“the other way” program evaluation

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The author(s) shown below used Federal funds provided by the U.S.

Department of Justice and prepared the following final report:

Document Title: The Other Way Program Evaluation, Summary

Author(s): Remi J. Cadoret M.D. ; Anita M. Patterson MSW ;Sarah Barten M.A. ; Christopher Richards M.A.

Document No.: 183645

Date Received: July 25, 2000

Award Number: 97-RT-VX-K009

This report has not been published by the U.S. Department of Justice.

To provide better customer service, NCJRS has made this Federally-funded grant final report available electronically in addition totraditional paper copies.

Opinions or points of view expressed are thoseof the author(s) and do not necessarily reflect

the official position or policies of the U.S.Department of Justice.


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PROPERTY OFNational Criminal Justice Reference Service (NCJRS)3 2 ) . 60007-~ y < ~ ~ ~ i ! c,,(c

The Other Way Program EvaluationSummary

Grant # 97-RT-VX-KO09March 31, 1999

Remi J. Cadoret, M.D.Anita M. Patterson, M.S.W.Sarah Barten, M.A.Christopher Richards, M.A.

Iowa Consortium for Substan ce Abuse Research and EvaluationM306 OHUniversity of IowaIowa City, IA 52245

FINAL REPORT bJ-Approved BY:Date: _I

.S. Department of Justice.f the author(s) and do not necessarily reflect the official position or policies of theas not been published by the Department. Opinions or points of view expressed are thosehis document is a research report submitted to the U.S. Department of Justice. This report


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IntroductionThe National tnstitute of Justice aw arded a grant to the Iowa Consortium forSubstance A buse Research and Evaluation to conduct a process evaluation of the "TheOther Way" (TO W ) program In October 1997. The TOW program had recently been

awarded funds through RSAT funding to expand and enhanc e their existing program.The objectives of this evaluation were to : (1 ) set up a system to eva luate the impact theClarinda TOW Program has inmates who have completed the program; (2) develop aninstrument package to measure change on variables of interest; (3 ) develop a procedurefor collecting relevant data at intake, discharge and six-month follow up points; (4 ) act asa technical assistant for the developm ent and implementation of the evaluation. Thisreport covers the period January 1998 through March 1999.

Description of Program"The Other Way" (TOW) program is an intensive residential substance abusetreatment program housed at the Clarinda Correctional Facility (CCF) in Clarinda, Iowa.The program currently employs 15 full-time co unselors to provide comprehensivesubstance abu se treatment serv ices on three dedicated treatment units totaling 240treatment beds. The program is licensed by the Iowa Department of Public Health,Division of Substance Abuse and Health Promotion, and funded in part through theNational Institute of Justice (NIJ) Residential Substance Abuse T reatment for StatePrisoners (RS AT) program.Inmates are referred to this program if they have an identified need for residentiallevel substance abuse treatment and are w ithin twelve months release consideration. Allinmates in the state of Iowa are initially housed at the Iowa M edical and C lassificationCenter (IM CC ) at Oakdale, IA. Wh ile they are at IMC C, they are given a substanceabuse evaluation. They are referred to the TO W program based upon this evaluation.

Program modificationsWhen the R SAT funding was awarded to the TOW program in October 19 97 theTO W program was required to implement some changes in order to be eligible for thefunding. Tw o of the most notable changes were the change in program length andhousing of inmates. The TOW program w as originally four months long. After thereceipt of the 'RSAT funding, the length of the program increased to six months as

required. The inmates were also moved to three TO W dedicated units. The inmates inTOW are separated from the general population for all activities as part of the fundingrequirements as well.Another m odification was to change the curriculum in one of the three units to acognitive treatment model. This took place in Spring, 19 98. Current research in the field sof substance abus e treatment and corrections suggest that a more cognitive approach to

.S. Department of Justice. the author(s) and do not necessarily reflect the official position or policies of theas not been published by the Department. Opinions or points of view expressed are thosehis document is a research report submitted to the U.S. Department of Justice. This report


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treatment may have more effect Lvith this population and thus result in decreasedrecidivism rates. Program administrators chose to initially use this new curriculum ononly one of the units in order to pilot i t and see if there w ere any improvem ents beforerestructuring the curriculum of the entire TOW program. The inmates are randomlyassigned to this unit based on bed availability. Because of this. there is a somewhatexperimental design a s to the assignment to cognitive unit.

Another notable change is the addition of a continuing-care program for thoseinma tes that have completed the primary treatment program. Typically there is aperiod of time betwee n the completion of the program and when the inm ate isactually released from the prison. This period can be anywh ere from weeks tomonths in length.

Evaluation designThe main objectives of this project were to: (1) set up a system to eva luate theoperations and effectiveness of Th e Other W ay program at the C larinda CorrectionalFacility; and to (2) assist program staff to develop and implement intake, discharge, andfollow-up instruments and evaluation protocols to document inm ate characteristics andchanges over time related to substance use/abuse, mental he alth, social functioning, andcriminal behavior and attitudes.The primary evaluation sample consisted of adult male inmates of the ClarindaTO W program. Approximately 500 inma tes enter and com plete the program per yearwith an estimated drop out rate of 2%. This 2% consists of those that voluntarily quit theprogram and are asked to leave the program (usually due to rule violations and/or lack ofprogress in treatment).Data w as collected from the inm ates using a series of standardized instruments.These instruments consisted of a semi-structured interview (the Addiction SeverityIndex) and several self-administered questionnaires. These instrum ents will be describedin greater detail later in this report. Th e inmates are assessed using this instrumentpackage at three points throughout the project.The first point of data collection is the Intake Assessm ent. Program staffadminister the intake version of the instrument package shortly after the inm ate beginsthe program. Usually this takes place within the first week of phase one. The intakeprovides baseline information about the inmates history. This information can be used

as a comp arison for discharge and follow-up data to see if inmates have changed on anyof the variables of interest.The staff administers the instrument packet a secon d time ab out one week prior todischarge from the program. The packet consists of the sam e, though slightly differentversions. of the same instruments give to the inmate at intake. Th e purpose of the



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discharge interview is to measure w hat. if anything, has changed regarding the inmatesfunctioning and attitudes towards sub stance use since the inmate has been in the programTh e third phas e of the assessm ent is at a six-mon th follow-u p. LVhile the follow-up instruments and procedures were d evelope d during this grant period. the actual data

collection will not begin until the "outcom e evaluation phase" of this project for whichthe Consortium was recently awarded mo ney to complete. Th e follow-up instrumentpackage consists of mod ified versions of the intake and discharge instrum ents. AConsortium research assistant will cond uct a telephone interview with the inm ates afterthey have been out of prison for six month s. These instruments measure the sam evariables as the intake and discharge ove r the past six months only. Th e purpo se of thisphase is to see how the inmates function on ce they are returned to the comm unity andhow much information a 9 t ti tudes acquired in treatment are retained once out of thetreatment environm ent.All inm ates participate in the intake and discharge compon ents of the evaluation

because these have been added to the protocol for the TO W program. Inm ates must berecruited and g ive written consent, however, to participate in the follow-up study.Beginning in the M ay 1998, inmates were recruited to participate in the follow- upcomponent of the project. The protocol wa s developed so those inmates who were beingdischarged each mon th were visited in person by a Consortium Research Assistant toinvite their participation i n the follow-u p study.

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InstrumentationIntuke and Discharge.

The Iowa Consortium worked with the Department of Corrections (DO C) and theClarinda TOW treatment staff to identify and/or develo p valid instruments measuringsubstance use/abuse, mental health and personality, criminal behavior and attitudes,social support, and involvement in edu catio dem ploy me nt and therapeutic activities. Theinstruments measured the inmates longitudinally on variables relevant to the TOWprogram goals. C riteria for the selection of instruments included the reliability an dvalidity of the instruments, ease of administration, potential for dual clinical andevaluation use, and any duplication with existing efforts.As a result o f these meetings the following instruments were selected for

inclusion in the intake, discharge and follow-up:The A ddiction Severitv Index (ASI) [McL ellan, 19791 is a structured clinicalinterview that assesses the respondent on seven different areas: medical status,employm ent/support status, drug and alcohol use, legal status, family history, familyand social relationships, and psychiatric status. The AS1 is designed to measureactivity in the responden ts lifetime and during the past thirty days on m any of thequestions, particularly on the drug and alcohol use, crime, and psychiatric sections.The AS1 identifies critical areas of patient need and is useful for treatment planningand monitoring. Because of its use as a research instrument, the AS1 has u ndergonerigorous validation and has been found to have high reliability and validity.The Colora do Cognitive Assessment Ouestionnaire [Center for Action R esearch,199 ] was used by the Consortium in the New ton and Mitchellville Violator Programanalysis. Th e instrument measures cognitive skills and attitudes on a variety ofdimensions, and demonstrates chang es in those over time. This assessm entinstrument has the added benefit of having be en given to over 2000 Violator Programparticipants, who could then become a comparison group with regard to Iowaprisoner sub stance abuse attitude changes achieved through a different program. Thedata from this instrument will primarily be used to m easure intermediate changes ininmate skills and ab ilities that have been show n in the Violator Project to predictpost-release outcomes.Circumstances, M otivation, and Readiness (C M R) Scales for Substance AbuseTreatment. CM R Prison Intake Version. George De Leon, Ph.D. (et al.) developedthis instrument in 1993. It is a self-administered Likert scale that asse sses the inmatein three areas regarding feelings about treatment (circum stances, readiness andmotivation). Th e National Evaluators recomm ended this instrument for use. Thiswill allow the C onsortium to examine the relationship between treatmen t readinessand treatment outcomes.

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The Social Provisions Scale (SPS). Russell and Cutrona (198 7) developed the SP S.I t consists oFZ4 Likert scale items. Th e purpose of the SPS is to assess importantproperties of the subject's interpersonal relationships. The scale also determ ines theindividuals current perception of the influence of significant others and perceivedsocial support.Self-Help Questionnaire. The Self-help Questionnaire was developed by Patterson( I 993) to measure the number of AA/N A/Other su pport meetings attended, use ofsponsor and p eer contracts, and related variables.The STE PS Questionnaire. Francis Gilbert (et al.) developed the STE PS . It isdesigned to measure attitudinal congruence (agreement) with the first three step s ofthe Alcoholic Anonymous' twelve steps. The autho r labeled the three sub-scales as' 'powerlessness" (powerlessness over alcohol use and life), "higher power'' (u se of aHigher Pow er as a crucial element in recovery), and "surrender" (willingness to turnone's life over to a Higher Power to achieve recovery). The Consortium renamed thisinstrument the "Life Attitudes Related to A lcohol/Drug use'' for the purpose o f theevaluation.A consumer satisfaction survey. The TOW program developed an instrumentmeasuring inm ates' p erceptions of the program atmosphere, materials, structure, andbenefits. This wa s given to the inmates at discharge only. The consortium h adoriginally planned to assist in the dev elopm ent and/or mo dification o f this survey.How ever, after discussion the evaluation team and program staff felt that the currentsatisfaction survey was sufficient for measuring th e variables that we w ere interestedin .All instruments, with the exception of the satisfaction survey, are adm inistered at theintake and discharge interviews. We trained the Program Staff in the data collection andinformed consent procedures and m onitored their progress during the course of theproject

Essentially the sam e instruments used at intake and discharge will be used atfollow-up, with necessary modifications for telephone interviewing.Data Analysis

In its current incarnation, the TO W Program began admitting prisoners on4/18/97. and has seen a total of 736 prisoners as of 12/30/98. The data set was frozen atthat time fo r the purposes of this report, and all numbers below refer to this period.This data analysis section will exam ine the following things:1 .9-.

Number of instruments givenDemographic breakdown of TOW subjects.

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3 . Criminal history of TOW subjects.4. Substance usage patterns o f TO W subjects.5 . TOW subject satisfaction with TOW program.6. Discussion of outcom e analysis and im plications.

InstrumentsFive separate instrument packets (See Append ix for copies) were filled out onTOW subjects as part of this evaluation. At intake, each subject com pletes an IntakePacket and is given an AS1 by a counselor. The TO W staff then fills out an OakdaleAssessment packet from the subject's file. At discharge each subject completes aDischarge Packet. Before leaving the prison environment, subjects are recruited by aConsortium staff member to be contacted six months after release when a Follow-Upinterview is conducted over the phone.

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The following numbers detail how many of each instrument packet have beenadministered:NOakdale Assessment 265Intake Packet 239AS1 146

Instruments -Discharge Packet 20 1Follow-up Packet 0

These numbers vary because of the following reasons:1. The Oakdale A ssessment packet was started earlier than the others because it was astraight forward records review.2. The TO W staff began adm inistering the intake packet as soon as the instruments werechosen, which did not happen imm ediately.3 . The TO W staff began administering the discharge packet as soon as the necessaryadjustments to the intake packet w ere made, w hich did not begin until after the intakepacket was in place.4. The AS1 packets were only given after extensive staff training sessions were held, andthen only after a pilot program of small trials and re-training.5 . Recruitment for follow-up questionnaires began on May 16 , 1998 and continuedmonthly through Decem ber 1 1 , 1998. A total of 77 permission packets were returned tous , with 70 of those (90.9%) agreeing to participate in a follow-up interview. These

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interviexvs could not be conducted until six months after release, which had not occurredat th e time the data set was frozen for this report.6. Even when all instrumentation was in place. TOW staff still occasionally failed toc ive the intake packet or AS1 at intake or the discharge packet at discharge for reasonsthat are currently under investigation.

DemographicsThe Clarind a TOW program is male only. The men in the program exhibit thefollowing demo graphic characteristics.The mean age of TOW program participants is 30.2 years with a standarddeviation of 8.3 years. Subjec ts range from 17 to 58 . Subjects are predominan tly white(66.2%) followed by African American (23.2% ), American Indian (4.2%), Hispanic

(2.8%), Asian o r Pacific Islander (1.4%), and Other (2.2%).Most subjects have at least a GED or high school diploma (70.4%), with 1.4%having graduated from college or commu nity college. Most subjects were employedbefore becoming incarcerated (82.4% ). Of those, most worked as unskilled employees(43.1%) semi-skilled employees (23.0%), or skilled manual employees (26.2%). Only7.7% of the employed workers held som e type of white collar position.Most T OW inmates have been married (including common-law m arriages) orhave cohabitated (6 1.3%) though only 35.2% were in such a relationship a t the time o fTOW intake. Mo st inmates lived in a house/apartment/mobile home before incarceration(89.4%), while 2.1% responded Homeless and 8.4% responded Other.

Criminal HistoryThe follow ing chart details TO W participants prior exp erience with thecorrectional system:

Correctional ExDerience YoCoun ty or Municipal Jail 95.3Work Release Center 49.1Residential Correctional Facility 36.7State Prison 93.6Federal Prison 3.7

The average TO W p rogram participant reports being arrested anywhere from 0 to 58times. with an average of 13.2 and a standard deviation of 10.3 arrests.

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The folloLving chart details whether an inmate entering the TOW Program reports everhaving been arrested for a particular type of crime:

ArsonAssault/Abuse (Domestic)Assault (Other)Burglary/Larceny/B&EChild A bandonmentNeglectChild AbuseContempt of CourtCriminal G ang ParticipationDrug Intent to SellDrug PossessionForgeryHomicidehlanslaughterParole/Probation V iolationProstitutionRapeRobberySexual A ssaultShopliftingNandalismStalkingTerrorismWeapons OffenseOther

Crime %16.335.061.758.02.16.434.38.639.155.325.54.383.10.71.439.710.666.01.410.040.818.8

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Substance Usage PatternsThe following table examines the substance abuse history of TOW program participants.

Drug UseAlcohol- any use atallAlcohol- tointoxicationAmphetamines

Barbiturates

Cannabis

YO Lifetime Use N Age at first Us e N # Davs Used N l#of years #of years Typical 30 days78.8 12.7, sd=9 .0 12 I 12.9, sd=3.5 I34 12.2, sd=l 1.7 I2 9min=0.0 min=3.0 min=0.0max=46 .O max=23 .O max=3 1.Omin=0.0 min=6.0 min=0.0max=40.0 max=25.0 max=3 1.O

82.9 11.0, sd=9.1 128 14.0, sdz3 .2 123 12.7, sd=1 1.7 13 4

59.6 5.3, sd=6.5 113 20.0, sd=6.2 88 15.4, sd=1 2.9 123r" min=0.0 min=7.0 min=0.0 1max=3 2.0 max=39.0 max=3 1.O21.9 0.9, sd=3.4 72 18.0, sd=3.2 11 8.8, sd=13.6 95min=0.0 min=13 .O min=O.Omax=23.0 max=23.0 max=3 1.O82.9 11.0, sd=7.6 128 14.0, sds3 .3 124 18.0, sd=12.3 133min=0.0 min=5.0 min=0.0

Cocaine max=30.0 max=27.0 max=3 1 O54.1 I 4.4, sd=5.5 9 8 I 19.8, sd=6.4 84 11.5, sd=1 2.4 1 I 6Hallucinogens

Heroin

Inhalants

Methadone

min=0.0 min=9.0 min=0.0max=25.O max=42.0 max=3 1.Omin=0.0 min=5.O min=O.0max=2 1.O max=25 .O max=3 1.Omin=0.0 min= 10.0 min= 0.0max=24 .O max=35.0 max=3 1.Omin=O.O min=9.0 min=0.0max=13.0 max=40.0 max=3 1.O

43.2 3.3, sd=4.9 89 16.2,sd=3.2 63 8.5, sd= l 1.9 111

27.4 1.5, sd=4.4 77 19.5, sd=5.2 29 10.2, sd=1 4.1 102

25.3 0.7, sd=2 .0 77 16.8, sd=6.7 19 8.7, sd=13.5 103

18.5 0. , sd=0.5 74 18.3, sd=5.0 6 8.3 , sd=13.7 95

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I max=4.0 max=23 .O max=3 1.Osubsta nce per day(excl. tobacco)Opiat es/ analgesics

Sedat vesitranqu i izersTobacco

min=O.0 min=5.0 min=O.Omax=32.0 max=42 .O max=3 I .O26.7 1.9, sd=5 .1 76 19.8, sd=6.1 33 8.8, sd=13.3 98min=O.0 min= 12.0 min=0.0max=26.0 max=46.0 max=3 1.O26.0 1.9, sd=5 .3 77 18.8, sd=6.6 27 9.5, sd=1 3.5 98min=0.0 min=6.0 min=0.0max=30.0 max=3 7.0 max=3 1.O92.7 14.9, sd=9 .7 135 13.8, sd=4 .6 126 27.7 , sd=8 .5 136min=0.0 min=5.0 min=0.0max=44.0 max=3 2 O max=60.0



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As expected based on the usage patterns found in Iowa. following alcohol (78.8)the most frequently used were canna bis (82.9% ). amphetam ines. includingmethamphetamine (59.6%). and cocaine (53.I%j .The .4SI (see Appendix ) assesses substance abuse life intrusion into thirteen

different areas. The m ost frequent effects of drug or alcohol use reported by TO Wsubjects a re: legal pro blem s (95.1?40). missed world schoo l (81.7% ), physical fights(81 O%j, and marital and family problems (84.6%).

TOW Subject SatisfactionTh e Clarinda Co rrectional Facility gives a Tow Service Evaluation assessmentinstrument to inmates who com plete the TO W Program (see Appendix). This instrumentis completed anonym ously and is neither a scientific nor a validated instrument, but thestaff still finds it usefbl in assessing which parts of the program inmates a re happy and

unhappy with.The TO W Service Evaluation has undergone several changes over time. Therewere a total of 76 com pleted instruments available to us for analysis since the last change.This format is considered final and sh ould remain in place throughout the duration of thisevaluation.

Reported satisfaction rates are as follows:Treatment Satisfaction O/OVery Satisfied 58Satisfied 34Indifferent 7Dissatisfied 1

When asked to Please rate the follo win g treatment activities based on theirusefulness to you, the treatment a reas that were reported to be the m ost helpful were:assignments (95% ), therapy groups (84% ), lectures/videos (83%), individual counseling(82%), staff interaction (67%), and peer interaction (53%). Th e areas with the smallestnumber of responses in the Mo st Helpful category were: AA /NA study groups, RA Pstudy groups, RAP M eetings, and AA/NA meetings.When asked Lo oking back at your treatment, please rate the following accordingto your satisfaction, subjects appear to be most satisfied with their primary coun selor,with 95% responding either Satisfied or Very S atisfied, and nobody respondingDissatisfied. Subjects appear to be less satisfied with other TO W staff, suggesting thata bond is being formed with the primary counselor that is not possible with more cursorycontact. Not surprisingly, physical setting was the least popular program com ponen t, as

th e TOW program must also function as a prison.

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Implications a nd Future AnalysisI t is not siirprising that most of the interesting information to be gathered in anoutcomes evaluation is not available before outcom e inform ation is collected. but that is anecessary result o f writing reports based o n a calen dar rather than a research schedule.The followin g pieces of data will be gathered du ring the second half of this project. Adiscussion of each an d how it will be used in con junction with the descriptive datacontained in this report follows.

Scale Scores and Pre- to Post-Test ChangesThe T OW staff is giving the sam e assessment instruments to their inmates at

intake and at discharg e (see Appendix for sam ple copies of all instruments given). Allscale scores will be analyzed and reported. Th e differences between pre- and post-testscores will allow us to determine what chang es com e about as a result of participation inthe TOW p rogram and how these changes are linked to specific dem ograph ic, criminalhistory, and substance abuse traits. Staff can use this information to determ ine whetherparts of the curriculum are not doing the jo b they were intended and perhap s augmentsections of the curriculum. Whole new sections of curriculum can be added if aparticularly large need is determined.Staff can also ensure that the curriculu m appears to work equally well with TOWinmates of all ages, races, and educational background, or if a disparity is detected, work

through the curriculum to correct the situation.Recidivism Sweep

A recidivism sw eep will be performed during the summer and fall of 2000, and\vi11 be concluded just before the data set is frozen on O ctober 1,2000 for final analysis.The State of Iowas ASIS and ICBIC computer systems will be examined to determineLvhich of the TOW Program participants has returned to prison, why, and how long ittook. This inform ation will be used in conjunc tion with both descriptive an d pre- to post-test change scores to build a statistical mod el of T OW inmates who have a good chanceof succeeding after release and those who have a poo rer chance.

Once the models are built, they can be used in several ways. Th e Department ofCorrections can use them to h e 1 nmates w ith a greater chance of success into theprogram if program space becomes scarce, so that potential benefits are m aximize d.TOW staff can exa mine which inmates are failing and follow those people m ore closelyas they move through the program. TO W adm inistrators may find information thatsuggests a different curricular emphasis, or pe rhaps an entirely new app roach if certain

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combinations of substance abuse or inmate characteristics proves to be particularly likelyto recidivate.Subject Intervieics

Subjects are currently being recruited for participation in a phone interview to beconducted six months after subject release from the TOW facility. Th is substance useand follow-up sca le scores will be used to build a statistical model to de termine how topredict post-release behaviors in areas suc h as substance use and comm unityreadjustment.There are potential generalizability c oncern s with this population however.Inmates who w ish to opt out do not have to attend our recruitment se ssion. We are onlyallowed to contact those inmates who sign up at out recruitment session . Sinc e ourfollow-up interview is conducted six mon ths after release, any inmate who re-offendsbefore this time or disappea rs is not interviewed. Of those we ca n find who are still out

of prison after six months, some are bound to have changed their mind abo utparticipation. H ow large any of these numbe rs is can not be known at this juncture, butwill be reported in full in the final project report along with an analysis of contactinformation which ma y be of interest to researchers attemp ting similar contac t with anequivalent population .

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“the other way” program evaluation

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