Integrating Risk/Needs Assessment Into Drug Court

Report
Judge Shanta Owens
Jefferson County Drug Court
Tenth Judicial Circuit
Birmingham, AL
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Develop understanding of the Risk and
Need Principle
Develop understanding of the effective
use of ARAS in Drug Court
Develop an understanding of Integrating
the Risk/Needs Assessment into Drug
court
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Presiding Judge, Jefferson County
Drug Court Birmingham Division
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Drug Court Judge since 2009
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Prior Experience
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338 Active Participants
6 Case Managers
Drug Court Team
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Judge
Case Managers
Program Administrator
Treatment Coordinator
Law Enforcement Officer
Peer Specialist
Job Placement Program Coordinator
Medical Provider
Defense Attorneys
Jefferson County Drug Court
Drug Court Works!
We Also Know…
Drug Court is a scarce
and precious resource
that should be used in a
manner that maximizes
its benefits to
participants and society
in general
Jefferson County Drug Court
Comprehensive Review of
Information related to Substance
Use Disorders and Risk for
Recidivism. Can examine both
psychosocial functioning and risk
factors (Risk Assessment)
According to what are known as the Risk
Principle and the Need Principle, the
most effective and cost-efficient
outcomes are achieved when treatment
and supervision services are tailored to
the (1)Prognostic Risk Level and (2)
Criminogenic Needs of the Participants
(Andrew & Bonta, 2010; Taxman & Marlowe, 2006)
Characteristics of offenders that
predict relatively poorer outcomes
in standard rehabilitation
programs
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Younger age during treatment (especially < 25)
Male Gender
Early onset of substance abuse or delinquency
Prior Felony Convictions
Previously unsuccessful treatment attempts
Co-Existing Diagnosis of antisocial personality
disorder
Familial History of Crime or Addiction
Regular Contacts with antisocial or drug-using
peers or associates
(Marlowe, 2003)
Clinical disorders or functional
Impairments that, if treated,
significantly reduce the likelihood
of future involvement in crime
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Diagnosis of substance dependence or addiction
Major Mental Illness
Lack of basic employment skills/poor
employment history
Lack of daily living skills
Lack of education
Collateral Needs
◦ Dual Diagnosis
◦ Chronic Medical Conditions (ex. HIV, Diabetes, HCV)
Belenko, 2006; Simpson & Knight, 2007
Prognostic Risk and Criminogenic
Need indicate what level of treatment
and supervision are likely to be
required to manage an offender, and
what consequences should ensue for
new instances of alcohol or drug use
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Most intensive treatment should be reserved
for Higher Risk offenders
Must survey important Risk Factors to
produce an accurate measure of Risk
What does Risk Indicate?
◦ Level of Supervision
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Interventions must be very focused and target
the Needs that are related to Risk
Stabilize the Client first. Then, start to treat
the addiction
Higher Risk = More Intensive Supervision Services
Higher Need = More Intensive Treatment Services
High Risk/High Need = Typically Require full array of Treatment and
Supervision services embodied in 10 Key Components of Drug Court
Low Risk = Less Intensive Supervision Services
Low Need = Less Intensive Treatment Services
Low Risk/Low Need = Typically do not require the full menu of
services specified in the 10 Key Components of Drug Court
Providing too much treatment or too
much supervision is not merely a
potential waste of scarce resources.
It can increase crime or substance
abuse by exposing individuals to
more seriously impaired or antisocial
peers, or by interfering with their
engagement in productive activities
such as work, school, or parenting.
(Lowenkamp & Latessa, 2004; McCord, 2003)
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Low Risk Offenders
RECIDIVATE at
higher rates when
placed in residential
interventions
and/or intensive
supervision
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High Risk Offenders
respond BETTER
when placed in a
residential
intervention and/or
intensive
supervision
Jefferson County Drug Court
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We figured out DOSAGE MATTERS
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Started using ARAS
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(Alabama Risk Assessment System)
◦ Adopted from ORAS (Ohio Risk Assessment System)
Length of time in Drug Court now based on
Clients Risk and their Level of Needs
4 Drug Court Tracks with different
Requirements and Phases
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RISK
What level of
supervision services
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NEED
What level of
treatment services
Jefferson County Drug Court
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Assessment is done on every client accepted
into Drug Court
Time: Approximately 2 hours per client
Completed by Case Managers
Plea is Taken on Thursday
ARAS is scheduled a few days later
Based upon score, clients are placed in Track
1, 2, 3, or 4
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Criminal History
Education, Employment, and Finances
Family and Social Support
Neighborhood Problems
Substance Abuse
Peer Associations
Criminal Attitudes and Behavioral Problems
Mental Health Screening Form
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Overall score does not matter as much as the
scores in the individual domains
Moderate to High Score in Substance Abuse,
Formal Treatment is required. Therefore,
client will be Track 2 or 4, depending on
scores in other domains.
Tracks 1 and 3 are clients who do not score
Moderate or High in Substance Abuse
TRACK 4
High Risk, High Need
12 Months
TRACK 2
Low Risk, High Need
6 Months
TRACK 3
High Risk, Low Need
9 Months
TRACK 1
Low Risk, Low Need
3 Months
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Dependent on alcohol or drugs
At Risk for failure in standard correctional
rehabilitation programs
◦ Using drugs or committing crimes at early age
◦ Failed previously in less intensive dispositions
◦ Possible diagnosis of antisocial personality disorder
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Need all services embodied in the 10 Key
Components
◦ Should Appear Frequently in Court: No less than Biweekly for
the first few months until stable interval of sobriety or
engaged in treatment
◦ Our clients appear Weekly in Phase 1, Biweekly in Phase 2,
Monthly in Phase 3, and Noncompliance Calendar in Phase 4
◦ Formal Treatment is Required
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Need interventions that focus on remediating
“criminal thinking” patterns
Minimum dosage of 200 hours of cognitive
behavior services
◦ Lack inclination to engage in productive activities
such as work, school, or parenting
◦ Do not attach importance to the assumption of
responsible roles
◦ Endorse antisocial attitudes and values
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Deficient in adaptive life skills, such as
employability, education, financial
management, and homemaking
Adaptive habilitation services are often
required to teach vocational skills, address
educational deficits, improve daily living
skills, and model effective interpersonal
problem-solving strategies
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Deficient in adaptive life skills, such as
employability, education, financial
management, and homemaking
Adaptive habilitation services are often
required to teach vocational skills, address
educational deficits, improve daily living
skills, and model effective interpersonal
problem-solving strategies
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Compliance with the conditions of
supervision and treatment is the primary goal
Abstinence is a more difficult goal
The use of appropriately prescribed
medications by a qualified addiction
psychiatrist constitutes an evidence-based
practice for addicted offenders and should be
available in appropriate cases (National
Institute on Drug Abuse, 2006).
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Dependent on drugs or alcohol
Do not have substantial prognostic risk
factors that would predict failure in standard
Primary focus for this group is Treatment
services
Do not require frequent supervision on status
calendar
◦ Monthly judicial hearings and then noncompliance
calendar in Phase 2
◦ Rather than appear in court interacting with highrisk antisocial peers, they should focus their energy
on Treatment
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Formal Substance Abuse Treatment Required
◦ However, research suggests that low-risk
individuals should not be treated in the same
groups as high-risk individuals because they may
adopt antisocial attitudes or values (Lowenkamp &
Latessa, 2004).
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Adaptive Habilitation services may be
required such as vocational or educational
assistance, family therapy, or mental health
counseling.
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Consequences should be focused on
Treatment
◦ Abstinence is still a difficult goal
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Use of appropriately prescribed medications
by a qualified addiction psychiatrist may be
indicated for some addicted offenders
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Non-Dependent substance abusers
But have substantial Risk Factors for failure on
standard supervision
Emphasis should be on closely monitoring their
behavior, holding them accountable for their
conduct, and teaching them pro-social life skills
Should appear in court on a status calendar for
judge to review progress
◦ Weekly judicial hearings
◦ Because they are at risk for failing to comply with
standard supervision requirements
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Better suited for Early Intervention classes
that teach about the dangers of drugs and
alcohol and activity-scheduling exercises that
re-orient their daily activities away from
drug-related peers and events
Because High Risk, 200 hours of cognitive
behavioral services may be needed to reduce
criminal activity
Focus consequences on Abstinence and
Supervision
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Unnecessary to expend substantial resources on
this group because they have a low probability of
recidivism
Noncompliance Calendar
Prevention Services such as Early Intervention
classes on an individual basis or in separately
stratified groups
Drug and alcohol use are under their voluntary
control
Important that this group is NOT mixed with high
risk offenders or that they spend lots of time in
court
Jefferson County Drug Court
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Better understanding of client’s circumstances
and what level care is needed to treat him/her
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You do not want to mix occasional pot smoker
with hardcore IV drug user in treatment
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Want to use resources wisely and treat the right
people
◦ Ex: Low Risk, Low Need folk don’t need inpatient
treatment. Without an assessment, this would be a
waste of resources
Jefferson County Drug Court
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Goal: Information Gathering
Environment should be conducive to disclosure of
information
Purpose of Assessment should be explained
Client should be alone
Interviewer should be Patient, Open-Minded, and
Attentive
Interviewer should exhibit good listening skills
Open-Ended Questions
Avoid Close-Ended, Biased, Double-Barreled
questions
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Dealing with Inconsistencies
◦ Use collateral info/resources
◦ Lightly challenge inconsistent info
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Dealing with Oppositional Behavior
◦ Offer Choices
◦ Offer a Break
◦ Redirect
QUESTIONS?

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