Therapeu(c*Communi(es:*The*Interna(onal*Journal*of*Therapeu(c*Communi(es Stay’n'Out'–'The'Evolu2on'of'a'Prison8Based'Therapeu2c'Community'over'30'Years' Seep$Varma$and$Ron$Williams$

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Stay’n Out – The Evolution of a Prison-Based Therapeutic Community over 30 Years

Seep Varma and Ron Williams

ABSTRACT: This article traces the evolutionary history of the Stay’n Out Program, which is a prison-based therapeutic community program in State. The authors describe the early challenges, essential program elements and the lessons learned over the past 30 years. The Stay’n Out Program is the oldest prison-based program in the United States.

Introduction

For nearly three decades, from the 1960s well into the 1980s, the larger cities of the United States, in particular, were in the grip of a drug epidemic. Heroin was the primary drug of choice. Drug addiction, and the accompanying drug-related crime, was at the highest level in history. The criminal justice system was overwhelmed. In 1977, the New York State Department of Corrections was experiencing massive overcrowding, with over 18,000 inmates. The New York State Division of Parole was experiencing high rates of , due to new crimes committed by parolees. The majority of these parolees were substance abusers, who had relapsed. The New York Division of Substance Abuse Services (DSAS) was responsible for addressing substance abuse treatment in New York. Officials had been attempting to combat this epidemic by rapidly expanding residential drug treatment facilities throughout the State, especially in the harder hit urban areas. The TC was chosen as a primary response, accompanied by a strong prevention effort and the utilization of methadone maintenance. When federal funding became available to assist in this first ‘War Against Drugs’, the larger TCs in New York joined forces with the Division of Substance Abuse Services, the Department of Corrections and the Division of Parole, to develop an in-prison program.

History

The Stay’n Out Program was launched in 1977 by a coalition of New York-based therapeutic community programs known as New York Therapeutic Communities Inc. At the time this coalition existed to advocate for expansion and

Seep Varma and Ron Williams are at New York Therapeutic Communities, Inc., Stay’n Out & Serendipity Programs, New York, NY 10018, USA. E-mail: [email protected] therapeutic communities, 29, 1, spring 2008 © The Author(s) 90 therapeutic communities, 29, 1, spring 2008 implementation of the TC methodology for substance abusers. The membership and Board of Directors included Phoenix House, Daytop Village, Project Return, Samaritan Village, Odyssey House and others. It was chaired by Dr Mitchell Rosenthal of Phoenix House. In 1977, the Federal Government provided incentives to States to establish treatment services for inmates in correctional facilities. Initial funding in New York was provided to the New York State Division of Substance Abuse Services (DSAS) to implement an in-prison therapeutic community. DSAS established an alliance with the TC coalition in New York to provide the in-prison treatment with a continuum of aftercare services through existing community-based programs. The idea of providing substance abuse treatment services to inmates through the application of a prison-based TC was met with so much skepticism that no treatment agency wanted to take it on directly for fear of tarnishing the reputation of their program. The project became a collective effort of all New York-based therapeutic community programs. A Project Director, Ron Williams, was hired to lead the effort. His colleagues joked that he had just ruined his career since this effort was not likely to last. After a few years of operation and promising initial results, the program was renamed ‘Stay’n Out’ by the male program participants. The logo of a key with the door swinging open was established as a symbol of the program being the ‘Key to getting out and Stay’n Out’. In 1980, the program separated from the parent organization of the TC coalition to become an independent non-profit enterprise. Today the agency is still led by the founder, Ron Williams.

Initial participants

The Stay’n Out Program was designed to accept inmates through strict selection criteria. These were primarily first-time offenders with histories of substance abuse and were usually younger than the average inmate. Excluded from participation were inmates convicted of sex offences, arson or extensive histories of violent crime. The selected participants would enter the program 12 months before their parole release eligibility date. Six months would be spent in the prison program adapting to the therapeutic regimen. If successful, they would be eligible for release six months earlier than under normal conditions. They would be referred to a member agency of New York Therapeutic Communities Inc. to complete the remaining six months in community-based residential TC treatment. Progress was monitored and successful completion of treatment (a minimum of six months) would guarantee parole, while lack of success guaranteed a return to incarceration.

Early strives

Initial opposition to the program was acute. The State agency responsible for substance abuse treatment services was funding and supervising a program within the Department of Corrections. The correctional setting is generally self- contained and insular. Therefore, the notion of a private, non-correctional

Seep Varma and Ron Williams 91 organization controlling any aspect of the operation of a prison was unheard of and was met with suspicion. In 1980, when the initial federal funding expired, the Department of Correctional Services (DOCS) decided to continue the services and to fund the program since its early accomplishments were positive. There were many initial benefits of operating a prison-based therapeutic community. TC practitioners were working with a ‘captive audience’, who were actively engaged in the treatment process. The program results were similar to those experienced in community-based settings. Program graduates (former inmates of the program) were allowed to work in the prison, which had been unheard of previously in New York. From another perspective, correctional administrators viewed the program as a management tool. In the TC Units, inmates were engaged in meaningful activities. There were fewer incidents of rule infractions, violence and misconduct. Correctional staff who were associated with the treatment program took less sick leave and were more engaged in their jobs than those who were not associated with the TC. In New York State in the 1980s, the crack and heroin epidemic and associated crime was on the increase, as were the incarceration rates for drug offenders. The prison-based TC was a logical and proven response that now boasted a strong track record of positive outcomes, such as 77% of the graduates remaining successful in the community five years after release (NIJ 1995). The Federal Government responded to the success of the prison-based TC with the implementation of Project Reform, which provided funding to States to design and implement prison-based TCs. Stay’n Out was chosen to be the model for this effort and began, in conjunction with the National Development Research Institute (NDRI), to conduct in-prison TC training throughout the US. Initial States included Ohio, , California and Alabama. This training effort eventually became international in scope, through the assistance of the US Department of State and included Thailand, Malaysia and Columbia.

Program sustainability

Several aspects of the Stay’n Out Program have proven critical to sustaining the program over the last 30 years. Stay’n Out is unique, not in the sense of operating a prison-based TC but, rather, in operating one that has lasted as long as it has. Similar efforts had been tried previously, but were ultimately terminated within a few years of inception. Research has been important to the ongoing operation of Stay’n Out. Measurement from external sources as well as internal management and evaluation of program outcomes has been critical. Stay’n Out has been evaluated since inception. Building this component into the initial design of the program has had tremendous benefit. Continuation and expansion of the prison-based TC was directly linked to the fact that Stay’n Out had included an outcome evaluation within the program design. The initial structure of the program involved participants being paroled or released directly into a community-based residential facility that was operated

92 therapeutic communities, 29, 1, spring 2008 by a member of New York Therapeutic Communities Inc. This continuity of care from a custody-based program to community-based residential services provided the best results in terms of recidivism and drug-free rates among graduates (Wexler, Lipton & Foster 1985). This eventually led to Stay’n Out opening a residential treatment centre in the community in 1989. The ongoing cooperation between correctional staff and non-security staff is greatly enhanced by having annual staff cross-trainings. Providing correctional employees with the opportunity to learn about and experience the essential elements of a TC while teaching TC staff about the safety and security regulations of a prison pays enormous dividends. Program staff must operate with the highest standards of integrity within the prison setting, following all rules ‘to the letter’ and never compromising the security of the correctional setting. Of course, TC staff interactions with partici- pants often generate skepticism among some correctional staff. Counseling staff can counter this stereotype by operating at the highest levels of ethical conduct. Another hallmark of success is to obtain and maintain program certification. This may vary from jurisdiction to jurisdiction, but certification from the State substance abuse agency or credentialing body enhances the program’s credibility and ensures the longevity of the program. Adherence to these external standards for a prison TC will aid in evaluation, staff training and quality assurance activities (ONDCP 1999). The Stay’n Out Program was among the first to be accredited by the American Correctional Association for prison- based TC programs. Stay’n Out also maintains an operating license from the State Office of Alcoholism & Substance Abuse Services and undergoes an on-site regulatory compliance review every three years. Prison-based TC programs should have a strong role in the selection of participants including the ability to interview prospective candidates and to assess suitability and motivation. Additionally, the program should have the capacity to exclude candidates based on the program eligibility criteria. Even in instances where programs are required to admit involuntary participants referred by the prison, a screening and admission interview holds strong clinical value. Stay’n Out believes that having and maintaining external activities, such as graduations, reunions and alumni events, are additional critical elements of a successful prison-based TC. There is tremendous value to external graduations – attended by correctional staff outside the prison setting – who see first-hand the success of individuals who were formerly in the in-prison program. Reunions and alumni associations also allow former participants to continue the fellowship, camaraderie and support systems which were developed in the program.

Challenges and lessons learned

Stay’n Out has been challenged in many ways since its inception. After the program was accepted into the two correctional facilities where it currently

Seep Varma and Ron Williams 93 operates, the NY Legislature began exploring solutions to the rapidly-expanding prison population and the seemingly never-ending construction of new facilities. In 1989, a prison reform bill was passed, calling for the development of new treatment beds operated within the NY prison system. Since geo- graphical balance was deemed important, a decision was reached that some of these new programs would be staffed by correctional employees. While, on the one hand, it was a victory for advocates who had long called for inmates to receive treatment options, there was much concern about the quality and integrity of these new programs, which were not TCs in the traditional sense. Additionally, it also pitted the programs under contract, such as Stay’n Out, in direct competition for funding with the Correctional Agency. After gaining widespread acceptance into the prison setting, community- based providers of TC services should be aware that, once the program evolves past the acceptance phase, Department of Correctional Services staff may eventually view the TC as another vehicle for opportunities for their own correctional staff and may discontinue contracting with community-based providers. Significant pressure will be placed on the program from the correctional facility. Demands will be placed on program participants in terms of facility work assignments and other mandatory activities. The TC is often misunder- stood and, in an attempt to make it more psychologically palatable, correctional staff will often attempt to place it within a paradigm they understand. The corrections system is often time-driven. Correctional staff attempt to create a dichotomy between a calendar-driven process and a behavioral/ environmental-driven experience. Successful programs must resist efforts to place the TC structure into unreasonable time frames. Studies of the Stay’n Out model have shown the most robust results are achieved with varying lengths of stay, optimally, between nine and 12 months (Aziz & Wierschem 1996). In accordance with the generally accepted tenet of ‘community as method’ (De Leon 2000), programs must also be sure to resist any pressure to revert to a psycho-educational model of learning and didactic classes. The TC can have a curriculum for different services and integrate differential learning models into the core methodology while remaining faithful to the core behavioral and peer- driven focus. In keeping with that ideal, programs must maintain flexibility in scheduling groups, adjusting daily activities and adjusting for individual length of stay when deemed necessary by program staff. Historically, what has made the Stay’n Out program valuable and effective is the strict adherence to the core values and principles of the TC.

Correctional staff vs. non-profit providers

Once a TC has been accepted by custody staff there is the question of whether to use contracted treatment providers or correctional staff to provide services. In the case of Stay’n Out, there is continuous discussion by policy makers regarding the best approach to this question. There are many reasons why

94 therapeutic communities, 29, 1, spring 2008 the use of a community-based provider has distinct advantages. These are discussed below. Flexibility of staff selection – non-profit providers are able to hire a mix of recovering staff, ex-offender staff and candidates that meet the staffing needs of the program at any given time. Government workers are often hired through civil service procedures with complex testing and transfer policies. Having the flexibility to hire (and fire) staff quickly and without regard to these external influences is important. Lower cost – generally speaking, government workers come at a higher cost than a non-profit worker. This is not meant to advocate lower salaries for non- profit workers; however, even side by side, a government worker is likely to have much higher costs in the long-term due to enhanced pension/retirement benefits, mandatory pay rates based on years of service, and higher costs associated with other fringe benefits such as insurance and leave pay. Continuity of Care – non-profit providers of service, such as Stay’n Out, are able to offer a seamless continuum of care into community-residential treatment. A 2004 study conducted by UCLA researchers of the Donovan Correctional Facility/Amity Prison Program (Pendegrast et al. 2004) found a dramatic decrease in recidivism rates of those inmates who completed the prison TC and then went to Amity’s community-based residential TC compared with those who just completed in-prison treatment without follow-up. Agility of the program – generally speaking, community-based providers are able to integrate the most cutting edge interventions and have flexibility in terms of program design. As research and best practises evolve, those programs with connections to the field will be able to rapidly adjust to and integrate new interventions into their service delivery system.

Conclusions

TC programs within a prison setting must be ‘cutting-edge’, using the most advanced interventions in terms of theoretical approaches and program modifications. They must be able to adapt and modify services to accommodate different population groups such as individuals with co-occurring disorders, youths, women and the elderly. Programs must also resist any pressures towards over-modification of the core elements of the TC. Ideally, programs should be agile in operations, and able to rapidly modify and make adjustments when environmental pressures such as time, schedule and location of the services require these changes. Programs should be able to continuously promote their services through outcomes research and articulation of the cost-effectiveness of these services. Stay’n Out continues to serve as a model for prison-based TC programing, having served the New York State Department of Corrections and thousands of participants in over three decades of operation.

Seep Varma and Ron Williams 95

References

Aziz, D. & Wierschem, D. (1996) Stay’n Out: A Program Study. New York State Department of Correctional Services, New York: Albany. De Leon, G. (2000) The Therapeutic Community: Theory, Model, Method. New York: Springer Publishing Company. Office of National Drug Control Policy, ONCDP (1999) Therapeutic Communities in Correctional Settings: The Prison Based TC Standards Development Project, DC. Pendegrast et al. (2004) The Prison Journal, 84(1), pp.36–60. The effectiveness of treatment for drug abusers under criminal justice supervision (1995) A National Institute of Justice (NIJ) Research Report. Wexler, H., Lipton, D. & Foster, F. (1985) Outcome evaluation of a prison therapeutic community for substance abusers. Presented at the American Criminological Association, San Diego, November.