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Treatment of Incarcerated Women with Substance Use Disorder and Post-traumatic Stress Disorder in Providence, Rhode Island, 1999-2001
The goal of this study was to evaluate the initial efficacy, feasibility, and acceptability of Seeking Safety (SS) treatment in a sample of incarcerated women with comorbid substance use disorder (SUD) and comorbid post-traumatic stress disorder (PTSD). Seeking Safety, a cognitive-behavioral psychotherapy treatment, is a psychosocial treatment for women with comorbid PTSD and SUD and, at the time this study was conducted, it was the treatment with the most efficacy data for this population. SS treatment appears to be a promising intervention for incarcerated women with PTSD and SUD because (1) the treatment targets many of the deficits found in this population that may interfere with their recovery and place these women at risk for reoffending (such as impulsiveness, anger dyscontrol, and maladaptive lifestyle activities), and (2) it teaches skills to manage these problematic behaviors. This study aimed to conduct an open feasibility trial of Seeking Safety treatment in a sample of six incarcerated women with SUD and PTSD and to conduct a randomized controlled pilot study to evaluate the initial efficacy, feasibility, and acceptability of the proposed treatment as an adjunct to treatment as usual (TAU), compared to a TAU control group in a sample of 22 incarcerated women with comorbid PTSD and SUD. The primary hypothesis was that, compared to the TAU condition, women in the SS treatment condition would have less severe drug and alcohol use as well as fewer PTSD symptoms and legal problems after intervention, and at six weeks and three months after release. The first six participants recruited for the study received SS group treatment as an adjunct to the treatment provided by the Discovery Program, the substance abuse treatment program in the minimum security arm of the Women's Facility of the Adult Correctional Institution in Providence, Rhode Island. The remaining participants were randomly assigned to either the control group (TAU) or to a group that received SS treatment as an adjunct to TAU. The treatment groups were conducted by clinicians who worked as substance abuse therapists in the Discovery Program and a clinical psychologist from Brown University. All SS therapists received training in delivering SS therapy from Dr. Lisa Najavits, who developed SS treatment. Assessments were conducted at pretreatment, post-treatment during incarceration, and three and six months postrelease for PTSD-related measures. Measures of severity of substance abuse and legal problems were taken at pretreatment, as well as at the six- and 12-week postrelease intervals. Measures were taken with a variety of clinical instruments, including the Addiction Severity Index (ASI), the Structured Clinical Interview for DSM-IV (SCID) module on substance use, the Clinician Administered Post-Traumatic Stress Disorder Scale-I (CAPS-I), the Trauma History Questionnaire (THQ), the Helping Alliance Questionnaire-II (HAQ-II), the Client Satisfaction Questionnaire, and the End-of-Treatment Questionnaire. Basic demographic data were also collected from administrative records. Variables include alcohol, drug, and legal composite scores at pretreatment and post-treatment, number of relapses, whether the woman returned to prison, whether the woman lied about substance abuse, use of particular substances one month prior to prison and during lifetime, PTSD indicators of frequency and intensity, total client satisfaction scores, patients' ratings of therapists and treatment, and trauma scales for crime, sexual abuse, and physical abuse. Demographic variables include age, ethnic background, education, first time in prison, the nature of the current conviction, and number of arrests with convictions.
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National Study of Innovative and Promising Programs for Women Offenders, 1994-1995
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The purpose of this study was to conduct a national-scale evaluation of correctional facilities housing female offenders in order to assess the effectiveness of current programs, including alternative sanctions and treatment programs, and management practices. The goal was to gather information on "what works for which women" with respect to the program characteristics most related to positive outcomes. The first stage of the study consisted of gathering the opinions of administrators in state departments of corrections, including state-level administrators and administrators in institutions for women (Part 1). Administrators from jails that housed women were also interviewed (Part 2). Data collected for Parts 1 and 2 focused on attitudes toward the influx of women into jails and prisons, the needs of incarcerated women, and management and program approaches for meeting those needs. Respondents were asked to identify programs that in their view stood out as especially effective in meeting the needs of incarcerated women. From this list of nominated programs, researchers conducted 62 in-depth telephone interviews with administrators of programs located in jails, prisons, and the community (Part 3). A supplement to this study consisted of telephone interviews with 11 program directors who headed mental health programs that appeared to be "state of the art" for incarcerated women (Part 4). Variables in Parts 1-4 that concern the nominated programs include the underlying principles guiding the programs, whom the programs targeted, what types of staff were employed by the programs, the most positive effects of the programs, and whether program evaluations had been completed. Program effort variables found in Parts 1-4 cover whether the programs focused on trying to treat substance abuse, stop child abuse, provide women with nontraditional job skills, parenting skills, HIV/AIDS education, and life skills, change cognitive thinking, and/or promote self-esteem. Several variables common to Parts 1-3 include whether the programs provided women with follow-up/transitional help, helped to stimulate pre-release planning, allowed visits between women and children, or used ex-offenders, ex-substance users, volunteers, or outside community groups to work with the women. Variables focusing on the types of assessment tools used cover medical assessments, VD screening, reading/math ability screening, mental health screening, substance abuse screening, needs regarding children screening, and victim-spouse abuse screening. Variables pertaining to institution management include background knowledge needed to manage a facility, the types of management styles used for managing female offenders, security and other operational issues, problems with cross-sex supervision, and handling complaints. Similar variables across Parts 1, 2, and 4 deal with the impact of private or state funding, such as respondents' views on the positive and negative outcomes of privatization and of using state services. Both Parts 1 and 2 contain information on respondents' views regarding the unique needs of women offenders, which programs were especially for women, and which program needs were more serious than others. Planning variables in Parts 1 and 2 include whether there were plans to have institutions link with other state agencies, and which programs were most in need of expansion. Further common variables concerned the influx of women in prison, including how administrators were dealing with the increasing number of women offenders, whether the facilities were originally designed for women, how the facilities adapted for women, and the number of women currently in the facilities. In addition, Part 1 contains unique variables on alternative, intermediate sanction options for women, such as the percentage of women sent to day supervision/treatment and sent to work release centers, why it was possible to use intermediate sanctions, and how decisions were made to use
Process Evaluation of the Gender Appropriateness of the Residential Substance Abuse Treatment (RSAT) Program at Baylor Women's Correctional Institute, 1999-2001
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The overall goals of the process evaluation were to assess the participants' views on the Residential Substance Abuse Treatment (RSAT), a Therapeutic Community program at Baylor Women's Correctional Institute, and to determine whether the women thought the program met their needs specifically based on gender. The specific goals of the study were: (1) to determine drop-out points along the continuum of the treatment model and to review the case files to discover any patterns in client participation and review demographic data in the program, and (2) to assess what current participants thought about the program and treatment model. For Part 1, Recent Graduate Data, data were secured from case files of women who had been discharged from the Therapeutic Community (Key Village) program in Baylor Women's Correctional Institute in 1999. This analysis was used to prepare the survey instrument used for the interviews given to the women currently participating in the program. For Part 2, Client Assessment Satisfaction Data, the current residents of the program were interviewed. During fall of 2000 and spring of 2001, a survey was developed to assess how the current participants viewed the Key Program. The questions were intended to gather information to assess the gender appropriateness of the program. A database was constructed to search for any consistencies or variables that would address the issue of gender appropriateness or lack of such in the operation of the program from the participants' point of view. During the interview period there were a total of 88 women in the Key Program. Of the 88 women, 76 agreed to participate in the study. For Part 1, the variables cover demographic data, criminal history information, medical information, prior drug treatment histories, and program success or failure. Part 2 variables cover demographic information, and questions dealing with prior drug use, the first four weeks of the program, the confrontation aspects of the program, sanctions and program rules, staff/participant interaction, program activities and responsibilities as opposed to the general population, readiness for change, support systems, children's visits and children as motivation, physical aspects of the program, mental health, the need for additional vocational and educational services, significant aspects and experiences from the program, and desired changes to the program.
Outcome Evaluation of the Forever Free Residential Substance Abuse Treatment (RSAT) Program at the California Institution for Women, 1997-2000
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This study was an outcome evaluation of the Forever Free Substance Abuse Treatment Program at the California Institution for Women (CIW). Data were collected from 119 women who entered Forever Free between October 1997 and June 1998. Comparison data were collected from 96 women enrolled in Life Plan for Recovery, an eight-week substance abuse education course at CIW, between April and November 1998. Program participants completed an intake questionnaire, approximately one month after the beginning of treatment, designed to collect information on background, therapeutic alliance with counselors, group identification with fellow participants, treatment motivation, and psychological status. Members of the comparison group completed an intake form that collected background information. Treatment participants completed a pre-release form before leaving the program, which collected information on clients' therapeutic alliance with their counselors, psychological status, drug-related locus of control, and post-release treatment plans. Women in both groups participated in 12-month follow-up interviews between September 1999 and August 2000, which were used to update background information and collect information on subjects' relationships with their children, drug use since release, substance abuse treatment since release, vocational training since release, services needed and received, social support, current treatment motivation, psychological status, and drug-related locus of control. Reincarceration data for the entire sample were obtained from the Offender-Based Information System, a database maintained by the California Department of Corrections.
Outcome Evaluation of the Wisconsin Residential Substance Abuse Treatment (RSAT) Program: The Mental Illness Chemical Abuse (MICA) Program at Oshkosh Correctional Institution, 1997-2000
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This study evaluated the Mental Illness-Chemical Abuse (MICA) Program at Oshkosh Correctional Institution in Wisconsin. MICA is a residential substance abuse treatment program that consists of three stages: (1) an 8- to 12-month residential therapeutic community stage, (2) an institutional aftercare stage, and (3) a community aftercare stage. This outcome study documented important aspects of program implementation and effectiveness. It included all 141 inmates admitted to MICA between October 1997 and March 2000. A control group comprised of 66 inmates who were too close to their mandatory release dates to participate in the program but who were otherwise eligible was also included. Data were gathered from Department of Corrections administrative records regarding admissions information, assessment results, institutional behavior, institutional placement and services after program completion or exit, and recidivism. MICA staff provided information on treatment progress, behavior, and mental health status. MICA outreach specialists provided three-month post-release data on community outcomes for MICA graduates. Parole agents provided three-month post-release data on parole compliance and recidivism for all study participants. Variables include assessment results, institutional services received, history of incarceration, urinalysis testing, changes in mental health status and program behavior throughout treatment, clinical test results, conduct reports, institutional placement and services after MICA, whether the individual had appropriate resources upon release to the community, parole status, recidivism, mental health and chemical use status after release, support services provided by MICA staff after release, and other support services received after release.
Outcome Evaluation of the Residential Substance Abuse Treatment (RSAT) Program for State Prisoners in Massachusetts, 1999-2002
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This study was an outcome evaluation of the Residential Substance Abuse Treatment (RSAT) program at the Barnstable House of Corrections in Massachusetts. The study is based on the 188 inmates referred to the RSAT program at Barnstable between January 1, 1999, and June 6, 2001. Data on participants' criminal histories were gathered from the Criminal History Systems Board through March 2002. Data on offender age, entry, and discharge dates were supplied by the Barnstable County House of Corrections. Data from offender scores on psychological inventories and offender outcomes in the RSAT program were supplied by AdCare Criminal Justice Services.
Evaluation of the Pine Lodge Pre-Release Residential Therapeutic Community for Women Offenders in Washington State, 1996-2001
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In 1996, Washington State's Department of Corrections (DOC) implemented "New Horizons" (referred to as "First Chance" from its inception in late 1996 to early 2000), a residential therapeutic treatment community for drug-addicted women offenders housed within the Pine Lodge Pre-Release minimum security and co-ed facility in the northeastern part of the state. The target population for the program was women who had been screened and identified as having a serious substance abuse problem and who had 12 months or less to serve on their sentences. Maximum capacity for this program was established at 72 treatment slots with members of the therapeutic community residing together and separate from the rest of the general population. The program approaches addiction as a biopsychosocial disease and strives to restructure and develop pro-social cognitive, behavioral, and affective skills of addicted women offenders. This study investigated (1) factors that affected successful completion of the program, and (2) outcomes (i.e., recidivism) for Pine Lodge participants compared to outcomes for a control group. This project was funded by the National Institute Justice as part of its initiative for local evaluations of prison-based residential substance abuse treatment programs. Data represent an outcome evaluation for Pine Lodge residents compared to outcomes for a matched control group provided by the Washington State Department of Corrections. Through a case-by-case examination of the datasets from Pine Lodge and the Washington State DOC, the researchers created a data file that contained program completion/non-completion data and demographic variables for 322 Pine Lodge participants and a control group of 279 women. Variables include the month and year admitted to the Pine Lodge program, reason for leaving the program, race/ethnicity, crime committed, month and year started the program, sentence length, age, number of months in the program, education level, number of previous offenses, number of months at risk to reoffend, whether reconvicted after release, number of months between release and reconviction, and reconviction offense.
Women Coping in Prison at the Fluvanna Correctional Center for Women in Virginia, 1999-2000
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This study contributed to the growing interest in mental illness and impairment among incarcerated individuals. It focused on the larger spectrum of psychopathology that characterized the general, nonhospitalized population at the Fluvanna Correctional Center for Women in Virginia. Part 1 consists of clinical data obtained through several questionnaires completed by a sample of 812 inmates between April 1999 and January 2000. Parts 2 through 4 consist of additional clinical data on subsamples of the Part 1 sample that were obtained between June 1999 and July 2000 through interviews and self-enumerated questionnaires. Part 5 contains data on inmate behavior and attitudes obtained through questionnaires completed by correctional officers.
Process and Outcome Evaluation of the Residential Substance Abuse Treatment (RSAT) Program in Kyle, Texas, 1993-1995
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This study was undertaken to evaluate the treatment process and outcomes associated with a Residential Substance Abuse Treatment (RSAT) In-Prison Therapeutic Community (ITC) component of the 1991 Texas Criminal Justice Chemical Dependency Treatment Initiative, as well as to assess the effectiveness of prison-based drug treatment. Specifically, this study evaluated the RSAT ITC treatment process and outcomes in Kyle, Texas, using the prison-based treatment assessment (PTA) data systems. The study design included process and outcome evaluations using a sample of graduates from the first ITC treatment facility (Kyle cohort) and a matched comparison group of prison inmates who were eligible, but not selected, for assignment to an ITC. Data collection occurred at three points in time -- at the end of treatment in the Kyle ITC, and at six months and one year following an offender's release from the ITC program. Variables in the 19 files for this study include: Part 1 (Educational Demographic Data, Kyle Cohort): Highest grade level achieved by respondent, Texas Department of Criminal Justice education achievement and IQ scores, and the number of days at the Kyle ITC program. Parts 2-4 (Treatment Background Data, Kyle Cohort, Aftercare Treatment Data, Kyle Cohort, Treatment Condition Data, Kyle Cohort): Treatment condition, discharge codes, and whether there were three months of residential aftercare. Part 5 (Session One Interview Data, Kyle Cohort): Gender, ethnicity, age, marital status, whether the respondent was given medication, followed directions, made friends, or got into trouble while in elementary school, whether he held a job prior to prison, if either of his parents spent time with, yelled at, or sexually abused him, whether he used drugs, if so, specific drugs used (e.g., alcohol, inhalants, marijuana, or crack), and whether he did jail time. Part 6 (Session Two Interview Data, Kyle Cohort): Whether drugs kept the respondent from working, caused emotional problems, or caused medical problems, if people were important to the respondent, if he had trouble staying focused, felt sad or depressed, satisfied with life, lonely, nervous, or got mad easily, whether he felt the staff was caring and helpful, whether he showed concern for the group and accepted confrontation by the group, whether the respondent felt the counselor was easy to talk to, respected him, or taught him problem-solving, and whether the respondent viewed himself as thinking clearly, clearly expressing thoughts, and was interested in treatment. Part 7 (Session Three Interview Data, Kyle Cohort): How the respondent saw himself as a child, whether he was easily distracted, anxious, nervous, inattentive, short-tempered, stubborn, depressed, rebellious, irritable, moody, angry, or impulsive, whether the respondent had trouble with school, was considered normal by friends, ever lost a job or friends due to drinking or drug abuse, or was ever arrested or hospitalized for drug or alcohol abuse, and in the last week whether the respondent's mood was one of sadness, satisfaction, disappointment, irritation, or suicide. Parts 8 and 9 (Six-Month Follow-Up Interview Data, Kyle Cohort, and One-Year Follow-Up Interview Data, Kyle Cohort): Organization of meetings and activities in the program, rules and regulations, work assignments, privileges, individual counseling, the care and helpfulness of the treatment staff and custody staff, the respondent's behavior, mood, living situation, drug use, and arrests within the last six months, whether the counselor was easy to talk to, helped in motivating or building confidence, or assisted in making a treatment plan, whether the respondent felt a sense of family or closeness, if his family got along, enjoyed being together, got drunk together, used drugs together, or had arguments or fights, if the respondent had a job in the last six months to a year and if he enjoyed working, whether he was on time for his job, whether he had new
Process Evaluation of the Residential Substance Abuse Treatment Program at the Minnesota Department of Corrections, 1999
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The objective of this process evaluation was to evaluate the integrity of the Minnesota Correctional Facility (MCF)-Red Wing Residential Substance Abuse Treatment (RSAT) program service delivery system in order to (1) provide feedback designed to enhance the existing strengths of the RSAT program and improve any existing or potential weaknesses, and (2) prepare for a subsequent outcome evaluation. The process evaluation data consist of two administrations of the Correctional Institution Environment Scale (CIES) (Parts 1 and 2) and three rounds of Rating of Facilitation of RSAT Groups (Parts 3-5). Resident-participants in this study were male juvenile offenders incarcerated at the MCF-Red Wing who had been determined to have significant substance abuse problems as an aspect of their delinquency. A total of 69 residents participated in the RSAT program during the course of the evaluation. All RSAT program residents were required to participate in all aspects of the program. Four caseworkers, one chemical dependency counselor, and two teachers participated in all aspects of the process evaluation. Ten corrections officers and three administrators participated in the CIES administration. There are four forms of the Correctional Institution Environment Scale (CIES): (1) The Real Form (Form R), (2) the Short Form (Form S), (3) the Ideal Form (Form I), and (4) the Expectations Form (Form E). Form R and Form I were employed in this study. Form R measures resident and staff perceptions of the current or "actual" climate of the program. Form I is worded to allow residents and staff to answer questions in terms of an ideal program. Both forms are comprised of 90 true-false statements. The CIES was administered twice for this study, with the first administration in September 1999. Participants in this administration of the CIES were 28 residents of the Princeton Cottage (the cottage that housed the RSAT participants) and 12 staff (administrators, caseworkers, and corrections officers). The second administration was in December 1999. Participants in this administration were 25 residents of the Princeton Cottage and 10 staff (administrators, caseworkers, and corrections officers). The surveys were collected and sent to Marquette University investigators for scoring and interpretation. An extensive evaluation of group facilitation was undertaken, with all groups videotaped between May 1999 and September 1999. These videotapes were shipped to Marquette University for review. In total, 122 videotapes were reviewed and rated. Two randomly selected raters evaluated each tape on the 22-item Red Wing Global Scale developed for this evaluation. The primary components of the sessions evaluated by the rating scale involved (1) the adherence of the facilitators to the treatment model, (2) the skill level of the facilitators, and (3) the contribution of the residents to the group processes. Following training, the raters began rating the videotapes in a progression of three rounds (each round consisting of a month) conducted in June, August, and October of 1999.
Effect of Prison Based Alcohol Treatment: Treatment and Recidivism Data from Montana, Ohio, and Texas, 2006-2012
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This study evaluated program design, quality of treatment delivery, and program effectiveness of three separate state sponsored alcohol specific treatment programs in prisons located in Montana, Ohio, and Texas from 2006 to 2012.