Introduction Research Risk Need Treatment Conclusion Lessons Learned from the PA DOC’s Recidivism Reduction Efforts: Practical Experiences in Implementing.

Introduction

Research

Risk

Need

Treatment

Conclusion

Lessons Learned from the PA DOC’s Recidivism Reduction Efforts:

Practical Experiences in Implementing Evidence-Based Assessment & Treatment Practices

Jeffrey A. Beard, Ph.D.Secretary of Corrections

Pennsylvania Department of Corrections

Presentation for : ASCA All Directors Training Program

November 14, 2008San Diego, CA

Introduction

Research

Risk

Need

Treatment

Conclusion

Why Follow Evidence-Based Practice (EBP)?

Population growth is unrelenting…

Fiscal impact is tremendous…

Most importantly, public safety is our responsibility…

Failed response – confinement has not been sufficient…

costly, ineffective as long-term solution to criminal behavior, & creates “roadblocks to re-entry”

recidivism - 68% arrested for new crime within 3 yrs of release (BJS)

Treatment works - addressing crime-producing needs is longer-term solution

recidivism rates reduced 10–30% with quality program

some programs are more effective than others

effective programs embrace the “Principles of Effective Intervention”

Introduction

Research

Risk

Need

Treatment

Conclusion

Principles of Effective Correctional Intervention

Risk Principle

Need Principle

Treatment Principle

Responsivity Principle

Dosage Principle

Relapse Principle

Community Integration Principle

Staffing Principle

Fidelity Principle

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 1: The Risk Principle

• Definition of risk probability of re-offense not to be confused with seriousness, dangerousness,

public objection, or political sensitivity

• Risk principle high risk likely to re-offend if not treated low risk unlikely to re-offend, even if untreated treatment of low risk may increase risk level

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 2: The Need Principle

• Definitions dynamic risk factors (changeable) – can be addressed criminogenic needs – related to re-offending (Handout #1)

• Need Principle - target criminogenic needs: Anti-social attitudes, values, beliefs, cognitions Anti-social associates & pro-social isolation Temperamental & personality factors

weak socialization, egocentrism impulsivity, risk taking aggressive energy, hostility, anger weak decision-making, problem-solving, coping skills

Low levels of educational, vocational, financial achievement Familial factors (e.g., marital/spouse) – poor quality personal relationships,

lack of mutual caring/respect/interest/accountability; anti-criminal expectations or neutral expectations with regard to criminal behavior

Substance abuse• Do not target non-criminogenic needs (self-esteem, anxiety, depression, etc)

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 3: The Treatment Principle

• Most effective approach = Cognitive Behavioral Integrates three theories:

• Behaviorism/Learning Theory Operant conditioning, reinf & punishment (Handout #2) Action-oriented Direct training – role play, practice, graduated rehearsal

• Social Learning Theory Observational learning Modeling, imitation, feedback

• Cognitive Theory Targets thoughts influencing behavior Two basic models:

Cognitive Restructuring - attempt to alter thought content (beliefs, values, attitudes)

Cognitive Skills - attempt to alter and improve thought processes (structure & form of reasoning)

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 3: The Treatment Principle, continued…

Ineffective Theoretical Models• Psychodynamic (traditional “Freudian” theory, psychoanalysis, Gestalt, Rogerian

non-directive, and other client-centered approaches)• Biological (diet, pharmacological treatments, etc.)• Deterrence (“offenders lack discipline”, “punishing-smarter” strategies, etc.)

Questionable Approaches & Programs (see Handout #3 for more examples)• Drama Therapy• Handwriting Formation Therapy• Physical Strength Training for Substance Abusers• Yoga, Meditation, Sweat Lodges• Bibliotherapy• Drug Education• Shaming Offenders• Gardening• Famous Ineffective Programs – Scared Straight, DARE, Wilderness Camps

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 4: The Responsivity Principle

• Definition of responsivity Individual factors influencing potential for results/change

• Types of responsivity factors (Handout #4) Personality (anxiety, depression, etc.) Motivation (readiness, amenability, compliance, etc.) Cognitive (learning style, IQ, attention deficits, etc.) Demographic (age, gender, race, etc.) Other (offender typology, etc.)

• Application of responsivity principle = Matching Offender to program

(e.g., anxious offender/Encounter group) Offender to staff

(e.g., low cognitive level offender/high conceptual level staff)

Staff to program (e.g., staff prefers structure/contingency management program)

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 5: The Dosage Principle

• Dosage defined: total hours of treatment exposure (duration & intensity) high dosage – exceeds 100 contact hours low dosage – little evidence low dosage programs are effective by

themselves • Duration

defined: length of service/program last for 3-9 months

• Intensity defined: how “compact” program is delivered (dense)

• Recommendations for Duration & Intensity: ideal program has both high intensity and longer duration no “watering down” - give dosage over shorter, rather than longer period Match dosage to individual risk/need profile

higher risk require greater dosage (more intensive, longer duration)

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 6: The Relapse Principle

• Purpose: maintain treatment gains

• Provide booster sessions

• Deliver aftercare in prison and community settings

• Teach relapse prevention strategies & techniques: identify triggers avoid high risk individuals, settings, situations practice low-risk alternative responses reward improved competencies train family & friends in supportive roles

• Intervene as soon as possible when circumstances deteriorate

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 7: The Community Integration Principle

continuity of care – integrate with community-based services for seamless transition

advocacy & brokerage – refer offenders to programs with quality & relevant services

public education – transfer knowledge of research & EBP to community stakeholders

collaboration – communicate, cooperate, & form relationships with key stakeholders

address obstacles – identify, then minimize or eliminate obstacles to re-entry

external monitoring – regularly evaluate the quality of service delivery by providers

delivery setting – provide services in community to greatest extent possible

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 8: The Staffing Principle

Who should deliver the programming/formal treatment intervention?

• Staff should have appropriate: levels of education experience training personal qualities, skills, & characteristics (Handout #5)

Who is responsible for targeting changes in offender behavior? …When should efforts toward rehabilitation be made? ALWAYS – develop an environment/culture supportive of

rehabilitation through all frontline staff, not just treatment staff Every social interaction with an offender in prison/center is

opportunity to reinforce appropriate behavior (Handout #6)

Introduction

Research

Risk

Need

Treatment

Conclusion

Principle 9: The Fidelity Principle

Internal Methods for Promoting Quality Assurance

Implementation - pilot minimum 1 month (formal start & end dates), literature review, develop & utilize treatment manual

Post-assessment of offenders• actuarial reassessment of offenders on target areas• observation – pro-social speech, no excuses, demonstrate skills• institutional conduct

Feedback• inmate/client satisfaction surveys• staff questionnaires & other input mechanisms• formal advisory board

Monitoring & Supervision• file reviews• regular observation of direct service delivery (Handout #7)• clinically-specific performance evaluations• adherence to program/treatment manual• involvement by leadership (e.g., regular service delivery)

Introduction

Research

Risk

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Treatment

Conclusion

Principle 9: The Fidelity Principle, continued…

External Evaluation

Audits, Inspections, Site Visits – licensure, accreditation, etc.

Process evaluations - measure extent to which program is operating as intended, “black box” (Handout #8)

• Correctional Program Checklist (CPC) examines 5 areas: Program Leadership & Development Staff Characteristics Offender Assessment Treatment Characteristics Quality Assurance

Outcome evaluations – measures extent program achieves intended results• recidivism (collect follow-up data at 3, 6, 12, 18 months)• drug abstinence• misconducts• escapes

Introduction

Research

Risk

Need

Treatment

Conclusion

Who should we focus on? Which needs must we address?

Needs are Diverse & Significant…

65% serious alcohol, drug problem (another 6% w/lower level need)

68% hostility, anger, violence, aggression

59% antisocial attitudes, criminal thinking

43% no HS/GED & 80% unemployed 6 months+ before prison

7% sex offender issues

Introduction

Research

Risk

Need

Treatment

Conclusion

Current Practice: The Risk & Need Principles

1. Target High Risk Cases

(Risk Principle)

2. Assess Criminogenic Needs

(Need Principle)

AdministerRisk ScreenTool (RST)

Need forOverride?

No

Medium-High

Low

Yes

No TreatmentPrescribed

Administer FullAssessment

Battery

Educational & Vocat ional

Programm ing Only

Sexual O ffe ndi ng

H ost ility & Anger

Educa tion

Crim inal T hin king

Substance Ab use

Vocation

AdministerCSS-M

AdministerHIQ & Batterer's

Screen

AdministerTCU DrugScreen II

AdministerStatic-99 &

other indicators

AdministerTABE, W RAT,

Beta III

AdministerCareer Scope

SexOffender?

Yes

Batterer's Programor

Violence Prevention

Sex OffenderProgram

Outpatient Alcohol &Other Drug Program

Any PFA

2+ DUI

Instant SO

Violence

Recommend LowIntensity Program Track:

Introduction

Research

Risk

Need

Treatment

Conclusion

Current Practice: The Risk & Need Principles

CSS-M HIQ TCUThinking for a

ChangeViolence

PreventionBatterer's

Intervention AOD OutpatientTherapeutic Community

Low (0-2) l

Medium (3-5) l

High (6-9) l

Low (0-2) o o

Medium (3-5) o o l

High (6-9) o o l

Low (0-2) l

Medium (3-5) l l

High (6-9) l

Low (0-2) l o o

Medium (3-5) l o o l

High (6-9) o o l

o

l

Assessment Results:

Recommend Violence Prevention, Batterer's Intervention, or both programs based on needs presented by case

Required program recommendation

Key:

Correctional Plan Recommendations:

Low (18 & Below)

Low (55 & Below)

Med-High (56 & Above)

Med-High (19 & Above)

Low (55 & Below)

Med-High (56 & Above)

Introduction

Research

Risk

Need

Treatment

Conclusion

Current Practice: The Treatment Principle

Anti-social Attitudes/Crim Thinking:

Thinking for A Change

Changing Offender Behavior (pilot)

Victim Awareness (leg. mandate)

Anger, Hostility, Aggression, Violence:

Violence Prevention

Batterer’s Intervention

Substance Abuse/Alcohol & Other Drug (AOD):

Therapeutic Communities

Standard

Hispanic

Outpatient (standard, parole violator, dual-diagnosis)

Special Needs Addiction Issues

Sex Offending:

Medlin Program – low & mod/high intensity

SO Aftercare & SO Therapeutic Community

Life Skills & Transitional Programs:

Back on Track/Criminal Attitudes Program

PennCAPP

MIDAS – life skills

COR – re-entry & transitional issues

Money Smart

Parenting

Specialized Sub-Populations:

Young Adult Offenders – LDP, TC, Re-entry

Females – abuse, relationships, maternal, etc.

Special Mgt, Special Needs, & Long-Term Offenders

Dual-Diagnosis

Parole Violators

PA DOC’s Standard Program Menu ensures cognitive-behavioral programs are offered to address offender needs in each major crime-producing area:

Introduction

Research

Risk

Need

Treatment

Conclusion

7 Overall Lessons Learned: Risk, Need & Treatment Principles

Keep it Simple

Select basic instrument short, easy to use, automate use, costs, training, method, time, cut-off levels

e.g., LSI-R

(underutilized, inter-rater reliability, validity)

Centralize functions easier to train, modify, monitor QA, maintain consistency, & manage resources

e.g., Initial plan development at 27 SCI’s (waiting lists - monitor for better control, placement)

Offer fewer programs of better quality focus on “recidivism-reduction” programs (Principles) not other activities (prevent child abuse, improve health, better physical condition, etc.)

e.g., What Works Project

(gut, feel good, popular) – programs failed to follow Principles, heavy reliance on didactic or eclectic mix

Introduction

Research

Risk

Need

Treatment

Conclusion

Use Comprehensive Battery – select set of tools to identify:

Risk Level e.g., RST (Handout #9)

override protocol

Crime-Producing Needs e.g., Coping skills - PV Study

Responsivity Factors

(e.g., mental health/co-occurring)

e.g., Burns/Roe (literacy), PAI (personality), MH Questionnaire

Overall Lessons Learned, continued…

Make it Clear & Specific – standardize to promote uniformity & accuracy:

Assessment Procedures/Protocol

(Handout #10)

e.g., Programming for med & high risk only, unless override is applied

Guidelines for Treatment Plan Development e.g., 27 SCI’s – gut, CYA, over-prescribe, lack of consistency/variation

CCC placement guidelines

Core Menu of Program Offerings e.g., Central approval - new programs

Definition: “program” vs. “activity”

Introduction

Research

Risk

Need

Treatment

Conclusion

View Delivery as a Process

Dosage – deliver sufficient dosage to effect lasting change (not too brief)

e.g., TC - 3,4,6,9 months & OP - intensive or standard

Re-assess – post-test to measure progress & identify unmet needs

e.g., Re-administration of SAIT battery

Seamless – boosters, continuity of care planning & treatment follow-up

e.g., COR, CCC services

Develop & Support Infrastructure

Staffing resources, qualifications, supervision

e.g., Separate counselor functions - less to train & re-train, better selection, buy-in

Advanced clinical training (skill development)

CCC – transitional housing vs. treatment facility

Support by leadership e.g., Positions, org structure, share vision

Create formal partnerships w/community e.g., L&I, DPW, PennDOT, etc. - meeting basic needs (driver’s license, replacement SS card, med asst, birth certificate, debt, non-driver ID)

Culture supports rehabilitative ideal e.g., Reinforcing Positive Behavior (all staff)

Overall Lessons Learned, continued…

Introduction

Research

Risk

Need

Treatment

Conclusion

Research, Monitor, & Stay Open to Change

Continue to research effective change strategies

e.g., DOC Collaborative Research Model (Handout#11) (More than 20 outcome & 12 process evaluations)

Develop quality assurance protocols for regular monitoring (not just about program, but also implementation & faithfulness to model on ongoing basis)

e.g., Quality Improvement Division in PRSG

Program Evaluation Tool

Develop program audit for CCC private vendors (conflict of goals - for-profit vs. public safety)

Remain open to critique & prepared to modify as knowledge base increases

e.g., What Works – eliminated programs

COR results – informed decision-making, CCC results

Ensure offender needs drive model – monitor & “tweak” Maintain Integrity – remain faithful to model & ensure adequate resources by:

Educate stakeholders relative to EBP to promote buy-in

e.g., Communication - PBPP, Leg, Public, PPS, DA, Judges

Base policy decisions on clinically-relevant factors/EBP

e.g., Need for RST overrides for low risk cases (public fear vs. evidence), false positive vs. false negative rates (policy decision informed by science/analysis)

Overall Lessons Learned, continued…

Introduction

Research

Risk

Need

Treatment

Conclusion

Questions regarding this presentation may be addressed to:

Jeffrey A. Beard, Ph.D.Secretary of Corrections

Pennsylvania Department of CorrectionsP.O. Box 598

2520 Lisburn RoadCamp Hill, Pennsylvania 17001-0598

Phone: (717) 975-4918Fax: (717) 703-3621