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Treatment Alternatives Treatment Alternatives to Street Crimeto Street Crime

The TASC Model

Elizabeth A. PeytonPresentation at the 7th National Conference on Drugs

and CrimeOrlando, Florida, October 2000

Bpeyton@delanet.com

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Understanding the ProblemUnderstanding the Problem

The impact of substance abuse on our justice & treatment systems is astounding

High levels of substance abuse in offender populations

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Per cent incr ease in state pr isonPer cent incr ease in state pr isonadmissions between 1980 & 1995admissions between 1980 & 1995

0% 200% 400% 600% 800% 1000% 1200%

Violent Crime

Property Crime

Drug Offenses

Source: Corrections Program Office, U.S. Department of Justice

1100%

85%

50%

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Only a small percentage of Only a small percentage of inmates receive treatment inmates receive treatment

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101520253035404550

NeedTreatment

ReceiveTreatment

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Offenders in the community are Offenders in the community are substance involved & substance involved &

Incarceration is expensiveIncarceration is expensive

Costs to incarcerate in state and federal prisons and jails will exceed $41 Billion in 2000 (Camp, 1999)

Many states spend more money on prisons than on higher education (Justice Policy Institute, 1999)

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The use of illicit drugs & alcohol is a central factor driving correctional growth.

Treatment is effective as reducing substance abuse & related criminal activity.

Treatment is cost effective.

Providing adequate services to justice populations is difficult.

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Managed Care is HereManaged Care is Here

In most jurisdictions, the adoption of managed care techniques has reduced access to services

Lengths of stay are shortened

Thresholds for admission to intensive treatment have increased

Referral and admission procedures are more complex, and may involve third-party authorization

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What is TASC?What is TASC?

A program model and methodology to:

Engage persons referred by the justice system into substance abuse treatment and other services

Collaborate with both justice and treatment to ensure that appropriate and adequate services are available for justice clients

The 13 Critical Elements define TASC

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TASC Provides the TASC Provides the Infrastructure forInfrastructure for

managing substance involved persons throughout the justice process

providing support during transitions

engaging clients at all points in the justice system

integrating services into justice system processing

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Systems Coordination

Organizational

Operational

13 Critical Elements

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Systems Systems Coordination Coordination

ElementsElements

Systems Systems Coordination Coordination

ElementsElements

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A Process to Coordinate Justice, A Process to Coordinate Justice, Treatment & other SystemsTreatment & other Systems

Develop collaborative approaches to integrate treatment & justice to provide a seamless continuum of treatment and accountability

Develop & expand treatment networks

Influence the policies, procedures & priorities of the justice & treatment systems Ensure adequate & appropriate services for

justice clients

Element 1

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Procedures for Providing Information & Procedures for Providing Information & Cross-Training to justice, treatment & other Cross-Training to justice, treatment & other

systemssystems

Continuously develop skills & relationships

Keep policymakers & practitioners current about status of & effective strategies for managing substance involved justice populations

Element 2

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Organizational Organizational ElementsElements

Organizational Organizational ElementsElements

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A Broad Base of Support from the A Broad Base of Support from the Justice System with a Formal Justice System with a Formal

System for Effective CommunicationSystem for Effective Communication

Establish & maintain a coordinated effort & understanding for referrals between TASC & justice system components

Element 3

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A Broad Base of Support by the A Broad Base of Support by the Treatment & Other Social Services Treatment & Other Social Services

CommunityCommunity

Establish and maintain the linkages & understanding to:Ensure availability & quality

of treatment for justice clients

Make client referralsConduct tracking, monitoring

& case management activities

Element 4

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Organizational IntegrityOrganizational Integrity

Ensure TASC program integrity and organizational capability to carry out the program mission

Ensure objectivity and autonomyOver-identification with either

system can limit TASC’s credibility and functioning

Element 5

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Policies and procedures for Policies and procedures for regular staff trainingregular staff training

Ensure that all staff understand the TASC mission, philosophies & procedures to ensure competency

TASC staff must be experts in all participating systems

TASC staff must have skills to connect with & manage clients

Clinical & non-clinical staff can be effective

Element 6

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A management information A management information system with a program evaluation system with a program evaluation

designdesign

Provide timely and accurate informationfor developing & managing

program servicesfor determining & improving

operational effectivenessfor policymakers & funding

sourcesto meet public information needs

Element 7

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Important Important Data ElementsData Elements

Number of potential clients identified & referred; outcome of referral; reasons for exclusion; demographics; screening &/or assessment information

Demographic & socioeconomic characteristics of all admitted clients by referral source

Client characteristics including justice & substance abuse history & status; screening & assessment results; drug screen results; & mental health status

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Important Data Important Data ElementsElements

Records of all contacts & events that occur at TASC, treatment, other services & the justice system, along with outcomes of those events

Costs associated with delivery of client services

Performance measures, including process & outcome

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Operational Operational ElementsElements

Operational Operational ElementsElements

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Clearly Defined ClientClearly Defined ClientEligibility CriteriaEligibility Criteria

Set clear standards for inclusion & exclusion of individuals from TASC

Justice system involvement

Current &/or previous AOD involvement

Informed voluntary consent

Element 8

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Performing Client CenteredPerforming Client CenteredCase ManagementCase Management

Maintain ongoing connection with each client as he/she moves through various justice processes & multiple programs

Communicate progress & changes regularly to both justice & treatment

Provide the leverage, support & advocacy to encourage treatment engagement & retention

Intervene before behavior results in treatment termination

Element 9

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Case ManagementCase Management

Ties everything together & provides structure in and between systems that aren’t very systematically organized

The mortar that holds everything together

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Primary Functions of Primary Functions of TASC Case ManagementTASC Case Management

Screening & assessment

Referral & linkage to services

Ensuring access to services

Monitoring progress through client contact & chemical testing

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Primary Functions of Primary Functions of TASC Case ManagementTASC Case Management

Communicating with all relevant parties

Providing encouragement & support

Providing advocacy

Maintaining primary responsibility for the client as he/she participates in various justice & treatment programs & interventions

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TASC Case TASC Case ManagementManagement

Can be distinguished from traditional case management by:

its level of assertiveness its ongoing nature its focus on long-term

positive outcomes resulting from multiple interventions

its continual inter-agency & inter- system communication

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Screening Procedures for Screening Procedures for Identification of TASC Clients Identification of TASC Clients

within the Justice Systemwithin the Justice System

Determine appropriateness & suitability for treatment

Determine TASC eligibility

Begin building a plan for treatment & supervision

Element 10

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Documented Procedures for Documented Procedures for Assessment & ReferralAssessment & Referral

Provide a standardized assessment that includes clinical, justice & other information

Referral to an appropriate level of care that is coordinated with justice requirements

Development of a comprehensive case management plan

Element 11

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Assessment and Referral IssuesAssessment and Referral Issues

Assessments should include, at a minimum:

Chemical dependency status Justice involvement & justice

history Social history Agreement to participate in TASC

& treatment - and understanding of confidentiality rules

If treatment is not immediately available, monitoring by TASC should be available for an interim period

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Policies, Procedures & Protocols for Policies, Procedures & Protocols for Monitoring Drug & Alcohol Use Monitoring Drug & Alcohol Use

through Chemical Testingthrough Chemical Testing

Reliably monitor & report client’s use of or abstinence from alcohol & other drugs to encourage compliance & to facilitate the therapeutic process

Element 12

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Competency with Diverse Competency with Diverse PopulationsPopulations

Ensure that TASC & treatment delivery systems are sensitive to & provide relevant services regardless of client race, culture, religion, gender, age, ethnicity or sexual orientation

Treatment engagement & success is dependent on the ability programs & counselors have to connect with the client

Element 13

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Effectiveness of TASCEffectiveness of TASC

TASC programming is effective in:

Identifying populations in great need of treatment

Assessing the nature & extent of drug use patterns & specific treatment needs

Referring to treatment Serving as a linkage between justice

& treatment Providing monitoring services Retaining clients in treatment longer,

with better post-treatment success

Inciardi and McBride, 1991

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Effectiveness of TASCEffectiveness of TASC

TASC clients remain in treatment six to seven weeks longer than voluntary clients or other criminal justice referrals

Hubbard et. al., 1989

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Effectiveness of TASCEffectiveness of TASC

Involvement in TASC results in the provision of significantly more substance abuse & other services compared to non-TASC control groups

In study sites, TASC had the strongest effect at reducing drug use & drug crimes with the most problematic offenders

Turner and Longshore, 1998

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Effectiveness of TASC Effectiveness of TASC

Clients diverted to TASC through Maricopa County’s Do Drugs Do Time program had a 22% recidivism rate, compared to 54% of matched clients who didn’t receive TASC services

Hepburn, 1996

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Effectiveness of TASCEffectiveness of TASC

In 1998, New York City TASC diverted almost 2,000 offenders from prison & into treatment.

70% of participants have successfully completed the program since its inception in 1990.

Rearrest rates 12 months after completion remained around 10% in three separate studies.

EAC, 1999

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Benefits of TASCBenefits of TASC

Provides the organizational infrastructure to manage substance involved offenders in a logical, organized & cost effective fashion

Provides the organizational infrastructure to support other programming, including drug courts, re-entry management programs, Breaking the Cycle, networks, mental health courts, & other initiatives to integrate treatment into justice processes

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Benefits of TASCBenefits of TASC Uses resources efficiently by

screening, assessing & placing justice clients in the appropriate level of care - and ensuring that transitional & aftercare needs are met

Builds the capacity & capability of treatment to serve justice populations effectively through the development of treatment networks

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Benefits of TASCBenefits of TASC

Manages clients to make sure they access & benefit from treatment

Ensures that treatment requirements are coordinated with justice processes

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Benefits of TASC Benefits of TASC

Improves inter-system communication

Ensures that treatment is available to coincide with or capitalize on the “motivational opportunities” created by justice processing

Augments available services through case management, treatment readiness & chemical testing - and by using justice system leverage to encourage treatment compliance

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TASTASCC::

ClientClient & & SystemsSystems

ManagementManagement

TASTASCC::

ClientClient & & SystemsSystems

ManagementManagement