Outcome Evaluation of the Wisconsin Residential Substance Abuse Treatment (RSAT) Program: The Mental Illness Chemical Abuse (MICA) Program at Oshkosh Correctional Institution, 1997-2000 (ICPSR 3082)

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Study Purpose View help for Study Purpose

This study evaluated the Mental Illness-Chemical Abuse (MICA) Program at Oshkosh Correctional Institution (OSCI) in Wisconsin. MICA, which has a 25-bed capacity, admitted its first cohort of patients in October 1997. MICA is a residential substance abuse treatment (RSAT) program that uses a modified therapeutic community model to provide treatment to male inmates who are dually diagnosed with substance abuse and mental health disorders. The program is based on the New Hampshire Greater Manchester Integrated Treatment Model for dually diagnosed individuals and emphasizes providing pre-treatment services prior to active treatment. It consists of three stages: (1) an 8- to 12-month residential therapeutic community stage that provides a wide array of mental health and substance abuse treatment and support services, (2) an institutional aftercare stage that offers support services to program graduates while they complete their sentences, and (3) a community aftercare stage that provides support services to program graduates who have been released into the community. At the time of the study, MICA was housed within the Transitional Treatment Center for mentally ill inmates at OSCI. Program participants shared cells in one wing of this unit, but they had contact in common areas with the other 115 inmates who resided in the unit. This outcome study documented important aspects of program implementation and effectiveness, including institutional (intermediate) outcomes and community outcomes of MICA program participants. This was done partly through comparison to a control group of dually diagnosed inmates who were not admitted to the program. Specifically, the study documented the following aspects of the program: (1) participants' characteristics and their involvement in treatment, (2) the program's impact on substance abuse and mental health disorders while in the institution, (3) its impact on substance use outcomes after release, (4) its effect on mental health outcomes after release, (5) its impact on outcomes related to stability of living situation after release, (6) its impact on recidivism, and (7) its effect on access to community treatment services for parolees.

Study Design View help for Study Design

This study included all 141 inmates admitted to MICA between October 1997 and March 2000. A control group comprised of 66 inmates who were too close to their mandatory release dates to participate in the program but who were otherwise eligible was also included. Part 1, Admissions Data, consists of baseline descriptive data and intermediate outcome data for program participants. Participant data collection forms were used to abstract inmate descriptive data from existing Department of Corrections (DOC) forms and collect intermediate outcome data, including assessment results, institutional behavior, and MICA staff ratings of treatment progress, behavior, and mental health stability. Outcome data were gathered whenever a program participant exited one of the five phases of treatment. These forms were developed, with program staff input, during the 1997-1998 National Institute of Justice (NIJ)-funded process evaluation of MICA. The Center for Health Policy and Program Evaluation (CHPPE) developed a database for systematizing the forms, which was maintained at the MICA site. A copy of the database file was received from MICA on a semi-annual basis and was checked for systematic and data entry errors. The CHPPE also collected institutional data from participants' official case files. Researchers traveled to institutions holding study participants on a monthly basis to review inmate case files and abstract selected data from them. Offender files located in institutions more than three hours' drive from the research office were sometimes temporarily transferred to the central records repository for review. Part 2, Comparison Data, consists of baseline demographic and descriptive data and intermediate outcome data for the comparison group. As much relevant information as possible was abstracted from the Department of Corrections Integrated Program Information System (CIPIS) database. These data were summarized into a format consistent with that of the MICA participants, and were supplemented by a review of each offender's institutional case file. Some of the data were contained only in the social services sections of the inmate case file located at the institution where the individual was incarcerated. These data were collected by travelling to each institution with comparison group members. As each comparison group offender was released to the community, data on institutional behavior and services for the comparison group were gathered during an additional case file review. Part 3, Institutional Post-Graduation Data, consists of data on intermediate outcomes and institutional placement and services after program completion. These data were collected at eight months after graduation (two months for the optional transition phase plus six-months follow-up) or at time of release (whichever came sooner). Part 4, Termination Data, is a summary of the institutional services received after OSCI-MICA by those who did not complete the program. These data were gathered from case files for each terminated inmate at ten and 16 months after admission to MICA. Part 5, Three-Month Post-Release Data, contains data on community outcomes for MICA graduates three months after their release. CHPPE and MICA staff developed a format for reporting personal, substance abuse, mental health, and criminal justice measures. A MICA outreach specialist, who was in regular contact with these parolees, obtained these data as graduates approached three months in the community. The MICA outreach specialist also readministered two of the assessments performed at program admission and discharge, the Brief Symptom Inventory and the Addiction Severity Index. Part 6, Recidivism Data, contains data from a three-month post-release summary completed by parole agents and a summary of recidivism data from DOC databases. Parole agents for both the treatment and comparison groups were asked to provide information pertaining to outcomes of interest to the study. As each participant approached the three-month post-release date, a follow-up summary form and brief instruction sheet were sent to the relevant parole agent's unit supervisor. The first such mailings were sent in late June 1999. The unit supervisors distributed the follow-up forms to the appropriate agents and returned them to CHPPE in the return envelope provided. In addition, follow-up information was obtained from parole agents in Illinois and Florida for two MICA graduates being supervised out of state. If a completed form was not returned within four weeks, a voice mail or e-mail message was sent reminding the agent to complete and return the form. If this did not elicit a response, the unit supervisor was asked to remind the agent of the importance of returning the form. If the form was still not returned, the statewide administrator's office was notified by CHPPE and asked to contact the unit supervisor. Data on arrests were obtained from the Wisconsin Crime Information Bureau (CIB) database by DOC staff for offenders in the treatment and comparison groups. These data were supplemented and verified by incarceration data from Wisconsin's CIPIS database. From this database, MICA support staff obtained information regarding current incarceration status and dates and reasons for incarceration in the state prison system. The Offender Active Tracking System (OATS) database was used to obtain information on custody in county jails. The DOC also provided a data file with information regarding time spent in county jails during the study period. A recidivism abstract form was developed to aid in the summary of data from these sources.

Sample View help for Sample

Eligibility criteria for MICA state that an inmate must: (1) receive an Axis 1 diagnosis of a severe and persistent mental illness that prevents participation in a traditional correctional substance abuse treatment program, (2) receive a diagnosis of substance abuse or substance dependence, (3) volunteer to enter the program, (4) be medically and clinically stable, (5) have at least 12 months until mandatory release, and (5) be at a medium or minimum security level. The comparison group, which was identified during the previous process evaluation study, met all program diagnostic and eligibility criteria. However, they did not receive MICA services because they had less than 18 months to mandatory release, which meant they would likely have been released prior to completion of the treatment program. A group of 79 of these inmates was initially identified by the DOC Bureau of Offender Classification using the CIPIS database. Of these 79, 13 were excluded for a variety of reasons, leaving a comparison group of 66 men.

Universe View help for Universe

Male inmates eligible for the Wisconsin RSAT program who were in the custody of the Wisconsin DOC between October 1997 and March 2000.

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Data Source View help for Data Source

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Description of Variables View help for Description of Variables

Part 1, Admissions Data, variables related to referral/admission include MICA referral information, clinical assessment information, medical assessment, correctional information, including offenses and number of major and minor conduct reports in last six months, education/career assessment, and program eligibility information. Variables related to Phase I include discharge date, reason for leaving Phase I, behavior in Phase I, treatment services received in Phase I, other support services received, urinalysis testing, change in mental health status during Phase I, ratings of treatment program behavior improvement since admission to Phase I, and results for Composite International Diagnostic Interview/ Diagnostic Interview Schedule, Wechsler Abbreviated Scale of Intelligence, Mini Mental Status Examination, Hare Psychopathy Checklist-Screening Version (PCL-SV), Brief Symptom Inventory (BSI), Derogatis Psychiatric Rating Scale (DPRS), Addiction Severity Index (ASI), Circumstances, Motivation, and Readiness for Treatment Scales (CMRS), and Daily Living Skills Assessment. Variables for Phases II through IV are the same as for Phase I except that there are no test results for Phases II and III, and Phase IV data only include results for PCL-SV, BSI, DPRS, CMRS, and Daily Living Skills. Phase V variables include date of MICA graduation, days in Phase V, reason for not participating in Phase V, reason for exiting Phase V, placement after exiting Phase V, number of major and minor conduct reports, treatment services received in Phase V, other support services received, urinalysis testing, rating of mental health stability, and ratings of treatment program behavior improvement since admission to Phase V. Part 2, Comparison Data, variables include the same referral/admission variables as in Part 1. Also included are date of release, date of sentence start, date of mandatory release, institutional placement during last 12 months, institutional services received in last 12 months, rating of mental health in last 12 months, medication type, conduct reports, urinalysis testing, and whether upon release inmate had appropriate housing, financial support, support system, mental health services, and substance abuse services. Part 3, Institutional Post-Graduation Data, variables include date form completed, reason for exiting MICA, institutional placement after MICA, mental health status, services received through MICA, urinalysis testing, plans after release, and ratings of treatment program behavior improvement. Part 4, Termination Data, variables include length of follow-up interval, type of termination, date of MICA admission, date of MICA exit, end date of follow-up period, institutional placement after MICA, institutional services received after termination, rating of mental health, conduct reports, urinalysis testing, and whether individual had appropriate housing, financial support, support system, mental health services, and substance abuse services upon release. Part 5, Three-Month Post-Release Data, variables include release date, MICA completion status, parole status, arrests and convictions since release, whether returned to prison, mental health and chemical use status since release, whether parolee had appropriate housing, financial support, support system, mental health services, and substance abuse services, number of contacts by MICA staff since release with parolee, parolee family, treatment providers, support services, and parole agent, rating of offender and parole agent cooperativeness with MICA staff, assessment results for BSI and ASI, and date of assessments. Part 6, Recidivism Data, variables obtained from CIB and CIPIS databases include date of release, whether individual belonged to comparison, graduate, or termination group, total adult arrests, date of first arrest after release, last adult arrest, total arrests and convictions since release, total days sentenced, whether currently incarcerated, days in prison and jail since release, entry date, exit date, and days in prison for three most recent prison episodes, charge, statute number, and whether misdemeanor or felony for two most recent arrests. Variables from the parole agent Three-Month Post-Release Summary form include current parole status, rating of parole compliance, urinalysis results, number of arrests and convictions since release, whether returned to prison, whether used alcohol/drugs since release, rating of mental health stability since release, whether individual had taken mental health medication as recommended since release, number of episodes of mental health relapse, whether parolee had appropriate housing, schedule of daily activities, financial support, support system, mental health services, and substance abuse services, whether offender participated in MICA or received MICA aftercare services, contact with MICA staff by parole agent since offender's release, effect of involvement of MICA staff on coordination of community services, rating of MICA staff cooperativeness, treatment, and support services received by offender since release, and offender's access to community treatment and support services since release.

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For Part 6, Recidivism Data, parole agents returned 100 percent of the three-month post-release summary forms.

Presence of Common Scales View help for Presence of Common Scales

Scales used were Axis I, Axis II, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), Diagnostic Interview Schedule (DIS), Circumstances, Motivation, and Readiness for Treatment Scales (CMRS), Addiction Severity Index (ASI), Mini Mental Status Evaluation (MMSE), Wechsler Abbreviated Scale of Intelligence (WASI), Brief Symptom Inventory (BSI), Derogatis Psychiatric Rating Scale (DPRS), Hare Psychopathy Checklist, screening version (PCL-SV), Daily Living Skills Assessment (modified by the MICA psychologist to be more relevant to the institutional environment), Tests of Adult Basic Education (TABE) for reading and math, and several Likert-type scales.

Original Release Date View help for Original Release Date

2003-06-05

Version History View help for Version History