Elements of an Effective Substance Abuse Treatment Model for Offenders

Overview andPart 1: Assessment

Presentation to Caribbean CICAD membersSt. Lucia

November, 2004

Elements of an Effective Substance Abuse Treatment Model for Offenders

Overview andPart 1: Assessment

Presentation to Caribbean CICAD membersSt. Lucia

November, 2004

Correctional Service of Canada

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Overview of ModelOverview of Model

Although the actual programs / interventions are often the cornerstone of any effective substance abuse treatment model, interventions may not be successful if not rooted in an overall approach that considers:• Assessment• Treatment Matching• Maintenance• Adjunctive Services• Quality Assurance and Evaluation

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Overview of ModelOverview of Model

Programs

AssessmentNeeds of offender pop.

Individual

for evaluation purposes

Treatment MatchingProblem severity

Risk, needs, responsivity

Quality Assurance, Evaluation & Monitoring

Maintenance•What happens after intensive treatment phase of treatment?

Adjunctive Services

•What other the offender’s other need areas?

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Part 1 - AssessmentPart 1 - Assessment

• The first element of an effective substance abuse intervention model for offenders that we will discuss is:

assessment

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Overview of AssessmentOverview of Assessment

Are three main ways in which assessment contributes to an effective substance abuse treatment model:

Through NEEDS ASSESSMENT to evaluate the profile of your population and the services that they require

Through the INDIVIDUAL ASSESSMENT of the offender to determine his/her needs

Through the use of assessment measures to EVALUATE THE EFFECTIVENESS of your interventions

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Needs AssessmentNeeds Assessment

To provide the most effective services in the most cost-effective way, it is key to evaluate the profile of your target group and the services they require

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Needs AssessmentNeeds Assessment

A good needs assessment will*:

• Identify the needs of a target population in a particular area;

• Help to prioritize those needs to ensure better planning of services an more effective allocation of resources

• Develop an implementation plan that outlines how identified needs will be addressed

* From”Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users, 2004, Effective Interventions Unit, Scottish Executive

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Needs Assessment - ComponentsNeeds Assessment - Components

A review of the existing sources of information relevant to target population

A profile of existing services and description of the client profile

The views of your target population The views of relevant practitioners and service providers Analysis and interpretation of results Taking action by prioritizing identified needs, appraising

options for meeting those needs, and implementing an action plan including resource implications

Monitoring and evaluation to examine that changes made have the desired effect of meeting the needs of your target population

* From”Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users, 2004, Effective Interventions Unit, Scottish Executive

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Needs Assessment – Types of Assessment Measures

Needs Assessment – Types of Assessment Measures

Existing sources of information local population surveys, published or unpublished research

papers, existing data sets, individual assessment data Need to be mindful of the strengths and weaknesses of the

information – remember that these data sources were not originally collected to answer your needs assessment questions

New information questionnaires or surveys, interviews, focus groups Need to ensure good methodology to prevent distortion of

results and recommendations (e.g., piloting of questionnaires/surveys to ensure clarity)

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Individual AssessmentsIndividual Assessments

For the treatment planning and case management of the individual client

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Individual Assessments – Purpose Individual Assessments – Purpose

Substance abuse assessments completed within the correctional context should, at a minimum, serve to:• Identify and verify the existence of a problem

warranting intervention;• Provide detail and shed light on the nature and

seriousness of the individual’s substance abuse problem;

• Identify the link with criminal behaviour;• Guide clinical decision-making in the

development of an appropriate and individualized treatment plan

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Individual Assessments – Types of Measures

Individual Assessments – Types of Measures

Main methods:

Structured interviews Psychometric tests /

questionnaires

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Individual Assessments – Correctional Service Canada

Individual Assessments – Correctional Service Canada

In the Correctional Service of Canada, all offenders undergo a comprehensive assessment when they enter the federal correctional system at a regional reception centre

When there is an indication of substance abuse, the offender is referred for a more in-depth assessment for this issue

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CASACASA

315 items

Computerized; optional audio component for offenders with literacy problems

Identifies critical substance abuse related factors and link to criminal offending

Identifies severity of problem – used to determine level of treatment required

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CASA - ComponentsCASA - Components

Assessment of the reliability of self-report using the Paulhus Deception Scale

Identify topography and density of alcohol and drug use

Assess severity and consequences of alcohol and drug abuse using standardized measures including:• Michigan Alcoholism Screening Test (MAST)• Alcohol Dependence Scale (ADS)• Problems Related to Drinking (PRD)• Severity of Dependence Scale (SDS)• Drug Abuse Screening Test (DAST)

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CASA – Components (cont.)CASA – Components (cont.)

Identify poly-substance abuse

Explore substance abuse history as it relates to biological parents

Idenify prior programming involvement including Methadone Maintenance Treatment

Assess treatment readiness using operationally recognized criteria

Recommend programming intensity levels using algorithms

Generate automated summary reports to assist decision-makers

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Assessment to Evaluate and Monitor Effectiveness

Assessment to Evaluate and Monitor Effectiveness

In addition to assisting with treatment planning, assessment instruments also play a critical role in evaluating the progress of the individual client and the effectiveness of your intervention in general

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Assessment to Evaluate and Monitor Effectiveness (cont.)

Assessment to Evaluate and Monitor Effectiveness (cont.)

In CSC’s national substance abuse programs, a battery of instruments has been put together by our Addiction Research Centre for pre- and post- treatment testing

These instruments were selected following a thorough review of the “best practices” research literature on the topic and reflect the areas targeted by the program

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Criteria for Instrument Selection CSC Substance Abuse ProgramsCriteria for Instrument Selection CSC Substance Abuse Programs

The following criteria were considered for instrument selection:

Provides information and feedback on participant functioning

Assesses specific treatment targets Measures participant progress in treatment Self-administered quickly Alcohol and Drug specific Low cost Sound psychometric properties Suitable for treatment evaluation Suitable for male offender population Recognized as valid by best practices literature

National Substance Abuse Programs - High Intensity Evaluation Framework, Research Branch, CSC, 2004

2020

Program Phase Pre-release

Booster Table 1: Standardized Instruments Administration

Pre Post Pre Post

Community based

Maintenance Phase

(Post only)

Assessment Targets

1. Paulhus Deception Scales (PDS) Self Report

Reliability

2. Treatment Entry Questionnaire (TEQ) Motivation

3. Inventory of Drug Taking Situations (IDTS) Risk Situations

4. Drug Taking Confidence Questionnaire (DTCQ) Self-Efficacy

5. Effectiveness of Coping Behaviours Inventory

Coping-Alcohol

6. Drug Avoidance Self Efficacy Scale (DASES) Coping-Drugs

7. Craving Beliefs Questionnaire (CBQ) Beliefs- Cravings

8. Beliefs about Substance Abuse Beliefs - General

9. Drinking/Drug Related Locus of Control (DRIE) Locus of Control

10. Client Satisfaction Questionnaire (CSQ-8) Client Satisfaction

Correctional Service of Canada Pre & Post Program Measures for National Substance

Abuse Programs

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Assessment InterviewAssessment Interview

Offenders in CSC’s National Substance Abuse Offenders in CSC’s National Substance Abuse Programs also undergo a structured “Timelines Programs also undergo a structured “Timelines Interview” at the beginning of programmingInterview” at the beginning of programming

The aim of the 143-item Timelines Interview is to The aim of the 143-item Timelines Interview is to map out an accurate depiction of the link between map out an accurate depiction of the link between the offender's substance use and concomitant the offender's substance use and concomitant criminal behaviour. criminal behaviour.

Builds on the results of the CASABuilds on the results of the CASA

Most item responses are categorical in nature, but Most item responses are categorical in nature, but for the purpose of analyses, qualitative interview for the purpose of analyses, qualitative interview information is transformed and coded into information is transformed and coded into

quantitative data.quantitative data.

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CSC Pre–Post Program MeasuresCSC Pre–Post Program Measures

• Used to evaluate the offender’s Used to evaluate the offender’s progress in different treatment progress in different treatment target areastarget areas

• Used by the Research Branch as Used by the Research Branch as part of evaluation framework to part of evaluation framework to evaluate treatment effectivenessevaluate treatment effectiveness

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Reliability of Self-Report DataReliability of Self-Report Data

Concerns are sometimes expressed Concerns are sometimes expressed regarding the accuracy of self-report regarding the accuracy of self-report data on substance abuse from offendersdata on substance abuse from offenders

Research conducted on this question in Research conducted on this question in CSC has demonstrated that instruments CSC has demonstrated that instruments such as the CASA produce accurate and such as the CASA produce accurate and valid informationvalid information

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Last wordLast word

Assessment is a critical component of any Assessment is a critical component of any substance abuse treatment model with substance abuse treatment model with offendersoffenders

Assessment techniques and measures not Assessment techniques and measures not only allow you to examine the needs of only allow you to examine the needs of your target population, but also assist in your target population, but also assist in case planning with the individual offender case planning with the individual offender and are integral to the ongoing monitoring and are integral to the ongoing monitoring of cases and the evaluation of treatment of cases and the evaluation of treatment programs.programs.

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Assessment

Questions and Comments