What Works in Reducing Recidivism: Understanding Effective Treatment Models and How to Apply Them Presented by: Edward J. Latessa, Ph.D. School of Criminal Justice University of Cincinnati www.uc.edu/criminaljustice Edward.Latessa@uc.edu

Treatment Principle The most effective interventions are behavioral: Focus on current factors that influence behavior Action oriented Staff follow “core correctional practices”

Core Correctional Practices Effective Reinforcement Effective Disapproval Effective Use of Authority Quality Interpersonal Relationships Cognitive Restructuring Anti-criminal Modeling Structured Learning/Skill Building Problem Solving Techniques

Core Correctional Practices and Recidivism Effect Size Gendreau (2003). Invited Address. APA Annual Conference. Toronto.

Ratio of Rewards to Punishments and Probability of Success on Intensive Supervision Widahl, E. J., Garland, B. Culhane, S. E., and McCarty, W.P. (2011). Utilizing Behavioral Interventions to Improve Supervision Outcomes in Community-Based Corrections. Criminal Justice and Behavior, 38 (4).

List of Rewards and Sanctions Verbal reprimand Written assignment Modify curfew hours Community service hours Restrict visitation Program extension or regression Electronic Monitoring Inpatient or outpatient txt Detention time Verbal praise and reinforcement Remove from EM Level advancement Increased personal time Approved special activity Fees reduced Approve of extend special visitation Widahl, E. J., Garland, B. Culhane, S. E., and McCarty, W.P. (2011). Utilizing Behavioral Interventions to Improve Supervision Outcomes in Community-Based Corrections. Criminal Justice and Behavior, 38 (4).

Sanction Type by Offender Compliance Wadahl, Boman and Garland (2015) examined 283 offenders on ISP and looked at the effectiveness of jail time versus community-based sanctions. Widahl, E. J.,Boman, J. H. and Garland, B. E.. (2015). Responding to Probation and Parole Violations: Are Jail Sanctions more Effective than Community-based Graduated Sanctions? Journal of Criminal Justice,43:243-250.

List of Sanctions Verbal reprimand Written assignment Modify curfew hours Community service hours Restrict visitation Program extension or regression Electronic Monitoring Inpatient or outpatient txt County jail time Widahl, E. J.,Boman, J. H. and Garland, B. E.. (2015). Responding to Probation and Parole Violations: Are Jail Sanctions more Effective than Community-based Graduated Sanctions? Journal of Criminal Justice,43:243-250.

They found Jail Time: Was not related to number of days until the next violation Did not increase or decrease the number of subsequent violations Receiving jail time as a sanction as opposed to a community-based sanction did not influence successful completion of supervision

Most Effective Behavioral Models Structured social learning where new skills and behaviors are modeled Family based approaches that train family on appropriate techniques Cognitive behavioral approaches that target criminogenic risk factors

Social Learning Refers to several processes through which individuals acquire attitudes, behavior, or knowledge from the persons around them. Both modeling and instrumental conditioning appear to play a role in such learning

Some Family Based Interventions Designed to train family on behavioral approaches Functional Family Therapy Multi-Systemic Therapy Teaching Family Model Strengthening Families Program Common Sense Parenting Parenting Wisely

Effectiveness of Family Based Intervention: Results from Meta Analysis 38 primary studies with 53 effect tests Average reduction in recidivism= 21% However, much variability was present (-0.17 - +0.83) Dowden & Andrews, 2003

Mean Effect Sizes: Whether or not the family intervention adheres to the principles

The Four Principles of Cognitive Intervention Thinking affects behavior Antisocial, distorted, unproductive irrational thinking can lead to antisocial and unproductive behavior Thinking can be influenced We can change how we feel and behave by changing what we think

Recent Meta-Analysis of Cognitive Behavioral Treatment for Offenders by Landenberger & Lipsey (2005)* Reviewed 58 studies: 19 random samples 23 matched samples 16 convenience samples Found that on average CBT reduced recidivism by 25%, but the most effective configurations found more than 50% reductions

Significant Findings (effects were stronger if): Sessions per week (2 or more) - RISK Implementation monitored - FIDELITY Staff trained on CBT - FIDELITY Higher proportion of treatment completers -RESPONSIVITY Higher risk offenders - RISK Higher if CBT is combined with other services - NEED

Some Examples of Cognitive Behavioral Correctional Curriculums UC’s Cognitive Behavioral Interventions for Substance Abuse (non-proprietary) Moving On (Female Offenders) UC’s Cognitive Behavioral Treatment for Sex Offenders (non-proprietary) UC's Cognitive Behavioral Interventions for Offenders - A comprehensive curriculum (non-proprietary – pilot underway). Also adaptable for MDOs. Aggression Replacement Training (ART) Criminal Conduct and Substance Abuse Treatment Thinking for a Change (non-proprietary) UC's Cognitive Behavioral Interventions for Offenders Seeking Employment (non-proprietary – pilot underway)

Effective Practices in Correctional Supervision (EPICS) We are currently training on a new model of PO and Case Manger interaction Effective Practices in Correctional Supervision (EPICS)

Traditional Officer-Offender Interactions are often not Effective because: They are too brief to have an impact Conversations focus almost exclusively on monitoring compliance conditions (and therefore emphasize external controls on behavior rather than developing an internal rationale for pro-social behavior) Relationship is often more confrontational and authoritarian in nature than helpful What is targeted is not always based on assessment More areas discussed=less effective

Structure of EPICS Meeting SESSION OVERVIEW Each session should be structured in the following way: 1. Check-In 2. Review 3. Intervention 4. Homework 21

Rationale for EPICS Preliminary Data from Canada: Trained officers had 12% higher retention rates in comparison with untrained officers at six months. Also found reductions in recidivism 22

Two year Recidivism Results from Canadian Study Bont, et al, (2010) The Strategic Training Initiative in Community Suopervision: Risk-Need-Responsivity in the Real World. Public Safety Canada.

Findings from Federal Probation Sample Robinson, Vanbenschoten, Alexander, and Lowenkamp, Forthcoming, Federal Probation, Sept. 2011.

Recidivism Results from Ohio Study looking at Fidelity and High Risk Offenders (adult and juvenile   Latessa, E., Smith, P., Schweitzer, m., and Labrecque, R. (2013). Evaluation of the Effective Practices in Community Supervision Model (EPICS) in Ohio. School of Criminal Justice, University of Cincinnati.

We are Currently Piloting a New Version: Effective Practices for Community Support (EPICS for Influencers) Pilot Sites include: LA County Jail Reentry Program Hamilton County (Cincinnati) Reentry Coalition Portsmouth, OH Juvenile Truancy and Mentoring Program

EPICS for Influencers is Designed for: Mentors Coaches Family Members Friends Faith Based Organizations Reentry Coalitions Law Enforcement School Officials Significant others

EPICS Helps bring together all of your EBP efforts: Risk assessment and priority on higher risk offenders Focus on criminogenic needs Takes motivational interviewing to the next level Supports programs and services Helps PO and others become more effective agents of change Increases compliance Reduces recidivism

These approaches help us…. Structure our interventions Teach and model new skills Allow offender to practice with graduated difficulty Reinforce the behavior

What Doesn’t Work with Offenders?

Lakota tribal wisdom says that when you discover you are riding a dead horse, the best strategy is to dismount. However, in corrections, and in other affairs, we often try other strategies, including the following: Buy a stronger whip. Change riders Say things like “This is the way we always have ridden this horse.” Appoint a committee to study the horse. Arrange to visit other sites to see how they ride dead horses. Create a training session to increase our riding ability. Harness several dead horses together for increased speed. Declare that “No horse is too dead to beat.” Provide additional funding to increase the horse’s performance. Declare the horse is “better, faster, and cheaper” dead. Study alternative uses for dead horses. Promote the dead horse to a supervisory position.

Ineffective Approaches with Offenders Programs that cannot maintain fidelity Programs that target non-criminogenic needs Drug prevention classes focused on fear and other emotional appeals Shaming offenders Drug education programs Non-directive, client centered approaches Bibliotherapy Talking cures Self-Help programs Vague unstructured rehabilitation programs “Punishing smarter” (boot camps, scared straight, etc.)

Fidelity Principle Making sure the program is delivered as designed and with integrity: Ensure staff are modeling appropriate behavior, are qualified, well trained, well supervision, etc. Make sure barriers are addressed but target criminogenic needs Make sure appropriate dosage of treatment is provided Monitor delivery of programs & activities, etc. Reassess offenders in meeting target behaviors

Drug Court Effectiveness: What Does the Research Tell Us?

Research Includes: Primary Studies Cost Benefit Analysis Meta-Analysis

Primary Research Mixed evidence and wide range of treatment effects

Primary Research Results: Some studies show drug courts are effective in reducing recidivism rates Some show no effects At least one found that participation in drug court was associated with increased rates of recidivism (Miethe et al, 2000).

Results from Cost Benefit Studies Are the reductions in recidivism associated with drug court participation worth the additional costs? Most studies show that drug courts are cost effective Drake et al (2012) found the benefit to cost ratio was $1.77 return for $1 spent

Meta Analysis Meta analysis is a study of studies Researchers gather and code primary studies Data is then used to estimate an average effect size on recidivism

Meta Analytical Results Most have concluded that adult drug courts can reduce recidivism, however overall the effects are modest

Meta Analysis of Adult Drug Courts Aos et al (2001) 26 studies Average 13% reduction in recidivism Latimer et al (2006) 60 studies Average 12% reduction in recidivism Lowenkamp et al (2005) 22 studies Average 7.5% reduction in recidivism Stronger effects for higher risk offenders (10%) Wilson et at (2006) 48 studies Shaffer - Koetzel (2010) Average 10% reduction in recidivism 8 to 16 months more effective Requiring AA less effective Wilson et al (2012) 42 studies

Juvenile Drug Court Results have not been as Positive Shaffer (2006) found 5% reduction in recidivism Mitchell et al.( 2012) small effect on recidivism (6.5%) Latimer et al (2012) found no significant difference

2014 UC Juvenile Drug Court Study 9 Programs Across US Sites varied in location type, size, and drug court model All were reasonably-mature and funded by OJJDP Outcome Evaluation Quasi-experimental design with matched comparison group of probationers (N=1372) Official recidivism and other measures collected from records during process Process Evaluation Courts and sample of referral agencies assessed with evidence-based Correctional Program Checklist – Drug Court (CPC-DC) See Latessa et al. (2013), Sullivan et al. (2014), Blair et al. (In Press) for more. I am also happy to answer questions on aspects of the methods as well. Youth Participants   To complete the outcome evaluation, a quasi-experimental design, with matching on possible confounders and sociodemographics, was used (n=1372 with 686 in Drug Court [DC] and 686 in the Comparison [C] group). All youth enrolled in the study (youth assent and parent consent were obtained) were matched within the same jurisdiction. Youth enrollment in the study began in May 2008 and continued through December 2011. Regular correspondence with the JDCs indicated that fewer than 10 youth–across both groups–refused to participate. While some sites struggled with consenting matched comparison youth, this was from the standpoint of coordinating with probation units as opposed to parents/youth not providing consent. As an alternative, a blanket consent process was implemented to allow the research team to collect de-identified record data for matching and follow-up. The number of youth enrolled in the study per site ranged from 72 to 292, split evenly between the DC and C groups (i.e., matched one-to-one). Each site was asked to match DC participants with a standard probation youth on risk level, race, gender, and alcohol/drug abuse or dependence 196 youth (279%) in the probation group were enrolled in the study through this process, which allowed for each drug court to identify a comparison case by accessing already collected court data to match cases and collect official record data without specific consent or assent. In sites where blanket consents were sought, the University IRB and the Court in question was required to approve the process. These cases are equivalent to administrative record controls. The data predominantly consisted of drug court descriptions and individual-level measures on drug court participants and their matches. These were collected by study staff and site contractors who were trained on data extraction, coding, and ethical research practices. The individual-level measures were intended to have been easily found through case reviews. As shown in Table 1, eight of the drug courts assessed risk. Three used validated fourth-generation risk/need instruments, two used validated state-specific instruments, two used validated county-specific instruments, and one used a non-validated local instrument. In the site where no risk assessment was used (Site 7), a risk score was created based on the number of prior charges, the level of the youth's current charge, age at first referral, and number of prior adjudications. In order to create a pooled risk assessment measure across sites, benchmarks associated with each of the original instruments were used to categorize youth as low, medium, or high risk. All sites used some form of substance abuse assessment, but each differed in their preferred diagnostic tool. Approaches varied from biopsychosocial interviews which used American Society of Addiction Medicine (ASAM) or Diagnostic and Statistical Manual of Mental Disorders (DSM) criterion to assessments such as the Adolescent Substance Abuse Subtle Screening Inventory (SASSI). Numerous youth-level measures were drawn from file review including offender sociodemographics (e.g., age, sex, race/ethnicity), characteristics of the current court case (e.g., date, level and charge for the most serious offense, date of first court appearance, legal status [adjudicated or pre-adjudicated], disposition date), prior criminal history (e.g., number of prior referrals [felony and misdemeanor], and previous drug charges), drug use history (e.g., drugs used, frequency of use, age of first use), and family factors (e.g., living arrangements, criminal history). In addition, motivation surveys were given to both the DC and C groups at the time of consent. Specifically, the TCU Treatment Motivation Scale from the Client Evaluation of Self and Treatment, which has been validated previously (Simpson & Joe, 1993), was administered. It had an alpha reliability of .76 in this sample, which is in line with previous research. Other youth-level measures include legal processing indicators (e.g., date of referral and disposition, time in detention), treatment services received (e.g., type of program, completion status), drug screen results (e.g., date, result), court violations (e.g., reason, sanctions received) and associated sanctions, rewards for compliance (e.g., reason, reward received), and case closing information (e.g., treatment completed, JDC requirements met). Outcome measures consisted of official referrals to juvenile court or new arrests in the adult system and adjudications (i.e., a court finding that the youth was delinquent) or convictions in the adult system. Given the ages of youths involved, the outcome measures were predominantly drawn from juvenile records, but cases were followed into the adult system via record as necessary A self-report follow-up survey was also administered, but data are not analyzed here due to a low overall response rate.

Recidivism for Drug Court Youth vs. Comparison See Latessa et al. (2013) and Sullivan et al. (2014) for more details.

Process Evaluation Results Summary  N=9 Juv Drug Courts Domain Brief Definition from CPC-DC Average Score (%) Standard Deviation Range Development, Coordination, Staff Support Conditions exist for implementation of EBPs (e.g., staff training, case reviews) 60.5 17.5 22.2—77.8 Quality Assurance Processes for monitoring program and service providers 28.6 16.5 0.0—42.9 Assessment Practices Standardized screening and assessment for risk/need 55.5 21.6 22.2—89.0 Treatment Matching, targeting, and treating criminogenic needs in evidence-based way 40.7 7.4 27.8—50.0 Overall Total Score Across Domains 46.0 9.6 25.6—60.5 The CPC-DC is derived from the Evidence-Based Correctional Program Checklist (CPC) which is modeled after the Correctional Program Assessment Inventory (CPAI) developed by Gendreau and Andrews (1989). A number of studies of the CPC have found strong correlations with measures of recidivism outcomes for both domain areas and individual items (e.g., Holsinger, 1999; Lowenkamp, 2004; Shaffer, 2006). The CPC-DC was constructed based on previous studies of both adult and juvenile drug courts. As such, the CPC-DC has not been fully validated on either adult or juvenile drug courts as of yet. For this study, CCJR researchers spent between three and five days on-site at each drug court. All of the site visits occurred between June 2009 and October 2009. Data were collected through structured interviews with selected program staff and program participants as well as through observation of groups, service delivery, and a drug court staffing session. In some instances, surveys were used to gather additional information about the key items on the CPC-DC. Other sources of information included policy and procedure manuals, schedules, treatment materials, manuals, curricula, a review of a sample of case files, and other selected program materials. Once the information was gathered and reviewed at each site, the program was The Drug Court tool includes 41 indicators, worth 43 total points. The Referral Agency tool (CPC-DC: RA) has 49 indicators worth a total of 51 points. Each area and all domains are scored and rated as either "highly effective" (65% to 100%); "effective" (55% to 64%); "needs improvement" (46% to 54%); or "ineffective" (less than 45%). The scores in all domains are totaled and the same scale is used for the overall assessment score. It should be noted that not all of the domains are given equal weight, and some items may be considered "not applicable," in which case they are not included in the scoring. Benchmarks: “Highly Effective” (65%-100%); “Effective” (55%-64%); “Needs Improvement” (46%- 54%); “Ineffective” (≤45%)

Why are we seeing these results? Results are in line with other studies which question the use of drug courts with juvenile offenders Youth in drug courts have more opportunity to fail Youth tend to use alcohol and marijuana only: drug of choice 23.5 alcohol, 71% marijuana) Drug courts struggled to meet principles of effective intervention – most scored poorly on CPC-DC Referral agencies were not using evidence-based practices

Summary Adult drug courts can reduce recidivism and save taxpayers money, but there is no panacea Most results are promising Results for juvenile drug courts less favorable and it maybe that this is not an appropriate intervention for youth

Effectiveness of Adult Drug Courts can be Increased by taking a Systematic Approach to Program Design and Implementation Program length – most are too long and often completion rates are low Need to do a better job of assessment (cover all criminogenic needs) Target population – need to focus on higher risk Provide or match to services to meet criminogenic needs Increase intensity based on risk Use curriculum driven treatment (preferably CBT) Include structured aftercare

Some Lessons Learned from the Research How you target offender for change is important – use behavioral approaches Program Integrity makes a difference - Service delivery, training/supervision of staff, support for program, QA, evaluation, etc.