Christine Grella, Ph.D.UCLA Integrated Substance Abuse Programs
American Society of Criminology Los Angeles, CA
November 1, 2006
Funded by Contract No. C98.316 with Office of Substance Abuse Programs/California Department of Corrections & Rehabilitation
Predictors of Return to Prison Predictors of Return to Prison Following Participation in a Re-entry Following Participation in a Re-entry
Program for Substance-Abusing Program for Substance-Abusing Women OffendersWomen Offenders
BackgroundBackground
Increase in incarceration of women Increase in incarceration of women for drug-related crimesfor drug-related crimes
Women offenders have greater Women offenders have greater needs for parenting, mental health, needs for parenting, mental health, and trauma-related servicesand trauma-related services
Development and evaluation of in-Development and evaluation of in-prison and re-entry programs for prison and re-entry programs for women offenders in Californiawomen offenders in California
California Inmate Population California Inmate Population by Gender, 1985 - 2005by Gender, 1985 - 2005
150,000
100,000
50,000
10,000
8,000
6,000
4,000
2,000
47,205
156,573
2,906
11,462
1985 2005 1985 2005Males Females
No. of inmates
Source: CDCR (2006). Historical Trends 1985-2005.
3.3 increase
3.9 increase
Proportion of Offenders in Proportion of Offenders in California Incarcerated for Drug-California Incarcerated for Drug-
Related Offenses by Gender, 1985-Related Offenses by Gender, 1985-20052005
0
10
20
30
40
50
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Pe
rce
nt
Source: CDCR (2006). Historical Trends 1985-2005. SACPA
Females
Males
50
40
30
20
10
0
Growth in the U.S. Female Growth in the U.S. Female Prison Population, 1977-2004Prison Population, 1977-2004
Source: Institute on Women & Criminal Justice, 2006
Research QuestionsResearch Questions
What are correlates of treatment needs What are correlates of treatment needs among substance-abusing women among substance-abusing women offenders prior to their re-entry?offenders prior to their re-entry?
Do treatment needs predict completion of Do treatment needs predict completion of community-based re-entry treatment?community-based re-entry treatment?
Do treatment needs and completion of re-Do treatment needs and completion of re-entry treatment predict return-to-prison?entry treatment predict return-to-prison?
Study DesignStudy Design Participants (N = 1,404) were recruited at admission to in-Participants (N = 1,404) were recruited at admission to in-
prison substance abuse treatment in 5 prisons in California prison substance abuse treatment in 5 prisons in California from September 1998 – January 2004from September 1998 – January 2004
Upon completion of the in-prison program and parole, Upon completion of the in-prison program and parole, participants transferred to community based treatment in participants transferred to community based treatment in the Female Offender Treatment & Employment Project the Female Offender Treatment & Employment Project (FOTEP)(FOTEP)
Participation in prison-based treatment can be mandated; Participation in prison-based treatment can be mandated; participation in FOTEP is voluntary, but encouraged participation in FOTEP is voluntary, but encouraged (SB (SB 1453)1453)
FOTEP TreatmentFOTEP Treatment Residential treatment is provided for 5-15 Residential treatment is provided for 5-15
months in 10 community programs in 8 months in 10 community programs in 8 counties in Californiacounties in California
Core services:Core services:► Case managementCase management► Vocational training/job preparationVocational training/job preparation► Parenting skills training and family servicesParenting skills training and family services► Trauma-related and mental health servicesTrauma-related and mental health services► Co-residence with up to two children (< 12 Co-residence with up to two children (< 12
years old)years old)
Demographics/Background Demographics/Background Characteristics of SampleCharacteristics of Sample
(N = 1,404) (N = 1,404)
Average age: 33.8 (SD = 7)Average age: 33.8 (SD = 7) Ethnicity: Ethnicity:
► African American, 36%African American, 36%► Hispanic, 24%Hispanic, 24%► White, 38% White, 38%
47% had never been married 47% had never been married 80% had minor children80% had minor children 52% had a HS degree or GED52% had a HS degree or GED 50% were employed prior to incarceration50% were employed prior to incarceration 29% had unstable housing prior to incarceration29% had unstable housing prior to incarceration
Substance Use CharacteristicsSubstance Use Characteristics(N = 1,404)(N = 1,404)
Average age 1st drug use: 14.5 (SD = 4)Average age 1st drug use: 14.5 (SD = 4) 83% were drug dependent (DSM-IV criteria) 83% were drug dependent (DSM-IV criteria) 35% were alcohol dependent (DSM-IV criteria)35% were alcohol dependent (DSM-IV criteria) Most frequently used substances:Most frequently used substances:
► Cocaine/crack, 49%Cocaine/crack, 49%► Amphetamines, 41%Amphetamines, 41%► Marijuana, 40%Marijuana, 40%► Opiates, 21%Opiates, 21%► Sedatives, 12%Sedatives, 12%
20% were injecting daily prior to incarceration20% were injecting daily prior to incarceration 77% used tobacco daily77% used tobacco daily
Mental Health StatusMental Health Status(N = 1,404)(N = 1,404)
29% had used prescription meds for psych 29% had used prescription meds for psych problemsproblems
21% had prior suicide attempts 21% had prior suicide attempts 32% were classified with mental health 32% were classified with mental health
problems by criminal justice systemproblems by criminal justice system 44% had a history of physical/sexual abuse44% had a history of physical/sexual abuse
Criminal Justice HistoryCriminal Justice History(N = 1,404)(N = 1,404)
Mean age 1st arrested: 20.1 (SD = 6.7)Mean age 1st arrested: 20.1 (SD = 6.7) Mean no. of lifetime arrests: 15.5 (SD = 25)Mean no. of lifetime arrests: 15.5 (SD = 25) Mean no. of times incarcerated > 30 days: 6.7 (SD Mean no. of times incarcerated > 30 days: 6.7 (SD
= 9.8)= 9.8) Category of most recent offense:Category of most recent offense:
► Drug related, 57%► Property, 24%► Crimes against persons, 8%► Other, 11%
61% were under influence of AOD when committed last offense
61% had volunteered for in-prison treatment
MeasuresMeasures
Baseline assessment was conducted at admission to in-prison treatment
Information on completion of the FOTEP re-entry program was obtained from treatment providers
Data on return to prison was obtained from the state criminal justice administrative data system (OBIS)
AnalysesAnalyses
Multiple regression model predicting Treatment Needs Index
Logistic regression model predicting FOTEP treatment completion
Cox regression model predicting return-to-prison within 12 months after FOTEP discharge
Treatment Needs IndexTreatment Needs Index
Sum of 13 items rating need for treatment at baseline in each area
► (0 = not at all, 4 = extremely) Range: 0-52, Mean = 17.4 (SD =
9.8)
43.240.9
46.7
17.0
41.438.5
0
10
20
30
40
50
Medical Family Social Work Legal MentalHealth
Per
cen
tag
e
1Rated need as “considerable” or “extremely” high
Treatment/Service Needs Among Treatment/Service Needs Among Women Offenders: Social and Health Women Offenders: Social and Health
NeedsNeeds11
33.6
14.9
38.0
18.522.1
25.6
0
10
20
30
40
50
Tobacco Alcohol Heroin/Opiates
Cocaine/Crack
Marijuana Amphetamines
Per
cen
tag
e
1Rated need as “considerable” or “extremely” high
Treatment/Service Needs Among Treatment/Service Needs Among Women Offenders: Substance UseWomen Offenders: Substance Use11
Greater Treatment Needs at Greater Treatment Needs at Admission to In-Prison Admission to In-Prison
Treatment Were Positively Treatment Were Positively Associated With:Associated With:
Unstable housing prior to incarcerationUnstable housing prior to incarceration History of physical/sexual abuseHistory of physical/sexual abuse Mental health disorderMental health disorder Drug or alcohol dependence (vs. abuse or no Drug or alcohol dependence (vs. abuse or no
disorder)disorder) First arrest at less than 19 years oldFirst arrest at less than 19 years old Volunteered for treatment (vs. mandated)Volunteered for treatment (vs. mandated) White (vs. African American or Hispanic)White (vs. African American or Hispanic)
NS variables: age, education, prior legal incomeNS variables: age, education, prior legal income
Treatment CompletionTreatment Completion
FOTEP treatment completion: 39%
Mean (SD) / median days in treatment:
► Completers = 217 (86) /median = 188
► Non-completers = 76 (77) / median = 55
Type of Discharge from Type of Discharge from FOTEPFOTEP
45%39%
10%4%
1% 1%0
20
40
60
80
100
Left againstadvice
Completion Rule violation
Medical/Psychiatric
Parole violation/
arrest
Refer to otherFOTEP program/
Parole DC
%
Predictors of FOTEP Treatment Predictors of FOTEP Treatment CompletionCompletion
1.07*
0.73* 0.73*
0.46***
1.66**
0.82*
0.67**
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Odds
Education(years)
African American
(vs. White)
Hispanic(vs. White)
Mental HealthStatus
DrugDependence
No. ofIncarcerations
1st Arrest < 19 Years
NS variables: Tx need index, age, legal income, stable housing, any abuse, alcohol dependence, mandated to tx*p < .05, **p < .01, ***p < .001
Return to Prison in 12 Return to Prison in 12 Months Following FOTEP Months Following FOTEP
Discharge Discharge Includes returns due to parole violation
and new commitments Overall RTP: 32.7% FOTEP Completers: 15% vs.
Non-completers: 45% Vs. 36.9% for females who completed
in-prison treatment, but did not transfer to community-based aftercare
Predictors of Return to PrisonPredictors of Return to Prison
0.98** 0.95*
1.28*
1.82***
1.26** 1.25*
0.31***
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
Odd
s
Age(years)
Education(years)
AfricanAmerican
(vs. White)
Mental HealthStatus
No. ofIncarcerations
EnteredFOTEP fromcommunity(vs. parole)
CompletedFOTEP
NS variables: Tx need index, Hispanic, legal income, stable housing, any abuse, drug/alcohol dependence, mandated to tx, first arrest < 19 years old, crime of commitment*p < .05, **p < .01, ***p < .001
Time to First Incarceration for Up to 12 Months Time to First Incarceration for Up to 12 Months After FOTEP Discharge by Completion Status After FOTEP Discharge by Completion Status
Conclusion & ImplicationsConclusion & Implications
Completion of community-based re-entry treatment reduces recidivism for women offenders
However, those with co-occurring disorders and more CJS-involvement remain at high risk for recidivism
Treatment providers need to assess for co-occurring disorders and develop treatment plans that address high-severity profiles
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