Process Evaluation of a Residential Substance Abuse Treatment (RSAT) Program in Dallas County, Texas, 1998-1999 (ICPSR 3077)

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Date of Collection View help for Date of Collection

Study Purpose View help for Study Purpose

This study assessed the Dallas County Judicial Treatment Center (DCJTC) in Texas. The DCJTC is a residential substance abuse treatment center for drug-involved felony offenders. Opened in 1991, the DCJTC has a 228-bed capacity, including four 35-bed units for men and three 20-bed units for women. This program represents the final and most restrictive sanction county and district judges can impose before state jail or prison terms. No systematic screening procedures were used to determine offenders' needs for drug treatment or therapeutic intervention during the time period covered by this study. The DCJTC is managed by Cornell Corrections, Inc., under contract from the Dallas County Community Supervisions and Corrections Department. The DCJTC was designed as a therapeutic community (TC). It provides a treatment program of approximately six months in three major phases: orientation, main treatment, and re-entry. Offenders advance through a hierarchical recovery sequence in which they receive progressively more responsibilities and privileges. This study's primary goal was to address the need to assess and appropriately classify inmates' problems and monitor service delivery and therapeutic progress to help ensure effective treatment. The treatment episode was seen as a series of interrelated events, each presenting an opportunity to collect data that could improve the effectiveness of treatment. This study developed a set of data collection instruments to be administered at regular intervals throughout treatment. The regular use of these instruments was seen as narrowing the feedback loop between stakeholders, program staff, and program participants in order to improve participant selection, classification, and the treatment process. These instruments were administered to DCJTC program participants and used to (1) assess the risks and needs that offenders present at admission, including classification of drug dependence problems, (2) examine the short-term impact of the TC on improvements in psychosocial functioning and treatment motivation, and (3) determine whether it can be predicted who will prematurely drop out of the program.

Study Design View help for Study Design

Data were collected from 429 offenders admitted to the DCJTC between January and December 1998. Many of the data collection instruments used in this study originated in the Drug Abuse Reporting Program (Sells and Simpson, 1976, Simpson and Sells, 1982, 1990). These instruments were modified more recently for use in a project titled Improving Drug Abuse Treatment, Assessment, and Research (Simpson, Chatham, and, Joe, 1993, Simpson, Dansereau, and Joe, 1997). This evaluation system was adapted further in other studies for use in residential correctional settings. Revisions to these forms for this study included rewording items to reference the six months prior to the commitment arrest as the time frame for the collection of baseline information. During their first week of treatment, residents completed a comprehensive intake battery that included (1) the Texas Christian University (TCU) initial assessment, (2) the TCU self-rating form (SRF), and (3) the TCU intake interview. The initial assessment was a structured, counselor-led interview completed within 24 hours of treatment entry and was divided into four major sections: (1) mental status, (2) background and psychosocial functioning, (3) alcohol and other drug use, and (4) psychological status. Indication of severe mental impairment was gauged through four questions adapted from the Mini-Mental Status Exam. Immediately following the initial assessment, residents completed the SRF, a 95-item self-report instrument designed to assess psychological functioning, social functioning, and motivation for treatment. A counselor administered the intake interview approximately two to seven days after the initial assessment in order to give residents time to acquaint themselves with the program and staff. It included detailed questions on the resident's social background, family and peer relations, health and psychological status, criminal history, drug use problems, and behavioral risks for HIV/AIDS. Progress made during treatment was measured by the TCU Resident Evaluation of Self and Treatment (REST) and the TCU Counselor Rating of Client (CRC) forms. These instruments were administered at the end of treatment months one, three, and six, linking them to major landmarks in residents' treatment episodes: end of orientation, completion of the 90-day treatment plan, and completion of the discharge plan. The REST included all 95 questions on the SRF and sections on offenders' perceptions of the structure of the program and their experiences while in treatment, an evaluation of the counselor, an evaluation of their own personality, and ratings of group and individual treatment sessions. The CRC forms were completed by each resident's primary counselor. They rated residents on a set of 25 attributes related to residents' ability to benefit from treatment and indicated the extent to which counseling activities with each client had focused on certain activities.

Sample View help for Sample

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Universe View help for Universe

Drug-involved felony offenders in the Texas prison system eligible to be admitted to the DCJTC between January and December 1998.

Unit(s) of Observation View help for Unit(s) of Observation

Data Source View help for Data Source

Data Type(s) View help for Data Type(s)

Description of Variables View help for Description of Variables

Variables include gender, admission date, discharge date, discharge code, and treatment discharge code. Variables from the initial assessment include mental status, date of birth, race, residence in last month, marital status, education history, employment history, sources of financial support, kind of health insurance, legal status, degree of pressure felt from others to enter treatment program, how important it was to patient to get treatment for different types of problems, history of use of alcohol, marijuana, opiates, cocaine or crack, speedballs, inhalants, amphetamines, hallucinogens, sedatives or tranquilizers, and nicotine, history of injecting drugs, how problematic alcohol and other drug use was in past year, history of psychological problems, whether eligibility criteria were met, and whether patient met any exclusionary criteria. Variables based on initial assessment responses include whether patient met the Diagnostic and Statistical Manual, fourth edition, criteria for being classified as dependent on or an abuser of alcohol, cocaine, cannabis, or opiates. Variables from the SRF include answers to the 95 items on the form and scales based on those responses for self-esteem, depression, anxiety, decision-making, childhood problems, hostility, risk-taking, social conformity, problem recognition, desire for help, treatment readiness, and self-efficacy. Variables from the intake interview include living situation prior to entering treatment, number of children, what relationship was like with spouse/primary partner and children in last six months, marital history, problems experienced in elementary school, employment history, sources of financial support in last six months, what adults patient lived with during childhood, quality of parenting provided by mother and father, number of siblings, relationship with family members in last six months, role of religion in patient's life, number of friends in past six months, number of friends who did not use drugs, characteristics of friends (including criminal activities engaged in), relationship with friends, and leisure activities. Additional variables focus on criminal history (including arrests and reasons for arrests), age at first arrest, income from illegal activity, arrests on drugs or trying to get drugs, history of incarceration, current legal status, health and psychological status, drug use history (including which drugs were most serious problem and age at first use of different drugs), frequency of use of different drugs in last six months and last 30 days, alcohol use history, problems caused by drug and alcohol use, whether friends and family had undergone drug treatment, reasons for using drugs and alcohol, number of times quit using drugs or alcohol, previous treatment experience, whether family and friends would support treatment efforts, patient's assessment of how successful treatment would be, history of gambling, activities relating to AIDS risk, attitudes toward AIDS, and counselor assessment of patient, including physical and mental health and the areas in which the counselor thought the patient was in most need of treatment. Variables from the REST and CRC forms appear three times, once for each administration of the forms (at one month, three months, and six months after admission). Variables from the REST include answers to the 95 items that appear on the SRF, patients' ratings of treatment program features, their own participation in therapeutic groups, counselors' attitudes and behavior, their own attitudes and behavior, group counseling sessions, individual counseling sessions, and the amount of time devoted to different issues in the group and individual sessions, date of admission of form, and counselor who administered the form. Variables based on answers to the REST include the same scales derived from answers to the SRF along with scales measuring patients' perceptions of program structure, staff empathy, peer support, therapeutic sessions, treatment engagement, personal progress, trust in staff and other patients, counselor competence, and counselor rapport. Variables from the CRC include answers to 25 questions that rate patient attributes, answers to 23 questions about the focus of treatment with the patient, date form was completed, and counselor who completed the form.

Response Rates View help for Response Rates

For the initial assessment, 419 forms were collected of a possible 428 (97.9 percent). The sample originally included 429 offenders, but one was discharged prior to admission to treatment. There were 421 Self-Rating Forms collected of a possible 428 (98.3 percent). There were 419 intake interviews collected of a possible 425 (98.6 percent). For the Resident Evaluation of Self and Treatment form, 399 of a possible 405 (98.5 percent) were collected at month one, 349 of a possible 358 (97.5 percent) were collected at month three, and 296 of a possible 307 (96.4 percent) were collected at month six. There were 402 of a possible 415 (96.9 percent) Counselor Rating of Client forms collected at month one, 353 of a possible 371 (95.1 percent) collected at month three, and 300 of a possible 315 (95.2 percent) collected at month six.

Presence of Common Scales View help for Presence of Common Scales

Many scales used in this study were based on those that originated in the Drug Abuse Reporting Program conducted by Sells and Simpson and later modified for the Improving Drug Abuse Treatment, Assessment, and Research project by Simpson, Chatham, Joe, and Dansereau. A measure for classifying risk of recidivism was modeled after the Lifestyle Criminality Screening Form. Measures of patients' perceptions of program structure and their treatment experience were adapted from the Client Self-Rated Progress Checklist. Other scales used in this study were the Diagnostic and Statistical Manual, fourth edition, the Mini-Mental Status Exam, the Pearlin Mastery Scale, the problem recognition, desire for help, and treatment readiness scales developed by Joe, Knezek, Watson, and Simpson, the TCU HIV/AIDS Risk Assessment, and several Likert-type scales.

Original Release Date View help for Original Release Date

2003-06-05

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