Transcript Jeffrey Beard`s Presentation - Lesson`s Learned from the PA

Introduction
Research
Lessons Learned from the PA DOC’s
Recidivism Reduction Efforts:
Practical Experiences in Implementing
Evidence-Based Assessment & Treatment Practices
Risk
Need
Jeffrey A. Beard, Ph.D.
Secretary of Corrections
Pennsylvania Department of Corrections
Treatment
Conclusion
Presentation for :
ASCA All Directors Training Program
November 14, 2008
San Diego, CA
Why Follow Evidence-Based Practice (EBP)?
Introduction
 Population growth is unrelenting…
 Fiscal impact is tremendous…
Research
 Most importantly, public safety is our responsibility…
Risk

 costly, ineffective as long-term solution to criminal behavior, & creates
“roadblocks to re-entry”
Need
Treatment
Conclusion
Failed response – confinement has not been sufficient…
 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”
Principles of Effective Correctional Intervention
Introduction
Research
Risk
Need
Treatment
Conclusion

Risk Principle

Need Principle

Treatment Principle

Responsivity Principle

Dosage Principle

Relapse Principle

Community Integration Principle

Staffing Principle

Fidelity Principle
Principle 1: The Risk Principle
Introduction
•
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
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…
Introduction
Research
Risk
Need
Treatment
Conclusion
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
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
•
Introduction
Research
•
Risk
Need
•
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)
Treatment
Conclusion
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
Principle 6: The Relapse Principle
Introduction
Research
Risk
Need
•
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
Treatment
Conclusion
Principle 7: The Community Integration Principle
Introduction
Research
Risk
Need
Treatment
Conclusion
 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
Principle 8: The Staffing Principle
Introduction
Who should deliver the programming/formal treatment intervention?
•
Research
Risk
Staff should have appropriate:
 levels of education
 experience
 training
 personal qualities, skills, & characteristics (Handout #5)
Need
Treatment
Conclusion
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)
Principle 9: The Fidelity Principle
Internal Methods for Promoting Quality Assurance
Introduction
Research
Risk
Need
Treatment
Conclusion
 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)
Principle 9: The Fidelity Principle, continued…
External Evaluation
Introduction
Research
Risk
Need
Treatment
Conclusion
 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
Who should we focus on? Which needs must we address?
Introduction
Needs are Diverse & Significant…
Research
Risk
Need
Treatment
Conclusion

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
Current Practice: The Risk & Need Principles
1.
Introduction
Research
Risk
Target High Risk Cases
(Risk Principle)
Administer
Risk Screen
Tool (RST)
Low
Any PFA
Treatment
Need for
Override?
Criminal Thinking
Assess Criminogenic Needs
(Need Principle)
Administer
CSS-M
Hostility & Anger
Administer Full
Assessment
Battery
Medium-High
Violence
Need
2.
Administer
HIQ & Batterer's
Screen
Recommend Low
Intensity Program Track:
Substance Abuse
Administer
TCU Drug
Screen II
Batterer's Program
or
Violence Prevention
Yes
No
Instant SO
2+ DUI
Sex Offender
Program
Outpatient Alcohol &
Other Drug Program
Sex
Offender?
Yes
Sexual Offending
Administer
Static-99 &
other indicators
Education
Conclusion
No Treatment
Prescribed
Administer
TABE, WRAT,
Beta III
Vocation
Educational & Vocational
Programming Only
Administer
Career Scope
Current Practice: The Risk & Need Principles
Assessment Results:
Introduction
CSS-M
HIQ
TCU
Low (0-2)
Research
Risk
Low
(55 & Below)
Med-High
(56 & Above)
Need
Low
(55 & Below)
Med-High
(56 & Above)
Batterer's
Intervention
AOD Outpatient
Therapeutic
Community
l
l
Medium (3-5)
l
Low (0-2)
o
o
Medium (3-5)
o
o
High (6-9)
o
o
Low (0-2)
l
Medium (3-5)
l
l
l
l
l
Low (0-2)
l
o
o
Medium (3-5)
l
o
o
o
o
High (6-9)
Key:
Violence
Prevention
High (6-9)
Med-High
(19 & Above)
Conclusion
Thinking for a
Change
High (6-9)
Low
(18 & Below)
Treatment
Correctional Plan Recommendations:
l
o
Recommend Violence Prevention, Batterer's Intervention, or both programs based on needs presented by case
l
Required program recommendation
l
Current Practice: The Treatment Principle
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
Anti-social Attitudes/Crim Thinking:
 Thinking for A Change
 Young Adult Offenders – LDP, TC, Re-entry
 Changing Offender Behavior (pilot)
 Females – abuse, relationships, maternal, etc.
 Victim Awareness (leg. mandate)
 Special Mgt, Special Needs, & Long-Term Offenders
Anger, Hostility, Aggression, Violence:
Conclusion
Sex Offending:
 Violence Prevention
 Medlin Program – low & mod/high intensity
 Batterer’s Intervention
 SO Aftercare & SO Therapeutic Community
Life Skills & Transitional Programs:
Treatment
Specialized Sub-Populations:
 Back on Track/Criminal Attitudes Program
Substance Abuse/Alcohol & Other Drug (AOD):
 Therapeutic Communities
 PennCAPP

Standard
 Dual-Diagnosis
 MIDAS – life skills

Hispanic
 Parole Violators
 COR – re-entry & transitional issues
 Outpatient (standard, parole violator, dual-diagnosis)
 Money Smart
 Special Needs Addiction Issues
 Parenting
7 Overall Lessons Learned: Risk, Need & Treatment Principles
Introduction
Research
Risk
Need
Treatment
Conclusion

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
Overall Lessons Learned, continued…

Use Comprehensive Battery – select set of tools to identify:
Introduction
Risk Level
e.g., RST (Handout #9)
override protocol
Research
Crime-Producing Needs
e.g., Coping skills - PV Study
Risk
Responsivity Factors
(e.g., mental health/co-occurring)
e.g., Burns/Roe (literacy), PAI
(personality), MH Questionnaire
Need
Treatment
Conclusion

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, overprescribe, lack of consistency/variation
CCC placement guidelines
Core Menu of Program Offerings
e.g., Central approval - new programs
Definition: “program” vs. “activity”
Overall Lessons Learned, continued…

Introduction
Research
Risk
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

Need
View Delivery as a Process
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)
Treatment
Conclusion
Overall Lessons Learned, continued…

Research, Monitor, & Stay Open to Change
Introduction
Continue to research effective
change strategies
e.g., DOC Collaborative Research Model (Handout#11)
(More than 20 outcome & 12 process evaluations)
Research
Develop quality assurance
protocols for regular monitoring
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)
Risk
Need
Treatment
Conclusion
(not just about program, but also
implementation & faithfulness to model
on ongoing basis)
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)
Introduction
Questions regarding this presentation may be addressed to:
Research
Risk
Need
Treatment
Conclusion
Jeffrey A. Beard, Ph.D.
Secretary of Corrections
Pennsylvania Department of Corrections
P.O. Box 598
2520 Lisburn Road
Camp Hill, Pennsylvania 17001-0598
Phone: (717) 975-4918
Fax: (717) 703-3621