Sami Abdel-Salam

Effect of an Organizational Linkage Intervention on Staff Perceptions of Medication-Assisted Treatment and Referral Intentions in Community Corrections☆

INTRODUCTION Medication-assisted treatment (MAT) is effective for alcohol and opioid use disorders but it is stigmatized and underutilized in criminal justice settings. METHODS This study cluster-randomized 20 community corrections sites to determine whether an experimental implementation strategy of training and an organizational linkage intervention improved staff perceptions of MAT and referral intentions more than training alone. The 3-hour training was designed to address deficits in knowledge, perceptions and referral information, and the organizational linkage intervention brought together community corrections and addiction treatment agencies in an interagency strategic planning and implementation process over 12 months. RESULTS Although training alone was associated with increases in familiarity with pharmacotherapy and knowledge of where to refer clients, the experimental intervention produced significantly greater improvements in functional attitudes (e.g. that MAT is helpful to clients) and referral intentions. Corrections staff demonstrated greater improvements in functional perceptions and intent to refer opioid dependent clients for MAT than did treatment staff. CONCLUSION Knowledge, perceptions and information training plus interorganizational strategic planning intervention is an effective means to change attitudes and intent to refer clients for medication assisted treatment in community corrections settings, especially among corrections staff.

A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol

BackgroundSubstance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services.Methods/designEach of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels.DiscussionThrough closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits.Trial registrationClinical Trials gov registration number NCT01344122.

CORRELATES OF INTERORGANIZATIONAL SERVICE COORDINATION IN COMMUNITY CORRECTIONS.

Because weak interagency coordination between community correctional agencies (e.g., probation and parole) and community-based treatment providers has been identified as a major barrier to the use of evidence-based practices (EBPs) for treating drug-involved offenders, this study sought to examine how key organizational (e.g., leadership, support, staffing) and individual (e.g., burnout, satisfaction) factors influence interagency relationships between these agencies. At each of 20 sites, probation/parole officials (n = 366) and community treatment providers (n = 204) were surveyed about characteristics of their agencies, themselves, and interorganizational relationships with each other. Key organizational and individual correlates of interagency relationships were examined using hierarchical linear models (HLM) analyses, supplemented by interview data. The strongest correlates included Adaptability, Efficacy, and Burnout. Implications for policy and practice are discussed.

Therapeutic Engagement as a Predictor of Retention in Adolescent Therapeutic Community Treatment

The adolescent drug problem places a huge toll on society and a heavy burden on the criminal justice system. Research regarding the benefits of therapeutic community (TC) treatment for adolescents has shown it to be effective. Despite the ability of therapeutic communities to lower drug relapse and reduce criminality, a great deal remains unknown in terms of how the process of treatment actually works for adolescents. Using data collected as part of the Drug Abuse Treatment Outcomes Study-Adolescent, this study examines the relationship between therapeutic engagement and treatment retention. The primary findings are that measures of therapeutic engagement had a significant association with whether or not an adolescent completed treatment. Findings suggest that instruments that evaluate therapeutic engagement are important in assessing involvement in treatment, and that programming designed to engage the adolescent in TC treatment should be utilized in order to reduce the risk of premature treatment dropout.

Self-control as a predictor of relapse and recidivism in adolescent therapeutic community treatment.

Despite the effectiveness of Therapeutic Communities (TCs), empirical studies of TCs are mostly atheoretical. In this study, concepts related to Gottfredson and Hirschis General Theory of Crime were used to predict posttreatment delinquency among adolescents. Using data collected as part of Drug Abuse Treatment Outcomes Studies–-Adolescents (1993–1996), this study examined whether characteristics associated with low self-control predicted posttreatment substance use and posttreatment crime (N = 727). Contrary to the hypotheses, characteristics associated with low self-control had no relationship with posttreatment delinquency. Although these findings do not support the hypothesis, this study begins the process of linking criminological theory to adolescent TC treatment research. The studys limitations are noted.

Influence of Organizational Characteristics on Success in Implementing Process Improvement Goals in Correctional Treatment Settings

Although research indicates that organizational characteristics substantially influence the adoption and use of evidence-based practices (EBPs), there has been little empirical research on organizational factors most likely to influence successful implementation of EBPs, particularly in criminal justice settings. This study examined organizational characteristics related to the success of change teams in achieving improvements in assessment and case-planning procedures for persons leaving correctional settings and receiving community services. In this evaluation of the Organizational Process Improvement Intervention (OPII), part of the National Institute on Drug Abuse’s (NIDA’s) Criminal Justice Drug Abuse Treatment Studies (CJDATS) cooperative, 21 sites were randomized to an early-start or a delayed-start condition. For this analysis, data from both conditions were combined. Agencies with fewer program needs, good communication, adequate staffing levels, good supervision, positive attitude toward rehabilitation, and higher institutional capacity for change were better able to implement planned changes in assessment and case-planning procedures. Such agencies may be better candidates for implementation improvement strategies, whereas other agencies could benefit from pre-intervention efforts aimed at strengthening these characteristics before attempting to improve assessment procedures.Although research indicates that organizational characteristics substantially influence the adoption and use of evidence-based practices (EBPs), there has been little empirical research on organizational factors most likely to influence successful implementation of EBPs, particularly in criminal justice settings. This study examined organizational characteristics related to the success of change teams in achieving improvements in assessment and case-planning procedures for persons leaving correctional settings and receiving community services. In this evaluation of the Organizational Process Improvement Intervention (OPII), part of the National Institute on Drug Abuse’s (NIDA’s) Criminal Justice Drug Abuse Treatment Studies (CJDATS) cooperative, 21 sites were randomized to an early-start or a delayed-start condition. For this analysis, data from both conditions were combined. Agencies with fewer program needs, good communication, adequate staffing levels, good supervision, positive attitude toward rehabilitation, and higher institutional capacity for change were better able to implement planned changes in assessment and case-planning procedures. Such agencies may be better candidates for implementation improvement strategies, whereas other agencies could benefit from pre-intervention efforts aimed at strengthening these characteristics before attempting to improve assessment procedures.

Effects of a strategy to improve offender assessment practices: staff perceptions of implementation outcomes

BACKGROUND This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery. METHODS To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites. RESULTS Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility. CONCLUSIONS Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects.

Building Bridges in New Jersey Strengthening Interagency Collaboration for Offenders Receiving Drug Treatment

This article describes the experience and outcomes of the National Institute on Drug Abuse–funded Criminal Justice Drug Abuse Treatment Studies 2 Improving Best Practices in Assessment and Case Planning for Offenders protocol in the state of New Jersey. The protocol was designed to test the effectiveness of an Organizational Process Improvement Intervention in improving four assessment and case planning domains for drug-involved offenders in correctional settings transferring to community treatment based agencies. This article describes the protocol and the change team model process through which correctional and community agency staff collaborated to improve assessment and case planning for offenders with substance abuse problems. The primary goal of these collaborative efforts was to link information across stages of the treatment continuum to improve service coordination. Data taken from qualitative interviews with agency participants are used to illustrate the common themes that emerged relating to the intervention process, barriers to implementing developed goals, and facilitative factors that contributed to successes. The findings from the current study provide indication that organizational process improvement strategies can be implemented within a correctional setting to reduce interorganizational barriers and to facilitate improvements in the continuum of care involved in the treatment of offenders with histories of substance abuse.

Offender Assessment, Case Planning, and Referral to Community-Based Treatment: Effects of a Structured Process Improvement Initiative

Background CJDATS-2 (Criminal Justice Drug Abuse Treatment Systems), a 5-year multisite national research collaborative funded by the National Institute on Drug Abuse (NIDA), targeted implementation of evidence-based approaches for assessing and treating drug abuse within criminal justice settings. The Organizational Process Improvement Intervention, one of the major projects within the collaborative, was an intervention designed to improve the assessment of prisoners, the development of case plans for community services, the transfer of this information to community treatment agencies, and the use of the case plans by community treatment agencies that provide the recommended services. A local change team (LCT) consisting of criminal justice and community treatment staff and a facilitator conducted an organizational needs assessment and then identified and implemented targeted process improvement goals over an 18 to 24-month period.

Examining the relationship between self-control and adolescent TC treatment completion

A type of treatment intervention that is widely regarded in terms of treating adolescents with issues of substance use is the therapeutic community (TC). Despite their effectiveness, empirical studies of drug treatment are mostly atheoretical, even though treatment programming is based on theory. In this study, an attempt was made to apply concepts related to a Gottfredson and Hirschi’s General Theory of Crime to predict treatment completion. Using data collected as part of the Drug Abuse Treatment Outcomes Studies Adolescents (DATOS-A), a multisite prospective study of adolescent drug abuse treatment effectiveness, this study examined whether characteristics associated with low self-control predicted treatment completion. The primary finding was that motivation for treatment was significantly related to treatment completion. Although the characteristics associated with low self-control did not predict treatment completion in the hierarchical linear modeling (HLM) models that included the demographics and risk and protective factors, there were several significant bivariate relationships between pretreatment behaviors and the characteristics associated with low self-control. Because of these relationships, it is important that TC practitioners are aware of how these characteristics might interplay with treatment completion and how TC strategies may help the adolescent to overcome them.