Recognizing the Need for Prisoner Input in Correctional Research

Abstract

Although evaluation has become a common component of substance abuse treatment programs in correctional settings, few evaluation designs use a mixed-methodological approach and even fewer incorporate participant interviews in the data collection process. This oversight is problematic for a number of reasons, one of which is the uniquely disadvantaged position of the subjects under study (i.e., prisoners). Using data from an evaluation of an in-prison alcohol treatment program, this article illustrates the utility of the qualitative interview in correctional research. Findings suggest that interviews are capable of providing information otherwise inaccessible through quantitative designs and identifying process and management barriers to optimal program operation. Discussion centers on implications for policy and practice enhancement.

Keywords

correctional DWI treatment program program evaluation qualitative interviews

Introduction

The widespread implementation of residential substance abuse treatment in correctional settings across the nation over the last two decades has been coupled with evaluations of program effectiveness (Knight, Simpson, & Hiller, 1999; Martin, Butzin, Saum, & Inciardi, 1999; Miller & Miller, 2010; Prendergast, Hall, Wexler, Melnick, & Cao, 2004). The assessment process entails not only addressing whether or not the treatment “works” in terms of reducing recidivism and relapse but also identifying the specific element(s) of the treatment modality responsible for observed outcomes. Few program evaluations, however, seek data from sources most capable of providing detailed information—those delivering and receiving rehabilitative services. This is problematic for a number of reasons, most notably missed data from fundamental data sources with insider knowledge of the value of the treatment. More specifically, evaluations that fail to investigate how subjects are qualitatively responding to treatment may not be able to effectively interpret a program’s holistic value.

The issue of subject input in evaluation research is an even more pointed concern within correctional settings. Prisoners are, after all, a vulnerable population whose views and experiences are often not obtained through traditional, more quantitative methods common to program evaluation (e.g., an experimental or quasi-experimental design). Too often, evaluation research includes no effort to connect treatment subjects’ experiences with modality assessment, resulting in noncontextualized findings that do not adequately inform how and why outcomes are realized. This unfortunate oversight can be remedied through mixed-methodological strategies capable of more thoroughly assessing treatment impact and success.

This study presents qualitative findings from a process evaluation of an in-prison alcohol treatment program for drunk drivers to exemplify the utility of qualitative methods in the evaluation process. In particular, we demonstrate how the use of qualitative interviewing can provide data otherwise inaccessible through more traditional approaches. Information offered by prisoners can reveal aspects of program content and operation that cannot be obtained through alternative research techniques. We further argue that interviewing, especially inmate interviews as part of a program evaluation, can enhance understanding of their everyday world in treatment, the environmental features perceived as barriers to recovery, and the degree to which services meet stakeholder expectations. These data can augment conclusions derived from a quantitative analysis and situate findings in a qualitative context.

Background

Qualitative Methods and Program Evaluation

Within the criminal justice system, program evaluation most often involves making determinations regarding effectiveness through outcome assessments. In these types of studies, effectiveness is typically indicated by recidivism which is usually operationalized by rearrest or reconviction measures, consistent with public safety interests (Belenko, 2001; Knight et al., 1999; Martin et al., 1999; Miller & Miller, 2010; Prendergast et al., 2004). A considerable body of research has also been devoted to implementation and process evaluations, no doubt resulting from the ongoing emphasis on program fidelity and accountability (see, for example, Burdon, Farabee, Prendergast, Messina, & Cartier, 2002; Prendergast, Hall, Wellisch, & Baldwin, 1999). These evaluations assess program processes and procedures to understand the connections between various program activities, rather than program impact and effectiveness, both as stand-alone studies and initial steps toward outcome assessment.

A cursory review of the extant evaluation literature reveals an overwhelming preference for quantitative inquiry (Banks & Gottfredson, 2003; Kadish, Glaser, Calhoun, & Risler, 1999; Knight et al., 1999; Martin et al., 1999; Pelissier et al., 2000; Salazar, Emshoff, Baker, & Crowley, 2007; Wexler, DeLeon, Kressel, & Peters, 1999; Wexler, Melnick, Lowe, & Peters, 1999; Whetstone & Tewksbury, 2000). Program impact and effectiveness are typically assessed through experimental, quasi-experimental, or time-series designs, all of which rely almost exclusively on the use of quantitative data. Systematic standardized quantitative data are favorable as they can be aggregated for analysis, ideally with sample representativeness enabling generalizable results and implications. Quantitative data, however, can obscure the “real-life” context in which service delivery occurs. For example, quantitative data cannot inform participants’ treatment response or program operational fidelity over time.

Qualitative techniques are often contrasted to quantitative methods as a rejection of methodological positivism that unfortunately tends to confine scientific evidence to measurable, quantitative realities (Kvale & Brinkmann, 2009). The inclusion of qualitative empiricism in program evaluation has tremendous potential for improving assessment processes through more detailed depictions of program operation, quality of treatment, participant characteristics, and, perhaps most importantly, how program processes may be related to observed quantitative outcomes. Although qualitative techniques potentially useful for evaluations range from case studies to participant observation, possibly the most relevant and frequently used approach is interviewing (Creswell, 2007; Patton, 1987; Silverman & Marvati, 2008). The qualitative research interview has unique potential for obtaining access to and describing the world of the subjects under study. This approach seeks to understand the meaning of central themes of subject experience and encourages explanations and contextualization through an open-ended data acquisition approach. These accounts and descriptions can be quite valuable to a program evaluation, particularly when assessing program fidelity.

By capturing program context and participant characteristics and dynamics, qualitative interviewing is capable of producing pragmatic knowledge providing useful information for research and applied purposes (Kvale & Brinkmann, 2009). Interviews allow for a better understanding of program operation and success through in-depth and detailed information regarding successes and failures of a program from the vantage point of active participants (Rubin & Rubin, 1995). Using qualitative methods can also begin to elucidate parts of the “black box” of treatment effects that plagues many outcome evaluations. Though several longitudinal studies of drug treatment programs have been conducted (i.e., those evaluations which include both process and outcome components; see Langworthy & Latessa, 1996; Simpson & Brown, 1999; Simpson & Curry, 1997), these are more the exception than the norm in evaluation research.

Evaluation Research in Correctional Settings

Conducting research in correctional settings poses a number of challenges, and particularly so for program evaluation (Cullen & Gendreau, 1989). Linking quantitative outcomes to what occurs during treatment can be a daunting task for evaluators since they are often not privy to program operation, content, and processes. Most evaluations of prison-based treatment suffer from a hyperfocus on recidivism where a lowered rate of reoffending is attributed to treatment program success. By not factoring participant accounts regarding treatment, outcomes such as recidivism can less easily be effectively generalized across settings and are subject to coincidence effects.

Qualitative methods have long been regarded by some to be the optimal approach to gathering data from populations that are difficult to access, including prisoners (Ferrell & Hamm, 1998; Miller, 1995; Miller & Tewksbury, 2006; Pogrebin, 2003; Ulmer & Spencer, 1999). Few, however, have done so within the context of evaluating correctional programming. Inmate input is, then, salient for evaluation research, as giving “voice” to prisoners may offer greater understanding of what constitutes effective treatment.

Due to human subjects research designation as a vulnerable population, institutional review standards and requirements for studying inmates are different from other types of human subjects and can present specific challenges. The process to simply gain access to inmates is often more arduous than other types of human subjects research (for a discussion of the issues related to prison research, see Schlosser, 2008). Given that these protections are provided during the course of a research project, why not also consider their vulnerability during the actual delivery of treatment? Prisoners are considered an at-risk population for neglect and abuse and thus similarly susceptible to receive flawed or otherwise ineffective and inefficient programming and treatment. Only the evaluator serves as an independent, outside judge of treatment quality. We argue that as prisoners are identified as vulnerable due to their incarcerated position, their accounts of treatment are all the more important for validating prison-based evaluations.

When prisoners are the subjects of evaluation research, political, logistical, and bureaucratic realities can, at times, interfere with the ability to access active treatment group participants. However, because of the unique data potential through qualitative methods, we submit that the benefits greatly outweigh the costs. Interviewing and observing inmates receiving treatment can provide rich, detailed information related to a variety of issues including participant selection and assessment, program delivery, institutional culture, and facility realities.

Current Research

This research summarizes the implementation and process evaluation of an in-prison treatment program focused on chronic¹ driving while intoxicated (DWI) offenders as a demonstration of the utility and value of qualitative methods in correctional research. This study involved conducting interviews with DWI program participants to gather data regarding program implementation and perceived effectiveness. The following section provides a brief overview of the treatment program, followed by a description of the methods and findings from the qualitative dimension of the evaluation.

The Treatment Program

The in-prison DWI program is a 6-month treatment program based on the principles of a cognitive-behavioral approach. Working with up to 500 offenders, participants are housed in nine dormitories and progress through six stages of treatment covering topics that include, but are not limited to, the use and abuse of alcohol, decision-making, and relapse prevention. Participants are initially screened using the Addiction Severity Index (ASI), which is designed to assess an individual’s capacity in seven areas including medical, employment, alcohol and drugs, legal, family, social, and psychiatric (McGahan, Griffith, Parente, & McLellan, 1986; McLellan, Luborsky, Cacciola, & Griffith, 1985). More broadly, the initial assessment is used to tailor program implementation to reflect specific offender needs. Treatment sessions are conducted 5 days a week by licensed substance abuse counselors who deliver all curricula. Treatment sessions are four hour and involve two hour of the Residential Drug Abuse Treatment (RDAT) curriculum,² 1 hr of workbook exercises, and 1 hr of life-skills development. The remainder of the time is spent working within the facility, attending educational and/or job training classes, participating in one-on-one counseling sessions with a psychiatrist/psychologist, or engaged in recreational activities. Counselors conduct progress assessments on each participant once a month, and all six tracts must be successfully completed to graduate.

Method

Assessment of the treatment program was conducted during two multiday site visits to the facility. The central goal of these visits was to collect information on the implementation of the treatment program from the perspective of the program participants facility administrators, and staff. Interviewing was the primary mechanism of data collection, and all interviews were conducted during one-on-one sessions with the facility administration and in small focus groups with the treatment staff (i.e., counselors) and program participants.³

Interviews serve as a well-documented strategic research method to collect in-depth, detailed data (Krueger, 1988; Maxfield & Babbie, 2008; Morgan, 1988, 1996; Shover, 1979). Interviews in this evaluation followed a semistructured format in which predetermined questions were posed and accompanied by follow-up questions to expand on subject responses and explore additional topics. Semistructured formats do not presume complete knowledge of all relevant topics, but rather engage the participants in an open, honest dialogue to better understand issues related to the subject matter.

A total of 115 program participants took part in the focus groups conducted during the two site visits. Each focus group consisted of between four and seven program participants and was moderated by two research team members to ensure reliability and accuracy in recording all information. Each focus group lasted between 45 and 60 minutes and began with an explanation of the voluntary nature of their participation and the guarantee of confidentiality. No facility administrators or staff were present during any of the focus groups, thereby ensuring that no specific participant comments would result in retaliation by facility employees. All information provided by the participants was recorded with pen and paper and maintained by the research team in a secure, locked environment with access restricted to authorized research personnel.

The focus group discussions covered a wide range of topics regarding program implementation and its potential effectiveness. Topics included a discussion of the participants’ initial arrival at the facility, their opinions regarding the content of the program, and their perceptions of program effectiveness. The research team also inquired about the participants’ perceptions regarding barriers to effective program implementation and the source of those impediments.

At the completion of the interview sessions, all comments were collated for independent review by members of the research team. Each research team member reviewed the content of the focus groups and identified the major and minor themes. Once these themes were independently identified, they were shared with other members to ensure reliability in theme identification. The themes most pertinent to program assessment are summarized below and represent the broad, collective opinions of the DWI program participants regarding program effectiveness.

Results

Three broad themes emerged from the focus groups with the 115 program participants. The participants described their transfer, arrival, and intake processes at the facility, their perceptions regarding the implementation and operation of the treatment program, and their opinions of the facility. Although quantitative analyses offer general information regarding program impact, qualitative methodologies present information and contextual understanding on specific topics.

Getting In: Transfer and Program Initiation

Program participants were initially queried about their transfer to the facility. Several respondents described the lack of information available to them regarding their transfer. For example, little or no information was offered regarding the length of time the transfer would take to accomplish, where they were being moved within the system, or if family was notified of the transfer. The lack of information created a negative, a priori impression of the program and generated suspicion and confusion among the program participants. In turn, their willingness to participate in the program was jeopardized. The participants uniformly agreed that this exerted a negative impact on their recovery experience.

On arrival at the facility, program participants described a failure by facility administrators and staff to clearly explain the goals of the program, the inmate’s role within the treatment program, and the long-term strategy or plan for the residents within this new environment. Moreover, discussions with the program participants revealed an inconsistent intake assessment process; in particular, the failure to develop individualized treatment plans was identified as a key impediment to program success. In addition, respondents consistently mentioned a lack of knowledge regarding the date of their next parole hearing or their chances of release following completion of the program. Numerous participants identified this uncertainty as a significant barrier to program effectiveness. Coupled with their transfer experience, program participants indicated that the failure to fully orientate them into the program was an impediment to building rapport between the participants and treatment staff. These findings were particularly salient as the addictions literature has identified patient engagement and rapport development as a cornerstone of treatment success (see Simpson, 2001).

Qualitative research findings regarding transfer and intake are of significant relevance for immediate actionable feedback toward program betterment. Although traditional quantitative analyses may offer general knowledge regarding the experiences of transfer and intake, qualitative methodologies can provide specific information on how transfer and intake impediments, whether real or imagined, impact program implementation and operation.

Daily Treatment: Program Delivery

Program delivery was a second broad theme discussed by program participants. The respondents described developing a working understanding of the treatment goals and objectives. In particular, they outlined how the program targets consequences of behavior, the identification of triggers leading to drinking behavior, the importance of developing new cognitive tools to improve emotional response, and an improved ability to identify and circumvent “thinking errors” that led to inappropriate behavior in the past. The RDAT component of the treatment program was reported to be the preferred treatment material.

Participants also identified several concerns regarding program delivery. Excessive repetition and redundancy in course materials and nonsequential introduction of the six treatment stages were consistently mentioned as frustrating components of the program. Others suggested the presentation style for the different modules could be altered to improve treatment delivery.

Coupling the strengths and weaknesses of program delivery, participants offered two suggestions for improvement. First program effectiveness would be strengthened if offenders were allowed to voluntarily enroll. Forced participation fosters a negative attitude in some participants thereby poisoning the environment and interrupting program delivery. The subject of coercive treatment has long been debated in the addictions treatment literature (see, for example, Wild, 1999), and there remains considerable argument over the viability of mandated recovery. Although the empirical literature is mixed in terms of the effectiveness of forcing offenders off drugs and alcohol (see Farabee, Prendergast, & Anglin, 1998), the findings presented here suggest that correctional systems consider allowing eligible offenders to volunteer for participation in treatment programs to eliminate some of the unintended consequences of mandated treatment.

Second, the respondents suggested that the treatment process could be improved if all participants received clear and accurate information regarding their next parole hearing and potential release date. The potential that the parole board would view program completion positively underscored all decisions undertaken by the participants. In other words, notwithstanding any program implementation barrier or treatment topic, the participants viewed acceptance of and participation in the program as paramount to increasing their chances of release at their parole hearing. A clear path to release would not only motivate program participants but also ensure a safe environment for treatment delivery.

Similar to the transfer and intake discussion, basic strengths and weaknesses of a program may be identified through quantitative work, but the value of interviews is exemplified by the gathering of specific information and can lead to direct and effective program modification. The specific skills participants deemed important and criticisms of program redundancy provide targeted areas for program improvement. In addition, suggestions offered by participants represent arguably the most compelling evidence for the value of qualitative research, as other analyses would not have identified these factors.

Recovery Behind Bars: The Facility

The third theme discussed by program participants was broadly grouped under the heading of the facility and encompasses participants’ comments regarding the counselors, facility services, and available privileges. Comments on these issues are most useful when interpreted through the lens of understanding how they affect treatment delivery.

Participant reactions to treatment staff were mixed. Generally, respondents offered positive responses regarding the counselors; however, some participants criticized the staff because of their lack of experience and limited authority to offer incentives for program participation. Moreover, the ratio of roughly 30 participants to one counselor was noted as problematic by the inmates.

In regard to services within the facility, program participants reported a significant shortcoming in medical services. Numerous participants described a failure to possess the necessary on-site equipment or medication, a delay in receiving or possessing medical records at the facility, and slow or ineffective staff. Negative reaction to the medical facilities was one of the most consistent responses offered by participants and represents a significant barrier to effective treatment implementation and participation.

Finally, program participants described their opinions regarding facility privileges. Generally, these comments were negative and included a lack of free time to exercise their body or reorient their mind to nontreatment related activities, the stifling facility environment consisting of treatment or boredom, limited phone access, and inconsistent visiting privileges. Recognizing the common nature of inmates complaining about the facility, it is important to acknowledge the recovery process requires a supportive environment. Furthermore, it is generally agreed that prisoners, whether in treatment or not, should maintain close ties with family if possible to ease the burden of eventual reentry (Schafer, 1994).

Collectively, the comments gathered from the program participants suggest several barriers to program implementation and effectiveness. Transfer and intake issues, treatment delivery limitations, and facility characteristics all combine to limit the effectiveness of this program. Although quantitative analyses could uncover and generally inform these issues, the specificity and nuance of them are best understood through qualitative methodologies.

Discussion

Evaluating the effectiveness of correctional treatment programs is a daunting task for the social and behavioral sciences. There are few endeavors, however, more central to criminal justice policy and practice in the United States. Billions of dollars are spent on millions of prisoners each year, and the majority of these offenders are seriously involved with drugs and alcohol (Bureau of Justice Statistics, 1998, 2007, 2008). Mandatory treatment appears, then, a viable option for a system strained by nearly 30 years of explosive growth. Determination of program success or impact remains central for coherent policy implementation and resource allocation, and evaluation research should be carefully designed and executed to inform these decisions.

Toward that end, this paper explored the utility of qualitative interviewing in an evaluation of a prison-based alcohol treatment program for chronic DWI offenders. We attempted to use these interviews as a means of accessing data otherwise unavailable. In particular, we hoped that the unique perspective offered by the prisoners themselves would allow us to offer better recommendations for policy and practice related to mandatory substance abuse treatment.

Data gathered through inmate interviews produced several specific recommendations. First, the research team was made aware of the inconsistencies in the intake process and the subsequent problems this posed for initial patient engagement and rapport development. Moreover, inmates reported a lack of fidelity regarding the individual treatment plans (ITPs) which were touted as the cornerstone of the treatment process. In effect, treatment was largely delivered through a “cookie-cutter” approach to addiction where all patients were viewed similarly.

Second, these interviews elucidated the fact that the treatment material, which is intended to be delivered in six sequential stages, was being presented out of order. Though the intervention itself was conceived in a best practices approach, the delivery was convoluted and problematic. Furthermore, the inmates found the material repetitive and redundant, which affected their level of engagement throughout the program.

Finally, the inmate interviews provided the research team with a thorough depiction of the everyday world of the treatment program and, thus, their recovery experience. Serious problems with the medical services, facility privileges, and access to family members were all highlighted by the inmates during the interviews. This information allowed the evaluation team to offer immediate feedback to the facility administrators toward the goal of improving patient experiences while in treatment.

The findings generated from this study contribute to the extant evaluation literature in a number of important ways. Primarily, this study confirmed the value of qualitative methods, interviewing in particular, for conducting evaluation research. The interviewing of the inmates themselves allowed for the identification and discussion of the themes most relevant to effective program implementation in the view of those who receive treatment. This information is critical to understanding the strengths and weaknesses of the program under evaluation.

Importantly, the aforementioned barriers to effective program implementation are not always readily apparent in quantitative analyses. Qualitative results offer a detailed and substantive view regarding effective program delivery that is not available using traditional quantitative methods. Although quantitative analyses are a highly important tool to assess program outcomes (i.e., whether recidivism is decreased), qualitative analyses such as these present important insights into the specific processes associated with treatment delivery and evaluation research. Quantitative methods can inform an evaluation, however, without the benefit of speaking directly to participants, quantitative analyses cannot contextualize the experiences and perspectives of the participants. Thus, the specific description and intensity of the themes discussed by the program participants offer a unique and crucial perspective on the implementation of this treatment program. More broadly, these themes exemplify the strength of employing qualitative methods to further inform all types of evaluation research.

The use of qualitative methods in evaluation research does not only offer a better understanding of the totality of the program and its day-to-day operation, it also provides specific information that can be used to contextualize quantitative findings and offer directions for policy and practice. The majority of incarcerated offenders have a problem with drugs and alcohol (many of whose use of these substances is the very behavior that has led to their incarceration) and drug treatment in prison has perhaps the greatest potential for disrupting the drugs-crime nexus. From a policy standpoint, these types of programs will be most effective when they are adequately evaluated and modified as necessary. Here, we make the argument that policy and practice can be better informed and much improved if evaluations of such treatment programs are conducted to maximize data acquisition. We contend that the qualitative interview can be an invaluable source of such information, particularly for process evaluations.

This article is not intended as a criticism of quantitative methods but rather as advocacy for mixed-methodological approaches in evaluation research. Not only do inmates have considerable data to offer an evaluation but also their reports can alert evaluators and stakeholders to abuses, violations, or other program-related problems that can be addressed more expeditiously. The findings presented here suggests that qualitative methods can enhance an evaluator’s ability to offer specific recommendations regarding policy and practice and enhance program operation in both the short term and long term.

Footnotes

Points of view are those of the authors and do not necessarily reflect the official positions of the Texas Legislative Budget Board.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Texas Legislative Budget Board, contract no. LBB 2008 CJ 1001.

Notes

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