Therapeutic Community Treatment in Correctional Settings

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

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ABSTRACT

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

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ABSTRACT (Contd.)

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

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A. RESEARCH CONCLUSIONS AND IMPLICATIONS FOR
INTEGRATED SYSTEMS

• A considerable research literature on TC
  treatment in correctional settings has developed
  in the past 15 years.

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A. RESEARCH CONCLUSIONS AND IMPLICATIONS FOR
INTEGRATED SYSTEMS

• Studies have mainly focused upon the issue of
  effectiveness and cost effectiveness of Prison TC
  treatment but have generated other findings that
  are relevant to the issues of recovery, re-entry
  and aftercare.

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A. RESEARCH CONCLUSIONS AND IMPLICATIONS FOR
INTEGRATED SYSTEMS (Contd.)

• The main conclusions from this research are
  outlined along with key implications for an
  effective system of aftercare.

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1. Client Profiles in Correctional Treatment

• The substance abusers entering prison-based TC
  treatment settings (as well as community-based
  residential TC treatment) reveal severe drug use,
  deviant social and psychological profiles.
•    

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1. Client Profiles in Correctional Treatment
(Contd.)

• Thus, an effective treatment and aftercare system
  must address the cognitive, emotional and
  behavioral dimensions that define the substance
  abuse disorder. Moreover, aftercare resources
  must make available the treatment and social
  services that promote recovery, not simply manage
  the disease.

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2. Treatment Effectiveness and Aftercare

• Research documents that the effectiveness of
  modified prison TC for the treatment of substance
  abusing offenders is considerably enhanced when
  treatment continues in TC-oriented aftercare
  settings.

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2. Treatment Effectiveness and Aftercare (Contd.)

• Positive outcomes obtained with clients who
  complete prison aftercare reconstitute the
  time-in-treatment effects universally obtained in
  community based studies. Namely, duration of
  treatment involvement is directly related to post
  treatment success.

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2. Treatment Effectiveness and Aftercare (contd)

• Thus, an effective aftercare system must be
  capable of keeping the individual engaged in
  treatment and/or social services long enough to
  assure stability in the recovery process.

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3. Client Motivation and Treatment

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

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3. Client Motivation and Treatment (contd)

• Thus, an effective and cost-efficient system of
  aftercare must be capable of assessing and
  sustaining client motivation and readiness to
  constructively utilize treatment and social
  services to advance their recovery.

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4. Recovery

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

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4. Recovery (contd)

• Thus, an effective aftercare system must have a
  common understanding of the process of recovery
  in order to define its goals and inform the
  deployment of resources on treatment
  interventions and social services.

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B. THE CURRENT TREATMENT AND AFTERCARE SYSTEM

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

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B. THE CURRENT TREATMENT AND AFTERCARE SYSTEM
(contd)

• The current system of aftercare consists of a
  fragmented aggregate of diverse community
  providers of social and treatment services, or
  surveillance activities.

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B. THE CURRENT TREATMENT AND AFTERCARE SYSTEM
(contd.)

• Goals are defined by the providers ideology,
  mission or mandate (e.g., medical, educational,
  medicational, vocational, housing).

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B. THE CURRENT TREATMENT AND AFTERCARE SYSTEM
(contd.)

• Service delivery is loosely coordinated or
  conceptually unrelated. This usually leads to
  duplication or lack of services, non utilization
  or poor utilization services, cost inefficiency,
  professional and agency turf conflicts. Notably,
  client dropout from aftercare is high.

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C. THE BARRIERS TO AN INTEGRATED SYSTEMS APPROACH

• There are inherent barriers to
  integration which reflect political, pragmatic,
  and professional features across the major
  components of the system.

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C. THE BARRIERS TO AN INTEGRATED SYSTEMS APPROACH
(contd.)

• Differing philosophies regarding substance abuse
  and treatment and the conflicting goals of those
  representing the CJS (corrections departments,
  parole departments, courts, judges, prosecutors)
  and those representing the treatment system
  (prison based and community based treatment
  providers).

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C. THE BARRIERS TO AN INTEGRATED SYSTEMS APPROACH
(contd.)

• An integrated systems approach to Prison-based
  TCs and community based aftercare programs must
  be informed by what is known about the client,
  the disorder, treatment and recovery.

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D. A RECOVERY ORIENTED INTEGRATED SYSTEM (ROIS)

• ROIS is a paradigm of a systems approach. It
  emphasizes partnership linkages among community
  providers and prison-based treatment providers to
  coordinate transitional and aftercare treatment
  and services for post release clients.

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D. A RECOVERY ORIENTED INTEGRATED SYSTEM (ROIS)
(contd.)

• Additional partners in the system are
  parole/probation officers, judges, and social
  services agencies. (e.g., education, employment,
  family, mental health).

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D. A RECOVERY ORIENTED INTEGRATED SYSTEM (ROIS)
(contd.)

• Key components of ROIS are
• Recovery Stage Framework
• System-wide vernacular
• Uniform assessment protocol
• Coordinated procedures for referral and
  placement.

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D. A RECOVERY ORIENTED INTEGRATED SYSTEM (ROIS)
(contd.)

• The integrative ingredient of the system is an
  overarching framework of recovery.

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KEY ASSUMPTIONS OF ROIS

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

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KEY ASSUMPTIONS OF ROIS (contd.)

• In a ROIS, settings and modalities may change,
  but their purpose remains the same, to move the
  individual to the next stage in the process of
  recovery.

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KEY ASSUMPTIONS OF ROIS (Contd.)

• Treatment services, social services and
  surveillance differ in their contribution to the
  recovery process.

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KEY ASSUMPTIONS OF ROIS (Contd.)

• The optimal utilization of aftercare services in
  halfway houses, day treatment or outpatient
  setting depends upon the clients stage of
  recovery.

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KEY ELEMENTS OF ROIS

• A Recovery Stage Framework
• System-wide vernacular
• System-wide assessment protocol
• Coordinated procedures for referral and placement.