WB-HIDTA-presentation-Final-3-7-10

							Prince William HIDTA
 A Cross-Disciplinary
      Approach


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     HIDTA Partner Agencies
             Community
              Services



Criminal
             PRINCE            Adult
Justice      WILLIAM         Probation
              HIDTA

           Adult Detention
               Center
                                         2
    REFERRAL PROCESS
1. Probation officers refer offenders who meet
   HIDTA admission criteria to on-site HIDTA
   therapists.
2. Therapists use assessment tools to determine
   offender DSM diagnosis, criminogenic risk/
   needs and responsivity characteristics and
   recommend treatment options.
3. The 11 member HIDTA Review Team evaluates
   client data and scrutinizes public safety risks as
   well. Voting members from each agency
   determine admission.
                                                        3
ADMISSION CRITERIA

   Drug dependent with previous
    treatment episodes
   History of non-violent drug-related
    criminal behavior
   Minimum probation period of 12-18
    months

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ASSESSMENT TOOLS

Addiction Severity Index
Level of Service Inventory (LSI-R)
  Most HIDTA clients score between 25-29
Biopsychosocial



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 PW HIDTA Client
The typical HIDTA client is a male in his
20’s with heroin dependence, which
began as prescription opiate use in high
school. Criminal activity is directly
related to the need to obtain heroin
daily. Employment is spotty. Mood
disorders are common.

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2009 INSTANT OFFENSES




                        7
DRUG OF CHOICE 2009




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FIVE LEVELS OF TREATMENT
1.IOP (2 group sessions and one
  individual session per week for
  minimum 4 months)
2.OP (2 group sessions per week for
  minimum 4 months with an individual
  session optional)
3.Continuing care (1 session per week
  for minimum 4 months; options include
  individual, group or family)
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  FIVE LEVELS OF TREATMENT
        ADJUNCT SERVICES

4.Residential treatment (90 days with
  Suboxone taper or maintenance
  optional)
5.Suboxone assisted treatment available
  since 2008 at both treatment sites

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    Successful Treatment Outcomes
   Improved community support system, i.e.
    family, self-help, etc.
   Program completion with no further arrests,
    sustained period of no drug use with or
    without Suboxone maintenance
   Improved mental and physical health status
    with ongoing care, if needed
   Stable employment and/or engagement in
    education or training program
   Safe housing
                                                  11
    DISCHARGE CRITERIA
Successful Discharges
   Complete a minimum of two phases of
    treatment
   No drug or alcohol use
   No new legal charges



                                          12
    DISCHARGE CRITERIA
Unsuccessful Discharges
   Failing to attend treatment or probation
    meetings
   Selling or giving drugs to other clients
   New arrests
   Threatening clients or staff
   Continued drug use after exhausting all levels
    of treatment available

                                                     13
    LENGTH OF STAY

   Our expected length of stay is a
    minimum of twelve months
   The average length of stay for
    2009 clients is 10.75 months
   Unsuccessful clients = 7.5 months
   Successful clients = 15.7 months

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TREATMENT TARGETS
   Increase motivation to stop drug &
    alcohol use; engage in recovery
   Change attitudes, beliefs and values
    favorable to law violations
   Model pro-social behavior and values
    and promote identification with same
   Reduce impulsivity; increase self-
    regulation and problem-solving skills
   Reduce anti-social peer associations;
    increase involvement in positive groups
    and activities
   Replace anti-social skills with pro-social
    skills                                       15
      CLINICAL APPROACHES

   Motivational Interviewing
   Group Treatment for Substance Abuse, a Stages
    of Change Model (Velasquez, et. al.)
   Twelve Step Facilitation Handbook (Nowinski
    and Baker)
   Suboxone assisted treatment continuum
    integrated into treatment programming

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       CLINICAL APPROACHES (CONT.)
   CBT - Criminal Conduct and Substance Abuse
    Treatment (Wanberg and Milkman) – Pilot to
    begin April, 2010 replacing Samenow series.
   Sanctions & Incentives revision underway with
    consultation from Gray Barton – Pilot to begin in
    May, 2010
   Staff supervision EBP focused (MIA-STEP, etc.)
   Performance goals and evaluations include
    targets for EBP skill development & proficiency
                                                        17
    CLIENT OUTCOME MEASURES

   Rate of Successful treatment completion
    CY2009 – 40%
   Post treatment recidivism
    CY 2008-2009 not yet available




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SUCCESSFUL COMPLETIONS




                         19
Rates of Opiate Dependence
 and Recidivism Reduction




                             20
      CLIENT OUTPUTS – 2009
   New clients- 27
   Clients who successfully completed Tx - 11
   Clients discharged unsuccessfully - 17
   Drug tests given - 656
   Number and type of sanctions (62) and rewards
    (176) applied
   Number and type of referrals for ancillary
    services: employment, education/training,
    housing, medical, parent training - 102
                                                    21
DRUG TESTING
Probation
 Random; 2/month maximum intensity

 Observed

 Test sticks (GCMS available)

Community Services
 Random; 2/week maximum intensity

 Not consistently observed

 12 panel Test cups (no GCMS)

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BEHAVIORS             REWARDS               SANCTIONS
    Attend Tx          Verbal praise         Verbal warning
     FTA Tx         Congratulatory card        3 way mtg
   Attend PO            Candy treat          Increase urines
    FTA PO             Group praise         Increase self-help
  Appear Urine       3 way affirm mtg       Increase PO mtg
   FTA Urine          Self Help chip        Increase Tx mtg
  - Urine result      Decrease urines       Move back in Tx
  + Urine result        Travel pass         Meet with Chief
Complete Tx phase   Decrease PO mtgs       Termination Appeal
Incomplete Tx D/C       Pizza Party        HIDTA Termination
   New arrest       Graduate Certificate   Probation Violation
Graduates Program   Early release prob.        Tx in ADC
                                                                 23
CROSS-AGENCY COORDINATION
   MOA outlines each agency’s roles and
    responsibilities
   Mutual commitment to public safety and
    rehab
   HIDTA Review Team - 12 year history;
    LOS is 6 years
   Co-location makes communication SOP
    and efficient
   Therapists train new officers routinely
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CROSS-AGENCY Continued
   HIDTA Tx provided 10 days of EBP
    cross training for CJS, corrections and
    treatment staff over the past year
   Problems are approached from a “we”
    perspective
   Role confusion sometimes occurs
   Tx has to be mindful about privacy and
    confidentiality issues while living at the
    host agency

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MAJOR PROBLEMS
   Reshaping the program to meet the needs of
    a primarily opiate dependent client population
    in a way that improves outcomes
   Dealing with the increased failure rate
   Weak institutional structures and support to
    insure appropriate care and running into
    stigma at all levels
   Insufficient ability to apply judicial strictures
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   What are realistic benchmarks for this
    population?
   How to balance client retention in Tx with
    the need to set clear boundaries and
    behavioral norms?
   How can we best measure our recidivism
    rate?
   Are there any initiatives to make Suboxone
    more available to people without insurance
    or means in community based treatment
    settings?
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