Prisoners with Special Needs:Making Programs Work

Richard Parker

Principal Psychologist

ACT Corrective Services

richard.parker@act.gov.au

What Works in Reducing Recidivism: A primer

• Risk: Treatment to higher risk, assess risk using actuarial instruments, e.g. LSI-R, LS/CMI

• Needs: Address multiple criminogenic needs• Responsivity: Deliver services in a manner which

suit the target group/individual• Human Services: Not punishment• Treatment Integrity: Deliver what you intended• Coordination of Strategies• Adapt interventions to local needs/culture

Special Needs?

• Traditionally thought of as “unusual” categories of offenders e.g.– Intellectual disabilities– Minority racial group– Mental Illness– Illiterate, etc.

• This thinking leads to a wide range of specialised programs for each sub-group of offenders– Not feasible for small (or poor) jurisdictions– Presumes homogeneity within each sub-group

Mentally Disordered Offenders

• Recommendations (Muller-Isberner & Hodgkins, 2000)– Assess Risk & Needs– Address treatment needs for mental disorder

and criminogenic needs– Collaboration between treatment providers

Mentally Disordered Offenders

• …require all the treatments and services needed by non-offenders who suffer from these disorders, plus additional components which teach them skills for autonomous living and the skills necessary to prevent further aggressive behaviour and/or non-violent criminality”

» (Hodgkins, 2001)

Offenders with Brain Damage

• Recommendations (Nedopil, 2000)– Behaviour can be modified– Patients present with multiple deficits and

social tasks can overwhelm them and lead to frustration and maladaptive behaviours

– Inappropriate treatment demands provoke acting out by patient and resignation on the part of the staff

Personality Disordered Offenders

• Recommendations (Burke & Hart, 2000):– Identify criminogenic needs and target them

with a combination of pharmacotherapy and Cognitive Behavioural Therapy (CBT)

Psychopathic Offenders

• Recommendations (Wong, 2000):– Highly structured CBT– Use positive reinforcers (rewards)– Trained & experienced staff– Actuarial Assessments– Relapse Prevention– Decent dosage– Address criminogenic needs

Special Needs or Individual Needs?

• All offenders have special needs• No two are alike (although many share

similarities)• E.g. They may have the same criminogenic

needs, but have different pathways to resolving them

Special Needs

• The same criminogenic need may require different approaches.

• e.g. Antisocial associates– One offender may simply need to recognise the

impact of these and make a decision to return to previous positive associates

– Another may be wedded to their antisocial ties and know no other world

The Challenge• The Challenge is not to develop special adaptations of

every type of program, e.g.– Cog Skills for Women– Cog Skills for Indigenous– Cog Skills for Young Offenders– Cog Skills for Older Offenders– Cog Skills for long termers

• But to design interventions which are flexible enough to cope with diversity at the micro cultural level

• Some categories (e.g. Intellectually disabled) may still require their own special programs

Culture

• Broad Culture - e.g. Aboriginal

• Sub-Culture - The group from Smith St who use heroin together

• Micro-culture - particular styles of thinking, relating and viewing the world.

Making Programs Work

• Rationale: Some programs work under certain circumstances, and then they don’t under others

• E.g. Cognitive Skills Programs in UK

Findings 161 (2002) &Findings 206 (2003)

0

10

20

30

40

50

60

70

80

Recidivism Rate

Low MediumLow

MediumHigh

High

Treatment 2002Control 2002Treatment 2003Control 2003

What Goes Wrong?

• Doing “to” not “with”• Going through the motions• Undermining/ not owning the interventions• Not containing drop outs/poor referral practices• Wrong staff• Unsupported/untrained staff

Doing “to” not “with”

• Many programs appear to presume that the offender will change simply by being exposed to certain material:– “By the 22nd lesson, participants are ready to

evaluate themselves using a skills checklist”• What if they aren’t ready?

• What about those who were ready at Week 10?

Skills Training

“To”

Motivational Interviewing

“With”Assumes that the offender is motivated

Employs specific principles & strategies for building motivation

Seeks to identify & modify maladaptive cognitions

Explores & reflects offender perceptions without labelling or correcting them

Prescribes specific coping strategies

Elicits possible change strategies

Common Program Mistakes*

• Packing sessions as much as possible with activities … from ice breaking to closing;

• Overloading with simplified explanations of too many concepts (with overuse of acronyms);

• Setting the agenda (often with poor sequencing) and assuming that offenders are willing to move on to new concepts or learn new skills at our pace;

(*Porporino, 2003)

Common Program Mistakes

• Constantly questioning offenders, supposedly “socratically” as a technique to engage, but oftentimes without any rhyme or reason at all (and in such a repetitive, staccato fashion that would undoubtedly enrage most of us).

• Packaging “motivational enhancement” front pieces to programs to adequately “motivate” before programs are actually delivered;

• And, perhaps most importantly, giving little if any time for offenders to reflect, for themselves, on meaning and significance of what is being said.

Going Through the Motions

• Why do results of pilot programs often not continue in the full roll-out?

• Pilot– “Who Wants to run a new Program?”

• “Me, me!! Please pick me!”

• Full Roll-out– “You have to run a program”

• “What!! I already have too much to do”

Drop-Outs/Referral Practices

• “Gondolf & Foster (1991) reported attrition rates of 73% between initial enquiry into the program and the intake assessment phase and a rate of 86%by the time clients entered counselling. After 12 session had passed, 93% of the initial treatment referrals had dropped out, and at the end of the full 8 month program, only 1% of the men had successfully completed.”

(Wormith & Olver, 2002)

Drop outs

• This is fairly typical result in Community Corrections - completion rates tend to be higher in custodial environments as there are less incentives for non attendance (what else are you going to do with your time?)

Drop-out/Exclusion Types

• Client initiated• Agency initiated

– YAVIS (Young, Attractive, Verbal, Intelligent, Socially Skilled)

• Administrative (For reasons other than the offender or program)

• High risk offenders are much more likely to drop out or be excluded from programs

Attitude Problems by Staff/Courts

• He’s not a real sex offender (What is a “real” sex offender?)

• Programs don’t work/ don’t work for this type of offender (How do you know?)

• You can lead a horse to water, but you can’t make it drink (You can add some sugar to the water)

• The offender is resistant (as opposed to resisting what he thinks we are trying to do to him)

Undermining, not owning

• Strongest predictor of program completion was “effective liaison between case managers and program staff”. r = 0.39

Finding a Language

• We may have a concept we want an offender to adopt, but they cannot do so until we present it in a manner they can relate to

• E.g. “Russian Roulette” instead of “Risk”• This cannot be imported, it has to make sense for

your offenders (who are not all the same, hence you may need numerous languages)

How to Find a Language

• Be open

• Be patient

• Be positive & optimistic

• Use videos, role plays, examples, real life stories from group members

• Listen to your participants (particularly the ones who are doing well)

Cognitive Self Change: A flexible Program

• Open ended– Offenders can progress at their own pace;– New members can join as soon as a vacancy

occurs;

• Task based graduation– Participants graduate when they have

competently demonstrated the four steps of cognitive self change

Cognitive Self Change: A flexible Program

• Adaptable– Facilitators continually assess the factors that

underpin each participant’s offending, and assign tasks which will lead the offender to address that issue

• Assumes offenders are unmotivated and will often agree to participate to avoid some sanction. These offenders will plan to “jump through the hoops”

Cognitive Self Change: A flexible Program

• Strategy of Choices– You can choose to attend this program and abide by the

rules (which include homework and presentations in session); or

– You can choose to not participate (and face whatever consequences may arise from that decision);

– However, we will not allow you to attend and break the rules!

– What is your choice right now?

Cognitive Self Change

1. Learn to observe objectively your own thoughts and feelings, attitudes and beliefs.

2. Learn to recognize the thinking (thoughts, feelings, attitudes and beliefs) that leads you to do offending behavior.

3. Find new thinking that doesn’t lead you to do offending behavior, and that helps you feel good about yourself when you use it.

4. Practice using it until you’re good at it.

In Summary

• No need to have a large suite of programs– A few carefully chosen programs will do

• Pay as much attention to the circumstances you place a program into as you do to the selection/design of the program itself

• Make sure your programs are flexible and that staff are trained to use that flexibility without losing the integral core of the program