Faye S. Taxman, Ph.D. Center for Advancing Correctional Excellence Criminology, Law and Society George Mason University www.gmuace.org [email protected]
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Faye S. Taxman, Ph.D.
C e n t e r f o r A d v a n c i n g C o r r e c t i o n a l
E x c e l l e n c e
C r i m i n o l o g y , L a w a n d S o c i e t y
G e o r g e M a s o n U n i v e r s i t y
w w w. g m u a c e . o r g
f t a x m a n @ g m u . e d u
Bureau of Justice Assistance
BJA: 2009-DG-BX-K026
Center for Substance Abuse Treatment
SAMHSA: 202171
Public Welfare Foundation
Special Thanks to:
Ed Banks, Ph.D.
2
ACKNOWLEDGEMENTS
Client or Patient Centered Care
Match on Needs
Use Risk Level (CJ) to determine intensity and dosage
Systemic Responsivity refers to the abil ity of the system to be responsive to individual program placement
Focus on the system to ensure that appropriate resources are distributed
Move away from boutique programming
Look at building systems of care
Biggest issues: lack of methods to estimate needs
3
INDV. VS. SYSTEMIC RESPONSIVITY
Recidivism Reduction
Responsivity
RiskNeeds
RNR IN PRACTICE
5
http://www.gmuace.org/tools/
55
THE RNR SIMULATION TOOL
3 steps:
Survey all programs and classify, grade
Characterize the population using risk and need information; use existing database
Compare the programs capacity to the needs
Program Tool focuses on:
Classifying Programs
Rating Key Program Features
Linking to meta-analyses/systematic reviews
Gap analyses focuses on: capacity to identify programming that will address public safety and health needs
Population-level impact
Reduce recidivism and costs through responsivity6
SYNTHETIC DATABASE (20,000+ PROFILES) FOR
INDIVIDUAL, PROGRAM, & SYSTEM ESTIMATES OF
RECIDIVISM REDUCTION
Race Gender Age Risk … Recidivism Prevalence Implication Prevalence Implication Prevalence Implication Prevalence Implication
White Male 16-27 High … Recidivist 630 74% 595 70% 610 72% 623 73%
White Male 16-27 High … Non-Recidivist 220 255 240 227
White Male 16-27 Medium … Recidivist 240 65%
White Male 16-27 Medium … Non-Recidivist 130
White Male 16-27 Low … Recidivist …
White Male 16-27 Low … Non-Recidivist …
White Male 28-35 High … Recidivist …
White Male 28-36 High … Non-Recidivist …White Male 28-37 Medium … Recidivist …
White Male 28-38 Medium … Non-Recidivist …
White Male 28-39 Low … Recidivist …
White Male 28-40 Low … Non-Recidivist …White Female 16-27 High … Recidivist 35 60%
White Female 16-27 High … Non-Recidivist 23
White Female 16-27 Medium … Recidivist …
White Female 16-27 Medium … Non-Recidivist …
White Female 16-27 Low … Recidivist …
White Female 16-27 Low … Non-Recidivist …
White Female 28-35 High … Recidivist …
White Female 28-36 High … Non-Recidivist …
White Female 28-37 Medium … Recidivist …
White Female 28-38 Medium … Non-Recidivist …
White Female 28-39 Low … Recidivist …
White Female 28-40 Low … Non-Recidivist …
… … … … … … …
Black Male 16-27 High … Recidivist …
Black Male 16-27 High … Non-Recidivist …
Black Male 16-27 Medium … Recidivist …Black Male 16-27 Medium … Non-Recidivist …
… … … … … … …
Other … … … … … …
… … … … … … …
PlacementOption1 PlacementOption2 PlacementOption3
Base Recidivism Rate
Reflect Expected Reductions in Recidivism (from Meta-Analysis)
7
RESPONDING TO RISK AND NEEDS
8
How well do
the programs
adhere to
EBPs?
How well does my system address risk-
needs of offenders?
What type of risk/needs does a particular
Person need?
9
9
PROGRAM GROUPS
Six program groups based on specific target behaviors
10
RISK Levels Needs Stabilizing Factors
PROGRAM GROUP MECHANISM OF ACTION RESEARCH EVIDENCE
Group A
Severe Substance
Use/Dependence
Treatments to reduce use of
heroin, cocaine, amphetamines,
and methamphetamine
Holloway, Bennett, & Farrington,
2006; Prendergast, Huang, & Hser,
2008; Prendergast, Podus, Chang &
Urada, 2002; Lipton, Pearson,
Cleland & Yee, 2008; Mitchell,
Wilson & MacKenzie, 2007
Group B
Criminal Thinking
Cognitive restructuring to change
maladaptive thinking and
behavior patterns
Andrews & Bonta, 2010; Lipsey,
Landenberger & Wilson, 2007;
Wilson, Bouffard & MacKenzie,
2005; Little, 2005; Tong &
Farrington, 2006 & 2008
Group C
Self-Improvement
and Management
(abuse)
Developing social and problem
solving skills to address MH, SA,
and self-control.
Botvin & Wills, 1984; Botvin, Griffin,
& Nichols, 2006; Martin, Dorken,
Wamboldt & Wootten, 2011
Group D
Social and
Interpersonal Skills
Structured counseling and
modeling of behavior to reduce
interpersonal conflict and
develop more positive
interactions.
Botvin & Wills, 1984; Beckmeyer,
2006; Wilson, Gallagher &
MacKenzie, 2000; Visher,
Winterfield & Coggeshall, 2005
Group E
Life Skills
Stabilize education, housing,
employment, and financial
concerns.
Andrews & Bonta, 2010;
Beckmeyer, 2006
12
6 DOMAINS AND 6 PROGRAM TYPES
(GROUPS)
On-line survey of program
structure and features
Uses criteria from research
literature
Includes CPC+ASAM+LOCUS;
behavioral health
Identifies major areas of
strengths and weaknesses
Focuses on quality
improvement
13
13
SPECIALTY COURT PROGRAM TOOL
OUTPUT
WILMINGTON RESET - LINC
15
16
WILMINGTON REENTRY-SPECIFIC
OUTPUT
17
ROCKDALE, GA JMCHP GRANTEE 29(!!)
PROGRAMS ENTERED IN RNR PROGRAM TOOL
18
Program Name Primary Intervention Category Score
Georgia Intervention
Alternatives
Outpatient treatment for
substance abuse, domestic
violence, anger
management issues and
Values Clarification
A 43%
Rockdale House for
Men
Therapeutic community A 56%
Rockdale House for
Women
Therapeutic community A 51%
Rockdale County
Adult Drug Court
Drug court A 56%
19
Program Name Primary Intervention Category Score
Rockdale Residential
Substance Abuse
Treatment Program
In-custody therapeutic
community
A 69%
Teen Challenge
Georgia International
Therapeutic community A 45%
Rockdale County DUI
Court
Education, life skills, case
management
B 31%
Rockdale County
Behavioral Health
Treatment Court
Collaborative
Reentry case management B 38%
Assertive Community
Management
Client-centered case
management
C 42%
20
Program Name Primary Intervention Category Score
Excel Global
Outreach
AA/NA for homeless
individuals
C 25%
Prime Solutions Substance abuse treatment C 42%
SAMHSA Matrix Intensive Outpatient (IOP) for
substance use disorder
C 42%
Spiritual Health Faith-based C 29%
Substance Abuse
Prevention: Prime
Solutions
In-custody drug education C 42%
Trauma Group MRT with trauma-informed
care
C 50%
Viewpoint Health Client-centered case
management
C 48%
21
Program Name Primary Intervention Category Score
Certified Anger
Management
Domestic violence education
and awareness
D 36%
Character
Development
Group counseling for
interpersonal skill development
D 39%
Parenting and Family
Values
Group counseling to address
domestic violence
E 39%
12-Step Addiction
Recovery
12-step support group for
substance abuse
D 28%
Angel House Housing and employment
services for individuals with
SUD who need housing
E 40%
Computer Skills and
Keyboarding
Vocational classes in computer
skills
E 39%
First Step Staffing
and Benefits
Employment and benefits
assistance
E 40%
22
Program Name Primary Intervention Category Score
GED Services and
Testing
In-custody education-GED
classes
E 40%
Job Readiness Vocational skills training E 39%
Mary Hall Freedom
House
Housing and employment
services for women who are
homeless
E 40%
Money Management Financial education classes E 36%
Rockdale Emergency
Relief
Housing and case
management, life skills
E 19%
United Way of
Greater Atlanta
Employment and education
services for individuals who are
homeless
E 19%
23
24
Key Domains of the Quality of the 472 Programs(Mean (Range of Scores))
Type of Program Risk Need Respond Implem Outcome Staff
Quality Improve Dosage Restrict
Total Score
SUD 7.3(0-15)
11.6(5-15)
13.8(2-18)
12.5(0-24)
2.1(0-5)
3.7(0-7)
3.4(0-7)
9.9(0-20)
3.9(0-10)
59.0(15-86)
CrmlThink
7.4(0-15)
12.2(5-15)
11.7(2-18)
8.03(0-20)
1.4(0-5)
2.7(0-7)
2.1(0-6)
6. 7(9-18)
3.15(0-9)
49.2(23-85)
Self-Improve
5.1(0-15)
10.0(6-13)
8.9(0-18)
10.3(0-19)
1.7(0-5)
3.3(0-7)
3.3(0-7)
7.3(0-16)
3.12(0-8)
44.73(8-78)
Interper-sonal Skills
2.4(0-12)
6.4(4-11)
8.6(2-15)
8.8(0-18)
1.8(0-4)
2.4(0-7)
3.0(0-7)
4.7(0-8)
2.3(0-6)
33.4(8-58)
Life Skills 2.9(0-15)
7.6(4-11)
9.3(2-18)
7.5(0-19)
1.3(-5)
2.4(0-7)
2.1(0-7)
4.1(0-10)
2.4(0-8)
33.8(11-56)
Reentry 8.4(0-14)
8.0(1-15)
13.8(2-19)
13.1(4-21)
1.7(0-3)
1.0(0-1)
5.0(3-6)
9.3(0-18)
4.4(0-8)
57.0(21-87)
Programs serve a heterogeneous population
of varying risk and needs
High demands to make progress in a short
period of time
Fragile infrastructure with little networking
Low adoption of EBPs—often in the type of
treatment (CBT) but not in all CBT components
Quality assurance is low
25
WHAT HAVE WE LEARNED WITH ANALYZING
472 PROGRAMS IN 60 JURISDICTIONS?
CASE STUDY: A CALIFORNIA COUNTY
Issues
Corrections reform results in influx of probationers
AB-109 offenders differ from general probation population
Application of tools
Programs trained and completed the RNR Program Tool
Through Program Tool data and stakeholder meetings, identified program-level issues and system-level issues
Used the tools for 2 years with substantive changes including
Change in type of programming offered
Improved program features
Implemented system wide changes includinguniversal intake form, training on CBT, building network
of providers, stability in funding for providers, etc. 26
27
NUMBER OF PROGRAMS INCREASED
MORE CLINICAL PROGRAMS
5
6
11
4
5
5
8
4
9
1
2
1
0 2 4 6 8 10 12
Severe Substance Use - A
Criminal Thinking - B
Self-Improve/Mgmt - C
Social/Interpersonal Skill - D
Life Skills - E
Punishment Only - F
Number of Programs2015 2013
28
CHANGE IN PROGRAM QUALITY SCORES
44%
57%
65%
57%
41%
67%
55%
42%
46%
50%
43%
29%
64%
51%
0% 20% 40% 60% 80% 100%
Risk
Need
Responsivity
Implementation
Dosage
Restrictiveness
Total
2013 2015
29
30
APD ESTIMATED RESPONSIVITY GAP
• Greatest unfulfilled needs are cognitive
restructuring programs, mental health, co-
occurring disorders, and substance abuse
RESPONSIVITY GAP FOR FEMALES
31
• Higher rates of substance dependence than
males; similar need for cognitive restructuring,
mental health, co-occurring disorders programs
• Limited gender-specific treatment available
RESPONSIVITY GAP FOR YOUNG ADULTS
32
• Clients age 18-27: lower rates of substance
dependence; VERY high rates of criminal thinking,
resulting in pronounced gap
DOC POPULATION NEEDS & RECIDIVISM RATES
(N=2844)
33
0%
5%
10%
15%
20%
25%
30%
High Dosage Moderate Dosage
34
AAI REENTRY OUTPUT & CASE
PLANNING
35
Implementation of the RNR Sim Tool
How is it used?
• The RNR tool provides the initial screening and evaluation of the inmates level of risk and available treatment options based upon the RNR principle.
• Assists us with the treatment plan (added to case file.)
• Aids in participant staffing.
• Re-assessments measure a participants recovery progress while in the program.
Rockdale, GA: Advantages of Using the Tool
Advantages in general
With a diverse population the tool allows us to assess all potential participants by accomplishing what many tools do individually.
It takes the mystery out of interpreting by its being easy to use.
RNR tool works with the specific treatment options available in our program, allowing us to address responsivity, and helping our clients focus on motivation to change.
It shows us the gaps in services so that we can start working on them while our clients are still incarcerated.
Gives multiple options for treatment to use when one will not work for the current situation.
Helps reduce recidivism and costs by correctly auditing issues that our clients may encounter upon release.
Jurisdictions Using RNR Simulation Tool
Center for Advancing Correctional Excellence! www.gmuace.org/tools
This project is funded by BJA: 2009-DG-
BX-K026
WWW.GMUACE.ORG/TO
OLS
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