Integrating Risk/Needs Assessment Into Drug

Court

Judge Shanta OwensJefferson County Drug Court

Tenth Judicial CircuitBirmingham, AL

Develop understanding of the Risk and Need Principle

Develop understanding of the effective use of ARAS in Drug Court

Develop an understanding of Integrating the Risk/Needs Assessment into Drug court

OBJECTIVES

Presiding Judge, Jefferson County Drug Court Birmingham Division

Drug Court Judge since 2009

Prior Experience

My Bio

338 Active Participants 6 Case Managers Drug Court Team

◦ Judge◦ Case Managers◦ Program Administrator◦ Treatment Coordinator◦ Law Enforcement Officer◦ Peer Specialist◦ Job Placement Program Coordinator◦ Medical Provider◦ Defense Attorneys

Jefferson County Drug Court

Prior to March 2013

Jefferson County Drug Court

What Do We All Know About Drug Court?

Drug Court Works!

Drug Court is a scarce and precious resource that

should be used in a manner that maximizes its benefits to participants and society

in general

We Also Know…

Risk/Needs Assessment

Jefferson County Drug Court

Comprehensive Review of Information related to Substance Use Disorders and Risk for Recidivism. Can examine both psychosocial functioning and risk factors (Risk Assessment)

What Is An Assessment?

RISK AND NEED PRINCIPLE

According to what are known as the Risk Principle and the Need Principle, the most effective and cost-efficient

outcomes are achieved when treatment and supervision services are tailored to

the (1)Prognostic Risk Level and (2) Criminogenic Needs of the Participants

(Andrew & Bonta, 2010; Taxman & Marlowe, 2006)

Characteristics of offenders that predict relatively poorer outcomes in standard rehabilitation programs

Prognostic Risk

Younger age during treatment (especially < 25) Male Gender Early onset of substance abuse or delinquency Prior Felony Convictions Previously unsuccessful treatment attempts Co-Existing Diagnosis of antisocial personality

disorder Familial History of Crime or Addiction Regular Contacts with antisocial or drug-using

peers or associates

Risk Factors

(Marlowe, 2003)

Clinical disorders or functional Impairments that, if treated, significantly reduce the likelihood of future involvement in crime

Criminogenic Needs

Diagnosis of substance dependence or addiction

Major Mental Illness Lack of basic employment skills/poor

employment history Lack of daily living skills Lack of education Collateral Needs

◦ Dual Diagnosis◦ Chronic Medical Conditions (ex. HIV, Diabetes, HCV)

Needs

Belenko, 2006; Simpson & Knight, 2007

Prognostic Risk and Criminogenic Need indicate what level of treatment and supervision are likely to be required to manage an offender, and what consequences should ensue for new instances of alcohol or drug use

Most intensive treatment should be reserved for Higher Risk offenders

Must survey important Risk Factors to produce an accurate measure of Risk

What does Risk Indicate?◦ Level of Supervision

RISK PRINCIPLE

Interventions must be very focused and target the Needs that are related to Risk

Stabilize the Client first. Then, start to treat the addiction

Need Principle

Higher Risk = More Intensive Supervision Services

Higher Need = More Intensive Treatment Services

High Risk/High Need = Typically Require full array of Treatment and Supervision services embodied in 10 Key Components of Drug Court

Low Risk = Less Intensive Supervision Services

Low Need = Less Intensive Treatment Services

Low Risk/Low Need = Typically do not require the full menu of services specified in the 10 Key Components of Drug Court

Providing too much treatment or too much supervision is not merely a potential waste of scarce resources. It can increase crime or substance abuse by exposing individuals to more seriously impaired or antisocial peers, or by interfering with their engagement in productive activities such as work, school, or parenting.

(Lowenkamp & Latessa, 2004; McCord, 2003)

Low Risk Offenders RECIDIVATE at higher rates when placed in residential interventions and/or intensive supervision

High Risk Offenders respond BETTER when placed in a residential intervention and/or intensive supervision

RISK

So…What Did We Do in Our Program?

Jefferson County Drug Court

We figured out DOSAGE MATTERS

Started using ARAS (Alabama Risk Assessment System)

◦Adopted from ORAS (Ohio Risk Assessment System)

Length of time in Drug Court now based on Clients Risk and their Level of Needs

4 Drug Court Tracks with different Requirements and Phases

RISK What level of

supervision services

NEED What level of

treatment services

Where Does the Client Fall ?

Alabama Risk Assessment System

(ARAS)Jefferson County Drug Court

Assessment is done on every client accepted into Drug Court

Time: Approximately 2 hours per client Completed by Case Managers Plea is Taken on Thursday ARAS is scheduled a few days later Based upon score, clients are placed in

Track 1, 2, 3, or 4

Alabama Risk Assessment System

Criminal History Education, Employment, and Finances Family and Social Support Neighborhood Problems Substance Abuse Peer Associations Criminal Attitudes and Behavioral Problems Mental Health Screening Form

ARAS Consists Of:

Overall score does not matter as much as the scores in the individual domains

Moderate to High Score in Substance Abuse, Formal Treatment is required. Therefore, client will be Track 2 or 4, depending on scores in other domains.

Tracks 1 and 3 are clients who do not score Moderate or High in Substance Abuse

ARAS Score

TRACK 4High Risk, High Need12 Months

TRACK 2Low Risk, High Need6 Months

TRACK 3High Risk, Low Need9 Months

TRACK 1Low Risk, Low Need3 Months

Dependent on alcohol or drugs At Risk for failure in standard correctional rehabilitation

programs◦ Using drugs or committing crimes at early age◦ Failed previously in less intensive dispositions◦ Possible diagnosis of antisocial personality disorder

Need all services embodied in the 10 Key Components◦ Should Appear Frequently in Court: No less than Biweekly for

the first few months until stable interval of sobriety or engaged in treatment

◦ Our clients appear Weekly in Phase 1, Biweekly in Phase 2, Monthly in Phase 3, and Noncompliance Calendar in Phase 4

◦ Formal Treatment is Required

High Risk/High Need

Need interventions that focus on remediating “criminal thinking” patterns

Minimum dosage of 200 hours of cognitive behavior services ◦ Lack inclination to engage in productive activities

such as work, school, or parenting◦ Do not attach importance to the assumption of

responsible roles ◦ Endorse antisocial attitudes and values

High Risk/High Need (cont’d)

Deficient in adaptive life skills, such as employability, education, financial management, and homemaking

Adaptive habilitation services are often required to teach vocational skills, address educational deficits, improve daily living skills, and model effective interpersonal problem-solving strategies

High Risk/High Need (cont’d)

Deficient in adaptive life skills, such as employability, education, financial management, and homemaking

Adaptive habilitation services are often required to teach vocational skills, address educational deficits, improve daily living skills, and model effective interpersonal problem-solving strategies

High Risk/High Need (cont’d)

Compliance with the conditions of supervision and treatment is the primary goal

Abstinence is a more difficult goal

The use of appropriately prescribed medications by a qualified addiction psychiatrist constitutes an evidence-based practice for addicted offenders and should be available in appropriate cases (National Institute on Drug Abuse, 2006).

High Risk/High Need (cont’d)

Dependent on drugs or alcohol Do not have substantial prognostic risk factors

that would predict failure in standard Primary focus for this group is Treatment

services Do not require frequent supervision on status

calendar◦ Monthly judicial hearings and then noncompliance

calendar in Phase 2◦ Rather than appear in court interacting with high-risk

antisocial peers, they should focus their energy on Treatment

Low Risk/High Need

Formal Substance Abuse Treatment Required◦ However, research suggests that low-risk

individuals should not be treated in the same groups as high-risk individuals because they may adopt antisocial attitudes or values (Lowenkamp & Latessa, 2004).

Adaptive Habilitation services may be required such as vocational or educational assistance, family therapy, or mental health counseling.

Low Risk/High Need (cont’d)

Consequences should be focused on Treatment◦ Abstinence is still a difficult goal

Use of appropriately prescribed medications by a qualified addiction psychiatrist may be indicated for some addicted offenders

Low Risk/High Need (cont’d)

Non-Dependent substance abusers But have substantial Risk Factors for failure on

standard supervision Emphasis should be on closely monitoring their

behavior, holding them accountable for their conduct, and teaching them pro-social life skills

Should appear in court on a status calendar for judge to review progress◦ Weekly judicial hearings◦ Because they are at risk for failing to comply with

standard supervision requirements

High Risk/Low Need

Better suited for Early Intervention classes that teach about the dangers of drugs and alcohol and activity-scheduling exercises that re-orient their daily activities away from drug-related peers and events

Because High Risk, 200 hours of cognitive behavioral services may be needed to reduce criminal activity

Focus consequences on Abstinence and Supervision

High Risk/Low Need (cont’d)

Unnecessary to expend substantial resources on this group because they have a low probability of recidivism

Noncompliance Calendar Prevention Services such as Early Intervention

classes on an individual basis or in separately stratified groups

Drug and alcohol use are under their voluntary control

Important that this group is NOT mixed with high risk offenders or that they spend lots of time in court

Low Risk/Low Need

Jefferson County Drug Court

Better understanding of client’s circumstances and what level care is needed to treat him/her

You do not want to mix occasional pot smoker with hardcore IV drug user in treatment

Want to use resources wisely and treat the right people◦ Ex: Low Risk, Low Need folk don’t need inpatient

treatment. Without an assessment, this would be a waste of resources

ARAS IS IMPORTANT BECUASE

How Do You Get Reliable Information?

Jefferson County Drug Court

Goal: Information Gathering Environment should be conducive to disclosure

of information Purpose of Assessment should be explained Client should be alone Interviewer should be Patient, Open-Minded, and

Attentive Interviewer should exhibit good listening skills Open-Ended Questions Avoid Close-Ended, Biased, Double-Barreled

questions

ARAS INTERVIEW

Dealing with Inconsistencies◦ Use collateral info/resources◦ Lightly challenge inconsistent info

Dealing with Oppositional Behavior◦ Offer Choices◦ Offer a Break◦ Redirect

The Challenging Interview

QUESTIONS?