Project What Works and What Doesnt

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					What Works/ What Doesn’t in
    Changing Behaviors

     The Principles of Effective
           Interventions

                Presented by:
           Jennifer A. Pealer, Ph.D.
           Assistant Commissioner
      Research & Program Development
       Kansas Juvenile Justice Authority
Levels of Research
 Lowest level of evidence
   Anecdotal evidence (Gut feeling)
 Highest level of evidence
   Empirical evidence (data based)
 Need to examine a body of literature
   Literature reviews
   Ballot counting
   Meta-analysis
      Quantitative review of the research
           A standardized way of examining research
What Do We Know?
 Not a single study has found
  reductions in recidivism using punish-
  oriented programs.
 Punishment programs have actually
  made offenders (youth and adults)
  worse
   Punishment does not “work” for those who
    have a history of being punished, are under
    the influence, or are psychopathic risk
    takers
What Do We Know?
 Majority of studies have shown that
  correctional treatment interventions
  have reduced recidivism rates relative
  to various comparison
 Average reduction in recidivism is
  approximately 10 percent
 Now looking at characteristics of
  stellar programs versus mediocre
  programs
So What Works to Reduce
Recidivism?
   Risk principle
   Need principle
   Responsivity principle
   Human service (treatment) principle
   Program fidelity principle
Risk Principle (Who to Target)
 Need to identify the factors that drive
  risk of committing delinquency
 Match the level of supervision and
  programming to level of risk
Major Risk Factors
 Antisocial attitudes
 Antisocial peers
 Antisocial personality
 History of antisocial behavior
 Family criminality and psychological problems in
  family origin
 Low levels of education/employment achievement
 Lack of participation in prosocial leisure activities
 Substance abuse
Antisocial Attitudes

 Criminal attitudes have central role in
  major theories of criminality
 Until recently, criminal attitudes have
  been virtually ignored in the
  mainstream assessment & treatment
  of offenders
Antisocial Attitudes

 Attitudes, values, beliefs, rationalizations,
  cognitions, negative cognitive emotional
  states that support criminal behavior
     Rage
     Anger
     Defiance
     Criminal identity


 What we think and believe affects what we
  do
Identifying Antisocial Attitudes:
What to Listen For:
   Procriminal attitudes are what people think (the content of
    the message) and not how people think

   Negative expression about the law

   Negative expression about conventional institutions, values,
    rules, & procedures; including authority

   Negative expressions about self-management of behavior;
    including problem solving ability

   Negative attitudes toward self and one’s ability to achieve
    through conventional means

   Lack of empathy and sensitivity toward others
Neutralizations and Minimizations
   Sets of verbalizations that serve to make it “ok” for behavior

       Denial of Responsibility: Criminal acts are due to factors beyond the
        control of the individual, thus, the individual is guilt free to act.
       Denial of Injury: Admits responsibility for the act, but minimizes the
        extent of harm or denies any harm
       Denial of the Victim: Reverses the role of offender & victim & blames
        the victim
       “System Bashing”: Those who disapprove of the offender’s acts are
        defined as immoral, hypocritical, or criminal themselves.
       Appeal to Higher Loyalties: “Live by a different code” – the demands of
        larger society are sacrificed for the demands of more immediate
        loyalties.
How to Address Antisocial
Attitudes?
 Use programming and techniques
  that:
   Identify antisocial thinking
   Stop blockers
   Changing the antisocial thinking
Influence of Peers
 Elevated risk
   Delinquent associations
   Absence of prosocial associations
 Based on social learning
   Learn through interaction of others
   Provide reinforcements
Reducing Peer Associations
   Restrict associates
   Set and enforce curfews
   Ban hangouts
 Teach youth to recognize & avoid negative influences
  (people, places, things)
 Practice new skills (like being assertive instead of
  passive)
 Teach how to maintain relationships w/o getting into
  trouble
 Identify or develop positive associations: mentors,
  family, friends, teachers, employer, etc.
 Train family and friends to assist youth
 Set goal of one new friend (positive association) per
  month
 Develop sober/prosocial leisure activities
Antisocial Personality Patterns:

 Psychopathy
 Weak socialization
 Impulsivity
 Restless/aggressive energy
 Egocentricism
 Below average verbal intelligence
 A taste for risk
 Weak problem-solving
 Poor self regulation skills
 Hostile interpersonal interactions, lack of empathy

                                                        15
How Do We Address Antisocial
Personality
 Skill based programs
     Anger management
     Impulse control
     Decision making
     Problem solving
     Thinking skills
History of Antisocial Behavior
 The best predictor of future behavior is past
  behavior
   Age of onset & escalation of offending
   Variety of acts
   Across settings
• 40% of serious offenders commit their first
  criminal offense by age 12
• 85% of serious offenders have committed
  an offense by age 14
Family Factors
 Includes parental criminality and a
  variety of psychological problems in
  the family of origin
   Low levels of affection, caring and
    cohesiveness
   Poor parental practices
       Recognition of antisocial behaviors
       Parental supervision
       Discipline (none or too much)
       Neglect and abuse
Addressing Family Factors
 Family counseling to repair
  relationships
 Teach to recognize antisocial behavior
 Enhance supervision practices
 Enhance disciplinary practices
Education and Employment
 Employment or education occupies
  time with a prosocial activity
 Receiving rewards for participation in
  prosocial activity
 Interacting with prosocial others
 Factors include:
   Low levels of personal
    educational/vocational achievement
 Cumulative disadvantage
Leisure & Recreation
 Low involvement in prosocial leisure
  and recreational activities
 “Idle hands”
Substance Abuse
 Activity is illegal itself
 Use may lead to other criminal behaviors
   Theft/robbery to get drugs
   Lower inhibitions “beer muscles”
 Buying drugs puts a person in contact with
  criminal others
 Selling/buying drugs usually creates an
  environment that is conducive to other
  criminal behaviors
The Risk Principle & Correctional
Intervention Results from Meta Analysis

                                25

                                                         19
   Change In Recidivism Rates




                                20

                                15

                                10

                                5
                                                                  -4
                                0

                                -5
                                                   High Risk   Low Risk




                                     Dowden & Andrews, 1999
                    Risk Level by New Conviction: Results from 2005
                    Ohio Study of over 14,000 Youth

                   50

                                                                         41
                   40
Recidivism Rates




                                              30                              29 30
                   30                                28    27 26

                            20      18
                   20                    16

                        8
                   10


                   0
                            Low     Moderate              High       Very High

                                  Community        CCF     Institution
                                                                                                                                                                                                                                                                                                                                                         M
                                                                                                                                                                                                                                                                                                                                                       M
                                                                                       Violation of the Risk Principle




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                                                                                                                                                        A                                                                          Probability of Reincarceration
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                     0
                                                Probability of Reincarceration
      Recent Study of Intensive Rehabilitation
      Supervision in Canada

                    60
                    50
                    40
                    30
                    20
                    10
                      0
                                             Treatment                                          Non-Treatment
         High Risk                                 31.6                                                   51.1
         Low Risk                                  32.3                                                   14.5
Bonta, J et al., 2000. A Quasi-Experimental Evaluation of an Intensive Rehabilitation Supervision Program., Vol. 27 No 3:312-329. Criminal
Justice and Behavior
How Do We Determine Risk Levels?
 First generation (1800s) – using unstructured interview
  to make recommendations based on professional
  experience
      Considerable personal discretion
      Accuracy is legally, ethically, and practically
       unacceptable
 Second generation (1928 – 1979) – empirically based to
  develop estimates of re-offending
      Provided little direction for treatment
      Many items were historical in nature (static)
 Third generation (1979 – 1990s) – empirically based for
  risk management and rehabilitation
      Match supervision and treatment to level of risk and
       needs
What Does the Risk Principle Look
Like in Action?
 High risk juveniles should receive
  more intensive services for a longer
  period of time
   Intensity = more groups, services,
    supervision more often
 Low risk juveniles have fewer
  problems
   They do not require intensive
    interventions/supervision
Incorporating the Risk Principle
 Residential placements and juvenile
  correctional facilities
   High risk juveniles should be separated
    from low risk juveniles
     Living situations
     Groups
   High risk juveniles should receive more
    groups for a longer period of time
   High risk juveniles should have more
    supervision
Incorporating the Risk Principle
 Community/Probation
   High risk juveniles should be monitored
    more closely
     Face to face contacts; home visits,
      school/work visits
     More drug testing
   Make referrals to programs that separate
    high risk juveniles
   Make referrals to programs that differentiate
    services for high risk juveniles
Violating the Risk Principle
 Low risk juveniles being over
  supervised and over treated
   At BEST no reductions in recidivism
   At WORST causing harm – increase
    recidivism
 Why?
   Disrupt the very things that make the
    youth low risk
Violating the Risk Principle
 High risk juveniles being under
  supervised and under treated
   High risk substance abuser being given
    AA/NA
   Increased risk of recidivating
 Why?
   Does not provide enough
    supervision/control to reduce recidivism
   Does not provide enough intensity of
    programming to disrupt risk factors
What Makes Youth High Risk?
 They have many risk factors
   Criminogenic needs
     Dynamic (Changeable) factors related to
      recidivism
 To reduce risk have to address the
  criminogenic needs
Need Principle:
 Assess and target the needs/problems related
  to criminal behavior that can change

 Criminogenic needs = dynamic risk factors
   Attitudes, peers, substance abuse, lack of
     empathy, low self control, impulsivity, low
     educational achievement, anger, egocentric

 Non-criminogenic needs = problems not
  related to criminal behavior
   Medical issues, low self esteem, anxiety,
     depression, art skills, physical ability
              Needs Targeted & Correlation with Effect Size for Youthful Offenders
               0.4

               0.3
Reduced
Recidiv ism
               0.2

               0.1

                  0
Increased
Recidiv ism   -0.1

              -0.2
                                                   Bond Anti Social Peers




                                                                             Target Self-Esteem




                                                                                                   Vague Emotional Problems




                                                                                                                               Respect Anti Social Thinking




                                                                                                                                                                                   Criminogenic Needs
                             Fear of Punishment




                                                                                                                                                               Physical Activity
       Ef f ect Size       -0.18                  -0.12                     -0.09                 -0.06                       -0.05                           -0.03                0.36

 Source: Dowden and Andrews, (1999). What Works in Young Offender T reatment: A Meta Analysis. Forum on Correctional Research.
 Correctional Services of Canada
                    Targeting Criminogenic Need:
                    Results from Meta-Analyses
                  0.35
                     0.3
Reduction in      0.25
Recidivism

                     0.2
                  0.15
                     0.1
                  0.05

Increase in
                        0
Recidivism                                Target 1-3 more non-                                            Target at least 4-6 more
                 -0.05
                                           criminogenic needs                                               criminogenic needs

Source: Gendreau, P., French, S.A., and A.Taylor (2002). What Works (What Doesn’t Work) Revised 2002. Invited Submission to the International Community Corrections
Association Monograph Series Project
Incorporating the Need Principle
 Residential
   Put juveniles into programs (not
    necessarily residential) that target the
    criminogenic needs using effective
    techniques
     Thinking/cognitions
     Substance abuse/sex offender
       treatment
     Education/employment
     Family relationships and skills
Incorporating the Need Principle
 Community/Probation
   Make referrals to programs that target
    criminogenic needs using effective
    techniques
     If you do not have these programs, train
      staff to administer services or work with
      agencies to implement
   Referrals should address the
    criminogenic needs and not just mental
    health issues
Responsivity Principle:
 Refers to the learning/interaction
  styles of the juveniles which can
  affect their engagement/
  successfulness in programming
 Identify responsivity characteristics
  and then match the juvenile to
  various staff and groups to assist in
  removing the barriers
Responsivity Factors
 General – programs that are based
  on cognitive-behavior/social learning
  theories are generally responsive to
  offenders
 Specific – offenders learn differently
  and have certain barriers that should
  be removed before programming or
  addressed during programming
Responsivity Factors
 External responsivity factors
   Program characteristics
   Facilitator characteristics
   Program setting
 Internal responsivity factors
     Motivation
     Mental health – anxiety, psychopathy
     Maturity
     Transportation
     Cognitive deficiencies
     Demographics
Incorporating the Responsivity
Principle
 Residential/ juvenile correctional facility
   Match the juveniles to social workers based
    on responsivity factors
   Match the juveniles to groups based on
    responsivity factors
   Assist in removing barriers
 Community/probation
   Assign caseloads based on responsivity
    factors
   Assist in removing the barriers
  Risk, Need, Responsivity

                                                                            Caseload




             Low risk youth                           Moderate risk youth                                               High risk youth




Parenting & Family        Education      Peers             Leisure               Attitudes   Attitudes   Personality   Substance Abuse    Education   Peers




                                                                                                                          Motivation
 Transportation                       Peers outside
                                                       Health problems                                     ADHD                           Dyslexic
     Issue                             age range
                                                                                                                            Denial




                                                                                                                                                              45
The Treatment Principle:
 Supervision alone will not be sufficient
  to change behaviors for certain types of
  juveniles
 Punishment programs (criminal
  sanctions) do not work to change
  behavior
 Need services that are behavioral in
  nature
The Treatment Principle
 Programs & services should be
  behavioral in nature
   Focus on current factors that influence
    behavior
   Action-oriented
   Behavior is reinforced
     Behavioral Versus Nonbehavioral

                   0.4

    Reduced                                                                                   0.29
                   0.3
    Recidivism

                   0.2
Mean Effect Size
     (Phi)                                                  0.07
                   0.1

    Increased        0
    Recidivism
                   -0.1   -0.07
                              Cr                                 No                                Beh
                                im   ina                           nbe                                   avi
                                         l                               hav                                ora
                                             San                            i   ora                            l   (N=
                                                c   tion                           l   (N=                               41)
                                                        s   (N                               83)
                                                                 =3
                                                                   0)
Effective Programs Have Certain
Program Characteristics
 Are based on research & sound theory
 Have leadership
 Use effective treatment models
 Disrupt criminal networks
 Provide aftercare
 Have qualified, experienced, dedicated, &
  educated staff
 Evaluate what they do
 Are stable & have sufficient resources &
  support
Effective Programs Are
Implemented as Designed
 Interventions are piloted & tested
  before full implementation
 Valued & supported by community or
  institution
 Perceived as cost-effective
 Adequate funding
Effective Programs Have
Leadership
 Experienced
 Trained
 Hands-on
   Designing program
   Hiring, training, supervising staff
   Provide service to offenders
How Effective Programs
Identify Targets
 Assessment, Assessment, Assessment
   Use standardized and objective instruments that
    address criminogenic needs
   Instruments are normed and validated on local
    population
 Risk
   The “who”
 Need
   The “what”
 Responsivity
   The “how”
How Effective Programs
Address Targets
 Therapeutic alliance
   Therapeutic alliance is a collaborative
    relationship, affective bonding, and mutual
    understanding and sharing of treatment goals
    between the offender and the treatment provider
     Building a supportive environment
     Holding offender accountable
     Belief that offenders can change
     Get offenders to believe they can change
 Use effective program models that provide
  opportunities to model, practice, and
  reinforce behavior
Most Successful Types of
Treatment Models
 Social learning – anti-criminal modeling,
  skills development
 Cognitive behavioral – cognitive theory,
  problem solving
 Radical behavioral – token economies,
  contingency management
 Family based therapies – Multi-systemic &
  Functional Family therapy
 Targeting specific criminogenic needs – sex
  offender, violence, mentally disordered
The Four Principles of Cognitive
Intervention
 Thinking affects behavior
 Antisocial, distorted, unproductive
  irrational thinking causes antisocial
  and unproductive behavior
 Thinking can be influenced
 We can change how we feel and
  behave by changing what we think
   Cognitive-Behavioral Cycle
                                                        Situations tell us what
Consequences (negative or                               conditions led to the
positive) determine the                                 behavior (people,
likelihood of continuance                               places, things)
                        Consequences       Situation




                   Behavior                                    Thoughts drive
Behaviors represent                           Thoughts         behaviors
the ultimate behavior
the person engages in


                                Feelings   Feelings stem from thoughts and can
                                           be healthy or problematic depending on
                                           how one copes with the feelings
Cognitive Behavioral
 Address thinking
   Cognitive restructuring – changing “what” a person
    thinks
   Cognitive skills – changing how a person thinks
 Address behaviors
     Modeling – staff showing
     Practicing – youth roleplaying
     Feedback
     Reinforcement
Reasons why CBT is Effective in
Reducing Recidivism
 Based on scientific evidence (cognitive &
  behavioral theories)
 Based on active learning (not talk therapy)
 Focus on the present (how the youth
  current think and behavior)
 Based on learning (most crime is learned)
 Target major criminogenic needs (e.g.,
  attitudes, values, beliefs)
 Provides structure to groups and programs
  (manualized treatment)
Reasons that CBT is Popular in
Corrections
   Can be done in any setting
   Existing staff can be trained on CBT
   Relatively cheap to deliver
   Wide range of curriculums are
    available
Effective Programs Provide
Services & Treatment
 Vary based on risk and need of offender
 Intensive & sufficient length
 Have detailed curriculums and manuals
 System of rewards and consequences
 Completion criteria are based on acquisition of
  prosocial skills
 Youth are referred to other services
 Family members are trained to provide
  support
Effective Programs Provide
Structured Aftercare
 Planning begins during the treatment
  phase
 Family involvement
 Frequent meetings including home
  visits
 Reassessment occurs
 Services are available to address
  offender needs
Recent Meta-Analysis of CBT
Programs for Offenders
 Reviewed 58 studies:
   19 random samples
   23 matched samples
   16 convenience samples


 Found that on average CBT reduced
  recidivism by 25%, but the most
  effective configurations found more
  than 50% reductions
Factors Not significant:
 Type of research design
 Setting - prison (generally closer to
  end of sentence) versus community
 Juvenile versus adult
 Minorities or females
 Brand name
Significant Findings (effects were stronger if):

   Sessions per week (2 or more)
   Implementation monitored
   Staff trained on CBT
   Higher proportion of treatment completers
   Higher risk offenders
   Higher if CBT is combined with other
    services
Effective Programs Have
Qualified Staff
   Educated
   Experienced
   Remain with the program
   Hired on personal qualities
   Have input into the program
   Are well trained
   Are well supervised & regularly
    evaluated
Cognitive Curriculums for
Offenders
 Controlling Anger and     Persistently Violent
  Learning to Manage It      Curriculum
  (CALM and CALMER)         Corrective
 Aggression Replacement     Thinking/Truthought
  Training (ART)            Reasoning and
 Thinking for a Change      Rehabilitation
 Choices, Changes,         Moral Recognition
  Challenges                 Therapy
 Pathways to Self          Drug Abuse Treatment
  Discovery and Change      Moving On (Female)
  Percent Reduction in Recidivism
  by Program Characteristics
                        TR          5


                    T R+3Y              10


                T R+3Y+CB                     18


            T R+3Y+CB+CT                           23


        T R+3Y+CB+CT +RP                                  32


  T R+3Y+CB+CT +RP+RISK                                         39



TR = Acceptable termination rate        CT = Criminogenic Targets
3Y = In operation 3 or more years        RP = Role Playing almost every session
CB = Cognitive Behavioral Program       RISK = Program varies intensity by RISK.
Program Fidelity
 Implementing the program and
  services as they were designed
 Ensuring quality control over the
  program and services
Effective Programs Evaluate
Themselves

 Quality assurance process (both
  internal and external)
 Assess progress of offenders in
  meeting target behaviors
 Track offender recidivism
 Have an evaluator working with the
  program
  Effects of Quality Programs Delivery for Evidenced Based
                Programs for Youth Offenders
                40


                30


Reduced
Recidivism
                20


                10


                  0

Increased
Recidivism
               -10


               -20
                                Functional Family Therapy                    Aggression Replacement Therapy
Competently Delivered                        38                                               24
     Not Competent                         -16.7                                            -10.4

 Source: Outcome Evaluation of Washington State's Research-Based Programs for Juvenile Offenders. January
 2004. Washington State Institute for Public Policy.
                                Therapist Competency Ratings and Recidivism
                                35

                                30                 29
12 Month Felony Recidivism




                                                                               25
                                25
                                                                                                                                                               22
                                20
                                                                                                           17
                                15                                                                                                     14


                                10

                                  5

                                  0
                                           Not Com petent                   M arginal                 Com petent             Highly Com petentControl Group
                             Source: Outcome Evaluation of Washington State's Research-Based Programs for Juvenile Offenders. January 2004. Washington State
                             Institute for Public Policy.
Program Integrity and Recidivism
 Every major study we have done has
  found a strong relationship between
  program integrity and recidivism
 Higher integrity score – greater the
  reductions in recidivism
Impact of Program Factors Predicting
Felony Adjudication for Juvenile Programs

                              70
                                                                                   60
 Predicted Recidivism Rates




                              60
                                                                                        53
                              50                                                             47
                                                                   43
                              40                                         36
                                                    27                        31
                              30
                                                         22
                              20                              18
                                    11
                              10          8    7


                               0
                                         Low        Moderate            High       Very High

                              Program Score 0      Program Score 12       Program Score 24
Ineffective Approaches
    Drug prevention classes focused on fear and other
     emotional appeals
    Drug education programs
    Shaming offenders
    Non-directive, client centered approaches
    Bibliotherapy
    Freudian approaches
    Talking cures
    Self-help programs
    Targeting low risk offenders
    Vague unstructured rehabilitation programs
    Medical model
    Fostering self-regard (self-esteem)
    “Punishing smarter” (boot camps, scared straight, etc.)
   Average Effects of Punishing Smarter Programs on
                       Recidivism
                   4
   5


                                     0

   0


                                                      -3                -3
                                                                                          -4
  -5
                                                                                                            -6



 -10
                                                                                                                             -11



 -15
             Fines                             Restitution                       Scared Straight                  Juvenile Boot Camps
                            Drug testing                     Electronic Monitoring                       ISP

Sources: Gendreau et al (2000). The Effects of Community Sanctions and Incarceration on Recidivism, FORUM;
Aos et al (1999). The Comparative Costs and Benefits of Programs to Reduce Crime, Washington State Institute for Public Policy.
Why These Things Do Not Work
   Does not teach skills
   Mixing low and high risk youths
   Not targeting crime producing needs
   Too abstract
   Reinforces antisocial personality
    characteristics and thinking
Important Considerations
 Assessment is the engine that drives effective behavioral
  change
   Know who and what to target
   Do NOT mix low and high risk youth
   “If they need it they get it; if not then they don’t”
 Design programs around empirical research
   Helps you know how to target change
 Program integrity makes a difference
   Service delivery, disruption of criminal networks
     training/supervision of staff, support for program,
     QA, evaluation
Questions
      Jennifer A. Pealer, Ph.D.
      Assistant Commissioner
  Research & Program Development
  Kansas Juvenile Justice Authority
         jpealer@ksjja.org
           785-296-4213

				
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