Organizational Readiness for Change in Correctional and Community Substance Abuse Programs

Significant needs exist for increased and better substance abuse treatment services in our nation's prisons. The TCU Organizational Readiness for Change (ORC) survey has been widely used in community-based treatment programs and evidence is accumulating for relationships between readiness for change and implementation of new clinical practices. Results of organizational surveys of correctional counselors from 12 programs in two states are compared with samples of community-based counselors. Correctional counselors perceived strong needs for new evidence-based practices but, compared to community counselors, reported fewer resources and less favorable organizational climates. These results have important implications for successfully implementing new practices.     

Development and Implementation of Trauma-Informed Programming in Youth Residential Treatment Centers Using the ARC Framework

This project describes application of an evidenced-based, trauma-informed treatment framework, Attachment, Regulation and Competency (ARC), with complexly traumatized youth in residential treatment. The processes of implementing the ARC model into clinical and milieu programming at two residential treatment programs are described. Particular attention is paid to system-level processes and strategies for embedding ARC in a sustainable manner. Pilot data demonstrated a significant relation between use of ARC and reductions in PTSD symptoms, externalizing and internalizing behaviors, and the frequency of restraints used across programs. Preliminary findings contribute to an emerging empirical basis for the ARC model and are supportive of its clinical utility as a practice in the residential context. Next steps include: a) expanding the study findings by conducting controlled efficacy research, b) examining system level variables as mediators of change, and c) describing the full operation stage of implementation of the ARC framework.     

Traumatized Youth in Residential Treatment Settings: Prevalence, Clinical Presentation, Treatment, and Policy Implications

Children and adolescents with histories of traumatic exposure comprise a substantial portion of youth in residential treatment programs. However, until recently, little has been known about this specific population. Given the well-documented unique treatment considerations for traumatized youth, it is important to understand how the distinct needs of this population factor into the particular residential treatment setting approach. This paper presents a comprehensive overview of the current understanding of this vulnerable youth population, the impact trauma exposure can have on their clinical presentation and response to treatment, and the available empirical research regarding effective intervention strategies. In addition, policy implications specific to traumatized youth receiving treatment in residential settings are discussed.     

Identifying and Responding to the Complex Needs of Domestic Violence Housing Practitioners at the Onset of the COVID-19 Pandemic

The social, financial, and emotional repercussions of the COVID-19 pandemic has left many organizations that support survivors of intimate partner violence questioning how to maintain core services while addressing compounding individual, organizational, and public health issues. Stay-at-home orders and other COVID-19 mitigation strategies have resulted in reduced shelter availability and increased intimate partner violence rates. Coupled with the economic impact of the pandemic, these factors have threatened financial and housing stability. To better understand these challenges and provide immediate support, The National Alliance for Safe Housing (NASH) co-hosted a peer support call to provide a virtual platform for practitioners to ask questions, discuss challenges, and share strategies for quality service provision during the COVID-19 pandemic. Over 800 practitioners from across the United States participated in the NASH call, most of whom were advocates, program directors, and managers. NASH gathered data on practitioners’ needs from a brief survey from the registration form analyzed using conventional inductive content analysis. Practitioners’ primary concerns were situated within eight questions, which we categorized into four meta-categories: (1) managing residential housing programs; (2) getting survivors materials resources; (3) keeping staff safe; and (4) maintaining organizational operations. The paper concludes with community-grounded and empirically supported practice recommendations aligned with practitioners’ expressed needs.

     

Conducting Cost Benefit Analyses in Criminal Justice Evaluations: Do We Dare?

The last decade has witnessed a demand for evidence-based programs in virtually every field of social research. Presumably evidence will help inform officials as to which programs are likely to yield successful outcomes as well as help practitioners operate programs with best practices. But program effectiveness is only half the answer. The other half is affordability. Policy makers make budget-constrained decisions. A decision to implement a program in one area means cuts in programs in some other area. Evaluations that report only effectiveness findings cannot contribute much toward social program decision making. Evaluators must start to provide information on both costs and effectiveness or costs and benefits. This paper presents some of the challenges of incorporating cost benefit analysis into traditional criminal justice program evaluations. It presents illustrations of the conceptual and measurement issues to be faced evaluating programs in such areas as private security, juvenile delinquency, police interventions, and correctional rehabilitation when researchers attempt to add cost analysis to program inputs and try to convert outcomes into monetary units. It raises issues regarding availability, program externalities, hidden resources, and inadequacies of outcome measures. It concludes with some general guidance for evaluators on conducting such analyses and a checklist of questions to consider when deciding between cost effectiveness analysis and cost benefit analysis.     

Texas Christian University (TCU) Short Forms for Assessing Client Needs and Functioning in Addiction Treatment

The TCU Short Forms contain a revised and expanded set of assessments for planning and managing addiction treatment services. They are formatted as brief (1-page) forms to measure client needs and functioning, including drug use severity and history (TCUDS II), criminal thinking and cognitive orientation (CTSForm), motivation and readiness for treatment (MOTForm), psychological functioning (PSYForm), social relations and functioning (SOCForm), and therapeutic participation and engagement (ENGForm). These instruments facilitate optically-scanned data entry, computerized scoring, and rapid graphical feedback for clinical decisions. The present study (based on 5,022 inmates from eight residential prison treatment programs) examines evidence on scale reliabilities and measurement structures of these tools. Results confirmed their integrity and usefulness as indicators of individual and group-level therapeutic dynamics.     

Contract program for veterans with alcohol and drug dependence disorders--VA. Final rule

This document amends 38 CFR part 17 by adopting as a final rule the proposal to modify eligibility criteria for veterans participating by contract in the Department of Veterans Affairs' programs of alcohol and drug dependence or abuse treatment and rehabilitation in residential and nonresidential facilities. Previous regulations stipulated that, prior to participation in contract care under this programs, veterans were to be provided hospital care in facilities over which the Secretary has direct jurisdiction. It was proposed to change the regulations to stipulate that, prior to participation in contract care, veterans must have been or must be receiving care (regardless of whether it was or is hospital care) by professional staff over whom the Secretary has jurisdiction (regardless of whether it is direct jurisdiction). The elimination of the requirement of "hospital care" is necessary to address changed clinical practices and continue the intended program. In the past, substance abuse treatment generally was provided in a hospital setting. Now, much substance abuse treatment also is provided in an ambulatory care or residential setting. Further, this document changes "direct jurisdiction of the Secretary" to "jurisdiction of the Secretary" to allow for continuation of any cases in which the VA has had involvement (including, among other things, fee basic care) and thereby help ensure that a complete course of treatment is provided.     

PROTECTING YOUTH PLACED IN UNLICENSED,UNREGULATED RESIDENTIAL “TREATMENT” FACILITIES

Throughout the country, there is considerable inconsistency in how states regulate residential treatment programs for youth. In states with little oversight, the health and safety of youth are unprotected and they may be subject to substandard treatment, rights violations, and/or abuse. Three initiatives to address this issue are reported: (1) an Internet survey of youth who are former residents, (2) a four‐state pilot study of how states regulate and monitor residential programs, and (3) a bridge‐building conference between residential treatment providers and mental health leaders. Recommendations address the next steps for lawmakers, lawyers, judges, mental health and education professionals, and parents.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--DoD. Final rule

This final rule is to reform CHAMPUS quality of care standards and reimbursement methods for inpatient mental health services. The rule updates existing standards for residential treatment centers (RTCs) and establishes new standards for approval as CHAMPUS-authorized providers for substance use disorder rehabilitation facilities (SUDRFs) and partial hospitalization programs (PHPs); implements recommendations of the Comptroller General of the United States that DoD establish cost-based reimbursement methods for psychiatric hospitals and residential treatment facilities; adopts another Comptroller General recommendation that DoD remove the current incentive for the use of inpatient mental health care; and eliminates payments to residential treatment centers for days in which the patient is on a leave of absence.     

Re-thinking the cost of supply chain security

Post 9/11 we have witnessed the introduction and further strengthening of a range of trans-border security programs designed to protect international supply chains against acts of unlawful interference. In some cases compliance with these programs is mandatory. In other cases compliance results in a preferential treatment by appropriate authorities. To a great extent, these programs comprehend the introduction of situational measures. In most instances, however, operators within the supply chain—being made responsible for their actual implementation—are left with limited guidance. In this paper it is argued that a lack of guidance may result in measures being introduced without taking full account of their potential consequences. Based on an analysis of previous research findings and on the outcome of a literature review, direct and indirect implementation costs have been differentiated from a range of (consequential costs provoked by) potential reverse effects, and from a series of generic preconditions, enabling practitioners in industry to conduct a proper cost analysis and come to an informed decision on what particular measure(s) best to implement. It is argued that criminology and management science can support this decision making process, provided that policy makers allow operators a certain freedom of choice between alternative measures and approaches.     

Medicare and state health care programs: fraud and abuse; amendments to OIG exclusion and CMP authorities resulting from the Medicare and Medicaid Patient and Program Protection Act--Office of Inspector General (OIG), HHS. Final rule

This document amends a technical error that appeared in the final rule, which amends the OIG exclusion and CMP authorities, published on January 29, 1992 designed to implement section 2 of the Medicare and Medicaid Patient and Program Protection Act, along with other conforming amendments. The final rule is designed to protect program beneficiaries from unfit health care practitioners, and otherwise improve the anti-fraud provisions of the Department's Medicare and State health care programs.     

Barriers to evaluating the effectiveness of drug treatment behind bars

The delivery of substance abuse treatment within correctional settings marks one of the criminal justice system's primary opportunities to disrupt the drugs-crime nexus. Federally funded residential substance abuse treatment programs were rapidly introduced across the nation, although implementation problems increased their operational variability. This article examines how implementation barriers interrelate with other types of obstacles and multiply to hinder determinations of program effectiveness. Specific barriers were identified from a case study of process and outcome evaluations of the South Carolina Residential Substance Abuse Treatment (RSAT) program. A conceptual framework groups barriers by type into four interrelated domains wherein additive effects and reciprocal consequences that can undermine effective program assessment are illustrated.     

Mitigation Evidence and the Ethical Role of a Defense Attorney in a Capital Case

In 1972, the U.S. Supreme Court decided Furman v. Georgia. This landmark case changed the death penalty in the United States. In Gregg v. Georgia (1976), the Supreme Court made it clear that mitigating factors were to be heard before sentencing to ensure individualized sentencing. Every defendant has a story, a family, a childhood, trauma, and celebration—a reason their life should be spared from execution. In a capital case, a defense attorney’s ethical role is to craft that story and articulate it in a way that enables the jury to have a complete picture of the defendant’s background and character as they decide his punishment. Mitigating factors are not an excuse for the defendant’s behavior, but rather an insight into who the defendant is and what has shaped his life. A defense attorney’s ethical duty in a capital case is to argue the case on all legal points and to present a thorough investigation of mitigating evidence. A thorough investigation of all such evidence is required by case law and explained by the standards set forth by the ABA guidelines.     

Does Treatment Quality Matter?

Research Summary

The Florida Department of Juvenile Justice has implemented a process to evaluate the treatment quality of interventions provided statewide in all long‐term residential programs. In the current study, we examine the predictive validity of this treatment quality component in the prediction of recidivism of youth (N = 2,397) who completed juvenile justice residential programs from July 1, 2013 to June 30, 2014. We use hierarchical linear modeling to assess the effects of treatment quality (as youth are nested within programs), controlling for demographic and criminal history factors. The results indicate that higher average treatment quality scores of interventions received within a residential program decreased the likelihood of subsequent arrest, conviction, and reincarceration, whereas the highest treatment quality score of any specific intervention provided within the program decreased the odds of reincarceration only.

Policy Implications

In this study, we confirm the importance of fidelity and implementation quality in the provision of crime prevention treatment interventions to serious, deep‐end juvenile offenders. Additionally, our results shed light on the ability of a juvenile justice agency to measure treatment quality in a substantively meaningful way with the use of limited additional resources. The services provided to keep communities safe, prevent future offending, and rehabilitate juvenile offenders must be held accountable for producing such outcomes, and one method of measuring such compliance is to evaluate the quality of the interventions with respect to staff training, fidelity adherence, evaluation, and corrective action processes.     

Mothers of Violent Children with Mental Illness: How They Perceive Barriers to Effective Help

The goal of the present study was to understand how mothers perceive and experience barriers to effective help for their violent child with mental illness. Data from ethnographic interviews with 26 self-identified mothers of violent children with mental illness were analyzed using grounded theory and focused coding. Our study identified three themes that represent barriers to help: (1) denial of mental illness and severity of violence by treatment providers, extended family, and non-family members; (2) limited access to quality treatment and supports; and (3) a recurring cycle from optimism to hopelessness. To inform policy makers and practitioners on how best to remove these barriers, we draw comparisons between the current sample and survivors of intimate partner violence. Our paper concludes with recommendations for mental health practitioners and family intervention specialists.     

Assessment and Intervention with Parents to Stabilize Children Who Have Witnessed Violence

When children are exposed to violence, interventions require the assessment of parents. Whether parents can create a safe environment, are able to hear their children's story of their exposure, and then can help them move forward in healthy life patterns, must be evaluated. When safety is established, treatment of parents must be focused on how the parent can enhance the child's sense of security and empathic connection. Assessment must identify the red flags that suggest a need for more intensive work with the parent to address these issues, before specific work with the child begins. Treatment can utilize the parent's best wishes for their child to help motivate parents do the work needed for their own and their children's recovery.     

Prevention Research in Schools

The August Vollmer Award Address is intended to focus on contributions to justice and on the recipient's research and policy experiences. This is a story of one person's career devoted mainly to developing effective collaborations between researchers and practitioners to produce useful knowledge. Her early work focused on delinquency prevention in schools and included evaluations of two different efforts aimed at altering school and classroom environments to reduce student misbehavior in Charleston, SC, schools, and an organization development intervention intended to reduce violence and related problem behaviors in Baltimore City, MD, schools. For many years, the author directed a project that provided research expertise to the Maryland Governor's Office of Crime Control and Prevention. She also partnered with public agencies to develop and implement randomized experiments to test the effectiveness of the Baltimore City Drug Treatment Court, the Strengthening Families Program in Washington, D.C., and afterschool programs in Baltimore County, MD. She is currently implementing a randomized trial of a gang prevention program in Philadelphia, PA, and a study of the effects of School Resource Officers in Florida and California.     

Managing and Sustaining Your Juvenile Drug Court

Since the introduction and subsequent growth of the juvenile drug court movement in the mid‐1990s, practitioners have struggled to fully implement the Juvenile Drug Courts: Strategies in Practice. This struggle may lead to weaker outcomes for youth and a dysfunctional team atmosphere. Originally written as a two‐part technical assistance brief, this article will guide readers through the Juvenile Drug Court Development Cycle in order to help re‐direct practitioners to a more “back‐to‐basics” approach that focuses on collaboration, team dynamics, and decision making.     

Clinical Laboratories Improvement Act program; granting and withdrawal of deeming authority to private nonprofit accreditation organizations and of CLIA exemption under state laboratory programs--HCFA. Final rule

This rule permits HCFA to approve or disapprove accreditation organizations and State laboratory programs and thereby determine that laboratories accredited by a HCFA-approved private, nonprofit accreditation organization are deemed to meet the requirements set forth in 42 CFR part 493 of the regulations, which implement section 353 of the Public Health Service Act (PHSA) or, in the case of State laboratory programs, are exempt from the requirements. Section 353 of the PHSA was enacted by the Clinical Laboratories Improvement Act of 1967 (CLIA '67) and was amended by the Clinical Laboratory Improvement Amendments of 1988 (CLIA).     

Inmate Attitudes Toward Treatment: Mental Health Service Utilization and Treatment Effects

This study examined inmate attitudes toward treatment, mental health treatment utilization, and treatment effects that maximize treatment effectiveness. Participants consisted of 278 incarcerated male adult offenders from the Kansas Department of Corrections. Multiple linear regression analysis indicated that inmate attitudes toward treatment were predictive of the number of mental health treatment sessions (dosage) inmates received. Hierarchical linear regression analyses indicated positive help-seeking attitudes were associated with institutional behavior (decreased number and severity of disciplinary infractions) and scores on a measure assessing risk for future criminal behavior; however, the amount of mental health treatment an inmate received (treatment dosage) was associated with problematic institutional behavior (i.e., increased severity and number of disciplinary infractions). These results indicated that treatment dosage and behavioral outcomes were impacted by inmate attitudes toward treatment. As a result, correctional psychologists may be better able to predict which inmates will receive the most benefit from services. Implications of these findings for practitioners and policy makers are discussed.