Kevin Knight, Ph.D., Associate Director Texas Corrections ...ibr.tcu.edu/wp-content/uploads/2014/09/KK-_TCA-Sugarland_2014-FINAL.pdfKevin Knight, Ph.D., Associate Director Impact of

Kevin Knight, Ph.D., Associate DirectorImpact of Drug Treatment

Texas Corrections AssociationJune 10, 2014 Sugar Land, TX

Copyright © 2014 TCU Institute of Behavioral Research (IBR), Fort Worth, Texas. All rights reserved. Website: www.ibr.tcu.edu Page 1 of 8

The Impact of Drug Treatment on Public Safety & Public Health

Kevin Knight, Ph.D.

Institute of Behavioral ResearchTexas Christian University

2014 Texas Corrections Association2014 Annual Training Conference & Services Display

June 10, 2014

© 2014Funded in part by the National Institute on Drug Abuse (NIDA) R01 DA025885

Treating CJ Populations

TCU Mapping: A Visual Representation Strategy

Fort WorthTexas

Kevin

TCU

Married& 2 Children

TCU NIDA Grants

AddictionStudies

TCA Presentation

IBRWeb

Assoc. Dir. Of

CJ IBRScientist

TreatmentEffectiveness

Implementation

Process FUOutcomes

Engagement

Readyto Chg

OrgFunctioning

© 2014

www.ibr.tcu.edu© 2014

CJ Stats for US and TexasTX has 4th highest adult incarceration rate (tied with AL 648/100,000)[1st 867-LA, 2nd 686-MS, 3rd 654-OK]

22% from Harris County15% from Dallas County

Good News: TX incarceration rate has fallen nearly 20% since 2007 compared with national decline of 5%

National Institute of Corrections; TX Public Policy Foundation; National Research Council© 2014

Approximately 2.3 million in US prison or jail, another 7 million under supervision (about 3% of US population)

Crime in Texas

The Sagamore Journal, 4/13/2010© 2014

Prisoners

Per

cent

General Population

70%

9%

100

90

80

70

60

50

40

30

20

10

0

Regular Drug Abuse

Bureau of Justice Statistics, 1999.

00

2020

4040

6060

8080

100100

120120

140140

160160

180180

200200

Bil

lion

s of

$$

Bil

lion

s of

$$

$181 Billion$181 Billion

$107 BillionAssociated withDrug-Related

Crime

$107 BillionAssociated withDrug-Related

Crime

Approximate Cost of Drug Abuse in the U.S. in 2002Approximate Cost of Drug Abuse in the U.S. in 2002

ONDCP, 2004© 2014




22 2124

37

44

0

10

20

30

40

50

None Low Moderate Substantial Severe

% Reincarceration (15 Months)

Drug Use Severity

Drug Use Severity and Reincarceration

N=324; Weekes, Milison, & Lightfoot, http://198.103.98.138/crd/forum/e073/e073c.htm© 2014

Criminal Recidivism in 3 Years

68% Re-arrested

47% Convicted

50% Re-incarcerated

Relapse to Drug Abuse in 3 Years

95% Relapse

Recidivism and Relapse

© 2014

In a Given Year . . . About 14% of all people in the US with HIV,

& 33% of those with Hep C,

& 40% of those with TB

‐‐will pass through a correctional facility.

In a Given Year . . . About 14% of all people in the US with HIV,

& 33% of those with Hep C,

& 40% of those with TB

‐‐will pass through a correctional facility.

Source: Spaulding et al. (2009); Hammett, Harmon, & Rhodes (2002). AJPH, 92 (11), 1789‐1794.

Chronic Medical Conditions (HIV/AIDS, Hep B/C, & TB)

© 2014

0

2

4

6

8

10

12

Rel

ativ

e R

isk

of D

eath

Death Among Recent Inmates of the Washington State Corrections

Compared to Other State Residents

© 2014

-8

2

12

22

32

Sanctions InappropriateTreatment

AppropriateTreatment

-7 -6

30

Andrews, D.A. 1994. An Overview of Treatment Effectiveness. Research and Clinical Principles, Department of Psychology, Carleton University. The N refers to the number of studies.

% R

ed

uct

ion

in R

ecid

ivis

m

Treatment Can Work!(review of 154 studies)

© 2014

California/Amity Program3-Year Return-to-Custody Rates (%)

7582 79

27

No Treatment

(n=189)

ITC Dropout(n=73)

ITC, but noAftercare(n=154)

ITC +Aftercare*

(n=162)

Wexler, Melnick, Lowe, & Peters, 1999 (The Prison Journal)

*p<.001




2922

52

26

0

20

40

60

80

100

Lower Severity (n=91) Higher Severity (n=181)

No Treatment (n=103)

In-Prison+Aftercare (n=169)

Problem Severity and Intensive Treatment

% 3-Year Recidivism

Knight, Simpson, & Hiller, 1999, The Prison Journal© 2014

Texas/New Offenses Only3-Year Return-to-Custody Rates (%)

1922

6

NoTreatment

AftercareDropouts

AftercareCompleters

Knight, Simpson, & Hiller, 1999, The Prison Journal© 2014

80,000 adults, 5,000 juveniles were released in FY2012

355,000 adults, 30,000 juveniles under active supervision

Rearrested/Reincarcerated within 3 Years (FY08)

Prison-47%/22%; State Jail-63%/31%

IPTC-45%/23%; SAFPF-41%/39%

TJJD (Secure Residential)-78%/46%;

Juvenile Probation Depts (Secure Residential)-67%/30%

Revocation Rates (FY08)

Adult System 10-15%; Juvenile System 4-14%

Recidivism—More Recent #s

© 2014

Texas Legislative Budget Board, January 2013

NIDA Research-Based Guide

Principles of Drug Addiction Treatment: A Research Based Guide (NIDA, 2000)For Criminal Justice Populations

© 2014

How do I know if someone is a good candidate for drug treatment?

• History of drug use may indicate a need for treatment

• Screening for history of drug use first step (short, quick, can be done by CJ professionals)

• Comprehensive assessment of drug use and related problems second step (longer, results in treatment plan, typically done by treatment professional)

– drug use

– other problem areas (e.g. employment, housing)

– treatment experience

– mental, and physical health

© 2014

83 84 84

70

30

TCUDS ASI-D SSI SASSI-2 Others

Alcohol and Drug Dependence Screens

% Overall Correct Classification

N=400; Peters et al., 2000 (Journal of Substance Abuse Treatment)© 2014




TCU Drug Screen (TCUDS):Short assessment (2 pages) for --

• Drug problems/dependence• Treatment history/needs

Eligible for Treatment?The TCU Drug Screen

47%

24%

1. TCUDS Diagnosis

2. Existing Records

71% referred to treatment

Assessments:N ~ 50,000

per Year

All newinmates at

state jails/prisons

© 2014

Severity of Problem->Level of Care

Low Intensity(Education)

High Intensity(Residential/TherapeuticCommunity)

Aftercare(or Re-entry)

Program

OffenderDrug Use?

LowSeverity

HighSeverity

LongerTerm

© 2014

“Black Box” of Treatment

UserReducedCrime AndHealth Problems

© 2007

Program

Staff

ResourcesResources

Climate

Patient

Severity

ReadinessReadiness

SufficientSufficientRetention

Early Engagement

Early Recovery

Posttreatment

DrugUse

Crime

RelationsSocial

Relations

ProgramParticipation

TherapeuticRelationship

BehavioralChange

Psycho-SocialChange

TCU Treatment Model

CognitiveStrategies

BehavioralStrategies

Social SkillsTraining

Family &Friends

SupportiveNetworks

Motivation& Induction Personal Health Services

Social Support ServicesProgramInterventions

Retention/ Transition

Simpson, Knight & Dansereau, 2004 (Journal of Community Corrections)© 2014

Longer Manuals(6-10

Sessions)

© 2014

Individuals Motivated to Participate in Adherence, Care and Treatment

A collaboration between TCU/TDCJ, UNC/NC DOC, and NIDA

Patrick Flynn & Kevin Knight TCU Institute of Behavioral Research

David Wohl & Carol GolinUNC Center for AIDS Research




Main AimCompare effect of standard prison test-and-treat (sTNT) with imPACT intervention on HIV viral load 24 weeks following prison release. 400 HIV+ inmates with HIV RNA levels <400

copies/mL on ART and who are 2 months prior to prison release in NC and TX are randomized to either:

• a) standard of care, wherein following HIV testing, infected inmates receive ART during incarceration with referral to community-based care and services by prison staff prior to release, or

• b) imPACT, which includes the sTNT plus our integrated, multi-component intervention

Viral Load Assessment

Enroll

= Prison Release = Face to Face MI with Cognitive Mapping

= Telephone MI= daily text reminders

Connect to Clinic

Link Coordinator Needs Assessment

Study Week-12 -4 0 2 4 6 8 10 12 14 16 18 20 22 24

imPACT Intervention

Next Steps Complete enrollment by Q3 2014 Last study visit by Q1 2015 Primary and a secondary analyses to follow including:

HIV RNA suppressionAdherence to community HIV care and ARTRisk behaviorModeling of transmission potential ART resistance

Sustainable Disease Risk Reduction Strategies for CJ Systems

Funded by the

National Institute on Drug Abuse (NIDA)

R01 DA025885

PI: Wayne Lehman, PhDCo-PI: Kevin Knight, PhD

Developed and tested interventions that…

had a focus on the critical high‐risk transition time between incarceration and return to the community

were designed to increase positive decision‐making skills among offenders for healthy living

included teaching skills for making decisions for reducing disease risk behaviors, particularly those involving HIV and Hepatitis B & C.

Included prison‐based group curriculum (completed) and community corrections self‐administered computerized tools (under development).




DRR 1 WaySafe Sessions

Way Safe Sessions

1. Introduction to Mapping Background about node‐link mapping, a thinking and problem solving tool that helps people explore their beliefs and decisions.

2. Risks and Reasons Thinking about why people take risks and examine own beliefs about risk‐taking.

3. The Game Reviewing what you know and don’t know about HIV and other illnesses.

4. The Should/Want Problem Distinguishing between WANTs and SHOULDs.

5. Risk Scenes Learning about and identifying risky situations.

6. Planning for Risks Most people do not do a very good job planning for how they will deal with risks in life. Learn how to think ahead and enjoy the benefits.

WaySafe Results The WaySafe curriculum was successfully implemented

in 8 different prison‐based substance abuse treatment programs in two different states, varying by gender, type of program and program length.

The evidence supports the effectiveness of WaySafe in improving knowledge confidence; knowledge, confidence and motivation in avoiding risky sex and drug use activities; knowledge and confidence for getting tested for HIV and skills for preventing HIV and confidence and motivation to use those skills.

WaySafe had a positive effect in each of the 8 facilities in which it was implemented.

DRR 2: StaySafefor Community Corrections

An important goal for StaySafe is to develop a sustainable, evidence-based product to help probationers make better decisions regarding health risk behaviors and

that can be administered by probation departments with minimal staff training and time,

that is engaging and easy to use by probationers,

that requires minimal maintenance,

and is free to probation departments (other than the cost of the touch screen computers).

DRR2: StaySafe Development

• Will adapt concepts from WaySafe including evidence-based TCU Mapping-Enhanced counseling to be developed for community corrections.

• Will be self-administered by participating probationers while waiting for meetings with their probation officers and will require minimal staff assistance.

• Twelve StaySafe sessions will be designed to take approximately 15-20 minutes each to complete during the first six months of probation.

• StaySafe will utilize touchscreen tablet computers that allow the intervention to be individualized to the needs and goals of each participant and provide an easy-to-use interface to complete guide maps and recall completed assignments from previous sessions.

THE TCU ADOLESCENT PROJECTTREATMENT RETENTION AND INDUCTION PROGRAM (TRIP)

PI: PAT FLYNN, PHD & PD: DANICA KNIGHT, PHDFUNDED BY: NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)

TCU INSTITUTE OF BEHAVIORAL RESEARCH

TRIP UNDERLYING COMPONENTS

Retention &Engagement

PerspectiveTaking

Judgment & Decision‐making Processes

Self‐Regulation

Planning

Motivation Self‐efficacy

Work ItDown Spiral GamePeer Interaction

NudgesEngaging Demos

MappingWork It

Mapping

Down Spiral Game

Peer Interaction

Nudges

Work It

GOALS

READINESS

COMPLEXSKILLS

BASICPROCESSES

© 2011




Leader’s manualTrip Sessions 1 – 8Peer Leader ModuleResource guide maps

Downward Spiral Game SetGame BoardDice and game pieces“Quick” RulesScorecards

IcebreakersAsh Adams Magic DVDDecks of cardsCandies, crayons

A CLIENT DRAWN MAP

Work It helps train clients in the process of “working through” a problem or goal. A first focus is on perspective-taking.

Juvenile Justice - Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative AgreementPI: Danica Knight, PhD

Juvenile Justice - Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS)

• 5‐year Cooperative Agreement w/ $5m/year budget

– 6 Research Centers, 1 Coordinating Center

– Funding to begin July 2013

– Official Launch: October 2013

• Overarching philosophy: Every adolescent in the juvenile justice system could benefit from evidence‐based prevention and/or treatment interventions that target substance use and HIV risk behaviors.




JJ-TRIALS Cooperative Agreement Geographic Locations

JJ-TRIALS Research CentersJJ-TRIALS Juvenile Justice Sites

JJ TRIALS FunderJJ-TRIALS Coordinating Center

DC

JJ-TRIALS Study Components

National Survey of Juvenile Justice Prevention & TreatmentNational Survey of Juvenile Justice Prevention & Treatment

Pre‐Implementation Assessment Pre‐Implementation Assessment

Implementation StudiesImplementation Studies

TCU Client Evaluations

Joe et al, 2002; Simpson, 2004 (JSAT): Simpson & Knight, 2007 (CJB)

Social Functioning• Hostility• Risk Taking• Social Support• Social Desirability

Psychological Functioning• Self Esteem• Depression/Anxiety• Decision Making• Expectancy

Treatment Engagement• Satisfaction • Rapport • Participation• Peer Support

Motivation• Problems• Desire for Help• TX Readiness• Needs/Pressures

Criminal Thinking• Entitlement• Justification• Irresponsibility• Power Orientation• Cold Heartedness• Rationalization

© 2014

www.ibr.tcu.edu

That’s All Folks!

© 2014

Documents

Kevin Knight, Ph.D., Associate Director Texas Corrections ...ibr.tcu.edu/wp-content/uploads/2014/09/KK-_TCA-Sugarland_2014-FINAL.pdfKevin Knight, Ph.D., Associate Director Impact of