In this section, you will learn the importance of prioritizing resources and targeting intervention strategies based on system and individual factors. Clearly, given the diversity of the jail population, unpredictable lengths of stay, limited resources, and principles of evidence-based practice, it is not possible or desirable to provide the same level of intervention to everyone who enters the jail setting.
In fact, to obtain an optimum level of efficiency and effectiveness, quick screening tools should be used to separate low-risk offenders from their medium- and high- risk counterparts. The key is to match the right person to the right resources so that higher risk individuals receive more intensive interventions in the jail and the community.
This research-driven practice of targeting the needs of higher risk offenders is often controversial. Many jails and communities tend to “over-program” lower risk offenders and use valuable resources to change their behavior despite the fact that intensive programming of lower risk offenders is likely to make them worse rather than better. As a part of such a practice, not only does it make lower risk offenders worse, but valuable treatment opportunities are missed for higher risk offenders who are far more likely to reoffend at a much higher rate and frequency than their lower risk counterparts. Therefore, the TJC project recommends a triage system to help a system determine “who gets what.”
The word triage comes from the French term “trier,” to sort. We often think of triage scenarios when natural and human disasters occur and decisions have to be made quickly to identify and treat the most seriously injured.
Triage protocols are effective because they:1
- Bring order to a chaotic situation.
- Quickly sort a large number of people on the basis of a serious condition.
- Set the path for individualized treatment.
- Facilitate a coordinated effort between jail- and community-based supervision agencies and providers.
- Are fluid enough to accommodate changes in the number of people involved in the process, the availability of resources, and the extent of need.
A jail setting is a busy and sometimes chaotic environment, but decisions still have to be made at reception to determine each individual's risk and needs. This is a particularly acute problem within a jail facility because of the rapid rate of turnover and short length of stay of most inmates. A triage matrix, tailored to the needs, resources, and timelines of your jurisdiction, will help determine the appropriate allocation of services by categorizing individuals and identifying the appropriate mix of targeted interventions.
The following case studies will help you to begin thinking about the unique risk and needs of your population.
Case study 1. Mrs. Thomas is a 42-year old, married mom of two children awaiting trail and charged with driving under the influence. She is a recovering addict, has one prior felony for drug possession for which she served 180 days in jail, and has been drug free for two years before her most recent relapse. Mrs. Thomas has also worked part-time at a convenience store for the last two years. She does not have a history of failure to appear.
Case study 2. Mr. Banks is a 33-year-old, single male serving a nine-month sentence in the county jail for possession of a half of gram of methamphetamine. Mr. Banks started using drugs when he was 12, dropped out of school in the 11th grade, and served his first prison term at 19 for robbery. He has spent 8 years in prison, the last time before his recent jail stay was for stealing a car while under the influence. At the time of his current arrest, Mr. Banks was unemployed and living in a shelter after losing his construction job for not showing up to work on time.
Case study 2. Mr. Jones is a 19-year-old, single man serving a 15-day sentence for possession of marijuana and medication (i.e., Concerta, a stimulant used to treat ADHD) for which he didn't have a prescription. Prior to his arrest, Mr. Jones had no prior criminal record, attended community college, was employed part-time as a waiter at a local eatery and lived with his mother.
Using these three case studies, ask yourself the following questions about these individuals:
- Which screenings and assessment instruments are needed to identify their risk and needs as they enter your facility?
- What are their unique risks?
- What is the likelihood of Mrs. Thomas in case study 1 appearing in court when required?
- How pressing is the need for intervention?
- How extensive is the need for intervention?
- What is the likelihood of reoffending and how severe might the crime be?
- What are their unique needs?
- Do you know their length of stay?
- What factors would you use to sort them by risk and needs?
- What type of jail and community intervention is required?
- What type of transition planning and which specific targeted interventions, if any, are needed?
Don't worry if you don't have all the answers. In this module and the next three modules, you will learn how to perform the following 11 tasks (outlined in the Targeted Intervention Strategies section of the TJC Implementation Roadmap and designed to address these and related topics):
- Complete the Triage Matrix Implementation Tool.
- Apply screening instruments to all jail entrants.
- Apply risk/needs assessment instrument(s) to selected jail entrants.
- Produce transition case plans for selected jail entrants.
- Develop pretrial practices to support jail transition
- Define scope and content of jail transition interventions currently in place.
- Provide resource packets to all jail inmates upon release.
- Deliver in-jail interventions to selected inmates.
- Deliver community interventions to selected released inmates.
- Provide case management to selected jail entrants.
- Provide mentors to selected jail entrants.
To begin, review The Triage Matrix Implementation Tool referenced in Task 1 and developed by the TJC project team to help your jurisdiction prioritize goals, identify target populations, and allocate limited resources to your jurisdiction's intervention strategies. The underlying concept is that everyone in the jail population should get some intervention, which may be as minimal as receiving basic information on community resources, but the most intensive interventions are reserved for inmates with higher risk and needs. The triage matrix includes the following four sections:
- Screening and Assessment
- Transition Case Plan
- Pre-Release Interventions
- Post-Release Interventions
The triage matrix includes a worksheet for each section and a sample matrix with all sections completed. All content in the sample triage matrix is approximate and should be adapted to fit your community. We recommend that you fill in the triage matrix as soon as possible to better understand the strengths and gaps in your present transition system.
1 United States Army, Office of the Division Surgeon, 10th Mountain Division. Presentation delivered as part of a Trauma-Focused Training. Fort Drum, NY.
2 Fretz, Ralph. 2006. What Makes a Correctional Treatment Program Effective: Do the Risk, Need, and Responsivity Principles (RNR) Make a Difference in Reducing Recidivism? Kearney, N.J.: Community Education Centers, Inc. http://www.academia.edu/31758960/What_Makes_A_Correctional_Treatment_Pro....
Section 1: Resources
- Bogue, Brad, Nancy Campbell, Mark Carey, Elyse Clawson, Dot Faust, Kate Florio, Lore Joplin, George Keiser, Billy Wasson, and William Woodward. 2004. Implementing Evidence-Based Practice in Community Corrections: The Principles of Effective Intervention. Washington, DC: National Institute of Corrections.
- Christensen, Gary. January 2008. Our System of Corrections: Do Jails Play a Role in Improving Offender Outcomes? Washington, DC: Crime and Justice Institute and the National Institute of Corrections.
- Dunworth, Terry, Jane Hannaway, John Holahan, and Margery Austin Turner. 2008. Beyond Ideology, Politics, and Guesswork: The Case for Evidence-Based Policy. Washington, D.C.: The Urban Institute.
- Urban Institute. Case planning worksheet.
- U.S. Department of Health and Human Services, Substance Abuse & Mental Health Services Administration. October 2007. A Guide to Evidence-Based Practices on the Web.
Let's revisit what we have learned so far in the Targeted Intervention Strategies module. Please answer the following question.
|The TJC Triage Matrix helps you to:|
Now that you have completed this section, you should understand that incarcerated people have varying needs. Some require intensive interventions, while others require little or no intervention. The Triage Matrix Implementation Tool and the TJC Implementation Roadmap can help you prioritize goals, identify task and target populations, and allocate resources efficiently and effectively.