Bringing Excellence To Substance Abuse Services in Rural And Frontier America
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Catherine E. Bartels, M.Ed., CCDC III
Administrator, Corrections Substance Abuse Program
South Dakota Department of Human Services
Division of Alcohol and Drug Abuse
Pierre, South Dakota
| Abstract
The South Dakota Corrections Substance Abuse Program, which began in 1988, has grown and evolved to include a full array of chemical dependency services at all adult and juvenile corrections institutions plus referral and collaboration with community-based alcohol/drug agencies for parolees. The program content for the institutional chemical dependency program is focused on the link between criminal behavior and chemical use, and the program format is specific to offenders. This program utilizes the cognitive ôCriminal Thought Processö approach in combination with 12-step therapeutic materials. Chemical dependency services in the three State adult correctional facilities include chemical dependency assessments on all incoming inmates based on DSM-IV criteria; pretreatment services and intensive chemical dependency treatment for those adults who have a chemical dependency diagnosis; relapse prevention; individual counseling; Alcoholics Anonymous and Narcotics Anonymous (AA/NA) opportunities; crisis intervention; referral to community-based programs; and program evaluation and outcome measures. Chemical dependency services provided in the three State juvenile correctional facilities include all of those listed above for adult programs plus prevention education groups. |
In 1988, the South Dakota Department of Corrections determined through the use of chemical dependency assessments conducted with adult inmates, and reviews of adult and juvenile criminal histories, that at least 70 percent of the juveniles and 80 percent of the adults in Department of Corrections facilities had alcohol and other drug problems that were not being addressed. The decision was made by the Department of Corrections to apply to the South Dakota Attorney General's Task Force on Drugs for funding for chemical dependency programming in correctional facilities under the State and Local Law Enforcement Assistance Programs Anti-Drug Abuse Act of 1988. The application for funding was approved, and the program began in 1988.
Since the program began, it has expanded and evolved to provide a continuum of chemical dependency services to adult and juvenile offenders while they are incarcerated and while they are supervised in communities after institutional release. The institutional chemical dependency units, which are all located in South Dakota Department of Corrections facilities, are State-accredited programs staffed by certified chemical dependency counselors who are employees of the State.
During State Fiscal Year 1995, a total of 925 adults and 273 juveniles received chemical dependency assessments in South Dakota correctional facilities. Of these, about 80 percent of the adults and 68 percent of the juveniles had a diagnosis of substance abuse, using DSM-IV criteria. During this same time frame, 428 adults and 154 adolescents completed chemical dependency treatment in correctional institutions. Those who complete these treatment programs are referred to community-based agencies when they exit the institutions.
The three South Dakota institutional chemical dependency programs for adults are located at the South Dakota State Penitentiary in Sioux Falls, the Springfield State Prison, and the Yankton Trusty Unit. The juvenile institutional chemical dependency programs are located at the State Training School in Plankinton, the Youth Forestry Camp in Custer State Park, and the Lamont Youth Development Center located in Redfield. A total of 21 chemical dependency counselors provide a full range of services in these facilities.
Linkages between the institutional programs and community-based agencies and between State entities have been established through interagency agreements and memoranda of understanding so that offenders may be served throughout their involvement with the criminal justice system.
The mission of the Corrections Substance Abuse Program is to provide a continuum of quality chemical dependency services to adult and juvenile offenders. This will give them the knowledge and tools to live chemically free lifestyles, which will enhance their opportunity for successful community reintegration following release from custody and/or supervision.
While the programs have changed in many aspects since 1988, the primary goal of providing the appropriate level of service based on detailed assessment data and diagnoses has always been a foremost concern. Another basic tenet of the program has been the recognized need for integration and acceptance of chemical dependency services within each institution. The level of program integration and acceptance is different in each of the facilities based on the level of institutional security needs, the level of other programming available, the institutional organizational hierarchies that are in place, and the physical locations at each facility for substance abuse program provision.
Those adults and juveniles who have received chemical dependency treatment services while they are incarcerated are referred to community-based agencies for continuing care and related services upon institutional release. Adults on parole are supervised by Parole Agents who are employees of the Department of Corrections. Juveniles on aftercare are supervised by Court Services Officers who are employees of the Unified Judicial System. Employees of the institutional chemical dependency programs, Parole Services, Court Services, community-based agencies, and the Division of Alcohol and Drug Abuse have a great deal of contact with each other in order to provide an appropriate level of continuing services to offenders after they leave correctional facilities.
The following section will describe the methods used to screen, assess, and provide appropriate service delivery to the juveniles and adults in Department of Corrections facilities.
A variety of validated screening and assessment tools for juveniles and adults are available and used during the assessment process. Each adult and juvenile inmate completes a battery of written screening and assessment tools and a structured interview that delineates the effects of alcohol and drugs on nine critical life areas. Diagnoses are based on the DSM-IV criteria for substance abuse related disorders. The level and type of institutional services received are based on the results of the assessment, program availability, and length of sentences or parole dates.
All of the chemical dependency counselors in the Corrections Substance Abuse Program are trained in the cognitive theory based Criminal Thought Process Model, which is integrated with the 12-step based therapeutic model. Abstinence from all mood-altering chemicals and abstinence from criminal behavior are the two key programmatic goals. Issues related to personal responsibility and accountability are at the forefront of programming along with education about the progression of the disease of chemical dependency and the effects of chemical use on self and others.
Approximately 20 percent of the adults and juveniles who receive chemical dependency services in the correctional facilities are Native American. While separate programming for Native Americans is not offered, all of the counselors are trained in issues related to Native American cultural and spiritual values. Most of the counselors have received training in the Red Road approach to chemical dependency treatment for Native Americans, and sweat lodges, pow-wows, and other self-help groups specifically for Native Americans are available at the correctional facilities.
The services offered at each of the Department of Corrections institutional chemical dependency program are described next.
All male adults sentenced to the Department of Corrections receive a chemical dependency assessment as well as medical, mental health, educational, and vocational assessments at the Orientation and Induction Unit of this facility. The inmates who receive chemical dependency treatment services at the penitentiary must be at the minimum custody level before receiving treatment.
All chemical dependency programming at this all-male, multicustody level facility is provided at the West Farm Unit, which is located 12 miles from Sioux Falls. The specific chemical dependency services provided at this unit include pretreatment services and treatment. The inmates who receive these services are housed together at the West Farm and are separated from other inmates. Three chemical dependency counselors provide the services at the West Farm.
The pretreatment program consists of a 24-hour, 4-week educational and group treatment format. Subjects covered include alcohol and drug effects information, the use of criminal thinking errors and tactics to avoid responsibility, and the development of written chemical use and criminal behavior histories. The goal of this program is to help inmates prepare for treatment by decreasing denial and resistance and increasing self-knowledge about the effects of chemical use and criminal activity on their lives.
The intensive treatment program at this facility consists of 72 hours of programming over 6 weeks. The format includes didactic presentations, group therapy, and individual therapy, combined with Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) attendance. The last 2 weeks of programming are basically devoted to relapse prevention education and the development of individual relapse prevention and aftercare plans.
Springfield State Prison is a medium security coed prison with an emphasis on vocational and chemical dependency programming. The inmates who are involved in chemical dependency programming are housed separately from the general population. Seven chemical dependency counselors provide the treatment services at this unit. The men at this prison receive chemical dependency assessments at the State Penitentiary prior to transfer to Springfield, and the women receive their assessments at Springfield.
A phased treatment program modality is in place at this facility. All inmates with a chemical dependency diagnosis attend a 100-hour, 4-week, basic treatment program that consists of didactic presentations, group therapy, and individual therapy combined with AA/NA attendance. Following completion of this phase, inmates may enter one of three programs depending on an objective assessment of progress during the first phase. Some inmates move directly to the continuing care program, but most enter either the Advanced Treatment or the New Beginnings group. The Advanced Treatment group is designed for those who made progress during the first phase, and the New Beginnings group is for those inmates who are more entrenched in chemical use and criminal thinking.
Chemical dependency pretreatment services and treatment similar to that offered at the South Dakota State Penitentiary are currently available at this minimum security unit. Plans for a 40-bed therapeutic community are developing with a start date scheduled for November 1996. Currently, two counselors provide the chemical dependency services at this unit, and when the new programming begins, another counselor will be added.
All adults who complete treatment at one of the above institutional chemical dependency programs are referred to community-based chemical dependency programs following institutional releases. Funding has been established for community-based chemical dependency aftercare programming for parolees. The community-based services for parolees may include transitional care, custodial care, aftercare groups, family and individual counseling, and case management services in which the parolees, the service providers, and the Parole Agents establish the parole chemical dependency services plan.
A full range of chemical dependency services are available at this 105-bed coed facility for adjudicated juveniles. Five chemical dependency counselors provide the services, which are integrated and coordinated with all other program areas and services at this institution. The institutional therapeutic approach is the Positive Peer Culture, which works well with the model that has been developed for chemical dependency services delivery. The approach integrates the cognitive/behavioral Criminal Thought Process model with a 12-step based practical and philosophical program.
Each new juvenile admitted to this facility has complete chemical dependency assessment, and the services that are provided are based on the results of the assessment. Those who do not have a DSM-IV chemical abuse or dependency diagnosis are referred to the Prevention Education Program. Those who do have a dependency or abuse diagnosis are referred to the Pre-Treatment Program, where issues regarding denial, the effects of chemical use, and criminal activity are addressed. After completing the pretreatment component, these juveniles are referred to the Adolescent Intensive Treatment Program. This 70-hour program consists of educational presentations, group therapy, individual counseling, and AA/NA attendance. Those who complete the treatment program are then referred to the Continuing Care Program, where individual relapse prevention and aftercare plans are developed.
This 54-bed all-male correctional facility is located within the Custer State Park. The boys who are in this facility are involved in park maintenance and fire suppression activities as well as school and therapeutic programs. The chemical dependency program components at this facility are very similar to those at the State Training School. Two chemical dependency counselors provide assessments, prevention education, pretreatment services, intensive treatment, and continuing care.
The Lamont Youth Development Center is a 24-bed all-female correctional facility located in Redfield, South Dakota. This program for girls has a full range of chemical dependency services that are similar to those offered at the State Training School and the Youth Forestry Camp. Because this is an all-female facility, additional program activities are provided that are more pertinent to females such as abuse issues, eating disorders and self-image, and co-dependency.
All juveniles who complete the treatment program at one of the three juvenile correctional facilities are referred to community-based alcohol and other drug (AOD) programs for aftercare services. The juveniles are supervised by Court Services Officers following institutional release.
Assessment data for all persons, both youth and adults, who are clients of one of the Corrections Substance Abuse Programs, are collected by three questionnaires. A client's assessment questionnaire, administered at the completion of the treatment program, is used to obtain the client's perception of the usefulness of various aspects of the program. The counselors' assessment of the client's progress is also completed at the conclusion of the treatment program. The records are fairly complete for the client and counselor assessments. The third form administered is a followup form designed to measure client outcomes in the areas of arrests, substance use, work status, educational program attendance, and other progress while on supervision.
The followup information for the youths comes from Court Services Officers after 3 months of probation following discharge from one of the three juvenile corrections programs. Followup information is available on about three-quarters of the youths.
Followup information for adult clients is obtained from parole
officers who supervise former clients of the institutional treatment programs who have been paroled. Information is available on approximately one-half of the former inmates who have completed a substance abuse treatment program while incarcerated. Information is not available on former clients who are directly discharged from the institutions and not placed on parole or who are paroled to other States.
The clients give very high ratings to the programs. The clients are especially impressed with the counselors, the group and individual counseling, and the overall program. Overall, about 90 percent of the clients rated important aspects of the program as good or excellent. About 96 percent of the clients who completed the treatment programs indicated that they would recommend the program to other people.
After 3 months of supervision, the youths were found to have an abstinence rate for alcohol of 61.7 percent. The abstinence rate for all substance use of those from the juvenile program was a very respectable 58.9 percent. Alcohol is the main substance of use and abuse of young and old in South Dakota.
About one-half (49 percent) of the juveniles with poor relationships with persons in their homes were arrested while they were on probation, while only 10.2 percent with good relationships were arrested while on probation. Nearly one-half (46.7 percent) of the juveniles with poor progress in academic areas were arrested while they were on probation, while only 6.2 percent with good progress were arrested while they were on probation. More than one-half (52.4 percent) of the juveniles with poor progress in vocational areas were arrested while they were on probation, while only 6.1 percent with good vocational progress were arrested while on probation.
After an average of 13.5 months of parole supervision, the former adult clients had an abstinence rate of 58.2 percent for alcohol. The abstinence rate for all substance use of those from the adult programs was 57.7 percent.
Those who attended community-based aftercare and AA/NA were much more likely to have successful outcomes (abstinent, not arrested, did not violate parole, did not abscond) than those who did not take part in these services.
Those with higher levels of education were less likely to be using substances. In general, people with favorable ratings of the institutional treatment program were less likely to violate parole or to be using chemicals following institutional release. Other results demonstrated that those who were working were less likely to violate parole, be arrested, abscond from parole, or use mood-altering chemicals.
From the inception of the program, the Secretary of the Department of Corrections was very supportive of chemical dependency services in the correctional institutions. The Secretary fought for the creation of new chemical dependency counselor positions in the department, and she directed that the programs be implemented within the adult and juvenile corrections institutions. In order to decrease administrative functions and consolidate fiscal and programmatic efforts, the employees and the funding for the Corrections Substances Abuse Program moved from the Department of Corrections to the Department of Human Services, Division of Alcohol and Drug Abuse, in August 1995. This decision was made with the approval of the Governor and the Secretaries of the Departments of Human Services and Corrections. This illustrates the point that the success of programming efforts in correctional facilities must have the support of key decisionmakers in order to develop and maintain viability.
Early in the program development and implementation process, a few of the institutional administrators and security staff were not supportive of chemical dependency services. Additionally, institutional educational and vocational program staff were concerned that their time and programming efforts with inmates would be decreased because of the new chemical dependency programming. There was a period of tension, adjustment, and gradual accommodation in all of the institutions as the programs became operational.
Much of the opposition to chemical dependency services diminished as the institutional program and security staff began to realize that inmates were easier to work with and more motivated after they had completed chemical dependency programming. Chemical dependency counselors now sit on inmate classification boards and disciplinary hearing teams, and provide information to the Parole Board. They also provide preservice training to all new institutional staff on the criminal thought process model and chemical dependency issues so that all employees are familiar with what the program is attempting to accomplish. Inmates who have chemical dependency treatment needs do not move through the prison system until they complete programming, so all employees are working toward assisting inmates achieve the needed level of programming.
Another reason for gradual acceptance of the chemical dependency staff and programming efforts is that a concerted effort has been made to cooperate with other programs and institutional areas such as security, food services, and medical units. The chemical dependency programs have always operated under the caveat that institutional security is a priority and that programming must conform to security needs.
In the juvenile institutions, where there is a greater overall therapeutic emphasis than in the adult institutions, the chemical dependency units are integrated into the facility-wide programming. The chemical dependency counselors are part of the ôtreatment team,ö and the various programs work together and share information freely.
Many of the institutional chemical dependency counselors came to the corrections system from community-based programs, where they had infrequent contact with offenders. These counselors implemented the program content and philosophy that they had applied in other settings and were frustrated when they did not obtain similar positive results. In 1992, all of the State corrections chemical dependency counselors attended training provided by Koerner and Fawcett, Inc. on the Criminal Thought Process. The Criminal Thought Process model incorporates material from Stanton Samenow's and Samuel Yochelson's research on criminal personalities. The curriculum offers a practical approach for working with offenders and also incorporates the principles of the 12-Steps Program.5
Since 1992, the Criminal Thought Process has become integrated into all correctional chemical dependency program elements. Many of the counselors have attended additional training, and several have become Corrective Thinking Specialists and are training others in the model. Parole Agents throughout the State have also been trained in the model, and many counselors from community-based agencies have received training. Inmate-facilitated Criminal Thinking self-help groups have begun in the prison system and several inmates have stated that they plan to implement these groups in their communities after institutional release.
When those adults and juveniles who receive chemical dependency treatment in the institutions are released from custody, they are to be referred to community-based agencies for aftercare services. Juveniles are supervised by Court Services Officers following institutional discharge, and adults who are paroled are supervised in the communities by Parole Agents.
In the past, when juveniles were released from correctional institutions and returned to their communities, they often did not contact the community-based agency for aftercare, and the Court Services Officers were often not aware of an individual's failure to attend aftercare sessions. In response to this problem, an interagency agreement was developed between the Department of Corrections, the Department of Human Services, and the Unified Judicial System, which delineated the responsibilities of each agency and the intent that juveniles with a chemical dependency diagnosis who leave correctional institutions under the supervision of the courts will attend community-based aftercare. While this has been a positive step, there still remains more work to be done to keep juveniles involved in chemical dependency services as they make the transition from one agency and program to the next.
In the adult system, many adults on parole also did not receive community-based aftercare services. One reason for this is that there was no funding for the services, and Parole Agents were reluctant to insist that parolees attend aftercare when they could not afford to pay for the service. A pool of money was made available through the Division of Alcohol and Drug Abuse for community-based chemical dependency services for parolees. The State-accredited agency directors who provide the services signed agreements delineating their responsibilities and agreeing to develop programming specifically for offenders. As in the case for juveniles, adults who leave the institutions are not always involved in aftercare when they return to their communities even though funding is now available for the services. More education is needed for Parole Agents on the nature of chemical dependency and the benefits of aftercare. Education is also needed for the community-based agencies on the special characteristics and needs of offenders in order to make the program more widely accepted and utilized.
A continuum of chemical dependency services has been developed and implemented for chemically dependent adults and juveniles in the South Dakota Department of Corrections facilities. These programs have become specific to serve the characteristics and needs of offenders. Many of these adults and juveniles would require inpatient treatment services if they were not incarcerated because of the severity of their chemical use and their lack of an adequate community support system.
The latest analysis of costs for the program indicates that the per-adult inmate cost of treatment is $840; the cost for each juvenile to complete treatment is $960. This is about half of the cost for outpatient treatment in community-based programs and is less than one-sixth of the cost for inpatient treatment in South Dakota.
Arbogast, D. Wounded Warriors: A Time for Healing. Omaha, NE: Little Turtle Publications, 1995.
Samenow, S. Inside the Criminal Mind. New York: Times Books, 1984.
Yochelson, S., and Samenow, S.E. The Criminal Personality: A Profile for Change. Vol. 1. Northvale, NJ: Jason Aronson, 1976.
Yochelson, S., and Samenow, S.E. The Criminal Personality: The Change Process. Vol. 2. Northvale, NJ: Jason Aronson, 1977.
Yochelson, S., and Samenow, S.E. The Criminal Personality: The Drug User. Vol. 3. Northvale, NJ: Jason Aronson, 1986.
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