In-Patient & Out-Patient Treatment
- Treatment programs that follow the risk-need-responsivity (RNR) principles are more effective than those that do not.
- The RNR principles for effective treatment include the following:
- conducting comprehensive actuarial assessment of static (unchanging) and dynamic (changeable) risk factors with periodic reassessment
- prioritizing treatment resources for higher-risk clients or clients with higher needs in a particular area
- targeting specific criminogenic needs
- providing treatment that is responsive to an individual’s temperament, learning style, motivation, culture, and gender
- In-patient treatment is effective for the following reasons:
- it removes individuals from environments that promote alcohol and drug use
- it provides an environment where treatment efforts can be concentrated
- it offers medical/psychiatric care and emotional support to patients
- Out-patient treatment is effective for the following reasons:
- it keeps individuals in their environment
- it allows the individual to apply their skills in managing themselves and the environment
- it provides opportunities for the client to address difficulties “real-time” and coping strategies to be created and tested while having the support provided by the treatment
- it can teach clients to mobilize support within their environment to manage relapse
- Both in-patient and out-patient treatment can include some combination of the following:
- individual therapy sessions
- group therapy sessions
- medication services
- CBT interventions
- alcohol and drug use education
- life skills
- mental health services
- compulsory self-help meetings (i.e., 12-step recovery)
- support services
Mental Health Screening and Evaluation
- It is recommended that an evidence-based screener be used (see Appendix A1 for a list of free, online tools).
- An evidence-based screener should include the following elements:
- type of mental health symptoms the client is experiencing (e.g., anxiety, depression, hallucinations [auditory or visual], mood swings)
- frequency with which the client experiences these symptoms
- last time the client experienced these symptoms
- negative impact (social, legal, employment, family) these symptoms may have had on the client’s life
- Risk-need assessment tools are not substitutes for a dedicated mental health screening tool.
Substance Use Screening and Evaluation
Screening Tool
- When possible, an evidence-based screener should be used (e.g., Drug Abuse Screening Test [DAST]). (See additional sources for more information.)
- Most risk-need assessment tools are not effective screeners.
- Substance use screening should focus on use within the past 30 days.
- When an evidence-based tool is not available, departments should develop a screener that includes the following domains:
- type of substance used (alcohol, marijuana, opioids, other hard drugs)
- frequency of use by substance category
- negative impact (social, legal, employment, family) of substance use
- negative impact by substance category
- Officers should discuss the results of any screenings. Clients should then be informed if an evaluation is necessary.
Evaluation Tool
- Evaluations should be administered with all clients identified by the screener as potentially having a problem.
- In-depth substance use evaluations are best administered by a trained clinician.
- If administered by an outside practitioner, evaluation results should be communicated to the supervising officer.
- Officers should discuss the evaluation results with the client and work collaboratively with them to incorporate those results into the client’s case plan.
Alcohol and Drug Use Education
- ADE is most often delivered in community settings such as clinics, school settings for youth, and over the internet. Within the community supervision setting, ADE is typically included as a part of a client’s in-patient or out-patient treatment.
- ADE programs aim to do the following:
- provide information about the neurological and biological effects of substance use to help individuals understand how the brain operates and why substances can be addictive
- provide information about the negative consequences (social, physical, cognitive) of alcohol abuse and illicit drug use
- educate individuals on the nature of social pressures to use alcohol and drugs
- teach a set of personal and social resistance skills to help individuals resist pressure from peers
- Within community supervision, ADE is considered an intervention aimed at reducing substance use because most individuals in the criminal legal system (the “criminal justice” or “legal” system will be referred to as the criminal legal system in this document) have used drugs and alcohol before entering the system.
- ADE is effective when it is a component of a broader health and personal development curriculum concerned with an individual’s social and mental health well-being.
- Effective ADE programs often include an interactive curriculum that engages participants in learning problem-solving and critical thinking skills. These skills can be used to craft strategies for real-world situations.
- ADE is most effective when it is responsive to the specific cultural and social needs of the individuals.
Cognitive Behavioral Techniques
- CB techniques have three different strategy sets:
- Strategy 1 (Behaviorism): Focuses on changing observable behaviors to reduce a person’s risk of future criminality.
- Strategy 2 (Cognitive): Focuses on changing thought processes to improve decision-making that will reduce a person’s risk of future criminality.
- Strategy 3 (Mindfulness): Focuses on increasing client’s awareness and acceptance of internal processes, and aligning their behaviors with their prosocial values.
- Clients should be assessed to determine if they will benefit from CB techniques. Potential factors which may make CB techniques more difficult to use with clients are:
- presence of mental illness
- presence of SUD
- client unready to change
- client unreceptive to CB techniques
- frequency of offending behavior
- offending behavior is motivated by social circumstances (not mindset)
- literacy
- Clients should be assessed periodically to determine if CB techniques are still appropriate.
- CB techniques are appropriate for all risk levels.
Incentives
- Several forms of contingency management have shown promise in reinforcing patterns of behavior change.
- Some programs provide participants with a choice of various rewards (some monetary and others social).
- Some programs increase the amount of the reward offered to participants the longer they maintain the pattern of behavior change.
- Some programs allow participants to draw from a prize bowl containing redeemable slips for prizes. The number of draws a participant receives increases as they maintain the pattern of behavior change and resets back to one if they slip up.
- The principles of contingency management can be applied to reinforce many indicators of behavior change.
- First the individual/officer must agree on goals and short-term steps.
- The agreement should include what behaviors are to be reinforced and how frequently the incentives are given.
- During the early phase, it is important to reward often and frequently to get a neuro-physical reaction.
- During the later phase, incentives should be staggered to maintain the changed behavior.
- Incentives can be financial (gift card, voucher, etc.) or social (use computers in the office, get a letter from the officer indicating they are doing well).
- Positive behaviors may include seeking employment, taking educational classes, participating in community activities, etc.
- Desistance from negative behaviors can also be included (e.g., refraining from hanging out with friends the client has identified as detrimental to the desired behavior change, successfully resisting a temptation to commit a crime, etc.).
- Incentives can come in several forms.
- Financial prize-based incentives include items like TV sets, gaming systems and radios.
- Social rewards like reduced-supervision incentives include actions like reducing a client’s time on supervision, the number of visits they are required to make to the probation office each week/month, and the frequency they are required to submit for drug testing.
- Financial practical incentives include items that help clients (and potentially facilitate compliance with other supervision conditions), such as transportation vouchers and cell phone minutes.
Prosocial Modeling
- Officers model prosocial values in a variety of ways, including through their actions, positive reinforcement, negative reinforcement, and empathy.
- Officers should promote the following prosocial behaviors: complying with supervision conditions, being punctual, not offending, collaborative problem-solving, expressing empathy, and treating others with respect.
- To establish legitimacy, officers should behave in a way that aligns with the values they will promote to clients.
- Officers can reinforce their client’s prosocial values through their body language (e.g., smiling, active listening) and verbally through words of affirmation and acknowledgment.
- Officers can reinforce their client’s prosocial behaviors through rewards.
- Effective rewards can be material (i.e., clothing referrals, transportation services), reducing the frequency of contact, or investing additional time helping the client.
- Officers can effectively negatively reinforce non-prosocial behaviors by giving space for clients to express their negative feelings, suggesting alternative perspectives or behaviors, and working with clients to find new ways to deal with difficulties.
- Officers should avoid harsh criticism and confrontation during these encounters.
Sanctions
- Sanctions are used to induce behavior change through threats of punishment for noncompliant behavior.
- A variety of potential sanctions exist in community supervision. These can be jail time, fines, house arrest, electronic monitoring, or verbal reprimand from the PO.
- POs may be able to use verbal reprimand or other forms of expressing disapproval and disappointment as a sanction.
- For this to be effective, the PO-client relationship must be strong enough for the client to be invested in the PO’s opinion of them.
- This may require that the PO refrain from using sanctions too much since this can damage the PO-client relationship (see below).
Environmental Restructuring
- Since officers have limited ability to modify the environment that a client resides in (for example, lower the crime rate, provide better recreational facilities, or even improve street lighting), environmental restructuring in community supervision typically requires officers to make clients aware of the risks associated with their environment so that they make changes to it or move to a new one.
- Traditionally, environmental restructuring in community supervision often involves mandates prohibiting clients from frequenting certain areas (physical contexts) or associating with certain friends and family members (social contexts) via curfews, electronic monitoring, etc.
- These mandates can be accompanied by a sanction if the person is unable to make the changes immediately or at all.
- Environmental restructuring is best achieved by building and relying on the officer-client relationship.
Transportation Resources
- Transportation resources are usually provided in two ways:
- as an incentive for clients who comply with the conditions of supervision (for example, some programs provide clients with bus passes for every negative drug test the client provides showing they have not used drugs recently)
- on a scheduled basis to help clients comply with supervision conditions and get where they need to go (for example, the officer may provide the client with bus passes to help them get to work, a treatment center, or the supervision agency office)
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