Frank S. Pearson

A Meta-Analytic Review of the Effectiveness of Corrections-Based Treatments for Drug Abuse

The Correctional Drug Abuse Treatment Effectiveness project obtained and coded evaluation research studies (unpublished as well as published) of treatment/intervention programs reported from 1968 to 1996. Meta-analysis was used to examine evidence for their effectiveness in reducing recidivism for incarcerated offenders who are drug abusers. Results supported the effectiveness of therapeutic community programs but not of boot camps and drug-focused group counseling. Evaluations of other interventions were based on too few studies to draw strong conclusions, but promising treatments that warrant further attention include use of methadone maintenance treatment, substance abuse education, 12-step programs, and cognitive behavioral therapy for offender populations.

The Effects of Behavioral/Cognitive-Behavioral Programs on Recidivism

The CDATE project coded studies of treatment/intervention programs in prison, jail, probation, or parole settings reported from 1968 through 1996. Meta-analyses were conducted on the 69 primary research studies on the effectiveness of behavioral and cognitive-behavioral treatment in reducing recidivism for offenders. Results on this heterogeneous collection of studies show that this treatment is associated with reduced recidivism rates. However, this effect is mainly due to cognitive-behavioral interventions rather than to standard behavior modification approaches. The specific types of programs shown to be effective include cognitive-behavioral social skills development programs and cognitive skills (Reasoning and Rehabilitation) programs.

Evaluation of New Jersey's Intensive Supervision Program

New Jerseys Intensive Supervision Program (ISP) has an active caseload of approximately 400 nonviolent offenders. ISP requires employment and provides a high frequency of field contacts with participants, including random tests to detect drug use. Because ISP requires that participants first serve a few months in prison, perform community service, and obey curfews, it provides a level of punishment intermediate between probation and ordinary terms of imprisonment. Evaluation research showed that, in comparison to ordinary imprisonment and parole, ISP achieved slight reductions in recidivism, modest saving of prison space, and was substantially more cost-effective.

Outcomes from a therapeutic community for homeless addicted mothers and their children.

A womens therapeutic community (TC) designed to prevent homelessness was evaluated using a quasi-experimental process. Propensity analysis selected comparable experimental (E) and comparison (C) participants. Significant improvements were found for the E group at the domain level, both in “psychological” dysfunction on symptoms (e.g., depression), and in “health,” including ratings of health and adherence to medication regimens. No significant difference was found at the domain level for “parenting” or “housing stabilization,” but specific outcomes did differ. For example, a greater number of children resided with the E group mothers who also assumed financial responsibility for more of their children.

Meta-analyses of seven of the National Institute on Drug Abuse's principles of drug addiction treatment

Of the 13 principles of drug addiction treatment disseminated by the National Institute on Drug Abuse (NIDA), 7 were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in the EPT, we found that 5 of the NIDA principles examined are supported: matching treatment to the clients needs, attending to the multiple needs of clients, behavioral counseling interventions, treatment plan reassessment, and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders.

New Jersey's Intensive Supervision Program: A Progress Report:

This is a progress report on the first year of operation of New Jerseys Intensive Supervision Program (ISP). The program design includes, among other components, very selective screening of applicants and multiple contacts with each offender every week. Results of a survey of judges, prosecutors, and public defenders on ISP are outlined. A summative evaluation would be premature at this time because only a handful of the 226 offenders admitted thus far into ISP have completed a full year in the program. However, preliminary indications of program accomplishments, including employment and rates of recidivism, are very promising.

Evaluations of Correctional Treatment Programs in Germany: A Review and Meta-Analysis

This study presents a review and meta-analyses of research on the recidivism-reducing impact of correctionally based treatment programs in Germany. The data are part of the Correctional Drug Abuse Treatment Effectiveness (CDATE) project meta-analytic database (covering 1968-1996) of evaluation research studies of correctional interventions. Overall, the five studies of educational programs show no practical impact of these programs in reducing recidivism. Four studies of programs to counsel driving-under-the- influence (DUI) offenders fall in an intermediate area (not statistically significant, but promising enough to warrant further research). The eight studies of Social Therapy programs did show, on the average, a statistically significant practical impact in reducing recidivism.

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.

Substance Use, Mental Health Problems, and Behavior at Risk for HIV: Evidence from CJDATS

Abstract This study examined the relationships between substance abuse, mental health problems and HIV risk behavior in offenders discharged from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,358) in a federally-funded cooperative agreement, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self reports for the six-month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. HIV risk behavior was operationalized as either (a) unsafe injection drug use, e.g., sharing needles and/or sharing injection equipment, or (b) unsafe sex, e.g., sex without a condom. The findings were that (1) unsafe injection drug use was associated with unsafe sex and vice versa, (2) unsafe sex behavior was related to frequency of drug use, and (3) unsafe sex behavior was related to frequency of alcohol use. In these samples, mental health problems did not have a significant effect on risk behavior, controlling for other variables. Future research should probe this “nonfinding” using standardized diagnostic and symptom measures to provide greater detail on the mental health problems (e.g., age of onset, frequency, and severity of the problem).

Efficacy of a Process Improvement Intervention on Delivery of HIV Services to Offenders: A Multisite Trial

OBJECTIVES We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. METHODS As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. RESULTS The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. CONCLUSIONS Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments.