Aftercare for Substance abuse treatment for correctional residents upon reentry

The North Dakota Department of Corrections and Rehabilitation (DOCR) will use RSAT grant funds to enhance services for individuals with mental health conditions and substance use disorders during community supervision and post-incarceration. Currently, DOCR oversees 7,115 individuals on community supervision. The department faces high rates of substance use disorder (95 percent for women and 91 percent for men) and mental health diagnoses (52 percent for women and 40 percent for men) among individuals entering correctional facilities, many of whom require treatment both during and after incarceration.

Access to behavioral health services post-incarceration or during community supervision is challenging due to barriers such as homelessness, lack of insurance, unemployment, and transportation difficulties. Service-providing agencies also face staffing shortages, leading to long waiting lists and the inability to meet demand. The need for behavioral health services is greater than ever. DOCR’s prison population has increased by 10 percent over the past decade, and projections suggest a 42 percent rise by 2040, requiring the construction of an additional prison. North Dakota’s behavioral health system struggles with significant staff and resource shortages, especially among Licensed Addiction Counselors (LACs) and accessible substance use disorder treatment programs.

Programs following the Risk-Need-Responsivity (RNR) model can reduce recidivism by up to 35 percent. This model identifies who should receive services (moderate and high-risk individuals), what rehabilitation targets should be (criminogenic needs), and how services should be delivered (e.g., through motivational interviewing, social learning, and cognitive-behavioral interventions) (Andrews and Bonta, 2010). While in-prison treatment programs in North Dakota follow the RNR model, community-based programs still need to incorporate evidence-based correctional practices.

Accessing treatment is especially difficult for individuals in rural areas, tribal lands, and minority populations. Of the 7,115 people on community supervision, nearly 40 percent are Black, Indigenous, or People of Color (BIPOC). In North Dakota, BIPOC individuals are overrepresented in prison, probation, and parole. Black North Dakotans are five times more likely, Latino North Dakotans 1.7 times more likely, and Native American North Dakotans six times more likely to be under DOCR control than their white counterparts. DOCR plans to increase the number of individuals receiving services through the subcontractor Lives Transformed North Dakota (Lives Transformed) to meet the growing demand for behavioral health services. North Dakota's behavioral health system is particularly strained in long-term, community-based treatment options, with the most acute shortages in remote areas that have limited access to behavioral healthcare.

In 2018, the Human Services Research Institute (HSRI) conducted a study of North Dakota's behavioral health system for the state's Department of Health and Human Services, resulting in a strategic plan addressing 13 priority areas. DOCR and its subcontractor are working to address seven of these priority areas in collaboration with key stakeholders. These areas include expanding outpatient and community-based service options and continuing to refine the criminal justice strategy, such as reviewing jail capacity for behavioral health needs identification, support, and referrals, and creating a plan to address service gaps. Additionally, efforts focus on recruiting and retaining qualified behavioral health staff and expanding the use of tele-behavioral health interventions. The system is also being shaped to reflect person-centered, health equity-focused, and trauma-informed approaches. Communities are encouraged to share responsibility with the state for promoting high-quality behavioral health services. Finally, there is an emphasis on diversifying and enhancing funding for behavioral health.

In 2023, DOCR partnered with Lives Transformed to improve access to community-based behavioral health services through the Lives Transformed program. Launched in Minot, Rolla, and Williston, this program has served 253 individuals with assessments, group therapy, trauma-informed care, and personalized intervention plans. The program employs a person-centered, solution-focused, and trauma-informed approach, expanding outpatient behavioral health services while prioritizing empirically supported risk assessments like the Levels of Service Inventory-Revised (LSI-R) to provide individualized reentry services addressing criminogenic risk factors.

This award is funded as an administrative funding adjustment of 15PBJA-22-GG-00510-RSAT.