Residential Substance Abuse Treatment for State …. Department of Justice Office of Justice...

U.S. Department of JusticeOffice of Justice ProgramsNational Institute of Justice

Special

AP

R.03

ImplementationLessons Learned

REPORT

Residential Substance Abuse Treatment for State Prisoners

WEB-ONLY DOCUMENT

U.S. Department of Justice

Office of Justice Programs

810 Seventh Street N.W.

Washington, DC 20531

John Ashcroft

Attorney General

Deborah J. Daniels

Assistant Attorney General

Sarah V. Hart

Director, National Institute of Justice

This and other publications and products of the U.S. Department

of Justice, Office of Justice Programs, National Institute of Justice

can be found on the World Wide Web at the following site:

Office of Justice Programs

National Institute of Justice

http://www.ojp.usdoj.gov/nij

Residential Substance Abuse Treatment

for State Prisoners

Implementation Lessons Learned

Lana D. Harrison and Steven S. Martin

APR. 03

NCJ 195738

Findings and conclusions of the research reported here are those of the authors and do notreflect the official position or policies of the U.S. Department of Justice.

The National Institute of Justice is a component of the Office of Justice Programs, which alsoincludes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the Office of JuvenileJustice and Delinquency Prevention, and the Office for Victims of Crime.

Sarah V. Hart

Director

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These evaluations of the ResidentialSubstance Abuse Treatment (RSAT) pro-gram critique a Federal effort to encourageStates to develop substance treatmentprograms for incarcerated offenders. TheCorrections Program Office within theOffice of Justice Programs provided in-valuable support for both the RSAT pro-gram and these evaluations.

This publication offers program administra-tors the opportunity to modify or improveprograms that are working well and adjustor discontinue programs that are not per-forming adequately. An evaluation may re-veal that a program can achieve the goal itwas designed to achieve with just a fewmodifications. It may also reveal that theprogram simply is not producing enoughresults to justify continued funding.

With the advent of performance-basedbudgeting and increased accountability totaxpayers, substance abuse professionalsmust clearly articulate and demonstrate—with data—how treatment programs foroffenders can be successful and costeffective to the government.

Pilot programs can be set up so that theirsuccess or failure is measured throughobjective evaluation that will enable pro-gram administrators to learn which pro-grams are producing the best results forthe best price. Effective programs willprove themselves through data, and

program administrators will no longer have to convince the general population andgovernment that treatment works.

It is important to collect program datacarefully so that the data truly representthe program reality. Only accurate datacan contribute to an effective evaluation.Program administrators must continuallyimprove both their programs and their datacollection and management procedures.

This publication will allow substanceabuse professionals to share ideas. Thosein one State can learn from another’s suc-cesses or failures as they develop, imple-ment, and evaluate programs. Increasingawareness of similar programs across thecountry will open new channels of com-munication. Objective program evaluationand open dialog within the treatment community—as well as publication ofreports such as this—will enable RSATparticipants to make new contacts, gathernew ideas, and offer suggestions.

This report represents a significant accomplishment—both for the programsreviewed and for the RSAT program creators—and will be a practical tool infuture evaluation efforts.

Richard Nimer

Director of Program ServicesFlorida Department of Corrections

Preface

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The prison population is at a record high,and most of these inmates have sub-stance abuse problems. With this problemin mind, Congress created the ResidentialSubstance Abuse Treatment (RSAT) forState Prisoners Formula Grant Program,which encourages States to develop sub-stance abuse treatment programs for in-carcerated offenders. Because of RSAT,intensive drug treatment programs havebecome the norm in correctional settingsrather than the exception. Reductions inthe costs of crime, criminal justice servic-es, and health care services have shownthat treatment is cost effective. This re-port summarizes the results of a NationalEvaluation of RSAT and process evalua-tions of 12 local sites across the country.

RSAT highlights■ RSAT has been responsible for substan-

tial increases in the availability of treat-ment slots for offenders with substanceabuse problems and in the number ofstaff trained to treat them.

■ By the end of the 2-year evaluation,more than 13,000 inmates had beenadmitted to these programs.

■ About 70 percent of the programswere aimed at adult offenders; therest targeted juveniles.

Remaining obstacles■ RSAT programs experienced some start-

up difficulties in locating and buildingfacilities, recruiting trained staff, andcontracting with treatment providers.Preexisting programs did better in thisrespect.

■ Although research shows that aftercareleads to a reduction in reoffense rates,less than half of RSAT programs wereable to include an aftercare component,largely because RSAT funds can be usedonly for residential treatment for offend-ers in custody.

■ Many RSAT programs combined ele-ments of one or more treatment types;such combinations, however, have notbeen evaluated and may lead to a“watering down” of treatment.

Who should read this report?Corrections officials, substance abusetreatment providers, and Federal, State,and local policymakers.

About This Report

vii

The Residential Substance AbuseTreatment (RSAT) for State PrisonersFormula Grant Program was created bythe Violent Crime Control and Law En-forcement Act of 1994 in response to theincreasing number of incarcerated individ-uals in the United States with substanceabuse problems. RSAT encourages Statesto develop substance abuse treatmentprograms for incarcerated offenders byproviding funds for their development andimplementation.

RSAT grants may be used to establish orexpand substance abuse treatment pro-grams for inmates in residential facilitiesoperated by State and local correctionalagencies. To receive RSAT funding, pro-grams must be 6 to 12 months in dura-tion, provide residential facilities that areset apart from the general correctionalpopulation, be devoted to substanceabuse treatment, teach inmates the social,behavioral, and vocational skills to resolvesubstance abuse problems, and requiredrug and alcohol testing. States are alsorequired to give preference to programsthat provide aftercare services.

All of the Nation’s 56 States and Territorieshave RSAT programs. By March 2001,more than 2,000 programs were in place.

To test RSAT’s effectiveness, the NationalInstitute of Justice (NIJ) and the Correc-tions Program Office (CPO) developedan evaluation program that includes aNational Evaluation of RSAT and 37 pro-cess evaluations of the local RSAT pro-grams. The National Evaluation and thefirst 12 process (or implementation) evalu-ations completed are discussed in the fol-lowing pages. The complete backgroundand findings of these evaluations may befound online at http://www.ojp.usdoj.gov/nij/rsat. (Results of a third component of

the NIJ/CPO evaluation program—18 outcome evaluations of selected pro-grams—are pending.)

Findings from the National Evaluationindicate that—

■ RSAT has been responsible for substan-tial increases in the number of residen-tial and nonresidential treatment slotsavailable for offenders with substanceabuse problems and in the number ofstaff trained to work in substance abusetreatment programs.

■ By the end of the 2-year evaluation,more than 13,000 inmates had beenadmitted to RSAT programs, 3,600 hadgraduated, and 7,700 were still activelyinvolved.

■ About 70 percent of operational pro-grams were aimed at adult offenders;the remainder targeted juveniles.

■ About 70 percent of RSAT programswere for men, 12 percent were forwomen, and the rest were for bothsexes.

Evaluators found that at the outset, manyRSAT programs experienced difficulties inlocating and building facilities, recruitingtrained staff, and contracting with treat-ment providers. Preexisting programsfared better in this regard, perhaps be-cause they had overcome their startup difficulties before the evaluation.

Unfortunately, administrative expediencyand demands often took precedence overprogram operations. Programs were filledto capacity before sufficient staff werehired. Mistakes were made in referringinmates to the program and in matchingtreatment to their remaining sentences.The pressures of overcrowding often

Executive Summary

viii

meant that RSAT inmates could not be iso-lated from the general inmate population.

Despite research that shows that aftercareleads to a reduction in recidivism, evalua-tors found that less than half of the RSATprograms included an aftercare compo-nent, in large part because RSAT fundingcould not be used for aftercare programs.

The merging of different types of treat-ment was another concern. Most of theprograms evaluated combined elementsof one or more treatment types. Suchcombination treatments, however, havenot been fully evaluated and may lead toa “watering down” of treatment.

Evaluators also noted the need for treat-ment options in jail settings. Jail-basedoffenders with substance abuse problemsare a significant group, as the ArresteeDrug Use Monitoring (ADAM) programstudies make clear, but the transientnature of jail-based populations is not con-ducive to a lengthy, structured treatment

program. Jails should consider incorporat-ing short-term education and interventionrather than long-term, phased treatment.Such programs require further investiga-tion, but their absence represents a neg-lected opportunity to reduce drug use and recidivism among offenders.

Nevertheless, the evaluations showedthat RSAT programs had made notableprogress in overcoming their startup prob-lems. Only a few programs seemed to bein serious trouble; established programsthat used RSAT funds to expand theiroperations fared best. Thorough planning,a dedicated and experienced staff, andsupport from higher level administratorswere all seen as crucial to a program’ssuccess.

At least until a pharmacological “silverbullet” is found, the only way to addressthe offender substance abuse problem isthrough lengthy and intensive behavioralintervention. RSAT promises to be a signif-icant step in this direction.

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Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

About This Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

RSAT for State Prisoners: A Major Federal Initiative . . . . . . . . . . . . . . . . . . . . . . . 1

National Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Local Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

RSAT Success: Past and Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Appendix: Summaries of Completed Local Evaluations . . . . . . . . . . . . . . . . . . . 19

Contents

1

The Residential Substance Abuse Treat-ment (RSAT) for State Prisoners FormulaGrant Program has had significant nationalimplications for treating drug-involvedoffenders. Created by the Violent CrimeControl and Law Enforcement Act of1994, RSAT has encouraged States todevelop substance abuse treatment pro-grams for incarcerated offenders by pro-viding funds for their development andimplementation.

Although some noteworthy and well-publicized residential treatment programsfor offenders emerged during the late1980s and early 1990s (for example,Stay’n Out, CREST, Amity, and Kyle), theRSAT program represents the first nationalmandate or directive to affirm the value oftreatment for criminal justice populations.With the prison population at a record highand substance abuse problems presentamong a majority of inmates, RSAT hasthe potential to help break the drug-crimelink and significantly reduce the probabilityof relapse and recidivism for many offend-ers. Reductions in the costs of crime,criminal justice services, and health careservices have shown that treatment iscost effective.

RSAT is helping intensive treatment pro-grams become the norm in correctionalsettings rather than the exception. Withthe RSAT formula grant program in oper-ation, every State has been offered anincentive to expand its residential treat-ment capacity and has applied for, and isusing, RSAT funding to expand its treat-ment capacity. (See “Funding,” page 2.)

All 56 States and Territories have RSATprograms. As of March 2001, more than2,000 programs were in place around theNation.

As a direct result of RSAT, therapeuticcommunity treatment programs that hadseemed unworkable or esoteric are nowoperating successfully nationwide, andcorrections programs now regularly in-clude a cognitive-behavioral componentthat encourages inmates to change theirthinking and behavior.

Program characteristicsRSAT grants may be used to implement orexpand treatment programs for inmates inresidential facilities operated by State andlocal correctional agencies that provideindividual and group treatment activitiesfor inmates. RSAT programs also must—

■ Be 6 to 12 months in duration.

■ Provide residential treatment facilitiesset apart from the general correctionalpopulation.

■ Be directed at inmates’ substanceabuse problems.

■ Develop inmates’ cognitive, behavioral,social, vocational, and other skills toresolve substance abuse and relatedproblems.

■ Require urinalysis or other drug andalcohol testing during and after release.

RSAT for State Prisoners: A Major Federal Initiative

About the Authors

Lana D. Harrison is associate director of theUniversity of Delaware’s

Center for Drug andAlcohol Studies, where

Steven S. Martin is a senior scientist.

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SPECIAL REPORT / APR. 03

States are required to give preference toprograms that provide aftercare servicescoordinated between the correctionaltreatment program and other humanservice and rehabilitation programs.

Another important requirement of theRSAT initiative to States was to—

... ensure coordination between cor-rectional representatives and alcoholand drug abuse agencies at the Stateand, if appropriate, local levels. Thisshould include coordination betweenactivities initiated under the Programand the Substance Abuse Preventionand Treatment Block Grant providedby the Department of Health andHuman Services Substance Abuseand Mental Health ServicesAdministration.

Partnerships were encouraged betweenevaluations, State departments of correc-tions, and RSAT providers.

Evaluation characteristicsThe evaluation program developed by theNational Institute of Justice (NIJ) and theCorrections Program Office (CPO) of theOffice of Justice Programs has three components:

■ The National Evaluation of RSAT.

■ A set of implementation/process evalua-tions that examine individual RSAT sites.

■ A set of outcome evaluations thatextend some already funded processevaluations.

One goal of the evaluation was to assessa variety of programs, including those foradults and juveniles, males and females,and prisons and jails; programs based ondifferent theoretical approaches; and pro-grams conducted in different regions ofthe United States.

This report reviews findings from theNational Evaluation, which documentedthe RSAT program through its midpoint,and the first 12 local site evaluations to be completed.

FUNDING

Funding for the RSAT initiative represented the largest sum everdevoted to the development of substance abuse treatment pro-grams in State and local correctional facilities—$270 million over5 years (1996 to 2000). The sums available for the program foreach year from 1996 to 2000 were $27 million, $30 million, $63 mil-lion, $63 million, and $72 million, respectively.

Each State received a base amount of 0.4 percent of the totalfunds. The rest of the money was allocated on the basis of theratio of each State’s prison population to the total prison popula-tion of all participating States. States had to contribute 25 per-cent in matching funds. The grants are for 3 years and cannot be

used to supplant non-Federal funds that would otherwise beavailable. The mean award to the States for RSAT implementationwas about $450,000 in fiscal year (FY) 1996, rising to about$495,000 in FY 1997 and to $1 million in FY 1998; funding could becarried over to subsequent years.

The Corrections Program Office (CPO), Office of JusticePrograms, within the U.S. Department of Justice, awards RSATformula grant funds to the States and provides the NationalInstitute of Justice (NIJ) with funds for evaluating the grantprogram. NIJ and CPO developed an evaluation program thatreflects the range of RSAT programs.

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Scope and fundingThe National Evaluation was designed totrack implementation of RSAT nationallyusing data provided by the States and pro-grams. The evaluation was to includeprocess and outcome elements thatexamined the types of RSAT programsand client characteristics, the impact ofthe RSAT program on treatment capacityand the costs of treatment, and the keyelements of successful programs.

The evaluation team was also expected toidentify promising programs for intensiveimpact evaluations, appraise the evalua-tion capacity of “State residential sub-stance abuse programs,” and enhancethose capacities through feedback andtechnical assistance. NIJ hoped to developa coordinated data set from the data gath-ered from the RSAT programs. Each Statewas required to cooperate with the nation-al evaluators’ requests for data gathering.

National Development and Research In-stitutes, Inc. (NDRI), under a cooperativeagreement with NIJ and CPO, conductedthe National Evaluation from 1997 to1998. It used a series of three question-naires to collect data from all the Statesand programs. Information was updatedthrough March 30, 1999, for the finalreport.

The National Evaluation report provides asummary page for each State with correc-tional and treatment statistics for the

State, a map identifying RSAT programlocations, and a summary table of RSAT-implemented programs in the State.1

All 50 States, the 5 U.S. Territories, andthe District of Columbia had developedplans and received funds for RSAT pro-grams. By the time the evaluators con-cluded their work in March 1999, they hadidentified 97 programs that were opera-tional or about to become operational.At midpoint, at least 70 programs in 47States were fully operational and admittingclients. About one-third (35 percent) werelocated in medium-security prisons, 29percent in minimum-security prisons, and16 percent in maximum-security prisons.

Challenges

The evaluators experienced a number ofchallenges as they conducted the NationalEvaluation. Programs were continuallycoming online, and the numbers and typesof programs and the characteristics of theclients they served were constantly in flux.

Because the RSAT initiative was rapidlyexpanding, new issues became apparentas the program matured. As a result, theevaluation’s focus changed over time, andthe evaluation ended without being fullyabreast of all the activities in all the pro-grams in all the States and Territories.

National Evaluation

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Treatment modalities

The National Evaluation identified threeprimary treatment modalities in RSAT programs: therapeutic communities,cognitive-behavioral approaches, and such 12-step programs as AlcoholicsAnonymous (AA) and Narcotics Anony-mous (NA).

About 60 percent of RSAT programsreported using some elements of the therapeutic-community approach. Somecognitive-behavioral approaches werereported by most programs, and 12-stepprograms also were nearly universal.Based on the responses to the evalua-tion’s mail surveys, the National Evaluationcategorized 58 percent of the programs ascombined or mixed modalities, 24 percentas primarily therapeutic communities, 13percent as cognitive-behavioral approach-es, and 5 percent as primarily 12-step programs.

About one-fifth of the National Evaluationfinal report reviews treatment approachesin general. In practice, however, none ofthe approaches exists in pure form. Eventhe strictest therapeutic community incor-porates cognitive-behavioral group workand includes 12-step meetings, and manytherapeutic-community techniques (e.g.,group encounters, reward and punish-ment, and phased programming) are usedin other programs. (See “TreatmentModalities and Their Implications.”)

Findings and lessons learnedThe National Evaluation found that three-fourths of the RSAT programs were new;the remainder were existing programswhose capacity was expanded using RSATfunds. State officials unanimously reportedthat RSAT increased their State’s treatment

capacity for substance-abusing prisoninmates. Although the States often provid-ed information that was not comparable,the National Evaluation was able to con-clude the following:

■ Prison treatment slots increased froman average of 330 slots per year perState to an average of 400 slots overthe 2-year evaluation period.

■ Nonresidential treatment slots increasedfrom an average of 842 in FY 1995 to910 in FY 1998.

■ The numbers of State treatment staffincreased from 17 full-time equivalent(FTE) staff before implementation ofRSAT to 26 by the end of 1998; the nonresidential staff mean rose from16 to 22.

■ A total of 9,600 treatment beds or slotswere created.

■ Although many programs had not yetopened, by the end of the evaluationperiod, more than 13,000 inmates hadbeen admitted to RSAT programs, 3,600inmates had graduated, and 7,700 in-mates were still in RSAT programs.

■ More than 860 FTE staff were providingtreatment in 97 programs that wereeither open or about to begin by March1999; the majority of RSAT programswere in State prisons, although 17 werein jails.

■ About 70 percent of operational pro-grams were aimed at adult offenders;the remainder targeted juveniles.

■ About 70 percent of these programswere for men, 12 percent were forwomen, and 18 percent included bothsexes.

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RESIDENTIAL SUBSTANCE ABUSE TREATMENT FOR STATE PRISONERS

TREATMENT MODALITIES AND THEIR IMPLICATIONS

Therapeutic Community

About 60 percent of RSAT programs were usingat least some elements of the therapeutic-community approach at midpoint. A distinguish-ing feature of therapeutic communities is theiruse of the community as the primary method forfacilitating an individual’s social and psychologi-cal change. Another hallmark of correctionaltherapeutic communities is their isolation fromthe general correctional population. (The RSATRFP required that therapeutic-community pro-grams be set apart.)

The therapeutic community houses the inmatesassigned to the program, a few professionalstaff members from the treatment and mentalhealth fields, and recovered addicts, who servea mentoring and staffing role. Residents areinvolved in all aspects of governing the thera-peutic community and its operations. The thera-peutic community is organized hierarchicallywith a clear chain of command. New residentsare assigned to the lowest level of jobs in thehierarchy and earn better work positions andprivileges as they move up the chain of com-mand. They take responsibility for their owntreatment and that of others. Groups and meet-ings provide positive persuasion to change atti-tudes and behavior, and group members areconfronted by peers when values or rules areviolated. Therapeutic communities try to social-ize individuals, helping them develop a senseof personal identity and the values, attitudes,and conduct consistent with “right living.”Most therapeutic communities today includeadditional services, such as family treatmentand educational, vocational, medical, and men-tal health services.

Cognitive-Behavioral Treatment

Cognitive-behavioral treatment approachesare based on the social learning theory, whichassumes that people are shaped by their envi-ronment. These approaches help offendersunderstand their motives, recognize the conse-quences of their actions, and develop new waysto control their behavior. Cognitive-behavioralprograms are frequently augmented by trainingin problem solving, social skills development,and prosocial modeling with positive reinforce-ment. Although most evaluations of cognitive-behavioral therapy have been conducted withjuveniles and young defenders, they consistent-ly show substantial reductions in recidivism.Relapse-prevention techniques are generallypart of cognitive-behavioral therapy and havebeen incorporated into all RSAT programs.

12-Step Programs

The 12-step approach, which views substanceabuse as a spiritual and medical disease, beganwith Alcoholics Anonymous, but the principleshave been applied to other drug and behavioralproblems as well. Each program consists of 12steps—specific graduated practices, beliefs, andtraditions that progress from dealing with denialto sustaining a healthy, responsible, abstinentlifestyle. Although few research studies haveevaluated the effectiveness of 12-step approach-es with offender populations, they probably rep-resent the most widespread treatment within thecorrectional system. This is partly due to their lowcost, as they are typically operated by volunteersoutside the prison. The National Evaluation found12-step programs evident in about one-third ofRSAT programs, always in conjunction with othertherapeutic approaches.

Merging of treatment components. TheNational Evaluation also expressed con-cern over the merging of treatment com-ponents. RSAT programs are “intended todevelop the inmate’s cognitive, behavioral,social, vocational, and other skills,” whichlends itself to a multifaceted approach. Yetthe evaluators pointed out that therapeuticcommunities, and 12-step programs inparticular, are based on different theoriesand practices. The 12-step programs arespiritually based, which is different fromprofessional therapy. Nevertheless, 12-step programs have worked in conjunctionwith therapeutic communities for manyyears. The National Evaluation accuratelypointed out that combination treatmentshave not been fully evaluated and thatmany combinations may result in watered-down components, leading to less effec-tive treatment.

Other problems. The National Evalua-tion showed that 55 percent of the RSATprograms lacked one or more operationaltreatment components, and 53 percentof program directors still considered theirprograms to be in the “shakedown” phaserather than stabilized at the RSAT midpoint.Programs had difficulty recruiting stafftrained in the therapeutic-communityand/or cognitive-behavioral methods assuggested in the RSAT RFP. Many Statesencountered difficulties employing ex-offenders and recovering addicts as coun-selors in prison therapeutic communities;often, individuals with criminal records werenot allowed to enter the institutions to workor visit. Evidence regarding therapeutic-community staff effectiveness, however,shows that staff should consist of a mix-ture of recovered therapeutic-communitygraduates and other counseling (socialwork, educational, or mental health) professionals.2

Program difficulties

The most severe problems reported byState officials involved locating or con-structing appropriate facilities, recruitingtrained treatment staff, and contractingwith treatment providers under lengthy orcomplex bidding and proposal processes.More than half (53 percent) reported mod-erate or severe delays related to difficul-ties in locating facilities for the residentialtreatment program, and 37 percent re-ported delays resulting from the need toconstruct or physically alter existing struc-tures. About one-fourth of States (28 per-cent) reported encountering difficulties asa result of State regulations, and one-fifth(21 percent) reported delays due to Statebidding or competitive processes. Nearlytwo-thirds (62 percent) of the States re-ported difficulties in obtaining training fortreatment staff.

Lack of aftercare. The National Evalu-ation’s report expressed concern over thelack of aftercare, particularly because theRSAT Request for Proposal (RFP) forStates emphasized that in-prison programswith aftercare services should be givenpreference. Aftercare was not funded,however, and RSAT funds could be usedonly for the residential treatment compo-nent. The National Evaluation found thatwork release (23 percent) or halfway hous-es (20 percent) were incorporated as after-care programs in less than half of theRSAT programs. A few others had parole-supervised treatment as part of aftercare,but these numbers were not reported inthe National Evaluation. The NationalEvaluation determined that 86 percent of RSAT in-prison treatment programshave either specified how graduates maycontinue treatment in the community orindicated their intention to do so. Continuityof care is an important element in treat-ment for offenders and is strongly linkedto reductions in recidivism and drug use.

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7


The National Evaluation also pointed outthat treatment programs should be inplace in jails, not just prisons. About onein five jails reported a drug treatment pro-gram supported by paid staff.

National Evaluationshortcomings

In hindsight, it is easy to note problemswith the National Evaluation’s strategy ofrelying solely on mail surveys to gatherprogram data. The study would have ben-efited from using other data sources, suchas State block grant and statistical analysisreports. It appears that diverse researchand evaluation interests led to very longand complex questionnaires, which re-sulted in missing data or inconsistent re-sponses across States. The evaluatorswere unable to use survey data to deter-mine the costs of treatment or States’contributions.

National Evaluationachievements

Although the National Evaluation was ableto produce only a partial and preliminarypicture of the scope and early accomplish-ments of the large national RSAT programby the time it ended in March 1999 (andany assessment of impact would havebeen premature), important lessons werelearned from it.

The National Evaluation achieved somenoteworthy goals:

■ It presented a breakdown of the num-ber, focus, and increased treatmentcapacity provided nationwide by theRSAT program.

■ It provided a useful description of treat-ment modalities.

■ Its recommendations included someuseful and important suggestions forfuture treatment and evaluation.

9

Scope and fundingIn addition to the National Evaluation, 55individual program evaluations were con-ducted. NIJ funded these State and localjurisdiction evaluations, which focused pri-marily on implementation of the RSAT pro-grams. These program evaluations providemore specific and detailed program data.Brief summaries of the findings of the first12 completed RSAT program evaluationsare presented at the end of this report.It is beyond the scope of this report toestablish how representative the 12 RSATevaluations are of the 55 that were fundedor to determine how well they representthe total array of all RSAT programs fund-ed nationwide.

The 12 program evaluations summarizedhere were awarded between March 5,1997, and September 30, 1998, causingthe startup dates to be spread over 18months. Some evaluators delayed theirinception in an attempt to compensate forRSAT program delays. Others began theirevaluations right away, even if their partic-ular RSAT program was not operational.The awards for the local evaluations werescheduled to be for a maximum of 15months each, while the RSAT programsthemselves were funded for 3 years. Con-sequently, each evaluation represents aspecific, varying, and only partial period inthe lifecourse of each RSAT program thatwas studied. When one looks across eval-uations, it is apparent that the time ofstudy is often not coterminous from oneevaluation to another.

Local evaluations either could look at a single program or, if a State funded morethan one program with RSAT funds, couldexamine all or a subset of sites. The RFPrequested information on program charac-teristics (such as number of participants,number of graduates, demographics, andother information about the participants)and “in-prison performance of participantson pertinent dimensions.” The applicantswere given discretion to propose addition-al topics. Each evaluation was expected toprepare for an eventual outcome evalua-tion. The fact that each evaluation covereddifferent time periods and topics makesstructured comparisons difficult, althougha number of cross-site observations canbe made. Many themes found in theNational Evaluation were echoed in thelocal site evaluations.

Treatment modalities

All 12 of the RSAT programs whose evalu-ations have been completed establishedtreatment programs that used a multi-modal treatment approach. Only one ofthese programs (the juvenile program inMichigan) did not indicate that it was atherapeutic community or that it incorpo-rated major elements of therapeutic com-munities. Yet several that identifiedthemselves as therapeutic communities ormodified therapeutic communities con-tained too few elements typically found insuch programs (e.g., the in-prison RSATprograms in New Mexico, South Carolina,and Wisconsin; the jail program in Harris

Local Evaluations

10


County, Texas; and the six Virginia jailprograms); these may, however, evolveinto mature programs. The programs inDelaware and Missouri are mature thera-peutic communities, and the women’sprogram in Washington State adapted acommendable therapeutic-communitymodel responsive to women’s issues.The RSAT programs in Wisconsin, NewMexico, and the six Virginia jails were notisolated from the remainder of the generalincarcerated population, as the RSAT for-mula grant requires. All 12 programs in-cluded cognitive-behavioral elements andAA/NA meetings or 12-step philosophies.

Findings and lessons learnedThe evaluations documented the manyand varied demands and obstacles beyondthe control of the RSAT programs. One ofthe most consistent findings across thenational and local RSAT evaluations is thelack of effective aftercare programming.Several States had little or no aftercare, oraftercare was planned but not implement-ed. This was, in part, because the RSATlegislation explicitly precluded funding ofaftercare programs. Yet recent research(much of it sponsored by NIJ) has demon-strated marked increases in long-termpositive outcomes for offenders whoreceive both residential therapeutic-community treatment and an aftercareprogram.3 The lasting effects from in-prison residential treatment alone, howev-er, are not significant. Therefore, moreattention to developing viable aftercareprograms is necessary.

Few programs, even those that were fullystaffed, delivered all the services they hadplanned (e.g., fewer group counseling ses-sions were held than planned and few in-dividual counseling sessions were held inany RSAT treatment program).

Many programs experienced significantstaff turnover, and programs were ofteninitiated with inexperienced staff. Somecontributing factors (such as isolatedprison locations, poor pay, and the correc-tional environment’s lack of appeal) areendemic to all prison employment. A slowprocess of gradually breaking in new staffand filling client slots, which is preferablefor startup, often was not an option be-cause of institutional overcrowding andthe need to keep beds filled. Several cor-rectional institutions have policies that discourage or deny employment to individ-uals with criminal backgrounds or to thosein recovery. Because therapeutic commu-nities are often staffed with a mixture ofrecovering therapeutic-community gradu-ates and degreed professionals, such poli-cies further limited the programs’ ability tolocate and retain qualified staff.

In light of high turnover rates, it would bebeneficial to give greater attention nation-ally to providing training for correctionaltreatment staff. In starting a correctionalresidential treatment program, a full com-plement of experienced, well-trained staffis especially important. The required plan-ning would have to be supported and im-plemented by administrators developingand overseeing a program.

Researchers noted the need for RSAT pro-grams to use more valid and reliable sub-stance abuse screening and assessmentinstruments. Nearly all programs experi-enced difficulties with inappropriate refer-rals—generally, inmates with too little ortoo much time remaining on their sen-tences. Some programs successfullymatched sentence to treatment. For ex-ample, South Carolina created a novelRSAT program that based the incarcera-tion period of offenders sentenced tothe RSAT program under the YouthfulOffenders Act on treatment completion.Similarly, in Pennsylvania, technical parole

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violators were sentenced for 12 monthsto correspond to the RSAT programs’ totalof 6 months of in-prison treatment and6 months of aftercare. Tying sentencelength to treatment completion also moti-vated inmates to complete the programsin a timely manner.

Startup programs that tried to respondto the multiple and conflicting demandsplaced on them experienced most of theidentified problems. Virtually all the pro-grams experienced moderate to severestartup problems. The exceptions werepreexisting programs that were expandedwith RSAT funds (the Delaware and Mis-souri programs and, to a lesser extent, theVirginia and Michigan juvenile programs);these also had startup problems, but theprograms were in a more mature stage ofdevelopment at the time of RSAT funding.

The local evaluations documented thatadministrative expediency and demandsoften took precedence over program oper-ations. Reported problems included thefollowing:

■ Programs were initially filled to capacityalthough they lacked sufficient staff.

■ Staff members were inexperienced.

■ Inappropriate inmates were referred tothe programs.

■ Clients were not isolated because ofovercrowding and the need to fill allbeds.

■ Graduates were returned to the generalprison population when treatment wascompleted.

■ Inmates’ demand for treatment was toogreat or too little.

■ Programs for dually diagnosed inmatesappeared to be the hardest to imple-ment because they also deal with the

most difficult clients: offenders who areboth mentally ill and substance abusers.

Major program transitions, where neces-sary, should be well planned before imple-mentation is attempted. A program needsto be strong enough to survive the unin-tended consequences of bureaucraticchanges. Even a mature treatment pro-gram or therapeutic community can bethreatened by external program changes,such as new funding levels, reassignmentof key administrators, and the actions ofjudges. For example, State bidding pro-cesses may mean a new treatment con-tractor is selected for an establishedprogram (as happened at one site). Thisexample illustrates the need for stronginstitutional leadership to oversee andassist in the transition of treatment pro-viders. It is critical that correctional treat-ment programs have outstanding supportfrom higher level administrators who arecommitted to the program’s success.

RSAT program achievements

The local evaluations emphasized the diffi-culty of establishing and maintaining atreatment program within a correctionalsetting. Even with adequate resourcesand excellent administrative support fromthe correctional system, program imple-mentation was a tortuous process, andprogram stability was not reached for atleast 2 to 3 years. It is notable that somany RSAT programs were doing as wellas they were during early program phasesand unfortunate that the local site evalua-tions were unable to encompass the pro-grams’ entire history.

A principal finding from the local evalua-tions was that many and varied demandsand obstacles were placed on the RSATprograms. Their ability to survive andadapt when faced with obstacles beyondtheir control is more than praiseworthy.Only a few of the RSAT programs ap-peared to be in serious trouble. The

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programs that fared best were establishedprograms that used RSAT funds to expandtheir operations.

Both established and new programs bene-fited greatly when they had higher leveladministrative support and cooperation,which was essential to weathering manyof the implementation obstacles. Pro-grams with experienced and well-trainedstaff also had fewer implementation difficulties.

South Carolina and the Pennsylvania RSATprogram for parole violators achieved com-mendable advance planning and coordina-tion in sentencing inmates to treatmentprogram completion. They reduced sen-tences somewhat to the length of thetreatment programs, matching treatmentand sentence length while saving theStates some correctional costs. By tyingsentence length to treatment completion,these programs eliminated the problemof returning graduates to the general population.

Several States had good aftercare pro-grams in place, including the more estab-lished programs in Delaware and Missouri.One of the two Pennsylvania RSAT pro-grams for parole violators had establishedthe foundation for a good aftercare pro-gram; inmates flowed into halfway housesand their treatment plans were overseenby the in-prison program director. Goodplanning for aftercare was also evident inWashington State, and promising planswere being developed in a few otherStates.

Another achievement noted in manyStates was the cooperation between theevaluators and those involved with theprogram. Evaluators were able to feedinformation back to program officials andhigher level administrators, who were ableto respond to problems. Many evaluationsadapted or created instruments and/ordata management systems that theyshared with program staff.

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Established programs that used RSATfunds to expand operations and those thatreceived higher level administrative sup-port and cooperation were the most suc-cessful at maintaining stable programs. Itremains to be seen whether the increasedcapacity will be retained after the RSATblock funding to the States ends. The sup-port of higher level administrators wasessential to overcoming many implemen-tation obstacles. If the State administra-tion and prison officials were committedto treatment, the prospect was good—even for programs that faced major prob-lems in implementation—that the programwould develop, stabilize, mature, andbecome a regular part of the correctionalsystem. Also, programs with experiencedand well-trained staff had fewer imple-mentation difficulties. However, variousfactors—including low pay, geographic iso-lation, and the correctional environment—made it harder for programs to find andretain experienced staff.

Another important observation from thenational and local RSAT evaluations is theneed for treatment options in jail settings.Jail-based offenders with substance abuseproblems are a significant group, as theArrestee Drug Abuse Monitoring (ADAM)program studies have made clear. At thesame time, however, the jail programsthat have been evaluated by the NationalInstitute on Drug Abuse (NIDA), theCenter for Substance Abuse Treatment(CSAT), and NIJ provide some under-standing of the limitations of jail-basedtreatment.

The transient nature of jail-based popu-lations is not conducive to a lengthy, structured treatment program based oncommunity continuity and phased pro-gression. (Therapeutic-community-typeprograms generally last 6 to 12 months.)Moreover, jail-based offenders are lesslikely to want treatment, and are less likelyto perceive that they have time for treat-ment, than prison-based substanceabusers. Treatment modalities should fitcorrectional mandates; jails should incor-porate short-term education and interven-tion rather than long-term, phasedtreatment. Even relatively short-terminterventions (6 to 8 weeks) can teachinmates coping skills that are crucial torecovery. Such programs require furtherinvestigation, but the absence of in-jailtreatment services represents a neglectedopportunity to reduce drug use and recidi-vism among offenders.

Two other major theoretical and practicalconcerns emerged from the local evalua-tions. First is the need to match the clientwith the appropriate treatment. Severallocal evaluations questioned whether theright kind of clients were being recruitedinto the programs. A growing literatureis showing the importance of matchingclients with the right kind of treatment andthe implications of appropriate assignmentin successful treatment.4 Therapeuticcommunities are generally less costly thanother residential treatment options be-cause they rely less on paid professionalstaff. Twelve-step approaches have alsobeen favored in prisons, primarily because

RSAT Success: Past and Future

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they are “staffed” by volunteers and be-cause clients can continue participating insuch programs when they return to theircommunities. It is important to identifythe treatment modalities most appropriatefor each type of inmate and the mix ofelements that contribute to inmates’ success.

The second area that needs to be con-sidered is whether treatment should be compulsory or voluntary.5 Compulsorytreatment might work better than volun-tary treatment for offenders. Holding outthe possibility of a reduced sentence ortying sentence length to successful pro-gram completion can serve as the “car-rot” that encourages more offenders tovolunteer for treatment (as is the casein the Federal system—see 18 USC §3621(e)(2)). Conversely, the “stick”might be increases in the length of timein treatment, which is the most consistentprogram characteristic associated withlong-term client success.

EvaluationThe local RSAT evaluations demonstratedthat it is possible to conduct a very suc-cessful evaluation that can have implica-tions for research and treatment agendas.To do so, the evaluation needs a function-ing program, good internal data collectionand management, good working relation-ships between program staff and outsideevaluations, and resources for evaluation.

Process evaluations can be very usefultools. Outside researchers, as neutralobservers, are in a key position to providefeedback on issues and problems to ad-ministrators positioned to help create nec-essary changes. Although they requireseveral years of data to be informative,process evaluations are not necessarilycostly, especially in light of what they canbring to a program. Some of the local eval-uations reviewed here did a good job of

process evaluation; others conducted onlyimplementation evaluations.

Future evaluations of RSAT programs willrequire sufficient sample sizes, appropri-ate comparison groups, and sufficienttime to conduct a prospective analysis tosee whether successes are maintainedover a reasonable followup period afterrelease from prison. Longitudinal evalua-tions are necessary to evaluate programseffectively. Longitudinal process evalua-tions should be conducted for a minimumof 3 years, and outcome evaluations shouldbe conducted for 5 years.

AftercareClients who receive aftercare fare signifi-cantly better than clients who do not.6

Several recent outcome evaluations sug-gest that treatment programs for offend-ers need a strong aftercare componentand that the aftercare should probably be tied to probation or parole stipulations.One of the most consistent findings acrossthe RSAT evaluations, both national andlocal, was the lack of effective aftercareprogramming.

The Office of Justice Programs might con-sider introducing a new initiative to fundaftercare for existing and ongoing residen-tial treatment programs that have beensponsored by RSAT. A good aftercare pro-gram is not a cost-free option, but it wouldbe much less costly per client than a resi-dential treatment slot. This would be acost-effective approach that would buildon the residential treatment programsfunded by RSAT.

CollaborationOne lesson learned from the local siteevaluations was the need to plan, cooper-ate, and coordinate among criminal justiceand public health administrators and

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agencies. Such a model of collaborationneeds to be replicated at the Federal levelamong agencies interested in treatmentfor drug-involved offenders.

In the early 1990s, NIJ, NIDA, and CSATparticipated in several meetings at whichthe Federal agencies and their granteesshared information, findings, and strate-gies. It would be beneficial if these agen-cies and others interested in treatment forcriminal offenders renewed their effortsand moved another step closer to real col-laboration. The RSAT initiative and the pro-grams that resulted from it represent apotential laboratory for research in treat-ment efficacy.

Treatment benefitsversus costsThe connections between drug abuse andcriminal activity have long been recog-nized. But only recently have policymakersacknowledged the efficacy of treatment incriminal justice settings. The past decadehas seen some reversal of policies andpractices, and many criminal justice pro-fessionals (police, judges, probation/paroleofficers, correctional personnel, and oth-ers) now serve as major sources of re-ferral to, and payment for, drug abusetreatment.7 The criminal justice systemhas become the largest source of man-dated, or coerced, drug treatment in theUnited States.8

One of the classic questions in drug abuse research is whether the benefits oftreatment outweigh the economic cost. Although different treatment modalitieshave different costs, the answer appearsto be that treatment is cost effectiveregardless of the modality considered.Perhaps the classic study in this arenawas published by the California Depart-ment of Alcohol and Drug Programs in1994.9 Known as the CALDATA (CaliforniaDrug and Alcohol Treatment Assessment)

study, this 2-year investigation included arigorous probability sample protocol of thenearly 150,000 individuals who receivedalcohol and/or drug treatment in 1992 inCalifornia. All treatment modalities wereincorporated, including methadone treatment.

The estimated cost of treating almost150,000 recipients was $209 million.Weighed against the cost were the esti-mated benefits amassed during treatmentand during the first year thereafter; thisfigure was estimated at about $1.5 billion.Hence, for every $1 spent on treatment,approximately $7 were saved. Generallythese gains took the form of reducedcriminality and reduced hospital episodes.Criminality, from pretreatment to post-treatment, was reduced by two-thirds andhospital episodes by one-third. Nearly a40-percent reduction was also realized in the before-after model in the use ofalcohol and other drugs.

Also of note was the CALDATA findingthat treatment efficacy did not differ bygender, age, or ethnic group.10 Recent eco-nomic research suggests that the quickestand most cost-effective way to reducethe cost of drug abuse to the Nation as awhole is to treat chronic hard drug users.11

Additional implicationsfor practice, policy,and researchDue to strict sentencing policies, criminaljustice systems nationwide have receiveda growing number of offenders with sig-nificant and lengthy drug-using careers.Any prospect of changing this scenario requires effective substance abuse treat-ment for incarcerated offenders. Untilpharmacological researchers and brainchemists find their “silver bullet,” howev-er, the only proven means of counteract-ing an offender’s longstanding substance

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abuse problem is a lengthy and intensivebehavioral intervention.

In the late 1980s, the U.S. Departmentof Justice, through the Bureau of JusticeAssistance’s support of Project Reformand Project Recovery, introduced and eval-uated innovative and intensive treatmentprograms. In the early 1990s, NIDA andCSAT funded a variety of new treatmentapproaches in correctional settings andevaluation of the programs. Most impor-tant, they disseminated and promotedsuccessful treatment programs. The publi-cized success of therapeutic-communityprograms in California, Delaware, NewYork, and Texas was instrumental in turn-ing policymakers’ attention to funding andevaluating new offender treatment pro-grams through RSAT.

One observation from the local evalua-tions is that the most successful programs(in the limited timeframe of these evalua-tions) are those that expand existing andrelatively stable programs. It would be aneasy mistake to infer that these are thebetter programs. That may not be thecase; rather, these programs experiencedsimilar startup problems, but they occurredbefore RSAT funding. In the case of theDelaware programs, the startup difficultieswere enormous, and the programs might

not have survived except for administrativecommitment, well-managed oversight, andvery well-funded implementation budgets.

Several local evaluations were particularlyinstructive about the strengths programsneed to survive when changes occur intreatment providers and institutional poli-cies and leadership—the kinds of mid-stream changes that many correctionaltreatment programs face. State require-ments about bidding contracts affect notonly food services and health care pro-viders but also treatment providers. More-over, treatment programs have to bestrong enough and sufficiently document-ed to survive changes in key personnel.Old-fashioned therapeutic communitieswith charismatic leaders rather than insti-tutional leadership cannot survive long ina bureaucratic State system.

Conversely, a supportive system can be areal strength to a treatment program, par-ticularly in its startup phase. Even whenprograms face major problems in programimplementation, if the State administrationand prison officials have a commitment totreatment, the prospects are good that theprogram will develop, stabilize, mature,and become a regular part of the correc-tional system.

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Notes

1. Lipton, D.S., F.S. Pearson, and H.K. Wexler,“National Evaluation of the Residential SubstanceAbuse Treatment for State Prisoners Program FromOnset to Midpoint,” final report for National Instituteof Justice and Corrections Program Office, 1999.NCJRS, NCJ 182219. (This document may be ob-tained from NCJRS by calling 800–851–3420.Documents under 25 pages are $10 each; docu-ments 25 pages and over are $15 each.)

2. Wexler, H.K., “Therapeutic Communities inAmerican Prisons: Prison Treatment for SubstanceAbusers,” in E. Cullen, L. Jones, and R. Woodward,eds., Therapeutic Communities for Offenders,Chichester, NY: John Wiley and Sons, 1997:161–179.

3. Lipton, D.S., F.S. Pearson, and H.K. Wexler,“National Evaluation of the Residential SubstanceAbuse Treatment for State Prisoners Program FromOnset to Midpoint” (see note 1); Wexler, H.K., G.De Leon, G. Thomas, D. Kressel, and J. Peters, “TheAmity Prison TC Evaluation: Reincarceration Out-comes,” Criminal Justice and Behavior 26 (2) (1999):147–167; Knight, K., D.D. Simpson, and M.L. Hiller,“Three-Year Reincarceration Outcomes for In-PrisonTherapeutic Community Treatment in Texas,” ThePrison Journal 79 (3) (1999): 337–351; Martin, S.S.,C.A. Butzin, C.A. Saum, and J.A. Inciardi, “Three-YearOutcomes of Therapeutic Community Treatment forDrug-Involved Offenders in Delaware: From Prison toWork Release to Aftercare,” The Prison Journal 79(3) (1999): 294–320.

4. De Leon, G., G. Melnick, D. Kressel, and N.Jainchill, “Circumstances, Motivation, Readiness,and Suitability (the CMRS Scales): Predicting Re-tention in Therapeutic Community Treatment,”American Journal of Drug and Alcohol Abuse 20 (4)(1994): 495–515.

5. Leukefeld, C.G., and F.M. Tims, “CompulsoryTreatment: A Review of the Findings,” in C.G.Leukefeld and F.M. Tims (eds.), Compulsory Treat-ment of Drug Abuse: Research and Clinical Practice(NIDA research monograph 86). Rockville, MD: U.S.

Department of Health and Human Services, 1988:236–254; De Leon, G., J.A. Inciardi, and S.S. Martin,“Residential Drug Treatment Research: Are Conven-tional Control Designs Appropriate for AssessingTreatment Effectiveness?” Journal of PsychoactiveDrugs 27 (1) (1995): 85–92.

6. Pearson, F.S., and D.S. Lipton, “A Meta-AnalyticReview of the Effectiveness of Corrections-BasedTreatments for Drug Abuse,” The Prison Journal 79(4) (1999): 384–410; Wexler, H.K., G. Melnick, L.Lowe, and J. Peters, “Three-Year ReincarcerationOutcomes for Amity In-Prison Therapeutic Com-munity and Aftercare in California,” The PrisonJournal 79 (3) (1999): 321–336; Knight, K., D.D.Simpson, and M.L. Hiller, “Three-Year Reincarcer-ation Outcomes for In-Prison Therapeutic CommunityTreatment in Texas” (see note 3); Martin, S.S., C.A.Butzin, C.A. Saum, and J.A. Inciardi, “Three-YearOutcomes of Therapeutic Community Treatment forDrug-Involved Offenders in Delaware: From Prisonto Work Release to Aftercare” (see note 3).

7. O’Brien, C.P., and A.T. McLellan, “Myths Aboutthe Treatment of Addiction,” The Lancet 347 (8996)(1996): 237–240.

8. National Institute on Drug Abuse, Extent andAdequacy of Insurance Coverage for SubstanceAbuse Services (Institute of Medicine Report:Treating Drug Problems), Drug Abuse ServicesResearch Series, No. 2, Vol. 1, Bethesda, MD:National Institute on Drug Abuse, 1992.

9. Gerstein, D.R., R.A. Johnson, H.J. Harwood, D. Fountain, N. Suter, and K. Malloy, Evaluating Recovery Services: The California Drug and AlcoholTreatment Assessment (CALDATA), Sacramento, CA:California Department of Alcohol and Drug Programs,1994.

10. Ibid.

11. Caulkins, J.P., and Reuter, P. “Setting Goals forDrug Policy: Harm Reduction or Use Reduction?”Addiction 92 (9) (1997): 1143–1150.

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Copies of the reports summarized beloware available for a fee from the NationalCriminal Justice Reference Service by call-ing 800–851–3420. Documents under 25pages are $10 each; documents 25 pagesand over are $15 each. The individual sitereports also are posted online at http://www.ojp.usdoj.gov/nij/rsat.

DelawareFactors Affecting Client Motivation inTherapeutic Community Treatment for Offenders in Delaware (NCJ 182358).An expansion of the residential com-ponents of an existing continuum oftherapeutic-community treatment in pris-ons, work release, and parole settings.Journal articles summarize a series ofoutcome studies. Programs operated inseven facilities, and each program wasisolated from the rest of the facility. Staff-ing was reasonably stable, programs werelicensed, staff met State certificationrequirements, and the programs werehighly functional.

MichiganProcess Evaluation of an RSAT Programfor State Prisoners: The W.J. MaxeyBoys Training School (NCJ 182358). Anexpansion of substance abuse treatmentservices at Michigan’s most secure facilityfor adjudicated male delinquents. Despitethe program’s thorough advance planningand smooth implementation, fewer serv-ices than intended were delivered, and

inmates were taking longer than expectedto complete the program.

Process Evaluation of the MichiganDepartment of Corrections’ RSATProgram (NCJ 181650). A treatment program for males in a minimum-securityprison based on the cognitive-behavioralapproach, which included a 6-month in-prison component followed by mandatory12-month aftercare. Some parts of theprogram, such as individual counselingsessions and AA/NA meetings, were notimplemented during the evaluation. Otherdifficulties included communication prob-lems with the aftercare provider (who wassubsequently terminated), staffing delays,and a shortage of bed space.

MissouriReport of a Process Evaluation of theOzark Correctional Center Drug Treat-ment Program: Final Report (NCJ181648). Expansion of a well-establishedadult male in-prison therapeutic communi-ty started in 1993 with CSAT funds thathas scored well on the national instrumentfor evaluating therapeutic communities.The report provides a process evaluationof three changes in the institution sincethe RSAT phase began: a change in thetreatment provider, institution of a work-release component, and an abortiveattempt to institute a no-smoking policy.These changes hurt the program in theshort run, but it seemed to recover well.

Appendix: Summaries ofCompleted Local Evaluations

TexasAn Evaluation of the “New Choices”Substance Abuse Program in the HarrisCounty Jail, Houston, TX (NCJ 182364).A modified therapeutic community (with12-step elements) in the Nation’s fourth-largest jail. The program suffered fromstartup difficulties (changes to the physicalstructure and delays in hiring) but therehas been progress in resolving them. Noaftercare program is in place, but new dis-charge procedures have been developedand contractual agreements are beingmade for aftercare client placement.

VirginiaA Qualitative Examination of the Imple-mentation Process at Barrett JuvenileCorrectional Center (NCJ 178737). Anexpansion of an existing therapeutic com-munity program in Virginia for male juve-niles originally started with CSAT support.The program has gotten off to a good startand appears to have avoided many of thestartup issues experienced elsewhere.Some concerns remain, however: Youthsassigned to Barrett may not be correctlyassessed or appropriate for the program,the program’s family education compo-nent is ineffective, and the program con-tains no aftercare component.

Residential Substance Abuse Treatment(RSAT) in Jail: Comparison of Six Sitesin Virginia (NCJ 182858). Virginia alsoused RSAT funds to establish six jail-basedtreatment programs in the eastern andcentral parts of the State. Although someof the programs claimed to be therapeuticcommunities, none could be characterizedeven as a modified therapeutic communi-ty. Program clients were housed withother inmates, staffing was low, andstaffers were unable to deliver plannedservices. Most clients did not completethe program, many because of earlyrelease.

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New MexicoProcess Evaluation of the GenesisProgram at the Southern New MexicoCorrectional Facility (NCJ 179986).A modified therapeutic community formale inmates in the minimum-securitywing of a medium-security prison. Theprogram suffered from startup difficultiesand was not completely staffed until theend of the evaluation period. Because ofovercrowding, inmates not in treatmentwere housed with RSAT clients.

PennsylvaniaA Collaborative Evaluation of Penn-sylvania’s Program for Drug-InvolvedParole Violators (NCJ 180165). Two in-prison modified therapeutic communities(one at a maximum-security prison andone at a medium-security prison) for tech-nical parole violators returned to prison.The program consisted of 6 months in anin-prison program followed by 6 monthsin a halfway house with specialized treat-ment programming. Problems with programimplementation and aftercare, especially inthe maximum-security prison, were detri-ments to success.

South CarolinaEvaluation of South Carolina RSAT forState Prisoners (NCJ 181050). A modi-fied therapeutic community in a medium-security prison targeting male offenderssentenced under the Youth Offender Actthat incorporates elements of cognitive-behavioral therapy and 12-step programs.The program experienced many startupdifficulties but also made great strides.Although more attention to aftercare wasneeded, the coordination of release dateswith program graduation was exemplary.

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WashingtonA Collaborative, Intermediate Evalua-tion of the Pine Lodge Pre-ReleaseTherapeutic Community for WomenOffenders in Washington State (NCJ181406). A 72-bed modified therapeuticcommunity for women (with special attention given to women’s issues) in aminimum-security institution. The prob-lems documented in the evaluation reportare characteristic of a startup program.The plan seems to be a sound one (al-though the aftercare component has notyet been put in place), and the therapeuticmodel appeared to be well developed andevolving over time in response to needs.

WisconsinProcess Evaluation of the WisconsinRSAT Program: The Mental Illness–Chemical Abuse (MICA) Program at Oshkosh Correctional Institution1997/1998 (NCJ 174986). A mixed-modality program in a medium-securityprison. The evaluation found that the pro-gram had excellent administrative ele-ments but had difficulty successfullytreating dually diagnosed clients duringa short 8-month program and in segre-gating RSAT clients from the generalinmate population.

About the National Institute of JusticeNIJ is the research, development, and evaluation agency of the U.S. Department of Justice.The Institute provides objective, independent, nonpartisan, evidence-based knowledge andtools to enhance the administration of justice and public safety. NIJ’s principal authorities arederived from the Omnibus Crime Control and Safe Streets Act of 1968, as amended (see 42U.S.C. §§ 3721–3723).

The NIJ Director is appointed by the President and confirmed by the Senate. The Director estab-lishes the Institute’s objectives, guided by the priorities of the Office of Justice Programs, theU.S. Department of Justice, and the needs of the field. The Institute actively solicits the views ofcriminal justice and other professionals and researchers to inform its search for the knowledgeand tools to guide policy and practice.

Strategic Goals

NIJ has seven strategic goals grouped into three categories:

Creating relevant knowledge and tools

1. Partner with State and local practitioners and policymakers to identify social science researchand technology needs.

2. Create scientific, relevant, and reliable knowledge—with a particular emphasis on terrorism,violent crime, drugs and crime, cost-effectiveness, and community-based efforts—to enhancethe administration of justice and public safety.

3. Develop affordable and effective tools and technologies to enhance the administration ofjustice and public safety.

Dissemination

4. Disseminate relevant knowledge and information to practitioners and policymakers in anunderstandable, timely, and concise manner.

5. Act as an honest broker to identify the information, tools, and technologies that respond tothe needs of stakeholders.

Agency management

6. Practice fairness and openness in the research and development process.

7. Ensure professionalism, excellence, accountability, cost-effectiveness, and integrity in themanagement and conduct of NIJ activities and programs.

Program Areas

In addressing these strategic challenges, the Institute is involved in the following programareas: crime control and prevention, including policing; drugs and crime; justice systems andoffender behavior, including corrections; violence and victimization; communications and infor-mation technologies; critical incident response; investigative and forensic sciences, includingDNA; less-than-lethal technologies; officer protection; education and training technologies; test-ing and standards; technology assistance to law enforcement and corrections agencies; fieldtesting of promising programs; and international crime control.

In addition to sponsoring research and development and technology assistance, NIJ evaluatesprograms, policies, and technologies. NIJ communicates its research and evaluation findingsthrough conferences and print and electronic media.

To find out more about the NationalInstitute of Justice, please contact:

National Criminal Justice Reference Service

P.O. Box 6000Rockville, MD 20849–6000800–851–3420e-mail: [email protected]

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