1. Integrating Risk/Needs Assessment Into Drug Court
Judge Shanta Owens
Jefferson County Drug Court
Tenth Judicial Circuit
Birmingham, AL

2. OBJECTIVES Develop understanding of the Risk and Need Principle
Develop understanding of the effective use of ARAS in Drug Court
Develop an understanding of Integrating the Risk/Needs Assessment into Drug court

3. My Bio
Presiding Judge, Jefferson County Drug Court Birmingham Division
Drug Court Judge since 2009
Prior Experience

4. Jefferson County Drug Court
338 Active Participants
6 Case Managers
Drug Court Team
Judge
Case Managers
Program Administrator
Treatment Coordinator
Law Enforcement Officer
Peer Specialist
Job Placement Program Coordinator
Medical Provider
Defense Attorneys

5. Prior to March 2013
Jefferson County Drug Court

6. What Do We All Know About Drug Court?
Drug Court Works!

7. We Also Know…
Drug Court is a scarce and precious resource that should be used in a manner that maximizes its benefits to participants and society in general

8. Risk/Needs Assessment
Jefferson County Drug Court

9. What Is An Assessment?
Comprehensive Review of Information related to Substance Use Disorders and Risk for Recidivism. Can examine both psychosocial functioning and risk factors (Risk Assessment)

10. RISK AND NEED PRINCIPLE
According to what are known as the Risk Principle and the Need Principle, the most effective and cost-efficient outcomes are achieved when treatment and supervision services are tailored to the (1)Prognostic Risk Level and (2) Criminogenic Needs of the Participants
(Andrew & Bonta, 2010; Taxman & Marlowe, 2006)

11. Prognostic Risk
Characteristics of offenders that predict relatively poorer outcomes in standard rehabilitation programs

12. Risk Factors Younger age during treatment (especially < 25)
Male Gender
Early onset of substance abuse or delinquency
Prior Felony Convictions
Previously unsuccessful treatment attempts
Co-Existing Diagnosis of antisocial personality disorder
Familial History of Crime or Addiction
Regular Contacts with antisocial or drug-using peers or associates
(Marlowe, 2003)

13. Criminogenic Needs
Clinical disorders or functional Impairments that, if treated, significantly reduce the likelihood of future involvement in crime

14. Needs Diagnosis of substance dependence or addiction
Major Mental Illness
Lack of basic employment skills/poor employment history
Lack of daily living skills
Lack of education
Collateral Needs
Dual Diagnosis
Chronic Medical Conditions (ex. HIV, Diabetes, HCV)
Belenko, 2006; Simpson & Knight, 2007

15. Prognostic Risk and Criminogenic Need indicate what level of treatment and supervision are likely to be required to manage an offender, and what consequences should ensue for new instances of alcohol or drug use

16. RISK PRINCIPLE
Most intensive treatment should be reserved for Higher Risk offenders
Must survey important Risk Factors to produce an accurate measure of Risk
What does Risk Indicate?
Level of Supervision

17. Need Principle
Interventions must be very focused and target the Needs that are related to Risk
Stabilize the Client first. Then, start to treat the addiction

18. Higher Risk = More Intensive Supervision Services
Higher Need = More Intensive Treatment Services
High Risk/High Need = Typically Require full array of Treatment and Supervision services embodied in 10 Key Components of Drug Court
Low Risk = Less Intensive Supervision Services
Low Need = Less Intensive Treatment Services
Low Risk/Low Need = Typically do not require the full menu of services specified in the 10 Key Components of Drug Court

19. Providing too much treatment or too much supervision is not merely a potential waste of scarce resources. It can increase crime or substance abuse by exposing individuals to more seriously impaired or antisocial peers, or by interfering with their engagement in productive activities such as work, school, or parenting.
(Lowenkamp & Latessa, 2004; McCord, 2003)

20. RISK
High Risk Offenders respond BETTER when placed in a residential intervention and/or intensive supervision
Low Risk Offenders RECIDIVATE at higher rates when placed in residential interventions and/or intensive supervision

21. So…What Did We Do in Our Program?
Jefferson County Drug Court

22. 4 Drug Court Tracks with different Requirements and Phases
We figured out DOSAGE MATTERS
Started using ARAS (Alabama Risk Assessment System)
Adopted from ORAS (Ohio Risk Assessment System)
Length of time in Drug Court now based on Clients Risk and their Level of Needs
4 Drug Court Tracks with different Requirements and Phases

23. Where Does the Client Fall ?
RISK
What level of supervision services
NEED
What level of treatment services

24. Alabama Risk Assessment System (ARAS)
Jefferson County Drug Court

25. Alabama Risk Assessment System
Assessment is done on every client accepted into Drug Court
Time: Approximately 2 hours per client
Completed by Case Managers
Plea is Taken on Thursday
ARAS is scheduled a few days later
Based upon score, clients are placed in Track 1, 2, 3, or 4

26. ARAS Consists Of: Criminal History Education, Employment, and Finances
Family and Social Support
Neighborhood Problems
Substance Abuse
Peer Associations
Criminal Attitudes and Behavioral Problems
Mental Health Screening Form

27. ARAS Score
Overall score does not matter as much as the scores in the individual domains
Moderate to High Score in Substance Abuse, Formal Treatment is required. Therefore, client will be Track 2 or 4, depending on scores in other domains.
Tracks 1 and 3 are clients who do not score Moderate or High in Substance Abuse

28. TRACK 4
High Risk, High Need
12 Months
TRACK 2
Low Risk, High Need
6 Months
TRACK 3
High Risk, Low Need
9 Months
TRACK 1
Low Risk, Low Need
3 Months

30. High Risk/High Need Dependent on alcohol or drugs
At Risk for failure in standard correctional rehabilitation programs
Using drugs or committing crimes at early age
Failed previously in less intensive dispositions
Possible diagnosis of antisocial personality disorder
Need all services embodied in the 10 Key Components
Should Appear Frequently in Court: No less than Biweekly for the first few months until stable interval of sobriety or engaged in treatment
Our clients appear Weekly in Phase 1, Biweekly in Phase 2, Monthly in Phase 3, and Noncompliance Calendar in Phase 4
Formal Treatment is Required

31. High Risk/High Need (cont’d)
Need interventions that focus on remediating “criminal thinking” patterns
Minimum dosage of 200 hours of cognitive behavior services
Lack inclination to engage in productive activities such as work, school, or parenting
Do not attach importance to the assumption of responsible roles
Endorse antisocial attitudes and values

32. High Risk/High Need (cont’d)
Deficient in adaptive life skills, such as employability, education, financial management, and homemaking
Adaptive habilitation services are often required to teach vocational skills, address educational deficits, improve daily living skills, and model effective interpersonal problem-solving strategies

33. High Risk/High Need (cont’d)
Deficient in adaptive life skills, such as employability, education, financial management, and homemaking
Adaptive habilitation services are often required to teach vocational skills, address educational deficits, improve daily living skills, and model effective interpersonal problem-solving strategies

34. High Risk/High Need (cont’d)
Compliance with the conditions of supervision and treatment is the primary goal
Abstinence is a more difficult goal
The use of appropriately prescribed medications by a qualified addiction psychiatrist constitutes an evidence-based practice for addicted offenders and should be available in appropriate cases (National Institute on Drug Abuse, 2006).

35. Low Risk/High Need Dependent on drugs or alcohol
Do not have substantial prognostic risk factors that would predict failure in standard
Primary focus for this group is Treatment services
Do not require frequent supervision on status calendar
Monthly judicial hearings and then noncompliance calendar in Phase 2
Rather than appear in court interacting with high- risk antisocial peers, they should focus their energy on Treatment

36. Low Risk/High Need (cont’d)
Formal Substance Abuse Treatment Required
However, research suggests that low-risk individuals should not be treated in the same groups as high-risk individuals because they may adopt antisocial attitudes or values (Lowenkamp & Latessa, 2004).
Adaptive Habilitation services may be required such as vocational or educational assistance, family therapy, or mental health counseling.

37. Low Risk/High Need (cont’d)
Consequences should be focused on Treatment
Abstinence is still a difficult goal
Use of appropriately prescribed medications by a qualified addiction psychiatrist may be indicated for some addicted offenders

38. High Risk/Low Need Non-Dependent substance abusers
But have substantial Risk Factors for failure on standard supervision
Emphasis should be on closely monitoring their behavior, holding them accountable for their conduct, and teaching them pro-social life skills
Should appear in court on a status calendar for judge to review progress
Weekly judicial hearings
Because they are at risk for failing to comply with standard supervision requirements

39. High Risk/Low Need (cont’d)
Better suited for Early Intervention classes that teach about the dangers of drugs and alcohol and activity-scheduling exercises that re-orient their daily activities away from drug-related peers and events
Because High Risk, 200 hours of cognitive behavioral services may be needed to reduce criminal activity
Focus consequences on Abstinence and Supervision

40. Low Risk/Low Need
Unnecessary to expend substantial resources on this group because they have a low probability of recidivism
Noncompliance Calendar
Prevention Services such as Early Intervention classes on an individual basis or in separately stratified groups
Drug and alcohol use are under their voluntary control
Important that this group is NOT mixed with high risk offenders or that they spend lots of time in court

41. Jefferson County Drug Court

42. ARAS IS IMPORTANT BECUASE
Better understanding of client’s circumstances and what level care is needed to treat him/her
You do not want to mix occasional pot smoker with hardcore IV drug user in treatment
Want to use resources wisely and treat the right people
Ex: Low Risk, Low Need folk don’t need inpatient treatment. Without an assessment, this would be a waste of resources

43. How Do You Get Reliable Information?
Jefferson County Drug Court

44. ARAS INTERVIEW Goal: Information Gathering
Environment should be conducive to disclosure of information
Purpose of Assessment should be explained
Client should be alone
Interviewer should be Patient, Open-Minded, and Attentive
Interviewer should exhibit good listening skills
Open-Ended Questions
Avoid Close-Ended, Biased, Double-Barreled questions

45. The Challenging Interview
Dealing with Inconsistencies
Use collateral info/resources
Lightly challenge inconsistent info
Dealing with Oppositional Behavior
Offer Choices
Offer a Break
Redirect

46. QUESTIONS?