Two understudied issues are the distribution of treatment services available, given the needs of substance abusers, and the capacity of these programs to provide adequate service for offenders. Advances have occurred in an understanding of the factors that affect the adoption of innovations or programs that are designed to improve outcomes. Yet, these studies have not looked at one of the critical issues facing the field of substance abuse treatment which is the plethora of low intensity programs when the population needs more intensive care. While program improvements such as adding specific therapies (i.e. cognitive behavioral therapy, motivational enhancements, etc.), assessment tools, or medications are lauded as important, if program dosage is inadequate, then it is unlikely that long-term gains can occur in achieving better outcomes. A better understanding of the factors that affect the adoption of intensive services that include adequate dosage units can then serve as foundation to advancing the components of the treatment program.
This study was designed to be exploratory in terms of the first step in advancing an understanding of the factors that affect the availability of treatment programs for a subgroup of the addict populations—substance abusers in correctional settings and the capacity of the programs. The emphasis is on programs for offenders that are in jail or that are offered to offenders supervised by probation or parole offices (collectively this is nearly 90 percent of the offenders under correctional control). The importance of this exploratory work is to begin to review the factors that affect capacity levels, particularly for intensive treatment programs. A need exists to expand the number of intensive treatment programs that are available for offenders given the severity of their substance abuse disorder (Belenko & Peugh, 2005
; Chandler et al., 2009
The findings indicate that structural county-specific variables have a limited impact on the availability of certain types of treatment programs as well as on the capacity of the programs as they were found on the lower branches of the tree predictors. For the most part, whenever these variables were important they tended to have a secondary or tertiary impact compared to advances in correctional agency practices (i.e. the adoption of a standardized substance abuse tool), and the organizational climate that focuses on an organizational learning environment, and the emphasis on working relationships (connections) with other agencies. The general perception is that availability and capacity are a function of the jurisdiction’s commitment to substance abuse treatment as evidenced by available resources. However, the classification and regression trees did not find that perception of resource availability by administrators associated with levels of service availability or capacity. Together, this suggests that theories about adoption and implementation may be more advanced by focusing on institutional theories rather than resource-dependency theories. The notion that organizations can create environments that are supportative of innovation through the enhancement of relationships with external agencies and development of internal supports have been found to be important in other studies (see D’Annuo, 2006
). Further work may examine theories to understand how these attributes affect absorptive capacity (Knudsen & Roman, 2004
This exploratory analysis also contributes to a better understanding of the factors that contribute to utilization of intensive programs for offender populations. Three key variables—organizational learning, working relationships, and use of substance abuse tool—when appearing together are more likely to operate in concert to provide a fruitful environment to support intensive programs in terms of availability and capacity. These three variables are unlikely to achieve the same gains for low or medium intensive programs, suggesting that the combination of these contextual factors warrant further investigation. Furthermore, it appears that these intensive programs that address the substance abuse and criminal lifestyles of offenders (i.e. therapeutic communities) are consistent with the values of many correctional administrators in their belief in punishment. This is evidenced by the models for intensive treatment where the availability is influenced by the counterintuitive support for punishment. Given the culture of correctional agencies where punishment-oriented policies have dominated the landscape for the last thirty years, it is likely that administrators are more supportive of strong social control therapeutic programs which serve to both punish and treat the offender.
The CART methodology can be useful in considering the social context in which treatment programs for offenders can be offered. It is apparent that communication and social networks are important in the adoption of treatment programs with an emphasis on working relationship with other agencies and an organizational learning environment. Future studies may therefore consider different processes that serve to improve the social environment such as the Availability/Responsiveness/Continuity (ARC) model which focuses on policy and evidence-based treatments in social welfare and juvenile justice settings (Glisson & Schoenwald, 2005
). In the ARC model, the change strategies involved agents that were focused on communicating key messages to staff regarding the value and importance of these innovations. Little scholarly work has focused on these communication strategies in correctional settings, particularly the means to mix public safety and treatment messages as part of a change strategy.
The last decade has seen a focus on correctional agencies establishing partnerships with other organizations (e.g. substance abuse, mental health, police, housing; see Reentry Policy Council, 2006
) as a means to expand the services provided to offenders. Additionally, the literature has emphasized the need to assist correctional agencies in transforming from paramilitary organizations into learning organizations, thus expanding correctional options (including treatment programs). The socio-political environment has provided support for the advancements in the three variables that were detected as being important to the availability of substance abuse treatment programs and to build the capacity of these programs. Building upon these trends in the field, absorptive capacity theories can be developed to test how an organization’s ability to seek and utilize information impacts adoption patterns (see Knudsen & Roman, 2004
). Little is available in the literature on how these patterns can truly affect the issues of availability of appropriate programs, as well as the capacity of such programs. Given the results from the Fighting Back demonstration initiative where the emphasis on the resolution of drug problems did not contribute to improved capacity of appropriate treatments in the community, it would be valuable to study these issues.
A few comments about the CART methodology are warranted. The methodology allows us to isolate how these variables interact to explain availability and capacity for certain programs in correctional settings. The main challenge is that the CART technique splits variables to create homogeneous subgroups. This provides some challenges to interpretation, since one often results in small cell sizes (as small as one) for a “winning” combination. Other challenges to the CART methodology is that the decisions about pruning, and the size of the tree, are generally left to the researcher regarding the number of branches and the decision rules regarding the size of each branch. The visual display is appealing but that depends on the number of branches.
This study, as well as the other papers in this special edition, use self-report administrator data from the National Criminal Justice Treatment Practices Survey (NCJTP). The nature of the data is therefore self-report and reflect the perspectives of the administrators of the surveyed agencies. The survey findings outline organizational and structural characteristics from the lens of that administrators which is a strength but also a limitation. Further work should be done to validate key measures such as working relationships by surveying other stakeholders to understand how their perspective on the correctional agency and the working relationships with that organizations as well as the perspective of the staff on the issues of the culture of the agencies.
The key to improving treatment capacity of the system, particularly for intensive programs that are more expensive, has yet to be answered. Our review of the literature found very little on this topic overall. In the correctional literature there is a small body of research studies that address the microlevel factors that affect service delivery such as correctional officer attitudes and participation (Farabee et al., 1999
; Taxman & Bouffard, 2000
) and prosecutor policy (Terry-McElrath & McBride, 2004
). Although most of these studies have shown how these policies affect offender’s participation in treatment programs, little has focused on policies that affect capacity of programs. A health service utilization model that integrates program capacity is warranted as another area of research development.
Criminal justice policy is at a crossroads between continuing with the incarceration-based policies of the last thirty years and incorporating a balanced approach that integrates substance abuse treatment programs within the fabric of correctional agencies. The staggering ratio of incarcerated offenders to general population (1 to 99 according to Pew Charitable Trusts, 2008
) has brought a great deal of criticism to incarceration-based policy. However, the integrated treatment-corrections model has struck a difficult nerve due to the policy and programmatic efforts to provide drug treatment to offenders during the same period of time that incarceration-based policies blossomed. Many of these policies were the result of the perceived failure of the correctional system to reduce recidivism and the recognition that it is difficult to provide treatment services in correctional agencies. This study begins to identify two issues—availability of treatment programs and capacity of the programs—that need attention as other efforts mount to provide a more balanced approach by looking at the systemic factors that affect the availability of core treatment programs and capacity within those systems. More work on these issues is needed as the question changes from “should we provide substance abuse treatment services” to “how best to provide these services” to drug-involved offenders. This study suggests that structural variables appear to be less important than culture and climate in affecting the program capacity in community correctional agencies. More work is needed to test some of the hypotheses generated from this study concerning communication and social networks practices that can assist correctional agencies in achieving balance between safety and rehabilitation goals.