Presentation to the 8 th Annual Georgia School of Addiction Studies

1. Presentation to the 8th Annual Georgia School of Addiction Studies Evidence Based Principles of Offender Rehabilitation Christopher A. Petrozzi, Senior Vice President of Correctional Services

2. Prevalence of Individual Adverse Childhood Experiences

3. Prevalence of Individual Adverse Childhood Experiences

4. Enduring Effects of Abuse and Related Adverse Experiencesin Childhood Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress-responsive neurobiological systems An expanding body of research suggests that early stressors cause long term changes in multiple brain circuits and systems (Sanchez 2001; Bremner 2003a)

5. Enduring Effects of Abuse and Related Adverse Experiences in Childhood The ACE score had a strong, graded relationship to the prevalence and risk of affective disturbances (mental health disturbances). For persons with ≥ 4 ACEs, the risk of panic reactions, depressed affect, anxiety, and hallucinations were increased 2.5-, 3.6-, 2.4 and 2.7-fold, respectively. Substance use and abuse also increased as the ACE score increased. The risk of smoking, alcoholism, illicit drug use, and injected drug use were increased 1.8-, 7.2-, 4.5-, and 11.1-fold, respectively, for persons with ≥ 4 ACEs. All three measures of sexuality were associated with the ACE score. The risk of early intercourse, promiscuity, and sexual dissatisfaction were increased 6.6-, 3.6-, and 2-fold, respectively, for persons with ≥ 4 ACEs.

6. Enduring Effects of Abuse and Related Adverse Experiences in Childhood The risk of impaired memory of childhood was increased 4.4-fold for persons with ≥ 4 ACEs. The number of age periods affected for memory disturbances increased in a graded fashion as the ACE score increased. High perceived stress, difficulty controlling anger, and the risk of perpetrating intimate partner violence (IPV) were increased 2.2-, 4.0-, and 5.5-fold, respectively, for persons with ≥ 4 ACEs

7. Delinquency Pattern of behavior that is seen across the lifetime Pattern of rule breaking & criminality Disengagement from cultural norms for achievement and behavior Easily bored and often irritable Risky behavior despite high likelihood of punishment Delinquency often resulting in incarceration Beauchalne, T. & Tapert ,S. Brain Science as a Means to Understanding Delinquency & Substance Abuse in Youth . U WTV

8. Progression of Delinquency Hyperactivity School Conduct Problems Academic Problems Drug Use Suspension Criminality Oppositional Disengagement Delinquent Peer Aggression Group Incarceration Pre SchoolMiddle SchoolAdolescence Beauchalne, T. & Tapert ,S. Brain Science as a Means to Understanding Delinquency & Substance Abuse in Youth . U WTV

9. Current Delinquency Interventions • Few impulsive or aggressive children receive any form of intervention • Those who are treated usually receive some form of group intervention: Special Education Placements Summer School / Summer Camps Institutionalization Beauchalne, T. & Tapert ,S. Brain Science as a Means to Understanding Delinquency & Substance Abuse in Youth . U WTV

10. Mesolimbic Dopamine Activity Phasic Response Tonic Activity Neural Firing Reward Cue Satiation Beauchalne, T. & Tapert ,S. Brain Science as a Means to Understanding Delinquency & Substance Abuse in Youth . U WTV

11. ADHD Mesolimbic Dopamine Activity Phasic Response Tonic Activity Neural Firing ADHD Reward Cue Satiation Beauchalne, T. & Tapert ,S. Brain Science as a Means to Understanding Delinquency & Substance Abuse in Youth . U WTV

12. Dopamine & Impulsivity Dopamine - neurotransmitter that controls the brain's reward and pleasure centers. DA helps regulate movement and emotional responses, it enables us to see rewards and take action to move toward them. The major behaviors dopamine affects are movement, cognition, pleasure, and motivation. Children with ADHD exhibit low tonic and low phasic activity Low mesolimbic DA activity is predisposing to impulsivity & aggression Environmental stress during development exacerbates this effect (i.e., further down regulation) This effect can be pre-natal or post-natal Beauchalne, T. & Tapert ,S. Brain Science as a Means to Understanding Delinquency & Substance Abuse in Youth . U WTV

13. Reward Seeking Model People low in tonic DA activity experience high levels of negative affect and irritability This leads to reward seeking behavior to up-regulate a chronically aversive mood Low phasic DA activity means less pleasure from reward seeking behaviors This elicits more reward seeking and predisposes to delinquency – high risk environments have lots of opportunities for maladaptive reward seeking Beauchalne, T. & Tapert ,S. Brain Science as a Means to Understanding Delinquency & Substance Abuse in Youth . U WTV

14. Cost of Incarceration Incarceration rates flat for nearly 50 years up until the “War on Drugs,” and “Get Tough on Crime” US incarcerates 730/100,000, England 140/100,000 2.2 Million Americans Incarcerated Disproportionate Number of Minorities

15. Costs of Incarceration 20% of African Americans and 10% of Latinos serve time in prison Once incarcerated there are limited opportunities for upward mobility Nationally, recidivism rates are over 60% within five years Early intervention is far more effective than incarceration when delivered before delinquency emerges

16. Paradigm Set of assumptions, concepts, values, and practicesthat constitutes a way of viewing reality.

17. Criminal World View Paradigm Offenders base their criminal lives on escaping accountability Offenders experience a set of attitudes perceptions and thinking patterns that add up to a special subjective logic, a criminal world view Offenders’ perception of their relationship with legitimate authority is at the crux of this world view

18. Criminal World View Paradigm • Offenders frequently view authority, social limits and accountability as a challenge to their power and autonomy • When forced to be accountable offenders feel themselves to be confronted by an unjust force and see themselves as victims

19. Cognitive Behavioral Model Behaviors – “Burglary, Theft” Cognitions – “ Lot’s of people get away with it” Attitudes – “it’s a dog eat dog world” Beliefs – “people like me never get breaks” Values – “money/status”

20. Culture Clash / Cognitive Dissonance Prison CulturePro-Social Culture Don’t trust, talk, or feelTrust, disclose Don’t be weak Risk vulnerability Do your own time Responsible concern Live for today Plan for the future Get respect Offer respect Suffer in private Seek help Retaliation Acceptance / Surrender

21. Security & Treatment Paradigms

22. Criminal Desistance Best defined as a process, not an event, in which the frequency of crimes decelerates and exhibits less variety (Bushway et al., 2001; Laub and Sampson, 2003; Maruna, 2001;Uggen and Massoglia, 2003; Weitekamp and Kerner, 1994; Loeber and LeBlanc, 1990; LeBlanc and Fréchette, 1989).

23. Criminal Desistance There is remarkable heterogeneity in criminal offending It is useful to view criminality as following a path consisting of one or more crime and non-crime cycles (Glaser, 1969) Decision to stop appears to be preceded by a variety of negative consequences both formal and informal

24. Process of Individual Change Prison releasees arrested for property or drug offenses are more likely to be arrested early in the post release period than those arrested for violent offenses Although risk for arrest declines over time for all three crime types, a much steeper decline occurs for property and drug offenders, whose arrest risk drops by nearly 50 percent between the 1st and 15th month after release; for violent offenders, the decline is only about 20 percent from the 1st to the 15th month out of prison.

25. Process of Individual Change Multiple processes appear to be involved in sustaining and reinforcing the decision to change. Motivation and commitment Initial behavior change Maintenance of change (Brownell et al., 1986).

26. Process of Individual Change The goal of desistance programs is not necessarily zero offending, but less offending and less serious offending It is important for policy makers and program administrators to have realistic goals and to have forms of punishments/sanctions and rewards available that will support these goals

27. Process of Individual Change A main objective of intensive supervision parole is a reduction in recidivism for new crimes A rigorous study by Petersilia and Turner (1993) of intensive supervision parole and probation programs in nine states, found that offenders in intensive supervision programs had relatively the same number of subsequent arrests, but more technical violations and returns to incarceration, than their no intensive supervision program counterparts

28. Process of Individual Change However, if those programs combined drug treatment, community service, and employment programs with surveillance, recidivism rates were 10 to 20 percent lower than for those who did not participate in such activities A meta-analysis of intensive supervision probation and parole programs also found that combining surveillance with treatment resulted in reduced recidivism (Gendreau and Little, 1993)

29. Termination of Criminal Career The successful establishment of bonds with conventional others and participation in conventional activities are major contingencies on the path that leads to termination of a criminal career, (Shover, 1996) A process characterized by particular behavioral states or markers is marked by the assumption of: • Adult occupational and family roles, Uggen & Massoglia (2003) • Social integration or reintegration through a developed coherent, prosocial identity, Maruna (2001)

30. Social Learning Theory • Social Learning Theory: people learn and adopt new behaviors through cognitions,positive and negative reinforcement, observation, and skill practice,(Bandura, 1977; 1969) • SLT and Psychology of Criminal Conduct have become the nexus of evidence-based principles of offender rehabilitation

31. Evidence Based Principles of Offender Rehabilitation 1. Assess Actuarial Risk/Needs 2. Enhance Intrinsic Motivation 3. Target Interventions: a. Risk Principle b. Need Principle c. Responsivity Principle d. Dosage 4. Skill Train with Directed Practice (use cognitive behavioral treatment methods) 5. Increase Positive Reinforcement 6. Engage Ongoing Support in Natural Communities 7. Measure Relevant Processes/Practices 8. Provide Measurement Feedback National Institute of Corrections & Crime and Justice Institute, (2003)

32. 1. Assess Actuarial Risk & Needs • Clinical judgment has consistently under-predicted re-arrest rates when compared to empirically-based tools • Offenders’ characteristics predict future offenses more than the current offense. Use risk tools to determine supervision level. For purposes of risk reduction, risk profile – rather than offense – should drive the intervention.

33. 1. Assess Actuarial Risk & Needs Common Risk/Needs Assessment Instruments Level of Service Inventory-Revised (LSI-R) 3G Violence Risk Appraisal Guide (VRAG) Wisconsin Risk and Needs, (CAIS) 4G Historical, Clinical, and Risk Management Factors (HCR-20) 1G Correctional Offender Management Profiling for Alternative Sanctions (COMPAS) 4G

34. 2. Enhance Intrinsic Motivation • Behavioral change is quite often an inside job; for lasting change to occur, there needs to be a level of intrinsic motivation • Feelings of ambivalence that usually accompany change can be explored through motivational interviewing-based communication to enhance intrinsic motivation • Research strongly suggests that motivational interviewing techniques, rather than persuasion tactics, more effectively enhance motivation for initiating and maintaining change behavior

35. Motivation & Outcomes • Research demonstrates that a ratio of four positive affirmations for every, (4:1) expression of disapproval/confrontation has a positive effect on behavioral change.Andrews & Bonta, 2006; Gendreau, 1996; Gendreau & Goggin, 1996; Gendreau, Little, & Goggin, 1996;Gendreau & Paparozzi, 1995. • Motivation is dynamic - affected by internal and external factors, but internally motivated change usually lasts longer

36. Self Determination Theory • Studies have shown that a person’s perception of what is prompting the change is more important than what is actually prompting the change • According to SDT, staff can increase internal motivation for change by addressing three basic factors: autonomy, competence, and relatedness.

37. Autonomy • Autonomy is an individual’s perception of himself or herself as the agent of an action (“I chose to do this”) • When people think that they are making changes for their own reasons, they work harder and are more likely to stick with the new behaviors • Too much coercion can undermine internal motivation because it makes people feel they are being manipulated, which in turn makes them less likely to change (Deci and Ryan, 1985)

38. Competence • Competence involves beliefs about confidence (“I can do this”) • To change, a person needs to believe that change is both important and possible • Helping offenders set realistic goals, talking about personal strengths, and giving positive feedback on small successes can increase one’s sense of competence

39. Relatedness • Change is more likely when people are available to support the offender • Relatedness: powerful explanation of why people sometimes act against their own self-interest (Deci and Ryan, 1985). For better or worse, people tend to behave like those with whom they associate • Individuals engage in prosocial behaviorsbecause they are meaningful to others to whom they feel connected

40. 3(a) Risk Principle • Prioritize primary supervision and treatment resources for offenders who are at higher risk to re-offend • Shifting program and personnel resources to focus more on higher risk offenders promotes harm-reduction and public safety

41. 3(a) Risk Level: Patterns in Risk Level & Treatment Intensity Offender RISK LEVEL % Recidivism: Tx BY RISK LEVEL Impacton RECIDIVISM Authors of Study Minimum Intensive 22% 56% Low Risk High Risk 16% 78% ( 6%) ( 22%) O’Donnell et al., 1971 Low Risk High Risk 10% 18% 3% 37% ( 7%) ( 19%) Baird et al., 1979 17% 31% Low Risk High Risk 12% 58% ( 5%) ( 27%) Andrews & Kiessling, 1980 Low Risk High Risk 12% 92% 29% 25% ( 17%) ( 67%) Andrews & Friesen, 1987 * Some studies combined intensive Tx with supervision or other services 41

42. 3(a) Risk Level: Triage Low Risk Offender – has more favorable pro-social thinking and behavior than other risk levels. Divert to administrative supervision. 42

43. 3(a) Risk Principle Factors Predictive of Prison Misconducts, (Austin, 1998): Current Age Gender History of Violence History of Mental Illness Gang Membership Program Participation: Inmates not involved in or not completed programs more likely to commit misconducts Recent Disciplinary Actions: Inmates with recent misconducts are more likely to continue Education Level: Predictor of poor institutional adjustment, Proctor 1994, Motiuk(1991) and Stephen (1990; cited in Proctor, 1994), Fernandez and Neiman (1998)

44. 3(a) Risk Principle Factors Not Predictive of Institutional Misconduct: Drug and alcohol use History of escape Sentence length Severity of offense Time left to serve

45. 3(b) Criminogenic Need Principle • Criminogenic needs are dynamic risk factors that, when addressed or changed, affect the offender’s risk for recidivism • Criminogenic needs contribute to or co-vary with criminal behavior

46. Central Eight Criminogenic Needs Andrews, Bonta & Wormith, (2006) identified what are referred to as the “central eight” criminogenic needs. 1) Antisocial attitudes/orientation 2) Antisocial peers 3) Antisocial personality 4) Antisocial behavior patterns 5) Absence of pro-social leisure/recreation activities 6) Dysfunctional family 7) Employment issues 8) Substance abuse problems

47. Service ToolsImpact of Matching Offender Needs with Appropriate Services on Recidivism

48. Antisocial Attitudes/Orientation • Values, beliefs, attitudes, and cognitions relative to criminal conduct and pro-social alternatives are strongly correlated with criminal behavior, (Andrews, Bonta & Wormith, 2005)

49. Antisocial Peers • Antisocial support network reinforces the behavior, attitudes, orientation, definitions, and technology favorable to committing criminal acts. • Antisocial peers and affiliating with security threat groups/gangs is one of the single best predictors of criminal behavior (Andrews, Bonta & Wormith, 2005).

50. Antisocial Personality • Callousness, risk taking, weak self-control, and high antagonism have been directly linked to criminality, (Andrews, Bonta & Wormith, 2006). • Offenders displaying antisocial personality traits often do not care how their actions affect others and do not feel remorse.