Therapeutic Communities In Correctional Settings
The (SEEQ)*: Criminal Justice Version
Therapeutic Community Model Standards
Field Review Protocol*
* Much of the material in this document is based upon the Therapeutic Community Scale of Essential Elements Questionnaire (SEEQ, Melnick and De Leon 1993), and adaptations made by Allen I. Bernhardt. The SEEQ is based upon theoretical writings on the therapeutic community model and method (e.g., De Leon 1995). No part of this material may be reproduced in any form of printing or by any other means, electronic or mechanical, including, but not limited to photocopying, audiovisual recording and transmission, portrayal or duplication in any information storage and retrieval system without express permission from the authors of the SEEQ, and publishers, Center for Therapeutic Community Research, at NDRI, Inc. , New York, NY.
Therapeutic Community Model Standards
This instrument is intended for internal use as a working document only, and not for distribution. Scoring is based upon reviewer’s subjective interpretation of observed behavior (on-site) and objective data obtained from the provider.
Scoring Guide
0 = Program lacks this element or fails to meet this standard.
1 = Program has this element, but does not successfully engage this standard.
2 = Program has element but needs more work before meeting this standard.
3 = Program has element and is working reasonably well. Standard is met.
4 = Program has element and is working very well. Additional work is not needed in this area.
N/A = not applicable, or appropriate
Standards
Section I – TC perspective
The TC Perspective includes a four-view way of looking at the problem of substance abuse, and its treatment. It is a social model which views addiction as a disorder of the whole person. Within this view, substance abuse is a symptom and the actual physical addiction is secondary to the need for total treatment of the individual. Treatment is seen as a process of experiential learning including direct confrontation of the individual’s values, behaviors and attitudes. It takes place in a highly defined community with firm boundaries and expectations.
1.0 View of the Addictive Disorders
1.1
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The program’s written philosophy of addiction is consistent with the TC perspective.
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_____
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1.2
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In language, actions and attitude, the community clearly and consistently demonstrates adherence to the TC Perspective.
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_____
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Comments:
_____________________________________________________________
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2.0 View of the Addict
2.1
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Residents and staff clearly acknowledge and identify common personality and behavioral problems shared by all substance abusers.
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_____
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2.2
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The prevailing attitude in the community is a sense that the individual needs to make major, conscious life changes, rather than that the person is “sick” and in need of care.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
3.0 View of Recovery
3.1
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Abstinence is seen as a prerequisite to recovery, as evidence by a drug-free environment.
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_____
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3.2
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Recovery is discussed as an on-going process; continuing after treatment.
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_____
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3.3
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Residents and staff clearly identify elements of the TC Perspective (e.g. Right Living) as keys to true recovery, including global self-changes.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
4.0 View of Right Living1
4.1
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The program openly displays and promotes prosocial values, including: honesty, self-responsibility, work ethic, community responsibility, etc.
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_____
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4.2
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A common theme of all interactions in the community reflects a commitment to clearly defined values of Right Living.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section I Summary:
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_______
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section II – The Agency: Treatment Approach and Structure
The agency provides the structure, resources and framework for the treatment approach, which needs to support the TC Perspective. Lines of authority, agency policies and procedures, rules and regulations and practices should help to define the therapeutic community.
5.0 Agency Organization
5.1
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The program maintains positive and supportive relationships with all stakeholders sufficient to maintain the integrity and autonomy of the therapeutic community process.
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_____
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5.2
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The program has financial resources sufficient to maintain the integrity and autonomy of the therapeutic community process.
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_____
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5.3
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The program maintains written administrative policies and procedures that are known to the staff, and are updated at least annually.
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_____
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5.4
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The program has established “cardinal” rules (no sex, violence, substance use, etc.) which, if violated, may result in termination of client’s participation in the program.
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_____
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5.5
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There is a minimum planned duration of treatment which is based upon research and is related to the target population, with actual length varying by individual treatment plans.
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_____
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5.6
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The entire staff (clinical, admin., support, etc.) meets and communicates regularly in order to address clinical issues and to assess the functioning of the TC process.
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_____
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_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Comments:
6.0 Agency Approach to Treatment
6.1
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The primary approach to treatment is the “community-as-healer”, versus individual focus.
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_____
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6.2
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Treatment activities emphasize experiential learning (direct and vicarious); “doing” rather than “getting” therapy.
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_____
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6.3
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Residents are accountable to each other and the community on a continuous basis, fostering a strong sense of responsibility for self and others.
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_____
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6.4
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Treatment emphasizes the development of behavioral alternatives to substance use.
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_____
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6.5
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All elements of the multidimensional program are linked through the community process, which takes precedence over specific treatments.
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_____
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6.6
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The program reflects inclusion and respect for all, regardless of cultural background, gender, age, ethnicity, sexual preference and medical status (e.g. HIV).
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_____
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_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Comments:
7. 0 Staff Roles and Functions
7.1
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The clinical staff includes substance abusers in recovery, preferably with thorough knowledge of TC theory and method.
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_____
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7.2
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The locus of programmatic control is shared between staff and residents, however, the staff maintains ultimate authority, and applies it in a rational manner.
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_____
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7.3
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Throughout interactions, the staff tends to redirect individual members to the community healing process.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
8.0 Members’ Roles and Functions
8.1
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There is a clearly defined stratification of members which establishes increasing levels of responsibility and clinical status.
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_____
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8.2
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Senior residents take a responsible role in relation to junior residents, including roles such as: Running house meetings, orientation of new members, and other peer and house management functions.
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_____
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8.3
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Interpersonal relationships are reflective of appropriate boundaries as represented by the brother/sister model.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
9.0 Health/Mental Care
[Note: services in this section may be provided outside the actual TC, perhaps by other providers – particularly in the case of correctional programs. Scoring takes this into account.]
9.1
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The treatment provider works in conjunction with the host institution to allow for the provision of initial and regular physical exams, with appropriate labwork and provides for the ongoing medical care of residents, as indicated.
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_____
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9.2
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The program provides health education training in both prevention and control of threatening diseases.
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_____
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9.3
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The treatment provider works in conjunction with the host institution to allow for the provision of appropriate mental health screening and treatment, according to the target population’s needs.
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_____
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9.4
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The treatment provider works in conjunction with the host institution to allow for the integration of health/mental health services with appropriate modifications to the clinical program to accommodate special needs.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section II Summary:
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_______
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section III – Community as Therapeutic Agent
The primary therapeutic agent in the TC is the whole milieu, best defined as “community-as-healer.” The process depends upon a solid structure that provides a surrogate family and community, with distinct values and mores. Key to the process is direct, honest and immediate feedback or “mirroring,” which gives external control and definition to the individual in a way that provides “social order.”
10.0 Peers as Gate Keepers
10.1
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The prevailing mode of interaction is positive peer pressure, including confrontation and supportive feedback aimed at changing behavior and attitudes.
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_____
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10.2
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Negative behaviors and attitudes are confronted immediately and directly by peers, and this practice is seen as acceptable by the community, reinforced by it, and acts to neutralize “jailhouse” attitudes.
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_____
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10.3
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The program culture fosters the development of personal relationships to facilitate individual change.
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_____
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10.4
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Peers are given the opportunity for input regarding behavioral sanctions to be imposed by staff.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
11. 0 Mutual Help
11.1
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Much of the actual help received by members is through informal interactions between members in the course of daily activities.
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_____
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11.2
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Therapeutic groups are held regularly, and allow members to help each other in their treatment goals.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
12.0 Enhancement of Community Belonging
12.1
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There are regular points of interaction between staff and residents that indicate a shared mission and experience, e.g., recreational activities, special events such as program anniversaries and holiday celebrations.
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_____
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12.2
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There are regularly held meetings and seminars, which serve to motivate, educate and coordinate members; and general meetings ad hoc to address negative behaviors, including the entire house
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_____
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12.3
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Residents participate in activities to mark significant program milestones (e.g. movement between program phases, scholastic achievement). attainment of treatment goals.
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_____
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12.4
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Residents and staff work together to solve community problems; residents have meaningful input into program planning.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
13.0 Contact with Outside Community [for Aftercare units]
13.1
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Contact with individuals outside the TC is limited, and closely monitored by the program.
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_____
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13.2
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Residents earn unsupervised contact with people outside the TC through clinical progress.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
14.0 Community/Clinical Management: Privileges
14.1
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There are clearly defined privileges that are earned based upon clinical progress, including status advancement.
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_____
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14.2
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Actual choices of privileges are supportive of recovery, self-enhancement, positive behavior, and values of right living.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
15.0 Community/Clinical Management: Sanctions
15.1
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There are clearly defined behavioral norms that govern resident behavior.
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_____
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15.2
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Sanctions for violation of rules are well defined, and known by all residents; including learning experiences.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
16.0 Community/Clinical Management: Surveillance
16.1
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The treatment provider, in conjunction with the host institution, will allow for the conducting of regular and random urine screening, including testing for probable cause, using a reliable system.
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_____
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16.2
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There is a well-documented system (e.g., sign-in/sign-out logs) that keeps continuous track of the whereabouts of all residents.
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_____
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16.3
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The program screens belongings and conducts “room runs” in order to minimize the presence of contraband and drugs.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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Section III Summary:
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_______
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section IV – Educational and Work Activities
The TC is structured as an educational experience, teaching right living and responsibility in addition to independent living skills. The structure of job functions has as a secondary goal the maximization of employability. In addition, the TC should provide formal educational assessment and instruction to support high school completion.
17.0 Formal Educational Elements
[Educational and vocational elements may be provided off-site, and by another provider, particularly in corrections program. Scoring will account for this.]
17.1
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The program supports and encourages resident participation in available educational assessment and instructional services on-site.
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_____
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17.2
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The program supports and encourages resident participation in available vocational training, including actual job preparation.
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_____
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17.3
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The program includes seminars that enhance independent living skills and contains a learning lab to assist participants in such areas as GED preparation, English as a Second Language, and other tutoring.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
18.0 Therapeutic-Educational Elements
18.1
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A major focus of member learning is on the development of affective skills, including the ability to identify and express feelings in an appropriate manner.
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_____
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18.2
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Conflict resolution and decision making skills are emphasized in the clinical program.
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_____
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18.3
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The program includes formal and informal training in relapse prevention.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
19.0 Work as Therapy
19.1
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There is a clearly defined hierarchical structure of levels of resident job functions.
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_____
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19.2
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Members perform all possible house chores, e.g. cleaning, maintenance, etc.
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_____
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19.3
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Work is used to fully support the clinical program goals and to reinforce the sense of community and individual self-esteem.
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_____
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19.4
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A key clinical focus of job functions is to improve the participant’s ability both to give direction to subordinates and to take direction from superiors.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section IV Summary:
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_______
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section V – Formal Therapeutic Elements
In addition to the 24-hour per day therapeutic process of the TC, group counseling (especially encounter) is the primary therapeutic element. Individual and family counseling are adjunctive and serve to enhance the TC process. Substance abuse counseling is relatively informal and includes role modeling and mentoring by ex-addict staff, as well as personal sharing.
20.0 General Therapeutic Techniques
20.1
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Confrontation focuses on negative behavior and attitudes, not on the individual.
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_____
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20.2
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Members are encouraged to “act as if” as a means of developing a positive attitude.
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_____
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20.3
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In the balance, peer feedback occurs more frequently than staff counseling.
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_____
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20.4
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The program prohibits public humiliation, physical punishment, and the withholding of sleep, food, water, and the use of the toilet.
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_____
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
21.0 Groups as Therapeutic Agents
21.1
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The program uses groups as a primary clinical intervention, including: encounters, probes, marathons, tutorials, etc.
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_____
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Comments:
22.0 Counseling Techniques
22.1
|
Counselors’ interactions with residents contain a high degree of positive role modeling.
|
_____
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22.2
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Staff counseling techniques include didactics, personal sharing and redirecting members to the peer/community process.
|
_____
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22.3
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Staff counselors meet individually with residents on a regular basis no less than twice monthly.
|
_____
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Comments:
23.0 Role of the Family
23.1
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Where applicable, family services are provided as determined by individual treatment plans.
|
_____
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23.2
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Where appropriate, the family is utilized as a therapeutic or behavior management agent.
|
_____
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Comments:
Section V Summary:
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_______
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section VI – Process
The program is segmented into distinct phases that enable residents to gauge their progress, and to generate personal motivation to continue treatment to completion. The stages of treatment generally reflect classic therapeutic process, but allow more formal transition and rites of passage, a corrective experience in the rehabilitation of addicts.
24.0 Stages of Treatment
24.1
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The program is designed in 3 main stages, each with clearly defined goals, activities, and member expectations.
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_____
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Comments:
25.0 Introductory Period
25.1
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Activities of the orientation/induction period are clearly aimed at assimilating the new resident into the community.
|
_____
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25.2
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A complete psychosocial assessment is completed in writing within 10 days of admission.
|
_____
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Comments:
26.0 Primary Treatment Stage
26.1
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Major goals of primary treatment include full incorporation into the community process, focus on abstinence and psychological growth.
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_____
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26.2
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This phase emphasizes full use of the positive reinforcement of privilege and status level systems.
|
_____
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26.3
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Members develop job readiness skills, strengths in interpersonal relationships in the workplace and resolve authority relationship problems in order to improve employability.
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_____
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_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Comments:
27.0 Community Re-entry Period
27.1
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The major clinical focus of re-entry is on preparation for transition to living in the community, family reintegration and development of an aftercare plan.
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_____
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27.2
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Re-entry/aftercare plans include a clear list of personal objectives such as: employment and/or education/training, support network, family reintegration, living arrangements, transportation, savings, and continuing treatment as indicated.
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_____
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27.3
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The program provides for continuity of care via referral to appropriate service providers.
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_____
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_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Comments:
Section VI Summary:
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_______
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section VII - Administration
Therapeutic communities are now impacted by significant external forces that require accountability. Administrative activities need to continuously interface with local, state and federal agencies, and other funding and regulatory entities. Matching the demands of these with the unique characteristics of the therapeutic community necessitates proactive approaches from administrative units.
28.0 Quality Assurance
28.1
|
The agency has a written plan and conducts identifiable quality assurance activities, and documents same.
|
_____
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28.2
|
The quality assurance oversight body is situated in a manner that insures corrective action takes place in a timely fashion
|
_____
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28.3
|
Each resident has a written treatment plan, which is reviewed and updated regularly.
|
_____
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28.4
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The program demonstrates its commitment to documenting the effectiveness of treatment through the maintenance of record-keeping systems that will facilitate analysis of program performance, and through its willingness to participate in evaluation studies and criminal justice system follow-up.
|
_____
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28.5
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There is an ongoing effort to support each resident’s staying in treatment as long as necessary.
|
_____
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29.0 Staff Training
29.1
|
The agency is committed to ongoing enhancement of the TC through assessment of training needs, provision of relevant staff training and regular communication with other TC’s.
|
_____
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29.2
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There is documentation of attendance at all required staff trainings, and evidence of an ongoing schedule of activities.
|
_____
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30.0 Physical Plant
30.1
|
The facility is clean, safe and adequate in space to meet the needs of the population.
|
_____
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30.2
|
The facility meets all applicable fire/safety and building codes, and local, state and federal regulations, including licensing.
|
_____
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31.0 Client Records
31.1
|
The agency maintains clinical records in a manner that meets regulatory requirements, but also facilitates clinical work.
|
_____
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31.2
|
Confidentiality is clearly maintained in the handling of all client-identifying materials.
|
_____
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Section VII Summary:
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_______
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Section VIII – Corrections Programs
While most of the key elements of corrections-based TC’s are common to all TC’s, some unique characteristics are essential in the appropriate application of the model to the environment of prisons.
32.0 Corrections-Based TC Standards
32.1
|
The political/fiscal environment enables the TC to maintain its integrity, while insuring safe integration into the prison population.
|
_____
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32.2
|
The TC program operates within a distinct space, separate from the main prison population.
|
_____
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32.3
|
In the balance, the environment is supportive of identification with the TC culture.
|
_____
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32.4
|
The area in which the TC is housed is clean and well-maintained.
|
_____
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32.5
|
Where permissible, the TC staff includes ex-inmates who provide appropriate role modeling.
|
_____
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32.6
|
The program length-of-stay is adequate to provide necessary rehabilitation and preparation for re-entry.
|
_____
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32.7
|
Program participants agree to be subject to sanctions for infractions of program rules that may involve the loss of program status or privileges.
|
_____
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Section VIII Summary:
|
_______
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Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Overall Summary
Section I ______
Section II ______
Section III ______
Section IV ______
Section V ______
Section VI ______
Section VII ______
Section VIII (Corrections only) ______
Comments:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
References
De Leon, G. (1995). Therapeutic communities for addictions: A theoretical framework. International Journal on Addictions, 30 (12), 1603-1645.
Kerr, D.H. Certification Manual, Task Force on Credentialing. Newark, NJ: Therapeutic Communities of America.
Sugarman, B. (1986). Structure, variations, and context: A sociological review of therapeutic community. In G. De Leon & J.T. Ziegenfuss, Jr. (Eds.), Therapeutic communities for Addictions. Springfield, IL: Charles C. Thomas Publishers.
1 “Right Living” refers to an understanding that particular lifestyle and behavioral choices lead to physical and mental health, and a positive and prosocial outlook on life overall.
