Confronting Relapse and Recidivism: Case Management and ...

[Pages:178]The author(s) shown below used Federal funds provided by the U.S. Department of Justice and prepared the following final report:

Document Title:

Author(s): Document No.: Date Received: Award Number:

Confronting Relapse and Recidivism: Case Management and Aftercare Services in the OPTS Programs

Shelli Rossman; Caterina Gouvis; Janeen Buck; Elaine Morley

181047

February 18, 2000

94-IJ-CX-0010

This report has not been published by the U.S. Department of Justice. To provide better customer service, NCJRS has made this Federallyfunded grant final report available electronically in addition to traditional paper copies.

Opinions or points of view expressed are those of the author(s) and do not necessarily reflect

the official position or policies of the U.S. Department of Justice.

G RELAPSE AND RECIDIVISM: AND AFTERCARE PROGRAMS

The Urban Institute

2100 M Street, N.W. Washington, DC 20037

nay 21, 1999

Shelli Rossman Caterina Gouvis Janeen Buck Elaine Morley

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

TABLE OF CONTENTS

EXECUTIVESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CaseManagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Supervision and Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 ServiceProvision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Systems Integration and Program Institutionalization . . . . . . . . . . . . . . . . . . . . . . 8

Chapter 1: The Opportunity to Succeed Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 TheOPTSModel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 The OPTS Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 The Research Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Datasources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 TheScopeofThisReport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Chapter 2: The Primary Partnerships and Case Management Services . . . . . . . . . . . . . . . 19

The Primary Partnerships: Lead Service Agencies and Community-Based Corrections

Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 CaseManagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ServicePianning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 ServiceProvision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Monitoring Client Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Client Satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Case Management Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Chapter 3: Substance Abuse Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Clients' Presenting Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 The Spectrum of Substance Abuse Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Self-Help Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Outpatient Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Residential Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Detoxification Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Challenges to Providing Substance Abuse Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Chapter 4: Employment Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Employment Service Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Challenges to Providing Employment Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Chapter-5: Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Transitional Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Crisis Shelter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

1

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Permanent Housing and Housing Assistahce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Challenges to.Providing Housing Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Chapter 6: Family Strengthening and Life Skills Services . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Skills Building Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Domestic Violence Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Family Outreach Efforts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Challenges to Providing Family Strengthening and Life Skills Services . . . . . . . . . . .108

Chapter 7: Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Medical and Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Challenges to Serving OPTS Clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Chapter& LessonsLearneFd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 CaseManagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Service Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Familiarity With Core Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 CrisisManagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Recommendations for Strengthening Case Management . . . . . . . . . . . . . . . . . 126

Systems Integration: The OPTS Lead Agency and the Criminal Justice System 128

Establishing OPTS Within the Criminal Justice System . . . . . . . . . . . . . . . . . .128 Institutionalizing Roles and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Supervision of Substance-Abusing Offenders . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Recommendations for Strengthening Supervision and Criminal Justice Systems Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

ServiceNetwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Recommendations for Strengthening Service Networks . . . . . . . . . . . . . . . . . . 138

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

APPENDIX A APPENDIX B .APPENDIX C APPENDIX D

Tampa Materials Kansas City Materials St. Louis Materials APPENDIX E

..

11

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

LIST OF 8XHIBITS

Exhibit 1-1 : The OPTS Evaluation Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Exhibit 2-1: Primary Partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Exhibit 2-2: Overview of OPTS Collaborative Service Delivery Structure. by Site . . . . .26

Exhibit 2-3: In-Person Contact With Case Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Exhibit 2-4: Home Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Exhibit 2-5: PO Contact: Comparing OPTS Clients to Routine Supervision . . . . . . . . . . . 39 Exhibit 2-6: Average Number of Drug Tests. per Client . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Exhibit 2-7: Clients' Perception of Case Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Exhibit 2-8: Clients' Perception of Probatioflarole Officers . . . . . . . . . . . . . . . . . . . . . . 48 Exhibit 3-1: Drug Use History of OPTS Clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Exhibit 3-2: Prevalent Patterns of Drug Use for OPTS Clients ..................... 56 Exhibit 3-3: Substance Abuse Treatment Providers. by Treatment Type and Site . . . . . . .58 Exhibit 3-4: Substance Abuse Services Used by Clients . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Exhibit 3-5: Duration. Intensity. and Short-Term Outcomes of Substance Abuse

Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Exhibit 4-1 : Employment-Related Problems Reported by OPTS Clients . . . . . . . . . . . . . 79 Eshibit 4-2: Referrals for Employment Assistance. by Site . . . . . . . . . . . . . . . . . . . . . . . . 80 Exhibit 5-1 : Referrals for Housing Services. by Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Exhibit 6-1: Referrals for Family Strengthening. Life Skills. and Self Sufficiency.

by Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

. Exhibit 6-3: Client Participation in Parenting Skills by Site . . . . . . . . . . . . . . . . . . . . . . . 103

Exhibit 7-1 : Referrals for Health Care.by Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

...

111

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

EXECUTIVE SUMMARY

Overview

The Opportunity to Succeed (OPTS) program was designed to reduce substance abuse relapse and criminal recidivism by providing comprehensive aftercare services to felony offenders who have alcohol and drug offense histories. Enrollment in OPTS was anticipated to improve access to, and.utilization of, needed community-based services by eligible probationers/parolees. In addition to supporting sobriety and reducing criminal activity, OPTS services were expected to promote pro-social attitudes and behaviors among participants, resulting in such desirable outcomes as gainful employment and responsible family/domestic arrangements.

The Opportunity to Succeed Mission

I1

Opportunity to Succeed programs are intended to deliver community-based services that promote sobriety, lawabiding. and other pro-social behavior in adult, substance-abusing felons. The program rationale is that such offenders are less likely to relapse and engage in hture crimes if they are exposed to a comprehensive suite of aftercare services (including substance abuse treatment, counseling, and skills-building activities), as well as graduated sanctions that include incentives for positive behavior and penalties for failure to comply with program requirements. Service delivery is structured around case management, involving collaborative partnerships between a lead service agency and the local probatiowparole office in each demonstration site.

OPTS programs were initiated in 1994 as three-year demonstrations in five communities - Kansas Cit)?,MO; New York City, NY; Oakland. CA; St. Louis, MO; and Tampa, FL. The proyam model \\!as developed by The National Center on Addiction and Substance Abuse ( C.AS.4): both program implementation and evaluation occurred under CASA's administrative o\.crsight.The demonstration programs were funded by the Robert Wood Johnson Foundation ( Rii.1 I and the Bureau of Justice Assistance at the U.S. Department of Justice. OPTS programs continued in three of the original sites beyond the demonstration phase, which concluded in Summer. 1997. The National Institute of Justice (NIJ) and RWJ funded The Urban Institute's e\.aluation of OPTS implementation and impact in three communities -- Kansas City, MO; St. Louis. 310: and Tampa, FL.

OPTS pairs local probatiowparole departments -- offices of the Missouri Department of ('orrections i n Kansas City and St. Louis, and the Florida Department of Corrections in Tampa -\\ i t h icad s e n ice azencles that provide case management and other social services. The primary s c n ice pro\ iders -- The National Council on Alcoholism and Drug Dependence (Kansas City), tht' Drug Abuse Comprehensive Coordinating Office (Tampa), and Lutheran Family and Children's Sen,ices(St. Louis) -- directly delivered some treatment and supportive services to

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

adult probationer/parolees (as well as provided limited assistance to their family or domestic networks), in addition to referring OPTS clients to other service providers with whom the sites had established MOUs or close working relations.

The research used an experimental model that randomly assigned eligible felons to either the OPTS program (treatment group) or routine supervision (control group).Program implementation was documented by rt searchers using a number of techniques, including field visits to directly observe program activities; one-on-one interviews and small group discussions with staff, and separately with clients; and secondary analysis of program materials (e.g.. memoranda of agreement, brochures, newsletters).

This report describes the major components of the OPTS model, including aspects of case management and supervision, as well as core services offered to OPTS clients in each of the five core domains in the three selected sites (see Morley et al., 1995, 1998; and Rossman et al., 1998a, 1998b, for other OPTS documentation reports).

OPTS Core Services

Substance abuse treatment, ranging from 12-step programs through intensive residential placements,

is a key component of the OPTS model.

.

E m d o v m e n t services that assist clients in finding and maintaining legitimate employment.

HousinP. including adequate, drug-free supportive living situations, such as halfway houses, group houses. and apartments to share, to assist clients in avoiding relapse.

Familv strengthening services, such as parenting classes, family counseling, anger management, and domestic violence counseling.

Health and mental health services. ranging from regular check-ups to specialized care when needed, are envisioned since substance abusers often have a wide variety of physical and mental health problems.

Although the model calls for the provision of these core senices, it does not expect that each OPTS client will require the full spectrum of support Rather. senices are to be provided on an as-needed basis. The exception to this is the substance abuse treatment. which is a mandatory requirement for all participants.

This report also assesses selected service utilization attributes and outcomes, including such considerations as: 1 ) the use of specific categories of services (e.g., housing, family skills training. education or training programs); 2 ) the variety and comprehensiveness of services supporting individuals; 3) the service intensity, ].e., the number of contacts and duration of utilization by senice type; and 4)recipients' reported level of satisfaction with the services they recei \.ed.

2

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

Key Findings

There was a high degree of variation among the sites in terms of program implementation, consistent with the model's intent to allow flexibility and autonomy in local decision making and practices. For example, sites were expected to use existing communitybased resources, in preference to developing their own services. Thus, it is not surprising that the suites of services and mix of providers varies dramatically across the three programs, as these reflected the extant service networks and capacities in Kansas City, St. Louis, and Tampa. Other site variations likely resulted from the visions, internal organizational structures, and decision making of the lead agencies and/or the partnering probation and parole agencies regarding the roles and responsibilities of their respective staffs. For example, St. Louis was the only one of the three sites to use a team approach that co-located case managers, POs, and core service providers from the substance abuse treatment and employment service areas.

In general, the sites were satisfied with their efforts in mounting this demonstration; however, both line staff and administrators acknowledged areas of weakness as their programs evolved. To their credit, individuals and organizations were often quite proactive in defining weak or troublesome elements and introducing refinements that could strengthen their local efforts.

Case Management

A key feature of the OPTS model is its use of case management. Although the model does not specify the form case management should take, it does imply that case management should involve service planning; service provision, either directly by lead agency staff or using brokered services; and monitoring of client progress. Case manager contact also facilitates the intcnsi\,e supervision anticipated by the OPTS model (as an adjunct to probation officer o\ ersight). Overall, OPTS clients generally appreciated their case managers, viewing them as ad\,ocates who supported and motivated them.

0 OPTS clients had considerable amounts of contact with their case managers, particularly in their early stases of OPTS participation. Clients experiencing a crisis situation (e.g., having a relapse, being evicted) or those with particularly difficult problems received more focused attention until the situation was resolved. Overall, 69% of clients reported they met with their case manager at least weekly during the first three months ofparticipation in OPTS, and 19% of this group reported daily or almost daily meetings during that time period; 25% of clients reported daily telephone contact during that timeframe. Frequency of case manager-client contact diminished over time, as planned by the sites. By the last three months of their first year in OPTS, only 35% of clients reported weekly contact with case managers.

3

This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download