In consideration of all of the evaluation activities undertaken in this grant, several recurring themes have emerged from our study. These lessons learned are offered to the community of Second Chance grantees as well as other probation, parole, or pre-trial supervision agencies struggling to effectively serve high-risk women with co-occurring mental health and substance abuse disorders.

Counseling is not enough

Based on the outcomes observed between the treatment and control groups, the provision of clinical counseling is not, by itself, enough to create long-lasting stability for women with co-occurring disorders and complex care needs. This resource needs to be part of a larger intervention and stabilization plan.

Create a community-based setting that offers the observed benefits of jail

Practitioners and participants in this program experienced unintended benefits from jail bookings of a certain length. This was made possible, in part, by the practitioners continuing to engage with the women behind bars. Some jail sentences allowed enough time for participant detox, medication access and stabilization, case planning, safety planning, and other beneficial activities. While all agreed that jail was not the ideal setting for these therapeutic activities, none were aware of an equivalent option in the community.

Promote medication access and medication monitoring

Unaddressed or poorly managed mental health symptoms often derailed participant progress and created barriers to an effective therapeutic alliance. Similarly, more medication assisted options were also needed to address the physical symptoms associated with drug and alcohol addiction.

Encourage the co-location of mental health and probation/parole services

This was another area where both the practitioners and the clients experienced benefits. For the women in the program, on-site mental health services removed transportation and other accessibility barriers to counseling. For the practitioners, co-location of services lent itself to improved communication and coordination between clinicians and the probation/parole officers. Through this coordination, resources that were once only known to clinicians or to probation officers should be shared for the purposes of coordinated case planning and intervention.

Invest in more low barrier, community-based housing

Based on recurring themes arising in the qualitative data, a lack of available, low barrier housing created routine challenges in locating and engaging with these women. Many of the women in the program had been disruptive and subsequently banned from the few housing services in the community. Housing challenges kept preempting the participant from making sustainable forward progress towards a healthy, safe, and stable life.

Re-imagine short-term success and find ways to measure it

An emphasis on the long-term goals of traditional recidivism reductions diverts attention and resources from monitoring the more immediate goals of stability and sobriety. Front-end work to define “stability” and related indicators of success would help create shared expectations across practitioners and promote more monitoring and accountability to those goals.

Future studies with this population could help further refine and develop these conclusions. There are several emerging trends from the qualitative data that would benefit from a more sophisticated quantitative analysis if larger sample sizes were available. The complexity of these cases continues to raise questions about how agencies can be most effective with limited resources before probation/parole sentences end.