ucla integrated substance abuse programs gender-responsive drug treatment services for women...

UCLA Integrated Substance Abuse Programs

Gender-Responsive Drug Treatment Services for Women Offenders

Elizabeth Hall, Ph.D.

Criminal Justice Research GroupIntegrated Substance Abuse Programs

Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los Angeles

Research funded by the National Institute of Justice, the California Department of Corrections and Rehabilitation, and the National Institute on Drug Abuse


Overview

• Discuss treatment and service needs of women drug offenders

• From an ongoing study:

Psychological functioning

Parenting

Social support

Adult relationships

• Describe gender-responsive treatment• Describe the current state of research knowledge on

gender-responsive treatment


Background: What are the characteristics of national and state populations of women in prison and on parole?

• Growing population Increased by 21% from 2000 to 2006 to total of 103,100 just last year, the number of women prisoners increased by 4.5%

from the previous year

• Mostly due to drug offenses 11% in 1979, nearly 35% in 1997, 30% in 2001, 29% in 2004 59% of women used drugs in the month prior to their offense Female inmates (17%) were more likely than males (10%) to report

use of methamphetamines in the month before their offense Female inmates (60%) were more likely than males (53%) to meet

drug dependence criteria 40% committed offense under the influence of drugs

• Underclass population 70 to 90% were unemployed, 50% were functionally illiterate, 42%

had not completed high school or the GED prior to incarceration


Background: What does prior research say about women offenders’

need for health and mental health services upon release?

Health~ 37% of women parolees report needing medical or

dental services in the year after releaseMental health

~23% of women in jails and state prisons are mentally ill

High level of prior physical and sexual abuse 51% of women, and, 78% of mentally ill women in state

prisons reported having been physically or sexually abused prior to incarceration

63% of mentally ill women released from prison received community mental health treatment; 19% were hospitalized (Massachusetts)



need for daily living services upon release?

Welfare assistance56% of women parolees received welfare

assistance in the year after releaseHousing

9% of state prison inmates (men and women) were homeless in the year before incarceration

One-third of mentally ill women offenders were anticipating homelessness upon release



need for parenting assistance services?

Family

Seven in ten women inmates had children under 18 years of age, and of these, two-thirds of the children were living with their mothers before incarceration

Responsibility for children may preclude residential treatment after release


Background: What does prior research say about women

offenders’ need for vocational services?

• Less likely to have viable work skills or employment history, as compared with males

• Lower wages


Why have gender-responsive programs?

• Research suggests that women may be more responsive to treatment within women-only treatment facilities or groups, because they feel less intimidated or concerned about being stigmatized in such settings, because of a desire to obtain services specific to their needs, or because they seek shelter from intimate partner violence.


Characteristics of Gender-Responsive Programs

• Focus on the psychosocial profile of substance-abusing women •Designed to meet need for

comprehensive services• pregnancy• childcare and parenting• physical and mental

health problems • employment and

housing• history of trauma and

victimization


Is gender-responsive treatment successful?

Research shows that women are more likely to complete treatment and have better outcomes when targeted services are available

• residential treatment with live-in accommodations for children

• provision of family therapy • comprehensive supportive services, such as case

management, pregnancy-related services, parenting training/classes, childcare, vocational training, and aftercare

More research needs to be done


Evidence-based treatment approaches for women substance abusers

• Relapse prevention approaches focus on teaching clients to recognize “cues” or “triggers” for substance use and strategies for avoiding relapse in those situations

• Motivational interventions use therapeutic strategies to increase the individual’s awareness of their substance abuse problems and to engage their commitment to behavior change

• Contingency management approaches employ a schedule of rewards to strengthen the practice of desired behaviors (e.g., abstinence)


Evidence-based treatment approaches for women substance abusers, cont’d

• Trauma and PTSD interventions Seeking Safety – cognitive-behavioral Trauma Recovery and Empowerment Model – group

therapy Beyond Trauma – “relational theory”


Recommendations

Drug courts should: • refer women to treatment programs that are either

focused exclusively on women clients or that provide services specifically tailored for women’s needs.

• make sure that mental health screening and assessment occurs for all women and, when indicated, that mental health treatment is integrated with addiction treatment

• ensure that treatment programs screen women for their history of trauma and the ongoing effects of exposure to trauma, violence, and victimization


Recommendations

Drug courts should: • assure that treatment programs provide services that

address their need for education and employment skills • ensure that parenting-related needs are assessed,

and, if appropriate that treatment is coordinated with child welfare services

• refer women to treatment programs that screen for health problems commonly found among female substance abusers

• utilize treatment programs that incorporate evidence-based treatment approaches


Gender Responsive Treatment for Women Offenders

Michael Prendergast, Ph.D.

Nena Messina, Ph.D.

Elizabeth Hall, Ph.D.


Gender Responsive Treatment for Women Offenders

• Los Angeles

• In Drug Court and

Prop. 36

programs• Average number

of days in

treatment for

those who

attended (n=47)

127.0 (SD 84.6)

Demographics (baseline) N = 57

Age (mean) 38.1 (SD 10.7)

Education (mean years) 11.7 (SD 2.0)

Lifetime arrests (mean) 11.5 (SD 23.6)

Age first arrested (mean) 24.3 (SD 9.3)

Marital status (% married or living together)

29.8

Employed (% working in 30 days before arrest)

17.5


Ethnicity (%)

White 31.6

Latina 28.7

African American 29.8

Have minor children (%) 45.6

Primary drug (%)

Alcohol 5.3

Cocaine/crack 28.1

Heroin/opiates 10.5

Marijuana 1.8

Methamphetamine 38.6

Other 15.8


Psychological and Social Functioning

ScaleBaseline(N=57)

12-Month (N=57)

BSI Global Severity Index 35.0 (SD 33.2) 29.2 (SD 34.9)1

ECRI dimensions (mean)

Adult attachment anxiety 4.2 (SD 1.2) 3.9 (SD 1.2)*

Adult attachment avoidance 3.5 (SD 0.9) 3.4 (SD 0.9)

ECRI adult attachment styles (%)

Secure 15.8 17.5

Fearful 54.4 38.6

Pre-occupied 21.1 24.6

Dismissing 8.8 19.3

Social support (mean) 16.9 (SD 7.8) 20.4 (SD 6.4)**

1p<.10, *p<.05, **p<.01


Parenting

Baseline(N=57)

12-Month (N=57)

AAPI (parenting) STEN scores (N=26) (N=26)

Inappropriate expectations 5.4 (SD 1.7) 5.6 SD (1.3)

Empathy 1.0 (SD 0.2) 1.1 (SD 0.6)

Physical punishment 1.8 (SD 1.2) 1.8 (SD 1.1)

Reverses family roles 2.1 (SD 1.5) 2.2 (SD 1.5)

Restricts power/independence 1.0 (SD 0.0) 1.1 (SD 0.4)


Conclusions

A minority of participants (16%) had a secure adult attachment style in which they found it easy to be emotionally close to others.

While attachment styles did change over time, most notably a reduction in the percentage of women exhibiting a fearful attachment style (discomfort in getting close to others), the move to a dismissing attachment style (preferring not to depend on others or have others depend on them) was not a positive sign of growth.

Participants showed personal growth in social support and improvement in their psychological symptoms.


Conclusions

While participants had expectations for their children

that were age-appropriate, they lacked empathy for

their children, tended to favor physical punishment,

tended toward parentification of their children (reversed

roles), and tended toward an authoritarian relationship

(restricting power/independence) with their children.

Given the cyclical nature of abuse, the lack of

improvement in parenting attitudes over time shows a

high need among this population for additional

parenting intervention.


Questions?

www.uclaisap.org

[email protected]


Gender-Responsive Drug Treatment Services for Women Offenders

Elizabeth Hall, Ph.D.Michael L. Prendergast, Ph.D.

Jean Wellisch, Ph.D.

Criminal Justice Research GroupIntegrated Substance Abuse Programs

Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles

Research funded by the National Institute of Justice, the California Department of Corrections, and the National Institute on Drug Abuse


Background: Forever Free Substance Abuse Treatment Program

• Started in 1991

• Designed specifically for women

• Cognitive-behavioral model (Gorski)

• Participants housed separately, but mix with other inmates

during meals and work assignments

• Intensive six-month program provided to volunteering

women inmates during the end of their imprisonment

• Upon release, women may also volunteer for an additional

six months of residential treatment in the community


Aims

• Compare the post-release service needs of Forever Free participants with similar inmates from the general prison population

• Compare the post-release services received by Forever Free participants with similar inmates from the general prison population

• Determine the levels of unmet need for post-release services

• Examine changes in needs and services over time


Subjects

• Female• 215 inmates

119 enrolled in Forever Free 96 in comparison group enrolled in drug education

• Housed at California Institution for Women near Chino• Low educational attainment • 66% have children under 18• Offenses were primarily drug or drug-related• During the 30 days before incarceration, the treatment

group reported spending an average of $125 on alcohol and $1,976 on illegal drugs


Methods

In-prison assessment: Twice for the treatment group Once for the comparison group (abbreviated form)

One-year post-release interviews: Telephone and face-to-face Urine samples

Follow-up interviews were completed with 84% of the original sample.


Findings: Treatment post-release (percent)

0 20 40 60 80 100

Any treatment

Residential

Outpatient

Sober living

Self-help

Forever Free Comparison

1

1 p<.10* p<.05

*** p<.001

*

***

1


Findings: Psychological functioning (mean score)

0 1 2 3 4 5 6

Self-esteem

Depression

Anxiety


***

*** p<.001

***

***


Findings: Employment (percent)

0 10 20 30 40 50 60 70

Employed at timeof interview


*

* p<.05


Findings: Children’s status at follow up (percent)

0 10 20 30 40 50 60 70 80

Of those withminor children, %

living withmother

Have minorchildren


*

* p<.05


Findings: Self-rating of how well doing as parent (percent)

0 10 20 30 40 50 60

Well

Fair

Poor

Incarcerated attime of interview


*

* p<.05


Findings: Substance abuse treatment needs post-release (percent)

0

10

20

30

40

50

60

70

80

90

Relapse prevention Treatment

Forever Free

Comparison

*


Findings: Substance abuse treatment services received post-release (percent)

0

10

20

30

40

50

60

70

80

90

Relapse prevention Treatment

Forever Free

Comparison

*


Findings: Health and mental health services needs post-release (percent)

0

10

20

30

40

50

60

70

80

90

Medical dental Spiritual support Family counseling Grief counseling Psychologicalcounseling

Forever Free

Comparison

*


Findings: Health and mental health services received post-release (percent)

0

10

20

30

40

50

60

70

80

90

Medical dental Spiritual support Family counseling Grief counseling Psychologicalcounseling

Forever Free

Comparison

*


Findings: Daily living services needs post-release (percent)

0

10

20

30

40

50

60

70

80

90

Welfareassistance

Transportation Living skillstraining

Housing Food, furniture,clothing

Paying bills

Forever Free

Comparison

* **


Findings: Daily living services received post-release (percent)

0

10

20

30

40

50

60

70

80

90

Welfareassistance

Transportation Living skillstraining

Housing Food, furniture,clothing

Paying bills

Forever Free

Comparison

**


Findings: Educational and vocational service needs post-release (percent)

0

10

20

30

40

50

60

70

80

90

Employment assist Education, GED Vocational training

Forever Free

Comparison**


Findings: Educational and vocational services received post-release (percent)

0

10

20

30

40

50

60

70

80

90

Employment assist Education, GED Vocational training

Forever Free

Comparison


Findings: Parenting assistance needs post-release (percent)

0

10

20

30

40

50

60

70

80

90

Parenting skills training

Forever Free

Comparison**


Findings: Parenting assistance received post-release (percent)

0

10

20

30

40

50

60

70

80

90

Parenting skills training

Forever Free

Comparison


Conclusions• Women in both groups had a high need for services

during parole

• Women in the comparison group generally had greater needs, but were less likely to receive services during parole

• The greatest unmet need for both groups was for vocational and educational services (37% - 40% service gap)

• Women also had a great unmet need for housing (35% service gap)


Discussion

• While previous national research found that custodial treatment programs report that they provide women offenders with treatment, housing, and welfare assistance; the percentage of women actually receiving such assistance may be small.

• Compared to previously reported research on an earlier group of Forever Free and comparison women, service needs have increased in all areas.

• Ask the women!


Ask the Women!

We wanted to know about:

• Supports for success on parole

• Barriers to success on parole

• Why women didn’t enter treatment during parole

• Personal factors that may influence success


Method

We conducted focus groups with 4 groups of women (all had received or were receiving drug treatment in prison):

1. Those about to parole

2. Those on parole and in community drug treatment

3. Those who paroled, got a new charge, and were returned to prison (Returnees)

4. Those who paroled and were long-term successes


What women learned in prison treatment:

“What I learned were things about myself - what’s inside. I learned that I don’t have to live like that anymore. I learned about self-esteem, post-acute withdrawal, etc.” [Rs]

“They teach us about abuse and relationships, about how it’s not our fault that we’re abused.” [Tx]

“I didn’t know I have an anger problem. They’ve taught me how to deal with my anger.” [Tx]


“They help you realize that you aren’t that bad; that you have a lot of mistaken beliefs. You need to take a look at what you really are; that covered a lot of areas for me.” [LT]

“They explained why; just like elementary school; over and over again until you got it. But it was based on self-esteem. Conglomeration of a lot of different aspects. They really worked with you to make sure you really understood about all the different aspects of drug and alcohol use.” [LT]

What women learned in prison treatment:


Treatment After Parole

• The greatest influence on parole success

• In addition to the basics of drug treatment, women got:

“unconditional love”

education

social and emotional support from counselors and

other clients

networking experience

the 12 Steps


Concerns about finding employment:

No one wants to give you a chance if you’re an ex-

offender. I couldn’t even get a job bagging groceries.

[Tx]

They don’t tell you about certain things, like the

difficulty of finding a job if you’re a felon. [LT]

The girls need some outlet for work. I finally got a

job, but you need determination and a willingness to

work for minimum wage. [LT]


Barriers to Success on Parole: EmploymentYou need resources, places to go. The CDC doesn’t

provide you with anything. There is voc rehab through the parole agency, but you have to apply in advance. [LT]

Drug programs need job placement services. They need to help you educate yourself. There are all these computers here at [Program C] and they are going unused. [Res]

Residential programs need to inform us. We learn a lot of things here through word of mouth. A lot of us didn’t know about the Department of Voc Rehab, grants, schools, etc. and found out about them through other residents. [Program C] doesn’t help with job placement—they just tell you to go out and get a job. [Res]

ucla integrated substance abuse programs gender-responsive drug treatment services for women...

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