Providing Integrated Treatment to the Criminal Justice Population: Engaging Mandated Clients

Victoria Simon, Ph.D., MFT

An overview…

• RNR Overview• Engagement and the impact of

GENERATIONAL POVERTY• Engagement and the impact of TRAUMA• Trauma Treatment • Self-Sabotage: why we see it and how to help• The impact of ENVIRONMENT and

COMMUNITY

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Risk-Needs-Responsivity Model

• Risk-Need-Responsivity (RNR) Model developed in the 1980s and operationalized in the 1990s

• Designed for treatment of a criminal justice population

• Risk– Must be assessed

• Need– Must be targeted to level of risk and criminogenic issues

• Responsivity– Must be provided in a format that makes sense for this

population

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RNR, continued

• Risk– Must be assessed– Criminal behaviors can be reliably predicted– The “big eight”

• antisocial attitudes • antisocial associates • history of antisocial behaviors • antisocial personality pattern • problematic circumstances at home • problematic circumstances at school/work• problematic leisure circumstances• substance abuse

RNR, continued

• Needs– Treatment design and delivery must be specified

for offenders• Moral Reconation Therapy• Values• The Con Game• Thinking Errors• Mindfulness

– http://www.changecompanies.net/– https://www.ccimrt.com/mrt

– Treatment must target criminogenic needs5

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RNR, Continued

• Responsivity– Describes how treatment should be provided• Cognitive Behavioral Therapy with Cognitive Social

learning approach (practicing pro-social behaviors, problem solving tools and experience, etc.)• Focus on client’s learning style• Focus on motivation and stage of change (pre-

contemplation, contemplation, preparation, action, maintenance)• Focus on abilities and strengths

RNR, continued

• When working with a criminal justice population, why is it important that treatment design and delivery be specified for offenders?– Standard outpatient programs that don’t address

criminogenic need (1% INCREASE in recidivism)– Programs addressing criminogenic need (19%

decrease in recidivism)– Programs with criminogenic and CBT/RNR

approaches (32% decrease in recidivism)

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The Impact ofGENERATIONAL POVERTY

data compiled by Dr. Carrie Petrucci; following from (Payne, et al., 2009)

- Characteristics of Generational Poverty• Defined as two or more generations in poverty• The mother is usually the center of the family

- Impacts of Generational Poverty- Allostatic load (“wear and tear” on the body from the

neuroendocrine, nervous, cardiovascular, metabolic and immune systems): the greater the allostatic load, the greater the impairment to other brain functions

• Negatively impacted by poverty and its effects:– Language – Memory ability– Working memory– Executive functions

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• Impact on learning:• Decreased Executive Functioning impacts:

• behavior self regulation• adult intelligence• problem solving

• Working memory includes the ability to do the following:• Giving/receiving multiple directions at once• Planning• Task Completion• Behavioral self regulation• Ability to identify options

Generational Poverty, continued

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Generational Poverty, continued

- Impacts of Generational Poverty on treatment• The majority of EBP and PP curriculums – even those

designed for the offender population – don’t take into account the impacts of generational poverty on learning– Curriculums are primarily reading/writing intensive– Demand independent problem solving– Depend on memory without repetition or role play– Require planning and task completion– Often use language that is set in a more formal register (rather

than the casual register that clients use)

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Generational Poverty, continued

What has NOT been impacted by Generational Poverty?Visual and spatial abilities - suggesting that visual teaching and learning techniques are the most effective

– Training for treatment staff needed about how to modify information within a sensory learning format• Sight, sound, smell, taste, visual, tactile experience• Repetition and role play is vital

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The Impact ofTRAUMA

Trauma data from Lynne Marsenich, LCSW

– What is Trauma?• A Traumatic event is one in which a person experiences,

witnesses or is confronted with actual or threatened death or serious injury, or threat to the physical integrity of oneself or others• Responses to trauma often include intense fear,

helplessness or horror

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Trauma, continued

– Prevalence• Individuals with trauma histories from childhood

onward make up the majority of clients with mental health and substance abuse issues• 90% of all clients receiving MH support have been

exposed to or experienced trauma (Mueser et al., 1998)• 75% of all clients receiving SA treatment report trauma

histories (SAMSHA/CSAT, 2000)• Males are most likely to report witnessing violence,

while females report being victims of violence (Hennessey et al., 2004)

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Trauma, continued

– Trauma experiences• When abused in childhood, individuals commonly

experience trauma and re-victimization through domestic violence, sexual assaults, gang and drug related violence, homelessness and poverty• Females sexually abused during childhood are 2.4 times

more likely than non abused females to be sexually assaulted as adults (NASMHDP/NTAC, p. 55)• Adults with trauma histories are frequently traumatized

further in incarcerated settings and in the community by supervising and social service agencies– Unsafe environments– Coercive interventions

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Trauma, continued

– Trauma and the Criminal Justice population• The majority of men and women in the criminal justice

system report having been abused as children• Trauma experiences are interpersonal in nature,

intentional, prolonged and repeated; they may extend over years of life• They include sexual abuse and/or incest, physical

abuse, severe neglect, psychological abuse• They include witness and threats of violence (personal

and community), repeated abandonment and sudden and traumatic losses

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Trauma, continued

– Trauma Informed Interventions• Incorporate knowledge about trauma – prevalence,

impact and recovery – in all aspects of service delivery• Create environments that are hospitable and engaging

for survivors• Consider factors of gender and culture• Minimize re-victimization• Facilitate recovery and empowerment• Symptoms are not understood as pathology but primarily

as attempts to cope and survive• Survivors are survivors – their strengths need to be

recognized

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Trauma, continued

– Trauma Informed Interventions, continued• A collaborative relationship between the

consumer and the provider• Both the consumer and provider are assumed

to have valid and valuable knowledge bases• The consumer’s safety must be guaranteed and

trust must be developed over time

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Trauma Treament

• Trauma Narrativevs.

• Symptom Management

SELF SABOTAGE

– Why do we see self-sabotage?• Success tests limits and creates vulnerability• Fear of embarrassment/shame if there is real or

perceived failure• Ambivalence about new image• Practical concerns

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Self-Sabotage, continued

• How to address self-sabotage– Basic CBT approaches• Increase awareness of fears/concerns• Look at Pros/Cons• Teach thought stopping and replacement tools• Take small steps• Seek peer support• Ensure that there are support systems in place for

practical needs• Allow for both forward and backward movement

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Questions to ask when looking to increase engagement

• Do clients feel comfortable in their treatment environment?

• Is the treatment environment welcoming?• Does the client feel safe? Do the female clients feel

safe?• Does the treatment environment understand and

address literacy?• Are groups offered in a sensory learning format?• Is individual literacy support provided to clients who

have reading/writing/comprehension issues?

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Questions for increase engagement, continued

• Is the treatment provider aware of client’s trauma history?

• Is there not only trauma treatment, but trauma informed care?

• Are there coercive treatment interventions being used? How are “mandatory” services handled?

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Questions for increase engagement, continued

• How is Malingering handled?– Has the client learned pro-social behaviors yet?– When the client says that something is wrong, do

people listen?– If the client says that something is “a little wrong,”

do people listen?– Does the client feel shut down when they make a

request?

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The Impact of ENVIRONMENT and COMMUNITY

How is a discussion about the environment and community of a treatment agency relevant to a

training on the treatment of offenders?

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ENVIRONMENT and COMMUNITY, continued

– What makes people stay connected? Retention is driven by emotional factors!

– The Power of Habit by Charles Duhigg sites a study done in 2000 for YMCA to determine why certain clubs had significantly higher retention than others. The conclusion? “Retention, the data said, was driven by emotional factors, such as whether employees knew members’ names or said hello when they walked in.” (p. 211)

– This is most likely the same reason that community based organizations are the ONLY treatment providers to invert the retention numbers (70% retention vs. the 30% that is typically seen)

– Underlines the importance of feeling “connected” to an agency

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• A Welcoming Environment– This is as simple as good customer service– Why do social service agencies think they work in an

industry where the idea of “customer service” doesn’t apply?

– Basic customer service skills that don’t seem to be expected in the social service world:• Either answer your phone or return your calls• Don’t make promises unless you can keep them• Listen to your customers• Deal with complaints• Be helpful – even if there is no immediate profit in it• Train your staff to be helpful, courteous and knowledgeable • Take the extra step• Think outside the box

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Please feel free to get in touch with additional questions at any time…

Victoria Simon213 620 5712 x 100

vsimon@project180la.com