Program Evaluation of the Therapeutic Community in a Correctional Setting

McKinnon, Shaune, Nursing Practice - School of Nursing, University of Virginia
Westphal, Richard, NR-Nursing: Faculty, University of Virginia

Criminal and anti-social behaviors are often intertwined with trauma and chronic substance abuse. Exposure to traumatic experiences is disproportionately present and has the most significant impact on individuals and communities burdened by poverty, violence, social isolation, racism, and exposure to criminal justice systems. The use of criminal sanctions and retributive measures by the criminal justice system without rehabilitation or treatment are the least effective means of reducing future criminal behaviors. Retributive (Punishment) justice and Restorative (Recovery) justice are two models used within the criminal justice system. Restorative justice focuses on offenders taking responsibility and acceptance for their actions to promote rebuilding their morale and social selves. Organizations that use a rehabilitation model often have a separate program and housing unit for inmates and this is called the therapeutic community (TC). In rehabilitation, the therapeutic community is a standard of care across the United States.
Purpose: This scholarly project was to conduct a TC program evaluation with a focus on opportunities to integrate trauma-related and substance abuse issues. The TC program at Albemarle Charlottesville Regional Jail (ACRJ) was implemented in 2000 and paused in March 2020 due to the COVID-19 pandemic. As part of the Post-COVID-19 restart, the TC program is preparing to integrate Medication Assisted Treatment (MAT) for substance abuse recovery. A program evaluation of the TC program was needed before implementing major program changes related to supports for inmates with substance use disorders and trauma-based behaviors.
Methods: Agency Clinical Innovation (ACI) framework was used to examine the worth of the program in terms of effectiveness, efficacy, and appropriateness. An eight-step summative approach was used to complete a program evaluation of policies, program elements, and the TC environment in the correctional setting.
Results: The major strength of the TC program is a well-established evidenced-based program of cognitive, behavioral, and milieu interventions that are foundational for effective trauma informed and substance abuse recovery interventions. The major limitation was a lack of integrated medication assisted therapy for substance abuse and withdrawal. There are three major recommendations for integration into planned TC program revisions. First, implement a tiered approach that supports early assessment and integration of TC skills for all inmates. Second, integrate evidenced-based medication assisted treatment into the TC for inmates with acute substance abuse treatment needs. Third, implement a tri-annual program evaluation to assess the effectiveness of TC, MAT, and trauma informed approaches to support program effectiveness and efficiency.

DNP (Doctor of Nursing Practice)
Therapeutic Community, Trauma-Informed Care
All rights reserved (no additional license for public reuse)
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