NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

1. TIP 44: Adults in the Criminal Justice System Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

2. Screening and Assessment Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

3. Screening Purpose Screen out offenders who do not need treatment Assess the extent of offenders’ treatment needs Gather information for wrap-around referrals Determine eligibility and suitability Information sources Booking records Interview Instruments Correctional records/presentence investigations Past treatment records Police reports Drug Tests Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

4. Screening Areas of Concern Accuracy of information Continuity and system-wide sharing of information The importance of re-screening and re-assessing Timing of screening and assessment Drug testing Detoxification needs Readiness for treatment History of trauma Psychopathy Risk for violence Recidivism Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

5. Diagnosis Pitfalls Stigma Inaccuracy due to withdrawal SA diagnosis may preclude from MH treatment SA diagnosis may limit offenders access to work assignments or vocational training/rehab Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

6. Reasons for Diagnosis Reimbursement To support pharmacological interventions When psychiatric concerns emerge Clarification of co-occurring disorders Research/evaluation Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

7. De-stigmatizing Diagnosis Explain that diagnosis is just short hand Review presenting issues and discuss differential diagnosis Normalize diagnoses Google “Famous people with…” Do an “All About Me” worksheet Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

8. Screening Instruments Instruments with adequate reliability and validity with incarcerated populations Reproduced in appendix C of TIP 44 Addiction Severity Index–Alcohol Use subscale (ASI-Alcohol) ASI–Drug Use subscale (ASI-Drug) Drug Abuse Screening Test (DAST-20) Michigan Alcoholism Screening Test (MAST) Simple Screening Instrument for Substance Abuse (SSI-SA)—Reproduced in TIP 42 (CSAT 2005) Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

9. Assessment Instruments: ASI Addictions Severity Index reproduced in TIP 38, Integrating (CSAT 2000) structured interview format (75 minutes) examines the following areas of functioning: Drug/alcohol use Relationships Employment Legal involvement Physical health Mental health Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

10. Assessment Areas SA Substance use history Motivation Severity and frequency of use Detoxification needs Treatment history Criminal Involvement Criminal thinking Current and prior offense(s) types and numbers Prior successful completion of probation for drug use offenses Prior involvement in diversionary programs History of diagnosis of any personality disorder Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

11. Assessment Areas cont… Health Intoxication Infectious disease Pregnancy General health Acute conditions MH Suicidality MH diagnosis and treatment history Acute symptoms Current medications Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

12. Assessment Areas cont… Special Considerations Educational level Reading level/literacy Language/cultural barriers Physical disability Developmental disability Learning/cognitive disability Housing Dependants/family issues History of abuse (victim or perp) Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

13. Triage and Placement Continuum of services Pretreatment (Detoxification) Outpatient Inpatient Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

14. Triage and Placement cont… Key staff preparations Develop a treatment resource database Define eligibility and suitability for each program Document referral process to each program MOU including information to be shared supervision and treatment responsibilities of each party evaluate effectiveness of offender matching (ongoing) Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

15. Placement Strategies Target offenders with moderate to high risk of recidivism Criminal history Poor employment history Poor support environment Homelessness Antisocial traits (impulsivity, lack empathy, anger issues, entitlement) Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

16. Placement Strategies cont… Moderate to severe substance abuse problems Substance dependence SA related arrests History of SA with or without treatment Positive drug tests Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

17. Placement Strategies cont… Moderate to severe mental health issues Suicidal or violent behaviors Acute symptoms Cognitive impairment (concentration, problem solving) Social impairment (interpersonal skills, frustration tolerance Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

18. Offender characteristics Perceived severity of problems (Readiness for change) Motivation (SOCRATES*, TIP 35) Prior evidence of attempts to improve Perceived importance of treatment *Stages of Change, Readiness, and Treatment Eagerness Scale Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

19. Implementing Treatment Offender involvement in treatment planning Motivational interviewing Coordination with “team” Plan updates at status changes Community based linkages at re-entry Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

20. Implementing Treatment cont… Outreach and low-intensity interventions Provided to all offenders Entrance As part of daily activities (webcast via TV) Exit/Re-entry Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

21. General CJ Treatment Issues Components of criminality Criminal thinking Criminal code (inmate value system) Manipulation Criminal Thinking Learned behavior Help offenders recognize thinking errors and understand how they can lead to behavior CBT and Staff/Peer confrontation Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

22. General CJ Treatment Issues cont… Criminal Code Refusal to cooperate with authority Refusal to confront negative behavior Participation in treatment viewed as weakness “Snitch syndrome” Manipulation Throwing focus Team splitting Demeaning others (Power plays) Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

23. General CJ Treatment Issues cont… Addressing manipulation Identifying the primary thinking errors observed Instructing the client to begin self-monitoring when these occur (journaling) Providing regular feedback to the client, usually from peers in a treatment group Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

24. General CJ Treatment Issues cont… Excuse making Blaming Justifying Throwing focus “I think; therefore it is,” permits function according to what he wants, rather than according to the facts Lying: commission/omission Making Fools Of : pulling the wool Build-up: focus on positives and bring down others Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

25. General CJ Treatment Issues cont… Assuming I'm unique / It doesn’t apply to me Ingratiating : phony manipulation Fragmented Personality Behaviors are inconsistent Minimizing / Exaggerating Vagueness / Non-committal Anger Power plays Victim playing Closed channel : unreceptive, undisclosing Ownership / lack of awareness of other’s boundaries Image cowboy or victim Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

26. Addressing Anger and Hostility Identifying the feeling(s)—other feelings may be involved, such as embarrassment or guilt Understanding clearly where the feeling is coming from Identifying the goals the anger is serving (e.g., deflecting attention) Identifying the goals the anger is undermining (e.g., staying out of jail or keeping a job) Working toward taking the longer view (e.g., beginning to use a positive/pro-social thought process to manage the anger) Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

27. Barriers to Effective Treatment Assessment: inaccurate placements Poor staff training Staff transition Overreliance on institutional sanctions instead of letting peers pressure for internal controls Aftercare availability and compliance Coercion Treatment competes with other facility opportunities Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

28. Sentencing Alternatives Pretrial Diversion Supervision in lieu of detention Treatment in lieu of prosecution Maintain a client’s confidentiality Avoid discussing the client’s criminal case the client is presumed innocent before trial Be realistic about the responsibilities that a client is capable of handling Avoid allowing individuals to be inadvertently penalized for enrolling in treatment Be aware that clients may be more focused on “beating the case” than on recovery Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

29. Drug Courts 10 Components Drug courts integrate alcohol and drug treatment services with justice system case processing. Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants’ due process. Eligible participants are identified early and promptly placed in the drug court program. Drug courts provide access to a continuum of co-occurring disorders treatment. Abstinence is monitored by drug testing. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

30. Drug Courts cont… A coordinated strategy governs drug court responses to participants’ compliance. Ongoing judicial interaction with each drug court participant is essential. Monitoring and evaluating achievement of program goals is necessary to gauge effectiveness. Continuing interdisciplinary education promotes effective drug court planning, implementation, and operations. Forging partnerships among drug courts, public agencies and community-based organizations generates local support and enhances drug court program effectiveness. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

31. Treatment Accountability for Safer Communities (TASC) TASC programs provide a bridge between treatment providers and the CJ system Provide a range of services Screening and assessment Referral to community-based services Monitoring of treatment Case management Court liaison Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

32. Interventions Brief (TIP 34) Motivational (TIP 35) Behavior contacts Phased treatment Substance abuse education Detoxification Day reporting Drugtesting Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

33. Interventions cont… Criminal thinking assessment and treatment (video feedback) Coping skills training Relapse prevention tools Strengths building Communication skills enhancement Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

34. Wrap Around Services Vocational Job readiness assessment and preparation Liaison with employer Literacy assessment and referral Anger management training HIV education/testing/counseling Assistance in accessing public assistance Self-help programs Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

35. Treatment Issues in Jails Most treatment is involuntary Scheduling constraints: treatment or…something else Gang affiliation Confidentiality Trauma Hopelessness (esp. prisons) Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

36. Special Issues: Community Supervision Therapeutic community Intensive outpatient Half-way houses Day reporting Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

37. Special Issues: Women Mental health issues Abuse history HIV positive Poorer employment histories Child custody issues Lower educational level Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

38. Special Population: Elderly Many have spent most of their life in and out of “the system” Prison rules and mores are the norm Developmental milestones (marriage, raising children, career, education, etc.) are absent leading to disculturation Engage them by having them help others Special Issues Increased health problems Slow response to directions Physical issues presenting as MH Lack of assertiveness allowing them to slip through the cracks Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

39. Summary Persons in the CJ system have a unique set of learned behaviors Consider the drawbacks as well as the benefits to giving up criminality Work with the client Set and consistently enforce clear boundaries and rules Identify biopsychosocial issues and their influence on treatment and recovery Ensure clients have a seamless transition into the community Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC