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This radio program is available at http://media.csosa.gov/podcast/audio/2010/03/iowa-jail-based-substance-abuse-treatment-project-ncja-dc-public-safety/
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Len Sipes: From the nation’s capital, welcome to D.C. Public Safety. I am your host, Leonard Sipes. This program is going to focus on the Iowa Jail-Based Substance Abuse Treatment project, and let me tell you, ladies and gentlemen, there are some extraordinary results from this. One year after program completion 78.5% say that they are clean, 91.9% have not been arrested, and 68.2% are employed full time, and I find those to be absolutely amazing statistics. Our guest today, Lonnie Cleland, a program planner with the Iowa Department of Public Health; Leesa McNeil – she is the District Court Administrator for Woodland County, Iowa; and Kim Brangoccio – she is clinical director of United Community Services. This program is brought to you by the National Criminal Justice Association. As the regular listeners are aware, we do a regular series with the National Criminal Justice Association. Their website: www.ncja.org. Before we begin the program, once again, we thank everybody for the 200,000 requests on a monthly basis for D.C. Public Safety radio, television, blog, and transcripts. You can reach us at www.media M-E-D-I-A.csosa C-S-O-S-A .gov. You can reach me for all the comments – and I get a lot of comments, and I’m appreciative of all the comments – you can reach me directly via email: Leonard L-E-O-N-A-R-D.sipes S-I-P-E-S@csosa.gov or follow us via Twitter, which is Twitter/lensipes, L-E-N-S-I-P-E-S. Back to our guests: Lonnie Cleland, Leesa McNeil, and Kim Brangoccio. Welcome to D.C. Public Safety.
Kim Brangoccio: Hi.
Lonnie Cleland: Hello.
Leesa McNeil: Hi.
Len Sipes: Lonnie, Lonnie Cleland, the program planner for the Iowa Department of Public Health, give me an overview of the Iowa Jail-Based Substance Treatment project.
Lonnie Cleland: Yeah, the Jail-Based Treatment project is a four-county initiative centered in the county jails, but also including outpatient substance abuse treatment for nonviolent offenders. We started the project in 2002 with one county, and it was directly a result of research that came out saying that the longer you kept offenders in treatment, and the more structure they had, the more successful you could be in helping them being integrated back into society. Our substance abuse treatment programs can bring in nonviolent offenders, and the focus of the project is to reduce substance abuse and criminal behavior simultaneously. It’s a curriculum-based treatment program, at least at the jail level, using a cognitive-behavioral therapy approach. When offenders get out of jail, then they’re involved in outpatient treatment, which focuses on a more individual kind of approach. Typically, offenders are in the treatment program anywhere from 120 to 180 days. Now that varies from individual to individual.
Len Sipes: Well, I think the impressive part of that is the outpatient component, where you have – a lot of programs throughout the country have in-jail or in-prison based programs, and their concept of follow-up treatment is referral to AA or referral to the local health department who does drug treatment, and you sit for three or four months before you finally get into drug treatment. This concept of the outpatient part of it I think is extraordinarily valuable. It may be one of the key components of your success. Leesa McNeil, did you want to give a shot at that?
Leesa McNeil: Well, I think part of the success, too, is keeping the entire network of the community around the program. One of the things we’ve done in the Woodbury site is to create a program committee, and we have players around the table who meet periodically, at least bimonthly, and we visit about what programs are operating that impact the jail and troubleshoot them. And this is also our way of trying to keep people educated on what’s going on, make sure that we’re providing a safety net to solve any problems that may develop with the program, and we see players cycle through sheriff’s departments, public defenders offices, county attorney offices, judges, even treatment providers. And this is a way we use to make sure we keep educating people and keep the system engaged with promoting the program.
Len Sipes: So, the lesson here, Leesa, is that there’s no such thing as going it alone; you’ve got to build a network in the larger community who are going to supply the services necessary for those offenders, and they’ve got to be supportive and pretty much everybody’s got to be on board.
Leesa McNeil: Right, and we’ve even been successful in getting our county to put money on the table to assist with treatment, so the collaboration amongst the group is key and keeping players educated as they come in and out of the system and having a place where treatment folks can come and say, “Hey, we’re having a problem here,” and bringing the collaborative group together to say, “What can we do to that?” Sometimes we have problems with, you know, we need to find more clients to participate in the program, so we beat the bush, if you would, for attorneys to be reminding their clients that this is available. Sometimes judges forget it’s available, if they haven’t been on the criminal docket for a period, so it’s a continuous process that seems to work well for us.
Len Sipes: Kim Brangoccio, it’s a nice segue into what Leesa said about the clinical folks. You’re the clinical director of United Community Services, so you’re the person basically in charge – tell me if I’m wrong – of making sure that they get the various treatment modalities that are offered and that they are customized for that particular individual offender, correct?
Kim Brangoccio: Yes, that’s correct. I did want to comment, Len, on your talk about how the curriculum, both in the jail and out of the jail, affects the person. We really have found that to be successful, that once they have completed the in-jail portion, they are able to get out into the community. They’re already met their counselors out of the jail; they continue with them once they’re in the community, and they continue to use what they learned in jail, but they still have 6-8 months with us out of the jail where they can utilize what they’ve learned and make sure that they are following through. And that has been very successful for us.
Len Sipes: You know, if anybody doubts that, could you imagine, if a person goes inside the jail, and most jails are nonsmoking, so for the first time in their lives, they’re not smoking, for the three months they’re inside the jail. But as soon as you get outside that jail, you want that cigarette. I don’t care what the circumstances – I mean, before, it’s easy to go through a behavioral therapy-based program, a cognitive-behavioral-based therapy program within a correctional facility. It’s hard as the dickens applying all those skills when you get on the outside.
Kim Brangoccio: Right, exactly. And we talk a lot about that. I mean, we do talk about smoking and a lot of the clients do get out of the jail and start smoking again, but they really utilize the tools that they learn when they’re in jail when they get out, so they don’t go back to using drugs and alcohol. And one of the big things that the clients say to me that they think is a difference is that the program really focuses on both criminal and addictive thinking, so it’s not just the addictive thinking that they might have in another treatment program; they’re focusing on how those two interplay and how that got them into trouble. So we really try to help them always be looking at “What are they thinking?” as well as whether there are addictive patterns.
Len Sipes: You know, when I explain this to people, because I’ve done three stints in terms of dealing with offenders directly – jail, or job corps, doing gang counseling when I was putting myself through college after leaving the law enforcement community, and running group in a prison system – and to explain to people that you have to reorient the individual’s thinking patterns through cognitive-behavioral therapy or what we used to call ‘thinking for a change’ to get people to rethink how they look at life, rethink how they deal with problems, rethink how they process the information that’s in front of them. People who are not part of this process look at me as if I have five heads. “What do you mean? I learned at age five not to beat somebody with a stick if they made me angry, and you mean to tell me that you’ve got to take adult men, or adult women, and teach them that that’s probably not the best way to resolve a problem?” And my response to that is, “Yeah, that’s exactly what I’m saying,” that you have to sometimes train a lot of individuals to think through what it is that they do, and once they develop a different way of thinking through a problem, they don’t revert back to their violent or nasty ways of doing things, and they don’t necessarily go back to doing drugs, because there is an alternative. Now, am I in the ballpark of being right?
Lonnie Cleland: Yeah, could I jump in there for a second, Kim.
Len Sipes: Yeah, please.
Lonnie Cleland: Len, I think Polk County historically has a perfect example of that. As part of our project, we have the University of Iowa’s Consortium for Substance Abuse Research and Evaluation doing criminal thinking assessment so that each of the offenders in the project, the providers of the service give them the criminal thinking test during treatment or admission, and then it’s also followed up later on. What we found – I think it was 2003 or 2004 – was that the criminal thinking scales changed drastically a month after they got out of jail. And so, as a result, the projects were able to adjust their treatment – the frequency, the intensity, the kinds of things that they discussed with the offenders in outpatient treatment – as a way of once again readdressing those criminal thinking kinds of things. You’re absolutely correct. You have to reinforce this at all points, in my opinion.
Len Sipes: And this program is basically based on the individual offender facing a criminal charge, going before the judge, and making a plea either on a pre-trial basis or on a post-trial basis, agreeing to stay within these four jails for a certain amount of time, and then to continue that treatment in the community. That’s pretty much the agreement. They go and they’re sanctioned by a judge and the judge remands them to this treatment program and it’s something that they must complete, and in some cases, the charges are waived or done away with, and in some cases, they continue during a probationary period. Am I correct?
Kim Brangoccio: That’s correct. That’s how it works.
Len Sipes: Okay, cool. All right. And basically, you’ve done about 2000 offenders, 2000 clients throughout that time, correct?
Lonnie Cleland: It’s probably up around 2600 now. Because of some funding problems we had about a year and a half ago, we had to reinitiate the evaluation project, and so we had to start it over, and I think we have – I was talking to the evaluators just a few days ago – I think we’ve got 800 more in the project at this point.
Len Sipes: Wow, that’s amazing.
Lonnie Cleland: But those results, because we had to start it over, those results are still sort of in process.
Len Sipes: Okay. And to go with the results, this is one-year follow-up, but this is a self-assessment on the part of an offender, basically through an interview process done by an outside agency. 78.5% were clean, 91.9% had not been arrested, and 68.2% were employed on a full-time basis, correct?
Lonnie Cleland: Full or part time, yes.
Len Sipes: Full or part time. Now, those are amazing results.
Kim Brangoccio: Yes they are.
Lonnie Cleland: Yes they are.
Leesa McNeil: We think so.
Len Sipes: Congratulations. Congratulations to the three of you and congratulations to everybody involved. Those are amazing results. Before getting involved in the larger question of the take-aways – what are the things that the rest of us in the criminal justice system can learn from all of this – in essence, you have these participants, they’re basically successful. And this evaluation is focusing on the people who’ve completed the program – it is cognitive-behavioral therapy based, but you provide lots of other services, both inside the institution and out in the community. But the interesting thing about all this is that it’s done within a jail environment, and being exposed to a jail when I was with the Maryland Department of Public Safety at the Baltimore city jail, which is one of the biggest in the country, I was like blown away by the complexity of running a jail. I mean, a prison is relatively simple and straightforward and easy compared to tens of thousands if not hundreds of thousands of individuals coming into and out of the jail in a rapid-fire fashion. They’re coming into the booking center, if the booking center is within the jail. Any jail is chaotic. Any jail is just an immensely complicated place to run, and the fact that you were able to produce this sort of a program and have these sort of results within the jail setting, I think are enormous. But am I right? The jail is just a difficult place to do this sort of thing.
Leesa McNeil: Oh, it’s very difficult, Len. This is Leesa. Space is an issue, because you need to find space where you can kind of isolate the defendants that you want to participate in the program. As you know, jail space is at a premium. The lack of jail space is what actually prompted our county to be very anxious to get to the table to get some better outcomes, because overcrowding was an issue. And through a series of programs, you know, here we are six years later. We’re aren’t facing building a new jail, so –
Len Sipes: And every government administrator who is listening to this program, their ears just perked up. So you were able to avoid building a facility because of this program.
Leesa McNeil: Well, not just this program. We have a group of programs, and that’s one of the keys to success in terms of a walk-away, I think, is you need to have a collaborative group that supports the bigger offender population in terms of working to get better outcomes for them. We have a drug court, we have a mental health court, and now we have this Jail-Based Treatment program. And we attribute our success to not building a new jail to the combination of those programs and the collaboration, that all of the players came to the table and worked to make them all a success.
Len Sipes: We’re halfway through the program. I do want to give the website for this particular program: www.idph.state.ia.us and search for jail-based programs. I’m going to repeat that one more time, but in the show notes, ladies and gentlemen, I’ll have the web address that goes directly to the publications that address the Iowa Jail-Based Substance Treatment program project. Stumbling over that. Again, it is www.idph.state.ia.us. Search for jail-based programs. Our guests today are Lonnie Cleland. He is the program planner, Iowa Department of Public Health. Leesa McNeil, District Court Administrator for Woodbury County, Iowa. And Kim Brangoccio – she is the clinical director for United Community Services. The program is brought to you, once again, by the National Criminal Justice Association – www.ncja.org. Okay, Leesa, you were talking about taking about take-aways, and that’s exactly where I want to go with this, is that there are people throughout the country who are saying, “Eh, the jail is just not the setting to do clinical-based programs.” Or they’re saying, “No, it’s just too expensive,” or they’re going to throw a lot of reasons up as to why they can’t do what they want to do, so what would you say to them?
Leesa McNeil: I would say the take-away is that it is key to have program evaluation, because that shows it’s a success. And when people say we can’t afford to do this, we can’t afford not to. Everybody knows that to house a prisoner for a year costs $25,000 plus, depending on the jurisdiction. We can show that treatment of an individual for a fourth of that amount can keep a person out of prison, and so when the community says, “Why are we paying for treatment for these people?” it’s like, “Well, would you rather pay for them to be in an institution in the future for how many years?” And now we’re turning them out and they’re paying their child support, they’re keeping jobs, they’re staying clean. We’re not building jails. Those things are expensive. I think when we look at the human cost, the taxpayer cost, and unfortunately, there aren’t a lot of studies that pull all that together for the taxpayer to see, but that is the true savings. And so, not only saving the person from a horrible life in terms of abuse, but saving the taxpayers and saving our future workforce, saving future families, all that. You can’t compare the cost.
Kim Brangoccio: Len, this is Kim, and I would also add to that the fact that it really does affect future generations. Many of the clients that we see in the jail, they have young children. And if they turn things around because of their treatment, their kids are way less likely to end up in jail. And right now, as it stands in our jail, there are many, many people that their grandpa was there, or their father was there, their mother was there, and if we can stop that cycle, it helps into the future.
Leesa McNeil: Again, add the cost of foster care. Oh, my god.
Lonnie Cleland: Yeah, and we haven’t – we’ve actually, Len, done a cost analysis of this project and compared the cost of this project versus the cost of prison, which is where many of these offenders would end up without the project.
Len Sipes: Right, correct.
Lonnie Cleland: The average daily cost for these four counties is $30.19 per offender. The average prison daily cost is $64.00. So we’re saving the state taxpayers $34.00 per offender, per day.
Len Sipes: Basically, we want tax burdens to become taxpayers. We want non-parents to become parents. We want to reduce the odds, which according to research, are very high, of the children of offenders – instead of them continuing the ways of their parents and continuing within the criminal justice system – we’re trying to reach them as well, through their parents. So this is from an economic point of view, from a crime control point of view, from a fiscal responsibility point of view, this seems to be a win-win situation.
Kim Brangoccio: Yep.
Leesa McNeil: Mm-hmm.
Lonnie Cleland: I agree.
Len Sipes: Then the other issue is that administrators who are listening to this are basically saying, “Leonard, you could tell me that an investment of $5,000,000 will give me the goose that lays the golden egg, and eventually, those golden eggs will more than make up for that $5,000,000. I don’t have the money.” And how many times have I heard from administrators throughout the country, “Leonard, what is it that you don’t understand about the fact that I don’t have the money?”
Leesa McNeil: Well, you’ve got to ask them, “Do you have the money to build a new jail?” And our community said no. And that is why we, I think, as administrators and people who are working in the system need to help people understand there is a cost to doing nothing. And people have to be educated about that cost and we have to get decision makers to say, “This isn’t just a program we should wait for the feds to come and solve; this is a program that affects every county in the nation.”
Lonnie Cleland: Yeah, and Leesa and Kim, I’m wondering if you might not agree that the first step is just getting everybody to the table and getting information out, but also having a conversation about, okay, let’s talk about what some of the options are that are out there.
Kim Brangoccio: Yeah, I think if you do that, if you have a conversation with everyone involved, there may be some other ways to get it started without the jail just having to fund it, or the community, or maybe a treatment program would be able to utilize some of their dollars in the jail, doing treatment with those folks, and it’s just a change of site. Or maybe there’s some arrangements that can be made where the services that are already being provided in another way, just the dollars could be shifted a little so that they could start a jail program, and then once you see the success, it really does prove itself and the money can be easier to find.
Leesa McNeil: Len, this is Leesa. That’s just one of the walk-aways. You have to have a good evaluation, or you won’t be able to prove that you’re doing the kinds of things we’re doing.
Len Sipes: Bingo. That’s exactly where I was going, Leesa. The point is that you can prove your impact. The great majority of the programs out there that are similar to yours don’t have an evaluation, so they really can’t prove their impact. I mean, one of the ways they’re proving their impact, by the way, is in lieu of a formal evaluation, is that the jail population seems to go down, or seems to be steady, so they don’t have to build another jail, and without the evaluation, you never know if it was attributable to your program or not, but they’re happy with that. They’re just tickled pink that they do not have to invest several hundred million dollars to construct a new jail and a million – oh, I’m sorry, probably I’m going to guess $50,000,000 a year to maintain it. They’re just tickled pink that that is the result, but it’s more than that, is what you just said before. It’s less crime, it’s more kids being taken care of. It’s just a win-win situation across the board, but yet the average county administrator in the United States is not jumping up and down to do these programs.
Kim Brangoccio: Yeah, and I think that’s why we’ve got to make the case.
Lonnie Cleland: Yeah, one of the benefits of evaluation is not just the long-term benefit of being able to show that these projects save money or that they have a social benefit, but it’s also being able to move more efficiently, more effectively, when you get a snapshot of how a project is working. As I pointed out earlier, finding out that criminal thinking increases a month after people are released from jail has a powerful affect on being able to adjust the treatment program quickly and to be able to keep the social impact of those folks at a minimum. And so the evaluation component can also help you be more flexible and faster and meaner when it comes to successfully treating these folks.
Len Sipes: Right, because the process of evaluation, a third of the way through, will show some success and some problems, so thereby you address the problems, because you were evaluating the program from the very beginning. Is there something in the water in Iowa that causes everybody to sit at the same table? We did another show with the National Criminal Justice Association about a jurisdiction in New York City, Red Hook, where the judge got everybody together and had fabulous results. It’s that sense of – and it’s funny, the President’s Commission on Crime and Justice back in the ’60s made this point – and in my forty years in the criminal justice system, I haven’t seen many examples of everybody coming together and sitting at the same table and cooperating for the common good, so what’s in the water out there in Iowa that calls in four counties and calls to everybody to sit at the same table and to share resources and to try to do something for the common good?
Leesa McNeil: Len, this is Leesa, and I’ll pipe in to start the conversation on that topic. And that is, in our community, it took two things. We had a jail overcrowding crisis where we were under federal court supervision to do something or build a new jail. And we had a judge who worked with me and stepped up to the table and said, “I’ll help lend credence to getting everybody to the table.” And as you know, Leonard, when a judge says, “Come to a meeting,” everybody comes. Well, once we got people there, we kind of semi-formally organized ourselves and made some agreements about future meetings, and the groups hung with it over ten years now. And they see the benefit, after we start the process going to making these productive meetings and that we’re talking about things that affect them. And one of our collaborative groups – we have twenty-two different criminal justice entities, or entities that affect the criminal justice system – that come to the table on a regular basis. And it’s just to hear about, well, “What’s going on? What are the problems? Who’s doing what? How is that going to impact me? What am I doing that’s going to impact everybody else?” And it gives a forum for sharing, and then it creates a synergy unto itself.
Len Sipes: And more and more judges, Leesa, are taking center stage, and I’m very happy to see that, because judges traditionally have found that their role, in terms of separation of powers, the tri-partied sense of you have the executive branch, you have the legislative branch, and you have the judicial branch, and the judicial branch should not intermingle with the other two. And that seems to be falling by the wayside, and when judges take the lead, they seem to have a powerful impact on the rest of us.
Leesa McNeil: Yep, it’s working in Iowa.
Len Sipes: Lonnie, you were trying to get in here.
Lonnie Cleland: Yeah, I think also sheriffs are more interested than they used to be. I think they’re seeing more of the impact of high levels of drug and alcohol use in their jails – the offenders getting into jail and having that history. And the word is starting to get around that when we can intervene with those folks successfully, then they’ve got some ideas about, “Well, okay, maybe we can do this too.” But I think the important part is understanding that we have to go to folks right from the start with information, as Leesa said, with data, with “Here’s how much it’s costing you folks to not do anything.”
Len Sipes: Well, it’s my hope that jail administrators throughout the country, or county administrators, will hear this program and say, “Well, son of a gun, if they can do it, I guess we can do it. It’s worth the conversation.
Lonnie Cleland: Yeah, but you know, it’s not easy. Kim, do you remember back in the early stages of the Polk County project, folks, you know, that was a struggle.
Kim Brangoccio: It was.
Lonnie Cleland: Getting folks together.
Kim Brangoccio: It was lots and lots of meetings, initially, trying to get people at the table, just us going to lots of different places and talking with public defenders and the county attorney’s office and going to roll call and really trying to talk with everybody about the results of this outcomes-based, evidence-based practices and that it would really be helpful. But it was very tricky at first.
Len Sipes: Well, we are out of time, and I do want to thank the three of you and the National Criminal Justice Association for bringing this program to our attention, and to congratulate the three of you and everybody involved with the Iowa Jail-Based Substance Treatment project. I mean, what you guys have accomplished, especially within a jail setting, is nothing short of miraculous. And you’ve got the data to prove it, and you have the organization in four counties to support it. And the fact that it’s both jail-based and community-based is, I think, extraordinarily impressive. Ladies and gentlemen, our guests today, Lonnie Cleland, program planner with the Iowa Department of Public Health; Leesa McNeil, District Court Administrator for Woodbury County, Iowa; and Kim Brangoccio, clinical director of United Community Services. Again, the program brought to you by the National Criminal Justice Association, www.ncja.org. I will have the exact address for the report on the Iowa program in the show notes, but for the moment, if you would go to www.idph.state.ia.us and simply do a search for jail-based programs, you’re going to be able to find exactly what it is that we’ve been talking about for the last half hour. Ladies and gentlemen, again, we really appreciate the fact that you are so influential and coming to us with lots of comments about what it is we can do, shouldn’t do, suggestions and criticisms about the program. Leonard.firstname.lastname@example.org is my direct email address. Or you can go to media.csosa.gov and comment on there, or you can follow us via Twitter at twitter.com/lensipes, and I want everybody to have themselves a very, very pleasant day.
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