“Drug Offender Treatment

Lessons Learned: New Challenges from

Institution to Community”

2013 FADAA/FCCMH Annual Conference

Robert L. Neri, LMHC, CAPSenior Vice President /Chief Clinical OfficerWestCare Foundation, Inc.

Lessons Learned in Corrections

•Learning from the Past

•Lessons of the Present

•Looking to the Future

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Lessons Learned in Corrections

Training Objectives:Participants will be able to list examples of the

many dynamic changes in the field of drug offender treatment

Participants will be able to assess their programs’ readiness for future anticipated changes

Participants will be exposed to the significance of the treatment environment and culture as it

relates to outcomes

Participants will leave with several ideas to process and plan with their program staff 21

Lessons Learned in Corrections

Do you know that 90% of your brain works without using any words at all?

Just so you know that means there’s only a 10% chance of me making any sense at all

once I start talking 31

Lessons Learned in Corrections

“I kept trying to be what you wanted, he said- but at a certain point you needed to

stop adding to the list”

Ex Offender41

Lessons Learned in CorrectionsTREATMENT/CORRECTIONS CONTINUUM

TREATMENT

Prev

entio

nIn

terv

entio

nBas

ic O

utpa

tient

In

tensiv

e Out

patie

nt

Sobe

r Hou

sing

GPS

Sh

ort-t

erm

Res

iden

tial

Day

Rep

ortin

g Cen

ters

Long-

term

Res

iden

tial

In Ja

il/In

Pris

on

CORRECTIONS

Civil C

itatio

ns

Pre-tri

al Pro

gram

s

Basic

Commun

ity Sup

ervisi

on

House

Arre

stCom

munity

Con

trol G

PS

Jail:

in T

reatm

ent +

Re-

entry

Priso

n: in

Tre

atmen

t + R

e-en

try

51

Lessons Learned in CorrectionsTreatment Is Dynamic &

ChangingSeparated vs. Integrated

Relapse (Shame-based) vs. Relapse Analysis

Medication (Shunned) vs. Medication Valued

Harsh Confrontation vs. Motivational Continuum

Recovering Staff vs. Multi-Disciplinary61

Lessons Learned in Corrections

Treatment Is Dynamic & Changing Continued

Instinct-Based vs. Research- Based

One Size Fits All vs. Individualized

Supervision vs. Supervision Intermittent

Planned

Must Hit Bottom vs. Coercion Works71

Lessons Learned in Corrections

CLIENT

JUDGE COUNSELOR

RECOVERY IS

RELATIONAL

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Lessons Learned in Corrections

Client Motivation is Dependent Upon Internal as well as

External Pressures

91

Lessons Learned in Corrections

Motivational Changes in Treatment

Treatment Dosage

External

Internal

101

Lessons Learned in Corrections

Developmental Model Principles

• “It’s a process not an event”

• “Treatment is cumulative”

•Developmental Psychology means:

“Psychology of Maturation”111

Lessons Learned in Corrections

COMPETENCY BASED APPROACH TO LEARNING

Competency Mastery Requires:

• Information knowledge

• Implementation knowledge121

Lessons Learned in Corrections

Establish a therapeutic alliance:

build and facilitate trust transfer

131

Lessons Learned in Corrections

HHIGH HOPE

LOW HOPE

HIGH PAIN

LOW PAIN

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Lessons Learned in CorrectionsRatio of Rewards to Sanctions and the

Probability of Success

15

Lessons Learned in Corrections

Incentives & Sanctions

Maximize benefit by timing of rewards and

consequences161

Lessons Learned in CorrectionsFinding a New Vocabulary for

Affirmation and Validation• Pulling Up the Positive to Avoid the

Punitive

• Affirm the Small Steps and Progress

• Educate- Which Means “Lead Forth”

• Learn to Articulate Affirmations

• Develop Emotional Literacy….Name it,

Claim it, Own it, Change it!171

Lessons Learned in Corrections

{Assess / Deprivation Needs}

•Trauma History

•Resiliency Factors181

Lessons Learned in Corrections

Programs are:

Expectations based-

Emphasize relationships

Rules based-

Emphasize compliance191

Lessons Learned in Corrections

Compliance is adaptation

Not

Treatment201

Lessons Learned in Corrections

Institutionalization requires treatment

Emotional Incarceration

211

Lessons Learned in CorrectionsGender Specific Challenges for Men

Masculinity Demands

Treatment Demands

Being Self-Reliant Seeking Help

Being Stoic Expressing Feelings

Taking Action Becoming Introspective 22

Vs.

Lessons Learned in CorrectionsGender Specific Challenges for Men

Masculinity Demands

Treatment Demands

Showing Strength Showing Weakness

Experiencing Pride

Experiencing Guilt & Shame

Acting Invincible Acting Vulnerable23

Vs.

Lessons Learned in Corrections

Facilitate movement from compliance to

internalization through gradual reduction of structure and insight

work241

Lessons Learned in Corrections

Create a treatment culture that promotes

“Mistakes as wonderful opportunities to learn”.

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Lessons Learned in Corrections

Teach social network mapping and assist

clients with building a social support network

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Lessons Learned in Corrections

How Can Programs Improve Care

• Ask and integrate trauma related questions / practices

• Deliver more experiential based learning

• Improve cognitive health approach

(teach memory / thinking skills)

• Use incentives 4:1 to sanctions 271

Lessons Learned in CorrectionsHow Can Programs Improve

Care Continued

• Insure program cultures are expectations based vs. rules based

• Aftercare can be more of a system rather than a loose aggregate of diverse providers

• Develop a youthful offender track of services 28

Lessons Learned in Corrections

Risk, Need, Responsivity

The Big 8NEED GOAL

Anti-social cognitions Reduce anti-social cognition, recognize risky thinking and feelings, adopt alternatives

Anti-social companions Reduce association with criminals, enhance contact with pro-social friends

Anti-social personalities Build problem-solving, self-imaging, anger awareness, and coping skills 29

Lessons Learned in Corrections

Risk, Need, Responsivity

The Big 8NEED GOAL

Family and marital relationships

Reduce conflict, build positive relationships and communication

Substance abuse Reduce usage, reduce the support for abusive behavior, enhance awareness

Employment Provide employment-seeking-and –keeping skills and enhance performance?

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Lessons Learned in Corrections

Risk, Need, Responsivity

The Big 8NEED GOAL

Education Increase performance rewards and satisfaction

Leisure and recreation Enhance pro social activities

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Lessons Learned in Corrections

Expectations Reality

Not easy, but worth it32

Lessons Learned in Corrections

Questions?

Thank you

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