(PI: K. Knight)
As a national crisis, substance use (SU) among people in the criminal justice (CJ) system requires effective intervention. The Federal Bureau of Prisons (BOP) provides substance use treatment in federal prisons through a number of different programs designed to assist participants in examining the impact of substance use on their lives, committing to and maintaining recovery from substance misuse, and addressing associated criminogenic risk factors. Delivering effective intervention programs is needed to mitigate the problems associated with this targeted population. The purpose of this study is to help the BOP maintain its compliance with the First Step ACT of 2018 by conducting an evaluation of the Bureau’s drug abuse treatment programs: Drug Education (DE), residential drug abuse program (RDAP), non-residential drug abuse program (NRDAP) and medically assisted treatment (MAT), as well as evaluating outcomes for people who have participated in two or more of these programs; as part of a separate contract, we will also evaluate the BOP’s Anger Management (AM) programs. A major component of our research design will examine the existing screening and assessment process that serves as an essential first step to understanding the nature and severity of the health and social problems that might have led to or resulted from substance use.
During the first phase of the BOP-contracted project across these tasks, a core set of procedures will be implemented. De-identified archival data requested from BOP includes participants in the target programs during a five-year time frame as well as comparison samples (when available) composed of people who met eligibility requirements but did not participate. A core set of research questions across the tasks include:
1: Do enrolled program participants (regardless of length of program participation) have better program-related outcomes than do comparable non-participants?
2: Do program completers have better outcomes than do program non-completers?
2a. Is program dose (i.e., time in program, number of sessions) related to outcomes?
3: What pre-program variables (e.g., social determinants) are associated with program placement, completion and outcomes?
3a. What risk, needs, and responsivity factors are used for program placement?
3b. What static/dynamic risk and criminogenic needs factors are associated with program completion and outcomes?
BOP Drug Abuse Programs (DAP) Contract (base year plus four subsequent option years)
TASK I: Drug Education (DE; Lead- Y. Yang) – This can be perceived as a “primer” for other programs; individuals are required to complete DE if they meet the criteria. DE is a 12-15hr psychoeducational program that addresses the cycle of drug use and crime, offers a compelling perspective on the consequences of continued drug use, and introduces available treatment options. For the first research phase, the evaluation targets two primary objectives: (1) assess participant knowledge acquisition; and (2) determine if participants are more likely than non-participants to request subsequent drug treatment.
TASK II: Non-Residential Drug Abuse Program (NRDAP; Lead- R. Proffitt) – The purpose of NRDAP is to afford all individuals with a self-reported drug problem the opportunity to receive substance use treatment, guided by an individualized treatment plan. The cognitive-behavioral treatment (CBT) protocol is designed to be completed over 12-14 weeks of group therapy. The initial evaluation of the NRDAP will address three primary objectives utilizing archival data, (1) to determine what percentage of those who participated in the NRDAP unit-based component completed the required treatment hours, (2) an assessment of NRDAP unit-based graduates who completed NRDAP compared to those who did not complete the program and (3) compare NRDAP graduates with individuals who were eligible for NRDAP but did not participate in the program.
TASK III: Residential Drug Abuse Program (RDAP; Lead- W. Lehman) – RDAPs are located in a separate unit away from the general population and are present in more than half of BOP’s facilities. This program is based on Cognitive Behavioral Therapy (CBT) models incorporated in modified therapeutic communities and generally comprises 500 hours of programming in a 9-month curriculum. The evaluation of the RDAP will address these primary objectives: (1) determine what percentage of RDAP participants complete the program; (2) identify predictors of program completion and behavioral change; (3) examine post-RDAP outcomes including institutional adjustment and recidivism; (4) examine access of follow-up services for RDAP completers and non-completers; and (5)examine participation and completion of the Community Treatment Services (CTS) reentry component of RDAP in a Residential Reentry Center (RRC) or Home Confinement.
TASK IV: Medically Assisted Treatment (MAT; Lead- J. Pankow) is used to treat substance use disorders as well as sustain recovery and prevent overdose. The primary aims for the initial MAT evaluation will focus on (1) examining program fidelity, (2) program placement, and (3) medications, dose, and adherence. The goal of the current MAT evaluation is to provide the Bureau with evidence of program effectiveness to support improvements in curricula, treatment protocols, program operations, and oversight, and more proximately, using results from this initial evaluation to inform the development of the analytic plans for evaluations in subsequent years.
TASK V: Multiple Program Participation (MPP; Lead- G. Joe) – An evaluation of multiple program participation – participation in two or more drug programs – to consider the interactional and additive effects of multiple program participation. The primary objective for this program evaluation will examine program participation by comparing subsamples with an untreated comparison group to identify predictors of behavioral change.
BOP Anger Management (AM) Contract (base year plus two subsequent option years)
TASK: Anger Management (AM; Lead- J. Lux) is also a key component of prison programming because anger is linked to violent criminal behavior, self-harm, conflict in custodial settings, and failure to adjust to community supervision post-release. Specific research questions include: (1) what factors predict referral to and participation in AM services; (2) is participation in and completion of AM associated with improved outcomes (institutional misconduct, institutional adjustment, recidivism); and (3) what individual-, program-, and institutional-level factors are associated with improved outcomes?
The planned analyses will examine the impact that these existing programs have had on improving long-term, post-release public safety outcomes, as well as identifying factors that have impacted the treatment process and were found to be associated with short-term outcomes. This strategy includes taking a close look at the program eligibility and screening process concerning the use of risk and needs information and the tailoring of treatment process strategies through an examination of participant characteristics associated with measures of program process and outcomes. Program evaluations such as the BOP study have the potential to serve as an important tool for informed decision-making concerning the efficient allocation of resources, treatment efficacy, and accountability to stakeholders.
Research questions that cannot be addressed during the first phase of the project using archival data will be considered for subsequent project years when prospective data will be collected. Based on results from these initial analyses, we plan on implementing prospective measures including pre- and post-program measures, and follow-up outcomes on samples of clients in selected BOP facilities to more closely examine the impact of the programs. We will also be examining staffing and institutional factors on program outcomes and implementation. New or revised curricula or programs may be examined in pilot studies. Ultimately, based on the analyses of existing and newly collected data, the proposed study will include recommendations for optimizing program impact by identifying the most effective and efficient uses of these BOP programs (e.g., program type, amount, intensity), potentially resulting in more efficient allocation of resources, better treatment fidelity and efficacy, and enhanced stakeholder accountability.