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TIP 44:  Adults in the Criminal Justice System<br />Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC<br />Copyright 2008-2012 Al...
Screening and Assessment<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
Screening<br />Purpose<br />Screen out offenders who do not need treatment <br />Assess the extent of offenders’ treatment...
Screening Areas of Concern<br />Accuracy of information <br />Continuity and system-wide sharing of information <br />The ...
Diagnosis Pitfalls<br />Stigma<br />Inaccuracy due to withdrawal<br />SA diagnosis may preclude from MH treatment<br />SA ...
Reasons for Diagnosis<br />Reimbursement<br />To support pharmacological interventions<br />When psychiatric concerns emer...
De-stigmatizing Diagnosis<br />Explain that diagnosis is just short hand<br />Review presenting issues and discuss differe...
Screening Instruments<br />Instruments with adequate reliability and validity with incarcerated populations<br />Reproduce...
Assessment Instruments: ASI<br />Addictions Severity Index<br />reproduced in TIP 38, Integrating (CSAT 2000)<br />structu...
Assessment Areas<br />SA<br />Substance use history <br />Motivation<br />Severity and frequency of use <br />Detoxificati...
Assessment Areas cont…<br />Health<br />Intoxication<br />Infectious disease<br />Pregnancy <br />General health <br />Acu...
Assessment Areas cont…<br />Special Considerations<br />Educational level <br />Reading level/literacy <br />Language/cult...
Triage and Placement<br />Continuum of services<br />Pretreatment (Detoxification)<br />Outpatient<br />Inpatient<br />Cop...
Triage and Placement cont…<br />Key staff preparations <br />Develop a treatment resource database<br />Define eligibility...
Placement Strategies<br />Target offenders with moderate to high risk of recidivism<br />Criminal history<br />Poor employ...
Placement Strategies cont…<br />Moderate to severe substance abuse problems<br />Substance dependence<br />SA related arre...
Placement Strategies cont…<br />Moderate to severe mental health issues<br />Suicidal or violent behaviors<br />Acute symp...
Offender characteristics<br />Perceived severity of problems (Readiness for change)<br />Motivation (SOCRATES*, TIP 35)<br...
Implementing Treatment<br />Offender involvement in treatment planning<br />Motivational interviewing<br />Coordination wi...
Implementing Treatment cont…<br />Outreach and low-intensity interventions<br />Provided to all offenders <br />Entrance<b...
General CJ Treatment Issues<br />Components of criminality<br />Criminal thinking<br />Criminal code (inmate value system)...
General CJ Treatment Issues cont…<br />Criminal Code<br />Refusal to cooperate with authority<br />Refusal to confront neg...
General CJ Treatment Issues cont…<br />Addressing manipulation<br /> Identifying the primary thinking errors observed <br ...
General CJ Treatment Issues cont…<br />Excuse making <br />Blaming <br />Justifying <br />Throwing focus<br />“I think; th...
General CJ Treatment Issues cont…<br />Assuming <br />I&apos;m unique / It doesn’t apply to me<br />Ingratiating : phony m...
Addressing Anger and Hostility <br />Identifying the feeling(s)—other feelings may be involved, such as embarrassment or g...
Barriers to Effective Treatment<br />Assessment: inaccurate placements<br />Poor staff training<br />Staff transition<br /...
Sentencing Alternatives<br />Pretrial Diversion<br />Supervision in lieu of detention<br />Treatment in lieu of prosecutio...
Drug Courts<br />10 Components<br />Drug courts integrate alcohol and drug treatment services with justice system case pro...
Drug Courts cont…<br />A coordinated strategy governs drug court responses to participants’ compliance. <br />Ongoing judi...
Treatment Accountability for Safer Communities (TASC) <br />TASC programs provide a bridge between treatment providers and...
Interventions<br />Brief (TIP 34)<br />Motivational (TIP 35)<br />Behavior contacts<br />Phased treatment<br />Substance a...
Interventions cont…<br />Criminal thinking assessment and treatment (video feedback) <br />Coping skills training<br />Rel...
Wrap Around Services<br />Vocational <br />Job readiness assessment and preparation <br />Liaison with employer <br />Lite...
Treatment Issues in Jails<br />Most treatment is involuntary<br />Scheduling constraints: treatment or…something else<br /...
Special Issues: Community Supervision<br />Therapeutic community<br />Intensive outpatient<br />Half-way houses<br />Day r...
Special Issues: Women<br />Mental health issues<br />Abuse history<br />HIV positive<br />Poorer employment histories<br /...
Special Population: Elderly<br />Many have spent most of their life in and out of “the system”<br />Prison rules and mores...
Summary<br />Persons in the CJ system have a unique set of learned behaviors<br />Consider the drawbacks as well as the be...
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T I P 44 Edited

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NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

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Transcript of "T I P 44 Edited"

  1. 1. TIP 44: Adults in the Criminal Justice System<br />Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  2. 2. Screening and Assessment<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  3. 3. Screening<br />Purpose<br />Screen out offenders who do not need treatment <br />Assess the extent of offenders’ treatment needs <br />Gather information for wrap-around referrals<br />Determine eligibility and suitability<br />Information sources<br />Booking records<br />Interview<br />Instruments<br />Correctional records/presentence investigations<br />Past treatment records<br />Police reports<br />Drug Tests<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  4. 4. Screening Areas of Concern<br />Accuracy of information <br />Continuity and system-wide sharing of information <br />The importance of re-screening and re-assessing <br />Timing of screening and assessment <br />Drug testing <br />Detoxification needs <br />Readiness for treatment <br />History of trauma <br />Psychopathy<br />Risk for violence<br />Recidivism<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  5. 5. Diagnosis Pitfalls<br />Stigma<br />Inaccuracy due to withdrawal<br />SA diagnosis may preclude from MH treatment<br />SA diagnosis may limit offenders access to work assignments or vocational training/rehab<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  6. 6. Reasons for Diagnosis<br />Reimbursement<br />To support pharmacological interventions<br />When psychiatric concerns emerge<br />Clarification of co-occurring disorders<br />Research/evaluation<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  7. 7. De-stigmatizing Diagnosis<br />Explain that diagnosis is just short hand<br />Review presenting issues and discuss differential diagnosis<br />Normalize diagnoses <br />Google “Famous people with…”<br />Do an “All About Me” worksheet<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  8. 8. Screening Instruments<br />Instruments with adequate reliability and validity with incarcerated populations<br />Reproduced in appendix C of TIP 44<br />Addiction Severity Index–Alcohol Use subscale (ASI-Alcohol)<br /> ASI–Drug Use subscale (ASI-Drug)<br />Drug Abuse Screening Test (DAST-20) <br />Michigan Alcoholism Screening Test (MAST)<br />Simple Screening Instrument for Substance Abuse (SSI-SA)—Reproduced in TIP 42 (CSAT 2005)<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  9. 9. Assessment Instruments: ASI<br />Addictions Severity Index<br />reproduced in TIP 38, Integrating (CSAT 2000)<br />structured interview format (75 minutes)<br />examines the following areas of functioning: <br />Drug/alcohol use<br />Relationships<br />Employment<br />Legal involvement<br />Physical health<br />Mental health<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  10. 10. Assessment Areas<br />SA<br />Substance use history <br />Motivation<br />Severity and frequency of use <br />Detoxification needs<br />Treatment history<br />Criminal Involvement<br />Criminal thinking <br />Current and prior offense(s) types and numbers<br />Prior successful completion of probation for drug use offenses <br />Prior involvement in diversionary programs <br />History of diagnosis of any personality disorder <br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  11. 11. Assessment Areas cont…<br />Health<br />Intoxication<br />Infectious disease<br />Pregnancy <br />General health <br />Acute conditions <br />MH<br />Suicidality<br />MH diagnosis and treatment history<br />Acute symptoms<br />Current medications<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  12. 12. Assessment Areas cont…<br />Special Considerations<br />Educational level <br />Reading level/literacy <br />Language/cultural barriers <br />Physical disability <br />Developmental disability <br />Learning/cognitive disability <br />Housing <br />Dependants/family issues <br />History of abuse (victim or perp)<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  13. 13. Triage and Placement<br />Continuum of services<br />Pretreatment (Detoxification)<br />Outpatient<br />Inpatient<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  14. 14. Triage and Placement cont…<br />Key staff preparations <br />Develop a treatment resource database<br />Define eligibility and suitability for each program<br />Document referral process to each program<br />MOU including <br />information to be shared<br />supervision and treatment responsibilities of each party<br />evaluate effectiveness of offender matching (ongoing)<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  15. 15. Placement Strategies<br />Target offenders with moderate to high risk of recidivism<br />Criminal history<br />Poor employment history<br />Poor support environment<br />Homelessness<br />Antisocial traits (impulsivity, lack empathy, anger issues, entitlement)<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  16. 16. Placement Strategies cont…<br />Moderate to severe substance abuse problems<br />Substance dependence<br />SA related arrests<br />History of SA with or without treatment<br />Positive drug tests<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  17. 17. Placement Strategies cont…<br />Moderate to severe mental health issues<br />Suicidal or violent behaviors<br />Acute symptoms<br />Cognitive impairment (concentration, problem solving) <br />Social impairment (interpersonal skills, frustration tolerance<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  18. 18. Offender characteristics<br />Perceived severity of problems (Readiness for change)<br />Motivation (SOCRATES*, TIP 35)<br />Prior evidence of attempts to improve<br />Perceived importance of treatment<br /> *Stages of Change, Readiness, and Treatment Eagerness Scale <br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  19. 19. Implementing Treatment<br />Offender involvement in treatment planning<br />Motivational interviewing<br />Coordination with “team”<br />Plan updates at status changes<br />Community based linkages at re-entry<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  20. 20. Implementing Treatment cont…<br />Outreach and low-intensity interventions<br />Provided to all offenders <br />Entrance<br />As part of daily activities (webcast via TV)<br />Exit/Re-entry<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  21. 21. General CJ Treatment Issues<br />Components of criminality<br />Criminal thinking<br />Criminal code (inmate value system)<br />Manipulation<br />Criminal Thinking<br />Learned behavior<br />Help offenders recognize thinking errors and understand how they can lead to behavior <br />CBT and Staff/Peer confrontation<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  22. 22. General CJ Treatment Issues cont…<br />Criminal Code<br />Refusal to cooperate with authority<br />Refusal to confront negative behavior <br />Participation in treatment viewed as weakness<br />“Snitch syndrome”<br />Manipulation<br />Throwing focus<br />Team splitting<br />Demeaning others (Power plays)<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  23. 23. General CJ Treatment Issues cont…<br />Addressing manipulation<br /> Identifying the primary thinking errors observed <br />Instructing the client to begin self-monitoring when these occur (journaling)<br />Providing regular feedback to the client, usually from peers in a treatment group<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  24. 24. General CJ Treatment Issues cont…<br />Excuse making <br />Blaming <br />Justifying <br />Throwing focus<br />“I think; therefore it is,” permits function according to what he wants, rather than according to the facts<br />Lying: commission/omission<br />Making Fools Of : pulling the wool<br />Build-up: focus on positives and bring down others<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  25. 25. General CJ Treatment Issues cont…<br />Assuming <br />I&apos;m unique / It doesn’t apply to me<br />Ingratiating : phony manipulation<br />Fragmented Personality Behaviors are inconsistent<br />Minimizing / Exaggerating<br />Vagueness / Non-committal<br />Anger <br />Power plays <br />Victim playing <br />Closed channel : unreceptive, undisclosing<br />Ownership / lack of awareness of other’s boundaries<br />Image cowboy or victim<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  26. 26. Addressing Anger and Hostility <br />Identifying the feeling(s)—other feelings may be involved, such as embarrassment or guilt<br />Understanding clearly where the feeling is coming from<br />Identifying the goals the anger is serving (e.g., deflecting attention)<br />Identifying the goals the anger is undermining (e.g., staying out of jail or keeping a job)<br />Working toward taking the longer view (e.g., beginning to use a positive/pro-social thought process to manage the anger)<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  27. 27. Barriers to Effective Treatment<br />Assessment: inaccurate placements<br />Poor staff training<br />Staff transition<br />Overreliance on institutional sanctions instead of letting peers pressure for internal controls<br />Aftercare availability and compliance<br />Coercion<br />Treatment competes with other facility opportunities<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  28. 28. Sentencing Alternatives<br />Pretrial Diversion<br />Supervision in lieu of detention<br />Treatment in lieu of prosecution<br />Maintain a client’s confidentiality<br />Avoid discussing the client’s criminal case<br />the client is presumed innocent before trial<br />Be realistic about the responsibilities that a client is capable of handling<br />Avoid allowing individuals to be inadvertently penalized for enrolling in treatment<br />Be aware that clients may be more focused on “beating the case” than on recovery<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  29. 29. Drug Courts<br />10 Components<br />Drug courts integrate alcohol and drug treatment services with justice system case processing. <br />Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants’ due process. <br />Eligible participants are identified early and promptly placed in the drug court program. <br />Drug courts provide access to a continuum of co-occurring disorders treatment.<br />Abstinence is monitored by drug testing. <br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  30. 30. Drug Courts cont…<br />A coordinated strategy governs drug court responses to participants’ compliance. <br />Ongoing judicial interaction with each drug court participant is essential. <br />Monitoring and evaluating achievement of program goals is necessary to gauge effectiveness. <br />Continuing interdisciplinary education promotes effective drug court planning, implementation, and operations. <br />Forging partnerships among drug courts, public agencies and community-based organizations generates local support and enhances drug court program effectiveness. <br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  31. 31. Treatment Accountability for Safer Communities (TASC) <br />TASC programs provide a bridge between treatment providers and the CJ system<br />Provide a range of services<br />Screening and assessment<br />Referral to community-based services<br />Monitoring of treatment <br />Case management<br />Court liaison<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  32. 32. Interventions<br />Brief (TIP 34)<br />Motivational (TIP 35)<br />Behavior contacts<br />Phased treatment<br />Substance abuse education<br />Detoxification<br />Day reporting<br />Drugtesting<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  33. 33. Interventions cont…<br />Criminal thinking assessment and treatment (video feedback) <br />Coping skills training<br />Relapse prevention tools<br />Strengths building<br />Communication skills enhancement<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  34. 34. Wrap Around Services<br />Vocational <br />Job readiness assessment and preparation <br />Liaison with employer <br />Literacy assessment and referral <br />Anger management training <br />HIV education/testing/counseling<br />Assistance in accessing public assistance<br />Self-help programs<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  35. 35. Treatment Issues in Jails<br />Most treatment is involuntary<br />Scheduling constraints: treatment or…something else<br />Gang affiliation<br />Confidentiality<br />Trauma<br />Hopelessness (esp. prisons)<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  36. 36. Special Issues: Community Supervision<br />Therapeutic community<br />Intensive outpatient<br />Half-way houses<br />Day reporting<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  37. 37. Special Issues: Women<br />Mental health issues<br />Abuse history<br />HIV positive<br />Poorer employment histories<br />Child custody issues<br />Lower educational level<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  38. 38. Special Population: Elderly<br />Many have spent most of their life in and out of “the system”<br />Prison rules and mores are the norm<br />Developmental milestones (marriage, raising children, career, education, etc.) are absent leading to disculturation<br />Engage them by having them help others<br />Special Issues<br />Increased health problems<br />Slow response to directions<br />Physical issues presenting as MH<br />Lack of assertiveness allowing them to slip through the cracks<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
  39. 39. Summary<br />Persons in the CJ system have a unique set of learned behaviors<br />Consider the drawbacks as well as the benefits to giving up criminality<br />Work with the client<br />Set and consistently enforce clear boundaries and rules<br />Identify biopsychosocial issues and their influence on treatment and recovery<br />Ensure clients have a seamless transition into the community<br />Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC<br />
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