George De Leon by ert554898

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									Therapeutic Community Treatment
      in Correctional Settings
The Call for An Integrated System

            George De Leon, Ph.D.

Center for Therapeutic Community Research at NDRI,
                         Inc.
                   New York City


         Cite only with permission of the author     1
        ABSTRACT
    Some 20 years of research
and clinical experience
underscores the necessity for
a systems-approach to
advance the recovery and re-
entry of substance abusers
treated in corrections-based
therapeutic communities.        2
       ABSTRACT (Cont’d.)
  This presentation reviews
a) key research conclusions and
   implications for integrated systems.
b) the state of the current system of
   aftercare.
c) barriers to an integrated system.
d) components of a Recovery Oriented
   Integrated System (ROIS).
 A. RESEARCH CONCLUSIONS AND
  IMPLICATIONS FOR INTEGRATED
            SYSTEMS

 A considerable research
  literature on TC treatment in
  correctional settings has
  developed in the past 15 years.



                                    4
 A. RESEARCH CONCLUSIONS AND
  IMPLICATIONS FOR INTEGRATED
             SYSTEMS

 Studies have mainly focused
  upon the issue of effectiveness
  and cost effectiveness of Prison
  TC treatment but have
  generated other findings that
  are relevant to the issues of
  recovery, re-entry and aftercare.
                                      5
 A. RESEARCH CONCLUSIONS AND
  IMPLICATIONS FOR INTEGRATED
        SYSTEMS (Cont’d.)


 The main conclusions from this
  research are outlined along with
  key implications for an effective
  system of aftercare.



                                      6
   1. Client Profiles in Correctional
               Treatment

 The substance abusers entering
  prison-based TC treatment settings
  (as well as community-based
  residential TC treatment) reveal
  severe drug use, deviant social and
  psychological profiles.

                                        7
 1. Client Profiles in Correctional
        Treatment (Cont’d.)

 Thus, an effective treatment and
  aftercare system must address the
  cognitive, emotional and
  behavioral dimensions that define
  the substance abuse disorder.
  Moreover, aftercare resources
  must make available the treatment
  and social services that promote
  recovery, not simply manage the
  disease.                          8
  2. Treatment Effectiveness and
            Aftercare

 Research documents that the
  effectiveness of modified prison
  TC for the treatment of substance
  abusing offenders is considerably
  enhanced when treatment
  continues in TC-oriented aftercare
  settings.
                                       9
  2. Treatment Effectiveness and
         Aftercare (Cont’d.)
 Positive outcomes obtained with
  clients who complete prison +
  aftercare reconstitute the time-in-
  treatment effects universally
  obtained in community based
  studies. Namely, duration of
  treatment involvement is directly
  related to post treatment success.
                                    10
  2. Treatment Effectiveness and
         Aftercare (cont’d)

 Thus, an effective aftercare
  system must be capable of
  keeping the individual engaged in
  treatment and/or social services
  long enough to assure stability in
  the recovery process.

                                       11
  3. Client Motivation and Treatment

 Research has illuminated the role of
  motivation in substance abuse
  treatment both in community based
  and criminal justice populations.
  Client motivation is a significant
  predictor of entry into treatment,
  retention in treatment, engagement
  in treatment and entry into
  aftercare.                         12
3. Client Motivation and Treatment
              (cont’d)

 Thus, an effective and cost-
  efficient system of aftercare must
  be capable of assessing and
  sustaining client motivation and
  readiness to constructively utilize
  treatment and social services to
  advance their recovery.

                                    13
           4. Recovery

 Decades of treatment follow up
  and natural history studies
  document the fact of recovery in
  significant numbers of addicts.

 Clinical experience, supported by
 developing research, indicates
 that recovery unfolds as a process
 of change which can be described
 as stages.                        14
       4. Recovery (cont’d)

 Thus, an effective aftercare
  system must have a common
  understanding of the process of
  recovery in order to define its
  goals and inform the deployment
  of resources on treatment
  interventions and social services.

                                       15
B. THE CURRENT TREATMENT AND
      AFTERCARE SYSTEM

    The conclusions from 20 years
 of research and clinical
 experience underscores the
 necessity for a systems-approach
 to advance the recovery and re-
 entry of substance abusers
 treated in corrections-based
 therapeutic communities.
                                16
B. THE CURRENT TREATMENT AND
   AFTERCARE SYSTEM (cont’d)


 The current system of aftercare
  consists of a fragmented
  aggregate of diverse community
  providers of social and treatment
  services, or surveillance activities.


                                      17
B. THE CURRENT TREATMENT AND
  AFTERCARE SYSTEM (cont’d.)


Goals are defined by the
 provider’s ideology, mission
 or mandate (e.g., medical,
 educational, medicational,
 vocational, housing).


                                18
 B. THE CURRENT TREATMENT AND
   AFTERCARE SYSTEM (cont’d.)

 Service delivery is loosely
  coordinated or conceptually
  unrelated. This usually leads to
  duplication or lack of services,
  non utilization or poor utilization
  services, cost inefficiency,
  professional and agency turf
  conflicts. Notably, client dropout
  from aftercare is high.
                                        19
     C. THE BARRIERS TO AN
INTEGRATED SYSTEMS APPROACH


       There are inherent barriers
to integration which reflect
political, pragmatic, and
professional features across the
major components of the system.


                                 20
       C. THE BARRIERS TO AN
 INTEGRATED SYSTEMS APPROACH
                (cont’d.)
 Differing philosophies regarding
  substance abuse and treatment and
  the conflicting goals of those
  representing the CJS (corrections
  departments, parole departments,
  courts, judges, prosecutors) and
  those representing the treatment
  system (prison based and
  community based treatment
  providers).                       21
     C. THE BARRIERS TO AN
INTEGRATED SYSTEMS APPROACH
             (cont’d.)

 An integrated systems approach
  to Prison-based TCs and
  community based aftercare
  programs must be informed by
  what is known about the client,
  the disorder, treatment and
  recovery.
                                22
    D. A RECOVERY ORIENTED
   INTEGRATED SYSTEM (ROIS)
 ROIS is a paradigm of a systems
  approach. It emphasizes
  partnership linkages among
  community providers and
  prison-based treatment
  providers to coordinate
  transitional and aftercare
  treatment and services for post
  release clients.
                                23
    D. A RECOVERY ORIENTED
   INTEGRATED SYSTEM (ROIS)
            (cont’d.)


 Additional partners in the
  system are parole/probation
  officers, judges, and social
  services agencies. (e.g.,
  education, employment, family,
  mental health).

                                   24
    D. A RECOVERY ORIENTED
   INTEGRATED SYSTEM (ROIS)
            (cont’d.)
 Key components of ROIS are:
    Recovery Stage Framework;
    System-wide vernacular;
    Uniform assessment
     protocol;
    Coordinated procedures for
     referral and placement.
                                  25
    D. A RECOVERY ORIENTED
   INTEGRATED SYSTEM (ROIS)
            (cont’d.)


 The integrative ingredient of the
  system is an overarching
  framework of recovery.



                                  26
    KEY ASSUMPTIONS OF ROIS:


 (ROIS) consists of interrelated
  treatment interventions,
  surveillance and social services
  provided in a variety of settings,
  which is guided by a common
  perspective on the disorder and
  recovery.
                                       27
    KEY ASSUMPTIONS OF ROIS
            (cont’d.)


 In a ROIS, settings and
  modalities may change, but their
  purpose remains the same, to
  move the individual to the next
  stage in the process of
  recovery.

                                 28
    KEY ASSUMPTIONS OF ROIS
            (Cont’d.)


 Treatment services, social
  services and surveillance differ in
  their contribution to the recovery
  process.



                                   29
    KEY ASSUMPTIONS OF ROIS
            (Cont’d.)


 The optimal utilization of aftercare
  services in halfway houses, day
  treatment or outpatient setting
  depends upon the client’s stage of
  recovery.


                                    30
    KEY ELEMENTS OF ROIS

 A Recovery Stage Framework;
 System-wide vernacular;
 System-wide assessment
  protocol;
 Coordinated procedures for
  referral and placement.
                                31

								
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