Office of Budget and Evaluation
Jail Chemical Dependency Treatment Program
411 Elm Street, 3rd Floor, Dallas, Texas 75202
Prepared by: Melissa Watts, Budget and Policy Analyst
December 14, 1999
On August 26, 1999, the Office of Budget and Evaluation briefed Commissioners Court on the Jail Chemical Dependency Treatment Program (JCDTP)'s request for County funding over and above its CJAD grant. That briefing explained that JCDTP needed additional funding to maintain service at the same level in large part because the program had drawn on other sources to cover expenses in FY99 that would no longer be available in FY2000.
Ultimately, Commissioners Court approved, through the FY2000 budget process, $47,274 in County funding. This amount covers the cost of one counselor for the full year and the community resource coordinator through December 31, 1999, pending evaluation of the program by the OBE. The purpose of this briefing is (1) to evaluate the effectiveness of the Jail Chemical Dependency Treatment Program, in terms of inmates' success at sustaining their recovery from addiction and avoiding reincarceration; (2) to examine the capacities of the program, in order to suggest maximum utility; and (3) to address obstacles to filling all the currently authorized counselor positions.
Description of Current Program
The Jail Chemical Dependency Treatment Program operates on a modified therapeutic community model. Participants are housed separately from the general population in tanks of 24-28 inmates each, who together take part in group sessions, educational forums, and AA/NA meetings. The inmates also receive two one-hour individual counseling sessions each month and discharge planning prior to release. Group sessions meet four times each week for 2 ½ hours each.
The program's current capacity is 100- one maximum security men's tank of 28 inmates, two moderate security men's tanks of 24 each, and one moderate security women's tank of 24. The program also has two men's tanks for inmates on the program's waiting list. These individuals receive AA/NA meetings and educational programming but have no counselors assigned to them. CJAD- JCDTP's main funding source- requires that at least 90% of participants be court-ordered, CSCD inmates. As a result, JCDTP has a maximum of ten places for volunteers.
Prior to the CSCD requirement, most program participants were volunteers. Statistical studies show that volunteers are more likely to succeed upon release, due to motivation and readiness to alter thought and behavior patterns. Inmates court ordered to the program are generally more resistant to treatment. While they may achieve somewhat lower rates of success than volunteers, on average, they receive treatment they would not otherwise have had. Furthermore, recidivism rates have changed very little from the time that JCDTP admitted mostly volunteers to its present enrollment of mostly court-ordered clients.
Staffing consists of 6 FTEs: the program director, four substance abuse counselors, and one community resource/aftercare coordinator. The program is licensed by TCADA, which requires that each counselor have an LCDC license. Caseloads per counselor equal the number in the tank to which they are assigned, either 24 or 28.
This non-medical treatment program relies on principles of rational behavior therapy and 12 step programs. The aim is to make inmates aware of and capable of interrupting their own patterns of thought and feeling that keep them dependent on drugs and alcohol. This curriculum is supplemented by drug and alcohol education, HIV-related education, anger management workshops, and the AA/NA meetings mentioned above.
In FY99 the total cost of the JCDTP was $238,539. The program was funded by a grant from CJAD ($179,992), Sheriff's Commissary funds ($31,040), and carryover from its FY98 CJAD grant ($27,507). In FY2000, JCDTP again received a grant from CJAD in the amount of $179,992. The County has matched this with $47,274 for $227,716 total funding.
The chief measures of the program's effectiveness are reincarceration and recovery rates in the first 12 months following release from jail. Since 1996 (one year after the first participants were discharged), the Jail Chemical Dependency Treatment Program has maintained a consistent program of recidivism measurement by monitoring jail reports and contacting graduates at the two-, six-, and twelve-month periods following their release. As shown in Figure 1, reincarceration rates below 15% have been observed. Between 60% and 80% of program graduates have sustained their recovery (or "clean") status (see Figure 2). Employment rates have hovered around 35% (see Figure 3). (JCDTP have been unable to recover data from January to September of 1996.)
JCDTP measures favorably with other jail- and prison-based programs in the country. Recidivism figures in other program evaluations cluster around 20% (recidivism variously defined as criminal justice involvement- parole/probation violations, arrest, conviction, and/or reincarceration). In two more closely comparable jail programs, the rate of reincarceration in the first year post-release was approximately 24%. The County's DIVERT Court program, though only roughly similar to the JCDTP, aims to keep recidivism (defined as arrests) to 20% this year.
Although it cannot offer rigorous statistical proof of success, the Jail Chemical Dependency Treatment Program's follow-up data is strong and consistent enough to support a positive evaluation. In the future, it may be possible to utilize the County database to track both the 100 inmates in the program as well as 100 inmates with similar profiles (in terms of reasons for incarceration) to provide a control group.
In 1996 members of the Department of Psychiatry at UTSW Medical Center presented preliminary findings for a study of the JCDTP. Unfortunately, the project ran out of time and funding before it could complete the study. The findings derived from interviews and assessments conducted with inmates at the start of treatment and after one month in the program. The study was able to establish that, in this one-month period, inmates in the treatment program were more likely to change behaviors, attitudes, and thought processes associated with substance abuse than were their counterparts in the untreated control group. Although the preliminary results seemed positive, the project was abandoned before outcome data could be gathered to validate the study's predictive findings that treated inmates were more likely to succeed after discharge than untreated ones.
Studies by the National Institute of Justice estimate that, since 1987, 60-85% of arrestees are illicit drug users who could benefit from treatment. According to the Sheriff's Department, JCDTP regularly has a waiting list of 40-50 male volunteers and 30-35 female volunteers. The number of court-ordered participants on the waiting list varies with court activity, but ranges from 2-15 per week. This number could be much greater if an aggressive effort were made to alert judges to the availability and benefits of the program.
Forty-eight of the wait-listed inmates are housed in holding tanks (both male) reserved for JCDTP. There they at least can participate in AA and NA meetings and receive some educational services from the Ethel Daniels Foundation. The other fifty volunteers for the program wait in the general population. The Sheriff's Department estimates that approximately half of all those wait-listed get into the program eventually. The other half are released or transferred to another correctional facility without treatment. There currently is no follow-up information on these individuals.
How long each individual remains in the program depends on whether the inmates are awaiting transfer to another facility and how soon the transfer comes. Some inmates remain for six weeks, some for as long as six months while waiting on the backlog at TDC for transfer to prison. Approximately four months in the program is considered necessary, with increased lengths of stay improving outcomes, according to statistical studies.
If approximately half of the waiting list inmates complete the desired four months, then at least 40 volunteers remain on the waiting list without ever benefitting from JCDTP. (Court-ordered inmates have placement priority over volunteers, and they must complete the program as a condition of their release.) At least one more (male) tank could be supported by this volume, two tanks if the number of court-ordered inmates rose even slightly. Furthermore, because research indicates that volunteers are more successful in treatment programs than court-ordered inmates, the program would improve its outcome measures-- and the savings to the County-- if it could serve more of these volunteers.
Recruiting Qualified Staff
To increase capacity, the County would first have to address the program's difficulty in hiring and retaining LCDCs (licensed chemical dependency counselors). The program now has four tanks available for its use, not counting the two waiting tanks. To meet licensing standards, the program needs one counselor for each 24-person tank. The program has a long history of difficulty in keeping its positions occupied. Presently there are only two counselors- one LCDC and one counselor intern- leaving inmates in two tanks without the treatment program. They are offered AA and NA meetings and some educational programming, just as the inmates in the waiting tanks.
The Sheriff's Personnel Section posted the position in September and has run ads in the newspaper since October 26, just as the Juvenile Department does for its substance abuse counselor vacancies. Counselor positions in the jail and at Juvenile are graded the same (EE), yet Juvenile reports no difficulty in hiring LCDCs. The JCDTP director adds that he and his staff have also posted the position at the Greater Dallas Council on Alcohol and Drug Abuse and regularly announce the opening at professional meetings. Greater Dallas Council has itself been having trouble hiring LCDCs. Its chief means of recruitment is also an ad in the Dallas Morning News.
According to Sheriff's Personnel, there have been only four applicants for the most recent jail counselor vacancy, and a second position is unfilled due to extended medical leave. Of the four applicants to date, one was not qualified on educational requirements, one rejected an offer because of unsatisfactory salary, one has just been polygraphed and interviewed, and another has just submitted his application.
Although a scarcity of qualified LCDCs has been confirmed by community substance abuse treatment providers, the dearth of applicants suggests that new recruitment tactics must be considered for JCDTP. Among the possibilities, Juvenile's Personnel section could share applications with JCDTP when its own positions are filled. JCDTP's director could then call those applicants directly to encourage them to apply at the jail, while also answering questions and concerns about the jail setting. Formal and regular use of professional organizations' newsletters might advertise positions more reliably than word of mouth. Internet sites may also be located for posting job openings.
After discussing the issue with staff in the Sheriff's Personnel Section and JCDTP's director, three issues appear to be most responsible for the difficulties in filling these posts, once applications arrive:
(1) Salary range - Sheriff's Personnel reports that the only applicant for the recent vacancy to be offered the job rejected the offer on the basis of pay. Although the salary range available for this position is commensurate with LCDC salaries available at community treatment providers, it may be that the additional burden of working in the jail causes applicants to expect more. Sheriff's Personnel staff also suggests that the newspaper ad, which announces the upper limit of the range, may distort the expectations of applicants whose background does not qualify them for the maximum in-hire salary.
Applicants are also disappointed to find that their many hours of pre-certification experience (4,000 hours in order to obtain the LCDC license) do not count in Personnel's calculations to determine entry-level salary. A change in Personnel policy regarding qualifying experience could improve the salary range for applicants.
(2) Jail setting - As mentioned above, the fact that the job is set in the jail-- with its intrusive security procedures, drab therapeutic environment, and criminal clients- is likely to turn away potential applicants. Others have accepted jobs in the jail only to find that they are not comfortable after all and quit, according to Sheriff's Personnel staff. One possible way to compensate for this obstacle is to reclassify the positions, which would involve distinguishing the jail from juvenile detention as a secure setting imposing additional difficulties on counselors.
(3) Polygraph testing - Unlike Juvenile substance abuse counselors, applicants for the JCDTP must undergo polygraph testing. Staff involved in the process have suggested that this often poses a problem for LCDCs, many of whom often have overcome addictions themselves prior to becoming counselors. Additionally, this past involvement with illicit substances may have also involved some criminal experience. For security purposes, the Sheriff's Office disallows applicants with certain kinds of criminal history from working in the jail, although past substance abuse does not disqualify an individual from serving as a counselor. In point of fact, many highly qualified counselors are former substance abusers. It may be that Sheriff's Personnel can get the polygraph requirement waived for counselor applicants, or at least make clear that truthful answers about prior substance use will not disqualify them.
Charles Beran has documented a turnover problem in the JCDTP as well, which he attributes to the issues of salary and promotion paths. The table below shows, for five recent employees, the length of tenure at JCDTP and the jobs for which they left JCDTP.
Substance Abuse Counselors at JCDTP
Cost of Maintaining JCDTP - Funding for this program has come from CJAD, TCADA, and the County (through the Sheriff's Commissary and, in FY2000, match funds). In FY99, the program's expenses were covered by a $179,992 grant from CJAD, and salary lag from FY98 and FY99. For FY2000, JCDTP received the same grant funding from CJAD.
JCDTP submitted an application to CJAD for additional funding in FY2000, to a total of $274,326. When the increase was denied, JCDTP submitted a PIR to the County for almost $270,000 in funding beyond the grant amount. The additional dollars were to have provided the following:
Based on the OBE recommendation, the Commissioners Court approved $47,274 to fund one counselor for all of FY2000, and to fund the community resource coordinator through December, pending evaluation of the program. The cost to the County to fund the community resource position for the remainder of FY2000 is $33,100.
Separately, at the August 31,1999 meeting of the Civil Service Commission, some of the JCDTP positions were regarded, resulting in increased salary costs. The substance abuse counselors were upgraded from DD to EE. The program director, formerly an FF position, was changed to grade F (and will likely be upgraded to G at a future Civil Service meeting). The community resource coordinator position remained at grade CC.
Cost of JCDTP Expansion - The annual cost to the County of increasing the program's capacity by one (24-person) tank, at current caseloads, is approximately $38,000. At JCDTP's requested counselor-client ratio of 1:12, the cost is $76,000. Several thousand dollars could be saved by employing a counselor intern in the second counselor position (depending on classification of a counselor intern position). This arrangement would require time and effort on the part of the senior counselor to train the intern, while also relieving the counselor of the full burden of group and individual sessions.
Another option, employing part-time interns to handle all inmate assessments, would also allow more counselor hours per client. These positions would also need to be proposed and classified, but the cost of two interns at twenty hours each would not exceed $25,000 total. This would also save senior counselors the time involved in training counselor interns on a full-time basis. The JCDTP director is less inclined toward this option, arguing that it is best for counselors to be involved with inmates from assessment to program completion.
Savings from Treatment - A study by the RAND Corporation concludes that every dollar spent on treatment saves $7 on law enforcement. California's Department of Alcohol and Drug Programs has also published research demonstrating savings to citizens from crime reduction, as well as health care savings resulting from the treatment of addicted offenders.
TCADA has published extensive figures on the costs of drug and alcohol abuse as well as the cost of treatment in Texas (see Attachment 1). In 1997, the cost of treatment totaled $1.5 million, while the direct and indirect costs in death, disability, victimization, and disease came to almost $18 million.
For the County, the cost of drug-addicted offenders can be measured in terms of court costs and jail time. Total court costs, figured on an average one day per case, come to $1,824 (inclusive of court staff, DA and Public Defender representation). A typical day in jail costs the County a minimum of $21.66.
Given its proven efficacy in curbing recidivism and promoting addiction recovery, the Jail Chemical Dependency Treatment Program merits continued support by the County. Furthermore, funding expansion of the program outside the boundaries of the CJAD grant will allow more volunteers to be treated. This is particularly desirable as volunteer clients realize a greater degree of success, and so community savings, than court-ordered participants required by the grant. The Office of Budget and Evaluation recommends the following:
Allocation of $33,100 in match funds to continue, for the rest of FY2000, the community resource coordinator position held in contingency pending this evaluation.
Creation of a recruitment plan to overcome the counselor vacancy problems. The JCDTP director will be responsible for briefing the Court on the plan before any staff will be added to the program. The OBE will assist in devising the plan.
After the recruitment plan has proven successful (e.g., when the vacancies have been filled), creation of two intern positions for individuals in the process of attaining their LCDC license, thus alleviating caseload burdens for counselors. As interns complete their training and are licensed, they will also be eligible-- and particularly well suited-- for the counselor positions. Depending on Personnel's grading of the new positions, annual cost should not exceed $64,000.
Consideration of addition of two licensed counselor positions during the FY2001 budget process. Such consideration would depend upon the success of the recruitment plan and/or the potential for interns to move into counselor slots. Two additional licensed counselors would allow the program to expand by offering complete treatment to those 48 inmates currently in holding tanks. Annual cost is approximately $75,000.
JCDTP and the OBE grants planner will continue to search for grant funding to defray the cost of any expansion. As mentioned above, JCDTP requested- unsuccessfully-- a dramatic increase in funding from CJAD for FY2000 in order to double its staff. CJAD functions as the regulatory office of CSCD, which is why it requires that 90% of JCDTP's clients come from CSCD. The Director of CSCD explains that, despite his support for JCDTP and its benefits for probationers, CJAD is unlikely to increase the jail program's funds in the future, simply due to its own budgetary constraints.
The performance measures and targets below are suggested in order to monitor the effects of these recommended investments.
Additionally, a method for tracking inmates with similar offense profiles to those of inmates in the JCDTP is being devised. In this way the County will be able to compare recidivism rates between those discharged with treatment and those without. Such comparison will provide more definitive proof of the benefits of investing in treatment.