Integrating Risk/Needs Assessment Into Drug Court

1. Integrating Risk/Needs Assessment Into Drug Court Judge Shanta Owens Jefferson County Drug Court Tenth Judicial Circuit Birmingham, AL

2. OBJECTIVES • Develop understanding of the Risk and Need Principle • Develop understanding of the effective use of ARAS in Drug Court • Develop an understanding of Integrating the Risk/Needs Assessment into Drug court

3. My Bio • Presiding Judge, Jefferson County Drug Court Birmingham Division • Drug Court Judge since 2009 • Prior Experience

4. Jefferson County Drug Court • 338 Active Participants • 6 Case Managers • Drug Court Team • Judge • Case Managers • Program Administrator • Treatment Coordinator • Law Enforcement Officer • Peer Specialist • Job Placement Program Coordinator • Medical Provider • Defense Attorneys

5. Prior to March 2013 Jefferson County Drug Court

6. What Do We All Know About Drug Court? Drug Court Works!

7. We Also Know… Drug Court is a scarce and precious resource that should be used in a manner that maximizes its benefits to participants and society in general

8. Risk/Needs Assessment Jefferson County Drug Court

9. What Is An Assessment? Comprehensive Review of Information related to Substance Use Disorders and Risk for Recidivism. Can examine both psychosocial functioning and risk factors (Risk Assessment)

10. RISK AND NEED PRINCIPLE According to what are known as the Risk Principle and the Need Principle, the most effective and cost-efficient outcomes are achieved when treatment and supervision services are tailored to the (1)Prognostic Risk Level and (2) Criminogenic Needs of the Participants (Andrew & Bonta, 2010; Taxman & Marlowe, 2006)

11. Prognostic Risk Characteristics of offenders that predict relatively poorer outcomes in standard rehabilitation programs

12. Risk Factors • Younger age during treatment (especially < 25) • Male Gender • Early onset of substance abuse or delinquency • Prior Felony Convictions • Previously unsuccessful treatment attempts • Co-Existing Diagnosis of antisocial personality disorder • Familial History of Crime or Addiction • Regular Contacts with antisocial or drug-using peers or associates (Marlowe, 2003)

13. Criminogenic Needs Clinical disorders or functional Impairments that, if treated, significantly reduce the likelihood of future involvement in crime

14. Needs • Diagnosis of substance dependence or addiction • Major Mental Illness • Lack of basic employment skills/poor employment history • Lack of daily living skills • Lack of education • Collateral Needs • Dual Diagnosis • Chronic Medical Conditions (ex. HIV, Diabetes, HCV) Belenko, 2006; Simpson & Knight, 2007

15. Prognostic Risk and Criminogenic Need indicate what level of treatment and supervision are likely to be required to manage an offender, and what consequences should ensue for new instances of alcohol or drug use

16. RISK PRINCIPLE • Most intensive treatment should be reserved for Higher Risk offenders • Must survey important Risk Factors to produce an accurate measure of Risk • What does Risk Indicate? • Level of Supervision

17. Need Principle • Interventions must be very focused and target the Needs that are related to Risk • Stabilize the Client first. Then, start to treat the addiction

18. Higher Risk = More Intensive Supervision Services Higher Need = More Intensive Treatment Services High Risk/High Need = Typically Require full array of Treatment and Supervision services embodied in 10 Key Components of Drug Court Low Risk = Less Intensive Supervision Services Low Need = Less Intensive Treatment Services Low Risk/Low Need = Typically do not require the full menu of services specified in the 10 Key Components of Drug Court

19. Providing too much treatment or too much supervision is not merely a potential waste of scarce resources. It can increase crime or substance abuse by exposing individuals to more seriously impaired or antisocial peers, or by interfering with their engagement in productive activities such as work, school, or parenting. (Lowenkamp & Latessa, 2004; McCord, 2003)

20. RISK • High Risk Offenders respond BETTER when placed in a residential intervention and/or intensive supervision • Low Risk Offenders RECIDIVATE at higher rates when placed in residential interventions and/or intensive supervision

21. So…What Did We Do in Our Program? Jefferson County Drug Court

22. We figured out DOSAGE MATTERS • Started using ARAS (Alabama Risk Assessment System) • Adopted from ORAS (Ohio Risk Assessment System) • Length of time in Drug Court now based on Clients Risk and their Level of Needs • 4 Drug Court Tracks with different Requirements and Phases

23. Where Does the Client Fall ? NEED • What level of treatment services RISK • What level of supervision services

24. Alabama Risk Assessment System (ARAS) Jefferson County Drug Court

25. Alabama Risk Assessment System • Assessment is done on every client accepted into Drug Court • Time: Approximately 2 hours per client • Completed by Case Managers • Plea is Taken on Thursday • ARAS is scheduled a few days later • Based upon score, clients are placed in Track 1, 2, 3, or 4

26. ARAS Consists Of: • Criminal History • Education, Employment, and Finances • Family and Social Support • Neighborhood Problems • Substance Abuse • Peer Associations • Criminal Attitudes and Behavioral Problems • Mental Health Screening Form

27. ARAS Score • Overall score does not matter as much as the scores in the individual domains • Moderate to High Score in Substance Abuse, Formal Treatment is required. Therefore, client will be Track 2 or 4, depending on scores in other domains. • Tracks 1 and 3 are clients who do not score Moderate or High in Substance Abuse

30. High Risk/High Need • Dependent on alcohol or drugs • At Risk for failure in standard correctional rehabilitation programs • Using drugs or committing crimes at early age • Failed previously in less intensive dispositions • Possible diagnosis of antisocial personality disorder • Need all services embodied in the 10 Key Components • Should Appear Frequently in Court: No less than Biweekly for the first few months until stable interval of sobriety or engaged in treatment • Our clients appear Weekly in Phase 1, Biweekly in Phase 2, Monthly in Phase 3, and Noncompliance Calendar in Phase 4 • Formal Treatment is Required

31. High Risk/High Need (cont’d) • Need interventions that focus on remediating “criminal thinking” patterns • Minimum dosage of 200 hours of cognitive behavior services • Lack inclination to engage in productive activities such as work, school, or parenting • Do not attach importance to the assumption of responsible roles • Endorse antisocial attitudes and values

32. High Risk/High Need (cont’d) • Deficient in adaptive life skills, such as employability, education, financial management, and homemaking • Adaptive habilitation services are often required to teach vocational skills, address educational deficits, improve daily living skills, and model effective interpersonal problem-solving strategies

33. High Risk/High Need (cont’d) • Deficient in adaptive life skills, such as employability, education, financial management, and homemaking • Adaptive habilitation services are often required to teach vocational skills, address educational deficits, improve daily living skills, and model effective interpersonal problem-solving strategies

34. High Risk/High Need (cont’d) • Compliance with the conditions of supervision and treatment is the primary goal • Abstinence is a more difficult goal • The use of appropriately prescribed medications by a qualified addiction psychiatrist constitutes an evidence-based practice for addicted offenders and should be available in appropriate cases (National Institute on Drug Abuse, 2006).

35. Low Risk/High Need • Dependent on drugs or alcohol • Do not have substantial prognostic risk factors that would predict failure in standard • Primary focus for this group is Treatment services • Do not require frequent supervision on status calendar • Monthly judicial hearings and then noncompliance calendar in Phase 2 • Rather than appear in court interacting with high-risk antisocial peers, they should focus their energy on Treatment

36. Low Risk/High Need (cont’d) • Formal Substance Abuse Treatment Required • However, research suggests that low-risk individuals should not be treated in the same groups as high-risk individuals because they may adopt antisocial attitudes or values (Lowenkamp & Latessa, 2004). • Adaptive Habilitation services may be required such as vocational or educational assistance, family therapy, or mental health counseling.

37. Low Risk/High Need (cont’d) • Consequences should be focused on Treatment • Abstinence is still a difficult goal • Use of appropriately prescribed medications by a qualified addiction psychiatrist may be indicated for some addicted offenders

38. High Risk/Low Need • Non-Dependent substance abusers • But have substantial Risk Factors for failure on standard supervision • Emphasis should be on closely monitoring their behavior, holding them accountable for their conduct, and teaching them pro-social life skills • Should appear in court on a status calendar for judge to review progress • Weekly judicial hearings • Because they are at risk for failing to comply with standard supervision requirements

39. High Risk/Low Need (cont’d) • Better suited for Early Intervention classes that teach about the dangers of drugs and alcohol and activity-scheduling exercises that re-orient their daily activities away from drug-related peers and events • Because High Risk, 200 hours of cognitive behavioral services may be needed to reduce criminal activity • Focus consequences on Abstinence and Supervision

40. Low Risk/Low Need • Unnecessary to expend substantial resources on this group because they have a low probability of recidivism • Noncompliance Calendar • Prevention Services such as Early Intervention classes on an individual basis or in separately stratified groups • Drug and alcohol use are under their voluntary control • Important that this group is NOT mixed with high risk offenders or that they spend lots of time in court

41. Jefferson County Drug Court

42. ARAS IS IMPORTANT BECUASE • Better understanding of client’s circumstances and what level care is needed to treat him/her • You do not want to mix occasional pot smoker with hardcore IV drug user in treatment • Want to use resources wisely and treat the right people • Ex: Low Risk, Low Need folk don’t need inpatient treatment. Without an assessment, this would be a waste of resources

43. How Do You Get Reliable Information? Jefferson County Drug Court

44. ARAS INTERVIEW • Goal: Information Gathering • Environment should be conducive to disclosure of information • Purpose of Assessment should be explained • Client should be alone • Interviewer should be Patient, Open-Minded, and Attentive • Interviewer should exhibit good listening skills • Open-Ended Questions • Avoid Close-Ended, Biased, Double-Barreled questions

45. The Challenging Interview • Dealing with Inconsistencies • Use collateral info/resources • Lightly challenge inconsistent info • Dealing with Oppositional Behavior • Offer Choices • Offer a Break • Redirect

46. QUESTIONS?