criminogenic risk and mental health: what works and what ...• 100-bed secure residential facility...
TRANSCRIPT
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Criminogenic Risk and Mental Health: What
Works and What Doesn’t in Reducing Recidivism
Presented by:
Edward J. Latessa, Ph.D.
School of Criminal Justice
University of Cincinnati
www.uc.edu/criminaljustice
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Evidence Based – What does it mean?
There are different forms of evidence:
– The lowest form is anecdotal evidence;
stories, opinions, testimonials, case studies,
etc - but it often makes us feel good
– The highest form is empirical evidence –
research, data, results from controlled
studies, etc. - but sometimes it doesn’t make
us feel good
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Evidence Based Practice is:
1.Easier to think of as Evidence Based Decision
Making
2. Involves several steps and encourages the use
of validated tools and treatments.
3. Not just about the tools you have but also how
you use them
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Evidence Based Decision Making Requires
1.Assessment information
2.Relevant research
3.Available programming
4.Evaluation
5.Professionalism and knowledge from staff
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What does the Research tell us?
There is often a Misapplication of Research: “XXX
Study Says”
- the problem is if you believe every study we wouldn’t eat anything (but we would drink a lot of red wine!)
• Looking at one study can be a mistake
• Need to examine a body of research
• So, what does the body of knowledge about correctional interventions tell us?
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First, it is important to understand the body
of knowledge on risk factors
What are the risk factors correlated with
criminal conduct?
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Major Set of Risk/Need
Factors
1. Antisocial/procriminal attitudes, values, beliefs and cognitive-emotional states
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Cognitive Emotional States
• Rage
• Anger
• Defiance
• Criminal Identity
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Identifying Procriminal Attitudes, Values & Beliefs
What to listen for:
• Negative expression about the law
• Negative expression about conventional institutions, values, rules, & procedures; including authority
• Negative expressions about self-management of behavior; including problem solving ability
• Negative attitudes toward self and one’s ability to achieve through conventional means
• Lack of empathy and sensitivity toward others
Procriminal sentiments are what people think, not how people think; they
comprise the content of thought, not the skills of thinking.
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Neutralization & Minimizations
Neutralization Techniques include:
• Denial of Responsibility: Criminal acts are due to factors beyond the control of the individual, thus, the individual is guilt free to act.
• Denial of Injury: Admits responsibility for the act, but minimizes the extent of harm or denies any harm
• Denial of the Victim: Reverses the role of offender & victim & blames the victim
• “System Bashing”: Those who disapprove of the offender’s acts are defined as immoral, hypocritical, or criminal themselves.
• Appeal to Higher Loyalties: “Live by a different code” – the demands of larger society are sacrificed for the demands of more immediate loyalties.
(Sykes and Maltz, 1957)
Offenders often neutralize their behavior. Neutralizations are a set of verbalizations
which function to say that in particular situations, it is “OK” to violate the law
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Major set Risk/needs continued:
2. Procriminal associates and
isolation from prosocial others
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Major set Risk/Needs continued:
3. Temperamental & anti social personality pattern conducive to criminal activity including:
– Weak Socialization
– Impulsivity
– Adventurous
– Pleasure seeking
– Restless Aggressive
– Egocentrism
– Below Average Verbal intelligence
– A Taste For Risk
– Weak Problem-Solving/lack of Coping & Self-Regulation Skills
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Major set of Risk/Need factors continued:
4. A history of antisocial behavior:
– Evident from a young age
– In a variety of settings
– Involving a number and variety of
different acts
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Major set of Risk/Needs Continued:
5. Family factors that include criminality
and a variety of psychological
problems in the family of origin
including:
– Low levels of affection, caring and
cohesiveness
– Poor parental supervision and discipline
practices
– Out right neglect and abuse
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Major set of Risk/Needs continued:
6. Low levels of personal
educational, vocational or
financial achievement
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Leisure and/or recreation
7. Low levels of involvement in
prosocial leisure activities
–Allows for interaction with antisocial
peers
–Allows for offenders to have idle time
–Offenders replace prosocial behavior
with antisocial behavior
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Substance Abuse
8. Abuse of alcohol and/or drugs
–It is illegal itself (drugs)
–Engages with antisocial others
–Impacts social skills
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Recent study by Bucklen and Zajac
of parole violators in Pennsylvania
found a number of criminogenic
factors related to failure*
*Conducted by Pennsylvania Dept. of Corrections
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Pennsylvania Parole Study
Social Network and Living Arrangements
Violators Were:
• More likely to hang around with individuals
with criminal backgrounds
• Less likely to live with a spouse
• Less likely to be in a stable supportive
relationship
• Less likely to identify someone in their life
who served in a mentoring capacity
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Pennsylvania Parole Study
Employment & Financial Situation
Violators were:
• Only slightly more likely to report having difficulty getting a
job
• Less likely to have job stability
• Less likely to be satisfied with employment
• Less likely to take low end jobs and work up
• More likely to have negative attitudes toward employment
& unrealistic job expectations
• Less likely to have a bank account
• More likely to report that they were “barely making it” (yet
success group reported over double median debt)
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Pennsylvania Parole Study
Alcohol or Drug Use
Violators were:
• More likely to report use of alcohol or
drugs while on parole (but no difference in
prior assessment of dependency problem)
• Poor management of stress was a primary
contributing factor to relapse
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Pennsylvania Parole Study
Life on Parole - Violators were:
• Had poor problem solving or coping skills
• Did not anticipate long term consequences of behavior
• Failed to utilize resources to help themselves
• Acted impulsively to immediate situations
• Felt they were not in control
• More likely to maintain anti-social attitudes
• Viewed violations as an acceptable option to situation
• Maintained general lack of empathy
• Shifted blame or denied responsibility
• Had unrealistic expectations about what life would be like
outside of prison
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Pennsylvania Parole Violator
Study:
• Successes and failures did not differ in
difficulty in finding a place to live after
release
• Successes & failures equally likely to
report eventually obtaining a job
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So what about Mental Health?
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Mentally Disordered Offenders (MDOs)
Conventional Clinical Wisdom:
• Criminal activities of MDOs best explained by psychopathological models
• Assessments typically focus on psychiatric diagnoses, psychiatric symptomatology, and personal distress (i.e. anxiety, depression)
• Assessments are often costly and time consuming
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MDOs Continued
Review of the Empirical Research:
• The Psychopathological model has little relevance regarding the
prediction of MDO criminal behavior
• Gendreau conducted meta-analysis on studies of psychiatric symptomatology and general recidivism: Correlation=ZERO
• Bonta’s meta analysis found correlation between having a diagnosed mental disorder, mood disorder, or psychosis and general/violent recidivism ranged from r = .01 to -.17.
• Criminogenic risk factors were the strongest predictors (r=.23)
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Major Set of Risk/Need Factors
1. Antisocial/procriminal attitudes, values, beliefs & cognitive emotional states
2. Procriminal associates & isolation from anti-criminal others
3. Temperamental & anti-social personality patterns conducive to criminal activity:
4. A history of antisocial behavior
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Major Set of Risk/Need Factors Cont.
5. Familial factors that include criminality and a
variety of psychological problems in the family of
origin
6. Low levels of personal, educational, vocational,
or financial achievement
7. Low levels of involvement in prosocial leisure
activities
8. Substance Abuse
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A Large Body of Research Has
Indicated…. ….that correctional services and interventions can be
effective in reducing recidivism for offenders, however, not all programs are equally effective
• The most effective programs are based on some principles of effective interventions
• Risk (Who)
• Need (What)
• Treatment (How)
• Program Integrity (How Well)
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Let’s Look at the Risk Principle
Risk refers to risk of reoffending and
not the seriousness of the offense.
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Risk Principle
As a general rule treatment effects are stronger if
we target higher risk offenders, and harm can be
done to low risk offenders
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Risk Level by Recidivism for the Community
Supervision Sample
9.1
34.3
58.9
69.2
0
10
20
30
40
50
60
70
80Low Risk Medium Risk High Risk Very High Risk
Pe
rce
nt
wit
h N
ew A
rre
st
Low 0-14 Medium = 15-23 High = 24-33 Very High 34+
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There are Three Elements to the
Risk Principle
1. Target those offenders with higher probability of recidivism
2. Provide most intensive treatment to higher risk offenders
3. Intensive treatment for lower risk offender can increase recidivism
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#1: Targeting Higher Risk
Offenders
• It is important to understand that even with
EBP there will be failures.
• Even if you reduce recidivism rates you
will still have high percentage of failures
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Example of Targeting Higher Risk Offenders
• If you have 100 High risk offenders
about 60% will fail
• If you put them in well designed EBP for
sufficient duration you may reduce
failure rate to 40%
• If you have 100 low risk offenders about
10% will fail
• If you put them in same program failure
rate will be 20%
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Targeting Higher Risk Offenders
continued:
• In the end, who had the lower recidivism
rate?
• Mistake we make is comparing high risk
to low risk rather than look for treatment
effects
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The question is: What does more
“intensive” treatment mean in practice?
• Most studies show that the longer
someone is in treatment the great the
effects, however:
• Effects tend to diminish if treatment goes
too long
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The question is: What does more
“intensive” treatment mean in practice?
• Most studies show that the longer
someone is in treatment the great the
effects, however:
• Effects tend to diminish if treatment goes
too long
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Provide Most Intensive Interventions to
Higher Risk Offenders
• Higher risk offenders will require much
higher dosage of treatment
– Rule of thumb: 100 hours for moderate risk
– 200+ hours for high risk
– 100 hours for high risk will have little effect
– Does not include work/school and other
activities that are not directly addressing
criminogenic risk factors
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Results from a 2010 Study (Latessa,
Sperber, and Makarios) of 689 offenders
• 100-bed secure residential facility for adult male felons
• Cognitive-behavioral treatment modality
• Average age 33
• 60% single, never married
• 43% less than high school education
• 80% moderate risk or higher
• 88% have probability of substance abuse per SASSI
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Findings & Conclusions
• We saw large decreases in recidivism when dosage
levels go from 100 to 200 hours for high risk offenders---
81% to 57%.
• The results are not as strong for moderate risk
offenders
• Supports previous research including the risk principle
• Indicates that we cannot have “one size” fits all
programs
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Placing lower risk offenders in
intensive programs can
increase recidivism
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Recent Study of Intensive Rehabilitation Supervision in
Canada
0
10
20
30
40
50
60
High Risk 31.6 51.1
Low Risk 32.3 14.5
Treatment Non-Treatment
Bonta, J et al., 2000. A Quasi-Experimental Evaluation of an Intensive Rehabilitation Supervision Program.,
Vol. 27 No 3:312-329. Criminal Justice and Behavior
Recidivism
Rates
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2002 STUDY OF COMMUNITY
CORRECTIONAL PROGRAMS IN OHIO
• Largest study of community based correctional treatment facilities ever done up to that time.
• Total of 13,221 offenders – 37 Halfway Houses and 15 Community Based Correctional Facilities (CBCFs) were included in the study.
• Two-year follow-up conducted on all offenders
• Recidivism measures included new arrests & incarceration in a state penal institution
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Increased
Recidivism
Reduced
Recidivism
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Treatment Effects For High Risk Offenders
-34
-18
-15-14
-6-5
-2 -2
23 3 3
56
78 8
910 10
12 12 1213 13 13
15
2122
2425
27
3032
34
River C
ity
Fresh Start
Alternative A
gency
Talbert H
ouse Cornerstone
Com
munity A
ssessment Program
(Men’s)
Monday
WO
RTH
Cincinnati V
OA
McM
ahon Hall
Talbert H
ouse Spring Grove
NEO
CA
P
Oriana H
ouse RIP
Alvis H
ouse Dunning H
all
Lorain/M
edina
All C
BC
F Facilities
Canton C
omm
unity Treatm
ent Center
Lucas C
ounty
SRC
CC
All Facilities
Licking/M
uskingum
Summ
it County
Butler
SEPT
A
Com
munity T
ransitions
Franklin County
Small Program
s
Oriana H
ouse TM
RC
Cincinnati V
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Chem
ical Dependency Program
Alvis H
ouse Alum
Creek
Talbert H
ouse Beekm
an
Com
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Harbor L
ight Salvation Arm
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Com
munity C
orrections Association
Toledo V
OA
Mahoning C
ounty
EO
CC
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10
20
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-10
-20
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Pro
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2010 STUDY OF COMMUNITY
CORRECTIONAL PROGRAMS IN OHIO
• Over 20,000 offenders – 44 Halfway Houses and 20 Community Based Correctional Facilities (CBCFs) were included in the study.
• Two-year follow-up conducted on all offenders
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Treatment Effects for Low Risk
-60
-50
-40
-30
-20
-10
0
10
20
30
40
50
60
Har
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Treatment Effects for High Risk
-60
-50
-40
-30
-20
-10
0
10
20
30
40
50
60
AH
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Need Principle By assessing and targeting criminogenic needs for change,
agencies can reduce the probability of recidivism
Criminogenic
• Anti social attitudes
• Anti social friends
• Substance abuse
• Lack of empathy
• Impulsive behavior
Non-Criminogenic
• Anxiety
• Low self esteem
• Creative abilities
• Medical needs
• Physical conditioning
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Targeting Criminogenic Need: Results from Meta-
Analyses
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Target 1-3 more non-
criminogenic needs
Target at least 4-6 more
criminogenic needs
Reduction in
Recidivism
Increase in
Recidivism
Source: Gendreau, P., French, S.A., and A.Taylor (2002). What Works (What Doesn’t Work) Revised 2002. Invited Submission to the International Community
Corrections Association Monograph Series Project
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Criminal Thinking and Mental Illness*
Morgan, Fisher and Wolff (2010) studied 414 adult offenders
with mental illness (265 males, 149 females) and found:
• 66% had belief systems supportive of criminal life style (based on
Psychological Inventory of Criminal Thinking Scale (PICTS)
• When compare to other offender samples, male offenders with MI
scored similar or higher than non-mentally disordered offenders.
• On Criminal Sentiments Scale-Revised, 85 % of men and 72 % of
women with MI had antisocial attitudes, values and beliefs – which was
higher than incarcerated sample without MI.
Center for Behavioral Health Services Criminal Justice Research Policy Brief, April 2010. Rutgers University.
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Conclusion
• Criminal Thinking styles differentiate people who
commit crimes from those who do not
independent of mental illness
• Incarcerated persons with mental illness are
often mentally ill and criminal
• Needs to be treated as co-occurring problems
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The Christopher Columbus Style
of Program Design
WHEN HE SET OUT…
He didn’t know where he was going.
WHEN HE GOT THERE…
He didn’t know where he was.
WHEN HE GOT BACK…
He didn’t know where he had been.
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Definitely NOT Criminogenic
Needs
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DOGSLEDDING AS
RESTORATIVE JUSTICE
METHOD – London Free Press – 07/03/11
The Hollow Water First Nation, who live 200 km
northeast of Winnipeg, have used dogsledding
as a restorative justice program, which tries to
restore relationships between victims and
perpetrators in criminal cases. Exercising
wilderness skills was seen as a way of rebuilding
the perpetrator’s self-esteem, explained Marcel
HARDESTY, restorative justice program
director.
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Assessment is the engine that drives
effective correctional programs
• Need to meet the risk and need principle
• Reduces bias
• Aids decision making
• Allows you to target dynamic risk factors
and measure change
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To understand assessment
one needs to consider types of risk
factors
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Dynamic and Static Factors • Static Factors are those factors that are
related to risk and do not change. Some examples might be number of prior offenses, whether an offender has ever had a drug/alcohol problem.
• Dynamic factors relate to risk and can change. Some examples are whether an offender is currently unemployed or currently has a drug/alcohol problem.
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According to the American Heart Association, there are a
number of risk factors that increase your chances of a first
heart attack
Family history of heart attacks
Gender (males)
Age (over 50)
Inactive lifestyle
Over weight
High blood pressure
Smoking
High Cholesterol level
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There are two types of dynamic
risk factors • Acute – Can change quickly
• Stable – Take longer to change
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In addition to Risk factor it is important to
Assess Responsivity Factors
• Often neglected
• Can be useful in assigning offenders to
programs and groups
• Addressing responsivity factors can
improve treatment effectiveness
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The Responsivity Principle
• General
– Most offenders respond to programs that are
based on cognitive behavioral/social learning
theories
• Specific
– Offenders learn differently and have certain
barriers that should be addressed so that they
are more likely to succeed in programs
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Specific Responsivity
What gets in the way of offenders
benefiting from treatment?
– Must take individual learning styles into
account
– Must consider possible barriers to
interventions
– Assessment of responsivity is important to
maximize benefits of treatment
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Responsivity areas to assess can
include
• Motivation to change
• Anxiety/psychopathy
• Levels of psychological development
• Maturity
• Cognitive functioning
• Mental disorders
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Prioritizing Interventions: What to
Change and Why
• Criminogenic targets – reduce risk for
recidivism
• Non-criminogenic targets – may reduce
barriers but NOT risk
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• List three speeches that have changed
your life
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• List three people who have changed your
life
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Treatment Principle
The most effective interventions are behavioral:
• Focus on current factors that influence
behavior
• Action oriented
• Staff follow “core correctional practices”
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Results from Meta Analysis:
Behavioral vs. NonBehavioral
0.07
0.29
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Nonbehavioral (N=83) Behavioral (N=41)
Reduced
Recidivism
Andrews, D.A. 1994. An Overview of Treatment Effectiveness. Research and Clinical Principles,
Department of Psychology, Carleton University. The N refers to the number of studies.
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Most Effective Behavioral
Models • Structured social learning where new skills
and behaviors are modeled
• Family based approaches that train family
on appropriate techniques
• Cognitive behavioral approaches that
target criminogenic risk factors
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Social Learning
Refers to several processes through which individuals
acquire attitudes, behavior, or knowledge from the persons
around them. Both modeling and instrumental
conditioning appear to play a role in such learning
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Family Based Interventions
• Designed to train family on behavioral
approaches
– Functional Family Therapy
– Multi-Systemic Therapy
– Teaching Family Model
– Common Sense Parenting
– Strengthening Families Program (Office of
Juvenile Justice and Delinquency Prevention)
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Effectiveness of Family Based Intervention:
Results from Meta Analysis
• 38 primary studies with 53 effect tests
• Average reduction in recidivism= 21%
However, much variability was present
(-0.17 - +0.83) Dowden & Andrews, 2003
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Mean Effect Sizes: Whether or not the
family intervention adheres to the
principles
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Risk Need Treatment
Yes
No
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The Four Principles of Cognitive
Intervention
1. Thinking affects behavior
2. Antisocial, distorted, unproductive irrational thinking can lead to antisocial and unproductive behavior
3. Thinking can be influenced
4. We can change how we feel and behave by changing what we think
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Recent Meta-Analysis of Cognitive Behavioral Treatment
for Offenders by Landenberger & Lipsey (2005)*
• Reviewed 58 studies:
19 random samples
23 matched samples
16 convenience samples
• Found that on average CBT reduced recidivism by 25%,
but the most effective configurations found more than
50% reductions
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Significant Findings (effects were stronger if):
• Sessions per week (2 or more) - RISK
• Implementation monitored - FIDELITY
• Staff trained on CBT - FIDELITY
• Higher proportion of treatment completers -
RESPONSIVITY
• Higher risk offenders - RISK
• Higher if CBT is combined with other services -
NEED
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Reducing Prison & Jail
Misconducts
• Findings from a 2006 meta analysis of 68 studies involving 21,467 offenders
• Outcomes included violent misconduct, nonviolent misconduct, and institutional adjustment
• Sample included 73% male, 8% female & 19% coed.
• Included both adult and juvenile samples
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Average Effect Size for Misconducts by Treatment Type
From: French, S, & Gendreau P.. (2006). Reducing Prison Misconducts What Work!. Criminal Justice and Behavior. 33 (2); 185-218.
0.26
0.1
0.02 0.02
Behavioral Non-behavioral Educational/Vocational Unspecified
0
0.05
0.1
0.15
0.2
0.25
0.3
Av
era
ge
Eff
ec
t S
ize
Type of Treatment
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Average Effect Size for Misconducts by Number of Criminogenic Needs Targeted
From: French, S, & Gendreau P.. (2006). Reducing Prison Misconducts What Work!. Criminal Justice and Behavior. 33 (2); 185-218.
0.29
0.16
0.06
3 to 8 1-2 0
0
0.05
0.1
0.15
0.2
0.25
0.3
Av
era
ge
Eff
ec
t S
ize
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Average Effect Size for Misconducts by Program Quality
From: French, S, & Gendreau P.. (2006). Reducing Prison Misconducts What Work!. Criminal Justice and Behavior. 33 (2); 185-218.
0.38
0.2
0.13
HIgh Moderate Low
0
0.1
0.2
0.3
0.4
0.5A
ve
rag
e E
ffe
ct
Siz
e
Program Qualtiy
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Average Effect Size for Misconduct Reductions and Recidivism
From: French, S, & Gendreau P.. (2006). Reducing Prison Misconducts What Work!. Criminal Justice and Behavior. 33 (2); 185-218.
0.13
-0.05High Misconduct Reductions Low Misconduct Reductions
0
0.05
0.1
0.15
-0.05
Re
du
ce
d R
ec
idiv
ism
Inc
re
as
ed
Re
cid
ivis
m
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Cognitive-Behavioral
Cognitive Theories Social Learning Theory
WHAT to change HOW to change it
What
offenders
think
How
offenders
think
Model
Practice
Reward
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These approaches help us….
• Structure our interventions
• Teach and model new skills
• Allow offender to practice with graduated
difficulty
• Reinforce the behavior
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What Doesn’t Work with
Offenders?
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Lakota tribal wisdom says that when you discover you are riding a dead
horse, the best strategy is to dismount. However, in corrections, we
often try other strategies, including the following:
• Buy a stronger whip
• Change riders
• Say things like “This is the way we always have ridden this horse.”
• Appoint a committee to study the horse.
• Arrange to visit other sites to see how they ride dead horses.
• Create a training session to increase our riding ability.
• Harness several dead horses together for increased speed.
• Declare that “No horse is too dead to beat.”
• Provide additional funding to increase the horse’s performance.
• Declare the horse is “better, faster, and cheaper” dead.
• Study alternative uses for dead horses.
• Promote the dead horse to a supervisory position.
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Ineffective Approaches with Offenders • Programs that cannot maintain fidelity
• Programs that target non-criminogenic needs
• Drug prevention classes focused on fear and other emotional appeals
• Shaming offenders
• Drug education programs
• Non-directive, client centered approaches
• Bibliotherapy
• Freudian approaches
• Talking cures
• Self-Help programs
• Vague unstructured rehabilitation programs
• Medical model
• Fostering self-regard (self-esteem)
• “Punishing smarter” (boot camps, scared straight, etc.)
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Fidelity Principle
Making sure the program is delivered as designed and with integrity:
• Ensure staff are modeling appropriate behavior, are qualified, well trained, well supervision, etc.
• Make sure barriers are addressed but target criminogenic needs
• Make sure appropriate dosage of treatment is provided
• Monitor delivery of programs & activities, etc.
• Reassess offenders in meeting target behaviors
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Some Lessons Learned from the
Research
Who you put in a program is important – pay attention to risk
What you target is important – pay attention to criminogenic needs
How you target offender for change is important – use behavioral approaches
Program Integrity makes a difference - Service
delivery, training/supervision of staff, support for
program, QA, evaluation, etc.