Presented by Darcy Edwards, PhD & Robyn Feese, LCADC Nevada Department of Corrections November 19, 2014

In 2011, Nevada Department of Corrections (NDOC) made a commitment to adopt evidence-based practices (EBP) for all its substance abuse programs With that system change & with RSAT funding, we were given an opportunity to redesign our treatment programs by operationalizing the principles of EBP for corrections clients 2

 The first thing we wanted to do was to get baseline assessments for all of our programs  We wanted credibility & the ability of our findings to stand up to scrutiny, so we wanted our programs to be assessed by independent, objective reviewers  We wanted the reviewers to use a standardized, evidence- based instrument that was designed specifically to evaluate corrections programs  We wanted the reviewers to be certified to use the instrument  For us, the evidence-based instrument & the reviewers’ certifications were the foundation of our commitment to quality assurance 3

 To assess the programs, we chose the Correctional Program Checklist (CPC)  The CPC is a standardized instrument that was developed by Dr. Ed Latessa & Team ~ University of Cincinnati (UC), School of Criminal Justice  The CPC is used to assess how well programs adhere to the known principles of effective interventions for offenders 4

According to the research, adhering to the principles can significantly reduce recidivism: Meta-analyses of correctional interventions have found that programs that meet these principles are achieving on average a recidivism reduction of 30% to 50% (Andrews, Zinger, et al, 1990) Source: Matthews, Hubbard, Latessa (2001) Making the next step: Using evaluability assessment to improve correctional Programming, The Prison Journal, 81(4), pp

 1.Capacity - measures whether the program has the infrastructure to deliver evidence- based interventions. Includes: ◦ Leadership & program development ◦ Staff characteristics ◦ Quality assurance (Staff: initial & on-going training & regular clinical supervision)  2.Content - focuses on offender assessment & treatment 6

 The CPC has 5 areas & includes 77 items for a total of 83 points  Each area & all domains are rated separately & then combined for an overall rating: Highly effective - 65% to 100% Effective - 55% to 64% Needs Improvement - 46% to 54% Ineffective - less than 46% 7

2012 baseline ratings: Ineffective 2013 intermediate ratings: Needs Improvement 2014 final ratings: Effective Note: We did 3 assessments in 3 years ~ Most programs take up to 2 years between assessments because that is generally how long it takes to make improvements. 8

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RSAT funded:  3 rounds of assessments for 3 programs  1 three hour report-out to stakeholders  Without RSAT funding, NDOC would not have been able to assess, redesign, or improve our programs 10

 Gave us a place to start  Broke the change process down into bite sized chunks that were manageable  Helped us understand how 1 or 2 system changes could improve our entire treatment process  Helped us to identify things we were already doing that were in alignment with the 8 EBPs  Helped us understand how to prioritize & operationalize the principles 11

1. Assess Actuarial risk/needs 2. Enhance intrinsic motivation 3. Specifically target the interventions 4. Skill train/directed practice 5. Increase positive reinforcement 6. On-going support from natural communities 7. Measure relevant processes/practices 8. Provide measurement feedback 12

 Principle 1: Risk/Needs Assessment  Principle 2: Enhance Intrinsic Motivation  Principle 3: Target Interventions: 1.Risk 2.Need 3.Responsivity  Principle 4: Skill Train/Directed Practice (using cognitive behavioral methods in a social learning environment) 13

To address this principle, we adopted the Ohio Risk Assessment System (ORAS) Dynamic risk/needs assessment that can be used with offenders at any point in the criminal justice system: Pre-trial Community Supervision Prison Intake Prison Re-Entry 14

 Provides reliable instruments with consistent meaning (Quality assurance, inter-rater reliability)  Allows for professional discretion & overrides without losing the integrity of the instrument (Quality assurance) 15

 The system can generate case plans that identify & prioritize the offender’s dynamic criminogenic needs & aid in treatment planning & service delivery. The case plan can follow the offender as he or she moves through the criminal justice system$$$  Since ORAS is designed as a set of “cross- system” tools, it has the potential to reduce duplication of efforts & it can enhance communication & sharing of information across the criminal justice system$$$ 16

 ORAS is fully automated with potential for auto-population to other criminal justice IT systems $$$  Provides more efficient allocation of supervision & treatment resources $$$  Predicts likelihood of re-arrest & recidivism at different points in the criminal justice system $$$ 17

 In order to use ORAS, users must be trained by certified trainers (quality assurance)  We used RSAT funds to train users across the criminal justice system  Once trained, users have unrestricted use of the tools $$$  To make the practice sustainable, we used additional RSAT funds to send a staff to UC to become a certified trainer 18

To date, we have used RSAT funds to train & certify over 100 users across the criminal justice system & we have more trainings scheduled: ◦ Prison  Substance Abuse Treatment Team  Associate Wardens  Intake  Case Managers  Mental Health  Re-entry ◦ Parole Board ◦ Parole & Probation ◦ County Re-Entry Court 19

Intrinsic motivation for behavioral change is dynamic & generated from within one’s self. It’s influenced by one’s values, thoughts, beliefs, & experiences While change is an “inside job,” the counselor can use motivational strategies & social learning techniques to provide the offender with new experiences & help her or him to make that internal shift 20

 Relational: Assumes people change through relationships  Social learning: Assumes our behaviors & attitudes develop in response to reinforcement & encouragement from the people around us  Good or bad, offenders are just like we are, they seek relationships & they learn from those around them 21

Hire the right staff. You want those who:  Have good interpersonal skills  Believe people can change  Have confidence in the therapeutic process  Are willing to meet the offender where he or she happens to be in the change process  Are willing to be trained on the model, as needed 22

Training Resources :  TCU Contingency Management Strategies & Ideas  Motivational Incentives: positive reinforcement  Enhancing Motivation for Change in Substance Abuse Treatment (open domain) Substance-Abuse-Treatment/SMA

 Catch them doing something good (give them a positive experience ) & give concrete, measurable feedback. (Sometimes this is a hard one for those of us who have been trained to “catch them doing something wrong”)  Ratio of good to bad should be 4:1 (quality assurance)  Praise (especially praise that is in the moment): ◦ Verbal ◦ “Thumbs up” ◦ Written 24

 Certificates: ◦ Super Star ◦ Crew Lead ◦ Most Improved ◦ Active Participant ◦ Active Leadership ◦ Peer Support 25

 Ask the group what they value & incorporate those values whenever possible: ◦ Prime real estate on the housing units ◦ First in chow line ◦ First to the weight pile ◦ First to the phones  Role plays ~ instant opportunity to have a positive experience ~ Role playing is a fine art & staff need to be trained on how to do it correctly (Quality assurance) 26

 Include offenders in quality assurance surveys & debrief the results with them: TCU, Engagement Scale: ibr.tcu.edu/wp-content/uploads/sites/2/2014/08/TCU-ENGFORM-Rev.pdf 1.Treatment Participation  Sample statement: You have learned ways to analyze & plan ways to solve your problems 2.Treatment Satisfaction  Sample statement: This program is well organized & well run 3.Counseling Rapport  Sample statement: Your counselor helps you develop confidence in yourself 4.Peer Support  Sample statement: You are similar to other clients of this program 27

 Have a suggestion box & respond  Have them measure their change across time TCU IBR: Motivation Scale  Give them individualized time & go over the instruments with them (4:1) 28

IntakeDischarge  TCU MOTform Intake Graph  TCU MOTform Discharge Graph 29

Risk Principle Need Principle Responsivity Principle Treatment Principle  30

 Use your risk/needs assessment (ORAS) to determine the offenders’ risk levels  Target those who are most at risk to recidivate  Provide more intense services to higher-risk offenders (High risk ~ 200+ hours) (Moderate risk ~ 100 hours)  Intensive treatment for lower risk offenders has been shown to actually increase recidivism 31

Tells you to target the factors that correlate with future crime:  Antisocial attitudes  Antisocial associates  Antisocial personality patterns  History of antisocial behavior (early, continued)  Family (criminal, dysfunctional)  Substance abuse  Lack of education, vocation  Lack of prosocial activities 32

Studies indicate that cognitive- behavioral therapy (CBT) based on a social learning model is the most effective intervention for offenders Milkman & Wanberg: 33

CBT/Social Learning approach:  Focus is on the “here & now” (quality assurance)  Strategies are aimed at addressing the dynamic risk factors that contribute to & drive criminal behavior  Action Oriented ~ participants are required to role play high-risk scenarios in increasingly difficult situations (quality assurance)  Completion based on acquisition of prosocial skills 34

 Counselors need to: ◦ Be trained on criminogenics (Risk/Need/Responsivity) ◦ Be trained on the CBT model (action-oriented, here & now, participant accountability) ◦ Be trained on the curriculum ◦ Maintain fidelity to the curriculum ◦ Be trained on how to do role plays ◦ Receive regular supervision, 2x/month  All of the above are critical quality assurance issues 35

 Curriculum should include homework: ◦ Counselors need to allow group time to review homework but also need to know how to keep the review from becoming the sole purpose of the session  Group size needs to be small enough to allow time for all the participants to practice the skills ~ 1:10 36

 Integrates the core components of cognitive behavioral treatment with a focus specific to substance abuse  Designed for offenders who have moderate to high criminogenic needs in the substance abuse domain  Designed to change the cognitions that influence maladaptive behavior 37

1. Motivational Enhancement Explores personal values, goals, & stage of change 2. Cognitive Restructuring Teaches the connection between thoughts, feelings, actions, & consequences 3. Emotion Regulation Teaches understanding, managing, & controlling feelings associated with cravings & urges 38

4. Social Skills  Counselor is a role model & demonstrates the skill  Participant sees skill modeled  Participant role plays the skill at his or her stage of change  Group gives the participant feedback  By learning new skills & having a positive experience, the participant gains a heightened sense of self- efficacy 39

5. Problem Solving Participants learn & practice steps to effective problem solving 6. Success planning (relapse prevention) Participants create individualized success plans based on their self-identified risk situations 40

 In order to facilitate the curriculum, staff need to be trained & certified by a certified trainer. We used RSAT funds to train & certify all substance abuse treatment staff  Since only certified trainers can train facilitators, we used additional RSAT monies to send a staff to UC to become a certified trainer. With that, we now have the capacity to sustain programming when the funding ends 41

Refers to the individual characteristics of the offender that can effect her or his engagement in treatment  Age  Anxiety/psychopathy  Cognitive deficits/functioning  Co-occurring disorders  Criminal thing  Culture  Gender  Learning style  Psychological functioning  Maturity  Motivation to change  Social functioning 42

 Criminal Thinking (CTSform) ◦ Entitlement ◦ Justification ◦ Irresponsibility ◦ Power Orientation ◦ Cold Heartedness Rationalization  Motivation (Motform) ◦ Problems ◦ Desire for Help ◦ TX Readiness ◦ Needs/Pressures  Psychological Functioning (Psyform) ◦ Self-esteem ◦ Depression/Anxiety ◦ Decision Making ◦ Expectancy  Social Functioning (Socform) ◦ Hostility ◦ Risk Taking Social Support ◦ Decision Making ◦ Expectancy 43

Criminal ThinkingSocial Functioning 44

Staff train offenders to anticipate high risk situations & teach pro-social ways to respond. (Good place to focus on motivational enhancement) Offenders identify their high risk situations then rehearse & practice prosocial responses. (Role plays & practice in natural situations). They practice each scenario until staff are satisfied they have the skills to get out of the situation. Offenders practice new behaviors in increasingly difficult situations or through more difficult role-plays Train staff well. They must: ◦ Understand antisocial thinking ◦ Understand how social learning theory works in practice ◦ Know how to do role plays  Must be willing to do role plays 45

 CBI Fidelity Form  SKILLS Group Fidelity Form 46

We are really interested in sharing what we have learned by going through this process, so if anyone is interested in a mentoring relationship with us, please contact us: Darcy Edwards, PhD Robyn Feese, LCADC

Problem Gambling: The Hidden Addiction December 17, :00 – 3:00 p.m. ET This webinar is aimed at identifying the relationship of problem gambling and addiction, as well as effective strategies in integrating problem gambling services. The training is aimed at exploring the new diagnostic criteria of Gambling Disorders, as well as explore the challenges and opportunities within the correctional system. This webinar will identify strategies for managing treatment barriers, as well as explore best practices. Presenter: Victor Ortiz, MSW 48