1. 2/2/20141 Case Planning and Case Management IACCAC 2012

2. 2/2/20142 Training Format and Goals Format - Distribution of MaterialsDistribution of Materials Presentation, Discussion and Practice of ConceptsPresentation, Discussion and Practice of Concepts QuestionsQuestions Goals - To provide participants with information and tools to assist them implement (or continue to implement) effective case planning and case management strategies.To provide participants with information and tools to assist them implement (or continue to implement) effective case planning and case management strategies. To provide participants with resources to further develop the case planning and case management process in their workplace.To provide participants with resources to further develop the case planning and case management process in their workplace.

3. 2/2/20143 The Eight Principles of Evidence-Based Practice Assess Actuarial Risk/Need.Assess Actuarial Risk/Need. Enhance Intrinsic Motivation.Enhance Intrinsic Motivation. Target Interventions.Target Interventions. Skill Train With Directed Practice.Skill Train With Directed Practice. Increase Positive Reinforcement.Increase Positive Reinforcement. Engage Ongoing Support in Natural Communities.Engage Ongoing Support in Natural Communities. Measure Relevant Processes/Practices.Measure Relevant Processes/Practices. Provide Measurement Feedback.Provide Measurement Feedback.

4. 2/2/20144 The Principles Tell Us Assessment is necessary to conduct effective case planning and case management. Assessment is necessary to conduct effective case planning and case management. The assessment tells us not only who to target for services (risk principle), but also what to target (need principle). The assessment tells us not only who to target for services (risk principle), but also what to target (need principle). Assessment drives case planning. Assessment drives case planning.

5. 2/2/20145 Why Use Case Planning and Case Management? Provides a bridge between client assessment and client risk reduction.Provides a bridge between client assessment and client risk reduction. Provides structure (staff and clients).Provides structure (staff and clients). Documents interventions and progress.Documents interventions and progress. Clarifies expectations of clients.Clarifies expectations of clients. Gauges client motivation/readiness to change.Gauges client motivation/readiness to change. Engages clients in the process of change.Engages clients in the process of change. Guides decision-making.Guides decision-making. Ensures the focus of participation remains on reduction of criminogenic need.Ensures the focus of participation remains on reduction of criminogenic need. EPICS & Rhode Island Department of Correction 2010

6. 2/2/20146 Staff Characteristics Case Manager Relationship Skills –Case Manager Relationship Skills – –Open, warm and engages in respectful communication with clients (and others in the workplace). –Non-blaming and genuine. –Flexible, using appropriate humor. –Enthusiastic and expresses optimism. –Avoids argumentation and supports self-efficacy.

7. 2/2/20147 Case Plans At Minimum, Case Plans Should – –Identify client risk level and criminogenic need based on empirically- based, validated risk and need assessments. –Outline client responsibilities. –Lay out appropriate interventions to address the highest areas of criminogenic need. –Clearly/concisely articulating client goals related to his/her criminogenic need. –Each goal should include strategies for achievement that are specific, time-bound and measurable. –Include assessments of clients readiness for change. –Be updated to reflect client progress. TPC Case management Handbook: An Integrated Case Management Approach 2010

8. 2/2/20148 Stages of Change Understanding the Stages of Change is an important element in case planning and case management.Understanding the Stages of Change is an important element in case planning and case management. –Pre-Contemplation – Client believes nothing needs to change. –Contemplation – Client begins to consider change. –Preparation – Client figuring out how to change. –Action – Client is working on reaching goals. –Maintenance – Client now working on keeping up changes. –Relapse – Client Feeling Ive fallen back... All is lost. Adapted from Motivating Offenders to Change: A Guide for Probation and Parole, by S.T. Walters, M.D. Clark, B.A.Gingerich, and M.A. Meltzer (Washington, DC: U.S. Department of Justice, National Institute of Corrections, 2007), p. 15.

9. 2/2/20149 Assess Readiness for Change Offender Self-Assessment Survey (O-Self)Offender Self-Assessment Survey (O-Self) –Maryland Division of Probation and Parole O-Self Tool. Change QuestionnaireChange Questionnaire –By William R. Miller, Theresa B, Moyers, and Paul Amrhein (2005) Department of Psychology, University of New Mexico.

10. 2/2/201410 Addressing the Stages of Change Pre-Contemplation – Raise doubt. Increase clients perception of risks related to behavior.Pre-Contemplation – Raise doubt. Increase clients perception of risks related to behavior. Contemplation – Evoke reasons for change. Promote clients self-efficacy related to making the change.Contemplation – Evoke reasons for change. Promote clients self-efficacy related to making the change. Preparation – Assist client develop a plan.Preparation – Assist client develop a plan. Action – Implement plan.Action – Implement plan. Maintenance – Assist client develop strategies to avoid relapse.Maintenance – Assist client develop strategies to avoid relapse. Relapse – Assist the client recycle through the preceding stages, without becoming stuck or demoralized by the relapse.Relapse – Assist the client recycle through the preceding stages, without becoming stuck or demoralized by the relapse. Prochaska and DiClemente (1986).

11. 2/2/201411 Effective Communication Techniques An integral part of case planning and case management is reliance on effective communication techniques.An integral part of case planning and case management is reliance on effective communication techniques. Motivational Interviewing, for example, facilitates the work of case planning and management - Motivational Interviewing, for example, facilitates the work of case planning and management - –Expresses Empathy. –Amplifies Ambivilance. –Reminds staff that resistance is expected and encourages us to roll with it. –Supports Self-Efficacy.

12. Supervision by risk Risk Management (low risk)Risk Management (low risk) - Involves providing the least restrictive, most appropriate sanctions and supervision Risk Reduction (moderate-high risk)Risk Reduction (moderate-high risk) - Involves determining criminogenic needs and reducing risk factors through effective intervention and appropriate supervision Risk Control (extreme high risk)Risk Control (extreme high risk) - Involves techniques that control risk of reoffending while under correctional authority The Carey Group 2/2/201412

13. Applying the assessment Low risk – GET OUT OF THE WAYLow risk – GET OUT OF THE WAY - intensive treatment for lower-risk offenders an actually increase recidivism Moderate-high risk – ZERO INModerate-high risk – ZERO IN - Target these offenders Extreme high risk – LIVE IN THEIR BACK POCKET – provide the most intensive treatment to higher-risk offendersExtreme high risk – LIVE IN THEIR BACK POCKET – provide the most intensive treatment to higher-risk offenders Carey group 2/2/201413

14. 2/2/201414 Case Planning by Risk and Need. The Risk Principle:The Risk Principle: –More service should be delivered to higher risk clients. The Practice: The Practice: See client more frequently. See client more frequently. Use more focused interventions. Use more focused interventions. Use community and family resources. Use community and family resources.EPICS

15. 2/2/201415 Case Planning by Risk and Need The Need Principle:The Need Principle: –Focus interventions on criminogenic needs. The Practice:The Practice: –Translate risk and need assessment into need priorities. –Facilitate change in thoughts, attitudes, values and beliefs. EPICS

16. 2/2/201416 Case Planning by Risk and Need The Responsivity Principle:The Responsivity Principle: –Enhance behavioral change efforts by delivering services that are responsive to the client. The Practices: The Practices: Structure the case management sessions. Structure the case management sessions. Establish rapport with the client. Establish rapport with the client. Teach clients concepts and skills in a clear and concise manner. Teach clients concepts and skills in a clear and concise manner.EPICS

17. Gender Responsivity Programs should be gender-specific whenever possiblePrograms should be gender-specific whenever possible DistractionsDistractions Trauma/History issuesTrauma/History issues Group dynamicGroup dynamic Men and women have different ways of learning and relating to othersMen and women have different ways of learning and relating to others 2/2/201417

18. 2/2/201418 Provide Most Intensive Interventions to Higher Risk Offenders Higher risk offenders will require much higher dosage of treatmentHigher risk offenders will require much higher dosage of treatment –Rule of thumb: 100 hours for moderate risk –200+ hours for higher risk –100 hours for high risk will have little if any effect –Does not include work/school and other activities that are not directly addressing criminogenic risk factors (Latessa, 2010)

19. Case Plans for high risk offenders Use the risk assessment to develop the case planUse the risk assessment to develop the case plan When developing, ask the offender what areas they need to work on but include risk factors if they offender does not recognizeWhen developing, ask the offender what areas they need to work on but include risk factors if they offender does not recognize Identify immediate targets and prioritizeIdentify immediate targets and prioritize 2/2/201419

20. Referrals The assessment should determine program/community referralsThe assessment should determine program/community referrals Make sure the offender meets program criteria for referralMake sure the offender meets program criteria for referral Ensure the offender is appropriate for the programEnsure the offender is appropriate for the program Assess the defendants motivation to changeAssess the defendants motivation to change 2/2/201420

21. Referrals cont… If referred to substance abuse/mental health agency, COMMUNICATE with the referring agencyIf referred to substance abuse/mental health agency, COMMUNICATE with the referring agency - referral form and release of information - Give the agency as much information as possible (PSI, drug screens, prior use history, current family/social situation) - the treatment agency should make recommendation for type of treatment 2/2/201421

22. 2/2/201422 Case Management Targets Target First: Target First: Attitudes, values/beliefs Attitudes, values/beliefs Peer Associations Peer Associations Personality factors (impulsivity, low self-control, etc.) Personality factors (impulsivity, low self-control, etc.)

23. 2/2/201423 Case Management Targets Then These:Then These: –Education/Employment –Family –*Substance Abuse –Leisure/Recreation *Substance Abuse can be identified as an acute issue and dealt with at the same time we address the first three areas. time we address the first three areas.

24. 2/2/201424 The Four Principles of Cognitive Intervention 1.Thinking affects behavior. 2.Antisocial, distorted, unproductive irrational thinking can lead to antisocial and unproductive behavior. 3.Thinking can be influenced. 4.We can change how we feel and behave by changing what we think.

25. 2/2/201425 Cognitive-Behavioral Approach Cognitive-behavioral models involve the following - Scientific approach.Scientific approach. Active.Active. Focus on the present.Focus on the present. Based on theories of learning.Based on theories of learning. Individualized.Individualized. Progression oriented.Progression oriented. Can be accomplished in brief periods of time.Can be accomplished in brief periods of time. Information Taken from EPICS.

26. 2/2/201426 Session Structure 1.Check-In: Goals – Develop relationship (How are you and what is going on?) Enhance working relationship. Assess for crisis. Assess for crisis. Assess for compliance.

27. 2/2/201427 Session Structure 2.Review: Goals - Build trust and respect Enhance collaboration through mutually agreed upon goals. Enhance learning through repetition and feedback. Community agency follow-up.

28. 2/2/201428 Session Structure 3.Intervention: Goals -Focus on pro-criminal thinking. Demonstrate cog-behavioral link. Demonstrate cog-behavioral link. Use strategic CB Techniques. Use strategic CB Techniques. Teach new prosocial attitudes and skills. Teach new prosocial attitudes and skills.

29. 2/2/201429 Session Structure 4.Homework: Goals -Practice, generalize, connect Rehearse new learning. Rehearse new learning. Generalize new learning. Generalize new learning. Connect to community resources. Connect to community resources.EPICS

30. 2/2/201430 Effective Strategies Effective Use of AuthorityEffective Use of Authority Effective Use of ReinforcementEffective Use of Reinforcement Effective Use of DisapprovalEffective Use of Disapproval Effective Use of Problem-SolvingEffective Use of Problem-Solving Tapes and CountersTapes and Counters Thinking ReportsThinking ReportsEPICS

31. 2/2/201431 Effective Use of Authority 1.Focus the message on behavior and not the client. 2.Be direct and specific concerning requirements. 3.Use your normal voice, avoiding yelling. 4.Specify choice and the potential consequences (rather than using doomsday ultimatums). 5.Give encouraging messages. 6.Support words with action. Be sure to follow through. 7.Provide respectful guidance towards compliance. 8.Look for the positive. 9.Reward/praise compliance.

32. 2/2/201432 Effective use of Authority Group Activity

33. 2/2/201433 Increase Positive Reinforcement Increase Positive Reinforcement Reinforcement always involves frequency of behavior.Reinforcement always involves frequency of behavior. The reinforcing consequence is known as a reinforcer.The reinforcing consequence is known as a reinforcer. Research shows that behavioral change occurs at a ratio of four reinforcers to one punisher.Research shows that behavioral change occurs at a ratio of four reinforcers to one punisher.

34. 2/2/201434 Reinforcements/Incentives Reinforcers should be: Specific and valued by the client.Reinforcers should be: Specific and valued by the client. Client behavior must be: Monitored, recognized, reinforced/rewarded, punished/sanctioned and corrected.Client behavior must be: Monitored, recognized, reinforced/rewarded, punished/sanctioned and corrected. Must be used with staffs use of prosocial modelingMust be used with staffs use of prosocial modeling (Fulton, B.A., S.B. Stone, P. Gendreau, 1994.)

35. 2/2/201435 Effective Use of Reinforcement 1.Immediately inform the client that you like what he/she did or said. 2.Tell the client why you like what he/she did or said. Be very specific. 3.The emphasis given should be different from the support he/she normally receives. 4.Explore with the client the short and long-term consequences of continuing to engage in that behavior. 5.Use a variety of social reinforcers. 6.Pair your verbal reinforcement with other reinforcers.

36. 2/2/201436 Contingency Contracts Contingency Contracts are also known as behavioral contracts. This tool can be used as a means to reinforce a desired behavior.Contingency Contracts are also known as behavioral contracts. This tool can be used as a means to reinforce a desired behavior. Elements of a Contingency Contract include:Elements of a Contingency Contract include: –Clarification of roles for both the client and staff. –Detailed description of expected behavior. –Detailed description of the expected reinforcement/reward. –Specific criteria to determine if the desired behavior occurred. –Defined process for revising the contract (Patricia VanVoorhis, Michael Braswell, and David Lester)

37. 2/2/201437 Effective Disapproval 1.Immediately tell the client that you did not like the type of behavior or speech just exhibited by him/her. 2.Explain to the client why you did not like what he/she said or did. Be specific. 3.Explore with the client the short and long-term consequences of continuing to engage in that behavior. 4.Discuss and identify prosocial alternatives that could be used in place of the unacceptable behavior.

38. 2/2/201438 Effective Disapproval Group Activity

39. 2/2/201439 Effective Use of Problem-Solving 1.Stop, think, and identify the problem. Assist the client in recognizing cues that might alert him/her there is a problem. Assist the client in recognizing cues that might alert him/her there is a problem. 2.Clarify goals. Assist client identify positive outcomes. Assist client identify positive outcomes. 3.Generate alternative solutions. Brainstorm possible solutions with client. Make a list of actions. Brainstorm possible solutions with client. Make a list of actions. 4.Evaluate. Review the list of solutions and discuss the possible short and long-term consequences of each alternative. Review the list of solutions and discuss the possible short and long-term consequences of each alternative. 5.Implement the plan. Have the client develop a concrete action plan. Have the client develop a concrete action plan. Role-play the plan. Role-play the plan. Have client practice the plan between sessions. Have client practice the plan between sessions. 6.Evaluate the plan. Determine if the plan is working. Determine if the plan is working. Assist client develop ways to modify and evaluate the plan. Assist client develop ways to modify and evaluate the plan.

40. 2/2/201440 Problem-Solving Group Activity

41. 2/2/201441 Tapes and Counters These are thoughts, attitudes, values and beliefs that perpetuate criminal behavior.These are thoughts, attitudes, values and beliefs that perpetuate criminal behavior. Generally, we see two categories of tapes: Neutralizations and Macho Man Violence.Generally, we see two categories of tapes: Neutralizations and Macho Man Violence.

42. 2/2/201442 Tapes and Counters Neutralizations (Sykes and Matza, 1957) include various types of denial (i.e. responsibility, injury, victim), system bashing and appealing to higher loyalties.Neutralizations (Sykes and Matza, 1957) include various types of denial (i.e. responsibility, injury, victim), system bashing and appealing to higher loyalties. Macho Man Violence – representing more aggressive ways to approach people and situations (i.e., Fighting is just part of life).Macho Man Violence – representing more aggressive ways to approach people and situations (i.e., Fighting is just part of life).

43. 2/2/201443 Changing Tapes To promote risk reduction, we can engage in activities designed to target pro-criminal attitudes and beliefs.To promote risk reduction, we can engage in activities designed to target pro-criminal attitudes and beliefs. Strategy:Strategy: –Teach clients to – Catch it.Catch it. Counter it.Counter it. Cookie self.Cookie self.

44. 2/2/201444 Changing Tapes Catching it:Catching it: –The first step is learning to recognize the tape. Countering it:Countering it: –Generate more prosocial behaviors. Begin with working on developing a new prosocial alternate attitude.Begin with working on developing a new prosocial alternate attitude. Then identify a new behavior.Then identify a new behavior. –Follow the RULE (Realistic, Useful, logical, and evidence) tool. Cookie self:Cookie self: –Identify and apply an internal reward for doing the above. EPICS

45. 2/2/201445 Tapes and Counters Group Activity

46. 2/2/201446 Thinking Reports Thinking Reports - A brief description of the situation.A brief description of the situation. A detailed account of the clients thoughts.A detailed account of the clients thoughts. A brief report of the clients feelings.A brief report of the clients feelings.

47. 2/2/201447 Major Risk and/or Need Factors and Promising Intermediate Targets for Reduced Recidivism FactorRiskDynamic Need Family and/or maritalTwo key elements areReduce conflict, build nurturance and/or caringpositive relationships, better monitoring and/orcommunication, enhance supervisionmonitoring & supervision School and/or workLow levels of performanceEnhance performance, & satisfactionrewards, & satisfaction Leisure and/or recreationLow levels of involvement Enhancement involvement & satisfaction in anti- & satisfaction in prosocial criminal leisure activitiesactivities Substance AbuseAbuse of alcohol and/orReduce SA, reduce the Substance AbuseAbuse of alcohol and/orReduce SA, reduce the drugspersonal & interpersonal supports for SA behavior, enhance alternatives to SA Adopted from Andrews, D.A. et al, (2006). The Recent Past and Near Future of Risk and/or Need Assessment. Crime and Delinquency, 52 (1).

48. 2/2/201448 Major Risk and/or Need Factors and Promising Intermediate Targets for Reduced Recidivism FactorRiskDynamic Need History of AntisocialEarly & continued Build noncriminal Behaviorinvolvement in a number alternative behaviors antisocial actsin risky situations Antisocial personalityAdventurous, pleasureBuild problem-solving, self- seeking, weak self management, anger mgt & control, restlessly aggressive coping skills Antisocial cognitionAttitudes, values, beliefsReduce antisocial cognition, & rationalizations recognize risky thinking & supportive of crime, feelings, build up alternative cognitive emotional statesless risky thinking & feelings of anger, resentment, &Adopt a reform and/or defianceant criminal identity Antisocial associatesClose association withReduce association w/ criminals & relative isolationcriminals, enhance from prosocial peopleassociation w/ prosocial people from Andrews, D.A. et al, (2006). The Adopted Recent Past and Near Future of Risk and/or Need Assessment. Crime and Delinquency, 52 (1).

49. 2/2/201449 Where to Get More Information University of Cincinnatis Corrections Institute - corrections.institute@uc.eduUniversity of Cincinnatis Corrections Institute - corrections.institute@uc.edu National Institute of Corrections – nicic.govNational Institute of Corrections – nicic.gov Indiana Department of CorrectionIndiana Department of Correction