1. What Works in Reducing Recidivism: Understanding Effective Treatment Models and How to Apply Them
Presented by:
Edward J. Latessa, Ph.D.
School of Criminal Justice
University of Cincinnati

2. Treatment Principle The most effective interventions are behavioral:
Focus on current factors that influence behavior
Action oriented
Staff follow “core correctional practices”

3. Core Correctional Practices
Effective Reinforcement
Effective Disapproval
Effective Use of Authority
Quality Interpersonal Relationships
Cognitive Restructuring
Anti-criminal Modeling
Structured Learning/Skill Building
Problem Solving Techniques

4. Core Correctional Practices and Recidivism
Effect Size
Gendreau (2003). Invited Address. APA Annual Conference. Toronto.

5. Ratio of Rewards to Punishments and Probability of Success on Intensive Supervision
Widahl, E. J., Garland, B. Culhane, S. E., and McCarty, W.P. (2011). Utilizing Behavioral Interventions to Improve Supervision Outcomes in Community-Based Corrections. Criminal Justice and Behavior, 38 (4).

6. List of Rewards and Sanctions
Verbal reprimand
Written assignment
Modify curfew hours
Community service hours
Restrict visitation
Program extension or regression
Electronic Monitoring
Inpatient or outpatient txt
Detention time
Verbal praise and reinforcement
Remove from EM
Level advancement
Increased personal time
Approved special activity
Fees reduced
Approve of extend special visitation
Widahl, E. J., Garland, B. Culhane, S. E., and McCarty, W.P. (2011). Utilizing Behavioral Interventions to Improve Supervision Outcomes in Community-Based Corrections. Criminal Justice and Behavior, 38 (4).

7. Sanction Type by Offender Compliance
Wadahl, Boman and Garland (2015) examined 283 offenders on ISP and looked at the effectiveness of jail time versus community-based sanctions.
Widahl, E. J.,Boman, J. H. and Garland, B. E.. (2015). Responding to Probation and Parole Violations: Are Jail Sanctions more Effective than Community-based Graduated Sanctions? Journal of Criminal Justice,43:

8. List of Sanctions Verbal reprimand Written assignment
Modify curfew hours
Community service hours
Restrict visitation
Program extension or regression
Electronic Monitoring
Inpatient or outpatient txt
County jail time
Widahl, E. J.,Boman, J. H. and Garland, B. E.. (2015). Responding to Probation and Parole Violations: Are Jail Sanctions more Effective than Community-based Graduated Sanctions? Journal of Criminal Justice,43:

9. They found Jail Time:
Was not related to number of days until the next violation
Did not increase or decrease the number of subsequent violations
Receiving jail time as a sanction as opposed to a community-based sanction did not influence successful completion of supervision

10. Most Effective Behavioral Models
Structured social learning where new skills and behaviors are modeled
Family based approaches that train family on appropriate techniques
Cognitive behavioral approaches that target criminogenic risk factors

11. Social Learning
Refers to several processes through which individuals acquire attitudes, behavior, or knowledge from the persons around them. Both modeling and instrumental conditioning appear to play a role in such learning

12. Some Family Based Interventions
Designed to train family on behavioral approaches
Functional Family Therapy
Multi-Systemic Therapy
Teaching Family Model
Strengthening Families Program
Common Sense Parenting
Parenting Wisely

13. Effectiveness of Family Based Intervention: Results from Meta Analysis
38 primary studies with 53 effect tests
Average reduction in recidivism= 21%
However, much variability was present
( )
Dowden & Andrews, 2003

14. Mean Effect Sizes: Whether or not the family intervention adheres to the principles

15. The Four Principles of Cognitive Intervention
Thinking affects behavior
Antisocial, distorted, unproductive irrational thinking can lead to antisocial and unproductive behavior
Thinking can be influenced
We can change how we feel and behave by changing what we think

16. Recent Meta-Analysis of Cognitive Behavioral Treatment for Offenders by Landenberger & Lipsey (2005)*
Reviewed 58 studies:
19 random samples
23 matched samples
16 convenience samples
Found that on average CBT reduced recidivism by 25%, but the most effective configurations found more than 50% reductions

17. Significant Findings (effects were stronger if):
Sessions per week (2 or more) - RISK
Implementation monitored - FIDELITY
Staff trained on CBT - FIDELITY
Higher proportion of treatment completers -RESPONSIVITY
Higher risk offenders - RISK
Higher if CBT is combined with other services - NEED

18. Some Examples of Cognitive Behavioral Correctional Curriculums
UC’s Cognitive Behavioral Interventions for Substance Abuse (non-proprietary)
Moving On (Female Offenders)
UC’s Cognitive Behavioral Treatment for Sex Offenders (non-proprietary)
UC's Cognitive Behavioral Interventions for Offenders - A comprehensive curriculum (non-proprietary – pilot underway). Also adaptable for MDOs.
Aggression Replacement Training (ART)
Criminal Conduct and Substance Abuse Treatment
Thinking for a Change (non-proprietary)
UC's Cognitive Behavioral Interventions for Offenders Seeking Employment (non-proprietary – pilot underway)

19. Effective Practices in Correctional Supervision (EPICS)
We are currently training on a new model of PO and Case Manger interaction
Effective Practices in Correctional Supervision (EPICS)

20. Traditional Officer-Offender Interactions are often not Effective because:
They are too brief to have an impact
Conversations focus almost exclusively on monitoring compliance conditions (and therefore emphasize external controls on behavior rather than developing an internal rationale for pro-social behavior)
Relationship is often more confrontational and authoritarian in nature than helpful
What is targeted is not always based on assessment
More areas discussed=less effective

21. Structure of EPICS Meeting
SESSION OVERVIEW
Each session should be structured in the following way:
1. Check-In
2. Review
3. Intervention
4. Homework 21

22. Rationale for EPICS Preliminary Data from Canada:
Trained officers had 12% higher retention rates in comparison with untrained officers at six months.
Also found reductions in recidivism 22

23. Two year Recidivism Results from Canadian Study
Bont, et al, (2010) The Strategic Training Initiative in Community Suopervision: Risk-Need-Responsivity in the Real World. Public Safety Canada.

24. Findings from Federal Probation Sample
Robinson, Vanbenschoten, Alexander, and Lowenkamp, Forthcoming, Federal Probation, Sept

25. Recidivism Results from Ohio Study looking at Fidelity and High Risk Offenders (adult and juvenile
Latessa, E., Smith, P., Schweitzer, m., and Labrecque, R. (2013). Evaluation of the Effective Practices in Community Supervision Model (EPICS) in Ohio. School of Criminal Justice, University of Cincinnati.

26. We are Currently Piloting a New Version: Effective Practices for Community Support (EPICS for Influencers)
Pilot Sites include:
LA County Jail Reentry Program
Hamilton County (Cincinnati) Reentry Coalition
Portsmouth, OH Juvenile Truancy and Mentoring Program

27. EPICS for Influencers is Designed for:
Mentors
Coaches
Family Members
Friends
Faith Based Organizations
Reentry Coalitions
Law Enforcement
School Officials
Significant others

28. EPICS Helps bring together all of your EBP efforts:
Risk assessment and priority on higher risk offenders
Focus on criminogenic needs
Takes motivational interviewing to the next level
Supports programs and services
Helps PO and others become more effective agents of change
Increases compliance
Reduces recidivism

29. These approaches help us….
Structure our interventions
Teach and model new skills
Allow offender to practice with graduated difficulty
Reinforce the behavior

30. What Doesn’t Work with Offenders?

31. Lakota tribal wisdom says that when you discover you are riding a dead horse, the best strategy is to dismount. However, in corrections, and in other affairs, we often try other strategies, including the following:
Buy a stronger whip.
Change riders
Say things like “This is the way we always have ridden this horse.”
Appoint a committee to study the horse.
Arrange to visit other sites to see how they ride dead horses.
Create a training session to increase our riding ability.
Harness several dead horses together for increased speed.
Declare that “No horse is too dead to beat.”
Provide additional funding to increase the horse’s performance.
Declare the horse is “better, faster, and cheaper” dead.
Study alternative uses for dead horses.
Promote the dead horse to a supervisory position.

32. Ineffective Approaches with Offenders
Programs that cannot maintain fidelity
Programs that target non-criminogenic needs
Drug prevention classes focused on fear and other emotional appeals
Shaming offenders
Drug education programs
Non-directive, client centered approaches
Bibliotherapy
Talking cures
Self-Help programs
Vague unstructured rehabilitation programs
“Punishing smarter” (boot camps, scared straight, etc.)

33. Fidelity Principle
Making sure the program is delivered as designed and with integrity:
Ensure staff are modeling appropriate behavior, are qualified, well trained, well supervision, etc.
Make sure barriers are addressed but target criminogenic needs
Make sure appropriate dosage of treatment is provided
Monitor delivery of programs & activities, etc.
Reassess offenders in meeting target behaviors

35. Drug Court Effectiveness: What Does the Research Tell Us?

36. Research Includes:
Primary Studies
Cost Benefit Analysis
Meta-Analysis

37. Primary Research
Mixed evidence and wide range of treatment effects

38. Primary Research Results:
Some studies show drug courts are effective in reducing recidivism rates
Some show no effects
At least one found that participation in drug court was associated with increased rates of recidivism (Miethe et al, 2000).

39. Results from Cost Benefit Studies
Are the reductions in recidivism associated with drug court participation worth the additional costs?
Most studies show that drug courts are cost effective
Drake et al (2012) found the benefit to cost ratio was $1.77 return for $1 spent

40. Meta Analysis Meta analysis is a study of studies
Researchers gather and code primary studies
Data is then used to estimate an average effect size on recidivism

41. Meta Analytical Results
Most have concluded that adult drug courts can reduce recidivism, however overall the effects are modest

42. Meta Analysis of Adult Drug Courts
Aos et al (2001)
26 studies
Average 13% reduction in recidivism
Latimer et al (2006)
60 studies
Average 12% reduction in recidivism
Lowenkamp et al (2005)
22 studies
Average 7.5% reduction in recidivism
Stronger effects for higher risk offenders (10%)
Wilson et at (2006)
48 studies
Shaffer - Koetzel (2010)
Average 10% reduction in recidivism
8 to 16 months more effective
Requiring AA less effective
Wilson et al (2012)
42 studies

43. Juvenile Drug Court Results have not been as Positive
Shaffer (2006) found 5% reduction in recidivism
Mitchell et al.( 2012) small effect on recidivism (6.5%)
Latimer et al (2012) found no significant difference

44. 2014 UC Juvenile Drug Court Study
9 Programs Across US
Sites varied in location type, size, and drug court model
All were reasonably-mature and funded by OJJDP
Outcome Evaluation
Quasi-experimental design with matched comparison group of probationers (N=1372)
Official recidivism and other measures collected from records during process
Process Evaluation
Courts and sample of referral agencies assessed with evidence-based Correctional Program Checklist – Drug Court (CPC-DC)
See Latessa et al. (2013), Sullivan et al. (2014), Blair et al. (In Press) for more. I am also happy to answer questions on aspects of the methods as well.
Youth Participants
To complete the outcome evaluation, a quasi-experimental design, with matching on possible confounders and sociodemographics, was used (n=1372 with 686 in Drug Court [DC] and 686 in the Comparison [C] group). All youth enrolled in the study (youth assent and parent consent were obtained) were matched within the same jurisdiction. Youth enrollment in the study began in May 2008 and continued through December Regular correspondence with the JDCs indicated that fewer than 10 youth–across both groups–refused to participate. While some sites struggled with consenting matched comparison youth, this was from the standpoint of coordinating with probation units as opposed to parents/youth not providing consent. As an alternative, a blanket consent process was implemented to allow the research team to collect de-identified record data for matching and follow-up. The number of youth enrolled in the study per site ranged from 72 to 292, split evenly between the DC and C groups (i.e., matched one-to-one). Each site was asked to match DC participants with a standard probation youth on risk level, race, gender, and alcohol/drug abuse or dependence 196 youth (279%) in the probation group were enrolled in the study through this process, which allowed for each drug court to identify a comparison case by accessing already collected court data to match cases and collect official record data without specific consent or assent. In sites where blanket consents were sought, the University IRB and the Court in question was required to approve the process. These cases are equivalent to administrative record controls.
The data predominantly consisted of drug court descriptions and individual-level measures on drug court participants and their matches. These were collected by study staff and site contractors who were trained on data extraction, coding, and ethical research practices. The individual-level measures were intended to have been easily found through case reviews. As shown in Table 1, eight of the drug courts assessed risk. Three used validated fourth-generation risk/need instruments, two used validated state-specific instruments, two used validated county-specific instruments, and one used a non-validated local instrument. In the site where no risk assessment was used (Site 7), a risk score was created based on the number of prior charges, the level of the youth's current charge, age at first referral, and number of prior adjudications. In order to create a pooled risk assessment measure across sites, benchmarks associated with each of the original instruments were used to categorize youth as low, medium, or high risk. All sites used some form of substance abuse assessment, but each differed in their preferred diagnostic tool. Approaches varied from biopsychosocial interviews which used American Society of Addiction Medicine (ASAM) or Diagnostic and Statistical Manual of Mental Disorders (DSM) criterion to assessments such as the Adolescent Substance Abuse Subtle Screening Inventory (SASSI).
Numerous youth-level measures were drawn from file review including offender sociodemographics (e.g., age, sex, race/ethnicity), characteristics of the current court case (e.g., date, level and charge for the most serious offense, date of first court appearance, legal status [adjudicated or pre-adjudicated], disposition date), prior criminal history (e.g., number of prior referrals [felony and misdemeanor], and previous drug charges), drug use history (e.g., drugs used, frequency of use, age of first use), and family factors (e.g., living arrangements, criminal history). In addition, motivation surveys were given to both the DC and C groups at the time of consent. Specifically, the TCU Treatment Motivation Scale from the Client Evaluation of Self and Treatment, which has been validated previously (Simpson & Joe, 1993), was administered. It had an alpha reliability of .76 in this sample, which is in line with previous research. Other youth-level measures include legal processing indicators (e.g., date of referral and disposition, time in detention), treatment services received (e.g., type of program, completion status), drug screen results (e.g., date, result), court violations (e.g., reason, sanctions received) and associated sanctions, rewards for compliance (e.g., reason, reward received), and case closing information (e.g., treatment completed, JDC requirements met).
Outcome measures consisted of official referrals to juvenile court or new arrests in the adult system and adjudications (i.e., a court finding that the youth was delinquent) or convictions in the adult system. Given the ages of youths involved, the outcome measures were predominantly drawn from juvenile records, but cases were followed into the adult system via record as necessary A self-report follow-up survey was also administered, but data are not analyzed here due to a low overall response rate.

45. Recidivism for Drug Court Youth vs. Comparison
See Latessa et al. (2013) and Sullivan et al. (2014) for more details.

46. Process Evaluation Results Summary
 N=9 Juv Drug Courts
Domain
Brief Definition from CPC-DC
Average Score
(%)
Standard Deviation
Range
Development, Coordination, Staff Support
Conditions exist for implementation of EBPs (e.g., staff training, case reviews)
60.5
17.5
22.2—77.8
Quality Assurance
Processes for monitoring program and service providers
28.6
16.5
0.0—42.9
Assessment Practices
Standardized screening and assessment for risk/need
55.5
21.6
22.2—89.0
Treatment
Matching, targeting, and treating criminogenic needs in evidence-based way
40.7
7.4
27.8—50.0
Overall
Total Score Across Domains
46.0
9.6
25.6—60.5
The CPC-DC is derived from the Evidence-Based Correctional Program Checklist (CPC) which is modeled after the Correctional Program Assessment Inventory (CPAI) developed by Gendreau and Andrews (1989). A number of studies of the CPC have found strong correlations with measures of recidivism outcomes for both domain areas and individual items (e.g., Holsinger, 1999; Lowenkamp, 2004; Shaffer, 2006).
The CPC-DC was constructed based on previous studies of both adult and juvenile drug courts. As such, the CPC-DC has not been fully validated on either adult or juvenile drug courts as of yet.
For this study, CCJR researchers spent between three and five days on-site at each drug court. All of the site visits occurred between June 2009 and October Data were collected through structured interviews with selected program staff and program participants as well as through observation of groups, service delivery, and a drug court staffing session. In some instances, surveys were used to gather additional information about the key items on the CPC-DC. Other sources of information included policy and procedure manuals, schedules, treatment materials, manuals, curricula, a review of a sample of case files, and other selected program materials. Once the information was gathered and reviewed at each site, the program was
The Drug Court tool includes 41 indicators, worth 43 total points. The Referral Agency tool (CPC-DC: RA) has 49 indicators worth a total of 51 points. Each area and all domains are scored and rated as either "highly effective" (65% to 100%); "effective" (55% to 64%); "needs improvement" (46% to 54%); or "ineffective" (less than 45%). The scores in all domains are totaled and the same scale is used for the overall assessment score. It should be noted that not all of the domains are given equal weight, and some items may be considered "not applicable," in which case they are not included in the scoring.
Benchmarks:
“Highly Effective” (65%-100%); “Effective” (55%-64%); “Needs Improvement” (46%- 54%); “Ineffective” (≤45%)

47. Why are we seeing these results?
Results are in line with other studies which question the use of drug courts with juvenile offenders
Youth in drug courts have more opportunity to fail
Youth tend to use alcohol and marijuana only: drug of choice 23.5 alcohol, 71% marijuana)
Drug courts struggled to meet principles of effective intervention – most scored poorly on CPC-DC
Referral agencies were not using evidence-based practices

48. Summary
Adult drug courts can reduce recidivism and save taxpayers money, but there is no panacea
Most results are promising
Results for juvenile drug courts less favorable and it maybe that this is not an appropriate intervention for youth

49. Effectiveness of Adult Drug Courts can be Increased by taking a Systematic Approach to Program Design and Implementation
Program length – most are too long and often completion rates are low
Need to do a better job of assessment (cover all criminogenic needs)
Target population – need to focus on higher risk
Provide or match to services to meet criminogenic needs
Increase intensity based on risk
Use curriculum driven treatment (preferably CBT)
Include structured aftercare

50. Some Lessons Learned from the Research
How you target offender for change is important – use behavioral approaches
Program Integrity makes a difference - Service delivery, training/supervision of staff, support for program, QA, evaluation, etc.