Researchers at the Treatment Research Institute developed a pilot project to train public defenders in Pennsylvania to identify clients with substance abuse issues and refer them to appropriate health and social services. The institute is a Philadelphia-based nonprofit group specializing in research affecting addiction and substance use practice and policy.
According to the researchers, "this is the first time the addiction field has conceptualized an intervention specifically for public defenders."
Researchers used the CASPAR Resource Guide that Treatment Research Institute developed as part of prior research efforts under the direction of Deni Carise, PhD.
During the grant period, project staff:
- Surveyed the chief public defenders in 24 Pennsylvania counties about their knowledge, attitudes and current practices in asking clients about substance abuse and making appropriate referrals. The survey took place from November 2008 through March 2009. Researchers also interviewed eight chief public defenders on the same topics.
- Developed standardized procedures for public defenders to use to detect, advise and refer substance-abusing offenders to necessary services. The detection component included nine questions about drug and alcohol use and was based on a modified version of the World Health Organization's "Alcohol, Smoking, and Substance Involvement Screening Test" (WHO-ASSIST).
- Piloted and evaluated the use of DARTS procedures by 14 public defenders in Montgomery County, Pa., over a three-month period beginning in March 2009. The participants attended training sessions earlier in the month to guide them in the use of these procedures.
Researchers conducted baseline and follow-up surveys with the participating public defenders to assess their use of DARTS procedures (10 surveys were completed). They also conducted a focus group with 12 participants and reviewed client folders to determine whether the required forms had been completed and filed appropriately.
The Pennsylvania Continuing Lawyer Education Board offered credits for completing the DARTS training.
- Researchers created a website describing the project and presented a poster of preliminary findings at the annual Addictions Health Services Research conference held in San Francisco in October 2009.
Key Findings: Pre-Pilot Survey: In 24 surveys completed by chief public defenders prior to the launch of the pilot:
- Approximately 79 percent agreed or strongly agreed that most clients represented by public defenders in their counties need alcohol or drug treatment. All agreed or strongly agreed that it is important to know whether a client has an alcohol or drug problem.
- Some 83 percent believed that public defenders in their counties were expected to ask their clients about substance use, but only 33 percent believed they were trained to do so.
- Approximately 58 percent believed that public defenders in their counties would be interested in learning how to talk to clients about alcohol and drug use, and about 63 percent believed that their public defenders would be interested in learning to help those clients.
Assessing the Pilot: In follow-up surveys completed by 10 chief public defenders who participated in the pilot:
- Approximately 60 percent said that they have routinely asked their clients about substance abuse since receiving DARTS training.
- Some 80 percent believed the training should be offered to public defenders in all states.
The review of client folders suggested, however, that actual use was much more limited and the focus group following the pilot revealed a number of barriers. In particular, a majority of the participants thought DARTS procedures were too lengthy, too structured and not necessarily appropriate for all clients. They preferred to ask questions about substance use when it seemed suitable within the context of the case and only when they believed the client might benefit from the conversation.
Many public defenders who used the social service directory expressed frustration about the dearth of treatment resources available to their clients. Some noted that their clients might benefit more from information about how to apply for benefits.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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