Archive for Substance Abuse

Correctional System: Responding to Juveniles with Substance Abuse and Mental Health Needs

In their own words:

In order to provide effective treatment and programming to youth with behavioral health needs, juvenile justice authorities and their partners must be equipped to quickly identify individuals who may have these needs, make referrals for full assessments and appropriate services, and provide services both while the youths are in custody and during the reentry process. Presenters focus on the use of assessment tools and other treatment needs, and matching youths to appropriate and effective programs and supports.

Speakers:

  • Randy Muck, Senior Clinical Consultant, Advocates for Youth and Family Behavioral Health Treatment, LLC
  • Valerie Williams, Research Instructor and Co-Director, National Youth Screening and Assessment Project, Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School
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A Conversation with Jeanne McAlister

Today our resident blogger had the opportunity to talk with Jeanne McAlister, Chief Executive Officer and founder of McAlister Institute. The conversation was enlightening to say the least!

Jeanne McAlister, the Chief Executive Officer and founder of McAlister Institute, has been a pioneer in the field of recovery. She has constantly advocated for responsive and needed treatment services and developed programs which could easily be replicated by others. Recognizing that drug abuse negatively affects all aspects of the individual, family, and community life, the goal of McAlister Institute programs is to assist individuals in regaining their lives by supporting the recovery process. As a result, tens of thousands of youth and adults have successfully regained their lives through her vision and with the help of McAlister Institute’s wide variety of programs.

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Talking Justice: Dr. Igor Koutsenok and Susan Madden Lankford

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Today we have a rare treat for you, our own Susan Madden Lankford sat down for a chat about the current sad state of affairs in the arena of American criminal justice. Fortunately we were able to record most of it for your edification.

Igor Koutsenok, MD, MS, is Director of the University of California San Diego, Center for Criminality and Addiction Research, Training and Application (CCARTA) and he has full time faculty appointment at the UCSD Department of Psychiatry. Among other place he attended St. Georges Hospital Medical School, where he received a Masters Degree in Addictive Behavior. Before joining UCSD, he worked in Bulgaria as Head of Department at the National Center for Addictions and Deputy Director of the Institute of Psychology.

During the last 20 years, he served as an expert for many international organizations such as the Council of Europe, European Union, and the United Nations. Dr. Koutsenok was recruited by the UCSD Department of Psychiatry in 1997. Dr. Koutsenok led the design and implementation of the Workforce Development Training series for substance abuse counselors and criminal justice professionals working in custody and community-based treatment programs in California. He is the UCSD FACT (Forensic Addiction Treatment Certification) Board of Education Director and Director of the Offender Substance Abuse Treatment Institute.

Dr. Koutsenok serves as of the trainers for the National Drug Court Institute, providing training and education for judges and members of the judicial system nationwide. Dr. Igor Koutsenok and Dr. David Deitch designed an innovative approach to reduce recidivism in parolees, which in 2006 was presented to and authorized by the California legislature as Senate Bill 618 – Offender Re-Entry Program.
Dr. Koutsenok is teaching General Psychopathology course for second year UCSD medical students, human growth and development course for 1st year UCSD medical students, as well as he runs support group for 3rd year UCSD psychiatry residents. In 2006-2009 he designed and directed the Cal-METRO training project, a large-scale Motivational Interviewing training project to train over 3000 professionals working in juvenile correctional institutions statewide. In 2010 he designed and conducted a year long San Diego Probation Department Leadership Academy training probation supervisors in practical implementing of evidence based practices in community corrections, such as motivational interviewing, and cognitive behavioral interventions. Recently in collaboration with Christopher Lowenkamp, PhD, he designed the IBIS program – Integrated Behavioral Interventions Strategies. Currently over 300 probation officers and supervisors are undergoing training, coaching and mentoring in implementation of a truly integrated package of behavioral interventions – motivational interviewing, EPICS-II, and incentives and sanctions. He has authored and co-authored over 50 scientific publications and book chapters, such as “Substance Abuse: A Comprehensive Textbook” 4th edition, Lowinson, J., Ruiz, P., Millman, R., & Langrod, J. (Eds.), 2004; “Treating Addicted Offenders – A Continuum of Effective Practices”, K.Knight & D. Farabee (Eds.), 2005; “Advances in Corrections Based Treatment: Building the Addiction Treatment Workforce”, Praeger International Collection on Addictions, A. Browne-Miller (Ed.), 2009, “Motivational Interviewing Training for Correctional Professionals – The CalMetro Project”, Praeger International Collection on Addictions, A. Browne-Miller (Ed.), 2009. He is a member of the International Motivational Interviewing Trainers Network. In 2011 he served as a trainer for the new group of MI trainers in Sheffield, England. Dr. Koutsenok has been training motivational interviewing and other treatment strategies in offenders in Bulgaria, Malta, England, Hong Kong, Greece, Poland, Sweden, Mexico, Argentina, Hungary, and Norway. He has been invited as guest speaker to numerous conferences and professional gatherings nationwide and in more than 15 countries. He is a proud father of three.

Susan Madden Lankford

In the early 1990s, Susan Madden Lankford began photographing—and befriending—the homeless on the streets of downtown San Diego. Compelled to learn more, she gained access to a women’s detention center and soon was shooting within its walls, speaking with candor with inmates and staff. Next, pursuing the link between crime and childhood neglect, she met with young people in juvenile hall, challenging them to face their hopes and fears through artwork and the written word. Lankford’s award-winning books on homelessness, incarceration, and juvenile justice are testament to many years of commitment to complex social issues. Her venture in the realm of documentary film continues this work.

Susan Lankford grew up in the Midwest and holds a BS degree from the University of Nebraska. She attended Ansel Adams’ prestigious workshops, studied under such photographic masters as Richard Misrach and Ruth Bernhard, and spent many years as a successful wildlife photographer and portraitist. The parents of three adult daughters, Susan and Rob Lankford live in San Diego.
Please explore the rest of our website for more about Susan and her works!


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New Study: Health Care in the Juvenile Justice System

SyringeHealth care is an issue that has been all over the news for quite some time now. Unfortunately the health care of the youthful and incarcerated has often been overlooked as Washington attempts to implement new programs for the voting masses.

Not anymore. The American Academy of Pediatrics’ Committee on Adolescence has released a policy statement, the first update in a decade to the Health Care for Youth in the Juvenile Justice System. It finds that incarcerated youth are at high-risk for health issues, physical, mental and developmental. Here is the statement’s abstract for an overview:

Youth in the juvenile correctional system are a high-risk population who, in many cases, have unmet physical, developmental, and mental health needs. Multiple studies have found that some of these health issues occur at higher rates than in the general adolescent population. Although some youth in the juvenile justice system have interfaced with health care providers in their community on a regular basis, othershave had inconsistent or nonexistent care. The health needs of these youth are commonly identified when they are admitted to a juvenile custodial facility. Pediatricians and other health care providers play an important role in the care of these youth, and continuity between the community and the correctional facility is crucial. This policy statement provides an overview of the health needs of youth in the juvenile correctional system, including existing resources and standards forcare, financing of health care within correctional facilities, and evidence-based interventions. Recommendations are provided for the provision of health care services to youth in the juvenile correctionalsystem as well as specific areas for advocacy efforts. Pediatrics 2011; 128:1219–123

According to the report nearly 11 million juveniles across the nation were arrested in 2008. Not all of them suffered detention, long or short term, but the average stay behind bars for the ones who did was 65 days as of 2006. Of those in custody, 80% remained in detention for at least 30 days and 57% for at least 90 days. All of them requiring health care of some sort. Unfortunately that health care often does not appear, and when it does it is often substandard.

Ryan Schill, a writer for the Juvenile Justice Information Exchange, shares some of the policy statement author’s views on why these changes have been enacted:

‘We wanted to advocate for these youth to have the same level and standards of care as non-incarcerated youth in the community,” the report’s lead author, Dr. Paula Braverman, Director of Community Programs at the Cincinatti Children’s Hospital Medical Center said in an email. She said the Committee on Adolescence also “outlined specific recommendations which included the training and skill of the health care providers.’

All too often health care in detention facilities is administered by people with insufficient training in the subject. She also touched on a subject that we here at HumaneExposures find to be vital:

‘We also wanted to highlight some areas for advocacy,’ she said, ‘including the need for adequate levels of funding to provide for the medical, behavioral health and educational needs of these youth.’ Equally important, she said, are intervention programs in the community ‘that address the risk and protective factors related to involvement in the juvenile justice system.’

Once more we have support for the idea that intervention, rehabilitation, and education are vital pieces to the puzzle. With such a preponderance of evidence that these tactics work there is still resistance to them. Hopefully as we see more high stature organizations like The American Academy of Pediatrics weigh in on the subject we will see the needed shift in public opinion.

Image Source: Yanivba on Flickr, used under it’s Creative Commons license

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The Second Chance Women’s Re-Entry Court: Choosing Treatment Over Incarceration

Maggots in My Sweet Potatoes: Women Doing TimeJudge Michael Tynan’s fourth-floor courtroom in downtown L.A.’s Criminal Courts building is in our spotlight today. It’s a room that’s usually packed with people that are often discarded by society: the addicts, the mentally ill or disadvantaged, the homeless, and, more recently, the female parolees.

Victoria Kim, a reporter for The Los Angeles Times, writes:

The Los Angeles County Superior Court judge oversees a number of programs known as collaborative or problem-solving courts, designed to address the underlying issues — addictions, mental health, poverty — that lead to repeated arrests and prison terms.

For this, we applaud Judge Tynan. One of the biggest flaws of the current system is that it’s like an over-the-counter medicine that treats the symptoms but often not the ailment itself. This pattern of issues has an amazing impact on the lives of those who experience them firsthand, almost always to their own detriment as well as the society’s. Tynan has a solid understanding of this, and has steadily worked to address these social ills.

Kim brings us a thumbnail view of Tynan’s most recent program, a three-year-old effort that aims to help transition women inmates to appropriate treatment rather than use traditional incarceration:

Since 2007, Tynan has been running the Second Chance Women’s Re-entry Court program, one of the first in the nation to focus on women in the criminal justice system. Through the court, women facing a return to state prison for nonviolent felonies plead guilty to their crimes and enter treatment instead.

Although women make up only a small fraction of prison inmates, their numbers have been climbing for decades at a far steeper rate than men’s. Women are also more likely to be convicted of nonviolent drug or property crimes motivated by addictions or necessity.

As a publisher, we have examined these underlying factors and their influence on the individual and on society. Our award-winning documentary, It’s More Expensive to Do Nothing, addresses them, and looks at both the social and financial cost of not going after the root causes.

Tynan’s work is yet another proof that our assertions are correct. The women in this program are housed in a Pomona drug treatment facility for women called Prototypes. If accepted, the women live there for six months while their schedules are filled with job-skills classes, therapy, support-group meetings, and  chores. Incarcerated mothers and their children are reunited, and the mothers both undergo counseling and attend parenting classes. Pretty comprehensive, isn’t it?

Let’s take a look at Kim’s article once more and evaluate the cost factor:

The treatment, currently funded through a grant from the California Department of Corrections and Rehabilitation and donated services from Prototypes, costs about $18,000 for each woman per year. But compared with keeping them in prison and their children in foster care for years, the state is saving millions of dollars, the program’s organizers say.

All of our studies indicate that this is not a fluke, but rather is representative of the savings that can generally be attained once a more proactive social stance is adopted. In short, if we fix the societal ills that lead to incarceration or recidivism directly, it will have more impact for less monetary expenditure than simple imprisonment. Remember, it really is more expensive to do nothing!

Source: “Court program helps women turn their lives around,” The Los Angeles Times, 10/18/10
Image copyright Susan Madden Lankford, from the book “Maggots in My Sweet Potatoes: Women Doing Time.” Used with permission.

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The Link Between Prostitution and Homelessness

Homeless girlAmong the significant number of homeless teens on the street there are many who have been reduced by circumstances to prostitution. It’s a grim and ugly reality.

One of the factors that makes this issue less visible, in addition to the blind spot many develop towards the homeless in general, is the fact that it does not always adhere to the expectations. The classic stereotype of “hooker and pimp” is only one of many permutations possible on the streets. Prostitution does not always involve an exchange of favors for currency.

Laura Rillos, KVAL News, reports:

[Chris] Mirabal [program manager of Looking Glass New Roads, a day shelter dedicated to homeless youth] said the most common is called ‘survival sex.’  Typically, a person will offer a homeless youth a place to stay and expect sexual activity in return.

Sometimes, said Mirabal, the teen is not aware of the arrangement until after they’ve stayed with a person for a few days or weeks.

This form of predatory behavior is not confined to targeting the female gender. Homeless males find themselves being pushed into these compromising situations as well:

‘They wanted to have, like me have sex with her, while I’m staying on their couch, as part of rent,’ said a young homeless man who wanted to be identified as Brain. ‘I was like, I can’t do that. I’m sorry.’

Brain is 21 years old. He acknowledges his age and gender made it easier for him to say no and leave that situation.

Lack of resources can drive people to desperate measures. Add in the possibility of mental health or substance abuse issues, and the situation gets rapidly worse. When you don’t know where your next meal is coming from it become easier to rationalize things like this.

The escalating harshness of life on the streets over the recent years is also a factor. Young homeless girls in particular are at risk of rape, assault, and descent into prostitution. Without the normal support infrastructure provided by family and friends their vulnerability escalates.

Wendy McElroy, editor of ifeminists and someone who has herself been homeless, has commented on this aspect of the situation back in 2001:

The situation confronting homeless teens is worse today than when I ran away. It was the dead of winter when I left, and for the first nights I slept on the pew of a church whose doors were always open. Today, those doors would probably be locked. I was at one point ‘discovered,’ which was my greatest fear, but the person simply put a blanket over me and left without waking me up. Today, society is numbed to homelessness; we are overwhelmed with compassion fatigue and acts of gratuitous kindness seem to be fewer. We avert our eyes from the hand-painted signs and ignore the rattling cups.

McElroy’s position in the column is a controversial one. She advocates loosening of the child-labor restrictions so that the underage homeless can work and develop their own resources. Her reasoning is that most of the homeless in that age range are fleeing an abusive environment at home, and most programs are geared to return them to that home. Obviously, it is an idea that has gained little traction in the near decade since.

Source: “‘Survival sex’ lures homeless teens into prostitution,” KVAL.com, 02/09/10
Source: “Homelessness and Prostitution,” ifeminists, 05/15/01
Image by Franco Folini, used under its Creative Commons license.

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How To Become Homeless

HomelessAs we watch the economy spiral seemingly out of control, the specter of homelessness looms disturbingly close for people of all socioeconomic strata. Add in the chaos in the American housing market, and the picture becomes starkly unpleasant.

It’s a simple fact that we are seeing the number of the homeless grow, and it is disturbingly easy to end up on the streets. Right now, in Colorado, thousands face this possibility as the wildfires ravage the state. I know that feeling well from personal experience. You see, I am a native of New Orleans.

Just over five years ago, hurricane Katrina hit the city, and then the next morning the levees failed, flooding New Orleans. My wife and I had just emptied our savings account to pay for our wedding and honeymoon, and the checking account was low because it was a few days before payday. We ended up evacuating across the country with a total of about $200 and no vehicle.

With our friends, family and support network also scattered across the U.S., things became scary in very short order. Thanks to a few friends in other states we did not lack for a roof, but, as the weeks dragged on, the situation became more and more uneasy. I had a broken hand at the time, and so most earning opportunities were not viable. I was able to pick up a few bucks here and there, but nothing resembling enough income for a fresh start.

It was weeks before we had any inkling of whether we would be able to return to the city, much less whether anything we owned had survived. My then fiancee and I had a backpack of clothes each, a laptop, and our five cats. Things looked bleak.

“What about those legendary FEMA checks for $2,000 that everyone got?” you might ask. Not everyone got assistance, I know I sure didn’t. The Red Cross in New York helped us out with some clothes and a few hundred dollars. Let me tell you, you’ve never seen just how little $300 really is until it is all you have.

I will never forget having to swallow my pride and extend my hand for aid. We made it through thanks to the generosity of friends and strangers in Indiana and New York, but the awareness of the precipice was never absent from my thoughts. A few days before, everything was great: the wedding expenses were paid, I had a great new job, and we had just moved into a new apartment. Then, suddenly, it was all gone, taking all of my social resources with it.

We were very lucky. We made it back to NOLA six weeks after the disaster had struck — to find that most of our stuff had survived. It could easily have gone the other way, leaving us homeless. For many, it did.  I will never forget the fear in my heart during those times.

Just about anyone is susceptible to the whims of Mother Nature, and she can take the roof from over your head in a heartbeat. Whether it is the levee failures in NOLA, wildfires in Colorado, or some other species of disaster — it can happen to you.

Of course, due to my experience, this is what I think of first, but there are many other causes of homelessness. The Walk For The Homeless website enumerates a number of factors, including job loss:

As someone who has been homeless, I can tell you that loss of employment is one reason people, even whole families, become homeless. This is more likely to occur when there is only one wage earner in the family, if employment is seasonal such as construction or lawn maintenance, or if you both work and each earns only minimum wage. While there is usually a combination of reasons why people become homeless a particular one often stands out: illness.  Injury, sickness, and even mental illness can lead to being fired, laid off or replaced. Most of the time if you’re not able to do the work, you are out of a job. When you live from paycheck to paycheck, sometimes all it takes is to miss one or two paychecks and you can end up homeless. This is especially true if you have no friends or family to turn to for help.

Drawing on this information, Drea Knufken at Business Pundit boils things down into the Five Ways to Become Homeless, a list of things and situations that can leave you living on the streets. She also makes a very apt cultural observation:

Homelessness in the United States has always struck me as particularly painful. Penury is not well tolerated in the Land of Opportunity. People think money is easy to come by here, giving extreme poverty an especially powerful stigma.

In some countries, the homeless are seen as being cursed. In America, we do the cursing ourselves, labeling homeless people as lazy — one of Calvinistic capitalism’s direst sins.

The truth is that most homeless people know how to work hard.

This cultural perception is often borne out by observing the way that the majority of people treat the homeless when they encounter them on the streets. Not always, thankfully, but quite often.

Illness, job loss, foreclosure, or natural disaster — all can be harbingers of an upcoming life on the streets. It is worth remembering that these faces could be your own, and it would not take as much as you might think to end up there.

Source: “Why Do People Become Homeless?,” Walk For The Homeless
Source: “5 Ways to Become Homeless,” Business Pundit, 08/15/08
Image by Franco Folini, used under its Creative Commons license.

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Once More, Rehabilitation Urged Over Incarceration

CDC poster, 1940

CDC Poster, 1940

In Dallas, there is a debate raging over the proper way to deal with prostitution offenders. On one side, a police officer Randy Watkins from Ft. Worth endorses the reintroduction of a bill increasing the penalties for offenders caught in or near community spaces. School yards, public parks, churches and child care facilities all being examples of the public spaces in question. Officer Watkins says that, once enacted, word of the higher sentences will act as a deterrent to further crime.

On the other side of the argument is Judge Peggy Hoffman, presiding judge of a special court that rehabilitates prostitution offenders. At a recent hearing by the House Criminal Jurisprudence Committee, she stated publicly that increased jail time would be the least effective way to stop the “revolving door” that keeps prostitutes on the streets.

Erin Mulvaney, a staff writer for The Dallas Morning News, reports:

Hoffman disagreed, saying that increasing the jail time would not deter women from committing the crime. In Dallas County, 98 percent of women charged with prostitution opted to take jail time. The average time served in jail for prostitution is 10 to 20 days. That costs the city of Dallas $56 a day.

Judge Hoffman, it appears, is not alone in sharing this view. Mulvaney reports:

State Rep. Paula Pierson, D-Arlington, agreed that more jail time may not be the answer.

‘I’m sure some women aren’t victims of child abuse, some might not be drug addicts, but the majority of them are victims. They have been victimized all their lives,’ Pierson said. ‘It’s a bigger problem, a complicated problem.’

Acknowledging the social complexity of the issue is a start, but there is much more to be done. Hoffman favors cracking down on those who promote and enable the prostitution in the first place:

Hoffman also called for increased penalties for the promotion of prostitution, the ‘pimps,’ and for the solicitors, or the ‘Johns.’ In fiscal year 2009, there were 61 arrests for the promotion of prostitution, compared with 2,500 for prostitution itself.

Pierson also stated that her office will be monitoring Hoffman’s special court to determine its effectiveness.

What are your thoughts on rehabilitation vs. incarceration? We would love to hear them in the comments!

Source: “Dallas County judge urges rehabilitation over long jail terms for prostitutes,” The Dallas Morning News, 09/01/10
Image by pingnews.com, used under its Creative Commons license.

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Recidivism May Be Worse Than We Think

Maggots in my Sweet Potatoes: Women Doing TimeRecidivism: returning to a behavior pattern despite negative reinforcement. It’s a term most often used in cases of criminal activity or substance abuse. It is a chronic problem in the penal systems around the world, not just in the United States.

A few years ago, the BBC examined recidivism rates in the U.S. and the U.K., with some interesting results (via the Wikipedia entry for “recidivism”):

As reported on BBC Radio 4 on 2 September 2005, the recidivism rates for released prisoners in the United States of America is 60% compared with 50% in the United Kingdom but cross-country statistical comparisons are often questionable. The report attributed the lower recidivism rate in the UK to a focus on rehabilitation and education of prisoners compared with the US focus on punishment, deterrence and keeping potentially dangerous individuals away from society.

While the actual statistics may be a bit out of date, the idea on what fuels the disparity is worthy of note. The U.K. approach is geared towards reintegrating inmates into society by giving them tools with which to operate within its strictures. The programs taking this approach are popping up across the U.S. as well.

Still, the sheer number of people returning to jail after their initial term is staggering. What’s worse, according to a new study conducted in Memphis, Tennessee, those numbers may be higher than we have previously thought. Michael Lollar, a reporter for The Commercial Appeal, gives us the details:

[...U]p to 94 percent of former inmates will be rearrested and up to 81 percent will wind up behind bars again.

The numbers are part of a 20-year study that shows recidivism is far worse than statistics usually indicate. It is the only study done over such a long period of time, tracking inmates who were first jailed at the correction center between 1987 and 1991, says psychologist Dr. Greg Little…

Drs. Greg Little and Kenneth Robinson, founders of Correctional Counseling Inc., began the study in order to track the effectiveness of their treatment program as opposed to “traditional” incarceration. One reason that their numbers show a greater increase is, they say, grounded in methodology. Lollar’s article explains:

Tennessee Department of Correction studies show recidivism rates of about 51 percent over a three-year period, and national studies show recidivism averages of roughly 65 percent over three years. But Little and Robinson say the numbers keep going up over time, and the numbers are higher because most studies don’t count re-incarcerations that took place in other states or in courts other than the original case. For instance, an inmate released on state probation or parole is seldom counted as a recidivist if later jailed for a federal crime.

Even if their numbers prove incorrect, the ones they purport to replace are bad enough. Once jailed, more than half of all inmates will face a return to prison in their fairly near future. I think we can all agree that a system that is less than 50% effective is far from being in good working order.

The questions remain: How do we reduce the rates of recidivism? Does rehabilitation have a greater overall effect than simple punishment? Are there other techniques that can aid in rectifying this unfortunate situation? Let us know your thoughts in the comments – HUMANE EXPOSURES wants to know!

Source: “Recidivism,” Wikipedia
Source: “Recidivism rate worse than statistics indicate, Memphis-area study finds,” The Commercial Appeal, 03/07/10
Image copyright Susan Madden Lankford, from the book “Maggots in my Sweet Potatoes: Women Doing Time.” Used with permission.

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