Bennett W. Fletcher

National Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) Overview

In 2002, the National Institute on Drug Abuse (NIDA) launched the National Criminal Justice Drug Abuse Treatment Studies (CJ-DATS), a major research initiative. Researchers from 9 research centers and a coordinating center and NIDA work together with federal, state, and local criminal justice partners to develop and test integrated approaches to the treatment of offenders with drug use disorders. There are 13 major studies within CJ-DATS that cover 8 study areas, including screening and referral, modifying treatment programs and interventions for reentering offenders, improving engagement and retention, linking services in the community, improving coordination with criminal justice reentry processes, addressing the needs of special populations, understanding the general organizational and contextual factors in treating offenders, and understanding current treatment practices for the drug-involved offender.

Organizational factors and collaboration and integration activities in criminal justice and drug abuse treatment agencies

Despite strong interest in improving collaborations between correctional and substance abuse treatment organizations, there is a lack of empirical data describing the existing practices. The current study used a national survey of correctional administrators to examine organizational factors related to cross-agency collaboration and integration activities between corrections and substance abuse treatment organizations. Using a measure of collaboration that scaled cross-agency activities from less structured, informal networking and coordination to more structured and formalized levels of cooperation and collaboration, we found that different correctional settings (e.g., community corrections, jails, prisons) differed significantly in terms of their collaborative activities with substance abuse treatment agencies. We also found that the organizational characteristics that were associated with different levels of collaboration and integration differed across the correctional settings. Further research is needed to better understand how and why correctional agencies decide to formalize collaborative arrangements with treatment agencies and whether these efforts lead to more favorable outcomes.

Treatment Service Patterns and Organizational Structures An Analysis of Programs in DATOS-A

The availability of a variety of treatment services was examined within a national sample of programs treating adolescent drug abuse patients. Treatment service delivery profiles were created and examined in the context of organizational variables such as program modality, program directors’ academic credentials, program capacity, staff composition, accreditation, and patient problems. Results suggested that distinct profiles of services existed within residential and outpatient modalities and that these service profiles were related both to organizational factors and to patient problem profiles.

Treatment refusal/attrition among adults randomly assigned to programs at a drug treatment campus: The New Jersey Substance Abuse Treatment Campus, Seacaucus, NJ.

The New Jersey Substance Abuse Treatment Campus was funded to assess the feasibility of establishing a new model for delivering substance abuse treatment services and to serve as a research laboratory for conducting comparative evaluations of those services. The 350-bed campus was designed to improve treatment effectiveness by providing special services needed by underserved populations, and reduce treatment costs by serving large numbers of clients, centralizing services, and sharing facilities. First-time clients who met preliminary eligibility requirements during phone screening were randomly assigned to therapeutic community and chemical dependency programs. We used data collected on 1,573 adults who were ultimately accepted for admission to analyze treatment refusals and attrition during the 25 days after admission. Only 6.4% of the clients refused admission when informed of their treatment assignment. Planned duration of the residential phase of treatment, gender, and language spoken (English/Spanish) interacted with one another and differentially predicted treatment refusal/attrition. These findings may be useful for understanding treatment refusal and attrition in substance abuse treatment programs.

A cluster randomized trial of utilizing a local change team approach to improve the delivery of HIV services in correctional settings: study protocol

BackgroundPersons held in correctional facilities are at high risk for HIV infection and their prevalence of HIV is substantially higher than in the general population. Thus, the need for proper surveillance and care of this high risk population is a paramount public health issue. This study aims to evaluate an organization-level intervention strategy for improving HIV services for persons in prison or jail.Methods/DesignHIV Services and Treatment Implementation in Corrections (HIV-STIC) is using a cluster randomized trial design to test an organization-level intervention designed to implement improvements in preventing, detecting, and treating HIV for persons under correctional supervision. Matched pairs of prison or jail facilities were randomized using a SAS algorithm. Facility staff members in both Experimental and Control conditions involved in HIV service delivery are recruited to receive training on HIV infection, the HIV services continuum, and relevant web-based resources. Staff members in both conditions are tasked to implement improvements in HIV prevention, testing, or treatment in their facility. In the Control condition facilities, staff participants use existing techniques for implementing improvement in a selected area of HIV services. In contrast, the Experimental condition staff participants work as a Local Change Team (LCT) with external coaching and use a structured process improvement approach to improve a selected part of the HIV services continuum. The intervention period is 10 months during which data are obtained using survey instruments administered to staff members and aggregate services delivery data. The study is being implemented in 13 pairs of correctional facilities across nine states in the US. Experimental sites are hypothesized to show improvements in both staff attitudes toward HIV services and the number and quality of HIV services provided for inmates.DiscussionThe current study examines a range of process and outcome data relevant to the implementation of a Change Team approach across diverse correctional settings in the United States. This initial study represents an important step toward a national best practices approach to implementing change in U.S. correctional settings and could serve as an exemplar for designing similar implementation studies.

Who Participates in the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS)?

The national Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) is a multisite research program to improve outcomes for offenders with drug problems who are reentering the community after incarceration. Baseline data from three ongoing CJ-DATS studies were pooled to examine the characteristics of study participants. These analyses suggest that CJ-DATS study participants have serious drug problems, criminal histories, and mental health problems that can decrease the likelihood of successful community reentry unless addressed. HIV-risk behavior was associated with several categories of criminal acts, suggesting that the relationship between sexual risk behaviors and crime may need further investigation.

Patient and program factors in obtaining supportive services in DATOS.

This study examined patient and program factors that influenced the receipt of scheduled supportive services in the Drug Abuse Treatment Outcome Studies (DATOS). Patients (N = 2,932) in 21 long-term residential (LTR) programs, 27 outpatient methadone treatment (OMT), and 25 outpatient drug-free programs were interviewed at admission and at 3 months during treatment. A hierarchical regression analysis was used to examine the relationship between patient-level and program-level factors associated with receiving supportive services in seven categories (medical, psychological, family, legal, educational, vocational, and financial). LTR patients received more services on average than outpatients (especially OMT), but patients overall received few services in the first 3 months of treatment. The patient-level likelihood of receiving services was related to being female and to having higher problem severity at intake. At the program level, outpatient clientele with higher problem severity received more services if they entered a program whose other enrolled patients were less troubled on average.

Preface to the Jar Special Issue The Drug Abuse Treatment Outcome Studies for Adolescents

The Drug Abuse Treatment Outcome Studies for Adolescents (DATOSA) is a national, multisite prospective outcome study of adolescents in drug treatment sponsored by the National Institute on Drug Abuse (NIDA). Outcomes for younger patients were examined in two earlier NIDA-sponsored national drug treatment studies, the Drug Abuse Reporting Program (DARP) (Sells & Simpson, 1979), conducted mostly in the 1970s, and the Treatment Outcome Prospective Study (TOPS) (Hubbard, Cavanaugh, Craddock, & Rachal, 1985), conducted in the 1980s. In both of these outcome evaluation studies, substantial numbers of youth and young adults were admitted to treatment. In DARP, most younger patients were admitted to residential (therapeutic community) or outpatient drug-free modalities. For example, in the 1971-1972 DARP cohort, 47% of drug-free admissions and 44% of therapeutic community admissions were younger than 21 years of age (Gorsuch, Abbamonte, & Sells, 1976). Between 1979 and 1981 in TOPS, 19% of residential and 27% of outpatient drug-free admissions were younger than 21 years (Hubbard et al., 1989). In most instances, these younger patients were treated in adult-oriented drug programs not specifically designed for adolescents. Special programs for adolescents became more prevalent in the 1980s and 1990s, and admissions of younger patients to programs not specializing in adolescent treatment appear to have declined. Only about 3% of short-term

Assessing outpatient drug abuse treatment programs

Drug abuse is a major domestic health problem in the United States, and evaluators, policy makers, interest groups, and the general public are critically interested in knowing which treatments work best. Costs of drug abuse in America are conservatively estimated at 47 billion dollars per year (Harwood, 1984). It is estimated that over 27 million persons in households in the United States, or about one in every ten Americans, used illicit drugs in 1990 (National Institute on Drug Abuse, 1991). The Drug Abuse Reporting Program (DARP) and the Treatment Outcome Prospective Study (TOPS) represent two major drug abuse treatment outcome studies. The DARP study tracked over 44,000 drug users admitted to 52 drug abuse treatment programs during 1969-1973. DARP found that demographic and socioeconomic characteristics explained only a small amount of outcome variance (Sells and Simpson, 1980). Better predictors of treatment outcome were the length of time in treatment and the behavior during treatment (Simpson et al., 1982). TOPS included 11,750 drug users admitted to 41 drug abuse programs during 1979-l 98 1. A finding from this study was that drug abuse treatment reduced illicit drug use and criminal behavior (Hubbard et al., 1989). As in DARP, time in treatment was positively related to drug abuse treatment outcome. While the DARP and TOPS studies established the effectiveness of drug abuse treatment, many issues remain to be clarified. For example, more work is needed in efforts to match clients to treatment. The study of treatment process has remained tantalizingly difficult and little is known about the role that treatment structure and organization play in treatment outcome (Tims and Ludford, 1984). The purpose of this paper is to report data about outpatient treatment unit followup evaluations drawn from selected evaluation items in the recent National Drug Abuse Treatment Survey. A section of questions related to treatment evaluation activities was included in this national survey of drug abuse treatment programs. These

Analyzing shelter organizations and the services they offer: Testing a structural model using a sample of shelter programs

Abstract Although the need for services for homeless people, including health, substance abuse, and mental health treatment, has been widely documented, very little attention has been paid to the structural demands on shelter organizations that deliver these services. The present paper presents an exploratory study of 192 shelters in 29 cities that provide overnight accommodation to individuals and families using structural equation analysis to analyze the characteristics of the organizational and service delivery system. The resulting model suggests that services and amenities offered within the sample of shelter organizations are best understood as being influenced by organizational structure, as measured by occupational specialization, mediated through the organizations relationship with the external actors. This preliminary model offers researchers, policy makers and program planners a tool for analyzing the organizational needs that are necessary to support different services and amenities.