TX Forensic Mental Health Conf. #6 What Works

What Works?What Works?Reducing Criminal OffendingReducing Criminal Offending

Reasons for IncarcerationReasons for Incarceration

PunishmentPunishmentJustice for VictimJustice for VictimIncapacitationIncapacitationImpact on Potential OffendersImpact on Potential OffendersReduction of RecidivismReduction of Recidivism

Impact of More Severe Sanctions on Impact of More Severe Sanctions on RecidivismRecidivism

Incarceration vs. ProbationIncarceration vs. Probation

Intermediate Sanctions vs. Intermediate Sanctions vs. Standard SupervisionStandard Supervision

(Smith, (Smith, 2002)2002)

Characteristics of StudiesCharacteristics of Studies

117 Studies117 Studies

N = 442,471N = 442,471

(Smith, 2002)(Smith, 2002)

Impact of Incarceration on Impact of Incarceration on RecidivismRecidivism

N = 268,806N = 268,806

68% American Studies68% American Studies

No Change in RecidivismNo Change in Recidivism

or Slight Increase in Recidivismor Slight Increase in Recidivism

(Smith, 2002)(Smith, 2002)

High Quality vs. Low Quality StudiesHigh Quality vs. Low Quality Studies

High QualityHigh Quality

Random AssignmentRandom Assignment Comparison Group DesignsComparison Group Designs

AgeAgeCriminal HistoryCriminal HistoryAntisocial ValuesAntisocial Values

(Smith, 2002)(Smith, 2002)

Random Assignment StudiesRandom Assignment Studies

2 Studies2 Studies

Incarceration Vs CommunityIncarceration Vs Community

Slight increases in recidivism Slight increases in recidivism

(Smith, 2002)(Smith, 2002)

Intermediate SanctionsIntermediate Sanctions

Electronic MonitoringElectronic MonitoringFinesFinesRestitutionRestitutionIntensive SurveillanceIntensive SurveillanceScared StraightScared StraightDrug TestingDrug TestingBoot campBoot camp

(Smith, (Smith, 2002)2002)

Intermediate Sanctions vs. Standard Intermediate Sanctions vs. Standard SupervisionSupervision

N = 66,500 N = 66,500

American Studies 80%American Studies 80%

Slight Decrease in Recidivism Slight Decrease in Recidivism

Or No DifferenceOr No Difference

Boot Camps Vs. RestitutionBoot Camps Vs. Restitution

Scared StraightScared Straight No ImpactNo Impact

Boot campsBoot camps No ImpactNo Impact

RestitutionRestitution 5% Decrease 5% Decrease

(Latimer et al., 2001; MacKenzie et al., 2001)(Latimer et al., 2001; MacKenzie et al., 2001)

Same FindingsSame Findings

Juveniles vs. AdultsJuveniles vs. Adults

Men or Women (maybe)Men or Women (maybe)

White or Minority Race (few studies)White or Minority Race (few studies)

Low and High Risk OffendersLow and High Risk Offenders

(Smith, 2002)(Smith, 2002)

WomenWomen

More Severe Punishment More Severe Punishment

May Increase Recidivism in Women More May Increase Recidivism in Women More than Menthan Men

(Smith, 2002)(Smith, 2002)

ExceptionException

Intensive Supervision plus treatmentIntensive Supervision plus treatment

Slight decrease in recidivism (10%)Slight decrease in recidivism (10%)

(Smith, 2002)(Smith, 2002)

Incarceration: More or LessIncarceration: More or Less

N = 107,165N = 107,16590% American Studies90% American Studies

Mean Time for More: 31 MonthsMean Time for More: 31 MonthsMean Time for Less: 13 MonthsMean Time for Less: 13 Months

Slight Increase in RecidivismSlight Increase in Recidivism

(Smith, 2002)(Smith, 2002)

Impact of Length of IncarcerationImpact of Length of Incarceration

Difference in TimeDifference in Time Mean Effect SizeMean Effect Size

Between More & LessBetween More & Less (Weighted for (Weighted for SampleSample

GroupsGroups Size)Size)

1.1. < 6 Months< 6 Months -.01-.01

2.2. 7 to 12 Months7 to 12 Months -.02-.02

3.3. 13 to 24 Months13 to 24 Months .03 .03

4.4. > 24 Months> 24 Months .06 .06

(Smith, 2002)(Smith, 2002)

Impact of Treatment Vs. SanctionsImpact of Treatment Vs. Sanctions(Andrews, 1998)(Andrews, 1998)

-0.1

-0.05

0

0.05

0.1

0.15

0.2

Treatment

Sanctions

Impact of Treatment Vs. SanctionsImpact of Treatment Vs. SanctionsYoung OffendersYoung Offenders

-0.020

0.020.040.060.080.1

0.120.14

CriminalSanctions

Treatment

Dowden & Andrews, 1999

Impact of Appropriate Vs. Impact of Appropriate Vs. Inappropriate TreatmentInappropriate Treatment

(Andrews, 1998)(Andrews, 1998)

-0.1

-0.05

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Combined Tx

Appropriate

Inappropriate

Sanctions

Type of TreatmentType of Treatment

0

0.05

0.1

0.15

0.2

0.25

0.3

Non Behavioral

CognitiveBehavioral

Andrew, 1994

Type of Treatment & Young OffendersType of Treatment & Young Offenders

0

0.05

0.1

0.15

0.2

0.25

Non Behavioral

CognitiveBehavioral

Dowden & Andrews, 1999

““All meta-analyses on offender treatment All meta-analyses on offender treatment have a positive mean effect size.”have a positive mean effect size.”

(Losel, 1995)(Losel, 1995)

Appropriate TreatmentAppropriate Treatment

Higher Risk More IntensiveHigher Risk More Intensive

Targets Criminogenic NeedsTargets Criminogenic Needs

Uses Cognitive-Behavioral TreatmentUses Cognitive-Behavioral Treatment

Implement Treatment As Designed Implement Treatment As Designed

(Andrews, 1998)(Andrews, 1998)

Targeting Criminogenic NeedsTargeting Criminogenic Needs

Criminogenic NeedsCriminogenic Needs

CriminogenicCriminogenic Non Non CriminogenicCriminogenic

Antisocial AttitudesAntisocial Attitudes Self-EsteemSelf-Esteem

Antisocial FriendsAntisocial Friends AnxietyAnxiety

Substance AbuseSubstance Abuse DepressionDepression

ImpulsivityImpulsivity

Targeting Criminogenic NeedsTargeting Criminogenic Needs

-0.05

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Targets 1 - 3Noncriminogenic Needs

Targets 4 - 6CriminogenicNeeds

Gendreau, French & Taylor, 2002

Self Esteem Vs. Criminogenic NeedsSelf Esteem Vs. Criminogenic Needs

-0.1-0.05

00.050.1

0.150.2

0.250.3

0.350.4

Self Esteem

CriminogenicNeeds

What WorksWhat Works

Higher Risk OffendersHigher Risk Offenders At least 2 sessions per weekAt least 2 sessions per week Smaller groupsSmaller groups Implementation MonitoredImplementation Monitored Staff Trained on Cognitive-Behavioral TxStaff Trained on Cognitive-Behavioral Tx Higher Proportion of Treatment CompletersHigher Proportion of Treatment Completers

Programming That Doesn’t WorkProgramming That Doesn’t Work

PsychodynamicPsychodynamic

Non-directive/Client-centeredNon-directive/Client-centered

Disease ModelDisease Model

(Andrews, (Andrews, 1998)1998)

Impact of Cognitive Self-Change Impact of Cognitive Self-Change ProgramProgram

LengthLength New Accusations After YearsNew Accusations After Years

Of Time (Mo.)Of Time (Mo.) 11 22 33

No treatmentNo treatment 49%49% 71%71% 77%77%

1 – 61 – 6 54%54% 67%67% 80%80%

7 +7 + 25%25% 42%42% 46%46%

(Bush, 1995)(Bush, 1995)

How Many Programs Are How Many Programs Are Appropriate?Appropriate?

Correctional Program Assessment Inventory Correctional Program Assessment Inventory Scores (CPAI)Scores (CPAI)

50 correctional programs 50 correctional programs

(Latessa & Holsinger, (Latessa & Holsinger, 1998)1998)

How Many Programs Are How Many Programs Are Appropriate?Appropriate?

29.431.3

27.4

11.7

0

5

10

15

20

25

30

35

Unsatis. NI Satis. VerySatis.

(Latessa & Holsinger, 1998)(Latessa & Holsinger, 1998)

ATSA Collaborative StudyATSA Collaborative Study

N = 43 studiesN = 43 studies

All treated between 1965 – 1999All treated between 1965 – 1999 80% treated after 198080% treated after 1980 9,316 subjects9,316 subjects 23 Institutional programs23 Institutional programs 16 Community programs16 Community programs 3 both3 both

ATSA Collaborative StudyATSA Collaborative StudyRecidivism DataRecidivism Data

TreatedTreated UntreatedUntreated Odds Odds RatioRatio

Only current Only current programsprograms

SexualSexual 9.9%9.9% 17.3%17.3% .60.60

GeneralGeneral 32.3%32.3% 51.3%51.3% .57.57

Psychopathy: TreatmentPsychopathy: Treatment

• Program for personality disordered offendersProgram for personality disordered offenders• "Maxwell Jones" Therapeutic Community"Maxwell Jones" Therapeutic Community• Minimum 2 yrs in programMinimum 2 yrs in program• Mean follow-up after release = 8 yrs, 4 monthsMean follow-up after release = 8 yrs, 4 months• Psychopaths defined by PCL-R score of 27Psychopaths defined by PCL-R score of 27• PCL-R coded from files only (r = .96)PCL-R coded from files only (r = .96)• 176 treated patients; 146 untreated patients176 treated patients; 146 untreated patients• Mean time to failure = 47 monthsMean time to failure = 47 months

(Rice, Harris, & Cormier, 1992)

Psychopathy and Recidivism After Treatment

Psychopathy & TreatmentPsychopathy & Treatment

Non Non PsychopathsPsychopaths

TreatedTreated 22%22%

UntreatedUntreated 39%39%

(Harris, Rice et al., 1994)(Harris, Rice et al., 1994)

Psychopathy & TreatmentPsychopathy & Treatment

PsychopathsPsychopaths

TreatedTreated 77%77%

UntreatedUntreated 55%55%

(Harris, Rice et al., 1994)(Harris, Rice et al., 1994)

Psychopathy, Treatment, and Reconvictions Psychopathy, Treatment, and Reconvictions in HMP Servicein HMP Service

•Tx anger-management, social skills

•24-month reconviction rate

(Hare, Clark, Grann, & Thornton, 2000)Hare, Clark, Grann, & Thornton, 2000)

0

10

20

30

40

50

60

70

80

90

Low Fac I High Fac 1

Untreated

Treated

Per

cen

t R

econ

vict

ed2-Year Post-release Reconviction Rates in the

English Prison Service

Hare, Clark, Grann, & Thornton (2000)

Cost of RecidivismCost of Recidivism

To TaxpayersTo Taxpayers

To VictimsTo Victims

Computing Cost of RecidivismComputing Cost of Recidivism

Police InvestigationPolice InvestigationAdjudicationAdjudicationCorrectionsCorrectionsMedical Care of VictimsMedical Care of VictimsMental Health Care of VictimsMental Health Care of VictimsProperty DamageProperty DamageReduced Future EarningsReduced Future Earnings

(Aos, (Aos, 1999)1999)

Computing Victim Cost of Computing Victim Cost of RecidivismRecidivism

Medical CareMedical CareMental Health CareMental Health CareProperty DamageProperty DamageReduced Future EarningsReduced Future EarningsPain and SufferingPain and SufferingLoss of LifeLoss of Life

(Aos, (Aos, 1999)1999)

Cost Effectiveness of Correctional Cost Effectiveness of Correctional ProgrammingProgramming

Every $1 Spent on Correctional ProgrammingEvery $1 Spent on Correctional Programming

Taxpayers Save $5Taxpayers Save $5

Victims Save $7Victims Save $7

(Aos, 1999)(Aos, 1999)

Cost Effectiveness of Vocational and Cost Effectiveness of Vocational and Basic Education ProgramsBasic Education Programs

For Every $1 SpentFor Every $1 Spent

Taxpayers save between $1.71 & $3.23Taxpayers save between $1.71 & $3.23

(Aos et al., 1999)(Aos et al., 1999)

Cost Effectiveness of Cognitive-Cost Effectiveness of Cognitive-Behavioral Treatment ProgramsBehavioral Treatment Programs

For Every $1 SpentFor Every $1 Spent

Taxpayers Save Between $2.54 and $11.48Taxpayers Save Between $2.54 and $11.48

(Aos et al., 1999)(Aos et al., 1999)

““We found the largest and most consistent We found the largest and most consistent returns are for programs designed for returns are for programs designed for juvenile offenders.”juvenile offenders.”

(Aos et al., 1999, p. 6)(Aos et al., 1999, p. 6)

Cost Effectiveness of Programming Cost Effectiveness of Programming for Juvenilesfor Juveniles

For Every $1 Spent on Juvenile ProgramsFor Every $1 Spent on Juvenile Programs

Tax Payers Save Between $7.62 & $31.4Tax Payers Save Between $7.62 & $31.4

(Aos, 1999)(Aos, 1999)

Cost/Benefit of Adolescent Non Cost/Benefit of Adolescent Non Offender ProgramsOffender Programs

ProgramProgram TaxpayersTaxpayers Taxpayers Taxpayers &&

AloneAlone Victims Victims

QuantumQuantum $.09$.09 $.13$.13

Big BrothersBig Brothers $1.30$1.30 $2.12$2.12

(Aos, 1999)(Aos, 1999)

Cost/Benefit of Adolescent Non Cost/Benefit of Adolescent Non Offender ProgramsOffender Programs

ProgramProgram Cost/ Cost/ EffectEffect

ParticipantParticipant SizeSize

QuantumQuantum $18,292$18,292 -.42-.42

Big BrothersBig Brothers $1,009$1,009 -.05-.05

(Aos, 1999)(Aos, 1999)

Cost/Benefit of Adolescent Cost/Benefit of Adolescent Supervision ProgramsSupervision Programs

ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers & AloneAlone Victims Victims

DiversionDiversion $7.62$7.62 $13.61$13.61 Intensive Intensive

ProbationProbation .90 .90 1.49 1.49 Boot CampBoot Camp .42 .42 .26 .26

(Aos, 1999)(Aos, 1999)

Cost/Benefit of Adolescent Cost/Benefit of Adolescent Treatment ProgramsTreatment Programs

ProgramProgram TaxpayersTaxpayers Taxpayers Taxpayers &&

AloneAlone Victims Victims

ARPARP $19.57 $19.57 $31.40$31.40

Multi-SystemicMulti-Systemic 8.38 8.38 13.45 13.45

Functional FamFunctional Fam 6.85 6.85 10.99 10.99

Multi Tx FosterMulti Tx Foster 14.0714.07 22.58 22.58

Cost/Benefit of Adolescent Cost/Benefit of Adolescent Treatment ProgramsTreatment Programs

ProgramProgram Cost/ Cost/ EffectEffectParticipantParticipant SizeSize

AggressionAggressionReplacementReplacementTrainingTraining $404$404 -.26-.26

Multi-SysMulti-SysFamily TxFamily Tx $4,540$4,540 -.68-.68

(Aos, 1999)(Aos, 1999)

What Does It Take to Break EvenWhat Does It Take to Break Even

Depends on the CostDepends on the Cost

Percent Reduction to Percent Reduction to Break EvenBreak Even

AggressionAggressionReplacement Replacement TrainingTraining 1.4%1.4%

Multi-SystemicMulti-SystemicFamily TherapyFamily Therapy 10.2%10.2%