Client Profiles in the Offender Re- entry Program (ORP) and the Need to Address the Twin Issues of Trauma and Crime Michael Dennis, Ph.D. and Vinetha Belur,

Client Profiles in the Offender Re-entry Program (ORP) and the Need to

Address the Twin Issues of Trauma and Crime

Michael Dennis, Ph.D. and Vinetha Belur, Ph.D.Chestnut Health Systems, Normal, IL

Presentation at the Community Corrections and Offender Reentry Program Grantee Meeting, May 3, 2011, Denver Colorado

Acknowledgement and Contact Information

• Data from SAMHSA/CSAT 2004-2009 Young Offender Re-entry Program (TI16904, TI16915, TI16928, TI16939, TI16961, TI16984, TI16992, TI17046, TI17070, TI17071) and 2009-2013 Offender Re-entry Program (TI21580, TI21585, TI21595, TI21597, TI21624, TI21632, TI21639, TI21682, TI21688, TI21705, TI21714, TI21748, TI21774, TI21788, TI21815, TI21948)

• Opinions are those of the author and not official positions of the government

• Available from www.chestnut.org/li/posters • Please direct comments to Michael Dennis, Chestnut

Health Systems, 448 Wylie Drive, Normal, IL 61761, 309-451-7801, [email protected] .

http://www.chestnut.org/li/posters

mailto:[email protected]

Goals

• To give a profile of the clients seen in SAMHSA/CSAT’s Offender Re-entry Program (ORP) and how needs, treatment and outcomes vary by age

• Examine the high rate of victimization and demonstrate how it is related to co-occurring mental health issues, criminal activity and other presenting problems

Demographics

13%

22%

20%

40%

16%

3%

12%

19%

21%

44%

14%

2%

43%

16%

50%

21%

11%

2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Female

African American

White

Hispanic

Mixed

Other

<18 (N=1,734)

18-25 (N=811)

26+ (N=421)

Adults more likely than other ages to be female

and White

Adolescents & Young Adults more likely to be

Hispanic and Mixed

Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)

Grantee Location & Age of Clients

Years of Use

27%

77%98%

0%10%20%30%40%50%60%70%80%90%

100%

<18(N=1,734)

18-25(N=811)

26+(N=421)

Less than 11-2 years3-4 years5 or more years

Adults (OR=132.5) and young adults

(OR=9.1) more likely than youth to have 5 or more years of use


Weekly Pre-Controlled Environment Alcohol/Drug Use By Age

11%

18%

17%

39%

22%

72%

6%

9%

11%

41%

55%

74%

6%

4%

6%

31%

57%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Other Drug

Heroin

Crack/Cocaine

Alcohol

Marijuana

Any Drug

<18 (N=1,734)

18-25 (N=811)

26+ (N=421)


Adolescents and Young adults more likely to use marijuana

71%

Substance Use Severity

59% 66%

91%

0%10%20%30%40%50%60%70%80%90%

100%

<18(N=1,734)

18-25(N=811)

26+(N=421)

UseAbuseDependence

Adults (OR=9.7) and young adults (OR=1.9)

more likely than adolescents to have

dependence


9

Past-Year Violence & Crime

80%

90%

95%

100%

40%

57%

72%

42%

41%

0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Any Violence or Illegal Activity

Physical Violence

Any Illegal Activity

Any Property Crimes

Other Drug Related Crimes*

Any Interpersonal/ Violent Crime

Lifetime Juvenile Justice Involvement

Current Juvenile Justice involvement

1+/90 days In Controlled Environment

*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)


10

Type of Crime by Severity Group

54%

28%

7%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Under 18 18-25 26+

Drug Useonly

OtherCrime*

ViolentCrime

*Other crime includes vandalism, possession of stolen goods, forgery, and theft.

Odds ratio (OR) for

Youth (15.6) and young adults (3.0) higher than

adults


11

Intensity of Justice System Involvement

Past-Year Illegal Activity/SA Use .1%

Past Arrest/JJ/CJ Status 2%

Other JJ/CJ Status 2.8%

Other Probation, Parole, or Detention 16.3%

On Probation/ Parole 14+ Days w/1+Drug Screens 20%

In Detention/ Jail 14-29 Days 6.6%

In Detention/Jail 30+ Days 51.9%


12

46%56%

68%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Under 18 18-25 26+

Past year illegal activity/drug use

Past arrest/ JJ/ CJstatus

Other JJ/ CJ status

Other prob/ parole/detention

On prob/ parole 14+days w/1+ drug screens

In detention/ jail 14-29days

In detention/ jail 30+days

Intensity of Justice System Involvement by Severity Group

Adults (OR=1.6) and young adults (OR=1.5) more likely than

adolescents to be coming from long term detention Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966)

13%

23%

31%

33%

33%

56%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

General AnxietyDisorder

Traumatic StressDisorder

Major DepressiveDisorder

Attention Deficit/Hyperactivity Disorder

Conduct Disorder

Any Co-OccurringPsychiatric

Co-Occurring Psychiatric Problems


Pattern of Co-morbidity

63%60%

44%

0%

20%

40%

60%

80%

100%

<18(N=1,734)

18-25(N=811)

26+(N=421)

InternalizingonlyExternalizingonlyBoth


Adolescents more likely

than adults to have only

ExternalizingDisorders (OR=8.4)

Adults more likely than adolescents

to have only Internalizing

Disorders (OR=4.4)

41%

8%

13%

44%

56%

74%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Prior Mental Health Treatment

Any Self Mutilation

Any Homicidal/ Suicidal Thoughts

Ever Homeless or Runaway

High Severity Victimization (GVS > 3)

Ever Physical, Sexual or EmotionalVictimization

Other Psychiatric Issues


GAIN-I Main Scale Problem Profile

5.38

0% 20% 40% 60% 80% 100%

Physical Health Conditions

Current Withdrawal

Financial Problem

Environmental Stress

Personal Sources of Stress

Health Problem Symptoms

Internalizing Disorders Sx

Personality Disorders Sx

HIV Risk Behaviors

Externalizing Disorder Sx

Substance Problem Sx

Crime and Violence Sx

Average No. of High/Mod Prob.

0 1 2 3 4 5 6 7 8 9 10 11 12 13

High

Moderate

Low


Count of GAIN-I Main Scales Problems By Age Group

26% 34%57%

0%10%20%30%40%50%60%70%80%90%

100%

<18 (N=1,734)

18-25 (N=811)

26+ (N=421)

None1 to 23 to 67 to 13


Vast majority endorse one or more problems

Adults more likely than adolescents

to report 7 or more problems

(OR=3.7)

Vast majority endorse 3 or

more problems

Initial Level of Care

10%6% 43%

62% 58%39%

0%10%20%30%40%50%60%70%80%90%

100%

<18 18-25 26+

OPIOPLTRCC-OP


Adults more likely than

youth to start in IOP

Treatment System Involvement

94%

79%

64%

39%

97%

75%75%

96%

79%

54%89%

14%

0% 20% 40% 60% 80% 100%

Initiation within 2wk

Engagement for6+ wks

Continuing Care3+mons.

Positive SystemOutcome 6+

mons.

<18 (N=1,734)

18-25 (N=811)

26+ (N=421)


Adults more likely than youth to be in phased program and to have positive 6

month outcome (retention/ completion)

21.8

7.5

13

1.4

1.2

12.1

1.2

13

0.4

13.4

4.7

1.2

9.8

14

4.1

3.8

6.4

14.2

0 5 10 15 20 25

Days in Any SATreatment

Times in SA OP

Days in SA IOP

Nights in SAResidential

Days in other SA Tx

Treatment SatisfactionScale (mean)

<18 (N=1,072)*

18-25 (N=561)*

26+ (N=235)*

Amount of Substance Abuse Treatment (intake to 3 months)


*At 3m follow-up

Adolescents received more

“days” of treatment

Young Adults received more Residential Tx

Range of Substance Abuse Treatment Content (Intake to 3 months)

4.8

1.4

4.01

10.21

0.75

3.0

7.59

3.8

6.25

2.51

0.58

3.15

0 2 4 6 8 10 12

Direct ServicesReceived

Family ServicesReceived

External ServicesReceived

TreatmentReceived Scale

<18 (N=1,072)*

18-25 (N=561)*

26+ (N=235)*


*At 3m follow-up

Adolescents received a

broader range of Tx Services

0.5

9.7

0.4

0.1

9.85.6

32

5.4

0.3

0

0.3

0.2

1.8

31.9

2

0 10 20 30 40

Days in MentalHealth w/o Meds

Days in MentalHealth Tx w/ Meds

Times in MH OP

Nights in MHhospital

Days on MH Meds

<18 (N=1,072)*

18-25 (N=561)*

26+ (N=235)*

Mental Health Treatment Received(intake to 3 months)


*At 3m follow-up

Adults received more mental

health services

Other Environmental Interventions Across Systems (intake to 3 months)

18.09

5.79

22.33

13.45

1.79

12.73

20.41

6.08

6.40

25.69

28.2

20.1

31.6

11.9

16.5

0 5 10 15 20 25 30 35

Days of structured activity withoutsubstance use

Times urine/breath analysis*

Days in a controlled environment

Days incarcerated

Days of self-help

<18 (N=1,072)*

18-25 (N=561)*

26+ (N=235)*


*At 3m follow-up

Adults more likely to be

reincarcerated and to get self

help

0%10%20%30%40%50%60%70%80%90%

100%Pr

e-co

ntro

lled

envi

ronm

ent

Inta

ke 3m 6m

<18 years18-25 years26+ years

Percent of Days Abstinent from AOD


Past Month Abstinence

0%10%20%30%40%50%60%70%80%90%

100%

Intake 3m 6m

<18 years 18-25 years 26+ years


No Past Month Substance Problems

0%10%20%30%40%50%60%70%80%90%

100%

Intake 3m 6m

<18 years

18-25 years

26+ years


No Days in a Controlled Environment

0%10%20%30%40%50%60%70%80%90%

100%

Intake 3m 6m 12m



In Recovery (no use, abuse or dependence in the past month

while living in the community)

0%10%20%30%40%50%60%70%80%90%

100%

Intake 3m 6m

<18 years18-25 years 26+ years


No Illegal Activity

0%10%20%30%40%50%60%70%80%90%

100%

Intake 3m 6m



General Victimization Scale

48%28%

10%65%

45%39%

27%30%

13%9%

13%9%

6%1%

58%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Ever attacked w/ gun, knife, other weapon

Ever hurt by striking/beating

Abused emotionally

Ever forced sex acts against your will/anyone

Age of 1st abuse < 18

Any with more than one person involved

Any several times or for long time

Was person family member/trusted one

Were you afraid for your life/injury

People you told not believe you/help you

Result in oral, vaginal, anal sex

Curently worried someone attack

Currently worried someone beat/hurt

Currently worried someone abuse emotionally

Currently worried someone force sex acts


Severity of Victimization by Gender

56% 53%70%

0%10%20%30%40%50%60%70%80%90%

100%

Total Male Female

LowModerateHigh

Odds ratio (OR) of

Females 2.1 times greater

than Males


Severity of Victimization by Race

39%

62% 58% 64% 63%

0%10%20%30%40%50%60%70%80%90%

100%

Afr

ican

Am

eric

an

Whi

te

His

pani

c

Mix

ed

Oth

er

LowModerateHigh

OR of other races 2.2 to

2.8 times greater than African Am.


Severity of Victimization by Age Group

50% 59%76%

0%10%20%30%40%50%60%70%80%90%

100%

<18(N=1,734)

18-25(N=811)

26+(N=421)

LowModerateHigh

OR higher for 18-25 (1.4) and adults (3.2) than

youth


Type of Crime By Severity of Victimization

30% 40% 45%

0%

20%

40%

60%

80%

100%

LowSeverity

ModerateSeverity

HighSeverity

SubstanceUse OnlyOther Crime

Violent Crime


High victimization group more likely (OR=1.9) to report violent crime than

low group

Intensity of Justice System Involvement By Severity of Victimization

41% 48%58%

0%10%20%30%40%50%60%70%80%90%

100%

LowSeverity

ModerateSeverity

HighSeverity

Past year illegalactivity/ drug usePast arrest/ JJ/ CJstatusOther JJ/ CJ status

Other prob/ parole/detentionOn prob/ parole 14+days w/1+ drug screensIn detention/ jail 14-29daysIn detention/ jail 30+days


Psychiatric Disorders by Severity of Victimization4% 7%

15% 21

%

23%

6%

13% 21

% 26%

26%

19%

34% 41

%

40%

40%

0%

10%

20%

30%

40%

50%

60%

GeneralAnxietyDisorder(OR=5.6)

TraumaticStress

Disorder(OR=6.8)

MajorDepressive

Disorder(OR=3.9)

AttentionDeficit/

Hyperactivity(OR=2.5)

ConductDisorder(OR=2.2)

Low Moderate High


37

GAIN-I Main Scales Problem Count By Severity of Victimization

11%25%

45%

0%10%20%30%40%50%60%70%80%90%

100%

Low Severity (N=763)

Mod Severity (N=532)

High Severity (N=1664)

None1 to 23 to 67 to 13

Source: CSAT 2010 YORP and ORP studies only (N = 2,966)

High victimization group more

likely (OR=6.6) to have 7 to 13 problems than

low group

Documents

Client Profiles in the Offender Re- entry Program (ORP) and the Need to Address the Twin Issues of Trauma and Crime Michael Dennis, Ph.D. and Vinetha Belur,