Bureau of Prisons: Improved Planning Would Help BOP Evaluate and Manage Its Portfolio of Drug Education and Treatment Programs

GAO-20-423 Published: May 26, 2020. Publicly Released: May 26, 2020.
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Fast Facts

The Bureau of Prisons provides a portfolio of drug education and treatment programs to help federal inmates with substance use disorders. In fiscal year 2019, the Bureau began treating inmates with opioid use disorder via a new medication-assisted treatment program.

The Bureau is expanding this program, but hasn’t documented how it will gauge the additional agency personnel needed, how it plans to recruit and onboard them, or when the expansion will be completed.

Our 7 recommendations could help the Bureau effectively expand its medication-assisted treatment program and evaluate and manage its portfolio of drug education and treatment programs.

A Bureau of Prisons Drug Treatment Unit Decorated by Inmates to Promote Positive Values

Prison interior

Prison interior

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Highlights

What GAO Found

The Bureau of Prisons (BOP) provides a drug education program and five drug treatment programs to federal inmates. BOP's most intensive drug treatment program—the Residential Drug Abuse Program—requires inmates to reside in a treatment unit set apart from the general population. From fiscal years 2015 through 2019, BOP obligated about $584 million for its programs. In fiscal year 2019, it implemented a new medication-assisted treatment (MAT) program for inmates with opioid use disorder. This program combines cognitive behavioral therapy with the use of medications—naltrexone, buprenorphine, and methadone.

Number of Inmates Who Participated in Each of the Bureau of Prisons' (BOP) Drug Education and Treatment Programs in Fiscal Year 2019

Number of Inmates Who Participated in Each of the Bureau of Prisons' (BOP) Drug Education and Treatment Programs in Fiscal Year 2019

Notes: BOP information on participation in its drug education and treatment programs captures the total number of discrete inmates who participated in a given program at any point during fiscal year 2019. Inmates may have participated in more than one program. BOP implemented the MAT program in fiscal year 2019.

BOP is taking steps to expand its MAT program nationwide to ensure all eligible inmates have access to the program and estimates needing $76.2 million across fiscal years 2020 and 2021 to do so. However, it lacks key planning elements to ensure its significant expansion efforts are timely and effective. For example, BOP lacks documentation on its methods for determining the number of additional agency personnel it reports needing to support MAT program expansion; how it plans to recruit and onboard these personnel; and time frames and target goals for key milestones, such as when the expansion will be completed. Developing these planning elements would better position BOP to identify and complete the tasks and objectives necessary to successfully implement its MAT program.

BOP's existing plan for evaluating its drug treatment programs has not been implemented and omits key programs, including MAT. Without an updated plan for evaluating all of its programs, the agency risks continuing or implementing programs that may not be effective. BOP also lacks a plan that agency leadership can use to manage its expanded portfolio of drug education and treatment programs, particularly given the substantial financial investment of the MAT program. Developing and implementing such a plan would help ensure BOP is effectively using available resources and making informed decisions in managing its portfolio of drug education and treatment programs.

Why GAO Did This Study

BOP is responsible for managing the care and custody of approximately 175,000 federal inmates—an estimated 20 percent of whom have been diagnosed with a substance use disorder. Through its drug education and treatment programs, BOP aims to help these inmates avoid substance use after reentering society—a time when they are at a high risk of drug overdose.

GAO was asked to review BOP's efforts to provide drug treatment to federal inmates. This report (1) describes BOP's drug education and treatment programs and funding for them from fiscal years 2015 through 2019, (2) examines BOP's plans for expanding the MAT program, and (3) examines BOP's plans for evaluating and managing these programs. GAO examined program documentation and data, interviewed BOP officials regarding the provision of drug treatment, and conducted site visits that included four BOP institutions and one privately managed institution selected, in part, for the range of drug treatment programs offered.

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Recommendations

GAO is making seven recommendations to BOP, including to develop key planning elements for expanding its MAT program and to develop and implement a plan that agency leadership can use to manage its portfolio of drug treatment programs. The Department of Justice concurred with our recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status
Bureau of Prisons The Director of BOP should develop and document the agency's methods for determining the number of additional agency personnel it reports needing to support its MAT program expansion. (Recommendation 1)
Open – Partially Addressed
BOP concurred with this recommendation and is taking steps to implement it. In June 2020, BOP stated it was working to identify the number of additional agency personnel needed to support its MAT program expansion, including evaluating existing program requirements and consulting with external subject matter experts. Further, in December 2020, BOP stated that given its existing structure of providing primary care services to inmates, BOP had identified its needs for additional agency personnel. However, BOP did not provide documentation on how it identified the number of additional agency personnel it needed to fully implement the MAT program. Further, in November 2021, BOP stated that it is developing Staffing Considerations, which are used as guidelines for various disciplines and departments within BOP institutions, specifically for its MAT program personnel. In July 2022, BOP developed a plan to manage its MAT program that included a description of how it determined the number of personnel needed to support its MAT program. However, this description did not include specific numbers to support how it made this determination. To further consider the recommendation for potential closure, BOP will need to provide documentation showing the specific numbers BOP used to make its MAT staffing determination and whether BOP will use this method in the future.
Bureau of Prisons The Director of BOP should document how the agency plans to recruit and onboard additional personnel for expanding and implementing the MAT program. (Recommendation 2)
Closed – Implemented
We found that the Bureau of Prisons (BOP) could better define key planning elements, including recruitment and onboarding personnel, to expand its Medication-Assisted Treatment (MAT) program by documenting them. As a result, we recommended that BOP document its plans to recruit and onboard additional personnel for expanding and implementing the MAT program. In July 2022, BOP developed a recruitment plan that includes strategies to staff its MAT program, such as using recruitment incentives and expediting the process of converting interns to full-time staff. To help with onboarding personnel, in April 2021, BOP made a training course on MAT mandatory for all BOP staff. The recruitment plan and training materials for onboarding staff are consistent with our recommendation.
Bureau of Prisons The Director of BOP should develop and document time frames and target goals for key milestones—including a completion date—for the MAT program expansion. (Recommendation 3)
Closed – Implemented
We found that the Bureau of Prisons (BOP) could better define key planning elements, including developing and documenting time frames and target goals for key milestones, to expand its Medication-Assisted Treatment (MAT) program. As a result, we recommended that BOP develop and document time frames and target goals for key milestones-including a completion date-for the MAT program expansion. In February 2022, BOP developed a MAT program expansion plan that included time frames and target goals for milestones, such as developing a policy. In July 2022, BOP documented in its recruitment plan the target date for completing its MAT program expansion-by the end of calendar year 2022. The MAT expansion and recruitment plans are consistent with our recommendation.
Bureau of Prisons The Director of BOP should update its program evaluation plan to include the MAT program and re-prioritize the time frames for evaluating all programs in the plan based on available funding and staffing levels for conducting evaluations. (Recommendation 4)
Closed – Implemented
We found that the Bureau of Prisons (BOP) could better understand whether its drug treatment programs are effective by evaluating them. As a result, we recommended that BOP update its program evaluation plan to include the MAT program and re-prioritize the time frames for evaluating all programs in the plan based on available funding and staffing levels for conducting evaluations. In July 2021, BOP updated its program evaluation plan to include MAT. It also reprioritized the time frames for evaluating other programs. Further, in September 2021, BOP contracted with an external entity to evaluate its drug treatment programs and the statement of work for that contract has target completion time frames for conducting these evaluations. The updated program evaluation plan and statement of work are consistent with our recommendation.
Bureau of Prisons The Director of BOP should implement the revised program evaluation plan based on available funding and staffing levels for conducting them. (Recommendation 5)
Open – Partially Addressed
BOP concurred with this recommendation and in July 2021 revised the program evaluation plan based on available funding and staffing levels. Further, in September 2021, BOP contracted with an external entity to evaluate its drug treatment programs. BOP expects the external entity to complete its initial analyses in October 2022. We will continue to monitor the status of the contract to ensure the contractor's efforts to evaluate BOP's drug treatment programs proceed as planned.
Bureau of Prisons The Director of BOP should develop and document a plan for managing its portfolio of drug education and treatment programs, including the MAT program. This plan should, among other components, identify specific activities and resources necessary to achieve desired results. (Recommendation 6)
Open – Partially Addressed
BOP concurred with this recommendation and is taking steps to implement it. In December 2020, BOP stated it will develop a portfolio management plan to ensure necessary resources are secured and appropriately allocated in a manner consistent with the agency's strategic plan. Specifically, as of November 2021, BOP developed the MAT Expansion Plan, Drug Education and Treatment Programs Management Plan, and the Health Services Division Strategic Plan for 2020-2024 to manage its portfolio of drug education and treatment programs. To fully implement this recommendation, BOP will need to update these plans to include, among other components, specific activities and resources necessary to effectively manage its portfolio of drug education and treatment programs. For example, in the Drug Education and Treatment Programs Management Plan, BOP could identify (1) a goal (or desired results) for managing these programs; (2) the resources needed, such as the source and type; and (3) activities to achieve this goal. If one of BOP's goals were to be to provide the Residential Drug Abuse Program (RDAP) to 100 percent of eligible inmates then the plan should outline the specific resources needed-such as the specific number of staff-and the activities-such as the screening of all inmates and steps to ensure all eligible inmates receive RDAP-to accomplish that goal. While the Budget Submission documents provide information on the number of inmates who participated in drug treatment programs, the resource information (number of staff and total costs) is for all Inmate Care and Programs and is not specific to drug treatment.
Bureau of Prisons The Director of BOP should implement BOP's plan for managing its portfolio of drug education and treatment programs. (Recommendation 7)
Open
BOP concurred with this recommendation and indicated in December 2020 that it would provide GAO with a plan for managing its portfolio of drug education and treatment programs. In November 2021, BOP provided GAO with these plans. In July 2022, BOP provided an additional plan. We will continue to monitor actions BOP takes to implement them, including its integration of specific activities and resources necessary to effectively manage its portfolio of drug education and treatment programs-as we note in our response to BOP's actions for addressing recommendation 6.

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