Transcript Community: Reducing Recidivism with Continuity of Care presented

RETURN TO COMMUNITY:
Reducing Recidivism with Continuity
of Care
Bob Kingman, J.D., M.Ed.
Crisis & Counseling Centers
OVERVIEW
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Program Continuation
Transition to Community
Aftercare treatment & continuity of care
VIDEO: Program participants & program
materials
• Discussion
OBJECTIVES
• Compatible ‘inpatient & out-patient’
treatment approaches
• Aftercare and community supervision
expectations
• Transparent/consistent communication
• CARA participant profiles
Problem Recognition in Maine
• 2015:
272 deaths from drug overdoses; a
31% increase from 2014 (208)
• 1013 babies drug-affected at birth; 8% of all
live births in Maine (668 in 2011).
• 1800 criminal convictions involving
opiates/heroin class. Increased from 1500 in
2014 and 1300 in 2013.
• “…..the horror of heroin and opiate addiction
in our youth, our middle-aged citizens and
even mature Mainers is growing…..the wave
of drug addictions is eating at the heart of our
beautiful state.”
– Leigh Saufley, Chief Justice, Maine Supreme Court
Integrated Treatment & Supervision
Has Most Impact
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Treatment Impact on
Recidivism Rates
Stephanie Lee, Steve Aos, Elizabeth Drake, Annie Pennucci, Marna Miller, Laurie Anderson, “Return on Investment:
Evidence-Based Options to Improve Statewide Outcomes,” (Olympia: Washington State Institute for Public Policy, April
2012); D.A. Andrews and James Bonta, “ColorPlot Profile Form for Men,” The Level of
Service Inventory - Revised: U.S. Norms, (North Tonawanda: Multi-Health Systems, Inc., 2003).
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Need to Retool?
• Traditional SA/MH
treatment
• Criminal Justice
Partnership
• Overlapping populations
• Revolving door
• Criminogenically
informed
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The Basics
• Treatment
Works!
• Yes…CBT, but…
• Aim for
criminogenic
targets!
Risk
Need
Responsivity
Dosage
Treatment
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Continuity: concepts & definitions
Criminogenic
Pro-social
Anti-social
Entrenchment
Desistance
Pathway In: Session 1
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CARA Philosophy
“…give people adequate information,
in a respectful supportive environment that
enhances pro-social values, with adequate
support inside and outside a jail setting and
pro-social change is possible.”
Pathway In: Session 1
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Effects of Social Disengagement
• Prolonged exposure to
negatively defines self,
other, and community
• Adaptive behaviors
result in an
accumulative anti-social
“culture”
• Pro-/Anti-social
“culture” is reinforced
and influences
decisional balances
OK
Not
OK
Self
Significant
Others
Community
Criminogenic Change
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Needs met with negation
and exclusion
Adaptive behavior
weakens social bond
Anti-social adaptation
becomes “culturally”
reinforced
Social
Disengagement
Criminogenic Change
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Expectation
Social
Capital
Obligation
Human
Capital
Trust
Criminogenic Change
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Pro-Social Amplification
Pro-social
capital and
bonding
Pro-social
reinforcement
Welcoming and
Inclusion
Reintegrative
Shame
Criminogenic Change
Pro-social
behavioral
supports
Amplify prosocial
motivations and
identity
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What is Best Practice?
8 Evidence Based Principles to Reduce Recidivism
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Assess Risk/Needs
Identify and enhance the individual's motivation
Target Criminogenic Targets
a. Risk Principle
b. Need Principle
 Gender Informed
c.
Responsivity Principle
 Strength-based
d. Dosage
e.
Treatment Principle
Experiential, “hands on”, practical treatment
Highlight pro-social values and behaviors
Multi-disciplinary team approach
Measure Criminogenic outcomes
Provide 360 degree feedback
http://cjinstitute.org/files/evidencebased.pdf
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Targeting Criminogenic Need: Results from MetaAnalyses
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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Scope of Treatment
Traditional:
Symptom
reduction
Criminogenic:
Pro-social
engagement
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Early Treatment Expectations
…of Psychotherapy
– It doesn’t help
– I’ll have to give something
up
– “Entertainment”
– Shame-based
– “Salvation”
– Unsafe
…of the Clinician
– From a “different
planet”
– Represents “the
system”
– …to be played
…of themselves
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Passive
Be in control
Be guarded
Play the “game”
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COMMON GOAL: BEHAVIOR CHANGE
Perception
+ Feelings
+ Thoughts
+ Actions
_________________
BEHAVIOR
Behavior changes when:
• Our needs change
• Old behavior is replaced
– New behavior ‘plans’ are tested upon return to
the community
– Pro-social pull and anti-social drift
Clinicians, case mgrs
and POs are from the
Pro-social Club!
Criminogenic process is
more powerful than a
vague desire to change
Pro-social
consequences can be
accumulative
Sustainable change is
relationship based
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Advantages of Care Continuity
• Facilitators are familiar
• Understanding is enhanced/build on prior
knowledge
• Consistent treatment philosophy
• Risk factors can be focused on in more depth
• Communication/investment in community
supervision process=less of treatment barrier
• DISADVANTAGES
– Ineffective therapeutic relationship
– Risk of clinician’s ‘BS meter’ malfunction
Examples of IOP Treatment Materials
• Situational confidence questionnaire
• Substance abuse change plan
• IOP group materials & outline
Brief Situational Confidence Questionnaire
• Right now I am confident [0%-100%]to resist the urge
to use/abuse substances in situations involving:
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(1) Unpleasant emotions
(2) Physical discomfort
(3) Pleasant emotions
(4) Testing control over my use of alcohol or drugs
(5) Urges and temptations
(6) Conflict with others
(7) Social pressure to use
(8) Pleasant times with others
Participant Profiles
• Video: Panel Discussion
• ‘Having all the tools’ needed for a successful
return to community
Community Supervision
• Treatment without supervision is likely to be
much less effective
• Value in understanding different
responsibilities and differing philosophies
• Transparent ‘team’ communication
• Use of random drug testing
• Sanctions and rewards
CRIMINOGENIC ADDICTION RECOVERY ACADEMY
CARA
CASE MANAGEMENT
Maine Pretrial Services
In custody
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Identify any pro-social community supports
Help secure the safest housing available
Help obtain any necessary identification
Make referrals as needed
Prepare and submit all release paperwork
Review all conditions of release
Positive support for release to the community
In the community
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Regular and random substance screening
Weekly meeting with CARA team
Verification of treatment progress
Medication accountability
Conditions of release compliance
Violation notifications
Home and activity visits
General community support as needed
Participant Profiles: different
pathways to recovery horizons
• David
• Jeromy
David’s Interview
• Comments on interview and David’s treatment
experience(s)
Jeromy’s Interview
• Comments on interview
• Compare/contrast Dan’s & Jimmy’s
experiences
• Highlight modifications to CARA program
Modifications to CARA Program
• Phase 1: In-facility CARA Program ONLY; no
IOP/aftercare, some supervision.
• Phase 2: In-facility CARA, some S/V and IOP
treatment; w/o continuity (1-5 weeks).
• Phase 3: In-facility CARA; mandated IOP with
variable S/V and some treatment continuity.
• Phase 4: In-facility CARA; mandated IOP with
continuity and deferred disposition
supervision for 12 months.
Addressing dynamic risk factors/
criminogenic needs
Dynamic Risk/Crimonogenic Need
Factor
Action
History of antisocial behavior
Build alternative behaviors
Antisocial personality pattern
Problem solving skills, anger management
Antisocial cognition
Develop less risky thinking
Antisocial attitudes
Reduce association with criminal others
Family and/or marital discord
Reduce conflict, build positive relationships
Poor school and/or work performance
Enhance performance, rewards
Few leisure or recreation activities
Enhance outside involvement
Substance abuse
Reduce use through integrated treatment
Source: Andrews (2006)
Determine Dosage and Intensity of
Services
• Higher-risk individuals benefit from significantly more
structure and services than lower-risk offenders
(Bourgon & Armstrong, 2006; Gendreau & Goggin, 1995; Latessa, 2008)
 Higher-risk:
300 hours
 Moderate-risk: 200 hours
 Low-risk:
100 hours
• During the initial three to nine months post-release, 40%70% of high-risk individuals’ free time should be occupied
with delineated prosocial routines and appropriate services
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Service Delivery Principles- “How You Do It”
Based Primarily on Risk of Recidivism
Lower-Risk
Service Delivery
Principles
Less Intensive Application for
Lower-Risk Individuals
Higher-Risk
More Intensive Application for
Higher-Risk Individuals
Engagement
Avoid intensive engagement and case
management
Intensive case management with
frequent contact
Timing
Timing is still important, but less of a
priority for lower-risk individuals
Connect with individuals before
release from jail/prison
Incentives
Incentives are less of a priority and
need for lower-risk individuals
Enhance motivation through
communication and incentives
Coordination
Community supervision should not be
intensive, and officers do not have to
play as active a role
Work closely with community
supervision officers, who can assist
with intensive engagement
Structured Time
Avoid structuring time that disrupts
existing pro-social ties
Highly structured time to provide a
pro-social environment
The challenges of implementing
effective interventions
• Requires a dedicated commitment to change by managers, line
staff, and everyone in between
- Not just in corrections agencies, but in all service
delivery agencies
• Requires an increased emphasis on accountability for our work –
individual and collective
• Requires us to reconsider current practices and let go of the “that’s
always how we’ve done it” philosophy
• Requires us to confront and address resistance
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Principles of Drug Abuse Treatment for
Criminal Justice Populations- NIDA
• Treatment should target factors that are associated
with criminal behavior
• Supervision should incorporate treatment planning
for drug abusing offenders, and treatment providers
should be aware of correctional supervision
requirements
• Continuity of care in the community is essential
• A balance of rewards and sanctions encourages
prosocial behavior
Reentry interventions for people with substance
use disorders on community supervision
• CBT and relapse prevention: Several manualized CBT programs for
adult offenders
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Cognitive Intervention Program (NIC)
Moral Reconation Therapy
Reasoning and Rehabilitation
Thinking for a Change (NIC)
• Case management (mixed results)
• Contingency management and motivational enhancement
techniques
• Residential treatment
• Pharmacotherapy
• Tailoring programming and strategies to special populations
• Continuing Care
Prendergast, M.L., et al. (2009). Interventions to promote successful reentry among drug- abusing parolees. Addiction Science & Clinical Practice.
Responses to technical violations
Swift and certain responses rooted in human development research
CERTAIN
• Sanctions and incentives are clearly defined before noncompliance occurs.
• Responses are applied consistently when goals are met or noncompliance
occurs.
• Certainty increases the offender’s perception that supervision responses are
fair which increases compliance.
SWIFT
• Sanctions or incentives occur immediately after violation.
GRADUATED
• Responses are matched or proportionate to the severity of the violation.
• The severity of the response increases with the number and severity of the
violation.
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Graduated Response Matrix
• Handout(s)
Ratio of Rewards to Punishments and
Probability of Success on Intensive Supervision
Probability of ISP Success
90%
80%
77%
70%
71%
60%
57%
50%
Greater LONG term behavioral
change attained through
positive reinforcement rather
than punishment contingencies.
40%
30%
20%
20%
10%
0%
81%
80%
7%
1:10
8%
1:08
9%
1:06
11%
1:04
1:02
2:01
4:01
6:01
Ratio of Rewards to Punishments
8:01
10:01
Source: Widahl, E. J., Garland, B. Culhane, S. E., and McCarty, W.P. (2011). Utilizing Behavioral Interventions to Improve Supervision
Outcomes in Community-Based Corrections. Criminal Justice and Behavior, 38 (4).
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Why Positive Reinforcement Works
• Punishment STOPS behavior – doesn’t replace it
with appropriate behavior.
• It is important to reinforce a competing response
by acknowledging the appropriate behavior.
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Principles of effective interventions
1. Screen and assess for behavioral health and criminogenic
risk and needs
2. Enhance instrinsic motivation
3. Target interventions according to the
risk/need/responsivity/dosage principles
4. Skill train with directed practice using CBT methods
5. Increase positive reinforcement/ graduated responses
6. Firm but fair supervision tailored to risk level
7. Engage ongoing support in natural communities
8. Measure relevant processes/practices
9. Provide measurement feedback
NIC, 2004: https://s3.amazonaws.com/static.nicic.gov/Library/019342.pdf
CONCLUSIONS/TAKE-AWAYS
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Common purpose/goal(s)
Collaboration and investment (training, etc.)
Consistency and structure
Community supervision
Continuity of care
Careful modifications and restructuring
THANK YOU