Response: the claims of public health and public safety.

Jennifer Mankey: The overall message of the article, I think, is most appropriate in this era of decreased funding for treatment, criminal justice, and behavioral and medical services. The purposeful, improved sorting and matching of offenders to the most appropriate treatment and supervision can help us to use our scarce resources most effectively, while maintaining community safety. William Wendt: The message certainly rings true to folks in our system. But the issue of having offenders in treatment for 12 months to maximize outcomes is of concern to providers because of funding. There aren’t enough resources to keep folks in treatment for that period of time. Allan Cohen: The author makes a compelling argument for the integrated approach. But while he points out that highly structured cognitive-behavioral therapy [CBT] works very well for the high-risk group, these are very expensive programs to run. I don’t know whether or how widely that could be adopted in community treatment programs. I don’t know if there is enough money for training and paying staff for those interventions. Money aside, training people to do structured, contingency-management, cognitive-behavioral therapies is not easy. Mankey: That’s true, but I think that we need to rise to the challenge. In Colorado, some probation officers deliver CBT to their clients. I wonder whether, in communities where teaching CBT would be a particular burden to treatment providers, the probation department and treatment programs could integrate what they both are using for these patients. Cohen: They could use manualized treatment models like the Matrix model. That would facilitate their joint role. After reading Dr. Marlowe’s work, I am more encouraged about serving these patients. My sense is that we’re getting better at addressing these issues, and that there is hope for bigger strides in the future. Wendt: It’s a tough road, but we are getting there, with more collaboration between the systems and blended funding. Mankey: I agree. And there is finally good research coming out that can help guide us in the juvenile offender field. Cohen: I’d like to know more about what it is that really makes the difference for these patients. Dr. Marlowe’s article suggests that a coercive factor is very important in the outcomes. I’d like to know a little bit more about what other specific factors do or don’t relate to treatment outcomes.