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Gender-Responsive Drug Treatment Services for Women Offenders

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Gender-Responsive Drug Treatment Services for Women Offenders

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    1. Gender-Responsive Drug Treatment Services for Women Offenders Elizabeth Hall, Ph.D. Criminal Justice Research Group Integrated Substance Abuse Programs Semel Institute for Neuroscience and Human Behavior University of California, Los Angeles Research funded by the National Institute of Justice, the California Department of Corrections and Rehabilitation, and the National Institute on Drug Abuse

    3. Background: What are the characteristics of national and state populations of women in prison and on parole? Growing population Increased by 21% from 2000 to 2006 to total of 103,100 just last year, the number of women prisoners increased by 4.5% from the previous year Mostly due to drug offenses 11% in 1979, nearly 35% in 1997, 30% in 2001, 29% in 2004 59% of women used drugs in the month prior to their offense Female inmates (17%) were more likely than males (10%) to report use of methamphetamines in the month before their offense Female inmates (60%) were more likely than males (53%) to meet drug dependence criteria 40% committed offense under the influence of drugs Underclass population 70 to 90% were unemployed, 50% were functionally illiterate, 42% had not completed high school or the GED prior to incarceration 2001 and 2002 statistics from: Harrison, P. M., & Beck, A. J. (2003). Prisoners in 2002. Bureau of Justice Statistics Bulletin, July 2003 (Revised 8/27/03), NCJ 200248. U.S. Department of Justice, Office of Justice Programs. 2004 and 2006 statistics from: Sabol, W. J., Couture, H., & Harrison, P. M. (2007). Prisoners in 2006. Bureau of Justice Statistics Bulletin, December 2007, NCJ 219416. U.S. Department of Justice, Office of Justice Programs. High school/GED stats from: Harlow, C. W. (2003). Education and correctional populations. Special Report, Bureau of Justice Statistics, January, 2003 (revised 4/15/03). NCJ 195670.2001 and 2002 statistics from: Harrison, P. M., & Beck, A. J. (2003). Prisoners in 2002. Bureau of Justice Statistics Bulletin, July 2003 (Revised 8/27/03), NCJ 200248. U.S. Department of Justice, Office of Justice Programs. 2004 and 2006 statistics from: Sabol, W. J., Couture, H., & Harrison, P. M. (2007). Prisoners in 2006. Bureau of Justice Statistics Bulletin, December 2007, NCJ 219416. U.S. Department of Justice, Office of Justice Programs. High school/GED stats from: Harlow, C. W. (2003). Education and correctional populations. Special Report, Bureau of Justice Statistics, January, 2003 (revised 4/15/03). NCJ 195670.

    4. Background: What does prior research say about women offenders’ need for health and mental health services upon release? Health ~ 37% of women parolees report needing medical or dental services in the year after release Mental health ~23% of women in jails and state prisons are mentally ill High level of prior physical and sexual abuse 51% of women, and, 78% of mentally ill women in state prisons reported having been physically or sexually abused prior to incarceration 63% of mentally ill women released from prison received community mental health treatment; 19% were hospitalized (Massachusetts) Health - Prendergast, Wellisch, & Wong, 1996 Mental Health – Ditton, P. M. (1999). Mental health and treatment of inmates and probationers. Special Report, Bureau of Justice Statistics, July 1999. NCJ 174463. Hartwell, S. (2001) Female mentally ill offenders and their community reintegration need: An initial examination. International Journal of Law and Psychiatry, 24, 1-11. Children – Richie, B. E., Freudenberg, N., & Page, J. (2001) Reintegrating women leaving jail into urban communities: A description of a model program. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 78(2), 290-303.Health - Prendergast, Wellisch, & Wong, 1996 Mental Health – Ditton, P. M. (1999). Mental health and treatment of inmates and probationers. Special Report, Bureau of Justice Statistics, July 1999. NCJ 174463. Hartwell, S. (2001) Female mentally ill offenders and their community reintegration need: An initial examination. International Journal of Law and Psychiatry, 24, 1-11. Children – Richie, B. E., Freudenberg, N., & Page, J. (2001) Reintegrating women leaving jail into urban communities: A description of a model program. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 78(2), 290-303.

    5. Background: What does prior research say about women offenders’ need for daily living services upon release? Welfare assistance 56% of women parolees received welfare assistance in the year after release Housing 9% of state prison inmates (men and women) were homeless in the year before incarceration One-third of mentally ill women offenders were anticipating homelessness upon release Welfare assistance - Prendergast, Wellisch, & Wong, 1996 Housing – Ditton, P. M. (1999). Mental health and treatment of inmates and probationers. Special Report, Bureau of Justice Statistics. July 1999, NCJ 174463. Hartwell, S. (2001) Female mentally ill offenders and their community reintegration need: An initial examination. International Journal of Law and Psychiatry, 24, 1-11. Children – Greenfield & Snell, 1999; Mumola, C. J. (2000). Incarcerated parents and their children. Special Report, Bureau of Justice Statistics. NCJ 182335; Richie, B. E., Freudenberg, N., & Page, J. (2001) Reintegrating women leaving jail into urban communities: A description of a model program. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 78(2), 290-303.Welfare assistance - Prendergast, Wellisch, & Wong, 1996 Housing – Ditton, P. M. (1999). Mental health and treatment of inmates and probationers. Special Report, Bureau of Justice Statistics. July 1999, NCJ 174463. Hartwell, S. (2001) Female mentally ill offenders and their community reintegration need: An initial examination. International Journal of Law and Psychiatry, 24, 1-11. Children – Greenfield & Snell, 1999; Mumola, C. J. (2000). Incarcerated parents and their children. Special Report, Bureau of Justice Statistics. NCJ 182335; Richie, B. E., Freudenberg, N., & Page, J. (2001) Reintegrating women leaving jail into urban communities: A description of a model program. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 78(2), 290-303.

    6. Background: What does prior research say about women offenders’ need for parenting assistance services? Family Seven in ten women inmates had children under 18 years of age, and of these, two-thirds of the children were living with their mothers before incarceration Responsibility for children may preclude residential treatment after release Housing – Ditton, P. M. (1999). Mental health and treatment of inmates and probationers. Special Report, Bureau of Justice Statistics. July 1999, NCJ 174463. Hartwell, S. (2001) Female mentally ill offenders and their community reintegration need: An initial examination. International Journal of Law and Psychiatry, 24, 1-11. Children – Greenfield & Snell, 1999; Mumola, C. J. (2000). Incarcerated parents and their children. Special Report, Bureau of Justice Statistics. NCJ 182335; Richie, B. E., Freudenberg, N., & Page, J. (2001) Reintegrating women leaving jail into urban communities: A description of a model program. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 78(2), 290-303.Housing – Ditton, P. M. (1999). Mental health and treatment of inmates and probationers. Special Report, Bureau of Justice Statistics. July 1999, NCJ 174463. Hartwell, S. (2001) Female mentally ill offenders and their community reintegration need: An initial examination. International Journal of Law and Psychiatry, 24, 1-11. Children – Greenfield & Snell, 1999; Mumola, C. J. (2000). Incarcerated parents and their children. Special Report, Bureau of Justice Statistics. NCJ 182335; Richie, B. E., Freudenberg, N., & Page, J. (2001) Reintegrating women leaving jail into urban communities: A description of a model program. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 78(2), 290-303.

    7. Background: What does prior research say about women offenders’ need for vocational services? Less likely to have viable work skills or employment history, as compared with males Lower wages Grella, 2008, Drug Court monograph Grella, 2008, Drug Court monograph

    8. Why have gender-responsive programs? Research suggests that women may be more responsive to treatment within women-only treatment facilities or groups, because they feel less intimidated or concerned about being stigmatized in such settings, because of a desire to obtain services specific to their needs, or because they seek shelter from intimate partner violence. Grella, 2008Grella, 2008

    9. Characteristics of Gender-Responsive Programs Focus on the psychosocial profile of substance-abusing women Grella 2008 Drug Court monographGrella 2008 Drug Court monograph

    10. Is gender-responsive treatment successful? Research shows that women are more likely to complete treatment and have better outcomes when targeted services are available residential treatment with live-in accommodations for children provision of family therapy comprehensive supportive services, such as case management, pregnancy-related services, parenting training/classes, childcare, vocational training, and aftercare More research needs to be done

    11. Evidence-based treatment approaches for women substance abusers Relapse prevention approaches focus on teaching clients to recognize “cues” or “triggers” for substance use and strategies for avoiding relapse in those situations Motivational interventions use therapeutic strategies to increase the individual’s awareness of their substance abuse problems and to engage their commitment to behavior change Contingency management approaches employ a schedule of rewards to strengthen the practice of desired behaviors (e.g., abstinence)

    12. Evidence-based treatment approaches for women substance abusers, cont’d Trauma and PTSD interventions Seeking Safety – cognitive-behavioral Trauma Recovery and Empowerment Model – group therapy Beyond Trauma – “relational theory”

    13. Recommendations Drug courts should: refer women to treatment programs that are either focused exclusively on women clients or that provide services specifically tailored for women’s needs. make sure that mental health screening and assessment occurs for all women and, when indicated, that mental health treatment is integrated with addiction treatment ensure that treatment programs screen women for their history of trauma and the ongoing effects of exposure to trauma, violence, and victimization From Grella 2008From Grella 2008

    14. Recommendations Drug courts should: assure that treatment programs provide services that address their need for education and employment skills ensure that parenting-related needs are assessed, and, if appropriate that treatment is coordinated with child welfare services refer women to treatment programs that screen for health problems commonly found among female substance abusers utilize treatment programs that incorporate evidence-based treatment approaches From Grella 2008From Grella 2008

    15. Gender Responsive Treatment for Women Offenders Michael Prendergast, Ph.D. Nena Messina, Ph.D. Elizabeth Hall, Ph.D.

    16. Gender Responsive Treatment for Women Offenders Los Angeles In Drug Court and Prop. 36 programs Average number of days in treatment for those who attended (n=47) 127.0 (SD 84.6) Clients recruited and interviewed according to procedures approved by UCLA IRB Assessments at intake, 1, and 12 months (includes urine sample at each time point) Payment with grocery gift cards (max. total possible $135 for all 3 interviews) Clients recruited and interviewed according to procedures approved by UCLA IRB Assessments at intake, 1, and 12 months (includes urine sample at each time point) Payment with grocery gift cards (max. total possible $135 for all 3 interviews)

    18. Psychological and Social Functioning Instruments include: Experiences in Close Relationships Inventory (ECRI), ISAP social support scale (SS), the Brief Symptom Inventory (BSI), and the Adult-Adolescent Parenting Inventory (AAPI). Statistical analyses include paired t-test and mutivariate regression Instruments include: Experiences in Close Relationships Inventory (ECRI), ISAP social support scale (SS), the Brief Symptom Inventory (BSI), and the Adult-Adolescent Parenting Inventory (AAPI). Statistical analyses include paired t-test and mutivariate regression

    19. Parenting Standard scores run from 1 to 10. The scales are normed at 5. Standard scores run from 1 to 10. The scales are normed at 5.

    20. Conclusions A minority of participants (16%) had a secure adult attachment style in which they found it easy to be emotionally close to others. While attachment styles did change over time, most notably a reduction in the percentage of women exhibiting a fearful attachment style (discomfort in getting close to others), the move to a dismissing attachment style (preferring not to depend on others or have others depend on them) was not a positive sign of growth. Participants showed personal growth in social support and improvement in their psychological symptoms.

    21. Conclusions While participants had expectations for their children that were age-appropriate, they lacked empathy for their children, tended to favor physical punishment, tended toward parentification of their children (reversed roles), and tended toward an authoritarian relationship (restricting power/independence) with their children. Given the cyclical nature of abuse, the lack of improvement in parenting attitudes over time shows a high need among this population for additional parenting intervention.

    22. Questions? www.uclaisap.org ehall@ucla.edu

    23. Gender-Responsive Drug Treatment Services for Women Offenders Elizabeth Hall, Ph.D. Michael L. Prendergast, Ph.D. Jean Wellisch, Ph.D. Criminal Justice Research Group Integrated Substance Abuse Programs Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles Research funded by the National Institute of Justice, the California Department of Corrections, and the National Institute on Drug Abuse

    24. Background: Forever Free Substance Abuse Treatment Program Started in 1991 Designed specifically for women Cognitive-behavioral model (Gorski) Participants housed separately, but mix with other inmates during meals and work assignments Intensive six-month program provided to volunteering women inmates during the end of their imprisonment Upon release, women may also volunteer for an additional six months of residential treatment in the community This is a description of the program at the time of the study. Changes since then: No longer funded by RSAT Now a 4-month program Number of beds increased to 240 (though only about 180 filled) Clients receive work credit for participation Community treatment options have been increased, so volunteer rate may increase This is a description of the program at the time of the study. Changes since then: No longer funded by RSAT Now a 4-month program Number of beds increased to 240 (though only about 180 filled) Clients receive work credit for participation Community treatment options have been increased, so volunteer rate may increase

    25. Aims Compare the post-release service needs of Forever Free participants with similar inmates from the general prison population Compare the post-release services received by Forever Free participants with similar inmates from the general prison population Determine the levels of unmet need for post-release services Examine changes in needs and services over time

    26. Subjects Female 215 inmates 119 enrolled in Forever Free 96 in comparison group enrolled in drug education Housed at California Institution for Women near Chino Low educational attainment 66% have children under 18 Offenses were primarily drug or drug-related During the 30 days before incarceration, the treatment group reported spending an average of $125 on alcohol and $1,976 on illegal drugs

    27. Methods In-prison assessment: Twice for the treatment group Once for the comparison group (abbreviated form) One-year post-release interviews: Telephone and face-to-face Urine samples Follow-up interviews were completed with 84% of the original sample.

    28. Findings: Treatment post-release (percent) Discuss types of treatment here: Self-help and sober living aren’t actually treatment Include a distinction between residential and therapeutic community Best practicesDiscuss types of treatment here: Self-help and sober living aren’t actually treatment Include a distinction between residential and therapeutic community Best practices

    29. Findings: Psychological functioning (mean score) At 12 months post-releaseAt 12 months post-release

    30. Findings: Employment (percent)

    31. Findings: Children’s status at follow up (percent)

    32. Findings: Self-rating of how well doing as parent (percent)

    33. Findings: Substance abuse treatment needs post-release (percent) * P < .05* P < .05

    34. Findings: Substance abuse treatment services received post-release (percent) * P < .05* P < .05

    35. Findings: Health and mental health services needs post-release (percent) * P < .05* P < .05

    36. Findings: Health and mental health services received post-release (percent) * P < .05* P < .05

    37. Findings: Daily living services needs post-release (percent)

    38. Findings: Daily living services received post-release (percent) ** P < .01** P < .01

    39. Findings: Educational and vocational service needs post-release (percent)

    40. Findings: Educational and vocational services received post-release (percent)

    41. Findings: Parenting assistance needs post-release (percent)

    42. Findings: Parenting assistance received post-release (percent)

    43. Conclusions Women in both groups had a high need for services during parole Women in the comparison group generally had greater needs, but were less likely to receive services during parole The greatest unmet need for both groups was for vocational and educational services (37% - 40% service gap) Women also had a great unmet need for housing (35% service gap)

    44. Discussion While previous national research found that custodial treatment programs report that they provide women offenders with treatment, housing, and welfare assistance; the percentage of women actually receiving such assistance may be small. Compared to previously reported research on an earlier group of Forever Free and comparison women, service needs have increased in all areas. Ask the women! Prendergast, Wellisch, & Falkin, 1995; Prendergast, Wellisch, & Wong, 1996Prendergast, Wellisch, & Falkin, 1995; Prendergast, Wellisch, & Wong, 1996

    45. Ask the Women! We wanted to know about: Supports for success on parole Barriers to success on parole Why women didn’t enter treatment during parole Personal factors that may influence success

    46. Method We conducted focus groups with 4 groups of women (all had received or were receiving drug treatment in prison): 1. Those about to parole 2. Those on parole and in community drug treatment 3. Those who paroled, got a new charge, and were returned to prison (Returnees) 4. Those who paroled and were long-term successes

    47. What women learned in prison treatment: “What I learned were things about myself - what’s inside. I learned that I don’t have to live like that anymore. I learned about self-esteem, post-acute withdrawal, etc.” [Rs] “They teach us about abuse and relationships, about how it’s not our fault that we’re abused.” [Tx] “I didn’t know I have an anger problem. They’ve taught me how to deal with my anger.” [Tx]

    48. “They help you realize that you aren’t that bad; that you have a lot of mistaken beliefs. You need to take a look at what you really are; that covered a lot of areas for me.” [LT] “They explained why; just like elementary school; over and over again until you got it. But it was based on self-esteem. Conglomeration of a lot of different aspects. They really worked with you to make sure you really understood about all the different aspects of drug and alcohol use.” [LT] What women learned in prison treatment:

    49. Treatment After Parole The greatest influence on parole success In addition to the basics of drug treatment, women got: “unconditional love” education social and emotional support from counselors and other clients networking experience the 12 Steps

    50. Concerns about finding employment: No one wants to give you a chance if you’re an ex-offender. I couldn’t even get a job bagging groceries. [Tx] They don’t tell you about certain things, like the difficulty of finding a job if you’re a felon. [LT] The girls need some outlet for work. I finally got a job, but you need determination and a willingness to work for minimum wage. [LT]

    51. Barriers to Success on Parole: Employment You need resources, places to go. The CDC doesn’t provide you with anything. There is voc rehab through the parole agency, but you have to apply in advance. [LT] Drug programs need job placement services. They need to help you educate yourself. There are all these computers here at [Program C] and they are going unused. [Res] Residential programs need to inform us. We learn a lot of things here through word of mouth. A lot of us didn’t know about the Department of Voc Rehab, grants, schools, etc. and found out about them through other residents. [Program C] doesn’t help with job placement—they just tell you to go out and get a job. [Res]

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