Note: The following was originally published on November 30th but it was not designated the Spotlight post as was my intention. So, in order to give Dr. Krupp's latest the appropriate attention, it has been reposted as today's feature item. [-ED]
Miracle cures or slight-of-hand?
Save us from tomorrow
Richard Krupp, Ph.D.
November 19, 2010
As described in its February 2005 report, Restructuring Government: A Review of the Governor’s Reorganization Plan Reforming California’s Youth & Adult Correctional Agency and in its 1998 and 2003 reports on the correctional system, the Little Hoover Commission recommended that the Department of Corrections adopt evidence-based practices and implement them faithfully to improve correctional outcomes. As the new administration starts to look at corrections again there may be more discussions about “evidence-based programs.” What does this mean to the public and to the prison system?
Over the past decade the California has had a great deal of experience with prison drug treatment and female offender programs that are reportedly based on “evidence.” Can the public rely on reports of program success? Sometimes government agencies provide one-sided “evidence.” The China Daily paper in the People’s Republic of China recently reported, Heroic whistleblowers take a stand for fellow citizens. The article describes several pieces of evidence to support their story, including an engineer who exposed design flaws in subway concrete work. However, there was no mention of the man who organized a support group for parents whose children were sickened by melamine-tainted milk and was sentenced to 30 months in prison for “inciting social disturbance.” This story was carried by the Associated Press.
Over the last ten years the California prison system expanded its in-prison substance abuse programs then recently reduced the programs due to budget cuts. The Office of the Inspector General in a 2007 report called the drug treatment programs a “Billion dollar failure.” The programs have been operated by contractors at an annual cost of about one million dollars per 200 bed program.
What evidence is available to help determine whether tax payer dollars are well-spent? Have there been any problems for prison managers or the public associated with these programs?
A prison system report, In-prison Substance Abuse Program (SAP) Return to Prison Analysis and Data Tables looks at how well inmates who participate in a SAP fare compared to the general prison population. The report covers inmates paroled in fiscal year 2005/2006. The following chart is for male inmates:
The actual chart in the official report only displays data for the inmates who complete the SAP and Continuing Care parts of the program for the one and two year rates and the general population rates. Data for the inmates who only participate in the prison drug treatment program (SAP Only) and those who participate in the SAP, but do not complete Continuing Care is provided in a table, but not displayed in the official report chart. By including all of the data as seen above, a more complete picture is provided.
It appears that inmates who attend SAP and not Continuing Care as well as those who attend SAP, but do not complete Continuing Care have Return to Prison rates about the same or HIGHER than those in the General Population who do not participate in any aspects of the drug treatment programs. These findings are similar to a study conducted by the University of California, Los Angeles (UCLA).
For almost ten years, UCLA followed a group of inmates who participated in drug treatment at the Substance Abuse Treatment Facility in Corcoran and compared them to a matched group that did not participate in drug treatment. The Non-treatment group consistently performed the same or slightly better than those who participated in drug treatment on return-to-prison rates.
This is troubling in several respects. Notwithstanding methodological weaknesses, the best outcomes have been found in those participants that complete in-prison treatment followed by at least 90 days of aftercare. Lower return-to-prison rates have been reported for this select group, though most of the recidivism reduction may be attributable to selection bias and at-risk time
Data obtained by “drilling down” must be viewed with caution. According to UCLA’s David Farabee, “It is an approach that capitalizes on self-selection, in which the treatment group is pared down to the most amenable 10-20 percent of the original group while the comparison group is left intact.” In this case the aftercare participation group represents about one third of the original group. There is a tendency to think that the low “cream of the crop” continuing care participant group Return To Prison rate can be reached for more or all of the SAP inmates by simply forcing them into aftercare. This is certainly not the case.
This error in logic can be explained by the post hoc ergo proper hoc (after this therefore because of this) fallacy. Because one thing happens after another does not mean that the first event was the cause of the second. Because the people that went to aftercare did better than those who did not does not mean that the aftercare caused the lower return to prison rate.
The contract staff that run the drug treatment programs are typically unskilled, under-educated, and in some cases former drug abusers and/or inmates. In many cases these counselors are able to “connect” with the inmates in a way that others are not able to. However, the use of contract staff can be a double-edged sword. On some occasions the in-prison treatment programs have had problems concerning over-familiarity with inmates, bringing drugs into the prison, etc.
- An in-prison SAP was temporarily closed after the prison discovered that treatment program staff were bringing cell phones, pornographic movies, and drugs into the prison and having sex with the inmates.
- A Continuing Care program in the community was training parolees to compete in cage-fighting contests. One parolee suffered a broken ankle.
- A parolee on a day pass from a Continuing Care community program killed a teen age girl in Los Angeles.
- An in-prison program counselor was involved in the murder and beheading of an elderly man.
Community-based programs have been problematic in other cases as well:
- Infants in a facility that housed female inmates and their children died under questionable circumstances in San Diego.
- Drug treatment inmates housed in a community-based facility stabbed teen agers in a public park after drinking with them.
Given the problems associated with contractor-based inmate programs, it would be worth considering an in-prison substance abuse treatment program facilitated by prison staff rather than contract staff. In fact, in the past prison staff did facilitate these programs. This would provide counseling staff with a higher level of skill and minimize some of the other institution operational problems.
At the very least the public should be provided a complete picture of the “evidence.” Drug treatment and other inmate programs may have benefits associated with keeping inmates occupied and occasionally improve outcomes, but they also present operational problems for prison managers and unreasonable expectations for the taxpayers. If the new administration determines funding for prison programs is a good use of tax dollars, there must be an independent evaluation of the “evidence.”