT-PDOA Evaluation grant and consented to complete a baseline evaluation interview (101% of
targeted baseline enrollment).
Participants were eligible for a 3-month follow-up interview between 2 and 5 months after their baseline intake date.
During the first year of the grant, 49 participants were eligible for a 3- month follow-up interview (i.e., had reached
3 months post-baseline) and 48 total had completed the interview for an overall follow-up rate of 98.0%. Participants
were then eligible for a 6-month follow-up interview between 5 and 8 months post-baseline. Eleven participants
were eligible for a 6-month follow-up interview during the first grant year (i.e., had reached 6 months post-baseline)
and 13 total had completed the interview for an overall follow-up rate of 118.2%.
This evaluation report highlights services provided through the CSAT-funded MAT-PDOA grant and successes
throughout the first grant year at the Kenton County Detention Center. A number of participants benefited
considerably from agency programming and services. At baseline, reflecting on their last 30 days on the street, 22.9%
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of participants reported being homeless, 62.4% were unemployed, 29.7% had experienced physical violence, and
71.3% had injected drugs. By 3-month follow-up, 83.3% of these individuals were still receiving inpatient substance
abuse treatment services through the JSAP program (87.5% were incarcerated), meaning that many outcomes post-
release (e.g., employment or housing) could not yet be validly assessed. However, 39.6% of 3-month follow-up
participants reported having participated in MAT during the last 3 months. Although 6-month follow-up findings are
preliminary given the small sample size (N=13), initial results are promising, including large reductions in many self-
reported mental health symptoms, increased attendance at recovery support meetings (such as AA/NA), more
contact with family and friends who supported their recovery, and 84.6% abstinence from drugs. Furthermore, 46.2%
of participants at 6-month follow-up reported MAT participation in the past three months, suggesting that linkages
to treatment in the community after release from JSAP have been successful.
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OVERVIEW OF CSAT-SUPPORTED SERVICES
With CSAT funding awarded by the present grant, the Kenton County Detention Center expanded treatment services
offered through its Jail Substance Abuse Program (JSAP) for adults diagnosed with an opioid use disorder (OUD). This
expansion included implementation of a Strong Start COR-12 Treatment and Reentry Program, as well as access to
expanded mediation-assisted treatments (MATs). Below is a detailed description of the JSAP program and its
expanded services, as well as services provided by key community partners.
Kenton County Detention Center (KCDC)
KCDC is recognized as a leader in Kentucky for its pioneering efforts in developing JSAP, which provides primary
treatment for substance misuse while people are incarcerated. Jailer Terry Carl identified the need for a substance
misuse program as the opioid epidemic ensued and people were being released from KCDC and immediately
overdosing. In September 2015, KCDC began offering JSAP, which grew in three years to serve 250 men and women
annually. JSAP uses an evidence-based biopsychosocial model which has proven successful at increasing employment,
reducing recidivism, and increasing access and engagement with community recovery support services. According to
University of Kentucky’s Criminal Justice Kentucky Treatment Outcome Study FY 2017, JSAP graduates have
significantly more positive outcomes than people who have been released from criminal justice facilities that do not
have a robust treatment program.
With funding awarded by the present grant, KCDC has implemented the Strong Start COR-12 Treatment and
Reentry Program, an integrated treatment approach offered through the Hazelden Betty Ford Foundation. This
model couples medications with evidence-based therapies, case management for OUD, and integration with peer-
support to provide a cohesive MAT model. It has been implemented throughout the nation in myriad settings,
including outpatient, inpatient, and federally-funded community-based behavioral health settings. One aspect of
COR-12 as implemented in KCDC JSAP is cognitive-behavioral therapy (CBT) delivered through “A New Direction”
programming, based on a modified therapeutic community model, with 15-25 hours of programming per participant
per week, focusing on changing patterns of behavior and thought related to addictive and criminal thinking and
behavior.
As mentioned, an important aspect of COR-12 is the integration of medication-assisted treatment (MAT) as
an option for clients with OUD diagnoses. Although KCDC offered clients the opportunity to initiate extended-release
naltrexone (Vivitrol®) prior to the current grant, additional CSAT funding supported expansion of these services to
include extended-release buprenorphine injections. Under the grant, eligible and consenting JSAP clients now have
the option of receiving A) no medications (abstinence-only), B) extended-release injectable naltrexone (e.g., Vivitrol®),
or C) 14 days of oral buprenorphine, followed by initiation to injectable extended-release buprenorphine. Medical
evaluations for MAT and provision of MAT services are provided by Southern Health Partners, primarily Medical
Director Dr. David Suetholtz, MD, who also offers continued services to clients in the community post-release through
his family medicine practice in Ft. Mitchell, KY.
Community Partnerships
Life Learning Center (LLC)
After release from the KCDC JSAP program, participants have the opportunity to receive 6 months of evidence-based
aftercare curriculum through LLC, including counseling, job readiness, childcare, and other reentry services. This
programming eases the transition from jail to the community by supporting clients’ efforts to maintain sobriety, to
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improve their mental and physical health, to achieve safe and stable housing, and to pursue goals such as education
or employment. In 2006, Bill Butler and other community leaders in Northern Kentucky established LLC as a 501(c)3
public charity to help “at-risk” individuals reach their highest potential. LLC provides an extensive continuum of
education and care to equip under- and unemployed individuals with the necessary resources and tools to envision,
achieve and sustain a better future for themselves and their families. LLC participants demonstrate a 100%
participation rate in employment, enlistment in U.S. Armed Forces, or enrollment in an institution of higher education
within 90 days of admission.
P.I.E.R. Recovery Community Center (Mental Health America)
Aftercare services for individuals with co-occurring OUD and mental health needs are often provided by the P.I.E.R.
Recovery Community Center. This “safe harbor,” located at Tenth & Monmouth Streets in Newport, KY, is the home
of Kentucky Certified Peer Support Specialists, who work with clients by sharing resources and building skills, leading
recovery groups, and mentoring and setting goals with clients. P.I.E.R. also offers peer support groups and classes
(including parenting, art classes, stress management, grief support, career coaching, dual diagnosis, anxiety and anger
management classes, and LGBTQIA+ groups). The Center also offers an Employment Lab (with resume, application,
and interviewing assistance), community engagement events, and pro bono counseling by licensed and insured
mental health professionals who volunteer to provide short-term counseling for unemployed, uninsured, or
underinsured clients.
Journey Recovery Center (St. Elizabeth Healthcare)
Many JSAP participants initiated to MAT pre-release choose to continue receiving MAT through Journey Recovery
Center. Journey also utilizes COR-12 programming, and offers the following services: medical and recovery support
from three board-certified doctors who specialize in substance use disorder treatment; therapists, nurses, case
managers, and peer support staff to support service provision; oral, injectable, and implant medications for detox and
withdrawal management; and intensive out-patient, individualized therapy, case management, and peer support
services.
Oxford House of Kentucky
Oxford House provides preferential review of JSAP clients and provides support with evidence-based housing for
many participants post-release to the community. Currently, there are five Oxford houses in Northern Kentucky which
follow the standards set by the Oxford House, Inc., a national 501(c)(3) organization dedicated to providing safe and
sober housing for people in recovery. Nationwide, there are nearly 2000 self-sustaining sober houses utilizing the
Oxford House model, serving more than 10,000 individuals in recovery living in houses at any one time during a year.
All Oxford Houses are democratically-run, self-supporting, and drug-free homes.
New Foundations Community Housing
New Foundations, a 501(c)(3) nonprofit transitional housing provider established in 2009, is another sober living
resource for participants transitioning to the community from JSAP. New Foundations provides fully furnished move-
in ready sober living options for those in recovery, as well as structure, accountability, and support through required
recovery meetings and sponsorship, service commitments, and mentoring relationships between junior and senior
program participants. New Foundations is also unique in offering MAT-friendly homes, which allow for individuals
prescribed oral buprenorphine to have their medications kept and dispensed securely by staff on-site (individuals
choosing to use injectable forms of medication are eligible to live in traditional non-MAT homes).
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Aetna Better Health of Kentucky
Aetna’s Start Strong Re-Entry program’s goal is to re-connect Members with their Aetna Better Health of Kentucky to
provide health and wellness resources to the justice-involved population of Kenton County Detention Center (KCDC).
Start Strong pays special attention to the medically frail population as they re-enter Kenton County and provides
members with ongoing case management and support throughout their transition. Aetna’s on-site Re-Entry Specialist
provides case management to members, as well as provides community resources and coordinated efforts to connect
members to their Aetna Better Health of Kentucky Medicaid providers. These efforts include sober living and
transportation resources, health and wellness resources as well as employment resources and justice advocacy.
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EVALUATION OVERVIEW
OUTCOME EVALUATION & METHOD
Recruitment for the evaluation begins when clients enter the JSAP program and receive a baseline biopsychosocial
assessment for OUD, based on criteria from the Diagnostic and Statistical Manual 5 (DSM-5). Two additional tools
are used in this assessment: The Criminal Justice Kentucky Treatment Outcome Study and the Level of Service/Case
Management Inventory (LSCMI) clinical assessment. Potential participants are also assessed for medical
appropriateness, past prescription use, risk of relapse, and anticipated release date when clinicians are considering
eligibility for MAT participation. During the first grant year, the total number of participants screened for study
participation, and proportions of participants screened as ineligible, or screened eligible but refused, were not
tracked; however, this information will be available in future reports.
If a participant is willing and eligible to participate in the study, a KCDC clinician performs a baseline interview using
the CSAT Government Performance and Results Act (GPRA) instrument, as well as a few additional measures. In
addition to the COR-12 enhanced JSAP services, participants are then offered the choice of A) no medications
(abstinence-only), B) extended-release injectable naltrexone (e.g., Vivitrol®), or C) 14 days of oral buprenorphine,
followed by initiation to injectable extended-release buprenorphine. From the start of the grant (October 1, 2018)
through September 30, 2019, 101 participants received services under the grant, consented to participate in the
study, and completed a baseline interview (101% of targeted baseline enrollment for year one).
Participants were eligible for a 3-month follow-up interview between 2 and 5 months after their baseline interview
date. Participants were eligible for a 6-month follow-up interview between 5 and 8 months post baseline. From the
start of the grant (October 1, 2018) through September 30, 2019, 49 clients reached 3-month GPRA eligibility and 48
completed the 3-month follow-up interview for a 3-month follow-up rate of 98.0%. 11 clients reached 6-month
GPRA eligibility and 13 completed the 6-month follow-up interview for a 6-month follow-up rate of 118.2%.
PROCESS EVALUATION
The purpose of the process evaluation was to assess grant project activities during the implementation year using
qualitative interviews with project administrators, project staff, and project participants. The process evaluation
provided descriptive information about program services, perspectives on program successes, and proposed
program recommendations. The process evaluation also addressed the extent to which the program matched the
proposed grant aims, modifications or deviations from the original plan, factors that led to modifications or changes,
and impact of changes to the program.
Process evaluation data were collected at the end of the grant year in July of 2019. The methodology included
interviews with administrators, staff, and participants. All respondents were interviewed face-to-face and reminded
that their participation was voluntary and confidential. Notes for each open-ended process evaluation interview
were written by hand during the interview and transcribed into a Microsoft Word data file for analysis. The
transcriptions were then examined to identify common themes within each respondent category.
Administrator/staff themes and participant themes were developed based on consistent discussion of constructs
across interview respondents.
YEAR ONE REPORT
The following report is organized according to the three goals of the grant (see next page): data related to MAT
utilization is presented under Goal 1; self-reported substance use, as well as other outcomes relevant to clients’
recovery and well-being, are presented under Goal 2; and results from the process evaluation, intended to inform
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continued project implementation activities, are presented under Goal 3. Due to a limited 6-month follow-up sample
size, results from both 3-month and 6-month outcome analyses are presented for the current grant year.
EVALUATION SNAPSHOT
KENTON COUNTY STRONG START COR-12 PROJECT GOALS:
100 Target number of clients to receive SAMHSA-funded services over the first year of the project
101 Number of clients served during the first grant year who consented to study participation and completed baseline interviews
101% GPRA baseline coverage rate
98% GPRA 3-month follow-up rate for participants with follow-up windows that opened prior to 8/30/2019
118% GPRA 6-month follow-up rate for participants with follow-up windows that opened prior to 8/30/2019
The overall goals of the project include:
Goal 1: To improve the capacity of clinical staff members in JSAP and at Life Learning Center, as well as those in the greater community, to provide Medication Assisted Treatment in conjunction with Evidence-Based Practices.
Goal 2: To demonstrate how expanded and enhanced access to medications
and other evidence-based therapies improves long-term recovery outcomes for high-risk individuals with OUD who are incarcerated and transition to the community.
Goal 3: To create a sustainable funding and service delivery model that will provide a robust suite of treatment and recovery support services and disseminate the results of this program so that other correctional institutions and community-based programs can replicate the evidence-based models, procedures, and policies that lead to its success.
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GOAL 1: TO IMPROVE THE CAPACITY OF CLINICAL STAFF MEMBERS IN JSAP AND AT LIFE
LEARNING CENTER, AS WELL AS THOSE IN THE GREATER COMMUNITY, TO PROVIDE
MEDICATION ASSISTED TREATMENT IN CONJUNCTION WITH EVIDENCE-BASED PRACTICES.
As shown in Table 1, at baseline, less than a quarter of all participants (23.8%) reported having participated in any
type of MAT during the 12 months before their current incarceration. Of these individuals, most (66.7%) were
prescribed oral buprenorphine (e.g., Suboxone or Subutex), while fewer participated in injectable extended-release
naltrexone (Vivitrol®; 29.2%), methadone (16.7%), or injectable extended-release buprenorphine (4.2%). The
majority of these individuals (62.5%) had discontinued treatment. Of participants who stopped, qualitative
responses indicate that 40% stopped because they became incarcerated, whereas the rest cited reasons related to
relapse, cravings, or “couldn’t stop using.”
At 3-month follow-up, MAT participation had increased to 39.6% of participants, with most using oral buprenorphine
(62.5%) or injectable extended-release buprenorphine (41.7%). Given that Kenton County MAT protocol requires
participants to engage in 14 days of oral buprenorphine before transitioning to the extended-release injection, these
increasing rates align with services offered through the JSAP program. Approximately three-fourths of participants
(73.7%) were still active in treatment at the time of the interview.
By the 6-month follow-up, when most participants were on the street, the MAT participation rate had increased
further to 46.2%. Although these results are preliminary and based on a small sample size (N=13), it is encouraging
that participants continue to engage in treatment post-release, indicating that linkages with systems of care and
support have been successful.
TABLE 1. MAT PARTICIPATION AT BASELINE AND FOLLOW-UPS
Baseline
(N=101)
3M Follow-Up
(N=48)
6M Follow-Up
(N=13)
Past 12 months
Past 3 months
Past 3 months
Participated in MAT 23.8% (n=24)
39.6% (n=19)
46.2% (n=6)
OF MAT PARTICIPANTS…
MATs prescribed:
Oral buprenorphine 66.7% 62.5% 66.7%
Injectable extended-release naltrexone 29.2% 0.0% 0.0%
Methadone 16.7% 4.2% 0.0%
Injectable extended-release buprenorphine 4.2% 41.7% 66.7%
Number of times received MAT 18.6 15.8 18.3
Treatment outcome
Completed recommended treatment 12.5% 0.0% 0.0%
Still active in treatment 25.0% 73.7% 50.0%
Discontinued treatment 62.5% 26.3% 50.0%
OF ALL PARTICIPANTS…
Sold, gave away, traded, lost, or had Suboxone stolen from them
6.9% 2.1% 7.7%
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GOAL 2: TO DEMONSTRATE HOW EXPANDED AND ENHANCED ACCESS TO MEDICATIONS AND OTHER
EVIDENCE-BASED THERAPIES IMPROVES LONG-TERM RECOVERY OUTCOMES FOR HIGH-RISK
INDIVIDUALS WITH OUD WHO ARE INCARCERATED AND TRANSITION TO THE COMMUNITY.
A. SUMMARY OF PARTICIPANT CHARACTERISTICS
Table 2 provides a sociodemographic profile of the
Kenton County COR-12 evaluation participants
who received services during the first grant year
(N=101). All information was self-reported by
participants at intake to the JSAP program and
based on the 30 days prior to participants’ current
incarceration.
On average, participants were 33.9 years old and
majority White (98.0%) and male (80.2%). The
majority of participants (66.4%) reported having
completed at least 12 years of education, with
about a quarter (24.8%) reporting some college or
technical school.
B. HOUSING STATUS
One objective of this grant goal was to increase the number of participants living in stable housing from 82% to 92%.
As shown in Table 3, at baseline, only 61.5% of participants reported staying in an apartment, room, or house (either
their own or someone else’s). Almost a quarter of participants (22.9%) were homeless, staying on the street or
outdoors, while an additional 6.3% stayed in an institution (e.g., jail or hospital) and 9.3% lived in a shelter or halfway
house. Almost half of participants (45.5%) were “dissatisfied” or “very dissatisfied” with their living arrangements.
TABLE 3. HOUSING STATUS AT BASELINE AND FOLLOW-UP
Baseline (N=101)
3M Follow-Up
(N=48)
6M Follow-Up
(N=13)
LIVING ARRANGEMENTS IN THE PAST 30 DAYS
Own/rent apartment, room, or house 29.2% 2.1% 7.7%
Someone else’s apartment, room, or house 32.3% 2.1% 23.1%
Homeless (street or outdoors) 22.9% 0.0% 0.0%
Institution 6.3% 87.5% 30.8%
Shelter or halfway house 9.3% 8.3% 30.8%
Residential treatment 0.0% 0.0% 7.7%
SATISFACTION WITH LIVING ARRANGEMENTS
Very dissatisfied 28.7% 8.3% 7.7%
Dissatisfied 16.8% 6.3% 7.7%
Neither satisfied nor dissatisfied 17.8% 22.9% 15.4%
Satisfied 20.8% 45.8% 38.5%
Very satisfied 15.8% 16.7% 30.8%
TABLE 2. PARTICIPANT CHARACTERISTICS AT BASELINE (N=101)
DEMOGRAPHICS
AGE (mean years) 33.9
GENDER (male) 80.2%
RACE
White 98.0%
Black 2.0%
MARITAL STATUS (single, never married) 60.4
EDUCATION LEVEL
Less than 12th grade 33.7%
HS Diploma or GED 41.6%
Some college or technical school 24.8%
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At 3-month follow-up, the majority of participants (87.5%) were still incarcerated,
mostly participating in the JSAP program and nearing their graduation date. However,
satisfaction with living arrangements improved, with 62.5% of participants reporting
being “satisfied” or “very satisfied” with where they lived. Satisfaction increased
further by 6-month follow-ups, with 69.3% of participants “satisfied” or “very
satisfied,” although most participants (69.2%) were not incarcerated. About a third
(30.8%) lived in their own or someone else’s house or apartment, 30.8% were in sober
living or a halfway house, and one participant (7.7%) resided at another residential
treatment program. Overall, given that no participants reported being homeless at 3- or 6-month follow-up (compared
to 22.9% at baseline), these results suggest that grant activities are on-track for the goal of improved housing stability.
C. EMPLOYMENT
A second objective of this grant goal was to increase employment rates from 67% to 92%. As shown in Table 4, at
baseline, fewer participants than anticipated – only 37.6% – reported working full-time or part-time, while 62.4% were
unemployed. Although only 6.3% of participants reported employment at the time of the 3-month follow-up, it is
important to note that 83.3% of these individuals were still receiving inpatient substance abuse treatment services
through the JSAP program (87.5% were incarcerated), meaning that concurrent employment was not possible. In
comparison, at 6-month follow-up, almost half of participants (46.2%) reported working full-time, in spite of the fact
that an additional 30.8% were incarcerated. These results suggest that, of participants who are free and unrestricted
to find employment, most are successful in seeking work.
TABLE 4. EMPLOYMENT AT BASELINE AND AT 3-MONTH FOLLOW-UP
Baseline (N=101)
3M Follow-Up
(N=48)
6M Follow-Up (N=13)
EMPLOYMENT STATUS
Unemployed 62.4% 93.8% 53.8%
Full-time 26.7% 6.3% 46.2%
Part-time or seasonal 10.9% 0.0% 0.0%
AVERAGE INCOME SOURCES IN THE LAST 30 DAYS
Wages $585 $83 $815
Non-legal income $424 $0 $0
Family/friends $243 $75 $196
Disability $73 $19 $0
Public assistance $8 $0 $0
These results are further reflected in trends of participants’ average income
sources, also reported in Table 4. Although participants reported little income
from any source at the 3-month follow-up (as expected), between baseline and 6-
month follow-up, average income from wages increased (from $585 to $815),
while decreases were observed in income from non-legal means ($424 to $0),
disability ($73 to $0), public assistance ($8 to $0), and family or friends ($243 to
$196).
22.9% of participants
were homeless at baseline, vs. none
at follow-ups.
Average wages increased by
$230 between baseline and
6-month follow-up
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D. CHILD CUSTODY AND PARENTING
A third objective of the grant was to increase the number of parents
providing financial assistance to their children from 78% to 93%; results are
shown in Table 5. At baseline, 70.3% of participants reported being parents
to at least one child, with an average of 2.6 children each. Many
participants faced custody challenges, with 43.7% reporting at least one
child living with someone else due to a child protection court order, and
33.8% having had rights terminated to at least one child. Parents who
provided financial support to children were fewer at baseline than
anticipated, with just over a third (35.2%) supporting at least one child.
By 6-month follow-up, the number of parenting participants providing financial support to children had increased to
45.5%. Although this increase may appear small, when it is considered that almost a third of participants were
incarcerated and unable to work at this time, this indicates that many parents who were free to work and gain income
were supporting their children financially. In future grant years, as the 6-month follow-up sample size increases, it
is hoped that this proportion will increase further.
TABLE 5. PARENTING AT BASELINE AND AT 3-MONTH FOLLOW-UP
Baseline (N=101)
3M Follow-Up
(N=48)
6M Follow-Up
(N=13)
Participants with 1+ children 70.3% (n=71)
72.9% (n=35)
84.6% (n=11)
Average number of children 2.6 2.4 2.4
% of parenting participants with children living with someone else due to a child protection court order
43.7% 28.6% 9.1%
% of parenting participants who reported losing parental rights of any children
33.8% 17.1% 18.2%
% of parenting participants providing financial support to 1+ child
35.2% 8.6% 45.5%
Currently pregnant 5.0%
(n=20) 0.0% (n=6)
--- (n=0)
E. PHYSICAL AND MENTAL HEALTH
Mental and physical health outcomes are another important focus of the current grant. Specifically, the grant
proposed to reduce rates of self-reported depression, anxiety, hallucinations, impaired concentration, and suicidal
thoughts and/or attempts. At baseline, as shown in Table 6, mental health symptoms were highly prevalent,
particularly for anxiety (80.2% of participants), depression (77.2%), and problems understanding, concentrating, or
remembering (66.3%). More than half of participants (61.4%) said that their health overall was “fair” or “poor,” or
reported having experienced violence or trauma during their lifetime (62.4%). Furthermore, 8.9% of participants
reported a past 30-day attempted suicide, while 29.7% had experienced physical abuse during that time period.
Although most participants were sexually active (82.2%), only three-fourths (74.3%) had ever been tested for HIV.
Finally, utilization of routine health care services was limited: while 19.8% of participants visited an emergency
department in their last 30 days on the street, far fewer used outpatient services for physical health, mental health,
or substance misuse treatment (5.0%, 8.9%, and 10.9%, respectively).
70.3% of participants at
baseline had at least one child, though only 35.2%
of parents were providing financial
support
P a g e | 16
TABLE 6. PHYSICAL AND MENTAL HEALTH STATUS
Baseline (N=101)
3M Follow-Up
(N=48)
6M Follow-Up
(N=13)
RATING OF OVERALL HEALTH
Excellent 2.0% 10.4% 7.7%
Very good 4.0% 20.8% 30.8%
Good 32.7% 43.8% 38.5%
Fair 38.6% 22.9% 7.7%
Poor 22.8% 2.1% 15.4%
Average rating 2.2 (Fair) 3.2 (Good) 3.1 (Good)
IN THE LAST 30 DAYS, EXPERIENCED...
Anxiety 80.2% 47.9% 30.8%
Depression 77.2% 33.3% 46.2%
Cognitive difficulties 66.3% 35.4% 30.8%
Violent behavior 43.6% 2.1% 7.7%
Hallucinations 23.8% 4.2% 0.0%
Suicidal thoughts/ideation 8.9% 2.1% 15.4%
Suicide attempts 8.9% 0.0% 0.0%
VIOLENCE, TRAUMA, AND PHYSICAL ABUSE
Ever experienced violence or trauma 62.4% 54.2% 53.8%
Experienced any physical abuse in the last 30 days 29.7% 4.2% 7.7%
SEXUAL ACTIVITY & RISK
Sexually active in past 30 days 82.2% 6.3% 46.2%
Ever been tested for HIV 74.3% (n=75)
66.7% (n=32)
92.3% (n=12)
Of those who have been tested, know test results 88.0% 100% 100%
HEALTH SERVICE UTILIZATION
Visited emergency department in last 30 days 19.8% 2.1% 0.0%
Received past-30-day outpatient treatment for…
Physical health 5.0% 6.3% 7.7%
Mental health 8.9% 2.1% 23.1%
Alcohol or substance misuse 10.9% 6.3% 23.1%
Prescribed medication for psychological/emotional problem 21.8% 16.7% 0.0%
By both 3- and 6-month follow-ups, participants’ health statuses had
improved notably. More participants rated their health as “excellent” or
“very good” (38.5% at 6-month follow-up, compared to 6.0% at baseline).
Furthermore, participants reported decreases across most mental health
symptoms, including anxiety (-49.4%), trouble controlling violent behavior (-
35.9%), cognitive difficulties (-35.5%), depression (-31.0%), and
hallucinations (-23.8%). It is hoped that the slight increase in suicidal
thoughts at 6-month follow-up (+6.5%) is an artifact of the small sample size
and will disappear as more interviews are conducted.
Additionally, fewer participants reported having experienced past 30-day physical abuse at 6-month follow-up
(7.7%). A lower proportion of participants reported being sexually active (46.2%), and more participants had been
tested for HIV (92.3%), all of whom knew their results. Finally, no 6-month follow-up participants reported
emergency department utilization, although more reported use of outpatient services for physical health (7.7%),
mental health (23.1%), and substance misuse treatment (23.1%).
By 6-month follow-up, anxiety, cognitive
difficulties, depression, and violent urges had decreased by at least
30 percentage points.
P a g e | 17
F. SUBSTANCE USE
A central objective of the current grant has been to increase the number of participants not using illicit opioids, other
illicit drugs, or misusing prescription opioids from 57% to 92%. As shown in Figure 1, lifetime substance use reported
at baseline indicated an extensive and diverse use profile, with almost all participants reporting having ever used
alcohol (97.0%); marijuana, non-prescription opioids, or heroin (all 93.1%); and cocaine or crack (90.1%).
As shown in Figure 2, at baseline, the primary
substance of choice reported by participants
was heroin (58.0% of participants), followed
by methamphetamine (24.0%). Fewer
participants preferred other substances,
including marijuana (7.0%), non-prescription
opioids (5.0%), or alcohol (3.0%).
97.0%
93.1%
93.1%
93.1%
90.1%
88.1%
76.2%
65.3%
60.4%
54.5%
49.5%
31.7%
29.7%
21.8%
7.9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Alcohol
Marijuana
N-P opioids
Heroin
Cocaine/crack
Methamphetamine
Suboxone/Subutex
Benzodiazepines
N-P methadone
Hallucinogens
Synthetic drugs
Inhalants
Barbiturates
Ketamine
GHB
Figure 1. Lifetime Substance Use Reported at Baseline (N=101)
Figure 2. Substance of Choice Reported at Baseline (N=101)
Marijuana7%
N-P Opioids5%
Alcohol3%
Other3%
Methamph.24%Heroin
58%
81.2% of participants reported ever
injecting drugs.
P a g e | 18
Table 7 profiles past 30-day substance use reported at baseline, 3-, and 6-month follow-ups. At baseline, describing
their last 30 days on the street, 99.0% of participants reported having used some type of illegal drug, with 82.2%
reporting past 30-day opioid use. Of opioid drugs, participants most commonly reported using heroin (79.2%) or
fentanyl (45.5%), with fewer reporting use of non-prescribed Suboxone or
Subutex (38.6%) or other prescription opioids (also 38.6%). Other than opioids,
the most commonly-used drugs were methamphetamine (65.3%), marijuana
(59.4%), and cocaine or crack (42.6%). Almost three-fourths of participants
(71.3%) reported past 30-day intravenous drug use, while the majority of these
individuals (61.1%) reported having shared injection equipment (e.g., syringes,
cookers, or cottons).
TABLE 7. 30-DAY SUBSTANCE USE AT BASELINE AND AT FOLLOW-UPS
Baseline (N=101)
3M Follow-Up (N=48)
6M Follow-Up (N=13)
% reporting use % reporting use % reporting use
Any illegal drug use 99.0% 2.1% 15.4%
Any opioid drug use 82.2% 2.1% 0.0%
Heroin 79.2% 0.0% 0.0%
Prescription opioids 38.6% 0.0% 0.0%
Percocet 32.7% 0.0% 0.0%
OxyContin/oxycodone 22.8% 0.0% 0.0%
Morphine 17.8% 0.0% 0.0%
Codeine 11.9% 0.0% 0.0%
Dilaudid 6.9% 0.0% 0.0%
Tylenol 2/3/4 6.9% 0.0% 0.0%
Demerol 3.0% 0.0% 0.0%
Fentanyl 45.5% 0.0% 0.0%
Non-prescription Suboxone/Subutex 38.6% 2.1% 0.0%
Non-prescription methadone 11.9% 0.0% 0.0%
Other drug use:
Methamphetamine 65.3% 0.0% 7.7%
Marijuana 59.4% 0.0% 15.4%
Cocaine/Crack 42.6% 0.0% 0.0%
Alcohol 39.6% 2.1% 0.0%
Benzodiazepines 27.7% 0.0% 0.0%
Hallucinogens 11.9% 0.0% 0.0%
Synthetic drugs 8.9% 0.0% 0.0%
Barbiturates 6.9% 0.0% 0.0%
Inhalants 5.0% 0.0% 0.0%
Tranquilizers/sedatives 2.0% 0.0% 0.0%
GHB 1.0% 0.0% 0.0%
Ketamine 1.0% 0.0% 0.0%
Same day use of alcohol and illegal drugs 36.6% 0.0% 0.0%
Injected drugs in the past 30 days 71.3% (n=72)
0.0% (n=0)
7.7% (n=1)
Of injectors, shared injection equipment in past 30 days
61.1% --- 0.0%
No participants reported opioid use at 6-month follow-up, compared to 82.2% at baseline
P a g e | 19
Consistent with grant objectives to reduce substance use and misuse, at 6-month follow-up, only 15.4% of
participants (n=2) reported use of illegal drugs, which did not include use of any opioids. Although rates of substance
use reported at 3-month follow-up were even lower (2.1% for illegal drugs and 2.1% for alcohol), it should be noted
that 87.5% of those participants were incarcerated and had little to no access to intoxicants. Therefore, rates
reported at 6-month follow-up, while slightly higher, are more representative of participants’ use patterns in an
uncontrolled environment, yet still promising.
G. RECOVERY SUPPORTS AND SERVICES
Recovery supports are another vital aspect of sustaining sobriety, and as such, the current grant aimed to increase
community connections for all participants by linking them with peer recovery support specialists and increasing
engagement in support groups from 73% to 93%. As shown in Table 8, recovery meeting attendance at baseline was
lower than anticipated, with only 21.8% of participants reporting meeting attendance during their last 30 days on
the street. Furthermore, less than one in five (19.8%) reported engaging in past 30-day inpatient or outpatient
substance misuse treatment, and 68.3% reported recently interacting with
friends or family who were supportive of their recovery.
However, at 3-month follow-up, 93.7% of participants reported past 30-day
recovery meeting attendance, with 84.6% sustaining attendance at the 6-month
follow-up. All participants were engaged in some type of substance misuse
treatment at 3-month follow-up, with almost half (46.2%) reporting treatment
at 6-month follow-up. Finally, past 30-day contact with supportive friends or
family members increased to 85.4% and 100% at 3- and 6-month follow-ups,
respectively. These results suggest that KCDC is on-track for their goal to
increase contact with recovery support systems for COR-12 participants.
TABLE 8. PAST 30-DAY RECOVERY SUPPORTS AND SERVICES AT BASELINE AND 3-MONTH FOLLOW-UP Baseline
(N=101)
3M Follow-Up (N=48)
6M Follow-Up (N=13)
Any recovery meeting attendance 21.8% 93.7% 84.6%
Attended voluntary self-help group (AA/NA) 18.8% 89.6% 84.6%
Attended religious/faith-affiliated self-help group
12.9% 10.4% 7.7%
Attended any other support meetings 9.9% 6.2% 15.4%
Engaged in past 30-day substance use treatment 19.8% 100% 46.2%
Outpatient 10.9% 6.3% 23.1%
Inpatient 11.9% 83.3% 23.1%
Interacted with friends/family supportive of recovery
68.3% 85.4% 100%
Who participant turns to when they need help:
Family member 61.4% 68.8% 69.2%
Friends 14.9% 2.1% 0.0%
No one 12.0% 10.4% 7.7%
Significant other or child’s parent 5.9% 14.6% 0.0%
Clergy member/religious community 1.0% 2.1% 15.4%
Sponsor 1.0% 2.1% 7.7%
100% of participants at 6-
month follow-up reported contact
with friends or family who
supported their recovery
P a g e | 20
H. CRIMINAL JUSTICE SYSTEM INVOLVEMENT
Lastly, the current grant aimed to reduce participants’ level of criminal justice involvement by increasing the number
of people not being reincarcerated from 56% to 86%. At baseline, participants reported that they had been
incarcerated, on average, 15.9 times in their life, for a total average of 49.5 months, suggesting extensive criminal
justice involvement. As shown in Table 9, approximately two-thirds of participants reported past 30-day arrests at
baseline, though it should be acknowledged that at baseline all participants were incarcerated at KCDC and
participating in the JSAP program. By 6-month follow-up, the proportion of participants reporting recent arrests had
decreased to 15.4%, aligning closely with the grant goal. Furthermore, from baseline to 6-month follow-up,
participants awaiting charges, trial, or sentencing decreased (from 51.5% to 30.8%) while those on parole or
probation increased (from 44.6% to 84.6%). These results indicate that individuals were progressing through
resolution of pending charges and towards community supervision, suggesting a transition towards a lower level of
involvement with criminal justice.
TABLE 9. 30-DAY CRIMINAL JUSTICE INVOLVEMENT
Baseline (N=101)
3M Follow-Up
(N=48)
6M Follow-Up
(N=13)
Arrested past 30 days 66.3% (n=67)
2.1% (n=1)
15.4% (n=2)
Arrested for drug-related offense 80.6% 100% 50.0%
Crimes committed (avg.) 39.0 0.0 1.0
Incarcerated in past 30 days 28.7% 89.6% 46.2%
Currently awaiting charges, trial, or sentencing 51.5% 45.8% 30.8%
Currently on parole or probation 44.6% 70.8% 84.6%
P a g e | 21
GOAL 3: TO CREATE A SUSTAINABLE FUNDING AND SERVICE DELIVERY MODEL THAT WILL
PROVIDE A ROBUST SUITE OF TREATMENT AND RECOVERY SUPPORT SERVICES AND DISSEMINATE
THE RESULTS OF THIS PROGRAM SO THAT OTHER CORRECTIONAL INSTITUTIONS AND
COMMUNITY-BASED PROGRAMS CAN REPLICATE THE EVIDENCE-BASED MODELS, PROCEDURES, AND POLICIES THAT LEAD TO ITS SUCCESS.
The third goal of the grant was addressed through an annual process evaluation, performed in order to better
understand challenges and successes of program implementation and offer insights to inform future replications or
adaptations of the KCDC MAT-PDOA COR-12 model.
PROCESS EVALUATION A process evaluation has been described as a method of assessment that can provide descriptive information about
program services and factors that lead to desirable and undesirable outcomes towards a program’s stated goals
(Krisberg, 1980; Scarpitti, Inciardi, & Pottieger, 1993). The purpose of the process evaluation within this MAT-PDOA
evaluation is to assess project implementation and maintenance using qualitative interviews with project
administrators, staff, and clients. The process evaluation focuses on how program services were implemented,
perspectives on program successes, and proposed program recommendations. The process evaluation also
addresses the extent to which the program matches the proposed grant aims, modifications or deviations from the
original plan, factors that led to modifications or changes, and impact of changes on the program.
Method Process evaluation data were collected at the end of the grant year in July of 2019. Two survey instruments were
developed for the process evaluation—one for administrators and staff and one for clients—allowing for data
collection to capture these unique perspectives. All clients who were enrolled COR-12 services at KCDC and had
consented to study participation were eligible to be randomly selected for the process evaluation interviews. Staff
and administrators were selected based on their familiarity and involvement with COR-12 MAT services and the grant
implementation process; the final sample of administrators and staff included individuals from the areas of
supervision, jail or JSAP administration, medical staff, clinical assessment, and counseling.
In total, interviews were completed with four administrators and six staff members at KCDC (N=10) and with clients
who had received COR-12 services from KCDC’s JSAP program (N=5). The content of the interview questions for
administrators and staff focused on program successes, accomplishments, and changes and transitioned to program
maintenance, while participants were asked about the provision of services and their overall perceptions of the
program. Interviews were conducted face-to-face, at the convenience of the respondents, and lasted approximately
thirty to forty-five minutes. All respondents were reminded that their participation was voluntary and confidential.
Notes for each open-ended process evaluation interview were written by hand during the interview and transcribed
into a Microsoft Word data file for analysis. The transcriptions were then examined to identify common themes within
each respondent category. Administrator/staff themes and participant themes were developed based on consistent
discussion of constructs across interview respondents. Primary themes were identified when quotations were
consistently noted across multiple questions and interview respondents. Secondary themes were identified when
quotations were noted across multiple interview respondents but may not have resonated across multiple interview
questions.
P a g e | 22
Administrator & Staff Themes
Offering an entirely new model of treatment, Kenton County Detention Center (KCDC) and the JSAP program
have had to be adaptable and flexible in the first year of grant implementation as they navigated challenges.
Given that injectable extended-release buprenorphine is still a relatively new medication (approved for sale in 2017),
KCDC has had to establish account setup, pricing, and negotiation through a limited number of providers nationwide.
Furthermore, as buprenorphine is a partial opioid agonist, staff and administrators have been under increased scrutiny
to prevent diversion of the medication, particularly in its daily oral form, which clients were initially given for 30 days
(now two weeks) to stabilize dosage and be monitored for adverse effects before being administered the injection.
Because of administrative “red tape,” several staff also expressed frustration that they were not able to provide
buprenorphine sooner after clients were incarcerated to prevent withdrawal symptoms; rather, clients are typically
fully detoxed prior to initiating the medication. As one staff member said, “It’s a lengthy process with a lot of moving
parts; we see people in detox and can’t help them because there
are so many steps to go through.” Finally, staff and administrators
faced occasional difficulties finding community partners,
particularly sober living providers, who were willing to
accommodate clients on MAT. In spite of these challenges, KCDC
staff expressed understanding that these complications were an
inevitable part of being the “tip of the spear,” forging a path to
improve access to MAT for incarcerated individuals with OUD in
order to “set the precedent for the rest of the state.”
Implementation of treatment “tracks” (buprenorphine, naltrexone, or abstinence) has created a valuable
opportunity for open dialogue and education of staff, community partners, JSAP clients, and other inmates
concerning MAT. As one staff member said, “MAT has a bad reputation – lots of people come from an abstinence-
only frame of mind,” particularly in a correctional context, where MAT is rarely implemented, limiting familiarity and
knowledge. Another staff member agreed, stating that “stigma has been a big challenge. Even though you try to
educate staff and peers, sometimes they still have a conditioned bias.” Education has thus been an important aspect
of implementation in the first grant year, in order to establish a culture of acceptance and understanding of MAT as a
valuable clinical tool. One element of this process, according to a staff member, has been to “have very real
conversations with [clients] and be very mindful about how we talk
about MAT. The language we use is important.” Staff and
administrators agreed that how MAT is discussed, what words are
used, has the potential to reinforce or correct biases: “we do get clients
in here that ‘want to get high,’” said one staff member, “and we have
to explain the difference between a medication, given by a doctor and
taken as prescribed, and a drug.” Although another staff member
lamented that there was “lots of misinformation,” they added that “I
take this as a learning opportunity” to better inform themselves and
others.
MAT is most effective when offered in conjunction with wrap-around services, and partnerships with
community organizations have been invaluable towards the positive outcomes observed during the first grant
year. Several staff and administrators agreed that “we stress that MAT is not a cure-all” or “a magic pill,” emphasizing
the importance of engagement with other services to support recovery. While in JSAP, COR-12 programming serves
“Substance use disorders and
mental health have kind of been an
elephant in the room for criminal
justice – now, we get to really
focus on it, and get the resources
to provide the services we need.”
“This has been a monumental
change. We’ve given hope to
clients and sent the message to
staff that incarceration alone
isn’t enough: we need to give
them the tools.”
P a g e | 23
this function, but post-release to the community, KCDC has made
significant efforts during the first grant year to build relationships
with other organizations to better serve clients. These partnerships
have included the Life Learning Center for aftercare coordination;
Mental Health America (particularly the PIER Recovery Community Center) and NorthKey for mental health services;
and sober living residencies, such as Oxford House. Continuation of MAT in the community is supported by Journey
Recovery Center (St. Elizabeth Healthcare), Transitions, and private practice doctors, including Dr. Suetholtz and Dr.
Keller. Finally, expansion of MAT services has required extensive coordination with judicial entities, including the
Administrative Office of the Courts (AOC), circuit and district court judges, Commonwealth attorneys, and probation
and parole. In part, this collaboration has helped to improve the accuracy of anticipated release dates for clients who
choose to initiate MAT and has progressively minimized interruption of services. Together, these partnerships have
helped staff and administrators to “keep people from slipping through the cracks.”
In the remaining grant years, staff and administrators agreed that they would like to focus on sustaining
positive changes, evaluating and adjusting existing procedures, and looking for opportunities for future
growth. For all of the challenges faced in the first year of program
implementation, staff and administrators agreed that being a part of an
innovative system of care and paving the way for future systemic changes
has been a rewarding and gratifying experience. As one staff member said,
“Just like recovery, implementing new programs is a process. But you have
to trust the process: it works.” Staff and administrators both discussed a
desire to continue to focus on the triage and intake process to more quickly
identify clients in need and link them to services, to continue to improve connections to aftercare providers, and to
expand their own capacity to serve more individuals with OUD, including offering new programs through JSAP (such
as grief and loss counseling, family-based interventions, and recovery yoga). “There have been so many unexpected
changes with the program growing,” one staff member said; “there has been a lot of learning and waiting, taking it
one day at a time.” An administrator agreed, saying, “We’re constantly re-evaluating and adjusting our procedures as
needed.” Nonetheless, staff and administrators expressed their excitement and commitment to continuing these
efforts throughout the coming grant years.
Client Themes
Clients valued the “safety net” of MAT as an important tool to reduce the chance of relapse after they were
released. Several clients mentioned that access to MAT had made them feel more confident in their ability to resist
using opioids when they returned to the community. One client reflected that “any other time when I was in jail, I
just thought about getting high. I would get butterflies in my stomach when other people would talk about it. With
Suboxone, that doesn’t happen. I don’t get the cravings.” Some clients had previous experience with MAT that
helped to inform their current choice of treatment track: for example, one participant had previous success
abstaining from opioids with non-prescribed Suboxone; others had tried methadone, with mixed results; yet another
had a partner who was prescribed Suboxone and was in recovery. This variability, however, emphasizes the fact that
MATs are not a one-size-fits all treatment, and highlights the importance of making multiple treatment options
“This is the greatest thing that’s ever happened to this jail.”
“We’re saving people’s lives.
That’s the best thing.”
“We’re trying something
different. What we did
before wasn’t working, but
this is amazing.”
P a g e | 24
available to clients with OUD. Finally, participants discussed the
importance of increasing education and acceptance of MAT in recovery
communities. As one participant said, “Everyone used to shun MAT, like
especially in AA/NA, but science shows that it works. There’s more
acceptance of MAT now.” It is likely that awareness of this increasingly
widespread acceptance has helped to support JSAP clients’ open-
mindedness towards MAT as a valid tool to support their recovery.
Although access to MAT was one important component of treatment, clients also appreciated many other
aspects of the JSAP program. Specifically, clients mentioned AA/NA meetings and step packets, Hazelden
curriculum and homeworks, group and community meetings (including discussing weekly goals), confrontational
therapy, guest speakers, and movies. One important element of these services is committed and nonjudgmental
counselors and staff, who clients praised as “really supportive and easy to talk to.” The group environment and
fellowship, according to one client, “forces you to face your reasons and excuses” through clients holding one
another accountable. Clients also discussed that the JSAP program provided them with a better understanding of
their patterns of addictive behaviors and thinking: “the drugs aren’t the problem, they’re the solution,” said one
client; “[OUD] is a thinking disease.” Another client agreed, stating, “I would
probably still be in the same mindset if it wasn’t for the JSAP program here. I
wouldn’t be thinking at all about rehab. That’s what’s important, is the change
in thinking.” Lastly, participants valued referrals to services after release from
jail (including to AA/NA meetings, the Life Learning Center, or Journey Recovery
Center for continued MAT), indicating that “it gives us hope for when we get
out. They give us lots of supports.”
In addition to services provided through JSAP, clients discussed the desire and willingness to stop using as an
important aspect of successful recovery. Before participating in JSAP, many clients had considered or tried other
treatment programs, but found that “it’s hard to stop [using opioids].” They discussed the dichotomy of “not wanting
to [quit], but wanting to at the same time,” and stated that this ambivalence made it difficult to commit to entering
treatment. Other participants talked about the influence of others around them: as one client said, “I was always
dating people that were using and I knew they didn’t want to quit or go to treatment. I figured it was a waste of
time.” Another client stated, “I didn’t want to go to detox; I was afraid. I didn’t want to be away from my family for
six to nine months. I had to be forced.” Although other people could act
as barriers or support for treatment, clients agreed that internal
motivations, or “self-will,” were a key component of sustained abstinence.
“You have to take it seriously,” one client said. As previously stated,
although MAT was viewed as an important “safety net,” clients agreed that
their personal commitment was a pivotal aspect of recovery. “You have to
want to stay sober,” one client stated; “I could just get the shot, leave, and
not get it again – you have to want to change. It’s just a pill or a shot. It’s
really up to you.”
“I know things will be
stressful when I get out and
drugs would be my go-to…
it’s how I dealt for the
majority of my life.”
“I’m afraid that when I get
out I’ll use again. There’s a
chance that I’d come back
here without MAT, and I
don’t want to take that
chance.”
“I had tried treatment
before, but without
MAT, and I wasn’t as
successful. I think it’s
about self-will.”
P a g e | 25
CONCLUSIONS AND RECOMMENDATIONS
This Year 01 report indicates that the Kenton County Detention Center has been very successful with the
implementation of this federally funded CSAT grant targeted to enhance services for JSAP clients with OUD through
COR-12 programming, access to MAT, and improved community relationships and support systems. The program
proposed three goals, and results from the process and preliminary outcome evaluations indicate that they are on-
target for meeting those goals during the three-year project. Based on feedback from process evaluation interviews,
the following recommendations are forwarded for consideration during Year 02:
1. Continue to focus on MAT education for staff, community partners, JSAP clients, and other inmates to
support a culture of acceptance and understanding of MAT as a valuable clinical tool. This will further
increase buy-in both within and outside the facility, as well as set an expectation among clients that both
medication-assisted recovery and abstinence are valid methods for achieving and sustaining sobriety.
2. Continue to build and sustain partnerships with community organizations that support clients’ successes
post-release. Both staff and clients indicated the value of knowing that there were resources available to
assist clients with housing, health, employment, education, and medications. This awareness gave clients
hope and a positive attitude about their return to the community.
3. Continue to engage in ongoing evaluation of existing program procedures and examine areas for future
growth and change. KCDC’s successes in the first year of grant implementation have been due, in part, to
staff and administrators’ ability to adapt as new circumstances and challenges arise, and it is expected that
this flexibility will facilitate continued successes in the years to come.