Treatment of Offenders

What is treatment?

Broad term, can mean just about anything

What did Sechrest define treatment as?

The result of any planned intervention that reduces an offender's further criminal activity, whether reduction is mediated by personality, behaviour, abilities, attitudes, values, or other factors

What is to be noted of Sechrest's definition of treatment?

It doesn't mention improvement of mental health outcomes

What is typically a correlate with decreased recidivism?

Improvement of mental health

What are levels of intervention based on?

Public health model

What are the levels of intervention?

Primary, secondary, and tertiary

What is primary prevention?

Stop it before it happens

What is required for primary prevention to occur?

Strong knowledge of development and risk factors

What does primary prevention depend on?

Large scale screening

What are examples of primary prevention programs?

Head start: intervene in education of kids w/ developmental disabilities

Mentoring: pair poor performing child with TA, better student

Big brothers/sisters: pair kid with adult to improve social skills

What is secondary prevention?

Nip it in the bud

Who is the target of secondary prevention?

Individuals showing early signs of criminal involvement but not yet formally charged

-Minor infractions

Who identifies candidates for secondary prevention?

Family court, school guidance offices, social services

What are examples of secondary prevention?

Custody diversion

Extrajudicial sanctions: community service, etc

Restorative justice: repair damage done

Why is criminal involvement difficult to evaluate?

Kids may already be more involved in crime than the infraction suggests

How is gang monitoring an example of secondary prevention?

Holds leaders responsible

-Provides recreational, economic, and educational supports to stay responsible

What is tertiary prevention?

Formal treatment for those who are already criminally involved

What is the most restrictive form of prevention?

Tertiary

What is the least effective form of prevention?

Tertiary

Why may tertiary prevention be the only option?

The client's legal circumstances limit other options

Why is early intervention best?

Early onsets of delinquent behaviour are associated with worse outcomes

How is harm reduction a form of treatment?

Not striving for abstinence, but a reduction in crime committed (i.e. shoplifting instead of murder) is preferable

What are the two goals of treatment?

Rehabilitation and punishment

What is the goal of rehab?

Produce productive citizen

What is the method of rehab?

Treatment

What is the agent of rehab?

Enable training/therapy

What is the goal of punishment?

Stop crime

What is the method of punishment?

Incarceration

What is the agent of punishment?

Restrict isolation/deprivation

How can treatments be ranked?

Along a continuum

-Rehab on one end, punishment on another

What is sentencing theory?

Purpose of sentencing is to contribute, along with crime prevention initiatives, to respect for the law and maintenance of a just, peaceful and safe society by imposing just sanctions that have one or more of the following:

-Denounce unlawful conduct

-Deter offender and others from committing offences

-Separate offenders from society where necessary

-To assist in rehabilitating offenders

-To provide reparations for harm done to victims or community

-To promote sense of responsibility in offenders and acknowledgement of harm done

How are the goals of treatment different than the goals of sentencing?

Sentencing is broader

-Treatment goals have no denouncement, isolation, or reparation component

How are are rehabilitation and punishment most different?

The environments in which they take place favour one or the other

What is the basic assumption of community based interventions?

They're much cheaper and generally more effective than institutional or inpatient approaches

Why are community based interventions so good?

Generalization of treatment effects due to delivery in operational environment

-Naturally occurring reinforcers

What is the tridactic model used in community interventions?

Use the therapeutic team, patient, and significant others as figures in treatment

Why are naturally occurring reinforcers so important in treatment?

Allows extinction of environmental cues in operational setting

What are considerations of community interventions?

-Security of community

-Interagency coordination (therapist, probation officer, police)

-Contingencies can be tough to manage

-Community may oppose

-If done in natural home, family can undermine efforts

-Therapist safety

What is the downfall of community opposition of residential treatment programs?

Some residential programs (counter point in YEG) can be extremely succesful

What are some examples of community based treatment programs, ordered from least to most restrictive?

-Juvenile awareness programs (scared straight)

-Wilderness experience programs (outward bound)

-Restitution/community service order (EJS)

-Street corner program

-Shape program

-Achievement place

Why do juvenile awareness programs have a flimsy track record?

They're based on intensity, not probability of punishment

What is the purpose of wilderness experience programs?

Foster self-esteem

What is the behavioural principle of restitution/community service?

Overcorrection

What is overcorrection?

Returning environment to an even better state than it was before offence

What are the benefits of restitution.community service?

Community is satisfied

Who is restitution effective with?

Less serious offenders who will comply

What did the street corner program (Schwitzgebel)?

Approached kids on the street, differentially reinforced prosocial statements

What was done in the "shape" program (Ostapiuk)?

Kids in housing or hostel taught "survival" skills such as job hunting

What was done in "Achievement place" (Braukman & Wolf)?

Simulated functional home

-Houseparent model (married couple)

What type of teaching was done in achievement place?

-Property care

-Table manners

-Democratic decision making

-Appropriate conversation (non-criminal content)

-Negotiation

Why is appropriate conversation important in treatment?

People gravitate to conversations based on what they're used to

-Refrain from criminal talk

How does learning occur in achievement place?

Token economy, then merit system, then homeward bound (discharge planning)

Why were outcomes of achievement place not as good as expected?

-Too many sacrifices were made based on cost

-Transition programs were needed

-Youth were returned to maladaptive homes

What is a useful form of transition programming?

Parent management training

What is done in parent management training?

Parents are taught rudiments of behaviour theory and contingency contracting

-Differential reinforcement of prosocial behaviour, identify delinquent behaviour

-Social skills, use of time outs, employment of role plays

What is the usefulness of roleplaying?

Practicing socially ambiguous situations allows development of skills that require less thought when in distress

Why is PMT more effective when children are younger?

They still have control over their kids

What type of punishment/reinforcement is best for long term behaviour change?

Positive reinforcement

-Allows for better relationship

What is more effective short term between punishment and reinforcement?

Punishment

What is functional family therapy based on?

Family systems theory

What is family systems theory?

Deviant behaviour is a consequence of pathological communication styles

What is the goal of functional family therapy?

Improvement of quality of interactions within family and learn effective problem solving

How effective if functional family therapy in reducing recidivism (vs controls) after 1 year?

11% recidivated vs 67% of controls

What is a waiting list control?

Given treatment at later time

-Control group while waiting for treatment

What was found in Fo & O'Donell's study on functional family therapy?

FFT group had 1/2 as many subsequent major offences (38% vs 64%)

-But had more subsequent minor offences (16% vs 7%)

What was the reason for FFT group having more minor offences?

-Regression to the mean

-Exposure to more serious offenders

How can a criminogenic environment increase subsequent crime?

Person can pick up on worse deviant habits

What is the regression to the mean effect?

An extremely high or low score becomes more moderate in subsequent testing

-Error influenced score

What is the most promising model of outpatient therapy?

Multisystemic therapy (MST) (Henggeler)

What is MST?

Teams available 24/7 to clients and family

-Therapist, on rotation workers, trained stakeholders

-Scheduled and non scheduled visits

-Real time crisis intervention

How is stakeholder (parent, teachers etc) training adapted to needs of patient?

Risk-needs assessment made in structured professional judgement

-Provides survival kit of coping strategies

What are the benefits of MST?

-Effective and cost efficient (even for high risk offenders)

-Lots of support and linkages with probation

-Generalization (training happens in real world)

What is treatment infidelity?

Treatment has changed enough to effectively embody a different form

-stops working

What will be the first elements dropped due to funds in MST?

24 hour service and real time support

What are the basic assumptions of inpatient/institutional treatment?

-Risk is high enough that community treatment isn't desired

-Role of therapy is to lower recidivism and relieve distress

What is the short term role of psychologists in institution?

Relieve distress, not treat

Why was the California rehab strip referred to as silly con valley?

Over 400 approaches were used in prisons

-Most unique to practitioners and not empirically grounded

Why was inpatient treatment such a mess?

Many non-forensic clinical psychologists failed to see that they weren't working with the "worried well" anymore

What does worried well mean?

Motivated and actively seeking treatment

What is there sparse evidence of efficacy of in the inpatient population?

Humanistic and psychodynamic approaches

What did Kassebaum find comparing counselling groups?

No significant difference in inpatient groups when comparing mandatory counselling, voluntary counselling, and controls

What are the major interventions used within institutions?

-Eclectic approaches

-Applied behaviour analysis

-Cognitive-behavioural approaches

What was the outcome of using eclectic treatments to boys in reformatories?

Treatment group received 80 hours of therapy over 20 weeks

-13 reincarcerated vs 25 controls

What is the problem with certain eclectic approaches?

If they become syncretic

-Take components from all but not integratively

What is the problem with eclectic treatment?

Unstandardized

-Can't isolate what produced effect

What has a dramatic influence on success of Tx?

Therapist qualities

-Alliance (warmth, empathy, sensitivity)

What are the ideas behind applied behaviour analysis?

-Change environmental cues and contingencies

-Punish deviant behaviour, reinforce prosocial behaviour

What are an offshoot of ABA?

Token economies

-Reward for compliant behaviour

What is the benefit of ABA?

It is easy to bring behaviour under control in institutions

What are problems of ABA?

-Lack of generalization

-Unclear relationship between behaviours and crime

-Ethical restraints on what privileges to withhold/reward (cigarettes?)

-Fails to promote intrinsic motivation

What is the predominate treatment approach in Canadian prisons?

Cognitive-behavioural therapy

What do CBT approaches resemble?

Remedial education

-Emphasis on skill training

What is taught in CBT?

Training strategies that counter habits, cognitions, deficits, lifestyle factors, that perpetuate a criminal lifestyle

What are some cognitive distortions that are targeted by CBT?

Hostile attributional bias, catastrophizing, blaming

Why is dangerous offender provision undesirable?

Sentence is indeterminate

When is dangerous offender provision given?

-Significant harmful behaviour is shown

-High risk

-Rehab unlikely within 10 years

What is different between long term offender vs dangerous offenders?

Rehabilitation may be effective within 10 years

-Basically 10 year sentence

Who is included under dangerous offenders?

Violent, sexual, psychopathic and antisocial offenders

What prohibits community treatment of dangerous offenders?

Risk level

What are biologically based treatments for sex offenders?

-Neurosurgery (hypothalamic nuclei)

-Orchidectomy (castration)

-Antiandrogenics (chemical castration