Justice Treatments

Research has demonstrated that individuals under legal coercion tend to stay in treatment longer and do as well as or better than others without legal coercion.

The 'client' in these cases can include the general public, victim, family, courts and the agency for whom you work as well as the person with the drug problem.

Cooperative, shared case management which clearly articulates the roles and boundaries of agencies and workers involved is essential. In particular, rewards and sanctions relating to drug use and other behaviour should be understood by all parties.

This page should be use in conjunction with the DrugNet page on Involuntary Clients.

Contents

Context

Diversionary Programs
Statutory Obligation & Treatment

Components of Intervention

Clinical Points

Primary Aims
Steps

Related Internet Sites

Community Based Justice Interventions

Context

Criminal justice interventions can either be in the prison setting or in the community setting. If treatment occurs in the prison setting, 'through care' or continuing treatment options into the community upon release should be included. While this page is primarily concerned with the community setting, many of the principles can be applied to the prison setting. Click here for strategies to reduce illicit drugs in prison.

Diversionary Programs

Offenders with drug-related issues can be diverted into treatment at several points:

- First police contact (eg cautioning with/without drug session as a condition)
- When charges are laid (eg court diversion service)
- During the court procedure (eg conditional parole, drug courts, court diversion service)
- In prison (drug free prison areas & treatment)
- When leaving prison (eg conditional parole).

It's important that clinical workers are clear on context as this relates to boundaries of treatment and statutory obligations.

Statutory Obligation & Treatment

The goals for treatment in these cases are:

reduction of re-offending (and thus harm to the community);
reduction of drug-related harm to the offender;
improvement of life domains; and
imposition of 'justice' (as it relates to punishment, deterrence & the restorative justice model).

Counsellors of statutory cases need to manage their statutory (policing) role with their therapeutic role. Behaviours which would result in a breach action or being reported to a community corrections officer need to be clearly outlined.

For example, if a client is on parole for a heroin related crime and reducing their heroin use, but continuing to use heroin, should this be reported? (especially if the client has little income and is therefore either dealing or stealing to finance their drug use). If a client switches from their heroin use to cannabis use, should this be reported?

To help in this decision making a referral form has been developed which helps to clarify boundaries and expectations of treatment interventions. Click here for HTML version. Click here for MS Word version (16 KB).

Barber six steps for dealing with the involuntary client can also help both therapist and client to manage the dual roles of individual therapist and protector of the community. Generally, one of the tasks of clients in the criminal justice system is to learn to develop and manage limits including those imposed by the general community. The counsellor's ability to model limit setting (reward when client is within limits and consistent sanctions when limits are crossed) may help to make up for poor role modelling in the past.

For a Solution Focused Brief Therapy approach for working with unmotivated, mandated clients, click Hot Tips by Insoo Kim Berg (USA).

Components of Intervention

The Treatment Accountability and Safer Communities (TASC) program is a well researched and successful diversionary program in USA. It typically includes counselling, medical care, parenting instruction, family counselling, school and job training, and legal and employment services.

The key features of TASC include:

Coordination of criminal justice and dug treatment;
Early identification, assessment, and referral of drug-involved offenders;
Monitoring offenders through drug testing; and
Use of legal sanctions as inducements to remain in treatment.
(From: Principles of Drug Addiction Treatment, (PDF - 186 KB) 1999 National Institute on Drug Abuse & National Institutes of Health)

Clinical Points

(See also Involuntary Clients)

Primary aims are to:

Help see the client through their court order;
Reduce the criminogenic factors around drug use;
Stop or reduce their drug use (using statutory and other motivations);
Reduce the harm (to others & the client) associated with their drug use;
Improve the client's quality of life as it relates to their drug use;
Maintain statutory obligations regarding their drug use; and
Maintain professional integrity in both statutory and counselling roles.

Possible Steps or Checklist

Be clear about what their order means

		Clarify with statutory agency.
		Ask what the client understands in general.
		Explain requirements & consequences (if requirements are met & if not met).
		Click here for statutory referral form to assist in providing this clarity.

Discuss the client's relationship between their drug use and their offence

Relationship between drug use and their (alleged) offence.

Relationship between illicit and other drug use and completion of their order:

		could be an illegal activity in itself
		may reduce motivation to get on with life
		may use up other resources such as money & energy
		mixing with negative peer groups

Set clear boundaries

Obligations & role(s) of yourself, supervisor, parole board, court, police, other agency if shared care;

Obligations & role of client;

Bottom line behavioural boundaries of client:

		allow for negotiation on bottom line where possible as per Barber's six steps in managing the Involuntary Client;
		include reward contingencies when within boundaries (eg freedom, completion of order, improved lifestyle) as well as sanctions.

Explain limits of confidentiality

		Describe what confidentiality is offered as well as the limits of confidentiality
		Policy regarding the management of disclosure of other behaviours such as stealing, sexual assault, child abuse or neglect, domestic violence and suicidal intent should be known and adhered to.
		Provide a hierarchy of risk in the context of disclosing drug use. eg, you might say that all illicit drug use will represent a risk of breach action. However, there is a significant difference in risk of breach action between admitting to cannabis use in the context of wishing to learn how to stop use as compared to being caught out with heroin in a urine test. The ethic here is about supporting clients taking responsibility for and managing their lives.

Provide drug counselling and treatment interventions as appropriate

If uncomfortable with the case (ie too complex, not comfortable with either statutory or drug aspects, refer to supervisor or specialist agency).

Develop a comprehensive treatment plan which takes into account the client's external world (ie accommodation, support & family network, child-care needs, financial situation, educational and employment issues).
Click here for a simple assessment tool which outlines a comprehensive approach.
Click here for a WA Training, Education and Employment Resource Manual - employment following release of drug users has been highly correlated with successful completion of orders regardless of severity of drug use.

Generally speaking there is an expectation for clients to consider abstinence in the first instance. If this is not possible, discuss reduced and more controlled drug use (within the bounds of statutory obligations). The aim here it to maximise the possibility of reduced harm to the community in the first instance within court expectations.

Use other drug management counselling skills such as motivational interviewing, goal-setting, and relapse prevention work.

		Click here for treatment steps.
		Click here for a review of context of motivational interviewing which is likely to be useful in mandated clients.

Consult with supervisor on the case, particularly if:

		High risk case;
		Highly criminogenic drugs such as heroin and amphetamines or alcohol if strongly related to crime continue to be used;
		The likely cost of drugs used far outweigh declared income;
		Drug use has changed to another hazardous substance (eg from a depressant like heroin to a stimulant like amphetamine);
		Other complicating factors (eg very depressed, HIV positive & practicing unsafe needle use, other illegal or dangerous behaviour identified, etc);
		Yourself or another staff member feels threatened in any way by the client.

(The above 'Clinical Points' are the modified results from a workshop exercise undertaken by the staff of Community Based Services, Midland Perth in Jan 1999).

Related Internet Sites

Drug Courts CEIDA

Drugs Misuse and the Criminal Justice System: A Review of the Literature (UK)

Relationship of Drug Use (Particularly Alcohol) to Violent Crime (USA)

Strategies to Reduce Illicit Drugs In Prison (Australia - SA)

Working with Unmotivated, Mandated Clients - Hot Tips by Insoo Kim Berg (USA)

Australian Institute of Criminology: Alcohol & Illicit Drugs

WA Training, Education and Employment Resource Manual