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PUBLIC HEALTH AND PUBLIC SAFETY
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LINKING PUBLIC HEALTH AND PUBLIC SAFETY


Moderators
Steve Wing
Senior Advisor for Drug Policy
Substance Abuse and Mental Health Services Administration
Department of Health and Human Services
United States

Oscar Fuentes Fierro
Attorney General’s Special Office for Crimes against Health (FEADS/PGR)
Mexico

Introduction
Allen Ault
National Institute of Corrections
Department of Justice
United States

Special Populations: Adolescents
Wilfred Rios Sánchez
Attorney General’s Special Office for Crimes against Health (FEADS/PGR)
Mexico

Duane McBride
Andrews University
United States

Richard Dembo
University of South Florida
United States

Mario Alva Rodriguez
National Institute of Sciences of Penal Investigations (INACIPE)
Mexico

Special Populations: Dually-Diagnosed
David M. Wertheimer, M.S.W.
King County Department of Community & Human Services
United States

Mark Simpson
Lexington Federal Penitentiary
Department of Justice
United States

Engagement into Treatment and Retention
Tom McLellan
Treatment Research Institute
University of Pennsylvania
United States

Relapse Prevention and Recovery Support
D. Dwayne Simpson
Texas Christian University
United States

A System-Based Approach
Steve Wing, United States
Oscar Fuentes Fierro, Mexico

Diversion and Community Corrections: Pre-trial Diversion, Drug Courts, and Pre-Trial Diversion
Barbara Zugor
Executive Director
Treatment Assessment Screening Center (TASC)-Arizona
United States

Drug Courts
Tim Murray
Office of Justice Assistance
Department of Justice
United States

Incarceration: Adult Populations
Allen Ault
National Institute of Corrections
Department of Justice
United States

Parole and Community Corrections
Dave Gaspar
Arizona Department of Juvenile Corrections
United States

Jennifer Mankey
Denver Juvenile Justice Integrated Treatment Network
United States

Hiram Suárez Villa
Office of the Secretary of Government
Mexico

Lilia Vasquez Portales
Office of the Attorney General (PGR)
Mexico


Introduction
Allen Ault
National Institute of Corrections
Department of Justice
United States

In the United States, substance abuse leads hundreds of thousands of people into the criminal justice system each year – many of them in need of treatment. This represents a problem for both the public health and public safety systems.

There have been numerous creative responses to this challenge. An ongoing dialogue sponsored by the U.S. Department of Justice, U.S. Department of Health and Human Services, and the Office of National Drug Control Policy has focused on how system-wide approaches are needed, including approaches to:

  • Prevent entry into the criminal justice system for those who can be safely diverted to community social service systems

  • Limit penetration into the criminal justice system for nonviolent offenders through community justice interventions

  • Intervene with those who must be incarcerated, through treatment and supervision, both during and after confinement.

The ONDCP policy paper Drugs, Alcohol Abuse, and Adult and Juvenile Offenders: Breaking the Cycle—Breaking Free of the Cycle: Policy for Community and Institutional Interventions to Safeguard Public Safety and Restore Public Health outlines the elements of an integrated system. Communities employing these approaches can reduce recidivism and drug-related crime.

Oscar Fuentes
Attorney General’s Special Office for Crimes against Health (FEADS/PGR)
Mexico

It is a pleasure to participate in this important conference. In Mexico there are a number of institutions involved with the processing and rehabilitation of persons within the criminal justice system.

Many speakers from Mexico will address the roles that various government institutions play in reducing drug use and related crime. Lilia Vázquez, representing Procuraduría General of the Republic (PGR), will address drug treatment in the criminal justice systems. Addressing system-wide challenges will be Wilfred Rios Sánchez (FEADS/PGR), Mario Alva Rodriguez (INACIPE), Hiram Suárez (Secretrariat of Government), and Licenciada Vázquez Portales (PGR).

This session examining the linkage between public health and public safety offers great opportunity for sharing knowledge and expertise between Mexico and the United States. It also offers a unique opportunity to build a continuing dialogue on this issue of mutual concern.

Special Populations: Adolescents and Dually-Diagnosed Adolescents
Wilfred Rios Sánchez
Attorney General’s Special Office for Crimes against Health (FEADS/PGR)
Mexico

Mr. Rios discussed the role that the Attorney General’s Office for Crimes against Health takes in Mexico’s anti-drug prevention campaigns and its efforts to discourage criminal behavior and the social consequences of drug related crime and violence.

Drug consumption is given special attention so that appropriate measures with specific targets can be applied to attack the supply and the demand of illicit substances. Information is a fundamental mechanism for all social sectors vulnerable to this phenomenon. Therefore, the diffusion of legal disposition applicable to the commission for crimes against health is vital, as well as the diffusion of organic damages brought by the use and abuse of drugs.

To accomplish these tasks, the Special Office for Crimes against Health is engaged in the following activities:

  • Organizing, developing, and implementing conferences, including training the trainer courses for the formation of leaders in drug prevention

  • Sponsoring diverse activities include anti-drug messages with special emphasis on school age youth.

An important concept to understand is that under Mexican legislation, addicts are not considered delinquents, but rather sick persons who should be treated in a special manner. Cases are reviewed and diagnosed by a competent authority in the field and in accordance with the federal penal code system. Diagnosed cases are referred to the appropriate health sector for treatment and rehabilitation.

Mexico deems a crime committed against health to be one where any responsible person is engaged in the production, transportation, commercialization, and trafficking, including the provision of drugs as a gift. Sanctions can reach up to 25 years in prison.

In training provided to the community the areas described above are discussed, placing special emphasis on the effect that trained drug detecting canines have contributed to the success of anti-drug operations. This tool has been used successfully in preventing drugs from infiltrating schools.

Special Populations: Adolescents
Duane McBride
Andrews University
United States

For more than two decades, researchers, clinicians, and juvenile justice program administrators have been aware of the consistent relationship between alcohol and other drug (AOD) use and juvenile crime. Poly-drug use in this population is prevalent and most commonly includes alcohol, marijuana, amphetamines, LSD, and crack.

The consequences of the juvenile drug-crime cycle are severe. AOD use among juvenile delinquents appears to be strongly related to other social and psychological problems, including lowered school performance, poor family relationships, arrested social emotional development, increased interactions with AOD-using peers, and adult unemployment. AOD use also appears to be associated with a number of delinquent behaviors including recurring, chronic, and violent delinquency that continues into adulthood.

The juvenile justice system is a viable point of entry for a comprehensive collaborative service designed to break the juvenile drug-crime cycle. Very few juvenile justice jurisdictions provide appropriate substance abuse treatment services for youth. In the U.S. treatment for adolescent substance offenders has be found to been available in less than 40 percent of the 3,000 public and private juvenile detention, correctional, and shelter facilities.

The following model program employing research-based components can be used to guide improvements within the system.

  • Intake. There should be a single point of entry into the system, an immediate comprehensive and culturally competent assessment, and a special emphasis on evaluating possible co-occurring mental illnesses and conditions.

  • Cross Systems Case Management. Each case should be ensured a continuum of care provided by coordinating needed services from various systems.

  • Collaborative Systems. In order to protect the public safety and ensure integration of relevant community and social services, a judge within the Juvenile Justice System should administer the system. Examples of such systems include Drug Courts and Treatment Alternatives to Street Crime (TASC) programs.

  • Treatment Interventions within Graduated Sanctions. Graduated sanctions coupled with careful monitoring of treatment progress can be successful in reducing both drug use and delinquent behavior.

  • Evaluation. The system should have an evaluation system in place that provides ongoing feedback to the entire system.

Presentation based on:

McBride, D.C., VanDerWaal, Terry, Y.M., VanBuren, H. Breaking the Juvenile Drug Crime Cycle. National Institute of Justice Research Web Monograph, http://www.ojp.usdoj.gov/nij/pubs-sum/186156.htm.

McBride, D.C., Terry, Y.M., & Inciardi, J.A. Alternative Perspectives on the Drug Policy Debate in The Drug Legalization Debate (second edition) Sage Publications, Newbury Park, California, (pp:9-54), 1999.

McBride, D.C., Pacula, R.L., VanderWaal, C.V., Chriqui J. & Terry, Y.M.. Conceptual Framework Report to ImpacTeen, April 2000.

Terry, Y.M., VanderWaal, C.J., McBride, D.C., & VanBuren H. Provision of Drug Treatment Services in the Juvenile Justice System: A System Reform. Journal of Behavioral Health Services and Research, 27 #2: 194-214, May 2000.

Richard Dembo
University of South Florida
United States

Over the last few years there has been an increase in juvenile crime. There is a high correlation between juvenile drug use and crime. In Florida, arrests for drug offenses have increased 300% in the last 10 years. Increasingly younger people are entering the criminal system, bringing with them ever more serious problems.

Juvenile offenders are in special need of holistic approaches that address mental health, education, substance use, and other psychosocial problems. Communities require more effective programs for children and families who have not been able to access services.

Much of what we know has been derived from working with adults. However, there is a growing knowledge base about alcohol and drug problems in youth, and how to handle them more effectively. Challenges faced by the system include:

  • Developing consistent evaluation systems to assess the impact of treatment and identify candidates for early intervention

  • Determining the cost effectiveness of treatment interventions

  • Ascertaining approaches for increasing entry into and retention in treatment programs (especially challenging for an adolescent population)

  • Improving community support services to increase post treatment retention

  • Developing integrative systems of care that follow clients through their entire time within the criminal justice system.

Systems can address these challenges by incorporating interrelated activities into their efforts by:

  • Establishing preliminary screening and triage to identify problem areas that could be targeted during a more in-depth assessment, including the severity and scope of problems

  • Involving clients in quality treatment programs at the residential and community levels

  • Developing collaborative systems of care

  • Providing aftercare services, including the post-sanctions period (this is a major problem throughout the country, where long-term investments in treatment are needed.)

Model programs have been developed in Florida where assessment centers provide centralized intake facilities for youngsters who are at high risk. The target population includes juveniles who: (1) have been taken into custody; (2) are truant from school; (3) have not been taken into the justice system, but are at high risk, and (4) have undergone screening process, and are referred to the program.

Assessment centers provide opportunities and challenges. The centers can gather comprehensive information on youngsters that help inform referrals, court disposition, and program placement. (Before centers were established juveniles cases went through the court system and youngsters were followed 3 weeks later, thereby providing little information to the court about how best to serve the juvenile.)

The centers provide an opportunity to employ early intervention and diversion programs. Centers can serve as focal point for coordinating and evaluating services for families and individuals. Routine drug testing can be used to identify new drug use trends in a community.

Assessment centers also face challenges. For example, it is important that programs limit their catchment population so as not to pull in youngsters not truly in need of treatment (i.e., minor misdemeanors.) Screening instruments should be as culturally sensitive as possible. Maintaining a strong infrastructure and the support of key stakeholders is important for program success. And finally, collecting data on treatment outcomes system-wide is critical for evaluating and creating cost-effective programs.

Mario Alba Rodriguez
National Institute of Sciences of Penal Investigations (INACIPE)
Mexico

In Mexico, 75 percent of drug users are between the ages of 12 and 34. Drug use in this population has been on the rise since 1980. Marijuana and inhalers are the drugs of choice with heroin being the least consumed drug. Drugs are available on the street, schools, bars, and discos. The consequences of addiction are crimes, accidents, and absenteeism.

Prevention is crucial to combat addiction, with education being a priority. Prevention studies in Mexico have focused on one of the most vulnerable populations – males between the ages of 10 and 20.

Studies have shown significant tobacco and alcohol in the younger populations, with alcohol being the most abused drug. Usage is greater in tourist and U.S. border areas, which might indicate that location is a factor in increased usage. Also, areas close to metropolitan areas are more extensively affected.

Of 6,374 violent deaths analyzed in Mexico City’s Coroner’s Office, over half of the bodies had excessive alcohol levels in the blood. Illegal substances accounted for a much smaller amount.

Special Populations: Dually Diagnosed
David M. Wertheimer
King County Dept. of Community and Human Services
United States

Dual diagnosis is the co-occurrence of mental illness and substance use disorders. A wide spectrum is possible. Mental health problems can be a situational crisis or a persistent mental disorder. Substance abuse problems can range from use to abuse to dependence.

Persons with co-occurring disorders represent a significant proportion of the prison and jail populations. Sixty-three percent of jail detainees have a mental illness or a substance abuse disorder. The rate of serious mental illness in jails is 3-5 times the rate in the community. Ninety percent of inmates with schizophrenia, major affective disorders, or anti-social personality disorders have co-occurring substance abuse problems.

Behaviors that result in incarceration are often byproducts of mental illness and chemical dependency rather than true sociopathy. Incarceration provides neither a disincentive to criminal behavior nor a setting for rehabilitation. Rates of recidivism are extremely high.

Integrated treatment (i.e., where a client’s mental health and substance abuse disorders are treated simultaneously) provides the most effective results. Achieving integration requires collaboration among the mental health, chemical dependency, and criminal justice systems – at all entry and exit points in each system.

In a structure with a "No Wrong Door" approach, every entry point into the system is the "right" door leading to appropriate care regardless of the presenting problem. Major mental health, substance abuse, and criminal justice linkage points include pre-booking, post-booking, and post-release services.

By focusing on appropriate placement, provision of quality treatment services, and community transition, states and localities can experience reduced recidivism in this population.

Mark Simpson
Lexington Federal Penitentiary
Department of Justice
United States

Criminal offenders with co-occurring addictive disorders and psychiatric illnesses pose a special problem for the criminal justice system. If untreated, these offenders are often among the most difficult to manage within an institution. Their behaviors are often disruptive to the general inmate population and require increased staff supervision. These inmates are at greater risk of relapse in substance use and criminal behavior following their release back to the community. One reason for this is the likelihood such individuals use illicit substances to medicate their psychiatric symptoms.

In the United States, the criminal justice system is being increasingly tasked with the responsibility of providing drug abuse treatment to its offender population. When done right, drug abuse treatment can effectively reduce relapse in drug use and recidivism in criminal behavior among offenders following their release back to the community. However, dually diagnosed criminal offenders often do not respond as favorably to more traditional forms of substance abuse treatment. There are a variety of reasons for this. Substance abuse counselors often lack the training necessary to assess mental illness. Many programs lack the psychiatric help needed to treat mental illness. Involvement and retention of dually diagnosed criminal offenders in treatment are often difficult, due to rationalization and blaming others for their difficulties, distrust of treatment providers, and sudden changes in their psychiatric symptoms.

In response to the unique challenges posed by dually diagnosed offenders, the U.S. Bureau of Prisons, Department of Justice created a specialized drug abuse treatment program in 1997 for dually diagnosed male inmates at the Federal Medical Center (FMC) in Lexington, Kentucky. The 16-bed dual–diagnosis program is a 9-month intensive residential program that operates within a larger residential program for general population inmates.

The experience of the dual diagnosis program at FMC, Lexington has helped to identify critical elements that significantly impact the success of such treatment initiatives. These elements include:

  • accurate assessment of an offender’s psychiatric illness

  • skilled drug abuse treatment personnel who are trained and experienced in working with mentally ill offenders

  • long-term and intensive treatment that integrates substance abuse treatment and management of psychiatric symptoms

  • transitional treatment in the community that assists dually-diagnosed offenders in successfully reintegrating back into society

  • the transfer of information between institution-based treatment staff and community treatment providers to assist in the offender’s transition back to the community.

Engagement into Treatment and Retention
Tom McLellan
Treatment Research Institute
University of Pennsylvania
United States

Evidence suggests that drug dependence is a chronic medical illness with biological, psychological, and social components. For treatment to be as effective as possible it should address these aspects of illness with medication, therapy and counseling, and skill building.

A study looking at treatment for opiate addiction in pregnant women found that addressing their addiction in holistic manner with medication, counseling, job and family therapy and psychiatric care yielded the best outcomes.

Disorders have a genetic, metabolic, and behavioral influence. The nature of an individual’s addictive disorder depends on both inherent tendencies and vulnerabilities in addition to behavior and environmental influences.

Factors that predict poor outcomes for conditions such as asthma, diabetes, and hypertension treatment are the same as for addiction, specifically: non-adherence to a physician’s orders, low socioeconomic status, low family support for change; and psychiatric comorbidity. Medication adherence and relapse rates are similar across these illnesses.

Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Drug dependence generally has been treated as if it were an acute illness. However, research suggests that long-term care strategies of medication management coupled with behavioral interventions and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses.

Relapse Prevention and Recovery Support
D. Dwayne Simpson
Texas Christian University
United States

Numerous studies based on almost 300 drug abuse treatment programs and 70,000 patients over the past 30 years have shown that treatment can be highly effective in reducing or eliminating drug use, criminality, and related problems. However, all patients do not have the same needs and all programs are not equally effective, so treatment evaluation research has been expanded in recent years to focus maximizing treatment effectiveness and efficiency. General findings show that

  • Problem severity dictates the appropriate type and intensity of treatment needed.

  • Patients with moderate-to-high problem severity levels usually need at least 3 months of treatment (and for chronic opiate addiction, this increases to a year or longer) before significant benefits can be documented following release. As problem severity increases the need for and benefits of intensive residential care rises. Good assessments of patient needs and progress are therefore essential.

  • Cognitive stages of treatment readiness (or motivation) influence the chances that patients will engage and benefit from treatment. Special cognitive-based "induction" strategies for poorly motivated patients can be effective antidotes, especially in correctional settings.

  • Several distinct, sequential phases of treatment (e.g., referral, induction, engagement, early recovery, and continuing care) are related to addiction recovery outcomes of patients. Establishment of therapeutic rapport is particularly important.

  • Specialized interventions have been developed that can improve each of these crucial steps of the therapeutic continuum.

  • Research now being supported by several federal agencies emphasizes the need to understand and improve the manner in which treatment innovations can be effectively introduced and used in treatment programs for community-based and correctional populations.

A System-Based Approach
Steve Wing
Substance Abuse and Mental Health Services Administration
Department of Health and Human Services
United States

Working in concert, justice and public health agencies can establish a continuum of accountability and treatment for juvenile and adult offenders with substance use disorders. The criminal and juvenile justice systems should operate in concert with other service systems as a series of opportunities for intervention with offenders experiencing substance use disorders. Interventions should be carried out in a systematic manner and at the earliest possible opportunity.

Improving public safety and public health requires systematic interventions to bring about long-term change in the substance abusing and criminal behaviors of offenders. Treatment must be a priority of the justice system and incorporated into the routine practices and decisions of justice officials. More than simple coordination is required for the justice system to work effectively with public health service providers, largely because the primary focus of the former is public safety, while the latter focuses primarily on improving the lives of individual clients.

Policies and operational procedures must cross organizational boundaries to make treatment decisions a critical element of justice decisions. Nine key elements have been identified to help communities move beyond coordination of programs to full collaboration among community agencies with integrated decisions and services, specifically:

1. Set the stage.
Recognize substance abuse as a public health and public safety problem that requires the collective efforts of the health and justice communities working in an integrated fashion.

2. First things first.
Identify areas where collaboration will result in long-term benefits.

3. Treatment's contribution.
Recognize treatment as a key element in crime control. Treatment is not an ancillary service. Rather, treatment is important to the reduction of recidivism and substance seeking and abusing behaviors.

4. The importance of assessment.
Employ assessment protocols that address both substance use and juvenile/criminal justice factors.

5. Rational placement.
Adhere strictly to placement based on an assessment of safety risk and the severity of substance use disorders.

6. Individual treatment plans.
Employ the assessment to develop an individual treatment plan for each offender.

7. Rigorous case management.
Manage offenders in treatment with testing, supervision, sanctions, and incentives. Adult and juvenile offenders in treatment must be closely supervised and their cases tightly managed.

8. Structured accountability.
Be fair and predictable in delivering sanctions and incentives. Offenders respond to situations that they believe are fair and just, and to sanctions and incentives that are uniformly applied.

9. Follow through.
Extend the impact of treatment by providing a continuum of supervision and support.

Oscar Fuentes Fierro
Attorney General’s Special Office for Crimes against Health (FEADS/PGR)
Mexico

In Mexico, the public health and public safety systems are linked in several ways. The Government of Mexico has a national program to combat illegal drugs, of which the main objective is to combat drugs in its entire dimension including programs in drug demand reduction.

Mexico’s fundamental judiciary framework, the Constitution of Politics, sets forth several important principles. Public safety is embodied in Article 21 of the basic rule of the Mexican penal system, which establishes the authority and rights of the Public Ministry for prosecuting criminal acts. Article 73 describes coordinated activities that must be established among the federation, the federal district, municipalities, and States, in matters of public safety. Article 73 also establishes the organization, duties, selection, and promotion of members in public safety institutions.

Public health is considered a judiciary right of the people. The law, however, defines the basis and actions for access to public health services that must be coordinated by the federation and the States.

Diversion and Community Corrections: Pre-trial Diversion and Drug Courts Pre-Trial Diversion
Barbara Zugor
Executive Director
Treatment Assessment Screening Center (TASC)-Arizona
United States

Collaboration between the criminal justice and treatment systems is essential in assuring that all available resources are most appropriately utilized. Such services should based on a thorough evaluation of the needs of the offender.

System success depends on an objective, comprehensive needs assessment. The initial assessment of substance abuse involved offenders should be administered at a centralized location and can take place while the offender is either in or out of custody. The assessment process must respect the offender’s constitutional and statutory rights and follow guidelines regarding confidentiality. A comprehensive treatment plan should be completed at the earliest possible juncture after entry into the criminal justice system.

Because no single factor causes substance abuse disorders, and because the effects of substance abuse extend to multiple areas of a person’s life, it necessary to evaluate a wide range of individual and environmental factors. A comprehensive treatment plan should be holistic in nature, covering, key components in treatment plan development also include the participation and active input of the offender, the knowledge of the treatment provider, and referring or supervisory criminal justice personnel.

The Women’s Treatment Network was developed to put these concepts into practice. At the time of the program’s inception there was little coordination between criminal justice and the client service delivery systems for women entering the system. TASC believed that for the program to be successful it must provide early intervention to the client on the individual, community, and criminal justice levels. Comprehensive treatment plans should take into account the strengths and needs of the offender, set realistic goals and objectives, and be flexible to allow for unplanned or unforeseeable events. Establishing a coordinated service delivery system will help clients get from treatment to success.

Drug Courts
Tim Murray
Office of Justice Assistance
Department of Justice
United States

Drug courts in the United States have experienced an evolutionary development. In the mid-1980’s, many states and local criminal justice systems were inundated with felony drug cases. Drug courts began in 1989 as an experiment by the Dade, Florida County Florida Circuit Court to call upon the authority of a sitting judge to devise – and proactively oversee – an intensive, community-based, treatment, rehabilitation, and supervision program for drug defendants.

The goal of the drug courts was to halt rapidly increasing recidivism rates and reduce drug usage. The program is now underway in 48 states as well as in the District of Columbia, Puerto Rico, Guam, a number of native American tribal courts, and one federal district court.

The appeal of the drug court lies in many sectors: more effective supervision of offenders in the community; more credibility to the law enforcement function (where arrests of drug offenders are taken seriously, even by court systems overwhelmed by cases); greater accountability of defendants for complying with conditions of release and/or probation; greater coordination and accountability of public services provided; and more efficiency for the court system by removing a class of cases that places significant resources demands for processing on the courts.

Since the program’s inception, close to 100,000 drug dependent offenders have drug court programs with over 70% either still enrolled or graduated. Drug court participants reflect all segments of the community. Approximately 66% are parents of minor children. Approximately 15% are veterans. Men participate at twice the rate of women although the percent of female participants is rising. Many drug court participants have been using drugs for many years and most are poly-drug users. A large proportion of participants has never been exposed to treatment previously although many have served jail or prison time for drug-related offenses.

The original goals of drug courts of reducing drug use and recidivism have largely been achieved. Challenges however remain. Improving the system to address the repeat offender remains an area for further work. However, with continued support from federal, state, and local jurisdictions, the advances achieved under this program can be extended even further.

Incarceration: Adult Populations
Allen Ault
National Institute of Corrections
Department of Justice
United States

In the United States, 60% of adult male arrestees tested positive for drugs. Eighty percent of men and women behind bars (1.4 million) in the United States are seriously involved with alcohol and other drug use. It costs the United States $30 billion per year to incarcerate this population, with an average length of stay of 27 months.

Moreover, non-drug users in drug using households are 11 times more likely to be killed compared to those in a drug free household. Drug abuse in a home increases a woman’s risk of being killed 28 times.

Treatment is essential to breaking the cycle of drug use and crime. It is important to note that Sanctions without treatment actually increase recidivism. Inappropriate interventions also increase recidivism.

The length of time in treatment is positively correlated with treatment success. Treatment assessment and matching inmates to necessary services yields better treatment outcomes. Programs that adopt combinations of treatment components that are suited to individual client’s problems and needs are more successful than "one size fits all" inflexible programs.

Programs must provide a significant level of structure throughout assessment, treatment planning, supervision, and swift and certain sanctions. Rewards must be a part of the correctional treatment program. A segregated treatment unit is found to increase the likelihood for success. Segregation provides more treatment accountability and structure. Transitional services provide significantly better outcomes than programs without transitional services.

There is a need for better information dissemination to public and legislative groups regarding what we know about treatment programs that work and how these efforts reduce costs and recidivism. Treatment outcomes could improve if there were more options for matching inmates with the necessary treatment and service needs, including inmates with co-occurring illnesses. There is also a need for more evaluation data that is useful to correction managers.

Substance abuse treatment coupled with post-release follow-up and support are highly successful in reducing recidivism. Programs require both components for success.

Parole and Community Corrections
Dave Gaspar
Arizona Department of Juvenile Corrections
United States

The Arizona Department of Juvenile Corrections (ADJC) is the state agency responsible for juveniles adjudicated delinquent and committed to its jurisdiction by the county juvenile courts. ADJC is accountable to the citizens of Arizona for the promotion of public safety through the management of the state's secure juvenile facilities and the development and provision of a continuum of services to juvenile offenders, including rehabilitation, treatment and education.

The Department is 10 years old, having separated from adult corrections in 1990. It has two responsibilities — the first responsibility is to keep the public safe and the second is to change an adolescent’s life. ADJC’s efforts are based on seven basic values:

  • A good future requires a good foundation

  • Valuing the safety of youth in our care and the citizens of Arizona

  • Believing that all individuals should have the opportunity to engage in continuous improvement and learning

  • Believing that all people, including the youth in our care, have the right to live productive lives

  • Valuing all people regardless of where they are in their development and who they are as individuals

  • Valuing instilling hope in our youth and families

  • Valuing data and research-based decision making.

The program begins with a 28-day assessment period. Here, staff conduct a thorough evaluation, including job skills and interests, and focus on the key issues to be addressed for the individual. A number of secure housing facilities are available to provide a continuum of care based on the severity of the problems presented. Sixteen hours per day are dedicated to programmed activities with six of those hours spent in a learning environment. A major goal of the program is to penetrate delinquent thinking and catalyze personal change.

Through this approach of getting young people involved in education and changing delinquent thinking and behavior, the program gives the program participants an opportunity to see new life paths and hopefully provide a chance at a better life.

Jennifer Mankey
Denver Juvenile Justice Integrated Treatment Network
United States

The Denver Juvenile Justice Integrated Treatment Network was founded in 1995. Its purpose is to bring a variety of juvenile offender, substance abuse intervention and treatment as well as other community agencies to one table to identify ways to assist in interrupting the cycle of delinquency and substance abuse. It is funded by the Center for Substance Abuse Treatment, U.S. Department of Mental Health and Substance Abuse Services Administration.

Comprised of every state and local juvenile justice agency with responsibility for Denver's juvenile offenders, in addition to a wide variety of other youth and family serving programs, the Network has made significant progress in expanding access not only to substance abuse treatment but to other needed services in the community for this population. In addition, the Network believes that one of the keys to long term innovation and change within the youth services community is an investment in current and future generations of youth workers through establishment of a higher education link.

Ms. Mankey related the story of a child, David, which illustrated the juvenile justice system's ability to fail when interventions are not done early enough. In his case opportunities for services were missed, multiple systems and services were involved but with no single entity with lead responsibility, and there was no role for or engagement of his family.

In addressing the needs of juvenile offenders it is important that collaborative treatment network be organized to serve their particular needs. Members of the treatment network should include law enforcement (including parole), state and city agencies, public schools, family members and family advocacy groups, social service agencies, and substance abuse and mental health service agencies and providers. Members should collectively identify barriers and options for resolution. There should be cross training for the purpose of knowledge and skills development. Information systems should be integrated and the data used to evaluate Network efforts.

In Denver this approach has resulted in more youth receiving more services and staying in treatment longer. Participants are showing an increased ability to abstain from alcohol and drug use, handle life problems, and stay in school. There is a 23% decrease in the conviction rate one year after release on parole.

The system is also working more collaboratively. There is a more comprehensive intake assessment conducted, an increase in referrals within the system, more family involvement, improved case management, and enhanced communication and information sharing. The changes brought about by the Network have a positive impact on the system, youth, community, and families.

Dr. Hiram Suárez Villa
Office of Secretary of the Government
Mexico

The Mexican Government agencies that address prevention and social rehabilitation are

  • Prevention and Social Rehabilitation
  • Prevention and Treatment for Adolescent
  • Adolescent Council
  • Patronage for Employment Social Rehabilitation
  • Executive Coordination of Penitentiary Infrastructure

We will only address two of these organizations, specifically:

  • Prevention and Education which formulates, coordinates, and evaluates social programs dealing with prevention and social rehabilitation of delinquent adults.

  • Prevention and Treatment for Adolescents which runs all programs that addresses preventing antisocial conduct among adolescents.

The administrative federation to support these programs manages five adult federal Institutions and six for adolescents. Federal prisons for adults in Mexico include Guadalajara, Jalisco, and Matamoros (Tamaulipas), a penal colony in the Marias Islands, and a Federal Center of Psychological Rehabilitation.

The adolescent institutions, which are complemented with prevention programs for orientating and supporting the adolescent and their parents, are:

  • The Diagnostic Center for Boys
  • The Diagnostic and Treatment Center for Women
  • The Treatment Center for Men
  • The Special Needs Center
  • The Interdisciplinary Center for Walk-in Treatment

Prevention programs are of utmost importance and should be a fundamental part of treatment programs; this is because it is a sad reality that drug usage is high among adults and adolescents during the commission of a crime. The Mexican Government promotes the fight for eradication of this ill that equally affects, institutionalized adolescents and adults through the coordination of strategies and programs of the various Government’s administrative entities.

In Mexico pharmaco-dependent prevention programs are a public health issue. Their implementation is of public and social interest. The Health Department is in charge of implementing these programs which, in coordination with State Governments, promote and support:

  • Prevention and treatment of drug dependency – the rehabilitation of drug dependent users.

  • Education on the effects of drugs, psychotropic substances, and other substances of probable addiction, as well as their social consequences.

  • Education and instruction of the families and the community on how to recognize the symptoms of drug dependency in order to provide timely prevention and treatment.

The Mexican Government has special interest in involving all of the essential health factions with the penal authorities in charge of the institutionalized adult and adolescent population through:

  • the design of novel drug prevention program within the institution

  • the development of lines of communication with society as a whole in order to develop new strategies that would reduce and eradicate this terrible epidemic that threatens the security and the health of our citizens.

Lilia Vasquez Portales
Office of the Attorney General (PGR)
Mexico

Drug usage in Mexico has increased in recent years due to several factors. A major reason is the availability of drugs derived from cash transactions. The usage index has increased primarily in urban centers, tourist areas, and northern frontier towns. Linking drug usage with the attorney’s office is difficult in cases where the usage of drugs is perceived during the commission of a crime and when cases involving possession of a controlled substance are transferred to the Public Ministry.

To solve this problem the Mexican institutions that comprise the public safety and public health systems address the following:

  • Substance abuse prevention and crime prevention.

  • Rehabilitation of drug addicts through:

    - rehabilitation as an alternative to penal punishment

    - rehabilitation as part of social readaptation of the criminal.

The coordination of the public health and public safety institutions is addressed in the National Program for Drug Control 1995-2000 (PNCD), which defines the objectives, strategies, and actions to be developed by the Mexican Government to confront drug issues. The national policy plan has as an objective to develop complementary programs to reduce drug demand as well as availability. To achieve this goal coordination between twelve Government institutions is promoted.

In the area of drug consumption affecting public safety, an effort is being made to promote the coordination between the public health and justice departments, in order to prevent drug consumption and to promote rehabilitation of substance abusers, including those whose are on trial or incarcerated. This effort is being supported to facilitate the transition of the delinquent into society.

Important advances have been made in substance abuse prevention, the rehabilitation of addicts, and treatment as part of social readaptation. The Public Health Ministry, the State Department, as well as the Attorney General’s Office have played a fundamental role. There are specific procedures in place that require the coordinated involvement of the respective authorities in concrete cases. For example, when a drug addict’s case has been transferred to the Public Ministry, during the initial stages of an existing investigation, or when a penal process is being referred to the corresponding judicial jurisdiction.