1. Motivating Offenders to Engage in Treatment Mary McMurran University of Nottingham

2. Plan 1.Information on treatment non-completers Work commissioned by OBPU Work commissioned by OBPU McMurran, M., & Theodosi, E. (in press). Is treatment non-completion associated with increased reconviction over no treatment? Psychology, Crime and Law. McMurran, M., & Theodosi, E. (in press). Is treatment non-completion associated with increased reconviction over no treatment? Psychology, Crime and Law. McMurran, M., & McCulloch, A. (in press). Why don’t offenders complete treatment? Prisoners’ reasons for non- completion of a cognitive skills programme. Psychology, Crime and Law. McMurran, M., & McCulloch, A. (in press). Why don’t offenders complete treatment? Prisoners’ reasons for non- completion of a cognitive skills programme. Psychology, Crime and Law.

3. Plan 1.Information on treatment non-completers 2.Motivational concepts ‘Good Lives’ and Theory of Current Concerns ‘Good Lives’ and Theory of Current Concerns McMurran, M., & Ward, T. (2004). Motivating offenders to change in therapy: An organising framework. Legal and Criminological Psychology, 9, 295-311. McMurran, M., & Ward, T. (2004). Motivating offenders to change in therapy: An organising framework. Legal and Criminological Psychology, 9, 295-311.

4. Plan 1.Information on treatment non-completers 2.Motivational concepts 3.Identifying goals, obstacles and actions Personal Concerns Interview Personal Concerns Interview Sellen, J.L., McMurran, M., Cox, W.M., Theodosi, E., & Klinger, E. (2006). The Personal Concerns Inventory (Offender Adaptation): Measuring and enhancing motivation to change. International Journal of Offender Therapy and Comparative Criminology, 50, 294-305. Sellen, J.L., McMurran, M., Cox, W.M., Theodosi, E., & Klinger, E. (2006). The Personal Concerns Inventory (Offender Adaptation): Measuring and enhancing motivation to change. International Journal of Offender Therapy and Comparative Criminology, 50, 294-305.

5. UK Recidivism Studies Early study was positive Early study was positive Friendship et al. (2002) Friendship et al. (2002) Prison evaluation of Enhanced Thinking Skills (ETS) and Reasoning & Rehabilitation (R&R) Prison evaluation of Enhanced Thinking Skills (ETS) and Reasoning & Rehabilitation (R&R) Treated (N=667) cf matched controls (N=1801) Treated (N=667) cf matched controls (N=1801) 2 year follow-up 2 year follow-up Treated reconvicted significantly less than untreated Treated reconvicted significantly less than untreated 14% reduction in reconviction 14% reduction in reconviction http://www.homeoffice.gov.uk/rds/pdfs2/r161.pdf

6. UK Recidivism Studies Later study not so positive Later study not so positive Cann et al. (2003) Cann et al. (2003) Prison evaluation of Enhanced Thinking Skills (ETS) Prison evaluation of Enhanced Thinking Skills (ETS) Treated cf matched controls Treated cf matched controls Adults (N= 2195) and young offenders (N=1544) Adults (N= 2195) and young offenders (N=1544) 1 and 2 year follow-up 1 and 2 year follow-up All starters cf comparison– no significant differences in reconviction All starters cf comparison– no significant differences in reconviction http://www.homeoffice.gov.uk/rds/pdfs2/r226.pdf

7. UK Recidivism Studies Cann et al. (2003) Cann et al. (2003) Completers Completers N= 1993 men & 1314 young offenders N= 1993 men & 1314 young offenders Significantly less likely to be reconvicted at 1 year than untreated Significantly less likely to be reconvicted at 1 year than untreated Non-completers Non-completers N= 202 adults, i.e., 9% N= 202 adults, i.e., 9% N= 230 young offenders, i.e., 15% N= 230 young offenders, i.e., 15% Reconviction higher for treatment non-completers than untreated Reconviction higher for treatment non-completers than untreated

8. UK Recidivism Studies Non-completers Non-completers Adults 9% Adults 9% Young offenders 15% Young offenders 15% Prison population Prison population Cann et al. (2003)

9. UK Recidivism Studies Probation Service programmes Probation Service programmes Think First, ETS, R&R, One-to-One, ASRO Think First, ETS, R&R, One-to-One, ASRO Hollin et al. (2004) Hollin et al. (2004) N= 2230 adults allocated to treatment N= 2230 adults allocated to treatment N= 2645 random sample of adults not allocated to treatment N= 2645 random sample of adults not allocated to treatment 1½ - 2 ¼ years post-release 1½ - 2 ¼ years post-release All starters cf comparison - no significant differences in reconviction All starters cf comparison - no significant differences in reconviction http://www.homeoffice.gov.uk/rds/pdfs04/rdsolr6604.pdf

10. UK Recidivism Studies Hollin et al. (2004) Hollin et al. (2004) Completers Completers N= 748 (34%) N= 748 (34%) Significantly less likely to be reconvicted at 1 year than untreated Significantly less likely to be reconvicted at 1 year than untreated Non-completers Non-completers N= 1482 (66%) N= 1482 (66%) Reconviction higher for treatment non-completers than untreated Reconviction higher for treatment non-completers than untreated

11. UK Recidivism Studies Non-completers Non-completers 66% 66% Probation population Probation population Hollin et al. (2004)

12. Questions Are these studies peculiar? Are these studies peculiar? Or is treatment non-completion more generally associated with increased risk of reconviction over no treatment? Or is treatment non-completion more generally associated with increased risk of reconviction over no treatment? How may we explain this? How may we explain this? What can we do about it? What can we do about it?

13. Method Systematic search of databases Systematic search of databases Offender treatment outcome studies Offender treatment outcome studies Cognitive-behavioural treatment programmes only Cognitive-behavioural treatment programmes only Data for: Data for: Completers, i.e., allocated to Tx and completed Completers, i.e., allocated to Tx and completed Non-Completers, i.e., allocated to Tx but did not complete Non-Completers, i.e., allocated to Tx but did not complete Untreated, i.e., not allocated to Tx Untreated, i.e., not allocated to Tx Groups unlikely to differ on risk (randomly allocated, risk matched, waiting list control) Groups unlikely to differ on risk (randomly allocated, risk matched, waiting list control) Reoffending or reconviction data Reoffending or reconviction data

14. Findings Identified 16 studies, reporting 17 samples Identified 16 studies, reporting 17 samples Location ~ Location ~ Community - 8 studies Community - 8 studies Detained – 9 studies Detained – 9 studies Sex ~ Sex ~ Male – 10 studies Male – 10 studies Mixed – 5 studies Mixed – 5 studies Not stated – 2 studies Not stated – 2 studies

15. Number of Offenders Total Institution Community Total Institution Community Completers 7744 6149 1595 Non-completers 2385 1056 1329 Untreated 9434 5443 3991 19,563 19,563

16. Non-Completion Rates Total Institution Community Total Institution Community Completers 7744 6149 1595 Non-completers 2385 1056 1329 Untreated 9434 5443 3991 Percentage non-completion 24%

17. Non-Completion Rates Total Institution Community Total Institution Community Completers 7744 6149 1595 Non-completers 2385 1056 1329 Untreated 9434 5443 3991 Percentage non-completion 24% 15%

18. Non-Completion Rates Total Institution Community Total Institution Community Completers 7744 6149 1595 Non-completers 2385 1056 1329 Untreated 9434 5443 3991 Percentage non-completion 24% 15% 45%

19. Untreated cf Treatment Completers Cohen’s d ranges from 0.04 to 1.52 Cohen’s d ranges from 0.04 to 1.52 Remove 5 studies to achieve homogeneity Remove 5 studies to achieve homogeneity (i.e., Q >.05), leaving 12 samples (i.e., Q >.05), leaving 12 samples Untreated N = 5626 Untreated N = 5626 Completers N = 6423 Completers N = 6423 Mean effect size d = 0.11 (95% CI 0.07 to 0.15) Mean effect size d = 0.11 (95% CI 0.07 to 0.15) The treatments in this study show a modest effect in reducing recidivism The treatments in this study show a modest effect in reducing recidivism

20. Untreated cf Non-Completers Cohen’s d ranges from 0.90 to - 0.50 Cohen’s d ranges from 0.90 to - 0.50 Remove 1 study to achieve homogeneity (i.e., Q >.05), leaving 16 samples Remove 1 study to achieve homogeneity (i.e., Q >.05), leaving 16 samples Untreated N = 9397 Untreated N = 9397 Non-completers N = 2207 Non-completers N = 2207 Mean effect size d = - 0.16 (95% CI - 0.13 to - 0.22) Mean effect size d = - 0.16 (95% CI - 0.13 to - 0.22) The treatments in this study show a modest but negative effect The treatments in this study show a modest but negative effect Non-completers are more likely to be reconvicted than untreated Non-completers are more likely to be reconvicted than untreated

21. Untreated cf Non-Completers Detained Detained 9 samples 9 samples Untreated N = 5443 Untreated N = 5443 Non-completers N = 1056 Non-completers N = 1056 Mean effect size d = -0.15 (95% CI - 0.08 to -0.22) Mean effect size d = -0.15 (95% CI - 0.08 to -0.22) Community Community Remove 2 study to achieve homogeneity (i.e., Q >.05), leaving 6 samples Remove 2 study to achieve homogeneity (i.e., Q >.05), leaving 6 samples Untreated N = 631 Untreated N = 631 Non-completers N = 400 Non-completers N = 400 Mean effect size d = -0.23 (95% CI - 0.11 to -0.36) Mean effect size d = -0.23 (95% CI - 0.11 to -0.36)

22. Summary Rates of non-completion are a concern, especially in the community Rates of non-completion are a concern, especially in the community Non-completers are more likely to be reconvicted than untreated Non-completers are more likely to be reconvicted than untreated The negative effect is more pronounced for community samples (d = -0.23) than detained samples (d = -0.15) The negative effect is more pronounced for community samples (d = -0.23) than detained samples (d = -0.15)

23. Why are non-completers more likely to be reconvicted? Compared with completers, non-completers are a higher-risk group, e.g., Compared with completers, non-completers are a higher-risk group, e.g., Score higher on risk scales Score higher on risk scales More convictions More convictions Younger Younger Less community stability Less community stability Why are higher risk offenders more likely to be non-completers? Why are higher risk offenders more likely to be non-completers? Do our treatments meet their needs? Do our treatments meet their needs?

24. Why don’t people complete? Unavailable, i.e., rearrested Unavailable, i.e., rearrested Administrative, e.g., release or transfer Administrative, e.g., release or transfer Expulsion, e.g., removed for rule-breaking Expulsion, e.g., removed for rule-breaking Drop-out, i.e., offender doesn’t want to continue Drop-out, i.e., offender doesn’t want to continue Negative, e.g., dislikes the programme Negative, e.g., dislikes the programme Positive, e.g., found a job Positive, e.g., found a job Neutral, e.g., practical difficulties attending Neutral, e.g., practical difficulties attending

25. When is non-completion? How much of a programme does an offender have to complete to be a completer? How much of a programme does an offender have to complete to be a completer? At what ‘dose’ does treatment work or not work? At what ‘dose’ does treatment work or not work?

26. Could non-completion make people worse? Removing people may Removing people may Increase anti-authority attitudes Increase anti-authority attitudes Decrease confidence in treatment Decrease confidence in treatment Increase feelings of exclusion Increase feelings of exclusion Dropping out may Dropping out may Reduce confidence in ability to benefit from treatment Reduce confidence in ability to benefit from treatment Early termination may highlight problems but not introduce coping skills Early termination may highlight problems but not introduce coping skills

27. Consequences May increase likelihood of reoffending May increase likelihood of reoffending Especially in community settings where opportunities to reoffend are immediately available Especially in community settings where opportunities to reoffend are immediately available

28. What do prisoners say? Interviews with 18 ETS non-completers Interviews with 18 ETS non-completers Non-completers said they were motivated for treatment Non-completers said they were motivated for treatment BUT, they saw ETS as not relevant to their current concerns BUT, they saw ETS as not relevant to their current concerns Specific problems more dominant, e.g., drugs and alcohol Specific problems more dominant, e.g., drugs and alcohol

29. What do prisoners say? Some non-completers found ETS too HARD Some non-completers found ETS too HARD Others found it PATRONISING Others found it PATRONISING Non-completers were not keen on GROUPS Non-completers were not keen on GROUPS

30. Improving practice Improve selection and sentence planning so that programmes meet people’s dominant concerns Improve selection and sentence planning so that programmes meet people’s dominant concerns Improve programmes so that high-risk offenders’ needs are catered for better Improve programmes so that high-risk offenders’ needs are catered for better Try not to expel people from treatment for showing the problem behaviours that they are in treatment for Try not to expel people from treatment for showing the problem behaviours that they are in treatment for Improve motivational theory and practice Improve motivational theory and practice

31. Motivational Concepts Good Lives Good Lives Primary human goods Primary human goods Life Life Knowledge Knowledge Mastery Mastery Autonomy Autonomy Peace Peace Relatedness Relatedness Meaning Meaning Happiness Happiness Creativity Creativity Professor Tony Ward New Zealand

32. Goals Important to the individual Important to the individual Clear and specific Clear and specific Attainable but challenging Attainable but challenging Positive change (rather than always giving things up) Positive change (rather than always giving things up) Focus on successes Focus on successes Develop valuable assets that are not worth risking Develop valuable assets that are not worth risking Coherent and meaningful life picture Coherent and meaningful life picture

33. Theory of Current Concerns Cox & Klinger (2004) Cox & Klinger (2004) Alcohol problems Alcohol problems A goal-based approach A goal-based approach A ‘current concern’ is an active goal A ‘current concern’ is an active goal People generally strive for satisfaction in the following life areas… People generally strive for satisfaction in the following life areas…

34. Life areas Home and household Home and household Employment and finance Employment and finance Partner, family and relatives Partner, family and relatives Friends and acquaintances Friends and acquaintances Love, intimacy, and sex Love, intimacy, and sex Self-changes Education and training Health and medical matters Substance use Spiritual matters Hobbies, pastimes and recreation

35. Personal Concerns Inventory Semi-structured interview Semi-structured interview Identify goals in life areas Identify goals in life areas Rate goals Rate goals Importance Importance Likelihood Likelihood Knowledge Knowledge Control Control Happiness Happiness Commitment Commitment

36. Identify Goals 129 male prisoners 129 male prisoners Stop offending Learn self-control Find and keep jobs Have stable accommodation Quit drink and drugs Change support networks Find new leisure pursuits Gain work experience Have good family relationships Get fit and healthy Theodosi, E., McMurran, M., Sweeney, A., & Sellen, J. (under review). Current concerns of adult male prisoners.

37. Focus on Problem Will drinking help? Will drinking help? Will drinking hinder? Will drinking hinder? OFFENDER ADAPTATION OFFENDER ADAPTATION Will offending/being in prison help? Will offending/being in prison help? Will offending/being in prison hinder? Will offending/being in prison hinder?

38. PCI:OA Motivation assessment Motivation assessment Adaptive motivation Adaptive motivation High - Commitment, Happiness, Likelihood High - Commitment, Happiness, Likelihood Maladaptive motivation Maladaptive motivation Low - Commitment, Happiness, Likelihood Low - Commitment, Happiness, Likelihood Factors replicated in our sample of offenders Factors replicated in our sample of offenders Additional Knowledge factor Additional Knowledge factor Offenders learn how to attain goals through prison activities (e.g., programmes, education, vocational training) Offenders learn how to attain goals through prison activities (e.g., programmes, education, vocational training)

39. PCI:OA High adaptive motivation may predict entry into and engagement with treatment High adaptive motivation may predict entry into and engagement with treatment A combination of adaptive motivation and treatment leads to reduced reoffending A combination of adaptive motivation and treatment leads to reduced reoffending Sellen, J.L., McMurran, M., Theodosi, E., Cox, W.M., & Klinger, E. (under review). The validity and reliability of the Personal Concerns Inventory: Offender Adaptation (PCI: OA) with adult male prisoners.

40. PCI: OA Do we select those with adaptive motivation for treatment? Do we select those with adaptive motivation for treatment? Or do we help offenders work towards a more adaptive profile? Or do we help offenders work towards a more adaptive profile? Cox & Klinger developed Cox & Klinger developed ‘Systematic Motivational Counseling’

41. Systematic Motivational Counselling Review goals and concerns Review goals and concerns Analyse goal inter-relationships Analyse goal inter-relationships Set new goals Set new goals Construct goal ladders Construct goal ladders Improve ability to attain goals Improve ability to attain goals Resolve conflict among goals Resolve conflict among goals Disengage from inappropriate goals Disengage from inappropriate goals Identify new incentives (intrinsically rewarding alternatives) Identify new incentives (intrinsically rewarding alternatives) Shift from aversive to appetitive lifestyle Shift from aversive to appetitive lifestyle Examine self-esteem Examine self-esteem

42. PCI:OA Not just an assessment of motivation Not just an assessment of motivation Also a motivational assessment Also a motivational assessment People thought about their lives People thought about their lives Clarified goals Clarified goals Considered the role of offending Considered the role of offending PCI:OA provides a framework for a motivational interview PCI:OA provides a framework for a motivational interview

43. AreaGoalsObstaclesHow does offending help or hinder goals? Plans Home and house Employment and finances Family and relatives Friends and acquaintances Love, intimacy and sexual matters Self changes (changes that people want to make to themselves) Education and training Health and medical matters Substance use Spiritual Leisure, hobbies, pastimes Other

44. Conclusions We need to research non-completion We need to research non-completion Reasons Reasons Dosage Dosage Effects of non-completion on individuals Effects of non-completion on individuals Improve Improve Selection Selection Prioritising problems Prioritising problems Sentence planning Sentence planning Develop Develop Motivational interventions Motivational interventions

45. Thank You Mary.McMurran@nottingham.ac.uk