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Women Offender Programs and Issues

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Implementing Choices at Regional Facilities: Program Proposals for Women Offenders with Special Needs

Executive Summary & List of Recommendations

Recent reports on women offenders (Laishes, 1997; Rivera, 1996; Whitehall, 1995) consistently identify the importance of developing specialized programs and living options in the regional facilities for women with special mental health needs. Program alternatives are required so that they can live successfully in a least restrictive environment rather than having to remain in maximum-security facilities. The purpose of this study is to investigate the needs of these women and make specific recommendations and program proposals to support and assist them to be accommodated safely in the regional correctional facilities at a medium- or minimum-security classification.

The research has been limited to the Atlantic and Ontario regions as these two areas were identified at the outset as having the highest numbers of women with special needs who could be maintained in regional facilities, if special programs were in place. The program models recommended may be applicable to other regional facilities. The research process included a review of literature, offender files, and an extensive number of interviews with inmates, community stakeholders, and staff at diverse organizational levels at Nova Institution, the Springhill Women's Unit, Grand Valley Institution, and the Kingston Prison for Women.

I. Lessons from Past Experience

A review of the experience in penitentiaries in Atlantic Canada and Ontario with women with special needs over the past two years provides the following important lessons which must be incorporated into new program proposals:

1. Diverse and Incompatible Needs: There are distinctive constellations of needs among women with "special needs" that require distinctive program approaches. Women with very different needs can be incompatible in less secure environments, resulting in explosive situations.

2. Relationship Issues Are Paramount: These women have unstable and emotionally charged relationships that make larger group situations very difficult, if not dangerous. Their needs must be addressed through individual and small group interactions, including the ability to separate women from each other.

3. Individualized and Intensive Learning Programs: These women have entrenched and long-term behaviour patterns and change comes slowly through programming and practice targeted on an individual basis to their learning styles and strengths.

4. Supportive, Consistent and "Present" Staffing: Experiences have been most positive when staff are regularly present with the women in their living environments such that they can establish supportive relationships with them. These women have difficulty establishing supportive relationships with staff if they are not present and have to be sought out.

5. Multi-Disciplinary Team Approach with Mental Health Expertise: Given the complexity of their difficulties, working with these women is extremely difficult and tiring for staff. A diversity of expertise is required and staff need a team approach to effectively support each other and the individual women. Mental health expertise is essential as well as correctional experience, and staff need on-going training and support. Effective communication among staff is essential or individuals will play staff off against each other.

6. Programs Require a Distinctive and Recognized Mandate in a Broader Institution: Specialized programs require a specialized structure and context that will have procedures which will depart from procedures across a broader institution. This must be recognized and agreed to at the outset.

7. Therapeutic Quiet Behaviour Management Options Are Required: Women with limited cognitive ability or those acting act due to extreme emotional distress in many instances need short term sanctuary or isolation in a therapeutic context akin to options available in a psychiatric setting, rather than a formal segregation process.

8. The Physical Facilities Must Be Designed to Meet Program Need:. The physical design must follow from the needs of the women and the program structure. The design must also be flexible given that programs and needs are likely to change over time.

9. Stigma and Labeling Issues Must Be Addressed: There will inevitably be stigma with respect to participation in special programs, and specific measures must be taken to recognize and reduce it.

II. Principles and Processes of Specialized Mental Health Programs

Specialized mental health programs, including the program proposals outlined in this report are to be structured and delivered under the auspices of the Mental Health Strategy for Women Offenders (Laishes, 1997). The key principles of this strategy are: wellness, access, women-centred, client participation, and least restrictive measures. The Mental Health Strategy also details a number of other essential elements/principles in the delivery of mental health services which are particularly appropriate to these proposals: consistent structure and environment, effective integration and information sharing, bridging to other services and the community, and quality staff training and education.

III. Identification of Women with Distinctive Constellations of Special Needs

The women offenders presently in maximum-security environments who could be maintained with additional and alternative program resources at the regional facilities must be distinguished by their constellation of needs: those with basic skill needs and cognitive challenges, and those with emotional distress needs. A third group of women in maximum-security environments may require intensive programming to assist them in changing anti-social attitudes and behaviour, but when they are ready, they can function within the regular programs at the regional facilities. Efforts to mix these groupings in the past have proven inappropriate and explosive.

Two distinct program models are required: a psychosocial rehabilitation (PSR) program model for women with basic skill needs and cognitive challenges, and a dialectical behaviour therapy (DBT) model for women with emotional distress needs who have severe behavioural difficulties. There are a very few women with emotional distress needs who are suffering from acute episodes of a major mental illness. If the new program models recommended here are implemented, it is judged that the existing resources and facilities can meet the needs of these women offenders.

IV. Psychosocial Rehabilitation Program Model For Women with Basic Skill Needs and Cognitive Challenges

Psychosocial rehabilitation has its conceptual roots in a response to the failure of the mental health system to assist disabled clients in coping with the psychosocial devastation brought on by severe mental or emotional illness, severe behavioural problems and traditional treatment methods (i.e., institutionalization and medication; Nel, 1994). Women with basic skill needs and cognitive challenges in federal penitentiaries have similar characteristics, backgrounds, and histories of institutionalization. Their successful return to the community is halted by...

    ˇ their limited resources, skills, and supports,

    ˇ their isolation, sense of hopelessness and despair brought on by institutionalization,

    ˇ their deviant behaviour patterns learned through institutionalization,

    ˇ their loss of community learning opportunities and supports that accompanied institutionalization.

Based on this perspective, the psychosocial rehabilitation field brought together three applied programming models in the 1980s in order to develop an effective means to support the recovery of these persons: (1) "Psychiatric Rehabilitation" (Anthony, Cohen & Farkas, 1990), (2) the "Clubhouse Model" (Beard, Propst, & Malamud, 1982), and (3) "Assertive Community Living" (Stein & Test, 1986). The PSR field has now evolved and expanded to become the most prominent conceptual approach in North America to working with persons with severe emotional disabilities and impairments. The approach is based on (1) the experiences and voices of consumers demanding participation and self-determination in treatment, (2) the recognition that core values such as hope, empowerment, and determination are essential to recovery, and (3) the importance of targeted skill development and specific environmental supports as means to overcome impairments and enable individuals to function effectively in normal social roles and community settings. The specific issues essential to the development of an effective psychosocial rehabilitation program for these women are outlined in sequence below along with specific recommendations for program implementation.

Conceptual Approach of Psychosocial Rehabilitation: The psychosocial rehabilitation approach is the most appropriate and potentially effective programming model for individuals with basic skill needs and cognitive challenges such that they can reside in the least restrictive environment in a regional facility. The approach must be adapted to the regional penitentiary setting by staff trained in the psychosocial rehabilitation approach. A disproportionate number of women in Canadian penitentiaries with basic skill needs and cognitive challenges come from Atlantic Canada.

    Recommendation 1: Implement the psychosocial rehabilitation approach for women offenders with basic skill needs and cognitive challenges through a specific program model appropriate for the regional facilities, which incorporates relevant elements of psychiatric rehabilitation, the clubhouse model, and assertive community living. This model shall reflect the specific strengths and limitations of the women with this constellation of needs and be based on a specific purpose and set of objectives. The psychosocial rehabilitation program model should initially be implemented as a pilot project at Nova Institution in Truro, Nova Scotia.

Admission Criteria and Assessment Process: Matching the needs of individuals with the program goals and structure is essential to success. Inappropriate mixes of women offenders will compromise the effectiveness of the program and represent a major threat to its effectiveness. This is a particular problem given the potential for operational pressure to place inappropriate women in the program simply as a result of their needing higher levels of supervision.

    Recommendation 2: A formal, written, multi-disciplinary assessment process with admission criteria based on the consent of the woman offender, a medium or minimum security classification, significant basic skill needs, significant cognitive challenges, and the need for staff supervision, is required for entry into the program. There must be an official, approved program description with clear admission criteria which requires staff at the regional facility to make the final decision on admission.

Individual Program Planning: The psychosocial rehabilitation planning technology incorporates some traditional mental health planning approaches such as careful assessment and structured skills-teaching. It differs from traditional approaches in several important ways: goal setting precedes skills-teaching, emphasis on the need to overcome barriers in order to commit to change, explicit core values, and an explicit client-driven technology.

    Recommendation 3: The individual programming with women with basic skill needs and cognitive challenges should be driven by the psychosocial rehabilitation technology process in which staff practitioners competent in the approach develop partnerships with the women offenders on an individual basis. Supportive relationships between the women offenders and a consistent and small number of staff are required to support this process.

Characteristics of the Physical Living Environment: It is important to provide these women with a small group living environment which simultaneously provides a home-like appearance that mirrors community standards, while also insuring safety and security in instances of acting-out behaviour. Staff expertise and input from women offenders is required to balance these design criteria.

    Recommendation 4: Plan and construct a duplex house with up to four women living on each side (8 per duplex) at the regional facility utilizing the proposed structure and criteria as a starting point for planning. The architects must utilize staff expertise, and input from relevant women offenders, to plan the house. The program coordinator must be hired as soon as possible such that the coordinator is able to facilitate staff and offender input into the design. A committee made up of the lead architect, the builder, the warden, and the PSR coordinator must have the final authority on all phases of the design and construction process.

Daily Living Expectations and Skills-teaching: The living environment is an important context in which these women can learn basic skills and take on practical responsibilities, but they will require assistance and support from staff to do so. Learning is most effective when it is a deliberate, structured part of carrying out daily living tasks with extensive feedback built into the process. Interpersonal communication difficulties will be an ongoing issue and a valuable forum through which the women can learn problem-solving skills.

    Recommendation 5: Staff should plan skills training in order to take advantage of daily activities that are completed as a part of the regular lifestyle as teaching opportunities. Interpersonal communication and relationships should also be utilized as a context for teaching social skills. Skills-teaching action plans should be based on the psychosocial rehabilitation plan. Daily structured meetings should be held to facilitate management of daily tasks, interactions and responsibilities in the home.

Work, Learning, and Leisure Programs and Skills: These women are typically fearful of new learning situations given their past histories of failure in community settings. On the other hand they often value meaningful, structured and practical tasks where they receive positive feedback and recognition. They have a particular affinity for art and music.

    Recommendation 6: Deliberate individual and small group activities defined through each person's psychosocial rehabilitation plan should provide opportunities for integration into regular programs, specific work and service projects, participation in creative arts activities for self-expression and awareness, and the development of a sense of ownership in the living setting. A clubhouse philosophy should guide this programming so as to promote recognition through work and service, and teach skills through practical experiences.

Behaviour Management in the Living Environment: These women have long term behavioural difficulties that will inevitably manifest themselves and they must be addressed effectively in a team context. There is a potential serious conflict between the emphasis on choice and empowerment which is fundamental to these women establishing hope, confidence, and a stake in their own lives, and behavioural programs and consequences that may be required to manage difficult behaviours.

    Recommendation 7: Staff must balance the need for hope and empowerment inherent in psychosocial rehabilitation with the need to cope with offenders' behavioural difficulties. Setting the appropriate balance should involve the use of group-defined house expectations, natural contingencies, multi-disciplinary team meetings, staff reflection on values and interaction style, and a continuum of quiet options.

Therapeutic Quiet: Women with basic skill needs and cognitive challenges may lose control of their behaviour and/or act out such that they require short-term, externally locked control and clear consequences, be it for a few minutes or a few hours. However, lengthy isolation is counter-productive as the offender loses focus on why she is isolated, and she may become more desperate, hopeless and dependent. Invoking segregation is often inappropriate for the circumstances and yet a brief therapeutic quiet option is required if segregation is to be avoided.

    Recommendation 8: Therapeutic quiet must be an essential element of the duplex design through which women can learn to better manage stressful situations, and through which they can be secured when a danger to themselves. Specific written procedures must be developed to monitor its use. Staff must be trained in its use. Medication may also be a useful tool to assist women in stressful situations but its use requires stringent monitoring and written procedures.

Stigma Versus Peer Support and Teaching: These women may be viewed by other offenders, and other members of the community, in a range of ways varying from disdain and rejection to solidarity. Frequently their experience has been one of isolation, rejection, and stigma. If the women in the PSR program become severely stigmatized by others, they will reject the program for themselves and act out to disrupt it. On the other hand, other women offenders have expressed a willingness to help and work with them on an individual basis in a structured and time-limited context.

    Recommendation 9: Stigmatization and labeling of these women offenders poses a serious threat to the success of the program and should be minimized or avoided through: a peer support program, peer education, facilitation of a sense of ownership in their home, adherence to the admission criteria, and their integration into regular programs.

Bridging for Community Integration: The present correctional release process is ineffective for women with basic skill needs and cognitive challenges due to its failure to provide a bridge of consistent relationships for the women to the community setting. There must be a process through which to advocate for and develop individualized plans, including education of community support systems.

    Recommendation 10: There must be an alternative release model in which a community integration worker builds a strong relationship with the individual woman in the penitentiary and then uses this relationship as a bridge to establishing her in a supported community setting. Sufficient funds must be provided to support this community integration process. The community integration worker must be based in the institution in order to develop the strong relationship with the individual offender that is required for success.

Staffing Complement, Qualifications, and Roles: High quality and committed staff are essential to an effective program. They must be committed to both direct work with difficult women and to the PSR program model. Although staffing is expensive for a program for these women with special mental health needs, insufficient or poorly trained staff will result in failure. The recommended staffing level is lower than the level of a maximum-security facility where these women would otherwise be maintained.

    Recommendation 11: It is essential to select staff with strong interpersonal skills and values for work with these women while allowing for a mix of expertise to provide for diverse perspectives. Programming will be most effective if there is a small, multi-disciplinary staff who can support each other and provide a consistent approach to work with the women. Core staffing should include a program coordinator and a community integration worker, two PSR workers on day and evening shifts, a night security staff, and a part-time psychologist, occupational therapist, and program evaluation consultant. Part-time PSR worker positions should be avoided wherever possible, as intermittent staff presence makes communication and coordination more difficult. Night staff should only work on night shifts with a security and supervision function.

Staffing Training, Support, and Communication: Effective staff training and support is essential to the success of the program and the ability to attract and retain quality staff.

    Recommendation 12: All core staff must participate in an eight week training program including six weeks of training in psychosocial rehabilitation, one week of training in clubhouse and assertive community living approaches, and one week devoted to team building, program planning and evaluation, and selected mental health topics. A brief training program should be provided for auxiliary staff. There must be on-going commitment and resources for staff communication and support.

Program Evaluation: Program evaluation is essential to program improvement and accountability.

    Recommendation 13: Either a team member with evaluation expertise or an external consultant should design and conduct the program evaluation in consultation with the staff team and the woman offenders.

Obstacles to Effective Implementation of the Program: The following issues could become major obstacles to the implementation of an effective program and therefore must be recognized and strategically addressed from the outset: failure to hire and/or maintain quality staff, conflicts with broader penitentiary policies and requirements, inability of the staff team and the local administration to control planning decisions, and a rapid and ineffective transition process for individual women transferring from maximum-security facilities.

    Recommendation 14: Specific strategies must be adopted from the outset to overcome these obstacles.

V. Dialectical Behaviour Therapy and Programming For Women with Emotional Distress Needs

Dialectical Behaviour Therapy (DBT) represents one of the most prominent approaches to work with women with borderline personality disorder in North America and has clinical research utilizing controlled trials to support its effectiveness (see Linehan, 1993). A majority of the women offenders with high emotional distress needs exhibit a combination of similar difficulties characterized by self-destructive and/or suicidal behaviour, emotional dysregulation, severe interpersonal relationship problems, unstable and low self-image, and cognitive disturbances and distortions The DBT model has been applied in forensic settings and appears to offer the most promise of available approaches for work with these women. A disproportionate number of women with these difficulties are in Ontario. Therefore, it is proposed that this model be initiated as a pilot project for a structured treatment program and living environment at Grand Valley Institution in Kitchener Ontario. This program should (1) serve women already present at Grand Valley who are not able to cope with life in regular houses due to their emotional distress and severe behavioural difficulties, and (2) allow some women in maximum-security facilities to be supported and maintained at regional facilities.

Before describing the proposed DBT program model, it is important to note that there remains a small group of women with emotional distress needs (four persons at present) who are suffering from the acute symptoms of major mental illness who would not be appropriate for a DBT program. Existing mental health resources, assuming that new resources are put in place for the DBT and PSR programs, are sufficient to serve these women with the exception of a serious deficiency in psychiatric nursing at the regional facilities.

    Recommendation 15: New nurses hired within the regional facilities should be required to have psychiatric training and/or experience. Existing nurses should be offered an extensive inservice training program to upgrade relevant mental health and substance abuse expertise for working with women offenders. Existing psychiatric nurses at the Prison for Women would be helpful in defining the training program.

Conceptual Basis For Dialectical Behaviour Therapy: The DBT approach for working with these women is rooted in three philosophical and therapeutic traditions: cognitive-behavioural approaches, humanist relationship approaches, and dialectical theory. Linehan (1993) identifies 8 assumptions (core values) as essential to the DBT approach. She emphasizes the need for practitioners to maintain a hopeful approach and avoid blaming the women for their behaviour and difficulties. It is also important to obtain the offender's agreement and commitment to reduce her self-injurious behaviours and work toward a better future, even if she can not foresee success.

DBT defines a hierarchy of behavioural targets for change across three stages of treatment such that the individual focuses on lower priority targets as their control over their behaviours increases and higher level targets are achieved. This hierarchy of behavioural targets provides the priority list for what is addressed through the treatment program, although there are distinctions as to which targets receive priority in each component of treatment. A particular strength of this approach is the emphasis on agreed upon behavioural priorities as women with these needs typically have an unending series of crises that make it extremely easy for both staff and offenders to lose focus on treatment priorities.

    Recommendation 16: Implement the dialectical behaviour therapy approach for women offenders with emotional distress needs and severe behavioural difficulties at Grand Valley Institution in Kitchener, Ontario through a specific program model which is appropriate for regional facilities. This model shall reflect the specific strengths and limitations of the women with this constellation of needs and be based on a specific purpose and set of objectives. Given the limited clinical resources presently at Grand Valley and the high demands on those who are present, it is recommended that senior staff from Prison for Women who are familiar with DBT approaches serve as consultants to Grand Valley Institution in setting up the DBT program.

Admission Criteria and Assessment Process: Matching the needs of individuals with the program goals and structure is essential to success. Inappropriate mixes of women offenders will compromise the effectiveness of the program and represent a major threat to its effectiveness. This is a particular problem given the potential for operational pressure to place inappropriate women in the program simply as a result of their needing higher levels of supervision.

    Recommendation 17: A formal multi-disciplinary assessment process with admission criteria based on the consent of the woman offender, a medium- or minimum-security classification, significant coping, communication and problem-solving skill needs, and the need for staff supervision, is required for entry into the program. There must be an official, approved program description with clear admission criteria which requires staff at the regional facility to make the final decision on admission.

Components of DBT Treatment: There are four interrelated components to conducting a DBT program and there must be overall effective coordination between them by the multi-disciplinary staff team.

    Recommendation 18: The individual counseling and coaching, group skills training, daily meetings, and informal staff consultation components must be implemented in a coordinated manner by a multi-disciplinary staff team with specific training in the approach. The DBT program should also be accessible to a limited number of women with emotional distress needs who are able to cope in regular houses with the extra support provided by the program.

Characteristics of the Physical Living Environment: It is important to provide women with emotional distress needs and severe behavioural difficulties with a small group living environment which simultaneously provides a home-like appearance that mirrors community standards, while also insuring safety and security in instances of acting-out behaviour. Staff expertise and input from women offenders is required to balance these design criteria.

    Recommendation 19: Plan and construct a duplex house with up to four women living on each side at the regional facility utilizing the proposed structure and criteria as a starting point for planning. The architects must utilize staff expertise, and input from relevant women offenders, to plan the house. The program coordinator must be hired as soon as possible such that the coordinator is able to facilitate staff and woman offender input into the design. A committee made up of the lead architect, the builder, the warden, and the DBT coordinator must have the final authority on all phases of the design and construction process.

Daily Living Expectations and Skills Application: The women offenders should be responsible for daily living tasks as in the regular houses. However, given their emotional instability and difficulties with relationships, there are likely to be difficulties in the process of working together and completing tasks. These difficulties will be valuable learning opportunities in which staff can coach and facilitate the women offenders to apply the core DBT skills to daily living problems. Informal interaction and leisure opportunities between individual women, and between individuals and staff are an important means to develop the trusting relationships and provide opportunities to address problem-solving and coping issues through the application of the core skills.

    Recommendation 20: Staff should utilize informal interactions as a means to foster trusting relationships with the women. Emphasis should be placed on using difficulties resulting from conflicts generated by relationship and/or daily living tasks as opportunities for individuals to apply their coping and problem-solving skills to practical situations. The amount of staff supervision may vary over time in relation to the specific grouping of women. It should balance needs for staff to develop strong relationships with the women, to provide for the safety of everyone, and to foster the independent functioning of the women.

Work, Learning, and Leisure Programs and Skills: Emphasis must be on insuring that these women are fully integrated into the general population with respect to work and leisure opportunities as the expectation is that they will eventually move into a regular house or an unsupported community living situation.

    Recommendation 21: Excepting their involvement in DBT specific program components, women in the duplex would participate in general programming in relation to their correctional plans like any other woman offender.

Behaviour Management in the Living Environment: These women have long term behavioural difficulties that will inevitably manifest themselves and they must be addressed effectively in a team context. There is a potential serious conflict between the emphasis on individuals taking responsibility for their behaviour utilizing DBT skills, which is fundamental to these women establishing hope, confidence, and a stake in their own lives, and behavioural programs and consequences that staff may utilize to manage difficult behaviours.

    Recommendation 22: Staff must balance the need for hope and personal motivation inherent in dialectical behaviour therapy with the need to cope with offenders' behavioural difficulties. Setting the appropriate balance should involve the use of group-defined house expectations, natural contingencies, dialectical concepts, multi-disciplinary team meetings, staff reflection on values and interaction style, and a continuum of quiet options.

Therapeutic Quiet: Women with emotional distress needs may be at risk for self-harm such that they may seek or require short-term, externally locked control, be it for a few minutes or a few hours. However, lengthy isolation is counter-productive as the offender loses focus on why she is isolated and she may become more desperate, hopeless and dependent. Invoking segregation is often inappropriate for the circumstances and yet a brief therapeutic quiet option may be required.

    Recommendation 23: Therapeutic quiet must be an essential element of the duplex design through which women can learn to better manage stressful situations, and through which they can be secured when a danger to themselves. Specific written procedures must be developed to monitor its use. Staff must be effectively trained in the use of therapeutic quiet.

Bridging for Community Integration: The present correctional release process is ineffective for women with emotional distress needs and severe behavioural difficulties due to its failure to provide a bridge of consistent relationships for the women from the penitentiary to community settings. These women require consistent relationships to make a successful transition across settings. Behavioural gains made in the DBT program will be lost, including a greater likelihood of recidivism, if there is not consistent and effective support provided in transitions.

    Recommendation 24: There must be an alternative release model in which a community integration worker builds a strong relationship with the individual woman in the penitentiary and then uses this relationship as a bridge to establishing her in a community setting. The community integration worker must be based in the institution in order to develop the strong relationship with the individual offender that is required for success. Sufficient funds must be provided to support this community integration process. Consistent relationships with DBT staff must also be maintained if a woman moves from the DBT duplex to a regular house within the penitentiary.

Staffing Complement, Qualifications, and Roles: High quality and committed staff are essential to an effective program. They must be committed to both direct work with difficult women and to the DBT program model. Although staffing is expensive for a program for these women with special mental health needs, insufficient or poorly trained staff will result in failure. This staffing level is lower than the level of a maximum-security facility where these women would otherwise be maintained.

    Recommendation 25: is essential to select staff with strong interpersonal skills and values for work with these women while allowing for a mix of expertise to provide for diverse perspectives. Programming will be most effective if there is a small, multi-disciplinary staff who can support each other and provide a consistent approach to work with the women. Core staffing should include a program coordinator/psychologist, one DBT worker on day and evening shifts, a second psychologist, a community integration worker, and a program evaluation consultant. Night shift staff, if required, should not be DBT workers in the program and should be limited to a security and supervision function. Core part-time staff positions should be avoided wherever possible as their intermittent presence makes communication and coordination more difficult. It may be difficult to fill the coordinator position and it is recommended that senior staff from the Prison for Women assist with the recruitment and hiring process for key staff, as well as a professional with specific DBT expertise.

Staffing Training, Support, and Communication: Effective staff training and support is essential to the success of the program and the ability to attract and retain quality staff.

    Recommendation 26: All core staff must participate in a multi-week DBT training program designed in consultation with DBT specialists at the University of Washington in addition to two weeks of training on team-building, program planning, evaluation, and selected mental health topics. A brief training program should be provided for auxiliary staff. There must be on-going commitment and resources for staff communication and support, including supervision and peer support for the individual therapists.

Program Evaluation: Program evaluation is essential to program improvement and accountability.

    Recommendation 27: Either the psychologist or an external consultant should design and conduct the program evaluation in consultation with the staff team and the woman offenders.

Obstacles to Effective Implementation of the Program: The following issues could become major obstacles to the implementation of an effective program and therefore must be recognized and strategically addressed from the outset: failure to hire and/or maintain quality staff, conflicts with broader penitentiary policies and requirements, inability of the staff team and the local administration to control planning decisions, and ineffective team communication processes and insufficient support for staff.

    Recommendation 28: Specific strategies must be adopted from the outset to overcome these obstacles.

Conclusion

The proposed psychosocial rehabilitation program for women with basic skill needs and cognitive challenges and the dialectical behaviour therapy program for women with emotional distress needs and severe behavioural difficulties represent important new initiatives in relation to realizing the vision that was initially defined in Creating Choices by the Task Force on Federally Sentenced Women (1990). Up to this point the regional facilities have only provided one living option that has not met the needs of women with special mental health difficulties. As the result, these women have either ended up in difficult and often explosive situations in the regional facilities or have had to remain in maximum-security facilities. These two program models are a major step toward actually implementing choices at the regional facilities. They require more resources than is now allocated to programs at the regional facilities, but they require less resources than what is now allocated to maximum-security facilities. It must be recognized that these models will only be effective if they have quality staff and a significant level of resources committed to them. The costs will be much higher if these women have to remain in maximum-security facilities or serious incidents result from insufficient support for them at the regional facilities. In the long run these programs offer the promise of helping these women to make a successful transition to the community, for their own benefit and that of the society.