Treatment Of Offenders

Front 1

What IS treatment? Fill in the blanks:

Sechrest et al (1979): "The result of any planned intervention that reduces ..., whether the reduction is mediated by personality, behavior, abilities, attitudes, values, or other factors."

Back 1

reduces an offender's further criminal activity

Front 2

The following are examples of which level of prevention?

"Head Start" program (Zigler, 1994)
Mentoring strategy (Sherman et a., 1998)
Big Brother/Sister programs.

Back 2

The primary level of prevention. There are examples of large scale screening, on which primary prevention depends. Along with knowledge of development and risk factors, these programs help to identify individuals who may be "stopped.. before it ever happens"

Front 3

Custody diversion and alternate measures are examples of which level of intervention?

Back 3

secondary prevention

Front 4

What makes it difficult to identify kids for secondary prevention?

Back 4

Those who show early signs of criminal involvement may be more involved in crime than the infraction suggests.

Front 5

What is Gang monitoring/the Spergal Model?

Back 5

Gang leaders are held responsible for actions of subordinate members.

Provides recreational, economic, and educational opportunities. (?)

Front 6

Gang monitoring / the Spergal Model is an example of which level of intervention?

Back 6

Secondary Prevention

Front 7

Which is the least effective level of prevention?

Back 7

Tertiary

Front 8

What is the most expensive level of prevention?

Back 8

Tertiary

Front 9

Formal Treatment is synonymous with which level of prevention?

Back 9

Tertiary

Front 10

What are two advantage of Community-Based interventions?

Back 10

When the context for treatment deliverance most resembles the patients actual living conditions/setting (ACTUAL OPERATIONAL ENVIRONMENT), treatment is more likely to produce long-lasting effects. (That is an EASIER GENERALIZATION of treatment effects.)

Also, it is CHEAPER.

Front 11

Which approach is the cheapest form of intervention:

1. Community-Based,
2. institutional, or
3. Inpatient Approaches

Back 11

1. Community-Based approaches are cheapest, (as well as most effective).

Front 12

What is the range of community-based interventions?

Back 12

Community-based interventions range from short-term to long-term, outpatient to residential.

Front 13

Which intervention uses a "tridactic model"?

Back 13

C-b interventions.

Front 14

Which type of intervention can utilize naturally occurring reinforcers?

Back 14

Community-based

Front 15

What are some risks/downsides of community-based intervention? (name 3 of 5)

Back 15

Community security and/or community opposition.

Family may undermine therapist's efforts (if done in natural home).

Contingencies may be difficult to manage. (when using natural reinforcers, I'm guessing).

Also:

interagency coordination

and

safety of therapists

Front 16

What is a problem with some juvenile awareness programs (such as "Scared Straight")?

Back 16

They have flimsy track records, because they are based on INTENSITY, rather than PROBABILITY of punishment. (Gendreau & Ross, 1987)

Front 17

Wilderness experience programs, such as "Outward Bound," (Eg., Garrett, 1985) focus on fostering self-esteem. What type of intervention are they an example of?

Back 17

C-b interventions

Front 18

Which example of a community-based intervention runs on the behavioral principle of "overcorrection"?

Back 18

Restitution/Community Service orders

Front 19

Restitution/Community Service orders run on what behavioral principle?

Back 19

Overcorrection.

Front 20

Are restitution/community service orders effective for serious offenders.

Back 20

No. It is effective for LESS SERIOUS offenders who will comply.

Front 21

What is the "Street Corner" program? (Schwitzgebel, 1967) What kind of reinforcement was used?

Back 21

It's an example of a C-b intervention.

Researchers approached kids on the street and did simple Tx: DIFFERENTIAL reinforcement of PROSOCIAL STATEMENTS

Front 22

What is the "Shape" program? (Ostapiuk, 1982)

Back 22

It's an example of a C-b intervention.

"Survival skills" (job hunting, etc.) were delivered in community housing or hostel settings.

Front 23

"Achievement Place" (Eg., Braukman & Wolf, 1987) was a community-based intervention effort in 1987, that started in the US Midwest in the late 60s and spread quickly until the mid 1980s. Describe it. AND WHAT ARE THE THREE PHASES?

Back 23

Simulates a function home and is based on a "houseparent" model (usually a married couple).

Direct and incidental teaching of prosocial skills:
-room/property care
-table manners
-non-aggressive speech
-group/democratic decision-making
-appropriate conversation
-negotation

Begins with a token economy, but proceeds through two additional phases:
-merit
-homeward bound

Front 24

How were the outcomes of the "Achievement Place" intervention?

Back 24

Outcomes weren't as good as was expected.
-Identified need for "transition programs" [LIKE PARENT TRAINING]
-problem could be that many youth were returned to homes in which prosocial skills weren't necessarily adaptive.

Front 25

Describe Parent Management Training.(Eg., Kazdin, 1987; Patterson, 1982)

Back 25

An example of a C-b intervention and a form of TRANSITION PROGRAMMING.

Teaches parents the rudiments of behavior theory, and contingency contracting.

Other systems focus on spotting antecedents of delinquent behavior and using DRO techniques.

Also teach:
-social skills
-use of time-outs
-how to employ role plays

Front 26

For what type of kids might Parent Management Training be most effective.

Back 26

May be most effective with younger, LESS DELINQUENT kids.

(b/c Parents still have control over their contingencies).

Front 27

Describe Functional Family Therapy (Alexander & Parsons).

Back 27

An example of C-b intervention.

Less of a psychological approach, more of a social-worker approach.

Based on family systems theory (deviant behavior is considered the consequence of pathological communication styles).

Works with family to improve style and quality of interactions, and learn effective problem solving.

Front 28

What is the outcome of Functional Family Therapy? What are two interpretations of the results?

Back 28

Well, early studies were promising. One study (Gordon et al,1988) showed only 11% recidivism of those treated compared to 67% recidivism of a control group at a one year follow up.

But subsequent studies were equivocal (Fo & O'Donell 1975)
Compared to the control group who had 64% recidivism, trtmt groups had only 38%. HOWEVER, MINOR OFFENSES actually increased (the control group only had a 7% reconviction rate, while 16% of the experimental group were reconvicted).
(This equivocal study had 254 in the FFT group and 178 waiting list controls).

Possible explanations:
1. Regression to the mean effects.

2. Exposure to more serious offenders.

Front 29

Describe Multisystemic Therapy (MST). (Henggeler et al, 1994)

Back 29

-Most promising of all models thus far.
-Not really a new idea, but only recently formalized and manualized. (TREATMENT FIDELITY)
-MST teams available 24/7 to clients and their families (make schedules and non-schedules visits.)
-Assist with RT(???) crisis intervention
-Do practical training of skills.
(Includes elements of supervision, instruction, crisis intervention, mentoring, instruction.)
-Highly effective and cost efficient (Even high risk offenders can be managed with relative safety).
-Lots of supports required for MST team members (e.g., linkages with probation(??))
-Generalization is maximized since training occurs in the real environment.

-Implemented most often with juvenile offenders.

Front 30

Treatment Fidelity was discussed in relation to which type of community-based intervention?

Back 30

Multisystemic Therapy (MST)
(Henggeler et al, 1994)

Front 31

Eclectic approaches were discussed in relation to which type of treatment (community-based or institutional)?

Back 31

Inpatient and Institutional

Front 32

What are the two main roles of therapy in prisons?

Back 32

1. Lower recidivism
2. Assess and relieve distress

Front 33

What did Kazdin (1986) find in his documentation of therapeutic approaches used within prisons.

Back 33

There were over 400 different approaches.

Most were unique to the practitioners, and not empirically grounded or formally evaluated.

Front 34

What does "Silly Con Valley" refer to?

Back 34

Parloff (1984) refered to the California rehab strip as "Silly Con Valley" in relation to Kazdin's documentation of the many different therapeutic approaches used within prisons.

Front 35

What are some explanations for Kazdin's finding of so many non-empirical therapeutic approaches used in prisons?

Back 35

-A large number of non-forensic clinical psychologists were failing to see that they're dealing with unwell populations (that is, "they are no longer dealing with the "worried well.") And there is SPARSE EVIDENCE FOR the efficacy of PSYCHODYNAMIC/HUMANISTIC approaches with this population.

Kassebaum et al (1971), for example, found that there was no significant difference in outcome between three groups: mandatory counselling, voluntary counselling, and controls (???)

Front 36

List some tasks of (most) correctional psychologists in Canada.

Back 36

-Crisis management

-Hostage negotiation

-Offender classification/risk assessment

-Parole hearings

-Counsel/debrief other staff (though this may be inappropriate since they are subject to the same stresses as their coworkers).

-Set up behavioral programs.

-Many delegate intervention to other staff. This may be necessary due to small numbers of psychologists.

Front 37

What are three major interventions used within institutions?

Back 37

1. Eclectic approaches

2. Applied Behavior Analysis

3. Cognitive-Behavioral Approaches (predominate in Canadian prisons)

Front 38

Describe a study of eclectic approaches used within institutions (Eg., Persons, 1967)?

What is the problem with eclectic approaches?

Back 38

Subjects were boys in reformatories.
-Matched on age and other demographic variables.
-Randomly assigned to treatment or control group. (Tx got 80 hours of therapy over 20 weeks including A VARIETY of interventions)

Results at 1 year follow up: 13 Tx vs 25 controls had been reincarcerated. Also had fewer probation violations.

The problem with the eclectic approach is they they are unstandardized. It is very difficult to isolate those aspects that produce the effect and it may be that the therapist's qualities have the greatest influence. (The therapeutic alliance is the strongest indicator of patient success. The therapist's reliability/punctuality is also very related to good outcome.)

Front 39

Describe the Applied Behavior Analysis approach to intervention within institutions.

Describe the problems also.

Back 39

The idea is to change environmental cues and contingences. Punish deviant behavior, reinforce prosocial behavior.

Big in the 60s and 70s. Token economies are an off-shoot.

Problems:
-Fairly easy to bring under control in the institutional setting (often surprisingly quickly), but lack of generalization is a huge problem.

Also,
-Sometimes there is an unclear relationship between target behaviors and crime.
-There are ethical constraints on what privileges can be withheld.
-Fails to promote intrinsic motivation.

Front 40

Token economy programs are an off-shoot of which major type of intervention used with institutions.

Back 40

Token economy programs are an off-shoot of the Applied Behavior Analysis approach.

(Note that token economy was also an aspect of the "Achievement Place" program.. at least in the initial phase, but the program proceeds through two additional phases (Merit and Homeward Bound)).

Front 41

Describe the Cognitive-Behavioral approach to intervention in institutions.

Back 41

Often resemble remedial education programs, because of emphasis on skills training (called training in this setting rather than counseling--to prevent patient defensiveness).
-Focus is on habits, cognitions, deficits, and lifestyle factors that perpetuate criminal lifestyle. (Remember Moffitt?!)
-More about this later.

Front 42

What types of offenders are considered to have DO status?

Back 42

Violent, sexual, and psychopathic/APD offenders are included under this heading.

(Risk level prohibits community treatment.)

Front 43

What types of treatments are available for Sex offenders?

Back 43

Biologically-based treatments

Psychotherapy (has some effectiveness! But remember the criticism of psychodynamic therapy: it was said earlier (Kazdin) to not work well within institutions??)

The following are examples of Cognitive Behavioral approaches:

-Early C-B: aversive shock

-Covert Sensitization

-"Shame" method (Serber, 1971)

-Satiation/Boredom Therapy

-Orgasmic Reconditioning (ORC)

-Relapse Prevention

-Others: Dating skills, anger management, cognitive distortions, human sexuality education, martial therapy.

Front 44

What are some biologically-based treatments available for sex offenders? (Freund, 1980) What is their efficacy?

Back 44

Neurosurgery (of the hypothalamic nuclei)

Orchidectomy

Antiandrogenics
(works in at least 70% of cases)

These treatments are fairly effective, but some males retain some sexual functioning (or they may order steroids to restore sex drive). Also, this suggests, in the likes of Roth, that the motivation of sex offending is not always/purely sexual.

Front 45

What is the assumption of psychotherapy as used in the treatment of sex offenders?

Back 45

It is based in the belief that identification of underlying issues such as abuse and anger will lower the risk. (it is a questionable assumption)

Front 46

Which treatment for sexual offenders is ethically contentious.

Back 46

Biologically-based treatments.

Front 47

What is the effectiveness of psychotherapy with sex offender populations? (As indicated by data on recidivism rates published by Groth (1983)).

Back 47

The data suggests this treatment can be quite effective. There was about a 50% reduction in reoffense rates of sexual offenders given psychotherapy compared to control groups without such therapy.

For sexual offense, exactly half reduction: 8% recidivism compared to 16%.

For non-sex offenses: 19% recidivism compared to 36% recidivism.

Front 48

What does the cognitive-behavioral approach with sex offenders look like?

Back 48

The C-B approach is focused on reducing deviant AROUSAL. Early efforts used aversive shock
-Pavlovian: Paired deviant stimulus with shock non-contingently
-Operant: Only if arousal is registered on PPG (penile plethysmograph)

Main Problem: Extinction effect. (That is, once the sex offender becomes aroused in the natural environment, and there is no following shock, what has been learned will subside... an example of differential learning).

Also, the individual may actually become aroused by the shock (BACKWARDS CONDITIONING)

Front 49

Explain the differences between pavlovian and operant conditioning administration of aversive shock (within C-B treatment of sex offenders). Which one uses a PPG?

Back 49

Pavlovian: Shock is not contingent on the offender's arousal. It just pairs the deviant images with the shocks.


Operant: contingent on sex offender's arousal to deviant stimuli (indicated by a PPG). Punishes that arousal by applying shock.

Front 50

What is the main problem of C-B aversive shock treatment of sex offenders?

Back 50

Extinction problems are the main problem.
(due to differential learning)

Front 51

What is "Covert Sensitization" treatment of sex offenders? Two parts.

Back 51

It is a C-B treatment. The person must be willing (and have a good imagination) to imagine pairing something incompatible with arousal (e.g., rotting cow placenta).

Also, patients imagine rewards of withholding deviant behavior.


??- Hayes, Brownell, Barlow (1978) monitored arousal with PPG. No monitoring over fantasy content however.

Front 52

What is the "Shame" method? (Serber, 1971)

Back 52

It is C-B treatment used with sexual offenders.

Patients are exposed to a clinical audience and videocamera while they verbalize their fantasies.

Front 53

What is "Satiation/Boredom Therapy"? (Marshall, 1979)

Back 53

After masturbating and orgasming to a to an appropriate fantasy, the client continues to masturbate after orgasm while verbalizing and tape recording deviant fantasy.

Front 54

What is "Orgasmic Reconditioning"? (ORC, Eg., Laws & Osborn, 1983)

Back 54

Client switches to an appropriate fantasy just prior to orgasm. In subsequent sessions, patient begins to switch earlier and earlier from deviant to appropriate fantasy.

Front 55

Which type of C-B therapy for sex offenders originates in substance abuse literature?

Back 55

Relapse Prevention

Front 56

Which group of offenders is less likely to be deemed in need and more likely to just be locked up? Sex, Aggressive, Psychopath/Personality Disordered offenders?

Back 56

Aggressive Offenders

Front 57

When does an aggressive offender seek therapy?

Back 57

As a group, aggressive offenders seldom seek therapy in the absence of secondary gains.

Front 58

Denial, blaming others, and refusal of responsibility are ubiquitous amongst what type of offenders?

Back 58

both sexual, and aggressive

Front 59

What is "Pharmacotherapy"?

Back 59

It is a therapy used with aggressive offenders.

Usually tranquilizers are given only on a PRN basis to manage outbursts.

Front 60

When is pharmacotherapy considered to be a lasting solution for aggressive offenders?

Back 60

It is not an enduring solution, unless the aggression is rooted in a psychosis, EPD, ADHD, or bipolar disorder. (though there are still lots of potentially harmful side effects.)

Front 61

What are some of the side effects of pharmacotherapy?

Back 61

E.g., Dry mouth, tremors, frequent urination, nausea.

Such side effects may encourage non-compliance.

Front 62

What therapies for aggressive offenders are listed in the notes?

Back 62

Pharmacotherapy

Cognitive-Behavioral therapy (Anger management)

and

Dialectical Behavior Therapy (Marsha Linehan)

Front 63

With which therapy is Marsha Linehan associated?

Back 63

She is associated with Dialectical Behavior Therapy.

Front 64

What are the three steps of Anger-management therapy? (Eg., Novaco, 1978)

Back 64

Three steps:
1) Prep (education)
2) Skills training
3) Practice

Front 65

Packages for which therapy are often sold commercially?

Back 65

Packages for anger management therapy are often sold commercially. Special versions for nasty kids and marital conflict are available.

Front 66

True or False: There is excellent transition support with anger management therapy.

Back 66

True. That's what the notes say.

Front 67

What is Dialectical Behavior Therapy?

Back 67

It is a behavior therapy used with aggressive offenders.

It stresses a balance between change and acceptance, teaching TOLERANCE of negative affective states that contribute to potentially criminal behavior. Particularly, it challenges all-or-nothing, or catastrophic thinking. Tolerance is gained through mindfulness, meditation, and relaxation.

It combines several elementals of conventional CBT.

Wikipedia: Dialectic (also dialectics and the dialectical method) is a method of argument for resolving disagreement ...

Front 68

APD is over-diagnose in jail settings. A study by Harris, Rice Cromier (1989) showed that ___ got the Dx, but only ___ actually qualified.

Back 68

2/3 had the Dx. Only 1/4 truly qualified.

Front 69

A study by Levine & Bornstein (1972) showed that... (topic: treatment of APDs and psychopaths)

Back 69

Only 8 of 295 meta-analyzed reports on APD treatment contained encouraging results.

Most of the 295 were methodologically unsound and could not be used however. (Picture "may" not be as bleak as once thought.)

Problem: APDs and psychopaths are not usually distressed. (Can't rely on negative Rf(reinforcement) of treatment effects.) ... there's nothing negative to take away

Front 70

True or false: Negative reinforcement is a good treatment for psychopaths/APDs.

Back 70

False, there is no negative stimulus to take away since APDs and psychopaths are not usually distressed.

Front 71

Just a note in relation to APDs (to ask Dr. Frenzel)

Back 71

"Some (eg., Carney) have argued that the question becomes moot upon conviction.
-Flawed assumption since "personality" implies enduring characteristics and therefore inflexibility."

Front 72

What were the results of a study by Gendreau (1996) that looked at the efficacy of treatment programs?

Back 72

It showed that purely punitive settings do not work well. If just put in jail, there is only 6% reduction in recidivism (6% less crime). But with treatment, there is 25% less crime.

Front 73

Martinson's (1974) statement "Nothing works!" relates to what...?

Back 73

Historically, treatment effectiveness has been very difficult to measure.

His comment is a reflection of interpretive errors.

Front 74

What is a "just desserts" model?

Back 74

A deserved (i.e., just) punishment or reward.

Mainstream crimonology, which has had an "anti-psychological" reputation has lent support to this model, fueling outcry for stiffer penalties.

Front 75

What was Palmer's (1975) finding in relation to the efficacy of treatment programs?

Back 75

Treatment can be effective, but it must be TAILORED to the CRIMINOGENIC NEEDS of the client.

Front 76

What did the meta-analysis by Gendreau & Ross (1980) show?

Back 76

They reviewed outcomes of 95 treatment studies and found that 86% showed positive outcomes.

(Though "positive outcomes" is vague.)

Front 77

What did Lipsey (1989) find in a formal investigation of the features of effective programs? (Six points, that were later added on to.)

Back 77

1) LONGER duration, more meaningful contact.

2) Services provided OUTSIDE correctional facility.

3) Programs are reviewed and ADJUSTED REGULARLY.

4) COGNITIVE-BEHAVIORAL, multifaceted, skill-oriented approach

5) Targets HIGHER RISK OFFENDERS

6) Includes CAREFUL DISCHARGE planning

Front 78

To the list of effective program features began by Lipsey (1989), Andrews, Bonta & Hoge (1990) added:

Back 78

7) CRIMINOGENIC FACTORS are SPECIFICALLY TARGETED

8) Treatment is matched to the LEARNING STYLE of the offender.

Front 79

To his list from 1989 Lipsey (and Widom) (1998) added this feature of effective treatment programs:

Back 79

9) Services should be delivered by mental health PROFESSIONALS.

Front 80

One more note about treatment programs:

Back 80

From a legal perspective, sanctions should be graded in severity.

Front 81

What did Frenzel add on to the lecture in relation to treatment programs?

Back 81

Research shows a direct relationship between treatment outcome and the use of R-N-R principles (Risk-Needs-Responsibility).

R-N-R principles are closely tied to SPJ (Structured Professional Judgment) instruments and shows their potential utility in treatment planning.

The reason: wrong treatment for an individual may actually INCREASE risk.

Front 82

Why are SPJ (structured professional judgment) instruments and the use of R-N-R (risk-needs-assessment) principles so closely?

Back 82

Because, by paying attention to the individuals, we may avoid giving the wrong treatment. And wrong treatment for an individual may actually increase the risk of offense.

Front 83

What is restitution?

Back 83

Community service order..