JSTEPS: Developing A Program
With Rewards and Sanctions
Drug Courts and Enhanced
Supervision Are Making
A Difference
Shifting focus from incarceration to treatment
€ Reducing cost of intervention
€ Treating drug users with hope and respect
€ Improving outcomes through structured
rewards and sanctions
€
› certificates, prizes and phase advance for meeting
goals
› penalties and revocation for poor performance
Drug Court Treatment for
Methamphetamine Dependence
Marinelli-Casey et al., 2008
Clients receiving Matrix Model tx
under drug court order (N = 57)
VERSUS
€ Clients receiving comparable Matrix
Model tx without drug court oversight
(N = 230)
€
Drug Courts Are Making A
Difference
Drug Court Conventional Tx
Remained for > 30 days (%)
80
57
Completed 16-week Tx (%)
56
32
Mean weeks retained
11
MA-free UA’s provided (%)
97
8
from: Marinelli-Casey et al., JSAT, 34, 242-48, 2008
91
Outcomes Can Improved
Negative UA’s provided by those who
stayed BUT
€ Nearly half drop out, suggesting relapse
€
€
More sophisticated and systematic
incentive and sanction programs could
potentially improve these outcomes
Positive Incentive Principles:
Review
Everyone likes to reward those who do well BUT
Incentives are meant to help those who otherwise
would not succeed in probation and/or specialized
courts. This may be up to 50% of your caseload
Set the bar low so all clients can receive
incentives; Goal is to move more into good
outcome category
Focus on the positive and always acknowledge
success!
Incentives Should be
Delivered
€
Immediately
› Delay muddies water since new behaviors have
occurred meanwhile
€
Consistently
› Following clearly established rules
€
Frequently
› To shape lower probability behavior and ‘catch
clients being good”
Concepts for Incentive Delivery
€
Rewards
› Give points for key behavior: Drug abstinence (Clean Urines)
› Escalating schedule reinforces periods of continuous
abstinence
€
Bonuses
› Bonus points awarded to acknowledge and reinforce periods
of sustained abstinence (e.g. 4 consecutive weeks)
€
RESET
› Reset penalty further motivates clients to remain abstinent
› Positive urine results in earnings “reset” back to 0
› Earnings begin again at 1 point with next negative urine &
escalate
ƒ
SPENDING EARNED POINTS
9 Clients do not ever lose points that have been earned
9 But spending may be put “on hold” during periods of
9 sanction for drug use or resolution of a new criminal charge
Concepts for Incentive Delivery
€
Supplement tangible rewards with social
praise and no cost acknowledgements
› At the PO office
› In the treatment program
› In the courtroom
St. Louis Drug Court
Judge Frank Lee Upright
This is to acknowledge that
____________________________
_
has achieved 1 Month
3 Months
6 Months
of continuous drug-negative urine
tests
Signed: _____________Date_______
Positive Incentive Principles
€
Let the incentive program work for you
€
Continue to focus on the positive
Look for a positive behavior to praise
€
Understand that nothing works for everybody
and that setbacks are the norm
Potential Role of Sanctions in a
Positive Reward System
€ Get
those who relapse back on track
more quickly
€ May
impact those not responsive to
positive incentives
› If consequences are immediate, fair,
consistent and known in advance
Case for Graduated Sanctions
€
Immediate consequences are most effective
€
A variety of sanctions are available that can be
graded in intensity and duration
€
Let the punishment fit the crime
› Save your big guns for large offenses
Adding Graduated Sanctions to an
Abstinence Incentive Program
€
Along what dimension will sanctions be graded?
€
How many levels will there be?
€
How many positive urines before sanctions kick in?
€
How many positive urines escalate sanctions to next
level?
€
What are the rules for sanction removal?
€
What happens if sanction is violated?
“Time Out” As a Response to Drug
Positive Urines
€
Client who uses drugs has succumbed to
temptations of the street
€
One appropriate response is to remove
offender from the street for period of
time
€
Time out could be used as a graded
sanction in response to positive UA’s
“Time Out” As A Sanction
€ Idea
is to restrict freedom and options
€ Kids are ordered to sit in the corner
€ CJ offenders could be ordered to spend
their time:
› In the courtroom
› In a jail cell
› At their home
Operationalizing “Time Out” as
a Graduated Sanction
€ Curfew
removes offender from street at
potentially critical times
€ Curfews
› Step 1:
› Step 2:
› Step 3:
› Step 4:
› Step 5:
can be graded in severity:
In by 12 midnight
in by 10 pm
In by 8 pm
home except for work hours
home with electronic monitoring
Graduated Sanctions Example
JSTEPS system is set up for 5 levels of
sanctions for continued drug/alcohol use
€ Example:
€
› Level 1 = 11 pm curfew
› Level 2 = 8 pm curfew
› Level 3 = house arrest
› Level 4 = electronic monitoring
› Level 5 = weekend in jail
Issues To Address In A
Graduated Sanction System
€
When to start sanctions?
› Second positive UA (after reset penalty)
€
How often to escalate?
› Each positive UA (once per week)
€
Both rules provide immediacy of response
€
Is this feasible?
Issues To Address In A
Graduated Sanction System
€
Rules for sanction removal?
› Abrupt removal with first negative UA
› Abrupt removal with XX negative UA’s
› Graduated de-escalation from final level
with consecutive negative UA’s
€
Rules for sanction violation?
› Move to next penalty level
Exercise 3:
Adding Sanctions to an
Abstinence Incentive Program
Rules For The Graduated
Sanctions Exercise
€
€
Along what dimension will sanctions be graded?
› gradual restriction of freedom via curfews
How many levels will there be?
› 5 as included in JSTEPS program
€
€
€
How many positive urines before sanctions kick in?
› 2 for immediate response
How many positive urines escalate sanctions to next
level?
› each successive positive; weekly increase in sanctions
What are the rules for sanction removal?
› cancel with first negative urine
€
Penalty for sanction violation?
› move to next sanction level
Escalating Sanction Example
UA Result
neg
neg
neg
neg
neg
pos
pos
pos
neg
neg
neg
neg
Points
1
2
3
14
5
0
0
0
1
2
3
14
Sanction Level
0
0
0
0
0
0
1 (late curfew)
2 (moderate curfew)
0
0
0
0
Escalating Sanction Example
UA Result
neg
neg
pos
pos
neg
pos
pos
pos
neg
neg
neg
pos
Points
1
2
0
0
1
0
0
0
1
2
3
0
Sanction Level
0
0
0
1 (late curfew)
0
1 (late curfew)
2 (moderate curfew)
3 (early curfew)
0
0
0
0
Exercise 4:
Adding Reinforcement for
Yellow and Green Behaviors
Incorporating Other Targets
Lots of reporting expected
› PO, treatment, court, NA/AA, voc services,
etc
€ Need to prioritize
€ May want to individualize goals
€ Suggest point distribution system where
everyone can succeed!
› 10 points that team can distribute in tailored
manner for meeting current behavioral goals
€
Rewarding Yellow and
Green Behaviors
€
Yellow = Attendance behaviors
Green = Other requirements and expectations
€
Assign points for 3 attendances expected of all clients
€
› e.g. PO visit, Tx sessions; self-help meetings
€
Assign individualized points for up to 3 other behaviors
(depending on where client is in program)
› e.g. completing essays; honest drug use reporting; taking
steps toward employment
Rewarding Yellow and
Green Behaviors
€
Yellow and Green points can (and should) be awarded
independent of urine test results
€
Points earned cannot be taken away
€
However, points may not be SPENT if client is currently in
sanction for positive UA’s or recent arrest
Point Distribution Example
Behavior
Visited PO
Attended 3 Tx sessions
Attended most NA
Applied to voc rehab
Wrote assigned essay
Total points
Weekly Points
Awarded
1
3
2
3
1
10
Point Distribution Example
Behavior
Weekly Points
Awarded
Visited PO
Attended one Tx session
Attended one NA
Gave honest drug use rpt
Wrote assigned essay
1
1
1
3
1
Total points
7