Overview and Inventory of HHS Efforts to Assist Incarcerated and Reentering Individuals and their Families . National Institute on Drug Abuse

Type of Activity: Research

Funding Mechanism: Grant

Total Available Funding: N/A

Number of Awards: 6

Average Award Amount (current year): $439,000

Length of Project Period: 5 years

Federal Partners: NIAAA/NIH

Summary: These grants are part of a broader research program on the behavioral (and combined behavioral and pharmacological) treatment of drug abuse and addiction and its consequences (i.e., HIV risk reduction). These specific grants are aimed at developing and testing behavioral therapies specifically for individuals who are part of the criminal justice system.

Background: More and better treatment is needed in the criminal justice system.It is estimated that about half of state and federal prisoners meet the criteria for drug abuse and dependence and yet fewer than 20 percent who need treatment receive it. Forced abstinence (when it occurs) during incarceration is not equivalent to treatment. Failure to receive needed treatment or access to services often leads to relapse and re-arrest, usually during the first 12 months after release. Moreover, criminal justice settings are important venues for providing drug abuse and HIV prevention services and for identifying and treating HIV and drug use disorders. The Behavioral Therapies Development Program was established in 1992 with the goal of comprehensively supporting the development of behavioral (and combined behavioral and pharmacological) treatments for drug abuse and addiction. In 2008, NIDA solicited research applications studying the Interaction of HIV, Drug Use, and the Criminal Justice System. Applications were required to include research projects for developing interventions or research on translating and disseminating effective interventions into criminal justice settings.

Location(s) of Projects: See above.

Evaluation Activities: Peer-reviewed publications to disseminate scientific data and findings; presentations of findings at scientific meetings.

Future Prospects: Future prospects dependent upon receiving highly meritorious investigator-initiated projects and funds available.

Contact:

Susan Weiss, Ph.D.
Phone: (301) 443-6071
Email: susan.weiss@nih.gov

Type of Activity: Research

Funding Mechanism: Grants

Total Available Funding: N/A

Number of Awards: 8 grants

Average Award Amount (current year): $521,000

Length of Project Period: Varies

Federal Partners: N/A

Summary: The National Institute on Drug Abuse’s (NIDA) Prevention Research Portfolio supports research across the lifespan to reduce risks and prevent the initiation and progression of drug use to abuse and prevent drug-related HIV acquisition, transmission and progression. This program, in particular, supports research related to drug abuse and HIV prevention for youth, adults and their families (including integergenerational studies) who are at increased risk for and involved in the criminal justice system, including incarceration and reentry. The currently funded grants cover a broad array of topics and populations. Several grants specifically target ethnic minorities including African American and Hispanic youth; these groups are over-represented in the incarcerated youth population. Other grants target adolescent girls who are involved in the juvenile Justice system; a population at particular risk for continued problem behaviors and victimization. As a whole these prevention intervention grants attempt to identify and intervene with youth who are at risk for increasingly more intense levels of criminal justice involvement. Strategies for intervention vary, but include education and empowerment activities, brief court-based substance use interventions, and motivational interviewing.

Background: More than 31 million youth aged 10 to 17 years were under juvenile court jurisdiction in 2007 ( National Center for Juvenile Justice, 2010). Of the 1,666,100 delinquency cases processed in 2007, 54% involved youth younger than 16; 27% involved females; and 64% involved white youth. The problem appears to be escalating at a greater rate for females than males with the female delinquency caseload growing at an average rate of 3% per year compared to 1% per year for males between 1985 and 2007.

From the prevention perspective, it is important to examine the intergenerational impact of criminal justice involvement. Children of parents in the criminal justice system are a population of "lost" (not captured in any system) and vulnerable children, many of whom live in families who have generations of problems with drug abuse, antisocial behavior, etc. In 2007, approximately 52% of state and 63% of federal inmates were parents, and over 1.7 million children had parents in prison (Glaze & Maruschak, 2008). Proportionately more inmates were persons of color than Caucasian, and thus Black and Hispanic children were much more likely to have an incarcerated parent than a White child (8 times and 3 times, respectively). Families with an incarcerated parent experienced a variety of problems including homelessness (9%), physical or sexual abuse (20%), medical problems (41%), mental health problems (57%) and substance abuse (67%). Despite these problems, just prior to arrest or incarceration, approximately two-thirds of mothers and half of fathers reported living with their minor children and about half of both fathers and mothers reported being the primary source of support for those children. During incarceration, 85% of mothers and 78% of fathers reported contact with a child. All of these factors must be taken into account when devising interventions to prevent the vicious cycle of drug abuse and criminal justice involvement.

Locations of Projects: See above

Evaluation Activities: Peer-reviewed publications to disseminate scientific data and findings; presentations of findings at scientific meetings.

Future Prospects: Future prospects dependent upon receiving highly meritorious investigator-initiated projects and funds available.

Contact:

Susan Weiss, Ph.D.
Phone: (301) 443-6071
Email: susan.weiss@nih.gov

Type of Activity: Research

Funding Mechanism: Grant; Cooperative Agreement Grant (U01)

Total Available Funding: N/A

Number of Awards: 12

Average Award Amount (current year): $538,000

Length of Project Period: Varies

Federal Partners: Center for Substance Abuse Treatment (CSAT/SAMHSA), Department of Justice, Centers for Disease Control and Prevention

Summary: The Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) is a research cooperative studying organizational processes involved in the successful implementation of high-quality drug abuse treatment services in criminal justice settings. Each Research Center has partnered with at least one criminal justice setting (i.e., prisons, jails, probation/parole offices, reentry drug courts) and the collaborative provides a platform for multi-site treatment services research trials on implementing and sustaining improved drug abuse treatment services across a coordinated continuum of care for offenders with substance use disorders who are returning to the community after detention or incarceration. Studies focus on three topics: implementation of effective screening and assessment for the development of post-release treatment service planning; implementing medication assisted treatment through the development of inter-organizational linkages between community corrections and community-based treatment service providers; and implementation of a coordinated HIV continuum of care including prevention, testing, and linkage to treatment for offenders transitioning from the institution to the community.

Background: Many research-based clinical interventions and treatment services have not been adopted for criminal justice populations and consequently few drug-involved offenders benefit from them.  From 2002-2007, NIDA funded the first phase of the CJ-DATS cooperative, which fielded 13 studies in 8 topical areas, all testing the effectiveness of specific interventions and treatment practices for incarcerated populations. In the course of conducting these studies, researchers identified multiple organizational and systems-level barriers to full-scale adoption and sustainability of these interventions in routine practice. The implementation of research-based drug abuse treatment practices in criminal justice settings often faces clinical, administrative, organizational, and policy barriers.  While various implementation barriers are often surmounted during the course of research, if the solutions are expedient rather than systemic the intervention may not be sustainable once the study ends — regardless of its clinical effectiveness or cost-effectiveness. Thus, the research being conducted under the second phase of CJ-DATS supports organizational and systems-level studies on implementation and sustainability of three key practices: assessment, medication-assisted treatment, and a continuum of HIV prevention, testing, and treatment services.

Location(s) of Projects:  See above.

Evaluation Activities:  Process evaluations are built into each of the three implementation trials being conducted in CJ-DATS. As a cooperative agreement, NIDA also plays an active role in study design and management. Peer-reviewed publications to disseminate scientific data and findings; presentations of findings at scientific meetings.

Future Prospects:  Dependent in part on results of research studies, which are just entering the field.

Contact:

Susan Weiss, Ph.D.
Phone: (301) 443-6071

Email: susan.weiss@nih.gov

Type of Activity: Research

Funding Mechanism: Grant

Total Available Funding: N/A

Number of Awards: 14

Average Award Amount (current year): $493,000 total costs

Length of Project Period: Varies

Federal Partners: National Institute on Mental Health (NIMH), National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Summary: The grants within the National Institute on Drug Abuse’s Criminal Justice Epidemiology Research Portfolio are primarily longitudinal studies and secondary data analyses investigating substance abuse in incarcerated or formerly-incarcerated youth and adults. Many of the grants included in this portfolio focus specifically on minority populations that are disproportionately represented in the criminal justice system (e.g., African American and Hispanic racial/ethnic groups). Grantees examine racial/ethnic and gender disparities; the effects of incarceration on the onset, persistence, desistence, and recurrence of drug abuse disorders; the dynamic relationships between patterns of drug use and adult social role performance; and how risk and protective factors mediate patterns of drug use. Some studies within this portfolio also focus on the spread of STIs and HIV/AIDS within this population, with the aim of informing future strategies to reduce the spread of these diseases. Other grantees examine the effects of parental incarceration on children with regard to mental health and substance abuse outcomes.

Background: In recent decades, the number of adults involved in the criminal justice system has soared from about 1.8 million in 1980 to 7.3 million in 2007, due in large part to prosecutions of drug-related crimes and drug-addicted offenders. Criminal offenders have rates of substance abuse and dependence that are more than four times that of the general population. To help identify solutions to address this devastating problem, NIDA funds projects that examine substance abuse disorders among incarcerated individuals. Ultimately, the studies funded follow the high-risk incarcerated or formerly-incarcerated populations in an effort to inform policy and interventions to protect and/or reduce this group from the burden of substance abuse disorders and other diseases

Location(s) of Projects: See above

Evaluation Activities: Peer-reviewed publications to disseminate scientific data and findings; presentations of findings at scientific meetings.

Future Prospects: Future prospects dependent upon receiving highly meritorious investigator-initiated projects and funds available.

Contact: Susan Weiss, Ph.D.

Phone: (301) 443-6071

Email: susan.weiss@nih.gov

Type of Activity: Research

Funding Mechanism: Grants

Total Available Funding: N/A

Number of Awards: 9

Average Award Amount (current year): $360,000

Length of Project Period: Varies

Federal Partners: N/A

Summary: These projects are testing treatments for opiate addiction and its medical consequences within criminal justice settings. Specifically, studies will be evaluating the effectiveness of initiating opiate replacement therapy (methadone) prior to release from prison vs referral to a methadone-treatment program on release, on reducing HIV risk behaviors; testing the efficacy of buprenorphine as well as methadone, prior to release from incarceration; testing a long-acting form of the opiate antagonist naltrexone; and adapting and testing a continuity of care model between the prison and community settings for inmates infected with Hepatitis C virus who have a history of drug use and comorbid psychiatric disorders.

Background: There are currently two medications available for opiate addiction, methadone and buprenorphine. However, these have not been widely adopted by criminal justice systems. Research to demonstrate their effectiveness within criminal justice populations as well as the development and testing of additional medications for both drug abuse as well as its medical consequences (e.g., HIV, Hepatits C) is necessary to encourage the implementation of these treatments within the criminal justice system.

 Evaluation Activities: Peer-reviewed publications to disseminate scientific data and findings; presentations of findings at scientific meetings.

Future Prospects: Future prospects dependent upon receiving highly meritorious investigator-initiated projects and funds available.

Contact:

Susan Weiss, Ph.D.
Phone: (301) 443-6071
Email: susan.weiss@nih.gov

Type of Activity: Research

Funding Mechanism: Grant

Total Available Funding:

Number of Awards: 9

Average Award Amount (current year): $925,000

Length of Project Period: Varies

Federal Partners: NIAID and NIMH

Summary: Seek, Test, and Treat: Addressing HIV in the Criminal Justice System is an initiative intended for funding in FY 2011 to empirically test the “seek, test, and treat” paradigm in criminal justice populations. This model involves reaching out to high risk, hard to reach groups who have not been recently tested (seek), engaging them in HIV testing (test), and initiating, monitoring, and maintaining HAART for those testing positive (treat).  Researchers will develop, implement, and test strategies to increase HIV testing and the provision of HAART to HIV seropositive individuals involved with the criminal justice system, with particular focus on continuity of HAART during and after community reentry following incarceration.  Key outcome measures include linkage to care (e.g., seen at care center post-release) and viral suppression (e.g., proportion with undetectable viral load 6 months or more after initiation of ART).  Researchers will conduct intervention research at the individual, organizational, or system level that leads to effective approaches for expanding access to HIV testing and HAART treatment in the criminal justice system and in community organizations working with criminal justice systems and populations. 

Background: The overrepresentation of both drug abuse and HIV within criminal justice populations demands better strategies to integrate services and improve outcomes for both. Fourteen percent of HIV-infected individuals pass through correctional facilities each year. Yet criminal justice-based services and health and social services offered in the community remain fragmented. Prison settings offer a good opportunity to integrate substance use treatment with early HIV diagnosis and initiation of HAART therapy and will offer a fertile testing ground for this innovative strategy — to include reliable maintenance of treatment in the community.

Current grantees:

A Randomized Controlled Trial and Cohort Study of HIV Testing and Linkage to Care (Principal Investigator: Michael Scott Gordon, DPA, Friends Research Institute, Inc., Baltimore, MD).

Effectiveness of Peer Navigation to Link Released HIV+ Jail Inmates to HIV Care (Principal Investigator: William E. Cunningham, MD, University of California at Los Angeles, CA).

HIV, Buprenorphine, and the Criminal Justice System (Principal Investigator: Frederick Lewis Altice, MD, Yale University, New Haven, CT).

Improving Linkage to HIV Care Following Release from Incarceration (Principal Investigators: Josiah Rich, MD, Miriam Hospital, Providence, RI; Liza Solomon, PhD, Abt Associates, Inc., Cambridge, MA).

Naltrexone for Opioid Dependent Released HIV+ Criminal Justice Populations (Principal Investigator: Sandra Ann Springer, MD, Yale University, New Haven, CT).

RCT (Randomized Control Trial) of an augmented test, treat, link, & retain model for NC and Texas Prisoners (Principal Investigators: David Wohl, MD, University of North Carolina at Chapel Hill, NC; Patrick Flynn PhD, Texas Christian University, Ft. Worth, TX; Carol Golin, MD, The University of North Carolina at Chapel Hill, NC; Kevin Knight, PhD, Texas Christian University, Ft. Worth, TX).

Seek, Test, Treat: An Integrated Jail-Prison-Community Model for Illinois (Principal Investigators: Lawrence Ouellet PhD, University of Illinois at Chicago, Chicago, IL; Michael Puisis DO, Cermak Health Services, Chicago, IL; Jeremy Young MD, University of Illinois at Chicago, Chicago, IL).

Seek, Test, and Treat Strategies (Principal Investigator: David W. Seal, PhD, Medical College of Wisconsin, Milwaukee, WI).

Seek, Test, Treat Strategies for Vietnamese Drug Users: A Random Controlled Trial (Principal Investigator: Vu Minh Quan, MD, Johns Hopkins University, Baltimore, MD).

START Together: HIV Testing and Treatment in and after Jail (Principal Investigator: Stanley Sacks, PhD, National Development and Research Institutes, New York City, NY).

CARE Corrections: Technology for Jail HIV/HCV Testing, Linkage, and Care (TLC) (Principal Investigators: Curt Beckwith, M.D., Miriam Hospital, Providence, RI; Irene Kuo, Ph.D., The George Washington University; Ann Kurth, Ph.D., New York University  (funded jointly with NIDA and NIAID))

Finding, Testing and Treating High-risk Probationers and Parolees with HIV (Principal Investigator:  Alexander Kral, Ph.D., Research Triangle Institute, Research Triangle Park, NC (Funded by NIMH))

Location(s) of Projects: Baltimore, MD; Chicago, IL; New York, NY; Washington DC, New Haven, CT; Los Angeles, CA; Madison, WI

Evaluation Activities: Peer-reviewed publications to disseminate scientific data and findings; presentations of findings at scientific meetings.

Future Prospects: Future prospects dependent upon receiving highly meritorious investigator-initiated projects and funds available.

Contact:

Susan Weiss, Ph.D.
Phone: (301) 443-6071
Email: susan.weiss@nih.gov