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American attitudes regarding offender rehabilitation in correctional populations and community reentry policies reflect high public safety concerns over the release of 700,000 prisoners annually (Krisberg & Marchionna, 2006).  Rehab services for prisoners were favored by a margin of 8 to 1 (versus “punishment only”), and 70% supported the use of addiction treatment during prison and after release.  A leading factor in the high re-arrest rates following prison release was believed to be offenders’ lack of life skills.  Research shows return to prison is less likely for offenders treated for drug addiction, but there is growing interest in how to provide more effective treatment to a higher proportion of offenders with drug-related problems (Belenko & Peugh, 2005).  Feedback from over 600 treatment counselors working in correctional and community programs located in three different states and involved in TCU research projects address this question.  Over 70% of these treatment professionals believe there is a need for more instruction on new medications, better interventions to deal with special populations (e.g., women, adolescent, and mentally ill offenders), more efficient tools for diagnostic and performance assessments, and a conceptual guide for managing treatment stages.  Three out of four also wanted training on innovations designed to help improve offender cognitive skills (thinking styles and problem solving) and direct access to user-friendly treatment delivery resources via the Internet.   

Lead Investigators:  Kevin Knight, Dwayne Simpson, Pat Flynn

Providing “better treatment” can be viewed as a 2-stage process.  Step one is the establishment of effective intervention and assessment resources for treating offenders, and the second is getting these clinical tools adopted and widely implemented in correctional treatment systems.  The major resources developed in these areas at TCU over the past 15 years fall into the following four categories.

Risk assessment.  The TCU Drug Screen is a clinical (DSM-based) tool to screen for offender drug use problem severity and treatment needs (Knight, Simpson, & Hiller, 2002).  This brief self-administered assessment yields a drug problem severity score (range 0-9) that, along with providing drug use and treatment history information, helps guide treatment decisions.  Its credibility in comparative studies with other assessments (Peters et al., 2000) has made it a leading diagnostic tool that is administered currently to a large percentage of all prison admissions in the U.S. 

Needs and performance assessments.  Brief assessments of client needs and functioning are fundamental to effective clinical management during treatment.  Within the context of the TCU Treatment Process Model (Simpson, 2004, 2006), the domains of motivation, psychological functioning, social functioning, and therapeutic engagement are central to client progress and performance.  The Client Evaluation of Self and Treatment (CEST, see Joe et al., 2002) contains scales shown to measure these areas and provides a reliable tool for monitoring change.  A version adapted to CJ populations has the same properties and is now being administered at predetermined points throughout treatment to help providers evaluate client progress and plan the appropriate “next stage” of care (Garner et al., 2007; Roberts et al., 2007).  Broader applications of these assessments are also discussed in a special volume of Criminal Justice & Behavior (Simpson & Knight, 2007), based on research conducted as part of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) project described later.

Life-skills interventions.  The need for interventions that focus on life skills—including social relations and communications, management of emotions, cognitive reasoning and problem solving, and health management—is common at correctional and community treatment settings.  To this end, a series of targeted intervention manuals and related modules have been developed using a mapping-based counseling strategy (i.e., node-link mapping) shown to be beneficial in treating correctional populations (Czuchry & Dansereau, 2003, 2005; Czuchry, Sia, & Dansereau, 2006; Dansereau, 2005).  Most of these life skill interventions are designed for delivery in 4 sessions, with user-friendly formatting for explaining purposes and procedures.  (Also see evidence for Counseling Manuals.)

Conceptual framework for treatment process.  A “high-altitude” overview of treatment components – care planning, assessments, and interventions – has been requested by clinical staff to help them understand how diverse elements of therapeutic care all fit together in an integrated, stage-based process.  The TCU Treatment Process Model assimilates research findings into a conceptual framework that facilitates management applications, both at the client and program levels (see Simpson, 2004, 2006; Simpson, Knight, & Dansereau, 2004).  The integrated and strategic use of interventions and assessments are the building blocks of this process. 

However, having effective treatment tools available does not mean they necessarily will be used.  TCU studies are also focusing, therefore, on how organizational resources and functioning influence the process of planning and effectively implementing innovations in field settings (see Simpson, 2002; Simpson & Flynn, 2007; Simpson & Dansereau, 2007).  Our most recent work within correctional systems has been carried out as part of the CJ-DATS cooperative agreement.

What is CJ-DATS?  In 2002, the National Institute on Drug Abuse (NIDA) funded the cooperative agreement “Criminal Justice Drug Abuse Treatment Studies” (CJ-DATS).  It includes national research centers that collaborate with regional treatment provider networks and NIDA.  Major research themes focus on offender risks and needs assessments, treatment interventions and monitoring, community reentry, special populations, and systems integration.  Formal guidelines facilitate the steps for research review, approval, implementation, monitoring, and reporting study results.  This scientific and dissemination management process as well as reports that summarize the rationale, goals, and methods for each approved study are available at the CJ-DATS Web site (www.cjdats.org).

This initiative includes the goal of studying how treatment effectiveness is achieved with regard to the therapeutic, organizational, and systems processes within correctional settings.  The original NIDA-funding announcement directed that among other things, attention be given to (1) development of measures on offender needs and functioning that can be used as indicators for monitoring treatment performance as well as evaluating intervention effectiveness, (2) how motivation and other offender attributes affect treatment engagement, participation, and outcomes, and (3) strategies for improving linkages between correctional and community-based treatment services.

The first protocol approved for implementation in CJ-DATS was the Performance Indicators for Corrections (PIC) study.  This multi-center study has been lead by the Texas Christian University (TCU) Southwest Research Center and included collaborating teams from the National Development and Research Institutes, Inc. (NDRI), University of California at Los Angeles (UCLA), University of Delaware, and University of Kentucky.  It evaluated two assessment tools on offender functioning – the TCU Criminal Justice Client Evaluation of Self and Treatment (CJ CEST), and NDRI Client Assessment Inventory (CAI).  Specific aims were to establish methodological evidence for assessments that focus on client functioning and treatment engagement, client responses to treatment interventions, monitoring needs and performance over time, and overall program functioning across a diverse national sample involving 26 correctional settings.  A special issue of Criminal Justice & Behavior (Simpson & Knight, 2007, guest editors) is devoted to publications from this work.

Another TCU-guided protocol approved for implementation in CJ-DATS is the Targeted Interventions for Corrections (TIC) study.  This investigation is evaluating the effectiveness of a series of brief (manual-guided) life skills interventions being adapted to correctional settings.  Each CJ-DATS Research Center recruited correctional systems and treatment providers to serve as collaborators in the development and testing of new treatment protocols.  Current TCU partners include the several state-level departments of corrections (including Texas, Oklahoma, New Mexico, Arizona, Illinois, and Nebraska), the Illinois Treatment Alternatives for Safe Communities (TASC) which specializes in mental health and drug treatment case management services, and national drug treatment provider organizations for correctional systems (CiviGenics and Gateway Foundation).  

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