266905 Residential substance abuse treatment in the New York City jail system

Monday, October 29, 2012 : 1:10 PM - 1:30 PM

Daniel Selling, PsyD , NYC Department of Health and Mental Hygiene, Correctional Health Services, East Elmhurst NY, NY
David Lee, MPH , NYC Department of Health and Mental Hygiene, Correctional Health Services, East Elmhurst, NY
Homer D. Venters, MD MS , Correctional Health Services, New York City Department of Health and Mental Hygeine, East Elmhurst, NY
New York City features the second largest jail system in the country, with half of those released recidivating within a year. Among inmates, there is an estimated 80% prevalence rate of substance abuse—a striking public health consideration, especially in the context of a national report that jail inmates who met criteria for substance dependence or abuse were much more likely than other inmates (70% vs. 46%) to have a prior criminal record. Around 100,000 people return to communities every year from NYC jails, highlighting a critical opportunity to prevent negative health outcomes associated with the cycle of substance abuse and criminality. Accordingly, the New York City Department of Health and Mental Hygiene—Correctional Health Services has established A Road Not Taken (ARNT), a unique residential substance abuse program based on evidenced-based practices. Unlike other programs aiming to treat substance abuse behavior, ARNT's approach expects durable reductions in recidivism by effecting mediators such as criminogenic thinking, internal motivation, and decision-making in other realms of life to prepare clients for active engagement in community treatment upon discharge. The program also leverages the Department's strong ties with local problem-solving drug courts to produce an unprecedented level of continuity of treatment. Since its inception in 2008, ARNT has partnered with drug courts to connect clients to services, with court support and praise mounting yearly. Last year alone, ARNT served 70 court-referred patients in addition to the over 400 other inmates in ARNT units. Preliminary analysis comparing inmate incarcerations one year before and after ARNT participation was promising, demonstrating a significant reduction in number re-incarcerations per year (1.2 vs. .75) and yearly recidivism (57% vs. 43%). Additionally, those with longer lengths of stay produced significantly reduced recidivism (55% vs. 32%) whereas those with shorter stays featured no significant effects, even though no group differences in recidivism between groups were observed pre-program. However, the realities of Rikers Island—including a high movement rate, short length of stay, and highly heterogeneous population with varied health risks even compared to other jail systems in the country—pose unique challenges of methodological and clinical concern. These unique problems compound the commonly cited difficulties in jail-based research, but their enacted solutions are described here along with learned lessons. Preliminary descriptive statistics about the client population are presented and actionable suggestions for identifying clients, tailoring treatment, and creating long-term changes in substance-abusing forensic populations are discussed.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Describe A Road Not Taken, Rikers Island’s novel Residential Substance Abuse Treatment (RSAT) program. 2. Identify challenges to program implementation and evaluation posed by security protocols and other features of correctional environments. 3. Discuss considerations for sampling strategies, data collection, and selection of study outcomes in light of these challenges. 4. Describe preliminary descriptive statistics about program clients and their implications for identifying populations and tailoring treatment.

Keywords: Jails and Prisons, Substance Abuse

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Executive Director of Mental Health and the Director of Substance Abuse Treatment for the New York City Department of Health and Mental Hygiene, Bureau of Correctional Health Services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.