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Presentation for HQ Dutch Prison Service, the Netherlands 2012

Implementing MI in Criminal Justice organizations - A Swedish experience. Presentation for HQ Dutch Prison Service, the Netherlands 2012. Carl Åke Farbring www.farbring.com. Effective treatment in Criminal Justice to reduce recidivism in drugs and crime.

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Presentation for HQ Dutch Prison Service, the Netherlands 2012

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  1. Implementing MI in CriminalJusticeorganizations - A Swedish experience Presentation for HQ Dutch Prison Service, the Netherlands 2012 Carl Åke Farbring www.farbring.com

  2. Effectivetreatment in CriminalJustice to reducerecidivism in drugs and crime Berman, A., & Farbring, C.Å. (2010)CriminalJustice in practice. Strategies to reducerelapse in crime and druguse. Studentlitteratur. I boken medverkar bl.a. James McGuire, Don Andrews, Philip Priestley, Joel Ginsburg, Belinda Seagram, Johan Franck, Sten Levander, Marie Levander, Sten Rönnberg, Johan Kakko, Björn Fries, Agneta Öjehagen, Hans Bergman, Helene Lööw, Siv Nyström m. fl. 800 pages c åke farbring, 2008

  3. MI - an explosion of knowledge • > 1000 publikationer • > 200 randomisedclinical studies • Dozens of books • 10 Multisiteclincaltrials • Coding system to controlquality • Research on how to learn MI • MIA-STEP – Structureas a help for trainers • And still we are only in the beginning!!! Weknowverylittle on how MI works. Motivational Interviewing; carl åke farbring, 2001- workshopmaterial

  4. Recent book about this implementation Farbring, C. Å. & Johnson, W.R. (2008). MI Corrections. In Hal Arkowitz, Henny Westra, William R. Miller & Steve Rollnick: Motivational Interviewing in the Treatment of Psychological Problems. New York: Guilford c åke farbring, 2008

  5. What Works; accredited programs Reasoning and Rehabilitation One-to-One  ART OffenderSubstanceAbuse Program (OSAP) Brotts-Brytet EnhancedThinkingSkills  ROS; sexualoffenders DomesticViolence (IDAP)  PRISM  BSF(MI:5;semistructured MI in five sessions) Relapse Prevention/MI

  6. What Works 2006 • ”…resultsdo not provide strong evidence of treatmenteffectiveness.” • …”there is limitedevidence to demonstratewhatimpactthese interventions actuallyhave in practice.” • ”Thus, no outcome evaluation in this report provides unequivocalevidence of ”whatworks” in corrections.” Harper & Chitty (2005). The Impact of corrections on re-offending. A review of What Works. Home Office Research Study 291

  7. Greenlight Project • A multidimensional re-entry demonstration programme to reduce recidivism in New York • Randomised design • Supervised by researchers, organisational support • Evidensbased programmes (R & R, Relapse Prevention, Job preparation training, social counseling, social skills training, drug treatment, prevention to avoid homelessness, family reunion groups; action plan etc.) • Two control groups • Results: ……..

  8. Greenlight Project: results Outcome Greenlight TSP Upstate Total Significance n=344 n=278 n=113 n=735 Any new arrest 44% 35% 32% 39% .02 New Felony Arrests 24% 19% 16% 21% Ns Revocations 29% 25% 17% 25% .05 Vera Institute of Justice

  9. Effect Size of MI Over Time Controlled Additive Comparative MARMITE

  10. A 3-year MI-training project • Workshops in MI since 1998 • 2500 probation officers and tutors and clientrelatedstaff in prisonweretrainedduring 3-day workshops 2001-2003. • Governmentmoney to reduce substanceabuse in prions – approx 80000 USD • Extremely positive feedback • Bill and Steve contributed • Governmentfundshelped

  11. MI in Swedish prison and probation • After about 100 of these 3-day workshops for prisonstaff, the Swedish National Council for Crime Prevention reported ” there is no evidence that therehadbeenanymotivational sessions with clients” (2005). • Risk for negative perception of MI (type 3 error) • Hypothesis: The work situation had not changed for prison officers and others

  12. The Implegration Report – A Driver´s Guide through MI • 5 guided semi structured conversations about change with a work book for clients • Advantage 1: Intentionally, deliberately performed motivational sessions – not just ”chat” sessions. • Advantage 2: Sessions are visible to all, recorded, counted and evaluated. Manual, originally presented 2003

  13. Supervision and support in BSF • Geographic organization • Peer groups – peer review every 5th week; peer monitoring and feedback on tapes (1 PASS) • Certification – 3 audio tapes with feedback between supervisor and tutor (program leader) • Supervisors meet in head office 4 times a year • Positive feedback or lie! Make participants enjoy! • Local ownership! Important!

  14. ONE PASS – monitoring, coaching and positive feedback in BSF/1

  15. ONE PASS – monitoring, coaching and positive feedback in BSF/2

  16. COMPLETIONS – a closer look • Programmepresented for the first time APRIL 2003 • 2003: 175 completions • 2004: 568 = 79% completion rate • BSF: 73% of increase of programs 2003-04 • BSF: 36% av program volume 2004. • 2005: 777 completions, 84% completion rate – 64 % of total program volume • 2006: 1011 completions • 2007: 1698 completions; 90 % completion rate • 2008: 2020; 93% completion rate • 2009 – 2011: morethan 2000 completions/year

  17. SOCRATES 8/D N Probl recognition /Ambivalence/ Steps ---------------------------------------------------------------- 950 0,36 - 0,66 1,84 p<.03 p<.0001 p<.0001 ----------------------------------------------------------------- Average difference from pre- to post test Clinical observation: Just mentioning change ”inflates” ratings of intentions to change.

  18. SOCRATES 8/A N Probl recognition /Ambivalence/ Steps ---------------------------------------------------------------- 304 0,63 - 0,56 1,78 p<.03 p<.01 p<.0001 ----------------------------------------------------------------- Average difference from pre- to post test

  19. URICA N Pre C/ Contempl/ Action/ Maintenance ---------------------------------------------------------------- 645 0,54 -0,83 1,69 -1,11 p<.004 p<0001 p<.0001 p<.0001 ----------------------------------------------------------------- Average difference from pre- to post test

  20. The Change Questionnaire – a motivational index based on change talk (Miller, Moyers, Amrhein, 2008) DIMENSIONS: Problem recognition: p <.02 Need: p <.3 Desire: p <.0006 Confidence: p <.002 Commitment/Do: p <.02 Taking Steps: p <.0009 Total (N=88) p <.0005 ____________________________________ Pearson r = .072 (2-tailed) p<.0001 (N=78)

  21. Motivational factors (scales) • Desire: 3,85; p<.0001 • Self Efficacy: 0,43; p<.0001 • Priority; 0,83; p<.0001 • Inner motivation: 0,61; p<.0001 • Total;3,85; p<.0001 Average difference from pre- to post test ME OTHERS The Scale of Balance Exercise: Why I want to change personally (ME) or Other people or circumstances that influence me (OTHERS)

  22. Graphical position in TTM

  23. Results N Prep-5th 5th-later 1368 43,82 24,51 P<.0001 P<.0001 Average difference from pre- to post test

  24. Program counselors assessment of client´s progress during intervention

  25. Client´s own assessment of the effect of the program on their thinking about change

  26. Whataccounts for the effect? 1. MI? 2. The person doing MI? His or hereducation? Or his or her personal skill? 3. Somethingelse?

  27. Evaluation of 38 programs in Ohio Group N Effect size All 38 - 0.43 Completers 38 0.15 Lowenkamp, C. T., Latessa, E. J., & Smith, P. (2006). Does Correctional Program Quality Really Matter? Criminology & Public Policy, 5, 3, 201-220

  28. A closer look Correctional Program Assessment Inventory (CPAI) Unsatisfactory level (24 programs): -1,7% Satisfactory but in need of improvement (13): - 8,1% Satisfactory (1): - 22% Very satisfactory (0) (Andrews & Gendreau, 2001)

  29. 70% 60% 40%r = -.40 50% 40% Recidivism Rate 30% 20% 10% 0.0% Control Treatment But not always…. Valence of the Effect Size:the difference between Positive and Negative Positive Effect Size Negative Effect Size 70% 60% 40%r = .40 50% 40% Recidivism Rate 30% 20% 10% 0.0% Control Treatment DAA – Don Andrews 31 31

  30. A MAJOR CHALLENGE: Programming in the “Real World of Corrections” versus the “Small Demonstration” Project Mark Lipsey: effects from treatment in demonstration projects are much higher than in the “real world” of regular programming Real world: Large samples; Evaluator not involved in design and/or delivery of service 32 DAA (Don Andrews, 2007)

  31. Two Separate Worlds of Practice “REAL WORLD” (k =209) “DEMO PROJECT” (k = 47) Any Human Service 65% 98% Mean RNR Adherence 0.82 2.30 Mean Breadth 0.06 2.11 Staff Selection, Training, Clinical Supervision 01% 28% Sum Core Correctional Practices 0.23 2.19 Sum of Integrity Scores 1.52 4.32 Mean ES 0.03 0.29 DAA – Don Andrews 33

  32. Integratedimplementation (implegration) ≠ onesizefits all • Implementation – an intentional process • Bottom-upperspective • An exploring and listeningattitude • Localownership (from the centrally decidedgoalorientation) • Balancebetweenguidelines and mindlines • Adjusting to localconditions = integration • Positive support morethanmonitoring and control

  33. Implegration - Integratedimplementation of MotivationalInterviewing, an evidencebasedtreatment in Swedish Corrections Implegration – a practitioner´s report ICTAB 12, Santa Fe, February 8-10, 2010Carl Åke Farbring

  34. Implementation - a new science Dean Fixsen et al., 2005)

  35. Dean L. Fixsen, NIRN Implementation Treatment 99% of budget goes to understanding etiologi and writingevidencebasedtreatments; only 1% of the budget to make them work People cannotbenefit from treatment that theydo not experience as useful for them! Implementionteam! 80% in 3 yearscompared to 14% pin 17 years. Treatment intervention is not the same thing as implementation. ICTAB 12, Santa FE, 2010

  36. What is implementation? • ”Implementation – the forgotten issue” (Gendreau, 1999) • E g. not just doing the ”right things” (evidence based) but doing them ”right”. • ”The implementation gap” (knowledge is not disseminated) • Not a clear discipline and too little research…

  37. Implementation: new demands from politicians demand new perspectives • Reduce relapse in crime, increase cost-effectiveness from investments. • Well posed hypothesis: Variations in effects = variations in quality of implementation… • Eliminate risk for (typ III-errors) • Use a deliberate implementation strategy to increase effects from evidence based knowledge and skills.

  38. What is in play? • Organization – problem and deficits on organizational level cannot be corrected by eduction (Fridell, 1996). • Teaching ≠ (learning)> courses, rules, regulations… • Climate • Rethoric = reality • Requires “supervision” from the executive level, but…more supportive than controlling and… • Not just contents (program integrity) but quality in implementation

  39. Implementation by rules • Large byreaucratic organisations with large distances between staff, high level of formal and strict (hierarchical) ways of decisions; • Rules, (sanctions) • Top – down • Production ideology, selling in • Lack of collective view, lack of feeling of collaboration, different motives • Insufficent analysis of employer´s situation • Risk for high levels of frustration • Risk for defensive attitudes

  40. Implementation > decisions/orders • Rationality is overestimated by heads and the need for implementation is underestimated • ”*That´s my decision (these are my orders)” • Of 356 attempts to introduce changes in organisations more than half failed. (Nutt, 1999) • I most cases this was caused by using the wrong strategy ; orders, rules, top-down Nutt, 1999, citerad i Robert Holmbergs rapport: Implementering av nya behandlingsprogram i kriminalvården, 2006

  41. Adjusted implementation (implegration) • Implementation – an intentional process • Bottom-up perspective • An exploring and listening attitude • Local ownership (from the centrally decided goal orientation) • Balance between guidelines and mindlines • Adjusting to local conditions = integration • Positive monitoring and support

  42. Is the organisation motivated for working with programmes • A validated instrument for assessing suitability and readiness for organisations. Organizational Readiness for change. (ORC) Lehman, Greeener, Simpson (2002) • Research at the Institute of Behavioral Research, Texas Christian University. • JSATs special issue October 2007: 10 articles about implemation (only).

  43. Positive correlations between outcome and implementation: • Experienced possibility for peer influence • Organisation can with credibility impart ”a mission” • Easy access to the Internet • Feeling of need to get better in working with programmes • Generous possibilties for personal growth and development • A certain level of stress in the organisation (!?) Fuller, Rieckmann, Nunes, Miller, Arfken, Edmundson, McCarty. (2007) Organizational readiness for change and opinios toward treatment innovations. Journal of Substance Abuse Treatment.

  44. An implegration model for Swedish Corrections (CIM) Dimensioner: • Organisation • Program characteristics • Staff • Clinical skills • Integration, contextual factors • Clients • Evaluation (Farbring, 2007)

  45. An implegration model for Swedish Corrections (KIM) Goals: • Increase effectiveness from programmes - reduce relapse • Assess need for support • Produce information for self assessment • Assess suitabilty for (further) programme work (Farbring, 2007)

  46. KIM- exempel på schema för bedömningar

  47. KIM - exempel på kodnyckel

  48. RESEARCH ON THE MI-IMPLEGATION IN SWEDISH CORRECTIONS

  49. Forsberg, L., Ernst, D., & Farbring, C. Å. (2010) Learning motivational interviewing in a real-life setting: A randomised controlled trial in the Swedish Prison Service. Criminal Behaviour and Mental Health. (wileyonlinelibrary.com) DOI: 10.1002/cbm.792  ABSTRACT: BackgroundMotivational interviewing (MI) is a client-centred, directive counselling style for helping people to explore and resolve ambivalence about behaviour change and shown to decrease drugand alcohol use. A five-session semi-structured MI intervention (BeteendeSamtalFörändring (BSF; Behaviour, Counselling, Change)) was implemented in Swedish prisons. Aims To examine whether, in a real-life implementation of semi-structured MI, staff receiving ongoing MI training, based on audio-recorded feedback in peer groups (BSF+) possess greater MI skill compared with staff receiving workshop-only MI training (BSF), and staff conducting usual prison planning interviews (UPI). Methods Prisoners were randomised to one of the three interventions. The first sessions between staff and prisoner with complete data were assessed with the Motivational Intreviewing Treatment Integrity Code 3.0. Results  Content analysis of 45 staff: prisoner sessions revealed that counsellors in the BSF+ group were significantly more competent in MI than those in the UPI group, but there was no difference in MI competency between the BSF and the UPI groups. Overall, staff were rated as not having achieved beginning proficiency. Conclusions  Our findings suggest that staff delivering motivational interviewing programmes for substance-misusing prisoners in Sweden are not being given sufficient training for the task. Previous literature has suggested that staff need more than a basic 3- to 5-day workshop training, but our findings suggest that they may need longer-term continuing supervision and support than previously recognised.

  50. Aims To examine whether, in a real-life implementation of semi-structured MI, staff receiving ongoing MI training, based on audio-recorded feedback in peer groups (BSF+) possess greater MI skill compared with staff receiving workshop-only MI training (BSF), and staff conducting usual prison planning interviews (UPI). Methods Prisoners were randomised to one of the three interventions. The first sessions between staff and prisoner with complete data were assessed with the Motivational Intreviewing Treatment Integrity Code 3.0. Results  Content analysis of 45 staff: prisoner sessions revealed that counsellors in the BSF+ group were significantly more competent in MI than those in the UPI group, but there was no difference in MI competency between the BSF and the UPI groups. Overall, staff were rated as not having achieved beginning proficiency.

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