Developing employment services for criminal justice clients enrolled in drug user treatment programs

Approximately 80% of parolees have a history of substance abuse and nearly all are unemployed following release from prison. Common stipulations of parole require offenders to obtain employment and to not use mood-altering substances. This article explores a series of strategies implemented from 1999 to 2001 to help offenders paroled to substance user treatment to gain employment. A total of 245 paroled offenders enrolled in an outpatient substance abuse treatment program voluntarily agreed to participate in one of four different vocational intervention programs (Job Skill Development and Supported Work, Life Skill Development, Job Training, and Welfare to Work). Programmatic data (e.g., attendance, completion, job acquisition, and wage) were collected and reported for each of the vocational programs. Additionally, a 12-month pilot study examined criminal justice, substance use, and employment outcomes of 36 offenders referred to the job skill development and supported work project. Overall, 78% of the offenders enrolled in the vocational services completed the program and 134/245 (55%) were able to obtain employment. The data showed that completion of vocational services was strongly associated with obtaining employment 12 months postenrollment. Offenders identified the employment services as an integral part of their improved overall functioning. A series of practice recommendations and policy suggestions is offered to develop and manage vocational services for substance-using offenders. Employment services for parolees require considerable coordination of activities with parole officers, vocational programs, substance abuse treatment professionals, and funding systems.     

Correlates of Risky Alcohol and Methamphetamine Use Among Currently Homeless Male Parolees

Homeless men on parole are a hard-to-reach population with significant community reintegration challenges. This cross-sectional study describes sociodemographic, cognitive, psychosocial, and drug-related correlates of alcohol and methamphetamine use in 157 homeless male parolees (age range 18–60) enrolled in a substance abuse treatment center in Los Angeles, California. Logistic regression results revealed that being African American and older were negatively related to methamphetamine use, whereas being older and more hostile were related to riskier alcohol abuse. Findings from this study provide a greater understanding of correlates of methamphetamine and alcohol—-two of the most detrimental forms of substances abused among currently homeless parolees.     

Drug treatment services for adult offenders: the state of the state

We conducted a national survey of prisons, jails, and community correctional agencies to estimate the prevalence of entry into and accessibility of correctional programs and drug treatment services for adult offenders. Substance abuse education and awareness is the most prevalent form of service provided, being offered in 74% of prisons, 61% of jails, and 53% of community correctional agencies; at the same time, remedial education is the most frequently available correctional program in prisons (89%) and jails (59.5%), whereas sex offender therapy (57.2%) and intensive supervision (41.9%) dominate in community correctional programs. Most substance abuse services provided to offenders are offered through correctional programs such as intensive supervision, day reporting, vocational education, and work release, among others. Although agencies report a high frequency of providing substance abuse services, the prevalence rates are misleading because less than a quarter of the offenders in prisons and jails and less than 10% of those in community correctional agencies have daily access to these services through correctional agencies; in addition, these are predominantly drug treatment services that offer few clinical services. Given that drug-involved offenders are likely to have dependence rates that are four times greater than those among the general public, the drug treatment services and correctional programs available to offenders do not appear to be appropriate for the needs of this population. The National Criminal Justice Treatment Practices survey provides a better understanding of the distribution of services and programs across prisons, jails, and community correctional agencies and allows researchers and policymakers to understand some of the gaps in services and programs that may negatively affect recidivism reduction efforts.     

The role of work in substance dependency treatment: a preliminary overview

This article describes four alternative models for the role of client work in substance dependency treatment. The most common model is Work as a Positive Outcome, which conceptualizes work (employment) as a desirable outcome of treatment. The Work Infusion Model conceptualizes work as a therapeutic factor in treatment. The Contingent Sanctions Model requires clients to work to avoid undesirable consequences, such as losing treatment. The Work as Reinforcement Model offers paid work as a reward for treatment adherence. This article discusses whether either standard substance dependency treatment or vocational services within treatment programs increase client employment, whether clients want to work, and whether sufficient services are available. The empirical support for each model of client work is summarized. Critical issues that must be addressed in this area are outlined.     

Special section: the most critical unresolved issues associated with contemporary vocational rehabilitation for substance users. The critical relationship between employment services and patient motivation

Several interventions and service delivery models now exist to help unemployed people in treatment for substance use disorder seek gainful employment (Platt, 1995). Some of these interventions can be conveniently offered within substance user treatment settings. One of the best known examples of these interventions is job seeking skills training and support services that help patients develop resumes, complete employment applications, learn effective networking strategies, and develop and practice effective responses to common issues and questions raised during employment interviews. A wide range of more comprehensive off-site employment programs that provide intensive vocational training and rehabilitation also exist in many communities. The growing availability of on-site services in substance user treatment programs also creates the     

Economic evaluation of a prerelease substance abuse treatment program for repeat criminal offenders

Substance use disorders are common conditions among repeat criminal offenders. Without addressing these underlying substance use behaviors, parolees are significantly more likely to recidivate within 1 year of release. New Jersey is one of the first states to actively pursue substance abuse treatment options for inmates who are in the final stages of their sentences. Given the fiscal realities of taxpayer-supported programs, such initiatives must clearly demonstrate economic benefits for sustainability and growth. This article conducted one of the few comprehensive economic evaluations of prerelease substance abuse treatment to determine whether Community Education Centers' programs in New Jersey generated desirable outcomes, significant economic benefits, and positive net benefits. Relative to a matched comparison group of offenders who did not receive treatment, the intervention group returned an average economic benefit of $4,307 to $6,209 over the 1-year postrelease period. These economic benefits are underscored by the fact that the treatment program is housed in a separate facility, with a lower average per diem from that of the general inmate population. These results provide quantitative economic evidence that prerelease substance abuse treatment programs have the potential to reduce recidivism and save taxpayer dollars without adding to existing prison resources.     

The Role of Work in Substance Dependency Treatment: A Preliminary Overview

This article describes four alternative models for the role of client work in substance dependency treatment. The most common model is Work as a Positive Outcome, which conceptualizes work (employment) as a desirable outcome of treatment. The Work Infusion Model conceptualizes work as a therapeutic factor in treatment. The Contingent Sanctions Model requires clients to work to avoid undesirable consequences, such as losing treatment. The Work as Reinforcement Model offers paid work as a reward for treatment adherence. This article discusses whether either standard substance dependency treatment or vocational services within treatment programs increase client employment, whether clients want to work, and whether sufficient services are available. The empirical support for each model of client work is summarized. Critical issues that must be addressed in this area are outlined.

“Work spares us from three great evils: boredom, vice and need.” Voltaire (1759)     

Program use of effective drug abuse treatment practices for juvenile offenders

This study examined the extent to which organizational context predicted use of consensus-based elements of effective substance abuse treatment practices with juvenile offenders. Participants were either directors of substance abuse treatment programs located in residential facilities (institutional sample) or directors of community-based treatment agencies providing services to adolescents in their home communities (community sample). The two settings differed significantly in the number and types of effective practices they were using. Community programs were more likely to have staff qualified to deliver substance abuse treatment, involve families in treatment, and assess their treatment outcomes. In contrast, institutional programs were more likely to provide comprehensive services. Resources dedicated to training, internal support for new programming, and network connectedness with non-criminal-justice facilities were associated with greater use of effective practices. These findings highlight the importance of establishing corrections-community partnerships designed to promote continuity of care for juvenile offenders.     

When the Junk Disappeared: Historical Case of a Heroin Shortage

Abstract

Because of high drop out rates, it is important to determine if enhancing standard substance treatment services will impact treatment completion rates among those in need of specialized services who are involved in the criminal justice system. The purpose of this research was to understand the impact of providing mental health services and gender-specific services for women in a modified therapeutic community setting. In the study, those who received mental health services and/or gender-specific treatment services, in additional to the substance abuse services, had similar rates of treatment completion as compared to those who received only substance abuse services. Logistic regression results indicated that controlling for other variables, age and length of time using one's primary drug were the only statistically significant predictors of treatment completion. The results suggest that the treatment model described in this article is a potentially cost-effective method of maximizing existing resources for treating substance abusing criminal offenders in community-based treatment settings.     

Ethnic differences in utilization of drug treatment services and outcomes among Proposition 36 offenders in California

This study examined whether ethnic differences exist in access to care, receipt of services, and associated outcomes of 1,057 offenders participating in California's Proposition 36. Data are based on intake and 3-month follow-up interviews conducted as part of a multisite prospective treatment outcome study. Logistic regressions were conducted to examine ethnicity and other predictors of treatment placement and services intensity. Across ethnic groups, services intensity in several domains was inadequately matched to need, and few services besides substance abuse treatment were provided. Blacks and Hispanics received alcohol and employment services that were not commensurate with their greater need. Although Blacks were more likely to be placed in residential programs, their employment status worsened from intake to follow-up. There were few other ethnic differences in outcomes. Assessing and eliminating ethnic-associated differences in health service delivery, even as moderate as our findings revealed, may improve program processes and outcomes.     

Substance abuse treatment staff perceptions of intimate partner victimization among female clients

Providing intimate partner violence (IPV)-related services to women enrolled in substance abuse treatment programs has the potential to reach a population disproportionately affected by IPV. Integrating basic IPV services into substance abuse treatment, however, poses challenges to organizations and staff. Using focus groups, the authors examined the experiences and attitudes of substance abuse treatment staff towards clients with IPV victimization experiences in order to elucidate factors that might affect the implementation of IPV services within substance abuse treatment. Seven focus groups were conducted with staff members from substance abuse treatment programs in New York City. Although participants believed that IPV is common and negatively affects client recovery, they felt competing time demands, complex confidentiality issues, insufficient training and lack of agency leadership would impede their provision of IPV-services. The study suggests that system-level assessment and change is needed to provide IPV-related services in substance abuse treatment settings.     

Evidence-based treatment practices for drug-involved adults in the criminal justice system

OBJECTIVE: The aim of this study was to estimate the extent and organizational correlates of evidence-based practices (EBPs) in correctional facilities and community-based substance abuse treatment programs that manage drug-involved adult offenders. METHODS: Correctional administrators and treatment program directors affiliated with a national sample of 384 criminal justice and community-based programs providing substance abuse treatment to adult offenders in the United States were surveyed in 2004. Correctional administrators reported the availability of up to 13 specified EBPs, and treatment directors up to 15. The sum total of EBPs indicates their extent. Linear models regress the extent of EBPs on variables measuring structure and leadership, culture and climate, administrator attitudes, and network connectedness of the organization. RESULTS: Most programs offer fewer than 60% of the specified EBPs to drug-involved offenders. In multiple regression models, offender treatment programs that provided more EBPs were community based, accredited, and network connected, with a performance-oriented, nonpunitive culture, more training resources, and leadership with a background in human services, a high regard for the value of substance abuse treatment, and an understanding of EBPs. CONCLUSIONS: The use of EBPs among facility- and community-based programs that serve drug-involved adult offenders has room for improvement. Initiatives to disseminate EBPs might target these institutional and environmental domains, but further research is needed to determine whether such organization interventions can promote the uptake of EBPs.     

Physicians in the substance abuse treatment workforce: understanding their employment within publicly funded treatment organizations

The employment of physicians by substance abuse treatment organizations is understudied, despite physicians' importance in implementing pharmacotherapy and integrating treatment into the broader system of medical care. Drawing on data collected from 249 publicly funded treatment organizations, this study examined organizational and environmental factors associated with the employment of physicians in these settings. A negative binomial regression model indicated that greater numbers of physicians were employed when organizations offered detoxification services, were embedded in health care settings, and were larger in size. Funding barriers, including the costs of physicians and inadequate reimbursement by funders, were negatively associated with physician employment. Programs unaware that they could use state contract funding to pay for medical staff employed fewer numbers of physicians than programs aware of this type of state policy. Attempts to increase physician employment in substance abuse treatment may require attention to both organizational and environmental factors rather than simply trying to attract individuals to the field. Increasing physician employment may be challenging in the current economic climate.     

Specialized substance abuse treatment for women and their children: an analysis of program design

In the present study, 36 specialized substance abuse treatment programs for women and their children were identified and chosen for review. These programs provide a wide range of services including substance abuse, mental health and medical treatment, life skills training (i.e. vocational and parenting training), and social services (i.e. child care and transportation). A cluster analysis was conducted, and three distinct patterns of program design were identified. Results suggest that programs vary considerably regarding the extent to which comprehensive services are provided and to whom they are offered. Many programs that appear to be comprehensive fail to provide the full range of services to all those who need them. In particular, many programs for pregnant women seem to focus almost exclusively on pregnancy-related issues. As such, specialized substance abuse treatment for women may be at risk for becoming too specialized. Recommendations are made for future substance-related program planning for women and their children.     

Do drug treatment services predict reunification outcomes of mothers and their children in child welfare?

The effect of mothers' participation in substance abuse treatment on reunification with their children who are in out-of-home care is an important policy issue. This article examines the predictors of child reunification among mothers who participated in a statewide treatment outcome study. Data were integrated from multiple sources to determine the contributions of characteristics of mothers (n = 1,115), their children (n = 2,299), and treatment programs (n = 43) on reunification outcomes. Hierarchical linear modeling was used to determine the fixed and random effects of mother, child, and program characteristics. Mothers with more employment and psychiatric problems were less likely to be reunified with their children; completion of 90 or more days in treatment approximately doubled their likelihood of reunification. Mothers who were treated in programs providing a "high" level of family-related or education/employment services were approximately twice as likely to reunify with their children as those who were treated in programs with "low" levels of these services.     

Organizational characteristics of drug abuse treatment programs for offenders

This article examines the association between the organizational characteristics of drug abuse treatment programs for offenders and the provision of wraparound services and three types of treatment orientations. Data are from the National Criminal Justice Treatment Practices Survey, which was conducted with program directors (N = 217). A greater number of wraparound services provided were associated with inpatient treatment, specialized treatment facilities, community setting (vs. correctional), services provided for more types of client populations, college-educated staff, and planned treatment for > 180 days. Therapeutic community orientation was associated with prison-based treatment and specialized treatment facilities. Cognitive-behavioral therapy orientation was associated with higher perceived importance of community treatment, more perceived staff influence on treatment, and treatment for 91-180 days. The 12-step orientation was most strongly associated with having staff specialized in substance abuse. Study findings have implications for developing effective reentry programs for offenders that bridge correctional and community treatment.     

Gender differences in substance use, mental health, and criminal justice involvement of adolescents at treatment entry and at three, six, twelve and thirty month follow-up

Many adolescents entering substance abuse treatment have coexisting mental health problems and are criminally involved. Examination of the complexities of substance use, mental health, and criminal justice involvement along with changes in these issues following treatment is needed. This study includes 941 males and 266 females enrolled in seven drug treatment programs located in geographically diverse areas of the United States. Comparisons between males and females at treatment entry and three, six, 12 and 30 months later were examined with regard to substance use, mental health, and criminal justice involvement. Results indicate that females showed significantly greater severity in substance use, problems associated with use, and mental health related variables at intake while males had significantly more days on probation/parole. With respect to change over time, the rate of change in mental health and days on probation/parole differed between the sexes. Results indicate that while rate of change is different for males and females on most variables, there was positive change following treatment for both groups with regard to substance use, mental health, and probation/parole status. The high severity levels of females at intake calls for gender-specific outreach and identification along with gender-specific treatments.     

Research on naltrexone in the criminal justice system

Many parolees and probationers are opioid abusers, and substance abuse is a leading factor for the revocation of probation, parole, and other alternatives to incarceration. The opioid antagonist naltrexone would appear to be an excellent treatment for opioid abuse and dependence in this population and the authors sought to systematically review this literature. Using the PubMed database, the authors identified large bodies of criminal justice (CJS) and naltrexone literature. The search terms used in both searches were crosschecked to identify all articles that involved research on naltrexone in the CJS. Only two articles were identified. The lack of research on naltrexone in the criminal justice system highlights the need for more research on naltrexone in our overburdened CJS.     

Individual and system influences on waiting time for substance abuse treatment

Waiting time is a contemporary reality of many drug abuse treatment programs, resulting in substantial problems for substance users and society. Individual and system factors that influence waiting time are diverse and may vary at different points in the treatment continuum. This study assessed waiting time preceding clinical assessment at a centralized intake unit and during the period after the assessment but before treatment entry. The present study included 577 substance abusers who were enrolled in a large clinical trial of two brief treatment interventions in a midsize metropolitan area in Ohio. Bivariate analyses identified individual and system factors that influenced preassessment and postassessment waiting time, as well as total wait to treatment services. Multivariate analyses demonstrated that longer wait time for an assessment is influenced by being court referred, less belief in having a substance abuse problem, and less desire for change. A shorter wait to actually enter treatment is predicted by having a case manager, being more ready for treatment, and having less severe employment and alcohol problems. The different influences present during the two waiting periods suggest that assessment and treatment programs need to implement system changes and entry enhancement interventions that are specific to the needs of substance abusers at each waiting period.     

Matching services to needs. Vocational services for substance abusers.

Problems with employment are common among individuals with substance use disorders, yet comprehensive vocational services are not generally available to them, and vocational interventions are often not matched to their specific needs. This article describes the wide range of vocational problems found among individuals with substance use disorders and the elements of a recently funded vocational program for patients in outpatient and residential drug and alcohol treatment programs. Data are presented describing program activity and documenting program effectiveness for the first 2 years of operation of the program. Three case histories are presented to illustrate the types of services delivered and the matching of services delivered to specific, identified client needs (see Case Histories).