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Adults with Behavioral Health Needs under Correctional Supervision
block grant.* Under the current Medicaid program, states tend to offer limited coverage for substance abuse treatment,† and it is usually not available for childless adults with these disorders.69 Research confirms that clients who are assessed as having more severe substance use disorders do better when they receive more intense and protracted treatment.70 Principles of substance abuse treatment include a recognition that services need to be readily available, that clients’ remaining in treatment for an adequate period of time is critical, that treatment does not need to be voluntary to be effective, and that successful treatment attends to multiple needs of the individual, not just his or her drug abuse.71
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Criminal justice and behavioral health practitioners must understand how to target the main drivers of recidivism— including drug dependence, which we know can be effectively addressed through treatment. Dependence (i.e., addiction) to hard drugs is where the research demonstrates a high correlation with recidivism. Practitioners need tools like this [paper’s] framework to help them make effective, evidence-based programming and supervision decisions.” —Faye Taxman, University Professor in Criminology, Law and Society and Director of the Center for Advancing Correctional Excellence, George Mason University
In general, a clinical assessment is performed when an individual enters into a treatment program. According to SAMHSA, a basic assessment consists of gathering key information and engaging in a process with the client that enables the counselor to understand the client’s readiness for change and to identify problem areas, diagnoses, disabilities, and strengths.72 There are tools that can facilitate this process,‡ including those that use set criteria to provide guidance for substance abuse counselors and other treatment staff in determining the best “match” between client characteristics and several levels of treatment services such as residential, intensive outpatient, or outpatient.73 For individuals with substance use disorders in the criminal justice system, research has generally found that some interventions alter their behavior such as those that include cognitive behavioral therapy or therapeutic communities that last at least 90 days, employ drug testing, offer a continuum of care, use
*Each year, Congress appropriates funds for states to use in treating substance abuse under this grant. The Center for Substance Abuse Treatment (CSAT) administers the block grant, which totaled $1.7 billion in 2009. According to CSAT, funds from the SAPT block grant went to support nearly 10,000 community-based treatment and prevention service providers in all 50 states, each U.S. territory, the District of Columbia, and the Red Lake Band of Chippewa Indians of Minnesota every year. Approximately 40 percent of the public funds spent on treatment and prevention in the states come from this grant. (See National Association of State Alcohol and Drug Abuse Directors, “Fact Sheet: Substance Abuse Prevention and Treatment (SAPT) Block Grant,” June 2009.) † Under federal guidelines, states are required to provide only a limited amount of mental health services and can provide most substance abuse treatment services under Medicaid at their discretion. See Anna Scanlon, State Spending on Substance Abuse Treatment (Washington, DC: National Council of State Legislatures, December 2002). ‡
An approach that has been developed to assist in triage and placement decisions for substance abuse treatment services is the revised version of the American Society of Addiction Medicine (ASAM) Patient Placement Criteria (PPC-2R) for the Treatment of Substance-Related Disorders, Second Edition, Revised (ASAM 2001).