“Catching People Doing Things Right”

(c) 2004, Robert Crumb. All Rights Reserved.

c) 2004, Robert Crumb. All Rights Reserved.

Collaborative Behavioral Management for Drug-Involved Parolees:

Step’n OutRhode Island Research Center – Peter Friedmann, Magdalena Harrington, Traci C. Green, Jennifer Clarke,

Randall Hoskinson.Advancing Correctional Excellence, George Mason University – Faye Taxman, Anne Giuranna Rhodes.Connecticut Research Center – Linda Frisman, Mark Litt, Susan Pease, Eleni Rodis.Mid-Atlantic Research Center – Dan O’Connell, Steven Martin, James Inciardi.Pacific Coast Research Center – William Burdon, Michael Prendergast. National Institute on Drug Abuse – Bennett Fletcher.Friends Research Institute – Elizabeth Katz

CJ-DATS is funded by NIDA in collaboration with SAMHSA, CDC, NIAAA, and BJA

Benefits of Integration Uncertain in Community Corrections

• Widely assumed integration is good• Integration will increase intensity of supervision

– More contacts (directly or indirectly)• Literature on intensive parole supervision (Petersilia &

Turner, 1993)

↑surveillance ⇒ ↑detection of technical violations ⇒↑sanctioning ⇒ ↑revocation*

• For integration to work, POs need behavioral management tools other than just sanctions

*(DSMB monitored closely in Step’n Out)

Collaborative Behavioral Management (CBM)

• Parole more meaningful if based on theory and evidence, not just surveillance and punishment– Translate NIDA’s community reinforcement approach to give POs

tools to reinforce pro-social behavior– Translate role induction principles to align & coordinate parole

with addiction treatment• Apply rewards and sanctions fairly & consistently

– Currently, rewards are foreign to parole culture– Adversarial relationships and parolees’ perception that the

system is “out to get them” does not facilitate behavioral change• Rewards related to recovery serve as bridge reinforcement

until natural reinforcers (e.g. paycheck, etc.)

Theoretical Foundations• Role Theory

– Integration ⇒ ↓ discrepant expectations • Procedural Justice Theory

– Clear, fair and equitable rules ⇒ ↑ compliance• Learning Theory

– Reinforced behavior is repeated– Reinforcement ideally immediate & reliable

• Collaboration ⇒ ↑ immediacy & reliability of reinforcers

Basic Principles of CBM• Agreement among all parties about most

important goals• Weekly behavioral contract with client for

target behaviors– Help client plan and take small, feasible steps

towards goals• Focus on good behavior and reinforce it

– “Catch People Doing Things Right”• Apply rewards and sanctions fairly and

consistently

Target Behaviors

• Four levels– Red: Target behaviors directly related to public

safety (i.e. lead to immediate arrest)– Orange: Target behaviors related to substance use– Yellow: Target behaviors directly related to achieving

abstinence (e.g., session attendance)– Green: Target behaviors that support recovery

• Differ in the extent to which they receive rewards and sanctions

Technology•Organize key information for managing offender progress•Provide decision support (eg. reminders, suggest rewards, etc.)•Minimize human limitations: memory, conflicting perceptions, etc.•Improve fidelity

Rewards

Points

GREEN

YELLOW

ORANGE

RED

Compliance

Points Accelerate with Continuous Compliance

0

50

100

150

200

250

Max. points /objective

Max. points /week

Max. totalpoints

1 2 3 4 5 6 7 8 9 10 11 12Week of CBM

0

10

20

30

40

50

60

1 2 3 4 5 6 7 8 9 10 11 12

Points Earned

Small Material Reward

Medium Social Reward

Week

Small Social Reward

No.

Acc

umul

ated

Poi

nts

Medium Material Reward

Graduated Rewards

• Local authorities approved menu of rewards relevant to recovery

• Offender selects rewards that are meaningful to him/her

• PO/counselor give rewards at point milestones

Graduated Rewards: SmallSocial Material

•Public recognition of client with cake•Coffee while client waits for drug screen•Help from PO in searching want ads•Ask family member to cook favorite meal•Assistance with job application•Comfortable chair in group session•Ride to treatment•Reduce wait time to see PO•Handwritten letter from PO and counselor specifying accomplishments to date•Handwritten letter from parole supervisor and/or treatment program director specifying accomplishments to date•Telephone call from PO / counselor to partner, parent, friend to say how well she/he is doing•Telephone and quiet space to call re: jobs

•Bus tokens or passes•Manicure or haircut•Gym pass•Gift certificate for phone card•Voucher for toiletries•Gift certificate for meal w/ children•Condoms•Food before group•Long-distance call from office•Candy bar•Toys, diapers, baby food•H/C gift certificate•Gift certificate to take sponsor for coffee or lunch•Gift certificate for gasoline•Purchase of fine paper for resume

or cover letter

Graduated Rewards: MediumSocial Material

•PO attends 30 day chip ceremony at AA•Organized group outing honoring client•Recognition Circle (PO, counselor, others present handwritten notes of recognition)•Opportunity to act as Group Leader•Designated parking for “Client of the Week”•Come to staff meeting & give feedback•Methadone take home privilege•Out of state travel•Mock interview to practice interviewing skills•Certificate of Attendance at treatment•Call from the PO to the client’s partner or friend asking them to give a massage•Step’n Out medallion•Secretary time to type resume/cover letter•Different format of contact (e.g., phone contacts alternating with in person contacts)•“Bye” week (i.e., miss a single session or urine test without consequences)

•Waiver of supervision fee•Access to a personal trainer•Gift certificate for shoes/apparel•Tickets to a sporting event•Gift certificate for child care•Magazine subscription•Monetary help for driver’s license•Rebates for treatment•Tickets to take children to zoo•Partial payment of rent or utilities•Gift certificate for groceries•Partial payment toward equipment for work or books for school•Payment toward clothes for interview•Partial payment of tuition for GED or other training program•Partial payment for prescribed medications or doctor’s visits•Partial payment of fines or restitution

Graduated Rewards: LargeSocial Material

•Letter to Department of Children and Families reporting progress in treatment•Letter to Judge or Parole Board requesting that a specific condition of parole be relaxed (e.g., that the client be released from home monitoring)•Certificate of program completion (“aftercare diploma”)•Letter from Judge, Parole Chair, or a Senior Correctional Officer (with a copy in file) commending for perfect or near perfect attendance to date•Decrease reporting frequency•Decrease frequency of UA testing

NA

Non-compliant

Reward

Point

Graduated Sanctions

Problem-Solving

Enter ResetPeriod

Arrest/Revocation

GREEN

YELLOW

ORANGE

RED

1

HeldNon-Compliance

Graduated SanctionsInfractions in 30 days Examples

One •Verbal Reprimand•Written Documentation

Two •Written Reprimand•Increased UA screening

Three •Tighten Curfew•Modify Treatment Conditions

Four •Electronic Monitoring•Daily Reporting

Five •Intensive Treatment Required•Report to Parole Board

Sanctions reset after two weeks of full compliance

Step’n Out Study Design

Informed Consent, Baseline Interview, Randomization

Screen: 12+weeks parole w/drug treatment mandate, moderate-to-high risk recidivism

CBM•Co-located team approach –initial & biweekly triad session•Initial session role induction•Weekly behavioral contract•Points and rewards with reset (SNOCONE)•Graduated sanctions

Traditional Parole•Separate parole and treatment according to local standards•Usual sanctions

3- and 9-month follow-up interviews, chart and admin. data

Sites

Final NWilmington, DE 258Bridgeport, CT 74Portland, OR 69Richmond, VA 85Providence, RI 32Hartford, CT 51

Final Recruitment

Screened 623Randomized 569Reached Initial Session 4763-month FUs: 437 (91.8%)9-month FUs: 325 (85.1%)

Study Population CBM Control

Mean Age 34 34Male 83% 81%White 55% 58%LCSF high risk 63% 62%Lifetime -arrests 11.2 (11) 11.8 (14)-treatment episodes 2.6 (2.9) 2.2 (2.2)

Primary heroinPrimary stimulant

24%27%

22%26%

Modeling Count Data

• Siméon-Denis Poisson in 1838 work “Research on the Probability of Judgments in Criminal and Civil Matters“– Assumes sample mean and variance are equal

• The negative binomial distribution is an alternative to the Poisson when varianceexceeds the sample mean– Much more conservative approach subject to Type

II error

Variable N Mean VarAll Crime 428 9.98 1085

Violent 428 0.556 51.8Property 428 0.474 22.6

Primary Drug

396 9.23 1005

Challenging Data Modeling

Overall Crime

1911

52

2495

58

‐250

250

750

1250

1750

2250

2750

Crimes committed People engaged in crime

Self‐reported criminal involvement over 9 months follow up

Coun

t

intervention

control

RR .79 ZIP; P<.001RR .75 ZINB; P=.49

Violent Crime

7 4

231

5

0

50

100

150

200

250

Crimes committed People engaged in crime

Self reported crime over 9 months follow up

Coun

t

intervention

control

RR .04 ZIP; P<.001RR .01 ZINB

P for ZINB=.002, alpha is NS, so ZIP model is OK

Property Crime

17

6

186

12

0

20

40

60

80

100

120

140

160

180

200

Crimes committed People engaged in crime

Self reported crime over 9 months follow up

Coun

t

intervention

control

RR .18 ZIP; P<.001RR .08 ZINB

P for ZINB=.01, alpha is NS, so ZIP model is OK

Primary Problem Drug Use

1377

40

2280

46

0

500

1000

1500

2000

2500

Days of drug use People reporting drug use

Coun

t

intervention

control

RR .67 ZIP; P<.001RR .71 ZINB; P<.43

Gender interaction*:1) women reduced more than

men 2) women in the CBM group

reduced more than men in CBM and control groups.

*CAUTION!: Small Ns and effect driven by the heavy drug use in the tails of the distributions

Marijuana Use

1329

37

1816

41

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Days of drug use People reporting drug use

Coun

t

intervention

control

RR .74 ZIP; P<.001RR .70 ZINB; P=.49

Opiate Use

1230

33

1449

29

0

200

400

600

800

1000

1200

1400

1600

Days of drug use People reporting drug use

Coun

t

intervention

control

RR .80 ZIP; P<.001RR .85 ZINB; P<.76

Stimulant Use

2110

59

1549

51

0

500

1000

1500

2000

2500

Days of drug use People reporting drug use

Coun

t

intervention

control

RR 1.20 ZIP; P<.001RR 1.19 ZINB; P=.65

Parole Violations

0

1

2

3

4

Mean no. parole

violations/100 days at

risk

3 month 9 month

Control CBM

CBM Integrated & Intensified Parole

same day parole and treatment(2.2 vs. 1.2 days)†total parole sessions (13 vs. 10)*face to face parole (9 vs. 8)†

*P<.10 compared to traditional parole group†P<.001 compared to traditional parole group

CBM Improved PO-Client Relationships

At 3-month follow-up, parolees reported:relationship with PO*

PO Probationer relationship scale45-item measure of offender perception of relationship with PO (Skeem and Taxman, in press).

therapeutic alliance with PO and counselor*Working Alliance Inventory: 14-item measure of therapeutic alliance (Horvath & Greenberg, 1989)

*P<.001 compared to traditional parole group

CBM Feasible and Acceptable

• Adaptable to local standards– Delaware adapted to group contacts– Rewards approved locally to suit local standards

• perception of value of direct collaboration• Helped PO see importance of communication

– few had thought about this as an issue • e.g. telling offender what to do vs. helping them learn to do it

• Contract provides structure / dialogue for contacts• Decision support systems helpful, but need

improvement

Promising Intervention

• Evidence-based contracting, CRA/CM can be adapted to CJ settings

• Lower than expected event rates– Research volunteer effect– Decreased study power

• Among those who re-offend, CBM:crime, primary drug useparole intensity with no change inviolations or arrests

rapport and therapeutic alliance

• Integrated parole/treatment feasible and acceptable

• Community supervision practice can be based on sound theory and evidence

• PO-parolee relationships crucial to reentry– CBM shows one way to facilitate better

therapeutic alliance• Research needed to examine impact of

CBM with evidence-based treatment

Implications