Download Women Offenders & the Principles of RNR (Risk, Need and Responsivity)

Women Offenders & the Principles of
RNR (Risk, Need and Responsivity)
FAYE S TAXMAN, Ph.D.
Department of Criminology, Law and Society
Center for Advancing Correctional Excellence!
GEORGE MASON UNIVERSITY
[email protected]
www.gmuace.org
RNR Simulation Tool (www.gmuace.org/tools): tx matching
& gap analysis
Faye S. Taxman, Ph.D.
James M. Byrne, Ph.D.
April Pattavina, Ph.D.
Avinash Singh Bhati, Ph.D.
Michael S. Caudy, Ph.D.
Stephanie A. Ainsworth, M.A.
Erin L. Crites, M.A.
Joseph, M. Durso, B.S.
Lauren Dunhaime
Gina Rosch
Special Acknowledgements:
Bureau of Justice Assistance
BJA: 2009-DG-BX-K026
Center for Substance Abuse Treatment
SAMHSA: 202171
Public Welfare Foundation
6/26/2013
Special Thanks to:
Ed Banks, Ph.D.
Ken Robertson
2
Can’t Reduce Recidivism with
--Service Gaps
--Punishment-Oriented Tx Programs
Need based on SUD
2400000
2200000
# Exposed to Treatment
2000000
1800000
1600000
1400000
1200000
1000000
800000
600000 524,000
400000
200000
398,000
101,000
0
No Need; SA
Education
Outpatient
Counseling
Intensive
Counseling
50,000
Drug Treatment
Courts
97,000
Structured
Residential Tx
GMU
Risk, Need, Responsivity
• CJ Risk: more criminal history, greater safety
risks and involvement with the justice system
• Needs: some needs are tied offending behavior
such as antisocial cognitions, criminal “peers”,
criminal personality (and then SUD,
employment, leisure, families); other needs are
not (mental health, housing, etc.)
• Responsivity: match to programming but focus
on CBT programming
6/26/2013
4
Public Health Impact
Population Impact in Hypothetical Jurisdiction (N=10,000)
Percent Rearrested within 3 Years
70
Standard Treatment
With RNR Matching
60%
60
50
48%
40
36%
30
20
0
10
20
30
40
50
5
60
70
Percent of Population in Programming
80
90
100
Scientists, policymakers, and practitioners promote the
use of the Risk, Needs, Responsivity model which is:
1. Guided by scientific findings
2. Triages resources for moderate to higher risk offenders
& places less emphasis on services for lower risk offenders
3. Promotes the use of treatment matching principles
4. Integrates resource allocation, efficiency &
effectiveness models
6/26/2013
But women offenders do not fit the mold
6
Silver Bullets
RNR Rhetoric
Science/clinical practice
• Treat high risk offenders
• Offer treatment in prison/jail
• Needs are more important in
treatment placement
• Drug abuse, mental health are
not “criminogenic”
• Community based TX is more
effective
• Developmental issues are not
important
• Age, gender, maturity are
important
• CBT: the programming
• Mental health affects stability
• Sanctioning is important for
compliance
• CM and incentives are
important for engaging
6/26/2013
7
• Reduce use of sanctions
Criminal Justice Risk
Use Actuarial Risk Measure to Prioritize for Care
6/26/2013
8
What is Risk?
• Risk is the likelihood that a person will engage in future
criminal behavior (recidivate)
• Can be discussed as static or dynamic or both
• Risk does NOT refer to dangerousness or likelihood of
violence
• Static risk factors have a direct correlation with criminal
behavior
• Historical – based on criminal history
• Cannot be decreased by interventions
6/26/2013
9
CJ Risk Assessment
• EBP: Risk level should drive receipt of care—
moderate to high risk offenders benefit more from care
• Actuarial based Models
• Main Factors
• Age of first arrest
• Number of arrests and/or convictions
• Number of failed attempts on probation (or parole)
• Number of incarcerations
• Number of escapes
• Substance Abuse
6/26/2013
10
CJ Risk Matters…..(3 year, all offenses)
Risk Level
High
Moderate
Low
0
20
40
% Rearrested
Probation
6/26/2013
Ainsworth, Crites, Caudy, & Taxman, 2011
Jail
11
60
Prison
80
100
Risk Principle in Action – High Risk
40
32
8% Recidivism
Reduction
30
30
27
24
21
19
20
Change in Recidivism Rates
15
12 12 12
10 10
10
7
8
8
8
5
2
3
3
3
0
-2 -2
-6
-10
-5
-8
-10
-15
-20
-18
-14
-17
-30
-34
-40
6/26/2013
Lowenkamp & Latessa, 2005
12
13 13
22
25 25
33
34
Risk Principle in Action – Low Risk
10
8
0
0
Change in Recidivism Rates
-2
-7
-7
-6
-5
-4
-4
-2
-2
1
1
1
2
3
3
-1
-4
-10
-11 -11 -11
-16
4% Recidivism
Increase
-15
-20
-21 -21 -21 -21
-30
-29 -29
-32
-36
-40
6/26/2013
Lowenkamp & Latessa, 2005
13
4
4
5
6
9
Risk & Other Health Needs
Piquero and colleagues (2007) found that chronic offenders tend
to suffer from more health problems than desisters.
Using the Baltimore stratification of the National Collaborative
Perinatal Project (n = 1,758 subjects), they examined the
trajectories of individuals 27 to 33 years old
 8+arrests in their lifetime were classified as “life-course
persistent”
 life-course persistent offenders had higher rates of
alcohol and other drug use and cigarette smoking than
desisters.
 significant relationship between adverse health
outcomes and being a life-course persistent offender.
6/26/2013
14
Women Offenders
• The static risk concept—early onset, # of instances of
CJ experience, prior failures—does not hold
• Women are less violent, less serious offending anddo
not fit the same male patterns of offending
• Women are influenced by others (relationships) which
poses a different dynamic risk factor
• Women are moderate to lower risk on a male
dominated instruments; women trailers overclassify for
risk
6/26/2013
15
Dynamic Risk (Needs)
👍
👍
Target in programming to change behavior
The area where CJ and Public Health organizations can address the
unmet habituation and socio-psychological needs
👍
6/26/2013
Managing risky behaviors and addressing health inequities
16
Health Issues Among Adults in the Correctional System
Sexually Transmitted Infection
1:2
Substance Use Disorder
1:2
Co-Occurring Disorders
1:2
Hepatitis C
1:4
Mental Health Disorder
1:2
Tuberculosis
1:5
HIV/AIDS
1:48
*Sexually transmitted infections include: HIV, AIDS, Hepatitis C, Chlamydia, gonorrhea, and syphilis.
*Correctional population numbers came from: Taxman et al. (2007), supplemented by information on federal prisoners,
probationers, and parolees from the Bureau of Justice Statistics’ “Prisoners in 2007” and “Probation and Parole in 2007”
(available at http://www.ojp.usdoj.gov/bjs/correct.htm).
6/26/2013
*Offender health status numbers came from Cropsey, et al172013
Theoretical Criminogenic Needs
6/26/2013
•
•
•
•
Criminal personality
Antisocial peers
Antisocial values, orientation
Prior criminal history
•
•
•
•
Substance use
Employment & Education
Dysfunctional Families
Recreational and lesure
18
Women do not fit the mold
• “Criminogenic needs” as conceptualized and used in
practice does not address female issues:
•
•
•
•
•
•
•
•
•
Substance abuse/use
Mental health and suicide attempts
Personal relationships (marital, significant others, partners)
Family structure
Dysfunctional Relationships
Housing
Economic Survival
Physical and sexual abuse
Relationship management
• Fails to recognize different pathways to offending
6/26/2013
19
Women do not fit the mold
• Jiang, Huang, & Hser (2013) studied 1444 offenders
in diversionary offenders (Prop 36) with co-morbid
drug abuse & mental health disorders:
• Women: greater problem severity (family, health,
psychological, sexual and physical abuse history)
• Men: had greater prior criminal history
• Lower education, cocaine use, arrest history were
related to women recidivism (compared by young
age, outpatient tx, arrest history)
6/26/2013
20
Drug of Choice Matters
• Alcohol: being older, white, male, having private health insurance,
being medicated for a mental health disorder, and having a criminal
history of person offenses.
• Cocaine: being older, black, female, attempting suicide, <high school
education, living in a shelter or with relatives, being unemployed,
being uninsured, being physically and sexually abused, and
committing property and court offenses but not person or substance
offenses.
• Marijuana: being younger, black, male, never being married, and
committing substance but not property or court offenses.
• Opioids: being white, female, being married, higher education, being
unemployed, and being medicated for a mental health disorder.
Clark
et al (2012) in a study of over 15,000 21
community corrections intakes
6/26/2013
Drug of Choice Matters
Odds of Offending by Drug Type
Marijuana
1.46
Cocaine
2.56
Crack
6.09
Heroin
3.08
0
2
4
6
Weighted Mean Effect Size
(odds ratio – random effects)
6/26/2013
Bennett, Holloway, & Farrington, 2008
22
8
Responsivity
👍
👍
👍
6/26/2013
Gender specific programming
Economic and financial needs
Managing risky behaviors and addressing health inequities
23
What Has Been Tried: CJ Interventions to
Change Offending Behaviors?
•
•
•
•
Intensive Supervision
Boot Camp
Case Management
Prison/Incarceration
• Case management & services provided
• Diversion to residential treatment
• Specified treatment programs (e.g. Break the Cycle,
Seamless System, etc.)
• Medication Assisted Therapies with Behavioral
Therapies
• Drug Treatment Courts
• RNR Supervision
• In-Prison Therapeutic Programs (TC) with Aftercare
Red: ineffective
6/26/2013
Blue: Promising
Green: Effective
24
What Has Been Tried: Clinical?
• Psycho-Social Educational
• Non-Directive Counseling
• Directive Counseling
•
•
•
•
•
Motivational Interviewing
Moral Reasoning
Emotional Skill Development
12 Step Based Programming
Medications for SUD & MH
• Cognitive Behavioral (Social Skills, Behavioral
Management, etc.)
• Family Interventions (MST, FFT)
• Therapeutic Communities (with aftercare)
• Contingency Management/Token Economies
6/26/2013
25
CBT-Related Issues
• Seeking Safety (CTN found no support within addiction treatment
programs); unsure about punitive environment & trust issues
• Thinking for a Change (deficit based—”stinking thinking”)
• Addiction Treatment does not deal with:
• Multidimensional
• Integrated service models
• Engagement in care
• Relationship
• Siloed programs
• If processing groups will not happen, little impact on cognitive
restructuring
6/26/2013
26
Relationship Model
• Importance of relationships and enhancing positive
relationships to help SUD women (Covington &
Surrey, 1997)
• Social support and skill building intervention
• Skill building and protective behavior
• Social support, service linkage, discharge planning
• El-Bassel & colleagues (2003) communication model
with negotiation and problem solving in relationships
6/26/2013
27
From the Voice of Women: Adapting Tx to Address
Relationships & Risky Behaviors in Women
• Drug Use: Addiction leads to Unprotected Sex
• Strategy: Use sex is used as a strategy to manipulate partners
• Trust: Practicing Safe Sex is not important in long term
relationships
• Safe Partner: HIV and other STIs were not viewed as potential
consequences of risky behaviors
• Invincibility: Majority said they were not concerned about
contracting HIV; they just didn’t feel like it could happen to them
• Self-Worth: Relationships influence the way that a women feels
about herself and this influences sexual activity
28
Stanton-Tildell, eta al 2007 looking at HIV risk behaviors
Better Outcomes via Tx Matching
Therapeutic
Community
(26.6% High
Need)
Substance
Abuse Tx
(25.8% High
Need)
Education
(63.5% High
Need)
26%
55%
31%
49%
31%
53%
% Reconvicted with High LSI-R Need
% Reconvicted with No Needs
Caudy,
Outcomes: A review of Kansas
6/26/2013 et al (2011). Using Data to Examine 29
Department of Corrections. Fairfax, VA: George Mason University.
Program Quality Matters
• Across the tools used, most programs score < 50 or are
unsatisfactory
• Program quality (Implementation, Risk-Need Assessment,
Orientation) related to Recidivism
High Score (N=1)
22%
Moderate Score (N=13)
8%
Low Score (N=24)
2%
0%
5%
10%
15%
20%
% Difference in Recidivism
6/26/2013
30
Lowenkamp,
Latessa, & Smith, 2006; see also Nesovic,
2003
25%
Getting past the
myths…Apply RNR to
Women
• Basic principles do not align with epidemiology of women in
the justice system, and interventions for women
• Need to focus on needs as a dynamic risk factor and use these
needs to identify services
• Move away from static risk
• Integrate relationships and incentives into the programming
• Focus on strengthening interpersonal and social skills as
compared to cognitive restructuring
6/26/2013
31
CJ RISK
“Criminogenic Needs”
Substance Tolerance for “Harder Drugs”
3+ Criminal Lifestyle—attitudes, family, peers, personality,
substance abuse
Stabilizers
Supportive Family
Stable Employment
Education > HS Diploma
Stable Housing
Location in non-Hot Spots
6/26/2013
Destabilizers
Alcohol Abuse
Drug Abuse
Family Dysfunction
Poor Mental Health Status
Employment-Related Issues
Literacy Related Problems
Housing Instability
Location in Hot Spots
Gender 32& Age
6/26/2013
34
RNR Program Level Targets
• Target = Primary intervention focus
• Placement based on primary and secondary needs
▫ Step-down model
6/26/2013
LEVEL A
• Dependence on Criminogenic Drugs
LEVEL B
• Criminal Thinking/Cognitive Restructuring
LEVEL C
• Self-Improvement
LEVEL D
• Social/Interpersonal Skills
LEVEL E
• Life Skills (Employment, Education, etc.)
LEVEL F
• Punishment Only
35
Scoring The Program Tool
• Essential features and targets drive program level
classification
• 6 scoring areas
•
•
•
•
•
•
6/26/2013
Risk principle (15pts)
Need principle (15pts)
Responsivity principle (15pts)
Implementation (25pts)
Dosage (20pts)
Additional features (10pts)
36
• Here’s the
link:
www.gmuace
.org/tools
6/26/2013
37
6/26/2013
38
6/26/2013
39
Gap Analysis
80%
60%
39%
40%
27%
20%
26%
38%
21%
22%
23%
4%
0%
Level A
6/26/2013
Level B
Level C
% Recommended
Level D
Level E
% Currently in Program
40
Level F
6/26/2013
41
Components of the Model
• Static Risk
▫ Use of validated risk assessment tool required
▫ High and moderate risk prioritized
• Demographics
▫ Age and gender weighted heavily
• Criminogenic Needs
▫ Drug dependence (hard drugs)
▫ 3 or more criminogenic needs
• Stabilizers and Destabilizers
▫ Clinically-relevant factors
6/26/2013
42
6/26/2013
43
$6.4 B=
+
A country
6/26/2013
+
300 new
schools
44
Cleveland
Browns
Thank you
www.gmuace.org/tools
45