IMPLEMENTATION ISSUES Initial Budget Planning

Although part of the Project Reform effort included technical assistance from NDRI and several research and clinical consultants, the initial planning undertaken prior to the BJA award was done without the benefit of expertise in either drug treatment facility design or TC operations. The result was an implementation budget that did not include funds for a number of items necessary for drug treatment programing, in general, and TC treatment, in particular. This lack of funds extended to program materials, videotaping, books and other educational elements, printing and copying, and resource for educational and vocational programs as well as for public relations and special event activities. Although some of these deficits were overcome through special arrangements with NDRI, the Delaware Department of Correction, and a few private contributors, the KEY operated in an atmosphere of scarce resources during much of its first year.

Choosing the Facility

Not all correctional facilities are appropriate for TC programing. This fact became painfully apparent during the planning phase of the Delaware effort. The State’s largest institution, the Delaware Correctional Center (DCC), was the initial choice for the new TC. It appeared to be a logical choice: DCC houses the overwhelming majority of Delaware’s felony inmates; the business offices of the Department of Correction are located nearby; and the facility had a vacant building that could be transformed into a somewhat isolated drug treatment program.

When a clinical director and the technical assistance staff were finally retained, it was quickly determined that DCC was unworkable as a program site. The issue was a two-pronged problem of security. DCC is an expansive minimum/ medium-security facility with numerous buildings, cell blocks, dormitories, and open spaces. It is characterized by the considerable and relatively unimpeded movement of inmates from one place to another. This freedom of mobility combined with the size of the compound serve to facilitate the use and trafficking of any variety of illegal drugs.

Moreover, the buildings designated as potential sites for the TC were suitable for sleeping and individual counseling activities but for little else. Group activity space was lacking, and program clients would have been required to mix with the general prison population three times a day for meals and for recreation— an unwholesome and unworkable situation for effective TC programing. More

appropriate quarters eventually were found at the Multi-Purpose Criminal Justice Facility, known locally as Gander Hill Prison, in Wilmington, DE. The move to a new location, combined with already crowded conditions at Gander Hill, resulted in a further delay in startup and slow initial growth.

The limited options of facility space and this final decision to place the program at Gander Hill affected the composition of the program. The original intent was to develop a co-ed TC. Due to the strict separation of men and women by the Delaware Department of Correction and the unwillingness to alter this practice, women were excluded from this project. To date, women still are excluded. Staff Recruitment

The staff recruitment problems that occurred in the Delaware experience also can have a direct impact on the efficient implementation of a TC in a correctional setting.

First, in these days of renewed and rapid program expansion, there is a general lack of experienced drug abuse counseling personnel and an acute lack of experienced TC staff, especially at the leadership levels. In the absence of any TCs in the State of Delaware from which to draw, Project Reform had to recruit a program director from Florida and its initial counseling staff from western Pennsylvania. The associated recruitment, transportation, and moving costs represented additional and unanticipated budget items that had to be absorbed. Second, there is the matter of the “professional model” of staffing vs. the “recovering addict model.” This is sometimes called “the democratic TC vs. the programmatic TC issue” (Glaser 1981). On a philosophic level, both seek to foster a family identity but with marked differences. One researcher has described it as similar to comparing the Society of Friends with the Church of Rome (Jones 1986). It is true that the programmatic approach— characterized by intensity, a militaristic orientation, a hierarchical social organization, and a recovering addict staff-is more appropriate, because of both the setting (prison) and the problem (drug addiction) for inmates. The recovering addict model also puts virtually all power and authority in the hands of the leader, who authorizes use of coercive methods, within limits, to achieve the desired behavioral changes in clients.

It is in drawing a fine line between a necessarily authoritarian structure in effecting behavior modification while avoiding a totalitarian society that programs such as the KEY may be most challenged. The role of the director takes on great importance. The KEY’s director achieved the necessary authority without abusing power.

Resides philosophy and leadership style, the professional and recovering addict models differ, as their names indicate, in the nature of their staffing. The professional model espouses the use of only professional staff having formal education, training, and experience in one of the behavioral sciences, social work, or counseling. The recovering addict model advocates the use of ex-addicts/ex-offenders in key leadership and clinical positions. It would appear that in a corrections-based TC, the most appropriate course would be a combination model. Recovering addicts are necessary for the positive role models they represent to prison inmates and because of their firsthand experience with the types of “con” games and other manipulations in which drug abuse clients engage. Professionally trained staff members are necessary for their clinical skills and the degree of therapeutic detachment that is often necessary in emotionally explosive settings. Lack of a professionally trained staff also may impede the acceptance of the TC approach by other drug treatment programs that may rely solely on professional staff and have not accepted the role of ex-addicts in the treatment process.

Delaware’s KEY program is primarily a recovering addict model, with some oversight and input from a professional psychologist. Although such partial oversight serves to contain costs, it reduces the control by professionals over all day-to-day activities.

Third, whereas it would be difficult to develop and operate a prison/jail-based TC without recovering addicts, many State departments of correction have regulations that prohibit the hiring of former felons for work in correctional facilities. This is the case in Delaware. This problem was circumvented, however, by directing Project Reform funding not to the Delaware Department of Correction but to Correctional Medical Systems (CMS), a private for-profit firm under contract with the State to provide medical services to all Delaware inmates. As such, counseling staff members at the KEY are actually CMS employees and are not prevented by their past drug use or criminal record from working inside the prison walls.

Client Selection

Prior to implementing a prison-based TC, it is crucial that the TC leadership meet with the prison security, classification, work release, and parole leadership to discuss and obtain written agreements on client selection and release eligibility criteria. This necessary groundwork was undertaken and accomplished only partially by Project Reform, KEY, and CMS staffs. This lapse in communication led to some negative implications for a few inmate- clients and for the KEY program itself.

The initial criteria for admission to the KEY TC required the inmate to satisfy the following conditions:

1. Participate on a voluntary basis

2. Be sentenced and not have any open charges

3. Be in the general prison population (as opposed to segregation or isolation) 4. Be eligible for a parole board appearance within 12 to 18 months (and 18 to

24 months from expiration date for those serving mandatory sentences)

5. Have a history of substance abuse or some indication of involvement in the

drug subculture

6. Have no history of aggressive, nonconsensual sexual offenses or arson

charges from the community or within the correctional system Although these criteria were thought to be stringent enough to satisfy institutional and parole authorities, such was not the case. A few of the inmates accepted into the KEY’s initial client cohort, who were parole eligible in 1989 and 1990, had short-term release dates (i.e., minimum sentence less good time accumulated) that were beyond the year 2000. The KEY counseling staff felt that, after spending a year or more in treatment, these clients were ready to move out of the institution and into work release or parole. However, the classification boards in the Department of Correction were not convinced. The results were conflict between the KEY and the classification staff and the development of a handful of program clients who were stymied and

disillusioned. Since these TC residents were effectively barred from “graduation” (e.g., movement into work release), some left the KEY on bad terms, while some remained as senior counselors in the KEY. In doing so, however, those remaining caused a “dam” at the upper level of the client hierarchy, negatively affecting the TC model.

Treatment Staff/Correction Staff Interaction

The failure to develop close working relationships with the classification board in the Delaware correctional system was not the only gap in treatment staff/ correction staff interactions. There was, and continues to be, a drug counseling program known as Greentree within the Delaware Department of Correction that had been operating for years in the State’s main facility-DCC. The Project Reform technical assistance team and the CMS staff hoped that Greentree would serve as a feeder to the KEY. However, communication failures

alienated the Greentree staff. The Greentree counselors had extensive contacts with the general inmate population. They reported and exaggerated aspects of the KEY program, resulting in a body of folklore about the KEY that made client recruitment difficult.

Program Autonomy

In several ways, the KEY has had only minimal control over its own fate. Part of the problem is grounded in the differing philosophical orientations of the KEY and the Department of Correction. Whereas KEY staff members have a clinical view of inmates as subjects for rehabilitation, corrections staff persons have an essentially cynical view of inmates as subjects for custody and control. Although there is some understanding and consideration of each other’s missions, in many ways the two philosophies remain mutually exclusive. A direct result of these differences can be seen in KEY expansion. It would appear that, as a consequence of custodial concerns and the crowded conditions at Gander Hill Prison, program growth tends to be at the whim of the Department of Correction and the State legislature. Although this is understandable from political, administrative, and pragmatic points of view, it tends to be frustrating from a clinical standpoint. Expansion of any program involves much more than additional beds and housing. Therefore, the clinical staff should be involved with expansion plans. This has yet to occur in Delaware.

Aftercare

Certainly, the most problematic aspect of the KEY implementation involves aftercare. BJA funding included resources for the planning and realization of the institutional phase of treatment; however, no monies were allocated for a community-based transitional facility. When the State of Delaware assumed responsibility for the continued funding of the KEY, again, only the institutional phase of treatment was supported. The result is the “graduation” of KEY clients into the Plummer Center, a work release facility in Wilmington, DE. Since the Plummer Center accepts work releasees from all the State’s institutions, as well as Delaware-resident releasees from Federal institutions, the uncontrolled environment can do much to undo progress in the KEY by throwing the recovering clients abruptly into an environment that is contaminated with the outside influences of the street-the drugs, the violence, and the attitudes and values that militate against rehabilitation. As such, appropriate continuity of care is lacking. Although the KEY recently placed one of its counselors at the Plummer Center on a 40-hour per week basis, TC treatment does not extend to the community-based setting, nor is there any systematic program of transition to the outside.