TIP 44: Adults in the
Criminal Justice System
     Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC




                        ...
Screening and Assessment
                   Copyright 2008-2012
                   AllCEUs.com A subsidiary of
           ...
Purpose

    ◦   Screen out offenders who do not need treatment
    ◦   Assess the extent of offenders’ treatment needs
 ...
Accuracy of information

    Continuity and system-wide sharing of

    information
    The importance of re-screening a...
Stigma

 Inaccuracy due to withdrawal
 SA diagnosis may preclude from MH
  treatment
 SA diagnosis may limit offenders...
Reimbursement

    To support pharmacological interventions

    When psychiatric concerns emerge

    Clarification of...
Explain that diagnosis is just short hand

 Review presenting issues and discuss
  differential diagnosis
 Normalize di...
Instruments with adequate reliability and

    validity with incarcerated populations
    Reproduced in appendix C of TIP...
Addictions Severity Index

    ◦ reproduced in TIP 38, Integrating (CSAT 2000)
    ◦ structured interview format (75 minu...
SA

    ◦   Substance use history
    ◦   Motivation
    ◦   Severity and frequency of use
    ◦   Detoxification needs
 ...
Health

    ◦   Intoxication
    ◦   Infectious disease
    ◦   Pregnancy
    ◦   General health
    ◦   Acute conditions...
Special Considerations

    ◦   Educational level
    ◦   Reading level/literacy
    ◦   Language/cultural barriers
    ◦...
Continuum of services

    ◦ Pretreatment (Detoxification)
    ◦ Outpatient
    ◦ Inpatient




Triage and Placement     ...
Key staff preparations

    ◦ Develop a treatment resource database
    ◦ Define eligibility and suitability for each
   ...
Target offenders with moderate to high

    risk of recidivism
    ◦   Criminal history
    ◦   Poor employment history
 ...
Moderate to severe substance abuse

    problems
    ◦   Substance dependence
    ◦   SA related arrests
    ◦   History ...
Moderate to severe mental health issues

    ◦ Suicidal or violent behaviors
    ◦ Acute symptoms
    ◦ Cognitive impairm...
Perceived severity of problems (Readiness

  for change)
 Motivation (SOCRATES*, TIP 35)
 Prior evidence of attempts to...
Offender involvement in treatment

    planning
    Motivational interviewing

    Coordination with ―team‖

    Plan u...
Outreach and low-intensity interventions

    ◦ Provided to all offenders
      Entrance
      As part of daily activit...
Components of criminality

    ◦ Criminal thinking
    ◦ Criminal code (inmate value system)
    ◦ Manipulation
    Crimi...
Criminal Code

    ◦   Refusal to cooperate with authority
    ◦   Refusal to confront negative behavior
    ◦   Particip...
Addressing manipulation

    ◦ Identifying the primary thinking errors
      observed
    ◦ Instructing the client to beg...
Excuse making

    Blaming

    Justifying

    Throwing focus

    ―I think; therefore it is,‖ permits function

   ...
Assuming

    I'm unique / It doesn’t apply to me

    Ingratiating : phony manipulation

    Fragmented Personality Be...
Identifying the feeling(s)—other feelings may

    be involved, such as embarrassment or guilt
    Understanding clearly ...
Assessment: inaccurate placements

    Poor staff training

    Staff transition

    Overreliance on institutional san...
Pretrial Diversion

    ◦ Supervision in lieu of detention
    ◦ Treatment in lieu of prosecution
    Maintain a client’s...
10 Components

    1. Drug courts integrate alcohol and drug treatment
       services with justice system case processin...
6. A coordinated strategy governs drug court
    responses to participants’ compliance.
 7. Ongoing judicial interaction w...
TASC programs provide a bridge between

  treatment providers and the CJ system
 Provide a range of services
    ◦   Scr...
Brief (TIP 34)

    Motivational (TIP 35)

    Behavior contacts

    Phased treatment

    Substance abuse education
...
Criminal thinking assessment and

    treatment (video feedback)
    Coping skills training

    Relapse prevention tool...
Vocational

    ◦ Job readiness assessment and preparation
    ◦ Liaison with employer
    Literacy assessment and referr...
Most treatment is involuntary

    Scheduling constraints: treatment

    or…something else
    Gang affiliation

    C...
Therapeutic community

 Intensive outpatient
 Half-way houses
 Day reporting




Special Issues: Community
Supervision...
Mental health issues

    Abuse history

    HIV positive

    Poorer employment histories

    Child custody issues
...
Many have spent most of their life in and out

    of ―the system‖
    Prison rules and mores are the norm

    Developm...
Persons in the CJ system have a unique set

    of learned behaviors
    Consider the drawbacks as well as the

    bene...
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TIP 44 Substance Abuse Treatment with Offenders

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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 "TIP 44 Substance Abuse Treatment with Offenders"

  1. 1. TIP 44: Adults in the Criminal Justice System Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  2. 2. Screening and Assessment Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  3. 3. 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 Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  4. 4. 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  Psychopathy  Risk for violence  Recidivism  Screening Areas of Concern Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  5. 5. Stigma   Inaccuracy due to withdrawal  SA diagnosis may preclude from MH treatment  SA diagnosis may limit offenders access to work assignments or vocational training/rehab Diagnosis Pitfalls Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  6. 6. Reimbursement  To support pharmacological interventions  When psychiatric concerns emerge  Clarification of co-occurring disorders  Research/evaluation  Reasons for Diagnosis Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  7. 7. Explain that diagnosis is just short hand   Review presenting issues and discuss differential diagnosis  Normalize diagnoses ◦ Google ―Famous people with…‖ Do an ―All About Me‖ worksheet  De-stigmatizing Diagnosis Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  8. 8. 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) Screening Instruments Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  9. 9. 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 Instruments: ASI Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  10. 10. 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 Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  11. 11. Health  ◦ Intoxication ◦ Infectious disease ◦ Pregnancy ◦ General health ◦ Acute conditions MH  ◦ Suicidality ◦ MH diagnosis and treatment history ◦ Acute symptoms ◦ Current medications Assessment Areas cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  12. 12. 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) Assessment Areas cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  13. 13. Continuum of services  ◦ Pretreatment (Detoxification) ◦ Outpatient ◦ Inpatient Triage and Placement Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  14. 14. 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) Triage and Placement cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  15. 15. 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 Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  16. 16. Moderate to severe substance abuse  problems ◦ Substance dependence ◦ SA related arrests ◦ History of SA with or without treatment ◦ Positive drug tests Placement Strategies cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  17. 17. Moderate to severe mental health issues  ◦ Suicidal or violent behaviors ◦ Acute symptoms ◦ Cognitive impairment (concentration, problem solving) ◦ Social impairment (interpersonal skills, frustration tolerance Placement Strategies cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  18. 18. Perceived severity of problems (Readiness  for change)  Motivation (SOCRATES*, TIP 35)  Prior evidence of attempts to improve  Perceived importance of treatment *Stages of Change, Readiness, and Treatment Eagerness Scale Offender characteristics Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  19. 19. Offender involvement in treatment  planning Motivational interviewing  Coordination with ―team‖  Plan updates at status changes  Community based linkages at re-entry  Implementing Treatment Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  20. 20. Outreach and low-intensity interventions  ◦ Provided to all offenders  Entrance  As part of daily activities (webcast via TV)  Exit/Re-entry Implementing Treatment cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  21. 21. 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 Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  22. 22. 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) General CJ Treatment Issues cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  23. 23. 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 General CJ Treatment Issues cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  24. 24. 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/omission  Making Fools Of : pulling the wool  Build-up: focus on positives and bring down  others General CJ Treatment Issues cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  25. 25. 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  General CJ Treatment Issues cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  26. 26. 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) Addressing Anger and Hostility Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  27. 27. Assessment: inaccurate placements  Poor staff training  Staff transition  Overreliance on institutional sanctions  instead of letting peers pressure for internal controls Aftercare availability and compliance  Coercion  Treatment competes with other facility  opportunities Barriers to Effective Treatment Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  28. 28. Pretrial Diversion  ◦ Supervision in lieu of detention ◦ Treatment in lieu of prosecution Maintain a client’s confidentiality  Avoid discussing the client’s criminal case  the client is presumed innocent before trial  Be realistic about the responsibilities that a  client is capable of handling Avoid allowing individuals to be inadvertently  penalized for enrolling in treatment Be aware that clients may be more focused  on ―beating the case‖ than on recovery Sentencing Alternatives Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  29. 29. 10 Components  1. 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 Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  30. 30. 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. Drug Courts cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  31. 31. 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 Treatment Accountability for Safer Communities (TASC) Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  32. 32. Brief (TIP 34)  Motivational (TIP 35)  Behavior contacts  Phased treatment  Substance abuse education  Detoxification  Day reporting  Drug testing  Interventions Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  33. 33. Criminal thinking assessment and  treatment (video feedback) Coping skills training  Relapse prevention tools  Strengths building  Communication skills enhancement  Interventions cont… Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  34. 34. Vocational  ◦ Job readiness assessment and preparation ◦ Liaison with employer Literacy assessment and referral  Anger management training  HIV education/testing/counseling  Assistance in accessing public assistance  Self-help programs  Wrap Around Services Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  35. 35. Most treatment is involuntary  Scheduling constraints: treatment  or…something else Gang affiliation  Confidentiality  Trauma  Hopelessness (esp. prisons)  Treatment Issues in Jails Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  36. 36. Therapeutic community   Intensive outpatient  Half-way houses  Day reporting Special Issues: Community Supervision Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  37. 37. Mental health issues  Abuse history  HIV positive  Poorer employment histories  Child custody issues  Lower educational level  Special Issues: Women Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  38. 38. Many have spent most of their life in and out  of ―the system‖ Prison rules and mores are the norm  Developmental milestones (marriage, raising  children, career, education, etc.) are absent leading to disculturation Engage them by having them help others  Special Issues  ◦ Increased health problems ◦ Slow response to directions ◦ Physical issues presenting as MH ◦ Lack of assertiveness allowing them to slip through the cracks Special Population: Elderly Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  39. 39. 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 client  Set and consistently enforce clear boundaries  and rules Identify biopsychosocial issues and their  influence on treatment and recovery Ensure clients have a seamless transition into  the community Summary Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

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