Robert L. Neri, LMHC, CAP Senior Vice President /Chief Clinical Officer WestCare Foundation, Inc.

1. “Drug Offender TreatmentLessons Learned: New Challenges from Institution to Community”2013 FADAA/FCCMH Annual Conference Robert L. Neri, LMHC, CAP Senior Vice President /Chief Clinical Officer WestCare Foundation, Inc.

2. Learning from the Past • Lessons of the Present • Looking to the Future Lessons Learned in Corrections 11

3. Training Objectives: Participants will be able to list examples of the many dynamic changes in the field of drug offender treatment Participants will be able to assess their programs’ readiness for future anticipated changes Participants will be exposed to the significance of the treatment environment and culture as it relates to outcomes Participants will leave with several ideas to process and plan with their program staff Lessons Learned in Corrections 21

4. Do you know that 90% of your brain works without using any words at all? Just so you know that means there’s only a 10% chance of me making any sense at all once I start talking Lessons Learned in Corrections 31

5. “I kept trying to be what you wanted, he said- but at a certain point you needed to stop adding to the list” Ex Offender Lessons Learned in Corrections 41

6. TREATMENT/CORRECTIONS CONTINUUM TREATMENT Lessons Learned in Corrections Prevention Intervention Long-term Residential Intensive Outpatient In Jail/In Prison Basic Outpatient Short-term Residential Sober Housing GPS Day Reporting Centers CORRECTIONS Prison: in Treatment + Re-entry Community ControlGPS Jail: in Treatment + Re-entry Civil Citations House Arrest Basic Community Supervision Pre-trial Programs 51

7. Treatment Is Dynamic & Changing Separated vs. Integrated Relapse (Shame-based) vs. Relapse Analysis Medication (Shunned) vs. Medication Valued Harsh Confrontation vs. Motivational Continuum Recovering Staff vs.Multi-Disciplinary Lessons Learned in Corrections 61

8. Treatment Is Dynamic & Changing Continued Instinct-Based vs. Research- Based One Size Fits All vs. Individualized Supervision vs. Supervision Intermittent Planned Must Hit Bottom vs. Coercion Works Lessons Learned in Corrections 71

9. CLIENT RECOVERY IS RELATIONAL Lessons Learned in Corrections COUNSELOR JUDGE 8

10. Client Motivation isDependentUponInternalaswell as External Pressures Lessons Learned in Corrections 91

11. Motivational Changes in Treatment Treatment Dosage Lessons Learned in Corrections External Internal 101

12. Developmental Model Principles • “It’s a process not an event” • “Treatment is cumulative” • Developmental Psychology means: “Psychology of Maturation” Lessons Learned in Corrections 111

13. COMPETENCY BASED APPROACH TO LEARNING Competency Mastery Requires: • Information knowledge • Implementation knowledge Lessons Learned in Corrections 121

14. Establish a therapeutic alliance: build and facilitate trust transfer Lessons Learned in Corrections 131

15. HIGH PAIN HHIGH HOPE Lessons Learned in Corrections LOW HOPE LOW PAIN 14

16. Ratio of Rewards to Sanctions and the Probability of Success Lessons Learned in Corrections 15

17. Incentives & Sanctions Maximize benefit by timing of rewards and consequences Lessons Learned in Corrections 161

18. Finding a New Vocabulary for Affirmation and Validation • Pulling Up the Positive to Avoid the Punitive • Affirm the Small Steps and Progress • Educate- Which Means “Lead Forth” • Learn to Articulate Affirmations • Develop Emotional Literacy….Name it, Claim it, Own it, Change it! Lessons Learned in Corrections 171

19. {Assess / Deprivation Needs} • Trauma History • Resiliency Factors Lessons Learned in Corrections 181

20. Programs are: Expectations based- Emphasize relationships Rules based- Emphasize compliance Lessons Learned in Corrections 191

21. Compliance is adaptation Not Treatment Lessons Learned in Corrections 201

22. Institutionalization requires treatment Emotional Incarceration Lessons Learned in Corrections 211

23. Lessons Learned in CorrectionsGender Specific Challenges for Men Vs. 22

24. Lessons Learned in CorrectionsGender Specific Challenges for Men Vs. 23

25. Facilitate movement from compliance to internalization through gradual reduction of structure and insight work Lessons Learned in Corrections 241

26. Create a treatment culture that promotes “Mistakes as wonderful opportunities to learn”. Lessons Learned in Corrections 25

27. Teach social network mapping and assist clients with building a social support network Lessons Learned in Corrections 261

28. How Can Programs Improve Care • Ask and integrate trauma related questions / practices • Deliver more experiential based learning • Improve cognitive health approach (teach memory / thinking skills) • Use incentives 4:1 to sanctions Lessons Learned in Corrections 271

29. How Can Programs Improve Care Continued • Insure program cultures are expectations based vs. rules based • Aftercare can be more of a system rather than a loose aggregate of diverse providers • Develop a youthful offender track of services Lessons Learned in Corrections 28

30. Risk, Need, Responsivity The Big 8 Lessons Learned in Corrections 29

31. Risk, Need, Responsivity The Big 8 Lessons Learned in Corrections 30

32. Risk, Need, Responsivity The Big 8 Lessons Learned in Corrections 31

33. Expectations Reality • Not easy, but worth it Lessons Learned in Corrections 32

34. Questions? Thank you Lessons Learned in Corrections 33