RNR Simulation Tool

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RNR Simulation Tool Phillip Barbour Master Trainer for Center for Health and Justice at TASC (CHJ) 1

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RNR Simulation Tool. Phillip Barbour Master Trainer for Center for Health and Justice at TASC (CHJ). Risk, Needs, Responsivity (RNR) and Recidivism: An Update on Theory. Center for Advancing Correctional Excellence (ACE!) George Mason University www.gmuace.org/tools. - PowerPoint PPT Presentation

Transcript of RNR Simulation Tool

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RNR Simulation ToolPhillip Barbour Master Trainer for Center for Health and Justice at TASC (CHJ)

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Risk, Needs, Responsivity (RNR) and Recidivism: An Update on Theory

Center for Advancing Correctional Excellence (ACE!)George Mason Universitywww.gmuace.org/tools

BJA: 2009-DG-BX-K026; BJA: 2010-DG-BX-K077; SAMHSA: 202171; Public Welfare Foundation

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Faye S. Taxman, Ph.DUniversity ProfessorCenter for Advancing Correctional

ExcellenceCriminology, Law and Society George Mason University10519 Braddock Road Suite 1900Fairfax, VA 22032

James M. Byrne, Ph.D.ProfessorUniversity of Massachusetts, LowellGriffith University

April Pattavina, Ph.D.Discrete Event ModelAssociate ProfessorUniversity of Massachusetts, Lowell

Avinash Singh Bhati, Ph.D.Simulation ModelMaxarth, LLC

Michael S. Caudy, Ph.D.Stephanie A. Maass, M.A.Erin L. Crites, M.A.Lauren Duhaime, B.A.Amy Murphy, MPPJoseph Durso, M.A.Gina Rosch Special Acknowledgements:• Bureau of Justice Assistance

▫ BJA: 2009-DG-BX-K026• Center for Substance Abuse

Treatment▫ SAMHSA: 202171

• Public Welfare Foundation• Special Thanks to:

▫ Ed Banks, Ph.D.▫ Ken Robertson

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What affects recidivism?The good, the bad, and the ugly!

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Understand RiskUnderstand What Affects

Recidivism

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67%

Reducing Recidivism:The RNR Framework Target individual risk Target needs that are amendable to

change Offer quality programs Engage offenders in change process

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What is Risk?

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•Risk is the likelihood that an offender will engage in future criminal behavior (recidivate).

•Risk does NOT refer to dangerousness or likelihood of violence

•Static Risk Factors have a demonstrated correlation with criminal behavior▫Historical – based on criminal history▫Cannot be decreased by intervention

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CJ Risk Matters…(3 year, all offenses)

Ainsworth, Crites, Caudy, & Taxman, 2011

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Risk is static factors: history of arrests, age of onset,history of incarceration, history of escapes, etc.

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Age & Rearrests

Langan & Levin, 2002

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Gender Matters

Ainsworth, et al 2011

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Evidence-Based Practices Lead to Better Outcomes

• Education (Psycho-Social)• Non-Directive Counseling • Directive Counseling

• Motivational Interviewing• Moral Reasoning• Emotional Skills• 12 Step with Curriculum

• Cognitive Processing• Cognitive Behavioral

(Social Skills, Behavioral Management, etc.)

• Therapeutic Communities (TC)

• Contingency Management/Token Economies

• Intensive Supervision• Boot Camp• Case Management• Incarceration

• TASC• DTAP (Diversion to TX, 12 Month Residential) • Treatment with Sanctions (e.g. Break

the Cycle, Seamless System, etc.)

• Drug Courts• RNR Supervision• In-Prison TC with

Aftercare

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Better Outcomes via Tx Matching

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Caudy, et al (2011). Using Data to Examine Outcomes: A review of Kansas Department of Corrections. Fairfax, VA: George Mason University.

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http://www.gmuace.org/tools/

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The RNR Simulation Tool•Provide decision support tools for the field

that enhance existing practices▫Individual level▫Program feedback▫System building capability

•Program Tool focuses on:▫Classifying programs to target specific needs▫Rating key program features▫Linking to meta-analyses/systematic reviews

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Compiled National Database (20,000+) or Develop Your Own Database

Reflect Expected Reductions in Recidivism (from Meta-Analysis)

Base Recidivism Rate

• Risk & Need Information• Destabilizers—performance inhibitors• Programs• Expected outcomes

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Model to Improve Outcomes: Big Picture• Current recidivism hovers around 67%

▫3 year re-arrest rate

• How can we make a dent in this at the system and individual level?

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Offender Individual Risk & Need Factors

Organizational Culture

Program Quality Implementation

Correctional Programming

Individual Outcomes (Reduced Recidivism)

Focus of EBP Research

Focus of RNR & RNR Simulation Tool

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RNR via Andrews & BontaAndrews & Bonta• Antisocial personality

patterns• History of antisocial

behavior• Antisocial peers• Antisocial attitudes• Family/marital factors• Employment/educational

deficits• Lack of prosocial leisure

activities• Substance Abuse

Updated research Responsivity, Recidivism, &

Clinical Relevance Substance dependence vs.

abuse Spectrum of needs can

override risk (3+) Change is a function of

problem severity History of antisocial behavior

is risk (cannot be changed) Recidivism reduction is

function of targeting specific needs within programs

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Major Criminogenic Needs•Severe Substance Use Disorders

▫A pattern of harmful use of any substance for mood-altering purposes

▫Includes 6 or more of the following: Increased tolerance, withdrawal, increased

time spent using, difficulty quitting or cutting back, or continued use despite negative consequences

▫Not the same as substance abuse▫Drug of choice matters

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Major Criminogenic Needs•Criminal Thinking/Lifestyle

▫A pattern of thinking that rationalizes and supports criminal behavior

▫Involvement with criminal lifestyle

▫Should be assessed using a validated instrument

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What is Responsivity?• Treatment to address criminal behavior should

be cognitive and/or behavioral based programming that has been shown to effectively reduce recidivism.

• Deliver controls and treatment in a manner that is consistent with individuals’ learning styles▫Considers age, gender, culture, intelligence,

motivation, etc.▫Translate Risk & Need into Program

Placement/Case Decisions▫Needs trump risk when there is 3+ needs▫Destabilizers require more social controls

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StabilizersSupportive Family Stable Employment

Education > HS Diploma

Stable HousingLocation in non-Hot

Spots

DestabilizersAlcohol AbuseDrug Abuse

Family DysfunctionPoor Mental Health Status

Employment-Related Issues

Literacy Related ProblemsHousing Instability

Location in Hot Spots

CJ RISKCriminogenic Needs

Substance Tolerance for “Hard Drugs”3+ Criminal Lifestyle—attitudes, family, peers,

personality, substance abuse

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Gender & Age

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What Information do I Need?•Static Risk

▫From a validated risk assessment tool▫Based on criminal history

▫Demographics▫Age and gender

▫Criminogenic Needs▫Substance Use▫Criminal thinking/lifestyle

•Stabilizers and Destabilizers▫Clinically-relevant factors

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The RNR Program Tool for Adults

Define target behaviors that drive program classification

Understand program group classification system

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Program Groups• Six program groups based on specific target behaviors

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Risk Type of Need Type of Stabilizers

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PROGRAM GROUP

MECHANISM OF ACTION RESEARCH EVIDENCE

Group A Severe Substance Use/Dependence

Treatments to reduce use of heroin, cocaine, amphetamines, and methamphetamine

Holloway, Bennett, & Farrington, 2006; Prendergast, Huang, & Hser, 2008; Prendergast, Podus, Chang & Urada, 2002; Lipton, Pearson, Cleland & Yee, 2008; Mitchell, Wilson & MacKenzie, 2007

Group B Criminal Thinking

Cognitive restructuring to change maladaptive thinking and behavior patterns

Andrews & Bonta, 2010; Lipsey, Landenberger & Wilson, 2007; Wilson, Bouffard & MacKenzie, 2005; Little, 2005; Tong & Farrington, 2006 & 2008

Group C Self-Improvement and Management

Developing social and problem solving skills to address MH, SA, and self-control.

Botvin & Wills, 1984; Botvin, Griffin, & Nichols, 2006; Martin, Dorken, Wamboldt & Wootten, 2011

Group D Social and Interpersonal Skills

Structured counseling and modeling of behavior to reduce interpersonal conflict and develop more positive interactions.

Botvin & Wills, 1984; Beckmeyer, 2006; Wilson, Gallagher & MacKenzie, 2000; Visher, Winterfield & Coggeshall, 2005

Group E Life Skills

Stabilize education, housing, employment, and financial concerns.

Andrews & Bonta, 2010; Beckmeyer, 2006

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Program Groups for SUD Treatment• Offenders with SUDs have unique Tx needs

▫Program Group A: Addicts▫Program Group C: Abusers with Lifestyle Factors

• Operationalized essential features▫Program content, dosage, implementation fidelity

• Example: Group A – most intensive▫ Individual profile: all CJ risk levels; dependence on hard drugs;

multiple criminogenic needs and destabilizers

▫ Program profile: cognitive restructuring techniques; adequate dosage to address high SUD need; clinical staff; evidence-based curricula; medication-assisted treatment

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Essential Features of Effective Programs

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Principles of Effective Interventions•Rehabilitative efforts have a greater

impact on recidivism

•There is no magic program▫There is no one program or program type

identified that will consistently have a large impact on recidivism

•We do know something about common features of effective correctional practice▫What really works?

McGuire, 2002; Lipsey & Cullen, 2007

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Program Quality Matters• Most programs score < 50% (unsatisfactory)• Program quality (Implementation, Risk-Need

Assessment, Orientation) related to Recidivism

Lowenkamp, Latessa, & Smith, 2006; see also Nesovic, 2003

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Program Tool Factors• Target Population• Program Goals• Program Theory• Client Level Factors

▫Spectrum of Needs/Severity of Program Needs▫Developmental Factors (e.g., age, gender,

cognitive, physical)• Program Structure• Program Dosage (a lot unknown, clinical literature)• Implementation Issues

▫Staffing▫Fidelity Monitoring, Training▫Quality Assurance

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Substance Abuse Treatment Program

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• Key Items: Use of a validated risk assessment and focus on appropriate risk levels

• Justification: ▫Use of a validated risk assessment is

associated with more effective programs (Smith, Gendreau, Swartz, 2008)

▫Provide more intensive services to higher risk individuals (Lowenkamp, Latessa, and Holsinger, 2006;

Andrews & Dowden, 2006)

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• Key Items: Program focuses on a primary target; uses appropriate content based on the target

• Justification: ▫Focus on criminogenic needs

(Andrews, Bonta, and Hoge, 1990)

▫Focus on stabilizers and destabilizers (Ward & Stewart, 2003)

▫Treatment is theoretically linked to changes in the target (Cordray & Pion, 2006)

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• Key Items: Program content with better evidence, use of rewards and sanctions, and addresses specific responsivity factors; ▫ Focus is on treatment matching

• Justification:▫ Programs more effective if consistent with an

individual’s learning style Andrews, Zinger, et al., 1990a; Smith et al., 2009; Taxman,

& Marlowe, Douglas, 2006

▫ Treatment matching improves outcomes Mee-Lee, Shulman, Fishman, Gastfriend, & Griffith, 2001;

Thornton, Gottheil, Weinstein & Kerachsky, 1998; Gastfriend & McLellan, 1997; Barbor, 2008

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• Key Items: completion criteria, appropriate administration based on target, appropriate staff credentials based on target, staff communication, program evaluation, use of a treatment manual, coaching, technical assistance, quality assurance protocols

• Justification: ▫ Implementation fidelity related to effectiveness

Landenberger & Lipsey, 2005; Andrews & Dowden, 2005; McGrew, Bond, Dietzen & Salyers, 1994; Stanard, 1999; Simons, Padesky, Montemarano, Lewis, Murakami, Lamb et al., 2010; Taxman & Bouffard, 2000; Fletcher, et al., 2009; Taxman & Belenko, 2012

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• Key Items: appropriate clinical hours, sufficient duration based on target, sufficient intensity based on target, sufficient frequency based on target, phases, and aftercare

• Justification:

▫ Dosage positively related to effect size (Landenberger & Lipsey, 2005)

▫ High risk approximately 300 hours of CBT (Bourgon & Armstrong)

▫ Higher risk saw recidivism reduction with more dosage in drug treatment (Taxman, Byrne, & Thanner, 2002; Lowenkamp & Latessa,

2005)

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•Key Items: Social controls in programs are also useful to enhance the impact of the content and dosage of programs

•Justification:

▫Increasing social controls for higher risk individuals can improve outcomes (Drake, Aos, & Miller, 2009; Padgett, Bales,

and Blomberg, 2006; Pattavina, Tusinski-Miofsky, & Byrne, 2009)

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Example Scores39

Domain Max Score MAT Drug Tx Center

Re-entry Program

Drug Court Outpatient Tx

PROGRAM GROUP A A B A B

Risk 15 0 0 15 15 5

Need 15 10 10 15 15 15

Responsivity 15 13 10 15 13 13

Implementation 25 17 18 21 21 21

Dosage 20 7 9 9 18 10

Restrictiveness 10 10 6 4 8 5

Total Score 100 60 53 79 90 69

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New! Specialty Court Output

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Building a Responsive System

Identify Core Principles of Responsivity Identify Key Stakeholders

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Core Principles of Responsivity• Individual

▫Match programming and controls to risk and need▫Involve the offender in the assessment of risk-need

information & selection of options▫Focus on motivation to change ▫Provide feedback reports to offenders on progress

• System▫Focus on correctional culture to increase receptiveness to

treatment ▫Measure client outcomes to gauge performance and share

with partner agencies ▫Increase communication and build systems of care

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What does a “Responsive Jurisdiction” look like?•Screening and assessment

▫Identify risk and primary criminogenic needs▫Link assessment info to specific case plans

•Treatment matching•High-quality, evidence-based programming

▫Sound implementation▫Enough dosage to make change

•Capacity to address population needs▫Alignment between needs and services▫Collaboration between CJ and Tx

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Identifying Key Stakeholders•Judges

•Prosecutors

•Defense Attorneys

•Probation/Parole Officers

•Program Directors/Administrators and Treatment Staff

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Jurisdiction Capacity Limitations•CJ agencies often lack capacity for

responsivity.

•Lack of information within correctional agencies about the specific nature and availability of community-based programs.

•Lack of quality decision-support tools to help them assess both individual-level and system capacity issues

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Group A Group C Group D Group E Group FGroup B

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Thank you!!www.gmuace.org/tools

This project received funding from Bureau of Justice Assistance, Center for Substance Abuse Treatment, and Public Welfare Foundation. Views expressed here are ours and not the

positions or policies of the funders.

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