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(1)

Improving Substance

Abuse Treatment in the

Criminal Justice System

Elizabeth Ressler

Jennifer Lerch

Faye Taxman

Scott Walters

Funded by R01 DA029010-01

(2)

Mumola, 1995

Two thirds of probationers

are drug involved…

…but less than

half participate

(3)

Program Wish List

1. Bridge criminological and

psychological theories.

2. Place no additional demands on the

probation system of care.

3. Target multiple behaviors that occur

together.

4. Tailored to the individual.

5. Very easy/intuitive to use.

6. Included material that would

actually increase motivation.

?

(4)

About MAPIT

2-session program targeting

drug-using probationers.

Targets motivation to change

substance use, criminal behavior,

and HIV risk.

Includes risk assessment,

planning, social support,

automated reminders.

Simple, intuitive layout.

Responsive “synthetic” narration.

Compatible with system of care.

(5)

Theoretical Background

Theory

Application

Extended Parallel

Process Model

Risk of probation violation based on static

and dynamic factors; Future behaviors most

likely to reduce risk.

Social Cognitive

Theory

How clients compare to others; Framing

suggestions in terms of what other people

do; Videos of model responses.

Motivational

Interviewing

Affirmations, Reflections, Summaries;

Interactive tone that emphasizes autonomy,

collaboration, evocation.

(6)

MAPIT Visit 1

•Static risk estimate •Dynamic risk estimate •Examples of risk reduction Offending •Norm comparison •Risk estimate •Consequences Substance Abuse •Risk behaviors •Testing recom-mendation •Risk reduction strategies HIV Risk •Summary; example goals •30 day goals •Text/email reminders Setting Goals

(7)

Go here to view MAPIT criminal justice risk

video example

(8)

Go here to view MAPIT substance use risk

video example

(9)

Making MAPIT “Smart”

TTS engine can read (almost) everything on

demand.

Tailored reflections based on single-item

responses.

Tailored reflections/information/suggestions

based on multi-question response patterns.

Responses can connect to earlier material, or

push a little bit beyond what the person said.

The program can “dial up” or “dial down” the

(10)

Thanks for sticking with me. You said that your most important reasons for completing probation had to do with your relationships and the hassle of paying

probation fees. Based on this, you are fairly committed to completing probation. One thing you thought you could do in the next week is to get rid of all your drug equipment so that you’re not tempted to use. I’ll make sure to text you, and remind you about your goal.

Thanks for sticking with me. You said that your most important reasons for completing probation had to do with the shame of being on probation and wanting to avoid future legal trouble. Based on this, you are very committed to completing probation. You’re willing to do whatever it takes. One thing you thought you could do in the next week is to put a phone number in your

phone of someone you could call if you needed to talk. I’ll make sure to text you, and remind you about your goal.

(11)

MAPIT Visit 2

•Review of motivation •Review of progress •New goals Checking In •Identifying preferred strategies •Managing cravings Managing

Cravings • List of helpful people • Plan for accessing social support Social Support • 30 day goals • Text/email reminders • Follow-up Setting Goals

(12)

Go here to view MAPIT goal setting and

texting video example

(13)

Most important reasons for wanting to finish

probation?

0 20 40 60 80 100

% Rated as “Very Important” Reason

Shame Financial Relationships Freedom Time Legal Moving On Initial data, n=38

(14)

Early probation goals?

0 10 20 30 40 50 60 70

% Selected Goal

Write down and questions I have

Get a binder to keep my probation documents in

Write down date and time of first visit.

Make a list of my biggest worries and share with PO.

(15)

Early treatment goals?

0 10 20 30 40 50 60 70 80

% Selected Goal

Look through my house and vehicle and throw out drugs and drug equipment.

Put a number in my phone of someone I could call if I needed to talk.

Ask someone with clean time how they did it.

Make a list of things I could do to stay sober.

(16)

Wanted reminders?

Text or email?

Yes

59%

Email

31%

Text

59%

(17)
(18)

Basic Demographics

Both sites primarily older, black, males

Dallas= m=33 yrs old; Baltimore= m=40 yrs old

More high risk females in Baltimore

Small number of Hispanics recruited in Dallas

Homelessness more prevalent among

Baltimore probationers

Average 11-15 arrests in lifetime except for

(19)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Baltimore:

Low/Moderate Baltimore: High Low/Moderate Dallas: Dallas: High

Baseline drug test results

Poly Marijuana Criminogenic* Negative (41% condition for tx) (58% condition for tx) (28% condition for tx) (43% condition for tx)

* Criminogenic drugs are harder drugs that exhibit a direct link with offending behavior such as

(20)

58.8% 41.2%

Baltimore: Low/Moderate

23.1% 76.9%

Baltimore: High

82.6% 17.4%

Dallas: Low/Moderate

50% 50%

Dallas: High

No Prior Treatment Prior Treatment

(21)

0 10 20 30 40 50 60 70 80 90 100 Baltimore:

Low/Moderate Baltimore: High Low/Moderate Dallas: Dallas: High

STD diagnoses and HIV testing

(22)

Dallas

Hospital 16.7% 40%

Baltimore

Where HIV tested in last 12 months

No one selected home testing, drug treatment, or syringe exchange.

Outpatient/ community program Outpatient/ community program Jail/prison Jail/prison Hospital Donating blood ER Other 65.6% 15.6%

(23)

Criminal Cognitions, Social Support,

and Treatment Motivation

Average scores on criminal cognitions, desire

for help, and problem recognition

High levels of social support

Overall, higher scores on desire for help as

(24)

Factors predicting desire for help (N= 91)

B SE Beta

Homeless 3.32 1.71 .18*

Lifetime prior treatment 6.75 1.46 .48***

Positive for criminogenic drug 2.70 1.74 .14

Positive for marijuana -3.01 2.42 -.11

Positive for multiple drugs .74 3.61 .02

Risk level .40 .36 .12

Site 1.37 1. 47 .10

(25)

Factors predicting problem recognition (N= 89)

B SE Beta

Lifetime prior treatment 8.59 1.94 .52***

Positive for criminogenic drug 3.09 2.11 .04

Positive for marijuana -1.54 2.91 -.05

Positive for multiple drugs 1.61 4.33 .04

Risk level .28 .43 .07 Site 1.96 1.80 .12 Age .06 .08 .02 *p < .10; **p <.05; ***p <.01 ¨ Unable to locate (n=4) ¨ Unable to locate (n=4)

(26)

Improving Substance

Abuse Treatment in the

Criminal Justice System

Elizabeth Ressler

Jennifer Lerch

Faye Taxman

Scott Walters

Funded by R01 DA029010-01

References

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