Residential Substance Abuse Treatment Program

This application outlines how the North Dakota Department of Corrections and Rehabilitation (DOCR) and its subcontractor, Management & Training Corporation (MTC), plan to enhance services for individuals with mental health conditions and substance use disorders during community supervision and post-incarceration. Currently, DOCR oversees 7,115 people on community supervision, with high rates of substance use disorder (95 percent for women, 91 percent for men) and mental health diagnoses (52 percent for women, 40 percent for men) upon entry into correctional facilities. These individuals often require treatment both during and after incarceration.

Accessing behavioral health services post-incarceration or during community supervision is challenging due to homelessness, lack of insurance, unemployment, and lack of transportation. Additionally, service-providing agencies often face staffing shortages, resulting in lengthy waiting lists and the need to turn away clients. The need for behavioral health services is more significant than ever. DOCR’s prison population has increased by 10 percent over the last decade, with projections indicating a 42 percent increase by 2040, necessitating the construction of an additional prison. North Dakota’s behavioral health system faces significant staff and resource shortages, particularly in the availability of Licensed Addiction Counselors (LACs) and accessible substance use disorder treatment programs.

Programs based on the Risk-Need-Responsivity (RNR) model can reduce recidivism by up to 35 percent. The model outlines who should receive services (moderate and higher-risk cases), the appropriate targets for rehabilitation services (criminogenic needs), and how services should be delivered (e.g., using 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 need to incorporate evidence-based correctional practices.

Accessing treatment is particularly challenging for individuals living in rural areas, tribal lands, and minority populations. Of the 7,115 people on community supervision, nearly 40 percent are BIPOC (Black, Indigenous, People of Color). In North Dakota, self-identified BIPOC individuals are overrepresented in prison, probation, and parole. Black North Dakotans are 5.0 times as likely, Latino North Dakotans 1.7 times, and Native American North Dakotans 6.0 times more likely to be under DOCR control than their white counterparts. DOCR plans to increase the number of individuals receiving services through MTC’s Lives Transformed North Dakota (Lives Transformed) program to address the growing demand for accessible behavioral health services. North Dakota’s behavioral health system faces significant shortages, particularly in long-term, community-based treatment options, and lacks alternatives to incarceration. These shortages are most acute in remote and isolated areas with limited access to behavioral healthcare.

In 2018, the Human Services Research Institute (HSRI) studied North Dakota’s behavioral health system for the North Dakota Department of Health and Human Services, resulting in a strategic plan addressing 13 priority areas. DOCR and MTC are working with key stakeholders to address seven of these priority areas: expanding outpatient and community-based services, continuing to implement and refine the current criminal justice strategy, recruiting and retaining qualified behavioral health staff, expanding tele behavioral health interventions, ensuring the system reflects person-centeredness, health equity, and trauma-informed approaches, encouraging communities to share responsibility for promoting high-quality behavioral health services, and diversifying and enhancing funding for behavioral health.

In 2023, DOCR partnered with MTC to enhance access to community-based behavioral health services through the Lives Transformed program. Launched in Minot, Rolla, and Williston, the program served 253 individuals through assessments, group therapy, trauma-informed care, and personalized intervention plans. The program uses 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) for individualized reentry services that address criminogenic risk factors.