1. “Drug Offender Treatment Lessons Learned: New Challenges from Institution to Community” 2013 FADAA/FCCMH Annual Conference Robert L. Neri, LMHC, CAP Senior Vice President /Chief Clinical Officer WestCare Foundation, Inc.

2. Lessons Learned in Corrections Learning from the Past Learning from the Past Lessons of the Present Lessons of the Present Looking to the Future Looking to the Future 1

3. Lessons Learned in Corrections Training Objectives: Participants will be able to list examples of the many dynamic changes in the field of drug offender treatment Participants will be able to assess their programs’ readiness for future anticipated changes Participants will be exposed to the significance of the treatment environment and culture as it relates to outcomes Participants will leave with several ideas to process and plan with their program staff 2121

4. Lessons Learned in Corrections Do you know that 90% of your brain works without using any words at all? Just so you know that means there’s only a 10% chance of me making any sense at all once I start talking 3131

5. Lessons Learned in Corrections “I kept trying to be what you wanted, he said- but at a certain point you needed to stop adding to the list” Ex Offender 4141

6. Lessons Learned in Corrections TREATMENT/CORRECTIONS CONTINUUM TREATMENT Prevention Intervention Basic Outpatient Intensive Outpatient Sober Housing GPS Short-term Residential Day Reporting Centers Long-term Residential In Jail/In Prison CORRECTIONS Civil Citations Pre-trial Programs Basic Community Supervision House Arrest Community Control GPS Jail: in Treatment + Re-entry Prison: in Treatment + Re-entry 5151

7. Lessons Learned in Corrections Treatment Is Dynamic & Changing Separated vs. Integrated Relapse (Shame-based) vs. Relapse Analysis Medication (Shunned) vs. Medication Valued Harsh Confrontation vs. Motivational Continuum Recovering Staff vs. Multi-Disciplinary 6161

8. Lessons Learned in Corrections Treatment Is Dynamic & Changing Continued Instinct-Based vs. Research- Based One Size Fits All vs. Individualized Supervision vs. Supervision Intermittent Planned Must Hit Bottom vs. Coercion Works 7171

9. Lessons Learned in Corrections CLIENT JUDGE COUNSELOR RECOVERY IS RELATIONAL 8

10. Lessons Learned in Corrections Client Motivation is Dependent Upon Internal as well as External Pressures 9191

11. Lessons Learned in Corrections Motivational Changes in Treatment Treatment Dosage External Internal 101

12. Lessons Learned in Corrections Developmental Model Principles “It’s a process not an event” “It’s a process not an event” “Treatment is cumulative” “Treatment is cumulative” Developmental Psychology means: Developmental Psychology means: “Psychology of Maturation” “Psychology of Maturation” 111

13. Lessons Learned in Corrections COMPETENCY BASED APPROACH TO LEARNING Competency Mastery Requires: Information knowledge Information knowledge Implementation knowledge Implementation knowledge 121

14. Lessons Learned in Corrections Establish a therapeutic alliance: build and facilitate trust transfer build and facilitate trust transfer 131

15. Lessons Learned in Corrections HHIGH HOPE LOW HOPE HIGH PAIN LOW PAIN 14

16. Lessons Learned in Corrections Ratio of Rewards to Sanctions and the Probability of Success 15

17. Lessons Learned in Corrections Incentives & Sanctions Maximize benefit by timing of rewards and consequences 161

18. Lessons Learned in Corrections Finding a New Vocabulary for Affirmation and Validation Pulling Up the Positive to Avoid the Punitive Pulling Up the Positive to Avoid the Punitive Affirm the Small Steps and Progress Affirm the Small Steps and Progress Educate- Which Means “Lead Forth” Educate- Which Means “Lead Forth” Learn to Articulate Affirmations Learn to Articulate Affirmations Develop Emotional Literacy….Name it, Develop Emotional Literacy….Name it, Claim it, Own it, Change it! Claim it, Own it, Change it! 171

19. Lessons Learned in Corrections {Assess / Deprivation Needs} Trauma History Trauma History Resiliency Factors Resiliency Factors 181

20. Lessons Learned in Corrections Programs are: Expectations based- Emphasize relationships Emphasize relationships Rules based- Emphasize compliance Emphasize compliance 191

21. Lessons Learned in Corrections Compliance is adaptation NotTreatment 201

22. Lessons Learned in Corrections Institutionalization requires treatment Emotional Incarceration 211

23. Lessons Learned in Corrections Gender Specific Challenges for Men Masculinity Demands Treatment Demands Being Self-ReliantSeeking Help Being StoicExpressing Feelings Taking ActionBecoming Introspective 22 Vs.

24. Lessons Learned in Corrections Gender Specific Challenges for Men Masculinity Demands Treatment Demands Showing StrengthShowing Weakness Experiencing PrideExperiencing Guilt & Shame Acting InvincibleActing Vulnerable 23 Vs.

25. Lessons Learned in Corrections Facilitate movement from compliance to internalization through gradual reduction of structure and insight work 241

26. Lessons Learned in Corrections Create a treatment culture that promotes “Mistakes as wonderful opportunities to learn”. 25

27. Lessons Learned in Corrections Teach social network mapping and assist clients with building a social support network 261

28. Lessons Learned in Corrections How Can Programs Improve Care Ask and integrate trauma related questions / practices Ask and integrate trauma related questions / practices Deliver more experiential based learning Deliver more experiential based learning Improve cognitive health approach Improve cognitive health approach (teach memory / thinking skills) (teach memory / thinking skills) Use incentives 4:1 to sanctions Use incentives 4:1 to sanctions 271

29. Lessons Learned in Corrections How Can Programs Improve Care Continued Insure program cultures are expectations based vs. rules based Insure program cultures are expectations based vs. rules based Aftercare can be more of a system rather than a loose aggregate of diverse providers Aftercare can be more of a system rather than a loose aggregate of diverse providers Develop a youthful offender track of services Develop a youthful offender track of services 28

30. Lessons Learned in Corrections Risk, Need, Responsivity The Big 8 NEEDGOAL Anti-social cognitionsReduce anti-social cognition, recognize risky thinking and feelings, adopt alternatives Anti-social companionsReduce association with criminals, enhance contact with pro-social friends Anti-social personalitiesBuild problem-solving, self- imaging, anger awareness, and coping skills 29

31. Lessons Learned in Corrections Risk, Need, Responsivity The Big 8 NEEDGOAL Family and marital relationshipsReduce conflict, build positive relationships and communication Substance abuseReduce usage, reduce the support for abusive behavior, enhance awareness EmploymentProvide employment-seeking-and – keeping skills and enhance performance? 30

32. Lessons Learned in Corrections Risk, Need, Responsivity The Big 8 NEEDGOAL EducationIncrease performance rewards and satisfaction Leisure and recreationEnhance pro social activities 31

33. Lessons Learned in Corrections  ExpectationsReality  Not easy, but worth it 32

34. Lessons Learned in Corrections Questions? Thank you 33