What Works What Doesnt in Changing Behaviors

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What Works/ What Doesnt in Changing Behaviors

• The Principles of Effective Interventions

Presented by Jennifer A. Pealer, Ph.D. Assistant
Commissioner Research Program
Development Kansas Juvenile Justice Authority
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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

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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

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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

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So What Works to Reduce Recidivism?

• Risk principle
• Need principle
• Responsivity principle
• Human service (treatment) principle
• Program fidelity principle

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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

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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

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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

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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

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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 ones ability
  to achieve through conventional means
• Lack of empathy and sensitivity toward others

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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
  offenders 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.

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How to Address Antisocial Attitudes?

• Use programming and techniques that
• Identify antisocial thinking
• Stop blockers
• Changing the antisocial thinking

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Influence of Peers

• Elevated risk
• Delinquent associations
• Absence of prosocial associations
• Based on social learning
• Learn through interaction of others
• Provide reinforcements

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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

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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

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How Do We Address Antisocial Personality

• Skill based programs
• Anger management
• Impulse control
• Decision making
• Problem solving
• Thinking skills

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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

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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

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Addressing Family Factors

• Family counseling to repair relationships
• Teach to recognize antisocial behavior
• Enhance supervision practices
• Enhance disciplinary practices

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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

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Leisure Recreation

• Low involvement in prosocial leisure and
  recreational activities
• Idle hands

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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

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The Risk Principle Correctional Intervention
Results from Meta Analysis
Dowden Andrews, 1999
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Risk Level by New Conviction Results from 2005
Ohio Study of over 14,000 Youth
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Violation of the Risk Principle Low Risk Offenders
Adherence to the Risk Principle High Risk
Offenders
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Recent Study of Intensive Rehabilitation
Supervision in Canada
Bonta, J et al., 2000. A Quasi-Experimental
Evaluation of an Intensive Rehabilitation
Supervision Program., Vol. 27 No 3312-329.
Criminal Justice and Behavior
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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

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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/superv
  ision

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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

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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

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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

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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

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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

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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

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Targeting Criminogenic Need Results from
Meta-Analyses
Reduction in Recidivism
Increase in Recidivism
Source Gendreau, P., French, S.A., and A.Taylor
(2002). What Works (What Doesnt Work) Revised
2002. Invited Submission to the International
Community Corrections Association Monograph
Series Project
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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

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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

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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

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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

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Responsivity Factors

• External responsivity factors
• Program characteristics
• Facilitator characteristics
• Program setting
• Internal responsivity factors
• Motivation
• Mental health anxiety, psychopathy
• Maturity
• Transportation
• Cognitive deficiencies
• Demographics

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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

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Risk, Need, Responsivity
Risk
Need
Resp.
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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

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The Treatment Principle

• Programs services should be behavioral in
  nature
• Focus on current factors that influence behavior
• Action-oriented
• Behavior is reinforced

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Behavioral Versus Nonbehavioral
Reduced Recidivism
Increased Recidivism
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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

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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

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Effective Programs Have Leadership

• Experienced
• Trained
• Hands-on
• Designing program
• Hiring, training, supervising staff
• Provide service to offenders

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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

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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

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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

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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

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Cognitive-Behavioral Cycle
Situations tell us what conditions led to the
behavior (people, places, things)
Consequences (negative or positive) determine the
likelihood of continuance
Thoughts drive behaviors
Behaviors represent the ultimate behavior the
person engages in
Feelings stem from thoughts and can be healthy or
problematic depending on how one copes with the
feelings
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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

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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)

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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

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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

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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

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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

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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

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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

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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

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Cognitive Curriculums for Offenders

• Controlling Anger and Learning to Manage It (CALM
  and CALMER)
• Aggression Replacement Training (ART)
• Thinking for a Change
• Choices, Changes, Challenges
• Pathways to Self Discovery and Change

• Persistently Violent Curriculum
• Corrective Thinking/Truthought
• Reasoning and Rehabilitation
• Moral Recognition Therapy
• Drug Abuse Treatment
• Moving On (Female)

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Percent Reduction in Recidivism by Program
Characteristics

• 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.

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Program Fidelity

• Implementing the program and services as they
  were designed
• Ensuring quality control over the program and
  services

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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

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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

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Impact of Program Factors Predicting Felony
Adjudication for Juvenile Programs
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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.)

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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.
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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

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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
  dont
• 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

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Questions

• Jennifer A. Pealer, Ph.D.
• Assistant Commissioner
• Research Program Development
• Kansas Juvenile Justice Authority
• jpealer_at_ksjja.org
• 785-296-4213