Dosage and Principles of Effective Intervention Eva Kishimoto

Dosage and Principles of Effective Intervention Eva Kishimoto, D. C. S. W Research Associate Corrections Institute University of Cincinnati October 2017 Ohio Justice Alliance for Community Corrections

Key Definition Evidence-Based Practice: A practice that has been shown to work through use of scientific research. Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Evidence Based – What does it mean? There are different forms of evidence: • The lowest form is anecdotal evidence; stories, opinions, testimonials, case studies, etc. - but it often makes us feel good • The highest form is empirical evidence – research, data, results from controlled studies, etc. - but sometimes it doesn’t make us feel good Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Evidence Based Practice is: • Easier to think of as Evidence Based Decision Making • Involves several steps and encourages the use of validated tools and treatments. • Not just about the tools you have but also how you use them Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Evidence-Based Decision Making Requires 1. Assessment information - Valid and reliable offender assessment process - Assessment of programs and practices 2. Relevant research - Consult research - Design and fund programs that are based on empirical evidence - Use existing resources (i. e. , Crimesolutions. gov) 3. Available programming - To reduce risk - Improve existing programs - Develop new programs Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Evidence-Based Decision Making Requires: 4. Evaluation - Offenders - Quality assurance processes - Performance measures - Data 5. Professionalism and knowledge from staff - Understand EBP - Trained, coached, and skilled - Commitment Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

In Corrections, What Have We Tried? • “Been there done that theory” • “Offenders lack creativity theory” • “Offenders need to get back to nature theory” • “Offenders lack discipline theory” • “Offenders lack organizational skills theory” • “Offenders (females) need to learn to put on makeup & dress better theory” • “Offenders have low self-esteem theory” • “Offenders need to change their diet theory” • “Treat them as babies & dress them in diapers theory” • “We just want them to be happy theory” • “Male offenders need to get in touch with their feminine side theory” Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

We Have Tried To Punish The Crime Out Of Them Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

We Have Tried To Scare the Crime Out of Them Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

We Have Tried To Dance the Crime Out of Them Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

We Have Tried To Run the Crime Out of Them Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

We Have Tried To Drum the Crime Out of Them Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

We Have Tried To Meditate the Crime Out of Them Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

We Have Tried To Cultivate the Crime Out of Them Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

What does the Research tell us? There is often a Misapplication of Research: “XXX Study Says” - the problem is if you believe every study we wouldn’t eat anything (but we would drink a lot of red wine!) • Looking at one study can be a mistake • Need to examine a body of research • So, what does the body of knowledge about correctional interventions tell us? Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

From the Earliest Reviews • Not a single reviewer of studies of the effects of official punishment alone (custody, mandatory arrests, increased surveillance, etc. ) has found consistent evidence of reduced recidivism. • At least 40% and up to 60% of the studies of correctional treatment services reported reduced recidivism rates relative to various comparison conditions, in every published review. Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Results from Meta Analysis: Criminal Sanctions versus Treatment Mean Phi Reduced Recidivism 0. 15 -0. 07 Increased Recidivism Treatment. 15 (Number of Studies=124) CS -. 07 (Number of Studies=30) Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

A Large Body of Research Has Indicated…. …. that correctional services and interventions can be effective in reducing recidivism for offenders, however, not all programs are equally effective • The most effective programs are based on some principles of effective interventions • Risk (Who) • Need (What) • Responsivity (How) • Program Fidelity (How Well) Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Principles of Effective Intervention RISK NEED RESPONSIVITY FIDELITY WHO WHAT HOW WELL Deliver more intense intervention to higher risk offenders Target criminogenic needs to reduce risk for recidivism Use CBT approaches Match mode/style of service to offender Deliver treatment services as designed Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Taking Stock of the Principles of Effective Intervention • There are more than 40 published meta-analyses of the correctional treatment literature. • Results have been replicated with remarkable consistency; there is considerable support for the RNR framework across quantitative reviews of the literature. Smith et al. (2009) Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

RNR and Reductions in Recidivism: General Recidivism Andrews and Bonta (2010) 0. 3 0. 25 0. 2 0. 15 0. 1 0. 05 0 -0. 05 0 1 2 # of Conditions Present Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved 3

Let’s Start with the Risk Principle Risk refers to risk of reoffending and not the seriousness of the offense. Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Risk Principle: Predictors of General Recidivism Criminal History Antisocial Attitudes/Cognitive-Emotional States Antisocial Peers Temperamental and Personality Factors ___________________________ Family and Marital Factors Education and Employment Substance Abuse Leisure and Recreation Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Risk Principle If you intend to reduce recidivism, then it is critical to focus on the offenders who are most likely to re-offend! Assess and identify higher risk offenders. Deliver greater dosage of treatment to higher risk offenders. Avoid including lower risk offenders in more intense (or restrictive) services. Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Targeting Higher Risk Offenders • It is important to understand that even with EBP there will be failures. • Even if you reduce recidivism rates you will still have a high percentage of failures Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Example of Targeting Higher Risk Offenders • If you have 100 High risk offenders about 60% will fail • If you put them in well designed EBP for sufficient duration you may reduce failure rate to 40% • If you have 100 low risk offenders about 10% will fail • If you put them in same program you may increase the failure rate to 20% Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Example of Targeting Higher Risk Offenders continued: • In the end, who had the lower recidivism rate? • Mistake we make is comparing high risk to low risk rather than look for treatment effects Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Question is: What does more “intensive” treatment mean in practice? • Most studies show that the longer someone is in treatment the greater the effects, however: • Effects tend to diminish if treatment goes too long • Consider the dosage of treatment… Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Provide Most Intensive Interventions to Higher Risk Offenders • Higher risk offenders will require much higher dosage of treatment – Rule of thumb: 100 hours for moderate risk – 200+ hours for high risk – 100 hours for high risk will have little effect – Does not include work/school and other activities that are not directly addressing criminogenic risk factors Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Results from a 2013 Study of 689 offenders • 100 -bed secure residential facility for adult male offenders • Cognitive-behavioral treatment modality • Average 33 • 60% single, never married • 43% less than high school education • 80% moderate risk or higher • 88% have probability of substance abuse per SASSI (Latessa, Sperber, & Makarios) Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Risk Principle Avoid including lower risk offenders in more intense (or restrictive) services as it is likely to increase recidivism rates. WHY? We disrupt protective factors. We expose them to higher risk peers. We also force them to interact with us… Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

2002 Study of Community Correctional Programs in Ohio • Largest study of community based correctional treatment facilities ever done up to that time. • Total of 13, 221 offenders – 37 Halfway Houses and 15 Community Based Correctional Facilities (CBCFs) were included in the study. • Two-year follow-up conducted on all offenders • Recidivism measures included new arrests & incarceration in a state penal institution Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Reduced Recidivism Increased Recidivism Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Translating the Risk Principle into Practice ASSESS RISK FACTORS USING STANDARDIZED AND VALIDATED TOOLS • Assessment is the engine that drives effective correctional programs • Assess both static and dynamic risk factors Static factors are those that are related to risk and do not change. Dynamic factors are related to risk and can change. 37 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Assessing Risk Level of Service Inventory (LSI) Level of Service/Case Management Inventory (LS/CMI) Psychopathy Checklist COMPAS Ohio Risk Assessment System (ORAS) Women’s Risk Need Assessment (WRNA) Static-99 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

What do the Results Tell Us? • Overall risk level of offender • Targets for change - Criminogenic need areas Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Maximizing the Results of the Assessment Match density and intensity of services to risk level: Case Plan Referrals Contact session Monitoring plan **Remember higher risk offenders need a greater number of referrals, meaningful contacts with supervision officers, and mechanisms to monitor behavior and highrisk situations. Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Need Principle: The Need Principle states that criminogenic needs should be targeted for change in order to reduce the risk to reoffend. Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Need Principle: Predictors of General Recidivism To understand the Need Principle we need to review the body of knowledge related to risk factors What are the risk factors correlated with criminal conduct? Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Need Principle: Predictors of General Recidivism Criminal History Antisocial Attitudes/Cognitive-Emotional States Antisocial Peers Temperamental and Personality Factors ___________________________ Family and Marital Factors Education and Employment Substance Abuse Leisure and Recreation Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Major Risk and/or Need Factor and Promising Intermediate Targets for Reduced Recidivism Factor Risk Dynamic Need History of Antisocial Behavior Early & continued involvement in a number antisocial acts Build noncriminal alternative behaviors in risky situations Antisocial personality Adventurous, pleasure Build problem-solving, selfseeking, weak self management, anger mgt & control, restlessly aggressive coping skills Antisocial cognition Attitudes, values, beliefs & rationalizations supportive of crime, cognitive emotional states of anger, resentment, & defiance Reduce antisocial cognition, recognize risky thinking & feelings, build up alternative less risky thinking & feelings Adopt a reform and/or anticriminal identity Antisocial associates Close association with criminals & relative isolation from prosocial people Reduce association w/ criminals, enhance association w/ prosocial people Adopted from Andrews, D. A. et al, (2006). The Recent Past and Near Future of Risk and/or Need Assessment. Crime and Delinquency, 52 (1).

Major Risk and/or Need Factor and Promising Intermediate Targets for Reduced Recidivism Factor Risk Dynamic Need Family and/or marital Two key elements are Reduce conflict, build nurturance and/or caring positive relationships, better monitoring and/or communication, enhance supervision monitoring & supervision School and/or work Low levels of performance Enhance performance, & satisfaction rewards, & satisfaction Leisure and/or recreation Low levels of involvement Enhance involvement & satisfaction in anti& satisfaction in prosocial criminal leisure activities Substance Abuse of alcohol and/or drugs Reduce SA, reduce the personal & interpersonal supports for SA behavior, enhance alternatives to SA Adopted from Andrews, D. A. et al, (2006). The Recent Past and Near Future of Risk and/or Need Assessment. Crime and Delinquency, 52 (1).

Targeting Criminogenic Needs: Results from Meta-Analyses Reduction in Recidivism Increase in Recidivism 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

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Translating the Need Principle into Practice ASSESS DYNAMIC RISK FACTORS USING STANDARDIZED AND VALIDATED TOOLS • Focus on criminogenic need factors (dynamic risk factors) 48 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Assessing Need Factors General Risk/Need Tools Level of Service Inventory (LSI) Level of Service/Case Management Inventory (LS/CMI) COMPAS Ohio Risk Assessment System (ORAS) __________________________ Need Specific Tools Subtle Substance Abuse Screening Inventory Stable/Acute (-97, -2000) Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Maximizing the Results of the Assessment Case Plan: prioritize need areas by score on assessment Referrals: refer to CBT programs to address high need areas Contact session: use CBT techniques to teach offenders how to recognize and anticipate high-risk situations and skills to manage/avoid those high need areas (be an active agent of change!) Monitoring plan: offer support by monitoring high need areas Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Evidence-Based Principles for Effective Interventions • • Use a risk assessment instrument Target higher risk offenders criminogenic needs Address any barriers to success Train offenders in new skills Use of positive reinforcements Build community supports for the offender Measure outcomes Quality assurance Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved 51

The Responsivity Principle Use cognitive-behavioral strategies to decrease antisocial behaviors and increase prosocial behaviors. Match the style and mode of service to key offender characteristics and learning styles. Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

General Responsivity Principle AKA: The Treatment Principle The most effective interventions are behavioral: • Focus on current factors that influence behavior • Action oriented Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Results from Meta Analysis: Behavioral vs. Non-Behavioral 0. 35 0. 29 0. 3 Reduced Recidivism 0. 25 0. 2 0. 15 0. 1 0. 07 0. 05 0 Nonbehavioral (N=83) Behavioral (N=41) 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. Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Core Correctional Practices Effective Reinforcement Effective Disapproval Effective Use of Authority Quality Interpersonal Relationships Anti-criminal Modeling Cognitive Restructuring Structured Learning Skill Building Problem Solving Techniques Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Core Correctional Practices Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Change versus Compliance • Our goal is to help the client: – Gain self-control – Regulate emotions – Manage behavior in a prosocial way • In unsupervised situations and sustained across environment and time Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Most Effective Behavioral Models in Corrections • Cognitive behavioral approaches that target criminogenic risk factors • Structured social learning where new skills and behaviors are modeled Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Cognitive-Behavioral Interventions Cognitive WHAT to change Behavioral HOW to change it Skill Development What offenders think How offenders think Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved Emotion Regulation Problem Solving

Defining Characteristics of CBT • • Scientific Active Present-focused Based on theories of learning Individualized Brief Step-wise progression Treatment packages 60 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Four Principles of Cognitive Intervention 1. Thinking affects behavior 2. Antisocial, distorted, unproductive irrational thinking can lead to antisocial and unproductive behavior 3. Thinking can be influenced 4. We can change how we feel and behave by changing what we think Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

In te rn a l Ex te rn al Cognitive Model Actions Thoughts Feelings Attitudes/Beliefs Thinking for a Change v 3. 1 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

For Example: Cognitive Restructuring GOAL: Change behavior Steps: IDENTIFY ANTISOCIAL THINKING CHALLENGE ANTISOCIAL THINKING REPLACE WITH PROSOCIAL THINKING 63 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Cognitive Restructuring TAPES CHALLENGES COUNTERS “He disrespected me so I should teach him a lesson” “This thinking is going to get me further away from my goal” “I’m just gonna let it go and not get to me” “It’s not a big deal because marijuana is natural and should be legal” “Thinking like this is going to get me violated” “I know it’s illegal and I’m probably going to get tested” “I can stop at one drink” “Thinking like this has never worked in the past” “I probably won’t be able to stop and don’t want to get out of control” “I’m not going to get caught” “I know this thinking isn’t true” “There’s a real chance I could get caught and go back to jail” “Selling drugs is the best way for me to make money for my family” “I’m just giving myself permission to sell drugs” “I’m not going to be any help to my family from prison” 64 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Meta-Analysis of Cognitive Behavioral Treatment 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 Landenberger & Lipsey (2005)* Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Significant Findings (effects were stronger if): • Sessions per week (2 or more) - RISK • Implementation monitored - FIDELITY • Staff trained on CBT - FIDELITY • Higher proportion of treatment completers -RESPONSIVITY • Higher risk offenders - RISK • Higher if CBT is combined with other services - NEED Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Social Learning Refers to several processes through which individuals acquire attitudes, behavior, or knowledge from the persons around them. Both modeling and instrumental conditioning appear to play a role in such learning Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Social Learning Albert Bandura Feedback Practice Model Teach Motivate Graduated Practice

Translating Responsivity into Practice Being an effective agent of change • Match staff characteristics to learning styles of offenders • Develop a collaborative relationship • Target and restructure antisocial thinking • Teach and model new social and coping skills • Teach problem solving • Reinforce prosocial behavior • Sanction antisocial behavior 69 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Translating Need and Responsivity into Practice Case Plan: Emphasis on criminogenic needs but allows for barriers to be addressed as well Referrals: refer to programs that adhere to a cognitivebehavioral model Contact session: use CBT to target high need areas for change during session (be an active agent of change!) Monitoring plan: offer support by monitoring high need areas; reinforce prosocial behavior and sanction antisocial behavior Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

In Summary: Translating Risk, Need, and Responsivity into Practice ASSESS RISK, NEED, AND RESPONSIVITY FACTORS USING STANDARDIZED AND VALIDATED TOOLS • Target moderate and high risk offenders • Focus on criminogenic need factors • Match staff characteristics to learning styles of offenders • Use CBT and social learning theory processes 71 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

In Summary: Translating Risk, Need, and Responsivity into Practice DEVELOP STAFF COMPETENCY WITH CORE CORRECTIONAL PRACTICES • Develop a collaborative relationship • Target and restructure antisocial thinking • Teach and model new social and coping skills • Teach problem solving • Reinforce prosocial behavior • Sanction antisocial behavior 72 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Dosage • • Adherence to RNR Targets a criminogenic need Utilizes a combination of CBT & SL Fidelity: Clear practice indicators

EBP • For what? • What evidence? • Fidelity

Fidelity Principle Making sure the program is delivered as designed and with integrity: • Ensure staff are modeling appropriate behavior, are qualified, well trained, well supervised, etc. • Make sure barriers are addressed but criminogenic needs are targeted • Make sure appropriate dosage of treatment is provided • Monitor delivery of programs & activities, etc. • Reassess offenders in meeting target behaviors Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

RNR CCP Curricula Program Outcomes

Drift • Accidental adaptation can pose significant problems • Too much adaptation might decrease an intervention's effectiveness Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Behind Closed Doors Ever Make you Nervous? ? ? Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Without Fidelity Monitoring • • No chance to reinforce good work No correcting mistakes or inconsistencies No provision for gaps in skill No assurance of fidelity with model Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Fidelity Monitoring Effective programs utilize Continuous Quality Improvement to help ensure program fidelity Not a discussion of RIGHT or WRONG Rather it is about Identifying what is CONSISTENT or INCONSISTENT Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

The Role of QA/QI in Community Corrections % Change in Recidivism (based on UC Halfway House and CBCF study) 8 6 6 4 2 1 0 Internal QA Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved No Internal QA

Study of Non-Residential Community Correctional Programs in Ohio involving over 13, 000 Offenders • Included both misdemeanants and felons under community supervision • Programs included day reporting centers, work release, ISP, and electronic monitoring programs Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Four Factors were Significantly Related to Outcome • Proportion of higher risk offenders in program (at least 75% of offenders in programs were moderate or high risk) RISK • Level of supervision for higher risk offenders (high risk offenders averaged longer periods of supervision than low risk) RISK • More treatment for higher risk offenders (at least 50% more time spent in treatment) RISK, NEED, TREATMENT • More referrals for services for higher risk offenders (at least 3 referrals for every 1 received by low risk) RISK, NEED, TREATMENT Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Change in Recidivism by Adherence to RNR for Probation Programs 0. 2 Reduced Recidivism 0. 15 0. 1 0. 03 r-value 0. 05 Increased Recidivism 0 -0. 05 -0. 15 -0. 13 0 Factors 1 or 2 Factors Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved 3 Factors

Washington State Example Examined two curricula with juvenile offenders – Functional Family Therapy – Aggression Replacement Training Purpose: Determine the effect of quality implementation – Specifically, quality of therapists – Quality of therapist determined by clinician offering clinical supervision and assessment of treatment staff Programs targeted moderate to high-risk kids – Measured staff competence and recidivism reductions Robert Barnoski, Washington State Institute for Public Policy Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Functional Family Therapy Results: % New Felony 70 60 50 FFT Not Competent 40 32 25 30 20 10 13 9 6 Control group 27 19 17 11 0 6 Months 12 Months 18 Months Results calculated using multivariate models in order to control for potential differences between groups Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved FFT Competent

Aggression Replacement Training (ART): Percent of Youth with New Felony 75 65 55 ART Not Competent 45 35 20 25 15 12 9 9 26 25 17 Control 19 12 5 6 months 12 months 18 months Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved ART Competent

Washington State Example Cont. • When FFT was delivered competently, the program reduced felony recidivism by 38% • When considering how much the program costs, substantial savings in ‘avoided crime’ were observed – particularly for the competent therapists • When ART was competently delivered, felony recidivism was reduced by 24% • Also resulted in substantial savings Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Therapist Competency Ratings and Recidivism Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Community Supervision Example: EPICS Research • High risk offenders assigned to high fidelity staff who focused on using core correctional practices, had significantly lower incarceration rates than high risk offenders assigned to low fidelity staff Latessa et al. (2013) Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Community Supervision Example: EPICS Research 35 High Fidelity/High Risk 30 25 20 15 Low Fidelity/High Risk 10 5 0 Incarceration Rate Latessa et al. (2013) Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Program Integrity and Treatment Effect in Community Programs As Scores for Integrity Rise Program Lowers Recidivism 0 -19% 20 -39% 40 -59% Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved 60+%

Program Integrity and Treatment Effect in Residential Programs As Scores for Integrity Rise Program Lowers Recidivism 0 -30% 31 -59% 60 -69% Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved 70+%

What Do We Know About Fidelity? • • Fidelity is related to successful outcomes (i. e. , recidivism reductions) Poor fidelity can lead to null effects or even iatrogenic effects Fidelity can be measured and monitored Fidelity cannot be assumed Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Some Lessons Learned from the Research: Be an Active Agent of Change! Adhere to the principles of effective intervention: • Assess risk and need levels • Target moderate and high risk offenders • Target criminogenic needs • Use cognitive behavioral interventions • Measure program integrity practices: • Quality collaborative relationship • Reinforcement, Disapproval, Use of Authority • Cognitive restructuring • Structured skill building • Problem solving skills 96 Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved

Contact Information Eva Kishimoto Research Associate, Corrections Institute kishimea@uc. edu www. uc. edu/corrections Corrections. institute@uc. edu Copyright © 2014, University of Cincinnati, Corrections Institute, Ohio. All Rights reserved