Case Management Proposal

Jose L. Robles

Colorado Technical University

CJHS300 - Human Service Practice in the Criminal Justice Setting

Dr. Barry Shreve

September 4th, 2022

Case Management Proposal

When considering the substance abuse population, which was covered in Unit 3, there are

a few services that currently exist to address the specific issues regarding this population in the

surrounding community. Located in Northeastern Pennsylvania, the local community (Luzerne

County) has a population of 325,594 residents with an estimated 10,046 individuals suffering

from substance use disorder as of 2020 in which, during that same year, the community

experienced 205 overdose deaths (Kelley, 2022; United States Census Bureau, 2022).

It has long been understood that this community lacks adequate resources to

accommodate the growing number of individuals with Substance Use Disorder (SUD). This

community currently maintains numerous outpatient services specializing in drug and alcohol

use/abuse, some of which include A Better Today, Choices, Pathways, and Wyoming Valley

Drug and Alcohol Services (Luzerne County Human Services, n.d.). Yet there are only two detox

and inpatient drug and alcohol services located within Luzerne County, namely Clear Brook

Manor and Choices; one of which (Choices) is closing and no longer accepting admissions

because of a lack of staff to work in the facility. Additionally, these two locations provide limited

bedspace and admissions to inpatient services are handled by the Luzerne County Drug and

Alcohol Program Case Management Unit, which dispatches clients to other facilities throughout

the state (Luzerne County Human Services, n.d.). This community is also home to three

methadone clinics (Choices Recovery Program, Hazleton Treatment Service, and Miners

Medical), but these clinics typically carry a two-year waiting list (which has remained a two year

wait since the late 1990’s), with an exception for pregnant women (Morgan & Perks, 2002).

In recent years, private doctors offices have been expanding to offer Medication-assisted

Treatment (MAT) in the form of Suboxone or Subutex for individuals with opiate addictions.
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The community also gained a hospital-owned MAT clinic and a new, larger scale MAT service

provider called Clean Slate that offers both a prescription for the medication and therapy in the

same setting (Perks, 2015).

Yet, in spite of the expansion of practices and new servicers specializing in drug

addiction and treatment entering the area, there is still a deficit in the community’s ability to treat

all patients suffering from SUD. There are plans to move an existing methadone clinic (Miners

Medical) to a larger location to allow them to treat more patients, but may still take some time to

initiate (Lynott, 2021). There are also waiting lists for the MAT clinic named Clean Slate, but

not nearly as long as the wait lists for Methadone. Additionally, one of the struggles individuals

experience when seeking MAT is insurance coverage. Private doctors, many times, do not accept

insurance for MAT, therefore patients are forced to pay out of pocket for the in-person

appointments. Wait times for inpatient rehabilitation and detox services are much shorter

(typically two weeks to a month), yet these wait times are still not acceptable for an individual

who is in crucial need of care. When considering the types of services made available to the

community in regard to SUD, the types of services are adequate, but unfortunately there is not

enough bed space and open case loads to accommodate the amount of patients seeking

assistance. The community does have adequate numbers of Narcotics Anonymous (NA) and

Alcoholics Anonymous (AA) meetings available to the public and offers meetings during most

days and times throughout the week and weekend which accommodate differing work and

school schedules.

Overall, the SUD population within the community has many needs on many levels.

When considering the population's needs on a micro level perspective they need the individual

services, such as outpatient and counseling services, inpatient and detoxification services, and
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the option of MAT or other medication based therapies to help reduce chances of relapse. One of

the micro level resources to consider would be transportation availability to allow individuals to

attend counseling and receive methadone or MAT maintenance, as well as referrals to proper

programs which are either covered by their insurance or financially attainable.

From a mezzo standpoint, the community could benefit from things like needle

exchanges, as well as . The county correctional facility also lacks any type of drug or alcohol

addiction based counseling and group support, and relies solely on outside speakers from AA

and NA to speak to the inmate population once a month; Therefore, integration of better recovery

based programming for the jail could potentially help reduce relapse and recidivism rates within

the community. Schools within the community may also benefit from an integration of a drug

counseling program (which currently does not exist) to help reach and counsel students engaged

in drug or alcohol use.

And on a macro level, the justice system within the community would need to recognize

the severity of the area’s drug problem and adapt their sentencing guidelines accordingly. Aside

from the Re-entry services and Day Reporting Center (DRC) program which has already been

implemented. The DRC program allows for an inmate to be released at half of their minimum

county jail sentence given by the judge as long as they attend the program each day while they

are in the community (Luzerne County Courthouse, n.d.). Additional guidelines should be

implemented, such as a program which forces offenders with drug-related convictions into a

mandatory treatment setting followed by tightly supervised mandatory Intensive Outpatient

Therapy. The community may also benefit from additional funding to maintain existing halfway

houses, create new halfway house locations, and zoning and funding permissions for additional

methadone clinics and inpatient treatment locations to account for the size of the community’s
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SUD population. Government funding to create drug and alcohol programs within the

correctional facility setting may also be necessary.

As a case manager within a prison setting, all of the above mentioned community

services and barriers would be taken into consideration. When considering a client who is

suffering from SUD, it would be important to ensure they receive the treatment necessary while

both incarcerated as well as when they re-enter the community, as studies show recidivism can

be reduced by continuing care (de Andrade et al., 2018). Although no current drug programs

exist within the correctional facility in my community, it would important to ensure that the

offender receives the proper level of care, so (sentence permitting) upon their release from the

correctional facility, the offender will be released to a long term inpatient treatment facility that

focuses on the biopsychosocial needs of the client. After their release from inpatient treatment,

the client would then be referred to IOP for a minimum of 6 months and would be suggested that

they attend local AA and NA meetings, although not required. It would also be important to offer

MAT for individuals who may benefit from the program, as MAT may help prevent the

individuals from relapsing. Additionally, I find it important to offer any inmate with SUD being

released back into the community Naloxone Nasal Spray (Narcan) to help avoid an opiate

overdose, as these individuals are particularly at risk for post-release overdose mortality (Berg,

2019).
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References

Berg, J. (2019, March 15). Breaking the Cycle: Medication Assisted Treatment (MAT) in

the Criminal Justice System. SAMHSA. Retrieved September 5, 2022, from

https://www.samhsa.gov/blog/breaking-cycle-medication-assisted-treatment-mat-

criminal-justice-system

de Andrade, D., Ritchie, J., Rowlands, M., Mann, E., & Hides, L. (2018, May 03).

Substance Use and Recidivism Outcomes for Prison-Based Drug and Alcohol

Interventions. Epidemiologic Reviews, 40(1), 121-133.

https://doi.org/10.1093/epirev/mxy004

Kelley, C. (2022, August 12). The Opioid Crisis in Pennsylvania: Spotlight on Luzerne

County. Pinnacle Treatment Centers. Retrieved September 4, 2022, from

https://pinnacletreatment.com/blog/opioid-crisis-luzerne-county-pa/

Luzerne County Courthouse. (n.d.). Re-Entry & DRC. Luzerne County. Retrieved

September 5, 2022, from https://www.luzernecounty.org/570/Re-EntryDay-Reporting-

Center

Luzerne County Human Services. (n.d.). Treatment Service Providers. Luzerne County.

Retrieved September 4, 2022, from https://www.luzernecounty.org/405/Treatment-

Service-Providers

Lynott, J. (2021, April 28). Methadone clinic proposed for Wilkes-Barre gets zoning

approval. Times Leader. Retrieved September 4, 2022, from

https://www.timesleader.com/news/1338085/methadone-clinic-proposed-for-wilkes-

barre-gets-zoning-approval
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Morgan, T., & Perks, M. (2002, April 21). A Fight To Improve Their Lives Local

Methadone Clinic Would ... Times Leader.

https://www.timesleader.com/archive/1019925/a-fight-to-improve-their-lives-local-

methadone-clinic-would-brighten-future-with-son-couple-says

Perks, M. (2015, September 18). Jesse Mayhew: New CleanSlate Center in Wilkes-Barre

differs from ‘drug rehab facility’. Times Leader. Retrieved September 4, 2022, from

https://www.timesleader.com/opinion/columns/404347/jesse-mayhew-new-cleanslate-

center-in-wilkes-barre-differs-from-drug-rehab-facility

United States Census Bureau. (2022). Luzerne County, Pennsylvania. Census Bureau.

Retrieved September 4, 2022, from

https://www.census.gov/quickfacts/luzernecountypennsylvania