Cognitive-Behavioral Treatment for Inmates: An Outcome Study

1. Cognitive-Behavioral Treatment for Inmates:An Outcome Study Thomas Powell, Ph.D. & Christine Sadler, M.A. Castleton State College Castleton, Vermont

2. Vermont Department of Corrections • Administration and management of prisons, jails, community release, parole and probation. • Mission explicitly promotes rehabilitative opportunities within the context of public safety and victims’ rights.

3. Vermont Department of Corrections • Vt.DOC has one of the highest per capita incarceration growth rates in the U.S. despite the fact that … • Vermont has the second lowest violent crime rate in the U.S.

4. Vermont Department of Corrections • Pervasive overcrowding has been the result of sentencing legislation, “get-tough” judicial appointments, and a poorly regulated pattern of PO’s returning parolees to prison for technical breeches and infractions. • 500 Vt. inmates have been displaced (outsourced) to private prisons in Kentucky and Oklahoma). • If ever there were a case for managed care …

5. Cognitive Self-Change Program • Originally based on techniques proposed by Yochelson & Samenow and Ross & Fabiano. • “Bad habits of the mind” are more responsible for criminal conduct than social circumstances (William Healy, 1915). • Jack Bush has been the program director since its inception in 1988.

6. Cognitive Self-Change Program • Pro-criminal thinking patterns become ingrained, automatic and reflexive. • CSC is designed to bring thinking habits and patterns under the offender’s conscious and deliberate control.

7. Cognitive Self-Change Program • Program participants learn to objectively observe and report their thinking without justification. • They identify the linkages between their specific thinking patterns and their antisocial conduct. • They rehearse and practice alternative thinking patterns, using actual events in their lives. Extensive use of journaling and role plays.

8. Cognitive Self-Change Program • Groups meet formally twice weekly for 3 hours. Inmates stay in the program for eight to 24 months, usually depending on sentence length. • At the three largest prison sites it is provided in the context of a therapeutic unit. It is also provided at the women’s prison and most probation/parole offices.

9. Cognitive Self-Change Program • CSC is a core designated “risk-reduction program” for Vermont inmates. • Any inmate who is convicted of a crime of violence or aggression and given a sentence of eight months or more is likely to have this in his/her case plan.

10. Cognitive Self-Change Program • In most cases the nature of the crime (presumed violence) and the length of sentence are the only factors weighed by caseworkers is assigning an inmate to the program. • Principles of risk, need and responsivity are generally ignored in favor of one-size-fits-all program requirements.

11. Inmate Assessment • The LSI-R is administered to all inmates, but it is only used (total score) to determine whether institutional program participation will be required for non-violent offenders. There is no evidence of its use as a case planning tool for any group of inmates. • There are no other assessment procedures to determine eligibility and appropriateness of the inmate for the CSC program.

12. Present Study • What recidivism rates are observed for inmates who participate in the CSC program? • What is the optimal dosage (time in program) as a function of an individual’s risk level (LSI-R score)? • Is there any evidence of improvement in recidivism rates for low risk inmates required to participate?

13. Treatment Dosing Total number of cognitive self-change hours (in institutions and field sites): • Low dosage: 1-65 hours • Medium dosage: 66-150 hours • High dosage: < 151 hours

14. Recidivism Measures • The number of days an offender was incarcerated after being released from a correctional facility. Measured at 12 and 24 months post-release. • The number of new post release criminal charges.

15. Participants • Sample of convenience. • 403 inmates identified retrospectively through Vt. DOC’s management information system. • Sixteen females were removed; final sample 387. • All subjects were exposed to all least some level of CSC treatment. No unbiased no-treatment group could be identified in the database due to design limitations.

16. Participants • Racial composition: > 90% Caucasian (n =351). • Age range: 21 to 68 years of age at time of release. • Average number of offenses leading to guilty conviction was 5.4 (SD = 3.7). Forty-one percent of the sample had more than five charges. • Virtually all the subjects were convicted of at least one violent crime or sex crime.

17. Risk Assessment • LSI-R total: M = 26.5 (SD = 6.7) with a range of 7 to 46.

23. Recidivism • The average number of incarceration days for the first year post-release was 60 (SD = 88.7) ranging from 0-361 days. • 42% had no incarceration days; 58% had at least one.

24. Recidivism • The average number of incarceration days for the second year post-release was 79 (SD = 120) ranging from 0-365 days. • 50% had no incarceration days.

26. Multivariate Results • One-way between-subjects MANOVA was used to determine the relationship between CSC dosing and recidivism with CSC level as the IV, and number of days incarcerated during the first year, number of days incarcerated during the second year and number of charges as the DVs. • Bivariate correlations among DVs ranged from .28 to .57, p < .01.

27. Multivariate Results • Significant main effect for CSC level; Wilks’Λ = .941, F(1, 386) = 3.94, p = .001, partial η2 = .03. • Significant effect for recidivism in the first year, F (2, 385) = 5.35, p = .005, partial η2=.027 with offenders in the high dose category spending fewer days in jail than the medium dose category. • There was a statistically significant effect for the second year F(2, 385) = 3.210, p = .041, η2=.016, but post-hoc tests did not reveal differences among means. • No statistically significant effect for number of charges.

28. Incarceration days Mean SD Low 59.64 91.69 Medium 77.98 a 95.03 High 42.38 a 72.37 Number of incarceration days during the first year post-release X CSC dosage Note. Subscripts denote statistically significant differences (Tukey HSD p = .005)

29. Multivariate Results • One-way between-subjects MANCOVA controlling for LSI-R score to determine if recidivism was a function of risk score. • Covariate was significant; Wilks’ Λ = .952, F(3, 384) = 6.391, p < .0001, partial η2=.05. • Significant effect for recidivism in the first year; F(6, 381) = 3.56, p = .002, partial η2=. 03. • Significant effect also found for second year; , F(1, 386) = 9.14, p =.003.

30. Multivariate Results • Follow-ups for CSC dosage demonstrated a significant main effect for recidivism for the first year only F (2, 385) = 3.819, p = .023, partial η2=.02 • Offenders in the high dosage group were less likely to spend time in jail than the medium dose group.

33. Limitations • Positively skewed data • Low internal consistency of LSI-R scores • Lack of comparison group • Lack of information regarding seriousness of recidivism (e.g. misdemeanor/felony/technical) • Unreliable data entry by field facilitators • Unknown treatment progress ratings • Demographics of sample

34. Policy Questions • Knowledge destruction is alive and well. • Inclusion of low risk cases in CSC probably had no demonstrable benefit, and it may have had an iatrogenic effect. • With bed space at a premium and DOC budget increases draining funds from other human service programs, there is a need for a managed care approach to the use of long term mandatory treatment.

35. Contact Information Thomas Powell tpowell@vtfa.com Christine Sadler christine.sadler@castleton.edu