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This page contains links to external Web sites. Managing Care to Improve Treatment Outcomes for Offender Populations — Melody M. Heaps, President, Treatment Alternatives for Safer Communities (TASC), Chicago, Illinois The tremendous volume of drug- and alcohol-addicted offenders throughout the country is overwhelming courts and correctional systems, as well as the substance abuse treatment and acute health care systems. Our criminal justice system has become a magnet for poor, severely addicted offenders who commit a large number of drug-related crimes to support their habits. Without treatment, these offenders keep recycling through the system. In addition, their presence impedes the criminal justice system's ability to manage violent and high-risk offenders effectively. Criminal justice officials across the country are increasingly aware of these issues and of the effectiveness of treatment. They are referring growing numbers of offenders to alcohol and other drug (AOD) treatment. Meanwhile, treatment resources for publicly funded clients are increasingly scarce. Limits of Managed Care in Handling Offenders Many States, operating with limited resources, have contracted with private managed care organizations to treat publicly funded substance abuse clients, including offenders referred through the courts. However, commercial managed care companies are inexperienced at dealing with the complex range of problems typical of this population and are unfamiliar with the needs of the referring criminal justice system. Because of their inexperience, these commercial companies have proven inadequate to the task of managing the substance abuse treatment of offenders. This task involves maximizing treatment outcomes while also meeting justice system requirements.
Unlike the privately insured alcoholics or drug-dependent clients with whom managed care companies have worked in the past, substance-abusing criminal offenders are likely to have issues of mental illness, poor health, inadequate housing and food, lack of available child care, absence of family support networks, and other problems. These offenders' ability to succeed in treatment will be tied to how successfully their life issues are addressed by the person managing their care.
States confront a difficult dilemma. They must effectively address the criminal justice system's need to place large numbers of offenders in treatment, while they also face the reality of limited resources. One solution is for States to consider using a specialized, comprehensive managed care system for criminal offenders. Such a system could blend state-of-the-art managed care tools, such as utilization management and resource allocation, with an ability to meet the requirements of the criminal justice and treatment systems. Principles for Managing Treatment of Offenders Illinois TASC has been a manager of behavioral health care for substance-abusing offender populations since 1976. Based on this experience, Illinois TASC advocates for certain managed care principles that we believe would improve treatment outcomes for offenders.
It is important to understand that placing offenders in treatment and managing their care can occur at a variety of points in the criminal justice/corrections continuum. Placement in treatment provides different advantages at different stages. When used as part of the court adjudication process, treatment programs move substance abusers out of crowded local jails more quickly and, through expedited processing, allow judges to spend time on more serious cases.
When offenders who would otherwise be sentenced to State correctional facilities go to treatment instead, this frees up resources that can be directed at violent and high-risk offenders. Managed treatment can also be used to improve the safety and effectiveness of early release and parole systems.
Principle #1: Prioritize the population. Establishing priorities is essential in this period of limited treatment resources, when the criminal justice and treatment systems each have their own specific goals. Drug-dependent people in need of rehabilitative services far exceed the resources available to treat them, and unless the system is managed effectively, offenders may utilize a disproportionate amount of treatment resources. Prioritizing should be based on:
The prioritizing stage also offers the chance to evaluate ancillary service needs, which significantly affect the offender's likelihood of successful recovery. Examples of those with ancillary needs are pregnant women who require prenatal care as well as addiction services, women with children who require treatment placements that include day care, and clients with a dual diagnosis of substance abuse and major mental illness. Principle #2: Designate resources that are geared to priority populations. Criminal offenders who have been mandated by the court are, by and large, reluctant treatment participants. Offenders often see treatment primarily as a way of avoiding incarceration, not as a mode for changing their behavior or lives. At least initially, offenders may participate in treatment as a condition of release and to avoid the criminal court sanctions that would be imposed for failure to comply. These external incentives and sanctions can be used to improve treatment outcomes. The length of time offenders spend in substance abuse treatment has been shown to be a decisive factor in positive treatment outcomes. A managed care plan geared to the offender population can offer definite advantages by linking sanctions with treatment. The criminal justice system's hold over offenders can be linked to the level and length of treatment best suited for each individual.
A number of criteria can assist in making appropriate decisions about placement in treatment and the level of case management necessary. The following factors need to be evaluated:
This evaluation allows the most intensive and costly modes of treatment — residential and intensive outpatient — to be employed only for those who actually need it, rather than expending intensive services on people whose addictions can be addressed in less restrictive environments.
Principle #3: Provide ongoing management of resources. All the issues identified under the first two principles remain in play throughout the course of treatment and supervision — from initial screening to the conclusion of the offender's involvement with the criminal justice and treatment systems. To ensure appropriate allocation of treatment resources, there must be continued utilization management, monitoring of criminal justice risk and status, and ongoing evaluation of clinical levels of care.
The 20-year experience of Illinois TASC demonstrates that it is possible for specialized managed care to enhance treatment success rates with offenders. This can happen with limited resources, if those resources are applied wisely and efficiently. Many TASC organizations around the country already have years of experience at simultaneously addressing the legal requirements of courts, the procedural standards of treatment providers, and the clinical needs of offenders. TASC organizations are poised to move into the management of substance abuse treatment for the offender population. To expand services, it would also be possible to involve other social service organizations that have staff with experience working in the criminal justice arena.
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