RNR-Based Assessment and Rehabilitation in Correctional Settings:
Severe Mental Illness, Substance Abuse, and Trauma
Kirk Heilbrun, PhD (kirk.heilbrun@drexel.edu)
David DeMatteo, JD, PhD (david.dematteo@drexel.edu)
Drexel University
Workshop sponsored by Community Education Centers, Inc. and
presented for the Pennsylvania Department of Corrections
April 28, 2011
Elizabethtown, PA
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Agenda
9:00 – 10:15
Overview of RNR: Evidence and Implications (Heilbrun)
10:15 – 10:30
Break
10:30 – 11:45
RNR-Based Assessment and Treatment of Individuals with Substance
Abuse (DeMatteo)
11:45 – 1:00
Lunch
1:00 – 2:15
RNR-Based Assessment and Treatment of Individuals with Severe Mental
Illness (Heilbrun)
2:15 – 2:30
Break
2:30 – 3:00
RNR-Based Assessment and Treatment of Individuals with Trauma
Histories (DeMatteo)
3:00 – 3:45
Small group exercise
3:45 – 4:00
Conclusion
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RISK-NEED-RESPONSIVITY OVERVIEW: EVIDENCE AND IMPLICATIONS
I. WHAT IS RISK-NEED-RESPONSIVITY?


A model of correctional intervention based on three principles of risk, need, and
responsivity
Developed by Andrews and Bonta (1990)

Risk
o Risk factor: characteristic associated with increased risk of criminal activity; ex.
Antisocial behavior, antisocial personality pattern
o Risk principle: individuals with a higher risk of recidivism benefit from high
levels of contact and more intensive intervention; some support for iatrogenic
effects of providing overly intensive services to low-risk offenders

Need
o Criminogenic need: dynamic risk factor; can change over time and in response to
planned intervention; improvements in these areas have been associated with
reduced risk of recidivism
o Need factor: programs should target criminogenic needs (e.g., family, peers,
substance abuse), and not target non-criminogenic needs (e.g. self-esteem,
ambition)

Responsivity
o Specific responsivity: individual characteristics of offenders that should be
considered in the delivery of interventions, such as verbal intelligence
o General responsivity: programs that follow a cognitive-behavioral or sociallearning orientation are most effective

How to determine what an individual’s risk level or criminogenic needs are?
o Use a specialized tool, especially a risk/needs tool (e.g., Level of Service/Case
Management Inventory, or LS/CMI)
o These tools help to integrate assessment and case management
II. RESEARCH SUPPORTING RNR

Adherence to the RNR model results in a 35% reduction in recidivism (Andrews &
Bonta, 2010)

Meta-analyses
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o Looked at studies of correctional programs, determined whether the programs: (1)
targeted high- vs. low-risk offenders; (2) had services in place to target the
criminogenic needs
o For adult and juvenile offenders: treatment following the RNR principles resulted
in lower recidivism rates than criminal sanctions alone, treatment not following,
or unspecified correctional service (Andrews et al., 1990)
o For violent offenders: programs adhering to the need and responsivity principles
were significantly more effective than programs not adhering to these principles;
risk principle adherence not associated with greater effects (Dowden & Andrews,
2000)
o For female offenders: greater effects for programs targeting high risk individuals
and programs that target more criminogenic than non-criminogenic needs for both
all-female and predominantly-female programs (Dowden & Andrews, 1990)
o For sex offenders: largest reductions in sexual and general recidivism for
programs adhering to all 3 RNR principles (Hanson, Law, Helmus, & Hodgson,
2009)

Risk principle: programs targeting high-risk populations were significantly more
effective than those targeting low-risk offenders (Andrews & Dowden, 2006)


Also, programs meeting each criminogenic need were more effective (with
the exception of substance abuse), and programs that targeted noncriminogenic needs were no more effective; risk principle more strongly
supported among females than males
Other empirical support
o Study examining the relationship between the risk principle and recidivism
(Lowenkamp, Latessa, & Holsinger, 2006)


Residential programs significantly more effective than non-residential
programs
Most effective programs served at least 2/3 high risk individuals, provided
more services to high risk individuals, and greater length of stay for high
risk
o Examining idea of “dosage” (Bourgon & Armstrong, 2005)
 High risk offenders who received longer interventions had lower
recidivism than those in a short-term program
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
Low risk offenders who participated in the longer-term intervention had
higher recidivism than those who participated in the short-term
intervention

o RNR and community-based electronic monitoring (Bonta, Wallace-Capretta, &
Rooney, 2000)


Compared offenders receiving vs. not receiving electronic monitoring
(EM)
Significant treatment/risk interaction – high risk individuals on EM did
better than high risk offenders with no treatment
o RNR and substance abuse (Taxman & Tanner, 2006)


Drug offenders assigned to seamless system of treatment vs. traditional
referral services
At one site, high risk offenders in seamless system had lower recidivism
and more days to rearrest; at second site, high risk offenders in treatment
had higher recidivism

o RNR and drug court ((Hall, Prendergast, Roll, et al., 2010)


Individuals completed either drug court or a less-intense diversion model
Although risk predicted overall treatment adherence and drug use, highrisk offenders did not do significantly better in drug court treatment than
the diversion program, as hypothesized

o Examination of treatment dosage (Kroner & Takahashi, 2011)



Study of offenders on community release who dropped out of a treatment
program
Current number of sessions (designed to target criminogenic needs)
completed by program participants was a significant predictor of
recidivism, though the program primarily targeted high risk offenders

Studies of individual program RNR adherence (Bonta, 2010)
o A tool has been developed to measure program adherence to RNR – found that
there’s limited adherence to the model among demonstration programs, and even
less adherence among ‘real world’ programs
o RNR and probation
 Recorded meetings with probation officers; found that probation officers
don’t tend to follow RNR principles, that criminogenic needs are not
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targeted very well, and that prosocial modeling and social learning
strategies were not always implemented
o Among the meta-analyses, few programs for sex offenders met all three principles
III. CURRENT RNR-RELATED GAPS

Research gaps
o Meta-analyses and program-level studies have focused on the programmatic
implementation of RNR, rather than RNR on an individual level
 E.g., are there programs available to meet each criminogenic need, instead
of looking to see if an offender’s specific criminogenic needs were met
o Inconsistencies come up in the research
 Risk principle not as well supported for some populations (violent
offenders) than others (general and youth offenders); risk principle more
effective for females than males; differences in effectiveness at different
sites in a single study

Common shortcomings in RNR implementation
o Not using up-to-date assessment tools
o Failing to base interventions on results of assessments
o Lack of any risk/need tools in the intervention process
o Reviews of treatment for various groups of offenders (sex offenders, juvenile
offenders, mentally ill offenders, drug-involved offenders) suggest that less
attention is paid to the risk, need, and responsivity principles than would be
preferable; instead, treatment is commonly one-size-fits-all (DeMatteo et al.,
2010)

Lack of empirical evidence that RNR works when implemented on an individual level
o Some studies have looked at implementation of the risk principle on an individual
basis
o For instance, one study compared 5-week, 10-week, and 15-week interventions
(Bourgon & Armstrong, 2005)
 Study attempted to match participants to length of intervention based on
risk level, but this was unable to be done perfectly due to varying lengths
of stay; as a result, some high-risk offenders were in the 5-week and 10week programs, some low-risk offenders were in the 10-week and 15week programs, etc.
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


This study found that match between risk level and service intensity did
make a difference
High risk offenders who received longer interventions had lower
recidivism than those in a short-term program
Low risk offenders who participated in the longer-term intervention had
higher recidivism than those who participated in the short-term
intervention
o However, this type of research has not been done with respect to criminogenic
needs


Based on the theory, risk/needs assessments should be given to offenders
at the beginning of a program to identify criminogenic needs
Then, these individuals can be matched into programs based on specific
deficits
 E.g., an individual whose needs include substance use and
education may be placed into relapse prevention, NA/AA, and
GED classes
 E.g., an individual whose needs include family/marital and
antisocial attitudes may be placed in family services, attend
lectures based on thinking errors, and individual therapy can focus
on specific criminal thinking that may present
o Little research has been done with regard to specific responsivity either

Most programs follow the general responsivity principle and employ a
social learning or cognitive-behavioral model

However, there is value in assessing other responsivity concerns, such as
IQ, mental illness, culture, and gender
 E.g., there is an increasing push toward gender-responsive
services, though it is unclear how widely these programs are
implemented (Bloom, Owen, & Covington, 2005; Covington &
Bloom, 2006)
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IV. SERIOUS MENTAL ILLNESS AND CRIMINAL OFFENDING

The big 8 risk factors are shared by offenders with and without mental illness (The
CMHS National Gains Center, 2010)
o A small proportion of offenders with SMI only need mental health treatment to
curb offending behavior; the rest need evidence-based practices for correctional
populations, such as RNR

There is evidence that increasing mental health services does not necessarily reduce
recidivism (Kingman, Olsen, Osher, & Skeem, 2009)
o In general, need to focus on high risk individuals, target criminogenic needs, and
consider responsivity factors, as RNR prescribes
 Process: assess these offenders using a screening with mental illness, and
assess with a risk-needs tool, like the LS/CMI
o There are several interventions that have been developed for offenders with SMI,
though most focus on mental illness
 This is only an effective strategy for a small minority of offenders with
SMI
o Some suggest that poverty may be the common denominator, and that poverty
among the mentally ill exposes them to many of the same risk factors as general
offenders (such as unemployment, substance use, criminal associates, poor family
situations, etc.)

One study examined risk factors for mentally ill vs. non-mentally ill offenders (Bonta et
al., 1998)
o The strongest predictors of a new violent offense among offenders with SMI were
antisocial personality, juvenile delinquency, criminal history, and employment
problems – similar to general offenders
o Mentally ill offenders had higher LS/CMI scores than non-mentally ill
counterparts

May need to consider mental illness as a responsivity factor, but should not be the focus
of treatment except for a small group of offenders
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RNR-BASED ASSESSMENT AND TREATMENT OF INDIVIDUALS WITH SUBSTANCE ABUSE
I. SUBSTANCE ABUSE AND THE CJ SYSTEM

In the early 1990s, the Arrestee Drug Abuse Monitoring Program (ADAM) and the Drug
Use Forecasting Program (DUF) showed that a large proportion of offenders were drug
users.

These data, in addition to prison overcrowding, and repeat offending led to a debate about
the effectiveness of incarceration as a deterrent, especially among drug-dependent
offenders, who were perceived by the justice system as repeat offenders driven by
addiction and/or unable to remain in treatment (Kassebaum & Okamoto, 2001;
Longshore et al., 2001; Spohn, Piper, Martin, & Frenzel, 2001)

Incarceration appeared to be ineffective for drug-dependent offenders because it did not
address the specific needs of these offenders, especially the social and psychological
correlates of drug addiction (Broome, Knight, Knight, Hiller, & Simpson, 1997; Senjo &
Leip, 2001).
II. COMMON TYPES OF SUBSTANCE ABUSE TX
Restrictive Intermediate Punishment (RIP) in PA

Act 193 of 1990, the Intermediate Punishment Act, created a post-conviction alternative
to incarceration for eligible offenders. It was incorporated into Pennsylvania’s guidelines
during the 1994 revisions and further expanded during the 1997 revisions.
o Restrictive Intermediate Punishment (RIP) programs were required to house
offenders full- or part-time, or significantly restrict their movement and monitor
their compliance with the program(s).
o Examples of RIP sanctions include drug and alcohol treatment, house arrest with
electronic monitoring, or boot camps (Warner & Kramer, 2009)
o Drug- and/or alcohol-dependent offenders are considered for a substance abuse
treatment-based restrictive intermediate punishment (RIP/D&A) in lieu of
incarceration.
o An initial recommendation is made regarding level of care needed.
 The levels of care include outpatient, halfway house, short-term
residential/detox, and long-term residential (Warner & Kramer, 2009).

It is important to examine whether these sentencing alternatives are effective in achieving
both their rehabilitative goals (eliminating drug use, increasing legitimate opportunities,
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encouraging prosocial behavior, etc.) and their criminal justice goals (decreasing the risk
of recidivism) (Warner & Kramer, 2009).
o Warner & Kramer (2009) studied if the RIP/D&A program was effective at
reducing the risk of rearrest among participants, compared to traditionally
sentenced offenders and if the effects of RIP/D&A on the risk of rearrest vary
across the different types of traditional sentencing: state incarceration, county jail,
and probation.
 Results: Offenders who did not successfully complete RIP/D& were more
likely to be rearrested, but offenders successfully completing RIP/D&A
had a much lower risk of rearrest compared to traditionally sentenced
offenders.
 State Incarceration: Successful RIP/D&A participants were more likely to
be rearrested than state incarcerated offenders 12 months post-release;
however, they had a much higher likelihood of rearrest 24 and 36 months
post-release.
 County Jail: Offenders sentenced to RIP/D&A had a 25% lower risk of
rearrest than offenders sentenced to county jail.
o People who successfully completed RIP/D&A had a risk of
rearrest that was 64% lower than offenders sentenced to county
jail.
o At 24 months post-release, RIP/D&A successful completers had a
44% lower risk of rearrest, and their risk of rearrest was 40% lower
than county jail offenders at 36 months post-release (after
controlling for offender, offense, and county characteristics).
o Offenders who did not complete RIP/D&A had a higher risk of
rearrest than county jail offenders at 24 and 36 months.
 Probation: At 12 months post-release, unsuccessful RIP/D&A participants
did not differ significantly from offenders sentenced to probation in terms
of risk of rearrest, but those who successfully completed treatment had a
64% lower risk of rearrest.
o Successful completers had a 56% lower risk of rearrest than
probationers and unsuccessful RIP/D&A participants had a 31%
higher risk of rearrest than probationers. These results were
maintained at 24 and 36 months.
Other Empirical Support

National surveys have found that 83% of state prisoners reported past drug and alcohol
use and that 56% reported using drugs and alcohol in the month before their offense
(Staton-Tindall, Havens, & Oser, 2009).
o The same study found that 53% of state inmates met DSM-IV criteria for drug
dependence or abuse.
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o Although more than 80% of offenders are substance users, 40% reported
participating in any type of drug or alcohol treatment or related program when
they were incarcerated.
Gender Differences in Substance Abuse Treatment

Women who enter community-based substance abuse treatment programs are less likely
to be employed, have criminal records, and more likely to be dealing with past
experiences related to emotional, physical, and sexual abuse, when compared to men in
treatment (Acharyya & Zhang, 2003; Pelissier & Jones, 2005)

When compared to incarcerated men, incarcerated women are more likely to use and
abuse multiple substances, to report a history of crack and cocaine use, to have
experienced sexual and/or physical abuse, and to have co-occurring mental health issues
(Blitz, Wolff, Pan, & Pogorzelski, 2005; Langan & Pelissier, 2001; Messina, Burdon,
Hagopian, & Prendergast, 2006; Pelissier, Camp, Gaes, Saylor, & Rhodes, 2003; Peters,
Strozier, Murrin, & Kearns, 1997; Sacks, 2004)

Incarcerated men are more likely to report problem alcohol use, have antisocial
personality characteristics, and be more involved with the criminal justice system.

Female community treatment participants report higher rates of mood disorders, phobias,
panic disorder, and obsessive–compulsive disorder, when compared to men. (Compton et
al., 2000)

Findings from a recent meta-analysis of gender differences among substance users found
that males consistently report having more involved criminal histories, when compared to
females.
o Males report more self-perceived legal problems, more arrests, and more serious
types of crimes, when compared to females.
o 67% of male and female participants reported a history of community substance
abuse treatment before their current incarceration (Staton-Tindall, Havens, &
Oser, 2009)
o That same study found that females who were not living in their own home were
more likely to utilize substance abuse treatment.

That finding contradicts another finding that females who reported living with someone
else (particularly, a partner) were more likely to have utilized substance abuse treatment
has been shown in other studies (Acharyya & Zhang, 2003).
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Chandler, Fletcher, & Volkow (2009)
1. An estimated one-half of all prisoners meet criteria for some kind of substance abuse or
dependence.
2. Even if they abstain during time incarcerated, former inmates are at substantial risk of
relapse upon release.
3. Drug abuse has a strong genetic component
4. Individuals learn to expect a reward from using a substance, becoming addicted to both
the substance and experiencing anticipation from exposure to settings or items associated
with the substance.
5. Initial assessment and tailored services are key parts of an effective drug treatment
program, particularly for those who also have a mental illness diagnosis
6. The most common treatments are behavioral:
a. Cognitive therapy
b. Contingency management (rewards for abstinence)
c. Motivational therapy
7. Facilities can adopt a “therapeutic community” model
8. Some offer in-house groups such as Alcoholics Anonymous
9. A combination approach is very effective (methadone plus counseling, for example)
10. Individuals may need ongoing care even after finishing a treatment program
Henderson & Taxman (2009)
1. Demand for services in the incarcerated population outweighs available offerings.
2. Prison administrators must decide on which programs will be most effective in their
facilities.
Messina, Burdon, Hagopian, & Prendergast (2006)
1. Time in treatment and motivation to attend treatment are significant predictors of
participation in aftercare for both men and women.
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RNR-BASED ASSESSMENT AND TREATMENT OF INDIVIDUALS WITH SEVERE MENTAL ILLNESS
I. ASSESSMENT
Step 1: Assessment of mental health problems

Psychiatric Symptoms (Health Canada, 2002)
 Using an index of suspicion
 Asking a few questions
 Psychiatric sub-scale of the Addiction Severity Index (ASI) device

Substance Abuse (Health Canada, 2002)
 Using an index of suspicion
 Asking a few questions
 Using the CAGE questionnaire
 Using case manager judgment
 Dartmouth Assessment of Lifestyle Instrument (DALI)
 Short Michigan Alcoholism Screening Test (SMAST)
 Drug Abuse Screening Test (DAST)
 Alcohol Use Disorders Identification Test (AUDIT)

Suicidality (e.g., Gray et al., 2003)
 E.g., Beck Hopelessness Inventory (BHS)
Step 2: Assessment of risk
Bonta, Law, and Hanson (1998):
The major predictors of general and violent recidivism appear comparable for mentally
disordered and nondisordered offenders. . . . These findings do not deny the importance
of psychopathology in managing mentally disordered offenders. They are certainly
important for efforts to alleviate their personal sufferings and to facilitate more effective
coping. However, in terms of risk assessment, these clinical factors are overshadowed by
the more general factors identified in the criminological research.

Historical, Clinical, and Risk Management (HCR-20)
 Tested in a sample of UK forensic psychiatric inpatients (Gray et al., 2003)
 Found to be strongly predictive of all forms of in-patient outward aggression (verbal,
property, and physical)
 Tested in a sample of UK forensic psychiatric inpatients (Gray et al., 2004)
 Performed moderately well (but less so than the actuarial measure using mainly
criminological variables) in the prediction of general recidivism
 Has been elsewhere demonstrated to be moderately to strongly predictive in forensic
psychiatric samples (see Douglas et al., 2005, for a discussion)
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
Level of Service Inventory (LSI)
 Single retrospective study with a sample of Canadian schizophrenic insanity
acquittees (Bonta, Law, & Hanson, 1998)
 Modest predictor of violent and nonviolent recidivism by SMI offenders

Level of Service Inventory–Revised: Screening Version (LSI-R:SV)
 Single study with an Australian sample of SMI and dually diagnosed (SMI + SA)
forensic psychiatric inpatients; used ROC curve to assess predictive ability (a better
technique than correlations to assess predictive validity) (Ferguson, Ogloff, &
Thomson, 2009)
 Good predictor of violent and nonviolent recidivism by SMI offenders, but not dually
diagnosed offenders

Level of Service/Case Management Inventory (LS/CMI)
 Although has not been tested in a forensic SMI sample per se, it has been shown to
have good criterion-related (concurrent and predictive) validity in comparison studies
(using general offenders) with the previous version of the tool, the Level of Service
Inventory–Revised (LSI–R; see Andrews, Bonta, & Wormith, 2004).


Psychopathy Checklist–Revised (PCL-R)
 Retrospective study with a sample of Canadian schizophrenic insanity acquittees
(Bonta, Law, & Hanson, 1998)
 Modest predictor of violent and nonviolent recidivism by SMI offenders
 Tested in a sample of UK forensic psychiatric inpatients (Gray et al., 2003)
 Found to be moderately predictive of all forms of in-patient outward aggression
(verbal, property, and physical)

Psychopathy Checklist: Screening Version (PCL: SV)
 Tested in a sample of UK forensic psychiatric inpatients (Gray et al., 2004)
 Performed moderately well (but less so than the actuarial measure using mainly
criminological variables) in the prediction of general recidivism

Violence Risk Appraisal Guide (VRAG)
 Derived from intake, treatment, and post-hospitalization data on Canadian mentally
disordered offenders (see Quinset et al., 2006, for a review and manual)
 PCL-R score is one of the VRAG’s core predictive factors
* The PCL and its variations, the HCR-20, and the VRAG, tend to perform roughly comparable
predictively with mentally disordered offenders (see, e.g., Douglas et al., 2005; Hog et al., 2009)
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II. TREATMENT
CBT Generally for Justice-Involved Populations (Rotter et al., 2010)
o Intervention for ameliorating distressing feelings, disturbing behavior, and the
dysfunctional thoughts from which they arise
o Improvements in symptoms (e.g., anxiety, depression) mediated through
identifying and disputing automatic thoughts that generate these feelings
o Behavioral techniques (e.g., skills training, role-playing) are well-established
ways of addressing phobias and postraumatic reactions; helps develop coping
mechanisms for managing thoughts and feelings
-
Offenders
o Problem is that antisocial cognitions and maladaptive emotional reactions are
largely interpersonal rather than intrapersonal, which is the original CBT focus
o CBT intervention requires more than symptom relief; it should target
interpersonal skills and acceptance of community standards for responsible
behavior
-
Recidivism-focused CBT
o Offenders with mental illness may have criminogenic needs associated with
criminal attitudes, values, beliefs, thinking styles, and cognitive emotional states.
Recidivism-focused CBT not initially developed for offenders with mental illness
but might be appropriate given that it is a structured approach focused on problem
behavior and criminogenic needs
o Uses traditional CBT elements (e.g., homework assignments, role plays) to
improve cognitive functioning (e.g., critical thinking, assertiveness, interpersonal
cognitive problem solving, negotiation skills, and pro-social values)
o Examples of typical CBT interventions used in correctional settings:
 Thinking for a change (T4C; Golden, 2002)
 Problem-solving approach
 Teaches offenders to work though problems without criminal
behavior
 Emphasizes introspection, cognitive restructuring, and social skills
training
 Lifestyle Change (Walters, 1999)
 Teaches structured, self-reflective, cost-benefit analysis of choices
and consequences, focusing on thinking styles that have been
found to support criminal activity
 Reasoning & Rehabilitation (R&R; Ross, Fabiano & Ewles, 1988)
 Targets cognitive processing and pro-criminal thinking
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Meta-analyses
-
Landenberger & Lipsey (2005)
o 58 experimental and quasi-experimental studies of the effects of cognitive
behavioral therapy (CBT) on the recidivism of adult and juvenile offenders
o Odds of not recidivating in 12 months after intervention for individuals in tx
group were 1.53 times as great as those in the control group
o .40 mean recidivism rate of control group compared to .30 for treatment group
(25% decrease)
o No significant differences in effectiveness of different “brand name” CBT
programs (see above); General CBT approach probably responsible for overall
positive effects on recidivism
-
o Only factors independently related to effect sizes were
 Risk level of participating offender
 How well treatment was implemented
 Presence or absence of few treatment elements
 Inclusion of distinct anger control and interpersonal problem
solving components in CBT programs enhance effects
 Victim impact and behavior modification diminish effects

Andrews & Dowden (2005) – see abstract below
Dialectical behavioral therapy (DBT)
-
Generally – empirically supported treatment for Borderline Personality Disorder and
reducing self-harm behaviors and emotional instability
-
Treatment of those with BPD in forensic psychiatric settings associated with fewer
violent incidents and reduction in self-reported anger (Berzins & Trestman, 2004)
-
DBT well suited for those with behavioral dysconrol such as self-harm, violent
aggression, and poor impulse control. It is highly structured, especially in the initial
stage of treatment when an individual is lacking in behavioral control (Berzins &
Trestman, 2004)
-
Colorado Mental Health Institute in Pueblo (CMHIP; McCann et al., 2000)
o 2/3 of forensic patients have Axis 1 diagnosis and remaining 1/3 have Axis 2
diagnosis
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o Goals: increase emotional attachment, increase mindfulness of empathy and
consequences to others.
o Incorporated skills such as “Random Acts of Kindness” and “Myths about
Interpersonal Effectiveness,” which were revised to target antisocial
characteristics
o Skills training groups – 2x/week for 75 minutes; Effectiveness is covered over 14
sessions; Emotion Regulation and Distress Tolerance covered over 10 sessions
-
Has been used for those engaged in stalking (Rosenfeld et al., 2007)
Schema-Focused Therapy (SFT)
-
Generally: based on theory that early maladaptive schemas are fixed patterns of thoughts,
feelings, and behaviors that arise from negative childhood experiences and continue into
adulthood
-
Implemented in forensic settings for those with severe form of APD and Psychopathy
(Bernstein, 2007)
Group Psychotherapy (Morgan & Flora, 2002)
-
Meta-analysis of 26 empirical studies that used treatment versus control group
-
Outcomes: institutional adjustment, anger, anxiety, depression, interpersonal relations,
locus of control, and self esteem
-
Group psychotherapy results in improvements in each outcome. Examples:
o Analysis of depression - mean effect size was 0.57, indicating that group
psychotherapy resulted in decreased (p < .01) levels of depression for inmates
receiving group treatment
o Analysis of anxiety – mean effect size was 0.85 (model 1) and 0.94 (model 2)
-
Benefits of group psychotherapy are broad and include symptom-focused problems and
more general behavioral and personality functioning
-
Cognitive behavioral or behavioral approaches incorporated into treatment programs
produce the most beneficial results
RNR Assessment and Intervention
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-
Authors note prison environment is not amenable to progressive change. Homework,
however, may allow inmates to continue to focus on therapeutic work and generalize
efforts to change
-
Those inmates who were referred or mandated to participate in group psychotherapy did
no better or worse than those who were self-referred
Critical Time Intervention (CTI; Draine & Herman, 2007)
-
Two components to CTI
o Strengthen long-term ties to community and family and friends
o Provide emotional and practical support and advocacy during critical time of
transition
-
Core elements: small caseloads, active community outreach, individualized case
management plans, psychosocial skills building, motivational coaching
-
CTI in the context of reentry planning:
o Sets in place a strategy for connecting individuals to housing, employment, and
education and creating social ties to reinforce connections
o Makes use of existing social connections, intervenes to preserve connections on
outside during incarceration, and builds new community connections
-
Blended service models – integrate mental health and addiction services into a unified
care approach
o May include supervision by psychiatrist trained in treatment of co-occurring
mental illness and substance use disorders and ongoing attention to relapse
prevention and maintenance of motivation
o Dural recovery therapy (DRT) – manualized set of structured group sessions
combined with ongoing support of case managers to enhance motivation to
engage in substance abuse treatment
Assertive Community Treatment (ACT; see Lamberti et al., 2004; Morrissey et al., 2007)
-
Background
o Service delivery model in which treatment is provided by team of professionals
with services determined by consumer needs
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o Combines treatment, rehab, and support services provided by self-contained,
inter-disciplinary team
o ACT intended for consumers with severe mental illness, functionally impaired,
and at high risk of inpatient hospitalization
o Found to be most effective in reducing number of days in hospital, but not
consistently effective in reducing symptoms and arrests/jail time or improving
social adjustment, substance abuse, and quality of life (Bond et al., 2001).
-
FACT (“forensic ACT Team”) – focus on keeping those with severe mental illness out of
jails and prisons
o 4 elements that distinguish FACT from ACT (Lamberti, et al., 2004)
 Goal of preventing arrest and incarceration
 Requiring that all consumers admitted to the team have criminal justice
histories
 Accepting majority of referrals from criminal justice agencies
 Development and incorporation of supervised residential treatment
component for high-risk consumers, especially those with co-occurring
substance-use disorders
Suicide prevention (Pompili et al., 2009)
-
indicators of inmate risk are severe depression, diminished self-esteem, complaints of
emotional or psychological pain, talking about or threatening suicide, and nonlethal selfinjury
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-
Monitoring
o Level of monitoring should be case-by-case basis and match level of risk
o Supervision
 Those judged to be actively suicidal require constant supervision
 Those who have raised suspicion but do not admit to being suicidal may
require monitoring every 10 to 15 minutes
-
Social intervention
o Social and physical isolation intensify risk of suicide
o Meaningful social interactions
o Placing at risk inmate in dorm or shared cell can reduce risk, specifically if placed
with sympathetic cellmates (precautions should be taken so inmate does not have
access to lethal instruments)
o Family visits as means to foster social support
o Social support by trained faculty/staff
-
Mental Health Treatment
o
Because of limited resources, correctional facilities must have strong links to
community-based programs
o
Multi-agency cooperation – general hospitals, emergency services, psychiatric
facilities, community mental health programs
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RNR-BASED ASSESSMENT AND TREATMENT OF INDIVIDUALS WITH TRAUMA HISTORIES
I. TRAUMA INFORMED CARE WITHIN A FORENSIC SYSTEM: KEY FACTORS
Trauma is:

Direct exposure to an extreme stressor

Actual or threatened death or serious injury or threat or injury

Witnessing an event that involves death, injury, or threat of injury to you or others

Learning about unexpected or violent death, serious harm or therat of death or injury to a
family member or close associate

All of which is marked by intense fear and helplessness
II. RECOGNITION OF TRAUMA INVOLVES SEEING AN INDIVIDUAL WITH THE “TRAUMA TRIAD”

Re-living, re-experiencing, and intrusive memories (flashbacks, nightmares, etc.)

Hyper-arousal, hyper-vigilance, intense physiological distress and reactivity (including
difficulty falling or staying asleep; exaggerated startle response; irritability or outburst of
anger; and difficulty concentrating or completing tasks

Dissociation avoidance and numbing (feelings of detachment, diminished interst,
avoiding contact and experiences that remind one of a traumatic event).

Trauma Informed Services involves incorporating knowledge about trauma (such as
prevalence, impact, and recovery) in all aspects of service.

It is important to create an environment which is hospitable and engaging to survivors, as
well as creating an environment which minimizes re-victimization

Services should help facilitate recovery and empowerment

Important to remember the repetitive cycle of risk and how violence/trauma are related to
incarceration, substance abuse, homelessness, and mental health problems
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
Primary goals are empowerment and recovery

Survivors are survivors; their strengths need to be recognized

Service priorities are prevention driven

Service time limits are determined by survivor self-assessment and recovery/healing
needs

Risk to the consumer is considered along with risk to the system and the provider
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III. PRINCIPLES RELEVANT TO TRAUMA INFORMED CARE

Safety: Ensuring physical and emotional safety
o How can we ensure physical and emotional safety for both consumer and staff?

Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining
appropriate boundaries
o Services should be delivered so that there are opportunities to maximize
trustworthiness, clarifying the goals and tasks for the service, and maintaining
appropriate boundaries, especially interpersonal boundaries

Choice: Prioritizing consumer choice and control
o Services should be changed so that the delivery includes more consumer choice
and control

Collaboration: Maximizing collaboration and sharing of power with consumers
o It is important to share the power with the consumer to ensure collaboration in
treatment

Empowerment: Prioritizing consumer empowerment and skill-building
o Recognition of empowerment, strength, and skill enhancement are important
when considering service delivery.
IV. RELEVANT EVIDENCE
Adverse Childhood Experiences Study (Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson,
D.F., Spitz, A.M., et al., 1998)

Studied the relationship between breadth of exposure to childhood emotional, physical, or
sexual abuse, and household dysfunction during childhood to health risk.

Seven categories of adverse childhood experiences were studied: psychological, physical,
or sexual abuse; violence against mother; or living with household members who were
substance abusers, mentally ill or suicidal, or ever imprisoned

Persons who had experienced four or more categories of childhood exposure, compared
to those who had experienced none, had 4-to 12-fold increased health risks for
alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in
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smoking, poor self-rated health, $50 sexual intercourse partners, and sexually transmitted
disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The
number of categories of adverse childhood exposures showed a graded relationship to the
presence of adult diseases including ischemic heart disease, cancer, chronic lung disease,
skeletal fractures, and liver disease. The seven categories of adverse childhood
experiences were strongly interrelated and persons with multiple categories of childhood
exposure were likely to have multiple health risk factors later in life.

Study found a strong graded relationship between the breadth of exposure to abuse or
household dysfunction during childhood and multiple risk factors for several of the
leading causes of death in adults.
Messina & Grella (2006)

Based on the ACE study, the authors looked at 500 women participating in the Female
Offender Treatment and Employment Program evaluation.

Findings showed that the impact of childhood traumatic events on health outcomes is
strong and cumulative, with greater exposure to childhood traumatic events increasing the
likelihood of 12 of 18 health-related outcomes, randing from a 15% increase in the odds
of reporting fair/poor health to a 40% increase in the odds of mental health treatment in
adulthood.

Authors suggest that there is a need for early prevention and intervention and appropriate
trauma treatment, within correctional treatment settings.
V. TRAUMA ASSESSMENT

Primary Care PTSD Screen (PC-PTSD; Prins et al., 2004): A 4-item public domain
screen developed for use in primary health care settings and the VA system. This
instrument examines symptoms of PTSD in the past month and requires approximately 2
minutes to administer.

PTSD Checklist – Civilian Version (PCL-C; Weathers et al., 1991): A 17-item screen for
diagnostic symptoms of PTSD. The PCL-C examines symptoms occurring in the past
month that are commonly experienced in response to stressful life events, and requires
approximately 8-10 minutes to administer

Trauma History Questionnaire (THQ; Green,1996): The Trauma History Questionnaire
(THQ) is a 24-item self report measure that examines experiences with potentially
traumatic events such as crime, general disaster, and sexual and physical assault using a
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yes/no format. For each event endorsed, respondents are asked to provide the frequency
of the event as well as their age at the time of the event. The THQ can be used in both
clinical and research settings.

Much more at the National Center for PTSD:
http://www.ptsd.va.gov/professional/pages/assessments/assessment.asp
VI. TRAUMA-SPECIFIC THERAPIES AND TREATMENT APPROACHES
Seeking Safety

Seeking Safety is a present-focused therapy to help people attain safety from
trauma/PTSD and substance abuse. The treatment is available as a book, providing both
client handouts and guidance for clinicians.

The treatment was designed for flexible use. It has been conducted in group and
individual format; for women, men, and mixed-gender; using all topics or fewer topics; in
a variety of settings (outpatient, inpatient, residential); and for both substance abuse and
dependence. It has also been used with people who have a trauma history, but do not
meet criteria for PTSD.

Seeking Safety consists of 25 topics that can be conducted in any order:
o Introduction/Case Management, Safety, PTSD: Taking Back Your Power, When
Substances Control You, Honesty, Asking for Help, Setting Boundaries in
Relationships, Getting Others to Support Your Recovery, Healthy Relationships,
Community Resources, Compassion, Creating Meaning, Discovery, Integrating
the Split Self, Recovery Thinking, Taking Good Care of Yourself, Commitment,
Respecting Your Time, Coping with Triggers, Self-Nurturing, Red and Green
Flags, Detaching from Emotional Pain (Grounding). Life Choices, and
Termination.

The key principles of Seeking Safety are:
1. Safety as the overarching goal (helping clients attain safety in their relationships,
thinking, behavior, and emotions).
2.
Integrated treatment (working on both PTSD and substance abuse at the same
time)
3. A focus on ideals to counteract the loss of ideals in both PTSD and substance
abuse
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4. Four content areas: cognitive, behavioral, interpersonal, case management
5. Attention to clinician processes (helping clinicians work on countertransference,
self-care, and other issues)

See Zlotnick, Najavits, Rohsenow, & Johnson (2003)
Trauma Recovery and Empowerment (TREM)

A fully manualized 24-29 session group intervention for women trauma survivors with
substance abuse and/or mental health problems, this model draws on cognitivebehavioral, skills training, and psychoeducational techniques to address recovery and
healing from sexual, physical, and emotional abuse. TREM groups include 8-10 members
and are facilitated by trained female co-leaders who focus on a specific recovery topic in
each weekly 75-minute session. TREM consists of three major parts. In the
empowerment section, sessions help group members learn strategies for self-comfort and
accurate self-monitoring as well as ways to establish safe physical and emotional
boundaries. The second component of TREM focuses more directly on trauma experience
and its impact. Topics address various forms of violence including physical, sexual,
emotional, and institutional abuse. Discussions help women to explore and reframe the
connection between their experiences of abuse and other current difficulties, including
substance use, mental health symptoms, and interpersonal problems. In the third section,
focus shifts more explicitly to skills building. These sessions include emphases on
communication style, decision making, regulating overwhelming feelings, and
establishing safer, more reciprocal relationships. TREM addresses substance abuse
throughout the intervention. In groups of women with substance abuse problems, the use
of alcohol and other drugs and corresponding recovery skills are discussed in virtually
every session. Skills such as self-awareness, self-soothing, emotional modulation,
development of safe and mutual relationships, and consistent problem solving are aimed
at active substance abuse treatment and relapse prevention. Settings—TREM has been
implemented in a wide range of settings including residential and nonresidential
substance abuse and mental health programs, correctional institutions, and welfare-to
work programs.

Pilot studies of the Trauma Recovery and Empowerment Model (TREM) demonstrate
that this model holds promise. In particular, preliminary findings indicate improvement
in overall functioning, psychiatric symptoms, use of emergency services, and HIV risk
behavior for individuals participating in the intervention as compared with pretreatment
scores (Fallot & Harris, 2002, 2004). Recent findings also indicate decreased substance
use among TREM participants. This decrease is significantly correlated with the
development of trauma recovery skills.
References and Abstracts
Acharyya, S., & Zhang, H. (2003). Assessing sex differences on treatment effectiveness
from the drug abuse treatment outcome study (DATOS). American Journal of Drug
and Alcohol Abuse, 29, 415-444.
Men and women entering drug treatment programs are known to differ in demographic
characteristics and psychosocial behavioral patterns. To be effective, any such program
that caters to individuals from both sexes should identify and address these gender-based
variations. Studies have also reported clinical differences in the effect of drugs on men and
women addicts. Here, we examine whether the treatment is equally effective on men and
women, when several demographic covariates are controlled. We construct a “problem
severity index” to categorize individuals based on how acute their problems were at the
start of the program. We also examine how the choice of treatment modality affects
treatment success. Cumulative logit models were used in our analysis. The choice of
treatment modality is sex specific, although sex did not appear to be a significant factor
for treatment effectiveness when we controlled for other explanatory variables.
Adams, K., & Ferrandino, J. (2008). Managing mentally ill inmates in prison. Criminal
Justice and Behavior, 35, 913–927.
Mentally ill inmates now comprise a substantial portion of the prison population and pose
administrative and therapeutic challenges to prison administrators and mental health
professionals. Some evidence suggests that both the size of the population and the
seriousness of their illnesses are increasing. Given this context, several issues are
highlighted and discussed in terms of contemporary efforts to deal with mentally ill
inmates. Specifically, discussion centers on the use of actuarial devices for prediction and
classification, the conflict between treatment and control and the relation between
treatment and management, the distinction between risks and stakes and use of the
environment as therapy, use of medication and isolation, and the role of correction
officers in mental health treatment. The authors make an argument for more sophisticated
approaches in dealing with mentally ill inmates that rely on expanded therapeutic options,
broader role definitions for prison staff, and an evidence-based approach for
individualizing treatment.
Andrews, D. A., & Dowden, C. (2005). Managing correctional treatment for reduced
recidivism: A meta-analytic review of program integrity. Legal and Criminological
Psychology, 10, 173-187.
Purpose. Although issues surrounding programme integrity and implementation seem
intuitively appealing as important contributors to effective correctional programming,
they have been relatively ignored within the extant literature. The present meta-analysis
provided the first systematic examination of these issues by exploring their impact on
recidivism reduction in correctional treatment programmes.
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Methods. A meta-analysis was conducted on 273 tests of the effectiveness of correctional
treatment programmes that were extracted from various human service programmes.
Indicators of programme integrity reviewed included several management variables (i.e.
selection, training and clinical supervision of service deliverers), evaluator involvement,
presence of training manuals, monitoring of treatment delivery, and using a small sample
of clients.
Results. Overall, the meta-analyses revealed that programme integrity provided an
independent source of enhanced programme effectiveness, even when controls were
introduced for other variables (e.g. involved evaluator and sample size).
Conclusions. Consistent with previous research, the present study demonstrated that the
positive contributions of programme integrity were limited to the enhancement of the
effects of human service programmes consistent with the principles of risk, need, and
general responsivity. However, the relatively poor reporting of programme integrity
indicators within primary studies necessitates that evaluators and programme deliverers
alike ensure that this information is included in future evaluations to provide an even
greater understanding of the influences of integrity.
Andrews, D., Zinger, I., Hoge, R., Bonta, J., Gendreau, P., & Cullen, F.T. (1990). Does
correctional treatment work? A clinically relevant and psychologically informed
meta-analysis. Criminology, 38, 369-404.
Careful reading of the literature on the psychology of criminal conduct and of prior
reviews of studies of treatment effects suggests that neither criminal sanctioning without
provision of rehabilitative service nor servicing without reference to clinical principles of
rehabilitation will succeed in reducing recidivism. What works, in our view, is the
delivery of appropriate correctional service, and appropriate service reflects three
psychological principles: (1) delivery of service to higher risk cases, (2) targeting of
criminogenic needs, and (3) use of styles and modes of treatment (e.g., cognitive and
behavioral) that are matched with client need and learning styles. These principles were
applied to studies of juvenile and adult correctional treatment, which yielded 154 phi
coefficients that summarized the magnitude and direction of the impact of treatment on
recidivism. The effect of appropriate correctional service (mean phi = .30) was
significantly (p <.05) greater than that of unspecified correctional service (.13), and both
were more effective than inappropriate service (−.06) and non-service criminal
sanctioning (−.07). Service was effective within juvenile and adult corrections, in studies
published before and after 1980, in randomized and nonrandomized designs, and in
diversionary, community, and residential programs (albeit, attenuated in residential
settings). Clinical sensitivity and a psychologically informed perspective on crime may
assist in the renewed service, research, and conceptual efforts that are strongly indicated
by our review.
Ashford, J.B., Wong, K., & Sternbach, K. (2008). Generic correctional programming for
mentally ill offenders: A pilot study. Criminal Justice and Behavior, 35, 457-473.
RNR Assessment and Intervention
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This pilot study examined differences in criminal attitudes and hostile attribution biases
among three groups of offenders diagnosed with serious mental disorders. It also
compared the criminal outcomes for a sample of mentally ill offenders (MIO’s) who
completed a modified version of the Options cognitive skills program with a treatmentas-usual sample of MIO’s. Results showed that pre- and posttest change scores for the
Overgeneralization subscale of the Hostile Interpretations Questionnaire (HIQ), the
Identification with Criminal Others subscale of the Criminal Sentiments Scale–Modified
(CSS-M), and the HIQ Authority subscale differed between the groups of offenders with
serious mental disorders. Participants identified for treatment by the pilot program
(intended treatment group) and participants who completed the entire intervention had
fewer arrests, including fewer arrests for violent offenses, but had higher technical
probation violations than a treatment-as-usual comparison group.
Bernstein, D. , Arntz, A., & Vos, M. (2007). Schema focused therapy in forensic settings:
Theoretical model and recommendations for best clinical practice. International
Journal of Forensic Mental Health, 6, 169-183.
Until recently few empirically supported treatments for patients with personality
disorders were available. Schema Focused Therapy (SFT) has recently shown efficacy in
(non-forensic) outpatients with Borderline Personality Disorder, raising the question if it
may also be effective in forensic PD patients. For the past two years, we have been
collaborating with Dutch forensic hospitals to adapt the SFT approach to meet the
challenges posed by this population. In this article, we present our forensic modification
of the SFT theoretical model, and make recommendations for the implementation of SFT
in forensic clinical practice.
Berzins, L. G., & Trestman, R. L. (2004). The development and implementation of
dialectical behavior therapy in forensic settings. International Journal of Forensic
Mental Health, 3, 93-103.
As a result of deinstitutionalization, currently there are three times as many men and
women with mental illness in U.S. jails and prisons than in mental hospitals. Appropriate
treatment of this population is critical to safety within correctional institutions, successful
integration of offenders into the community upon release and a reduction in recidivism.
Dialectical Behavioral Therapy (DBT), originally developed by Linehan for chronically
parasuicidal women diagnosed with Borderline Personality Disorder, has been adapted
for many other populations over the past decade, including male offenders in correctional
institutions. This article presents a rationale for use of DBT in a correctional environment
and reviews DBT implementations in correctional settings in North America. Because all
of the initiatives thus far have been driven by clinical need, there are no published
adaptations of DBT modified for and generalizable to correctional settings.
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Blitz, C., Wolff, N., Pan, K., & Pogorzelski, W. (2005). Gender-specific behavioral health
and community release patterns among New Jersey prison inmates: Implications for
treatment and community reentry. American Journal of Public Health, 95, 1741-1746.
Objectives. We describe behavioral health diagnoses and community release patterns
among adult male and female inmates in New Jersey prisons and assess their implications
for correctional health care and community reentry. Methods. We used clinical and
classification data on a census of "special needs" inmates (those with behavioral health
disorders) in New Jersey (n=3189) and a census of all special needs inmates released to
New Jersey communities over a 12-month period (n=974). Results. Virtually all adult
inmates with special needs had at least 1 Axis I mental disorder, and 68% of these had at
least 1 additional Axis I mental disorder, a personality disorder, or addiction problem (67%
of all male and 75% of all female special needs inmates). Of those special needs inmates
released, 25% returned to the most disadvantaged counties in New Jersey (27% of all male
and 18% of all female special needs inmates). Conclusions. Two types of clustering were
found: gender-specific clustering of disorders among inmates and spatial clustering of exoffenders in impoverished communities. These findings suggest a need for gendered
treatment strategies within correctional settings and need for successful reentry strategies.
Bloom, B., Owen, B., & Covington, S. (2005). A summary of research, practice, and guiding
principles for women offenders. Washington, D.C.: National Institute of Corrections.
Reviews information on gender-specific policies, programs, and services in corrections.
Topics covered by this bulletin include: the Gender-Responsive Strategies Project -approach and findings; defining gender responsiveness; national profile of women
offenders; the foundation for the principles a new vision -- six guiding principles for a
gender-responsive criminal justice system; general strategies for implementing guiding
principles; gender-responsive policy elements; and conclusion -- addressing the realities
of women's lives is the key to improved outcomes.
Bond, G.R., Dranke, R.E., Mueser, K.T., & Latimer, E. (2001). Assertive community
treatment: Critical ingredients and impact on patients. Disease Management and
Health Outcomes, 9(3), 141-159.
[No abstract]
Bonta, J. (2010). From evidence-informed to evidence-based: The Strategic Training
Initiative in Community Supervision (STICS). Presentation at the 18th Annual ICCA
International Research Conference.
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Bonta, J., Law, M., & Hanson, K. (1998). The prediction of criminal and violent recidivism
among mentally disordered offenders: A meta-analysis. Psychological Bulletin, 123,
123–142.
A meta-analysis was conducted to examine whether the predictors of recidivism for
mentally disordered offenders are different from the predictors for nondisordered
offenders. Effect sizes were calculated for 35 predictors of general recidivism and 27
predictors of violent recidivism drawn from 64 unique samples. The results showed that
the major predictors of recidivism were the same for mentally disordered offenders as for
nondisordered offenders. Criminal history variables were the best predictors, and clinical
variables showed the smallest effect sizes. The findings suggest that the risk assessment
of mentally disordered offenders can be enhanced with more attention to the social
psychological criminological literature and less reliance on models of psychopathology.
Bonta, J., Wallace-Capretta, S., & Rooney, J. (2000). A quasi-experimental evaluation of
an intensive rehabilitation supervision program. Criminal Justice and Behavior, 27,
312-329.
Over the past 20 years, an increased understanding has been developed of what
interventions do and do not work with offenders. Treatment programs that attend to
offender risk, needs, and responsivity factors have been associated with reduced
recidivism. There is also a recognition that sanctions without a rehabilitative component
are ineffective in reducing offender recidivism. This study evaluates a cognitivebehavioral treatment program delivered within the context of intensive community
supervision via electronic monitoring (EM). Offenders receiving treatment while in an
EM program were statistically matched on risk and needs factors to inmates who did not
receive treatment services. The results showed that treatment was effective in reducing
recidivism for higher risk offenders, confirming the risk principle of offender treatment.
The importance of matching treatment intensity to offender risk level and ensuring that
there is a treatment component in intensive supervision programs is reaffirmed.
Bourgon, G., & Armstrong, A. (2005). Transferring the principles of effective treatment
into a “real world” prison setting. Criminal Justice and Behavior, 32, 3-25.
The principles of risk, need, and responsivity have been empirically linked to the
effectiveness of treatment to reduce reoffending, but the transference of these principles
to the inside of prison walls is difficult. Results from a sample of 620 incarcerated male
offenders—482 who received either a 5-week, 10-week, or 15-week prison-based
treatment program and 138 untreated comparison offenders—found that treatment
significantly reduced recidivism (odds ratio of .56; effect size r of .10) and that the
amount of treatment (e.g., “dosage”) played a significant role (odds ratios between .92
and .95 per week of treatment; adjusted effect size r of .01 and .02). These results
RNR Assessment and Intervention
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indicate that prison-based treatment can be effective in reducing recidivism, that dosage
plays a mediating role, and that there may be minimum levels of treatment required to
reduce recidivism that is dependent on the level of an offender’s risk and need.
Broome, K., Knight, D., Knight, K., Hiller, M., & Simpson, D. (1997). Peer, family and
motivational influences on drug treatment process and recidivism for probationers.
Journal of Clinical Psychology, 53, 387-397.
Treatment efforts appear to be effective in reducing crime among drug using individuals,
but components of the treatment process associated with client improvement need to be
identified. Furthermore, these elements of treatment may play an intermediate role in the
connection between client background characteristics and later criminal activity. The
current study examines a structural equation model including client perceptions of their
drug related problems, peer deviance, and family dysfunction as influences upon the
formation of therapeutic relationships during treatment and rearrests following treatment.
Results showed therapeutic relationships were positively associated with recognition of
drug related problems and negatively related to rearrest. Peer deviance also was positively
related to rearrest.
Chandler, R., Fletcher, B., & Volkow, N. (2009). Treating drug abuse and addiction in the
criminal justice system. JAMA, 301, 183-190.
Despite increasing evidence that addiction is a treatable disease of the brain, most
individuals do not receive treatment. Involvement in the criminal justice system often
results from illegal drug-seeking behavior and participation in illegal activities that
reflect, in part, disrupted behavior ensuing from brain changes triggered by repeated drug
use. Treating drug-involved offenders provides a unique opportunity to decrease
substance abuse and reduce associated criminal behavior. Emerging neuroscience has the
potential to transform traditional sanction-oriented public safety approaches by providing
new therapeutic strategies against addiction that could be used in the criminal justice
system. We summarize relevant neuroscientific findings and evidence-based principles of
addiction treatment that, if implemented in the criminal justice system, could help
improve public heath and reduce criminal behavior.
Compton, W., Cottler, L., Abdallah, A., Phelps, D., Spitznagel, E., & Horton, J. (2000).
Substance dependence and other psychiatric disorders among drug dependent
subjects: Race and gender correlates. American Journal on Addictions, 9, 113-125.
Persons in drug treatment with drug dependence were interviewed with the NIMH
Diagnostic Interview Schedule to ascertain DSM-III-R disorders. Lifetime prevalence
rates were 64% for alcohol dependence, 44% for antisocial personality disorder (ASPD),
39% for phobic disorders, 24% for major depression, 12% for dysthymia, 10% for
generalized anxiety disorder, 3% for panic disorder, 3% for mania, 3% for obsessive
compulsive disorder, 2% for bulimia, 1% for schizophrenia, and 1% for anorexia. When
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stratified by race and age, significant main effects were seen, but there were no significant
interactions except in “any non-substance disorder” and in the mean number of nonsubstance use disorders. Caucasians had a higher mean number of drug dependence
disorders and higher overall rates of “any other” disorder than African-Americans, and
Caucasians and males had higher mean numbers of non-substance use disorders than
African-Americans and females, respectively. This was related to rates of alcohol,
cannabis, and hallucinogen dependence, and ASPD rates that were higher among men
than women and higher among Caucasian respondents than African-American for alcohol,
cannabis, hallucinogen, opiate and sedative dependence, major depression, dysthymia, and
generalized anxiety disorder. In contrast, women had higher rates than men of
amphetamine dependence, phobic disorder, major depression, dysthymia, panic disorder,
obsessive compulsive disorder, and mania. African-Americans had higher rates than
Caucasians of amphetamine, cocaine, and phencyclidine dependence, but for no comorbid
disorders were the rates higher among African-Americans than Caucasians. The
differences according to gender in rates of disorders among substance dependent persons
are consistent with the results of general population surveys, but the differences in rates
according to race are in contrast to these same community surveys. Limitations in the
utility of the concept of race as a valid category diminish the generalizability of the
findings; however, one possible explanation is differential treatment seeking in AfricanAmerican and Caucasian populations that would result in the differences seen.
Covington, S., & Bloom, B. (2006). Gender-responsive treatment and services in
correctional settings. Women and Therapy, 29, 9-33.
As the number of women under correctional supervision continues to increase, there is an
emerging awareness that women offenders present different issues than their male
counterparts. This paper addresses the importance of gender in terms of program design
and delivery and describes the context for the development of effective gender responsive
programming for women. Using the pathways theory of women’s criminality, the
elements that should be considered in women’s treatment and services are addressed,
such as: program environment/culture, staff competencies, theoretical foundation,
treatment modalities, reentry issues, and collaboration. The content of gender-responsive
programming that integrates substance abuse and trauma services is also discussed
DeMatteo, D., Hunt, E., Batastini, A., & LaDuke, C. (2010). The disconnect between
assessment and intervention in the risk management of criminal offenders. Open
Access Journal of Forensic Psychology, 2, 59-74.
Although research suggests that risk/needs assessment and intervention models may be
effective in reducing recidivism, there is emerging evidence that risk management
interventions commonly used with various groups of offenders are not based on a proper
assessment of offenders’ criminogenic needs. In this paper, we examine the apparent
disconnect between assessment and treatment among various groups of offenders,
including sex, juvenile, mentally ill, drug-involved, and female. As will be discussed,
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research in these areas suggests that interventions commonly used with these specific
groups of offenders may not be targeting appropriate criminogenic needs, which may be
attenuating the effectiveness of the provided interventions.
Douglas, K. , Yeomans, M., & Boer, D. (2005). Comparative validity analysis of multiple
measures of violence risk in a sample of criminal offenders. Criminal Justice and
Behavior, 32, 479–510.
Grann et al. (2000) compared the Historical (H) part of theHCR-20 to the VRAG in a
Swedish sample of 404 forensic patients. The measures performed similarly in the
prediction of community violence. Overall, the H scale had an AUC of .71 and the
VRAG had an AUC of .68. In a personality disordered cohort, the AUC for the H scale
also was .71. For the VRAG, the AUC was .68. In a schizophrenia cohort, the AUC for
the H scale was .66. For the VRAG, the AUC was .60 (ns). In a British sample of 87
mentally disordered offenders, Doyle et al. (2002) compared the H scale of the HCR-20
to the VRAG and the PCL:SV. They reported that all instruments were significantly
related to violence (AUCs for H scale = .66-.70; for VRAG, AUCs = .64-.71; for
PCL:SV, AUCs = .68-.76), with the PCL:SV having an edge. Douglas and Webster
(1999) reported that among 75 Canadian offenders receiving treatment, the H and
Clinical (C) scales from the HCR-20 were more strongly related to previous violence
than were the VRAG or the PCL-R, although this research was postdictive.
Dowden, C., & Andrews, D. (1999). What works for female offenders: A meta-analytic
review. Crime & Delinquency, 45, 438-452.
Although the question of what works for general offender populations has received
considerable attention within the rehabilitation literature, very little research has
examined female offenders. The present investigation examined the principles of
effective correctional treatment for female offenders through a meta-analytic review. The
results indicated that the clinically relevant and psychologically informed principles of
human service, risk, need, and responsivity identified in past meta-analytic reviews were
associated with enhanced reductions in reoffending.
Dowden, C., & Andrews, D. (2000). Effective correctional treatment and violent
reoffending: A meta-analysis. Canadian Journal of Criminology, 42, 449-467.
The clinically relevant and psychologically informed principles of human service, risk,
need, and responsivity have received strong support within several meta-analytic reviews.
Despite their widespread acceptance, however, no meta-analysis to date has examined
whether the appropriate application of these principles within correctional treatment
programs is associated with reduced levels of violent re-offending. This article provides
an overview of the role that each of these principles played in reducing violent
recidivism. Adherence to each of the four principles received empirical support, although
not to a statistically significant degree in the case of risk. In addition, a composite
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measure, reflecting adherence to the four principles revealed the greatest mean reduction
in violent recidivism. The principles of effective correctional treatment are discussed as
key elements that should be considered in developing effective correctional interventions
for reducing violent recidivism.
Draine, J., & Herman, D.B. (2007). Critical time intervention for reentry from prison for
persons with mental illness. Psychiatric Services, 58, 1577-1581.
Critical time intervention (CTI) is a nine-month, three-stage intervention that strategically
develops individualized linkages in the community and seeks to enhance engagement
with treatment and community supports through building problem-solving skills,
motivational coaching, and advocacy with community agencies. It is an empirically
supported practice shown to enhance continuity of care for people with mental illness
after discharge from homeless shelters and psychiatric hospitals. This article describes
CTI as a promising model to provide support for reentry from prison for people with
mental illness. A conceptual model is presented for evaluating the impact of CTI on the
transition from correctional settings to the community. The model is potentially useful for
further development of mental health service-driven models of reentry process and
outcome. Although CTI is a potentially useful model for reentry services for this
population, challenges remain in adapting it to specific correctional facilities, justice
systems, and community contexts.
Fallot, R. D., & Harris, M. (2002). The Trauma Recovery and Empowerment Model
(TREM): Conceptual and practical issues in a group intervention for women.
Community Mental Health Journal, 38, 475-485.
This article describes the Trauma Recovery and Empowerment Model (TREM), a
manualized group intervention designed for women trauma survivors with severe mental
disorders, and discusses key issues in its conceptualization and implementation. TREM
recognizes the complexity of long-term adaptation to trauma and addresses a range of
difficulties common among survivors of sexual and physical abuse. Focusing primarily
on the development of specific recovery skills and current functioning, TREM utilizes
techniques shown to be effective in trauma recovery services. The group''s content and
structure are also informed by the role of gender in the ways women experience and cope
with trauma.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., &
Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to
many of the leading causes of death in adults: The Adverse Childhood Experiences
(ACE) Study. American Journal of Preventive Medicine, 14, 245-258.
Background: The relationship of health risk behavior and disease in adulthood to the
breadth of exposure to childhood emotional, physical, or sexual abuse, and household
dysfunction during childhood has not previously been described. Methods: A
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questionnaire about adverse childhood experiences was mailed to 13,494 adults who had
completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded.
Seven categories of adverse childhood experiences were studied: psychological, physical,
or sexual abuse; violence against mother; or living with household members who were
substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories
of these adverse childhood experiences was then compared to measures of adult risk
behavior, health status, and disease. Logistic regression was used to adjust for effects of
demographic factors on the association between the cumulative number of categories of
childhood exposures (range: 0–7) and risk factors for the leading causes of death in adult
life. Results: More than half of respondents reported at least one, and one-fourth reported
≥2 categories of childhood exposures. We found a graded relationship between the
number of categories of childhood exposure and each of the adult health risk behaviors
and diseases that were studied (P < .001). Persons who had experienced four or more
categories of childhood exposure, compared to those who had experienced none, had 4to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide
attempt; a 2- to 4-fold increase in smoking, poor self-rated health, ≥50 sexual intercourse
partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical
inactivity and severe obesity. The number of categories of adverse childhood exposures
showed a graded relationship to the presence of adult diseases including ischemic heart
disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven
categories of adverse childhood experiences were strongly interrelated and persons with
multiple categories of childhood exposure were likely to have multiple health risk factors
later in life.
Conclusions: We found a strong graded relationship between the breadth of exposure to
abuse or household dysfunction during childhood and multiple risk factors for several of
the leading causes of death in adults.
Ferguson, A., Ogloff, J., & Thomson, L. (2009). Predicting recidivism by mentally
disordered offenders using the LSI-R: SV. Criminal Justice and Behavior, 36, 5–20.
The Level of Service Inventory–Revised: Screening Version (LSI-R:SV) has proven to
validly predict reoffending in general offender populations but has not previously been
studied specifically with offenders who have a major mental illness, including those with
a dual diagnosis. This research project measures the validity of the LSI-R:SV for use with
208 mentally ill offenders who were released from a secure forensic hospital in
Melbourne, Australia. Results indicate that the LSI-R:SV is a good predictor of
recidivism among mentally disordered offenders. However, the LSI-R:SV does not
reliably predict recidivism in individuals who attracted a dual diagnosis. Further research
needs to reevaluate risk factors associated with recidivism in offenders with a dual
diagnosis.
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Finkelstein, N., VandeMark, N., Fallot, R., Brown, V., Cadiz, S., & Heckman, J. (2004).
Enhancing substance abuse recovery through integrated trauma treatment. Sarasota,
FL: National Trauma Consortium.
Golden, L. (2002). Evaluation of the efficacy of a cognitive behavioral program for offenders
on probation: Thinking for a change. Retrieved March 26, 2011, from the National
Institute of Corrections Web site: http://www.nicic.org/pubs/2002/018190.pdf.
This study evaluates the efficacy of a National Institute of Corrections developed
cognitive behavioral program for adult offenders on probation, Thinking for a Change.
One hundred male and 42 female medium and high-risk probationers were studied.
Probationers assigned to Thinking for a Change were matched with a comparison group
not assigned to the program. Group completers, group dropouts, and the comparison
group were contrasted on the constructs the program is intended to affect: procriminal
attitudes, social skills, and interpersonal problem solving skills. These areas were
assessed with self-report measures, applied skill tests, and facilitator ratings. The groups
were followed for three months to one-year after completion of the program and assessed
for recidivism, as measured by new criminal offenses and technical violations of
probation. Results show that new criminal offense rates for group completers were 33%
lower than that for comparisons. There were no differences in technical violations
between completers and comparisons. Group dropouts received a significantly higher
number of technical violations that the completers or comparison groups. Being a group
dropout, being classified as “high risk,” and having poorer interpersonal problem solving
skills were all predictive of technical violations. On attitudinal measures, there were no
differences among groups in pro-criminal sentiments. Social skills improved for both
completers and dropouts but remained constant for comparisons. Group completers
improved significantly in interpersonal problem solving skills after Thinking for a
Change, while the dropout and comparison groups had no such gains. This study
provides some encouragement for cognitive behavioral group treatment for offenders, as
positive change was found for social and problem solving skills, and a trend toward
reduced criminal activity was observed. However, change findings were not as strong as
anticipated and more research in this area is necessary.
Gray, N. , Hill, C., McGleish, A., Timmons, D., MacCulloch, M., & Snowden, R. (2003).
Prediction of violence and self-harm in mentally disordered offenders: A
prospective study of the efficacy of HCR-20, PCL-R, and psychiatric
symptomatology. Journal of Consulting and Clinical Psychology, 71, 443–451.
The efficacy of the Historical, Clinical, and Risk Management Scales (HCR-20; C.
D.Webster, D. Eaves, K. S. Douglas, & A.Wintrup, 1995), Psychopathy Checklist—
Revised (PCL–R; R. D. Hare, 1991), Beck Hopelessness Scale (BHS; A. T. Beck, A.
Weissman, D. Lester, & L. Trexler, 1974), and Brief Psychiatric Rating Scale (BPRS) to
predict violence and self-harm in 34 institutionalized mentally disordered offenders was
assessed. Both the HCR-20 and BPRS were strong predictors of violence whereas the
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PCL–R had moderate predictive ability. BHS was the only variable predictive of selfharm. Although risk assessment measures were successful at predicting in-patient
violence, a clinical measure of mental state was at least as effective in these mentally
disordered offenders.
Gray, N., Snowden, R. J., MacCulloch, S., Phillips, H., Taylor, J., & MacCulloch, M. J.
(2004). Relative efficacy of criminological, clinical, and personality measures of
future risk of offending in mentally disordered offenders: A comparative study of
the HCR-20, PCL:SV, and OGRS. Journal of Consulting and Clinical Psychology,
72, 523–530.
The authors compared the ability of 3 commonly used measures of risk of future
offending in a sample of 315 mentally disordered offenders discharged from a mediumsecure unit in the United Kingdom. The authors explored whether the same criminogenic
factors that predict recidivism in the general population also predict recidivism in
mentally disordered offenders. The actuarial measure, using mainly criminological
variables, provided the best prediction of recidivism compared with measures based on
personality or clinical information, which provided no incremental validity over the
actuarial measure. The authors suggest that for maximum efficacy clinical risk should be
rated at a time of active symptoms rather than at discharge when symptoms are minimal.
Green, B. L. (1996). Trauma History Questionnaire. In B. H. Stamm (Ed.), Measurement
of stress, trauma, and adaptation (pp. 366-369). Lutherville, MD: Sidran Press.
Hall, E. Prendergast, M., Roll, J., Warda, U., Anglin, M., & Campos, M. (2010, November).
A comparison of two models of drug diversion treatment: Client outcomes. Paper
presented at the ASC Annual Meeting, San Francisco, CA.
This study sought to compare two models of jurisprudence: the drug court model
and a diversion model specified by California’s Substance Abuse and Crime
Prevention Act (SACPA). Study participants in both conditions were seen by the
same judge and received treatment in the same program. Aims: (1) Compare
baseline demographic characteristics, drug use, criminal history, and risk of Drug
Court and SACPA participants. (2) Using propensity scores as a control for
assignment bias, make a direct comparison of during-treatment retention and drug
use outcomes between the groups. (3) Determine whether Marlowe’s risk
hypothesis accounted for differing outcomes between the groups: higher-risk
clients should perform better in Drug Court, while lower-risk clients should
perform better in SACPA. Results: On most demographic and background
measures the two groups did not significantly differ. Drug Court participants
remained in treatment longer and had less drug use during treatment than did
SACPA participants. Risk predicted outcome overall, but not by condition, thus
the risk hypothesis was not supported. Conclusion: It is likely that the greater
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degree of judicial oversight and availability of sanctions in the drug court model
resulted in improved during-treatment outcomes for the Drug Court participants.
Hanson, R. K., Bourgon, G., Helmus, L., & Hodgson, S. (2009). The principles of effective
correctional treatment also apply to sexual offenders: A meta-analysis. Criminal
Justice and Behavior, 36, 865-891.
The effectiveness of treatment for sexual offenders remains controversial, even
though it is widely agreed that certain forms of human service interventions
reduce the recidivism rates of general offenders. The current review examined
whether the principles associated with effective treatments for general offenders
(risk-need-responsivity; RNR) also apply to sexual offender treatment. Based on a
meta-analysis of 23 recidivism outcome studies meeting basic criteria for study
quality, the unweighted sexual and general recidivism rates for the treated sexual
offenders were lower than the rates observed for the comparison groups
(10.9%, n = 3,121 vs. 19.2%,n = 3,625 for sexual recidivism; 31.8%, n = 1,979
vs. 48.3%, n = 2,822 for any recidivism). Programs that adhered to the RNR
principles showed the largest reductions in sexual and general recidivism. Given
the consistency of the current findings with the general offender rehabilitation
literature, the authors believe that the RNR principles should be a major
consideration in the design and implementation of treatment programs for sexual
offenders
Heilbrun, K., DeMatteo, D., Brooks, S., Yasuhara, K., Shah, S., Anumba, N., King, C., & Pich, M.
(2011). Risk-needs assessment: Bridging disciplinary and regional boundaries. Criminal
Behaviour and Mental Health, 21, 1-7.
(no abstract)
Health Canada, Centre for Addiction and Mental Health. (2002). Best practices:
concurrent mental health and substance use disorders. Retrieved from
http://www.hc-sc.gc.ca/hc-ps/alt_formats/hecs-sesc/pdf/pubs/adp-apd/bp_disordermp_concomitants/bp_concurrent_mental_health-eng.pdf
Henderson, C., & Taxman, F. (2009). Competing values among criminal justice
administrators: The importance of substance abuse treatment. Drug and Alcohol
Dependence, 103S, S7-S16.?... , lfaj
This study applied latent class analysis (LCA) to examine heterogeneity in criminal
justice administrators’ attitudes toward the importance of substance abuse treatment
relative to other programs and services commonly offered in criminal justice settings.
The study used data collected from wardens, probation and/or parole administrators, and
other justice administrators as part of the National Criminal Justice Treatment Practices
survey (NCJTP), and includes both adult criminal and juvenile justice samples. Results of
the LCA suggested that administrators fell into four different latent classes: (1) those who
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place a high importance on substance abuse treatment relative to other programs and
services, (2) those who place equal importance on substance abuse treatment and other
programs and services, (3) those who value other programs and services moderately more
than substance abuse treatment, and (4) those who value other programs and services
much more than substance abuse treatment. Latent class membership was in turn
associated with the extent to which evidence-based substance abuse treatment practices
were being used in the facilities, the region of the country in which the administrator
worked, and attitudes toward rehabilitating drug-using offenders. The findings have
implications for future research focused on the impact that administrators’ attitudes have
on service provision as well as the effectiveness of knowledge dissemination and
diffusion models.
Hog, H., Thomson, L., & Darjee, R. (2009). Violence risk assessment: the use of the PCLSV, HCR-20, and VRAG to predict violence in mentally disordered offenders
discharged from a medium secure unit in Scotland. Journal of Forensic Psychiatry
and Psychology, 20, 523–541.
Risk assessment tools are increasingly used in the management of mentally disordered
offenders in Scotland, but there has been limited research into their validity among this
population. The aim of this study was to examine the validity of risk assessment tools in
predicting violence following discharge from a Scottish medium secure unit. The PCLSV, the VRAG, and the historical subset of the HCR-20 were completed on 96 patients.
Follow-up information regarding post-discharge violence and clinical factors was
collected for two years. Four (4.2%) patients from the sample committed five serious
violent offences, while 38 (40.6%) patients committed more than 100 minor violent
offences. The risk assessment tools were found to have moderate predictive accuracy for
violent outcomes. Thus this study provides useful evidence supporting the validity of risk
assessment tools in Scotland. Individual clinical factors such as substance abuse,
personality disorder, treatment non-compliance, and symptom relapse are also relevant in
risk assessment and management.
Kassebaum, G., & Okamoto, D. (2001). The drug court as a sentencing model. Journal of
Contemporary Criminal Justice, 17, 89-104.
The sentencing model of the drug court puts a single judge into repeated contact with
defendants under supervision. The drug court sentencing model, first, provides court
monitoring and immediate, tangible punitive consequences for noncompliance with
program requirements and, second, offers a strongly supportive group that provides a
range of treatment options with which the defendant must be involved. Data in this article
are from (a) a database developed on cases accepted or rejected by the drug court, (b)
interviews with treatment providers, and (c) interviews with judges and administrators and
attendance at court hearings and drug court graduation ceremonies. The article presents
data on the conduct of the drug court judge and completion and attrition rates in the
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program, and it concludes that the activist judge role is the pivotal feature of the drug
court.
Kingman, R., Olsen, L., Osher, F., & Skeem, J. (2009, July). Integrating criminogenic risk
into mental health/criminal justice dialogue. Washington, D.C.: Justice Center, The
Council of State Governments.
Kroner, D., & Takahashi, M. (2011). Every session counts: The differential impact of
previous programmes and current programme dosage on offender recidivism.
Legal and Criminological Psychology, early edition, 1-15.
Purpose. The present study examined the impact of current treatment dosage on
recidivism among offenders.
Methods. Using a sample of dropouts from a community treatment programme, current
treatment dosage and past completed programmes were used to predict criminal
recidivism.
Results. After statistically controlling for risk levels, only current dosage was predictive
of recidivism.
Conclusions. Offenders’ current direction, indicated by current dosage, is central to
reducing recidivism. Strategies for offenders completing treatment sessions are discussed.
Lamberti, J. S., Weisman, R., & Faden, D. I. (2004). Forensic assertive community
treatment: Preventing incarceration of adults with severe mental illness. Psychiatric
Services, 55(11), 1285-1293.
Objective: Persons with severe mental illness are overrepresented in and prisons in the
United States. A national survey was conducted to identify assertive community
treatment programs that have been modified to prevent arrest and incarceration of adults
with severe mental illness who have been involved with the criminal justice system.
Methods: Members of the National Association of County Behavioral Health Directors
(NACBHD) were surveyed to identify assertive community treatment programs serving
persons with criminal justice histories and working closely with criminal justice agencies.
Programs were identified that met three study criteria: all enrollees had a history of
involvement with the criminal justice system, a criminal justice agency was the primary
referral source, and a close partnership existed with a criminal justice agency to perform
jail diversion. Senior representatives of each program were subsequently contacted, and a
telephone survey was administered to gather information about the design and operation
of the programs.
Results: A total of 291 of 314 NACBHD members (93 percent) responded to the survey.
Sixteen programs that met the study criteria were identified in nine states. The primary
referral sources for 13 of these programs (81 percent) were local jails. Eleven programs
(69 percent) incorporated probation officers as members of their assertive community
treatment teams. Eight programs (50 percent) had a supervised residential component,
with five providing residentially based addiction treatment. Eleven of the 16 programs
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have begun operating since 1999. Only three programs have published outcome data on
program effectiveness.
Conclusions: Forensic assertive community treatment is an emerging model for
preventing arrest and incarceration of adults with severe mental illness who have
substantial histories of involvement with the criminal justice system. Further research is
needed to establish the structure, function, and effectiveness of this developing model of
service delivery.
Landenberger, N. A., & Lipsey, M. W. (2005). The positive effects of cognitive behavioral
programs for offenders: A meta-analysis of factors associated with effective
treatment. Journal of Experimental Criminology, 1, 451-476.
A meta-analysis of 58 experimental and quasi-experimental studies of the effects of
cognitive behavioral therapy (CBT) on the recidivism of adult and juvenile offenders
confirmed prior positive findings and explored a range of potential moderators to identify
factors associated with variation in treatment effects. With method variables controlled,
the factors independently associated with larger recidivism reductions were treatment of
higher risk offenders, high quality treatment implementation, and a CBT program that
included anger control and interpersonal problem solving but not victim impact or
behavior modification components. With these factors accounted for, there was no
difference in the effectiveness of different brand name CBT programs or generic forms of
CBT.
Langan, N., & Pelissier, B. (2001). Gender differences among prisoners in drug treatment.
Journal of Substance Abuse Treatment, 13, 291-301.
Purpose: Nearly all prison-based substance abuse treatment programs have been designed
with male prisoners in mind. Administering these male-oriented programs to women
prisoners has been the standard correctional practice. Recently, this practice has received
considerable criticism. Critics argue that female prisoners have special needs that are not
met by programs originally designed for male prisoners. However, most of the empirical
support for the existence of such special needs rely on two inappropriate samples:
prisoners who are not in treatment and treatment participants who are not incarcerated.
Findings from these two different groups may not be generalizable to the population of
prisoners in treatment. Methods: This paper directly addresses this generalizability
problem with an examination of gender differences among 1326 male and 318 female
federal prisoners who were enrolled in a substance abuse treatment program. Results:
Women used drugs more frequently, used harder drugs, and used them for different
reasons than men. Women also confronted more difficulties than men in areas linked to
substance abuse such as educational background, childhood family environment, adult
social environment, mental health, and physical health. Conclusion: We find support for
the argument that substance abuse treatment programs which were originally designed for
men may be inappropriate for the treatment of women.
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Longshore, D., Turner, S., Wenzel, S., Morral, A., Harrell, A., McBride, D., et al. (2001).
Drug courts: A conceptual framework. Journal of Drug Issues, 31, 7-26.
Structural and process characteristics of drug courts may have a major influence on
offender outcomes. However, despite the existence of dozens of outcome evaluations in
the drug court literature, it is impossible to draw clear conclusions regarding variability in
outcomes in relation to drug court characteristics. The authors describe existing
approaches to the description of drug court structure and process and argue that a new
approach is needed. To address that need, they propose a conceptual framework of five
drug court dimensions: leverage, population severity, program intensity, predictability,
and rehabilitation emphasis. These dimensions, each scorable on a range from low to high,
lend themselves to a systematic set of hypotheses regarding the effects of structure and
process on drug court outcomes. Finally, the authors propose quantitative and qualitative
methods for identifying such effects.
Lowenkamp, C., Latessa, E., & Holsinger, A. (2006). The risk principle in action: What
have we learned from 13,676 offenders and 97 correctional programs? Crime &
Delinquency, 52, 77-93.
Over the recent past there have been several meta-analyses and primary studies that
support the importance of the risk principle. Oftentimes these studies, particularly the
meta-analyses, are limited in their ability to assess how the actual implementation of the
risk principle by correctional agencies affects effectiveness in reducing recidivism.
Furthermore, primary studies are typically limited to the assessment of one or two
programs, which again limits the types of analyses conducted. This study, using data
from two independent studies of 97 correctional programs, investigates how adherence to
the risk principle by targeting offenders who are higher risk and varying length of stay
and services by level of risk affects program effectiveness in reducing recidivism.
Overall, this research indicates that for residential and nonresidential programs, adhering
to the risk principle has a strong relationship with a program’s ability to reduce
recidivism.
Mallik-Kane, K., & Visher, C. (2008). Health and prisoner re-entry: How physical, mental,
and substance abuse conditions shape the process of reintegration. Washington, D.C.:
Urban Institute Justice Policy Center.
Each year, nearly 700,000 men and women are released from prison into communities
across the United States but many do not make a successful transition: two-thirds are
arrested within three years and one-half are returned to prison, either for parole violations
or new crimes. The Urban Institute’s study, Returning Home: Understanding the
Challenges of Prisoner Reentry, provides an in-depth examination of the reentry process
through a series of interviews with a representative sample of 1,100 returning prisoners
before and after their release. This report documents the health challenges facing
returning prisoners and describes how individuals with health conditions navigated the
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first year after release from prison. Taking a comprehensive perspective on “health,” we
report on the influence of physical health conditions, mental illness, and substance abuse
on the reentry process. We demonstrate, empirically, how returning prisoners with these
health conditions faced distinct challenges with regard to finding housing and
employment, reconnecting with family members, abstaining from substance use
and crime, and avoiding a return to prison.
McCann, R., Ball, E., & Ivanoff, A. (2000). DBT with an inpatient forensic population:
The CMHIP forensic model. Cognitive and Behavioral Practice, 7, 447-456.
Implementation of Dialectical Behavior Therapy (DBT) in a forensic or criminal justice
setting differs dramatically from standard outpatient DBT. Forensic patients are multiproblem patients with violent histories and multiple diagnoses including borderline
personality disorder (BPD), antisocial personality disorder (ASPD), and concomitant
Axis I psychotic or mood disorders. DBT was selected for this population because of its
emphasis on treating life-threatening behaviors of patients and therapy-interfering
behaviors of both patients and staff. The forensic inpatient DBT model described here
includes modification of agreements, targets, skills training groups, and dialectical
dilemmas. An additional skills module, the Crime Review, was developed to supplement
standard DBT. Conclusions and recommendations for applying DBT in a forensic setting
are presented.
Messina, N., Burdon, W., Hagopian, G., & Prendergast, M. (2006). Predictors of prisonbased treatment outcomes: A comparison of men and women participants.
American Journal of Drug and Alcohol Abuse, 32, 7-28.
The purpose of this study was to examine differences between men and women entering
prison-based therapeutic community (TC) treatment and to explore the relationship
of those differences to posttreatment outcomes (i.e., aftercare participation and
reincarceration rates). Extensive treatment-intake interview data for 4,386 women and
4,164 men from 16 prison-based TCs in California were compared using chi-square
analyses and t-tests. Logistic regression analyses were then conducted separately for men
and women to identify gender-specific factors associated with post-treatment outcomes.
Prison intake data and treatment participation data come from a 5-year process and
outcome evaluation of the California Department of Corrections' (CDC) Prison
Treatment Expansion Initiative. The return-to-custody data came from the CDC's
Offender Based Information System. Bivariate results showed that women were at
a substantial disadvantage compared with their male counterparts with
regard to histories of employment, substance abuse, psychological functioning, and
sexual and physical abuse prior to incarceration. In contrast, men had more serious
criminal justice involvement than women prior to incarceration. After controlling for
these and other factors related to outcomes, regression findings showed that there were
both similarities and differences with regard to gender-specific predictors of
posttreatment outcomes. Time in treatment and motivation for treatment were similar
predictors of aftercare participation for men and women. Psychological impairment was
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the strongest predictor of recidivism for both men and women. Substantial differences in
background characteristics and the limited number of predictors related to posttreatment
outcomes for women suggests the plausibility of gender-specific paths in the recovery
process.
Messina, N., & Grella, C. (2006). Childhood trauma and women’s health outcomes in a
California prison population. American Journal of Public Health, 96, 1842-1848.
Objectives. We sought to describe the prevalence of childhood traumatic events among
incarcerated women in substance abuse treatment and to assess the relation between
cumulative childhood traumatic events and adult physical and mental health problems.
Methods. The study was modeled after the Adverse Childhood Events study’s findings.
In-depth baseline interview data for 500 women participating in the Female Offender
Treatment and Employment Program evaluation were analyzed. Results. Hypotheses
were supported, and regression results showed that the impact of childhood traumatic
events on health outcomes is strong and cumulative (greater exposure to childhood
traumatic events increased the likelihood of 12 of 18 health-related outcomes, ranging
from a 15% increase in the odds of reporting fair/poor health to a 40% increase in the
odds of mental health treatment in adulthood). Conclusions. Our findings suggest a need
for early prevention and intervention, and appropriate trauma treatment, within
correctional treatment settings.
Morgan, R., & Flora, D. (2002). Group psychotherapy with incarcerated offenders: A
research synthesis. Group Dynamics: Theory, Research, and Practice, 6, 203-218.
The purpose of this study was to evaluate the efficacy of group psychotherapy with
incarcerated offenders. Meta-analytic techniques were applied to 26 empirical studies that
used a treatment group versus a control group. The outcome measures assessed in this
study included institutional adjustment, anger, anxiety, depression, interpersonal
relations, locus of control, and self-esteem. The results indicate that positive treatment
effects were found for the use of group psychotherapy with incarcerated offenders across
all outcomes. Supplemental analyses were also included to identify factors that contribute
to the efficacy of group psychotherapy and indicate that the use of homework exercises
resulted in significantly improved outcomes. Furthermore, participants mandated to
treatment did not negatively influence the efficacy of group psychotherapy.
Morrissey, J., Meyer, P, & Cuddeback, G. (2007). Extending assertive community
treatment to criminal justice settings: Origins, current evidence, and future
directions. Community Mental Health Journal, 43, 527-544.
This paper presents an overview of Assertive Community Treatment (ACT) as an
evidence-based practice in mental health care. We then consider current evidence for
FACT (ACT for forensic populations) and FICM (intensive case management for
forensic populations) and the ways these models have been extended and adapted to serve
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mentally ill persons in a variety of criminal justice settings. The available evidence about
the effectiveness of these models towards preventing recidivism among criminally-justice
involved persons with mental illness is weak. We conclude with several suggestions for
how the clinical model of FACT needs to be expanded to incorporate interventions aimed
at reducing criminal behavior and recidivism.
Pelissier, B., Camp, S., Gaes, G., Saylor, W., & Rhodes, W. (2003). Gender differences in
outcomes from prison-based residential treatment. Journal of Substance Abuse
Treatment, 24, 149-160.
This study examines gender similarities and differences in background characteristics, the
effectiveness of treatment, and the predictors of post-release outcomes among incarcerated
drug-using offenders. The sample of 1,842 male and 473 female treatment and comparison
subjects came from a multi-site evaluation of prison-based substance abuse treatment
programs. Three-year follow-up data for recidivism and post-release drug use were
analyzed using survival analysis methods. Despite the greater number of life problems
among women than men, women had lower three-year recidivism rates and rates of postrelease drug use than did men. For both men and women, treated subjects had longer
survival times than those who were not treated. There were both similarities and
differences with respect to gender and the other predictors of the two post-release
outcomes. Differences in background characteristics and in factors related to post-release
outcomes for men and women suggest the plausibility of gender-specific paths in the
recovery process.
Pelissier, B., & Jones, N. (2005). A review of gender differences among substance abusers.
Crime & Delinquency, 51, 343-372.
This article provides a review of various types of literature on gender differences among
substance abusers. The authors begin this literature review by summarizing the literature
on the differing treatment needs of men and women. The authors continue with a review
of the empirically based literature on gender differences in background characteristics of
substance users. They conclude with a review of treatment outcome studies. This review
provides a context for identifying the gaps in the literature and identifies a research agenda
that will help improve treatment services for women in both community-based and prison
settings.
Peters, R., Strozier, A., Murrin, M., & Kearns, W. (1997). Treatment of substance-abusing
jail inmates. Journal of Substance Abuse Treatment, 14, 339-349.
Females incarcerated for drug-related offenses represent one of the fastest growing
populations within jails and prisons. The few studies of female offenders with substance
abuse disorders depict a population with multiple psychosocial problems and treatment
needs, and one that is characterized by frequent exposure to sexual abuse and other
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violence. The current study examined intake assessment results from a sample of 1,655
substance-involved jail inmates referred to a jail treatment program in Tampa, Florida,
including 26% female and 74% male inmates. The study was designed to identify gender
differences in psychosocial characteristics and substance abuse treatment needs among jail
inmates. Results indicate that female inmates more frequently experienced employment
problems, had lower incomes, more frequently reported cocaine as the primary drug of
choice, and were more likely to report depression, anxiety, suicidal behavior, and a history
of physical and sexual abuse. Implications for developing specialized treatment
approaches for female offenders are discussed, including use of integrated treatment
strategies.
Pomili, M., Lester, D., Innamorati, M., Del Casale, A., Girardi, P., Ferracuti, S., et al.
(2009). Journal of Forensic Sciences, 54, 1155-1162.
Both among psychiatric inpatients and inmates of prisons and jails, suicide is highly
prevalent with alarming rates. In many countries, there has been a call for action to
prevent such deaths and to educate staff in the early recognition of suicide risk. A careful
MedLine search was used to identify relevant papers dealing with suicide prevention in
psychiatric inpatients. This paper reviews this research and the policy recommendations
that have been developed for psychiatric hospitals in order to reduce the incidence of
suicide in their patients. Results derived from this search indicated that these policy
recommendations can be applied to suicide prevention in correctional settings, and it is
argued that suicide prevention programs in correctional settings can benefit from the
research conducted and the policy recommendations for suicide prevention in psychiatric
facilities. In conclusion, the best practices for preventing suicides in jail and prison
settings should include the following elements: training programs, screening procedures,
communication between staff, documentation, internal resources, and debriefing after a
suicide.
Prins, A., Ouimette, P., Kimerling, R., Cameron, R.P., Hugelshofer, D.S., Shaw-Hegewer,
J., Thrailkill, A., Gusman, F.D., & Sheikh, J.I. (2004). The primary care PTSD
screen (PC-PTSD): Development and operating characteristics. International
Journal of Psychiatry in Clinical Practice, 9, 9-14.
Posttraumatic stress disorder (PTSD) is a frequently unrecognized anxiety disorder in
primary care settings. This study reports on the development and operating characteristics
of a brief 4-item screen for PTSD in primary care (PC-PTSD). 188 VA primary care
patients completed the PC-PTSD, the PTSD Symptom Checklist (PCL) and the Clinician
Administered Scale for PTSD (CAPS). The prevalence of PTSD was 24.5%. Signal
detection analyses showed that with this base rate, the PC-PTSD had an optimally
efficient cutoff score of 3 for both male and female patients. A cutoff score of 2 is
recommended when sensitivity rather than efficiency is optimized. The PC-PTSD
outperformed the PCL in terms of overall quality, sensitivity, specificity, efficiency, and
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quality of efficiency. The PC-PTSD appears to be a psychometrically sound screen for
PTSD with comparable operating characteristics to other screens for mental disorders.
Quincey, V., Harris, G., Rice, M., & Cormier, C. (2006). Violent offenders: Appraising and
managing risk. Washington, D.C.: American Psychological Association.
Rice, M. , & Harris, G. (1992). A comparison of criminal recidivism among schizophrenic
and nonschizophrenic offenders. International Journal of Law and Psychiatry, 15,
397–408.
Examined the usefulness of the Level of Supervision Inventory and the Psychopathy
Checklist, as well other criminal and clinical variables, in the prediction of both general
and violent recidivism among 145 male schizophrenics alone (mean age 29 yrs) and in
combined groups of schizophrenic and 124 matched nonschizophrenic offenders. All
study variables except those pertaining to recidivism were coded from institutional files.
Schizophrenic Ss were less likely to commit any offense upon release than their
nonschizophrenic counterparts. Among the schizophrenics, those who were more
seriously disturbed at the time of the index offense were no more likely to commit
another offense upon release than those who were less disturbed. An examination of the
types of offenses committed by both groups suggests that the schizophrenics were a less
dangerous group upon release.
Ross, R. R., Fabiano, E. A., & Ewles, C. D. (1988). Reasoning and rehabilitation.
International Journal of Offender Therapy and Comparative Criminology, 32, 29-35.
The Reasoning and Rehabilitation Project comprised an experimental test of the efficacy
of an unorthodox intervention program in the rehabilitation of high-risk adult
probationers. The program was derived from a series of sequential studies of the
principles of effective correctional programs. These studies indicated that many offenders
evidence deficits in cognitive skills which are essential for pro-social adjustment and that
training in these skills is an essential ingredient of effective correctional programs.
Compared to regular probation and life skills training, cognitive training provided by
probation officers led to a major reduction in re-arrest rates and incarceration rates among
adult high-risk probationers.
Rosenfeld, B., Galietta, M., Ivanoff, A., Garcia-Mansilla, A., Martinez, R., Fava, J.,
Fineran, V., & Green, D. (2007). Dialectical behavior therapy for the treatment of
stalking offenders. International Journal of Forensic Mental Health, 6, 95-103.
The need for effective mental health interventions for specific offender populations has
become clear in recent decades. In particular, individuals who engage in stalking and
harassment have increasingly attracted the attention of the public and mental health and
criminal justice professionals, however no evidence-based treatment currently exists for
this population. We adapted Dialectical Behavior Therapy (DBT) for the treatment of this
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offender group, in part because of the high prevalence of personality disorders. This
study describes the application of a 6-month treatment program to a sample of 29
individuals, 14 of whom completed treatment. Treated offenders were significantly less
likely to re-offend with another stalking offense (0 of 14) compared to treatment dropouts (26.7%) or to published recidivism data (47%). Measures intended to help determine
the nature of changes revealed increased thought suppression, but are qualified by the
high degree of defensive responding. These preliminary data suggest that DBT holds
promise for reducing stalking behaviors and warrants further study.
Rotter, M., & Carr, W. (2011). Targeting criminal recidivism in mentally ill offenders:
Structured clinical approaches. Community Mental Health Journal, published
online.
Decreasing criminal recidivism in justice-involved individuals with mental illness, is
among the most consistently desired outcomes by programs, policy makers and funding
agencies. Evidence-based practices with track records of effectiveness in treating mental
illness and co-occurring substance abuse, while important clinically, do not necessarily
address criminal recidivism. Addressing recidivism, therefore, may require a more
targeted criminal justice focus. In this paper, we describe recent challenges to
decriminalization approaches and review factors associated with recurrent criminal
behavior. In particular, we focus on structured clinical interventions which were created
or adapted to target the thoughts and behaviors associated with criminal justice contact.
Sacks, J. (2004). Women with co-occurring substance use and mental disorders (COD) in
the criminal justice system: A research review. Behavioral Sciences & the Law, 22,
449-466.
Associated with the dramatic increase in the numbers of women entering the criminal
justice system is the recognition of the prominent role of co-occurring substance use and
mental disorders (COD) in the lives of female offenders. This article reviews current
research examining the prevalence and range of COD among female offenders, the variety
of psychosocial problems faced by the female offender with COD, and the multiple
treatment needs of women with COD who are under criminal justice supervision. Women
with COD can enter the criminal justice system at several different points and, because
both substance use and mental disorders carry significant risk of relapse, effective
treatment approaches must address both disorders. The paper concludes with a discussion
of several important treatment issues and provides suggestions regarding an agenda for
future treatment and research.
Senjo, S., & Leip, L. (2001). Testing and developing theory in drug court: A four-part logit
model to predict program completion. Criminal Justice Policy Review, 12, 66-87.
The expansion of drug courts into numerous additional jurisdictions continues at a rapid
pace. Despite this, and the commensurate growth of drug court literature, there remains a
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surprising paucity of empirical studies that test and develop an underlying theory for drug
court. This research is an empirical study that analyzes and tests therapeutic jurisprudence
as the theory behind the drug court mission and its day-to-day operations. A logit model is
used to assess the strength of specific theoretical components on an offender's ability to
complete the drug court program. The findings indicate, among other things, that the
manner of interactions between the judge and offenders can increase the likelihood of an
offender's ability to remain abstinent and stay engaged in treatment for the duration of the
drug court program.
Skeem, J., & Louden, J.E. (2006). Toward evidence-based practice for probationers and
parolees mandated to mental health treatment. Psychiatric Services, 57, 333-342.
Objectives: Many individuals with serious mental illness are on probation or parole.
These individuals are twice as likely as those without mental illness to fail on
supervision—that is, to have their community term revoked for a technical violation or a
new offense. This article reviews a small but growing body of research on this problem
and on practices designed to respond to it.
Methods: Eight publication databases were searched for articles in English published
between January 1975 and April 2005 that focused on adult probationers or parolees with
mental illness. Unpublished evaluations were also included.
Results: Three studies suggest that the link between mental illness and supervision failure
is indirect and complex. A national survey of probation described five key features of
specialty agencies, where offenders with mental illness are assigned to officers with
relatively small caseloads. Two studies suggest that stakeholders perceive specialty
caseloads as more effective than traditional caseloads. Three studies (two randomized
controlled trials and one uncontrolled cohort study) suggest that specialty agencies are
more effective than traditional agencies in linking these probationers with treatment
services, improving their well-being, and reducing their risk of probation violation.
Evidence is mixed on whether specialty agencies reduce probationers’ longer-term risk of
rearrest. With respect to parole, two uncontrolled studies suggest that specialty agencies
are effective in reducing these individuals’ short-term risk of violation.
Conclusions: A growing body of literature indicates that specialty agencies hold promise
for improving clinical and criminal outcomes for probationers and parolees with mental
illness.
Skeem, J., Manchak, S., & Peterson, J. (2011). Correctional policy for offenders with
mental illness: Creating a new paradigm for recidivism reduction. Law and Human
Behavior, 35, 110-126.
Offenders with mental illness have attracted substantial attention over the recent years,
given their prevalence and poor outcomes. A number of interventions have been
developed for this population (e.g., mental health courts). They share an emphasis on one
dimension as the source of the problem: mental illness. Their focus on psychiatric
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services may poorly match the policy goal of reducing recidivism. In this article, we use
research to evaluate (a) the effectiveness of current interventions, and (b) the larger
viability of psychiatric, criminological, and social psychological models of the link
between mental illness and criminal justice involvement. We integrate theory and
research to offer a multidimensional conceptual framework that may guide further
research and the development of efficient interventions that meaningfully reduce
recidivism. We hypothesize that the effect of mental illness on criminal behavior reflects
moderated mediation (i.e., the effect is direct in the case of one subgroup, but fully
mediated in another); and that the effect of mental illness on other "recidivism" is
partially mediated by system bias and stigma. We use this framework to propose three
priorities for advancing research, articulating policy, and improving practice.
Snowden, R.., Gray, N.., Taylor, J., Fitzgerald, S. (2009). Assessing risk of future violence
among forensic psychiatric inpatients with the classification of violence risk
(COVR). Psychiatric Services, 60, 1522–1526.
Objectives: Instruments are needed to help clinicians make decisions about a patient’s
risk of future violence in order to manage this risk, protect others, and allocate resources.
One such actuarial instrument—the Classification of Violence Risk (COVR)—was
developed from the MacArthur Violence Risk Assessment Study. The COVR has not
been validated in a sample other than the one with which it was constructed or outside of
the United States. The purpose of this study was to provide an independent validation of
the COVR in a sample of forensic psychiatric inpatients in the United Kingdom.
Methods: The prospective study was conducted at four medium-security forensic
psychiatric units over six months. Two risk assessment instruments were completed for
52 patients: the COVR and the Violence Risk Appraisal Guide (VRAG), a wellestablished actuarial instrument. Incidents of verbal aggression, physical aggression
toward others, and aggression against property were documented for the next six months
from nursing records. Predictive accuracy of the instruments was analyzed using both
correlational techniques and signal detection theory. Results: COVR was a good predictor
of both verbal and physical aggression. Its predictive ability was similar to that of the
VRAG, although the VRAG was a better predictor of violence to property. Conclusions:
The study provides the first independent validation of the COVR and evidence of the
usefulness of the COVR in predicting harmful behavior in forensic inpatient settings in
the United Kingdom.
Spohn, C., Piper, R., Martin, T., & Frenzel, E. (2001). Drug courts and recidivism: The
results of an evaluation using two comparison groups and multiple indicators of
recidivism. Journal of Drug Issues, 31, 149-176.
Increases in the number of drug offenders appearing in state and federal courts, coupled
with mounting evidence of both the linkages between drug use and crime and the efficacy
of drug treatment programs, led many jurisdictions to implement drug treatment courts.
Although these courts vary on a number of dimensions, most are designed to reduce drug
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use and criminal behavior among drug-involved offenders. This study evaluates the
effectiveness of one drug court--the Douglas County (Omaha), Nebraska Drug Court--in
reducing offender recidivism. We use a variety of analytical techniques to compare drug
court participants and offenders in two matched comparison groups on a number of
measures of recidivism. Our results reveal that drug court participants have substantially
lower rates of recidivism than traditionally adjudicated felony drug offenders, and that the
differences in recidivism rates between drug court participants and drug offenders who
participated in a diversion program prior to the implementation of the drug court
disappeared once we controlled for the offender's assessed level of risk, as indicated by
his/her Level of Service Inventory score.
Staton-Tindall, M., Havens, J., & Oser, C. (2009). Gender-specific factors associated with
community substance abuse treatment utilization among incarcerated substance
users. International Journal of Offender Therapy and Comparative Criminology, 53,
401-419.
This article describes the independent correlates of preincarceration community substance
abuse treatment utilization for male and female offenders currently participating in prisonbased treatment. As part of the National Institute on Drug Abuse-funded Criminal Justice
Drug Abuse Treatment Studies cooperative agreement, this protocol was implemented by
4 collaborating research centers. Males with a history of treatment utilization were more
likely to be older, to have used crack, and to have had a greater number of arrests, and
they were less likely to be arrested for a violent charge. Females with previous treatment
were more likely to have been hospitalized for a health condition and were significantly
more likely to have lived with someone else before prison rather than in their own home.
These findings suggest that factors associated with preincarceration treatment utilization
differ by gender, which may have important implications for correctional-based treatment
assessment, reentry planning, and transitional case management.
Taxman, F., & Thanner, M. (2006). Risk, need, and responsivity (RNR): It all depends.
Crime & Delinquency, 52, 28-51.
Target populations have always been a thorny issue for correctional programs, primarily
in response to the question “what works for whom?” In this experiment of seamless
treatment for probationers in two sites, offenders were randomly assigned to the seamless
model (drug treatment incorporated into probation supervision) or traditional referral
model to services in the community. The experiment blocked on risk level, using a
version of the Wisconsin Risk Tool, to measure the differential effects on rearrest and
substance abuse. The seamless system model improved treatment participation with
greater gains for the high-risk offenders in both sites. Yet, no main effects were observed
on drug use or rearrest, although effect sizes illustrate that small effects can be observed
for the high-risk offenders and the direction of the effect size demonstrates negative
effects for moderate-risk offenders in one of the sites. Part of the failure to observe main
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effects may be due to instrumentation and measurement problems, namely that many of
the substance abusers in the experiment had low severity substance abuse problems and
the majority of the offenders were marijuana users which has a weaker crime-drug
linkage. Study findings illustrate the importance of theoretically driven and dynamic risk
and need measures. The focus on sound dynamic factors may assist with identifying the
appropriate target populations for correctional interventions.
Walters, G. D. (1999). Short-term outcome of inmates participating in the lifestyle change
program. Criminal Justice and Behavior, 26, 322-337.
A follow-up of 291 inmates who completed at least one phase of the Lifestyle Change
program revealed that these individuals recorded significantly fewer disciplinary reports
after entry into the program than 82 inmates who were transferred or released before they
had a chance to participate in a single session of the program. The 87 program
participants and 24 control subjects who had been released from custody at least 3
months prior to the end of the follow-up period were included in a survival analysis of
time elapsed between release and first negative outcome (halfway house failure,
parole/supervised release violation, or arrest). Although the results favored subjects in the
program condition, they failed to attain statistical significance. Greater program exposure
was associated with slightly better outcomes and high-risk participants appeared to
benefit more from the program than low-risk participants.
Warner, T. D. & Kramer, J. H. (2009). Closing the revolving door? Substance abuse
treatment as an alternative to traditional sentencing for drug-dependent offenders.
Criminal Justice and Behavior, 36, 89-109.
The criminal justice system is often viewed as a revolving door for drug-dependent
offenders due to its failure to recognize the association between addiction and offending,
and repeated incarceration of drug-dependent offenders has contributed to prison
overcrowding. This study evaluated the effectiveness of Pennsylvania's drug and alcohol
treatment-based intermediate punishment, Restrictive Intermediate Punishments
(RIP/D&A), at reducing the risk of rearrest. Rearrest was compared at 12, 24, and 36
months postrelease. Offenders who successfully completed treatment had a lower risk of
rearrest than traditionally sentenced offenders in general and county jail and probation
offenders specifically. However, offenders sentenced to RIP/D&A who did not
successfully complete treatment were more at risk for rearrest than traditionally sentenced
offenders in general. Also, offenders sentenced to state incarceration had a lower risk of
rearrest than RIP/D&A participants, regardless of program completion.
Weathers, F.W., Huska, J.A. & Keane, T.M. (1991). PCL-C for DSM-IV. Boston: National
Center for PTSD – Behavioral Science Division.
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Wormith, J., Althouse, R., Simpson, M., Reitzel, L., Fagan, T., & Morgan, R. (2007). The
rehabilitation and reintegration of offenders: The current landscape and some
future directions for correctional psychology. Criminal Justice and Behavior, 34,
879-892.
The treatment literature on offender rehabilitation is reviewed with the purpose of
deriving further direction for researchers and clinicians in the field of correctional
psychology. After addressing the measurement of recidivism and other indicators of
effectiveness, this empirically guided article reviews individual studies and meta-analyses
on effectiveness of psychosocial correctional treatment for adult offenders and
specialized treatment for substance abuse offenders and sexual offenders. A foundation in
the general principles of offender intervention is established; principles such as risk,
need, and responsivity are upheld; and common themes including the use of cognitivebehavioral interventions and the importance of treatment integrity emerge. However,
questions move beyond “what works” to detailed queries about the nuances of effective
service delivery, including client motivation. Well-controlled clinical studies and detailed
process evaluations are still required. Other new directions include the application of
positive psychology to offender treatment and the improvement of conditions under
which community reentry is more likely to succeed. Directions for further research on
correctional treatment are suggested.
Zlotnick, C., Najavits, L. M., Rohsenow, D. J., & Johnson, D. M. (2003). A cognitivebehavioral treatment for incarcerated women with substance abuse disorder and
posttraumatic stress disorder: Findings from a pilot study. Journal of Substance
Abuse Treatment, 25, 99-105.
Treatment for comorbid substance use disorder (SUD) and posttraumatic stress disorder
(PTSD) is of particular relevance for incarcerated women, whose rates of PTSD and SUD
are considerably higher than women in the general population. Yet virtually no
treatments have been developed or systematically evaluated that target concurrently the
symptoms of PTSD and SUD in this underserved population. This preliminary study
evaluates the initial efficacy of a cognitive-behavioral treatment, Seeking Safety, as an
adjunct to treatment-as-usual in an uncontrolled pilot study of incarcerated women with
current SUD and comorbid PTSD. Of the 17 incarcerated women with PTSD and SUD
who received Seeking Safety treatment and had outcome data, results show that nine
(53%) no longer met criteria for PTSD at the end of treatment; at a followup 3 months
later, seven (46%) still no longer met criteria for PTSD. Additionally, there was a
significant decrease in PTSD symptoms from intake to posttreatment, which was
maintained at the 3-month followup assessment. Based on results from a diagnostic
interview and results of urinalyses, six (35%) of the women reported the use of illegal
substances within 3 months from release from prison. Measures of client satisfaction with
treatment were high. Recidivism rate (return to prison) was 33% at a 3-month followup.
Overall, our data suggest that Seeking Safety treatment appears to be appealing to
incarcerated women with SUD and PTSD and that the treatment has the potential to be
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beneficial, especially for improving PTSD symptoms. However, these findings are
tentative given that there was no control group.