 You're watching FJTN, the Federal Judicial Television Network. Hello and welcome. My name is Kate Lynett with the Federal Judicial Center, and we bring you this program today in collaboration with the Office of Probation and Pretrial Services at the Administrative Office. Over the next hour, we're going to be talking about the Texas Christian University drug screen instrument. It was created at the Institute of Behavioral Research at Texas Christian University. And with me today to talk about this is the principal investigator from that project, Dr. Kevin Knight, who is from IBR at TCU. And he will be talking about the fundamental research that underlies this whole project and this screening instrument. We also have Derek Goddard, who as you all know is a probation and pretrial services administrator with the Office of Probation and Pretrial Services at the AO. And he's going to talk about the policy implications of the TCU. And for those people who are wondering about how you're going to implement this in your district, we have two people here to talk about that also. Two treatment specialists. The first is Mike Loughlin, who is from the Northern District of Texas, and we also have with us Grace Saunders, who is from the District of the District of Columbia. And both of them will be talking about different implementation issues and how to get this started in your district. So while this really essentially is a program about a form, stay with us because we really have a lot of important stuff to tell you about the research, the policy, and the implementation issues with this. We will assume that you've downloaded a copy of the TCU, which is included in your program materials available on our DCN, so that you can refer to it during the program. That will make it much easier for all of you. I'm going to turn the program over first to Dr. Knight. He has his doctorate in experimental psychology. He has been at the Texas Christian University since 1991, and as I said before, he's really the principal investigator on this project, so certainly the person to talk about the research that's behind the form for us. His primary focus in all the research he's done has been on working with substance abusers both in correctional and community correction settings using evidence-based practices. He's worked and been an advisor to probably every federal agency out there who has anything to do with treating substance abusers. So without further ado, I'm going to turn this over to Dr. Knight to talk about, first of all, the underlying research. Dr. Knight? Thank you, Kate. I am part of a team at the Institute of Behavioral Research which is directed by Dwayne Simpson that has been working on the TCU drug screen now for a number of years in terms of revising it for correctional settings and in terms of testing its effectiveness within those settings. But before I get into the nuts and bolts of the instrument itself, I want to start with a little bit of background research information and the rationale as to why you might consider using the instrument in your setting. First in terms of rationale, since the early 70s there's been a prevailing sentiment within the criminal justice system that nothing works, that treatment essentially is a waste of money and for the most part ineffective. And in many respects that is true when referral to treatment is inappropriate or when the treatment services that are being provided aren't well matched to the needs of the offender. However, we have a number of studies in the past decade that support the notion of treatment effectiveness when good treatment is provided appropriately to those offenders in need of treatment. And so let's begin by looking at a slide from a study conducted in Texas in 1999 published in 1999 in the prison journal where we looked at a number of offenders who had fairly severe problems with drug use. Those in the far left on the bottom were ones eligible for treatment but did not receive treatment primarily because they did not have enough time left to serve in their sentence. The middle group represents those who completed the in prison therapeutic community treatment program but did not complete the community based aftercare program. And on the bottom right is the group that completed the fully prescribed in prison and aftercare community based treatment components. When we look at return to custody rates over the three years after release we see at the end of the first year that those who completed the prescribed program on the far right in the orange did much better than the other two groups. This continued into the second year and into the third year where at the end of three years you see on the far right 26% of the aftercare completers were returned to custody. This compares with those in the far left who did not receive any sort of intervention 52% returning to custody within three years. And the middle group two out of three were back in custody in large part because one of the conditions of their release was their participation in the aftercare program so failing to participate did result in reincarceration. The key to these types of successful outcomes however is important to understand that the key is on successful appropriate treatment referral identifying those in need of treatment and not placing those with less severe problems into these more intensive programs. At this point what I'd like to do is point out that when we look at the impact of personal bias when subjective screening referral takes place we see that different views on addiction for example the view whether or not alcohol is considered a drug whether or not addiction is a disease or moral failure these types of different views result in differences in opinion on who needs treatment services. So when we think about why a drug screen is needed why you should be using a drug screen we understand that using an objective validated drug screen can help you determine if an offender might benefit from receiving treatment services no guarantee that they will but again a screen such as the TC drug screen can help provide an objective consistent means for identifying who might benefit from a drug from an objective screen. Next we look at don't all offenders have a drug use problem the reality is in fact most offenders do have a drug problem but not all if you look at a study conducted by NIJ over the past 15 years or so we see that early on about in the red bars 59% of offenders upon arrest were coming up dirty on a urine test 42% in 91 coming up positive for any or for cocaine use. The trends changed a little bit but not much to 1999 where we see again about two thirds coming up with any positive drug use urine test and 35%. These are only based on folks who volunteered to participate in the study so we know the rates are higher but again the point here is that not all offenders have drug use at the time of arrest and not all drug offenders need drug treatment. So that takes us into the development of the TCU drug screen and the fact that it is a very brief short assessment it's only two pages in length it is based on the diagnostic and statistical manual classification criteria for dependents it has another section which asks items about treatment needs motivation the history of treatment and perhaps one of the most important aspects besides its validation reliability is that it's a free instrument for you to use and when necessary can be self-administered. Currently the TCU drug screen is being administered in several locations across the United States including both state and federal systems its popularity continues to go forward and we're very excited about this initiative within the pretrial and probation services. Our research with this instrument that we have conducted as well as a group out of the University of South Florida have found that the instrument is highly accurate overall there's an 82% agreement rate that is 82% of those who have a problem are identified as having a problem as well as those who do not have a problem identified as not having a problem that leads to this notion of inappropriate referrals in that in this case the TCU drug screen is particularly effective at finding out those who do not need treatment and avoiding inappropriate referrals and finally the TCU drug screen is relatively good at identifying those who really have drug problems an important component obviously of any screen is correctly detecting those who have drug problems when the drug screen was compared with the ASI drug use section, C-SATS simple screening inventory, the SASI as well as a variety of other screening instruments. The TCU drug screen was one of the top three performers among these self-reported drug screen instruments when compared with the structured clinical diagnostic instrument that looks at DSM criteria the SCID. 83% of all correct classification for the drug screen 84% for the ASI and 84% for the SSI. I know many of you already used the SASI and I want to point out of this juncture that 70% were correctly classified with the SASI far lower than the other three instruments presented here. So at this point I'm going to turn it back over to you Kate. Thanks Dr. Knight. We're going to go back to Dr. Knight in a couple minutes to actually go through the form itself and through each question but for right now I want to turn this over to Derek Goddard from the AO and have a little chat with him because we're talking about the TCU. This has been one of your favorite projects for the last, I don't know, year or so and I know you have a lot of different responsibilities at OPS but let's just focus in on this. One of the things we know is that you are the chair of the National Expert Panel and can you talk to me a little bit about the National Expert Panel where it came from. Yes Kate, about a year ago we put together a group of probation and pretrial services personnel, deputy chiefs, supervisors, specialists and officers and what we wanted to do is to provide a communication bridge with the field and the administrative office. One of the things we wanted to do was to formalize that process so we selected a representative from each judicial circuit and what they are doing is basically being a two-way communication bridge for us. They are basically pretty much providing input and feedback from districts within their circuit and then we're providing information to them about some of our national initiatives. They have helped us on several national initiatives so far, the cost containment initiatives with the tough budget times that we have and they also have now helped us with pilot testing this TCU drug screening instrument. That was very, very helpful to us and we have a group of folks that are very talented throughout the system and we have two of them here that you will talk to later about the TCU drug screen. So why introduce this now? One of the things that we're trying to do here is we're trying to come up with a uniform screening process in the case planning cycle. Right now there's a lot of subjective ways that people are looking at substance abuse cases and making that determination. As a system we want to be able to be at a place where we can unify, in a unified way, have an instrument that kind of determines substance abuse not only presence but the severity and I think that's what we're looking for and hopefully as we become more of an outcome-based agency this will help us in having a baseline or foundation knowing what type of substance abuse cases that we have. Okay, so let's be real clear on this. This is not policy yet? No, Kate, it's not policy at this time. What we're trying to do now is just set the stage and we know that this is something that has been validated. It's a very solid instrument and what we're trying to do is get people to not only pilot tested but using it in their district. In December of 2004 we're going to ask the criminal law committee to look at the TCU. They've already been aware of it but also to endorse it as the TCU drug screen for the probation and pretrial services system. Okay, great. Now you talked about the communication back and forth. That's one of the reasons for having the National Expert Panel and they've really helped you out on this project. They've done the pilot testing. We're going to go back to them to talk a little bit about it. We know it's not policy right now. We know it's going to be taken to the criminal law committee. We'll see what happens with that. And the other thing you touched on were the tough budget times. And so one of the real joys to this particular screen is that... First of all, it's free. I mean, it's a free validated instrument. You don't have to pay for it. It's already been paid for through the research funds, the federal funds. We think that also that this TCU drug screen hopefully will save us money because you will be able to begin to start identifying those folks that do not need treatment at all and then also be able to identify those folks that may need further assessment or intervention or treatment. So we're hoping that the introduction of this TCU drug screen into our system will help save money in these tough budget times. Okay, thanks. And we'll be saving the right money and spending the right money as we go along. Okay, we're going to get back to Derek in a couple of minutes and he's going to talk to the two treatment specialists we have here who will talk about how they implemented it in their districts and what their experiences were. But we've talked about the screen. We've talked around the screen. We've talked about the purpose for introducing the screen. Let's go talk about the actual questions on the screen. So I'm going to turn this back over to Dr. Knight and let him go through each one of the questions on the screen and really tell you what's behind those questions. Dr. Knight. Thanks, Kate. Hopefully each of you has a copy of the instrument in front of you. As I go through the instrument, please follow along. On the top of the first page, you see a set of instructions and it's really imperative that when you sit down with the offender to do the interview, you make it emphatically clear the reason you're doing the interview and why it's imperative that the offender provide you with honest responses when you ask the questions. The rapport you establish with the offender at this point will really set the tone for whether or not they're truthful, which is obviously a big issue when you're interviewing an offender about their drug use lifestyle. So let's begin. On the very first page, you'll see on item number one, well, for all the items, the reference period that needs to be looked at is the 12 months before being incarcerated. In many cases, the offenders you will be interviewing will have been incarcerated for a number of years. We're not looking at the period of incarceration. We're looking at the 12 months that they were on the street prior to incarceration at the point of which they were at risk for using substance, such as alcohol and drug use. So going to the first item during that 12 months prior to incarceration, did you use larger amounts of drugs or use them for a longer period of time than you had planned or intended? For each of the items, they need to be read verbatim and wait for a response from the offender. After that has occurred, at that point, if clarification for the items needed, go ahead and provide that. For example, if you have to indicate that the number of beers that needed to be consumed to get the same effect had to be increased, go ahead and provide that. Hopefully by the time you're administering the instrument, you've already gone through their file and have a good understanding of their prior sentences, what they've been involved with, what they've reported in their pre-sentence investigation, and you can use this information not to confront the offender that's filling this out, but to simply bring up the point that, hey, you say that you haven't had to increase use, but based on what you indicated in the pre-sentence investigation, your use escalated over time. So definitely refer back to the information you have on hand to see if in fact the offender would like to change their mind in the response as they gain a better understanding of the item you're asking. As we move on now to the second item, you see that it asks, did you try to cut down on your drug use but were unable to do it? I think this is fairly straightforward for those who are dependent on substances. There's almost always an effort to cut back and they find that they simply can't do it. On the third item, did you spend a lot of time getting drugs using them or recovering from their use? Obviously the intention of this item is to get at time diverted away from things they should be spending on to their acquisition and use of the actual drugs. Moving now on to item number four, this is a two-part item. Notice there's an A and a B section and the stem of the question applies to both. Did you get so high or sick from drugs that it kept you from doing work, going to school, or caring for your children? That's part A. And part B asks, has it caused an accident or put you or others in danger? A yes, as we'll note in a minute, to either one of these items will constitute a yes response for item number four. Moving on to item number five, did you spend less time at work, school, or with friends so that you could use drugs? The same notion with this item in terms of the amount of time they're dedicating toward their drug use lifestyle. And again, I'd want to repeat that all of these items are those that are also found in the diagnostic and statistical manual, which is the gold standard currently for determining drug use dependence. Moving now on to item number six, a three-part question. Did your drug use cause A, emotional or psychological problems? B, problems with family, friends, work, or police? And C, physical health or medical problems? Now for most of the offender population that you'll be interviewing, they're there because they've had some run-in with the police that is most likely drug related. So if they're saying no to that item, that's a sure bet that that needs some sort of follow-up on your part to see if in fact their arrest was drug related. And if so, prompting the client to see if they need to change the response to yes on that item. Moving now on to item number seven, we see that it indicates did you increase the amount of drug use you were taking so that you could get the same effects as before? Item seven, eight, nine all refer to tolerance, which is a key part of drug dependence. On item eight, did you ever keep taking a drug to avoid withdrawal or keep from getting sick? And item number nine, did you get sick or have withdrawal when you quit or mistaking a drug? Again, these all referring to withdrawal aspects of drug addiction. Okay, these are the nine items on which the scoring is based. Simply summing the yes responses with items four and six collapsing across those sub-items should give you a score from zero to nine, where zero indicates no responses on all items and nine meaning that you have a yes response to all nine items. As you'll find on the back page of what you have in front of you, zero means no need for drug treatment, obviously. One and two, as will be discussed a little bit later, probably means more assessments needed. Three through nine corresponds with some sort of dependence-like problems with their drug use that definitely will require further assessments or additional assessment and possible treatment intervention. At this point, it's extremely important to note that this is simply a screen. It is just one component of the case plan in which you'll be making your treatment and referral decisions. A zero score on this, along with nothing else in the records should be a fairly good indication that no treatment's needed. Moving now on to item number 10, obviously you'll want to know what the substance or substances are that they're abusing and this is where you gather that information. A, bubble in, the worst drug, and this is their perception, not yours, so they may be a heroin user indicating that their worst substance uses with alcohol. B is the next most severe item and C, the next after that. If they do not have a second or third, simply indicate none. But again, refer back to the records if there's indication of multiple drug use because this is where you'll capture the types of substances used and may have some implication for the types of treatment services that will be provided. Moving on to the next page, you'll see that item number 11 addresses the frequency of use for each of these types of substances. Again, referring back to the last 12 months prior to incarceration. On item number 11, we know that there are a number of drugs that are currently in the process of being developed that we haven't captured here on A through K. It's there on item 11 that you'll indicate these other types of substances, particularly the newly synthetic drugs that are being developed. Write those in there and write the frequency of use for those substances on that line. Moving now on to the next item, number 12. This is where we start getting at injection drug use and motivation for treatment. Item number 12, you'll see that it says during the 12 months, how often did you inject drugs with the needle? Obviously, an important component here is beyond public safety and that is trying to get a sense of the risk for HIV and other types of communicable diseases that can be passed on through injection drug use. Item 13 asks, how serious do you think your drug use problems are from not at all to extremely? Again, as we'll be addressed here in a few minutes, if they're indicating that they have drug use problems on the front page and not on this particular item that they need drug treatment, they need to investigate further as to why they're responding that way. And finally, moving on to the next item, you see that it states how many times before now have you ever been in a drug treatment program? Being in a drug treatment before, program before, does not constitute need for continuing treatment. It could be that they participated in the RDAP program and simply need other types of reentry services as they re-enter the community. But again, this will give you a barometer of the types of treatment services they've already received, as well as the fact is whether or not they've had a drug problem that's needed to be addressed in the past. And finally, the last item on the instrument indicates how important is it for you to get drug treatment now? From not at all to extremely. And again, this speaks to motivation. They may recognize that they have a problem, but just simply do not feel like they're ready for drug treatment at this point. So at this juncture, let's turn it back over to you, Derek. Thanks, Kevin. Before I basically go any further, I'd like to reintroduce two of the members of the National Expert Panel that I talked about earlier. A talented group of folks. I want to first reintroduce from the District of Columbia, another talented contributor for the National Expert Panel, and Mike Laughlin. He's the fifth circuit representative in the National Expert Panel, and he's one of our go-to guys. Before we set up this role play, Mike, I want to ask you a question. I know when you were pilot testing the TCU drug screen, there was a need to basically kind of set the stage for an interview process. Can you tell us a little bit about that? Okay, sure. Well, basically during our pilot, and this was similar experiences with some of the other panel members who pilot tested this, we found that when we did an interview process, rather than just self-administering it and just marking up a score in our hurry to get the case opened up, we found that they were much more open. We were able to establish a relationship with them better and implemented the initial interview process to where we showed that we were just more than just compliance monitors for the court, but that we were also individuals who were trying to be advocates for them and to be an agent of positive change to help the partnership with them in developing jointly with us strategies and interventions and referrals to the community resources that would allow us to help them establish outcome-based objectives for provision and strategies in accordance with the revised monograph. In that process, we also will help them talk about the conditions. A lot of times, you know, we deal with folks that come out pretty negative, they don't want to do another thing, they got to get to their job and take care of their family, but we want them to help them understand that this is in their best interest to be able to get into treatment if necessary and to be able to make unnecessary referrals quite a bit, save money. And so in that process we're going to, we also help them establish we were able to clarify questions and also to reconcile any contradictions they had between their answers and the information that we found in reviewing the file, which is important that we review the file and talk to others that are involved in the case. So with that said, we're going to do a role play. Grace is going to be a new release and we're going to talk about establishing that rapport, building that trust and helping establish ourselves as an advocate and change agent. Okay. Hello, Grace. We've went over the conditions of supervision now and we've talked a little bit about where you're going to be living and your family situation, a little bit about your work. We've talked a little bit about what my role is as an officer in helping you to be successful but also beyond supervision. And now I want to find out a little bit more about your substance abuse history so that I can get a better idea on what referrals, if any, might be needed for you in the community to help you stay clean while you're on supervision and to just maintain that clean, drug-free lifestyle that you maintain while you're in custody. Okay. So I'm going to go ahead and we're going to do a TCU drug screen instrument and it's 15 questions. 15 questions that are yes, no. The back page talks a little bit more about your level of drug use. This is staged during the last 12 months of street time or non-custody time which will be before you got arrested and remained into custody. Okay. So we're going to use that as a point of reference. Keep in mind that I'm trying to help you to be successful so I want to be able to be real clear on what your status is so we can make sure we hook you up with the proper resources to be successful. Which asks, did you use during that 12 months larger amounts of drugs or use them for a longer period of time than you had planned or intended? No. No, you did not. Okay. Now, let me ask you. I'm reviewing your file, talking with your husband during the pre-release. I noticed that things were a little stressful from what he was saying and things were difficult during that time and also I noticed that you had lost your job and you had a prior drug possession charge although that was a little bit before the 12 months that was going on as well. Those seem to normally indicate what we call a loss of control of use. Well, I finished the BOP program when I was away. Okay. I gave you that certificate. Right. And when I was in pre-trial, they sent me away to a program and my job at some point they said, well, you need to go to treatment so I did some treatment with them too and I got a real nice certificate from BOP. Oh, good. Yeah, I saw that. I made that copy already. I had that in your file and I saw that you had went through the program when I reviewed your prison institutional materials. But let me emphasize that substance abuse and substance dependency is a chronic illness so it can be a problem now that you're on the street. You're in a brand new environment. A lot of stresses and pressures and old friends so we want to focus on the questions here as they relate to that 12 months so I can get a better feel. So I want to point back to the question which asked, though, in light of the DUI we talked about in your husband's input did you use larger amounts of drugs or for a longer period of time than you intended or planned? Oh, I see. I understand. Yes, I did. Okay. So then the answer to that question would be yes. I'm going to mark that as yes. That's correct. Now we're going to go on to question two which said, did you try to cut down the abuse but were unable to do so? Well, things at home got kind of crazy. My husband kept complaining and I was drinking and not taking care of the kids like I needed to. Okay. He wanted me to go to AA and I went just because he was like go to AA and you need some help so I did that but I still was drinking every now then so I don't know. I guess so. So basically from what you just said it sounds like you're saying that at times during that period it did get out of control that you did lose control so when it asked did you try to cut down on your drug or alcohol use which alcohol does relate, by the way to this instrument all the way through but were unable to do so then you would say that would be yes. Yes, yes, yes, yes. All right. So now that we've established some dialogue between her and her range agent and got some openness and got past a little bit of the denial and minimization now we want to move on and we're just going to intentionally jump on the instrument further down and go on to page two and we're going to ask her about we're going to jump to question number 13 and I'm going to ask you now Grace we've covered most of this tool now in the instrument and I want to move on to the next question I told you I went to the BOP program and I gave you that certificate I don't think you're listening to me it's not at all. Let me hear you. I don't have a problem. So you don't see at this point in time the choices are not at all, slightly moderately, considerably, or extremely important for you, excuse me that your seriousness of your problems you say not at all? Not at all. I'm going to mark that as not at all at this point and we're moving on to the last question Grace and that is how important is it for you to get drug treatment now? Well that's not at all I told you, BOP remember pre-trial I went through treatment with them and the whole time I was going to court I was going through that drug program and in my job they had me go away to treatment not at all. So you've had several prior treatment programs okay so I'm going to go ahead and put not at all there as well so that's the role play and that's basically what we would do at that point covering the subjects with them and walking them through the questions Okay very good let's turn this over to Kate at this point Thanks Derek, I'm going to do a couple of follow up questions on the role play between Mike and Grace being fairly consistent by the time Mike got her to those yes answers page one a little inconsistency in page two what are the differences if you get somebody I guess consistent with page one and two and then inconsistent between one and two Grace? I think that really isn't uncommon if you have an individual who's throughout the screening in questions one through nine saying yes and they're agreeing that there was an addiction but on page two you realize that the individual is starting to say well I don't have a problem it could be real for that person just as you saw in the role play that they have gone through the drug treatment programs while in an institution and maybe even pre-trial or in fact what you may be hearing is that there's some denial to the fact that that person needs treatment at that time and actually minimizing their addiction so what the officer or I suggest the officer do is I refer the offender back to what the score of the TCU actually said what those findings were and share with the offender what your recommendation is going to be based on those findings and just the opposite if you have an offender who's cooperative throughout the screening excuse me who's denying the need for treatment throughout the screening in questions one through nine no I haven't had a problem no there's been no difficulties however towards the end in page two they start to say yes there is a need there is a problem I do need treatment then that's good that's an indication that the officer may have actually broken through denial on the offender's part and that's what we want to do however what I would suggest is if you've received no's throughout that first part take the time to re-administer the tool because at that point you have the offender who's cooperative and you're more likely to get a more reliable answer or response okay thanks Grace and Mike from your perspective any comments you'd make on the role play or any comments you'd make on your experiences of actually doing this in your district thanks well I'd like to add to that that it's important that you help the individual deal with, be clear on the answers sometimes they may start minimizing at first and you can go along and then you start finding a little bit more honesty part of what maybe Grace was talking about later in the device you can go back and you can say okay let's talk about this area again it sounds like you're saying something a little bit different and so that was a valuable piece that we gained and also we found that it was important that we corroborated that information with other sources and we compared that it's important to emphasize this is a place to screen them quickly and to eliminate them as unnecessary referrals and to compare and contrast so that we have a good decision made based on several sources of information and not just the device by itself okay thanks Mike I'm going to turn this just to Dr. Knight for a minute for his comments on that whole role play and what was important from your perspective was your job showing how rapport can be established when an offender is being interviewed again if the form is placed in front of the offender and told to hurry up and fill it out because we got other things to do you shouldn't be surprised when the responses aren't consistent with what you expect so establishing rapport again is so critical and as Mike showed can be accomplished particularly with those experienced in interviewing the offenders for those who don't have the experience I highly suggest some training and basic interview skills can go a long way in getting the types of responses that are consistent with the problems the offenders present the other component is actually reading the item verbatim followed by clarification without actually leading the offender toward a certain answer probing's good but making them provide the answer you're looking for doesn't do you a service or the offender okay thanks one follow up with that Grace was saying that if the questions on page one and page two were just really contradicting each other or the answers I should say the questions don't contradict each other the answer if the answers are contradicting each other she was saying we administer the test don't just override what the score was with any instrument there should always be the option to override but it should be a difficult process to go through and in this case where she did on the second page indicate an openness to responses that weren't indicated on the first it is good to go back and go ahead and re-administer the first page so that you can end up with a drug screen score that is consistent with the referral that you're going to be making if in fact the in the end that doesn't occur perhaps an override needs to occur but I would suggest that at least one other correctional corrections person look at the form and look at the corroborating evidence to determine whether or not an override should occur so overrides are necessary but should be difficult to obtain okay thank you that's really important we have a number of facts that have come in with some good questions and I do want to get to them in a minute but first this is Mike Laughlin's favorite question so I'm going to go to him with this Mike you did the screening instrument you got at least three yeses from grace we know that that puts her into that DSM four category for drug addiction or drug dependency anyhow so now you've got the score of three or whatever you're coming up with and now you know exactly what to do with grace right no not quite please keep in mind that this is a tool by itself standalone it's a limited value so you really want to corroborate this information with other sources looking at reviewing the file material institutional records treatment records maybe even discussing the case with the defense or us attorney and some of their history back then the pre-trial officer other sources visits with the family during the pre-release can help you as well and so you want to compare and contrast that along with the answer and not just assume a high score like Kate just described does indicate a person needs to have some further step taken but that may mean only an evaluation by a provider and then they may look at that and say okay at this point in time the person is doing well enough and does not need anything further but at least you're looking at several sources and staffing the case with your specialist or your supervisor at the same time can help as well okay thanks Mike and to Derek other experiences from the national expert panel on how the interview is conducted or any other findings that the other members of the expert panel had that you'd like to add here yes Kate well the expert panel actually pilot tested the TCU drug screen they did they had options in fact they could actually self administer the TCU by actually giving the instrument to the defendant or the offender and have them fill it out and then have them give it back to them or they could use it as part of their one on one interview as you just saw Grace and Mike demonstrate and what we found out of the pilot was that the information was more solid when it was basically part of the one on one interview because it lends itself for an additional follow up question as you saw Mike did or clarification and it also kind of helps with that whole process but one thing that we did find is that it was easy to use and it took somewhere around 15-20 minutes I mean that's the approximation so it's just an additional tool that you put in your toolbox it's not a standalone you're still going to do pretty much the similar things that you've been doing but it gives you not only good solid interviewing questions that get to the heart of the substance abuse issue that the person may have but it also gives you an argument that you can basically have a uniformed way that you're kind of looking at the substance abuse cases and maybe even beyond the substance abuse cases. I also would like to add that at this stage because it's not policy we're encouraging people to use it at the pre-trial services stage if you think that that's something that you could benefit from also you know with pre-senders investigations and obviously for post-conviction cases when you're making decisions or trying to make decisions as it relates to treatment services so all in all we have found that this particular instrument is a good validated instrument that should be helpful in your district and for officers to use. Thanks Derek, let me just say that Derek just answered three different facts with what he just said so let me say that Jay Meyer from Minnesota Lou Harmon from the western district of Virginia and Karen Calhoun from Alabama Southern Pre-Trial all had pretty much those questions which went to the using the instrument at the pre-trial pre-sentence and post-conviction stage was one preferable over the other or could it be used at all stages and I think from what Derek was just telling us it certainly can be used at any stage I'm just going to ask Dr. Knight if he has any comments to make on that. Now I obviously can be used at a variety of different points in the process the key here though is the reference point is that 12 months prior to incarceration so whether it's being used at pre-trial or during probation the reference period should be the same in both settings but obviously the closer to that time at risk the more likely you are going to be getting honest responses so therefore the pre-trial stage may actually be the preferred place of assessment or in this case screening. Okay and a follow-up to that because we had one from Mark here in Georgia Northern and I'll find your name in a minute but Mark had asked if somebody was actually incarcerated you're talking about the 12 months prior to incarceration but we now have people who have been incarcerated for 5, 10, 15 20 up years so are we still talking about the 12 months prior to incarceration? Yes although it may be a common misperception that drug use is rampant in the correctional system and it may occur occasionally the reality is we're talking about the street time the at risk time prior to incarceration and although this one may have been incarcerated for 10 or 15 years the reality is they generally have a pretty good idea or memory of their drug use patterns and that's really what we're getting at here are drug use patterns during that 12 months prior to incarceration so ideally interviewing prior to incarceration is going to result in the best responses but 12, 15, 20 years later we still find that they can recall their drug use prior to being incarcerated Okay thanks doctor and I'm sorry that was Mark Davis from Georgia Northern so I thank you for that Mark Mark had another question that I'm going to take back to the panelists to and Mike to answer on this you've sort of touched on it but I really want you to focus in on his question the drug screen does not appear to address deception, defensiveness or denial certainly things that happen with a lot of our substance abusers our clients are not known for honesty and self-evaluation of chemical dependency and how do we address this issue so if you just go back and touch on that I'd appreciate it Okay the instrument does look at denial and the level of motivation that the individual may have we talked about that a little earlier and you can find out on page 2 in the last three questions and the way these questions are structured it actually determines what level of denial the offender may be at or what level of motivation he may be at in receiving treatment so it is there and it's built into these questions in addition to that it's important to look at as Mike has already shared the collateral information that you're going to have when you're sitting down with the offender so if it does appear that there is some denial there then you can simply take the time and make reference to what the pre-sentence report may say and just letting the person know that there appears to be denial and you want to talk about that Right and I want to add to that also that it's important that you use other individuals involved in their case as well so you may talk to a family member you may talk to the attorney or the pretrial officer and get other sources of information there also and I think just establishing yourself as an advocate even though I realize self-report answers which is what this tool is made of is a limiting factor using other sources of information and establishing yourself as an advocate helping them to produce positive change and be successful can minimize the level of denial as well Okay thanks and I think from what Mike and Grace are saying this really does support the principles of Monograph 109 and 111 very solidly so you're looking at the individual looking at that individual's risks and needs and tailoring your case plan to it and what this instrument does so beautifully is to really help support what conclusions you're coming up with Let me go Derek I'm going to get this back to you because you've said it twice and I want you to say it yet one more time I have a phone from Alabama Southern also asked is this a mandatory part of the supervision process or is it merely a recommended tool for substance abuse screening So let me go back to you Well at this particular point in time we are just now providing this drug screening instrument as information at this time as I said we are going to submit this to the criminal law committee in December to endorse this so right now it is not mandatory The national expert panel has already pilot tested this particular instrument so what we are trying to do is broaden pretty much the base of people to get a chance to use it at different stages and as we basically pretty much put it out there it will help everyone with your particular decisions that you have to make as it relates to substance abuse One of the things that we have done just to kind of set the stage is that at least two spaces impacts ECM the new 3.0 version so that is there is a place there but we are not requiring at this time and we don't know what the criminal law committee will do with regards to this but at this point we can honestly say that this has been an easy to use, validated good, helpful instrument and we want everyone now to kind of expand the use of this instrument just to see basically pretty much if it is helpful to them to do that also maybe a little bit and say that this is an understanding we are trying to eliminate unnecessary referrals and so this helps you to eliminate a lot of referrals that went there before and it is a quick screening instrument it is guided, you have got questions that are guided so you are going to get more accurate information from them and just not assume which many times we do that we get a condition on the judgment and we say okay off you go and we rubber stamp them down the road this gives us a tool in conjunction to determine what the level of true need is and we may be able to eliminate referrals in that process and it can be used and tested out now even though it hasn't been formal policy yet and I would also just add in addition to eliminating referrals you may also target those particular individuals that need services so I think they are very solid questions a lot of times you may ask some of these questions but chances are if you are doing an interview you are not going to have a time, well not necessarily a time but you are not going to actually ask those 15 questions I know we were talking to Grace earlier and you mentioned a scenario when you were administering this drug screening instrument and tell us a little bit about where you may have had some initial feelings about what this particular person may have as far as a substance abuse issue and then as you went through the screening process you found out something totally different as it was shared we are seeing many of our offenders had complete longer periods of incarceration and I was conducting an interview on an offender that had been incarcerated for six years so it was my natural feeling that well most likely there was not a need at that time at the present time for drug treatment however I went ahead with the interview and he was very cooperative and what it showed was that he admitted throughout the interview that he had an extensive history of drug use he admitted that there was some use while he was away and most importantly towards the end he admitted a need for continued treatment and I believe had I not used the TCU because of the validity of the questions and it helped me shake my interview it really got to the core questions of talking to him about his addiction and probing and getting him to respond appropriately and helping me to make that appropriate referral for treatment thank you Grace okay I appreciate that because I think that is the perfect story of what happens on that day to day basis when you're just so involved in what you're doing and this instrument really gives you a chance to kind of step back and check your own assumptions we have another facts from Jeff Purcell in northern Alabama and I'm going to give this to Dr. Knight most substance abuse screening tools like the sassy and mast are designed for the general population is the TCU drug screen instrument a better tool since it was designed for the criminal justice offender and if so how so well I think we've spoken to the reliability and validity of the instrument previously in the one slide that compared it with the other instruments the bottom line is the TCU drug screen was also developed for community application but has been revised and tested for correctional settings and fairly recently we've been able to establish its use as reliable across race and ethnic lines across gender breakouts and across age different age breakouts some of the other instruments that are commonly used do not hold up well in these different subgroups so obviously we feel like at this point we have the evidence to back its application in the correctional various correctional settings okay I'm going to stay with you just for a minute we've talked about this screen we've talked about using it and we know it's up on our website but that's not really where they should go for it right tell us a little bit about where people should go for more information yes for more information the best place I would recommend you go is to our website at the IBR and the website address as you've seen across the bottom of the screen before is www.IBR.TCU www.IBR.TCU.EDU in addition to the drug screen form you'll find another a number of other assessments and instruments that can be downloaded for free use a number of brief interventions that you may be interested in as well as a number of research summaries of the different projects we've been involved with I encourage you to go there and make use of it I would encourage you to do the same I've been up on that website and it really is it's easy to navigate through it's got a lot of great information and a lot of really good links so that's the IBR website for all of you out there in the field who are going to be using this and all the managers I'm going to turn this over to Derek so he can tell you how to get more support and what other information is going to be available from ops on this project yes on the JNET the OPPS website the TCU drug screen under the substance abuse treatment services section you can get information with regards to that there also under the national expert panel we have information there also the other thing that I would ask you to do in addition to Mike Laughlin from the 5th circuit and Grace Sanders from the District of Columbia circuit get in touch with your representative a list of those particular people on the JNET want you to kind of contact them they're just as intimately involved in this process as we all are they've been very invaluable when helping this process to get to where it is so it's on the JNET OPPS website and also under the national expert panel okay thanks Derek let me go back to Grace and to Mike and to ask you for some closing comments so Mike let me go to you first I think thanks Kate let me just close in my end in saying that our pilot test of this device found that it's a good, brief, accurate tool to measure and target our resources to those that are in the greatest need we also found that it was important to corroborate that information against other sources and to establish ourselves as an advocate in that process we feel like it's important that you work toward understanding that this is a risk a lot of people ask okay what do we do now what do we do with them we got this score understand it doesn't tell you where to go with them okay this score means this that's your professional judgment which we emphasize and so you need to look at all the sources including the score on the TCU to make that decision and to recognize that the whole purpose here is to be an advocate for positive change establishing objective objectives that are outcome driven and so that would be all I would add I like to add we found we had the same findings that Michael had but just to add as a result of all using the TCU in a district of Columbia and to stay to parallel that which has come out in a new monograph 109 we've developed a memorandum of understanding with the halfway houses in DC we want to have an early intervention into the offenders case planning and case work and a big part of that is going to be out using the TCU so we're excited about that and it's going to help the offender it's going to help us help the offender in determining what type of treatment he's going to need okay thanks to all of you I can't believe it our hour is up I'd like to thank Dr. Knight, Derek Goddard, Mike and Grace for joining us on the set go to their websites get more information thank you all for spending your time with us today and have a good one bye bye