Changing the Behavior of Drug-Involved Offenders: Supervision That Works
A small number of those who commit crimes are heavily involved in drugs commit a large portion of the crime in this country. An evaluation of a "smart supervision" effort in Hawaii that uses swift and certain sanctioning showed that individuals committing crimes who are heavily involved in drug use can indeed change their behavior when the supervision is properly implemented.
Drs. Angela Hawken and Mark Kleiman evaluated Hawaii's swift and certain supervision program, more commonly referred to as Hawaii HOPE. In this Research for the Real World seminar, they discussed what they learned and how the principles of HOPE are being applied elsewhere.
They discussed, for example, the types of individuals who are now being supervised under HOPE-style programs in Hawaii and on the mainland. They also discussed the important unanswered research questions, such as: the psychological mechanisms that underlie the dramatic behavior changes, the minimum effective sanction, whether sanctions should escalate, and when revocation is appropriate. They also discussed the wider implications for juveniles, alcoholics, pretrial releases and prisoners, as well as the appropriate role of the federal government.
John Laub: It's always a good sign when there's an intellectual buzz before the actual speakers talk, so I'm excited to hear this. I want to say good morning and welcome all of you to today's installment for Research for the Real World. This is National Institute of Justice Translational Criminology Seminar Series. My name is John Laub and I'm the Director of the National Institute of Justice and I want to thank you all for being here.
As you know, today's presentation is entitled "Changing the Behavior of Drug-Involved Offenders: Supervision That Works" and Dr. Angela Hawken from Pepperdine University and Dr. Mark Kleiman, NIJ Visiting Fellow from the University of California at Los Angeles, will be our presenters.
In their presentation they will discuss lessons learned from Hawaii swift and certain supervision program, commonly referred to as Hawaii HOPE. They'll also discuss the kinds of offenders that are now being supervised under HOPE-style programs in Hawaii as well as the mainland. They will discuss important unanswered research questions such as the psychological mechanisms that underlie dramatic behavioral changes in offenders, the minimum effect of sanction, whether sanctions should escalate, and when revocation is appropriate.
In keeping with the spirit of translational criminology, which, in short, seeks to bridge the gap between research, policy, and practice, Dr. Hawken and Kleiman will discuss the wider implications of swift and certain supervision programs for juveniles, alcoholics, pretrial releasees and prisoners, as well as the appropriate role of the federal government. They will also discuss how the principles of Hawaii HOPE are being applied elsewhere.
Now, it is my pleasure to introduce Drs. Angela Hawken and Mark Kleiman, both of whom have conducted evaluation studies of the Hawaii HOPE program. Dr. Angela Hawken is the Associate Professor of Economics and Policy Analysis at Pepperdine University School of Public Policy. Her research interests are primarily related to drugs, crime and corruption. She conducted the statewide cost/benefit analysis of California's Proposition 36, which changed the state's three strikes laws. Dr. Hawken consults regularly for the United Nations and for the U.S. Department of State. She holds a Ph.D. from the Pardee RAND Graduate School. Dr. Mark Kleiman is an NIJ Visiting Fellow and Professor of Public Policy in the School of Public Affairs at the University of California, Los Angeles. He is the author of several books and co-editor of the Drug Policy Analysis.
In addition to his academic work, Dr. Kleiman provides advice to local, state and national governments on crime and crime control policy, as well as drug policy. He holds a Ph.D. from Harvard University. And Mark has been a Visiting Fellow at NIJ for over a year now and I just want to take this moment to thank him for bringing incredible intellectual energy to the Institute, and I think my only regret is we did not take advantage of his intellectual firepower. So Mark, thank you for coming and resurrecting our Visiting Fellow program. So with that let me turn things over to Mark and Angela.
Mark Kleiman: Thank you, John, for that kind introduction and thanks to all of you for coming out. Other thanks are due to Tom Feucht, who brought the Visiting Fellowship program to my attention; to Marie Garcia — is Marie here? — who demonstrated the superhuman patience to wear out both OJP Human Resources and OJP Information Technology to actually get me in the building, and when I was too heavy a burden to bear, Tom took over the grant; and now Sherran Thomas — is Sherran here? — has found us as the coal in her Christmas stocking. So thanks to all of you. It really has been an enormous pleasure to be at NIJ for this year and meet people not only here but in the rest of the OJP family. And finally I want to thank my collaborators, John Caulkins, who couldn't be with us, and Angela Hawken, who is here despite deadly illness, and nothing like taking the redeye with a cold so she was truly heroic to show up.
This is part of the Research for the Real World Seminar Series. For those of you who've been to my previous seminars under this Fellowship, that must mean that those were about some fantasy planet, so take warning. And in the spirit of translational criminology, I'm going to babble for a few minutes and then Angela's going to translate it into both data and English.
A little bit of a bait and switch: we announced a seminar on managing drug-involved offenders. You can mostly strike the "drug-involved." We're going to talk about drug use, but that turns out to be merely an example of a much broader set of questions about how to manage the group of people who have been adjudged guilty of some crime and therefore statistically are much more likely to do it again. If our entire crime problem consisted of people who did it once, we wouldn't have much of a crime problem. And we need to think about how to manage that population, whatever their current status is.
They could be on probation — that's where HOPE started. They could be on parole. They could be on pretrial release. They could currently be in prison and maybe they don't need to be there. Or they could be part of the juvenile system. Those are all areas where we might want to look for better ways to manage the problem.
I think I can speak for Angela as well as myself in saying that we're here because we're angry and excited. Angry because we're doing this job unforgivably wrong at enormous, enormous human cost, and there's just no excuse for it now that we know how to do it right. We‘re excited because we think we know how to do it right.
Since Angela is an actual scientist and I'm a mere policy analyst, I'm much more convinced than she is — she waits for facts. But still. But the important takeaway lesson is we could do it better. We could do it better using no more resources than we currently have and using principles that are already demonstrated to work. Just to foreshadow a little bit: this is going to turn out not to be mostly an offender management problem. The offender management problem is completely, completely malleable. You set up the incentives right, the offenders will respond. This is a public management problem. The problem is getting the people in the system to make the threats and deliver on the threats consistently and in the right way. Pogo had it right: "We have met the enemy and he is us," or as Adele Harrell said after the DC drug court experiment, "Changing addict behavior is easy. Changing judge behavior is hard."
Why drug-involved offenders matter. Well, a very large fraction of the people in the criminal justice system have one or another substance abuse problem. If you look at the prison population, something like 80 percent have a diagnosable substance abuse disorder. A lot of that is alcohol, but some of it's the illicit drugs. Much of it is both. Those people also matter enormously to the drug markets. Most drug use — despite what Bill Bennett told us — most drug use is not by casual, employed middle-class users. That's a majority of the users; it‘s a minority of the use. The bulk of the physical consumption is a relatively small minority of very heavy users. That's true for alcohol: 80 percent of the alcohol in this country is consumed by the 20 percent of the people who drink too much. Other drugs have similar patterns. If we could stop all of the convicted offenders in this country from using cocaine, we would reduce our cocaine consumption by 50 percent. That's more of a service both to the inner cities that are devastated by the drug markets and to Mexico than we could do through any other drug policy approach, which is the way I came at this. I came at this through drug policy and saying, "Well, we want to reduce demand for drugs." Everybody know the first rule of duck hunting? Anybody? We're near the eastern shore — what's the first rule of duck hunting?
Male Voice 1: Find the ducks.
Kleiman: Go where the ducks are! We were pursuing demand reduction by telling more and more creative lies to schoolchildren. They don't demand much of the drugs. We didn't have anything in place that would reduce drug demand among the people who actually demand the drugs, and so that meant you were going to look at offenders.
It also turns out that most of the people who are very heavy drug users get in trouble with the law. Not mostly for their drug use, but for the stuff they do to get the money to pay for the drugs. Very hard to maintain a $15,000-a-year cocaine habit legally. I mean some people can do it. There are lobbyists in the world but, well, almost legally, or there are trust fund babies. But most of the people who use a lot of cocaine get their money criminally and therefore are likely to be under criminal justice supervision at any given moment, or could be if we extended our probation terms a little bit.
When we look at reentry, when we look at the frequent flier group in the prison system, they're going to be overwhelmingly the drug-involved folks. So if we don't get a handle on this population, we're not going to get a handle either on our drug problem or on our crime problem.
So they're on probation, they're on parole, they're on pretrial release. And they're under threat. Not so much on pretrial release, but on probation and parole you can get revoked. You could go back to serve your sentence for a single dirty drug test, but that mostly doesn't happen. Mostly what happens is the probation officer says, "Don't do that again," and the next time the probation officer says, "Don't do that again!" And the third time you're dirty, the probation officer says, "You know, if you keep doing this, you're going to get in a lot of trouble." And the seventh time or the ninth time or the twelfth time, you see the judge. And the judge looks at this long list of violations and says, "You're hopeless," and sends you off to prison. Could you imagine a system that combined more punishment with less effective social control? A parent to behave that way we would call both neglectful and abusive, and yet that's our criminal justice system. And it fails to deal with the basic fact about both people who become drug abusers and people who become active repeat low-level offenders — again, I'll leave the lobbyists out of this. They are not Lex Luthor. They are not calculating the benefits and costs of their next crime. They're people who are leading messed up lives because they have very little capacity to shape their future behavior — I'm sorry, shape their current behavior in light of their future goals, if they have any.
And so penalties that rely on deferred random threats have very little effect on them. So, A) we need penalties that will actually change the behavior of people who are not thinking about five years from now and, ideally, we need programs, whether penalties or something else, that actually change that characteristic. If you can't change the short-term-ism, you can't fix the problem.
In Daxue Confucius says, "From the Son of Heaven down to the people, self-discipline is the root," and I think what we're going to learn, what we're increasingly learning, is that at the root of most of our social problems lies peoples' inability to control their own behavior, and that‘s something that the criminal justice system, I think, is not fully awakened to yet. And, I must say, I wasn't awake to it at all. I thought of what's now HOPE or swift and certain or smart probation, which I gave the unfortunate name of coerced abstinence, as a deterrence program. We just kind of used the principles of deterrence, and I think that turns out to be an inadequate account of what really went on.
We've got a bunch of drug-involved folks on probation. How about giving them drug treatment? That's what they need. If they were in drug treatment, they would use fewer drugs and commit fewer crimes. That's well known. And there's a big treatment gap. If you look at the number of people who need substance abuse treatment by clinical standards and the number of people that are getting it, the difference is in the millions, as the Substance Abuse and Mental Health Services Administration will tirelessly tell you. What they won't tell you is that most of that treatment gap is on the demand side, not the supply side. The main reason people aren't in treatment is because they don't want to be in treatment. They'd rather use drugs, if that's the option. Now, that's only half true. They would like to be in treatment — that is to say, they say they would like to not be drug users. They're not having a good time. The worst thing about school-based drug prevention is it never mentions that being a drug addict is no fun. It makes it sound like being a drug addict is having a perpetual party except you're a bad person. Now, that's a deal that lots of seventh graders are willing to take. But in fact, as the Head of Probations for Massachusetts said to me, who has been in the probation business for 30 years, "You know, I've never met a happy probationer." So, yeah, folks who have heroin problems or meth problems or crack problems would really like not to have them, but they don't want to do it today. Tomorrow. So offering people treatment is useful if they take it, but many of them won't.
And so then the question is, again, their preferences are not time-consistent. So, if they won't go to treatment voluntarily and they've been convicted of something and they're on probation, then why not send them to treatment? Isn't that a reasonable deal? We won't send you to prison. You'll go to treatment instead. See, everybody's happier; everybody's better off. That sounds like the right solution. That's your cue, Angela.
Angela Hawken: Well, good morning everybody and thank you so much for the opportunity to be here today and I apologize for the nasal drawl you'll have to experience for the next half an hour.
I'd say I come at this with somewhat more muted enthusiasm than Mark. I have reason to be optimistic. I'm just concerned about whether we can actually pull this off. We work in many jurisdictions now and doing things differently is hard and doing things right is especially hard but still enthusiastic, Mark, don't undersell.
When I started in this field, it was primarily to do the cost/benefit analysis of California's Proposition 36, and at that time the big idea was to divert people into treatment providers rather than into jail or prison. And there was a lot of hope at the time. I was a big supporter of the program. I thought this was the right thing to do.
So I'm going to talk a little bit about the experience with Prop 36, the treatment diversion program and then drug courts, and then move us into what we know about this alternative program that Mark's alluding to today, smart probation. I'm not sure I'm going to call it "smart probation." That sounds, it makes it sound like we've found it. I think we should always be looking for it and never think we've found it. Swift and certain. I will talk a little bit about swift and certain, what we know and what we need to know still to do this even better.
The motivation for treatment diversion in many states that adopted those sorts of laws was primarily because of jail and prison overcrowding and the fact that they couldn't pay their bills. It was a budget issue. There was also a hugely successful advocacy movement in many states, ours especially in California, and the advocates, basically, managed to sell to the legislators this was a good idea and to the public that this was the right thing to do. They were also very good at manipulating public opinion data. We had a lot of public opinion data in the early 2000s saying that Americans overwhelmingly supported the idea of not incarcerating drug offenders, and that was true. The vast majority, about three in four Americans, said, "Let's not incarcerate; let's send people to drug treatment, which is more appropriate," and I think most of us would agree with.
What the advocates did not share was the American distaste for continued drug use while in the community. The vast majority of Americans said it's not okay to keep using while you're not in jail or prison and that there has to be an appropriate response and the typical American actually advocated for a jail sanction. That piece is rarely laid out there because it wasn't useful for the advocates.
So we ended up with Proposition 36 and similar programs on the books, which I think for most of us at that time did seem like a step in the right direction. We couldn't incarcerate our way out of the drug problem. The problem with these programs is really how they were implemented — poorly, in almost every jurisdiction that I know of. It required that everybody receive drug treatment. Everybody who is eligible under the law had to be treated even if they didn't have a diagnosable substance abuse disorder, which is a very bad idea. For those of you that know the literature, mixing people with no drug problem with people with serious drug problems in the same room is bad for everybody. That was not a victimless crime.
They also made treatment decisions based on self-reported behavior. Now, for those of you who've worked with the subjects I work with, self-report isn't a very high value commodity. I ask my subjects, those that were in residential treatment, "How many of you have exaggerated your drug use to get to treatment rather than jail or prison?" And the vast majority said, "Yes, of course I did. Of course I did. I'm human. I respond. I know what I should say." I said the other side, "How many of you have underestimated or have under-reported your drug use to get to a lower intensity of treatment?" The vast majority said, "Yes, that's me. Of course I did." So self-reported decisions with this population is of very limited value, and that's how we made decisions for treatment diversion. And there was extremely limited use of sanctions in California. We had these repeated headlines. It was ludicrous. Guy arrested again, another drug conviction, another drug conviction, what can the judge do? The judge can do nothing. All the judge can do is sentence you back to the drug treatment provider you refused to go to in the first place. And the lesson got out, and no one did anything, and the results stank in spite of a glowing cost/benefit analysis for the first year. Turns out if you divert people from prison, you save a lot of money, so doing anything's better than that.
What did we get? Well, we got a 25 percent completion rate of the people who were mandated by the court to go to treatment, 25 percent completed the program and please do not use that as your indicator of success. That doesn't mean they showed up sober on the day of treatment graduation. We have another study that looks at that. All that does mean is that they actually finished their required treatment program. There was no enforcement, poorly met treatment and the result was, well, what was implemented as a crime prevention act led to an increase in crime.
The red bar is a timeline lag comparison group. We had hundreds of thousands of subjects in our database, massive data sets. Those that were referred to Prop 36, by and large, had overwhelmingly higher arrest rates for new property crimes, new drug crimes. This was a major problem for the governor's office. And this is when we took a bad decision and we made it even worse, because the governor got mad and started de-funding. When you take a really bad program and then you take away its money because you can't get rid of the program because it's a law and then you take away the money, a really bad program becomes an even stinkier program because now you can't pay for the treatment for those who actually want to go.
The spirit of that law was to help drug-involved individuals. The results were really devastating if you had a serious addiction problem. Those with serious issues were much less likely to get good quality care after the change in the law, less likely to receive good quality care. There was also massive displacement of self-referrals. People who were on their own without a judge motivated to go to drug treatment, there were no slots for you because by law those beds had to be held for treatment diversion through the courts and they never came. Often, those beds went empty but by law they had to be held. Massive displacement of self-referrals, people who wanted to get care, and this is a story we never got to tell. I think the most devastating consequence of all. Massive displacements of people with alcohol problems. Those beds shrank if you had an alcohol problem. I can tell you, the cost/benefit numbers on that, if we were allowed to do the study, which we are not, would be devastating. The criminal costs associated with primarily alcohol uses dwarf many of the subjects that were otherwise in my study.
Drug courts is a much happier story. I'm sounding very negative, aren't I, and it is not only because of the cold. Drug courts are much more promising. It's been a very successful movement. There've been some very smart people involved with that. The problem with drug courts is their resource intensity. They have a problem with going to scale. We also have a problem in that many jurisdictions by way of how these drug courts were set up, the wrong people are being served. Only the small fish get to be supervised by this very expensive resource. The people who have real problems, the people with interesting criminal histories, are ineligible. Most of my subjects are interesting. They've done something. They've earned their way out of drug court and they've earned their way out of an opportunity to have any meaningful supervision as a result. Isn't that ridiculous? That the people we're most worried about are essentially ineligible for anything reasonable by way of supervision?
The reason why drug courts have an issue with scale is because of how they function and how they function is that every offender has to come before the judge on a routine basis, these regularly scheduled meetings. Judges are expensive, as are courts. If they have to meet with everybody all the time, the judge can't spread around. Everybody in a drug court has to receive treatment. I think what we're going to show you that we've learnt now and we're going to learn from all the HOPE sites because all the results that are coming in from across the country say the same thing: not everybody that has a conviction for drug use has an addictive disorder. Not everybody picked up on a drug charge needs treatment.
So we were all depressed. I was depressed and "What should we do?" and then Mark gave me a call and said, "There is something happening in Hawaii and the results are too good to be true," and then I yawned and I said, "If the results are too good to be true, I don't believe them. They probably are too good to be true." They very rarely aren't. Everybody exaggerates. They think they have a good program. It's a judge program. He's a nice guy. He's charismatic. I've seen him in court. He's charming. And so, I think they just don't know what they are doing. Maybe if we did it right we'd have a different result and we can go back to bed. Well, it turned out that we did a randomized controlled trial and the results did stick. I have some follow-up tale to that, but at the time that trial showed some really, really good result. And what was so exciting about that for researchers who were fed up was that this program wasn't all that expensive and it didn't take a whole lot of court time, so it could go to scale. Where drug courts were supervising on average between 50 and 100 probationers, Hawaii's dedicated HOPE court could supervise between 2,000 and 3,000. That's a very different kind of program, so we're enthusiastic.
This is what typical probation looks like, just to give you the contrast, with swift and certain probation. Typical probation has many rules. In fact, those rules are often handed over in a document that is unintelligible to the probationer who's receiving it. I've done that recently. I've run the reading levels. What your reading level has to be to read anything you receive from your criminal justice professionals. They can't understand it. There's lots of rules and they have no idea what you're telling them. And then that they don't obey the rules, because we don't watch them very carefully. We say a lot, but we do very little to monitor, and then they don't do it, often. Lots of violations and the violations are rarely detected because we don't watch them, and then that signals that violating's okay. You're doing what that list says you shouldn't do and nothing's happening so nothing — doing what I'm doing seems to be working for me, and especially if what you're doing is continue drug use, which you really like. So they keep violating and they keep using. Risk is low. The violations, when detected, are rarely sanctioned. Mark was talking about that list. In Hawaii it was often 16. 16 positive drug tests before any action was taken. How can you tell a drug user the first 16 are okay but number 17 is making us mad? Bad parenting. The sanctions, when delivered, tend to be too harsh. The one thing we‘ve learnt, I think, in the study, that is so valuable is that six months in jail means so little different than five days in jail, because you learn your friends. You get used to your bed and you get to learn to like the food, I guess. The last five months don't matter. The first month does and the first few weeks really, really matter. That bothers them. These harsh sentences cost us a fortune and they do nothing to change behavior. In fact, they reduce our opportunity to change behavior because we can't mete out multiple doses of punishment. We can't shape behavior because we go at it one time. Too much.
So these are the principles of swift and certain probation. A radical change from usual, and a lot of people you'll speak to will say, "This is what we're doing already." I promise you, I've traveled all over the country. I'm exhausted. They aren't! They really aren't. They think they are, often, until you look at their data. There is transparent good will. That probationer has to know you want him or her to succeed. A judge and a probation officer has to look them in the eye and say, "We are not on opposing teams here. We want what's best for you. We are going to help you win this," and that has to be a heartfelt conversation. There has to be procedural fairness. The rules have to be followed. There has to be a short list of rules in English they can understand so that they know what they're not supposed to be doing. Clear warnings, close monitoring and then when they do misstep, action has to be taken, but not, as is typical in Los Angeles, six weeks later. Use drugs today; if we violate, sanctions coming six weeks from now. By then I'm sober. I might be back at work. Now I'm being sanctioned? The sanction has to be immediate for it to have the behavior change effect, and it has to be proportionate. We've learned so soon: if it's one episode of drug use, six months isn't necessary. A couple of days in jail seems to get their attention. And I don't want to tip my hat to future results but we are starting to think that a couple of hours in a holding cell — forget the overnight, forget the toothpaste — a couple of hours may get exactly the same bang for the buck.
Right, so, the biggest example that you've heard of is Hawaii's HOPE, started by a judge in Hawaii when he was frustrated with the system that didn't seem to be working, and the idea here was to resolve this problem. Probation officers dealing with subjects who were drug-involved had one of two options: If they violated, they could either cajole them, talk to them, "don't do it again, don't do it again. Really, I mean it. This time I mean it. No, no, no, no." 16 times, 17th no, sometimes the 18th no; or, they could violate and say I am going to initiate proceedings to revoke your probation. Those were the only two options they had. Do nothing or revoke, and revoke — for a lot of these subjects, my subjects in Hawaii, some of them are facing underlying sentences of 20 years. Am I going to send the guy to prison for 20 years because he used methamphetamine on Saturday? They didn't want to do it so the result was they did nothing. They were trapped in this situation where they were allowed to just keep violating. So there was this dramatic move to like, "No, no, no, no, we need something in-between, something appropriate. Not too little, not too much." The probation rules are clearly articulated and they're actually enforced, and that is a stunning change from business as usual. There's also regular random drug testing if there's a drug condition. If they're drug-involved, they're regularly tested six times a month for the first two months until they can demonstrate that they can get by on the streets without using. And the violations are swift, and we're seeing — it's so fun watching our new jurisdictions now in Hawaii. Often, they'd be arrested within hours. If the drug use was then, they'd be arrested immediately, come before a judge. Now, other jurisdictions now, Massachusetts is our bombshell jurisdiction right now. If someone doesn't come in for a drug test, every single one of our arrests has taken place within hours. Law enforcement is taking this seriously. They bring them in, they're arrested and action is taken. But not draconian sentencing. Small doses of a sanction just to get their attention, and it turns out if you try and get their attention enough times, they are capable of changing their behavior. They are capable of change. Three or more violations and they are mandated to treatment, and this is a radical change from business as usual. Demonstrated that they are unable to stop use, then they go to treatment. A very different way of putting people into care.
There are now multiple versions of this program around the country. I'm not going to talk about each of these. We've seen some historically before HOPE started and some new ones now. Many of you would have heard of Project Sentry, DC Pretrial, DC Drug Court Experiment, Texas Swift, which I think some of you might know, Judge Alm in Hawaii and HOPE gets to be the program that we're studying. A probation head in Texas started Program Swift at almost exactly the same time at almost exactly the same month and had almost exactly the same results, and actually runs what I think is a slightly smarter version of the program. We have Arizona Safe. Arizona has been the state before Washington State that went at this in the biggest way — multiple HOPE sites, Safe sites across the state. Washington State I'm going to talk to a little bit later about what's happening in Washington State with their high-risk parolees. The program is called WISP. And now we have what, NIJ, I think, made a very — it took a big step. We had these little trials coming in, the experiment in Hawaii, we had nothing else at that time. Is this going to work on the mainland? There were many unknowns. I think that the federal government was criticized for not moving more quickly. Unlike Mark, I think the pace was appropriate. We moved at exactly the right pace. We couldn't get ahead of ourselves. We needed more data. NIJ launched a massive countrywide four-state DFE, demonstration field experiment, that will be the ultimate word on whether or not this is going to work for the mainland and what kind of offenders it will work for and New York City Climb that Mark's been involved with.
The two I'm going to focus on now are really HOPE in Hawaii and Washington's WISP because of just how important that case has become.
What have we learned? Well, HOPE was launched in Hawaii in 2004. We started the trial in 2007. Offenders were drug-involved. Unlike many studies like this, we scooped in the biggest problems. We wanted the highest-risk folk and we used third-party randomization.
What's really interesting here — and this is kind of a boring data slide that's not especially interesting — but it has enormous consequences. We randomized to HOPE and control and the first step in being a HOPE subject is you have to appear for a warning hearing and go before a judge, and about 7 percent of our subjects never bothered to show up. Most of the bad news report from HOPE is accumulated in that group, the guys that never showed up, and they never responded to that in Hawaii. They just kind of — they would be out there for months waiting to come into court. We've learnt from this. Within a month of starting that trial we had two homicides in that group. When someone doesn't show up when the court tells them to come into the program, warrants go out immediately and law enforcement are on them like flies. In all our new HOPE sites, no one has the opportunity of staying away because we know just how vulnerable that group is.
So there's big response now to that.
The characteristics of our subjects in that initial trial — just very quickly I wanted to point out — average 17 prior arrests. These kids knew the system — kids, they aren't kids, average age 35 — but they'd been around the block. We really had to train them, initially, to recognize this was something new. They were so used to a system that was broken, the message had to get made that this is something very different. Notice only a third of the subjects had a most-serious-drug charge that was only drug involvement. There was almost always something else going on, too; property crimes, violent crimes, other things were going on.
Why Mark and I were initially interested in that study is because of the drug use choice. Primary drug methamphetamine, 70 percent. As Californians we paid attention because that's what was going on in our state. The mix differs from state to state. We see lots more opiates in many of our other sites. We are not finding a primary drug effect. It doesn't seem to matter what the primary drug of choice is.
We had impressive outcomes from our one-year follow-up. Big reductions in no-shows to probation appointments, big reductions in drug reduce, big reduction in new arrest rate, reductions in revocation and, very importantly why people are paying attention, is reductions in the number of days spent incarcerated, which was really kind of a counterintuitive result.
This slide is from the Hawaii study. These are all screened in to be seriously drug-involved subjects. After they had that warning in open court, half of them never tested positive again in a one-year follow-up. Why would we have spent money treating them? Twenty-eight percent of them took one bite of the apple. Notice the tail on the far right-hand side: 9 percent tested positive three or more times, 9 percent of our carefully reviewed drug-involved subjects tested positive three or more times and they were tested often. The vast majority were simply able to stop when the appropriate incentives were in place.
So not every drug-involved offender needs treatment. I think that's the important lesson. We've repeated that lesson in Seattle when we did our trial there. I've never seen a number for the three or more subjects that's higher than 15 percent. We are always able to suppress the drug use of 80 percent of the population. You can understand, not to dwell on this, the implications for treatment resource allocation are enormous.
What else have we learned? We learned to be careful as researchers. WISP, Washington's Intensive Supervision Parole, high-risk parolees, Mark and I went in there and started a small trial. This trial was not intended to even be an evaluation trial. It was intended to be a proof of concept. Could we make this work with parolees? We just had small numbers because we wanted to see if we could make it work. It turned out we had effect sizes so we actually had statistical significance even though we weren't looking for it originally because the result, the outcome differences, were so stark. The high-risk parolees responded exactly the same as the relatively smaller fish in Hawaii, the probationers, had similar response. Drug use was down, incarceration's down and then Washington did something extremely irresponsible. I'm still fans of theirs, but they did something bad. They took a program that was studied based on 70 parolees and they made it law. In June of this year Washington's Intensive Supervision Parole, swift and certain parole, became the new business as usual in Washington State. There was no timeline to learn how to do this well and be really good at this before we press play. They launched immediately. Massive rollout. But one thing we've learnt about these kinds of programs is that doing it right is hard. We're not sure every jurisdiction can pull this off and when you do this statewide with no timeline, we're a little concerned. Luckily, with the help of BJA, we're now going to move in very, very quickly and try to work on fidelity. We have to get fidelity right in Washington. That is the state that will make or break this model, because it's law. We have a lot to do in 2013.
So can WISP go to scale? I was extremely pessimistic and saying some really uncomfortable things in public about what Washington was up to, and I have to say I'm turning my position somewhat. I still think it was a brazen move, but so far the outcomes don't look terrible. I keep getting reports from the implementation team, and what they're telling me now that they're so excited about in Washington is how quickly the jail numbers have come down. It turns out that it doesn't necessarily matter whether HOPE works or not or whether swift and certain works or not, reducing the number of days bodies languish in prison or jail waiting for a hearing is hugely cost effective. All they've done is made their system work more quickly, and that turns out to be a very good thing. People are being moved through jail and prison more quickly. Hearings are happening almost immediately, and they've shrunk the jail costs.
What else have we learnt? From Hawaii, here's a little pessimism. Probationers entering after year one, our study was done with a year one cohort, anyone entering after that year, not as rosy. Even in Hawaii, the mother ship, where we had the best of the best implementing this program. Why did that happen? Well, the researchers went away. We're pains in the rear! We monitor everything you do. If we don't like your sanction, we tell you. If they're waiting too long to get sanctioned we tell you, and if there was a positive drug test and no action, I'm on the phone to that PO saying "What's going on here?" Well, I went away and so did Judge Alm because he got busy, and the result is the data went south, the outcomes went south. What does that mean? It means we have to get really, really, really smart about the operational details. If we're going to take this stuff seriously, we have to do it well. How do we do it well? Well, the operational details — it sounds unexciting to talk about operational details. It's everything here. I have something I'm working on now that I am really excited about and thanks to BJ I'm going to test this at a statewide scale starting 2013. I call it FIT, the Fidelity of Implementation Tracker. I think this is going to revolutionize community corrections. Don't leave it up to personal discretion. Make them do the right thing. We can automate monitoring the people who operationalize our programs. I'm automating the job, and if you're not doing the right thing, you get an email, and if you haven't fixed it the next day your boss gets that email. Damn it, we're going to make the people do community supervision better. It is called FIT. I'm hoping it works.
What else have we learnt? Well, we have learnt that the magnitude of the sanction doesn't matter. Please tell this to every judge you know. The magnitude of the sanction doesn't matter. We had ten felony judges in Hawaii, all of them giving different sanctions because some of them liked the idea of a small dose and some of them just couldn't wrap their heads around that. Six months or six hours or six days: it doesn't matter. The only thing it changes is the costs. We've run out of money. Most HOPE sites I think have gotten the idea and are focusing on modest sanctions and I think we're going to learn to get more creative about sanctioning in general. There are some really small technical violations that I believe should not be dealt with through prisons or jail at all.
What have we learned from Arizona? How often is often enough? Drug testing is an important part of this program. Well, drug testing's expensive. You have to buy the cup. Then you have to have a person who observes the test. Manpower. It's expensive to do drug testing. The burden on the probationer — he has to find a bus ticket, get him to the office, take the UA, time off work, time away from school. It's a huge hassle. And we made up the number. We made up the number in HOPE. Six times a month is what we're going to do. That's not science. That's a number. And we just made it up. And getting that number right is going to be hugely influential and hugely, potentially, cost saving so they tried it in Arizona. The Head of Probation called me and said, "Can I test less often?" I said, "Well, you can test whenever you want to. I'm not the boss of you." He said, "Well, I want to test once a month." I said, "Ah, I don't know but try it. Try it," and he did and it flunked. Once a month is not often off for new people in this kind of program but don't you love the innovation? They tried something and within three months we knew it didn't work so they stopped doing that and started doing something better instead. Listen to that timeline because I'm coming back to this in a minute. Three months. We had an idea, we tested it and we changed practice. The standard is five to seven years. I'm going to talk to you about that in a bit because that — I'm going to end. Any ounce of energy I have left in this ill body of mine is going to that issue.
What we do know from behavioral economics is that the perception of how likely I am to be detected really, really matters. In non-criminal populations, it turns out that the probability of detection has to be close to 90 percent, your perceived probability of detection. How likely I think I am to be caught, non-criminal population, 90 percent to change my behavior? Can you understand why everybody, most of our subjects, are taking a chance at drug use? Their perceived probability of detection is so much lower than that. While testing once a month doesn't get us to the 0.9. Testing six times a month definitely does. We can probably test less often. That's a researchable question. Let's get to that question in a hurry.
What have we learnt — and this is where I'm going to spend my last energy — after thousands of hours in the field, what we have learnt is that not all good ideas originate in universities and think tanks. That might be shocking. Practitioners can tell us a huge amount. We don't talk to them. There's a huge disconnect between the suppliers of good ideas — that's often the practitioners — and the suppliers of the blessing of those ideas, the evaluators. There's a disconnect between those two and as a result, very few programs get to be tested. Very few good ideas ever get to the pilot phase. We don't even try things. Many good programs get to linger and I'm running out of time, but I have to tell you about — I did a trial in a state that I'm not going to say because this is being recorded. I did a trial, well-intended program; I loved everybody participating in that. The results showed nothing. That intervention did nothing. It is now on our national repository for evidence-based practices and programs because a customer satisfaction survey showed that the inmates liked it. The fact that it did nothing to change their lives — in fact, some of the outcomes went south — it's in our repository. But, you know why? Because it takes seven years to get the program in place, get the research money in place, do the evaluation, get to results. We have so many people wedded to this idea — they've made the manual! The book's there. You can't turn it back now. There's so much infrastructure. We can't work on five-year timelines. We have a plan. I can't talk about it now because I'm running out of time, but talk to me over lunch about a plan. We shouldn't be doing five criminal justice randomized control trials a year. We can do 500. I think we can do 5,000 by the end of 2014 if we get smart about this. Pilot trials, practitioner-led pilot trials. It turns out the easiest research to do in terms of analysis is a randomized control trial. My son can do it and he's four. You can press a button on my computer. If those conditions are maintained and we can monitor that, anybody can do it. Let the practitioners test. Let's equip them to do these tests on their own. Arizona's doing it now. He's testing everything every couple of days. They're testing, testing, testing. We're going to find improvements, but not with the way we do research and bless programs now. It's really ill-headed, and so am I, so I'm going to go away. Thank you.
Kleiman: Let me go back to generalizations here. We have programs for offenders that are either supervision-oriented or services-oriented, and of course all of us nice people prefer the service-oriented programs. You know, punishing people is no fun. And we think of them as competitors, right, so if you look at the reentry literature, it's all about service provision. What more could we give these folks? Very little interest in what kind of supervision will help keep them on track. And on the other hand the supervision-oriented programs mostly are pretty slack about services. A big unanswered research question is what the appropriate complementarities are between supervision, that is to say conditional threats, and services.
It seems inconceivable to me that there aren't service programs to reduce the cost of supervision programs as they improve compliance. But I don't think we know what they are. Would journaling turn out to help? For the opiate-dependent, would a substitution program turn out to help? I think that's a completely open question that there's not even a good intuition about. But we need to first get past the ideological orientation question and say, look, it's not a question of principal whether to use supervision or services. The question is what's the appropriate mix in this case, and I think we aren't learning as much as we could about that. But I'd love to see some swift and certain sanctions added to any of the standard reentry programs and see what we can do to the outcomes. Because it looks like a service-intensive mix has benefits that are in excess of the cost but still getting very, very high return-to-prison rates.
Here is a speculative idea. We know that, other than marriage, the thing that most diverts people from lives of crime is a job. But you're sort of — got a bootstrap problem. "What do you mean? What this guy needs is a job." He's got four felony convictions. Just getting out of prison. How are you going to get him a job? So Georgia used to have a program where you could get out of prison early if you get a job and then your condition of staying out of prison, you had to keep the job. And I evaluated that for the Ford Foundation Kennedy School Innovations Program. And it was obviously a successful program; the numbers were wonderful. So I said to the guy who ran it, a very smart guy, I said, "Okay. I see how this works. I just don't see how you do it. Aren't you sort of assuming a can opener? What do you mean you can get out of prison if you — how do you get a job for somebody who's in prison?" And he said, "Oh, that's easy. You call an employer and you say, ‘How would you like a minimum wage employee who shows up on time every day sober?' And they say, ‘How many?‘"
Part of the reason offenders can't get jobs is because they're lousy employees, on average. And the ones who aren't have no way of distinguishing themselves from their colleagues. I would love to see a system that's using swift and certain sanctions and drug testing get a job developer to start calling around to employers and say, "Hey, we could deliver you drug-free employees. And if you put a GPS monitor on them, we could even deliver you drug-free employees who show up for work on time every day." I have a feeling you could solve the problem, or at least a piece of the problem. I don't know that that's right, but I'd love to see it tried.
And again, this is back to what Angela said about doing lots of trials. There are millions of ideas out there. I mean, not all good ideas originate in universities and think tanks. That's true. Some do. I'm looking at Eric Wish. He invented HOPE in 1973 and it only took 30 years for a judge who'd never heard of it to reinvent the wheel on his own. So, yes, there's a problem about researchers who don't listen to practitioners and the other way around. And we do have a broken innovation engine in the criminal justice system. What you discover in the private sector is there isn't much innovation but all of it's imitated very quickly because the right corporate strategy is not to be an innovator but to be a very fast follower.
What the criminal justice system, like most public administration, lacks is strong incentives for good, fast following. That's a problem above my pay grade.
So lots of things we don't know. I'm not going to read the whole list, but we should do a bunch of trials and find out. What service should we use? When should we mandate them? What's the optimal — a question was raised about the optimal testing frequency for drug testing. Two questions there, really, right? What‘s the initial optimal frequency and how quickly should you phase it down with good behavior on the principle of behavioral triage? Same with sanctioning: what's the right initial sanction and how quickly should that escalate? Again, we've got very little experimental evidence on any of that except that initial severity doesn't seem to matter at all over any range we've now tested. So, we know in the 24/7 program, which we haven't mentioned, which is the alcohol version of swift and certain, Beau Kilmer's been doing this getting spectacular results, now a statewide program in South Dakota. Hours turn out to be adequate. New York City Climb, if it gets off the ground, which is not going to be a drug program, going to be a young, gang-involved gun offenders and then primary sanctioning mechanism is going to be GPS monitoring and curfews and stay-away orders, and the first sanction is going to be a weekend at home. And my bet is that that's going to work just fine as long as there's a jail cell as the backup. Right? The first sanction can be non-confinement as long as the penalty for violating that first sanction is confinement. Eventually you have to get something that's not voluntary. Anyway, lots of unknowns and not at the moment a lot of work on discovering the unknowns. Right? The DFEs are trying to figure out whether if you do exactly what was done in Hawaii in four sites on the mainland, it works. The answer, I think is going to be, yes, if you actually do that it will work, and if you actually don't do it, it won't work, and we're going to discover which sites could do it and which sites couldn't do it. But that doesn't give us much purchase on all of the program variables, right? I mean, we're basically working with a program that Steve Alm dreamed up in his sleep. Hadn't even read Eric's paper. So, yeah, it's great to find out whether that works but it would be greater to find out which variations of it work better and on which populations.
Okay, we're close to out of time but I just want to raise this as a more fundamental question. Because again, I don't think this is a drug problem. I think the drug problem and the criminal behavior are both manifestations of failures of self-command. This is characterized variously in the psychologic literature as locus of control, people's sense of whether they control their own outcomes, their self-efficacy, their self-command, a couple of subscales under big five conscientiousness. I mean, there are six different research literatures on this that don't talk to each other. But learning to measure that characteristic, the ability to shape your current behavior in light of your future plans and learning how to, A) influence the behavior of people who are sort of bad at that and, B) make them better at that. The thing I would most desperately like to learn about one of these swift and certain sites is whether we're actually changing people's capacity to control their own behavior because I think the extent of the behavioral change is bigger than you can get from simple deterrence.
Just to repeat what Angela said, in Hawaii, take a bunch of people who were picked for being non-compliant and on probation, who had an average of 17 prior arrests, who were heavily methamphetamine-involved, put them on this program, and if you use the following criteria for success: at one year, they're on the street, in compliance, have not had a new arrest, not had a positive drug test in three months even though they're being tested randomly. If we call that success — that's pretty stiff — 80 percent, 80 percent success. A very good drug treatment program would be happy to get 18 percent. We have revolutionized drug treatment, and the drug treatment industry hasn't noticed that or been prepared to admit it.
So what's the next step?
Prison cell, $25,000 a year. Really intensive community supervision if you add a GPS to drug testing, maybe $2,500. And yet it looks like you're getting very large reductions in criminal behavior and reductions in return to prison rates. What fraction of the people currently in prison would behave themselves if they were on drug testing and GPS monitoring? Fifty percent? Seventy-five percent? Don't know. We're close to 1965 crime rates again. How about getting back to 1965 incarceration rates? That would be an 80 percent cut in our current prison population. I suspect that if we learn to do community supervision right, we could do that simply by spending the money we don't spend putting them in prison, right? HOPE makes back in Hawaii four dollars for every dollar you spend on the program in reduced incarceration. So I claim that if we learn to do this and if we can turn around the community supervision system, right? We've talked about probation and parole, haven't talked about pretrial, which is where this started. DC Pretrial Services Agency, now CSOSA, cut its failure to appear and re-arrest rate by 50 percent with drug testing and sanctions in 1973 because Eric Wish told them to. And then they stopped doing it! People on pretrial release are 10 percent of new felony arrests in big cities. That's a huge population. Juveniles, right? How many people could we get out of the criminal justice system before they get into it if juvenile probation supervision weren't a joke and if we had weekend curfews as the penalty for breaking the rules?
So, not wanting to get too far ahead of the data and conditional on compliance not by the offenders now but by the people who do the work in disconnected systems — judges, court officers, probation office, probation managers, police, treatment providers — it's a complicated system. They don't all work for the same people. They're not at the same level of government. You're spending city and county money to save state money. There are lots of problems with getting this done, but if we can get it done, it seems to me we could reduce our crime rate while getting our prison population — I mean let's not forget: 2.4 million Americans behind bars, more prisoners than any other country in the world, 25 percent of the world's prisoners for 5 percent of the world's population. I don't know about you folks, but I'm having a harder and harder time singing "land of the free." That national disgrace and our other national disgrace of high violent crime rates, it seems to me, are subject to the same solution. I think we've got it in hand and now we have to go do it. Thanks very much.
Katrina Baum: Hi. My name is Katrina Baum from NIJ's Office of Research Partnerships and I have a question for Dr. Hawken. This is sort of a general question but I think there were a lot of very large overarching themes about the criminal justice system in general in the presentation that you both gave. We've been talking a lot at NIJ about translational criminology and a two-way dialogue between practitioners and researchers, and Dr. Hawken, you talked about the disconnect between suppliers of good ideas and the evaluators, and I absolutely agree that there's a lot of innovation going on. We just don't know about it and it's hard to be able to connect those two groups. So I'm wondering if you can offer any thoughts on how to better stimulate that dialogue between the folks on the ground that have really good ideas and the researchers. Because, you gave the very good example of Washington State. They had a, you know, good finding with a sample size of 70 so they passed a law. The policymakers, if you talk to them about effect size or sample size, so on and so forth, that's not their lexicon. They're trying to get elected. It sounds good, "Okay, let's pass a law." So how can we bridge that gap and simply find out about things that should be tested that are interesting?
Hawken: Thank you for asking that question. I felt as though I had planted it and I didn't. I think we do have to train our big decision-makers to I use this expression a lot and it's kind of cliché but, I think about what we did wrong in California with Prop 36 was we spent very little time thinking about it. Thought small, acted big. And that's what we see in a lot of places, that they don't do a lot of thinking and they act in these grand scales. We have to discipline people to — discipline our decision-makers to — we really have to know what works and then do it, and if we make it easier to know what works. But we've made it really had to know what works, and I think people get frustrated and they have to do something, especially if you're in an elected position and you're looking as though you're just impotent to the problems you have around you is a really tough thing to do, so they do, they act in a really big scale.
So this is my idea for bridging the divide. I think that we should consider them pilot trials. I'm not trying to put a Ph.D. out of a job. I have one. But I think we should launch, allow practitioners to launch their own pilot trials. So my idea is to create a repository, and all we have is tools for you. We'll randomize conditions if you want us to, or use our free tool. You can talk to us or don't talk to us. It's inexpensive. Here's a toolkit, you can figure out your results and tell us what you find. Here's our stuff. Tell us what you find. Enable them to do that. Know what I like about that idea is you become a magnet for the good ideas. We don't even know what the good ideas are, because they have a really hard time finding us. You create a magnet for good ideas and very quickly you can triage the good ideas into ones that are not really good ideas. But you're finding out within three months and nobody's got their career invested. My poor trial that went south? Someone's job depends on that program now, which is why that program's not going away. Don't let anybody's job depend on it. If they can implement trials, it's their own programs. They can do whatever they want to do in community supervision offices. They can launch their own programs tomorrow if they want to. There's no timeline. Give them the tools, show them how to do it, create a repository for these ideas. The other thing, researchers spend a lot of time, if you love trials, and I do, running around from jurisdiction to jurisdiction finding people that are willing to let you do a trial. Because there are lots of them out there but we don't know where they are. So you take away the legwork. We know who wants to have a trial, we know who's open to trials, and we know these are places with good ideas. Let's get going! It's not going to cost us any money. They're willing to do it. We don't need funding. We just need to equip them to do it, and it turns out some very small tools, which we could start writing right now, can be available to them within months. Let's just create a repository.
I have a proposal out now. When that's rejected, I'll send it somewhere else. Eventually someone will think this is a good idea and will make a difference. Sometimes my proposals are rejected.
Kara Dansky: Hi. So I'm Kara Dansky at the ACLU Center for Justice and just very quickly following up on that: I think that when you were talking about the repository, you mean trials at a county level or a local level, yes? Not quite at the state level? Okay.
So my main question has to do with the procedural fairness aspects of what you were talking about and I would really like to hear a little bit more about what mechanisms are in place to ensure maximum fairness at the level of sanctions, and I appreciate that there are a lot of unknowns about sanctioning, but just to hear about some of those mechanisms would be helpful.
And then I just have a really small question about the demographic table that you showed, which I think said average age was 36? That just struck me as a little bit surprising. I would have thought the age would be more like 25 or 30 but, I'm just curious. Thanks.
Hawken: Actually, it turns out not to be that different from Prop 36, either. The average age was rather similar. Especially for a study like that, we screened in people who had had problems with the law, so you often get slightly older subjects in that way because you want to make sure they're troublemakers. But the average age actually turns out to be often in the 30s, early 30s, for a lot of criminal justice studies. We know certainly you're not going to commit a whole lot of violent crime after a certain age, but in terms of other criminal behavior, you have long drug careers so you often see some older subjects as a result.
Kleiman: It's true generally in the criminal justice system that the age of people in the system is about ten years older than the age of people who commit the offenses. So our prison population has been aging much faster than our offender population. One trap, one thing we don't know, is it might turn out that this doesn't work as well on 18-year-olds as it does on 35 year olds — that they're less ready to turn themselves around. My guess is that just means you need to do the sanctioning differently.
In terms of procedural fairness, again, a warning, right, and Judge Alm's warning is actually, the script, is actually on the Hawaii court's website, and it is a masterpiece of psychological insight starting with the sentence "Everybody in this courtroom wants you to succeed on probation," which, when I started looking at this, I passed over as fluff, and I now think it's probably the most effective program element. And then he says, "Here are the rules: You are a grownup. I can't control what you do. I can control what I do. You obey these rules or here are the consequences. I hope to not see you again," and he mostly doesn't see them again. In Hawaii a probation modification hearing, it is called — this is not a revocation hearing — is full adversarial hearing, but there's not really much to argue about because there's the positive drug test or the report of a no-show, and so both the prosecutor and the defense attorney sort of stand there not doing anything very interesting when the judge administers the sanction he said he was going to administer. Mean time for a warning hearing is — sanctions hearing is 20 minutes, which means that the total court time consumed by HOPE probation over the course of the year, including the warning hearing, is 20 courtroom minutes, which is the reason you could have 2,000 or 3,000 people.
Some places don't have — Oregon, for example, has administrative sanctioning. Washington State has, because they're parolees, have hearing officers, same thing, and there doesn't really seem to be much of an issue. In Hawaii, if the guy when he's brought in says, "No, that dirty test was a mistake," the judge will cut him loose, and say, "All right, we'll send it out for a confirm. I'll see you in a week. But heaven help you if the confirm is positive." And there have been five requests for confirms. I mean the tests are actually pretty good these days.
So I think the procedural — the most interesting, most unexpected finding, I would say, from the first HOPE evaluation was 75 percent of the probationers on HOPE, which is an all-stick, no-carrot program, right, there's not a service within a million miles. It's just a threat of punishment. 75 percent expressed strong satisfaction with the program, and that was consistent with our interviews, where people were saying, "Well, Judge Alm, he's strict but he's fair. He told me what he'd do and he did it, and I guess I won't do that again."
So on all those dimensions it looks pretty good, and because you're dealing with a couple of days and with a single violation, it's much less fraught than a revocation hearing. And — this is the point that Angela made — the guy has not spent six weeks in jail awaiting his due process. Sir?
David Marimon: David Marimon, National Criminal Justice Association. I know that I'm not supposed to ask double-barrel questions but I'm going to ask one anyway. During my time in juvenile supervision, I realized the importance of practitioner buy-in, so if you could speak to that because I think that's real key. And, two, in relation to the parole, swift and certain, that Washington State had, do you see any implications for using that at the federal system? Because federally there are more incarcerated folks than there are in any particular state, so as the fed, you know, the fed is the largest compared to all the states.
Hawken: There has been some chatter of a federal study. Nothing that I know of, yet, I think federal parole, but there's been a lot of talk but not much action on that front. First barrel — remind me?
Kleiman: Practitioner buy-in.
Hawken: Practitioner buy-in, there's another cue. This is the problem that I see about moving this in a massive scale really quickly, is that practitioner buy-in is everything. If the practitioners aren't really excited about the ideas, or at least the ideas resonate with them, this program's going to fail. There's so much opportunity for sabotage, especially within probation departments, where they can make this not work well. So if you don't have practitioner buy-in, just don't start. That's my advice right now. Unless you can bring me a room and tell me all the key players are on board, don't waste your money. Just don't do it until you can get that buy-in.
Now, I do think that what will happen is there will be some natural momentum, and that some of the skeptics might start to change their minds. But if you aren't convinced of that, just don't mess with it. Too much room for sabotage.
Kleiman: So on the federal system, yes, we've got a big prison system and we've got a big probation and parole system.
Unfortunately, the probation and parole system's run by the courts, not by the Justice Department, which means it's very hard to get anything done. And the Bureau of Prisons at least believes it has no flexibility in terms of releasing people early. The other issue with federal probation is that federal probationers have a very high recidivism rate but not to federal prison. So, again, you have got a jurisdiction mismatch program.
The feds could spend some money to save the states money. The county should spend some money to save the states money. So I think what you need is a grant program that would be a one-time-per-jurisdiction grant program to fund the startup, and you could only get the grant if, A) you brought the signed memorandum of understanding from everybody saying, "Yeah, we'll play"; the legislation showing that, yes, you can actually do this and that you've got enough confinement space and all that stuff; and the third thing is that you set up a budget mechanism to first measure the savings from reduced incarceration and second recycle half of them into the program. So, we'll do venture capital at the federal level for your county program to save your state money if the state agrees to pick up the cost once it works. That's something where you could have the whole thing national in five years and I think, we now have, I know, the DFEs are still in play — I think we now have enough information to say "this will work if you do it and not work if you don't do it" and we still have lots of stuff we need to learn at a local level about appropriate program variations. But I think the notion of having this be no longer a program. I think Angela is right not to call this HOPE anymore. This is simply probation or community supervision done correctly, and we shouldn't think of it as a program that people either have or don't have. It's like community policing. Right? When community policing was six guys in the police department whose job was doing community relations, it was a failure. When it was a revolution in policing, it was a success. That's, I think, where we stand now on the community correction side. Eric?
Eric Wish: Sure. I'm Eric Wish. I'm Director of CESAR, the Center for Substance Abuse Research at the University of Maryland, and I think there's only one Eric Wish in the drug research field, so I assume it's my work that you've been referring to, but you are much too generous, Mark, because basically you took the data from the Duff Program and you put your thinking towards it to create a lot of these ideas. And the group that really needs to be acknowledged is the National Institute of Justice for bringing you there as a Visiting Fellow and to launching that whole program that, you know, went in a whole lot of different directions.
At CESAR we have been tracking the prescription drug epidemic that's occurring in this country, especially for prescription opioids, and what we have found is that the criminal justice system and a lot of other groups that do drug monitoring, they're stuck testing for the drugs of the last epidemic and that most of them are not testing for prescription opioids, for instance. And what happens, as you so eloquently stated, Angela, the offenders figure out right away what you're testing for and they switch to those drugs. So my question is, basically, what's the possibility — I don't know what you're testing for, but what's the possibility that a lot of your reduction in the drugs you are testing for was caused by switching to the these other drugs? And I would further say maybe it didn't affect your results, because you had some great results in terms of behavior, but as you go forward and spread these programs, I would urge you to include a wide variety of prescription drugs in there so you can see whether or not, what people are actually using.
Hawken: Actually, how we handled that in Hawaii was we did send out batches for massive, you know, a big battery of tests were run. We had that same concern. The big issue now is actually synthetic marijuana. A lot of the jurisdictions are really having problems with that now and it's true that in our sites right now — and typically it's a nine or five or a seven test — but every now and again what they will do is send some batches out, if there's any suspicion that there's continued use, they'll send it out for a much larger battery.
Wish: We're hearing a lot now from prison people and from testing that people are smuggling — and you see it in the media, too — smuggling the newly available buprenorphine into prisons and jails because people know they're not testing for them, so I would urge you to include that in your battery, too.
Kleiman: Okay, well, it looks like we've got two questioners and time for about two questions. Marlene?
Marlene Beckman: Okay, Marlene Beckman, OJP. I have some familiarity with this program from the early stage and I got an opportunity to actually visit it, and one of the things that impressed me early on about the success, which you didn't mention at all and somewhat troubles me, is that the Hawaii probation officers were very much, had a lot of training in a lot of procedural ways, motivational interviewing and so forth and evidence-based practices with how to deal with these probationers. And if you don't take into account the interaction between the probation officer and the client, all you have is a sanctions-based program, and in the past I think the literature has said sanctions only don't work.
Kleiman: So the mantra that sanctions only don't work — I think I'll probably skip the obscene comparison — reflects the fact that they're being done wrong. It turns out that if you do sanctions stupidly, they don't work. If you do sanctions intelligently, they do work. Yes, it's true the Hawaii probation officers are a pretty good group, well trained, better than probation officers in most other places. I think we're going to discover it doesn't matter. The people running Sobriety 24/7 in South Dakota are not trained in anything. And the Washington State folks, again, some of those were highly skilled, but not formally trained. So, the idea that what was at work in Hawaii was the motivational interviewing and the cognitive behavioral therapy reminds me of the story of the Vermont farmer who, having renovated an old farm, brought the local minister out to show it off to him. And he takes him around the farm and it is obviously flourishing and farmer says, "Did a pretty good job, didn't I?" And the minister looks at him and says, "You and God." And the farmer said, "Yep, but you should have seen the place when he had it to himself."
We know that the control group results are what you get from motivational interviewing and CBT. So, but this is back to the question I raised, which is what services mix — and I would certainly count those as services — optimizes results? I'd be very surprised if that didn't add something. I'd be equally surprised if it turned out to be essential, because the 24/7 results and the WISP results are all done without that, and we haven't talked about the California program because we would have both broken down in tears.
California started this with parolees. We're getting terrific results in terms of compliance — we didn't have re-arrest data — and it got shut down because they did the realignment program, which meant that the Corrections Department budget got cut to the point where they couldn't do the program that would keep people out of prison. But I don't want to wait on this program nationally until we have a Hawaii corps of probation officers that would wait too long. Sir?
Rob Morrison: Sure. Hi. I'm Rob Morrison from the National Association of State Alcohol and Drug Abuse Directors. Thanks. This is excellent and I worked a little bit with you with Kathy Jett and the rollout of 36 evaluation. You answered one of my questions in terms of the look you did, you mentioned the importance of fidelity in terms of the evaluation, was there a look at fidelity in terms of effective treatment and looking at NIDA's principles of effective treatment, and you mentioned some of those already. So the second question is, to what extent are you following clients post-discharge, how long, because as we know, the relapse issue is there, and you mentioned before the challenge of collaboration of the service connection between, in this case, state substance abuse agencies and our criminal justice agencies. Any insight from your study on that? Thank you.
Hawken: I think one of the reasons why Hawaii had their good results was that treatment resources were being used well. They just had a way to manage their drug treatment money, and the result was that people who had real dependency problems got really good quality care. Because everybody wasn't being treated; the people who really had issues were. And they had more money to focus on them so the result is that people who had real issues, they got really good quality care, often residential and often relatively long-term residential.
So I think we talk about this as a new resource allocation model, that's a big part of the story is that how we manage drug treatment has changed when it‘s paid with this model. We actual think that there's an independent therapeutic effect of this, because not only are we able to send them to better quality care, we've broken through denial. By the time they get to treatment, they know. They've had this opportunity to stay clean in the community. They couldn't do it. Let's get this fixed now.
The treatment providers in Hawaii are among the strongest supporters of this program. They testify regularly before the legislature. We have some communities now where they say, "Well, I don't actually want to accept this person into our program unless they are being supervised under HOPE," because they are easier to manage. So there is — the treatment issues here, we do have a long-term follow-up study coming out now. I am trying to not talk about specific data right now until we clear review, but I'd be happy to talk with you about some of the long-term findings when we are able to.
Kleiman: But the short answer is the follow-up is looking pretty good. The shorter answer I would give is, and if the follow-up didn't look pretty good, if I can take five years out of somebody, just drugs and crime career — John, with your tolerance, we'll take one more question.
Denise O'Donnell: Thank you. I'll be very brief. Denise O'Donnell. I'm the Director of BJA, so thank you for all the work that you're doing and thank you, NIJ, for putting this on. So I love Dr. Hawken's suggestion about, you know, a tool kit, a repository and enabling practitioners to do their own randomized control studies, and it's something that we've discussed a little bit but would really like to explore further.
My question is, the response always is the need for independence in the evaluation process, so how do we deal with that reality in the model that you're suggesting?
Hawken: I think what we have to remember, I used the term "pilot trials," ways to test around the edges. I think it doesn't matter as much. We're not looking for journal publications. What we're doing is giving them the opportunity to get better at what they are doing, trying new things. Once we've identified promising programs through their pilot trials, we can bring in the Ph.D.s. Let's find the nuggets but let's not be testing everything, everything with a big trial, because that means we can only test a few. That's the trap we're in. We can only test, you know, five, ten, a dozen trials a year. Well, let's triage those into ones we think have promise and then put our resources there. That's the way to grow this knowledge base.
O'Donnell: So it is really an early identification of promising programs.
Hawken: Exactly. It's a triage. We're triaging them into those that we're going to bother bringing the next tier into and those that we aren't. But in the meantime, those county or local probation officers are going to learn so much about themselves. This chap in Arizona that I'm working with, he's discovering new ways to improve supervision every three months because he's continuously trying trials, and it's costing nothing, no money.
O'Donnell: Thank you. And thank you for your presentation.
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