moving from principle to execution
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Moving from Principle to Execution. Applications of the Risk-Dosage Relationship Kimberly Sperber, PhD. Support for the Risk Principle. Hundreds of primary studies 7 meta-analyses Men, women, juveniles, violent offenders, sex offenders - PowerPoint PPT PresentationTRANSCRIPT
Moving from Principle to Moving from Principle to ExecutionExecution
Applications of the Risk-Dosage Relationship
Kimberly Sperber, PhD
Support for the Risk Support for the Risk PrinciplePrinciple
• Hundreds of primary studies• 7 meta-analyses• Men, women, juveniles, violent offenders, sex
offenders
• Programs that target higher risk offenders are more effective
• Reductions in recidivism are greatest for higher risk offenders
• Intensive interventions can harm low risk offenders
2002 UC Ohio Study of HH2002 UC Ohio Study of HH’’s and CBCFs and CBCF’’ss
2002 UC Ohio Study of HH2002 UC Ohio Study of HH’’s and CBCFs and CBCF’’ssTreatment Effects For High Risk Offenders
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River City
Fresh Start
Alternative Agency
Talbert House Cornerstone
Community Assessment Program (Men’s)
Monday
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Cincinnati VOA McM
ahon Hall
Talbert House Spring Grove
NEOCAP
Oriana House RIP
Alvis House Dunning Hall
Lorain/Medina
All CBCF Facilities
Canton Community Treatment Center
Lucas County
SRCCC
All Facilities
Licking/Muskingum
Summit County
Butler
SEPTA
Community Transitions
Franklin County
Small Programs
Oriana House TMRC
Cincinnati VOA Chemical Dependency Program
Alvis House Alum Creek
Talbert House Beekman
Comp Drug
Harbor Light Salvation Army
Community Corrections Association
Toledo VOA
Mahoning County
EOCC
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Challenges for PractitionersChallenges for Practitioners
• We understand more services/supervision for high risk and less services/supervision for low risk
• Conceptual understanding of the risk principle versus operationalization of the risk principle in real world community settings to achieve maximum outcome
• “Can we quantify how much more service to provide high risk offenders?”
Limited GuidanceLimited Guidance
• Prior Literature:– Lipsey (1999)
• Meta-analysis of 200 studies• Serious juvenile offenders
– Bourgon and Armstrong (2005)• Prison study on adult males
• More Recent Literature:– Sperber, Makarios, and Latessa (2013)
• Community-based setting
Identifying Effective Dosage Levels in Identifying Effective Dosage Levels in a Community-Based Settinga Community-Based Setting
• Sperber, Latessa, & Makarios (2013):– 100-bed CBCF for adult male felons– Sample size = 689 clients– Clients successfully discharged between 8/30/06 and
8/30/09– Excluded sex offenders– Dosage defined as number of group hours per client– Recidivism defined as new sentence to prison– All offenders out of program minimum of 12 months
Unanswered QuestionsUnanswered Questions(Sperber, Makarios, & Latessa, 2013)(Sperber, Makarios, & Latessa, 2013)
1. Defining dosage2. What counts as dosage?3. Prioritization of criminogenic needs4. Counting dosage outside of
treatment environments
Unanswered QuestionsUnanswered Questions
5. Sequence of dosage6. Cumulative impact of dosage7. Impact of program setting8. Low risk but high risk for specific
criminogenic need
Unanswered QuestionsUnanswered Questions
9. Nature of dosage for special populations
10.Impact of skill acquisition11.Identifying moderators of risk-
dosage relationship12.Conditions under which dosage
produces minimal or no impact
Treatment Dosage and the Risk Principle: An Treatment Dosage and the Risk Principle: An Extension and RefinementExtension and Refinement
Makarios, Sperber, and Latessa(under review)Makarios, Sperber, and Latessa(under review)
• Methodology– 100-bed CBCF for adult male felons
• Sample size = 980 clients
– Clients successfully discharged between 8/30/06 and 12/31/10
– Excluded sex offenders– Dosage defined as number of group
hours per client– Recidivism defined as return to prison– All offenders out of program minimum
of 12 months
Table 1. Descriptive Statistics for the Table 1. Descriptive Statistics for the Study Sample (n = 941)Study Sample (n = 941)
Variables N %RaceCaucasian 840 89Minority 101 11
Risk LevelLow/Moderate 195 21Moderate 587 62High/Moderate 159 17
Dosage Categories0-99 149 16100-149 190 20150-199 245 26200-249 234 25250-299 90 10300+ 33 3
Return to PrisonYes 360 39No 581 61
Mean/SD RangeAge 31.6/9.2 18-61Time at Risk 1344.8/398.8 550-2027
Table 2. Cox Regression Predicting Table 2. Cox Regression Predicting Time to Return to Prison (N = 941)Time to Return to Prison (N = 941)
Variable Slope (b) SE Wald Exp(B)
Age -.015** .006 6.163 .985
Minority .283* .157 3.265 1.328
Risk Level -.102*** .044 5.283 .903
Dosage Categories .529** .100 28.285 1.696
Model Chi-Square = 38.760***
Dosage by Risk LevelDosage by Risk Level
Categories with less than 20 cases excluded
Summary of FindingsSummary of Findings
• Overall, increased dosage reduces recidivism– But not equally for all categories or risk levels
• Low / Moderate and Moderate– Curvilinear relationship
• Matters at the low ends of dosage, but effects taper off and eventually reverse as dosage increases
• High / Moderate– Increases in dosage consistently result in decreases
in recidivism, but• Saturation effect at high dosage levels
LimitationsLimitations
• Single study from a CBCF in Southwestern Ohio
• Male Sample• Does not consider other potential
moderators• Lack of “0” Dosage comparison
group
Treatment Dosage and Personality: Examining Treatment Dosage and Personality: Examining the Impact of the Risk-Dosage Relationship on the Impact of the Risk-Dosage Relationship on
Neurotic OffendersNeurotic OffendersSperber, Makarios, and LatessaSperber, Makarios, and Latessa
• Research on the risk principle confirms that correctional practitioners should differentiate services by offender risk.
• Research also confirms that these services should be based on a cognitive-behavioral modality.
• At the same time, there is some research to suggest that offenders with certain personality types (e.g. neurotics) are higher risk for re-offending and may not fare as well as other personality types within cognitive behavioral programs.
• If this is true, increasing cognitive behavioral dosage for high risk neurotic offenders may have a detrimental impact on recidivism for those offenders.
• Consequently, this study examines personality type as a moderator of the risk dosage relationship to determine the impact on recidivism.
MethodologyMethodology
– 100-bed CBCF for adult male felons– Clients successfully discharged
between 8/30/06 and 12/31/10• 980 offenders total• 257 neurotic offenders
– Excluded sex offenders– Dosage defined as number of group
hours per client– Recidivism defined as return to prison– All offenders out of program minimum
of 12 months
Personality TypesPersonality Types
• Jesness Inventory• 9 Types collapsed into 4:
– Aggressives– Neurotics– Dependents– Situationals
Table 1: Sample Characteristics
Characteristics N % Race White 236 91.8 Non-White 21 8.2 Age 18 – 30 111 43.2 31 – 40 93 36.2 41 – 50 46 17.9 51+ 7 2.7 Mean Age 33.4 Risk Level Low/Low Moderate 33 12.8 Moderate 155 60.3 High/Very High 69 26.8 Mean 29.8 Dosage Categories 0 – 99 39 15.2 100-199 107 41.6 200+ 111 43.2 Mean Dosage 186.9 Recidivism Yes 111 43.2 No 146 56.8
Table 2: Cox Regression Predicting Time to Return to Prison Variable Slope (b) SE Wald Exp(B)
Age -.023* .011 3.984 .978
Moderate Risk .837* .404 4.301 2.309
High Risk 1.354** .442 9.358 3.871
100-199 Hours -.195 .275 .503 .823
200+ Hours -.540 .298 3.283 .583
** p < 0.01 *p<.05 Model X2 = 16.10**
0-99 hrs 30 54 49
100-199 hrs 15 42 85 42
200+ hrs 40 45 42
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Percentage Returned to Prison by Tx Dosage and Risk Level
0-99 tx hours
100-199 tx hours
200+ tx hours
SummarySummary
• Pattern for neurotics similar to the overall sample
• Increasing dosage reduces recidivism but not equally for all risk levels
• Largest decrease in recidivism was for the high risk/high dosage group
LimitationsLimitations
• Single study from a CBCF in Southwestern Ohio
• Limited number of cases in certain categories may have limited power of analysis
• Can’t address issues of service delivery content that may still be relevant for a neurotic population
Examining the Risk-Dosage Relationship in Examining the Risk-Dosage Relationship in Female OffendersFemale Offenders
Spiegel and SperberSpiegel and Sperber
• Studies on the number of treatment hours necessary to reduce recidivism for high risk offenders are few in number.
• Studies to date have relied on male samples. • Cannot assume that a standard number of
treatment hours necessary to reduce recidivism exists for both men and women.
• Present study examines the impact of varying levels of treatment dosage by risk for female offenders in a halfway house setting.
MethodologyMethodology
• Sample size = 314 clients• Clients successfully discharged between
10/1/07 and 2/28/10• Dosage defined as number of group hours per
client• Recidivism defined as re-arrest
– Checked Hamilton County and referral/home county websites
– All offenders out of program minimum of 12 months
Table 1: Sample Characteristics
Characteristics N % Race White 222 70.9 Non-White 91 29.1 Age 18 – 30 102 32.6 31 – 40 95 30.4 41 – 50 95 30.4 51+ 21 6.7 Mean Age 36.5 Risk Level Low/Moderate 169 54.0 Moderate 130 41.5 High/Moderate 14 4.5 Mean 22.8 Dosage Categories 0 – 50 174 55.6 51 – 100 96 30.7 101+ 43 13.7 Mean Dosage 60.0 Mental Health History Yes 165 52.7 No 148 47.3 Re-arrest Yes 69 22.0 No 244 78.0 Mean Range Time at Risk 1188.2 (SD= 442.0) 7 - 1802
Table 2: Cox Regression Predicting Time to Re-arrest
Variable Slope (b) SE Wald Exp(B)
Race (White=1) -.607** .246 6.084 .545
Mental Health History .604** .275 4.839 1.830
Risk Level .055** .021 6.829 1.056
Dosage Categories -.001 .003 .209 .999
** p < 0.05 Model X2 = 24.276***
19.3
34.1
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11.316.3
13.518.2
30
20.9
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10152025303540
Low-Moderate Risk Moderate + Risk Overall
Recidivism Rates by Dosage and Risk Level
0-50 Hours 51- 100 Hours 101+
SummarySummary
• Further evidence of the application of the risk principle to women– Over-treating lower risk women can result in
recidivism increase
• Findings suggest a non-linear relationship for both risk groups
• Initial increases in dosage have positive impact on recidivism
• Increasing dosage to 101+ hours appears to result in increases in recidivism
LimitationsLimitations
• Sample drawn from a single halfway house with limited geographical region
• Limited risk distribution• Limited dosage distribution• Inclusion of drug court clients in sample• Reliance on public websites for recidivism
checks• Limited geographical range for recidivism
– Doesn’t account for all Ohio counties– Doesn’t account for bordering counties of other
states
Forthcoming StudiesForthcoming Studies
• Under Construction:– Examining the Risk-Dosage
Relationship in Sex Offenders– The Relative Impact of Role-Play
versus Treatment Hours: Is There a Trade-Off?
– The Impact of Client Strengths on the Risk-Dosage Relationship
But What Do We Know?But What Do We Know?
• Research clearly demonstrates need to vary services and supervision by risk
• Currently have general evidence-based guidelines that suggest at least 100 hours for moderate risk and at least 200 hours for high risk
• Should not misinterpret to imply that 200 hours is required to have any impact on high risk offenders
• Not likely that there is a one-size-fits-all protocol for administering dosage
• Practitioners have a responsibility to tailor interventions to individual’s risk/need profile based on best available evidence
Practitioner Responsibilities for Practitioner Responsibilities for Effective Execution of the Risk PrincipleEffective Execution of the Risk Principle
• Process for assessing risk for all clients• Modified policies and curricula that allow for variation
in dosage by risk– Assess infrastructure and resources
• Definitions of what counts as dosage and mechanism to measure and track dosage– Unit of measurement– Quality versus quantity
• Formal CQI mechanism to:– Monitor whether clients get appropriate dosage by risk– Monitor quality of dosage– Monitor outcomes of clients receiving dosage outside of
evidence-based guidelines
ConclusionsConclusions
• Corrections has benefitted from a number of well-established Evidence-Based Guidelines and Evidence-Based Practices
• Next evolution will focus on bringing a more nuanced understanding and application of these EBG’s and EBP’s to the individual client level
• Practitioner-driven CQI/data needs to intersect with research to drive this process so that we continually move the field forward to maximize public safety outcomes