Performance Audit Report - IA DOC Substance Abuse Programs, IA DMPAP, 2007
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Does Prison Substance Abuse Treatment Reduce Recidivism? Performance Audit Report Iowa Department of Corrections Licensed Substance Abuse Programs May 25, 2007 Iowa Department of Management Performance Audit Program Iowa Department of Management Performance Audit Program State Capitol Building 1007 East Grand Des Moines, IA 50319 Scott J. Vander Hart, Performance Auditor 515/281-6536 515/242-5897 FAX Scott.VanderHart@iowa.gov The Iowa Legislature has given the Iowa Department of Management (IDOM) authority to implement a system of periodic performance audits in consultation with the Legislative Services Agency, Auditor of State and executive branch agencies. The performance audit is a key component of the Iowa Accountable Government Act. Its purpose is to evaluate agency performance, including program effectiveness, based on performance measures, targets and supporting data. In response, IDOM has created the consultative Performance Audit Program designed to improve state agencies ability to achieve and demonstrate key results by offering relevant and practical solutions to performance challenges. DOC Licensed Substance Abuse Programs Page 1 Executive Summary Report Highlights: Þ 59.6% of offenders with substance abuse needs are released without treatment. Þ 12.1% of offenders treated for substance abuse problems are convicted of new offenses within 12 months of release. Þ Substance abuse treatment reduces new conviction recidivism by 2.4%. Þ Less than 50% of substance abuse interventions reduce both new conviction and total recidivism. Þ Programs had little effect on prison population, operational cost savings, and overall crime reduction. Þ Mental health issues, community support, and implementation of evidencebased practices can significantly influence outcomes. Inside this Report: Background 2 % of Offenders Released without Treatment 9 Program effectiveness at preventing recidivism 11 Consequences of programs results 20 Issues significantly influencing program results 23 Conclusions and Recommendations 42 Department of Corrections Response 56 Appendices 57 The Iowa Department of Corrections faces a growing prison population expected to quickly exceed current capacities. Additionally, nine out of every ten offenders have a history of alcohol or drug problems often both. Research suggests that alcohol and drugs lead to criminal behavior, which lead offenders right back to prison creating a vicious circle and placing a financial and societal burden on the state. However, research also shows that substance abuse treatment can minimize criminal behavior, and offers a way to shut the revolving prison door. Substance abuse programming attempts to change offender thinking patterns and behavior in order to facilitate re-entry back into the community, lessen substance abuse relapse and reduce recidivism. Yet nearly 60% of offenders with identified needs are not treated, and many lacking treatment are high risk. Additionally, the percentage of offenders returning to prison varies significantly from program to program and some programs can not show they have reduced recidivism when compared to offender groups with substance abuse problems and receiving no treatment at all. All of which minimize the effect substance abuse programming has in curbing prison population growth and reducing crime. The Department of Corrections intends to reduce recidivism through evaluation of program fidelity and implementation of evidence-based practices. Many of the programs are already structured to accommodate continuous improvement centered on desired outcomes. Population characteristics and the type and level of community support can also significantly influence recidivism. All of which call for the department to: Þ Enhance community support and other re-entry initiatives to reinforce desired behaviors in the community where offenders face situations that can lead to relapse and criminal behavior; and Þ Develop planning, evaluation and service delivery approaches that support integrated substance abuse programming across the prison and correctional system, and enable internal benchmarking of best practices. DOC Licensed Substance Abuse Programs Page 2 Background The National Institute on Drug Abuse and continued use persists regardless (NIDA), one of the federal of medical, psychological, and social government s lead agencies for consequences. Methamphetamine, substance abuse research, describes Marijuana and Cocaine were identified drug addiction as a complex illness, as the three most prominent drugs characterized by compulsive, at used/abused by offenders in Iowa s times, uncontrollable drug prison system (Prell Substance Overtime, an craving, seeking and use Abuse 5). Short-term effects individual s Drug Abuse Treatment 9). of such drug use include: ability to choose In 2004, 83% of state impaired motor function and not to take drugs prisoners had used illegal judgment, and bizarre, erratic diminishes, and drugs, and 53% met the and violent behavior in high continued use DSM-IV1 criteria for drug doses (such as with cocaine). persists dependence or abuse Long-term effects include: regardless of (Mumola and Karberg 1). addiction, mood disturbances, medical, The Department of irritability, aggressive and psychological, Corrections (DOC) findings violent behavior, paranoia, and social are similar. 90% of hallucinations, and healthconsequences. offenders within the prison related problems (NIDA system have a history of Cocaine 4-5, Marijuana 5, alcohol or drug problems, and roughly Methamphetamine 5). 60% have had problems with both drugs and alcohol (Prell Substance Aggressive and violent behaviors and Abuse 5). The statistics make other drug effects can lead to criminal Drugs/Alcohol the top priority need of offenses. Illegal drug use was found to offenders within prison (DOC Strategic increase the odds of committing any Plan 19). crime sixfold (NIJ Adult Patterns ). According to Mumola and Karberg, nearly a third of state prisoners Alcohol and Drug Use and nationally were under the influence of Abuse Can Lead to Criminal illegal substances at the time of their Behavior offense, and over half had taken drugs Drug use can lead to addiction, within the month of their offense (2). negative behaviors, and many health There is also an association between related problems. Even experimental drug use and re-occurring crime. 21% use can quickly grow into an addiction more state prisoners dependent on or depending on individual vulnerabilities. abusing drugs also had at least three Over time, an individual s ability to prior sentences to probation or choose not to take drugs diminishes, incarceration when compared to other inmates (Mumola and Karberg, 1). 1 Criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). DOC Licensed Substance Abuse Programs Page 3 Recent meta-analyses of treatment program evaluations generally support the use of substance abuse Substance abuse is a recognized programming as a means to reduce dynamic risk factor2, altering the need drug use and criminal behavior. A can increase the likelihood of changing meta-analysis conducted by the criminal behavior and closing the Prendergast et al. concluded that revolving prison door (National treatment programs, as practiced in Institute of Corrections 5; Bonta Riskthe United States, are effective at Needs 23). Long-term use of drugs reducing drug use and crime (66).3 can temporarily and permanently alter The average effect sizes for drug use brain anatomy and chemistry. The and crime were both positive alterations persists long after drug use indicating on average, clients who (months to years) making it extremely participated in treatment had better difficult for addicts to quit on their own outcomes than did those who received (NIDA Drug Abuse Treatment 14; no treatment or those who received Treatment for Criminal Justice minimal treatment (61).4 Effect sizes Populations 1). This makes drug were translated to reflect a 15% higher addicts high risk for relapse even after success rate on drug use outcomes, prolonged periods of and a 6% higher success rate abstinence, suggesting the evaluations on crime outcomes for need for treatment even generally support treatment groups (63).5 with longer prison the use of Prendergast s study helped sentences. substance abuse dismiss claims that drug programming as treatment was not effective, DOC intends to impact and a means to and refocus on the question of reduce recidivism of reduce drug use how can treatment be offenders through evidenceand criminal improved, and better address based programming behavior. the needs of clients. Strategic Plan 5, Performance Plan 1, SelfAn analysis by Mitchell, Wilson, and Assessment 15, 19, 38). According MacKenzie focused more closely on to NIDA, substance abuse treatment the subject of this audit has the potential to support this effort. They state, Treatment offers the best 3 alternative for interrupting the drug Meta-analysis conducted on 78 drug treatment abuse/criminal justice cycle studies conducted between 1965 and 1996. However, only 25 of the studies had crime Treatment for Criminal Justice outcome information. The analysis compared Populations 13). Treatment Can Reduce Criminal Behavior 2 Dynamic or changeable risk factors are also known as criminogenic needs and serve as predictors to criminal behavior. those who received drug treatment to those who received minimal or no treatment. 59% of the studies assigned participants randomly or quasirandomly. 4 Effect size is an index that measures the magnitude of a treatment effect. 5 Binomial effect size display (BESD) equivalent was used to determine the success rates. DOC Licensed Substance Abuse Programs Page 4 further support the use of substance incarceration-based substance abuse abuse programs within correctional treatment programs. They conclude settings. They concluded that inmates that incarceration-based programs are receiving in-prison residential modestly effective in reducing treatment were less likely to be rerecidivism .6 In the study, the general arrested than untreated inmates recidivism odds-ratio favored the within the first six months after release treatment group over the comparison (329).9 group in 83% of the 65 evaluations having at least one measure for postrelease offending.7 The general Prison Programming recidivism rate is translated to be 7% The DOC attempts to address lower for treatment groups. Programs are this problem through the Far fewer of the intended to provision of substance abuse independent evaluations change offender programming to offenders reviewed in this study thinking patterns through 15 licensed programs assessed post-release drug and behaviors in in eight institutions.10 In SFY use. The meta-analysis order to reduce 2006, the licensed substance results for drug use recidivism. abuse programs collectively outcomes were not found to had the capacity to serve 2,014 be statistically significant offenders. In SFY 2007, the (12, 17).8 In a study of DOC budgeted $3.1 million for the substance abuse programs within the delivery of licensed substance abuse federal prison system, Pelissier et al. programs ( Budget Details 2). 6 The meta-analysis was based on 53 unique studies reporting the results of 66 independent evaluations with interventions conducted between 1980 and 2004. Two-thirds of the studies were post-1996. The scope was the review was experimental and quasi-experimental evaluations of incarceration-based drug treatment programs for juveniles and adults that utilized a comparison group (no or minimal treatment). 7 General recidivism included re-arrests, reconvictions, and re-incarcerations. 8 The odds-ratio compared the odds of an event occurring in comparison group to the odds of it occurring in the treatment group. The mean odds-ratio for the general recidivism was 1.37, re-arrests 1.40, re-convictions 1.43, and reincarcerations 1.22. An odds ratio of 1 implies that the event is equally likely in both groups. Results greater than one indicates that the recidivism event is more likely to happen in comparison group, values less than one would make it less likely to occur. All were found to be statistically significant. Although the substance abuse programs were often developed independently at the institutional-level, they all share a common purpose. Most employees, managers and stakeholders believe that the programs are intended to change offender thinking patterns and behavior in order to facilitate re-entry back into the community, lessen substance abuse relapse, and reduce recidivism (Performance Audit 9 Male and female treatment subjects were drawn from 20 different prisons of medium, low and minimum security levels. Comparison subjects were drawn from over 30 prisons. Both groups were limited to those released to supervision. 10 Programs conform to the licensure standards outlined in 641 Iowa Administrative Code Chapter 156. DOC Licensed Substance Abuse Programs Manager Interviews, Employee Survey, and Stakeholder Survey). However, how the programs fulfill this purpose differs: Þ the level of treatment varies among the licensed programs, four are inpatient residential programs, one is an intensive outpatient program, and the remaining programs are outpatient; Þ the minimum program duration generally ranges from 12 to 40 weeks (however, one program is significantly longer spanning an 18 month period); Þ the hours per week spent in or intensity of program activities vary among programs, and in many cases are dependent on individual case plans; and Page 5 Many other factors can affect their ability to do so, and as time passes the programs degree of influence diminishes. Figure 1 reflects the relationships among program activities and desirable results, as well as factors that can influence results. Patient with Substance Abuse Need Staff and Program Resources Intake & Orientation Assessment & Treatment Plan Development Factors Internal to System that Influence Results: - Level of Resources - Level of Service & Matching Treatment - Clinical Oversight - Staff Abilities - Staff Engagement - Climate -Therapeutic Relationships - Practices Used - Dosage - Offender Retention -Treatment Timing Substance Abuse Programming System However, the programs do share some common ground with 11 of the 15 programs using curriculums specifically incorporating cognitive and cognitive-behavioral therapies. One program also uses a gender specific curriculum designed to help women recover from substance abuse. Two programs curriculums are eclectic drawing from a variety of sources. Although the programs are attempting to lessen substance abuse relapse and criminal behavior, it is important to note they can not control the results but can only hope to influence them. Readiness Addiction Severity Mental Health Age Criminal History Þ the number of offenders per staff person also varies significantly from six offenders for every staff person to 40. Motivation Implements Treatment Plan/ Programming Monitors Progress Successful Treatment Completion Improved Awareness/ Enhanced skills Other Interventions Factors External to System that Influence Results Post-Release Supervision Employment Programs Desired Outcomes Lessen Relapse Social Environment Family Support Reduced Criminal Behavior Continuing Care Figure 1: General Logic Model for the DOC s Substance Abuse Programs. DOC Licensed Substance Abuse Programs Page 6 Audit Scope, Objectives and Methodology The performance audit focused on the licensed substance abuse programs available to offenders in prison. Substance abuse programs were selected, since substance abuse is the top criminogenic need among offenders within Iowa s prison system.11 The use of evidence-based practices is also a key strategy embraced by DOC to reduce offender recidivism, which can influence the means for which treatment is delivered. The offender population was set using offenders released between October 1, 2004 and December 31, 2005. The timeframe was limited because of availability of substance abuse intervention data in Iowa Corrections Offender Network (ICON). The follow-up period to capture recidivism information was one year. Two recidivism measures were used: new conviction resulting in prison or community supervision; and new conviction or return to prison for any reason (i.e. total recidivism rate). Exit or release was based on release from prison due to end of sentence or entrance into community supervision. The performance audit s purpose, developed as part of Iowa s Accountable Government Act, is to evaluate agency performance, including program effectiveness, based on performance measures, 11 Criminogenic needs are attributes of an offender that when changed can reduce the probability of criminal behavior. targets and supporting. In accordance with the program s legislative purpose, the following objectives were established to evaluate the effectiveness of licensed substance abuse programs within DOC: Objective 1: What percentage of offenders with a history of substance abuse is released without treatment? Objective 2: Are the DOC s licensed substance abuse programs effective at preventing offenders from being reconvicted for new offenses and returned to the correctional system? What are the consequences of the programs being effective or ineffective and why? 1) Condition What are the recidivism rates for offenders successfully completing licensed substance abuse programs 12 months following release from prison? 2) Criteria How do the 12 month recidivism rates of offenders successfully completing the substance abuse program compare to: a) offenders from the same institution with a history of substance abuse, but received no treatment; b) offenders who started the same program, but did not successfully complete it; and c) offenders from the same institution without a history of substance abuse? DOC Licensed Substance Abuse Programs 3) Effect How does this impact corrections population growth and operational costs? 4) Causes a) Do the following variables significantly influence recidivism rates: i) Co-occurring mental health problems, ii) Length of time between treatment and release, iii) LSI-R score, and iv) Participation in community aftercare? b) How does program management, structure and staffing influence recidivism rates? Substance abuse needs were identified by LSI-R, Iowa Risk, Custody Classifications, or Jesness Assessments. Treatment groups institution and location were defined by location where treatment was concluded, which may differ from an offender s release location. Comparison groups institution and location were based on offenders location at time of release for offenders comprising these groups. Comparisons were made by reviewing the difference in recidivism rates between the treatment group and the comparison groups at the same institution or location. The recidivism rates from the comparison group were subtracted from the recidivism rate of the treatment group to determine the difference. Negative values reflect positive results the expectation is that treatment groups will have a lower recidivism rate. Page 7 Causes were reviewed primarily by controlling for the specific variable of interest to see if a pattern emerges in recidivism rates. Where patterns emerged at the department-wide and institutional levels, population characteristics were reviewed at the program level if possible. Differences in population characteristics between treatment group and comparison group were examined specifically for co-occurring mental health problems, LSI-R scores, and offender demographics. Length of time between treatment and release, and participation in community aftercare were reviewed for each treatment group at the institution and program level where possible. The review of program management, structure and staffing was limited since many offenders received treatment two to three years ago. Observations made during the audit, may not be representative to how the program operated at the time offenders in the data set were treated. Additionally, previous evidence-based program assessments were conducted roughly two years prior to the offenders receiving treatment, and they were limited to five of the 15 programs. These evaluations are also limited to a specific point in time, and may not adequately reflect how the offenders in this data set were treated. The variables were compared to differences in recidivism rates for each program to identify those which appear to affect the difference. The data collection methodology for the performance audit is provided in Appendix A. The data was DOC Licensed Substance Abuse Programs supplemented with policy and procedure manual reviews, manager interviews and employee and stakeholder surveys. Page 8 DOC Licensed Substance Abuse Programs Page 9 What percentage of offenders with a history of substance abuse is released without treatment? Lack of treatment resources was one of the most pressing issues noted by managers, stakeholder and employees alike. Budget and staffing reductions and available treatment space limit DOC s ability to provide substance abuse treatment to many of the offenders in need (Performance Audit Employee Survey, Stakeholder Survey; Howard and Phillips; Dick and Comp; Dursky et al.; Bagby; Austin and Kelly). Of those released from prison between October 1, 2004 and December 31, 2005, slightly less than 60% of the offenders with substance abuse needs had not received substance abuse treatment, as shown in Figure 2. North Central Correctional Facility had the largest percentage of offenders with substance abuse needs released without treatment at 85.4% and Clarinda Correctional Facility the fewest at 36.6%, as shown in Table 1. Percent of Offenders with Substance Abuse Need Released without Treatment Group SA Need/No Prison Treatment SA Need/Successful Prison Treatment SA Need/Unsuccessful Prison Treatment SA Need/Prison Treatment - Other 59.6% Figure 2: Percent of Offenders with Substance Abuse Need Released without Substance Abuse Treatment. DOC Licensed Substance Abuse Programs Page 10 % of Offenders with Substance Abuse Needs Released without Treatment by Institution SA Need /No Prison Treatment SA Need /Successful Prison Treatment SA Need / Unsuccessful Prison Treatment SA Need /Prison Treatment Other Total Anamosa State Penitentiary 53.2% 39.1% 4.7% 3.0% 100.0% Clarinda Correctional Facility 36.6% 52.5% 9.1% 1.8% 100.0% Fort Dodge Correctional Facility 60.4% 34.5% 3.5% 1.6% 100.0% Iowa Correctional Institution for Women 56.7% 36.8% 4.7% 1.8% 100.0% Iowa Medical & Classification Center 81.3% 13.5% 3.1% 2.1% 100.0% Iowa State Penitentiary 82.4% 13.7% 1.1% 2.8% 100.0% Mount Pleasant Correctional Facility 43.8% 51.5% 1.2% 3.4% 100.0% North Central Correctional Facility 85.4% 13.1% .9% .7% 100.0% Newton Correctional Facility 64.0% 33.1% 1.6% 1.3% 100.0% Total 59.6% 35.1% 3.3% 2.0% 100.0% Institution Table 1: Percentage of Offenders with Substance Abuse Needs Released without Treatment by Institution. DOC Licensed Substance Abuse Programs Page 11 Are the DOC s licensed substance abuse programs effective at preventing offenders from being reconvicted for new offenses and returned to the correctional system? The DOC s licensed substance abuse programs have a new conviction recidivism rate of 12.1% and total recidivism rate of 26.6% at twelve months following release for the time period reviewed. Overall, these programs slightly reduce new conviction recidivism department-wide, but do not effect the total recidivism rate. As the data is disaggregated to the institution and intervention level, it demonstrates not all institutions performance is the same, and that not all interventions (i.e. substance abuse programs) are equally effective at reducing recidivism. Key findings: Þ 12.1% of offenders released after successful completion of substance abuse treatment Þ Þ Þ Þ are convicted for new offenses within 12 months; 26.6% return for either new offenses or technical violations. New conviction recidivism rates range from 3.4% to 21.1% for substance abuse programs; total recidivism rates range from 7.1% to 41.7%. Department-wide substance abuse treatment slightly lowers new conviction recidivism by 2.4%, but not total recidivism. Substance abuse treatment lowers new conviction and total recidivism in three out of eight institutions Newton Correctional Facility (NCF) and Iowa State Penitentiary (ISP) have the best overall performance. In eight out of 17 substance abuse interventions, substance abuse treatment lowers both new conviction and total recidivism. PSD and IFI at the Newton Correctional Facility stand out among the group. 12.1% of offenders with successful substance abuse treatment are convicted for new offenses within 12 months of release, and 26.6% return for either new offenses or technical violations. As shown in figure 3, the new conviction recidivism rate for offenders successfully completing treatment was 12.1% 12 months following release from prison. Among institutions, new conviction recidivism rates ranged from 5.1% (Iowa State Penitentiary) to 16.2% (Anamosa State Penitentiary). The total recidivism rate for this population was 26.6% departmentwide. Fort Dodge Correctional Facility had the highest total recidivism rate at 38.7% and Iowa State Penitentiary the lowest at 15.4%. New conviction recidivism rates for programs, as shown in figure 4, ranged from 3.4% (PSD at Newton Correctional Facility) and 21.1% (Violator s Program at ICIW). Total recidivism rates ranged from a low of 7.1% (STAR) to 41.7% (TC at Anamosa State Penitentiary). DOC Licensed Substance Abuse Programs Page 12 Recidivism Rates at 12 Months for Offenders Successfully Completing Substance Abuse Treatment - Department-wide and by Institution 45.0% 40.0% 38.7% 37.2% 35.0% 29.4% 30.0% 26.6% 25.0% 16.2% 15.0% 21.1% 19.7% 20.0% 19.2% 16.7% 15.4% 15.1% 13.5% 12.1% 11.6% 11.2% 11.5% 10.0% 5.9% 5.1% 5.0% 0.0% Departmentwide Anamosa State Penitentiary Clarinda Correctional Facility Fort Dodge Correctional Facility Iowa Correctional Institution for Women New Conviction Recidivism Iowa State Penitentiary Mount Pleasant Correctional Facility Newton Correctional Facility North Central Correctional Facility Total Recidivism Figure 3: New conviction and total recidivism rates of offenders successfully completing substance abuse treatment 12 months subsequent to release both department-wide and by institution. Data for figure provided in Table 2 and Appendix B. Recidivism Rates at 12 Months for Offenders Successfully Completing Substance Abuse Treatment by Program 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% New Conviction Recidivism W IN G S TC TO Vi ol W at @ or 's C Pr C TO F og Vi W r ol am @ at or C 's R C eg FL Pr ul og ar ra @ m -R C eg R C ul ar @ IC IW AR ST PC ec tT D EA Pr @ oj FM ec tT 3 E A @ JB SA U P @ M PC SA F T/ C rim in al ity oj Pr IF I Jo ur st er ne H y ei gh ts SA N P ew Fr on tie rs Lu AL TA 0.0% Total Recidivism Figure 4: New conviction and total recidivism rates of offenders successfully completing substance abuse treatment 12 months subsequent to release by program. Data for figure provided in Appendix C. DOC Licensed Substance Abuse Programs Page 13 Department-wide substance abuse treatment slightly lowers new conviction recidivism, but not total recidivism. needs and no treatment within prison. Within the prison system, new Although fewer offenders with conviction recidivism rates were 0.3% successful substance abuse program lower for offenders successfully completion were reconvicted completing substance Substance abuse for new offenses, more abuse treatment programs treatment returned to the correctional compared to offenders with reduces new system due to technical substance abuse needs conviction violations. Collectively, DOC s receiving no treatment in recidivism for substance abuse programs did prison. The difference in those with not demonstrate success for new conviction recidivism substance abuse either new convictions or total rates associates need by 2.4% recidivism rates or when Department-wide successful department-wide. compared to offenders substance abuse treatment released with no substance abuse with a 2.4% reduction in recidivism for needs. See Table 2 for additional new convictions12. However, the total information. recidivism rate for offenders successfully completing substance abuse treatment is 0.5% higher than those offenders with substance abuse Recidivism Rates by Comparison Group Did Not Recidivate Comparison Group No SA Need SA Need/No Prison Treatment SA Need/Successful Prison Treatment SA Need/Unsuccessful Prison Treatment SA Need/Prison Treatment - Other Total General Population Count % change = ((12.4%-12.1%)/12.4%) X 100 Total 184 % 78.2% 11.2% 10.7% 21.8% Count 1893 314 321 635 % 74.9% 12.4% 12.7% 25.1% Count 1095 180 216 396 % 73.4% 12.1% 14.5% 26.6% Count % Count % 95 22 24 46 67.4% 15.6% 17.0% 32.6% 63 9 11 20 75.9% 10.8% 13.3% 24.1% Count 3805 619 662 1281 % 74.8% 12.2% 13.0% 25.2% Table 2: Recidivism Rates by Comparison Group. 12 659 Recidivism Rates New Technical Convictions Violations 94 90 DOC Licensed Substance Abuse Programs Page 14 In three out of eight institutions, substance abuse treatment lowers new conviction and total recidivism. NCF and ISP were the only institutions to show success for both new conviction and total recidivism when compared to the substance abuse need/no prison treatment and no substance abuse need comparison groups. North Central Correctional Facility (NCCF) also reflected improvement relative to new conviction and total recidivism, but only when compared to the substance abuse need/no prison treatment group. offenders from the same institution with no substance abuse needs, see Figure 6. Iowa Correctional Institution for Women (ICIW), Anamosa State Penitentiary (ASP), and Mount Pleasant Correctional Facility (MPCF) had higher rates of new conviction recidivism for offenders successfully completing substance abuse treatment compared to offenders with no substance abuse need and those with substance abuse need/no treatment. The review of total recidivism rates Five of the eight institutions with reflected similar results. Five licensed substance abuse of eight institutions with programs had 0.5 to 7.9% Only NCF and ISP licensed substance abuse lower new conviction have lower new programs have lower total recidivism rates for offenders conviction and recidivism rates for offenders successfully completing total recidivism successfully completing substance abuse treatment rates among those successfully substance abuse treatment compared to offenders within completing compared to offenders from the same institution with treatment same institution with substance abuse needs, but regardless of substance abuse needs. no treatment within prison. comparison group NCF, NCCF, ISP, ICIW and As a result, within the NCF, evaluated. MPCF had total recidivism ISP, Fort Dodge Correctional rates ranging 1.2 to 12.4% Facility (FDCF), NCCF, and lower for offenders with Clarinda Correctional Facility successful substance abuse treatment (CCF), substance abuse treatment can than those with a substance abuse be associated with a 3.4 to 57.2% need and no treatment, as shown in reduction in new conviction recidivism Figure 7. Within the five institutions, depending on the institution. Figure 5 successful substance abuse treatment provides additional information. Three can be associated with a 5.4 to 42.6% of the five institutions (NCF, ISP, and reduction in total recidivism depending NCCF) also demonstrated lower on the institution. Additionally, ISP, recidivism rates for offenders NCF, and NCCF had lower total successfully completing substance recidivism rates than offenders from abuse treatment compared to DOC Licensed Substance Abuse Programs Page 15 abuse treatment compared to either offenders with no substance abuse need or those with a substance abuse need/no treatment. the same institution with no substance abuse needs, as shown in Figure 8. CCF, ASP, and FDCF had higher total recidivism rates for offenders successfully completing substance New Conviction Recidivism Rate - Difference Between Successful Treatment and Substance Abuse Need/No Treatment by Institution -10.0% -8.0% -6.0% -4.0% -2.0% 0.0% 2.0% 4.0% 6.0% Newton Correctional Facility Iowa State Penitentiary Fort Dodge Correctional Facility North Central Correctional Facility Clarinda Correctional Facility Iowa Correctional Institution for Women Anamosa State Penitentiary Mount Pleasant Correctional Facility Figure 5: Reflects the difference between new conviction recidivism rates for offenders successfully completing substance abuse treatment and offenders with substance abuse needs without prison treatment by institution. Negative values correspond to positive results. Figure based on data provided in Appendix B. DOC Licensed Substance Abuse Programs Page 16 New Conviction Recidivism Rate - Difference Between Successful Treatment and No Substance Abuse Need by Institution -10.0% -8.0% -6.0% -4.0% -2.0% 0.0% 2.0% 4.0% 6.0% 8.0% Newton Correctional Facility Iowa State Penitentiary Fort Dodge Correctional Facility Clarinda Correctional Facility Iowa Correctional Institution for Women North Central Correctional Facility Mount Pleasant Correctional Facility Anamosa State Penitentiary Figure 6: Reflects the difference between new conviction recidivism rates for offenders successfully completing substance abuse treatment and offenders with no substance abuse need by institution. Negative values correspond to positive results. Figure based on data provided in Appendix B. Total Recidivism Rate - Difference Between Successful Treatment and Substance Abuse Need/No Treatment by Institution -15.0% -10.0% -5.0% 0.0% 5.0% 10.0% 15.0% Newton Correctional Facility North Central Correctional Facility Iowa State Penitentiary Iowa Correctional Institution for Women Mount Pleasant Correctional Facility Clarinda Correctional Facility Anamosa State Penitentiary Fort Dodge Correctional Facility Figure 7: Reflects the difference between total recidivism rates for offenders successfully completing substance abuse treatment and offenders with substance abuse needs and no prison substance abuse treatment by institution. Negative values correspond to positive results. Figure based on data provided in Appendix B. DOC Licensed Substance Abuse Programs Page 17 Total Recidivism Rate - Difference Between Successful Treatment and No Substance Abuse Need by Institution -15.0% -10.0% -5.0% 0.0% 5.0% 10.0% 15.0% 20.0% Iowa State Penitentiary Newton Correctional Facility North Central Correctional Facility Iowa Correctional Institution for Women Fort Dodge Correctional Facility Mount Pleasant Correctional Facility Clarinda Correctional Facility Anamosa State Penitentiary Figure 8: Reflects the difference between total recidivism rates for offenders successfully completing substance abuse treatment and offenders with no substance abuse need by institution. Negative values correspond to positive results. Figure based on data provided in Appendix B. In eight out of 17 substance abuse interventions, treatment lowers both new conviction and total recidivism. Only eight of the 17 substance abuse interventions reduced both new conviction and total recidivism rates, which include: Þ PCD (NCF), Þ IFI (NCF), Þ Project TEA (ISP Þ Þ Þ Þ John Bennett Unit only), Luster Heights SAP (ASP Luster Heights), STAR (ICIW), SAT/Criminality (NCF Correctional Release Center), Journey (NCCF), and Þ TOW (CCF Lodge only).13 12 out of 17 substance abuse interventions had 1.1 to 14.0% lower new conviction recidivism rates for offenders successfully completing substance abuse treatment compared to offenders at the same location with a substance abuse need, but receiving no treatment as shown in Figure 9. Successful completion in substance 13 TOW and Project TEA were reviewed at more than one location accounting for 17 interventions compared to the 15 licensed programs previously noted. Project TEA at FM1 was excluded from the analysis for small population size only one offender was released during timeframe reviewed. DOC Licensed Substance Abuse Programs Page 18 substance abuse need, but no treatment as shown in Figure 10. Successful substance abuse treatment, within the ten interventions, was associated with an 8.4 to 50.5% decrease in total recidivism rates. Four programs stand out among the programs provided by DOC PCD and IFI at NCF, STAR at ICIW, and the Luster Heights Substance Abuse Program at ASP. abuse treatment was associated with a 1.1 to 80.2% reduction (depending on intervention) in new conviction recidivism. Three programs stand out PCD and IFI at NCF, and Project TEA at the John Bennett Unit within ISP. However, substance abuse interventions were slightly less successful with total recidivism. Ten out of 17 substance abuse interventions had 2.0 to 17.4% lower total recidivism rates for offenders successfully completing substance abuse programs compared to offenders at the same location with a ALTA at ASP, and WINGS and Violator s Program Regular at ICIW did not reduce either measure of recidivism. New Conviction Recidivism Rate - Difference Between Successful Treatment and Substance Abuse Need/No Treatment by Intervention -15.0% -10.0% -5.0% 0.0% 5.0% 10.0% 15.0% PCD IFI Project TEA @ JBU Luster Heights SAP STAR New Frontiers Violator's Program - Regular @ CRC SAT/Criminality Journey TOW @ CCF TC TOW @ CCFL Project TEA @ FM3 WINGS SAP @ MPCF ALTA Violator's Program-Regular @ ICIW Figure 9: Reflects the difference between new conviction recidivism rates for offenders successfully completing substance abuse treatment and offenders with substance abuse needs and no prison substance abuse treatment by intervention. Negative values correspond to positive results. Figure based on data provided in Appendix C. DOC Licensed Substance Abuse Programs Page 19 Total Recidivism Rate - Difference Between Successful Treatment and Substance Abuse Need/No Treatment by Intervention -20.0% -15.0% -10.0% -5.0% 0.0% 5.0% 10.0% 15.0% 20.0% IFI STAR PCD Luster Heights SAP Project TEA @ FM3 SAT/Criminality Project TEA @ JBU Journey SAP @ MPCF TOW @ CCFL WINGS Violator's Program - Regular @ CRC TOW @ CCF ALTA New Frontiers TC Violator's Program-Regular @ ICIW Figure 10: Reflects the difference between total recidivism rates for offenders successfully completing substance abuse treatment and offenders with substance abuse needs and no prison substance abuse treatment by intervention. Negative values correspond to positive results. Figure based on data provided in Appendix C. DOC Licensed Substance Abuse Programs Page 20 What are the consequences of the programs results? There are a number of consequences associated with recidivism reductions, such as: Þ Reductions in the incarcerated offender population or at least a reduction in the projected growth which is stressing the existing prison infrastructure; Þ Cost savings associated with keeping offenders out of the prison system and/or correctional system; and Þ Societal benefits from reduced crime. Key findings: Þ The substance abuse programs overall did very little to curb the growing prison population during the14-month review period. Þ Cost savings is not produced Department-wide, but institutions like NCF highlight potential with over $134,000 in saved operational costs one year following offender release. Þ Across the department, substance abuse treatment prevented less than five new offenses from occurring during the 14 month review period. Overall, substance abuse programs did not curb the growing prison population. The offender population in prison is expected to increase by over 31% in the next ten years, causing inmate capacity to be exceeded by 72% for females and 52% for males (Stageberg 3). Readmissions to prison are one of the factors influencing prison growth. The 2,086 readmissions occurred in state fiscal year 2006 and are expected to increase 20.8% over the next ten years (Stageberg 9). The readmission growth makes treatment interventions a key area of focus not only for recidivism, but as a strategy to help curb the prison inmate population growth. Unfortunately, because the total recidivism rate was not lowered through DOC s substance abuse programs (SA need/no treatment total recidivism rate was 25.1% compared to 26.6% for those successfully completing treatment see table 2) prison population growth should continue to grow at the same rate projected. Cost savings was not produced Department-wide, but institutions highlight potential savings. It costs $23,367 annually to house an offender in prison, and preventing one offender from returning to prison from parole or work release saves roughly $5,400 in incarceration costs (DOC Quick Facts 1; Prell Population Growth 13).14 Although there was cost savings of over $8 million associated with offenders released during the timeframe reviewed who 14 Annual costs estimated by taking the average daily cost and multiplying it by 365. DOC Licensed Substance Abuse Programs Page 21 received treatment, cost savings were not greater than what would have been achieved if results were the same as the substance abuse need/no prison treatment group. Additional information is provided in table 3. However, ISP and NCF, where the best performance related to total recidivism was achieved, reflected cost savings from offenders released to community supervision of roughly $12,800 and $134,600. Total cost savings are likely to be much higher, since savings only reflect DOC operational costs not the costs associated with the criminal justice system or other societal costs associated with crime. Return on investment could not be calculated, since recidivism rates were based on a 14 month release period. To calculate return on investments, recidivism rates would need to be established for the treatment period, since offenders could be released at different times. Cost Savings Comparisons Release to Community Supervision 1,334 Released from Correctional System 157 Annual Cost Reduction Per Offender Remaining Out of Prison $5,400 $23,367 % of Treatment Group Remaining Out of Prison @ 12 months Cost Savings 72.8% 79.0% $5,243,400 $2,897,545 72.3% 82.0% $5,211,610 $3,008,306 $8,219,916 $31,790 ($110,761) ($78,971) Total Released - Treatment Group % of SA Need/No Treatment Group Remaining Out of Prison @ 12 months Cost Savings using SA Need/ No Treatment Group Percentages Difference Total 1,491 $8,140,945 Table 3: Cost savings comparisons using release totals from the substance abuse need/successful treatment group. Compared savings associated with non-recidivism rates of the treatment group with those that would have been achieved if the rates were the same as those of the substance abuse need/no treatment group. Savings for offenders remaining out of prison for less than one year was not calculated. Cost savings were calculated by multiplying total released by % remaining out of prison and by the annual cost reduction per offender. DOC Licensed Substance Abuse Programs Page 22 Across the department, substance abuse treatment prevented less than five new offenses from occurring during 14 month review period. Substance abuse treatment lowers new conviction recidivism rates which benefits society. However, the benefit was relatively small. Recidivism rates were 0.3% lower among offenders receiving prison substance abuse treatment compared to those with a substance abuse need and no prison treatment. This amounts to slightly less than five new offenses. However, because of differing performance levels among institutions some prevent more new offenses. At NCF (where the best performance related to new conviction recidivism was achieved), 13 new offenses were prevented. If reconvicted, offenders completing substance abuse treatment had fewer property crimes as a percentage of total new offenses compared to those with substance abuse needs/no treatment. However, other crime types, including drug, were higher. Data was not available to make a comparison between initial convicting crime and new offenses committed which may reflect a greater societal benefit if treatment lowers the severity of the crimes committed. New Offense Comparison Convicting Crime Type Drug Other Property Public Order Violent Total Count % Count % Count % Count % Count % Count SA Need/Successful Prison Treatment 33 18.3% 4 2.2% 41 22.8% 71 39.4% 31 17.2% 180 SA Need/No Prison Treatment 55 17.5% 4 1.3% 80 25.5% 124 39.5% 51 16.2% 314 % 100.0% 100.0% Table 4: Comparison between treatment group and comparison group (substance abuse need/no treatment) for those committing new offenses within 12 months of release. Percentages are expressed as a percentage within the convicting crime type for all new offenses committed. DOC Licensed Substance Abuse Programs Page 23 What issues significantly influence program results? Evaluating program effectiveness using outcomes is complicated. When changes to outcomes occur, programs are often unable to explain why. The cumulative effect of numerous events or situations influence results (in this case recidivism results) make it challenging to understand what is truly causing observed changes. Many times, changes simply cannot be attributed or attached to one particular cause, or the program s contribution is relatively small in comparison to other factors and makes it difficult to see how operational or strategic changes are impacting results, see figure 11. Key findings: Þ Both new conviction and total recidivism rates were higher among offenders with mental Þ Þ Þ Þ Þ Þ Þ Þ Þ Þ health diagnosis highlighting the challenge to effectively treat individuals with multiple needs. Treatment should be made as close to an offender s release date, so new skills are retained before offenders face high risk situations questionable data made this variable difficult to evaluate. Offenders with higher risks had higher recidivism rates. Additional support in the community whether it is through supervision or continuing substance abuse treatment lowers new conviction recidivism. Older offenders were less likely to be reconvicted for new offenses, and incur technical violations. African Americans had higher new and total recidivism rates than Caucasians and other minority groups highlighting socioeconomic conditions/issues within communities African American offenders come from and return to. DOC has yet to fully identify where evidence-based practices are being successfully implemented. DOC does not consistently measure addiction severity, and responsivity factors reducing confidence that treatment approaches are best suited for individual offender characteristics. 22.8% of offenders treated by the substance abuse program were classified in low to low/moderate risk category whereas over 1,800 offenders with substance abuse needs and classified with moderate to high risks, and received no treatment while in prison. 500 of the higher risk individuals were released due to the end of their sentence leaving no other opportunity to provide treatment while in the correctional system. Consistent system-level measures are needed to enhance DOC s ability to manage for results, and enable program comparisons. More frequent recognition of quality work and ensuring adequate resources are available could enhance employee engagement. DOC Licensed Substance Abuse Programs Page 24 Factors Affecting New Conviction Recidivism Among Offenders Released with Substance Abuse Need 14.0% 12.0% 12.0% 10.0% 8.8% 9.1% 9.0% 8.0% 7.0% 7.4% 7.9% 5.6% 6.0% 4.7% 3.9% 4.0% 2.0% 0.3% 0.2% 0.0% No Substance Abuse Treatment Mental Health Diagnosis High Risk Classification No Community Supervision Under 40 Years in Age African American New Conviction Recidivism Difference (Recidivism Rate of Group with Characteristic - Recidivism Rate of Group w/o Characteristic) Group Difference (% of New Offense Group with Characteristic - % of Stay Out of Prison Group with Characteristic) Figure 11: Factors affecting new conviction recidivism among offenders released with substance abuse need. The first series (dark blue) reflects the difference in new conviction recidivism rates (e.g. The new conviction recidivism rate for the group of offenders with a mental health diagnosis is 3.9% higher than offenders without a mental health diagnosis). The second reflects population differences in the percent of offenders exhibiting the characteristic between offenders reconvicted for new offenses and offenders who have not returned to prison (e.g. The group of offenders returned to prison for new convictions had 8.8% more individuals with mental health diagnoses than the group of offenders who remained out of prison). Group differences by program are reflected in Appendix D. Both new conviction and total recidivism were higher among offenders with mental health diagnosis. DOC institutions and the Division of Behavioral Health and Professional Licensure at the Iowa Department of Public Health identified offenders with dual-diagnosis (i.e. substance abuse need and mental health diagnosis) as a key issue faced by substance abuse programs (Hebron and LeBarge; Durskey, et al.; Bagby; Austin and Kelly). They were concerned about the substance abuse curriculums abilities to help those with both a substance abuse and mental health need. This population is challenging because of the multiple issues they face. As such, it was expected that offenders with mental health diagnosis will be more likely to recidivate, and as offenders with dual-diagnoses increase as a percentage of population served by the substance abuse programs the new conviction and total recidivism rates would also increase. DOC Licensed Substance Abuse Programs Page 25 Department-wide, new conviction recidivism was 3.8% and total recidivism 7.4% higher among those successfully completing substance abuse treatment who have also been diagnosed with a mental health condition (other than substance abuse) compared to those who have not, see figure 12. When controlling the population for mental health diagnosis, new conviction recidivism among those receiving substance abuse treatment was 0.2% lower than offenders with substance abuse need and no treatment when neither population had offenders with mental health diagnosis. Generally, offenders with both substance abuse need and a mental health diagnosis had higher recidivism rates over those who just had substance abuse needs at all institutions. Offenders receiving substance abuse treatment at ASP and NCF were exceptions where offenders who had mental health diagnosis also had lower new conviction recidivism rates. Those offenders at NCF also had a lower total recidivism rate. See Appendix E for additional information. Recidivism Rates by Comparison Group and Mental Health Diagnosis SA Need/Successful Prison Treatment SA Need/No Prison Treatment 35.0% 31.9% 29.6% 30.0% 25.0% 23.5% 22.2% 20.0% 14.7% 14.7% 15.0% 10.9% 10.7% 10.0% 5.0% 0.0% No Yes No Yes Mental Health Diagnosis New Conviction Recidivism Total Recidivism Figure 12: Department-wide recidivism rates by Comparison Group and Mental Health Diagnosis. Mental health diagnosis does not include those with only a substance abuse disorder. Data supporting figure provided in Appendix E. DOC Licensed Substance Abuse Programs Page 26 The amount of time between the conclusion of treatment and release may influence recidivism, but data reliability made this difficult to evaluate. DOC attempts to time treatment with an offender s target release date to help improve offender outcomes following release. The length of time between when an offender receives substance abuse treatment and when they are released from prison is believed to effect recidivism. The longer the length of time; the harder it becomes to retain the skills acquired during treatment. This lessens the offender s ability to apply the new skills in the community environment where they encounter high risk situations that could lead to substance abuse relapse and criminal behavior. However, the reliability of treatment end date was questionable impairing the audit s ability to examine its relationship to recidivism. Two issues indicated questionable treatment end date data: Þ A small percentage of offenders had treatment end dates that were more recent than their release date; and Þ The Violator Programs at both CRC and ICIW reflected more than 80% of their treatment population completing treatment more than a year prior to release. The offenders in the violator programs are released once they have successfully completed treatment, therefore these programs should have a very small percentage if any in prison so long after treatment. High risk offenders had higher recidivism rates. Dynamic risk factors, including in Iowa was significantly related to criminogenic needs, serve as predictor predicting future criminal activity (30). of adult offender recidivism15. As Offenders with higher risks are more noted by Gendreu et al., likely to recidivate than those at LSI-R, the instrument used lower risk levels, and populations New conviction by DOC, produces with higher percentage of recidivism rates correlations with offenders within the high risk are 17.3% higher recidivism 62 75% of category is believed to have for offenders time, and is better than higher recidivism rates. Figures classified high risk compared to other actuarial measures 13 and 14, show the recidivism offenders in low available (590). rates progressively increase as risk category. Lowenkamp and Betchel the risk level of the offender also noted that LSI-R use population increases. Department-wide new convictions recidivism rates ranged from 3.1% of 15 Dynamic risk factors include: antisocial those within the low risk category to personality, attitudes and behavior, interpersonal 20.4% of those in the high risk conflict, personal distress, social achievement, and recent drug/alcohol abuse. DOC Licensed Substance Abuse Programs Page 27 offenders in the low/moderate risk category. For total recidivism, successful substance abuse treatment only demonstrated lower recidivism rates in the low and low/moderate risk categories. category among offenders successfully completing substance abuse treatment. Total recidivism ranged from 6.3% to 39.8%. With new convictions, substance abuse treatment had the greatest benefit to New Conviction Recidivism Rates by Comparison Group and LSI-R Category 25.0% 20.9% 20.4% 20.0% 16.5% 15.9% 15.0% 10.7% 11.1% 10.0% 7.9% 6.2% 5.0% 3.6% 3.1% 0.0% Low . Low/Moderate Moderate SA Need/No Prison Treatment Moderate/High High SA Need/Successful Treatment Figure 13: New conviction recidivism rates by comparison group and LSI-R category. LSI-R data was not available for all offenders, however the results presented in this figure were found to be statistically significant. Data supporting figure provided in Appendix F. DOC Licensed Substance Abuse Programs Page 28 Total Recidivism Rates by Comparison Group and LSI-R Category 45.0% 39.8% 40.0% 34.7% 35.0% 35.1% 32.4% 30.0% 26.5% 24.0% 25.0% 20.0% 15.0% 15.8% 15.2% 14.3% 10.0% 6.3% 5.0% 0.0% Low Low/Moderate Moderate SA Need/No Prison Treatment Moderate/High High SA Need/Successful Treatment Figure 14: Total recidivism rates by comparison group and LSI-R Category. LSI-R data was not available for all offenders, however the results presented in this figure were found to be statistically significant. Data supporting figure provided in Appendix F. Support within the community lowered new conviction recidivism; only 14.2% of offenders released to community supervision receive additional programming to continue their treatment. Stakeholders Survey). Studies have Offenders face situations once also demonstrated that individuals released into the community that may participating in both in-prison result in relapse. These Offenders and post-release treatment in situations are often relevant receiving the community have better at re-entry making them more community drug use and recidivism difficult to address in prisonsupervision had outcomes, than in-prison based treatment. The new conviction treatment alone (Klebe and National Institute on Drug recidivism rates Keefe 30; Inciardi et al., Abuse has framed continuity 6.9 to 10% lower Martin and Butzin 102; of care as a principle of drug than offenders Wexler et al. 163). abuse treatment, and receiving no suggests that treatment in community Transitional services following prison can initiate the supervision. prison-based treatment are process of therapeutic critical, and treatment effect can be change (4). Many stakeholders greatly reduced or lost unless followed agree, noting that there is a need for by continuous aftercare in the additional and expanded aftercare in community (Simpson 110; Huebner the community (Performance Audit DOC Licensed Substance Abuse Programs 25). Pelissier et al. conclude that first two months after release are crucial, noting that the first priority of probation officers and treatment providers may need to be on identifying how to avoid the high-risk situations for drug use and on finding alternative coping mechanisms to resist the temptation to use drugs (332). The Iowa Department of Public Health staff agreed that the transition to the community is full of challenges and changes requiring comprehensive discharge planning (Austin and Kelly). However, community treatment providers do not always have comprehensive knowledge on treatment provided during incarceration (Performance Audit Stakeholders Survey). Impaired communication between prison and the community could limit community aftercare s effectiveness when available. Page 29 New conviction recidivism rates among offenders receiving community supervision were 6.9 to 10% lower than offenders receiving no community supervision. The difference was larger among offenders who received substance abuse treatment, as shown in figure 15. Offenders who received substance abuse programming in the community also had lower new conviction recidivism rates than offenders who received prison treatment alone, except for inpatient/residential treatment, see figure 16. Total recidivism did not exhibit this pattern. Overall, only 14.2% of offenders released to community supervision were enrolled in programming to continue their treatment (i.e., case management, continuing care, and education). New Conviction Recidivism by Comparison Group and Community Supervision 25.0% SA Need/Successful Prison Treatment SA Need/No Prison Treatment 21.0% 20.0% 17.5% 15.0% 11.0% 10.6% 10.0% 5.0% 0.0% Community Supervison No Community Supervision Community Supervison No Community Supervision Figure 15: New conviction recidivism by comparison group and community supervision. Final discharge release codes were used to identify offenders without community supervision. Data supporting figure provided in Appendix G. DOC Licensed Substance Abuse Programs Page 30 Recidivism Rates for Offenders Successfully Completing Prison Treatment Grouped by Additional Substance Abuse Programming Received in the Community 40.0% 34.8% 35.0% 33.3% 29.4% 30.0% 27.1% 25.0% 20.0% 20.0% 16.4% 15.0% 11.7% 10.0% 11.8% 11.1% 9.1% 8.3% 4.1% 5.0% 0.0% None Case Management Continuing Care New Conviction Recidivism Education Outpatient Treatment Inpatient/Residential Treatment Total Recidivism Figure 16: Recidivism rates for offenders successfully completing prison treatment grouped by additional substance abuse treatment received in the community. Data was only available for those offenders released to community supervision. Case management, continuing care and education are perceived to be the interventions most likely associated with continuity of care. The results were not statistically significant to suggest a similar finding for entire release population. Data supporting figure provided in Appendix G. Older offenders were less likely to be reconvicted for new offenses, and incur technical violations. Uggen and Massogila found a tight linkage between an individual s involvement in crime and adult status, whether measured by behavioral markers (such as marriage, parenthood, full-time employment and school completion) or respondents own sense of themselves as adults (32). This suggests that deviant behavior and crime are inconsistent with adult roles, and are held incompatible when one views themselves as an adult. As such, larger percentages of older offenders may perceive themselves as being adults making them less likely to recidivate. The data analyzed reflected a steady decline for both new conviction and total and new conviction recidivism rates for older offender populations. This pattern was consistent for treatment and substance abuse need/no treatment comparison groups, as reflected in figures 17 and 18. The high new conviction recidivism rate within the successful treatment group in the Under 20 age group was likely attributable to a small number of offenders in this category. DOC Licensed Substance Abuse Programs Page 31 New Conviction Recidivism by Comparison Group & Age Category 45.0% 42.9% 40.0% 35.0% 30.0% 25.0% 20.0% 15.6% 14.8% 14.2% 15.0% 13.1% 12.2% 9.7% 10.0% 9.2% 5.0% 3.5% 1.5% 0.0% Under 20 20 - 29 30 - 39 40 - 49 SA Need/No Prison Treatment 50 & Over SA Need/Successful Treatment Figure 17: New conviction recidivism rates by comparison group and age category. The population within the Under 20 age category for those successfully completing treatment was very small only included seven offenders. Data supporting figure provided in Appendix H. Total Recidivism Rates by Comparision Group & Age Category 45.0% 42.9% 40.0% 35.0% 31.8% 29.3% 30.0% 26.9% 26.7% 25.1% 25.0% 20.7% 20.0% 19.9% 16.2% 15.0% 10.0% 4.6% 5.0% 0.0% Under 20 20 - 29 SA Need/No Prison Treatment 30 - 39 40 - 49 50 & Over SA Need/Successful Treatment Figure 18: Total recidivism rates by comparison group and age category. The population within the Under 20 age category for those successfully completing treatment was very small only included seven offenders. Data supporting figure provided in Appendix H. DOC Licensed Substance Abuse Programs Page 32 African Americans had higher new and total recidivism rates than Caucasians and other minority groups. return to disadvantaged and segregated urban communities that are: Recidivism studies have found certain minority groups (e.g., African Americans and Hispanics) to have higher rates of re-arrest. Findings from this audit are similar. African Americans had new conviction recidivism rates 4.7 to 4.8% than Caucasians, see figure 19. Total recidivism rates are 11.1 to 14.4% higher, as shown in figure 20. Reasons for higher recidivism rates among African-Americans represent a complex social phenomenon, and are likely similar to factors contributing to disparities in our state s prison population. According to the Governor s Task Force on Overrepresentation of AfricanAmericans in Prison, the vast majority of African-American inmates in Iowa Þ often plagued by crime; Þ have inadequate employment opportunities; and Þ have shrinking community resources and support to address poverty and unemployment, and provide safe housing, reliable transportation and adequate childcare. These offenders also often struggle with weakened family structures, low academic achievement, and have limited access to substance abuse and mental health treatment (12, 13, and 18). New Conviction Recidivism Rates by Comparison Group and Race/Ethnicity 18.0% 16.0% 15.9% 16.0% 15.3% 14.0% 12.0% 11.2% 11.2% 10.0% 8.8% 8.0% 6.0% 4.0% 2.0% 0.0% African American Other Minority Groups SA Need/No Prison Treatment Caucasian SA Need/Successful Prison Treatment Figure 19: New conviction recidivism rates by comparison group and race/ethnicity. Other minority groups include American Indian/Alaska Native, Asian/Pacific Islander, Hispanic, and unknown. Individually, they represented such a small percentage of the total population reviewed. Data supporting figure provided in Appendix I. DOC Licensed Substance Abuse Programs Page 33 Total Recidivism Rates by Comparison Group and Race/Ethnicity 40.0% 35.0% 37.9% 34.3% 29.0% 30.0% 25.0% 25.0% 22.2% 23.5% 20.0% 15.0% 10.0% 5.0% 0.0% African American Other Minority Groups SA Need/No Prison Treatment Caucasian SA Need/Successful Prison Treatment Figure 20: Total recidivism rates by comparison group and race/ethnicity. Other minority groups include American Indian/Alaska Native, Asian/Pacific Islander, Hispanic, and unknown. Individually, they represented such a small percentage of the total population reviewed. Data supporting figure provided in Appendix I. While evidence-based practices may improve effectiveness, their use within substance abuse programs had not been fully evaluated. Although, research has shown that substance abuse programs can be successful, it is important to recognize that success varies depending on the treatment approach utilized. NIDA recognizes that not all drug abuse treatment is equally effective ( Drug Abuse Treatment 8). The general assumption that any treatment works should be avoided. This assumption over-simplifies a complex recovery process often requiring sustained and repeated treatment episodes (White 23). Results from Mitchell, Wilson and MacKenzie s meta-analysis also demonstrated varying degrees of treatment effectiveness depending on the type of treatment provided (17). Palmer highlights more effective approaches at reducing recidivism, as those with the strongest positive results (e.g., the largest effect sizes or recidivism reduction). Approaches include: behavioral, cognitive behavioral or cognitive, life skills or skills oriented, multimodal, and family intervention (147 148). Interventions with the lowest percentage of successful outcomes include: diversion, group counseling or therapy, and individual counseling or therapy which often reflected mixed results toward recidivism reduction; and confrontation had the weakest (in DOC Licensed Substance Abuse Programs Page 34 fact, the most negative) (Palmer, 135, 146).16 As mentioned previously, DOC intends to reduce adult offender recidivism through evidence-based programming Strategic Plan 5; Performance Plan 1; SelfAssessment 15, 19, 38). Figure 21 outlines the principles embodied in DOC s efforts. They also intend to replicate and expand practices that prove to be the most effective through the redirection of resources (Bucklew, Prell Substance Abuse 19). Evidence-Based Principles for Effective Interventions 1. 2. 3. 4. 5. 6. 7. 8. Figure 21: Evidence-Based Principles for Effective Interventions developed by the National Institute of Corrections and Crime & Justice Institute. The principles are intended to help building learning organizations that reduce recidivism through systemic integration of evidence-based principles in collaboration with community and justice partners. DOC has partially evaluated the conformance to evidence-based principles (EBP) in the substance abuse programs. In 2002, five programs were assessed using the Correctional Program Assessment Inventory (CPAI). This assessment was developed by Paul Gendreau and Don Andrews in 1992. It is used to help ascertain how closely a program meets known principles of effective correctional treatment (DOC CPAI ). However, because of time and resources to conduct such assessments, DOC has moved towards a self-assessment survey approach which is scored by a team of evaluators previously trained in the CPAI process. Once completed, DOC believes the scored survey will provide a baseline for the status of EBP 16 Assess Actuarial Risk/Needs; Enhance Intrinsic Motivation; Target Intervention: Risk, Need, Responsivity, Dosage and Treatment; Skill Train with Directed Practice; Increase Positive Reinforcement; Engage Ongoing Support in Natural Communities; Measure Relevant Processes/Practices; and Provide Measurement Feedback. The results were from an aggregate review of 9 meta-analysis and 23 literature reviews (between 1975 and 1996). interventions across Iowa s correctional system (Bucklew). The effort to conduct the survey is currently underway. DOC intends to compare the findings from the EBP survey to those from this audit. The challenge comes in identifying the treatment approach that is most effective. Substance abuse programs often comprise multiple treatment approaches (modalities) making it challenging to understand which had the greatest impact on post-treatment drug use and recidivism. Harrison identifies the research needs to examine the effectiveness of various treatment modalities, including the mix of elements found in TCs and other residential and outpatient treatment programs. She continues by highlighting the need to examine other intervening variables (such as individual involvement in treatment, ethnicity, age, social support, employment, and psychological status) DOC Licensed Substance Abuse Programs that play a role and may predict treatment efficacy (478-479). The Iowa Practice Improvement Collaborative also note that although Page 35 the term evidence-based practice is commonly used, there is still no consensus on what exactly constitutes an evidence-based practice (4). DOC assesses offender risk and needs at institutions, but does not consistently measure addiction severity, and responsivity factors. an inside job that is it happens DOC utilizes LSI-R (Level of Service within the offender. Responsivity Inventory) as the main tool for factors include offender characteristics assessing actuarial risk/needs of such as: motivation, personality offenders. When properly characteristics, cognitive and administered, such assessments help intellectual deficits, and demographic identify the level of supervision and variables which may or may not be types of treatment required by criminogenic needs, but can impact offenders. However, Durrant states treatment choices (Bonta that the LSI-R assessments Offenders Offender Assessment 17; are completed at offenders cognitive and Kennedy 20). Offenders assigned institution not verbal skills may cognitive and verbal skills may reception, this limits impair their ability impair their ability to grasp potential treatment to grasp complex complex ideas, and limit the matches to those within the ideas, and limit the effectiveness of effectiveness of some cognitiveinstitution assigned (2). some cognitivebased programs. Additionally, based programs. responsivity factors are not Institutions expressed the always criminogenic need, but need for a consistent statethat does not diminish their wide assessment tool that importance: complements the LSI-R. LSI-R identifies a substance abuse need but Levels of anxiety are poor predictors does not indicate the level of addiction of recidivism and decreases in anxiety severity, or prevalence of mental are not associated with reductions in health issues (Howard and Phillips, recidivism. Yet, the anxiety levels of Nelson, and Bagby). Assessments to offenders could impact on the choice determine the required level of of treatment. For example, an anger management program may work well substance abuse treatment were in a group format consisting of previously conducted during reception, relatively non anxious individuals. For but due to budget reductions the clients who are extremely anxious in service is no longer provided (Durrant social situations however, the 2). program would be more effective if The LSI-R is also limited in assessing offender responsivity (DOC, CPAI ). Responsivity is critical because substance abuse treatment is mainly delivered on an individual basis (Bonta, 17). Such factors could have significant implications regarding the DOC Licensed Substance Abuse Programs effectiveness of the program, regardless of a program s therapeutic integrity or competency of its staff. Kennedy concludes, the need for a systematic and comprehensive assessment of responsivity and its related constructs (i.e., motivation and treatment readiness) is essential for the successful planning, implementation and delivery of appropriate and effective treatment programs (21). A similar argument could be made for why systematic and comprehensive assessments of addiction severity and mental health conditions are essential. Consistent approaches for offender responsivity assessments are not evident from reviewing DOC policy and procedure manuals. Some programs make use of psychological/social assessment questionnaires (DOC ICIW - Treatment 4; ICIW Violator Program 3; TOW 1). Newton notes the use of Client Management Page 36 Classification (CMC) and Jesness for their violator program ( NCF Violator Program 3). Most other programs, if noted at all discuss making use of various assessments when available; or rely on classification notes, presentence investigations, and other less structured approaches (DOC ASP 17; NCF - PSD 3; MPCF 3). Addiction severity assessments and instruments used reflected little consistency among substance abuse programs. FDCF noted utilizing Substance Abuse Subtle Screening Inventory (SASSI), and Adult Substance Use Survey (ASUS) (DOC New Frontiers 24). NCCF also notes the use of SASSI (DOC NCCF 4). Other institutions policies make no reference to any instruments, refer to an evaluation conducted by MECCA, or just reference the data collected during the intake process at Iowa Medical and Classification Center (IMCC). 22.8% of offenders treated had low to low/moderate risks, while over 1,800 moderate to high risk offenders with substance abuse needs received no treatment. According to the National Institute of Corrections and Crime and Justice Institute, the risk principle calls for programs to prioritize supervision and treatment resources for higher risk offenders (3). Their premise is that prioritizing the higher risk offenders places emphasis on harm-reduction and public safety, since higher risk offenders have a greater need for prosocial skills and thinking development and are more likely to commit new offenses (4). Bonta concurs stating that research evidence suggests that it is the higher risk client that can benefit from treatment more so than the lower risk offender ( Offender Assessment 16). 22.8% of the offenders (321 offenders) released with substance abuse treatment had low to low/moderate risk levels with Newton Correctional Facility having 50% of the offenders treated in the two lower risk categories, and Anamosa State Penitentiary the least at 13.9% - see table 5. During the DOC Licensed Substance Abuse Programs Page 37 specific admission/selection criteria related to risk level for entrance into the program LSI-R scores 25 and above for sentences 5 years and up is a specific admission criterion for STAR and WINGS (DOC ICIW - Treatment 3). NCF does as well for the violator program, will accept males who scored within the range of 24 to 40 (DOC NCF Violators Program 1). FDCF, ASP and MPCF note referring to LSI-R or LSI scores, but do not indicate how an offenders risk level will impact admission into the program (DOC ASP 11-12; DOC MPCF 3; DOC New Frontiers 15). same timeframe, 994 moderate risk offenders, 641 moderate/high risk offenders, and 211 high risk offenders in need of substance abuse treatment did not receive any prior to their release from prison. Of the higher risk offenders receiving no prison substance abuse treatment, 483 were released due to the end of their prison sentence offering no additional opportunity for treatment. Risk-based admissions/selection criteria were not prevalent in substance abuse treatment policy and procedure documents. ICIW has Percentage of Offenders Receiving Substance Abuse Treatment in Risk Categories by Institution LSI-R Score Category Institution Low Anamosa State Penitentiary Count Clarinda Correctional Facility Count Fort Dodge Correctional Facility Count Iowa Correctional Institution for Women Count Iowa State Penitentiary % % % % Count % Mount Pleasant Correctional Facility Count Newton Correctional Facility Count North Central Correctional Facility Count Total % % % Count % Low/Mod Moderate Total Mod/High High Low 0 19 77 31 10 137 .0% 13.9% 56.2% 22.6% 7.3% 100.0% 1 47 160 97 39 344 .3% 13.7% 46.5% 28.2% 11.3% 100.0% 1 29 115 63 17 225 .4% 12.9% 51.1% 28.0% 7.6% 100.0% 6 57 69 36 14 182 3.3% 31.3% 37.9% 19.8% 7.7% 100.0% 2 6 24 5 1 38 5.3% 15.8% 63.2% 13.2% 2.6% 100.0% 3 47 121 73 19 263 1.1% 17.9% 46.0% 27.8% 7.2% 100.0% 19 77 61 34 1 192 9.9% 40.1% 31.8% 17.7% .5% 100.0% 0 7 10 7 2 26 .0% 26.9% 38.5% 26.9% 7.7% 100.0% 32 289 637 346 103 1407 2.3% 20.5% 45.3% 24.6% 7.3% 100.0% Table 5: Table highlights the number and percentage of offenders receiving substance abuse treatment within each risk category by institution for those released between October 1, 2004 and December 31, 2005. DOC Licensed Substance Abuse Programs Page 38 System-level measures are either inconsistent or do not exist across programs limiting performance management capabilities new data systems may offer solutions. periodically (monthly, quarterly or at Licensure standards for substance the end of the treatment session). abuse treatment programs in Programs tend to look for patterns in correctional facilities provide the responses given for issues to address framework for establishing consistent and improvements to make. The data system-level measures. 641 Iowa is not compiled in such a way to see Administrative Code Paragraph changes over time, nor is there a 156.3(13) requires programs to consistent approach used across document the quality of inmate care programs minimizing the data s and use that information to usefulness for program detect trends and patterns The data is not compiled in such a comparisons. of performance. Iowa way to see Department of Public changes over time, FDCF, ASP, and NCCF Health staff said this nor is there a discussed the use of pre and requirement was initiated consistent post tests as ways to assess or three years ago, and approach used measure learning that takes progress has been made. across programs place as a result of the program However, it is left to the minimizing the (Dick and Comp; Hebron and individual programs to data s usefulness LaBarge; Johnson). Tests used define the criteria they will for program are usually associated with the look at (Austin and Kelly). comparisons. program s curriculum, and The effort is a step in the results are often kept in right direction, but when the offender files. No indication was criteria are developed independently it provided that the information is hinders the ability for DOC to use the aggregated to assess the programs information collected for program performance relative to offender comparison purposes. learning over time. One institution did not believe the test they use to be the Many of the programs attempt to learn greatest, but did not have another from offenders completing treatment alternative available. NCF conducts about the quality of their programs pre and post tests using the criminal through a survey or interview sentiment scale, which measures conducted when offenders exit the changes in antisocial attitudes (Dursky program. The survey or interview et al.).17 This was the only approach results serve as a gauge for offender satisfaction and a mechanism to learn what is working and what is not 17 The Criminal Sentiment Scale instrument (Howard and Phillips; Dick and Comp; measures antisocial attitudes to determine Nelson; Johnson; Dursky et al.; Bagby; offender tolerance for the law and identification Lawson et al.). The information with criminal activities, and reflects tendencies collected in this way is reviewed to have antisocial attitudes. DOC Licensed Substance Abuse Programs Page 39 does not have good response rates, identified that attempts to and ISP reviews ICON for behavior quantitatively measure behavioral issues recorded by parole officers and changes. However, the data produced urinalysis results (Johnson; Lawson et by the criminal sentiment scale test al.). was not mentioned when discussing performance data periodically DOC has begun to pilot test the Iowa reviewed for management purposes Service Management and Reporting suggesting it may be collected at the Tool (I-SMART) in two institutions which individual level, but not aggregated to promises to help with various research assess program performance. ISP and issues/questions, and will place all ICIW noted that behavior change is not individual record data in a database specifically measured but is captured enabling the aggregation of data through discussions between the (Lawson et al). According to the offender and counselor. The information is likely promises to help Iowa Department of Public Health, a key goal for I-SMART kept in progress notes and with various is to advance the not used for measuring research standardization and quality of program effectiveness issues/questions, and will place all treatment data to provide the (Lawson et al; Bagby). individual data in a best available treatment database enabling information for managing and Institutions also discussed the aggregation of monitoring system outcomes following-up on offenders data. I-SMART ). It will allow once they exit treatment providers using the system to programs. However, what capture data related to intake, they check and when they check treatment services, discharge, and varies. FDCF said an 18 month follow-up tracking. However, another recidivism check is conducted by chief benefit is that it will enable the counselors (Dick and Comp). MPCF sharing of treatment information within conducts follow-ups at 30, 60, and 90 the constraints of individual privacy days, six months and one year regulations, which is critical according following treatment completion to to stakeholders to enhance community check on arrests, parole violations and aftercare. Additionally, DOC s ICON convictions (Nelson). ASP said that system promises to offer a standard recidivism data is collected every six approach for gathering recidivism months on the TC for grant reporting data, as reflected in this performance purposes, but was not collected for audit, which will be beneficial for ALTA and LH SAT (Hebron and conducting future outcome LeBarge). NCCF sends mailings to evaluations. offenders one year after treatment, but DOC Licensed Substance Abuse Programs Page 40 More frequent recognition of quality work and ensuring adequate resources are available could enhance employee engagement. Simpson describes the The 12 Elements of Great Managing therapeutic relationship between offender and To identify the elements of worker engagement, Gallup conducted counselor as a major many thousands of interviews in all kinds of organizations, at all component to early levels, in most industries, and in many countries. These 12 statements the Gallup Q12 emerged from Gallup's pioneering research as engagement of offenders in those that best predict employee and workgroup performance. treatment programs. The offender-counselor 1. I know what is expected of me at work. relationship is commonly 2. I have the materials and equipment I need to do my work considered to be at the very right. 3. At work, I have the opportunity to do what I do best every core of effective treatment day. (106). The relationship 4. In the last seven days, I have received recognition or praise requires empathy, warmth for doing good work. and genuineness on behalf 5. My supervisor, or someone at work, seems to care about me of the counselor. As part as a person. 6. There is someone at work who encourages my development. of the performance audit, 7. At work, my opinions seem to count. employees were surveyed 8. The mission or purpose of my company makes me feel my to identify and measure the job is important. elements of worker 9. My associates or fellow employees are committed to doing engagement, utilizing quality work. 10. I have a best friend at work. questions developed by the 11. In the last six months, someone at work has talked to me Gallop Organization, see about my progress. figure 22. Results have 12. This last year, I have had opportunities at work to learn and shown a strong link grow. between high survey scores and worker performance Figure 22: The 12 elements of great managing. Copyright © 1992(Buckingham and Coffman 1999 The Gallup Organization, Princeton, NJ. All rights reserved. 31-41). A counselor more highlight issues DOC management can highly engaged (i.e. loyal and focus on to help improve future program productive) in their work arguably is performance. Over 25% of the more likely to develop the therapeutic employees working in the substance relationship required for effective abuse program disagreed or were neutral treatment than those who are with five statements: disengaged (i.e. unhappy and spreading Þ I have the materials and equipment I their discontent). As such, the survey need to do my work right (36.4%). results may serve as a proxy indicator Þ At work, I have the opportunity to do for the therapeutic relationship. what I do best every day (27.2%). Þ In the last seven days, I have Although the survey data can not be received recognition or praise for related to recidivism results, it does doing good work (45.5%). DOC Licensed Substance Abuse Programs Þ At work, my opinions seem to count (30.9%). Þ I have a best friend at work (34.5%). Over 25% disagreed with receiving recognition and praise in last seven days, and 18.2% disagreed with having the materials and equipment to do their job right. The percentages were higher among survey respondents.18 Survey data is provided in Appendix J. 18 65% of DOC employees working in the substance abuse programs responded to the employee survey. Page 41 DOC Licensed Substance Abuse Programs Page 42 Conclusions and Recommendations DOC has begun to look for ways to improve their substance abuse treatment programs, and is committed to reducing recidivism specifically with efforts to: Þ evaluate the utilization of EBPs within interventions and programs; Þ develop program corrective action plans to drive the implementation of EBPs; and Þ redirect resources into promising or excellent strategies. Even though connecting the implementation of evidence-based practices to improvements in recidivism is not possible currently, research supports their use. DOC should continually strive to evaluate, integrate and implement evidence-based practices into their treatment offerings. Many of the licensed substance abuse programs have also established quality assurance programs to allow ongoing continual improvement, focused on making small programmatic changes, which over time taken collectively have the potential to greatly affect program results. While the quality assurance programs offer a good start, DOC s efforts could be greatly enhanced with instruments to monitor patient progress or aggregate patient records to provide measures of motivation, engagement, and functioning and for these measures to be tracked over time. Such measures have the benefit of demonstrating program effectiveness, identifying problem areas and supporting focused improvement efforts. Approaching measurement consistently across the prison system will provide the added benefit of identifying unique programmatic problems from systemic problems prominent across the entire prison-system. DOC also has the need to fully understand dynamic population characteristics across the system. The limited information presents challenges in knowing which type of treatment in terms of intensity, duration, and modalities used are of greater need Department-wide. Currently, the delivery of appropriate and effective treatment is hindered by restricting programming to what is available at the institution where the offender has been placed, which may not best fit the offender s needs. It also places the burden of challenging offender populations, such as those with co-occurring disorders (mental health and substance abuse need), on the institutions where programming may not adequately address the problem. While many strategies can be implemented within the prison-system, some issues call for a broader approach. Recidivism rate changes associated with community supervision, enrollment in community based substance abuse programming, and environmental factors associated with higher recidivism rates among African Americans suggest the need for enhanced social support systems and networks within communities. More offenders need continuing support and care in the community to maintain and further enhance treatment received while in prison. DOC Licensed Substance Abuse Programs Page 43 The following recommendations are offered for DOC s consideration: Þ Enhance community support networks and release planning to positively reinforce desired behaviors; Þ Develop a consistent assessment protocol and standard intake process; Þ Develop a system for monitoring program performance, setting targets and furthering the use of evidence-based practices; Þ Deliver substance abuse programming across the correctional system in an integrated fashion; and Þ Develop strategies to give substance abuse treatment staff positive recognition and praise on a frequent basis. All of the recommendations discussed below will require DOC to manage change. Employees and stakeholders must understand the real costs, benefits and rationale. A communication plan accompanying strategies the Department intends to move forward with will be beneficial. The mantra regarding change management is to communicate early and often. Enhance community support networks and release planning to positively reinforce desired behaviors. Community aftercare is a critical element to NIDA. They have it listed as a principle of drug abuse treatment for criminal justice populations Continuity of care is essential for drug abusers re-entering the community ( Treatment for Criminal Justice Populations 5). Community aftercare is also listed as an evidence based principles for effective interventions, Engage ongoing support in natural communities, see figure 21. Its importance is further supported by researchers in the substance abuse field, Simpson states that nowhere is the importance of transitional services treatment more evident than for correctional populations, especially community re-entry programs that follow prison-based treatment (110). Data presented in this audit suggests that community aftercare can reduce recidivism. The following information presents a number of short-term and long-term actions DOC can undertake to enhance community support networks and release planning that will positively reinforce desired behaviors and reduce recidivism. Short-term actions: 1. Review recidivism data geographically by region or county where offenders are located following release to identify where additional support may be required. Release location variable was not part of the data set reviewed as part of this performance audit. 2. Review the discharge planning process to ensure substance abuse aftercare requirements are incorporated and detailed in offenders discharge plans. DOC Licensed Substance Abuse Programs Page 44 3. Reinforce treatment received in prison by encouraging offenders participation in self-help and peer support groups and religious activities after release that will improve offenders bonds to pro-social community members (National Institute of Corrections 6). 4. Enhance or expand interventions that increase offenders family contact and educate family members how they can better support offenders recovery. 5. Evaluate the effectiveness of I-SMART pilot in conveying prison treatment information to providers in the community, and mainstream the system to other programs if success is demonstrated. Long-term actions: 1. Develop partnerships with community-based organizations and substance abuse providers to ensure services are available to offenders after their release from prison. 2. Develop and pilot test a coordinated, supportive approach to community supervision that emphasizes offenders pro-social goals in their conditions to release and encourages positive responses to attainment of these goals (ReEntry Policy Council 5). See Step n Out behavioral management approach outlined on www.cjdats.org. The goal of the approach is to enable community supervision officials to become more of a change agent, and to rely less on negative sanctions which lead to recidivism due to technical violations. 3. Enable local care providers to meet with offenders prior to their release and to be involved in discharge planning. The Re-Entry Policy Council suggests community-based providers are likely to be more familiar with the community to which an individual will return after his or her incarceration than are corrections staff (12). In order to leverage departmental resources, DOC may want to explore ways to focus such initiatives, the following are some examples: Þ Build partnerships in communities where African Americans reside to help combat prevalent socioeconomic issues. Þ Build partnerships in communities where higher recidivism rates are evident. Þ Enhance discharge planning for higher risk offenders, or with those mental health diagnoses. Develop a consistent assessment protocol and standard intake process. The assessment process is arguably one of the most critical functions DOC conducts, because with growing prison populations and declining resources where and how services are provided become more and more critical with each admission. The following four offender classification factors help with security decisions and guiding treatment: DOC Licensed Substance Abuse Programs Þ Þ Þ Þ Page 45 Risk, Need (criminogenic needs), Responsivity, and Professional discretion, which uses professional judgment to assess variables, deemed important (Kennedy 19, Bonta Offender Assessment 16-17). However, as Bonta notes, interview questions can vary from offender to offender, and the range of error associated with measurement instruments available can make assessing offenders challenging. He suggests a multi-method measurement of theoretically relevant factors as a way to reduce error and increase the accuracy of the assessment. This approach combines the use of a measurement instrument (test) and a structured interview ( Offender Assessment 15-16). DOC utilizes the validated LSI-R to assess risk and need (Lowenkamp and Bechtel). Classification notes and pre-sentence investigation are also utilized by a number of substance abuse programs as part of their intake phase, but were not reviewed as part of this audit. However, the consistent use of instruments related to mental health, addiction severity and responsivity is not apparent. Short-term actions: 1. Review addiction severity instruments. According to a study of prisoner intake systems, SASSI, the Texas Christian University Drug Dependency Screen (TCUDDS) and the Addiction Severity Index (ASI) are common instruments used nationally (Hardyman et al. 12). 2. Review mental health instruments. Millon Clinical Multiaxial Inventory (MCMI) and Minnesota Multiphasic Personality Inventory (MMPI) were more common instruments used to assess psychopathology and address compulsive behaviors (Hardyman et al. 12). 3. Review responsivity instruments. Kennedy discusses CMC and the Jesness Personality Inventory, as commonly used instruments for responsivity, but highlights LSI Ontario Revision (OR) as the first risk assessment instrument to incorporate a section on special responsivity considerations The section measures motivation as a barrier, denial/minimization, interpersonal anxiety, cultural issues, low intelligence and communication barriers (21). Bonta highlights other valid and reliable measures for intelligence, anxiety, and interpersonal maturity ( Offender Assessment 18). 4. Review existing interview methodologies used, and identify ways to establish structured interviews that will help ensure consistency in administration. 5. Develop a standard comprehensive assessment protocol and intake process. In the DOC executive meeting on December 18, 2006, it was noted that 1) there is not a state-wide assessment, and 2) there is a need to make the reception/intake process at IMCC more efficient. DOC may want to consider utilizing a lean tool called Design for Lean Sigma, which is a methodology to DOC Licensed Substance Abuse Programs Page 46 create a new service, product or process; is applicable to any high-value project that needs a significant amount of new design; and places strong emphasis on capturing and understanding the customer and organization needs. 6. Train assessment staff on how the assessment and intake process will work and how to use the instruments. 7. Develop training material so substance abuse counselors and other treatment staff understand how the comprehensive assessment works and know how to use the information from the assessment in developing individual treatment plans. Long-term actions: 1. Train substance abuse counselors and other treatment staff. 2. Validate any new measurement instruments used. 3. Conduct an assessment to identify gaps in treatment services offered within the correctional system. 4. Establish treatment acceptance criteria for treatment offerings based on information provided by the comprehensive assessment. The criteria should be unique, so that it is appropriate for the specific intervention, yet standard among similar interventions. 5. Redirect staffing resources, especially those with strong substance abuse expertise to support the assessment function. Develop a system for monitoring program performance, setting targets and furthering the use of evidence-based practices. System-level measures allow program comparisons, help programs tell their story, track progress over time, and identify improvement opportunities. Measuring relevant processes/practices and providing measurement feedback are also two principles of for effective interventions (National Institute of Corrections and Crime & Justice Institute 7). The litmus test for any measurement system is how it is used. Managers need to define the specific purpose for the measurement system and specific measures, and how it will be used as well as what it will be answering. Measures should help agencies manage themselves better drive improvement, measure progress towards achieving one s mission (or at least to know whether or not they are doing a better job), and help answer key questions that stakeholders have about the program. DOC Licensed Substance Abuse Programs Page 47 Short-term actions: 1. Continue efforts to assess the use of evidence-based practices to better inventory what practices are used and where they are implemented. The Iowa Consortium for Substance Abuse Research and Evaluation highlight that numerous studies show positive outcomes in a variety of fields including substance abuse treatment when programs accurately implement evidence-based protocols (24). The integrity of program implementation is just as important as understanding program results whether it is relapse or recidivism. 2. Identify key aspects of the program that are the most important. The TCU Treatment Model highlights six broad areas, which may establish common aspects programs can look at: patient attributes, program attributes, early engagement, early recovery, stabilized recovery, and post-treatment outcomes (Simpson 103). DOC work on evidence-based practices provides a start on what to look at. 3. Identify who will have questions about aspects of the substance abuse program, and what questions they will have, and how the answers to those questions would be used. a. Internally, DOC has interest in knowing how well programs are implementing evidence-based practices and how do offenders change as a result of treatment, whereas policy makers are interested in broader outcome related questions such as does the program keep offenders from returning to prison? In these cases, the answers will generally be used for driving improvements and allocating resources. b. DOC may want to consider asking stakeholders what questions they have about the substance abuse programs. 4. Prioritize questions to answer. Generally, resources are not available to answer every possible question. Additionally, attempting to answer too many questions through measurement can hinder DOC s ability to explain what the data is telling you, which is just as important as the data itself. a. When prioritizing, DOC should look for commonalities among questions asked. b. Most performance management efforts place focus on outcomes, Iowa s Accountable Government Act is no different. DOC should consider focusing on more immediate outcomes for the substance abuse programs. Although reduced recidivism is key result, a lot of variables influence it. Incremental offender change is a more immediate outcome that can be directly attributable to the substance abuse program it is also more immediate giving management an opportunity to react, and make necessary changes. DOC Licensed Substance Abuse Programs Page 48 c. DOC must also have information that will help explain unusual or unexpected outcomes. For instance, dosage is a key principle for effective treatment so are offenders in therapeutic tasks 40% or more of their time? Does a drop in offenders meeting the dosage standard coincide with a reduction in the amount of change exhibited by offenders? 5. Identify data needed to help answer your questions; and how and when it will be collected. a. Queries have been built to answer recidivism questions related to this audit, which can be used. b. I-SMART database piloted in two institutions may offer other opportunities. c. Samples may be sufficient treatment managers are already sampling case files for quality assurance purposes, what other questions can they answer during this exercise? If sampling is used, questions asked, and how they are answered should be consistent across the substance abuse programs. d. DOC could continue to use the Q12 survey questions to measure employee engagement, as a proxy for therapeutic relationships. e. Some questions may need new data such as monitoring the change in an offender s dynamic risk factors as a result of treatment, or offender engagement during treatment. f. Consider how DOC will need the data disaggregated considering geographical or other demographic characteristics. In order to avoid a central office orientation, it is important to include measures that are relevant at the institution and program level as well. g. Avoid unnecessary precision or confidence requirements that are of little benefit and only make measurement more costly. h. Collect and document data to support monitoring performance over time and observing changes. i. Ensure what is measured and how frequently it is measured is consistent over time and across programs. 6. Baseline and set targets and standards for action for every measure intended to monitor performance. This helps establish what level of performance is expected and provides a means to signal problems. It also allows substance abuse programs to explore creative/innovative approaches for achieving targets. Having targets and standards can help evaluate a program or processes fidelity how close is the process or program implemented in the way it was intended. DOC Licensed Substance Abuse Programs Page 49 7. Assign individuals responsible for each performance measure identified. 8. Make the data visual utilizing graphical analysis of the data. This report provides some examples, other techniques are run and control charts, which are especially useful for time series data. 9. Use the data. Substance abuse programs have quality assurance teams or committees, and most also have periodic employee/team meetings where monitoring system data can be reviewed and corrective action plans devised. With measures that are consistently measured over time and across programs, the monitoring systems will support the inside out approach for implementing the Principles of Evidence-Based Practices allowing for comparisons across programs in search of best or at least better practices to replicate in other areas of the department (National Institute of Corrections and Crime & Justice Institute 12). 10.Share the data. The data, in some cases, was collected to answer stakeholder questions let them see it. Some of the substance abuse programs have advisory groups, which may serve as a good place to start. Long-term actions: 1. Develop a system for external benchmarking of other incarceration-based substance abuse programs/models supported by research. Although it is good to look internally for utilization of evidence-based practices, external review can provide new insights, and identify other practices or strategies that would benefit DOC s substance abuse programs. It can also serve as a major catalyst for change, and would allow DOC to build upon the work of others. External benchmarking should only be considered after DOC s internal monitoring and benchmarking methods are well developed. Deliver substance abuse programming across the correctional system in an integrated fashion. As noted previously, most of the substance abuse programming offered by DOC was developed at the institution level. Independent program development creates treatment programs that are specific to the institution rather than supportive of a comprehensive departmental system and may not adequately address service gaps when looking at needs across the department. Also, the small percentage of offenders receiving continuing substance abuse programming in the community, suggests that many of DOC s treatment programs are stand alone where therapeutic change is hopefully completed while the offender is incarcerated, rather than as part of a treatment continuum spanning incarceration, work release and parole. Approaching substance abuse programming in an integrated fashion promotes consistent delivery of services, as well as, provides for the standardization of key processes such as offender assessment and discharge planning. It would also allow DOC to focus on advantages that incarceration-based treatment offers such DOC Licensed Substance Abuse Programs Page 50 as time. As Inciardi et al. notes, there is the time and opportunity for focused and comprehensive treatment, perhaps for the first time in a drug offender s career (91). Short-term actions: 1. Work with Community Based Correction Districts to develop a multistage treatment continuum model. Durrant notes that CBC facilities are an integral and critical part of the correctional system (16). Exploring how the prisonbased and community-based substance abuse programs work together is a natural extension to DOC s efforts to evaluate the use of evidence-based practices and may offer opportunities to deliver services more cost effectively. The multistage model used within the Delaware correctional system since the mid-1990 has been the subject of many studies where primary treatment is provided in the prison system, transitional treatment is provided in a work release setting and aftercare is provided when the offender enters parole or is placed under some other form of community supervision (Inciardi et al. 91-92). This approach may also support utilizing prison treatment resources for offenders with more severe addictions requiring more intensive treatment. While others with less severe addictions could be treated in the community rather than in prison. 2. Evaluate opportunities to create prison-wide centers that address specific issues or needs. Focusing on a specific issue or problem typically allows for a greater degree of specialization that is not possible or practical in all situations. The co-occurrence of mental health and substance abuse needs may be appropriate for such a center. Develop strategies to give substance abuse treatment staff positive recognition and praise on a frequent basis. Evidence-based practices suggest that effective correctional programs are ones who utilize rewards at a much higher rate than punishments as a way to change offender behavior (DOC CPAI ). The same principle can be applied to employees in the form of frequent recognition and praise that: Þ Focus on positive interactions; Þ Promote positive emotions that can profoundly influence employee productivity; and Þ Enhance therapeutic relationships that are critical in substance abuse treatment. This is especially critical in the field of substance abuse treatment, where relapse is prevalent and often considered inevitable. DOC Licensed Substance Abuse Programs Page 51 Short-term actions: 1. Develop strategies to increase positive interactions occurring within work teams. How Full is Your Bucket? by Tom Rath and Donald O. Clifton and www.bucketbook.com offer some simple and practical suggestions on how an organization can increase positive interactions. DOC Licensed Substance Abuse Programs Page 52 References Austin, Dean and Cindy Kelly. Personal interview. 05 Feb. 2007. Bagby, Robin. Personal interview. 02 Feb. 2007. Bonta, James. Offender Assessment: General issues and considerations. FORUM on Corrections Research 12.2 (May 2000): 14-18. Bonta, James. Risk-Needs Assessment and Treatment. Choosing Correctional Options That Work: Defining the Demand and Evaluating the Supply. Ed. Alan T. Harland. Thousand Oaks, CA: SAGE Publications, Inc., 1996. 18-32. Buckingham, Marcus and Curt Coffman. First, Break All the Rules: What the World s Greatest Managers Do Differently. New York, NY: Simon and Schuster, 1999. Bucklew, Jeanette. E-mail to DOC Wardens, District Directors and Treatment Service Staff. 14 Nov. 2006. Dick, Mary and Tony Comp. Personal interview. 25 Jan. 2007. Durrant Group, Inc. State of Iowa Systematic Study for the State Correctional System. Des Moines, IA: Iowa Department of Corrections, 2007. Durskey, Jill, Dorthy Hanneman, Larry Liscomb, and Katrina Carter-Larson. Personal interview. 02 Feb. 2007. Gendreau, Paul, Tracy Little, and Claire Goggin. A Meta-analysis of the Predictors of Adult Offender Recidivism: What Works! Criminology 34.4 (1996): 575-607. Hardyman, Patricia L., James Austin, and Johnette Peyton. Prisoner Intake Systems: Assessing Needs and Classifying Prisoners. Washington, DC: National Institute of Corrections, Prisons Division, U.S. Department of Justice, 2004. Harrison, Lana D. "The Revolving Prison Door for Drug-Involved Offenders: Challenges and Opportunities." Crime & Delinquency 47.3 (July 2001): 462-484. Hebron, Steve and Dennis LeBarge. Personal interview. 22 Jan. 2007. Howard, Shawn and Roxanne Phillips. Personal interview. 26 Jan. 2007. Huebner, Beth M. Drug Abuse, Treatment, and Probationer Recidivism. 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DOC Licensed Substance Abuse Programs Page 53 Iowa Department of Corrections. Institution Budget Details for FY06 & FY07 Budgeted. Des Moines, IA: Iowa Department of Corrections, 2006. Iowa Department of Corrections. Iowa Correctional Institution for Women Substance Abuse Treatment Policy, No. 109.111. Mitchellville, IA: Iowa Correctional Institution for Women, Iowa Department of Corrections, 2003. Iowa Department of Corrections. Iowa Correctional Institution for Women Violator Program Policy, No. 109.121. Mitchellville, IA: Iowa Correctional Institution for Women, Iowa Department of Corrections, 2004. Iowa Department of Corrections. NCCF Journey Program Policy and Procedures Manual. Rockwell City, IA: North Central Correctional Facility, Iowa Department of Corrections. Iowa Department of Corrections. Mt. Pleasant Correctional Facility Substance Abuse Programming. Mt. Pleasant, IA: Mt. Pleasant Correctional Facility, Iowa Department of Corrections, 2007. Iowa Department of Corrections. Newton Correctional Facility-Primary Substance Abuse Program Staff Procedures and Treatment Records, O.M. 27-2. Newton, IA: Newton Correctional Facility, Iowa Department of Corrections, 2001. Iowa Department of Corrections. Newton Correctional Facility-Violator Program, O.M. 30-1. Newton, IA: Newton Correctional Facility, Iowa Department of Corrections, 2001. Iowa Department of Corrections. March 2007 Quick Facts. Des Moines, IA: Iowa Department of Corrections, 2007. Iowa Department of Corrections. TOW Intake and Assessment, TOW-IX-07. Clarinda, IA: Clarinda Correctional Facility, Iowa Department of Corrections, 2006. Iowa Department of Corrections. Self-Assessment. Des Moines, IA: Iowa Department of Corrections, 2004. Iowa Department of Corrections. 2006-2007 Strategic Plan. Des Moines, IA: Iowa Department of Corrections, 2006. Iowa Department of Public Health. I-smart Background. May 11, 2007. <http://www.idph.state.ia.us/ismart/background.asp>. Johnson, Robert. Personal Interview. 29 Jan. 2007. Kennedy, Sharon. Treatment responsivity: Reducing recidivism by enhancing treatment effectiveness. FORUM on Corrections Research 12.2 (May 2000): 19-23. Klebe, Kelli J. and Maureen O Keefe. Outcome Evaluation of the Crossroads to Freedom House and Peer 1 Therapeutic Communities Project. Washington, DC: National Institute of Justice, U.S. Department of Justice, 2004. Lawson, Roger, Anne Daily, and Bob Schnieder. Personal interview. 02 Feb. 2007. Lowenkamp, Christopher and Kristin Bechtel. Validating the LSI-R on an Iowa Probation and Parole Sample. Cincinnati, OH: University of Cincinnati, 2006. Mitchell, Ojmarrh, David B. Wilson, and Doris L. MacKenzie. The Effectiveness of Incarceration-Based Drug Treatment on Criminal Behavior. September 2006 <http://www.campbellcollaboration.org/docpdf/Incarceration-BasedDrugTxSept06final.pdf>. Mumola, Christopher J. and Jennifer C. Karberg. Special Report: Drug Use and Dependence, State and Federal Prisoners, 2004. Washington, DC: Office of Justice Programs, U.S. Department of Justice, 2006. DOC Licensed Substance Abuse Programs Page 54 National Institute of Justice. Research Preview: Adult Patterns of Criminal Behavior. Washington, DC: National Institute of Justice, Office of Justice Programs, U.S. Department of Justice, 1996. National Institute of Corrections, and Crime & Justice Institute. Implementing Evidence-Based Practice in Community Corrections: The Principles of Effective Intervention. Washington, DC: National Institute of Corrections, Community Corrections Division, U.S. Department of Justice, 2004. National Institute on Drug Abuse. Principles of Drug Abuse Treatment: A Research-Based Guide. Washington, DC: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, 1999. National Institute on Drug Abuse. Principles of Drug Abuse Treatment for Criminal Justice Populations. Washington, DC: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, 2006. National Institute on Drug Abuse. Research Report Series Cocaine Abuse and Addiction. Washington, DC: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, 2004. National Institute on Drug Abuse. Research Report Series Marijuana Abuse. Washington, DC: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, 2005. National Institute on Drug Abuse. Research Report Series Methamphetamine Abuse and Addiction. Washington, DC: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, 2006. Nelson, Jay. Personal interview. 26 Jan. 2007. Palmer, Ted. Programmatic and Nonprogrammatic Aspects of Successful Intervention. Choosing Correctional Options That Work: Defining the Demand and Evaluating the Supply. Ed. Alan T. Harland. Thousand Oaks, CA: SAGE Publications, Inc., 1996. 131-182. Pelissier, Bernadette, Susan Wallace, Joyce Ann O Neil, Gerald G. Gaes, Scott Camp, William Rhodes, and William Saylor. "Federal Prison Residential Drug Treatment Reduces Substance Use and Arrests After Release." American Journal of Drug and Alcohol Abuse 27(2) (2001): 315-337. Prendergast, Michael L., Deborah Podus, Eunice Chang, Darren Urada. "The effectiveness of drug abuse treatment: a meta-analysis of comparison group studies." Drug and Alcohol Dependence 67 (2002): 53-72. Prell, Lettie. Report to the Board of Corrections on Population Growth. Des Moines, IA: Iowa Department of Corrections, 2006. Prell, Lettie. Report to the Board of Corrections on Substance Abuse. Des Moines, IA: Iowa Department of Corrections, 2006. Re-Entry Policy Council. Substance Abuse Treatment and Re-Entry. Report of the Re-Entry Policy Council: Charting the Safe and Successful Return of Prisoners to the Community. New York, NY: ReEntry Policy Council, Council of State Governments, 2005. Simpson, D. Dwayne. A conceptual framework for drug treatment process and outcomes. Journal of Substance Abuse Treatment. 27 (2004): 99-121. Stageberg, Paul. Iowa Prison Population Forcast. Des Moines, IA: Criminal & Juvenile Justice Planning, Iowa Department of Human Rights, 2006. State of Iowa. Report of the Governor s Task Force on Overrepresentation of African-Americans in Prison. Des Moines, IA: Office of Governor Thomas J. Vilsack, State of Iowa, 2001. DOC Licensed Substance Abuse Programs Page 55 Uggen, Christopher and Michael Massoglia. Settling Down and Aging Out: Desistence from Crime as a Separate Facet of the Transition to Adulthood. October 23, 2006. <http://cas.uchicago.edu/workshops/crime/Crime%20and%20Punishment%20Workshop/Fall%20Qu arter%202006_files/Uggen_Massoglia_10_06.pdf>. Wexler, Harry K., George De Leon, George Thomas, David Kressel, and Jean Peters. The Amity Prison TC Evaluation: Reincarceration Outcomes. Criminal Justice and Behavior 26.2 (June 1999): 147167. White, William L. "Treatment Works! Is it time for a new slogan?" Addiction Professional 3.1 (January 2005): 22-26. DOC Licensed Substance Abuse Programs Department of Corrections Response Page 56 DOC Licensed Substance Abuse Programs Page 57 Appendix A: Data Collection Methodology 1 2 3 4 5 6 7 Notes: 1. The following releases were included: Release to work release (32), Release to Iowa Parole (36), Release to Shock/Non-shock PB (38/39), Final Discharge, End of Sentence (55), Final Discharge, Other (56), and Parole w/immediate discharge (81). If ties used Minimum Release Date. 2. The following admissions are included to track recidivism: New Court Commitment (1), New Court Commitment after PB Rev (2), Parole Revocation (11), Shock Probation Revocation (14), Admission from OWI Facility (30), and Work Release Revocation (71). Data Captured: Offense Dt, Crime Cd, Offense Description, and Convicting Crime Type/Sub Type. 3. Recidivism Type: New Charges = Prison Status Charge Offense Date > Release Date; Technical Violations = Prison Status Charge Offense Date < Release Date. If ties (multiple charges) ranked by Most Serious (1) Offense Class, (2) Offense Type and (3) Minimum Crime Cd Id. 4. Need Identified by: LSI-R, Iowa Risk, Custody Classification, and Jesness Assessments. 5. LSI-R Score was from assessments conducted between the offender s first supervision date and 90 days following release. Data Captured: Score, Submitted Date, Category (Low 0-13; Low/Moderate 14-23; Moderate 2433; Moderate/High 34-40; High 41+) 6. Community SA Intervention Data is not available for offenders released due to end of sentence. The intervention captured is the first intervention after release. Data Captured: Intervention, Start/End Date, and Intervention Category. 7. Institution Licensed Substance Abuse Interventions Data Captured: Region Name, Intervention, Start/End Date, Closure Reason, and Closure Category (Successful, Unsuccessful, Administrative, Intermediate Sanction). DOC Licensed Substance Abuse Programs Page 58 Appendix B: Non-Recidivism and Recidivism Rates by Comparison Group and Institution. Recidivism Rates Did Not Recidivate No SA Need Count % 47 81.0% New Convictions 6 10.3% SA Need/No Prison Treatment Count % 114 71.7% 23 14.5% 22 13.8% 159 100.0% SA Need/Successful Prison Treatment Count % 93 62.8% 24 16.2% 31 20.9% 148 100.0% SA Need/Unsuccessful Prison Treatment Count % 6 60.0% 2 20.0% 2 20.0% 10 100.0% SA Need/Prison Treatment - Other Count % 8 72.7% 2 18.2% 1 9.1% 11 100.0% Total Count % 268 69.4% 57 14.8% 61 15.8% 386 100.0% No SA Need Count % 52 76.5% 8 11.8% 8 11.8% 68 100.0% SA Need/No Prison Treatment Count % 156 75.0% 29 13.9% 23 11.1% 208 100.0% SA Need/Successful Prison Treatment Count % 257 70.6% 49 13.5% 58 15.9% 364 100.0% SA Need/Unsuccessful Prison Treatment Count % 38 59.4% 12 18.8% 14 21.9% 64 100.0% SA Need/Prison Treatment - Other Count % 17 85.0% 1 5.0% 2 10.0% 20 100.0% Total Count % 520 71.8% 99 13.7% 105 14.5% 724 100.0% No SA Need Count % 58 65.2% 16 18.0% 15 16.9% 89 100.0% SA Need/No Prison Treatment Count % 262 71.4% 62 16.9% 43 11.7% 367 100.0% SA Need/Successful Prison Treatment Count % 146 61.3% 36 15.1% 56 23.5% 238 100.0% SA Need/Unsuccessful Prison Treatment Count % 12 70.6% 3 17.6% 2 11.8% 17 100.0% SA Need/Prison Treatment - Other Count % 3 50.0% 1 16.7% 2 33.3% 6 100.0% Count 481 118 118 717 % 67.1% 16.5% 16.5% 100.0% Comparison Group Fort Dodge Correctional Facility Clarinda Correctional Facility Anamosa State Penitentiary Institution Total Technical Violations 5 8.6% Total 58 100.0% DOC Licensed Substance Abuse Programs Page 59 Recidivism Rates Did Not Recidivate No SA Need Count % 98 83.8% New Convictions 10 8.5% SA Need/No Prison Treatment Count % 219 78.2% 28 10.0% 33 11.8% 280 100.0% SA Need/Successful Prison Treatment Count % 151 80.3% 21 11.2% 16 8.5% 188 100.0% SA Need/Unsuccessful Prison Treatment Count % 22 81.5% 2 7.4% 3 11.1% 27 100.0% SA Need/Prison Treatment - Other Count % 10 76.9% 1 7.7% 2 15.4% 13 100.0% Total Count % 500 80.0% 62 9.9% 63 10.1% 625 100.0% No SA Need Count % 34 77.3% 8 18.2% 2 4.5% 44 100.0% SA Need/No Prison Treatment Count % 70 89.7% 6 7.7% 2 2.6% 78 100.0% Total Count % 104 85.2% 14 11.5% 4 3.3% 122 100.0% No SA Need Count % 86 75.4% 13 11.4% 15 13.2% 114 100.0% SA Need/No Prison Treatment Count % 231 78.6% 32 10.9% 31 10.5% 294 100.0% SA Need/Successful Prison Treatment Count % 33 84.6% 2 5.1% 4 10.3% 39 100.0% SA Need/Unsuccessful Prison Treatment Count % 2 100.0% 0 .0% 0 .0% 2 100.0% SA Need/Prison Treatment - Other Count % 7 77.8% 1 11.1% 1 11.1% 9 100.0% Comparison Group Iowa State Penitentiary Iowa Medical & Classification Center Iowa Correctional Institution for Women Institution Total Technical Violations 9 7.7% Total 117 100.0% Count 359 48 51 458 % 78.4% 10.5% 11.1% 100.0% DOC Licensed Substance Abuse Programs Page 60 Recidivism Rates Did Not Recidivate No SA Need Count % 120 83.9% New Convictions 10 7.0% SA Need/No Prison Treatment Count % 199 77.7% 18 7.0% 39 15.2% 256 100.0% SA Need/Successful Prison Treatment Count % 225 78.9% 33 11.6% 27 9.5% 285 100.0% SA Need/Unsuccessful Prison Treatment Count % 10 71.4% 3 21.4% 1 7.1% 14 100.0% SA Need/Prison Treatment - Other Count % 12 70.6% 2 11.8% 3 17.6% 17 100.0% Total Count % 566 79.2% 66 9.2% 83 11.6% 715 100.0% No SA Need Count % 96 77.4% 17 13.7% 11 8.9% 124 100.0% SA Need/No Prison Treatment Count % 359 70.8% 70 13.8% 78 15.4% 507 100.0% SA Need/Successful Prison Treatment Count % 169 83.3% 12 5.9% 22 10.8% 203 100.0% SA Need/Unsuccessful Prison Treatment Count % 5 71.4% 0 .0% 2 28.6% 7 100.0% SA Need/Prison Treatment - Other Count % 6 85.7% 1 14.3% 0 .0% 7 100.0% Total Count % 635 74.9% 100 11.8% 113 13.3% 848 100.0% No SA Need Count % 68 79.1% 6 7.0% 12 14.0% 86 100.0% SA Need/No Prison Treatment Count % 283 74.7% 46 12.1% 50 13.2% 379 100.0% SA Need/Successful Prison Treatment Count % 21 80.8% 3 11.5% 2 7.7% 26 100.0% Total Count % 372 75.8% 55 11.2% 64 13.0% 491 100.0% Comparison Group North Central Correctional Facility Newton Correctional Facility Mount Pleasant Correctional Facility Institution Technical Violations 13 9.1% Total 143 100.0% DOC Licensed Substance Abuse Programs Page 61 Appendix C: Non-Recidivism and Recidivism Rates by Comparison Group and Location. Did Not Recidivate Comparison Groups Luster Heights SAP LUH Locationwide TC Anamosa State Penitentiary Locationwide 19 Program ALTA Location ASP Institution 19 No SA Need Recidivism Rates New Technical Convictions Violations Count 45 6 5 Total 56 100.0% % 80.4% 10.7% 8.9% SA Need/No Prison Treatment Count 93 18 20 131 % 71.0% 13.7% 15.3% 100.0% SA Need/Successful Prison Treatment Count 51 15 14 80 % 63.8% 18.8% 17.5% 100.0% SA Need/Unsuccessful Prison Treatment Count 1 0 0 1 % 100.0% .0% .0% 100.0% SA Need/Prison Treatment Other Count 2 0 0 2 % 100.0% .0% .0% 100.0% SA Need/Successful Prison Treatment Count 35 8 17 60 % 58.3% 13.3% 28.3% 100.0% SA Need/Unsuccessful Prison Treatment Count 5 2 2 9 % 55.6% 22.2% 22.2% 100.0% SA Need/Prison Treatment Other Count 3 2 1 6 % 50.0% 33.3% 16.7% 100.0% No SA Need Count 2 0 0 2 % 100.0% .0% .0% 100.0% SA Need/No Prison Treatment Count 21 5 2 28 % 75.0% 17.9% 7.1% 100.0% SA Need/Successful Prison Treatment Count 7 1 8 % 87.5% 12.5% 100.0% SA Need/Prison Treatment Other Count 3 0 3 % 100.0% .0% 100.0% For those successfully completing treatment, the location was based on the location of the treatment, except for TOW at CCF. Location for TOW was determined by release location within CCF. Location for comparison groups were based on location of release. DOC Licensed Substance Abuse Programs Page 62 Did Not Recidivate Comparison Groups Location Program Locationwide New Frontiers FDCF Fort Dodge Correctional Facility TOW CCFL Locationwide TOW Clarinda Correctional Facility CCF Locationwide Institution No SA Need Count 39 Recidivism Rates New Technical Convictions Violations 5 7 Total 51 % 76.5% 9.8% 13.7% 100.0% SA Need/No Prison Treatment Count 118 24 16 158 % 74.7% 15.2% 10.1% 100.0% SA Need/Successful Prison Treatment Count 186 40 47 273 % 68.1% 14.7% 17.2% 100.0% SA Need/Unsuccessful Prison Treatment Count 29 12 10 51 % 56.9% 23.5% 19.6% 100.0% SA Need/Prison Treatment Other Count 15 1 2 18 % 83.3% 5.6% 11.1% 100.0% Count 13 3 1 17 100.0% No SA Need % 76.5% 17.6% 5.9% SA Need/No Prison Treatment Count 38 5 7 50 % 76.0% 10.0% 14.0% 100.0% SA Need/Successful Prison Treatment Count 71 9 11 91 % 78.0% 9.9% 12.1% 100.0% SA Need/Unsuccessful Prison Treatment Count 9 0 4 13 % 69.2% .0% 30.8% 100.0% SA Need/Prison Treatment Other Count 2 0 0 2 % 100.0% .0% .0% 100.0% No SA Need Count 58 16 15 89 % 65.2% 18.0% 16.9% 100.0% SA Need/No Prison Treatment Count 262 62 43 367 % 71.4% 16.9% 11.7% 100.0% SA Need/Successful Prison Treatment Count 146 36 56 238 % 61.3% 15.1% 23.5% 100.0% SA Need/Unsuccessful Prison Treatment Count 12 3 2 17 % 70.6% 17.6% 11.8% 100.0% SA Need/Prison Treatment Other Count 3 1 2 6 % 50.0% 16.7% 33.3% 100.0% DOC Licensed Substance Abuse Programs Page 63 Did Not Recidivate Comparison Groups Location Program STAR Violator's Program-Regular @ ICIW WINGS ICIW Iowa Correctional Institution for Women Locationwide Institution No SA Need Count 98 Recidivism Rates New Technical Convictions Violations 10 9 Total 117 % 83.8% 8.5% 7.7% 100.0% SA Need/No Prison Treatment Count 219 28 33 280 % 78.2% 10.0% 11.8% 100.0% SA Need/Successful Prison Treatment Count 52 3 1 56 % 92.9% 5.4% 1.8% 100.0% SA Need/Unsuccessful Prison Treatment Count 5 1 0 6 % 83.3% 16.7% .0% 100.0% SA Need/Prison Treatment - Other Count 3 1 1 5 % 60.0% 20.0% 20.0% 100.0% SA Need/Successful Prison Treatment Count 12 4 3 19 % 63.2% 21.1% 15.8% 100.0% SA Need/Unsuccessful Prison Treatment Count 6 0 0 6 % 100.0% .0% .0% 100.0% SA Need/Prison Treatment - Other Count 0 0 1 1 % .0% .0% 100.0% 100.0% SA Need/Successful Prison Treatment Count 87 14 12 113 % 77.0% 12.4% 10.6% 100.0% SA Need/Unsuccessful Prison Treatment Count 11 1 3 15 % 73.3% 6.7% 20.0% 100.0% SA Need/Prison Treatment - Other Count 7 0 0 7 % 100.0% .0% .0% 100.0% DOC Licensed Substance Abuse Programs Page 64 Did Not Recidivate Comparison Groups Location Program Locationwide Project TEA Locationwide SAP @ MPCF MPCF Mount Pleasant Correctional Facility JBU Locationwide Project TEA FM3 Iowa State Penitentiary Project TEA Class FM1 Locationwide Institution No SA Need Count 24 Recidivism Rates New Technical Convictions Violations 3 5 Total 32 % 75.0% 9.4% 15.6% 100.0% SA Need/No Prison Treatment Count 55 6 6 67 % 82.1% 9.0% 9.0% 100.0% SA Need/Successful Prison Treatment Count 1 1 % 100.0% 100.0% SA Need/Prison Treatment - Other Count 1 1 % 100.0% Count 11 0 1 12 % 91.7% .0% 8.3% 100.0% SA Need/No Prison Treatment Count 62 4 8 74 % 83.8% 5.4% 10.8% 100.0% SA Need/Successful Prison Treatment Count 13 1 14 % 92.9% 7.1% 100.0% SA Need/Prison Treatment - Other Count 3 1 4 No SA Need No SA Need 100.0% % 75.0% 25.0% Count 27 0 7 100.0% 34 % 79.4% .0% 20.6% 100.0% SA Need/No Prison Treatment Count 64 14 10 88 % 72.7% 15.9% 11.4% 100.0% SA Need/Successful Prison Treatment Count 19 1 4 24 % 79.2% 4.2% 16.7% 100.0% SA Need/Unsuccessful Prison Treatment Count 2 0 0 2 % 100.0% .0% .0% 100.0% SA Need/Prison Treatment - Other Count 3 0 1 4 % 75.0% .0% 25.0% 100.0% No SA Need Count 108 8 12 128 % 84.4% 6.3% 9.4% 100.0% SA Need/No Prison Treatment Count 158 18 34 210 % 75.2% 8.6% 16.2% 100.0% SA Need/Successful Prison Treatment Count 225 33 27 285 % 78.9% 11.6% 9.5% 100.0% SA Need/Unsuccessful Prison Treatment Count 10 3 1 14 % 71.4% 21.4% 7.1% 100.0% SA Need/Prison Treatment - Other Count 12 2 3 17 % 70.6% 11.8% 17.6% 100.0% DOC Licensed Substance Abuse Programs Page 65 Did Not Recidivate Comparison Groups Location Program SAT/Criminality IFI Locationwide Journey NCCF North Central Correctional Facility PCD NCF Locationwide Newton Correctional Facility Violator's Program - Regular @ CRC CRC Locationwide Institution Recidivism Rates New Technical Convictions Violations 8 3 Total 45 No SA Need Count 34 % 75.6% 17.8% 6.7% 100.0% SA Need/No Prison Treatment Count 160 17 26 203 % 78.8% 8.4% 12.8% 100.0% SA Need/Successful Prison Treatment Count 72 6 5 83 % 86.7% 7.2% 6.0% 100.0% SA Need/Unsuccessful Prison Treatment Count 1 0 1 2 % 50.0% .0% 50.0% 100.0% SA Need/Prison Treatment - Other Count 2 1 0 3 % 66.7% 33.3% .0% 100.0% SA Need/Successful Prison Treatment Count 11 1 3 15 % 73.3% 6.7% 20.0% 100.0% SA Need/Unsuccessful Prison Treatment Count 2 0 1 3 % 66.7% .0% 33.3% 100.0% SA Need/Prison Treatment - Other Count 2 0 0 2 100.0% No SA Need % 100.0% .0% .0% Count 62 9 8 79 % 78.5% 11.4% 10.1% 100.0% SA Need/No Prison Treatment Count 199 53 52 304 % 65.5% 17.4% 17.1% 100.0% SA Need/Successful Prison Treatment Count 63 4 9 76 % 82.9% 5.3% 11.8% 100.0% SA Need/Prison Treatment- Other Count 1 0 0 1 % 100.0% .0% .0% 100.0% SA Need/Successful Prison Treatment Count 23 1 5 29 % 79.3% 3.4% 17.2% 100.0% SA Need/Unsuccessful Prison Treatment Count 2 0 0 2 % 100.0% .0% .0% 100.0% SA Need/Prison Treatment - Other Count 1 0 0 1 % 100.0% .0% .0% 100.0% No SA Need Count 68 6 12 86 % 79.1% 7.0% 14.0% 100.0% SA Need/No Prison Treatment Count 283 46 50 379 % 74.7% 12.1% 13.2% 100.0% SA Need/Successful Prison Treatment Count % 21 80.8% 3 11.5% 2 7.7% 26 100.0% DOC Licensed Substance Abuse Programs Page 66 New Conviction Recidivism Difference Difference in % Pop with Mental Health Diagnosis Difference in % Pop within High LSI-R Risk Category Difference in % Pop within Low LSI-R Risk Category Difference in % Pop with African American Race/Ethnicity Difference in % Pop Over 40 Years Old Program ALTA IFI Journey Luster Heights SAP New Frontiers PCD Project TEA @ FM3 Project TEA @ JBU SAP @ MPCF SAT/Criminality STAR TC TOW @ CCF TOW @ CCFL Violator's Program Regular @ CRC Violator's ProgramRegular @ ICIW WINGS Total Recidivism Difference Appendix D: Summary Comparisons by Program Substance Abuse Treatment Program Compared to SA Need/No Prison Treatment Group from Same Location. 7.2% -17.4% -6.1% -12.5% 10.0% -13.8% -9.1% -6.4% -3.7% -7.9% -14.6% 12.7% 6.6% -2.0% 5.0% -12.2% -0.6% -5.4% -1.8% -14.0% 1.7% -11.7% 3.0% -1.1% -4.6% -0.4% -0.5% -0.1% -11.4% -19.7% -6.1% -17.9% 1.3% -19.3% 15.9% -3.5% 2.5% -4.5% -20.7% -5.6% -12.3% 0.5% 0.0% -5.8% -1.4% -4.3% -4.7% -5.8% -3.0% -7.5% 2.7% -4.8% -13.5% 1.9% -7.3% -4.6% 0.0% 16.2% -1.1% 0.0% 0.4% 4.7% -1.5% 8.3% -1.7% -1.2% 6.7% 0.0% -0.3% 0.0% 2.1% -18.4% 5.2% -3.6% -2.0% 9.5% -5.1% -4.2% 4.3% -1.0% -7.9% -2.9% -7.5% -14.4% -8.7% 1.4% -8.0% 16.1% -0.7% -4.8% -11.2% 6.5% -4.9% -6.8% 11.4% -0.8% -1.2% 10.7% 5.5% -1.7% 2.3% 2.9% -5.3% 8.2% -42.9% 15.1% 11.1% 11.9% 3.2% -0.4% -8.1% -17.4% 1.2% 2.4% 7.2% -3.3% 1.5% 2.6% 0.4% Difference = SA Need/Successful Prison Treatment - SA Need/No Prison Treatment DOC Licensed Substance Abuse Programs Page 67 Appendix E: Mental Health Data. Recidivism Rates by Comparison Group and Mental Health Diagnosis Mental Health Diagnosis Recidivism Rates Comparison Group SA Need/No Prison Treatment No SA Need/Successful Prison Treatment SA Need/No Prison Treatment Yes Did Not Recidivate SA Need/Successful Prison Treatment Count % Count % Count % Count % New Convictions Technical Violations Total 1165 164 169 333 77.8% 10.9% 11.3% 22.2% 710 99 119 218 76.5% 10.7% 12.8% 23.5% 694 145 147 292 70.4% 14.7% 14.9% 29.6% 372 80 94 174 68.1% 14.7% 17.2% 31.9% Institution Recidivism Rates by Comparison Group and Mental Health Diagnosis Clarinda Correctional Facility Anamosa State Penitentiary Institution Mental Health Diagnosis No Yes No Yes Recidivism Rates Did Not Recidivate Comparison Group SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count % % % % % % % % New Convictions Technical Violations Total 77 13 11 24 76.2% 12.9% 10.9% 23.8% 67 17 20 37 64.4% 16.3% 19.2% 35.5% 35 10 11 21 62.5% 17.9% 19.6% 37.5% 25 6 11 17 59.5% 14.3% 26.2% 40.5% 87 12 9 21 80.6% 11.1% 8.3% 19.4% 164 26 30 56 74.5% 11.8% 13.6% 25.4% 67 17 14 31 68.4% 17.3% 14.3% 31.6% 87 23 28 51 63.0% 16.7% 20.3% 37.0% DOC Licensed Substance Abuse Programs Mount Pleasant Correctional Facility Iowa State Penitentiary Iowa Correctional Institution for Women Fort Dodge Correctional Facility Institution Mental Health Diagnosis No Yes No Yes No Yes No Yes Page 68 Recidivism Rates Comparison Group SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count % % % % % % % % % % % % % % % % Did Not Recidivate New Convictions Technical Violations Total 178 33 27 60 74.8% 13.9% 11.3% 25.2% 104 22 29 51 67.1% 14.2% 18.7% 32.9% 77 27 16 43 64.2% 22.5% 13.3% 35.8% 41 14 26 40 50.6% 17.3% 32.1% 49.4% 85 8 10 18 82.5% 7.8% 9.7% 17.5% 62 3 6 9 87.3% 4.2% 8.5% 12.7% 131 20 22 42 75.7% 11.6% 12.7% 24.3% 87 18 10 28 75.7% 15.7% 8.7% 24.4% 143 19 15 34 80.8% 10.7% 8.5% 19.2% 21 1 1 2 91.3% 4.3% 4.3% 8.6% 83 13 16 29 74.1% 11.6% 14.3% 25.9% 11 1 3 4 73.3% 6.7% 20.0% 26.7% 116 9 20 29 80.0% 6.2% 13.8% 20.0% 150 18 17 35 81.1% 9.7% 9.2% 18.9% 83 9 19 28 74.8% 8.1% 17.1% 25.2% 73 15 10 25 74.5% 15.3% 10.2% 25.5% DOC Licensed Substance Abuse Programs North Central Correctional Facility Newton Correctional Facility Institution Mental Health Diagnosis No Yes No Yes Page 69 Recidivism Rates Comparison Group SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count % % % % % % % % Did Not Recidivate New Convictions Technical Violations Total 220 38 44 82 72.8% 12.6% 14.6% 27.2% 123 10 16 26 82.6% 6.7% 10.7% 17.4% 133 31 31 62 68.2% 15.9% 15.9% 31.8% 46 2 4 6 88.5% 3.8% 7.7% 11.5% 214 29 31 60 78.1% 10.6% 11.3% 21.9% 19 2 0 2 90.5% 9.5% .0% 9.5% 63 15 18 33 65.6% 15.6% 18.8% 34.4% 2 1 2 3 40.0% 20.0% 40.0% 60.0% DOC Licensed Substance Abuse Programs Page 70 % of Offender Population with Mental Health Diagnosis by Program and Institution Mental Health Diagnosis Iowa Correctional Institution for Women Fort Dodge Correctional Facility Clarinda Correctional Facility Anamosa State Penitentiary Institution Location Comparison Group SA Need/No Treatment ASP ALTA TC LUH SA Need/No Treatment Luster Heights SAP CCF SA Need/No Treatment TOW CCFL SA Need/No Treatment TOW SA Need/No Treatment FDCF % Count % Count % Count % Count % Count % Count % Count % Count % Count % Count New Frontiers SA Need/No Treatment STAR ICIW Count Violator's ProgramRegular @ ICIW WINGS % Count % Count % Count % Count % No Yes Substance Abuse Disorder Only 78 51 2 131 59.5% 38.9% 1.5% 100.0% 56 22 2 80 70.0% 27.5% 2.5% 100.0% Total 40 20 60 66.7% 33.3% 100.0% 23 5 28 82.1% 17.9% 100.0% 8 8 100.0% 100.0% 78 79 1 158 49.4% 50.0% .6% 100.0% 165 103 5 273 60.4% 37.7% 1.8% 100.0% 30 19 1 50 60.0% 38.0% 2.0% 100.0% 55 35 1 91 60.4% 38.5% 1.1% 100.0% 238 120 9 367 64.9% 32.7% 2.5% 100.0% 155 81 2 238 65.1% 34.0% .8% 100.0% 103 173 4 280 36.8% 61.8% 1.4% 100.0% 32 23 1 56 57.1% 41.1% 1.8% 100.0% 5 14 26.3% 73.7% 34 78 1 113 30.1% 69.0% .9% 100.0% 19 100.0% DOC Licensed Substance Abuse Programs Page 71 Mental Health Diagnosis Institution Location Iowa State Penitentiary FM1 Comparison Group SA Need/No Treatment Project TEA - Class FM3 SA Need/No Treatment Project TEA JBU SA Need/No Treatment Mount Pleasant Correctional Facility Project TEA SA Need/No Treatment MPCF Newton Correctional Facility SA Need/No Treatment NCF SAT/Criminality Count % Count % Count % Count % Count % Count % % Count % Count % Violator's Program Regular @ CRC Count SA Need/No Treatment Count IFI PCD North Central Correctional Facility % Count SAP @ MPCF CRC Count SA Need/No Treatment NCCF % % Count % Count % Count % Count Journey % Substance Abuse Disorder Only Total No Yes 51 16 67 76.1% 23.9% 100.0% 1 1 100.0% 100.0% 51 20 3 74 68.9% 27.0% 4.1% 100.0% 8 6 14 57.1% 42.9% 100.0% 51 36 1 88 58.0% 40.9% 1.1% 100.0% 14 9 1 24 58.3% 37.5% 4.2% 100.0% 143 67 210 68.1% 31.9% 100.0% 185 98 2 285 64.9% 34.4% .7% 100.0% 134 63 6 203 66.0% 31.0% 3.0% 100.0% 61 22 83 73.5% 26.5% 100.0% 10 5 15 66.7% 33.3% 100.0% 168 132 4 304 55.3% 43.4% 1.3% 100.0% 58 18 76 76.3% 23.7% 100.0% 20 7 2 29 69.0% 24.1% 6.9% 100.0% 274 96 9 379 72.3% 25.3% 2.4% 100.0% 21 5 26 80.8% 19.2% 100.0% DOC Licensed Substance Abuse Programs Page 72 Appendix F: LSI-R Category Data Case Processing Summary Cases Valid N LSI-R Score Category * Offender Recidivism * Group Missing Percent 3649 90.8% N Total Percent 370 N 9.2% Percent 4019 100.0% Recidivism Rates by Comparison Group and LSI-R Category Group SA Need/No Prison Treatment LSI-R Category Low Low/Moderate Moderate Moderate/High High SA Need/Successful Prison Treatment Low Low/Moderate Moderate Moderate/High High Did Not Recidivate Recidivism Rates New Technical Conviction Violation Total Count 24 1 3 4 % 85.7% 3.6% 10.7% 14.3% Count 310 29 29 58 % 84.2% 7.9% 7.9% 15.8% Count 755 106 133 239 % 76.0% 10.7% 13.4% 24.0% Count 433 106 102 208 % 67.6% 16.5% 15.9% 32.4% Count 137 44 30 74 % 64.9% 20.9% 14.2% 35.1% Count 30 1 1 2 % 93.8% 3.1% 3.1% 6.2% Count 245 18 26 44 % 84.8% 6.2% 9.0% 15.2% Count 468 71 98 169 % 73.5% 11.1% 15.4% 26.5% Count 226 55 65 120 % 65.3% 15.9% 18.8% 34.7% Count 62 21 20 41 % 60.2% 20.4% 19.4% 39.8% DOC Licensed Substance Abuse Programs Page 73 Chi-Square Tests Group SA Need/No Prison Treatment Value Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association 54.080(a) 54.866 8 8 .000 .000 30.760 1 .000 8 .000 N of Valid Cases SA Need/Successful Prison Treatment Pearson Chi-Square Asymp. Sig. (2-sided) df 2242 48.410(b) Likelihood Ratio 51.273 8 .000 Linear-by-Linear 35.300 1 .000 Association N of Valid Cases 1407 a 2 cells (13.3%) have expected count less than 5. The minimum expected count is 3.57. b 2 cells (13.3%) have expected count less than 5. The minimum expected count is 3.78. ASP LSI-R Score Category Comparison Group SA Need/No Treatment Count ALTA Count Low % % TC Count % LUH Anamosa State Penitentiary Institution Location % of Offender Population with Substance Abuse Need within Each Risk Category by Program and Institution20 SA Need/No Treatment Count Luster Heights SAP Count % % 20 Low/ Moderate Moderate Moderate /High 11 47 36 7 101 10.9% 46.5% 35.6% 6.9% 100.0% Total High 6 41 20 5 72 8.3% 56.9% 27.8% 6.9% 100.0% 13 29 10 5 57 22.8% 50.9% 17.5% 8.8% 100.0% 4 10 8 1 23 17.4% 43.5% 34.8% 4.3% 100.0% 7 1 8 87.5% 12.5% 100.0% The approximation to the chi-square distribution breaks down if expected frequencies are too low. It will normally be acceptable so long as no more than 10% of the events have expected frequencies below 5. Unfortunately, that is not the case here. Because of the missing values, the distributions presented in the table can not be related to the entire population. CCF Page 74 LSI-R Score Category Comparison Group SA Need/No Treatment Count TOW Count Low/ Moderate Low % % CCFL Clarinda Correctional Facility Institution Location DOC Licensed Substance Abuse Programs SA Need/No Treatment Count TOW Count FDCF ICIW Fort Dodge Correctional Facility Iowa Correctional Institution for Women New Frontiers Count 20 43 50 27 141 14.2% 30.5% 35.5% 19.1% 100.0% 1 33 115 75 30 254 .4% 13.0% 45.3% 29.5% 11.8% 100.0% 7 25 9 7 48 14.6% 52.1% 18.8% 14.6% 100.0% SA Need/No Treatment Count STAR Count % % Violator's ProgramRegular @ ICIW Count WINGS Count Count Project TEA - Class Count 22 9 90 24.4% 10.0% 100.0% 144 106 40 326 44.2% 32.5% 12.3% 100.0% 1 29 115 63 17 225 .4% 12.9% 51.1% 28.0% 7.6% 100.0% 1 40 115 62 34 252 .4% 15.9% 45.6% 24.6% 13.5% 100.0% 4 32 17 3 56 7.1% 57.1% 30.4% 5.4% 100.0% 4 4 7 3 18 22.2% 22.2% 38.9% 16.7% 100.0% 2 21 48 26 11 108 1.9% 19.4% 44.4% 24.1% 10.2% 100.0% % 7 31 24 3 65 10.8% 47.7% 36.9% 4.6% 100.0% 1 FM3 % SA Need/No Treatment Count Project TEA Count % SA Need/No Treatment Count Project TEA Count 100.0% 100.0% 11 40 13 2 67 1.5% 16.4% 59.7% 19.4% 3.0% 100.0% % % 1 1 % JBU Iowa State Penitentiary FM1 % 45 50.0% 36 % SA Need/No Treatment 14 15.6% 11.0% % % Total High 1 % Count Moderate /High .7% % SA Need/No Treatment Moderate 3 9 1 13 23.1% 69.2% 7.7% 100.0% 10 41 17 9 77 13.0% 53.2% 22.1% 11.7% 100.0% 2 3 14 4 1 24 8.3% 12.5% 58.3% 16.7% 4.2% 100.0% MPCF CRC NCF Newton Correctional Facility Mount Pleasant Correctional Facility Institution Location DOC Licensed Substance Abuse Programs LSI-R Score Category Comparison Group SA Need/No Treatment Count SAP @ MPCF Count % SA Need/No Treatment Count SAT/Criminality Count % % Violator's Program Regular @ CRC Count SA Need/No Treatment Count IFI Count % % Count SA Need/No Treatment Count Journey Count % % Moderate Moderate /High Total High 5 39 85 42 8 179 2.8% 21.8% 47.5% 23.5% 4.5% 100.0% 3 47 121 73 19 263 1.1% 17.9% 46.0% 27.8% 7.2% 100.0% 10 62 75 32 9 188 5.3% 33.0% 39.9% 17.0% 4.8% 100.0% 3 30 26 15 74 4.1% 40.5% 35.1% 20.3% 100.0% % % NCCF Low/ Moderate Low % PCD North Central Correctional Facility Page 75 6 6 1 13 46.2% 46.2% 7.7% 100.0% 6 48 114 91 16 275 2.2% 17.5% 41.5% 33.1% 5.8% 100.0% 14 43 15 4 76 18.4% 56.6% 19.7% 5.3% 100.0% 2 4 14 9 29 6.9% 13.8% 48.3% 31.0% 100.0% 4 56 159 100 32 351 1.1% 16.0% 45.3% 28.5% 9.1% 100.0% 7 10 7 2 26 26.9% 38.5% 26.9% 7.7% 100.0% DOC Licensed Substance Abuse Programs Page 76 Appendix G: Community Supervision Data. Case Processing Summary Cases Valid N CBCIntCategory * Offender Recidivism Missing Percent 1335 N 89.5% Total Percent 156 N 10.5% 1491 Recidivism Rates for Offenders Successfully Completing Substance Abuse Treatment By Intervention in the Community CBC Intervention Type None Case Management Continuing Care Education Inpatient/Residential Treatment Outpatient Treatment 757 New Conviction 122 Recidivism Rates Technical Violation 160 Total 282 72.9% 11.7% 15.4% 27.1% Did Not Recidivate Count % Count % Count 8 1 3 4 66.7% 8.3% 25.0% 33.3% 86 12 34 46 % 65.2% 9.1% 25.8% 34.9% Count % 36 80.0% 5 11.1% 4 8.9% 9 20.0% Count % Count % 24 4 6 10 70.6% 11.8% 17.6% 29.4% 61 3 9 12 83.6% 4.1% 12.3% 16.4% Chi-Square Tests Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases Value 17.472(a) 17.602 .275 10 10 Asymp. Sig. (2-sided) .065 .062 1 .600 df 1335 a 4 cells (22.2%) have expected count less than 5. The minimum expected count is 1.32. Percent 100.0% DOC Licensed Substance Abuse Programs Page 77 Recidivism Rates by Comparison Group and Supervision after Release Supervision After Release No Yes Did Not Recidivate Group SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count SA Need/No Prison Treatment Count SA Need/Successful Prison Treatment Count % % % % Recidivism Rates New Technical Conviction Violation Total 543 116 3 119 82.0% 17.5% .5% 18.0% 124 33 0 33 79.0% 21.0% .0% 21.0% 1350 198 318 516 72.3% 10.6% 17.0% 27.6% 971 147 216 363 72.8% 11.0% 16.2% 27.2% DOC Licensed Substance Abuse Programs Page 78 Appendix H: Age Category Data. Recidivism Rates by Age Category and Comparison Group Comparison Group Age Category Did Not Recidivate Count Under 20 SA Need/Successful Prison Treatment 20 29 30 39 40 49 % Count % Count % Count % Count 50 & Over % Count Under 20 SA Need/No Prison Treatment 20 29 30 39 40 49 % Count % Count % Count % Count 50 & Over % New Conviction Recidivism Rates Technical Violation Total 4 3 0 3 57.1% 42.9% .0% 49.2% 446 93 115 208 68.2% 14.2% 17.6% 31.8% 312 52 63 115 73.1% 12.2% 14.8% 26.9% 270 31 36 67 80.1% 9.2% 10.7% 19.9% 62 1 2 3 95.4% 1.5% 3.1% 4.6% 33 7 5 12 73.3% 15.6% 11.1% 26.7% 677 142 138 280 70.7% 14.8% 14.4% 29.3% 574 100 92 192 74.9% 13.1% 12.0% 25.1% 490 60 68 128 79.3% 9.7% 11.0% 20.7% 119 5 18 23 83.8% 3.5% 12.7% 16.2% Age Groups by Location and Comparison Group Institution Location Comparison Group SA Need/No Treatment ASP Anamosa State Penitentiary Age at Release Under 40 and 40 Older ALTA TC SA Need/No Treatment LUH Luster Heights SAP Total Count 95 36 131 % 72.5% 27.5% 100.0% Count 65 15 80 % 81.3% 18.8% 100.0% Count 44 16 60 % 73.3% 26.7% 100.0% Count 22 6 28 % 78.6% 21.4% 100.0% Count 5 3 8 % 62.5% 37.5% 100.0% DOC Licensed Substance Abuse Programs Institution Location CCF TOW SA Need/No Treatment CCFL TOW Fort Dodge Correctional Facility SA Need/No Treatment FDCF New Frontiers SA Need/No Treatment Iowa Correctional Institution for Women STAR ICIW Violator's ProgramRegular @ ICIW WINGS SA Need/No Treatment FM1 Project TEA - Class Iowa State Penitentiary SA Need/No Treatment FM3 Project TEA SA Need/No Treatment JBU Project TEA Mount Pleasant Correctional Facility Age at Release Under 40 and 40 Older Comparison Group SA Need/No Treatment Clarinda Correctional Facility Page 79 SA Need/No Treatment MPCF SAP @ MPCF Total Count 104 54 158 % 65.8% 34.2% 100.0% Count 183 90 273 % 67.0% 33.0% 100.0% Count 35 15 50 % 70.0% 30.0% 100.0% Count 54 37 91 % 59.3% 40.7% 100.0% Count 352 15 367 % 95.9% 4.1% 100.0% Count 229 8 237 % 96.6% 3.4% 100.0% Count 187 93 280 % 66.8% 33.2% 100.0% Count 31 25 56 % 55.4% 44.6% 100.0% Count 16 3 19 % 84.2% 15.8% 100.0% Count 75 38 113 % 66.4% 33.6% 100.0% Count 34 33 67 % 50.7% 49.3% 100.0% Count 1 1 % 100.0% 100.0% Count 34 40 74 % 45.9% 54.1% 100.0% Count 8 6 14 % 57.1% 42.9% 100.0% Count 46 42 88 % 52.3% 47.7% 100.0% Count 11 13 24 % 45.8% 54.2% 100.0% Count 140 70 210 % 66.7% 33.3% 100.0% Count 204 81 285 % 71.6% 28.4% 100.0% DOC Licensed Substance Abuse Programs Institution Location SAT/Criminality Violator's Program Regular @ CRC Newton Correctional Facility SA Need/No Treatment NCF IFI PCD North Central Correctional Facility Age at Release Under 40 and 40 Older Comparison Group SA Need/No Treatment CRC Page 80 SA Need/No Treatment NCCF Journey Total Count 116 87 203 % 57.1% 42.9% 100.0% Count 53 30 83 % 63.9% 36.1% 100.0% Count 15 15 % 100.0% Count 216 88 100.0% 304 % 71.1% 28.9% 100.0% Count 53 23 76 % 69.7% 30.3% 100.0% Count 22 7 29 % 75.9% 24.1% 100.0% Count 261 118 379 % 68.9% 31.1% 100.0% Count 20 6 26 % 76.9% 23.1% 100.0% DOC Licensed Substance Abuse Programs Page 81 Appendix I: Race/Ethnicity Data. Recidivism Rates by Race/Ethnicity and Comparison Group Group Race/Ethnicity African American SA Need/No Prison Treatment Other Minority % Count % Count Caucasian % African American SA Need/Successful Prison Treatment Count Other Minority Count % Count % Count Caucasian % Did Not Recidivate New Conviction Recidivism Rates Technical Violation Total 350 85 98 533 65.7% 15.9% 18.4% 100.0% 88 19 17 124 71.0% 15.3% 13.7% 100.0% 1455 210 206 1871 77.8% 11.2% 11.0% 100.0% 190 49 67 306 62.1% 16.0% 21.9% 100.0% 60 7 13 80 75.0% 8.8% 16.3% 100.0% 845 124 136 1105 76.5% 11.2% 12.3% 100.0% African American Other Minority Caucasian 30 5 96 22.9% 3.8% 73.3% Race/Ethnicity by Institution and Comparison Group Institution Location Comparison Group SA Need/No Prison Treatment ASP Anamosa State Penitentiary ALTA TC LUH SA Need/No Prison Treatment Luster Heights SAP Count % Count % Count % Count % Count % 20 2 58 25.0% 2.5% 72.5% 12 1 47 20.0% 1.7% 78.3% 1 1 26 3.6% 3.6% 92.9% 8 100.0% DOC Licensed Substance Abuse Programs Institution Location CCF CCFL SA Need/No Prison Treatment SA Need/No Prison Treatment TOW Fort Dodge Correctional Facility FDCF SA Need/No Prison Treatment New Frontiers SA Need/No Prison Treatment Iowa Correctional Institution for Women STAR ICIW Violator's ProgramRegular @ ICIW WINGS FM1 SA Need/No Prison Treatment Project TEA - Class Iowa State Penitentiary FM3 SA Need/No Prison Treatment Project TEA JBU SA Need/No Prison Treatment Project TEA Mount Pleasant Correctional Facility MPCF African American Comparison Group TOW Clarinda Correctional Facility Page 82 SA Need/No Prison Treatment SAP @ MPCF Count % Count % Count % Count % Count % Count % Count % Count % Count % Count % Count % Other Minority 39 7 112 24.7% 4.4% 70.9% 47 24 202 17.2% 8.8% 74.0% 16 2 32 32.0% 4.0% 64.0% 16 5 70 17.6% 5.5% 76.9% 103 21 243 28.1% 5.7% 66.2% 62 16 160 26.1% 6.7% 67.2% 52 20 208 18.6% 7.1% 74.3% 6 2 48 10.7% 3.6% 85.7% 2 17 10.5% 89.5% 24 6 83 21.2% 5.3% 73.5% 13 2 52 19.4% 3.0% 77.6% Count 1 % Count % Count % Count % Count % Count % Count % Caucasian 100.0% 9 65 12.2% 87.8% 1 13 7.1% 92.9% 33 4 51 37.5% 4.5% 58.0% 8 3 13 33.3% 12.5% 54.2% 47 15 148 22.4% 7.1% 70.5% 76 16 193 26.7% 5.6% 67.7% DOC Licensed Substance Abuse Programs Institution Location Newton Correctional Facility NCF SAT/Criminality NCCF Count % Count % Violator's Program Regular @ CRC Count SA Need/No Prison Treatment Count IFI PCD North Central Correctional Facility African American Comparison Group SA Need/No Prison Treatment CRC Page 83 SA Need/No Prison Treatment Journey % % Count % Count % Count % Count % Other Minority Caucasian 24 8 171 11.8% 3.9% 84.2% 9 1 73 10.8% 1.2% 88.0% 3 1 11 20.0% 6.7% 73.3% 76 12 216 25.0% 3.9% 71.1% 5 2 69 6.6% 2.6% 90.8% 10 1 18 34.5% 3.4% 62.1% 53 19 307 14.0% 5.0% 81.0% 5 21 19.2% 80.8% DOC Licensed Substance Abuse Programs Page 84 Appendix J: Q12 Results. I know what is expected of me at work. Valid Missing Total Disagree Neutral Agree Strongly Agree Total System Frequency 3 2 20 11 36 19 55 Percent 5.5 3.6 36.4 20.0 65.5 34.5 100.0 Valid Percent 8.3 5.6 55.6 30.6 100.0 Cumulative Percent 8.3 13.9 69.4 100.0 I have the materials and equipment I need to do my work right. Valid Missing Total Disagree Neutral Agree Strongly Agree Total System Frequency 10 10 11 5 36 19 55 Percent 18.2 18.2 20.0 9.1 65.5 34.5 100.0 Valid Percent 27.8 27.8 30.6 13.9 100.0 Cumulative Percent 27.8 55.6 86.1 100.0 At work, I have the opportunity to do what I do best every day. Valid Missing Total Disagree Neutral Agree Strongly Agree Total System Frequency 8 7 14 7 36 19 55 Percent 14.5 12.7 25.5 12.7 65.5 34.5 100.0 Valid Percent 22.2 19.4 38.9 19.4 100.0 Cumulative Percent 22.2 41.7 80.6 100.0 DOC Licensed Substance Abuse Programs Page 85 In the last seven days, I have received recognition or praise for doing good work. Valid Missing Total Strongly Disagree Disagree Neutral Agree Strongly Agree Total System Frequency 3 11 11 7 4 36 19 55 Percent 5.5 20.0 20.0 12.7 7.3 65.5 34.5 100.0 Valid Percent 8.3 30.6 30.6 19.4 11.1 100.0 Cumulative Percent 8.3 38.9 69.4 88.9 100.0 My supervisor, or someone at work, seems to care about me as a person. Valid Missing Total Disagree Neutral Agree Strongly Agree Total System Frequency 2 6 19 9 36 19 55 Percent 3.6 10.9 34.5 16.4 65.5 34.5 100.0 Valid Percent 5.6 16.7 52.8 25.0 100.0 Cumulative Percent 5.6 22.2 75.0 100.0 There is someone at work who encourages my development. Valid Missing Total Strongly Disagree Disagree Neutral Agree Strongly Agree Total System Frequency 1 3 8 18 6 36 19 55 Percent 1.8 5.5 14.5 32.7 10.9 65.5 34.5 100.0 Valid Percent 2.8 8.3 22.2 50.0 16.7 100.0 Cumulative Percent 2.8 11.1 33.3 83.3 100.0 DOC Licensed Substance Abuse Programs Page 86 The mission or purpose of my company makes me feel my job is important. Valid Missing Total Disagree Neutral Agree Strongly Agree Total System Frequency 3 7 17 9 36 19 55 Percent 5.5 12.7 30.9 16.4 65.5 34.5 100.0 Valid Percent 8.3 19.4 47.2 25.0 100.0 Cumulative Percent 8.3 27.8 75.0 100.0 My associates or fellow employees are committed to doing quality work. Valid Missing Total Strongly Disagree Disagree Neutral Agree Strongly Agree Total System Frequency 2 1 7 18 8 36 19 55 Percent 3.6 1.8 12.7 32.7 14.5 65.5 34.5 100.0 Valid Percent 5.6 2.8 19.4 50.0 22.2 100.0 Cumulative Percent 5.6 8.3 27.8 77.8 100.0 At work, my opinions seem to count. Valid Missing Total Disagree Neutral Agree Strongly Agree Total System Frequency 7 10 13 6 36 19 55 Percent 12.7 18.2 23.6 10.9 65.5 34.5 100.0 Valid Percent 19.4 27.8 36.1 16.7 100.0 Cumulative Percent 19.4 47.2 83.3 100.0 DOC Licensed Substance Abuse Programs Page 87 I have a best friend at work. Valid Missing Total Strongly Disagree Disagree Neutral Agree Strongly Agree Total System Frequency 2 5 12 12 5 36 19 55 Percent 3.6 9.1 21.8 21.8 9.1 65.5 34.5 100.0 Valid Percent 5.6 13.9 33.3 33.3 13.9 100.0 Cumulative Percent 5.6 19.4 52.8 86.1 100.0 In the last six months, someone at work has talked to me about my progress. Valid Missing Total Disagree Neutral Agree Strongly Agree Total System Frequency 4 11 15 6 36 19 55 Percent 7.3 20.0 27.3 10.9 65.5 34.5 100.0 Valid Percent 11.1 30.6 41.7 16.7 100.0 Cumulative Percent 11.1 41.7 83.3 100.0 This last year, I have had opportunities at work to learn and grow. Valid Missing Total Disagree Neutral Agree Strongly Agree Total System Frequency 2 8 16 10 36 19 55 Percent 3.6 14.5 29.1 18.2 65.5 34.5 100.0 Valid Percent 5.6 22.2 44.4 27.8 100.0 Cumulative Percent 5.6 27.8 72.2 100.0 DOC Licensed Substance Abuse Programs This page intentionally left blank. Page 88 DOC Licensed Substance Abuse Programs This page intentionally left blank. 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