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eeagle - 1/17/2013 10:44:28 AM
Staff to Client ratio variance
Kenneth Jones
Q: Your staff to client ratio is much smaller than in my state-do you see this as a factor for success in treatment?

A: The staffing ratio is written into our certification standards, which parallel community CD treatment licensing standards.  I think that if you want to provide quality CD treatment that is based on individually assessed needs, addresses co-occurring disorders, criminality, etc, you can’t have such large caseloads that every offender is getting the exact same “services” provided only in large groups.
Caseloads that are too large can result in treatment being reduced to a set of manualized “tasks” or all education/lecture.  This won’t allow the chance for clients/offenders to really practice new behaviors in a treatment environment.  This “practice” of new behaviors and attitudes is the basis for change that you want to see, even in residential settings outside of prisons.  Sobriety and self-management isn’t easy, even for non-criminals.
So, yes, I think you need caseloads small enough to allow the clinical staff to do clinical work based on the assessed needs of the clients, for the treatment program to be effective.  That’s just my opinion.

Fred Z
This is a very good question and a very important issue.  Certainly, other things being equal having more staff is better than fewer staff.  And certainly, diverse individual needs—real needs—may require special staff responses and perhaps more staff.  And of course, an effective program, especially in correctional settings, must have staffing adequate to support a secure environment conducive to social learning.  Whatever those numbers or ratios might be, I imagine, would vary a good bit from program to program. 


But sound programming does not necessarily call for high-end staff to offender rations.  Because we have learned a fair amount over the years about the kinds of precepts and practices and support structures almost all substance abusing offenders need to acquire.  We are also learning, if not so quickly, the kinds of treatment conditions most conducive to those gains.  We know that curriculum-driven groups can be at least as interactive and engaging as they are didactic.  And while it is a really important point that practicing new behaviors and attitudes is crucial to change, it seems that happens best and most often not in individualized sessions but, given adequate support, in the flow of one’s everyday events.


Even when it comes to individual challenges to learning and personal change, we know that a sound therapeutic social environment—a good TC for example—can go a long way to helping willing individuals overcome or cope with deficits and burdens.  And well-designed curricula, workbooks particularly, can guide offenders in personalizing the early recovery process. 


In fact, many of the current crop of what we call evidence-based interventions rely largely on standardized sets of activities, ones that offenders themselves can personalize with little staff intervention.


None of which is to deny the inevitable, genuine, sometimes urgent, needs that offenders may have or present in the treatment environment.  Again, real needs need real attention.  And if the program is largely about treating individual clinical issues then of course it will need ample clinical staff.  It’s just that I would urge giving priority to—or at least seriously thinking about—focusing the program on early recovery goals that can be effectively addressed for the great mass of institutionalized offenders.  That means adopting or creating ways that both efficiently and effectively (1) deliver generalizable therapeutic goods in live social contexts, and (2) make it practical, if not easy, for offenders to personalize the content and experience of the programming.