Opioid Agonist Treatment Recipients within Criminal Justice-Involved Populations.

Background: In 2014, nearly 2.5 million Americans had a substance use disorder for opioids (e.g., prescription pain medication or heroin) with over half estimated to have had prior contact with the criminal justice system. Despite strong evidence that opioid agonist treatment (OAT) is effective in reducing overdose, increasing treatment retention, and improving physical health and well-being outcomes, the use of OAT among justice-involved individuals is relatively rare. Methods: The current study uses national data of publicly funded admissions to substance abuse treatment to assess the extent to which OAT is used for cases referred to treatment by the criminal justice system. We explore the relationship between demographics, substance use severity, and access to treatment and OAT receipt. Results: Findings indicate that fewer than 6% of criminal justice cases received OAT as part of the treatment plan. Those with daily substance use, comorbid psychiatric problems, prior treatment, females, Latinos, and those who were older and those who were living independently were more likely to receive OAT, as were those living in the Northeast and with government health insurance. Conclusions: Improving the integration of the criminal justice system with substance use treatment programs would improve access to care and potentially reduce multiple health disparities faced by those in the justice system. As criminal justice responses to substance use disorder move toward a public health approach, it is imperative that the criminal justice system consider mechanisms for improving access and referrals to OAT.

Predicting drug court graduation: Examining the role of individual and programmatic characteristics.

INTRODUCTION: Although existing research suggests drug courts reduce recidivism and substance use, a large portion of drug court participants do not graduate. According to a conceptual framework, severity of need and program intensity may help to explain variation in drug court effectiveness. Understanding variation in drug court graduation can help to identify high risk participants and effective programmatic elements. METHODS: Our sample included 247 drug court participants from an adult felony-level drug court located in a large metropolitan area of the southeastern United States that either graduated (n = 113) or were terminated (n = 134) from the program. We used participant and program characteristics from drug court program records to predict drug court graduation. RESULTS: In bivariate analyses, several participant and program characteristics were significantly associated with drug court graduation. In the final multivariate model, only one participant-level characteristic was significantly related to graduation: emotional/personal risk and needs (aOR: 0.56, 95% CI: 0.33, 0.93). Alternatively, three program characteristics remained statistically significant predictors of drug court graduation in the final multivariate model. Receiving more individual counseling sessions was positively associated with drug court graduation (aOR: 1.27, 95% CI: 1.14, 1.41), while jail and monetary fine sanctions were negatively associated with drug court graduation (aOR jail: 0.45, 95% CI: 0.30, 0.68; aOR fine: 0.28, 95% CI: 0.10, 0.78). CONCLUSIONS: Our findings suggest that drug court programs may benefit by tailoring services for individuals with high emotional/personal risk and participants who receive certain types of sanctions. More rigorous research should explore the causal relationship between individual counseling and drug court graduation to determine if wide-scale programmatic changes are warranted.

Parent and Child Reports of Parenting Behaviors: Agreement Among a Longitudinal Study of Drug Court Participants.

Identifying ways to support children of parents with substance use disorder is a critical public health issue. This study focused on the parent-child relationship as a critical catalyst in child resilience. Using data from a longitudinal cohort study, the aims of this study were to: (1 ) examine the agreement between parent and child reports of parenting behaviors and (2 ) describe the association between agreement and child mental health. Participants were 50 parent-child dyads that included parents enrolled in an adult drug court and their children, aged 8-18. Overall, agreement (i.e., concordance) between parent and child reports of parenting was slight to fair. Parents reported their parenting behaviors to be slightly more positive than how children rated the same behaviors in the areas of: involvement, 0.53 (SD = 0.80); positive parenting, 0.66 (SD = 0.87), and monitoring behaviors, 0.46 (SD = 0.90). Parents also rated themselves, in comparison to their children's reports, as using less inconsistent discipline, -0.33 (SD = 1.00), and less corporal punishment, 0.13 (SD = 1.01). Agreement was related to some, but not all, child mental health outcomes. When parents rating their parenting as more positive than their child reported, that had a negative effect on child self-esteem and personal adjustment. Contrary to hypotheses, we did not find a significant relationship between positive parenting and internalizing problems. Findings have implications for obtaining parent and child reports of parenting within the drug court system, and for identifying children at higher risk for externalizing problems.

Drug Court as an Intervention Point to Affect the Well-Being of Families of Parents with Substance Use Disorders.

Background: A high proportion of justice-involved individuals have a substance use disorder and many of those individuals serve in a caregiving role to a child under 18. Given the negative impact of substance use and justice-involvement on the wellbeing of children, the criminal justice system may offer a unique intervention point with high public health impact. This study describes characteristics of adult drug court participants (DCP) that affect the wellbeing of their children and families and compares the DCP parenting and mental health characteristics to their child's other caregiver in order to understand how parenting differs within drug court families. Method: Data were collected from a sample of 100 DCP; 58 had a matched other caregiver. Drug court data regarding substance use and criminogenic risk/need were collected. Analyses differentiated the parenting behaviors and mental health needs of DCP from other caregivers. Results: The DCP were at moderate to high risk for recidivism and presented with multiple and significant criminogenic and psychosocial functioning needs. Risk for potential maltreatment and poor parenting behaviors were elevated, and significantly higher compared to other caregivers. DCP demonstrated clinically elevated mental health needs, and were significantly different across all indicators of mental health compared to other caregivers. Conclusions: Adult drug courts address the occurrence of substance use disorders but there are additional needs to be intervened upon. Adult drug courts may be a viable intervention point to address issues of parenting and mental health to improve the wellbeing of criminal justice-involved individuals, their children, and families.

Victims' Compensation as a Tool of Therapeutic Justice: Examining the Physical and Mental Health Needs of Victim Compensation Applicants and the Role of Health in Receiving Compensation.

OBJECTIVE: Victims' compensation programs are positioned to serve an important therapeutic role. Their use by persons with physical and mental health problems has not been investigated. This study evaluates the extent to which applicants have physical and mental health needs and whether receiving compensation is related to these needs. METHODS: Data were part of a larger study designed to assess satisfaction with victim compensation in Georgia. The sample included 500 victim compensation applicants. Individuals were surveyed about their experiences applying for compensation as well as their current wellbeing. Descriptive and multivariate analyses investigated the link between physical and mental health problems and denial of victim compensation. RESULTS: Applicants for crime victim compensation in Georgia experienced a range of physical and mental health problems. Almost half of applicants had been diagnosed with a mental health condition, and 60% had been diagnosed with at least 1 physical health condition. Co-occurring disorders were common. In addition, being denied compensation was significantly related to having a mental health condition and to the number of diagnosed mental health conditions. CONCLUSIONS: Crime victim applicants have clear physical and mental health needs. Being denied compensation benefits is related to having a mental health disorder. These results suggest that victim compensation programs can be an intervention point for victims and their families for either receipt of direct service or referral to needed services. In addition, changes in program administration may need to be made to alleviate disparity in award benefit related to mental health status.

Treating high-risk offenders in the community: the potential of drug courts.

The drug court model, which integrates drug treatment with community supervision and uses the authority of the court to facilitate compliance and behavioral change, provides an innovative alternative to processing as usual. While drug courts have enjoyed considerable empirical support, research suggests that they could increase their effectiveness through further refining their target population. In particular, it is hypothesized that drug courts are particularly well suited to treat drug offenders who have a high risk for recidivism. The purpose of the current study is to compare recidivism rates of high-risk drug court participants and high-risk probationers. Using new charges as a measure of recidivism, the results indicate drug court participants had significantly better outcomes than probationers. Implications for policy and practice are discussed.

Poly-Victimization Risk in Prison: The Influence of Individual and Institutional Factors.

Victimization research suggests that individuals who either witness or are direct victims of violence are substantially more likely to experience long-term negative outcomes. Although recent studies identifying factors associated with prison victimization are emerging, the risk factors predicting inmate's experience of multiple types of victimization, called poly-victimization, remain unknown. Utilizing a lifestyles model that incorporates the importation/deprivation framework, the current study examines whether certain features of the prison environment or individual characteristics predict who is most likely to experience victimization. Data from more than 1,600 recently released inmates confirm that the environmental and individual-level factors are related to poly-victimization in prison. The findings from the study have implications for policy and practice.

Using the level of Service Inventory-Revised to improve assessment and treatment in drug court.

More than 2,000 drug courts in the United States provide supervision and substance-abuse treatment to thousands of offenders. Yet the treatment continuum from assessment to aftercare is underexplored. The effectiveness of the Level of Service Inventory-Revised (LSI-R) as a risk assessment tool is well established. However, fewer studies have considered its use in guiding treatment strategies. In using the LSI-R, the drug court program relied on the structured interview protocol (not the risk classification scores) to identify criminogenic needs that then helped determine placement in a high- or low-needs treatment track. To evaluate the effectiveness of these treatment placement decisions, this research used the LSI-R scores to examine individual and group differences (N = 182). Significant and substantive differences at the individual and group levels were found thus providing empirical support for using the LSI-R as a link between assessment and treatment. Implications for developing standards and practice protocols for drug courts are discussed.