NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Center for Substance Abuse Treatment. Continuity of Offender Treatment for Substance Use Disorders from Institution to Community. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1998. (Treatment Improvement Protocol (TIP) Series, No. 30.)
Continuity of Offender Treatment for Substance Use Disorders from Institution to Community.
Show detailsIt is clearly in the public interest for offenders with substance use disorders to receive appropriate treatment both in prison or jail and in the community after release. Numerous studies show that those who remain dependent on substances are much more likely to return to criminal activity. Research also indicates that treatment gains may be lost if treatment is not continued after the offender is released from prison or jail. In part, this is because release presents offenders with a difficult transition from the structured environment of the prison or jail. Many prisoners after release have no place to live, no job, and no family or social supports. They often lack the knowledge and skills to access available resources for adjustment to life on the outside, all factors that significantly increase the risk of relapse and recidivism.
This TIP presents guidelines for ensuring continuity of care as offenders with substance use disorders move from incarceration to the community. The guidelines are for treatment providers in prisons, jails, community corrections, and other institutions, as well as community providers. The following recommendations are based on a combination of research and the clinical experience of the Consensus Panel that developed this TIP. Recommendations based on research are denoted with a (1); those based on experience are followed by a (2). Citations supporting the former appear in Chapters 1 through 6. References to specific programs appear throughout those chapters as well; Appendix B provides contact information for many of those model programs.
Improving Transition to The Community
Much of the responsibility for offenders moving from incarceration to the community lies with community supervision agencies, known in many jurisdictions as parole or postprison supervision. To reach the levels of system collaboration and services integration required, staffs from criminal and juvenile justice supervision and substance use disorder treatment agencies must reach beyond traditional roles and service boundaries by brokering services across systems, sharing information, and facilitating the treatment process. (2)
Overcoming Obstacles to Successful Transitions
Obstacles to successful transition include the fragmented criminal justice system, the lack of attention to offender issues by community treatment providers, disjointed (or nonexistent) funding streams, and the varying lengths of sentences. The following will help overcome those obstacles:
- Fostering criminal and juvenile justice systems integration (for example, CSAT's Juvenile/Criminal Justice Treatment Networks Program)
- Educating and providing incentives for community service providers to meet offender treatment needs
- Integrating funding streams and expanding the funding pool
- Coordinating sentencing practices with treatment goals
- Fostering institution and community agency coordination that promotes continuity of treatment (2)
Case Management and Accountability
Case Management
Case management is the coordination of health and social services for a particular client. When provided to offenders, case management also includes coordination of community supervision. Because case managers work across many agencies to serve their clients, they are sometimes known as boundary spanners. See TIP 27, Comprehensive Case Management for Substance Abuse Treatment (CSAT, 1998b), for more on case management.
Models for coordinating services for transitioning offenders include institution outreach, community reach-in, and third party coordination, in which a separate entity oversees transition. Though any one is appropriate for different circumstances, the Consensus Panel recommends combined models for optimal transition planning. (2)
Ideally, a single, full-time case manager works in conjunction with a transition team of involved staff members from both systems. However, if the infrastructure and resources do not allow for a full-time case manager position, the treatment provider working with the offender or the supervision officer should take the lead in providing this function. (2)
Need for Assessments
To assist in transition planning, the Panel recommends the use of standardized, comprehensive risk and needs assessment tools appropriate to offender populations. These instruments should be "normed" for various populations, including women and racial and ethnic minorities. (1) The instruments should be in the language of the client.
Assessments for offenders should be conducted within the institution as early and often as possible, and also 3 to 6 months before the offender's release. (2)
Multiple assessments of offenders having substance use disorders are necessary and should examine
- Treatment needs
- Treatment readiness
- Treatment planning
- Treatment progress
- Treatment outcome
Risk and needs assessments are ideally conducted by a multidisciplinary team, with cooperation among all players. Areas to be assessed include skills for daily living, stress management skills, general psychosocial skills, emotional readiness for the transition, literacy, and money management abilities. Criminal justice staff can contribute critical information on risk and dangerousness. Assessment results should follow the offender through the system(s). (2)
Accountability
Violations of any aspect of the transition plan must be dealt with consistently, appropriately, and in a timely manner. (1) Innovative sanctions should be developed to address violations. These sanctions are best given in a graduated manner, with the most severe being a return to prison. (1) The methods used should be understood and agreed upon by both the criminal justice and substance use disorder treatment staffs.
There should be periodic reviews of the issues addressed in the transition plan, including legal matters, appropriate placement in a level of care, the effectiveness of sanctions, and the extent to which the offender is meeting expectations. Correctional and treatment personnel should decrease levels of supervision as the offender takes on more responsibility.
An individualized relapse prevention plan should be developed for each offender. It is often developed as a standard form, written in simple, nonclinical language, with a checklist of behavioral indicators that help predict the potential for relapse. The plan should be used by all parties: the offender, treatment agency, supervising officer, and others. (2)
Treatment needs should be reassessed when there are problems (e.g., "dirty" urines, lack of progress in treatment) and, if clinically appropriate, the offender should be moved to a higher or more intensive level of care. (1) The length of stay in the program should be determined by the treatment provider who, along with the community supervision officer, can monitor the progress of the offender.
Guidelines for Institution and Community Programs
Institutions
The term institution refers to prisons, jails, and youth detention facilities. Prisons are either Federal or State facilities that usually house offenders for 1 year or more. Prisons represent the end of the adjudication process, whereas jails contain offenders who have not come to trial as well as those with short sentences. Jails are usually run by local governments, though some States, such as Alaska, oversee a jail system. Youth detention facilities provide temporary care and restrictive custody for juvenile offenders (or juveniles alleged to be delinquent). Youth detention can take place pre- or postadjudication, and facilities are usually under local jurisdiction. Regardless of which level of government is responsible for the facility, institution programs should comply with State treatment standards to the extent possible, bringing those programs into a larger context of community-based treatment. To that end, institutional treatment should focus on preparing and motivating the offender for continued care in the community. (1)
The Consensus Panel recommends that jail-based treatment be provided if an offender having a substance use disorder is scheduled for confinement in jail for a period of time sufficient to provide adequate treatment for the offender's needs. (1) Nevertheless, even brief jail interventions should introduce treatment concepts to the offender and at least begin the process of fostering treatment in the community. (1)
Treatment providers in prisons should take advantage of the longer period of incarceration to engage in thorough treatment, including frequent reassessments, training in life skills, and discharge planning. Providers should try to offset "institutionalization" by preparing the client for life in the community. (2)
Drug-involved youth in detention facilities should receive particularly thorough assessments, and family involvement in treatment should be a strong consideration in transition services. (2)
Community Programs
Community programs should build on the achievements and progress made in prison or jail, rather than starting over with the client. For example, an individual who completes 12 months of in-prison therapeutic community (TC) treatment should enter a community TC program at the commensurate level, rather than entering as if he had never received treatment. (2)
The Consensus Panel makes the following recommendations regarding the goals for communication between the releasing agency and the community supervision and treatment agencies:
- The community program and the releasing agency should discuss the roles of each agency during the transition.
- Community programs should become familiar with the forms and legal requirements used by releasing agencies as well as the restrictions placed on the offender returning to the community (i.e., parole, probation).
- Whenever possible, community programs and releasing agencies should collaborate in designing forms to record offender progress.
- The community provider must find out what kind of therapeutic interventions occurred in the institution and develop a plan for the community program to build on these interventions. Specifically, the community agency needs to determine whether there was
- A comprehensive substance use disorder assessment
- A formal substance use disorder treatment program
- An educational program
- Vocational training
- Community treatment providers working with offenders should receive education about the prison environment and structure, offenders with substance use disorders, and the criminal justice system in general. (2)
Administrative Guidelines
The administrative meetings to establish a transition team should include a representative of each agency who has authority to speak for the agency, make commitments on behalf of the agency, and sign agreements or other official documents. Each agency involved in setting up the team should have a working knowledge of every other participating agency's policies, internal dynamics, service capacities, and legal responsibilities and authority in relation to the client. (2)
During the planning phase of a transitional services program, it is important to agree on goals that are acceptable to each participating agency. The results of negotiating the key components of a transitional services program should be documented in writing (e.g., an interagency agreement). Interagency agreements should be renegotiated at least every 2 years. (2)
Policy and Procedures
During the planning phase of a transitional service program, it is important for each participating agency to agree on a set of goals. The underlying philosophies of different systems must be identified and discussed prior to program implementation. Failure to do so may foster interagency mistrust, inmate manipulation, and dishonesty and can result in program failure. Partnership goals and objectives must also be compatible with any legal conditions placed on an offender by the releasing or supervisory authority. Other key components that should be negotiated and agreed on between agencies are a shared "vision statement"; each agency's specific roles, expectations, and responsibilities; the timing of tasks; monitoring procedures; information-sharing requirements; client confidentiality; program evaluation needs; who pays for treatment; and methods for resolving disputes. The results of such negotiations should be documented in an interagency agreement. (2)
At the heart of effective transitional services is case management planning. Each participating agency administrator must ensure that the agreements reached among the partners address the timing, methods, and responsibility for case management.
Legislative Issues
Transitional service program administrators should be aware of how State legislatures can affect their programs or larger policies. In response to the ever changing legislative climate, a transitional services program administrator must educate the legislature on the necessity for these services, stay aware of opportunities to help develop new legislation, and identify the need for changes in existing legislation which present obstacles to successful offender transition. The three most important legislative opportunities to enhance transitional services programs for offenders result from provisions made in (1) community corrections acts, (2) structured sentencing laws, and (3) truth in sentencing laws.
State legislatures determine which agency is in charge of parole, probation, and community treatment. The legislature may also determine the agency in charge of transition to the community and/or community-based substance use disorder treatment. A transitional services program administrator must be aware of the States' legislative position on these issues and the current structure of these services to effectively navigate the planning and implementation processes. If there are obstacles, the administrator must be able to identify and work with those obstacles. The kinds of legislative obstacles a transitional services program administrator might expect to encounter are (1) determinant sentencing laws, (2) presumptive and mandatory minimum sentencing laws, and (3) legislative treatment mandates.
Confidentiality
Client confidentiality and the offender's right to privacy must be balanced against the needs of various agencies for information. The extent of computerization and the security of client data across agencies are areas of crucial concern in partnerships between various transitional services. During the planning process for information sharing, these issues should be addressed in great depth.
It is essential for the administrator charged with managing a transitional services program both to understand confidentiality regulations and to work out methods by which clients are informed of their rights. All staff members involved with transitional services need training on the parameters of client confidentiality. (2)
Program Evaluation
Because multiple agencies are involved in transitional services programs, certain evaluation issues must be addressed at the planning process phase. These include what data will be used; who will be responsible for collecting data; who will assist in data interpretation; and what, how, and to whom data will be reported. Participation of the evaluator and the cooperation of partners involved in the evaluation must be obtained early in the process because successful program evaluation depends on their full cooperation.
The many uses of information gathered from a program evaluation include
- Justifying program costs and identifying cost offsets
- Establishing program effectiveness or success
- Making program adjustments
- Assisting in legislative decisionmaking and funding allocation
- Serving as a basis for obtaining additional funding
- Serving as a justification for expanding services (2)
Process evaluation examines the implementation procedures and operations of a transitional services program as it compares with the program's stated goals and objectives. Outcome evaluation to determine effectiveness of a program can be conducted by comparing the group receiving services to a control group that receives no treatment, an alternative program, or standard treatment.
The focus of outcomes measurement should be on behavioral changes, such as reduced drug use or abstinence, stopped or reduced criminal activity, compliance with supervision requirements, and stability within the community.
Ancillary Services
Offenders with substance use disorders need certain basic services as they reenter the community, including housing, employment, health care, and possibly family counseling. These services are generally provided by a number of public systems that are not well-coordinated and, because of the factors discussed throughout this TIP, offenders' abilities to access these services are limited. However, efforts at treatment are unlikely to succeed unless these basic needs are met.
Housing
Because safe, secure, and substance-free housing is so important—and often difficult to obtain -- a housing plan should be in place before release from incarceration. (2) Offenders, along with the transition team responsible for this service, should identify a living arrangement that meets their needs and then arrange a linkage with the entity providing housing. Local housing agencies can be brought into the team as partners in this effort.
Employment
Planning for employment should begin well before release. Close collaboration with the welfare/workfare system is essential to avoid employment conflicts between the criminal justice and local social service agencies, which both have authority over the offender's fate. While still incarcerated, offenders can benefit from prevocational and job training, job readiness preparation, skills identification and assessment, role playing for future interviews and job situations, and reach-in programs that serve as quasi-internships or offer transferable pre-employment experience. Prior to release, case managers often develop a resource directory of employers that will hire offenders and talk with probation and parole officers about employment possibilities. The offender should be linked with employment services before release from the institution. (2)
Family
To the extent the offender's family agrees to participate, a prerelease assessment of the family environment should be conducted. This assessment should measure
- Whether other family members are using substances
- Whether there is domestic violence
- Criminal activity of other people living in the house
- The level of support for sobriety
- Hopes regarding family reunification
- Current child care and child custody status
- The availability of family members in nurturing roles
- The family services already in place
- Areas of potential vulnerability (2)
Peers
Permanent sobriety often involves avoidance of people, places, and things that may trigger relapse. The case manager (or those providing case management functions) can guide an offender toward new contacts. Formal peer support groups are invaluable. (1) A directory of peer groups and services can be maintained by the case manager, who should also identify whether support groups are open or closed, their focus, and where they are located.
Recommendations for Coordinating Ancillary Community Services
- Service providers in a community coalition should convene to promote access to offenders as they make the transition into the community. This builds linkages among different service systems and facilitates the job of the case manager or boundary spanner.
- Representatives of all involved service agencies and programs should meet face to face to explain what services they have to offer and exchange phone numbers and specific information about their programs (such as the name of the contact person and how many slots are in the program).
- Service providers should create networks to link with the legal sanction agency.
- The corrections system should make contracts with community organizations providing formal services, such as residential and outpatient substance use disorder treatment services, job training, and life skills training.
- If possible, and in partnership with other agencies, treatment providers should endeavor to ensure substance-free housing for offenders re-entering the community. In addition to providing the obvious need for shelter, supported housing arrangements provide a positive social setting because the other tenants, also in transition, can give support to one another.
- Providers should modify conditions of community supervision to promote participation in services (e.g., parenting classes, substance use disorder treatment).
- Treatment managers should train corrections and supervision staff about substance use disorder issues. (2)
Special Populations
Though treatment providers know that people with substance use disorders are extremely diverse, offenders tend to be treated as a homogeneous population. The effects of incarceration are different depending on a client's gender, culture, background, or age, and their treatment needs vary accordingly.
Furthermore, a higher proportion of offenders than of the population at large have mental illness, mental retardation, physical disorders, or long-term medical conditions. (1) Effective care for those with health problems must incorporate the care of these illnesses into the plan for treatment of substance use disorders and criminality. To provide effective care for diverse populations, assessment and treatment efforts must also acknowledge and incorporate cultural differences.
Ideally, staffing patterns at all levels of the treatment system will reflect the population served, from clerical staff through executive management. Specific efforts should be made to recruit and maintain these staff members. Licensing, certification, and credentialing should support the use of culturally competent staff—and support continuing education in the knowledge and skills relevant to the population. Staff members should be able to communicate in local languages and dialects, and published materials and consent forms should be available in these languages as well. In-service training and ongoing staff development should include issues related to specific populations.
Women
Women offenders' unique issues include child care, health issues, lack of employment experience, and possible victimization by their domestic partners. (1) Case management is particularly important when the offender is a mother. Parenting classes and quality child care may be essential for some women to make a successful transition.
Counseling and testing for all sexually transmitted diseases should be available to female inmates and be part of the transition plan. Because many incarcerated women have little or no work experience, elementary and intensive job readiness training and job seeking assistance should be available.
Many female offenders have been victims of physical or sexual abuse, and many may be returning to abusive situations upon release. Case managers should explore this issue as a critical part of the transition plan, and alert community treatment providers. If an offender has no safe place to go, she should be directed to a women's shelter.
The Consensus Panel recommends women-only programming wherever possible. (1)
Elderly Offenders
Older prisoners have more health problems and long-term medical conditions than their younger counterparts. The stress of return to the community can be much greater for elderly offenders, especially if they have been incarcerated for many years and have no family or familiar sources of support.
There are a variety of services and entitlement programs that older offenders returning to the community may need help accessing—Medicare, Social Security, or perhaps veterans' benefits. Their transition plans are more likely to require a search for supported living arrangements, such as nursing homes. It is especially important to have someone who can oversee medication management on the transition team. (1)
Offenders With Mental Illness
Incarcerated substance-users have high rates of coexisting mental health disorders; it is crucial for these offenders that medication orders and files are transferred. Careful reassessment of the inmate's medication is required upon release to the community.
Case managers should foster intersystem communication, as the mental health and substance use disorder systems are sometimes separate in prison and usually separate in the community as well. They also must work to identify funding to cover care for offenders with coexisting disorders. In the current environment of managed care, advocacy for this population is essential.
Sex Offenders
Generally, it is useful to address the sex offender's behavior prior to focusing on substance use disorder treatment issues. Because many States are now eliminating programs for sex offenders, the substance use disorder treatment community may become the first line of treatment for many of these individuals; this highlights the field's need for an indepth understanding of this population.
Long-Term Medical Conditions
Tuberculosis, hepatitis, and HIV/AIDS are more common in prisons and jails than in the community, so offenders are more likely to suffer from one or more of these problems. If offenders have had their medical needs met in prison, it will help facilitate a smooth transition back to the community. It is critical that there are no gaps in treatment or the receipt of medications.
The Panel recommends the mainstreaming of those with HIV into treatment groups. (1) HIV and other support groups within the community can enhance the effectiveness of substance use disorder treatment.
Offenders With Disabilities
A balance must be struck between providing special services for people who are disabled and mainstreaming. Sometimes special treatment programs will be necessary. In other instances, minor modifications can allow these individuals to participate in programs with the general population.
A screening for disabilities, including traumatic brain injury or certain physical conditions, should be conducted at intake into the correctional system. When the offender returns to the community, all relevant medical information should be transmitted to the appropriate parties. If medication is used to treat the disability, it is important that there is no gap in its use.
Many advocacy groups safeguard and promote the interests of persons with disabilities, who are protected by the Americans With Disabilities Act. During the transition period, contact should be made with representatives of these groups. For more information on this topic, see TIP 29, Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities (CSAT, 1998c).
Maintaining Sobriety
Release from incarceration is an extremely high-risk event for someone in recovery for a substance use disorder. It is critical that treatment gains be maintained as the offender moves into a new life with added responsibilities and stresses. Because offenders' relapse to substance use is so often accompanied by a return to criminality, maintaining sobriety is a public safety issue as well. Ideally, the institutional treatment program and the community provider share responsibility for the transition.
To help smooth the transition process, this TIP recommends ways in which those who work in the criminal justice system and community treatment providers who have little exposure to the incarceration system can collaborate and complement one another's efforts. The Consensus Panel that generated this TIP includes experts from across the substance use disorder treatment and criminal justice systems. Dozens of additional experts reviewed the document. The professionals who contributed to this book do not agree on every issue, but the TIP reflects those areas where consensus was reached. To avoid sexism and awkward sentence construction, the TIP alternates between "he" and "she" in generic examples.
- Executive Summary and Recommendations - Continuity of Offender Treatment for Sub...Executive Summary and Recommendations - Continuity of Offender Treatment for Substance Use Disorders from Institution to Community
- Chapter 2—Brief Interventions in Substance Abuse Treatment - Brief Interventions...Chapter 2—Brief Interventions in Substance Abuse Treatment - Brief Interventions and Brief Therapies for Substance Abuse
- Appendix E—Resource Panel - Brief Interventions and Brief Therapies for Substanc...Appendix E—Resource Panel - Brief Interventions and Brief Therapies for Substance Abuse
- What Is a TIP? - Behavioral Health Services for People Who Are HomelessWhat Is a TIP? - Behavioral Health Services for People Who Are Homeless
- Acknowledgments - Behavioral Health Services for People Who Are HomelessAcknowledgments - Behavioral Health Services for People Who Are Homeless
Your browsing activity is empty.
Activity recording is turned off.
See more...