Topic 11: Treatment of Offenders

Question 1

What is treatment?

Answer 1

term is used very broadly –> can mean just about anything

Sechrest et al. (1979): “the result of any planned intervention that reduces an offender’s further criminal activity, whether the reduction is mediated by personality, behavior, abilities, attitudes, values, or other factors”

note that this makes no mention of mental health outcomes per se

Question 2

What are levels of intervention?

Answer 2

based on the public health model

primary, secondary, and tertiary

Question 3

What is primary prevention?

Answer 3

“stop it before it ever happens”

requires good knowledge of development and risk factors

effectiveness depends on large scale screening

examples: “Head Start” program (Zigler, 1994), mentoring strategy (Sherman et al., 1998), Big Brother/Sister programs

Question 4

What is secondary prevention?

Answer 4

“let’s nip it in the bud”

aimed at individuals showing early signs of criminal involvement, but not yet formally charged

candidates identified by family court, school guidance offices, social services

examples are: custody diversion, alternative measures (extrajudicial sanctions; EJS)

usually only available for minor infractions

difficult to evaluate because their nature limits supervision, and kids may already be more involved in crime than the infraction suggests

Question 5

What is the secondary prevention of Gang monitoring?

Answer 5

Spergal Model

gang leaders held “responsible” for actions of subordinate members

provides recreational, economic, and educational opportunities

Question 6

What is tertiary prevention?

Answer 6

formal treatment

attempts to prevent/reduce future crimes by targeting individuals already criminally involved

most restrictive, most costly, least effective

may be only available option due to client’s legal circumstances

as in all other areas of health care, early intervention is preferable and tends to produce better outcomes than later intervention

Question 7

What is the continuum of treatment goals?

Answer 7

two goals: rehabilitation and punishment

Question 8

What is the goal, method, and agent of rehabilitation?

Answer 8

goal: produce productive citizen

method: treatment

agent: enable training/therapy

Question 9

What is the goal, method, and agent of punishment?

Answer 9

goal: stop crime

method: incarceration

agent: restrict isolation/deprivation

Question 10

What is the sentencing theory stated in CCC s. 718?

Answer 10

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

a. to denounce unlawful conduct
b. to deter the offender and other persons from committing offences
c. to separate offenders from society, where necessary
d. to assist in rehabilitating offenders
e. to provide reparations for harm done to victims or to the community
f. to promote a sense of responsibility in offenders, and acknowledgement of the harm done to victims and to the community

Question 11

What are the goals of treatment (i.e. rehabilitation)?

Answer 11

the goals of treatment (i.e., rehabilitation) are encapsulated in the goals of sentencing, but sentencing goals are much broader

there is no denouncement (general deterrence), public protection (isolation), or restitution (reparation) component inherent to treatment

they are hoped-for outcomes

Question 12

What is the comparison of rehabilitation and punishment?

Answer 12

while rehabilitation and punishment are not mutually exclusive, the environments in which they take place tend to strongly favor one or the other

Question 13

What are community-based interventions?

Answer 13

much cheaper, and generally more effective than institutional or inpatient approaches

range from short-term to longer-term, outpatient to residential

easier generalization of treatment effects

delivered in, or closer to, actual operational environment

can utilize naturally occurring reinforcers

often utilize a tridactic model

Question 14

What are the special considerations of community-based interventions?

Answer 14

community security

interagency coordination

contingencies may be difficult to manage

if done residentially, community may strongly oppose

if done in natural home, family may undermine therapist’s efforts

safety of therapists

Question 15

What are juvenile awareness programs?

Answer 15

e.g., Scared Straight

flimsy track record

problem: based on intensity, not probability of punishment

Question 16

What are wilderness experience programs?

Answer 16

e.g., Outward Bound

foster self-esteem

Question 17

What are restitution/community service orders (EJS)?

Answer 17

behavioral principle: Overcorrection (prove that shortcuts take longer and aren’t desirable)

frequently used in Alberta

often satisfies community

effective for less serious offenders who will comply

Question 18

What is the “Street Corner” program by (Schwitzgebel, 1967)?

Answer 18

approached kids on street and simple Tx: differential reinforcement of prosocial statements

Question 19

What is the “Shape” program by Ostapiuk (1982)?

Answer 19

delivered in community housing or hostel settings

taught “survival” skills: job hunting, etc.

Question 20

What is the “Achievement Place” program by Braukman & Wolf (1987)?

Answer 20

started in US Midwest in late 60s

based on a “houseparent” model: usually a married couple

simulates a functional home

spread quickly until the mid 1980s

outcomes weren’t as good as was expected: identified need for transition programs, in fairness many youth were returned to homes in which prosocial skills weren’t necessarily adaptive

Question 21

What are direct and incidental teaching of prosocial skills in the “Achievement Place” program by Braukman & Wolf (1987)?

Answer 21

room/property care
table manners
non-aggressive speech
group/democratic decision making
appropriate conversation
negotiation

Question 22

What are the phases that proceed the token economy in the “Achievement Place” program by Braukman & Wolf (1987)?

Answer 22

Merit: means of reinforcement are more direct

Homeward bound (discharge planning)

Question 23

What is Parent Management Training?

Answer 23

a form of transition programming

teach parents the rudiments of behavior theory, and contingency contracting

other systems focus on spotting antecedents of delinquent behavior and using DRO techniques

also teach: social skills, use of time-outs, how to employ role plays

may be most effective with younger, less delinquent kids: parents still have control over their contingencies

Question 24

What is Functional Family Therapy?

Answer 24

based on family systems theory: deviant behavior is considered the consequence of pathological communication styles

works with family to improve style and quality of interactions, and learn effective problem solving

early studies were promising, e.g., Gordon et al. (1988) 11% (treated) versus 67% (control) recidivism at 1 year follow up

subsequent studies were equivocal

results: Exp. group members committed fewer major but more minor offenses

possible explanations: regression to the mean effect, exposure to more serious offenders

Question 25

What is Multisystemic Therapy (MST)?

Answer 25

most promising of all OP models thus far not really a new idea, but only recently formalized and manualized MST teams available 24/7 to clients and their families make scheduled and non-scheduled visits assist with RT crisis intervention do practical training of skills includes elements of supervision, instruction, crisis intervention, mentoring, instruction highly effective and cost efficient: even high risk offenders can be managed with relative safety, lots of supports required for MST team members, e.g. linkages with probation generalization is maximized since training occurs in the real environment

Question 26

What is the role of therapy in prisons?

Answer 26

lower recidivism assess and relieve distress

Question 27

What were the approaches of therapy in prisons documented by Kazdin (1986)?

Answer 27

most were unique to the practitioners, and not empirically grounded or formally evaluated Parloff (1984) referred to California rehab strip as "Silly Con Valley"

Question 28

Why is treatment a mess in inpatient and institutional treatment?

Answer 28

large number of non-forensic, clinical psychologists failing to see they're no longer dealing with the "worried well" sparse evidence for the efficacy of psychodynamic/humanistic approaches with this population e.g., Kassebaum et al. (1971): no significant difference in outcome between three groups; mandatory counseling, voluntary counseling, controls

Question 29

What are the "eclectic" approaches used within institutions in the study by Persons (1967)?

Answer 29

subjects were 38 boys in reformatories matched on age and other demographic variables randomly assigned to treatment or control group: treatment got 80 hours of therapy over 20 weeks including a variety of interventions at 1 year follow up, 13 Tx vs 25 controls had been re-incarcerated; also had fewer probation violations

Question 30

What are the problems with the "eclectic" approaches used within institutions?

Answer 30

eclectic approaches are unstandardized very difficult to isolate those aspects that produce the effect therapist qualities can have a dramatic influence

Question 31

What are the applied behavioral analysis approaches used within institutions?

Answer 31

idea is to change environmental cues and contingencies punish deviant behavior, reinforce prosocial behavior token economy programs are on off-shoot big in the 60s and 70s fairly easy to bring behavior under control in the institutional setting

Question 32

What are the problems with the applied behavioral analysis approaches used within institutions?

Answer 32

lack of generalization is huge problem sometimes unclear relationship between target behaviors and crime ethical constraints on what privileges can be withheld (e.g., snacks, recreation) fails to promote intrinsic motivation

Question 33

What are the cognitive-behavioral approaches used within institutions?

Answer 33

now predominate in Canadian prisons often resemble remedical education programs because of emphasis on skills training habits, cognitions, deficits, lifestyle factors that perpetuate criminal lifestyle

Question 34

What is the treatment of dangerous offenders?

Answer 34

violent, sexual, and psychopathic/APD offenders are included under this heading risk level prohibits community treatment

Question 35

What are biologically-based treatments of sex offenders?

Answer 35

neurosurgery (hypothalamic nuclei), orchidectomy, antiandrogenics: all attempts to lower sex drive fairly effective, but some males retain some sexual functioning: ethically contentious

Question 36

What are psychotherapy treatments of sex offenders?

Answer 36

based in belief that identification of underlying issues such as abuse and anger will lower risk questionable assumption Groth (1983), however, published data suggesting significant effectiveness

Question 37

What were the results of the Groth (1983) study on the effectiveness of psychotherapy treatments of sex offenders?

Answer 37

non-sexual offenses: treated 19%, controls 36% sexual offenses: treated 8%, controls 16% in both cases, untreated were twice likely to reoffend

Question 38

What are cognitive-behavioral treatments of sex offenders?

Answer 38

focused on reducing deviant arousal early efforts used aversive shock Pavlovian: paired deviant stimulus with shock non-contingently Operant: only if arousal is registered on PPG (penile plethysmograph) extinction effects are the main problem

Question 39

What is the covert sensitization treatment of sex offenders?

Answer 39

imagined pairing with something incompatible with arousal also imagine rewards of withholding deviant behavior requires a cooperative client with good imagination Hayes, Brownell, Barlow (1978) monitored arousal with PPG; no monitoring over fantasy content however

Question 40

What is the "shame" method of treatment of sex offenders?

Answer 40

expose to a clinical audience and video camera; verbalize fantasies not effective at all

Question 41

What is the satiation/boredom therapy treatment of sex offenders?

Answer 41

client masterbates to appropriate fantasy continues after orgasm, while verbalizing and tape recording deviant fantasy

Question 42

What is the orgasmic reconditioning (ORC) treatment of sex offenders?

Answer 42

masturbates to deviant fantasy; switches to appropriate one just prior to orgasm orgasm is a reflex switches earlier in subsequent sessions

Question 43

What is relapse prevention treatment of sex offenders?

Answer 43

originated in substance abuse literature

Question 44

What are "other" methods of treatment of sex offenders?

Answer 44

dating skills, anger management, cognitive distortions, human sexuality, education, marital therapy

Question 45

What is the treatment of aggressive offenders?

Answer 45

less likely to be deemed in need; more likely to just be locked up as a group, seldom seek therapy in the absence of secondary gains as with sex offenders, denial, blaming of others, and refusal of responsibility are uniquitous

Question 46

What is the pharmacotherapy treatment of aggressive offenders?

Answer 46

usually tranquilizers are given only on a PRN basis to manage outbursts not an enduring solution, unless the aggression is rooted in a psychosis, EPD, ADHD, or bipolar disorder lots of potentially harmful side effects side effects may also encourage non-compliance, e.g., dry mouth, tremors, frequent urination, nausea

Question 47

What is the cognitive-behavioral treatment of sex offenders?

Answer 47

anger management (e.g., Novaco, 1978) three steps: 1. prep (education) 2. skills training 3. practice packages often sold commercially special versions for nasty kids and marital conflict are avilable excellent transition support

Question 48

What is the dialectical behavior therapy treatment of sex offenders?

Answer 48

actually designed and validated for Tx of BPD stresses balance between change and acceptance teaches tolerance of negative affective states that contribute to potentially criminal behavior: mindfulness, meditation, relaxation combines several elements of conventional CBT; particularly challenges to all-or-nothing thinking, or catastrophic thinking

Question 49

What is the treatment of personality disordered/psychopathic offenders?

Answer 49

APD is over diagnosed in jail settings; e.g., Harris, Rice, Cormier (1989), 2/3 got the Dx, but 1/4 actually qualified some (e.g. Carney) have argued that the question becomes moot upon conviction flawed assumption since "personality" implies enduring characteristics and therefore inflexibility

Question 50

What is the study by Levine & Bornstein (1972) on the treatment of personality disordered/psychopathic offenders?

Answer 50

only 8 of 295 meta-analyzed reports on ASPD treatment contained encouraging results most of the 295 were methodologically unsound and could not be used however picture may not be as bleak as once thought

Question 51

What is the problem with the study by Levine & Bornstein (1972) on the treatment of personality disordered/psychopathic offenders?

Answer 51

ASPDs and psychopaths are not usually distressed can't rely on negative Rf of treatment effects

Question 52

What studies show that purely punitive settings do not work well?

Answer 52

Gendreau (1996) studied reactions in recidivism jail only: 6% less crime treatment: 25% less crime

Question 53

Why has treatment effectiveness been difficult to measure?

Answer 53

Martinson (1974): "Nothing works!" reflection of interpretative errors mainstream criminology had an "anti-psychological" reputation lends support to a "Just desserts" model, which fuels outcry for stiffer penalties

Question 54

What were the results of the Palmer (1975) study on treatment effectiveness?

Answer 54

treatment can be effective, but it must be tailored to the criminogenic needs of the client

Question 55

What were the results of the Gendreau & Ross (1980) study on treatment effectiveness?

Answer 55

"meta-analysis" reviewed outcomes of 95 treatment studies 86% showed positive outcomes

Question 56

What were the features of effective programs proposed by Lipsey (1989)?

Answer 56

1. longer duration, more meaningful contact 2. services provided outside correctional facility 3. programs are reviewed and adjusted regularly 4. cognitive-behavioral, multifaceted, skill-oriented approach 5. targets higher risk offenders 6. includes careful discharge planning

Question 57

What features of effective programs were added to the ones proposed by Lipsey (1989) by Andrews, Bonta & Hoge (1990)?

Answer 57

7. criminogenic factors are specifically targeted 8. treatment is matched to the learning style of the offender

Question 58

What features of effective programs were added to the ones proposed by Lipsey (1989) by Lipsey & Widom (1998)?

Answer 58

9. services should be delivered by mental health professionals

Question 59

What is Risk-Needs-Responsivity?

Answer 59

research has shown a direct relationship between number of R-N-R principles utilized and Tx outcome closely tied to SPJ instruments, and shows their potential utility in Tx planning most treatment outcomes if have all three things, actually make people worse if none are present