adapting programs to incorporate ebps for cj-involved clients merrill rotter, md medical director,...
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Adapting Programs to Incorporate EBPs for CJ-Involved Clients
Merrill Rotter, MDMedical Director, EAC TASC Mental Health Programs
Associate Clinical Professor, Albert Einstein College of [email protected]
Why Incorporate EBPs
Engagement Clinical Improvement Decrease Untoward Behavior Improved quality of life Decreased recidivism (re-arrest)
RNR and EBPs
ResponsivityEngagementCBT intervention
NeedsThe Central Eight
Risk Match treatment intensity to level of risk
Needs Treat the offender, not the offense
Responsivity Modality must be one to which offender is responsive
CBT Engagement
Responsivity Principle
Responsivity:Tailoring Treatment
General Responsive to learning styles
e.g. CBT
Specific Responsive to socio-biological
personality factors Engagement
Why focus on engagement?
Treatment outcome and premature termination predicted by engagement Treatment outcome related to patient
effort Manner of therapist related to
engagement and effort
Engagement Challenges
Motivation Motivational Interviewing IMR Goal Setting Focus on Recovery
CJ culture Adaptation SPECTRM Intervention
SPECTRMThe Clinical Impact of
Doing Time
RiskNeeds
Responsivity
Trauma InformedTreatment
Cultural Competence
Trauma
Consequences Isolation Hypervigilance Emotional reactivity
Intervention principles Safe environment Processing of Trauma Identification of coping strategies
Cultural Competence
Cultural Proficiency Meaning of symptoms, illness, stressors Meaning of treatment Relationship with professionals
Overcoming mistrust Communication Rapport Disclosure
Using “natural” community support
These walls are kind of funny. First you hate 'em, then you get used to 'em. Enough time passes, gets so you depend on them. That's institutionalized.
Incarceration as Cultural Adaptation
AKA: The Inmate Code
Do Your Own Time
Mind Your Own Business
Trust No One
Show Respect
Ignore Others’ Infractions
Don’t Steal
Don’t Snitch
Don’t Show Weakness
Don’t Stare
Promote Cultural Re-adaptation by
Connecting Developing trust through shared experience
Exploring Challenging prison and jail attitudes
Changing Introducing new problem solving skills
Three Principles
CONNECTING Be willing to listen and learn: Where were you and what
was it like?
EXPLORING Be aware of differences and similarities in the two cultures:
What are the cues?
CHANGING Be neutral: Is it working for you here?
Needs PrincipleThe Central Eight
History of antisocial behavior Antisocial personality pattern
Pleasure seeking, restless, aggressive Antisocial cognitions
Attitudes supportive of crime Antisocial Associates Family support Leisure Activities School/work Substance Abuse
Needs - Interventions
Substance Abuse Integrated Treatment People, places and things
Family support Multi-family therapy
School/Work Supported Employment
Homelessness Housing first
Antisocial Cognitions/Associates/Character Monitoring Cognitive behavioral interventions
Cognitive-Behavioral InterventionsCJ-Involved Populations
Introspection skills Cognitive Restructuring
Problem Solving Identification of cognitions Cost-benefit analysis
Social Skills Conflict Resolution
Moral Reasoning/Community Responsibility
Cognitive-Behavioral AdaptationsCJ-Involved Populations
Thinking for a Change National Institute of Corrections
Lifestyle Change Journaling The Change Companies
Reasoning and Rehabilitation Moral Reconation Therapy
Cognitive-Behavioral InterventionsCJ-Involved Populations
MH Program adaptations
Target symptoms Frustration intolerance Social skills Misperception of environment
Examples Forensic DBT
Jail - decreased anger, aggression and incidents Community - decreased re-arrests in stalker-focused
program
RNR
Merrill Rotter, MDMedical Director, EAC TASC Mental Health Programs
Associate Clinical Professor, Albert Einstein College of Medicine