tx forensic mental health conf. #6 what works
DESCRIPTION
Texas Forensic Mental Health Conference Presenter: Dr. SalterPresentation: What Works#6TRANSCRIPT
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What Works?What Works?Reducing Criminal OffendingReducing Criminal Offending
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Reasons for IncarcerationReasons for Incarceration
PunishmentPunishmentJustice for VictimJustice for VictimIncapacitationIncapacitationImpact on Potential OffendersImpact on Potential OffendersReduction of RecidivismReduction of Recidivism
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Impact of More Severe Sanctions on Impact of More Severe Sanctions on RecidivismRecidivism
Incarceration vs. ProbationIncarceration vs. Probation
Intermediate Sanctions vs. Intermediate Sanctions vs. Standard SupervisionStandard Supervision
(Smith, (Smith, 2002)2002)
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Characteristics of StudiesCharacteristics of Studies
117 Studies117 Studies
N = 442,471N = 442,471
(Smith, 2002)(Smith, 2002)
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Impact of Incarceration on Impact of Incarceration on RecidivismRecidivism
N = 268,806N = 268,806
68% American Studies68% American Studies
No Change in RecidivismNo Change in Recidivism
or Slight Increase in Recidivismor Slight Increase in Recidivism
(Smith, 2002)(Smith, 2002)
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High Quality vs. Low Quality StudiesHigh Quality vs. Low Quality Studies
High QualityHigh Quality
Random AssignmentRandom Assignment Comparison Group DesignsComparison Group Designs
AgeAgeCriminal HistoryCriminal HistoryAntisocial ValuesAntisocial Values
(Smith, 2002)(Smith, 2002)
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Random Assignment StudiesRandom Assignment Studies
2 Studies2 Studies
Incarceration Vs CommunityIncarceration Vs Community
Slight increases in recidivism Slight increases in recidivism
(Smith, 2002)(Smith, 2002)
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Intermediate SanctionsIntermediate Sanctions
Electronic MonitoringElectronic MonitoringFinesFinesRestitutionRestitutionIntensive SurveillanceIntensive SurveillanceScared StraightScared StraightDrug TestingDrug TestingBoot campBoot camp
(Smith, (Smith, 2002)2002)
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Intermediate Sanctions vs. Standard Intermediate Sanctions vs. Standard SupervisionSupervision
N = 66,500 N = 66,500
American Studies 80%American Studies 80%
Slight Decrease in Recidivism Slight Decrease in Recidivism
Or No DifferenceOr No Difference
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Boot Camps Vs. RestitutionBoot Camps Vs. Restitution
Scared StraightScared Straight No ImpactNo Impact
Boot campsBoot camps No ImpactNo Impact
RestitutionRestitution 5% Decrease 5% Decrease
(Latimer et al., 2001; MacKenzie et al., 2001)(Latimer et al., 2001; MacKenzie et al., 2001)
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Same FindingsSame Findings
Juveniles vs. AdultsJuveniles vs. Adults
Men or Women (maybe)Men or Women (maybe)
White or Minority Race (few studies)White or Minority Race (few studies)
Low and High Risk OffendersLow and High Risk Offenders
(Smith, 2002)(Smith, 2002)
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WomenWomen
More Severe Punishment More Severe Punishment
May Increase Recidivism in Women More May Increase Recidivism in Women More than Menthan Men
(Smith, 2002)(Smith, 2002)
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ExceptionException
Intensive Supervision plus treatmentIntensive Supervision plus treatment
Slight decrease in recidivism (10%)Slight decrease in recidivism (10%)
(Smith, 2002)(Smith, 2002)
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Incarceration: More or LessIncarceration: More or Less
N = 107,165N = 107,16590% American Studies90% American Studies
Mean Time for More: 31 MonthsMean Time for More: 31 MonthsMean Time for Less: 13 MonthsMean Time for Less: 13 Months
Slight Increase in RecidivismSlight Increase in Recidivism
(Smith, 2002)(Smith, 2002)
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Impact of Length of IncarcerationImpact of Length of Incarceration
Difference in TimeDifference in Time Mean Effect SizeMean Effect Size
Between More & LessBetween More & Less (Weighted for (Weighted for SampleSample
GroupsGroups Size)Size)
1.1. < 6 Months< 6 Months -.01-.01
2.2. 7 to 12 Months7 to 12 Months -.02-.02
3.3. 13 to 24 Months13 to 24 Months .03 .03
4.4. > 24 Months> 24 Months .06 .06
(Smith, 2002)(Smith, 2002)
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Impact of Treatment Vs. SanctionsImpact of Treatment Vs. Sanctions(Andrews, 1998)(Andrews, 1998)
-0.1
-0.05
0
0.05
0.1
0.15
0.2
Treatment
Sanctions
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Impact of Treatment Vs. SanctionsImpact of Treatment Vs. SanctionsYoung OffendersYoung Offenders
-0.020
0.020.040.060.080.1
0.120.14
CriminalSanctions
Treatment
Dowden & Andrews, 1999
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Impact of Appropriate Vs. Impact of Appropriate Vs. Inappropriate TreatmentInappropriate Treatment
(Andrews, 1998)(Andrews, 1998)
-0.1
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Combined Tx
Appropriate
Inappropriate
Sanctions
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Type of TreatmentType of Treatment
0
0.05
0.1
0.15
0.2
0.25
0.3
Non Behavioral
CognitiveBehavioral
Andrew, 1994
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Type of Treatment & Young OffendersType of Treatment & Young Offenders
0
0.05
0.1
0.15
0.2
0.25
Non Behavioral
CognitiveBehavioral
Dowden & Andrews, 1999
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““All meta-analyses on offender treatment All meta-analyses on offender treatment have a positive mean effect size.”have a positive mean effect size.”
(Losel, 1995)(Losel, 1995)
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Appropriate TreatmentAppropriate Treatment
Higher Risk More IntensiveHigher Risk More Intensive
Targets Criminogenic NeedsTargets Criminogenic Needs
Uses Cognitive-Behavioral TreatmentUses Cognitive-Behavioral Treatment
Implement Treatment As Designed Implement Treatment As Designed
(Andrews, 1998)(Andrews, 1998)
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Targeting Criminogenic NeedsTargeting Criminogenic Needs
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Criminogenic NeedsCriminogenic Needs
CriminogenicCriminogenic Non Non CriminogenicCriminogenic
Antisocial AttitudesAntisocial Attitudes Self-EsteemSelf-Esteem
Antisocial FriendsAntisocial Friends AnxietyAnxiety
Substance AbuseSubstance Abuse DepressionDepression
ImpulsivityImpulsivity
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Targeting Criminogenic NeedsTargeting Criminogenic Needs
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Targets 1 - 3Noncriminogenic Needs
Targets 4 - 6CriminogenicNeeds
Gendreau, French & Taylor, 2002
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Self Esteem Vs. Criminogenic NeedsSelf Esteem Vs. Criminogenic Needs
-0.1-0.05
00.050.1
0.150.2
0.250.3
0.350.4
Self Esteem
CriminogenicNeeds
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What WorksWhat Works
Higher Risk OffendersHigher Risk Offenders At least 2 sessions per weekAt least 2 sessions per week Smaller groupsSmaller groups Implementation MonitoredImplementation Monitored Staff Trained on Cognitive-Behavioral TxStaff Trained on Cognitive-Behavioral Tx Higher Proportion of Treatment CompletersHigher Proportion of Treatment Completers
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Programming That Doesn’t WorkProgramming That Doesn’t Work
PsychodynamicPsychodynamic
Non-directive/Client-centeredNon-directive/Client-centered
Disease ModelDisease Model
(Andrews, (Andrews, 1998)1998)
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Impact of Cognitive Self-Change Impact of Cognitive Self-Change ProgramProgram
LengthLength New Accusations After YearsNew Accusations After Years
Of Time (Mo.)Of Time (Mo.) 11 22 33
No treatmentNo treatment 49%49% 71%71% 77%77%
1 – 61 – 6 54%54% 67%67% 80%80%
7 +7 + 25%25% 42%42% 46%46%
(Bush, 1995)(Bush, 1995)
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How Many Programs Are How Many Programs Are Appropriate?Appropriate?
Correctional Program Assessment Inventory Correctional Program Assessment Inventory Scores (CPAI)Scores (CPAI)
50 correctional programs 50 correctional programs
(Latessa & Holsinger, (Latessa & Holsinger, 1998)1998)
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How Many Programs Are How Many Programs Are Appropriate?Appropriate?
29.431.3
27.4
11.7
0
5
10
15
20
25
30
35
Unsatis. NI Satis. VerySatis.
(Latessa & Holsinger, 1998)(Latessa & Holsinger, 1998)
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ATSA Collaborative StudyATSA Collaborative Study
N = 43 studiesN = 43 studies
All treated between 1965 – 1999All treated between 1965 – 1999 80% treated after 198080% treated after 1980 9,316 subjects9,316 subjects 23 Institutional programs23 Institutional programs 16 Community programs16 Community programs 3 both3 both
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ATSA Collaborative StudyATSA Collaborative StudyRecidivism DataRecidivism Data
TreatedTreated UntreatedUntreated Odds Odds RatioRatio
Only current Only current programsprograms
SexualSexual 9.9%9.9% 17.3%17.3% .60.60
GeneralGeneral 32.3%32.3% 51.3%51.3% .57.57
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Psychopathy: TreatmentPsychopathy: Treatment
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• Program for personality disordered offendersProgram for personality disordered offenders• "Maxwell Jones" Therapeutic Community"Maxwell Jones" Therapeutic Community• Minimum 2 yrs in programMinimum 2 yrs in program• Mean follow-up after release = 8 yrs, 4 monthsMean follow-up after release = 8 yrs, 4 months• Psychopaths defined by PCL-R score of 27Psychopaths defined by PCL-R score of 27• PCL-R coded from files only (r = .96)PCL-R coded from files only (r = .96)• 176 treated patients; 146 untreated patients176 treated patients; 146 untreated patients• Mean time to failure = 47 monthsMean time to failure = 47 months
(Rice, Harris, & Cormier, 1992)
Psychopathy and Recidivism After Treatment
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Psychopathy & TreatmentPsychopathy & Treatment
Non Non PsychopathsPsychopaths
TreatedTreated 22%22%
UntreatedUntreated 39%39%
(Harris, Rice et al., 1994)(Harris, Rice et al., 1994)
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Psychopathy & TreatmentPsychopathy & Treatment
PsychopathsPsychopaths
TreatedTreated 77%77%
UntreatedUntreated 55%55%
(Harris, Rice et al., 1994)(Harris, Rice et al., 1994)
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Psychopathy, Treatment, and Reconvictions Psychopathy, Treatment, and Reconvictions in HMP Servicein HMP Service
•Tx anger-management, social skills
•24-month reconviction rate
(Hare, Clark, Grann, & Thornton, 2000)Hare, Clark, Grann, & Thornton, 2000)
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0
10
20
30
40
50
60
70
80
90
Low Fac I High Fac 1
Untreated
Treated
Per
cen
t R
econ
vict
ed2-Year Post-release Reconviction Rates in the
English Prison Service
Hare, Clark, Grann, & Thornton (2000)
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Cost of RecidivismCost of Recidivism
To TaxpayersTo Taxpayers
To VictimsTo Victims
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Computing Cost of RecidivismComputing Cost of Recidivism
Police InvestigationPolice InvestigationAdjudicationAdjudicationCorrectionsCorrectionsMedical Care of VictimsMedical Care of VictimsMental Health Care of VictimsMental Health Care of VictimsProperty DamageProperty DamageReduced Future EarningsReduced Future Earnings
(Aos, (Aos, 1999)1999)
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Computing Victim Cost of Computing Victim Cost of RecidivismRecidivism
Medical CareMedical CareMental Health CareMental Health CareProperty DamageProperty DamageReduced Future EarningsReduced Future EarningsPain and SufferingPain and SufferingLoss of LifeLoss of Life
(Aos, (Aos, 1999)1999)
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Cost Effectiveness of Correctional Cost Effectiveness of Correctional ProgrammingProgramming
Every $1 Spent on Correctional ProgrammingEvery $1 Spent on Correctional Programming
Taxpayers Save $5Taxpayers Save $5
Victims Save $7Victims Save $7
(Aos, 1999)(Aos, 1999)
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Cost Effectiveness of Vocational and Cost Effectiveness of Vocational and Basic Education ProgramsBasic Education Programs
For Every $1 SpentFor Every $1 Spent
Taxpayers save between $1.71 & $3.23Taxpayers save between $1.71 & $3.23
(Aos et al., 1999)(Aos et al., 1999)
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Cost Effectiveness of Cognitive-Cost Effectiveness of Cognitive-Behavioral Treatment ProgramsBehavioral Treatment Programs
For Every $1 SpentFor Every $1 Spent
Taxpayers Save Between $2.54 and $11.48Taxpayers Save Between $2.54 and $11.48
(Aos et al., 1999)(Aos et al., 1999)
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““We found the largest and most consistent We found the largest and most consistent returns are for programs designed for returns are for programs designed for juvenile offenders.”juvenile offenders.”
(Aos et al., 1999, p. 6)(Aos et al., 1999, p. 6)
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Cost Effectiveness of Programming Cost Effectiveness of Programming for Juvenilesfor Juveniles
For Every $1 Spent on Juvenile ProgramsFor Every $1 Spent on Juvenile Programs
Tax Payers Save Between $7.62 & $31.4Tax Payers Save Between $7.62 & $31.4
(Aos, 1999)(Aos, 1999)
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Cost/Benefit of Adolescent Non Cost/Benefit of Adolescent Non Offender ProgramsOffender Programs
ProgramProgram TaxpayersTaxpayers Taxpayers Taxpayers &&
AloneAlone Victims Victims
QuantumQuantum $.09$.09 $.13$.13
Big BrothersBig Brothers $1.30$1.30 $2.12$2.12
(Aos, 1999)(Aos, 1999)
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Cost/Benefit of Adolescent Non Cost/Benefit of Adolescent Non Offender ProgramsOffender Programs
ProgramProgram Cost/ Cost/ EffectEffect
ParticipantParticipant SizeSize
QuantumQuantum $18,292$18,292 -.42-.42
Big BrothersBig Brothers $1,009$1,009 -.05-.05
(Aos, 1999)(Aos, 1999)
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Cost/Benefit of Adolescent Cost/Benefit of Adolescent Supervision ProgramsSupervision Programs
ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers & AloneAlone Victims Victims
DiversionDiversion $7.62$7.62 $13.61$13.61 Intensive Intensive
ProbationProbation .90 .90 1.49 1.49 Boot CampBoot Camp .42 .42 .26 .26
(Aos, 1999)(Aos, 1999)
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Cost/Benefit of Adolescent Cost/Benefit of Adolescent Treatment ProgramsTreatment Programs
ProgramProgram TaxpayersTaxpayers Taxpayers Taxpayers &&
AloneAlone Victims Victims
ARPARP $19.57 $19.57 $31.40$31.40
Multi-SystemicMulti-Systemic 8.38 8.38 13.45 13.45
Functional FamFunctional Fam 6.85 6.85 10.99 10.99
Multi Tx FosterMulti Tx Foster 14.0714.07 22.58 22.58
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Cost/Benefit of Adolescent Cost/Benefit of Adolescent Treatment ProgramsTreatment Programs
ProgramProgram Cost/ Cost/ EffectEffectParticipantParticipant SizeSize
AggressionAggressionReplacementReplacementTrainingTraining $404$404 -.26-.26
Multi-SysMulti-SysFamily TxFamily Tx $4,540$4,540 -.68-.68
(Aos, 1999)(Aos, 1999)
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What Does It Take to Break EvenWhat Does It Take to Break Even
Depends on the CostDepends on the Cost
Percent Reduction to Percent Reduction to Break EvenBreak Even
AggressionAggressionReplacement Replacement TrainingTraining 1.4%1.4%
Multi-SystemicMulti-SystemicFamily TherapyFamily Therapy 10.2%10.2%