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Monday, January 14, 2013
People in prisons and jails are four times more likely to have a substance use disorder than the general public, yet services for this population are sorely lacking, according to experts at George Mason University. They have developed several screening tools designed to improve substance use treatment in the criminal justice system.
Both treatment and justice agencies would benefit from screening for criminal justice risk, as well as substance use disorders, according to Faye Taxman, PhD, of the university’s Center for Advancing Correctional Excellence! (ACE!) program in Fairfax, Virginia. “More than 30 percent of offenders could benefit from residential treatment, but less than 5 percent in prison, jail or community corrections have access to such services,” she says.
Taxman spoke recently about substance abuse treatment and the criminal justice system at the American Academy of Addiction Psychiatry annual meeting.
The Risk-Needs-Responsibility (RNR) Simulation Tools developed by the ACE! team focus on both individuals as well as systems as a whole. One tool developed by Taxman and her colleagues looks at a person’s history of involvement in the system—age of first arrest, number of times a person was arrested, incarcerated, on probation and rearrested—to assess how likely it is that the person will return to the system. Taxman notes this risk assessment is clinically relevant, since it signifies the intensity and structure of services needed.
“People who score moderate to high-risk also tend to have more behavioral health problems and patterns,” Taxman says. “They tend to have more risky behaviors and more entrenched substance abuse and mental health problems.” The tool allows practitioners to recommend appropriate substance use treatment programs for individual prisoners, based on their specific needs.
The ACE! team also has recently launched an online tool for clinicians working with the criminal justice system to assess whether their substance abuse treatment program meets the need of prisoners.
“The RNR tools help clinicians evaluate their own programs, and shows them how to strengthen them,” notes Taxman. Currently, the available services for offenders in the community are often not consistent with the risks and needs of offenders, she says. The tool takes into account the level of substance use disorders and mental health needs of the population. There is a minimal cost to store data in the RNR tool, depending on the size of the organization.
The RNR model asks how restrictive the setting is (such as prison or a halfway house), how often drug testing is done, what treatment consists of, whether other issues are addressed (such as anger management, domestic violence or employment services), what the rewards and punishments are for treatment successes and failures, the level of staff training and how closely the treatment manual is followed.
Taxman says when criminal justice agencies know what the risks and needs of their populations are, they are better able to identify available programs that are appropriate for their clients. The RNR Simulation Tool has a strategic planning capability to help systems identify gaps in services based on offender needs. The tool allows users to enter the characteristics of the offender population, and estimate how many would need each level of treatment. If the user enters information about what programs are available, the tool will identify where there is adequate programming available, and where gaps exist.
“Clinicians in the substance abuse field often don’t want to talk to patients about their criminal justice involvement, as though it’s not relevant to their medical problems,” Taxman observes. “But we’ve found it’s very relevant to providing the best care for them. If substance use agencies screened for criminal risk, they could better serve the population overall and reduce risk of recidivism and relapse.”