Treatment and Intervention Flashcards
1
Q
Treatment and rehab
A
- Terms often used interchangeably
- Oxford Dictionary of Law Enforcement (Gooch & Williams, 2015):
- “Treatment aimed at improving an offender’s character or behaviour (including education, counselling, employment, training, etc.) that is undertaken with the goal of reintegrating the offender into society.”
- Home Office Policy paper (2015), Government Prison Strategy White Paper (2021)
- Increase in prison population over time
- 134 prisoners per 100,000 people in the general population in England & Wales (Sturge, 8th July 2024)
88,263 (August 2024) – just under the useable operational capacity (89,383; Ministry of Justice, 2024).
2
Q
reoffending rates
A
- Proven reoffending rate ~ any offence committed in a one-year follow-up period that leads to a court conviction, caution, reprimand, or warning within one year or 18 months.
- Jan-March 2022 (England & Wales): 25.1% for adult offenders; 34.2% for juvenile offenders.
- Reoffending rates for violent offences > non-violent offences (Hunt et al., 2019; Motiuk & Belcourt, 1997)
Between 30 - 45% for violent offending, between 11-14% for sexual offending (Beaudry et al., 2023; Dowden et al., 1999; Hanson & Morton-Bourgon, 2005)
3
Q
treatment models and rehab frameworks
A
- Treatment models - models to apply psychological principles and strategies to change the behaviour of offenders in clinical settings (Ward et al., 2007).
- Target offending risk factors or ‘criminogenic needs’, e.g. impulsivity, low self-control, crime-supporting attitudes.
- Rehabilitation theories - describe the aims, values, and principles of forensic interventions.
Likened to a large map of a city outlining all the major landmarks (rehabilitation theory) versus a map of a specific area that shows how to navigate within a set of streets (treatment models; Ward et al., 2007, p. 89).
4
Q
treating violent offenders- general considerations
A
- Specialised vs non-specialised treatment (Polaschek & Collie, 2004) – different treatment needs?
- Offenders often have a history of a violent offence (general offending: Bourgon & Armstrong, 2005; Sex offenders: Newman, 2011)
- Heterogeneous nature of violent offenders – function of violence needs to be understood
- For example, violence as a result of anger, rage, frustration versus to obtain physical or material needs (Feshbach, 1964)
Treatment readiness – motivation (Polaschek & Collie, 2004) and responsivity to treatment (e.g., O’Brien & Daffern, 2016)
- For example, violence as a result of anger, rage, frustration versus to obtain physical or material needs (Feshbach, 1964)
5
Q
crimogenic needs (Davies & Beech, 2018)
A
- Anger; hostility; impulsivity
- Empathy deficits
- Issues with interpersonal, problem-solving, or social information-processing skills
- Antisocial personality; antisocial companions; antisocial attitudes
- Relationship instability
- Substance abuse
- Education/employment
Major mental health problems
6
Q
treatment programmes for violent offenders (Polaschek & Collie, 2004)
A
- Anger management
- Cognitive skills
- IPV interventions
Multi-modal programmes
7
Q
Anger management (Novaco, 1975)
A
- Assumes that violence is caused by anger.
- Treatment focuses on:
- Increasing awareness of anger
- Increasing awareness of what triggers anger
- Skills training, for example social skills and relaxation training
- Typically group-based,10 – 20 x 2-hour sessions.
- Limitations
- Relationship between anger and violence is not well understood
- Some studies show no relationship (e.g., Loza & Loza-Fanous, 1999) ~ might only occur in certain situations
- Some violence exists without anger (e.g. sadism, instrumental violence; Howells, 2004)
- More frequent, intense or longer episodes of anger tend to be the most dysfunctional (Novaco, 2011)
- Need for other criminogenic needs to be addressed too (multi-faceted)
- Effectiveness
- Dowden et al (1999)
○ 110 programmes in Canada, 3-year follow-up
○ 86% reduction in violent offending - Novaco (2013)
○ Review of the literature
○ ↓ rule violations, re-arrest rates, angry patient behaviours, verbal & physical aggression - Howells et al. (2002)
○ 200 male offenders in South and Western Australia (pre and post), compared with controls
○ Few sig findings, except for improving anger knowledge, readiness to change
But, shorter and less intense programmes
- Dowden et al (1999)
8
Q
cognitive skills programmes
A
- Focused on thought patterns which may lead to offending and redirect these thought patterns into pro-social thinking and better problem solving.
- Usually delivered in groups.
- Programmes range from 3 months to 3 years.
- Limitations:
- Not suitable for all offenders, e.g. those with learning difficulties (e.g., McClinton, 2009)
- Might not work for serious high-risk offenders à cognitions may be too engrained (Ward & Nee, 2009)
- Example: think first (McGuire, 2005)
Focused on problem solving, self-management, social interaction training, and values education. - Focused on thought patterns which may lead to offending and redirect these thought patterns into pro-social thinking and better problem solving.
- Usually delivered in groups.
- Programmes range from 3 months to 3 years.
- Limitations:
- Not suitable for all offenders, e.g. those with learning difficulties (e.g., McClinton, 2009)
- Might not work for serious high-risk offenders à cognitions may be too engrained (Ward & Nee, 2009)
- Example: think first (McGuire, 2005)
Focused on problem solving, self-management, social interaction training, and values education. - Effectiveness
- Tong and Farrington (2006)
○ Meta-analysis (16 studies, 4 countries)
○ 14% decrease in recidivism, in community & institutional settings; low and high-risk offenders - Friendship et al (2003)
○ Cognitive skills programmes in England and Wales, two-year follow up period
○ Significant reductions in violent reoffending - Falshaw et al (2004)
○ Prison-based cognitive skills programmes in England and Wales
○ 2-year reconviction rates (matched with control group)
No significant differences
- Tong and Farrington (2006)
9
Q
multimodal programmes
A
- More intense, examine an array of issues
- More individualised, responsive to the needs of the person
- Assume that violence may be caused by multiple issues which should be targeted
- Multi-disciplinary teams, including psychologists, custodial, educational and programme staff
- At least 12 months, treatment usually in a group (individually if needed)
- Intensive à can be difficult to put into practice
Typically only suited for high-risk offenders
10
Q
Violence prevention unit at Rimutaka prison, near wellington NZ (Polaschek et al., 2005)
A
- Intervention programme for high-risk violent offenders (voluntary, length of sentence not effected).
- Targets ‘hypothesised criminogenic needs of violent offenders’ (p.1616).
- Programme – closed groups of 10 men.
- Therapist team = a psychologist and rehabilitation worker.
- On arrival, 4 week assessment period to gain comprehensive understanding of social history, background, family and support systems, how each may function in a group (including motivation to change), offending history, risk factors, current offence, and reintegration needs on release.
- Assessment data collected by interviews, psychometric tests, questionnaires.
- Three programmes running at a time.
- Approx. 330 hours of treatment
- 4 x 3-hour group meetings
- Weekly, for 28 weeks
- Individual intervention for psychological issues.
- To plan for release – meetings with family members.
- Post-release follow-up – routine support from probation officers.
Programme components - Effectiveness
- Polaschek (2011)
○ Evaluation of VPU in NZ; over 3.5 years
○ 112 medium and high-risk offenders matched with controls
○ Reconviction data: 10-12% fewer offenders in the treatment condition were reconvicted for a violent offence. - Serin et al. (2009)
○ Evaluation of ‘Persistently Violent Offender’ programme in Canada (144 hour long)
○ 256 men against 2 groups (AM & control group)
○ Completers just ask likely to reoffend as AM and no programme. - Cortoni et al (2006)
○ Evaluation of Violence Prevention Programme (VPP) in Canada (94 sessions)- 500 offenders against a 466 matched untreated controls
- Follow-up at 6 months and one year
- Those who completed VPP à significantly less institutional misconduct charges
Those who did not receive treatment à Twice as likely to be reconvicted for a violent offence at one year follow-up
- Polaschek (2011)
11
Q
treating sex offenders- crimogenic needs (Davies & Beech, 2018)
A
- Deviant sexual interests: for example (multiple) paraphilias, sexual preoccupation
- Distorted attitude
- Low levels of socio-affective functioning: for example, intimacy issues, lack of emotionally intimate relationships with adults, emotional congruence with children
Problems in self-management: for example, lack of control over emotions and behaviour, impulsivity, poor problem-solving
12
Q
cognitive behavioural therapy
A
- Most common treatment for sex offenders (for a review, see Moster et al, 2008)
- Cognitive aspects
- Cognitive distortions (e.g. blaming the victim, denial and minimisation, rape myth acceptance)
- Other thinking patterns that might effect mood and behaviour
- Coping with negative emotions, empathy for others
- Therapy aims to encourage offenders to identify their own thinking patterns and develop skills to re-evaluate these beliefs/thinking patterns
- Behavioural aspects:
- Alter behaviour through reward and punishment, modelling (demonstrating behaviour), and skills training (e.g. interpersonal skills such as assertiveness and communication)
Comprehensive approach to treatment.
- Alter behaviour through reward and punishment, modelling (demonstrating behaviour), and skills training (e.g. interpersonal skills such as assertiveness and communication)
13
Q
relapse prevention
A
- Adapted from the addiction field (e.g. Marshall & Laws, 2003).
- Often used as an addition to CBT approaches.
- Self-management approach:
- How to anticipate and cope with relapsing (having thoughts about offending, and re-offending)
- Control over time across high-risk situations in the community.
- Limitations
- Presumes all offenders have the same pathway to offending (Laws & Ward, 2006)
- Negative focus, must avoid certain situations (avoidant v. approach strategy) ~ influences engagement (Mann et al., 2004)
- Effectiveness
- Beech et al (2015)
- Meta-analysis of 54 treatment studies (N = 14,694)
- Systemic and CBT most promising in terms of reducing reoffending
- Mpofu et al (2018)
- Review of 10 studies
- Moderate and high-risk sex offenders
- Reoffending rates lower for CBT interventions compared to matched control groups
- Harrison et al (2020)
- Meta-analysis of 25 studies (N = 12811)
- Significant reduction in sexual and violent reoffending, no significant effect on general reoffending
- Beech et al (2015)
14
Q
Rehabilitation frameworks- risk needs responsivity framework (Andrews & Bonta, 1998)
A
- Risk principle: Level of treatment should be matched with risk à high risk = more treatment (at least 100 hours of CBT over 3-4 month period)
- Needs principle: Treatment should target criminogenic needs
- Responsivity principle: Is the treatment appropriate for that person? May impede learning? e.g. gender, learning styles, culture, diversity, motivation
- Professional discretion- Focuses on identifying, managing and reducing risk (risk-management approach)
- Limitations
- Fails to motivate and engage offenders in the process (e.g. Ward & Beech, 2015)
- External motivators such as parole might make people more likely to follow a treatment programme (Jones et al., 2006)
- High attrition rates (30-50% e.g. Ware & Bright, 2008)
- Those who drop out more likely to reoffend than completers (e.g. Hanson et al., 2002)
- Focuses on avoidance goals, rather than approach goals
- Limited attention to non-criminogenic needs (e.g. personal distress) à focussing on these might improve treatment outcomes
Minimal focus on reintegration into society
15
Q
Good lives model (Ward & Stewart, 2003)
A
- General assumptions
- Grounded in the ethical concept of human dignity and universal human rights; strong emphasis on agency
- Strength-based approach: rehabilitation needs to 1) reduce risk but also 2) promote human needs and values through approach goals.
- 11 classes of ‘primary goods’ (offenders have value certain states of mind, personal characteristics and experiences) (Ward & Gannon, 2006; Ward et al., 2007)
- Sexual offending as the result of attempting to satisfy primary goods (direct route) or a “ripple effect” that occurs when trying to satisfy one or more primary goods (indirect route)
- Treatment will:
- Work out individual’s priorities/weightings and how to get secondary goods.
- Identify criminogenic needs that might be blocking the achievement of the goods (e.g. substance abuse might prevent living a healthy life).
- Devise a GL Treatment Plan, individual to the person.
- Mallion et al (2020):
- Systematic review (N= 17)
- GLM-consistent interventions as effective as standard RP programs, but also enhanced motivation to change, engagement in treatment and optimism for the future
- Limited evidence for GLM assumptions
- Zeccola et al (2021):
- Systematic review (N = 6)
- Little evidence for the GLM to be effective in reducing reoffending
- Some evidence that GLM increases motivation to desist from crime
More rigorous and high-quality evaluations are needed
