Adapting Programs to Incorporate EBPs for CJ-Involved Clients Merrill Rotter, MD Medical Director,...

Adapting Programs to Incorporate EBPs for CJ-Involved Clients

Merrill Rotter, MDMedical Director, EAC TASC Mental Health Programs

Associate Clinical Professor, Albert Einstein College of Medicinemerrill.rotter@gmail.com

Why Incorporate EBPs

Engagement Clinical Improvement Decrease Untoward Behavior Improved quality of life Decreased recidivism (re-arrest)

RNR and EBPs

ResponsivityEngagementCBT intervention

NeedsThe Central Eight

Risk Match treatment intensity to level of risk

Needs Treat the offender, not the offense

Responsivity Modality must be one to which offender is responsive

CBT Engagement

Responsivity Principle

Responsivity:Tailoring Treatment

General Responsive to learning styles

e.g. CBT

Specific Responsive to socio-biological

personality factors Engagement

Why focus on engagement?

Treatment outcome and premature termination predicted by engagement Treatment outcome related to patient

effort Manner of therapist related to

engagement and effort

Engagement Challenges

Motivation Motivational Interviewing IMR Goal Setting Focus on Recovery

CJ culture Adaptation SPECTRM Intervention

SPECTRMThe Clinical Impact of

Doing Time

RiskNeeds

Responsivity

Trauma InformedTreatment

Cultural Competence

Trauma

Consequences Isolation Hypervigilance Emotional reactivity

Intervention principles Safe environment Processing of Trauma Identification of coping strategies

Cultural Competence

Cultural Proficiency Meaning of symptoms, illness, stressors Meaning of treatment Relationship with professionals

Overcoming mistrust Communication Rapport Disclosure

Using “natural” community support

These walls are kind of funny. First you hate 'em, then you get used to 'em. Enough time passes, gets so you depend on them. That's institutionalized.

Incarceration as Cultural Adaptation

AKA: The Inmate Code

Do Your Own Time

Mind Your Own Business

Trust No One

Show Respect

Ignore Others’ Infractions

Don’t Steal

Don’t Snitch

Don’t Show Weakness

Don’t Stare

Promote Cultural Re-adaptation by

Connecting Developing trust through shared experience

Exploring Challenging prison and jail attitudes

Changing Introducing new problem solving skills

Three Principles

CONNECTING Be willing to listen and learn: Where were you and what

was it like?

EXPLORING Be aware of differences and similarities in the two cultures:

What are the cues?

CHANGING Be neutral: Is it working for you here?

Needs PrincipleThe Central Eight

History of antisocial behavior Antisocial personality pattern

Pleasure seeking, restless, aggressive Antisocial cognitions

Attitudes supportive of crime Antisocial Associates Family support Leisure Activities School/work Substance Abuse

Needs - Interventions

Substance Abuse Integrated Treatment People, places and things

Family support Multi-family therapy

School/Work Supported Employment

Homelessness Housing first

Antisocial Cognitions/Associates/Character Monitoring Cognitive behavioral interventions

Cognitive-Behavioral InterventionsCJ-Involved Populations

Introspection skills Cognitive Restructuring

Problem Solving Identification of cognitions Cost-benefit analysis

Social Skills Conflict Resolution

Moral Reasoning/Community Responsibility

Cognitive-Behavioral AdaptationsCJ-Involved Populations

Thinking for a Change National Institute of Corrections

Lifestyle Change Journaling The Change Companies

Reasoning and Rehabilitation Moral Reconation Therapy

Cognitive-Behavioral InterventionsCJ-Involved Populations

MH Program adaptations

Target symptoms Frustration intolerance Social skills Misperception of environment

Examples Forensic DBT

Jail - decreased anger, aggression and incidents Community - decreased re-arrests in stalker-focused

program

RNR

Merrill Rotter, MDMedical Director, EAC TASC Mental Health Programs

Associate Clinical Professor, Albert Einstein College of Medicine

merrill.rotter@gmail.com