T I P 44 Edited

transcript

TIP 44: Adults in the Criminal Justice System

Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC

Screening and Assessment

Screening

Purpose◦Screen out offenders who do not need treatment ◦Assess the extent of offenders’ treatment needs ◦Gather information for wrap-around referrals◦Determine eligibility and suitability

Information sources◦Booking records◦Interview◦Instruments◦Correctional records/presentence investigations◦Past treatment records◦Police reports◦Drug Tests

Screening Areas of Concern

Accuracy of information Continuity and system-wide sharing of

information The importance of re-screening and re-assessing Timing of screening and assessment Drug testing Detoxification needs Readiness for treatment History of trauma PsychopathyRisk for violenceRecidivism

Diagnosis Pitfalls

StigmaInaccuracy due to withdrawalSA diagnosis may preclude from MH

treatmentSA diagnosis may limit offenders access to

work assignments or vocational training/rehab

Reasons for Diagnosis

ReimbursementTo support pharmacological interventionsWhen psychiatric concerns emergeClarification of co-occurring disordersResearch/evaluation

De-stigmatizing Diagnosis

Explain that diagnosis is just short handReview presenting issues and discuss

differential diagnosisNormalize diagnoses

◦Google “Famous people with…”Do an “All About Me” worksheet

Screening Instruments

Instruments with adequate reliability and validity with incarcerated populations

Reproduced in appendix C of TIP 44◦Addiction Severity Index–Alcohol Use subscale (ASI-

Alcohol)◦ ASI–Drug Use subscale (ASI-Drug)◦Drug Abuse Screening Test (DAST-20) ◦Michigan Alcoholism Screening Test (MAST)

Simple Screening Instrument for Substance Abuse (SSI-SA)—Reproduced in TIP 42 (CSAT 2005)

Assessment Instruments: ASI

Addictions Severity Index◦reproduced in TIP 38, Integrating (CSAT 2000)◦structured interview format (75 minutes)◦examines the following areas of functioning:

Drug/alcohol use Relationships Employment Legal involvement Physical health Mental health

Assessment Areas

SA◦Substance use history ◦Motivation◦Severity and frequency of use ◦Detoxification needs◦Treatment history

Criminal Involvement◦Criminal thinking ◦Current and prior offense(s) types and numbers◦Prior successful completion of probation for drug

use offenses ◦Prior involvement in diversionary programs ◦History of diagnosis of any personality disorder

Assessment Areas cont…

Health◦Intoxication◦Infectious disease◦Pregnancy ◦General health ◦Acute conditions

MH◦Suicidality◦MH diagnosis and treatment history◦Acute symptoms◦Current medications

Assessment Areas cont…

Special Considerations◦Educational level ◦Reading level/literacy ◦Language/cultural barriers ◦Physical disability ◦Developmental disability ◦Learning/cognitive disability ◦Housing ◦Dependants/family issues ◦History of abuse (victim or perp)

Triage and Placement

Continuum of services◦Pretreatment (Detoxification)◦Outpatient◦Inpatient

Triage and Placement cont…

Key staff preparations ◦Develop a treatment resource database◦Define eligibility and suitability for each

program◦Document referral process to each program◦MOU including

information to be shared supervision and treatment responsibilities of each

party evaluate effectiveness of offender matching

(ongoing)

Placement Strategies

Target offenders with moderate to high risk of recidivism◦Criminal history◦Poor employment history◦Poor support environment◦Homelessness◦Antisocial traits (impulsivity, lack empathy,

anger issues, entitlement)

Placement Strategies cont…

Moderate to severe substance abuse problems◦Substance dependence◦SA related arrests◦History of SA with or without treatment◦Positive drug tests

Placement Strategies cont…

Moderate to severe mental health issues◦Suicidal or violent behaviors◦Acute symptoms◦Cognitive impairment (concentration, problem

solving) ◦Social impairment (interpersonal skills,

frustration tolerance

Offender characteristics

Perceived severity of problems (Readiness for change)

Motivation (SOCRATES*, TIP 35)Prior evidence of attempts to improvePerceived importance of treatment

*Stages of Change, Readiness, and Treatment Eagerness Scale

Implementing Treatment

Offender involvement in treatment planning

Motivational interviewingCoordination with “team”Plan updates at status changesCommunity based linkages at re-entry

Implementing Treatment cont…

Outreach and low-intensity interventions◦Provided to all offenders

Entrance As part of daily activities (webcast via TV) Exit/Re-entry

General CJ Treatment Issues

Components of criminality◦Criminal thinking◦Criminal code (inmate value system)◦Manipulation

Criminal Thinking◦Learned behavior◦Help offenders recognize thinking errors and

understand how they can lead to behavior ◦CBT and Staff/Peer confrontation

General CJ Treatment Issues cont…

Criminal Code◦Refusal to cooperate with authority◦Refusal to confront negative behavior ◦Participation in treatment viewed as weakness◦“Snitch syndrome”

Manipulation◦Throwing focus◦Team splitting◦Demeaning others (Power plays)

Addressing manipulation◦ Identifying the primary thinking errors

observed ◦Instructing the client to begin self-monitoring

when these occur (journaling)◦Providing regular feedback to the client, usually

from peers in a treatment group

Excuse making Blaming Justifying Throwing focus“I think; therefore it is,” permits function

according to what he wants, rather than according to the facts

Lying: commission/omissionMaking Fools Of : pulling the woolBuild-up: focus on positives and bring down others

Assuming I'm unique / It doesn’t apply to me Ingratiating : phony manipulation Fragmented Personality Behaviors are inconsistent Minimizing / Exaggerating Vagueness / Non-committal Anger Power plays Victim playing Closed channel : unreceptive, undisclosing Ownership / lack of awareness of other’s boundaries Image cowboy or victim

Addressing Anger and Hostility

Identifying the feeling(s)—other feelings may be involved, such as embarrassment or guilt

Understanding clearly where the feeling is coming from

Identifying the goals the anger is serving (e.g., deflecting attention)

Identifying the goals the anger is undermining (e.g., staying out of jail or keeping a job)

Working toward taking the longer view (e.g., beginning to use a positive/pro-social thought process to manage the anger)

Barriers to Effective Treatment

Assessment: inaccurate placementsPoor staff trainingStaff transitionOverreliance on institutional sanctions

instead of letting peers pressure for internal controls

Aftercare availability and complianceCoercionTreatment competes with other facility

opportunities

Sentencing Alternatives

Pretrial Diversion◦Supervision in lieu of detention◦Treatment in lieu of prosecution

Maintain a client’s confidentialityAvoid discussing the client’s criminal casethe client is presumed innocent before trialBe realistic about the responsibilities that a

client is capable of handlingAvoid allowing individuals to be inadvertently

penalized for enrolling in treatmentBe aware that clients may be more focused on

“beating the case” than on recovery

Drug Courts

10 Components1. Drug courts integrate alcohol and drug treatment

services with justice system case processing. 2. Using a non-adversarial approach, prosecution

and defense counsel promote public safety while protecting participants’ due process.

3. Eligible participants are identified early and promptly placed in the drug court program.

4. Drug courts provide access to a continuum of co-occurring disorders treatment.

5. Abstinence is monitored by drug testing.

Drug Courts cont…

6. A coordinated strategy governs drug court responses to participants’ compliance.

7. Ongoing judicial interaction with each drug court participant is essential.

8. Monitoring and evaluating achievement of program goals is necessary to gauge effectiveness.

9. Continuing interdisciplinary education promotes effective drug court planning, implementation, and operations.

10.Forging partnerships among drug courts, public agencies and community-based organizations generates local support and enhances drug court program effectiveness.

Treatment Accountability for Safer Communities (TASC)

TASC programs provide a bridge between treatment providers and the CJ system

Provide a range of services◦Screening and assessment◦Referral to community-based services◦Monitoring of treatment ◦Case management◦Court liaison

Interventions

Brief (TIP 34)Motivational (TIP 35)Behavior contactsPhased treatmentSubstance abuse educationDetoxificationDay reportingDrug testing

Interventions cont…

Criminal thinking assessment and treatment (video feedback)

Coping skills trainingRelapse prevention toolsStrengths buildingCommunication skills enhancement

Wrap Around Services

Vocational ◦Job readiness assessment and preparation ◦Liaison with employer

Literacy assessment and referral Anger management training HIV education/testing/counselingAssistance in accessing public assistanceSelf-help programs

Treatment Issues in Jails

Most treatment is involuntaryScheduling constraints: treatment or…

something elseGang affiliationConfidentialityTraumaHopelessness (esp. prisons)

Special Issues: Community Supervision

Therapeutic communityIntensive outpatientHalf-way housesDay reporting

Special Issues: Women

Mental health issuesAbuse historyHIV positivePoorer employment historiesChild custody issuesLower educational level

Special Population: Elderly

Many have spent most of their life in and out of “the system”

Prison rules and mores are the normDevelopmental milestones (marriage, raising

children, career, education, etc.) are absent leading to disculturation

Engage them by having them help othersSpecial Issues

◦ Increased health problems◦Slow response to directions◦Physical issues presenting as MH◦Lack of assertiveness allowing them to slip through

the cracks

Summary

Persons in the CJ system have a unique set of learned behaviors

Consider the drawbacks as well as the benefits to giving up criminality

Work with the clientSet and consistently enforce clear boundaries and

rulesIdentify biopsychosocial issues and their influence

on treatment and recoveryEnsure clients have a seamless transition into the

community

T I P 44 Edited

Health & Medicine