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					  Correctional Service of Canada


Elements of an Effective Substance Abuse
    Treatment Model for Offenders

             Overview and
           Part 1: Assessment

   Presentation to Caribbean CICAD members
                    St. Lucia
                 November, 2004
             Overview of Model

 Although the actual programs /
  interventions are often the cornerstone of
  any effective substance abuse treatment
  model, interventions may not be
  successful if not rooted in an overall
  approach that considers:
  •   Assessment
  •   Treatment Matching
  •   Maintenance
  •   Adjunctive Services
  •   Quality Assurance and Evaluation
                                               2
          Overview of Model

Assessment                 Treatment Matching
Needs of offender pop.
                             Problem severity
Individual
                             Risk, needs, responsivity
for evaluation purposes


                      Programs
Maintenance                        Adjunctive
                                    Services
•What happens after
intensive treatment           •What other the offender’s
phase of treatment?              other need areas?



Quality Assurance, Evaluation & Monitoring                 3
    Part 1 - Assessment



• The first element of an effective
  substance abuse intervention
  model for offenders that we will
  discuss is:
         assessment

                                      4
             Overview of Assessment


Are three main ways in which assessment
  contributes to an effective substance abuse
  treatment model:

 Through NEEDS ASSESSMENT to evaluate the profile of
  your population and the services that they require

 Through the INDIVIDUAL ASSESSMENT of the offender
  to determine his/her needs

 Through the use of assessment measures to EVALUATE
  THE EFFECTIVENESS of your interventions

                                                        5
       Needs Assessment



To provide the most effective
 services in the most cost-effective
 way, it is key to evaluate the
 profile of your target group and
 the services they require



                                       6
                 Needs Assessment

A good needs assessment will*:

    • Identify the needs of a target population
      in a particular area;
    • Help to prioritize those needs to ensure
      better planning of services an more
      effective allocation of resources
    • Develop an implementation plan that
      outlines how identified needs will be
      addressed

* From”Needs Assessment: A Practical Guide to Assessing Local Needs for           7
Services for Drug Users, 2004, Effective Interventions Unit, Scottish Executive
    Needs Assessment - Components

 A review of the existing sources of information relevant to
  target population
 A profile of existing services and description of the client
  profile
 The views of your target population
 The views of relevant practitioners and service providers
 Analysis and interpretation of results
 Taking action by prioritizing identified needs, appraising
  options for meeting those needs, and implementing an
  action plan including resource implications
 Monitoring and evaluation to examine that changes made
  have the desired effect of meeting the needs of your target
  population
   * From”Needs Assessment: A Practical Guide to Assessing Local Needs for           8
   Services for Drug Users, 2004, Effective Interventions Unit, Scottish Executive
          Needs Assessment – Types of
             Assessment Measures


Existing sources of information
 local population surveys, published or unpublished research
  papers, existing data sets, individual assessment data
 Need to be mindful of the strengths and weaknesses of the
  information – remember that these data sources were not
  originally collected to answer your needs assessment
  questions

New information
 questionnaires or surveys, interviews, focus groups
 Need to ensure good methodology to prevent distortion of
  results and recommendations (e.g., piloting of
  questionnaires/surveys to ensure clarity)                     9
 Individual Assessments




For the treatment planning
 and case management of the
 individual client




                              10
Individual Assessments – Purpose

Substance abuse assessments completed
 within the correctional context should, at a
 minimum, serve to:
  • Identify and verify the existence of a problem
    warranting intervention;
  • Provide detail and shed light on the nature and
    seriousness of the individual’s substance abuse
    problem;
  • Identify the link with criminal behaviour;
  • Guide clinical decision-making in the
    development of an appropriate and
    individualized treatment plan                  11
Individual Assessments – Types of
            Measures


  Main methods:

  Structured interviews
  Psychometric tests /
   questionnaires


                                12
    Individual Assessments –
   Correctional Service Canada

 In the Correctional Service of Canada, all
  offenders undergo a comprehensive
  assessment when they enter the federal
  correctional system at a regional
  reception centre

 When there is an indication of substance
  abuse, the offender is referred for a
  more in-depth assessment for this issue
                                               13
                   CASA
 315 items

 Computerized; optional audio
  component for offenders with literacy
  problems

 Identifies critical substance abuse
  related factors and link to criminal
  offending

 Identifies severity of problem – used to
  determine level of treatment required      14
                CASA - Components

 Assessment of the reliability of self-report using
  the Paulhus Deception Scale
 Identify topography and density of alcohol and
  drug use
 Assess severity and consequences of alcohol and
  drug abuse using standardized measures
  including:
   •   Michigan Alcoholism Screening Test (MAST)
   •   Alcohol Dependence Scale (ADS)
   •   Problems Related to Drinking (PRD)
   •   Severity of Dependence Scale (SDS)
   •   Drug Abuse Screening Test (DAST)                15
       CASA – Components (cont.)

 Identify poly-substance abuse
 Explore substance abuse history as it relates to
  biological parents
 Idenify prior programming involvement including
  Methadone Maintenance Treatment
 Assess treatment readiness using operationally
  recognized criteria
 Recommend programming intensity levels using
  algorithms
 Generate automated summary reports to assist
  decision-makers                                    16
 Assessment to Evaluate and
    Monitor Effectiveness


In addition to assisting with
treatment planning, assessment
instruments also play a critical role
in evaluating the progress of the
individual client and the
effectiveness of your intervention
in general

                                   17
  Assessment to Evaluate and
  Monitor Effectiveness (cont.)


 In CSC’s national substance abuse
  programs, a battery of instruments has
  been put together by our Addiction
  Research Centre for pre- and post-
  treatment testing

 These instruments were selected
  following a thorough review of the
  “best practices” research literature on
  the topic and reflect the areas targeted
  by the program
                                         18
       Criteria for Instrument Selection
       CSC Substance Abuse Programs
The following criteria were considered for instrument
  selection:
 Provides information and feedback on participant
  functioning
 Assesses specific treatment targets
 Measures participant progress in treatment
 Self-administered quickly
 Alcohol and Drug specific
 Low cost
 Sound psychometric properties
 Suitable for treatment evaluation
 Suitable for male offender population
 Recognized as valid by best practices literature
                                                                              19
   National Substance Abuse Programs - High Intensity Evaluation Framework,
   Research Branch, CSC, 2004
                      Correctional Service of Canada
           Pre & Post Program Measures for National Substance
                             Abuse Programs
                                                                  Pre-release     Community
                                                  Program Phase
Table 1: Standardized Instruments                                     Booster        based
            Administration                                                        Maintenance   Assessment Targets
                                                   Pre    Post    Pre      Post      Phase
                                                                                  (Post only)
                                                                                                    Self Report
1. Paulhus Deception Scales (PDS)                                                                  Reliability

2. Treatment Entry Questionnaire (TEQ)                                                              Motivation

3. Inventory of Drug Taking Situations (IDTS)                                                 Risk Situations

4. Drug    Taking   Confidence    Questionnaire
                                                                                              Self-Efficacy
          (DTCQ)

5. Effectiveness   of    Coping     Behaviours
                                                                                             Coping-Alcohol
         Inventory

6. Drug Avoidance Self Efficacy Scale (DASES)                                                 Coping-Drugs

7. Craving Beliefs Questionnaire (CBQ)                                                      Beliefs- Cravings

8. Beliefs about Substance Abuse                                                            Beliefs - General

9. Drinking/Drug Related Locus of Control
                                                                                            Locus of Control
         (DRIE)
                                                                                                            20
10. Client Satisfaction Questionnaire (CSQ-8)                                                Client Satisfaction
             Assessment Interview
   Offenders in CSC’s National Substance Abuse
    Programs also undergo a structured “Timelines
    Interview” at the beginning of programming

   The aim of the 143-item Timelines Interview is to
    map out an accurate depiction of the link between
    the offender's substance use and concomitant
    criminal behaviour.

   Builds on the results of the CASA

   Most item responses are categorical in nature, but
    for the purpose of analyses, qualitative interview
    information is transformed and coded into
    quantitative data.                              21
CSC Pre–Post Program Measures


 •   Used to evaluate the offender’s
     progress in different treatment
     target areas

 •   Used by the Research Branch as
     part of evaluation framework to
     evaluate treatment effectiveness

                                        22
Reliability of Self-Report Data


   Concerns are sometimes expressed
    regarding the accuracy of self-report data
    on substance abuse from offenders

   Research conducted on this question in
    CSC has demonstrated that instruments
    such as the CASA produce accurate and
    valid information
                                           23
                Last word


   Assessment is a critical component of any
    substance abuse treatment model with
    offenders

   Assessment techniques and measures not
    only allow you to examine the needs of
    your target population, but also assist in
    case planning with the individual offender
    and are integral to the ongoing monitoring
    of cases and the evaluation of treatment
    programs.
                                          24
     Assessment

Questions and Comments


                         25

				
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