“Practitioners Helping Practitioners” Evidence Based Practices for Juvenile Justice Wisconsin Juvenile Court Intake Association September 23, 2009 1:00

“Practitioners Helping Practitioners”

Evidence Based Practicesfor Juvenile Justice

Wisconsin Juvenile Court Intake AssociationSeptember 23, 2009

1:00 -4:30pm

Wilderness Resort-Glacier CanyonWisconsin Dells

September 23, 2009

© 2009 The Carey Group; www.thecareygroup.com 2

OBJECTIVES• Understand the research around risk reduction

• Examine ways the research is being applied in practical ways within correctional systems

• Understand how and why you, as a corrections professional, are critical to whether an offender changes behavior

• Identify the five key character traits required for a professional seeking risk reduction outcomes

• Identify one or two things you can do immediately to improve outcomes

•Juvenile residential treatment counselor

•Juvenile and adult probation/parole officer

•Director of four county Community Corrections agencies

•Deputy Commissioner, MN DOC; Juvenile and Community Services

•Warden, women’s prison

•Consultant/trainer

Background: Mark Carey


Definition

• Evidence Based Practices: A progressive, organizational use of direct, current scientific evidence to guide and inform efficient and effective correctional services.


Forerunner was evidence based medicine

• 1836: bloodletting was routine

• French physician Pierre Louis: one of first clinical trials in medicine

• Found bloodletting was linked to far more deaths


LEARNINGS: STUDIES AND EXPERIENCE

• Meta-analysis: are hundreds of studies

• We know a lot about what works in reducing recidivism

• Just as important: what doesn’t work

• We have learned why initiatives have failed and succeeded

Summary of Benefits and Costs (2003 Dollars)

Dollars Per Person: Benefits Costs B - C

Early Childhood Education $17,202 $7,301 $9,901

Nurse Family Partnership $26,298 $9,118 $17,180

Functional Family Therapy $16,455 $2,140 $14,315

Aggression Repl. Training $9,654 $759 $8,805

Multi-D Treat. Foster Care $26,748 $2,459 $24,290

Intensive Juv. Supervision $0 $1,482 -$1,482

Scared Straight Programs -$11,002 $54 -$11,056

Adult Drug Courts $5,787 $4,019 $1,768

Int. Adult. Sup: Surveillance $0 $3,478 -$3,478

Int. Adult. Sup: Treatment $5,870 $4,000 $1,870 7© 2009 The Carey Group; www.thecareygroup.com

Gold: Random Assignment

Silver: Matched + Controls

Bronze: Matched + ?Controls

Iron: Inadequate Design

Dirt: Conclusive Doesn’t Work

Research Standards

Best sources for “cleaned up” research

Links from NIC website: http://www.nicic.org/WebPage_387.htm

• Washington State Institute for Public Policy Conducts evaluations of evidence-based offender treatment interventions in the State of Washington.

• Center for the Study and Prevention of Violence, University of Colorado Conducts studies, provides information, and offers technical assistance regarding violence prevention.

• The Corrections Institute, University of Cincinnati Assists agencies seeking to change offender behavior.

• Bureau of Government Research, University of Maryland Helps government agencies identify and implement "best practices."

• Institute of Behavioral Research at TCU Studies addiction treatment in community and correctional settings.

• Campbell Collaboration Studies the effects of interventions in social, behaviorial, and educational arenas.

• National Criminal Justice Reference Service

© 2009 The Carey Group; www.thecareygroup.com

9

http://www.wsipp.wa.gov/

http://www.colorado.edu/cspv/

http://www.uc.edu/corrections

http://www.bgr.umd.edu/

http://www.ibr.tcu.edu/

http://www.campbellcollaboration.org/

http://www.ncjrs.org/

State of MarylandProactive Community Supervision Results

©

2009 The Carey Group;

www.thecareygroup.com; 651-226-4755

7

14

21

28

Probation Recidivism Rates Multnomah County

1 Year Rate

2 Year Rate

3 Year Rate

©



0

2

4

6

8

10

12

All Revocations

Technical Revocations

Re

voc

ati

on

Ra

teTravis County, Texas

Felony Revocation Rates

2005

2008

©



-17% Change in Rate Pre-TCIS to Post-TCIS

©



Why are recidivism rates high?

1. We are giving too much attention to the low risk and too little on the high risk

2. Programs have not applied research knowledge nor are these practices applied with fidelity

3. The system is not in alignment

4. We are focusing on the wrong issues


Lessons LearnedWho you put in a program is important

– pay attention to risk

What you target is important – pay attention to criminogenic needs

How you target offender for change is important – use behavioral approaches

and match to offender type

15© 2009 The Carey Group; www.thecareygroup.com

-10%

0%

10%

20%

30%

Adhere to all 3 principles Adhere to 2 principles Adhere to 1 principle Adhere to none

Impact of Adhering to the Core Principles of Effective Intervention: Risk, Needs, and

Responsivity*

* meta-analysis of 230 studies (Andrews et al.,

1999)

Better outcomes

Poorer outcomes

16

Risk Principle Summary

1. Risk PrincipleWho

2. Needs PrincipleWhat

3. Treatment & Responsivity Principles

What WorksHow

© 2009 The Carey Group; www.thecareygroup.com; 651-226-4755

Risk Principle Summary(Who)

• Do not target low risk offenders

• Do not target extremely high risk offenders

• Do target medium to high risk offenders



What happens when apply intensive treatmentto high and low risk populations?

-70

-60

-50

-40

-30

-20

-10

0

10

20

O'Donnellet al, 1971

Baird et al,1979

Andrewset al, 1980

Andrewset al, 1987

Low risk

High risk

Ch

ang

e in

rec

idiv

ism

Lowenkamp, Christopher and Edward Latessa, Evaluation of Ohio’s Community Based Correctional Facilities and Halfway House Programs, University of Cincinnati, Center for Criminal Justice Research (Cincinnati, OH: Jan. 1, 2002)

01020304050607080

Potential Impact on Recidivism

Recidivism rate in relation to R/A scores

Likely recidivism rate with most effective correctional intervention

©



Justice System Assessment & Training

CRIMINAL SANCTIONS - .07 (30 tests)

INAPROPRIATE TREATMENT - .06 (38 tests)

ISP’S - .07 (47 tests)

APPROPRIATE TREATMENT .30 (54 tests)

Link Between Treatment and Recidivism

22



Deterrence Theory

• Aware of the sanction

• Perceive it as unpleasant

• Weigh the costs and benefits

• Assess the risk

• Make a rational choice


Assumption Reality

Aware of the sanction Disorganized

Perceive it as unpleasant Use drugs and alcohol

Failed in school, jobs, etc.

Weigh the costs and benefits Short term perspective

Assess the risk Distorted thinking

Impulsive

Make a rational choice Not rational

Hang around with others like themselves


People who appear to be resistant to punishment

• Psychopathic risk takers

• Those under the influence of a substance

• Those with a history of being punished

Source: Ed Latessa, Ph.D.


Assessment is based on the risk and need principles

• Risk is based on likelihood of re-offense– Actuarial tools get better results– Best if validated on own population– Most tools do not distinguish on level of

offense– Some tools target kind of offense (eg, sex,

domestic, DUI)– Cost and time are major factors– Most need additional tools


RESULTS DRIVEN PRACTICE

Use of actuarial tool

Professional judgment alone

Use of actuarial tool with professional judgment

Risk of Heart Attack1) Elevated LDL and low HDL levels 2) Smoking 3) Diabetes 4) Hypertension 5) Abdominal obesity 6) Psychosocial (i.e., stress or depression) 7) Failure to eat fruits and vegetables daily 8) Failure to exercise



A Balanced Approach• Risk Management (low risk)

– Involves providing least restrictive, most appropriate sanctions & supervision

• Risk Reduction (moderate-high risk)

– Involves determining criminogenic needs and reducing risk factors through effective intervention & appropriate supervision

• Risk Control (extreme high risk)

– Involves techniques that control risk of reoffending while under correctional authority

Place Them in the Category

30

Top Four Criminogenic

Needs

Lesser Four Criminogenic

Needs

Non-Criminogenic Needs

1. 5. a.

2. 6. b.

3. 7. c.

4. 8. d.

e.

-Health issues-Mental Illness-Companions-Anti-social beliefs

-Employment-Family issues-Self esteem-Substance abuse

-Personal distress-Education-Temperament-Leisure-Intelligence

Needs Principle Summary(What)

• Target criminogenic needs (at least 3)

• Do not target non-criminogenic needs unless have to



Assessment is based on the risk and need

principles• Need is based on life and personal

conditions– Are dynamic as opposed to static– Are predictive– Provide the ingredients for a case intervention– Can be measured over time to determine

effectiveness– If done correctly, can drive major correctional

policy• Eg, discharge, release, conditions, admissions

The Big Four

Criminogenic Need ResponseAnti-social cognition Reduce anti-social cognition,

recognize risking thinking and feelings, adopt an alternative identity

Anti-social companions Reduce association with criminals, enhance contact with pro-social

Anti-social personality (temperament)

Build problem solving, self management, anger management, and coping skills

Family and/or marital Reduce conflict, build positive relationships and communication, enhance monitoring/supervision

Source: Ed Latessa, Ph.D. (with slight modification)

33

Temperament Examples

• Lack of empathy

• Anger and hostility

• Poor problem solving

• Risk taking

• Impulsive

• Lack of focus

• Narcissistic © 2009 The Carey Group; www.thecareygroup.com 34


Family Stressors

Familiar factors that include criminality and a variety of psychological problems in the family of origin including:– Low levels of affection, caring and

cohesiveness– Poor parental supervision and discipline

practices– Out right neglect and abuse

The Next Four

Criminogenic Need Response

Substance abuse Reduce usage, reduce the supports for abuse behavior, enhance alternatives to abuse

Education Enhance performance rewards and satisfaction

Employment Enhance performance rewards and satisfaction

Leisure and/or recreation Enhance involvement and satisfaction in pro-social activities

Source: Ed Latessa, Ph.D.36


Surprises

• What is not on the list that surprises you?

• What is not in the top four that surprises you?


Too Much Information orToo Little Relevant Information

Military record

Employment history

Medications

Mental healthFinances

Race/ethnicityAge

Prior record Educational achievement

Siblings

Parental influence

Family name

Neighborhood

Nationality

Height/weight

PostureScars/tattoos

Verbal intelligence

Attitude/beliefs

Physical health

Self esteemPast supervision

Previous treatments

Prior successesPrior failures

Current emotional disposition

Degree of deference

Motivation

IQ

Previous abuse history

Level of violence

Amount of support

Gender

Instigator/follower

Substance abuse

Peers

Poor self control

38



Applying the assessment

• GET OUT OF THE WAY. Intensive treatment for lower-risk offenders can actually increase recidivism

• LIVE IN THEIR BACK POCKET. Provide most intensive treatment to higher-risk offenders

• ZERO IN. Target those offenders with higher probability of recidivism


Need Principle

Criminogenic

• Anti social attitudes• Anti social friends• Substance abuse• Lack of empathy• Impulsive behavior

Non-Criminogenic

• Anxiety• Low self esteem• Creative abilities• Medical needs• Physical

conditioning

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

6 5 4 3 2 1 0 -1 -2 -3

Recidivism Reductions as a Function of Targeting Multiple Criminogenic vs. Non-

Criminogenic Needs*

(Andrews, Dowden, & Gendreau, 1999; Dowden, 1998)

Better outcomes

Poorer outcomes

More criminogenic than non-criminogenic needs

More non-criminogenic than criminogenic needs



Effective Assessments

• Has screening criteria (like the Proxy)

• Offenders assessed on all major risk, need, and responsivity factors

• Objective and standardized (a clear method of application to reduce subjectivity)

• Instruments are normed and validated



Common Assessment Problems

• Assess offender but ignore important factors• Don’t distinguish between L, M, H risk• Don’t use it: all get the same treatment• Make errors and don’t correct• Don’t assess offenders at all• Don’t adequately train staff in

use/interpretation• Instrument is not validated or normed


Treatment Principle Summary(What Works and How)

Also called the Responsivity Principle

• Some programs work; some don’t• Focus on criminogenic needs (especially top four)• Match right offender to right program• Use a cognitive behavioral approach• Use positive reinforcements• Seek right levels of dosage/intensity• Quality assurance


Responsivity

Reminder:

• Average recidivism reduction/gain

–Inappropriate treatment -.06

–Unspecified treatment .13

–Appropriate treatment .30

What Doesn’t Work to Reduce Recidivism

• Punishment, sanctions, or incarceration• Specific deterrence, or fear-based

programs, e.g. Scared Straight• Physical challenge programs• Military models of discipline and physical

fitness - Boot Camps• Intensive supervision without treatment


What Doesn’t Work to Reduce Recidivism (continued)

• Shaming programs • Drug education programs• Drug prevention classes focused on fear or

emotional appeal• Non-action oriented group counseling


What Doesn’t Work to Reduce Recidivism (continued)

• Bibliotherapy• Freudian approaches• Vague, unstructured rehabilitation programs• Self-esteem programs• Non skill-based education programs


What Does Work to Reduce Recidivism

• Programs that:– Focus on criminogenic needs (especially top four)– Match right offender to right program– Use a cognitive behavioral approach– Use positive reinforcements– Seek right levels of dosage/intensity– Have built-in quality assurance



Responsivity:Understanding gender

• Differences between male and female• Based on “The Opposite Sex” by Hara

Estroff Morano and Erik Strand, Psychology Today, July/August 2003 issue

• Hint: nine are attributed to men, and nine to women

Identify which fact belongs to male and which to female

• 13 times more likely to score above 700 on SAT

• Twice as likely to be developmentally delayed

• 3 times more likely to stutter• More susceptible to chronic

headaches• More susceptible to bed

wetting• 2.3 times more likely to be

psychologist• More likely to recall childhood

memories• Works out less often• 4 times more likely to commit

suicide

• 72% more likely to develop lung cancer

• Smiles more often• One twelfth to have group sex• 2 times more likely to develop

Alzheimer’s• Speaks sooner, makes fewer

speech errors• Brain ages faster, more damaged

by aging• 100 times more likely to be chess

grandmaster• 3 times more likely to buy X rated

movies• 5 times more likely to have had

more than 20 sex partners51



Three Kinds of Responsvity

• Offender character traits

• Traits of the individual working with the offender

• The program components

52

52


Responsivity Principle

– Motivation

– Learning Style

– Gender

– Age

– Culture

– Anxiety

– Depression

– Mental Illness

– Intelligence


Examples of responsivity tools

• JESNESS (personality subtype scales that measure key traits and attitudes)

• CMC (offender profile types)

• URICA (motivation level for adults)

• SOCRATES (related to drug use)


BEHAVIOR

THOUGHTS

FEELINGS

COGNITIVE STRUCTURE

(THINKING PATTERNS)

BELIEFS AND ATTITUDES

SkillStated Knowledge

More likely aware

UnderneathThe surface

Small Group Exercise

56

Event: Mall of America bumped shoulder

What was the behavior? Bumped shoulders; felony assault

What were the real or potential consequences of the behavior?What self thoughts likely emerged?What feelings or emotions were triggered?Which core belief(s) were behind those thoughts?


Self Talk

• Every person speaks to him or her self at a rate of 1300 words per minute


Cog training helps the offender….

• Stop and think

• Consider the consequences and awards of their actions

• Consider alternative responses

• Gain empathy for others

• Determine steps for alternative actions


Cognitive Behavioral Programs

• It interrupts anti-social thinking patterns (restructure)

• It creates dissonance

• It provides skills to handle situations such as conflict management, problem solving (cog skills)


Programming/intervention

• Dose, length, and intensity should increase with risk level

• Most (not all) respond best to cognitive behavioral programs

• They can be expensive to operate

• Cognitive restructuring, cog skills, life skills

• Treatment often works when combine cog intervention (eg, Safe Streets First)


Dosage and Intensity

• Treatment should be:– At least 100 hours of direct service (200-

300 hours for high risk)– Be 3-9 months long (6-18 months for high

risk) depending on risk level

• Intensive treatment (not including aftercare) that last too long (over 12 months) might begin to see diminishing results (exception: sex offenders)


Most commonly used cog curricula

• Thinking for a Change

• Aggression Replacement Therapy

• Moving On for Girls

• MRT

• Reasoning and Rehabilitation


Other Examples of Cognitive Behavioral Correctional Curriculums

List compiled by Dr. Ed Latessa

• Controlling Anger and Learning to Manage It (CALM and CALMER)

• Criminal Conduct and Substance Abuse Treatment (Strategies for Self-Improvement and Change) (SSC)

• Persistently Violent Curriculum

• Corrective Thinking/Truthought

• Drug Abuse Treatment Program (FBOP)

• Changing Offender Behavior: A Complete Evidence-Based System

Criminogenic Needs 1, 2, 3

1. Anti-Social Thinking and Attitudes2. Anti-Social Peers3. Self Regulation Skills/Temperament

Programs Matched to Criminogenic Needs

Thinking for a Change (males)

Aggression Replacement Training

Moving on for Girls (females)


Criminogenic Need 4

4. Family Stressors and Support


MST (Multisystemic Therapy)

FFT (Functional Family Therapy)

Girls N Gangs (process only)

Parenting Wisely


Criminogenic Need 5

5. Substance Abuse


Criminal Conduct and Substance Abuse Treatment: Pathways to Self Discovery and Change

66


Responsivity Need 1

1. Motivation

Programs Matched to Responsivity Needs

Getting Motivated to Change (by TCU)

Making Changes (by Change Companies)

67


Responsivity Need 2

2. Trauma


SPARCS (Structured Psychotherapy for Adolescents Responding to Chronic Stress


Responsivity Need 3

3. Mental Health


Dialectical behavioral therapy

(for borderline personality disorder)

69


Thinking for a ChangeStudy by Lowenkamp and Latessa (2006)

• Tippecanoe County, Indiana

• Probation plus T4 C compared to Probation


Recidivism Rates

0

5

10

15

20

25

30

35

Prob plus T4Csuccessful onlyProb plus T4C all

Prob

28-50% reduction in recidivism compared to traditional probation

71


What do you do when….?• You don’t have cog programs?

• The cog programs are filled?

• The offender completed a cog program but similar issues arise?

• They have certain traits that prevent such a placement?

• How do you apply these principles on a one-on-one setting?



Addressing anti-social peers• We normally:

– Restrict associates– Set and enforce curfews– Ban handguns– Etc. (extrinsic)

• We need to:– Teach offender to

recognize negative influences (people, place, things)

– Practice new skills (eg, assertiveness)

– Teach how to maintain positive relations

– Develop positive associations

– Train family/friends– Set goal of one new friend– Develop leisure activities



Thinking Reports

1. What happened? (describe the situation)

2. What was I thinking before it happened? (example: “I won’t get caught.”)

3. What was I thinking while it was happening? (example: Nobody says that to me.”)

4. What feelings emerged from that thinking?

5. What alternative thinking might have resulted in a different outcome?

What Works with Institutionalized Juveniles

Treatment Recidivism

Reduction

Evidence

Interpersonal Skills

39% Excellent

Teaching Family Homes

34% Excellent

Behavioral Programs

33% Good

Community Residential

28% Good

Multiple Services 20% Good

Source: James C. Howell, Preventing & Reducing Juvenile Delinquency, p. 204 75


Most Effective Programs for Serious and Violent Juveniles

They are programs that

Are relatively highly structured

Focus on developing skills

Use behavioral and cognitive-behavioral methods

Use multiple components to address delinquents’ problems in multiple domains (individual, family, school, peer group, and community)

Source: James C. Howell, Preventing & Reducing Juvenile Delinquency, p. 204 76


Remember……

• It works best when it contains behavioral components

–Use of role plays

–Practice skill

–Report on application outside of classwork

78

Non-Behavioral Approaches

• Drug prevention classes focused on fear and other emotional appeals

• Shaming offenders• Drug education programs• Non-directive, client centered approaches• Bibliotherapy• Freudian approaches• Talking cures• Self-Help programs• Vague unstructured rehabilitation programs• Medical model• Fostering self-regard (self-esteem)• “Punishing smarter” (boot camps, scared straight)


SLT Principles

• Modeling

• Rewards and Reinforcement

• Effective Use of Approval and Disapproval

• Practicing

79


Remember, we learn by…

• what we see…

• what we hear…

• what we practice…

• what is reinforced

80


There are virtually no serious competitors for the following when it comes to changing criminal behavior:

Modeling (if you want to get a behavior going, demonstrate it)

Reinforcement (if you want to keep a behavior going, reward it)

Role-Playing (set up opportunities for practice with corrective feedback)

Graduated Practice (some behaviors actually constitute a complex skill that may best be broken down and practiced in smaller steps)

Extinction (assuring that antisocial styles of thinking, feeling and acting are not inadvertently rewarded)

Cognitive Restructuring (pay attention to risky content of thought and assist in trying out less risky thoughts)

The Psychology of Criminal Conduct, 1998Andrews, D., Bonta, J., p. 270

There are virtually no serious competitors for the following when it comes to changing criminal behavior:

Modeling (if you want to get a behavior going, demonstrate it)

Reinforcement (if you want to keep a behavior going, reward it)

Role-Playing (set up opportunities for practice with corrective feedback)

Graduated Practice (some behaviors actually constitute a complex skill that may best be broken down and practiced in smaller steps)

Extinction (assuring that antisocial styles of thinking, feeling and acting are not inadvertently rewarded)

Cognitive Restructuring (pay attention to risky content of thought and assist in trying out less risky thoughts)

The Psychology of Criminal Conduct, 1998Andrews, D., Bonta, J., p. 270

81



Skill Development

• Demonstrate, rehearse, practice prosocial alternatives

• Increase difficulty

• Completion based on acquisition of new prosocial skills

Behavioral vs. Non-Behavioral

0.29

0.07

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Non-Behavioral (n=83) Behavioral (n=41)

Source: Andrews, D.A.1994. An Overview of Treatment Effectiveness.Research and Clinical Principles, Department of Psychology, Carleton University.*The n refers to the number of studies 8


What about PO traits?

• What difference do they make?


Case Manager Traits and Recidivism

0

5

10

15

20

25

30

NotCompetent

Marginal ControlGroup

Competent High Comp

Source: Washington State Institute for Public Policy, 2004Outcome Evaluation of Washington State’s Research-Based Programs for Juvenile Offenders

85


Five dimensions of successful ebp staff

• “The Importance of Staff Practice in Delivering Effective Correctional Treatment: A Meta-Analytic Review of Core Correctional Practice”

Craig Dowden and D.A.Andrews

86©


www.thecareygroup.com

Five dimensions of successful ebp staff

1. Effective use of authority

Firm but fairMake rules clear, visible, understandableCompliance through positive reinforcementKeep focus of message on behavior, not personUse of normal voiceGave choices with consequencesGuide offender toward compliance

2. Modeling and Reinforcing prosocial attitudes

Positive/negative reinforcementModel and rehearse pro-social behavior in concrete and vivid wayImmediate feedback on why behavior was approved/disapproved Offender encouraged to think about why certain behavior was desirableRole playing with increasing difficult scenarios

87


3. Teaching concrete problem solving skills

Engage offender in resolving issues that reduce satisfaction and rewards for non-criminal pursuitsHelp offender develop a plan, clarify goals, generate options/alternatives, evaluate options

4. Advocacy/Brokerage of community resource

Arrange the most appropriate correctional serviceSpeaking on behalf of client at home, school, work or other

5. Relationship factors

Open, warm, genuine, and enthusiastic communicationSelf confidentEmpatheticFlexible Mutual respect and likingDirective, solution focused, structured, non-blaming, contingency based communication

Five dimensions of successful ebp staff (continued)

88


Bonta “Black Box” Research (08).

PO activity targeted at influencing change Frequency exhibited in

sessions

Prosocial modeling 16.5%

Practice 22.3%

Prosocial reinforcement 68%

Antisocial discouragement 20.4%

Relapse prevention 16.5%

Homework assignment 28.2%

89

Exploring the Black Box of Community Supervision Journal of Offender Rehabilitation, Vol. 47(3), 2008. Pp. 248–270© 2009 The Carey Group; www.thecareygroup.com

Time Devoted to Discussion on Criminogenic Needs

Time Devoted Per Session Recidivism Rate

0-19 minutes 49%20-39 minutes 36%


* Best results when focus on one criminogenic need at a time

Documents

“Practitioners Helping Practitioners” Evidence Based Practices for Juvenile Justice Wisconsin Juvenile Court Intake Association September 23, 2009 1:00