Treatment engagement in a prison-based Therapeutic Community: A mixed-methods approach

Area of Science:

• Correctional Health
• Addiction Treatment
• Psychology

Background:

• Mass incarceration leads to a high prevalence of substance use disorders among inmates.
• Prison-based Therapeutic Communities (TCs) are common but often yield suboptimal post-release outcomes.
• Existing evaluations lack in-depth analysis of TC treatment mechanisms.

Purpose of the Study:

• To analyze quantitative and qualitative data on prison-based TC treatment engagement.
• To investigate the mechanisms underlying TC effectiveness and limitations.
• To identify areas for improving TC program implementation and outcomes.

Main Methods:

• Mixed-methods approach combining quantitative engagement metrics with qualitative resident narratives.
• Analysis of within-person and between-person variations in treatment engagement.
• Exploration of factors such as selection bias, treatment heterogeneity, and program fidelity.

Main Results:

• Quantitative data revealed minimal within-person increases in engagement over time.
• Significant between-person variation suggests individual differences impact outcomes.
• Qualitative findings highlighted selection bias, varied treatment effects, and fidelity issues.

Conclusions:

• TC treatment engagement shows limited growth within the program.
• Factors like selection bias and program fidelity impact effectiveness.
• Program modifications are needed to improve post-release outcomes for TC graduates.