The Role of Intervention Services within the Offender Personality Disorder Pathway

NOMS, Interventions Services

Personality Disorder within forensic settings

• Estimated that approximately 70% of men and women in prison meet the clinical diagnosis for at least one personality disorder (approx. 60 000 people)

– Males = higher prevalence of anti-social traits – Females = higher prevalence of borderline traits– Traits more prevalent within younger adults

Intervention Services

Reduce reoffending

Improve psychological wellbeing

Intervention Services

Key Principles

• Evidence based• Strength based • Appropriately targeted (RNR model) • Bio-psycho-social model of change • Use of integrative methods including CBT,

psychodrama, mindfulness, narrative therapy, schema therapy

• Responsive to individual need • Supportive of wider rehabilitative culture

Overview of the symposium

• Introduction to Interventions Services – Natalie Smith • What do I care about and want from my life? The motivation and

engagement programme – Chris Bull • Where does it all end? The importance of consolidation work –

Chris Bull • Exploring the use mentoring services as part of intervention

design and delivery – Natalie Smith• Enhancing Effectiveness; the Interventions Integrity Framework

- Vicky Nealon• Question time – Natalie Smith

What do I care about and want frommy life?

The importance of Motivation & Engagement

Chris Bull March 2015

What is motivation and engagement?

• Motivation – being willing to learn new skills that service users could choose to employ to live a life style where they do not resort to violence, or other crime

• Engagement – working effectively with staff in order to do this

What might get in the way?

• Service users may enjoy a lot of aspects of their criminal behaviour e.g. the thrill of it, status, being feared, having a sense of belonging

• Some PD traits make it difficult e.g. grandiose, ‘manipulative’, issues with attachment, issues with trust

• Way service users interact with others and have lived is lifelong and hard to change

• Service users may enjoy aspects of imprisonment e.g. status, being able to manipulate, feeling safe

• Staff may have difficulty understanding the service user(s) and relating to them

Why focus on motivation and engagement?

• To reduce and manage drop out and disruption• Offer treatment that is credible, meaningful and

personally relevant • Maximise chance that the service user will be able to

engage with the materials• Ensure change goes beyond the group room, and is

sustained long term – more than compliance

Applies to whole programme

Motivation And

Engagement

Assessment

Programme materials

Staff style

Wider environment

Sequencing treatment

Progression

Combined risk management and GLM approach

• Combined approach says you can get what you want out of life without offending

• Not changing the goals, just how they are achieved• The service users remain an expert in their own lives• Supports treatment being individualised• Staff can demonstrate genuine interest• The approach is collaborative and transparent• Focused positively on the future, not just negatively

on the past

Motivational Drivers

Control and choice

Complex needs

Collaborativeandtransparent

Novel and stimulating

Status andcredibility

Rewards andincentives

Future focused

Control and choice

• The three ingredients of choice…

Conscious deliberation

ConsequencesOptions

Choice and risk

Participation/Self-Management/Opportunity

Non-participation/Risk Management/Restriction

Choice

Complex needs and personal relevance

• Explore what really motivates and drives each individual

• Identify an individualised plan of how the service user can achieve what they want in life in pro-social and effective ways

• Deliver individualised treatment for greater flexibility and responsivity

• Exercises and examples highly relevant • Ongoing application of skills to own life

Future focused

Evidence suggests that treatment which focuses

positively on the future is more engaging

• Future focused approach• Frames risk factors as treatment goals• Focuses on how the person can have a more fulfilling

life in the future• Recognises strengths as well as needs

Collaborative and transparent

Concern about hidden agendas and unwanted side

effects from treatment

• Highly transparent• Staff promote transparency and collaboration• Work collaboratively to ensure participants feel they

have control and determination in treatment process

Novelty and stimulation

• Develop skills to tolerate boredom and structure activities

• Sessions dynamic, structured and paced

• Recognises people can find concentration difficult

• Emphasis on personal relevance, individualisation

• Novel and challenging exercises that are, meaningful and interesting

• Sequenced learning avoids repetition of material• Range of techniques and media used • Assignments individualised• Flexible learning environment

Status and credibility

• Explore how pro-social change can be credible • Programme materials and language professional and

credible. • Uses exercises and materials we would use on

ourselves or colleagues• Staff use respectful, professional collaborative

approach and language• Not over emphasising deficits, but building on

existing skills

Rewards and incentives

• Game playing and winning can be very motivating• Use this positively: exercises include element of

challenge to be engaging• Identify with participant what may be meaningful

incentives to acknowledge progress• Focus on intrinsic rewards of working towards own

personally meaningful life goals

In summary……

The programme is designed to meet the needs of the

participant, rather than expecting the participants to

meet the needs of the programme.

Where does it all end?

The importance of consolidation work

Chris Bull March 2015

Leading a Rewarding and Meaningful Life

‘………Rehabilitation as a practice has become so focussed on lowering risk and increasing community safety that it is easy to overlook a rather basic truth:

prisoners and probationers want a better life, not simply the promise of a less harmful one.’

Ward & Maruna, 2007.

We’ve been talking about it for some time:

National Offender Management Model 4 Cs:

Consistency: the (participant)needs to experience a consistency of message and behaviour, both by the same person over time and by different people working with the same (participant) at the same time

Continuity: there needs to be a continuity of care or treatment, but also a reasonable degree of continuity of relationship running through the whole of the sentence

Cont’d

Commitment: : (participants) need to experience those working with them as being committed or genuine, not just going through the motions

Consolidation: gains will be short-lived if new learning is not turned into normal behaviour through a process which reinforces and rewards it

The challenges:

• Unwillingness or inability to generalise skills• Misuse of skills• Difficulty with honest disclosure• Fake treatment progress• Manipulate staff assessments• Status orientation• Change is scary• Attachment issues

PCL-R as a Predictor of Violent Recidivism in Schizophrenic Offenders

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PCL-R 26-40

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Some key messages:

• Supervision can make a difference• Importance of ensuring that relevant

information is passed on to progression services

• Prison,Health and Probation need to work collaboratively for progression and resettlement to be effective.

A few quotes from a few authors

“You don’t reach points in life at which

everything is sorted out for us. I believe in

endings that should suggest our stories always

continue.” Lauren Oliver

“There’s no real ending. It’s just the place where

you stop the story.” Frank Herbert

And a few more

“It is always important to know when something

has reached its end. Closing circles, shutting

doors, finishing chapters, it doesn’t matter what

we call it; what matters is to leave in the past

those moments in life that are over.”

Paulo Coelho

“It’s the most important part of the story…..the

ending” Mort Rainey

Best practice

• Responding to individual needs• Recognising the context in which people live their

lives• Collaboration and transparency• Risk reduction and risk management• Developing new fulfilling ways of leading a pro-social

life• Generalisation• Staff competence• Good communication

Focusing on skills and observable behaviour

• A key emphasis needs to be on the development and generalisation of pro-social skills over the wider environment and over a long period of time.

Exploring the use mentoring services as part of intervention design and delivery

NOMS, Interventions Services

What do we mean by mentoring?

Defining mentoring is complex as it covers a vast range of activities including coaching, facilitating, counselling, befriending, tutoring, teaching, role-modeling, buddying and life-styling

Generally it aims to support and encourage people to manage their lives in order that they may maximize their potential, develop their skills, improve their performance and become the person they want to be

(Phillip, 1999, Clutterback, 2002).

Different types of mentoring

Differences in …

•Philosophies and aims •Method’s •Content •Duration •Location •Staffing model

Is mentoring effective?

• Reducing reoffending– Some evidence that mentoring can help to reduce re-offending if

through the gate services are provided and the mentoring is part of a wider pool of interventions (Philip and Spratt, 2007, Jollifee and Farrington, 2007, Taylor et al 2013)

• Promoting psychological wellbeing– Increased positive self-identity, self-confidence and employability

skills for the mentor

– Positive impact on attitudes, engagement and behaviour for the recipients of the services

– Positive impact on prison regime (South, 2014)

Intervention Service’s use of mentoring

• Building Skills for Recovery – use of Recovery Champions

• Pathways Programme for Sexual Offending – use of Peer Mentors

• Choices, Actions, Relationships and Emotions Programme– use of third sector organisation to provide through the gate support

CARE mentoring and advocacy service

• Designed for women with a history of violence and complex responsivity needs

• Currently delivered in two female prisons as part of the Women Offender Personality Disorder Pathway

• Each woman has assess to two years mentoring/advocacy support with an independent mentoring service

Types of services offered

• Attending adjudications/parole board hearings

• Liaising with employment/education providers within prison

• Completing grant application forms

• Supervising community ROTL licenses

• Registering with local GP

• Benefit support

• Setting up bank accounts

• Sourcing appropriate accommodation

• Advocating with statutory children’s services

• Joint care planning with health services and probation

• Sourcing college and training opportunities

• Signposting to external services

• Providing emotional support

Case Study S

Lesson’s learned …

• Benefits far outweigh challenges

• Clarity about the role is essential

• Local considerations

• Staff and service user involvement as early as

possible

• Resources

• Draw upon experience and examples

Vicky Nealon

Enhancing Effectiveness - The Interventions Integrity Framework

The Importance of targeting

• Risk-Need-Responsivity model.– 1. Risk principle (match level of programme intensity to offender

risk level)

– 2. Need principle (target criminogenic needs or those offender needs that are functionally related to criminal behavior)

– 3. Responsivity principle (match the style and mode of intervention to the offender’s learning style and abilities)

– Bonta, J. & Andrews, D. A. (2007)

• These form a key focus of the IIF process.

A clear focus on quality of delivery

• The effectiveness of a programme is determined by how well it is delivered; and how engaged the service users are in the process.

• A clear focus on responsivity and adopting the right approach to working with individual needs is key.

Good lives model, Ward & Maruna 2007

Working alongside the service user

• Therapeutic alliance has been shown to be one of the most important factors towards achieving a successful outcome in treatment and avoiding drop out.

Martin Garske & Davis (2000)

Piper et. al. (1999)

• Two clusters of facilitator behaviours are associated with positive outcome in cognitive behavioural treatment. – The first cluster related to the use of Rogerian values

(empathy, warmth, positive regard for clients, and genuineness).

– The second cluster was linked with the establishment of a good therapeutic alliance with the client.

• Keijsers, Schaap, Hoogduin (2000)

Importance of the therapeutic culture

• Focus on hearing the service users ‘voice’

• Desistance theory and the importance of ‘being believed in’

• MoJ Analytical Series, 2014

• Use of a rehabilitative culture questionnaire– Measure how embedded rehabilitation is

– Focusing on turning changes into everyday behaviour