The adoption of wraparound services among substance abuse treatment organizations serving criminal offenders: The role of a women-specific program

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Abstract

Women's substance abuse treatment outcomes are improved when women-specific needs are addressed through wraparound services, such as the provision of child care, employment assistance, or mental health counseling. Despite a higher prevalence of pre-incarceration drug use, women in prison report receiving fewer services than their male counterparts, suggesting they likely have greater service needs upon release. It is unknown whether community-based treatment organizations with a women-specific program offer more wraparound services than programs without a focus on women. This study uses data from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative's National Criminal Justice Treatment Practices Survey (NCJTPS), a nationally representative sample of community-based treatment programs serving predominantly criminal offenders (n = 217). First, bivariate analyses identified differences between organizations with and without a women-specific program on the number of wraparound services adopted as well as organizational-level characteristics (i.e., organizational structure, personnel characteristics, culture, sources of information, and systems integration) related to their adoption. Second, Poisson regression was used to identify the organizational characteristics associated with the number of adopted wraparound services, with having a women-specific program being the primary covariate of interest. Results indicate larger organizations that utilized a greater number of treatment approaches and believed that treatment could reduce crime were more likely to offer a greater assortment of wraparound services. In an effort to improve behavioral treatment outcomes, it is imperative to examine organizational-level contextual factors that shape the availability of wraparound services for female offenders in community-based substance abuse treatment settings.

Introduction

The examination of wraparound services for criminal offenders is important because individually tailored services may improve the offender's health and increase community public safety by reducing recidivism. According to the U.S. National Treatment Improvement Evaluation Study (Marsh et al., 2004), wraparound services positively impact post-treatment outcomes. The National Institute on Drug Abuse's (NIDA) report entitled “Principles of Drug Abuse Treatment for Criminal Justice Populations” (2006) outlines how a comprehensive treatment approach for criminal offenders should include health-related wraparound services such as the treatment of co-occurring disorders, providing medical services, social support services (e.g., housing or employment assistance) and HIV/AIDS testing, counseling and treatment. Moreover, the NIDA report (2006) emphasizes the need to individually tailor services based upon such factors as criminal history and gender. Yet there are no known studies which examine if organizational-level characteristics, including if the organization offers a women-specific program, impact the adoption of wraparound services in community-based organizations serving predominantly criminal offenders. Therefore, this study uses the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative's National Criminal Justice Treatment Practices Survey (NCJTPS) (Taxman et al., 2007a, Taxman et al., 2007b) to examine the organizational-level correlates of the adoption of wraparound services across a nationally representative sample of community-based substance abuse treatment programs serving criminal offenders, using the provision of a women-specific program as the primary covariate of interest. Differences in the organizational-level adoption of specific wraparound services among organizations with and without women-specific substance abuse treatment programs are also explored.

Etheridge and Hubbard (2000) define wraparound services as “psychosocial services that treatment programs may provide to facilitate access, improve retention and address clients’ co-occurring problems” (p. 1762). Wraparound services provide the opportunity to tailor services to the specific needs of re-entering criminal offenders. For example, re-entering female offenders likely need housing assistance, legal assistance, medical care, and potentially child care if they are reuniting with their families (Greenfield et al., 2007). Research suggests that women-specific programs offer more wraparound services than either male-specific programs or mixed-gender programs (Grella et al., 1999, Greenfield et al., 2007), but it is unclear if this association is present in organizations that primarily serve offenders.

This organizational-level study examines the adoption of these wraparound services by treatment providing organizations because making the decision to make these services available within an organization is a necessary step to be able to provide the service to meet client's need. However, it should be noted that these wraparound services are not needed for all clients. Substance abuse and related criminal, social, health and behavioral consequences need to be assessed to create appropriate treatment plans (Belenko and Peugh, 2005, McLellan et al., 1997) and to provide a subsequent referral to an appropriate level of care.

In this study, we consider wraparound services in terms of comprehensiveness, or the number of services, and the availability of eight specific services which have demonstrated some improvement in women's post-treatment behavioral outcomes: case management, housing assistance, legal assistance, child care, crisis intervention, mental health counseling, medical care, and HIV/AIDS testing or counseling (Brady and Ashley, 2005, Greenfield et al., 2007, Marsh et al., 2004, Morgenstern et al., 2006, Sun, 2006). A more diversified wraparound service portfolio will enable an organization to provide services to address the client's individual-level needs and provide tailored treatment.

The existing literature suggests that women involved in the criminal justice system face a variety of risks, including increased health problems and substance abuse (Bloom et al., 2005). For example, according to the Bureau of Justice Statistics (BJS), 60% of all female state inmates meet DSM-IV criteria for drug abuse or dependence (Mumola and Karberg, 2006), but not all women offenders in need of substance abuse treatment are receiving treatment while incarcerated (Belenko and Peugh, 1999, Belenko and Peugh, 2005, Blitz et al., 2006). The actual percentage of women in prison who receive needed substance abuse treatment services across the United States is unknown.

Given that 95% of criminal offenders will re-enter the community (Hughes and Wilson, 2002) and that access to treatment services in prison is low (Belenko and Peugh, 1999, Belenko and Peugh, 2005), women re-entering their communities are likely to have significant needs for substance abuse treatment as well as other services. Therefore, re-entering women are at greater risk of experiencing certain barriers to treatment entry including co-occurring psychiatric disorders and trauma histories (Greenfield et al., 2007, Pelissier and Jones, 2005). In addition, studies have shown that between half and two-thirds of incarcerated mothers were the primary caregivers of their children prior to incarceration (Mumola, 2000), so it is likely that the majority of those women will resume parenting roles when they are released. However, while mothers are likely to serve less time in state prison than fathers (average 49 months vs. 82 months) (Mumola, 2000), the length of incarceration often has consequences for reunification with children with the Federal Adoption and Safe Families Act of 1997 (ASFA). ASFA specifically regulates that if a child is in foster care for 15 of the past 22 months, the state will move to have parental rights terminated. Thus, child care issues and/or issues around retaining or resuming custody can also be barriers to community treatment utilization for re-entering women offenders.

Women-specific barriers to treatment are less likely to be addressed by mixed-gender substance abuse treatment programs (Grella et al., 1999, Greenfield et al., 2007, Pelissier and Jones, 2005). While studies examining treatment outcomes among women-specific and non-women-specific programs have yielded mixed results, numerous studies suggest that women's substance abuse treatment outcomes are improved when female-specific problems are addressed by providing services to meet their specific needs (for an overview, see Greenfield et al., 2007). Other barriers to successful re-entry include public policies which can be seen as “invisible punishments,” or the collateral sanctions of having a criminal record (Pogorzelski et al., 2005). These policies, which vary across States, could have a conditional or temporary restriction on re-entering offender's access to public services such as Temporary Assistance for Needy Families (TANF), food stamps, and public housing benefits (Pogorzelski et al., 2005).

Wraparound services, delivered in the context of community-based treatment, may provide re-entering women with strategies to overcome these exclusionary public policies and offer solutions to these highly pressing concerns (e.g., housing, legal, or child care issues) that otherwise would supersede recovery progress. For example, women receiving treatment in women-specific treatment facilities that provided child care services or mental health services had better behavioral outcomes such as a longer length of stay and the completion of treatment plans (Brady and Ashley, 2005). Therefore, it is important to examine differences between the prevalence of wraparound services provided as well as the organizational-level characteristics of organizations that do and do not offer a women-specific program.

Several organizational-level correlates may influence whether or not a community-based treatment center adopts a greater variety of wraparound services. Previous studies in the substance abuse treatment field have drawn on diverse theoretical traditions in order to consider the various facilitators and barriers to processes that have been labeled “innovation adoption,” “technology transfer,” or “organizational change.” Some approaches have been largely focused on internal factors within the context of organizations. Simpson, 2002, Simpson and Flynn, 2007) model of change in addiction treatment programs is largely focused on internal characteristics such as leadership, perceived need and readiness for change, training, resources, and organizational climate. Others have drawn on the work of Rogers (2003), who framed adoption processes in terms of the fit between the characteristics of a given innovation and the characteristics of organizations. It is a combination of Simpson's work (2002) and Rogers’ (2003) work on innovation adoption that guides the theoretical framework for this study.

Rogers (2003) defines an innovation as a practice that is perceived of as new to an organization. Rogers’ model suggests that treatment providers would perceive a more diverse wraparound service portfolio as an innovation because non-substance abuse related services (e.g., child care or legal assistance) could be viewed as auxiliary to the goals of recovery and thus, novel to the substance abuse treatment organization because they are not universally used in the treatment field. While wraparound services may not be appropriate for all clients, the substance abuse treatment organization must make the decision to make these services available within their organization (i.e., adopt the innovation) in order for any clients to benefit. It should be noted that this study only focuses on adoption, which differs from implementation, or the extent to which wraparound services are routinely used within the substance abuse treatment program.

The existing innovation adoption literature in the substance abuse treatment field has primarily focused on the adoption of medications by substance abuse treatment organizations, particularly by publicly funded programs (Ducharme et al., 2006, Knudsen et al., 2006, Knudsen et al., 2007, Oser and Roman, 2007) although Oser et al. (2009) in this special issue examined the adoption of medications in jails and prisons. There are no known organizational-level studies grounded in the innovation adoption literature that focus on variations in the adoption of wraparound services by community-based treatment programs that primarily serve criminal offenders.

The organizational-level correlates to be examined include women-specific programs, organizational structure, personnel characteristics, culture, sources of information, and systems integration. The first dimension of interest, being a women-specific program, is the primary variable of interest in this study. It is expected that community-based organizations which have a women-specific program and serve predominantly criminal offenders will offer a greater array of wraparound services than treatment organizations without a women-specific program. This hypothesis is based upon the literature that women have greater service needs (Greenfield et al., 2007, Pelissier and Jones, 2005) and is consistent with other community-based research which found similar trends for the provision of wraparound services in women-specific programs (Greenfield et al., 2007, Niv and Hser, 2007). While there is little research on the organizational characteristics of women-specific treatment programs, the studies that do exist suggest that programs treating exclusively or predominantly women have different organizational characteristics (Grella et al., 1999, Grella et al., 2000, Tinney et al., 2004, Uziel-Miller and Lyons, 2001), which provides the rationale for this study.

The second dimension of interest, organizational structure, includes the size of the organization and the ability to provide adequate care (e.g., counselor caseloads). Larger organizations are usually more likely to adopt more services because they have more capital and personnel available (Castle and Banaszak-Holl, 1997, Damanpour, 1991, Kimberly and Evanisko, 1981, Morabito, in press, Roman and Johnson, 2002).

Third, personnel characteristics could impact adoption behavior through a variety of avenues including leadership, experiential knowledge, and education. Community treatment programs must possess both the material and human institutional resources necessary to adopt an initiative, such as a greater number of wraparound services (Backer, 1991, Brown, 1998, Simpson, 2002). Research demonstrates a positive relationship among health care administrator's education level and pro-adoption behaviors (Castle and Banaszak-Holl, 1997, Kimberly and Evanisko, 1981). Also, administrator's with greater lengths of service are more prone to engage in adoption behaviors (Castle and Banaszak-Holl, 1997, Kimberly and Evanisko, 1981, Roman and Johnson, 2002).

Traditionally, the substance abuse field places a great degree of value on the background experiences of its paraprofessional staff, which ultimately shapes the delivery of treatment services (Backer et al., 1994, Brown, 2000). The majority of counselors possess a bachelor degree or less, which may mean that these counselors lack the expertise to deliver a variety of wraparound services (Brown, 2000). Conversely, organizations employing a high percentage of counselors with a Masters degree will be more likely to engage in adoption (Taleff and Swisher, 1997, Roman and Johnson, 2002).

Fourth, substance abuse treatment organizations with a cultural ideology compatible with the goals of treating criminal offenders are hypothesized to be more likely to diversify their wraparound services portfolio. Tornatzky and Klein (1982) in a meta-analysis of innovation studies found that compatibility with existing values, norms, and existing practices was the most common predictor of adoption. Klein and Sorra (1996) emphasize the importance of the fit between innovations and the values held by organizational members. Substance abuse treatment organizations which believe that crime is reduced by ensuring that offenders receive needed treatment may have an organizational culture compatible with providing a greater array of wraparound services. A study by Melnick et al. (2009) in this special issue examined this topic with prison personnel and found that the mean score on the belief in rehabilitation scale was associated with higher levels of organizational commitment and interdepartmental coordination; however, an HLM analysis found that the rehabilitation consensus index score was associated with a poor organizational climate, which may be the result of the conflicting dual functions of prisons as both custodial institutions and sources of rehabilitation.

The fifth component of interest is sources of information. Rogers’ (2003) concept of communication channels is key to influencing an organization to adopt more wraparound services for criminal offenders. Communication channels are sources of information exchange in which organizations can learn about new services from the Internet, peer-reviewed publications, professional development activities, or other professionals (Backer, 1991, Brown, 1998, Sorensen and Guydish, 1991). It is hypothesized that the more time spent gathering information about treatment services, the more wraparound services that will be adopted. While research findings are intended to improve the treatment field and provide a scientific foundational base for practice, many community practitioners are not aware, do not read, or cannot interpret research findings reported in scholarly journals or on the Internet (Brown, 1998, Brown, 2000, Froehle and Rominger, 1993, Simpson, 2002). It has been suggested that interpersonal contacts are a better avenue, rather than written materials or the Internet, to use when attempting to adopt new service delivery initiatives (Backer, 1991, Brown, 1998, Sorensen and Guydish, 1991). Greater communication with criminal justice professionals, such as prison based treatment providers, could help identify the unique treatment and service needs for re-entering criminal offenders. For example, communication between prison-based and community-based treatment providers could ensure that a continuum of care is established for re-entering offenders, which has been shown to improve behavioral outcomes (Knight et al., 1999, Martin et al., 1999).

Finally, another important concept in the literature on organizational adoption is systems integration, or the relationships between different organizations (e.g., community, substance abuse treatment, and correctional). In this special issue, Lehman et al. (submitted for publication) found that different correctional settings (e.g., prisons, jails, and community corrections) significantly differed in terms of their collaborative activities with community-based substance abuse treatment organizations. While the degree of collaboration might vary, most organizations are not isolated but share a variety of resources including information and finances (Damanpour and Schneider, 2006). Organizations that are more integrated with other organizations may experience pressure from these organizations to adopt a variety of wraparound services in order to “legitimate” themselves by providing “best treatment practices” to meet all of the clients service needs. The provision of services in substance abuse treatment organizations may also be influenced by legislative and federal priorities because they may provide funding for specific innovative initiatives (i.e., wraparound services such as child care or HIV services). Therefore, a positive association is expected between the influence of both legislative and federal government priorities and the adoption of more wraparound services in substance abuse treatment organizations primarily serving criminal offenders.

This study contributes to literature on the relevance of organizational-level characteristics on the adoption of wraparound services for criminal offenders. Specifically, the purpose of this organizational-level study is two-fold. First, we consider whether there are differences in the number of wraparound services adopted as well as differences in organizational characteristics (i.e., organizational structure, personnel characteristics, organizational culture, sources of information, and systems integration) between organizations with and without a women-specific treatment program. Second, this study examines organizational-level characteristics as potential correlates of the number of adopted wraparound services in treatment organizations serving predominantly criminal offenders in order to test whether these correlates explain the difference between organizations with and without a women-specific program.

Section snippets

Sample

Data from the National Institute on Drug Abuse funded Criminal Justice Drug Abuse Treatment Studies’ National Criminal Justice Treatment Practices Survey was used for these analyses. The NCJTPS is a nationally representative multi-level survey which collected data from State Criminal Justice Executives (Survey 1), Correctional Clinical Directors and State Alcohol and Drug Agency Directors (Survey 2), Correctional Administrators, Prison-Based Treatment Directors, and Community-Based Treatment

Descriptive statistics

Table 1 displays the descriptive statistics for the available data prior to imputation. The average treatment program adopted 3.5 wraparound services. The most commonly offered wraparound services included case management (81.3%), mental health counseling (76.9%), and crisis intervention (69.7%). The wraparound services that were least likely to be provided included housing assistance (23.1%), legal assistance (8.7%), and child care (5.3%). About one-fifth of the community-based substance abuse

Discussion

To our knowledge, this is the first study to identify the organizational-level correlates, including the provision of a women-specific program, on the adoption of wraparound services for the treatment of criminal offenders. The majority of the existing literature on organizational adoption of wraparound services has focused on community-based programs that treat a variety of clients (Ducharme et al., 2007, Etheridge et al., 1995, Fletcher et al., 1997, Friedmann et al., 1999). Criminal

Role of funding source

This study was funded under a cooperative agreement from the U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Drug Abuse (NIH/NIDA, U01-DA-016205). The authors gratefully acknowledge the collaborative contributions by federal staff from NIDA, members of the Coordinating Center (University of Maryland at College Park, Bureau of Governmental Research and Virginia Commonwealth University), and the nine Research Center

Contributors

All authors contributed to the design of the study and have approved the final manuscript. Carrie Oser, Michele Staton-Tindall, and Carl Leukefeld collected the data for the Central States Center. Carrie Oser and Hannah Knudsen managed the literature review. Carrie Oser undertook the statistical analyses. All authors contributed to the writing.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgments

The contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH/NIDA or other participants in CJ-DATS.

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