Post on 14-Jan-2016
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UCLA Integrated Substance Abuse Programs
Gender-Responsive Drug Treatment Services for Women Offenders
Elizabeth Hall, Ph.D.
Criminal Justice Research GroupIntegrated Substance Abuse Programs
Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los Angeles
Research funded by the National Institute of Justice, the California Department of Corrections and Rehabilitation, and the National Institute on Drug Abuse
UCLA Integrated Substance Abuse Programs
Overview
• Discuss treatment and service needs of women drug offenders
• From an ongoing study:
Psychological functioning
Parenting
Social support
Adult relationships
• Describe gender-responsive treatment• Describe the current state of research knowledge on
gender-responsive treatment
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Background: What are the characteristics of national and state populations of women in prison and on parole?
• Growing population Increased by 21% from 2000 to 2006 to total of 103,100 just last year, the number of women prisoners increased by 4.5%
from the previous year
• Mostly due to drug offenses 11% in 1979, nearly 35% in 1997, 30% in 2001, 29% in 2004 59% of women used drugs in the month prior to their offense Female inmates (17%) were more likely than males (10%) to report
use of methamphetamines in the month before their offense Female inmates (60%) were more likely than males (53%) to meet
drug dependence criteria 40% committed offense under the influence of drugs
• Underclass population 70 to 90% were unemployed, 50% were functionally illiterate, 42%
had not completed high school or the GED prior to incarceration
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Background: What does prior research say about women offenders’
need for health and mental health services upon release?
Health~ 37% of women parolees report needing medical or
dental services in the year after releaseMental health
~23% of women in jails and state prisons are mentally ill
High level of prior physical and sexual abuse 51% of women, and, 78% of mentally ill women in state
prisons reported having been physically or sexually abused prior to incarceration
63% of mentally ill women released from prison received community mental health treatment; 19% were hospitalized (Massachusetts)
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Background: What does prior research say about women offenders’
need for daily living services upon release?
Welfare assistance56% of women parolees received welfare
assistance in the year after releaseHousing
9% of state prison inmates (men and women) were homeless in the year before incarceration
One-third of mentally ill women offenders were anticipating homelessness upon release
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Background: What does prior research say about women offenders’
need for parenting assistance services?
Family
Seven in ten women inmates had children under 18 years of age, and of these, two-thirds of the children were living with their mothers before incarceration
Responsibility for children may preclude residential treatment after release
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Background: What does prior research say about women
offenders’ need for vocational services?
• Less likely to have viable work skills or employment history, as compared with males
• Lower wages
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Why have gender-responsive programs?
• Research suggests that women may be more responsive to treatment within women-only treatment facilities or groups, because they feel less intimidated or concerned about being stigmatized in such settings, because of a desire to obtain services specific to their needs, or because they seek shelter from intimate partner violence.
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Characteristics of Gender-Responsive Programs
• Focus on the psychosocial profile of substance-abusing women •Designed to meet need for
comprehensive services• pregnancy• childcare and parenting• physical and mental
health problems • employment and
housing• history of trauma and
victimization
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Is gender-responsive treatment successful?
Research shows that women are more likely to complete treatment and have better outcomes when targeted services are available
• residential treatment with live-in accommodations for children
• provision of family therapy • comprehensive supportive services, such as case
management, pregnancy-related services, parenting training/classes, childcare, vocational training, and aftercare
More research needs to be done
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Evidence-based treatment approaches for women substance abusers
• Relapse prevention approaches focus on teaching clients to recognize “cues” or “triggers” for substance use and strategies for avoiding relapse in those situations
• Motivational interventions use therapeutic strategies to increase the individual’s awareness of their substance abuse problems and to engage their commitment to behavior change
• Contingency management approaches employ a schedule of rewards to strengthen the practice of desired behaviors (e.g., abstinence)
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Evidence-based treatment approaches for women substance abusers, cont’d
• Trauma and PTSD interventions Seeking Safety – cognitive-behavioral Trauma Recovery and Empowerment Model – group
therapy Beyond Trauma – “relational theory”
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Recommendations
Drug courts should: • refer women to treatment programs that are either
focused exclusively on women clients or that provide services specifically tailored for women’s needs.
• make sure that mental health screening and assessment occurs for all women and, when indicated, that mental health treatment is integrated with addiction treatment
• ensure that treatment programs screen women for their history of trauma and the ongoing effects of exposure to trauma, violence, and victimization
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Recommendations
Drug courts should: • assure that treatment programs provide services that
address their need for education and employment skills • ensure that parenting-related needs are assessed,
and, if appropriate that treatment is coordinated with child welfare services
• refer women to treatment programs that screen for health problems commonly found among female substance abusers
• utilize treatment programs that incorporate evidence-based treatment approaches
UCLA Integrated Substance Abuse Programs
Gender Responsive Treatment for Women Offenders
Michael Prendergast, Ph.D.
Nena Messina, Ph.D.
Elizabeth Hall, Ph.D.
UCLA Integrated Substance Abuse Programs
Gender Responsive Treatment for Women Offenders
• Los Angeles
• In Drug Court and
Prop. 36
programs• Average number
of days in
treatment for
those who
attended (n=47)
127.0 (SD 84.6)
Demographics (baseline) N = 57
Age (mean) 38.1 (SD 10.7)
Education (mean years) 11.7 (SD 2.0)
Lifetime arrests (mean) 11.5 (SD 23.6)
Age first arrested (mean) 24.3 (SD 9.3)
Marital status (% married or living together)
29.8
Employed (% working in 30 days before arrest)
17.5
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Ethnicity (%)
White 31.6
Latina 28.7
African American 29.8
Have minor children (%) 45.6
Primary drug (%)
Alcohol 5.3
Cocaine/crack 28.1
Heroin/opiates 10.5
Marijuana 1.8
Methamphetamine 38.6
Other 15.8
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Psychological and Social Functioning
ScaleBaseline(N=57)
12-Month (N=57)
BSI Global Severity Index 35.0 (SD 33.2) 29.2 (SD 34.9)1
ECRI dimensions (mean)
Adult attachment anxiety 4.2 (SD 1.2) 3.9 (SD 1.2)*
Adult attachment avoidance 3.5 (SD 0.9) 3.4 (SD 0.9)
ECRI adult attachment styles (%)
Secure 15.8 17.5
Fearful 54.4 38.6
Pre-occupied 21.1 24.6
Dismissing 8.8 19.3
Social support (mean) 16.9 (SD 7.8) 20.4 (SD 6.4)**
1p<.10, *p<.05, **p<.01
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Parenting
Baseline(N=57)
12-Month (N=57)
AAPI (parenting) STEN scores (N=26) (N=26)
Inappropriate expectations 5.4 (SD 1.7) 5.6 SD (1.3)
Empathy 1.0 (SD 0.2) 1.1 (SD 0.6)
Physical punishment 1.8 (SD 1.2) 1.8 (SD 1.1)
Reverses family roles 2.1 (SD 1.5) 2.2 (SD 1.5)
Restricts power/independence 1.0 (SD 0.0) 1.1 (SD 0.4)
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Conclusions
A minority of participants (16%) had a secure adult attachment style in which they found it easy to be emotionally close to others.
While attachment styles did change over time, most notably a reduction in the percentage of women exhibiting a fearful attachment style (discomfort in getting close to others), the move to a dismissing attachment style (preferring not to depend on others or have others depend on them) was not a positive sign of growth.
Participants showed personal growth in social support and improvement in their psychological symptoms.
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Conclusions
While participants had expectations for their children
that were age-appropriate, they lacked empathy for
their children, tended to favor physical punishment,
tended toward parentification of their children (reversed
roles), and tended toward an authoritarian relationship
(restricting power/independence) with their children.
Given the cyclical nature of abuse, the lack of
improvement in parenting attitudes over time shows a
high need among this population for additional
parenting intervention.
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Questions?
www.uclaisap.org
ehall@ucla.edu
UCLA Integrated Substance Abuse Programs
Gender-Responsive Drug Treatment Services for Women Offenders
Elizabeth Hall, Ph.D.Michael L. Prendergast, Ph.D.
Jean Wellisch, Ph.D.
Criminal Justice Research GroupIntegrated Substance Abuse Programs
Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles
Research funded by the National Institute of Justice, the California Department of Corrections, and the National Institute on Drug Abuse
UCLA Integrated Substance Abuse Programs
Background: Forever Free Substance Abuse Treatment Program
• Started in 1991
• Designed specifically for women
• Cognitive-behavioral model (Gorski)
• Participants housed separately, but mix with other inmates
during meals and work assignments
• Intensive six-month program provided to volunteering
women inmates during the end of their imprisonment
• Upon release, women may also volunteer for an additional
six months of residential treatment in the community
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Aims
• Compare the post-release service needs of Forever Free participants with similar inmates from the general prison population
• Compare the post-release services received by Forever Free participants with similar inmates from the general prison population
• Determine the levels of unmet need for post-release services
• Examine changes in needs and services over time
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Subjects
• Female• 215 inmates
119 enrolled in Forever Free 96 in comparison group enrolled in drug education
• Housed at California Institution for Women near Chino• Low educational attainment • 66% have children under 18• Offenses were primarily drug or drug-related• During the 30 days before incarceration, the treatment
group reported spending an average of $125 on alcohol and $1,976 on illegal drugs
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Methods
In-prison assessment: Twice for the treatment group Once for the comparison group (abbreviated form)
One-year post-release interviews: Telephone and face-to-face Urine samples
Follow-up interviews were completed with 84% of the original sample.
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Findings: Treatment post-release (percent)
0 20 40 60 80 100
Any treatment
Residential
Outpatient
Sober living
Self-help
Forever Free Comparison
1
1 p<.10* p<.05
*** p<.001
*
***
1
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Findings: Psychological functioning (mean score)
0 1 2 3 4 5 6
Self-esteem
Depression
Anxiety
Forever Free Comparison
***
*** p<.001
***
***
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Findings: Employment (percent)
0 10 20 30 40 50 60 70
Employed at timeof interview
Forever Free Comparison
*
* p<.05
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Findings: Children’s status at follow up (percent)
0 10 20 30 40 50 60 70 80
Of those withminor children, %
living withmother
Have minorchildren
Forever Free Comparison
*
* p<.05
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Findings: Self-rating of how well doing as parent (percent)
0 10 20 30 40 50 60
Well
Fair
Poor
Incarcerated attime of interview
Forever Free Comparison
*
* p<.05
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Findings: Substance abuse treatment needs post-release (percent)
0
10
20
30
40
50
60
70
80
90
Relapse prevention Treatment
Forever Free
Comparison
*
UCLA Integrated Substance Abuse Programs
Findings: Substance abuse treatment services received post-release (percent)
0
10
20
30
40
50
60
70
80
90
Relapse prevention Treatment
Forever Free
Comparison
*
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Findings: Health and mental health services needs post-release (percent)
0
10
20
30
40
50
60
70
80
90
Medical dental Spiritual support Family counseling Grief counseling Psychologicalcounseling
Forever Free
Comparison
*
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Findings: Health and mental health services received post-release (percent)
0
10
20
30
40
50
60
70
80
90
Medical dental Spiritual support Family counseling Grief counseling Psychologicalcounseling
Forever Free
Comparison
*
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Findings: Daily living services needs post-release (percent)
0
10
20
30
40
50
60
70
80
90
Welfareassistance
Transportation Living skillstraining
Housing Food, furniture,clothing
Paying bills
Forever Free
Comparison
* **
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Findings: Daily living services received post-release (percent)
0
10
20
30
40
50
60
70
80
90
Welfareassistance
Transportation Living skillstraining
Housing Food, furniture,clothing
Paying bills
Forever Free
Comparison
**
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Findings: Educational and vocational service needs post-release (percent)
0
10
20
30
40
50
60
70
80
90
Employment assist Education, GED Vocational training
Forever Free
Comparison**
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Findings: Educational and vocational services received post-release (percent)
0
10
20
30
40
50
60
70
80
90
Employment assist Education, GED Vocational training
Forever Free
Comparison
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Findings: Parenting assistance needs post-release (percent)
0
10
20
30
40
50
60
70
80
90
Parenting skills training
Forever Free
Comparison**
UCLA Integrated Substance Abuse Programs
Findings: Parenting assistance received post-release (percent)
0
10
20
30
40
50
60
70
80
90
Parenting skills training
Forever Free
Comparison
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Conclusions• Women in both groups had a high need for services
during parole
• Women in the comparison group generally had greater needs, but were less likely to receive services during parole
• The greatest unmet need for both groups was for vocational and educational services (37% - 40% service gap)
• Women also had a great unmet need for housing (35% service gap)
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Discussion
• While previous national research found that custodial treatment programs report that they provide women offenders with treatment, housing, and welfare assistance; the percentage of women actually receiving such assistance may be small.
• Compared to previously reported research on an earlier group of Forever Free and comparison women, service needs have increased in all areas.
• Ask the women!
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Ask the Women!
We wanted to know about:
• Supports for success on parole
• Barriers to success on parole
• Why women didn’t enter treatment during parole
• Personal factors that may influence success
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Method
We conducted focus groups with 4 groups of women (all had received or were receiving drug treatment in prison):
1. Those about to parole
2. Those on parole and in community drug treatment
3. Those who paroled, got a new charge, and were returned to prison (Returnees)
4. Those who paroled and were long-term successes
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What women learned in prison treatment:
“What I learned were things about myself - what’s inside. I learned that I don’t have to live like that anymore. I learned about self-esteem, post-acute withdrawal, etc.” [Rs]
“They teach us about abuse and relationships, about how it’s not our fault that we’re abused.” [Tx]
“I didn’t know I have an anger problem. They’ve taught me how to deal with my anger.” [Tx]
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“They help you realize that you aren’t that bad; that you have a lot of mistaken beliefs. You need to take a look at what you really are; that covered a lot of areas for me.” [LT]
“They explained why; just like elementary school; over and over again until you got it. But it was based on self-esteem. Conglomeration of a lot of different aspects. They really worked with you to make sure you really understood about all the different aspects of drug and alcohol use.” [LT]
What women learned in prison treatment:
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Treatment After Parole
• The greatest influence on parole success
• In addition to the basics of drug treatment, women got:
“unconditional love”
education
social and emotional support from counselors and
other clients
networking experience
the 12 Steps
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Concerns about finding employment:
No one wants to give you a chance if you’re an ex-
offender. I couldn’t even get a job bagging groceries.
[Tx]
They don’t tell you about certain things, like the
difficulty of finding a job if you’re a felon. [LT]
The girls need some outlet for work. I finally got a
job, but you need determination and a willingness to
work for minimum wage. [LT]
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Barriers to Success on Parole: EmploymentYou need resources, places to go. The CDC doesn’t
provide you with anything. There is voc rehab through the parole agency, but you have to apply in advance. [LT]
Drug programs need job placement services. They need to help you educate yourself. There are all these computers here at [Program C] and they are going unused. [Res]
Residential programs need to inform us. We learn a lot of things here through word of mouth. A lot of us didn’t know about the Department of Voc Rehab, grants, schools, etc. and found out about them through other residents. [Program C] doesn’t help with job placement—they just tell you to go out and get a job. [Res]