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DOC Realizes Significant Cost Savings While Maintaining Outcomes through Changes to Substance Use Disorder Treatment

Tags: DOC
May 11, 2021 12:00 AM
By: DOC Staff

PA Coat of Arms

By Tracy Smith, Chief for the Division of Treatment Services

The primary goals of the DOC's Substance Use Disorder (SUD) treatment programs are to reduce incidents of relapse, decrease the likelihood of recidivism linked to substance use, promote pro-social behavior, enable individuals to exhibit conduct that follows DOC rules and procedures and assist reentrants with successful reintegration back into our communities.

The most intensive SUD program is the Therapeutic Community (TC). The DOC determines substance dependence by administering the Texas Christian University Drug Screen-II (TCUDS-II, or "TCU") at time of an incarcerated individual's classification.

In June 2019, the DOC's Division of Treatment Services (DTS) made a change to its SUD policy regarding an inmate's admission to the TC (or inpatient) level of care. Previously, an inmate who had a TCU score in the 6-9 range was recommended for TC placement; since the change, an individual must score in the 7-9 range to be recommended for the most intensive level of SUD programming in the DOC.

This change was precipitated by a DOC evaluation entitled Therapeutic Communities (TC) Evaluation (2018). It showed the many individuals who originally scored less than six on the TCU ended up completing a TC program instead of an in-prison Outpatient (OP) SUD program. (A TCU score ranging from 3-6 guides an Outpatient Program recommendation.) This variation occurred due to staff's ability to increase an inmates TCU score via a manual override process. The evaluation found that there were no significant differences in recidivism or relapse outcomes between TC and OP participants (i.e., for similar individuals, one program did not out-perform the other in terms of outcomes). By eliminating the override process and increasing the TCU threshold from six to seven for TC placement, there seemed to be the potential for significant cost savings without negatively affecting program participant outcomes. 

In order to determine if the Department did, in fact, achieve its intended cost savings as a result of the aforementioned policy and curriculum changes, a fiscal analysis was recently completed. The most recent fiscal reports have demonstrated a significant cost savings from 2018 to 2020 – approximately $1.4 million dollars. 

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