For the Defense - Vol. 8, Issue 3 - 58

management programs, financial assistance, and mental health
and substance use services, as well as receive housing vouchers.
The DRP was developed in 2015 and began accepting referrals
from the STAR program in that year. This development was in
response to a need for risk-reducing assessment and intervention
services for individuals returning to the community postincarceration.
The treatment provided by the DRP addresses
clients' needs by incorporating essential skills and problemsolving
sessions relevant to the stressors and demands frequently
experienced during reentry. The DRP prioritizes reducing
the likelihood of recidivism and continued engagement in
behaviors that negatively affect an individual's quality of life
following release. The DRP operates within a training clinic
(the Psychological Services Center, or PSC) for doctoral trainees
in clinical psychology at Drexel University. The PSC provides
evidence-based, affordable assessment and treatment to
residents of Philadelphia and surrounding areas, including those
enrolled within the STAR program. The DRP is directed by a
licensed clinical psychologist, coordinated by three doctoral level
students, and staffed by clinical trainees from Drexel as well as
several other universities within the surrounding area. Students
participate in weekly group supervision, during which recorded
session content is reviewed by the supervisor and treatment team.
Students also receive weekly, individual supervision provided by
more experienced students on the team.
The DRP maintains active communication with the STAR
program, although the information is limited as to not violate
confidentiality agreements. After each session, the STAR program
receives an email describing the client's attendance, participation,
homework completion, and program completion status. The
DRP does not disclose specific information discussed during
client sessions, aside from probation violations and information
relevant to mandated reporting or protective actions related
to harm to self or others. Clinicians encourage their clients to
disclose violations directly to their probation officer and support
open communication with the STAR program. In addition to
weekly correspondence, the DRP coordinates quarterly meetings
during which probation provides client updates and feedback for
treatment providers, and the DRP provides programmatic updates
and raises concerns related to attendance and participation.
Clinicians frequently collaborate with the STAR program to
improve session attendance. Probation officers often provide
important information regarding clients' life stressors that
are interfering with session engagement, including substance
use relapse, loss of employment, and relationship difficulties.
For clients with limited organizational skills, additional session
reminders are needed to improve attendance. Probation has
supported such efforts by calling, texting, or physically visiting
clients to remind them of upcoming sessions. Maintaining a
strong working relationship with the STAR program has been
invaluable to the success of the DRP.
Clients complete a comprehensive intake process prior to the
initiation of therapy in order to evaluate risk of re-offense and
inform treatment recommendations. The intake incorporates
various assessments that evaluate clients' (1) mental health needs,
(2) openness to change, (3) anger management skills, (4) problem
solving skills, (5) self-appraised risk domains, (6) experienced
stressful life events, (7) thinking patterns indicative of impulsivity
and continued engagement in crime, and (8) thinking patterns
58 For The Defense l Vol. 8, Issue 3
indicative of psychopathy. Treatment recommendations are
primarily informed by a semi-structured measure, the Level of
Service/Case Management Inventory, which comprehensively
addresses risk and need factors and identifies client strengths,
as well as areas that could be improved with intervention.11
Clients can be assessed as very low to very high risk, with higher
risk associated with higher intensity (frequency, duration) of
treatment. Clients are recommended to complete either one
or two treatment modules, each containing thirteen 60-minute
individual sessions administered once per week. Clients assessed
as between medium and very high risk are recommended to
complete both treatment modules. Treatment recommendations
are provided to clients during a motivational enhancement
session, during which clients are encouraged to discuss their
self-identified strengths, areas for improvement, and goals for
treatment. Clinicians review assessment results, including risk
factors relevant to treatment. The motivational enhancement
session is intended to be a collaborative discussion that welcomes
the client's perceptions of their risks and needs, which do not
always align with the information obtained through our
assessments. Although assessment is an integral part of evidencebased
practice, clients provide a more nuanced perspective on
their strengths, lived experiences, and areas for improvement.
Therefore, treatment goals are informed by both client and
clinician.
The treatment modules are informed by CBT principles, and
sessions are supplemented with skills from Acceptance and
Commitment Therapy (ACT) and Dialectical Behavioral Therapy
(DBT) to improve interpersonal effectiveness, distress tolerance,
emotion regulation, and mindfulness when indicated. The first
module is designed to incrementally increase skills relevant to
successful reentry, including values-driven decision making,
self-care; identifying thinking styles that have previously or
continue to contribute to risky behaviors; enhancing effective
communication skills; and understanding the relationship
between thoughts, feelings, and actions. The treatment modules
are intended to reflect skill acquisition and mastery before
proceeding to more advanced concepts, including problemsolving
skills that reduce thinking associated with offending
behavior reviewed within the second treatment module.
DRP clinicians have noted multiple barriers to client
engagement in therapy which have persisted through the
transition to telehealth following the COVID-19 pandemic. First,
clients are referred to the DRP from their probation officer, and
while participation in both the DRP and the STAR program is
entirely voluntary, clients often report pressure from the court to
participate in therapy services. Second, clients often struggle to
prioritize therapy when managing competing demands involving
work and family. Third, clients often struggle to develop time
management skills upon release from incarceration. Specifically,
clients transition from an environment in which every hour is
scheduled for them to having much more control over their own
schedules. Often, an early treatment target for clients involves
creating a scheduling system (e.g., agenda, phone calendar) and
setting phone alarms to remind them of session times. Fourth,
many clients have limited technological skills due to lengthy
placements within correctional facilities with few opportunities
to develop knowledge of platforms and devices frequently used
within the community. This interferes in their ability to effectively
utilize telehealth platforms, resulting in difficulty joining sessions
For the Defense - Vol. 8, Issue 3

Table of Contents for the Digital Edition of For the Defense - Vol. 8, Issue 3
