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Treatment programmes

+Treatment programmes

The main approaches within this area are Individual Differences, Cognitive, Social and Physiological Psychology.

This is because this section focuses upon how these factors can increase/reduce the success of treatment programmes for offenders.

The recidivism rate in the UK is approximately 64%.

In order to break the ‘revolving door’ phenomenon of repeat offending effective treatment and rehabilitation programmes are needed.

+Learning outcomes

Cognitive skills programmes (Cann, J. (2006) ‘Cognitive skills programmes: impact on reducing reconviction on a sample of female offenders’, Home Office Findings 276);

Anger management (Ireland, J. (2000) ‘Do anger management courses work?’, Forensic Updates 63, 12–16);

Using ear acupuncture with a drug rehabilitation program (Wheatley, M. (2007) ‘Needles help beat drug addiction’, Prison Service Magazine with Cambridge University Institute of Criminology).

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Cognitive Skills Key study: Cann (2006)

+Background: Psychologists believe that one way to stop the cycle is to break

down the faulty thinking patterns which they believe underlie criminal behaviour.

Before a criminal act can occur, it must be preceded by a criminal thought.

Therefore, changing the way offenders think can prevent re-offending.

This idea is the rationale behind cognitive behavioural therapy (CBT), in other words if you change the way a person thinks you will change the way they act.

CBT is a type of talking treatment that focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems.

+Background Friendship (2002) reported that re-offending rates for

prisoners who received CBT were 14% lower than those who had not.

However, a later study by Falshaw & Friendship (2003) failed to find a significant difference.

A major issue is that in order for CBT to be effective it must be well delivered by competent therapists and the prisoners must have a reasonably high IQ (at least 80), good literacy skills and be highly motivated.

Mainly males used in all research and therefore females needed to be represented.

+Cognitive skills programmes were first introduced in England and Wales in 1992, when two programmes were introduced:

Reasoning and Rehabilitation (R & R) – the aim was to develop prisoners’ cognitive skills, targeting thinking style; self control or impulsivity; interpersonal problem-solving; critical reasoning; moral reasoning; social perspective training.

The programme was made up of 36 sessions each of 2.5hrs, with assignments for prisoners to do between the sessions and after the programme was complete.

Those on the programme had served sentences of varying lengths, from a few months to over 4 years, and had to have basic literacy skills and an IQ of at least 80 to qualify for inclusion on the programme.

To study the effectiveness of the programme prisoners were classified into 4 different risk of reoffending categories: low risk, moderate low risk, moderate high risk and high risk.

They were also categorised in terms of the reason for their sentence: violent, sexual, theft or “other”.

+ Cognitive skills programmes were first introduced in England and Wales in 1992, when two programmes were introduced:

Enhanced Thinking Skills (ETS) - ETS is a relatively short programme (20 sessions), similar to R&R, which addresses thinking and behaviour associated with offending.

This includes impulse control, flexible thinking, social perspective taking, values/moral reasoning, reasoning, and inter-personal problem solving.

It was designed for the prison population in England and Wales who are at medium to high risk of reoffending and is currently the programme most frequently delivered, with over 40,000 offenders having completed this course within prison over the past 12 years.

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Cognitive Skills Key study: Cann (2006)Aim

To find out if Cognitive Skills programmes were effective in terms of lower re-offending rates for a sample of women prisoners.

+Sample

180 offenders who started Enhanced Thinking Skills (ETS) or Reasoning and Rehabilitation (R&R) between 1996 and 2000 (including fourteen non-completers).

A comparison group comprised 540 female offenders who did not participate in these programmes.

+Procedure

Expected two-year reconviction rates were calculated for all the women.

Actual reconviction rates were calculated for one and two years after release.

+Results

No significant difference was found between the treated group and the comparison group on expected reconviction.

No significant difference was found between the groups for actual reconviction after one or two years.

No significant difference was found for ETS but for R&R the treated group actually fared worse and were significantly more likely to re offend.

+Discussion

Cann suggests the following reasons in the case of females:

Women offend for different reasons than men and while they may have cognitive skills deficits, these are not necessarily criminal in nature. Women offend because of drug abuse, relationship

problems, emotional factors and severe financial hardship.

+Discussion (cont.)

The programmes were inappropriate for the women’s needs, having been developed for men and with men’s risk factors in mind.

The programmes were not delivered consistently in the women’s prisons and were limited in length.

+Evaluation

Class to complete

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Anger management Key research: Ireland (2000)

+Background

There is instrumental aggression (means to an end, calculated) and hostile aggression (an uncontrolled reaction, someone provokes you).

Hostile aggression common in prisons so prisoners have training on this.

CALM is a cognitive behavioural programme used in prisons.

It is an anger management programme which aims to develop prisoners emotional control.

One example is ‘thought-stopping’ in which the prisoner learns to stop negative aggressive thoughts and direct them somewhere else.

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Anger management Key research: Ireland (2000)Aim

To assess whether anger management programmes work with a group of young male offenders.

+Sample

50 prisoners who had completed an anger management course and a control group of 37 prisoners who had been assessed as suitable for such a course but had not actually completed one.

+Matched pairs design

their responses to a cognitive behavioural interview;

the Wing Behavioural Checklist (WBC);

a self-report questionnaire on anger management (AMA) completed by the prisoners themselves.

+Method

A quasi-experiment taking advantage of the two naturally occurring groups.

The three measures were given to the prisoners in the treatment group before and after they completed the program.

The control group also got them twice but without any intervention in between.

+Results

There was a significant reduction in prison wing-based aggression in the experimental group but not in the control group.

The experimental group scored lower on the self-report measures after completing the course but there was no difference in the control group.

+Results (cont.)

Overall

92% of the prisoners in the experimental group showed improvement on at least one measure;

48% on two measures;

8 % showed deterioration on both measures upon completing the course.

+Conclusions

In the short term these prisoners appeared to be helped by the programme.

It is interesting that 8% actually got worse which would require further investigation.

+Evaluation:

Method – Quasi Experiment This allows a cause and effect relationship to be

inferred as we can assess the offenders’ aggressive behaviours before and after the intervention

However, there is a lack of control over other extraneous variables which may have affected inmates’ anger such as relationships with other inmates, news from family, etc.

Some ecological validity as carried out in the institutional setting, however it is unclear whether these results apply when prisoners are released

+Evaluation:

Method – (cont’d...) It wasn’t possible to randomly assign

participants to each group, so they couldn’t be matched on variables such as age or offence type

There are inherent difficulties in using self-reports in a forensic setting where there may be clear incentives for individuals to appear successful following treatment e.g., for parole purposes

+Evaluation:

Sample The sample comprised all male young

offenders (mean age of 18-19 years) in a young offenders’ institution serving sentences of less than 3 months on average.

Therefore, the results cannot be generalised to other settings and groups such as female offenders, released offenders or those in a prison.

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FOCUS ear acupunctureKey research: Wheatley (2007)

+Background

Ear acupuncture is a more modern type of alternative treatment for prisons (although historically a very old treatment).

Its cheap, easily taught and is not effected by prisoners motivation levels.

Sometime difficult with drug-addicted offenders and they would need a talk-based therapy first.

+ Among the offender behaviour programmes delivered in HMPS are those specifically

aimed at drug rehabilitation, helping offenders to give up substance abuse.

These use a variety of techniques. One such programme, FOCUS, is a high-intensity drug and alcohol treatment programme operating in five of our high security prisons.

The FOCUS programme looks to enhance motivation, change thinking associated with drug misuse, improve social and emotion management skills and develop relapse prevention skills using role-play.

This alternative treatment has been used in prisons for 5 years and is popular as it is cheap, easily taught (prison officers can be taught in a 4-day course and two officers can administer the treatment to 10-15 inmates at a time in a 40 minute session).

Michael Wheatley, (Senior Manager for the Drug Strategy & Services Directorate of High Security Prisons in England and Wales), argue that it is a useful addition to the drug rehabilitation programme and does not require the prisoner to be highly motivated to participate.

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FOCUS ear acupunctureKey research: Wheatley (2007)Aim

To test the effectiveness of acupuncture in treating drug addicted prisoners.

+Sample

350 prisoners in six high security prisons who received acupuncture and the standard care program which is called FOCUS with a control group who did not receive acupuncture but did get the standard care.

+Procedure

Two trained practitioners worked with groups of 10-15 prisoners in a relaxed setting.

Fine needles were inserted into five acupuncture points in the ear and prisoners relaxed for a 40 minute period.

They then returned to normal duties.

Qualitative and quantitative data were collected.

+Results

Qualitative data: Prisoners reported better sleep, improved relaxation, better

coping skills, reduced cravings for nicotine, amended cognitions and health improvements.

They made more effort to communicate with their families and attend classes.

Staff commented that they could tell when prisoners had been to acupuncture because the wing was calmer and there was less demand for healthcare services.

+Results (cont.)

Quantitative data: 70% reduction in drug related incidents from six months pre

treatment to six months post treatment. 41% reduction in serious incident reports. 42% reduction in positive drug testing results (mandatory). 33% reduction in positive drug test results (voluntary).

+Conclusion

Wheatley believes that acupuncture works as a complementary therapy with other programmes.

There is enough evidence to expand the delivery of the programme throughout the prison system.

+Evaluation:

Method – Experiment (Independent Measures) This allows a cause and effect relationship to be

inferred as we can assess the offenders’ drug-taking behaviours before and after the acupuncture treatment

Independent measures design means that participant variables could potentially confound the results – e.g. motivation levels, etc.

Using a control group means not only can we see the effects of treatment in the experimental group, but we can also compare the results to those not receiving treatment

+Evaluation:

Sample Large sample used and participants were randomly

assigned to the treatment or control groups. This allows for greater generalisability of findings.

Qualitative/Quantitative Data Qualitative data allows prisoners to report how the

treatment makes them feel, however as this is self-report data there is the potential for offenders to be dishonest.

Quantitative data gives a more objective description of the treatments’ success and cannot be manipulated by offenders.

+Evaluation:

Reductionism/Holism This study takes a reductionist approach as it is only

studying the effect that ear acupuncture has on treating drug addiction

However, it is stated that ear acupuncture is only a small part of a more holistic approach to treating drug addiction

Therefore, how useful is it to isolate only one part of this treatment and using it as an independent variable?

Whilst the scientific method is usually preferred, it is worth considering whether developing other methods of assessing holistic alternative treatments is preferable