Adapting Programs to Incorporate EBPs for CJ-Involved Clients Merrill Rotter, MD Medical Director, EAC TASC Mental Health Programs Associate Clinical Professor, Albert Einstein College of Medicine

Why Incorporate EBPs Engagement Engagement Clinical Improvement Clinical Improvement Decrease Untoward Behavior Decrease Untoward Behavior Improved quality of life Improved quality of life Decreased recidivism (re-arrest) Decreased recidivism (re-arrest)

RNR and EBPs ResponsivityEngagement CBT intervention Needs The Central Eight

R isk R isk Match treatment intensity to level of risk Match treatment intensity to level of risk N eeds N eeds Treat the offender, not the offense Treat the offender, not the offense R esponsivity R esponsivity Modality must be one to which offender is responsive Modality must be one to which offender is responsive CBT CBT Engagement Engagement

Responsivity Principle

Responsivity : Tailoring Treatment General General Responsive to learning styles Responsive to learning styles e.g. CBT e.g. CBT Specific Specific Responsive to socio-biological personality factors Responsive to socio-biological personality factors Engagement Engagement

Why focus on engagement? Treatment outcome and premature termination predicted by engagement Treatment outcome and premature termination predicted by engagement Treatment outcome related to patient effort Treatment outcome related to patient effort Manner of therapist related to engagement and effort Manner of therapist related to engagement and effort

Engagement Challenges Motivation Motivation Motivational Interviewing Motivational Interviewing IMR Goal Setting IMR Goal Setting Focus on Recovery Focus on Recovery CJ culture Adaptation CJ culture Adaptation SPECTRM Intervention

SPECTRM The Clinical Impact of Doing Time Risk Needs Responsivity Trauma Informed Treatment Cultural Competence

Trauma Consequences Consequences Isolation Isolation Hypervigilance Hypervigilance Emotional reactivity Emotional reactivity Intervention principles Intervention principles Safe environment Safe environment Processing of Trauma Processing of Trauma Identification of coping strategies Identification of coping strategies

Cultural Competence Cultural Proficiency Cultural Proficiency Meaning of symptoms, illness, stressors Meaning of symptoms, illness, stressors Meaning of treatment Meaning of treatment Relationship with professionals Relationship with professionals Overcoming mistrust Overcoming mistrust Communication Communication Rapport Rapport Disclosure Disclosure Using “natural” community support Using “natural” community support

Incarceration as Cultural Adaptation

These walls are kind of funny. First you hate 'em, then you get used to 'em. Enough time passes, gets so you depend on them. That's institutionalized. Incarceration as Cultural Adaptation

AKA: The Inmate Code Do Your Own Time Mind Your Own Business Trust No One Show Respect Ignore Others’ Infractions Don’t Steal Don’t Snitch Don’t Show Weakness Don’t Stare

Promote Cultural Re-adaptation by Connecting Connecting Developing trust through shared experience Developing trust through shared experience Exploring Exploring Challenging prison and jail attitudes Challenging prison and jail attitudes Changing Changing Introducing new problem solving skills Introducing new problem solving skills

Three Principles CONNECTING Be willing to listen and learn: Where were you and what was it like? EXPLORING Be aware of differences and similarities in the two cultures: What are the cues? CHANGING Be neutral: Is it working for you here?

Needs Principle The Central Eight History of antisocial behavior History of antisocial behavior Antisocial personality pattern Antisocial personality pattern Pleasure seeking, restless, aggressive Pleasure seeking, restless, aggressive Antisocial cognitions Antisocial cognitions Attitudes supportive of crime Attitudes supportive of crime Antisocial Associates Antisocial Associates Family support Family support Leisure Activities Leisure Activities School/work School/work Substance Abuse Substance Abuse

Needs - Interventions Substance Abuse Substance Abuse Integrated Treatment Integrated Treatment People, places and things People, places and things Family support Family support Multi-family therapy Multi-family therapy School/Work School/Work Supported Employment Supported Employment Homelessness Homelessness Housing first Housing first Antisocial Cognitions/Associates/Character Antisocial Cognitions/Associates/Character Monitoring Monitoring Cognitive behavioral interventions Cognitive behavioral interventions

Cognitive-Behavioral Interventions CJ-Involved Populations Introspection skills Introspection skills Cognitive Restructuring Cognitive Restructuring Problem Solving Problem Solving Identification of cognitions Identification of cognitions Cost-benefit analysis Cost-benefit analysis Social Skills Social Skills Conflict Resolution Conflict Resolution Moral Reasoning/Community Responsibility Moral Reasoning/Community Responsibility

Cognitive-Behavioral Adaptations CJ-Involved Populations Thinking for a Change Thinking for a Change National Institute of Corrections National Institute of Corrections Lifestyle Change Journaling Lifestyle Change Journaling The Change Companies The Change Companies Reasoning and Rehabilitation Reasoning and Rehabilitation Moral Reconation Therapy Moral Reconation Therapy

Cognitive-Behavioral Interventions CJ-Involved Populations MH Program adaptations Target symptoms Target symptoms Frustration intolerance Frustration intolerance Social skills Social skills Misperception of environment Misperception of environment Examples Examples Forensic DBT Forensic DBT Jail - decreased anger, aggression and incidents Jail - decreased anger, aggression and incidents Community - decreased re-arrests in stalker-focused program Community - decreased re-arrests in stalker-focused program

RNR

Merrill Rotter, MD Medical Director, EAC TASC Mental Health Programs Associate Clinical Professor, Albert Einstein College of Medicine