Within jails and prisons, justice system personnel report that individuals with mental or substance use disorders present with a range of physical, behavioral, and developmental deficits and exhibit greater difficulty coping with institutional rules (Houser, Belenko, & Brennan, 2012). In an effort to address the needs of this population, new or expanded services have been introduced (Hills, Siegfried, & Ickowitz, 2004). The additional expense of these interventions has been justified by pointing to improved individual- and system-level outcomes (Cloud & Davis, 2013).

Prisons have a variety of programming that is specific for incarcerated populations that often have programming to fit the needs of the speciality populations. For example, prisons may have units that provide mental health treatment or units that are designated for substance use treatment. Other programming may include family preservation to reunify or prevent incarcerated parents from being separated from their children while serving their sentence.

In the Oregon Department of Corrections (DOC), people with developmental disabilities were not offered opportunities to engage in substance use or mental health programming because they could not meet mental rigor requirements. Currently, they are permitted into certain programming depending on their level of functioning. DOC has been able to make accommodations and provide flexibility where possible to increase opportunities for treatment for this population.

7.3.1 Family Preservation Programming

Family preservation programming works to keep parents connected to their children during their period of incarceration. These programs differ greatly depending on the correctional facility someone is housed in. Historically and still today, there continues to be significantly more programming offered for incarcerated women than what is available for incarcerated men. It is also important to note that location of correctional facilities can have a significant impact on how often parents are able to see their children. For instance, if a woman is convicted of a federal offense she will not serve her sentence in the state because there are no federal correctional institutions in the state of Oregon. The closest a woman could be housed for her sentence would be in Dublin, CA or Seattle, WA. Geographical distances can have significant impacts on the frequency families can see one another.

The Oregon Department of Corrections (DOC) offers family preservation programs that assist incarcerated parents to develop parenting skills. The Pathfinders Network is an organization that teaches a 12 week parenting program to both men and women in DOC. In addition to the parenting curriculum, they also provide support for visitation outside of custody. DOC assists incarcerated women who have an open child welfare case with the Department of Human Services (DHS). Head Start, a program within DOC, assists with mother and baby bonding after an incarcerated woman delivers. This program also has a breastmilk program, so new mothers can provide breast milk to their infants. Head Start organizes multiple family engagement events including an annual carnival. These programs provide an opportunity for incarcerated mothers to develop positive memories with their children even when they are serving a prison sentence.

For example, an in-custody program in Washington State allows for incarcerated mothers to have their children in custody with them for a portion of their prison sentence (Corley, 2018).

7.3.2 Substance Use Treatment Programs

Substance use treatment programs are more common in correctional settings than mental health programming. In the Oregon Department of Corrections, there are multiple alternative incarceration programs in various correctional facilities across the state. Alternative incarceration programs are substance use treatment programs in prisons, which can be ordered at the time of sentencing by a Judge.  These programs can provide the opportunity for a sentence reduction if the incarcerated person completes the program during their term of incarceration.

Alternative incarceration programs have historically excluded people with mental disorders, including people with developmental disabilities, and people with non-white cultural backgrounds. This programming can at times be rigid and limiting. For instance, programming requires that an incarcerated person is awake for 14 hours. This can be a limiting factor for certain already-marginalized groups of people – including those who experience some mental illnesses, people with developmental disorders, and women who recently delivered an infant. There is current legislative advocacy to make pieces of alternative incarceration programming more accessible to marginalized groups of people in custody. Another point to consider is that most incarcerated people must be eligible for alternative incarceration programs in order to receive treatment. If not identified at sentencing or during the in-custody assessment phase, someone is likely to be ineligible for alternative incarceration programs. Lastly, incarcerated people are generally unable to begin treatment for their substance use disorder until six months prior to their release from custody.

7.3.3 Residential Drug Abuse Program (RDAP)

In the Bureau of Prisons, clinical staff provide substance use treatment while the person is incarcerated. Residential Drug Abuse Programs (RDAP) are offered in several BOP facilities across the United States. Clinical staff are responsible for completing assessments, developing treatment plans, and providing both group and individual treatment. This treatment program focuses on providing residential and outpatient level substance use treatment while someone is incarcerated. RDAP houses incarcerated people in separate housing to allow for them to develop and live in a pro-social community. Programming is generally nine months long and often continues upon discharge from prison. On-going treatment upon discharge allows the incarcerated person to continue to engage in treatment as they transition back into the community. The BOP works closely with U.S Probation Offices across the country and contracted treatment programs to ensure people released from BOP remain engaged for a period of time in substance use treatment programming. Benefits of RDAP include: reduced rates of relapse, criminality, and recidivism. Results have been shown to increase levels of employment and education upon release from prison, improve relationships, and improve mental disorders.

7.3.4 Mental Health Treatment

A need for mental health treatment in the Oregon Department of Corrections is identified during the assessment and intake process. If someone is determined to need mental health treatment, they become eligible for mental health treatment one year prior to release from custody. Not every person who enters custody is assessed for needing mental health treatment. Generally, someone is assessed for mental health services if they have been flagged. There is one co-occurring in-custody program in the state of Oregon.

In 2014, the federal BOP issued a national policy requiring all incarcerated people receive mental health care. This policy requires that staff who ‘observe unusual behavior that may indicate mental illness’ must report these observations to a mental health professional in the BOP. This policy also gave language and expectations around the frequency on how often mental health staff are to meet with people identified as having a mental disorder. Mental health staff in the BOP must provide an individualized treatment plan including the goals and interventions that will be utilized to meet their mental health needs.

In the Bureau of Prisons (BOP), the overwhelming majority of mental health services consist of clinical assessment, psychiatric services, group therapy, individual therapy, and crisis management. There are few specialty programs that are specific for incarcerated people diagnosed with a mental disorder. Common evidence-based programming offered in custodial settings include Dialectical behavior therapy (DBT) and Cognitive behavioral therapy (CBT).

7.3.4.1 Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a type of CBT technique that works to address maladaptive behaviors and the negative thinking that comes with these behaviors. DBT works to incorporate healthy behaviors that are less detrimental to the person. For instance, DBT is regularly used to treat people diagnosed with Bipolar Disorder and those struggling with on-going self harm. A DBT technique may include using a red marker to mark on a person’s risk instead of actually using a sharp object on their wrist to inflict self-harm. This is one of many DBT techniques that is utilized to change negative thinking patterns and negative behaviors.

7.3.4.2 Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a broad set of therapeutic techniques that is utilized to some extent in almost all clinical practices today. CBT techniques work to address the ineffective cognitions that lead to ineffective behaviors. CBT techniques are aimed at adjusting someone’s cognitions to promote behavior change. It is utilized to treat many different mental disorders and has shown to be effective for many people.