Communications and Information SharingIn order to be effective, organizations that treat those with alcohol and other drug problems who are involved in the justice system often need to share information about these individuals. Information about the treatment of substance use disorders is subject to a set of federal laws and implementing regulations (42 C.F.R. Part 2) that contain safeguards to protect patient confidentiality beyond ordinary state health privacy provisions, and even more robust, in most respects, than those provided pursuant to the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). In part, the unique legal standing accorded to this treatment information is a response to the stigma and legal jeopardy that has long been associated with substance use disorders. Therefore, judges should give careful consideration to the need to balance information sharing and system coordination against concerns for patient privacy (Boldt, 2007).
Notwithstanding the federal confidentiality restrictions, information can be disclosed by treatment providers to officials in the justice system pursuant to specialized written consent forms that apply only to patients referred to treatment by the criminal justice system. The regulations make clear that information disclosed pursuant to a criminal justice consent form may be used only in connection with the matter for which consent was obtained. Once information relating to other events is in the hands of prosecutorial officials, however, it is difficult to insure that this limitation will be meaningful. Because of the likelihood that broadly worded consent forms permitting wholesale disclosures can lead to these kinds of harms, it is important that written waivers be limited to information (often objective data and the results of urinalysis tests) which is necessary to carry out the purpose of the disclosure. In concrete terms, this means that standardized consent forms should not be used, and that the drafting of waivers should be undertaken individually in each case after careful consideration of the precise scope of the permission that is to be granted (Boldt, 2007).
Linking to Social ServicesBecause alcohol and other drug problems can often be long-term, relapsing illnesses, it is crucial to develop and sustain an integrated continuum of care among health professionals, treatment providers, justice staff, and social service agencies. Linkages to the appropriate social services are essential elements of treatment. Resources should be made available for a range of services, including educational, vocational, legal, medical, and mental health. Collaboration among community agencies requires careful planning, ongoing communication, and adequate resources to develop and maintain. Treatment planning and case management will be easier overall if these relationships already exist and can be called upon as needed.
Community supervision should incorporate treatment planning and treatment providers should be aware of justice supervision requirements. The coordination of treatment with justice planning can encourage participation in treatment and can help treatment providers incorporate correctional requirements as treatment goals. Treatment providers should collaborate with justice staff to evaluate each individual’s treatment plan and ensure that it meets correctional supervision requirements as well as that person’s changing needs, which may include housing and childcare; medical, psychiatric, and social support services; and vocational and employment assistance. Planning should incorporate the transition to community-based treatment and links to appropriate post-release services to improve the success of drug treatment and re-entry. Abstinence requirements may necessitate a rapid clinical response, such as more counseling, targeted intervention, or medications, to prevent relapse. Ongoing coordination between treatment providers and courts or parole and probation officers is important to effectively address the complex and changing needs of these individuals re-entering into the community (NIDA, 2006).
There are many more challenges to coordination between the treatment and justice systems. To overcome these and other challenges, the Institute of Medicine has recommended several actions:
To further guide planning and implementation of education and training, CSAT’s Treatment Improvement Protocol 17 Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System has a chapter on Coordinated Training for Treatment and Justice Staff available at:
For more information on confidentiality and privacy:
CSAT TIP 44,
Legal Primer to Help the Community, the
Bench and the Bar Implement Change in
the Juvenile Justice System
|For more information on
Treatment Improvement Protocol 30, Continuity of Offender Treatment for Substance Disorders from Institution to Community