PA Rehab Association Professional Development Institute April 2015

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Substance Use, Criminal Records and Employment:

A Challenging Mix

Pennsylvania Rehabilitation Association

Randy Loss, M.A., CRC, GCDF

PRA Professional Development Institute April 2, 2015

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Objectives

>PRA Professional Development Institute April 2, 2015

Participants will have:• A basic understanding of substance use disorders

(SUD) and confidentiality considerations for individuals with this diagnosis.

• An awareness of employment barriers individuals face due to SUD, including criminal records

• Familiarity of roles community resources can play in assisting individuals with SUD in the job search.

• Knowledge on how to discern employment readiness for someone with SUD.

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Professional Ethics


Standards of conduct for a profession:• Some issues cannot be handled by codes alone

• Courts/systems may decide codes are not applicable

• Values of counselor may conflict with code

• Codes may conflict with agency policies & practices

• Codes tend to spring from past events

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Who is your customer?

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• Individual seeking recovery

(Mental Health/Substance Use Disorder)• Individual pursuing community employment• Individual with criminal records

• Sexual offenses??

• Felony

• Local business/ownerALL OF THE ABOVE


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Advocacy and Accessibility

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First ask, what is at the end?o Goal=Employment (Good for business/employer & PwD)

Defining the “Customer Ecology”

What is Your Attitude?o What role do you play to reduce stigma, including your own?

o How do you advocate to help your customer obtain any or all of the above items?


o Resourceso Educationo Supports

o Culture/Languageo Barrierso Unmet needs

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PA Drug Control Update


According to the Office of National Drug Control Policy (ONDCP) in 2012:

• Approximately 7.99% of Pennsylvania residents reported past-month use of illicit drugs; the national average was 8.82%.

• The rate of drug-induced deaths in Pennsylvania is higher than the national average.

• Heroin is the most commonly cited drug among primary drug treatment admissions in Pennsylvania.

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Pennsylvania Drug Control Update (continued)


• Pennsylvania has the 14th Highest Drug Overdose Mortality Rate in the United States.

• The number of drug overdose deaths - a majority of which are from prescription drugs

• Currently 15.7 per 100,000 in Pennsylvania• Represents an 93 percent increase since

1999 when the rate was 8.1 per 100,000

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ONDCP PA Admissions Data


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Substance Use Disorder

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• The DSM-5 combines the DSM-IV categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe.

• Each specific substance is addressed as a SUD but nearly all substances (alcohol use disorder, stimulant use disorder, etc.), are diagnosed based on the same overarching criteria.

• A diagnosis of substance abuse previously required only one symptom, mild SUD in DSM-5 now requires two to three symptoms from a list of 11 criteria within 4 categories.


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Category 1: Impaired Control


1. Taking the substance in larger amounts or for longer than intended.

2. Wanting to cut down or stop using the substance but not able to manage use.

3. Spending a lot of time getting, using, or recovering from use of the substance.

4. Cravings and urges to use the substance are occurring.

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Category 2: Impairment

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5. Not managing to do what you should at work, home or school due to substance use.

6. Continuing substance use, even when it causes problems in relationships.

7. Giving up important social, occupational or recreational activities.


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Category 3: Risky Use

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8. Using substances again and again, even when it puts one in harm’s way.

9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance


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Category 4: Pharmacological Criteria

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10.Needing more of the substance to get the effect desired (tolerance)

11.Development of withdrawal symptoms, which can be relieved by taking more of the substance.


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SUD Severity

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• Severity of the DSM-5 substance use disorders is based on the number of symptoms endorsed:

• 2–3 criteria indicate a mild disorder• 4–5 criteria, a moderate disorder• 6 or more, a severe disorder


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Substance Abuse

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• Substance abuse does not completely disrupt a person’s life.

• Besides the legal implications associated with it, drug and alcohol abuse causes real damage to the body, mind, and spirit.

• Risks of infectious diseases, overdose, organ damage, and other bodily harms still exists with even casual use.

• Individuals with a substance abuse problem are able to learn from negative consequences and change their behavior.


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Abuse?


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• Substance addiction is an illness that affects most if not all areas of a person’s life.

• A person with dependence often makes tragic decisions that worsen their situation.

• They often miss work or school, get into legal trouble, endanger their families physically or financially, have terrible health issues, and other serious problems because of their substance use.

• It is important to understand people with addictions have a chemical dependency that prevents them from changing on their own.

• The only way to change the habits of a person with dependence is through focused medical attention.


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Addiction?


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Addiction as an Illness?


Addiction as an illness: “the whole question can be summed up pretty simply, and the summary is consistent with illness in general: No one is responsible for having become sick, but everyone who has an illness is responsible for doing what they can to recover from it. It is an error, and a potentially harmful one, to call addiction a “chronic, relapsing brain disease.” Addictions do not relapse of themselves. People who have addictions relapse. That’s why they also can recover.”

Richard S. Sandor, MD

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Code of Federal Regulation (CFR) Title 42: Public Health

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• PART 2—Confidentiality of Alcohol and Drug Abuse Patient Records

• What it covers:• Records of identity, diagnosis, prognosis, or

treatment of any patient, which are maintained in connection with the performance of any program or activity relating to drug abuse, alcoholism or alcohol abuse education that is conducted, regulated or assisted by the Federal government must be confidential.


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42 CFR, Part 2 Oversight

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• Impacts any federally assisted treatment program:• Receiving Medicaid funds• Certified for Medicare reimbursements• Receiving federal pass-through dollars from

the state


Treatment program: any individual or entity that declares they/it provides and does provide alcohol/drug abuse diagnosis, treatment, counseling, or referral to treatment

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42 CFR, Part 2 Protection

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• Current patients• Past patients, including deceased• Those who are applying for treatment


Patient: an individual who has applied for or been given diagnosis or treatment for alcohol or drug abuse at a federally assisted

program

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CFR 42, Part 2 Patient information is protected from

being provided to:


• Family members• The patient’s attorney• Police (even with a search warrant, or in civil

cases without additional legal requirements)• Employer

Patient or legal guardian must sign a written release for these entities to acquire personal information

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PA Single County Authority

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• Community substance abuse programs are administered through county program offices called Single County Authorities (SCA)

• Payment for Drug and Alcohol Services

• The cost of these services will vary depending upon the type of service.

• Pennsylvania's Medical Assistance Program, either through a managed care organization or the traditional fee-for-service system, pays for many of these services for eligible individuals.

• People who use services, but are not on Medical Assistance and are without access to other insurance, will be assessed for their ability to pay for services by the county SCA.


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Why Care About SUD Treatment?


• One in four individuals has SUD in their family • One in four with SUD will die as a result

• Most individuals with SUD never commit crime • One person with addiction may commit 2-3

crimes per day, 3-4 days per week. • This calculates to 455 offenses per year

• Multiply this by the number individuals who commit crime and this number reaches tens of thousands of families affected by crime due to untreated addictions

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Recidivism Versus Relapse

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• Recidivism is a return to committing crimes • Statistics in PA (at the state corrections

level) 60% recommit crime• Relapse is a return to substance use • Often relapse happens first • Once the addiction process is restarted,

then crimes resume to fund the addiction.


27 >PRA Professional Development Institute April 2, 2015

Addiction Versus Criminality

• Recidivism is a return to committing crime

• Relapse is a return to substance use

• Most individuals who have addictions don’t engage in criminal behavior

• Many individuals with criminal records don’t become addicted

Addiction Criminality

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Criminal Justice Facts

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• There are approximately 51,000 inmates in the PA Correctional Prison System.

• In national studies, approximately 70-80% of offenders have a substance use problem.

• In national studies approximately 50% of offenders reach central booking under the influence of drugs and alcohol.

• Pennsylvania research finds comparable findings

• Every dollar spent in SUD treatment saves $7

• If medical expenses are included, that rises to $11

• Effective SUD treatment works.

• Clinically appropriate levels of care work.


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Basic Legal Process

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• Arrest is when the police take a person into custody, on suspicion that they have committed a crime.

• A charge is the beginning of formal legal proceedings against the person accused of the felony: it is when a district attorney brings formal accusations against the defendant before the court.

• Conviction is the formal announcement of the verdict against the individual.


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Pennsylvania Drug Courts


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Diversionary Court Process


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Drug Court Data

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PA Levels of Offense

(1) Murder 1st degree Mandatory death or life imprisonment

(2) Murder 2nd degree. Mandatory life imprisonment

(3) Felony 1st degree 20 years — $25,000

(4) Felony 2nd degree. 10 years — $25,000

(5) Felony 3rd degree. 7 years — $15,000

(6) Misdemeanor 1st degree 5 years — $10,000

(7) Misdemeanor 2nd degree 2 years — $5,000

(8) Misdemeanor 3rd degree. 1 year — $2,000

(9) Summary Offense 90 days — $300


HOUSING

TRANSPORTATION

SUPERVISION requirements restrictions

FINES & COSTS

CRIMINAL HISTORY

FAMILY SITUATION

Barriers “Fog” that Impact Employment

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IDENTIFICATION SUPERVISION

FINES AND COSTS EMPLOYMENT

SUBSTANCE USE

Employment


Additional Barriers to Employment

• Cultural/Language

• Lack of education

• Lack of training

• Disability

• Criminal Thinking Errors

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Collateral Consequences

Individual• Employment• Public Assistance• Voting • Public Housing• Driver’s Licenses• Adoptive and Foster

Parenting• Student Loans

Community• Neighborhoods• Families• Health• State budgets• Groups with High

Incarceration Levels

http://www.abacollateralconsequences.org/search/?jurisdiction=41


Integration Activities Required

• Determine entry point of customers.

• Establish one process for all customers to follow as they utilize core, intensive and training services.

• Outline and document each step through the process Standard Operating Procedures (SOP).

• Revisit process frequently and adjust as needed to make this process stay current.


Reentry Example: Lancaster County RMO

• Lancaster County WIB Partner• Workforce readiness program

Ready2Work• Specific skill training:

• welders, • construction workers • machine operators • forklift drivers • printers, and others.

http://www.jobs4lancaster.com/programs/job-seeker-services/ready2work


Pennsylvania-Justice Reinvestment Initiative

• Data driven approach

• PA one of 17 states involved in JRI• PA-Act 122 of 2012

• Reallocates funds back to the local level from state DOC funding.

• Counties have more resources to promote positive behaviors/divert individuals

• DOC has contracted private providers for substance abuse and employment services, among other reintegration services.

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What Does It All Mean?

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• Reentry=Restoration/Rehabilitation/Habilitation

• Professional champions• Needed in all agencies and organizations

• Big picture: • Housing

• Transportation

• Fees and Restitution

• Conditions of Supervision

• Increased public safety/tax paying citizens

• Increase in pro-social behaviorsPRA Professional Development Institute April 2, 2015

• Childcare

• Income Prior to Employment

• Collaboration

• Personal Identification

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Collaborative Approach to Reentry

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• Potential Challenges:• Differing goals• Different terminology/language• Information sharing agreements• Assumptions of “the system” (non-compliance,

defiance) vs clients’ actual abilities and limitations



Final Puzzle PieceEMPLOYER


Why Are Employers Adverse to Hiring Returning Citizens?

• Reluctant to hire returning citizens• May steal or harm customers

• Imperfect monitoring of employees-premium on trustworthiness

• Certain occupations are legally closed to applicants with prior felony convictions

• Protect against lawsuits• Legally liable for criminal actions of employees - theory of negligent hiring

http://www.nolo.com/legal-encyclopedia/employer-liability-employees-bad-acts-29638.html

http://www.nolo.com/legal-encyclopedia/employer-liability-employees-bad-acts-29638.html


Engaging Employers

• Business first, employer second• No shortcuts• Customer service• How are you of value to the employer


Business First, Employer Second

• What are business primary purposes• What hat do you wear• What do you know of the employer• What are there requirements for

employees• What skills are needed for job seekers


Customer Service

• What does customer service mean • Before, During and After• How do you deal with mistakes• Who do you represent


No Shortcuts

• How do you seek employers• What activities are you doing to

meet businesses in their environment

• How do you prepare in advance• What is your “Plan B”


Correlates of Employer Aversion to Returning Citizens

+ Smaller establishments- Service and FIRE sectors + Manufacturing open to hiring

+/- Amount of customer contact

+ Use informal recruiting methods- Unwilling to hire other “Disadvantaged

Groups”


What Favors Job Retention

• Getting a job isn’t good enough, high attrition rate• Development of attitudes and behaviors that support

retention must start immediately• Service providers should mirror the workplace• Do the client’s skills match the job - We may need to disappoint them• Effective workplace communication• Effective relationships between client and staff: - When to be supportive and when to be tough• Client’s beliefs and attitudes toward employment are crucial

(NIC, 2010)


What to Do to Raise Employment?

• Supports for Reentry

• Reverse Bans on Financial Aid and Public Assistance

• Employment Bans Based on Content of Criminal History• Not Blanket Use

• Use of Conviction, Not Arrest Records

• Ensure Accuracy of Records

• Incentivize Desistance-Expunge Certain Records After Fixed Time Period

• Indemnify Employers – Use of Bonds

• Re-examine Federal, State and Local Employment and Licensing Restrictions

• Provision of Child Support


Summary• Substance Use Disorder

• Abuse/Addiction

• CFR 42, Part 2• Confidentiality

• Community Treatment Resources• Single County Authority

• Drug Court

• Employment Barriers

• Community Reentry Resources

• Roles of Employment Professionals


Questions

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Thank You

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Randall E. Loss, M.A., CRC, GCDF

[email protected]

(717) 761-8346

PA Office of Vocational Rehabilitation1521 N 6th Street

Harrisburg, PA 17102


mailto:[email protected]/[email protected]


References• Substance-Related and Addictive Disorders

www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf• DSM-5 Changes: Addiction, Substance-Related Disorders & Alcoholism

http://pro.psychcentral.com/dsm-5-changes-addiction-substance-related-disorders-alcoholism/004370.html

• Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5 http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf

• List of SCA in Pennsylvania http://www.pacdaa.org/Documents/SCA%20Public%20Web%20List.pdf

• Electronic Code of Federal Regulations Part 2—confidentiality Of Alcohol And Drug Abuse Patient Records http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42%3A1.0.1.1.2#se42.1.2_12

• HIPAA & 42 CFR, Part 2 How do they effect you everyday? http://www.naadac.org/assets/1959/john_dunbar_-_drcloudemr_hipaa42cfrpart2_pp.pptx

• Pennsylvania Drug Control Update https://www.whitehouse.gov/sites/default/files/docs/state_profile_-_pennyslvania.pdf

http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf



http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf

http://www.pacdaa.org/Documents/SCA%20Public%20Web%20List.pdf

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42:1.0.1.1.2#se42.1.2_12

http://www.naadac.org/assets/1959/john_dunbar_-_drcloudemr_hipaa42cfrpart2_pp.pptx

http://www.naadac.org/assets/1959/john_dunbar_-_drcloudemr_hipaa42cfrpart2_pp.pptx

https://www.whitehouse.gov/sites/default/files/docs/state_profile_-_pennyslvania.pdf


References• The Disease Concept Of Addiction Revisited

http://www.addictionpro.com/article/disease-concept-addiction-revisited?page=3• Erasing Your Criminal Record: How to Get a Pardon in Pennsylvania

http://clsphila.org/sites/default/files/get-help/Pardon%20Guide%20NEW.pdf• § 303.15. Offense Listing

http://www.pacode.com/secure/data/204/chapter303/s303.15.html• Drug Courts Are the Most Sensible and Proven Alternative to Incarceration

http://www.nadcp.org/Drug%20Courts%20Are%20the%20Most%20Sensible%20and%20Proven%20Alternative%20to%20Incarceration

• Drug Courts Are Not the Answer: Toward a Health-Centered Approach to Drug Usehttp://www.drugpolicy.org/docUploads/Drug_Courts_Are_Not_the_Answer_Final2.pdf

• List of Problem Solving Courts http://www.pacourts.us/assets/files/setting-2502/file-3585.pdf?cb=c61994

• Research Update on Adult Drug Courts http://www.nadcp.org/sites/default/files/nadcp/Research%20Update%20on%20Adult%20Drug%20Courts%20-%20NADCP_1.pdf

http://www.addictionpro.com/article/disease-concept-addiction-revisited?page=3

http://clsphila.org/sites/default/files/get-help/Pardon%20Guide%20NEW.pdf

http://www.pacode.com/secure/data/204/chapter303/s303.15.html



http://www.drugpolicy.org/docUploads/Drug_Courts_Are_Not_the_Answer_Final2.pdf

http://www.drugpolicy.org/docUploads/Drug_Courts_Are_Not_the_Answer_Final2.pdf

http://www.pacourts.us/assets/files/setting-2502/file-3585.pdf?cb=c61994

http://www.nadcp.org/sites/default/files/nadcp/Research%20Update%20on%20Adult%20Drug%20Courts%20-%20NADCP_1.pdf

http://www.nadcp.org/sites/default/files/nadcp/Research%20Update%20on%20Adult%20Drug%20Courts%20-%20NADCP_1.pdf


References

• Effective Substance Abuse Treatment for the Criminal Justice Population March 26, 2015 PCCD CJAB Conference, Ken Martz, Psy.D. CAS

• Expanding Employment Trends Among Low Skilled Men Using Eitc http://www.piercegordon1.com/wp-content/uploads/2014/04/eitc-policy-memo.pdf

http://www.piercegordon1.com/wp-content/uploads/2014/04/eitc-policy-memo.pdf

http://www.piercegordon1.com/wp-content/uploads/2014/04/eitc-policy-memo.pdf