‘Effective interventions with offenders: Lessons learned’ out now

Edited by Ken McMaster & David Riley, RRP $34.95In this book we asked contributors to reflect upon their practice and identify lessons learned that can increase the effectiveness and reach of rehabilitation. We believe that despite the attacks upon the notion of investing in rehabilitation, to not do so leave those who have offended little chance of re-engaging with the norms of pro-social communities. This is an expensive and nonsensical approach when we are faced with the burgeoning costs of incarceration.
For those wondering about the picture on the front – it is a chamber pot that older prisons used for a long time. This still life was painted by Ron Jorgensen, one of New Zealand’s serious and notorious offenders.

An overview of each chapter follows.

Chapter 1: The Changing Nature of Interventions by David Wales and Nicola Tiller

The argument of this chapter is that the sceptical view of rehabilitation programmes that prevailed in the 70s — “nothing works” — should not exert the influence it still does, because the evidence for the success of properly focussed programmes has never been stronger. In the last 20 years over 2000 published evaluations and 75 meta-analyses “all provide reassuringly similar results — that carefully designed and delivered interventions that focus on offending-related behaviour and attitudes and that use recognised psychological methods, can have a significant effect on reducing re-offending rates.”

However, the effort needed to ensure that programmes are effective was underestimated in the 1980s and 1990s. The disconcerting discovery was made that when programmes that worked on a small scale were scaled up for mass delivery their effectiveness declined from an 11–14 percent reduction in offending to only a few per cent or no effect at all. Wales and Tiller search for explanations for this, and note that when 273 outcomes used in meta-studies were re-coded on the basis of 10 points of “programme integrity”, the effectiveness was in the region of 30 percent, which is higher than many expensive but widely accepted medical interventions such as heart bypasses, which have a success rate of 15 percent.

A key requirement for programmes to be effective is that those responsible for training and programme delivery have a strong investment in the success of the programme. Scaling up programmes for mass delivery needs to be at a pace that preserves the essential aspects of programme integrity, and the programmes should not be filled with offenders who do not want or need them. Wales and Tiller conclude their chapter by identifying gaps in our understanding and opportunities for further improving rehabilitation programmes.

Chapter 2: Treatment of Offending Behaviour: Is it a Legal Right? by Kris Gledhill

Most contributions to this book come from practicing psychologists or other treatment experts in the area of criminal offending. This paper is included for its contribution from a different perspective. It applies specialist legal reasoning to the important question of whether or not treatment for criminals, considered by key bodies such as parole boards to reduce risk of further offending, is an offender’s legal right or entitlement? If so, providing such treatment is not a matter of discretion but an obligation for the Department of Corrections. At present the department does not fully accept this, largely for practical reasons.
The article examines the purposes of detention, such as punishment, deterrence and incapacitation to commit crime (particularly in the instance of protective detention), and the wider context of international standards, as well as the scope and ability of available programmes and the mental health system to provide validated forms of treatment. These are knotty problems with which other jurisdictions also struggle; for example, severely personality-disordered, violent, sexual predators may have impaired volition — comparable to someone with hallucinations and delusions — but may not respond to any mental illness treatment modalities. What does this mean for the entitlement to treatment? The Department of Corrections cannot be expected to provide treatment that does not exist. In this case, does it fall to the mental health service to take responsibility for the person’s preventative incarceration?

Chapter 3: Programme Design: Getting it more right than wrong by Ken McMaster and Arthur Wells

A well thought out programme provides a challenge to offenders’ cognitions and pre-existing understandings about their behaviour, while embedding new skills to manage the situations of high risk they will find themselves in. Good programme design involves decisions about dosage, open versus closed interventions, matching delivery to responsivity factors such as learning styles, mental health and drug and alcohol issues, and how to platform and staircase the learning for greatest effectiveness. Take dosage, for example; it is arguably under-intervening to put serious offenders into a 50-hour, community-based programme when research shows they need 300 hours.

The 1970s and 1980s emphasised social skills but did not adequately address issues of gender and power, enabling some men to become more articulate and skilled abusers. Programmes responsive to feminism burgeoned towards the end of the period, targeting family violence and teaching the nature of gendered power. The assumption was that once we educated about this, behaviour change would follow. We have since had to reconsider this belief. Recent intervention design has tried to blend the best of cultural alignment, social skills training and relapse prevention, within the context of evidence-based therapeutic processes. Offence mapping is at the core of contemporary intervention design, to clarify and reveal the habitual nature of pattern behaviour. Returning to the map frequently during the treatment process enables workers and offenders alike to highlight key information about an individual’s criminogenic needs. Gone are the days of delivering a generalised programme in the hope that “something will get through.”

We now take more account, too, of the difficulty of changing personality styles, compared to changing behaviour that is socially learned. What can be learned can also be unlearned, so increasing a person’s opportunities and capacities for pro-social interaction is accomplished more quickly than changing possible underlying personality disorders, important as it is to be aware of these as part of a broader treatment plan. Therefore most current interventions focus on cognitive restructuring, emotional regulation and developing skills that reduce the risk of relapse, including educational and employment skills that increase social participation and normalise discipline in a person’s life.

Chapter 4: Supervision by Sam Farmer and Nev Trainor

Farmer in his chapter on supervision confronts the inherent difficulty of human service work, particularly with people mandated rather than voluntary participants in treatment. Workers are likely to be dealing with people who are ambivalent about change, there may be issues of safety, and if offending has been particularly sexual or violent there is a risk of vicarious trauma. The ever-present risk for workers is burn-out and ‘compassion fatigue.’ In addition, managing multiple demands from the service organisation and maintaining professional boundaries make human services work complex and unique. Good supervision is therefore a key systemic process.

The contemporary view is that supervision has three tasks: administrative oversight, professional development and clinical supervision. The first and second are the work of line managers and academic tutors. The third task, although it focuses on facilitating the worker’s therapeutic competence, inevitably involves the first two tasks as well, such as monitoring the quality of work, ensuring ethical standards are maintained and keeping in mind the safety of the client.

A supervisor therefore shoulders complex responsibilities. Farmer looks at the models that offer the greatest clarity in conceptualising the interconnected strands of a supervisor’s many accountabilities, particularly Hewson’s Supervision Triangle and the 3x3x3 multi-dimensional model of Rubel and Okech. The chapter then examines the responsibility of supervision to use evidence-based techniques and interventions and the range of macro and micro skills required for good supervision. Finally, the chapter argues that organisations have a responsibility to resource supervision adequately, as “a requisite investment in the effort to achieve important social justice outcomes.”

Chapter 5: Do No Harm: Equipping facilitators for competent practice by Sue Dark and Ken McMaster

Pedagogy, or the theory of learning, has changed rapidly over the last ten years. There is a new emphasis on the generic or soft skills that enable people to adapt to change, such as knowing how to access and put into practice new knowledge. The new direction of pedagogy focuses on learning rather than teaching, on workplaces as significant sites of learning and on learning as a lifelong endeavour. This chapter explores three key ideas: how current pedagogical shifts impact on how to best deliver training to facilitators, the core competencies we expect of facilitators and how to maximise the value of in-room training through blended learning solutions.

Blended learning solutions may include, for example, face-to-face classroom sessions with self-paced, online, distance learning. Dark and McMaster are developing an internet-based, open-source Moodle Virtual Learning Environment (www.moodle.org) to enable people in human resources training to access resources and interact online so they can collaborate on and discuss issues in their training and work experience as they arise. The authors note that online learners need a trainer who is available online, not necessarily 24/7 but by arrangement, as they develop self-discipline, self-motivation and independence in learning.

Chapter 6: Evaluation in Corrections: “Nothing Works” versus “What Works” by David Riley

This chapter by a well-known guardian of evidence-based service provision in New Zealand argues that the weight of evidence from numerous meta-analyses enables us to affirm the efficacy of properly focussed interventions. The scepticism of past decades that still exerts a powerful inertia on Corrections policy can be traced back to a narrative review in 1974 by Martinson. This created a widely held belief that “nothing works,” and led to the withdrawal of many treatment programmes in the belief that they were a waste of money. Sadly, Martinson’s virtual retraction in 1982 had little impact — the damage was done — and subsequent in-depth reviews by others, such as Gendreau and Ross in 1987 and Lipsey’s review of 450 studies in 1989, had minimal effect on the atmosphere of pessimism, despite clearly positive results. Then came Andrews, Zinger et al in 1990, whose work is the basis of the risk/needs/responsivity principles that underpin effective interventions, while McGuire in 2000 drew attention to 20 systematic reviews covering a huge number of studies that cumulatively support carefully targeted intervention. In 2008, the review by Lowencamp and colleagues reaffirmed McGuire’s view that modern psychological approaches have comparable efficacy to some standard medical treatments. Riley then gives careful consideration to what constitutes a robust standard of outcome evidence, sophisticated enough to identify the type and seriousness of offending yet containing more straightforward measures such as re-arrest, in order better to discern the presence of genuine treatment gains.

Chapter 7: Site Implementation Issues by Andrew Frost

The literature on ‘turning lives around’ from a criminal trajectory shows that transformation does not arise from merely ameliorating symptoms such as poverty or poor anger management. At least as influential are contextual factors, such as commitment to and positive expectation of change and the quality of working relationships. There is a dynamic of transition we need to attend to, that involves readiness, relationship and circumstance. We require accurate charts and fine compasses for this hazardous journey, says Frost, in order to use the wind and sea to best advantage, and any participant who takes a place in this waka must have a functional role in the passage and commit to its rules.

Research assigns about 30 percent of change to relationship factors (therapeutic relationship, partnership and collaboration), 40 percent to the client’s own resources, and a further 15 percent to hopeful expectation for the process engaged in (creating a narrative of new identity). This leaves only the last 15 percent for the intervention itself (theory and technical procedure). The first category, relationship factors, should not be thought to be confined to the ‘therapeutic alliance’ alone, but to include wider therapeutic systems such as therapeutic groups and communities and the additional value of informal connections with fellow clients, whânau members and non-clinical staff. The family and wider community are potentially part of the synergy in the rehabilitation process.

In view of the figures above, the siting of programmes in community and institutional contexts is important, as a matter of attending to the quality of social relationships that support an offender’s aspiration to live a ‘good life.’ Against a background of institutional norms of separation and isolation of offenders, who themselves come from a background of brutalising abuse and neglect, are grave obstacles in the way of establishing a purposeful and humane therapeutic community that fosters openness, responsibility, respect and collaboration.

Criminal behaviour is predicated on the failure to take into account the needs, rights and feelings of others. The traditional inmate code in prisons tends to maintain this deficit. A potential solution lies in countervailing community practices: the concerted community expression of anti-abusive sentiment, the public challenging of abusive practices (such as intimidation and stand-overs) and the use of community contact to contribute to a culture of respect, all as part of the ‘installation of hope.’

Chapter 8: Culture and Offender Rehabilitation in New Zealand: Considerations for programme delivery and development with Mâori and Pacific Peoples by Armon J. Tamatea and Tansy Brown

In New Zealand 50 percent of the more than 8,000 offenders in our prisons are Mâori, about a third are European in origin, and 12 percent are Pacific people. This reflects the forces at work in our history and our legacy of conflict, marginalisation and dislocation of Mâori resources and political autonomy, such that Mâori are over-represented in the lower percentiles of most health, education and labour force participation statistics. There are similarities too in the situation of the quarter of a million Pacific people whose home is now New Zealand.

These figures illustrate the extent to which culture is a perceptual lens through which the world is viewed by those on both sides of therapeutic interventions. Cultural awareness should be seen as a routine aspect of clinical care and the responsibility of all workers in human services, not just the domain of specialist advisers or providers, although consultation with a cultural supervisor is a valuable first step.

This chapter offers practical guidelines to help practitioners negotiate cultural differences in their work, to create a therapeutic alliance with Mâori and Pacific people. The authors show why clinical conceptualisation of work with Mâori and Pacific people should always be accompanied by a cultural formulation in order to guide treatment plans. If the level of acculturation of a Mâori or Pacific Island person is overlooked, workers may fail to appreciate how they are possibly themselves being cast in a role that is culturally familiar to an offender, such as healer, advocate, expert/authority or seer.

Such role-perceptions may determine patterns of responsiveness; eg deference to an older male or not speaking until asked. There are many things to be aware of; for example, Mâori and Pacific people may feel that self-affirmation is inappropriate self-aggrandisement. There is great importance in meeting a person face-to-face (kanohi te kanohi) and being careful not to isolate them from their spiritual community and significant others. In a communal society responsibility and accountability for wrong-doing is shared, so that the shame (whakamaa) has a wider impact than on the individual alone.

Chapter 9: Effective programmes for men who use family violence by Garth Baker

Programmes for men who use family violence grew out of feminist activism 30 years ago and were initially community based and provided by dedicated volunteers. In New Zealand the Domestic Violence Act of 1995 led to men being mandated by the Family Court to attend a programme after being served with a protection order. These programmes are commonly run with most Family Court clients, along with a few voluntary participants and others following sentencing requirements to undertake a course. The prevalent pattern is weekly community-based educational programmes of up to 50 hours for groups of 16 men.
Although funded mainly by the court systems, these programmes lack the heritage of academic backing and institutional provision that the Corrections programmes draw on. Consequently their evaluation and staff development practices are haphazard, yet they have arguably significantly increased public awareness of the prevalence of family violence and influenced the wider social environment in ways that are hard to measure. Studies of programme effectiveness indicate that factors such as maintaining a clear focus on violent behaviour, incorporating participants’ cultural values and identities, consistent attendance and the length of programme are important factors. A change which may improve effectiveness but not yet attempted in New Zealand is to match interventions to offenders, of which three are commonly identified: those abusive in a family setting who do not have significant pathology; those with dysphoric/borderline tendencies who are very clingy and controlling in close relationships; and those with severe anti-social behaviours.

A recent development is that programme providers are augmenting the Duluth model, with its gendered power and control focus, by including other therapeutic approaches such as: a cognitive behavioural focus on changing unhelpful thinking patterns and paying more attention to alcohol and drug problems; the clients’ own experience of being a victim; cultivating shared decision-making and parenting skills; increasing empathy, and managing complex issues of wider family relationships. The use of offence mapping adds an important tool in accord with this new direction in men’s programmes of paying closer attention to individual needs and motivations.

Chapter 10: Interventions with Women Offenders by Lucy King

Lucy King, in her chapter on “Interventions with women offenders” challenges us to develop a gender-informed approach to women’s offending, and identifies gender-specific pathways to antisocial behaviour and crime, such that men and women have some overlapping and some differing criminogenic needs. She notes significant differences; for instance having a harsh and adverse childhood is more predictive of offending in women than in men. A profile of women offenders in New Zealand suggests that women enter the criminal justice system with extensive gender-related problems, indicating a need to develop gender-responsive treatment programmes to address these multiple needs.

Women offenders have more mental health problems and more frequent suicide attempts than men, and widespread experiences of physical and sexual abuse or neglect as children. Offender biographies reveal that 37.5 percent of offending women come into the category of “harmed and harming women” (compared with 20% of men), and 25 percent of women offenders come into the category of “street women” who have run away from abusive households. Both categories involve typically heavy use of drugs and alcohol. In addition offending women tend to have extensive relationship and childcare problems, combined with educational, employment and financial disadvantages.

There are also protective factors in being a woman. Women rate less often on measures of low self-control than men, and much lower in terms of violent offending. Women make up only 6 percent of our prisoners and 20 percent of community sentenced offenders. However, the number of women in prison in New Zealand has increased four-fold since 1986, while the number of men increased two and a half times over the same period. Alarmingly, 60 percent of imprisoned women and 50 percent of offenders on community sentences (male and female) identify as Mâori.

Chapter 11: Working with Youth by Bronwyn Moth and Nikki Evans

What makes treatment of young people effective? Research shows that cognitive behavioural therapy (CBT) is less effective with youth offenders than with adult offenders (and also less effective for youth in some mental health contexts) (and also compared to its effectiveness in some mental health contexts). Cognitive approaches therefore need to be supplemented with other ways of promoting behaviour change in young offenders.

Meeting the criminogenic needs of youth — by which is meant all factors that call for intervention to stop the criminal behaviour — requires us to take into account the complex, dynamic risk factors that abound for youthful offenders. While ‘static risk factors’, such as the age of onset of offending, type of offending, age and gender etc, cannot be changed, ‘dynamic risk factors’ are responsive to intervention. These include school attendance, association with antisocial peers, lack of adult monitoring, interpersonal relationship problems, lack of social skills and self-control/self-management skills, problem-solving skills, alcohol and drug dependence and abuse and a lack of positive activities that reward a young person for non-criminal behaviour.

The research shows the superior effectiveness of a multi-modal approach, as you would expect when interventions are properly matched with the multiple dynamic risk factors in a youthful population. A lot of people are impacted by crime committed by youths, so it is no surprise that in New Zealand the community advocates contrary approaches to youth offending; we see punitive interventions being sanctioned and trialled alongside the proven advances discussed in this chapter. While questions remain unanswered and further work is needed to address the gender, ethnic, and specific cultural needs of youth offenders, providers of programmes can be confident that various relevant, appropriate and effective interventions are already available.

To order your copy, e-mail info@hma.co.nz

Published on Tuesday, June 7th, 2011, under Announcements, Learning & development

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