The prison-based Therapeutic Community: Resident recommendations for program improvement

Area of Science:

• Correctional Health
• Addiction Treatment
• Program Evaluation

Background:

• Prison-based Therapeutic Communities (TCs) are a common intervention for substance use disorders (SUDs) in correctional settings.
• While generally effective, recent mixed findings and the ongoing opioid crisis necessitate a closer look at TC operations and participant engagement.
• Participant perspectives are crucial for understanding variable treatment engagement but are often missing from evaluations.

Purpose of the Study:

• To explore prison-based TC resident perceptions and recommendations for program enhancement.
• To identify barriers to engagement and sources of treatment effect heterogeneity from the participant viewpoint.

Main Methods:

• Utilized data from the Therapeutic Community Prison Inmate Network Study (TC-PINS).
• Analyzed 470 responses from 177 residents to the open-ended question: "What can the TC do better?"
• Employed two independent coders to identify seven categories of recommended improvements.

Main Results:

• Residents offered practical suggestions for improving their TC program.
• Some recommendations challenged the core TC model, indicating implementation issues within prisons.
• Key suggestions included enhanced structure, individualized care, curriculum expansion, stricter rule enforcement, and better staff training/experience.

Conclusions:

• Resident feedback reveals critical insights into treatment heterogeneity and engagement barriers.
• Tangible program modifications can be made based on participant perceptions.
• Eliciting participant feedback is vital and feasible for improving correctional SUD treatment programs.