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Treatment responsivity, intervention, and reintegration: A conceptual model
This article highlights the constructs relevant to treatment responsivity2 and incorporates them into a risk management strategy for offender reintegration. In this context, treatment responsivity is a composite of treatment readiness and performance, and is defined as factors that affect intervention.3 Effective intervention will reduce risk and increase the probability of successful reintegration.4 In this article, "reintegration" covers transfers to reduced security as well as discretionary release to the community. Successful involvement in programs is one indicator that an offender is likely to reintegrate successfully.5
The proposed model emphasizes systematic risk/needs assessment6 to determine an offender's treatment requirements, including the appropriate intensity of treatment. This information anchors an offender's overall risk management strategy by giving correctional staff specific targets to consider for interventions, and by indicating the best setting for program delivery. Generally, programs should be provided early in an offender's sentence to ensure timely case preparation. The order of program delivery also probably influences the offender's response to treatment.
Structured assessments of treatment readiness and performance can provide a composite index of successful intervention. Further, treatment performance provides an intermediate measure of success that is critical to the effective management of offenders through their sentence. How these intermediate measures relate to successful release remains to be demonstrated, however.Background
Although increasing evidence indicates that appropriate correctional intervention reduces recidivism,7 a standardized method for incorporating treatment information into estimates of reintegration potential is currently unavailable. Without such a strategy, correctional staff are compelled to speculate about the efficacy of intervention for an individual offender, and his or her suitability for reintegration -- a situation that could increase decision errors. The goal of corrections is to minimize decision errors, and effective intervention is considered an important method of increasing release potential.
The principles of effective correctional programming are well articulated8 and will not be repeated here. Accreditation reviews will assess how well programs reflect these principles. The proposed model assumes that, if they are to produce effective interventions, programs must reflect these principles.9
Offenders vary with respect to their treatment needs and motivation; therefore, their responses to intervention vary, and it is not clear how their treatment performance might be integrated into release decisions. Development of a structured assessment method would be an important start, but staff would still need a comprehensive model to follow. Because the utility of treatment10 and the validity of clinical decision making are increasingly debated,11 the Research Branch has developed specific measures of treatment readiness and treatment performance.12
This article describes a strategy for integrating treatment information into risk management strategies. The effectiveness of such a model will influence the reintegration of offenders referred for correctional intervention. The model is being presented now to stimulate interest in its validation and/or the development of alternative strategies.Description
The essential components of the model are: pretreatment appraisals of risk and need, assessment of treatment readiness or motivation, and assessment of treatment participation and gain. The latter two components are combined to reflect treatment responsivity.13 Risk appraisals should indicate both the individual offender's criminogenic factors and the group variables associated with risk recidivism. Although individual criminogenic needs tend to be dynamic, actuarial scales often concentrate on static factors,14 and actuarial or statistical estimates of likelihood of reoffending are preferred as the basis of a risk appraisal. However, it is not clearly understood that actuarial scales can provide cutoffs that help users identify the decision errors for different types of outcome for different scores.15
Prochaska and colleagues describe the construct of treatment readiness.16 Miller17 also discusses the importance of motivation on treatment effectiveness in his work on motivational interviewing.18 Treatment readiness in offenders has been best studied with respect to substance abuse.19 This work is promising, but has yet to produce reliable, valid self-report measures of treatment readiness that apply to offenders. Other research suggests that structured clinical ratings using behavioural referents might address difficulties of social desirability inherent in such assessments.20 Motivation, then, is an important construct in considering how an offender will respond to treatment. Clinically, this has translated into efforts to enhance treatment engagement and therapeutic affiliation in a variety of resistant populations.21
Specific aspects of treatment gain have been demonstrated to be important in determining outcomes for sex offenders22 and substance abusers.23 Recent studies indicate that structured assessments of treatment participation and gain may add to what can be done in pretreatment risk appraisals to predict reoffence.24 Given the need for this work to be readily testable and operationally relevant, a somewhat restricted definition of treatment responsivity has been proposed in this model.25 The combination of treatment readiness motivation and participation and performance behaviour measures of treatment participation and gains are summed to reflect treatment responsivity.
This work by the Research Branch is intended to provide treatment staff with behaviourally based guidelines for evaluating the effectiveness of specific interventions. These measures are being piloted and are likely to be introduced to clinicians and program delivery staff for operational use.Decision rules
The next step is to provide explicit guidelines to integrate risk assessment and treatment measures so that reintegration potential can be determined accurately. Without such guidelines, the potential for judgment error is great.
Research supports linking treatment intensity with pretreatment risk and need appraisals26 -- more intensive intervention should be reserved for higher-need, higher-risk offenders. This aspect of intervention is not reflected in the current model, partly because few hierarchical programs are available. The model was developed to be used with core programs i.e., living skills and substance abuse for which the particular intervention is reflected in the Correctional Treatment Plan and the identified criminogenic needs. To some extent, risk is currently addressed by the offender's security level where intervention is provided.
Once an offender is referred to a correctional treatment program, he or she is interviewed for admission. If admitted, treatment staff assess the offender's readiness for treatment see Table 1 for the items represented in treatment readiness measures. The present model reflects overall ratings of low, moderate or high treatment readiness. Similarly, treatment performance see Table 2 can be assessed as low, moderate or high.
Indices for Treatment Readiness
|1. Problem recognition|
|2. Goal setting|
|6. Behavioural consistency|
|7. Views about treatment|
|10. External supports|
|11. Affective component|
Indices for Treatment Performance
|1. Knowledge of program content|
|2. Skills acquisition|
|5. Knowledge application|
|6. Skills application|
|7. Understanding of criminality|
|13. Depth of emotional understanding|
Figure 1 presents a conservative model of treatment responsivity. For instance, low readings and low performance combine to indicate of an overall rating of poor responsivity. High readiness and high performance combine to indicate high responsivity. Any other combinations yield an overall rating of moderate to ensure a judicious assessment of responsivity.
Treatment responsivity and risk appraisals are combined to arrive at the offender's reintegration potential or risk management strategy see Figure 2. Ratings of low, moderate or high responsivity and risk are inverted to reflect that high responsivity and low risk are the preferred situation, yielding the lowest risk management concerns and, therefore, the highest reintegration potential. To avoid an overestimate of intervention effectiveness, the cells have been differentially weighted, although this requires validation. That is, low or moderate responsivity when combined with high risk yields an overall rating of high-risk management concerns as does low responsivity and moderate risk. High responsivity and high or moderate risk yields an overall rating of moderate-risk management concerns. Low responsivity and low risk yields an overall rating of low-risk management concerns, but probably indicates that the offender should be placed in a minimum-security institution. Moderate and high responsivity and low risk yield an overall rating of low-risk management concerns, indicating either community-based management or placement in a minimum-security institution. The difference between these last two categories could also reflect factors such as time served, availability of programs in the community and dynamic risk factors.
Testing the model
Although speculative, this model provides a set of decision rules for incorporating treatment information into risk management strategies and, therefore, links intervention to reintegration potential. This approach is preliminary and may benefit from further conceptual work. It assumes that an offender has completed a treatment program for its application. This may not always be the case, and treatment readiness measures or prior response to intervention e.g., in another jurisdiction may be the only treatment information available. Employing such indices for a measure of treatment responsivity may significantly limit the utility of the model. Obviously, the model requires validation, beginning with the initial pilot work with the treatment measures27 and a consideration of cutoffs for these clinical ratings. Nonetheless, it should at least stimulate interest in the development of strategies for systematically incorporating intervention factors into correctional decision making.
2. J. Bonta, "The Responsivity Principle and Offender Rehabilitation," Forum on Corrections Research, 7, 3 1995: 34-37. See also R. C. Serin and S. Kennedy, Treatment Readiness and Responsivity: Contributing to Effective Correctional Programming, Research Report R-54 Ottawa, ON: Correctional Service of Canada, 1997.
3. Serin and Kennedy, Treatment Readiness and Responsivity.
4. D. A. Andrews and J. Bonta, The Psychology of Criminal Conduct Cincinnati, OH: Anderson Publishing, 1994.
5. F. Luciani, The Security Classification of Offenders: Development of Reclassification Protocols Ottawa, ON: Correctional Service of Canada, in press.
6. S. L. Brown and R. C. Serin, Situating Risk Assessments into Offender Reintegration: A Consumer's Guide In progress. See also R. C. Serin, "Assessment and Prediction of Violent Behaviour in Offender Populations," in T. A. Leis, L. L. Motiuk, and J. R. P. Ogloff eds. Forensic Psychology: Policy and Practice in Correction Ottawa, ON: Correctional Service of Canada, 1995: 69-91.
7. Andrews and Bonta, The Psychology of Criminal Conduct. And see H. McGuire, What Works: Reducing Reoffending. Guidelines from Research and Practice Toronto, ON: Wiley and Sons, 1995; R. Serin and S. Brown, "Strategies for Enhancing the Treatment of Violent Offenders," Forum on Corrections Research, 8, 3 1996: 45-58.
8. Andrews and Bonta, The Psychology of Criminal Conduct; McGuire, What Works: Reducing Reoffending; Serin and Brown, "Strategies for Enhancing the Treatment of Violent Offenders."
9. P. Gendreau, "The Principles of Effective Intervention with Offenders," in A. T. Harland ed. Choosing Correctional Options that Work: Defining the Demand and Evaluating the Supply Thousand Oaks, CA: Sage, 1996: 117-130.
10. V. L. Quinsey, M. E. Rice, G. T. Harris and M. L. Lalumière, "Assessing Treatment Efficacy in Outcome Studies of Sex Offenders," Journal of Interpersonal Violence, 8 1993: 512-523.
11. C. D. Webster, G. T. Harris, M. E. Rice, C. Cormier and V. L. Quinsey, The Violence Predictions Scheme: Assessing Dangerousness in High Risk Men Toronto, ON: Centre for Criminology, University of Toronto, 1994.
12. Serin and Kennedy, Treatment Readiness and Responsivity.
13. Bonta, "The Responsivity Principle and Offender Rehabilitation." And see Serin and Kennedy, Treatment Readiness and Responsivity.
14. Serin, "Assessment and Prediction of Violent Behaviour in Offender Populations."
15. Brown and Serin, Situating Risk Assessments into Offender Reintegration.
16. J. O. Prochaska, C. C. Diclemente and J. C. Norcross, "In Search of How People Change: Applications to Addictive Behaviors," American Psychologist, 47 1992: 1102-1114.
17. W. R. Miller, "Motivation for Treatment: A Review with Special Emphasis on Alcoholism," Psychological Bulletin, 98 1985: 84-107.
18. W. R. Miller and S. Rollnick, Motivational Interviewing New York: Guilford, 1991.
19. J. R. Weekes, A. E. Moser and C. M. Langevin, Assessing Substance Abusing Offenders for Treatment, Paper presented at the International Community Corrections Association Conference. Cleveland, OH: 1997.
20. K. S. Heilrun, W. S. Bennett, J. H. Evans, R. A. Offult, H. J. Reiff and A. J. White, "Assessing Treatability in Mentally Disordered Offenders: Strategies for Improving Reliability," Forensic Reports, 5 1992: 85-96. See also Serin and Kennedy, Treatment Readiness and Responsivity.
21. D. L. Preston and S. Murphy, "Motivating Treatment-resistant Clients in Therapy," Forum on Corrections Research, 9, 2 1997: 39-43. See also H. E. Barbaree, "Denial and Minimization Among Sex Offenders," Forum on Corrections Research, 3, 4 1991: 30-33. And see R. C. Serin, "Treatment Responsivity in Criminal Psychopaths," Forum on Corrections Research, 7, 3 1995: 23-26.
22. J. K. Marques, D. M. Day, C. Nelson and M. A. West, "Effects of Cognitive-Behavioral Treatment on Sex Offender Recidivism: Preliminary Results of a Longitudinal Study," Criminal Justice and Behavior, 21 1994: 28-54.
23. W. A. Millson, J. R. Weekes and L. O. Lightfoot, The Offender Substance Abuse Pre-Release Program: Analysis of Intermediate and Post-release Outcomes, Research Report R-40 Ottawa, ON: Correctional Service of Canada, 1995.
24. H. E. Barbaree, M. C. Seto and A. Maric, Sex Offender Characteristics, Response to Treatment, and Correctional Release Decisions at the Warkworth Sexual Behaviour Clinic, Research Report Toronto, ON: Forensic Division, Clarke Institute of Psychiatry, 1996.
25. Serin and Kennedy, Treatment Readiness and Responsivity.
26. Andrews and Bonta, "The Psychology of Criminal Conduct."
27. Serin and Kennedy, Treatment Readiness and Responsivity.