2 ASSESSMENTS DUE IN 48 HOURS

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15 Correctional Programming and Treatment

AP Photo/Sean Rayford

Media Library

CHAPTER 15 Media Library

PREMIUM VIDEOPREMIUM VIDEO

Career VideoCareer Video

Peak career video 15.1: Internal Affairs Investigator

SAGE News ClipSAGE News Clip

SAGE News Clip 15.1: US Jails Mentally Ill

SAGE News Clip 15.2: Drug Treatment

Feature VideoFeature Video

Schram Personal Perspective video 14.1: Rehabilitation Efforts

Journal ArticleJournal Article

Journal Article: 15.1: Defining Probability in Sex Offender Risk Assessment

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LEARNING OBJECTIVES

• Understand what rehabilitation is and why it is imperative

• Know the principles of evidence-

based practices

• Understand the risk, needs, and responsivity model of treatment

• Learn something about cognitive- behavioral therapy

• Understand the functions of therapeutic communities in corrections

• Know the special treatment modalities applied to sex offenders

TEST YOUR KNOWLEDGE

Test your current knowledge of correctional programming and treatment by answering the following questions true or false. Check your answers on page 394 after reading the chapter.

1. Trying to rehabilitate criminals is mollycoddling them and costs society too much; therefore, we should stop trying.

2. Programs to treat offenders and prevent recidivism are the biggest budget items in corrections after salaries.

3. Even the best-run treatment programs reduce recidivism by only

about 5%.

4. Personal experience will give you a better understanding of what will or will not work with criminals.

5. Because addiction is a brain disease, the major way of attacking it in corrections is through pharmaceutical means.

6. Sex offenders are less likely to reoffend than almost any other type of offender.

7. Most people arrested in major cities test positive for some kind of illegal drug.

8. There are more mentally ill individuals in U.S. jails and prisons than in mental hospitals.

LIFE’S TURNING POINTS

Kathy Gardener was born to an “all- American” family in Dayton, Ohio. Her parents sent her to a Catholic girls’ school, where she did well in her studies. All seemed to be going well for Kathy until she was 16 years old, when she went to a local air force base with two older friends from the neighborhood to meet the boyfriend of one of the girls. The boyfriend brought along two of his friends, and the six of

them partied with alcohol, drugs, and sex. It was Kathy’s first time experiencing any of these things, and she discovered that she liked all of them. Thus began a 9-year spiral into alcohol, drug, and sex addiction and into all the crimes associated with these conditions such as drug trafficking, robbery, and prostitution.

When Kathy was 25 years old, she was involved in a serious automobile accident in which she broke her pelvis, both legs, and an arm and suffered a concussion. She was charged with a probation violation, drunken driving, and possession of methamphetamine for sale. Kathy spent 10 months recuperating from her injuries, during which she was drug, alcohol, and sex free. Because of her medical condition, she was placed on probation. Her probation officer (PO) was a real “knuckle-dragger” who demanded full and immediate compliance with all conditions of Kathy’s probation but who also became something of a father figure to her. While she was recuperating, she was often taken care of by a male nurse she described as “nerdy but nice.” Her parents, who had been estranged from her for some time, became reacquainted with her, and her PO and nurse taught her to trust men again. She also occupied her time taking online college courses on drug addiction

and counseling. She eventually married her “nerdy nurse” with her parents’ blessing, and one of the guests was the “knuckle-dragger.”

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Kathy’s story illustrates some core ideas in this chapter. No matter how low a person sinks into antisocial behavior, he or she is not destined to continue the downward spiral. There are a number of treatment programs available for all sorts of problems that get people into trouble with the law. Of course, not everyone is confronted with such a dramatic turning point in his or her life as a major automobile accident, leaving the person plenty of time to ruminate about life and where he or she is going. Kathy’s addictive personality got her into all kinds of trouble, and she knew it. People must come to this realization, and when they do there must be programs in place to help them turn their lives around or else they will probably fail and the community will suffer.

Feature Video Schram Personal Perspective video 14.1: Rehabilitation Efforts

INTRODUCTION: THE RISE AND FALL (AND RISE AGAIN) OF REHABILITATION

As we have seen, there are five primary goals of the correctional system: deterrence, incapacitation, retribution, rehabilitation, and reentry. This chapter deals with the fourth of these goals—rehabilitation. The term rehabilitation means to restore or return to constructive or healthy activity (habilitation), but many offenders never experienced anything close to habilitation in the first place, so there is little to restore. Correctional treatment or programming needs to begin at the beginning and try to provide some of the things previously missing from the lives of offenders. Such programming obviously cannot supply the warmth and nurturing so critical during the early years of life or the deep sense of attachment and commitment to social institutions that comes from such experiences. However, programming and treatment can provide some of the concrete rewards, such as an education and job training, that most of us have had largely

thanks to the attachments to the family and other social institutions we enjoyed as children, and it can do its best to change the destructive thinking patterns that infect criminal minds.

We try to rehabilitate criminals with the realization that whatever helps offenders helps the community. As former U.S. Supreme Court Chief Justice Warren Burger opined, “To put people behind walls and bars and do little or nothing to change them is to win a battle but lose a war. It is wrong. It is expensive. It is stupid” (as cited in Schmalleger, 2001, p. 439). In this chapter, we look at various ways that treatment personnel have been fighting the war. When reading this chapter, keep in mind that the vast majority of money assigned to correctional agencies is spent on surveillance and control functions. According to the National Center on Addiction and Substance Abuse (2010), among the 1.5 million inmates in jails and prisons nationwide in 2006, only 11.2% had received professional treatment since admission.

The American Prison Association (now the American Correctional Association, ACA) declared its commitment to rehabilitation in the following excerpt from its Declaration of Principles written nearly a century and a half ago (see In Focus 11.1).

Influenced by British pioneers Alexander Maconochie and Walter Crofton,

rehabilitation was the goal of the early American prison reformers such as Zebulon Brockway. The ideal of rehabilitation reached the pinnacle of its popularity from about 1950 through the 1970s when the medical model of criminal behavior prevailed. The medical model viewed crime as a moral sickness that required treatment, and prisoners were to remain in custody under indeterminate sentences until “cured.” Consistent with the switch from a punishment role to a more rehabilitative corrections role, classification systems, individual and group counseling, therapeutic milieus, and college classes were added to the usual rehabilitative fare of labor, basic education, and vocational training (Cullen & Gendreau, 2001).

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IN FOCUS 15.1

The American Correctional Association’s 1870 Declaration on Treatment

Corrections is responsible for providing programs and constructive activities that promote positive change for responsible citizenship.

Opportunity for positive change or “reformation” is basic to the concept of corrections because punishment without the opportunity for redemption is unjust

and ineffective. Hope is a prerequisite for the offender’s restoration to responsible membership in society.

Sound corrections programs at all levels of government require a careful balance of community and institutional services that provide a range of effective, humane, and safe options for handling juvenile and adult offenders.

Corrections must provide classification systems for determining placement, degree of supervision, and programming that afford differential controls and services for juvenile and adult offenders, thus maximizing opportunity for the largest number.

Corrections leaders should actively engage the community to assist in the restoration and reintegration of the offender.

Offenders, juvenile or adult, whether in the community or in institutions, should be afforded the opportunity to engage in productive work, participate in programs including education, vocational training, religion, counseling, constructive use of leisure time, and other activities that enhance self-worth, community integration, and economic status.

Source: American Correctional Association

(2013). Reprinted with the permission of the

American Correctional Association,

Alexandria VA.

The rehabilitative goal was questioned and then fell apart with the publication in 1974 of Robert Martinson’s article, “What Works? Questions and Answers About Prison Reform,” in which the author concluded that “with few and isolated exceptions the rehabilitation efforts that have been reported so far have no appreciable effects on recidivism” (Martinson, 1974, p. 25). Unfortunately, the rhetorical question “What works?” got translated into a definitive “Nothing works” and became a taken-for- granted part of corrections lore. Before we can decide whether something does or does not work, we need to define thresholds for what we mean. If we demand 100% success, then we can be sure that “nothing works.” A program designed to change people is not like a machine that either works or does not. Human nature being what it is, nothing works for everybody, some things work for some people some of the time, and nothing will work for anybody all of the time. High failure rates existed in many fields at their inception, but as practitioners in those fields learned from their mistakes and their successes, failure rates inevitably dropped.

THE SHIFT FROM “NOTHING

WORKS” TO “WHAT WORKS?”

Many of the correctional programs Martinson (1974) surveyed sought to change behaviors unrelated to crime, used programs that were not intensive enough, and used staff who were not adequately skilled. Few programs were based on the proper assessment of offender risks and needs, and programs often were faddish “Let’s see what happens” programs, including everything from acupuncture to Zen meditation. While both these practices are beneficial in their own right, they are hardly useful for changing criminal lifestyles. One probation department actually insisted that male offenders should “get in touch” with their feminine side by requiring them to dress in female clothes, and another required “poetry therapy” (Latessa, Cullen, & Gendreau, 2002). Correctional resources are scarce and should be expended only on programs that have proven themselves useful in reducing recidivism.

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ETHICAL ISSUE

What Would You Do?

You are the chairperson of your state’s financial appropriation committee. The director of state corrections is again asking for a substantial increase in the

prison budget for new treatment counselors in the state’s five prisons. Given a realistic reduction in recidivism of about 10%, and given other pressing needs the state has, would you recommend appropriating the money or simply deny the request without taking it to the committee?

How have Martinson’s (1974) conclusions stood up over the last 30 years? Gendreau and Ross (1987) reviewed a number of studies of treatment programs and concluded, “It is downright ridiculous to say that ‘Nothing works’ . . . Much is going on to indicate that offender rehabilitation has been, can be, and will be achieved” (p. 395). Others have stated that properly run community-based programs could result in a 30% to 50% reduction in recidivism (Van Voorhis, Braswell, & Lester, 2000), although on the basis of major literature reviews, reductions in the 10% to 20% range are more realistic expectations (Cullen & Gendreau, 2001). A “success rate” is the difference in recidivism between a treatment group and a control group. A review of studies from prison, jail, probation, and parole settings conducted by Pearson, Lipton, Cleland, and Yee (2002) found that 55.7% of the subjects in treatment groups did not reoffend versus 43.3% of control group subjects. This difference translates into an average of 22.3% decrease in offending for treatment group members (55.7 – 43.3 =

12.4/55.7 = 22.3). Although there are still plenty of failures, if treatment programs managed only half this success rate, the financial and emotional savings to society would be truly enormous.

Lipsey and Cullen (2007) reviewed numerous studies of a variety of correctional intervention programs conducted from 1990 to 2006 and concluded that treatment works moderately well in reducing recidivism. Lipsey and Cullen believed that the biggest problem in offender treatment is not that “nothing works” but rather that correctional systems do not use the available research to determine what works—and then implement it. Rather, they tend to rely on convenience (“Who is available and what methods do they use?”), custom (“We’ve always done it this way and see no reason to change”), and ideology (“Criminals are scumbags; why waste time and money on them?”).

EVIDENCE-BASED PRACTICES

Moving from the medical model to the just deserts/risk management model in corrections did not mean the death of the rehabilitation goal, but terms such as “assessment” and “programming” have replaced medical terms such as “diagnosis” and “treatment.” The main concern of corrections is to reduce the risk that offenders pose to society, not to improve offenders’ lives. Of course, the two goals are not incompatible; if more offenders

can be taught to walk the straight and narrow, the risk of community members being victimized by them is reduced proportionately. Even though programs are run on a financial shoestring, prison officials like programming because it keeps inmates busy and out of trouble. Inmates also like it because it gives them something to do outside of their cells and looks good on their parole board records.

The movement to a “what works” frame of mind has resulted in the most progressive agencies moving to evidence-based practices (EBP). EBP simply means that in order to reduce offender recidivism, corrections must implement practices that have consistently been shown by rigorous empirical assessment to be effective in that endeavor. Extensive research has identified the following eight principles of evidence- based programming as formulated by the National Institute of Corrections and illustrated in Figure 15.1:

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1. Assess Actuarial Risk/Needs— Assessing offenders’ risk and needs (focusing on dynamic and static risk factors and criminogenic needs) at the individual and aggregate levels is essential for implementing the principles of best practice.

2. Enhance Intrinsic Motivation— Research strongly suggests that

Comstock/Comstock/Thinkstock

PHOTO 15.1: In addition to basic educational courses and vocational training, college classes are also offered as part of the rehabilitative role of correctional programs.

“motivational interviewing” techniques, rather than persuasion tactics, effectively enhance motivation for initiating and maintaining behavior changes. Motivational interviewing is a method of prompting behavior change

by helping clients to explore and resolve discrepant thinking, that is, the ambivalent feelings of wanting, and not wanting, to change. The task of the counselor is to facilitate and engage intrinsic motivation on the assumption that if people can resolve the ambivalence themselves, they will value it more than if it is resolved by others, and they will develop a “can do” attitude.

3. Target Interventions

a. Risk Principle—Prioritize supervision and treatment resources for higher risk offenders.

b. Needs Principle—Target interventions to criminogenic needs.

c. Responsivity Principle—Be responsive to temperament, learning style, motivation, gender, and culture when assigning to programs.

d. Dosage—Structure 40% to 70% of high-risk offenders’ time for 3 to 9 months.

e. Treatment Principle—Integrate treatment into full sentence/sanctions requirements. Take a proactive approach to treatment using cognitive-behavioral therapy.

4. Skill Train With Directed Practice— Provide evidence-based programming that emphasizes cognitive-behavior strategies and is delivered by well- trained staff.

5. Increase Positive Reinforcement— Apply four positive reinforcements for every one negative reinforcement for optimal behavior change results.

6. Engage Ongoing Support in Natural Communities—Realign and actively engage prosocial support for offenders in their communities for positive reinforcement of desired new behaviors.

7. Measure Relevant Processes/Practices—An accurate and detailed documentation of case information and staff performance, along with a formal and valid mechanism for measuring outcomes, is the foundation of EBP.

8. Provide Measurement Feedback— Providing feedback builds accountability and maintains integrity, ultimately improving outcomes.

Taking a closer look at some of these principles, the psychosocial assessment of offenders typically begins with the risk, needs, and responsivity (RNR) model. The RNR model is the premier treatment model in corrections today in the United States and in many other countries (Ward, Melser, & Yates, 2007). The risk principle refers to an offender’s probability of reoffending, and those with the highest risk are targeted for the most intense treatment (“dosage” under Principle 3). The needs principle refers to offenders’ needs, the lack of which puts them at risk for reoffending,

and suggests that these needs receive high priority. The responsivity principle maintains that if offenders are to respond to treatment in meaningful and lasting ways, counselors must be aware of their different development stages, motivation, and learning styles as well as their need to be treated with respect and dignity (Andrews, Bonta, & Wormith, 2006). The crux of these three principles is that we can no longer rely on “one size fits all” models, and treatment must be tailored to individual offenders’ risks and needs.

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Offenders’ risks and needs are assessed by two separate scales: one for risk and one for needs. These scales are used to make predictions about offenders’ success/failure based on actuarial data (Principle 1), that is, what has actually occurred and been recorded over many thousands of cases. It has been found time and time again across many professions that decisions made on the basis of actuarial statistical norms trump decisions based on the insight of individuals the great majority of the time (Andrews et al., 2006). Offender risk refers to the probability that a given offender will reoffend and thus the threat that he or she poses to the community. This is assessed by assigning numerical scores to the scale according to the extent that the offender evidences factors known to correlate with recidivism. Risk factors are either static or dynamic. Static risk factors are those that

cannot change (gender, age, ethnicity, and other background variables). Dynamic risk factors (e.g., substance abuse, attitudes, values, behavior patterns) are factors that are targeted for change.

FIGUREFIGURE 15.115.1 Integrated EBP Model Illustrated

Source: Crime and Justice Institute at Community

Resources for Justice (2009). United States

Department of Justice.

Offender needs refer to deficiencies in offenders’ lives that hinder their making a commitment to a prosocial pattern of behavior. Scores on the risks and needs sections of the scale tend to be highly

correlated—offenders with high risk tend to have high needs. Table 15.1 identifies and describes risks and dynamic needs that must be addressed; note that identifying needs mirrors the identification of risk. The other principles of EBP are either self-explanatory or addressed elsewhere in this book.

COGNITIVE-BEHAVIORAL THERAPY

The therapeutic concepts and methods that proponents of the RNR model find most useful in addressing offender risks and needs are cognitive-behavioral (Ward et al., 2007). Most of today’s programming consists of cognitive-behavioral therapy (CBT). CBT is an approach that tries to solve dysfunctional cognitions, emotions, and behaviors in a relatively short time through goal-oriented, systematic procedures and has been called “the most overtly ‘scientific’ of all major therapy orientations” (McLeod, 2003, p. 123). CBT combines the principles of operant psychology, cognitive theory, and social learning theory. Operant psychology asserts that behavior is determined by its consequences (rewards and punishments). Cognitive theory asserts that at a more proximal level, self-defeating behaviors are the result of unproductive thought patterns relating to our history of rewards and punishments (D. Wilson, Bouffard, & Mackenzie, 2005). We can do nothing about past experiences, but we can do something to

put the way we think about those things into proper perspective. Finally, social learning theory is a sociological view of socialization that asserts behavior is learned by modeling and imitation as well as by our history of rewards and punishments.

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TABLETABLE 15.115.1 Major Risk and/or Need Factors and Promising Intermediate Targets for Reduced Recidivism

Source: Andrews, Bonata, and Wormith (2006, p.

11). Reprinted with permission of SAGE

Publications.

A. Ellis (1989) claimed that the great religious leaders of the past were cognitive-behavioral therapists because they were trying to get people to change their behavior from self- indulgence to temperance, from hatred to love, and from cruelty to kindness by

appealing to their rational long-term self- interest. The common message imparted by religion is the need for personal change and the rewards that such change brings with it: “Do these things and you will feel good about yourself now, and you will be eternally rewarded.” This is what CBT tries to do: change offenders’ antisocial and self- destructive behavior into prosocial and constructive behavior by changing the way offenders think and by showing them that it is in their best interests to do so.

The first lesson of CBT is that criminals think differently from the rest of us. Yochelson and Samenow (1976) and Samenow (1999) pioneered treatment theories based on challenging criminal thinking errors when they realized that modalities based on “outside circumstances” theories did not work. The task is to understand how criminals perceive and evaluate themselves and their world so that we can change them. Criminal thinking is destructive; it lands offenders in trouble with family, friends, employers, and the criminal justice system. Habitual offenders tend to perceive the world in fatalistic fashion, believing that there is little that they can do to change the circumstances of their lives. To illustrate this fatalism and other criminal thinking patterns, B. Sharp (2006) cited a cartoon in which one of the characters named Calvin says,

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I have concluded that nothing bad I do is my fault. . . . I’m a helpless victim of countless bad influences. An unwholesome culture panders to my undeveloped values and it pushes me into misbehavior. I take no responsibility for my behavior. I’m an innocent pawn of society. (p. 3)

Criminals think like Calvin in the context of a society where many people prefer to claim victimhood rather than personal responsibility (“McDonald’s made me fat,” “cigarette companies made me smoke,” etc.). Many mainstream criminological theories locate the blame for crime on external factors such as poverty and peer pressure rather than on allowing criminals the dignity of owning responsibility for their behavior. Criminals are eager to jump on authoritative pronouncements that excuse their behavior, and defense lawyers are equally quick to argue them in court. All of this reinforces the patterns of criminal denial that treatment providers find so frustrating (B. Sharp, 2006; Walsh & Stohr, 2010). Challenging and changing maladaptive thought patterns takes on a central role in treatment as corrections workers strive to impress on offenders that whatever influences external factors may have on behavior, before they can affect behavior they need to be evaluated by individuals. The frustrations we experience do influence our behavior, but the important thing is not their presence but rather whether we deal with them constructively or destructively. The task

of correctional workers is to teach criminals to stop blaming outside circumstances for their problems, how to take responsibility for their lives, and how to deal constructively with adversity.

CBT methods are used to address issues relating to self-control, victim awareness, relapse prevention, critical reasoning, and anger control (Vanstone, 2000). CBT literally “exercises the thinking areas of the brain and thereby strengthens the [neuronal] pathways by which the thinking brain influences the emotional brain” (Restak, 2001, p. 144). Receive a high enough “dosage” of CBT, and it can literally reorganize the brain’s wiring patterns (Vaske, Galyean, & Cullen, 2011). A number of brain imaging studies show that CBT changes brain processes exactly the way that drugs such as Prozac do (Linden, 2006). A systematic review of brain imaging studies revealed neurobiological changes in people undergoing CBT. These studies show that CBT modifies the brain circuits involved in the regulation of negative emotions and fear extinction in treatment subjects. In short, CBT is able to change dysfunctions of the brain (Porto et al., 2009). However, these studies have been conducted only with individuals with problems such as depression, anxiety, and obsessive–compulsive disorder in which patients, unlike most criminals, are intensely motivated to overcome their problems.

SUBSTANCE ABUSE

PROGRAMMING

Alcohol is at the same time our most popular and most deadly way of drugging ourselves. Police officers spend more than half of their law enforcement time on alcohol-related offenses. One-third of all arrests (excluding drunk driving) in the United States are for alcohol-related offenses, about 75% of robberies and 80% of homicides involve a drunken offender and/or victim, and about 40% of other violent offenders in the United States were drinking at the time of their offenses (Mustaine & Tewksbury, 2004).

SAGE News Clip SAGE News Clip 15.2: Drug Treatment

Alcohol is a very powerful and addictive drug and is the biggest curse of the criminal justice system despite the system’s current obsession with illegal drugs. Illegal drug use presents almost as big a problem, with about 67% of state prisoners and 56% of federal prisoners

© iStockphoto.com/blueclue

PHOTO 15.2: Substance abuse often contributes to poor decision making and criminal engagement for inmates.

being regular drug users prior to their imprisonment (Seiter, 2005). Clearly, mind- altering substances, both legal and illegal, are strongly associated with criminal behavior, and as such the tendency of many criminals to over-indulge in them must be addressed by correctional agencies.

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Substance abuse problems are extremely difficult to treat because individuals most at risk for becoming addicted share many of the same traits associated with chronic criminal behavior, with many of these traits being strongly genetic (Vaughn, 2009). For instance, alcoholism researchers divide alcoholics into two types: Type I and Type II. Type II alcoholics start drinking and using other drugs earlier, become more rapidly addicted, and exhibit many more character disorders, behavior problems, and criminal involvement, both prior and subsequent to their alcoholism, than Type I alcoholics (Crabbe, 2002). Genetic researchers maintain that genes are much more heavily involved in Type II alcoholism than in Type I alcoholism (Crabbe, 2002).

It has been shown that drug addiction and criminality are part of a broader propensity to engage in many forms of deviant and antisocial behavior (Fishbein, 2003; Vaughn, 2009). For instance, the U.S. government’s Arrestee Drug Abuse Monitoring (ADAM) program collects urine samples from arrestees across the country to test for the presence of drugs. Figure 15.2 shows the percentage of adult arrestees in five large U.S. cities who tested positive for illicit drugs over a 3-year period. The numbers show that illicit drug abuse is clearly strongly associated with criminal behavior, but the association is not necessarily a causal one. A large body of research indicates that drug abuse does not

appear to initiate a criminal career, although it does increase the extent and seriousness of one (Menard, Mihalic, & Huizinga, 2001). In other words, research seems to point to the fact that chronic drug abuse and criminality are part of a broader tendency of some individuals to engage in a variety of deviant and antisocial behaviors. Numerous studies have shown that traits characterizing antisocial individuals such as conduct disorder, impulsiveness, and psychopathy also characterize drug addicts (Fishbein, 2003; McDermott et al., 2000). The large body of research indicating a strong genetic vulnerability to alcoholism/drug addiction helps to explain why many millions who drink and/or experiment with drugs do not descend into the hell of addiction and why others are “sitting ducks” for it (Walsh, Johnson, & Bolen, 2012).

DRUG TREATMENT WITH SWIFT CONSEQUENCES FOR FAILURE: HAWAII’S HOPE PROGRAM

The state of Hawaii has a drug treatment program highly touted by the National Institute of Justice (NIJ, 2012) called Hawaii’s Opportunity Probation with Enforcement (HOPE). The results of this program are based on 493 drug-using probationers with an elevated risk of violating probation, two-thirds of whom were randomly assigned to the HOPE program, with the rest being assigned to regular supervision. The program emphasizes a “no nonsense” delivery of both

treatment and “swift and certain” punishment for violations. HOPE probationers are more closely monitored for drug use and other violations than control probationers. Figure 15.3 shows that this program had very positive results after 12 months. For instance, HOPE participants were 55% (47 - 21 = 26/47 = 55.3%) less likely to be arrested and 72% less likely to have used drugs. This experiment needs to be repeated in other locations with larger samples, and if results of any further studies come close to Hawaii’s, there is real cause for optimism.

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PERSPECTIVE FROM A PRACTITIONER

Margaret Jackson, Drug Treatment Specialist

Position: Drug Treatment Specialist

Location: Phoenix, Arizona

Education: Northern Arizona University, B.S., criminal justice; Boise State University, M.A., criminal justice administration; Rio Salado University, drug and alcohol counseling courses

Career Video Peak career video 15.1: Internal Affairs Investigator

How long have you been a drug treatment specialist (DTS)?

I have been a drug treatment specialist for 3 years; I have been in the correctional field for a total of almost 5 years.

The primary duties and responsibilities of a drug treatment specialist:

My primary duties are to provide drug abuse treatment to inmates in the federal prison system. I provide individual and group counseling/therapy to drug- /alcohol-addicted inmates incarcerated in the federal prison system. The

Federal Bureau of Prisons provides a voluntary but criteria- based program called Residential Drug Abuse Program (RDAP), a 9-month (minimum of 500 hours of direct treatment) modified therapeutic community (TC). I provide clinical services using CBT techniques and introduce community as method to the inmates and develop a working system of a therapeutic community. The first step in working with inmates in this process is to determine their eligibility to receive counseling/therapy; one of the tools I use for this is a psychosocial assessment. If an inmate is eligible for treatment, I will use the psychosocial assessment to create an individual treatment plan for the inmate. Once eligibility and an assessment for treatment have been conducted, a team of three other therapists and I are responsible for providing residential treatment to the offenders. The inmates are assigned a series of workbooks and attend daily meetings. I construct the inmates’ individual therapeutic treatment plans, reviews, and recommendations for further treatment on release from federal prison.

The qualities/characteristics that are most helpful for one in a probation or parole career:

• Be fair and consistent

• Have good judgment

• Be aware of population at hand

• Know your craft well

• Be reliable

• Be a team worker

• Be able to communicate with multiple agencies

• Be attentive to detail when writing reports and preparing inmate charts

In general, a typical day for a drug treatment specialist in corrections:

Monday through Friday, the TC starts with a morning meeting called “community meeting.” This meeting is an inmate-run self-help meeting, with drug treatment staff supervising. During the treatment meetings/groups, inmates are learning and demonstrating therapeutic language and actions in a public “community” setting. After community meeting, inmates are separated into their appropriate phase groups, based on the date they entered treatment. RDAP, similarly to other TCs, uses a hierarchical form for the 9 to 12 months inmates are in treatment. Program participants typically have 3.5 hours of treatment daily; during this time, I am working directly with the inmates providing therapy. Therapy consists of using their RDAP workbooks and a facilitator guide to

treat the inmates’ addictions/behaviors. In RDAP, there are three phases of treatment, with new inmates entering treatment every 3 months (approximately 25 inmates per phase). With inmates phasing in and out of treatment, creating individual treatment plans, review of progress, and treatment summaries of each inmate are my responsibility to maintain and develop.

My advice to someone either wishing to study, or now studying, criminal justice to become a practitioner in this career field:

It would be important to understand the population for which you are providing therapy. In this regard, being an intern in a correctional setting would be beneficial to someone becoming a practitioner due to the nature of working inside a prison. Finally, practice development and presentation of lectures/seminars to groups as this will be a skill used often when providing group therapy.

Disclaimer: Opinions expressed in this article are those of the author and do not necessarily represent the opinions of the Federal Bureau of Prisons or the Department of Justice.

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THERAPEUTIC COMMUNITIES

Therapeutic communities (TCs) are residential settings for drug and alcohol treatment that use the community spirit generated by the influence of peers and various group processes to help individuals overcome their addiction and develop effective social skills. Most such communities offer long-term (typically 6–12 months) residence, in which opportunities for attitude and behavioral change operate on a hierarchical model, whereby treatment stages reflect increased levels of personal insight and social responsibility. The interactions of the residents are both structured and unstructured, but they are always designed to influence attitudes and behaviors associated with substance abuse (Litt & Mallon, 2003). TCs provide dynamic “mutual self-help” environments, in which residents transmit and reinforce one another’s acceptance of and conformity with the highly structured and stringent expectations of the TC and of the wider community. Life in a TC is extremely hard on people who have never experienced any sort of disciplined expectations from others, and as a consequence there are many dropouts; some residents withdraw voluntarily, and others are removed by TC staff for non-compliance.

TCs also operate within prison walls and are most often known as residential substance

abuse treatment (RSAT) communities. These RSATs typically last 6 to 12 months and are composed of inmates in need of substance abuse treatment and whose parole dates are set to coincide with the end of the program. RSAT inmates are separated from the negativity and violence of the rest of the prison and are provided with extensive cognitive-behavioral counseling and attend Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings as well as many other kinds of rehabilitative classes (Dietz, O’Connell, & Scarpitti, 2003). Most participants in these RSATs are positive about most aspects of their experience, with most inmates listing cognitive self-change programs as the most positive aspect of their treatment (Stohr, Hemmens, Shapiro, Chambers, & Kelly, 2002). Dietz et al. (2003) also found that most inmates in prison-based TCs were positive about the program and that they had significantly fewer rule violations and rates of grievance filing than inmates in the general population.

FIGUREFIGURE 15.215.2 Percentage of Arrestees Testing Positive for Drugs in Five U.S. Cities, 2007–2013

Source: Office of National Drug Control Policy

(2014).

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An interesting program implemented in a prison setting and transitioning into the community is the Delaware Multistage Program (Mathias, 1995). In the beginning stage, offenders spend 12 months in a prison- based TC called Key; in Phase 2, they spend 6 months in a pre-release TC called Crest; and finally, in Phase 3, they receive an additional 6 months of counseling while on parole or in work release. Figure 15.4 compares drug use and arrest outcomes for offenders completing all phases (Key, Crest, and Key-Crest) 18 months after release from prison and a comparison group of offenders who did not participate in any of the phases. We see that 76% of Key-Crest members remained drug free, and 71% remained arrest free compared with only 19% and 30%, respectively, of the control group. Put another way, three times as many Key-Crest participants were drug free

after 18 months than the comparison group, and 2.37 times more Key-Crest participants were arrest free than the comparison group.

FIGUREFIGURE 15.315.3 Comparison of Outcomes Between HOPE and Control Probationers

Source: National Institute of Justice (2012).

Inciardi, Martin, and Butzin (2004) followed this same group 5 years after release from prison. As expected, the greater the time lapse between treatment and evaluation, the greater the relapse rate. Over the 5-year period, it was found that 71% of drug abusers who went through a residential treatment program and who received additional treatment on release (the Key-Crest group) had relapsed and 52% had been rearrested. However, the contrast with the comparison group still makes the Key-Crest program impressive. Among the comparison subjects, 95% had relapsed and

77% had been rearrested. This study shows how extremely difficult it is to battle addiction even after a long period of forced abstinence and extensive psychosocial treatment.

PHARMACOLOGICAL TREATMENT

Leshner (1998) informed us that addiction is a brain disease and a “prototypical psychobiological illness, with critical biological, behavioral, and social context elements” (p. 5). Because addiction is basically a brain chemistry problem, pharmacological treatment with drug antagonists (drugs that work by blocking the effects of other drugs) stabilizes brain chemistry and renders addicts more receptive to psychosocial counseling. Proponents of pharmacological treatment emphasize that it is not a magic bullet and that it augments, not replaces, traditional treatment methods.

There are many drug antagonists, but only one has claimed success in curbing both alcohol and drug addiction—naltrexone. Naltrexone reduces craving among alcohol/drug abstinent addicts and reduces the pleasurable effects of those who continue to use (Schmitz, Stotts, Sayre, DeLaune, & Grabowski, 2004). A study of drug addicts on federal probation found that about one-third of probationers who received naltrexone plus counseling relapsed as opposed to two-thirds of those who only received counseling (Kleber, 2003). A new drug called Vivitrol is a slow-release version of naltrexone (it releases the drug into

the blood stream slowly over a period of days) that controlled clinical trials have shown to be effective not only in preventing drug abuse relapse but also in diminishing the cravings that drive it. “Vivitrol is the first non-narcotic, non-addictive, extended release medication approved for the treatment of opioid dependence—marking an important turning point in our approach to treatment” (Volkow, 2010).

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FIGUREFIGURE 15.415.4 Delaware Multistage Correctional Treatment Program 18 Months After Release From Prison

Source: Mathias (1995). National Institute on Drug

Abuse and Addiction.

Proponents of pharmacological treatment claim that the effects of such treatment are

more effective and immediate and wonder why the correctional system is relatively uninterested in pharmacological treatment (Kleber, 2003). It could be that corrections professionals received their training primarily in the social sciences, and there are some who have genuine ethical problems regarding chemical treatments for behavioral problems. However, according to the National Institute on Drug Abuse (2006), while medication is important for treating many addicts because medication helps them to stabilize their lives, it must be combined with counseling.

ANGER MANAGEMENT

A central component of many treatment programs in corrections is anger management, particularly in violent, drug, and sex offender treatment programs. Anger management programs consist of a number of CBT techniques by which someone with problems in controlling anger can learn the cause and consequences of anger to reduce the degree of anger and avoid anger-inducing triggers. Anger is often central to violent criminal behavior, and given the frustrations resulting from being in custody or under correctional supervision in the community, it often leads to violence. Anger is a normal and often adaptive human feeling that is aroused when we feel that we have been offended or wronged in some way. The tendency to undo that wrongdoing by retaliating is motivated by anger and is adaptive in the sense that it warns

those who have offended or wronged you that you are not to be treated that way. The problem, however, is not anger per se but rather the inability of some to manage it. These individuals often become excessively angry over minor real or imagined slights to the point of rage.

Anger management classes are taught in groups and designed to increase offenders’ responsibility for ownership of their emotions (anger) and their reactions to them. Offenders often become frustrated and angry because they think that life is not fair to them (“I’m a victim of circumstances”) and the world owes them a living. This kind of destructive thinking must be challenged and replaced by individual responsibility. Anger management classes also teach such skills as rational thinking (“Did this person really mean to diss me?”) to increase offenders’ ability to react to frustration and conflict in assertive rather than aggressive ways and to develop effective communication skills (Jolliffe & Farrington, 2009). There appears to be a growing consensus that properly conducted anger management programs reduce inmate violence and reduce violent recidivism for program completers versus control subjects by about 8% to 10% (Jolliffe & Farrington, 2009; Serin, Gobeil, & Preston, 2009). Although this seems like a small return on a corrections investment, even an 8% reduction in violent offenses prevents much needless suffering and millions of dollars in expenses.

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ETHICAL ISSUE

What Would You Do?

You are the chief psychologist in the largest state prison in the state. One of your counselors hasn’t recommended that any inmate be put on a program of pre- release in 6 months, and you get a lot of complaints about his “hard-nosed” attitude. The counselor tells you that he operates from a therapeutic theory with a “no nonsense, no excuses” framework and that he’s not going to let these “trailer trash out of here until they’ve completed their full minimums.” What would be your response to this counselor?

SEX OFFENDERS AND THEIR TREATMENT

The American public harbors all sorts of very negative images of sex offenders. We lock them up under civil commitment orders after they have completed their prison terms, and all 50 states have sex offender registration laws (Talbot, Gilligan, Carter, & Matson, 2002). However, the term sex offender defines

a very broad category of offenders ranging from “flashers” to true sexual predators, just as property offenders include everyone from petty shoplifters to career burglars. At least 98% of all sex offenders are either in the community on probation or parole or will be some day (Carter & Morris, 2002), making the issue of sex offender treatment of the utmost importance.

JOURNAL ARTICLE Journal Article: 15.1: Defining Probability in Sex Offender Risk Assessment CLICK TO SHOW

Although it is part of popular lore that sex offenders are untreatable and will never stop their offending, as a category of offenders they are actually less likely to reoffend than any other category. Looking at many years of British crime statistics, it was found that burglars are the most likely of all criminals to be reconvicted (76%) within 2 years of being released from prison, with sex offenders being the least likely (19%) (Mawby, 2001, p. 182). A review of 61 studies of sex offender recidivism found an average rate of reconviction for sexual crimes of 13.4% over a 4- to 5-year follow-up (Hanson & Bussiere, 1998). Perhaps the most instructive study of recidivism conducted to date was a study by the Bureau of Justice Statistics, whose researchers tracked 9,691 sex offenders released from prisons in 15 states in 1994 (Langan, Schmitt, & Durose, 2003). Over the

3-year period of the follow-up, sex offenders had a lower rearrest rate (43%) than 272,111 non–sex offenders released at the same time in the same states (68%). Rearrest rates included all types of crimes and technical violations such as failing to register as a sex offender and missing appointments with their parole officers. Only 3.5% of the sex offenders were reconvicted of a new sex crime during the follow-up period. Because recidivism rates include only those offenders who have been caught, in common with other types of offenders, the above figures should be considered bare minimums.

State-of-the-art treatment of sex offenders must include a thorough assessment of psychosocial problem areas, deviant arousal patterns, and polygraph (“lie detector”) assessment (Marsh & Walsh, 1995). Deviant arousal patterns are assessed by a device called a penile plethysmograph (PPG), which measures blood flow in the penis (the level of the swelling of the penis) when exposed to deviant sexual images. These measures are then compared with measures in response to consensual adult sexual images. If, for instance, a man achieves a 10% erection viewing non-deviant heterosexual pornography, but achieves a 75% erection viewing sex involving young boys, we know where his sexual tastes are—the penis finds it difficult to lie. Of course, the PPG is far from foolproof.

Counselors are in agreement that effective

© iStockphoto.com/Alina555

PHOTO 15.3: Group work is often used in offender programming both inside and outside of correctional facilities.

treatment is impossible until the full extent of the offender’s sex offending history is acknowledged by him or her and known to treatment personnel (Walsh & Stohr, 2010). But sex offenders are notorious for hiding their sexual histories, so polygraph assessment is needed to access their sexual histories. In comparing self-reports pre- and post- polygraph testing across 2 decades of research, it was found that child molesters underreport the number of sex crimes they have committed by about 500% and overreport their own childhood sexual victimization (the “I’m a victim too” excuse) by about 250% (Hindman & Peters, 2001). The polygraph therefore may be seen as a very useful tool if the first goal of treatment is to honestly acknowledge one’s sexual history.

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Unlike treatment for other problems in corrections, there has been a great deal of interest in the pharmacological treatment of sex offenders. Numerous researchers have concluded that optimal treatment (following a thorough psychosocial and physiological assessment) combines the biomedical and cognitive-behavioral approaches (Walsh & Stohr, 2010). The biomedical approach involves so-called chemical castration with a synthetic hormone called Depo- Provera, which is also sold as a method of female birth control. Depo-Provera works in males to reduce sexual thoughts, fantasies, and erections by drastically reducing the production of testosterone, the major male sex hormone. Depo-Provera prevents testosterone production, and it is testosterone activating a part of the brain called the hypothalamus that controls the male sex drive. Depriving the brain of testosterone allows offenders to concentrate on their psychosocial problems without the distracting fantasies and urges (Marsh & Walsh, 1995).

Following the State of California in 1997, several states now mandate chemical castration (“castration” is reversible on withdrawal from the drug) for repeat offenders. Not all sex offenders should be treated with this drug because there are sometimes negative side effects, and treatment can be provided only by a medical doctor. However, a number of reviews of the literature from Europe and America show that

anti-androgen drugs such as Depo-Provera result in recidivism rates for repeat rapists and child molesters that are remarkably low (in the 2%–3% range) when compared with offenders treated with only psychosocial methods (Maletzky & Field, 2003). A review of 11 meta-analyses covering 353 separate studies from 1943 to 2009 found that surgical castration had the strongest effect on lowering recidivism, followed by chemical castration (B. Kim, Benekos, & Merlo, 2016). Insight- oriented therapies such as psychoanalysis had essentially no effect, while CBT had a significant effect, but much less if not combined with some form of anti-testosterone medication.

MENTALLY ILL OFFENDERS

As graphically indicated in Figure 15.5 from the Council of State Governments Justice Center (2014), mental illness lurks behind many factors that are linked to criminal behavior. Mentally ill offenders under correctional supervision present a particularly difficult treatment problem. Alcoholics and drug addicts ingest substances that alter the functioning of their brains in ways that interfere with their ability to cope with everyday life, although their brains may be normal when not artificially befuddled. Mentally ill persons also have brains that limit their capacity to cope, but that limitation is intrinsic to their brains, not attributable to intoxicating substances. Studies around the

world have found that mentally ill persons (mostly schizophrenics and manic depressives) are at least three to four times more likely to have convictions for violent offenses than persons in general (Fisher et al., 2006). Most mentally ill persons, however, are more likely to be victims than victimizers, and many of them make their problems worse by abusing alcohol and/or drugs (Walsh & Yun, 2013). It is because of their substance abuse and greater propensity for violence, in addition to mental hospital deinstitutionalization, that the mentally ill are overrepresented in the correctional system.

SAGE News Clip SAGE News Clip 15.1: US Jails Mentally Ill

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Torrey and his colleagues (2014) told us that there were an estimated 356,268 inmates with severe mental illness in prisons and jails in the United States in 2012 and approximately

35,000 severely mentally ill patients in psychiatric hospitals. In addition, the Bazelon Center for Mental Health Law (2008) estimated that 16% of individuals on probation or parole have some form of mental illness. This state of affairs results from the deinstitutionalization of all but the most seriously ill patients from mental hospitals that occurred during the 1960s. For instance, there were 559,000 persons in U.S. mental hospitals in 1955; in 2000 (with a U.S. population about 80% greater), there were only 70,000 (Gainsborough, 2002), and as we have seen, it was down to 35,000 in 2012. Deinstitutionalization of the mentally ill from mental hospitals has shifted to their institutionalization in jails and prisons, which in essence has resulted in the criminalization of mental illness (Lurigio, 2000). Table 15.2 presents the highlights of a Bureau of Justice Statistics report on the mental health problems of prison and jail inmates (James & Glaze, 2006).

Mentally ill offenders in jails and prisons are often victimized by other inmates, who call them “bugs” and exploit them sexually and materially (stealing from them), although most inmates seek to avoid them. Mentally ill offenders are also punished by corrections officers for behavior that, while not pleasant, is symptomatic of their illness. These behaviors include such things as excessive noise, refusing orders or medication, self- mutilation, and poor hygiene. Obviously, correctional facilities are not the ideal place

for providing mental health treatment, even assuming that the staff are aware who the mentally ill are among their charges. Few correctional or probation/parole officers have any training about mental health issues, and one nationwide survey of probation departments found that only 15% of them operated special treatment programs for the mentally ill (Lurigio, 2000). It is not that anyone expects correctional workers to become treatment providers because that’s a job for psychologists and psychiatrists. However, they should be expected to recognize signs and symptoms of mental illness, know how to effectively deal with situations involving mentally ill persons, and have a basic understanding of the causes of and treatment for the major mental illnesses.

FIGUREFIGURE 15.515.5 Mental Illness Lurks Behind Many Other Problems

Source: Council of State Governments Justice

Center (2014).

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TABLETABLE 15.215.2 Prevalence of Mental Health Problems Among Prison and Jail Inmates

Source: James and Glaze (2006). U.S. Department of

Justice.

*Includes items not shown.

Treatment for the mentally ill in prisons and jails consists primarily of antipsychotic and antidepressive medication, typically administered by a nurse. Many mentally ill individuals, especially paranoid schizophrenics, often refuse to take their medication. It is permissible in a number of states to forcibly treat mentally ill inmates if they meet state-specific criteria, which is typically if inmates pose a risk to others or

themselves. This is determined on a case-by- case basis by a review committee composed of correctional and medical professionals (Torrey et al., 2014). Of course, just because such procedures are authorized by the state does not mean that they are used or that the inmate will be treated. According to Torrey and his colleagues (2014),

Given the many legal difficulties in providing treatment for individuals with serious mental illness in prisons and jails, it is not surprising that many of them, including those who are most severely ill, receive no treatment whatsoever. This leaves corrections officers with few options for controlling mentally ill inmates’ psychotic, often violent behavior. One option is seclusion, which often makes the inmate’s mental illness worse. (p. 10)

What is both morally and fiscally required of the criminal justice system is to provide offenders with mental illness the support and structure they need to avoid further criminal behavior. One of the ways this is attempted is through mental health courts modeled on drug courts in use across the nation (and discussed in Chapter 5). As with drug courts, mental health courts seek to divert offenders from jails and prisons by facilitating their access to services, providing intensive judicial monitoring, and promoting collaboration among the court, probation, mental health service, and social service providers.

Offender Treatment

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COMPARATIVE PERSPECTIVE

The treatment of criminal offenders in modern Western nations is fairly uniformly centered on the RNR model. Countries that care little about the civil rights and treatment of their citizens in general obviously are not very concerned about the humane treatment of their prisoners. A modern country concerned with rehabilitation, but with some different assumptions about how to achieve it, is Japan. A large cultural difference between Japan and Western nations such as the United States is that whereas the latter emphasizes individualism and a great degree of personal freedom, the Japanese emphasis is on collectivism and individual conformity to community norms. Unlike the general tendency in American criminology to shift the blame for crime away from the individual and onto “society,” the Japanese place responsibility for criminal behavior squarely on the shoulders of the individuals who commit it.

Western CBT counselors tend to play down introspection (gaining insight into one’s self) as too time-consuming and

believe that criminals need the participation and direction of counselors in order to benefit. Japanese correctional counselors, on the other hand, see their role as a kindly guide on the edge rather than as a trainer at the center providing definite directions (Bindzus, 2001). One type of counseling favored in Japanese corrections is called Naikan, which means “inside looking” and is designed to get offenders to see themselves as others see them. According to Kanazawa (2007), inmates undergoing Naikan therapy will spend many hours alone asking themselves three questions: “What has my mother (and other significant persons in my life) done for me?”; “What have I done for her (and other significant persons in my life) in return?”; and “What problems have I caused her (and other significant persons in my life)?” (p. 762). Thinking about these things is supposed to generate feelings of remorse, sadness, empathy, guilt, and consciousness of responsibility. The counselor will enter the offender’s cell every hour or so to check on progress. Only if the offender displays tendencies to blame outside forces for his or her criminal behavior, or has not adequately explored the questions, will the counselor intervene to clarify.

Could such introspective methods work with Western prisoners who exist in cultures that seem to have little respect

for individual responsibility? Bindzus (2001) expressed “doubts about the physical and psychological ability of European prisoners to stick through NAIKAN for a one-week period, with daily sessions up to sixteen hours” (p. 266). What works in one cultural context might not work in others for a variety of reasons. Of course, inmates require some sort of concrete help as well as introspective self-knowledge even in Japan. Indeed, Eskridge (1989) listed a large number of vocational training courses available in Japanese penal institutions, ranging from auto mechanics, to seamanship, to welding.

SUMMARY

• Although the vast majority of the correctional budget is spent on security, rehabilitation efforts have not completely ceased. The success rates of many rehabilitation programs are low, but outcomes are significantly better for treated offenders than for similarly situated offenders who did not receive treatment.

• Successful treatment programs

implement evidence-based practices (EBP) that proceed by conducting a thorough assessment of offenders’ risks and needs and then address these issues using cognitive- behavioral techniques along with the principles of responsivity. Treatment is best accomplished for severe substance abusers in therapeutic communities, although even then there is a significant percentage of failure. Much of this failure has to do with the intense psychological craving for the substance of abuse, which is something that may be significantly alleviated by certain alcohol/drug antagonists such as naltrexone.

• Similar observations were made about sex offenders who have difficulty in refraining from acting out their sexual fantasies with inappropriate targets. Repeat sex offenders treated with Depo- Provera combined with cognitive- behavioral counseling have much lower recidivism rates compared with offenders treated only psychologically.

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• Mentally ill individuals are represented in the correctional system by a factor of at least 3 or 4 times their prevalence in the general

population. The correctional system is not equipped to deal with mentally ill people, who are often victimized by other jail/prison inmates or disciplined by corrections officers for exhibiting behavior that is basically part of their mental disease syndrome.

KEY TERMS

Actuarial data, 332

Addiction, 338

Anger management programs, 339

Chemical castration, 341

Cognitive-behavioral therapy (CBT), 332

Evidence-based practices (EBP), 330

Needs principle, 331

Offender needs, 332

Offender risk, 332

Residential substance abuse treatment (RSAT), 337

Responsivity principle, 331

Risk, needs, and responsivity (RNR) model, 331

Risk principle, 331

Therapeutic communities (TCs), 337

DISCUSSION QUESTIONS

1. In your estimation, are the time, effort, and finances spent on rehabilitative efforts worth it given the low success rates? Would longer periods of incarceration better protect the public?

2. Cognitive-behavioral approaches stress thinking and rationality. How about emotions? Do you think that human behavior is motivated more by emotions than by rationality?

3. Given the greater involvement of genes in Type II alcoholism, in what ways would you treat Type II alcoholics differently from Type I alcoholics if you were a treatment provider? How about if you were a probation/parole officer?

4. Should all sex offenders undergo Depo-Provera treatment? What are the ethical problems of such invasive treatment?

5. Discuss the various component parts of the responsivity principle.

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FOR FURTHER EXPLORATION AND APPLICATION, TAKE A LOOK AT THE INTERACTIVE EBOOK FOR THESE PREMIUM RESOURCES:

Career Video 15.1 Internal Affairs Investigator

Feature Video 15.1 Rehabilitation Efforts

SAGE News Clip 15.1 U.S. Jails Mentally Ill

SAGE News Clip 15.2 Drug Treatment

Journal Article 15.1 Defining Probability in Sex Offender Risk

Assessment