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TX Forensic Mental Health Conf. #6 What Works

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Texas Forensic Mental Health Conference …

Texas Forensic Mental Health Conference
Presenter: Dr. Salter
Presentation: What Works
#6


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  • 1. What Works?What Works? Reducing Criminal OffendingReducing Criminal Offending
  • 2. Reasons for IncarcerationReasons for Incarceration PunishmentPunishment Justice for VictimJustice for Victim IncapacitationIncapacitation Impact on Potential OffendersImpact on Potential Offenders Reduction of RecidivismReduction of Recidivism
  • 3. Impact of More Severe Sanctions onImpact of More Severe Sanctions on RecidivismRecidivism Incarceration vs. ProbationIncarceration vs. Probation Intermediate Sanctions vs.Intermediate Sanctions vs. Standard SupervisionStandard Supervision (Smith, 2002)(Smith, 2002)
  • 4. Characteristics of StudiesCharacteristics of Studies 117 Studies117 Studies N = 442,471N = 442,471 (Smith, 2002)(Smith, 2002)
  • 5. Impact of Incarceration onImpact of Incarceration on RecidivismRecidivism N = 268,806N = 268,806 68% American Studies68% American Studies No Change in RecidivismNo Change in Recidivism or Slight Increase in Recidivismor Slight Increase in Recidivism (Smith, 2002)(Smith, 2002)
  • 6. High Quality vs. Low Quality StudiesHigh Quality vs. Low Quality Studies High QualityHigh Quality  Random AssignmentRandom Assignment  Comparison Group DesignsComparison Group Designs AgeAge Criminal HistoryCriminal History Antisocial ValuesAntisocial Values (Smith, 2002)(Smith, 2002)
  • 7. Random Assignment StudiesRandom Assignment Studies 2 Studies2 Studies Incarceration Vs CommunityIncarceration Vs Community Slight increases in recidivismSlight increases in recidivism (Smith, 2002)(Smith, 2002)
  • 8. Intermediate SanctionsIntermediate Sanctions Electronic MonitoringElectronic Monitoring FinesFines RestitutionRestitution Intensive SurveillanceIntensive Surveillance Scared StraightScared Straight Drug TestingDrug Testing Boot campBoot camp (Smith, 2002)(Smith, 2002)
  • 9. Intermediate Sanctions vs. StandardIntermediate Sanctions vs. Standard SupervisionSupervision N = 66,500N = 66,500 American Studies 80%American Studies 80% Slight Decrease in RecidivismSlight Decrease in Recidivism Or No DifferenceOr No Difference
  • 10. Boot Camps Vs. RestitutionBoot Camps Vs. Restitution Scared StraightScared Straight No ImpactNo Impact Boot campsBoot camps No ImpactNo Impact RestitutionRestitution 5% Decrease5% Decrease (Latimer et al., 2001; MacKenzie et al., 2001)(Latimer et al., 2001; MacKenzie et al., 2001)
  • 11. Same FindingsSame Findings  Juveniles vs. AdultsJuveniles vs. Adults  Men or Women (maybe)Men or Women (maybe)  White or Minority Race (few studies)White or Minority Race (few studies)  Low and High Risk OffendersLow and High Risk Offenders (Smith, 2002)(Smith, 2002)
  • 12. WomenWomen More Severe PunishmentMore Severe Punishment May Increase Recidivism in Women MoreMay Increase Recidivism in Women More than Menthan Men (Smith, 2002)(Smith, 2002)
  • 13. ExceptionException Intensive Supervision plus treatmentIntensive Supervision plus treatment Slight decrease in recidivism (10%)Slight decrease in recidivism (10%) (Smith, 2002)(Smith, 2002)
  • 14. Incarceration: More or LessIncarceration: More or Less N = 107,165N = 107,165 90% American Studies90% American Studies Mean Time for More: 31 MonthsMean Time for More: 31 Months Mean Time for Less: 13 MonthsMean Time for Less: 13 Months Slight Increase in RecidivismSlight Increase in Recidivism (Smith, 2002)(Smith, 2002)
  • 15. Impact of Length of IncarcerationImpact of Length of Incarceration Difference in TimeDifference in Time Mean Effect SizeMean Effect Size Between More & LessBetween More & Less (Weighted for Sample(Weighted for Sample GroupsGroups Size)Size) 1.1. < 6 Months< 6 Months -.01-.01 2.2. 7 to 12 Months7 to 12 Months -.02-.02 3.3. 13 to 24 Months13 to 24 Months .03.03 4.4. > 24 Months> 24 Months .06.06 (Smith, 2002)(Smith, 2002)
  • 16. Impact of Treatment Vs. SanctionsImpact of Treatment Vs. Sanctions (Andrews, 1998)(Andrews, 1998) -0.1 -0.05 0 0.05 0.1 0.15 0.2 Treatment Sanctions
  • 17. Impact of Treatment Vs. SanctionsImpact of Treatment Vs. Sanctions Young OffendersYoung Offenders -0.02 0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 Criminal Sanctions Treatment Dowden & Andrews, 1999
  • 18. Impact of Appropriate Vs.Impact of Appropriate Vs. Inappropriate TreatmentInappropriate Treatment (Andrews, 1998)(Andrews, 1998) -0.1 -0.05 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 Combined Tx Appropriate Inappropriate Sanctions
  • 19. Type of TreatmentType of Treatment 0 0.05 0.1 0.15 0.2 0.25 0.3 Non Behavioral Cognitive Behavioral Andrew, 1994
  • 20. Type of Treatment & Young OffendersType of Treatment & Young Offenders 0 0.05 0.1 0.15 0.2 0.25 Non Behavioral Cognitive Behavioral Dowden & Andrews, 1999
  • 21. ““All meta-analyses on offender treatmentAll meta-analyses on offender treatment have a positive mean effect size.”have a positive mean effect size.” (Losel, 1995)(Losel, 1995)
  • 22. Appropriate TreatmentAppropriate Treatment  Higher Risk More IntensiveHigher Risk More Intensive  Targets Criminogenic NeedsTargets Criminogenic Needs  Uses Cognitive-Behavioral TreatmentUses Cognitive-Behavioral Treatment  Implement Treatment As DesignedImplement Treatment As Designed (Andrews, 1998)(Andrews, 1998)
  • 23. Targeting Criminogenic NeedsTargeting Criminogenic Needs
  • 24. Criminogenic NeedsCriminogenic Needs CriminogenicCriminogenic Non CriminogenicNon Criminogenic Antisocial AttitudesAntisocial Attitudes Self-EsteemSelf-Esteem Antisocial FriendsAntisocial Friends AnxietyAnxiety Substance AbuseSubstance Abuse DepressionDepression ImpulsivityImpulsivity
  • 25. Targeting Criminogenic NeedsTargeting Criminogenic Needs -0.05 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 Targets 1 - 3 Noncriminogen ic Needs Targets 4 - 6 Criminogenic Needs Gendreau, French & Taylor, 2002
  • 26. Self Esteem Vs. Criminogenic NeedsSelf Esteem Vs. Criminogenic Needs -0.1 -0.05 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 Self Esteem Criminogenic Needs
  • 27. What WorksWhat Works  Higher Risk OffendersHigher Risk Offenders  At least 2 sessions per weekAt least 2 sessions per week  Smaller groupsSmaller groups  Implementation MonitoredImplementation Monitored  Staff Trained on Cognitive-Behavioral TxStaff Trained on Cognitive-Behavioral Tx  Higher Proportion of Treatment CompletersHigher Proportion of Treatment Completers
  • 28. Programming That Doesn’t WorkProgramming That Doesn’t Work PsychodynamicPsychodynamic Non-directive/Client-centeredNon-directive/Client-centered Disease ModelDisease Model (Andrews, 1998)(Andrews, 1998)
  • 29. Impact of Cognitive Self-ChangeImpact of Cognitive Self-Change ProgramProgram  LengthLength New Accusations After YearsNew Accusations After Years Of Time (Mo.)Of Time (Mo.) 11 22 33 No treatmentNo treatment 49%49% 71%71% 77%77% 1 – 61 – 6 54%54% 67%67% 80%80% 7 +7 + 25%25% 42%42% 46%46% (Bush, 1995)(Bush, 1995)
  • 30. How Many Programs AreHow Many Programs Are Appropriate?Appropriate? Correctional Program Assessment InventoryCorrectional Program Assessment Inventory Scores (CPAI)Scores (CPAI) 50 correctional programs50 correctional programs (Latessa & Holsinger, 1998)(Latessa & Holsinger, 1998)
  • 31. How Many Programs AreHow Many Programs Are Appropriate?Appropriate? 29.4 31.3 27.4 11.7 0 5 10 15 20 25 30 35 Unsatis. NI Satis. Very Satis. (Latessa & Holsinger, 1998)(Latessa & Holsinger, 1998)
  • 32. ATSA Collaborative StudyATSA Collaborative Study N = 43 studiesN = 43 studies  All treated between 1965 – 1999All treated between 1965 – 1999  80% treated after 198080% treated after 1980  9,316 subjects9,316 subjects  23 Institutional programs23 Institutional programs  16 Community programs16 Community programs  3 both3 both
  • 33. ATSA Collaborative StudyATSA Collaborative Study Recidivism DataRecidivism Data TreatedTreated UntreatedUntreated OddsOdds RatioRatio Only currentOnly current programsprograms SexualSexual 9.9%9.9% 17.3%17.3% .60.60 GeneralGeneral 32.3%32.3% 51.3%51.3% .57.57
  • 34. Psychopathy: TreatmentPsychopathy: Treatment
  • 35. • Program for personality disordered offendersProgram for personality disordered offenders • "Maxwell Jones" Therapeutic Community"Maxwell Jones" Therapeutic Community • Minimum 2 yrs in programMinimum 2 yrs in program • Mean follow-up after release = 8 yrs, 4 monthsMean follow-up after release = 8 yrs, 4 months • Psychopaths defined by PCL-R score of 27Psychopaths defined by PCL-R score of 27 • PCL-R coded from files only (r = .96)PCL-R coded from files only (r = .96) • 176 treated patients; 146 untreated patients176 treated patients; 146 untreated patients • Mean time to failure = 47 monthsMean time to failure = 47 months (Rice, Harris, & Cormier, 1992) Psychopathy and Recidivism After Treatment
  • 36. Psychopathy & TreatmentPsychopathy & Treatment NonNon PsychopathsPsychopaths TreatedTreated 22%22% UntreatedUntreated 39%39% (Harris, Rice et al., 1994)(Harris, Rice et al., 1994)
  • 37. Psychopathy & TreatmentPsychopathy & Treatment PsychopathsPsychopaths TreatedTreated 77%77% UntreatedUntreated 55%55% (Harris, Rice et al., 1994)(Harris, Rice et al., 1994)
  • 38. Psychopathy, Treatment, and ReconvictionsPsychopathy, Treatment, and Reconvictions in HMP Servicein HMP Service •Tx anger-management, social skills •24-month reconviction rate (Hare, Clark, Grann, & Thornton, 2000)Hare, Clark, Grann, & Thornton, 2000)
  • 39. 0 10 20 30 40 50 60 70 80 90 Low Fac I High Fac 1 Untreated Treated PercentReconvicted2-Year Post-release Reconviction Rates in the English Prison Service Hare, Clark, Grann, & Thornton (2000)
  • 40. Cost of RecidivismCost of Recidivism  To TaxpayersTo Taxpayers  To VictimsTo Victims
  • 41. Computing Cost of RecidivismComputing Cost of Recidivism Police InvestigationPolice Investigation AdjudicationAdjudication CorrectionsCorrections Medical Care of VictimsMedical Care of Victims Mental Health Care of VictimsMental Health Care of Victims Property DamageProperty Damage Reduced Future EarningsReduced Future Earnings (Aos, 1999)(Aos, 1999)
  • 42. Computing Victim Cost ofComputing Victim Cost of RecidivismRecidivism Medical CareMedical Care Mental Health CareMental Health Care Property DamageProperty Damage Reduced Future EarningsReduced Future Earnings Pain and SufferingPain and Suffering Loss of LifeLoss of Life (Aos, 1999)(Aos, 1999)
  • 43. Cost Effectiveness of CorrectionalCost Effectiveness of Correctional ProgrammingProgramming Every $1 Spent on Correctional ProgrammingEvery $1 Spent on Correctional Programming Taxpayers Save $5Taxpayers Save $5 Victims Save $7Victims Save $7 (Aos, 1999)(Aos, 1999)
  • 44. Cost Effectiveness of Vocational andCost Effectiveness of Vocational and Basic Education ProgramsBasic Education Programs For Every $1 SpentFor Every $1 Spent Taxpayers save between $1.71 & $3.23Taxpayers save between $1.71 & $3.23 (Aos et al., 1999)(Aos et al., 1999)
  • 45. Cost Effectiveness of Cognitive-Cost Effectiveness of Cognitive- Behavioral Treatment ProgramsBehavioral Treatment Programs For Every $1 SpentFor Every $1 Spent Taxpayers Save Between $2.54 and $11.48Taxpayers Save Between $2.54 and $11.48 (Aos et al., 1999)(Aos et al., 1999)
  • 46. ““We found the largest and most consistentWe found the largest and most consistent returns are for programs designed forreturns are for programs designed for juvenile offenders.”juvenile offenders.” (Aos et al., 1999, p. 6)(Aos et al., 1999, p. 6)
  • 47. Cost Effectiveness of ProgrammingCost Effectiveness of Programming for Juvenilesfor Juveniles For Every $1 Spent on Juvenile ProgramsFor Every $1 Spent on Juvenile Programs Tax Payers Save Between $7.62 & $31.4Tax Payers Save Between $7.62 & $31.4 (Aos, 1999)(Aos, 1999)
  • 48. Cost/Benefit of Adolescent NonCost/Benefit of Adolescent Non Offender ProgramsOffender Programs ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers & AloneAlone VictimsVictims QuantumQuantum $.09$.09 $.13$.13 Big BrothersBig Brothers $1.30$1.30 $2.12$2.12 (Aos, 1999)(Aos, 1999)
  • 49. Cost/Benefit of Adolescent NonCost/Benefit of Adolescent Non Offender ProgramsOffender Programs ProgramProgram Cost/Cost/ EffectEffect ParticipantParticipant SizeSize QuantumQuantum $18,292$18,292 -.42-.42 Big BrothersBig Brothers $1,009$1,009 -.05-.05 (Aos, 1999)(Aos, 1999)
  • 50. Cost/Benefit of AdolescentCost/Benefit of Adolescent Supervision ProgramsSupervision Programs ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers & AloneAlone VictimsVictims  DiversionDiversion $7.62$7.62 $13.61$13.61  IntensiveIntensive ProbationProbation .90.90 1.491.49  Boot CampBoot Camp .42.42 .26.26 (Aos, 1999)(Aos, 1999)
  • 51. Cost/Benefit of AdolescentCost/Benefit of Adolescent Treatment ProgramsTreatment Programs ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers & AloneAlone VictimsVictims ARPARP $19.57$19.57 $31.40$31.40 Multi-SystemicMulti-Systemic 8.388.38 13.4513.45 Functional FamFunctional Fam 6.856.85 10.9910.99 Multi Tx FosterMulti Tx Foster 14.0714.07 22.5822.58
  • 52. Cost/Benefit of AdolescentCost/Benefit of Adolescent Treatment ProgramsTreatment Programs ProgramProgram Cost/Cost/ EffectEffect ParticipantParticipant SizeSize AggressionAggression ReplacementReplacement TrainingTraining $404$404 -.26-.26 Multi-SysMulti-Sys Family TxFamily Tx $4,540$4,540 -.68-.68 (Aos, 1999)(Aos, 1999)
  • 53. What Does It Take to Break EvenWhat Does It Take to Break Even Depends on the CostDepends on the Cost Percent Reduction toPercent Reduction to Break EvenBreak Even AggressionAggression ReplacementReplacement TrainingTraining 1.4%1.4% Multi-SystemicMulti-Systemic Family TherapyFamily Therapy 10.2%10.2%