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BRITISH COLUMBIA CENTRE FOR WOMEN (BCCW)

9e9

_715 /1,3

•

INTENSIVE TREATMENT PROGRAM FOR FEMALE OFFENDERS

(ITPFO) •

98-05-20

Copyright of this document does not belong to the Crown.

Proper authorization must be obtained from the author for

any intended use.

Les droits d'auteur du présent document n'appartiennent

pas à l'État. Toute utilisation du contenu du présent

I document doit être approuvée préalablement par l'auteur.

1.19RARY 1ML1071-iÈCIUF, PSEPC/SPPCC

J AN 3 1 2008

OTTAWA (ONTARej OP8

BCCW • INTENSIVE TREATMENT PROGRAM FOR FEMALE OFFENDERS

TABLE OF CONTENTS

I. PROGRAM SYNOPSIS 4

IL PROGRAM MANDATE 5

TREATMENT PHILOSOPHY 6

IV. PROGRAM GOALS AND OBJECTIVES 7

V. STAFFING 10

Program Director 10 Composition of the BCCW Intensive Treatment Program For Female Offenders(ITPF0) 10 Program Director 11 Primary ITPF0 Team Members 11 ITPF0 Team Members 11

VI. ADMISSION 12

Sources ofReferrals 12 Screening Process 12 CRITERL4 FOR ADMISSION TO THE BCCW INTENSIVE TREATMENT PROGRAM" 13 Admission Decision Making Process 14 Prioritization Process 14 Waiting List 14 Individual Program File Review 15

SENTENCE MANAGEMENT/ SENTENCE MANAGEMENT 15

VII. ASSESSMENT AND CARE PLANNING 16

Assessments Conducted Not Specific To The Program 16 Assessments Conducted Specific To The Program 16 ITPF0 Team Meeting Review 16 Contents of BCCW Intensive Treatment Program Team Review 17 Psychological Assessment Test Battery 18 Progress Review Groups 21 Informal Reviews by MD 77' Staff 21 Program participant Outcome Evaluation Forms 21

VIII PROGRAM COMPLETION 38

Program Completion Documentation 38 Premature Termination 39

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IX. TREATMENT: COMPONENTS AND PROCESS 40

TREATMENT COMPONENTS 40 Treatment Content Overview 41

WEEKLY SCHEDULE 43 I. PSYCHOTHERAPY 42 Interpersonal Psychodynamic Group Psychotherapy 42 Staff Debriefing Sessions 51

REBT AND DIDACTIC GROUPS 52 Rational Emotive Behaviour Therapy (REBT) 54 Communications 56 Autobiography 58 Review, Examine, Challenge, Assess and Prepare (Recap) 60 Women Overcoming Violence Maintenance.(WOVE) 61 Thinking Errors 62 Intimacy and Relationships 64 Anger Management 65 Crime Cycle and Relapse Prevention 68 Victimization, Personal Healing, and Empathy Awareness Module 70 FLEX-TIME/SPECIALTY MODULES AND MODULE ADJUSTMENTS 72

III. INTERACTIVE GROUPS: EVALUATION AND MANAGEMENT 73 Program participant Review of Weekly Progress 73

IV. INDIVIDUAL CARE 74 Daily Logs 74

TREATMENT PROCESS 75 Review Meetings 75 Steering Committee 75

X. PROGRAM EVALUATION AND DEVELOPMENT 76

PROGRAM RETREAT 76 7REATMENT COMPONENT OUTCOME EVALUATION 76 UPDATED LITERATURE REVIEW 94 RESOURCE ANALYSIS 94 TREATMEN7' COMPONENT DELIVERY EVALUATION 98 DISCHARGE ANALYSIS 105 Discharge analysis form 107 IMPLEMENTATION OF CHANGE 112 LONG-TERM TREATMENT OUTCOME RESEARCH 112

XI. APPENDICES 113

Informed Consent Form 116 House Rules/Expectations 118

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I. BRIEF PROGRAM DESCRIPTION

The BCCW Intensive Treatment Program for Female Offenders offers twenty (20) weeks of treatment for program participants with a history of aggressive or self destructive acts in an institutional or community setting. The program operates on the "closed group" concept in that a maximum of 10 program participants are selected for each five (5) month session. Each program is served by a multi-disciplinary program team.

The BCCW ITPFO is built on the principle of experiential learning and developing "self-help" skills.

The program provides approximately nine (9) hours of cognitive/didactic group therapy, five and half (6.25) hours of interpersonal Psychodynamic group therapy, 3 -4 hours of structured homework exercises, and a further 5 -6 hours of various treatment components per week.

Pre and post assessments are conducted on each program participant and Sentence Management procedures are followed on an individual basis as required by the Sentence Management manual.

• Ongoing program evaluation, quality improvement, and treatment outcome studies are implemented.

The responsibility for learning rests with the individual. Program Participants must be motivated and have some idea of their own goals, if change is to occur. By actively participating in the Program, program participants will have the opportunity to develop insight/understanding to their aggressive, violent, dysfunctional, and self destructive behaviours, and learn "self-help" skills to prevent such behaviours becoming abusive towards self or others in the future.

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II. PROGRAM MANDATE

The Mission Statement of the Correctional Service of Canada (CSC) states,

"The Correctional Service of Canada, as part of the criminal justice system, contributes to the protection of society by actively encouraging and assisting offenders to become law-abiding citizens, while exercising

reasonable, safe, secure and humane control."

Core Value I of the Mission Statement states,

"We respect the dignity of individuals, the rights of all members of society and the potential for human growth and development "

Core Value Il of the Mission Statement states,

"We recognize that the offender has the potential to live as a law- abiding citizen."

Thus, BCCW offers the Intensive Treatment Program for Female Offenders with the clinical support of the Regional Health Centre (Pacific) for the purposes of reducing antisocial and aggressive criminal recidivism and the promotion of pro-social attitudes and behaviours in women convicted of antisocial and aggressive offenses.

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III. TREATMENT PHILOSOPHY

In accordance with the Program Mandate, the (ITPF0), is based on the treatment philosophy that

• The program participant can best be actively encouraged and assisted to become law-abiding by providing a supportive therapeutic environment.

• A treatment emphasis on the acquisition of "self-help" skills and the encouragement of the program participant to assume responsibility and control of their lives which will provide the best opportunity for the program participant to become law abiding.

• That our program participants have the right to the best care possible within our ability.

• That our programs and services are consistent with established standards and that they are provided in a safe, secure and humane environment.

• It is imperative to use each program participants' strengths as the foundation to the therapeutic - trust relationship and as the basis to address treatment issues.

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IV. PROGRAM GOALS AND OBJECTIVES

The following goals and objectives provide an overview of the program. Section IX of this manual describes the goals and objectives of each component of the program as well as specifying applicable measurable outcomes.

GOAL I To provide a therapeutic environment conducive to the prevention of dysfunctional behaviours.

OBJECTIVES: 1. The program participant will experience extensive personal interaction with other

program participants and staff.

2. The program participant will have the opportunity to participate in groups which are composed of other program participants with similar goals and who have the desire to be supportive of one another.

3. The security and safety of staff and program participants will be ensured through the cooperative work of institutional staff and clinical personnel via regular contact (e.g. by participating in the BCCW IPTFO Team Meetings).

4. Problem solving of program participant issues will be addressed in a therapeutic e group format to facilitate a sense of community and joint responsibility.

GOAL II To promote awareness and understanding in the program participant as to their dysfunctional interpersonal relations in terms of thoughts, feelings, and behaviours.

OBJECTIVES: 1. Program participants will participate in an interpersonal Psychodynamic group

experience for the duration of the program.

2. Each program participant will have the opportunity to use the group for the discussion of experiences past and present.

3. Each program participant will receive weekly feedback from the therapist and peers as to their participation in the group.

4. Therapy staff will debrief after each group and discuss the interpersonal dynamics of group members.

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GOAL III To provide the opportunity to team "self-help" skills in the development of a more adaptive level of psychosocial functioning.

OBJECTIVES 1. The program participant will participate in modules which are specifically focused

upon adaptive skills (e.g. Rational Emotive Behavioural Therapy and Anger Management).

2. Each program participant will be evaluated as to their progress in each of the skill focused modules as to their understanding and utilization of the skill areas.

3. Each program participant will meet weekly with a BCCW ITPFO Team Member who is assigned to the program participant for the duration of the program (i.e. Primary BCCW ITPFO Team Member) to help clarify the content of the modules.

GOAL IV To promote the use of "self-help" ski//s in present day functioning in order to facilitate the integration of teaming and increase the likelihood of more adaptive/pro-social functioning in the future.

Objectives:

11, 1. Program participants will be overtly encouraged in modules and the therapy group to apply the self-help skills in their exploration of past experience and present functioning.

2. In meetings between the program participant and the Primary BCCW ITPFO Team Member, the program participant will be encouraged to discuss the utilization of the skills in terms of daily functioning.

GOAL V To promote and maintain liaison with other related Correctional Services, related health agencies and referral sources.

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Objectives:

1. The Program Director will organize and implement the dissemination of the program manual to all specific referral sources as listed in the "Sources of Referral" subsection of this manual.

2. The Program Director will organize and implement the dissemination of the Program Manual to the directors of other Mental Health, Judicial, Correctional, and Community Agencies.

GOAL VI To maintain the highest standards of therapeutic care by actively promoting education and training for the staff responsible for program participant care.

Objectives:

1. All direct treatment staff will be qualified professionals in good standing with provincial affiliated licensing and regulatory professional associations.

2. All group therapists without prior extensive group therapy training will receive specialized training in group psychotherapy by a qualified senior clinician. This training will also include a formal examination process.

e 3. The Program Director will endeavor to have BCCW ITPFO Team Members participate in conferences and workshops as both presenters and recipients.

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V. STAFFING

The program is staffed by a Program Team which is collectively responsible for the ongoing delivery of treatment, assessment, progra m participant care, and program evaluation.

Program Director

The BCCW ITPFO Team Meeting is chaired by a Program Director who is responsible for providing leadership, direction, the allocation of resources as provided by the Regional Health Centre, the maintenance of referral and waiting lists, and the implementation of quality assurance procedures. The Program Director is a senior clinician and is expected to lead via expertise and team building strategies. The Program Director has no formal line authority over the BCCW ITPFO staff.

0 The Program Director reports directly to the Director of Programs at BCCW who is formally responsible for the quality of the Program at the Institution.

Composition of the BCCW INTENSIVE TREATMENT PROGRAM FOR FEMALE OFFENDERS

The following professionals comprise the ITPFO TEAM

1. Program Director/Therapist 2. Team Psychologist 3. Co-Therapist 4. Other professionals as determined by program participant need (e.g. native

liaison, Institutional Preventative Security Officer (IPSO), community agency representatives).

Program Director

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• Ensuring correct module is delivered on correct day.

• That in their or team member's absence, that a replacement (cover) is recruited.

• That modules are kept to schedule.

• Ensuring that evaluation statistics are maintained.

Primary ITPFO Team Member

• Each program participant is assigned a Primary ITPFO Team Member. The Primary Team Member is responsible for:

• Maintaining weekly counseling contact with assigned program participants.

• Providing ongoing support to the program participant.

• Provide direction to the program participant regarding any ongoing problems.

• Help clarify program contact for homework purposes.

e BCCW ITPFO Team Members

• Provide leadership for daily group therapy.

• Provide support for the preparation and delivery of didactic modules which comprise the cognitive aspect of the program.

• Participate in the screening of prospective program participants.

• Attend ITPFO Team Meetings.

• Attend debriefings of groups and modules.

• Assist in the evaluation of groups and modules as well as research projects which may include follow-up activities after discharge, completing weekly evaluations and post program evaluations.

• Communicate program participant behaviour and significant issues to program staff.

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VI. ADMISSION

Sources of Referrals

There are several sources of referrals to the BCCW Intensive Treatment Program for Female Offenders.

Referrals come from the Sentence Management Officer's, contract psychologists and other related program staff in consultation with ITPF0 Staff. Occasionally, a recommendation has been made at the point of sentencing by the sentencing judge and this may initiate a referral procedure acted upon by one of the aforementioned personnel.

Screening Process

Upon completion of the Referral and Rating Sheet the Sentence Management Officers refer prospective Program Participants to the Institution Program Board. Following the review of the Institutional Program Board a list of prospective Program participants are placed on the Program Referral Report.

In keeping with the Core Values, perspective program participants are prioritized to facilitate timely programming so that cases maybe prepared for prevention to the National Parole Board at the earliest opportunity.

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CRITERIA FOR ADMISSION TO THE BCCW INTENSIVE TREATMENT PROGRAM

• FOR FEMALE OFFENDERS

1. Voluntary admission of guilt to a violent ,aggressive or antisocial offense.

2. Willingness to participate in the 5 month program (motivated to change).

3. Willingness to cooperate with treatment recommendations (e.g. medication and behavioural contracts and make treatment their highest priority).

4. Has no ongoing appeals of conviction.

5. Has no upcoming release dates, parole application dates, or expiry dates which will occur during the program, or if so, the program participant voluntarily waives parole hearings or Statutory Release Dates to be considered for admission.

6. Has the capacity to understand and participate in group based therapy and modules.

7. Has intellectual ability/capacity in the average range or above and is able to read and write at the grade 6 level or above.

8. Is not presently psychotic, abusing intoxicants, or behaviourally volatile (likely to be

e assaultive or suicidal).

9. Willing to comply with assessment procedures as required.

During the screening interview the program participant will be given an explicit invitation to ask questions about the program. The program participant will be informed that they will receive a letter from the Program in approximately three weeks from the date of the interview detailing the ITPFO Team's decision as to their possible inclusion in the program.

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Admission Decision Making Process

The decision that a prospective program participant meets or doesn't meet the inclusion criteria is made by the BCCW ITPFO Program Team. The interview results will be reviewed by the ITPFO within 2 weeks of the screening interview. The prospective program participant will be notified in writing of the decision by the Program Director. Copies of the letter will be forwarded to the program participant's Sentence Management Officer. This letter will give a prospective program starting date or the reasons why the program participant did not meet the Inclusion Criteria.

If the program participant meets the criteria and has expressed an interest in being considered for inclusion in the program her name will be placed on the institutional wait list for program consideration as well as being added to the Programs component under the Offender Management System.

Prioritization Process

In the event of a waiting list which exceeds program seat allocation, admissions will be prioritized using the following criteria:

(a) Does sentence length limit the possibility of waiting for another program? (b) Has the person been on the waiting list for more than one program's

duration? (c) Will the person be an appropriate match with program participants accepted

into the program?

Waiting List

Program participants whom have been deemed suitable for program admission, but due to exceeding demands for seat allocation and have not been able to be admitted for the next program will be placed on a Waiting List. This waiting list is the Program Referral Report which is updated and maintained by the Education, Training & Employment Dept. in conjunction with the Program Director.

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The program participant is expressly given the opportunity to ask any questions and receive prompt feedback concerning these matters. A standard "Consent to Treatment" form is then offered to the program participant for consideration and signature ( Appendix).

Individual Program File Review

An individual program file is also utilized and stored in the ITPFO office. This file information contains program participant identification data, significant health and security data for quick reference, and brief recent progress notes by ITPFO staff. These progress notes contain references to significant events and issues as they relate to ongoing program participant care so that it is possible for the ITPFO members to familiarize themselves with ongoing program participant issues in an efficient manner.

Sentence Management File

The Sentence Management File is stored in the institutional Offender Records department. This file contains all Sentence Management documentation related to the program participants case since entering into the Correction Service of Canada (CSC).

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VU. ASSESSMENT AND CARE PLANNING

Assessments Conducted Not Specific To The Program

In addition to the assessments which are specific to the evaluation of the program participant in the program, program participants may be referred for further assessment on an as needed basis in order to clarify diagnostic issues or facilitate health care. Common examples of this include neuropsychological investigation for brain injury and referrals to outside medical specialists for physical evaluation. These assessments may be provided by BCCW personnel or may be provided in the community. Program participants sent out of the institution for assessment require an Escorted Temporary Absence pass (ETA) as per CSC policy.

Assessments Conducted Specific To The Program

There are three forms of assessment specific to program participant evaluation within the program. These are: 1) BCCW ITPFO Reviews are at pre and post program; 2) Progress Review Groups for the program participant, her peer group, and the group therapists; and 3) Informal Progress Reviews by BCCW ITPFO staff.

The ITPFO Team Meeting Review

5 • Each program participant will be presented at a Team meeting at the commencement, and termination of the program. If required a special Team Meeting will be called for individual program participants as identified during BCCW ITPFO staff meetings, debriefings and in consultation with the Program Director.

• The BCCW ITPFO Team members present their assessments at the ITPFO team and the program participant is interviewed.

• A standardized ITPFO form is utilized and the form is completed based upon the input of the various team members as well as the program participant's input during the review.

• The program participant is present at the ITPFO team meeting review to actively participate and to receive direct verbal feedback. The program participant is also given a written copy of the entire ITPFO team meeting clinical review form.

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• An assessment by the program participant and the ITPFO staff of presenting problem, institutional behaviour, program participation, progress, program participation, goal setting and evaluation of any previously established goals is conducted. The ITPFO staff also conducts a mental status examination, overall evaluation. The aim here is the understanding of the program participant in terms of a Bio-Psychosocial Model. Given the forensic setting and the primary target of treatment (i.e. the reduction of future criminal recidivism) the clinical and security mandates are incorporated into a coherent and focused approach.

In the Initial ITPFO Team Meeting Review the program participant in conjunction with the ITPFO staff members sets goals for each of the program components including modules, group therapy, individual therapies. A further evaluation of progress occurs at the Final ITPFO Team Review upon program completion. A more detailed account of the evaluation of progress in modules and group therapy can be found in the descriptions of the specific program components. In general , however, program participants are evaluated using a comprehensive attitude/behaviour/goal achievement assessment every four weeks in each module.

Contents of BCCW Intensive Treatment Program For Female Offenders Review

The following comprise the formal contents of the assessment package of the

II, ITPFO Team Meeting assessments:

1. An assessment of Psycho-Social Functioning will be done using file reviews. The ITPFO Team Member also insures that a thorough case history is on the Sentence Management file. The sentence management file includes reports detailing: a Criminal History; a Community Needs Assessment; any mental health assessments; a Criminal Profile; and Progress Summaries as detailed by previous Sentence Management Officers (SMOs)

2. Psychological Assessment. The following constitutes the available assessment tools/test battery and may be revised in keeping with research in the assessment of Female Offenders.

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Psychological Assessment Test Battery

Program participant Interview 3,4

Assessment Test Battery: General Personality Inventories

1. MMPI-2 1

2. MCMI-3 1

3. BPI

4. NEO

BARRET IMPULSIVITY SCALE - REVISED 10 R (10-R)

Anger Management Measures

1. Buss-Durkee Scale. 1 The complete scale score is used, as well as the scores on each of the following sub-scales. (a) Assault (b) Indirect (c) Irritability (d) Negativism (e) Resentment (f) Suspicion (g) Verbal (h) Guilt

2. Spielberger Self-Analysis 1 (Trait Anger)

Test-Taking Attitude Measures

I. Personal Reaction Inventory 1

2. Perceived Stress Scale 1

Interpersonal Judgment Measures

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1. Tolerance 1

2. Interpersonal Reactivity 1

3. Perspective Taking

4. Empathic Concern

5. Nowicki-Strickland Locus of Control 1

Interpersonal Emotional Reactions Measures

1. Depression Proneness 1

2. Fear of Negative Evaluation 1

3. Social Avoidance & Distress 1

4. Social Skills Survey 1

Cognitive-Behavioral Measures

1. Personal Data Form 1

e The complete score is used for this scale, as well as the scores for each of the following subscales. (a) Acceptance (b) Frustration (c) Injustice (d) Achievement (e) Worth (f) Control (g) Certainty (h) Catastrophizing

2. Jones Irrational Belief Test 1 The complete score is used for this scale, as well as the scores for each of the following subscales. (a) Demand for Approval (b) High Self-Expectations (c) Blame Proneness (d) Frustration Reactive (e) Emotional Irresponsibility (f) Anxious Overconcern (g) Problem Avoidance

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(h) Dependency (i) Helplessness for Change (j) Perfectionism

Risk Assessment Actuarial Instrument - RAG

1. Psychopathy Checklist Revised (PCL-R) percentiles 2 Two factors are assessed in order to calculate a complete score for this scale. (a) FACTOR 1 (b) FACTOR 2 (c) TOTAL

NOTE: I These measures are completed in pre/post format as per the recommended

2use of the measure according to published instructions.

These measures are completed on a single occasion (preferably prior to the initial ITPFOT Meeting) since the underlying construct being assessed is static in nature and is uot expected to change as a result of the program or other interventions.

This measure is completed on an ongoing basis (e.g. weekly,

Le Interview data is accrued throughout the program, although there is a • more detailed formal clinical interview conducted prior to program commencement.

STATISTICAL INFORMATION ON RECIDIVISM SCALE (SIR)

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Progress Review Groups

The program participant is encouraged on a bi-monthly basis to review progress or lack of progress within her own group. The group will be encouraged to give "feed-back" as to their perception of progress made or not made. A more detailed description of the Review Group can be found within the Program Content section of this manual.

Informal Reviews by ITPF0 Staff

Members of the Program team meet daily to review both the program participants and the "group process".

The program team will also meet once a week to review each program participant's treatment, progress or lack of progress in a "formal" case conference BCCW Intensive Treatment Program For Female Offenders

Program participant Outcome Evaluation Forms

The Prooram participant Outcome Forms presented in this manual are based on the designated outcomes for each specific module or component. The group therapist or Module Facilitator for each component will be expected to complete one table per program participant. For each of the desired outcomes, the therapist must determine whether the outcome has been achieved, and whether the program participant needs to improve upon that particular outcome variable. A copy of each component's Program participant Outcome Form follows:

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Interpersonal Group Psychotherapy

Participant: FPS: Participant's Unit: Group #

Date of Scheduled Audit Actual Date of Audit (Week: ) I (Week 21) Person Responsible for Audit: Group Therapist I

NA=Item not applicable for those instances where no improvement was needed

IDESIRED OUTCOME ACHIEVED I IMPROVEMENT (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory attendance. 2. Active participation. 3. Sharing relevant experiences. 4. Actively supporting others. 5. *Decrease in score on

Depression Proneness measure.

6. Overall improvement on IVIMPI-II profile.

7. Cohesive group member. Comments:

To be completed by Group Therapist:

Name:

*Person responsible for Psychological Testing:

Name:

Signature: Signature:

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Rational Emotive Behavioral Therapy (REBT)

Participant Name: FPS: Participant's Unit: Group #

Date of Scheduled Audit Actual Date of Audit (Week: ) (Week 21)

Person Responsible for Audit: REBT Module Facilitator /Psychologist

NA=Item not applicable for those instances where no improvement was needed.


1. Satisfactory attendance. 2. Active participation. 3. Adequate completion of exercises. 4. Proper use of REBT in Crime Cycle. 5. *Decrease in scale scores on Jones Irrational Belief Test. Improvement shown by lowered scores on the following subscales: -Demand for Approval -High Self-Expectations -Blame Proneness -Frustration Reactive -Emotional Irresponsibility -Anxious Overconcem -Problem Avoidance -Dependency -Helplessness for Change -Perfectionism

6. Can identify and correct irrational beliefs. 7. *Less extreme score on Personal Reaction Inventory

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8. *Increased score on Interpersonal Tolerance measure. 9. *Less extreme score on Nowicld -Strickland Locus of Control. 10.*Lowered score on Fear of Negative Evaluation measure. 11.*Decrease in scale scores on Personal Data Form. hnprovement shown by lowered scores on the following subscales: -Acceptance -Frustration -Injustice -Achievement -Worth -Control -Certainty -Catastrophizing

Comments:

To be completed by REBT Module Facilitator:

Name:

Signature:

*Person responsible for Psychological Testing:

Name:

Signature:

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Participant: Participant's Unit:

FPS: Group #

*Person responsible for PsychologicalTesting:

Name:

Communications

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I Date of Scheduled Audit Actual Date of Audit (Week: ) (Week 21) Person Responsible for Audit: Module Facilitator/Psychologist I

NA = Item not applicable for those instances where no improvement was needed. DESIRED OUTCOME ACHIEVED IMPROVEMENT

(Yes/No/NA) NEEDED (yes/no) 1. Satisfactory attendance. 2. Active participation. 3. Demonstrates adequate verbal skills

including listening. 4. Demonstrates awareness of

paralinguistic skills. 5. Appropriate use of conflict resolution

skills. 6. *Decreased score on Social Avoidance

& Distress measure. 7. *Increased score on Social Skills

Survey. 8. *Less extreme scale scores on the Social Expression Scale. Improvement shown by less extreme scores on the following subscales: -Overassertive - Actual -Underassertive - Actual -Overassertive - Ideal -Underassertive - Ideal -Deviation - Actual -Deviation - Ideal 9.MCMI-II profile improved. I I Comments:

To be completed by Module Facilitator:

Name:


Autobiography

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Participant: FPS:

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Participant's Unit: Group #

Date of Scheduled Audit Actual Date of Audit (Week: ) (Week 3) Person Responsible for Audit: Module

Facilitator/Psychologist

NA = Item not applicable for those instances where no improvement was needed.

IDESIRED OUTCOME ACHIEVED I 11VIPROVEMENT (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory attendance. 2. Active participation. 3. Completes & presents

autobiography. 4. Connects thoughts, feelings &

behaviors to personal events. 5. Demonstrates recognition of

relationship between past & present functioning.

6. Demonstrates level of trust through disclosure of comparable personal history.

Comments:


Name:

Signature:

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WOMEN OVERCOMING VIOLENCE MAINTENANCE (WOVE)




NA - Item not applicable for those instances where no improvement was needed.

IDESIRED OUTCOME ACHIEVED I IMPROVEMENT I (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory attendance. 2. Satisfactory participation. 3. Comprehends subject material. 4. Completes pre and post-testing.

Comments:


Name: Signature:

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e Participant: Thinking Errors FPS:



Facilitator/Psychologist NA=Item not applicable for those instances where no improvement was needed.

IDESIRED OUTCOME ACHIEVED I IMPROVEMENT I (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory attendance. 2. Active participation. 3. Comprehends 5 basic thinking

errors and satellite errors. 4. Identifies which thinking

errors lead to criminal thinking.

5. Challenges, disputes & changes her thinking errors.

6. Applies knowledge of thinking errors to other modules.

7. *Decrease in score on Perceived Stress Scale.

8. *Increased score on Personal Distress measure.

Comments:

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To be completed by Module Facilitator Name:

Signature:

Person responsible for Psychological Testing: Name:

Signature:

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Intimacy and Relationships


I Date of Scheduled Audit Actual Date of Audit (Week: ) (Week 21) Person Responsible for Audit: Module Facilitator


IDESIRED OUTCOME ACHI EVED I IMPROVEMENT (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory attendance. 2. Active participation. 3. Decides to change her relationship style. 4. Comprehends how maintaining current relationship style affects relapse prevention techniques. Comments:


Name:

Signature: --

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Anger Management

Participant: Participant's Unit: Group #

Date of Scheduled Audit Actual Date of Audit (Week: ) I (Week 21) Person Responsible for Audit: Module Facilitator/ Psychologist I

NA,---Item not applicable for those instances where no improvement was needed.


1. Satisfactory attendance. 2. Active participation. 3. Demonstrates an understanding of the causes,

signs, and associated feelings of anger. 4. Comprehends relapse prevention techniques. 5. Practices appropriate anger management skills. 6. *Decrease in scale scores on the Buss-Durkee: Improvement shown by lowered scores on the following subscales: -Assault

-Indirect -Irritability -Negativism -Resentment -Suspicion -Verbal -Guilt 6. Lowered score on Acceptance of Interpersonal Violence measure. 7. *MCMI profile improved:. -Aggressive-sadistic -Anti-social -Passive-aggressive 8.*Decrease in score on Speilberger Self-Analysis (Trait Anger) measure. Comments:

*To be completed by Psychologist:

Name:

Signature:

Crime Cycle and Relapse Prevention 30

FPS:


Name:

Signature:

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Date of Scheduled Audit Actual Date of Audit (Week: I ) (Week 21) Person Responsible for Audit: Module Facilitator 1


IDESIRED OUTCOME ACHI EVED I IMPROVEMENT (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory attendance. 2. Active participation. 3. Understands crime cycle. 4. Understands feelings,

fantasies, and thinking errors are part of the crime cycle.

5. Comprehends effective internal and external deterrents.

6. Awareness of interventions & responsibility for crime cycle.

7. Understands crime cycle as a tool to assist in relapse prevention.

Comments:


Name:

Signature:

31 •

VICTIMIZATION, PERSONAL HEALING, AND EMPATHY AWARENESS

•

FPS: Participant's Unit: Group #


Facilitator/Psychologist NA=Item not applicable for those instances where no improvement was needed.

IDESIR_ED OUTCOME ACHIEVED I IMPROVEMENT (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory attendance. 2. Active participation. 3. Understands the meaning of empathy. 4. Demonstrates an awareness of the victim's feelings. 5. Demonstrates her awareness of empathy through role-play. 6. Develops an awareness of the impact violence has on its victims. 7. *Increase in Overall Interpersonal Reactivity Score: hnprovement shown by increased scores on all of the following subscales: -Perspective Taking

-Empathic Concern -Fantasy

Comments:

1

Participant:


Name:

Signature:


Name:

Signature:

32 •

REVIEW, EXAMINE, CHALLENGE, ASSESS AND PREPARE • (RECAP)


I Date of Scheduled Audit Actual Date of Audit (Week: ) I (Week 21) Person Responsible for Audit: Module Facilitator I


IDESIRED OUTCOME ACHIEVED I IMPROVEMENT (Yes/No/NA) I NEEDED (yes/no) ,

1. Satisfactory attendance. 2. Active participation. 3. Demonstrates an

understanding of presented concepts.

4. Understands her responsibility for requesting assistance if and when he needs it.

5. Comments:


Name:

Signature:

•

33 •

Participant: FPS:

PROGRAM PARTICIPANT/Therapist Review of Weekly Progress

•


Date of Scheduled Audit Actual Date of Audit (Week: ) I (Week 21) Person Responsible for Audit: Group Therapist I


IDESIRED OUTCOME ACHI EVED I IMPROVEMENT I (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory attendance. 2. Active participation. 3. Program participant provides

accurate and insightful reviews of their week.

4. Program participant responds to feedback in a progressively more accepting fashion.

5. Program participant provides accurate and insightful feedback to other program participants.

Comments:


Name:

Signature:

34 •

• Individual Care - Daily Logs


I Date of Scheduled Audit (Week 21)

Actual Date of Audit (Week: Person Responsible for Audit: Primary Team Member

•


iDESIRED OUTCOME ACHIEVED I Ilv1PRO'VEMENT (Yes/No/NA) NEEDED (yes/no)

1. Satisfactory completion. 2. Exhibits satisfactmy degree

of understanding and progress.

3. Understands present experience as it relates to past experience.

4. Participant rates their experience with the log as being useful.

Comments:

To be completed by Primary Team Member:

Name:

Signature:

35

VIII. PROGRAM COMPLETION

Upon completion of the program, the assessment protocol, and the final ITPFO Team Meeting Review the program participant is deemed as having completed the Program.

Program Completion Documentation

Final ITPFO Progress Summary.

The psychologist member of the ITPFO team in conjunction with the other ITPFO team staff completes a final Progress Summary which summarizes the program participant's participation in the program and diagnosis (see Appendix). Recommendations are specified for referral for future treatment, follow-up, and community planning.

Psychological Review.

This review must be completed at program end by members of the ITPFO Team Staff. In this review all the psychological and psychiatric tests that have been administered to each program participant are reviewed. Any changes that have taken place between the pre-program test results and the post-program results are discussed •

in terms of the program participant's success (or lack thereof) in the program. The results are summarized and placed on the program participant's clinical file.

ITPFO Team Final Review.

This review must be completed at program end by the members of the ITPFO team. For more details as to what this review contains, refer to Section VII - Contents of ITPF0 Team Review by Discipline.

36

•

Premature Termination

1. Program participant Voluntary Withdrawal:

The program participant can freely exercise her right to terminate her program participation at anytime throughout her stay. VVhen a program participant either passively withdraws from participation or informs ITPFO staff the program participant will be offered the opportunity to meet with staff and/or her therapy group to explore the decision to terminate. This approach is preferred as it is often possible to help resolve the issues which have led to the desire to terminate. For example, an individual program participant's internal anxiety may have been the reason for withdrawal and this can often be ameliorated by intervention by staff and/or peers.

Should the program participant withdraw from the program notification is given to the Program Participant's Sentence Management Team, and Chief, Correctional Programs,

2. Termination by ITPFO Team:

A program participant may be discharged from the program by the ITPFO Team Staff. This can arise when the ITPFOT evaluates the program participant's progress and decides that the program participant isn't having their treatment needs met by the •

program. Ongoing substance abuse, violent behaviour, or significant non-compliance are typical reasons for premature discharge.

A program participant may also be discharged from the program if he is in serious conflict or in breach of the "House Rules/Expectations" (see Appendix ) such as seriously breaching the confidentiality of another program participant. The program participant's group, under the direction of the therapist, may request the termination of a program participant's attendance if the program participant is found to be in breach.

As a routine, the ITPFO team will discuss the program participant with her group providing the program participant is willing. The group, with the program participant, will then explore any c,oncerns or feelings regarding the decision. The program participant will be encouraged to make her own assessment regarding progress or lack of progress with "FEEDBACK" from both fellow program participants and staff members.

37

IX. TREATMENT: COMPONENTS AND PROCESS

TREATMENT COMPONENTS

The components of the program are as follows:

1. Interpersonal Psychodynamic Group Psychotherapy (a) Group Therapy (b) Staff Debriefing Sessions

2. Didactic Modules (a) Rational Emotive Behavioural Therapy (REBT) (b) Anger Management (c) Communications (d) Autobiography (e)Review, Examine, Challenge and Prepare (RECAP) (f) Thinking Errors (g) Intimacy and Relationships (h) Crime Cycle and Relapse Prevention (i) Victimization, Personal Healing, and Empathy Awareness (j) Women Overcoming Violence Maintenance (WOVE)

gib 3. Interactive Group Evaluation/Management (a) Bi-monthly program participant Review Groups

4. Individual Care (a) Primary Team Member Counseling (b) Daily Logs

38 •

•

e

1. Interpersonal Psychodynamic Group

2. Didactic Modules

4. Individual Care TOTAL SPECIFIED PROGRAM TIME

= 114.0 Hours = 436.0 Hours

Treatment Content Overview

TREATMENT COMPONENT WEEKS HOURS PER TOTAL HOURS WEEK

1. Interpersonal Psychodynamic Group 2-10 5 hrs/wk 62.50

11-20 4 hrs/wk 50

2. Didactic Modules (a) REBT 3-15 2 hrs/wk 26

(b)Communications 3-11 3 hrs per day for 16 4 days & 1 day

4hrs

(c)Autobiography 1 2 hrs/wk 20 (d)WOVE 2-20 1.5 hr/wk 28.5 (e)Thinking Errors 3-11 .75 hrs/wk 6.75 (I) Intimacy & Relationships 12-20 .75 hrs/wk 6.75 (g)Anger Management 12-20 2 hr/wk 18 (h)Relapse Prevention 2 3 hr/wk 3

16-20 2 hrs/wk 10 (i)Crime Cycle 3-15 2 hrs/wk 26 (j)Victimization Awareness 16-20 2 hr/wk 10

(k)RECAP 2 -20 .75hrs/wk 13.50

3. Interactive Group Evaluation/ Management (a) Review Group 25

every 2nd 2.5 hrs/wk week

4. Individual Care (a)Primary Team Member Counseling 2-20 3 hrs/wk 57 (b)Daily Logs/Assigmnents 2-20 3 hrs/wk 57

Total Program Hours = 112.5 Hours

= 184.50 Hours

3. Interactive Group Evaluation/Management = 25.0 Hours

39 •

•

•

WEEKLY SCHEDULE

WEEK 1 MONDAY TUESDAY WED. THURS. FRIDAY

0830-0945 GROUP GROUP GROUP GROUP

0946-1000 BREAK BREAK BREAK BREAK

1000-1115 AB AB AB AB

1116-1314 LUNCH LUNCH LUNCH LUNCH LUNCH

1315-1400 AB AB AB AB AB

1401-1415 BREAK BREAK BREAK BREAK BREAK

1416-1515 AB AB AB AB AB




1000-1115 RECAP WOVE WOVE FLEX


1315-1400 MODULE MODULE REVIEW MODULE FLEX

PREVIEW PREVIEW GROUP - PREVIEW INTRO


1416-1515 CON.'T CON'T CON'T CON'T


0830-0945 TEAM 1 EAM TEAM TEAM TEAM MEETING MEETING MEETING MEETING MEETING

0946-1000 CON'T CON'T CON'T CON'T CON'T 40 •

•

•

1000-1115 CON'T CON'T CON'T CON'T CON'T


1315-1400 CON'T CON'T CON'T CON'T CON'T

1401-1415

1416-1515 CON. 'T CON'T CON'T CON'T

WEEK 4-11 MONDAY TUESDAY WED. THURS. FRIDAY



1000-1115 RECAP WOVE WOVE THINKR■IG ERRORS


1315-1400 REBT COMMUNIC GROUP CRIME FLEX ATION CYCLE

1401-1415 BREAK BREAK FLEX BREAK

1416-1515 CON'T CON'T CON'T CON'T


0830-0945 GROUP GROUP GROUP GROUP 0946-1000 BREAK BREAK BREAK BREAK

1000-1115 RECAP WOVE WOVE INTIMACY RELATION SHIPS


41 •

CRIME CYCLE

FL,EX GROUP ANGER MANAGE-MENT

BREAK FLEX BREAK

CON'T CON'T CONT

1315-1400

1401-1415

1416-1515

REBT

BREAK

CONT

•

•




1000-1115 RECAP WOVE WOVE THINKING ERRORS


1315-1400 VICTIMIZ COMMUNIC GROUP RELAPSE FLEX ATION ATION PREVENTI AWARE- ON NE S S

1401-1415 BREAK BREAK FLEX BREAK

1416-1515 CONT CONT CON'T CON'T

I. PSYCHOTHERAPY

Interpersonal Psychodynamic Group Psychotherapy

GOAL • To help the program participant improve their interpersonal relationships and

emotional regulation as they relate to ongoing and past experience.

OBJECTIVES

• The program participant will actively participate in the sharing of her experiences both past and present with the group.

• The program participant will actively support other group members and the sharing by other group members.

42 •

• The group will develop as an entity in and of itself which will foster cohesion of a prosocial purpose-namely as a venue for interpersonal growth.

OUTCOMES

1. Attendance of the sessions.

2. The program participant will be expected to be an active participant in sessions.

3. The program participant will share relevant ongoing and past experiences as assessed by both therapists.

4. The program participant will actively support other members by demonstrating the appropriate use of clarification, positive confrontation, and empathic listening as assessed by both therapists.

5. The group will demonstrate increasing responsibility for its functioning by becoming self-directing which will require less input from therapists. This will be assessed by both therapists.

6. The program participant will indicate improvements in general mood and emotion regulation. Improvement in these areas will be indicated by the following changes in scores on the program participant's post-treatment measures as compared to scores on the individual's pre-treatment measures:

(a) An improved profile on the MCMI-II. (b) An improved profile on the MMP I-11. (c) A decrease in scores on the Depression Proneness Scale.

N.B. The MMPI-II and the MCMI-11 are general functioning and personality inventories that are not specifically designed to measure progress in group psychotherapy. For more information on measures and the subscales of measures, please see the Assessment section of this manual.

The interpersonal Psychodynamic group is a free floating group where the two co-therapists are seen to steer rather than direct the group. There will be no fixed agenda and the group will deal with issues, both in the present and past. The main emphasis being on the "here and now". Program participants will be encouraged to explore their feelings within this setting through the "group process".

The therapist will use a combination of analytical and generic techniques, encouraging group cohesion and participation. During this group, the therapist will be aware of individual program participant's level of participation and will encourage each program participant, when appropriate, to share their feelings. This group will maintain a time frame, always starting and finishing on time.

43 •

•

•

This portion of the program is a form of intensive time-limited psychotherapy. One of the principles of such an approach is to maintain a clear focus on the interpersonal style of each member.

The psychotherapy groups address interpersonal and emotional functioning and complement the didactic and cognitive behaviour emphasis in the treatment modules. This is in keeping with the multi-modal orientation of the total treatment program, addressing all levels of the offenders psychological functioning which are antecedents to criminal behavior. Most specifically it is an acknowledgment in this program of the importance of addressing not only those aspects of an offenders functioning of which he is aware but also those aspects of which he is not. Furthermore, it is a recognition that the emotional environment of a interpersonal psychotherapy group can bring to the fore important aspects of an offender's functioning which can go unnoticed and undealt with in a more benign didactic setting.

The cohesion and feedback process developed in these psychotherapy groups promotes a systematic confrontation of defensive styles. The goal is towards achieving greater inner cohesion and more modulated emotional and behavioral functioning under times of interpersonal stress. A greater awareness of the emotional triggers to violent and self destructive offending behaviours often emerges in the course of these groups.

Therapists keep to a strict treatment frame in setting the basic context and norms for the group. Within this frame, program participants are free to express their thoughts and feelings and come to understand how there own inner lives interact with the lives of the individuals in the group. This learning is slow and gradual but the time limited nature of the program stimulates the group process along predictable stages towards its final termination.

This treatment requires formally trained group psychotherapists who understand the psychopathology of personality disordered female offenders. Ongoing clinical supervision is a necessity as this population of offenders is very difficult to treat and places strong emotional pressures on the therapist.

Staff Debriefing Sessions

GOAL • To promote better group therapy.

OBJECTIVES

• To allow therapists to explore each others' experience of the group therapy sessions within the theoretical framework of the treatment approach.

44 •

• • To facilitate planning for subsequent therapy sessions.

• To allow the debriefing of personal reactions to help understand counter-transference issues.

OUTCOMES

1. The therapists' attendance at debriefing.

2. Therapist ratings of the helpfulness of debriefing in terms of advancing the therapy process.

3. Therapist ratings of the utility of debriefing in terms of dealing with counter-transference.

4. Therapy supervisor's assessment of utility of debriefing sessions for the group therapy process as observed in the supervision sessions.

Time has been set aside both in the morning and afternoon for staff to debrief the psychotherapy and module groups. The importance of these sessions is strongly stressed. Debriefing time should be seen as part of the psychotherapy group. This debriefing is designed to ensure that the therapists maintain a clear understanding of the group as a whole along with how each individual is progressing in the group context. The debriefing process provides an opportunity to receive valuable feedback from peers and clinical supervisor.

During these sessions, staff should examine the group process, staff intervention and individual program participant progress. During the afternoon group debriefing, a certain amount of strategizing may also take place for the next concurrent session.

IL REBT AND DIDACTIC GROUPS

These groups are seen to be structured and therapists will assume a more "directive" role. Time keeping is again of importance and the therapist must encourage group participation. Care must be taken, on the part of the therapist, to resist resolving anxieties/conflicts from the morning sessions, unless it is considered that a potentially dangerous situation is present.

1. Communication Module Duration - nine (9) weeks # of 2 hr. sessions -9

2. Autobiography Module Duration - 1 week

45 •

• Sessions - include 4 days of a total of 3hrs per day and 1 day of a total of 4 hrs

3. Intimacy and Relationships Module Duration - nine (9) weeks # of 2 hr. sessions -9

4. Victimization, Personal Healing and Empathy Awareness Module Duration - five (5) weeks # of 2 hr. sessions - 5

5. Review, Examine, Challenge, Prepare and Prepare (RECAP) Module Duration - eighteen (18) weeks # of .75 hr. sessions - 18

6. Women Overcoming Violence Maintenance (WOVE) Session Duration - eighteen (18) weeks # of .75 hr. sessions -36

•

46 •

7. Thinking Errors Module Duration - nine (9) weeks # of .75 hr. sessions - 9

8. Anger Management Module Duration - nine (9) weeks # of 2 hr. sessions -9

9. R.E.B.T. Module Duration - thirteen (13) weeks # of 2 hr. sessions - 13

10. Crime Cycle and Relapse Prevention Module Duration - fourteen (18) weeks # of 2 hr. sessions - 18

Rational Emotive Behaviour Therapy (REBT)

GOAL:

• To teach the program participant how irrational thinking, false beliefs, and false values can lead to criminal thinking patterns; to teach him to recognize these, challenge and dispute them, and to replace them with more rational alternatives.

OBJECTIVES:

• To teach the program participant the connection between thinking, feeling, and acting out behavior.

• To make the program participant aware of how irrational thinking patterns, coupled with irrational beliefs, and false values can lead to criminal thinking patterns, and criminal behavior.

• To teach the program participant to recognize irrational thinking patterns, and beliefs, and false values or antisocial values.

• To teach the program participant to dispute irrational thinking patterns, beliefs, and criminal values, and replace them with more rational thinking patterns.

47 •

•

OUTCOMES:

1. Attendance of the sessions. 2. The program participant is expected to be an active participant in the module.

3. The program participant will have learned that thinking and feeling are connected to behavior by actively participating in the associated therapy exercises.

4. The program participant will demonstrate her awareness of how irrational thinking patterns, beliefs, and values can lead to criminal behavior by incorporating these elements into her understanding of her crime cycle.

5. The program participants will demonstrate how to dispute irrational thinking patterns, beliefs, and values and replace them with more rational alternatives by participating in the related exercises in the therapy sessions.

6. The program participant will be able to identify irrational thinking patterns, beliefs, and values. Improvement in these skills will be indicated by the following changes in scores on the individual's post-treatment measures as compared to scores on the individual's pre-treatment measures:

(a) A less extreme score on the Personal Reaction Inventory. (b) An increased score on the Tolerance scale. (c) A less extreme score on the Nowicki-Strickland Locus of Control test. (d) A decreased score on the Fear of Negative Evaluation scale. (e) A decreased score on the Personal Data Form. Ideally, the program participant will show score decreases on all subscales of this test. (f) A decreased score on the Jones Irrational Beliefs Test. Ideally, the program participant will show score decreases on all subscales of this test.

N.B. For more information on measures and on measure subscales, please see the Assessment section of this manual.

Rational Emotive Behavioural Therapy (REBT) is a philosophical, educational and therapeutic approach developed by psychologist Albert Ellis. REBT teaches people how to get along better with themselves and others by disciplining their thinking emotions and behaviours. "Rational" in REBT theory means that which helps people to achieve their basic goals and purposes and "irrational" means that which prevents them from achieving these goals and purposes. In the REBT module, the basics of emotional disturbance will be taught and then how to overcome one's own emotional disturbance. Readings will include:

1. The Unfair Advantage - Tom Miller, Ph.D. 2. Think Straight! Feel Great. - Bill Borcherdt 3. A New Guide to Rational Living - Albert Ellis

48 •

•

4. How to Stubbornly Refuse to Make Yourself Miserable About Anything, Yes Anything! - Albert Ellis

5. The Rational - Emotive Therapy Companion - R. Grieger & P. Woods

Various REBT audio and video tapes will be presented. Written and behavioral homework assignments will be required.

A REBT personality data form will be administered during the first session to assess which irrational ideas each participant endorses. At the end of the module, it will be re-administered to evaluate progress.

Communications

GOAL:

• To help the program participant develop and maintain effective communication skills, which will enhance interpersonal relations.

OBJECTIVES:

• To learn basic skills in communicating with others via self expression, self disclosure, and active listening.

• To increase self awareness of using body language, para-language, and metamessages.

• To increase/enhance skills in conflict situations by uncovering hidden agendas, clarifying language, and applying assertiveness skills.

OUTCOMES:


2. The program participant is expected to be an active participant in group sessions.

3. The program participant will disclose thoughts and feelings during therapeutic contact by demonstrating the specific skills (verbal and non-verbal) covered in the module. This will be assessed by program staff.

4. The program participant will be able to demonstrate active listening as assessed by program staff during her interactions with others in group.

49 •

5. The program participant will invite other program participants to examine her communication style and its consequences. The program participant's abilities to participate appropriately in receiving this confrontation and her ability to participate appropriately in the confrontation of others will be assessed by program staff.

6. The program participant will be able to identify appropriate and inappropriate ways to communicate across different situations. Improvement in these skills will be indicated by the following changes in scores on the individual's post-treatment measures as compared to scores on the individual's pre-treatment measures:

(a) A decreased score on the Social Avoidance and Distress scale. (b) An increased score on the Social Skills Survey.

N.B. For more information on measures and on the subscales of measures, please see the Assessment section of this manual.

Text/Workbook - Messages - You and Me

The Communication module is designed to assist the program participant in developing a better/more constructive cognitive understanding of communication. During sessions, the following topics will be discussed/explored:

- impact of communication on our lives

e _ communication rights - interpersonal style - components of interpersonal communication skills - communication "know-how" such as the following;

listening, fair fighting, expressing, negotiation, and body language making contact. hidden agenda confrontation,

Program participants will be assisted with the use of the book Messages - the communications skills book - by Matthew McKay, Martha Davis and Patrick Fanning.

50 •

0 Autobiography

GOAL:

• To increase self awareness of one's life experiences and to gain insights and an understanding of the impact of significant events on behavior.

• To promote the therapeutic process.

OBJECTIVES:

• To gain a better understanding of the impact of past events and experiences on ones behavior.

• Through learning about other program participants' life histories, the program participant will have diminished self-perceptions of uniqueness and isolation.

• By sharing her life history fully the program participant will better be able to establish trust and openness with the therapy group.

OUTCOMES:


II 2. The program participant is expected to be an active participant in the sessions.

3. Program participant will complete an oral autobiography as per instructions and present this autobiography to the program participant group.

4. The program participant will demonstrate her recognition of the relationship between her past and present functioning as assessed by the program therapists. This assessment will be based upon the observations of the program participant during the module and therapy components in terms of connecting her thoughts, feelings, and behaviours to significant personal events.

5. The program participant will demonstrate her level of trust in the group by frequently sharing comparable personal history in support of another program participant who is disclosing during the group.

6. The program participant will demonstrate her recognition of the relationship between past and present functioning as assessed by a 20 question test from the book Messages.

The autobiography module is a verbal account of the psychosocial development of the program participant (birth - present) covering the following areas: sexual history,

51 •

family dynamics, relationships with others, criminal history and the use of alcohol and drugs.

52

•

•

Review, Examine, Challenge, Assess and Prepare (RECAP)

GOAL:

To review the presented concepts from the previous weeks modules. The RECAP module will include group discussion, smaller group work, as well as written exercises and quizzes.

OBJECTIVES:

To assist in the clarification of Program concepts

To provide an opportunity to discuss Program concepts and utilize acquired interpersonal communication skills;

Resource material will include all presented program material to that point.

OUTCOMES

1. Attendance at all sessions.

2. An acceptable level of participation in sessions.

Women Overcoming Violence Maintenance (VVOVE)

Goals:

To gain further insight into the role that violence plays in our daily lives and to examine how aggression often becomes a common response to handling our daily frustration to daily life.

Objective:

1. To assist the program participant in developing interpersonal communication skills, and to develop strategies to break destructive cycles;

2. To provide an opportunity to discuss presented concepts;

Outcomes:

53 •

e 1. Attendance at all sessions;

2. An acceptable level of participation at all sessions:

3. Develop further coping skills and recognition of cycles patterns of behaviour that impact on their daily functioning;

4. Recognition that aggressive, violent acting-out is a learned behaviour and is not a pro-social problem solving technique or coping strategy;

Thinking Errors

GOAL:

• To teach the program participant to identify, dispute, and correct thinking errors and defense mechanisms that lead to antisocial behaviours.

OBJECTIVES:

• To identify how thoughts have and influence on behavior.

• To teach the program participant the five basic thinking errors and how to identify e them in themselves and others.

• To teach the program participant the five categories of thinking fallacies;

• To teach the program participant techniques to dispute thinking errors/fallacies.

• To encourage the program participant to replace thinking errors/fallacies with rational thinking to establish a new constructive system of thinking.

OUTCOMES:

1. Attendance at all sessions.

2. A satisfactory level of participation by the program participant is expected.

3. The program participant will be able to identify her most frequently used thinking errors leading to criminal thinking as assessed by the Module Facilitator.

4. The program participant will have learned disputing techniques and be able to effectively challenge, dispute and change her thinking errors as assessed by the Module Facilitator.

54 •

• 5. The program participant will be able to apply knowledge about thinking errors to crime cycle, REBT, and Relapse Prevention as assessed in those modules.

6. The program participant will be familiar with the five basic thinking errors and satellite concepts, five groups of thinking fallacies as assessed by the Module Facilitator.

7. Improvement in skills in this module will be indicated by the following changes in scores on the individual's post-treatment measures as compared to scores on the individual's pre-treatment measures:

(a) A decreased score on the Jones Irrational Belief Test. Ideally, the program participant will show decreased scores on all the subscales of this measure. (b) A decreased score on the Perceived Stress Scale. (c) An increased score on the Personal Distress subscale of the Interpersonal Reactivity Scale.

N.B. For more information on measures and on the subscales of measures, please see the Assessment section of this manual.

Text/Workbook - Freeman Longo Series; Yochelson/Samenow; The Criminal Personality

Cohen, Elliot D.: Caution: Faulty Thinking Can be Harmful To Your Happiness

The concept of "thinking errors and thinking fallacies" will be presented in a didactic fashion. The program participant will be given practice in identifying cognitive processes through the writing of thinking reports and how to identify the thinking errors, thinking fallacies in these reports. Finally, the program participant will learn to apply deterrents to her thinking which will refocus her attention and disrupt her pattern.

55 •

Intimacy and Relationships

GOAL:

• To learn healthy attitudes and values toward sexuality and relationships.

• To enhance program participant's awareness of human sexuality, develop and maintain healthy and intimate relationships with others.

OBJECTIVES:

• To make the program participant aware of how to establish, maintain, and end a relationship.

• To examine personal values and attitudes toward sex and relationships.

OUTCOMES:

1. Attendance of all sessions

2. The program participant will show acceptable levels of participation in the module sessions.

3. The program participant will review her relationship patterns, identify her relationship style and make appropriate choices to change her relationship style.

4. The program participant will examine how maintaining her present relationship style affects relapse prevention techniques.

N.B. For more information on measures and on the subscales of measures, please see the Assessment section in this manual.

Text/Workbook - Module Manual; Videos A number of different text books will be used in conjunction with sessions.

56

Anger Management

GOAL:

• The program participant will understand anger and be able to manage it without harmful actions to others through effective relapse prevention techniques thwarting acting out.

OBJECTIVES:

• To teach the program participant that the causes of anger are within herself.

• To help the program participant to become aware of the physical and emotional signs of anger.

• To teach the program participant effective anger control techniques to prevent him from acting out, and to prevent him from relapsing into her anger cycle.

• To adapt new skills in expression of anger in a responsible manner.

• To understand how our anger affects others.

e OUTCOMES: 1. The program participant will become familiar with the causes, signs, and

associated feelings of anger as demonstrated by her c,ompletion of a daily anger log. This will be assessed by staff in discussions with the program participant.

2. The program participant will have learned effective methods to prevent relapse by incorporating the appropriate information into the anger cycle.

3. The program participant will practice appropriate anger management skills in daily living as demonstrated in therapeutic contact. This will be assessed by program staff.

4. The program participant will be better able to self-manage her anger. Improvement in this area will be indicated by the following changes in scores on the individual's post-treatment measures as compared to scores on the individual's pre-treatment measures: (a) A decreased score on the Buss-Durkee Scale. Ideally, there should be a decrease in scores on all subscales. (b) A decreased score on the Spielberger Self-Analysis (Trait Anger) Scale. (c) An improved score on the aggressive-sadistic subscale of the MCMI-II. (d) An improved score on the antisocial subscale of the MCMI-II.

57 •

(e) An improved score on the passive-aggressive subscale of the MCMl-ll.

N.B. For more information on measures and their subscales, please see the Assessment section in this manual.

Sessions/Hours = 1 Hours per week Week # 16-30 Text/Workbook -

Novaco Anger Management Shifting Gears, Learning to Live Without Violence Understanding and Managing Your Anger and Aggression Dr. Weisinger's Anger Work Out Book

And other related text books

Anger is an universal human emotion, however, the program participant experiences anger with such frequency and intensity that it has serious repercussions for herself and others. Anger is a major component of many program pa rt icipant's acting-out behaviour.

The module will be set up in two sections. The first will be understanding anger and the second will be 'skill building'. There will be weekly exercises to encourage the program participant to use the material discussed to examine her own uses of anger and to practice skills to manage it more effectively.

Some of the main topics to be discussed in the module are as follows:

• What is Anger?

• Myths of Anger

• Costs of Anger - physiological and interpersonal

• Anger as a Defense

• Time out techniques

• Working out Past Anger

• The Effects of Self-Anger

• Productive Anger Style • Thoughts that Trigger Anger

58 •

• • Stress Management and Relaxation Response

• Problem Solving Techniques

• Anger as a Choice

• VVho's Responsible for Anger

Crime Cycle and Relapse Prevention

GOALS:

• To teach the program participant how criminal behaviours can be understood as a "crime cycle" that is composed of behavior chains involving feelings, fantasy, and thinking errors.

• To teach the program participant effective deterrents and intervention to prevent him from perpetuating the crime cycle and its associated antisocial behaviors.

OBJECTIVES:

• To teach the program participant the concept of the "crime cycle" and how feeling,

0 fantasy, and thinking errors are its integral parts.

• To teach the program participant effective deterrent, internal and external, and intervention techniques to interrupt the cycle.

• To make the program participant aware that he is responsible for her behavior and that the cycle can be effectively broken to help him maintain a prosocial life style.

• The program participant will write a comprehensive crime cycle and present it to the group for feedback.

• The program participant will make revisions of the crime cycle according to the feedback and give copies of it for the Sentence Management.

OUTCOMES:

1. Attendance at all session.

2. An acceptable level of participation in sessions.

59

3. The program participant will have gained an understanding of her crime cycle as

e assessed by the final written product.

4. The program participant will have gained the knowledge that feeling, fantasy, and thinking errors are important parts of the cycle as assessed by program staff.

5. The program participant will have learned effective internal and external deterrents as well as interventions to interrupt her cycle as assessed by program staff.

6. The program participant will be aware that he is responsible for her cycle and that he can break it with effective intervention, as assessed by program staff.

7. The program participant will demonstrate and understanding of how to apply crime cycle as a tool to assist in the Relapse Prevention Program as assessed by program staff.

Resources: VVhv Did I Do It Again? Freeman/Longo. Safer Society Series.

The module helps to develop skills to alter the program participant's responses to prevent the elevation of a negative cycle. Sections discussed include:

• the steps that most cycles have;

te

• incidents in the program participant's life and identification of her feelings and thoughts surrounding each incident;

• 6-8 stages in the program participant's cycle and identification of behaviours, thinking errors, thoughts, feelings and sexuality;

• the OK stage: feelings, thoughts, behaviours and plans of this stage are looked at;

• stop signs are identified which give the program participant clear indicators of being in an unhealthy state;

• the last step in completing the behaviour cycle, which is to identify the program participant's interventions and deterrents, including external and internal ones.

Each section will be discussed in group in order to help program participants identify areas which need to be improved. The workbook is used for reference.

Each program participant will be expected to share her own completed Crime Cycle, together with realistic deterrents, during this module.

60

•

Victimization, Personal Healing and Empathy Awareness Module

GOAL:

• To teach the program participant the impact of her actions on the victim, and to make him aware of the victim's feelings during the commission of her offense(s).

OBJECTIVES:

• To familiarize the program participant with the concept of empathy.

• To help the program participant identify how the lack of empathy can contribute to antisocial behavior.

• To develop awareness of the victim's experience.

• To understand the effect of one's offending against victims in terms of short and long term consequences to their lives.

OUTCOMES:

• 1. Attendance at all sessions

2. An acceptable level of participation is expected.

3. The program participant will be familiar with the definition of empathy as assessed by the Module Facilitator. This assessment will be based on the offender's verbalizing of her understanding of empathy in group following the didactic presentation.

4. The program participant will demonstrate her awareness of how her victim may have felt by writing a letter from her victim to herself. He presents this letter to the group for feed-back and support.

5. The program participant develops awareness of the impact violence has on victims and takes part in group discussions, video presentation and reads handouts.

6. The program participant develops awareness of the impact violence has on victims and takes part in group discussion, video presentation, and reads handouts.

7. Understanding of the concepts covered in this module will be assessed. Improvement in this area will be indic,ated by the following changes in scores on the

61 •

individual's post-treatment measures as compared to scores on the individual's pre-

• treatment measures: (a) An increased score on the Perspective Taking subscale of the Interpersonal Reactivity Scale. (b) An increased score on the Empathic Concern subscale of the Interpersonal Reactivity scale.

This module is based upon the observation that personality disordered offenders have difficulty appreciating the impact of their behaviour on others. The purpose of this module is to increase the program participant's awareness and understanding of victimology through the development of affect genuine empathy. Techniques include group discussion (disclosure) regarding individual offenses, role playing, and various reading assignments (including discussion of recent media-reported current events, with emphasis upon victimology).

This module, because of the high levels of emotion , and possible problems of 'acting out' must be managed by treatment staff, that are trained and comfortable to lead such a group.

Flex-Time/Specialty Modules and Module Adjustments

Time has been set aside to allow flexibility if a special group or make-up modules are require.

Program participants may have additional homework which may be completed during flex-time where necessary. The Program Director in consultation with ITPFO staff will be responsible for the coordination of flex-time.

•

62 •

III. INTERACTIVE GROUPS: EVALUATION AND MANAGEMENT

Program participant Review of Bi-Monthly Progress

GOAL

• To promote increased treatment efficacy by keeping program participants aware of recent therapy experiences of self and others.

OBJECTIVES

• To have each program participant reflect upon their performance during the previous week of treatment.

• To provide each program participant the opportunity to receive feedback from fellow program participants regarding their performance.

+ To provide each program participant the opportunity to provide feedback to other program participants.

OUTCOMES

• 1. Attendance at all sessions.

2. An acceptable level of participation.

3. The program participant will provide more accurate and insightful reviews of their week as rated by the therapists.

4. The program participant will respond to the feedback received from others in a progressively more accepting fashion as assessed by the therapists.

5. The program participant will provide more accurate and insightful feedback to other program participants as rated by the therapists.

This session is spent reviewing the previous two week's progress, or lack of progress, in the program. Each program participant within the group is asked to individually examine their own two weeks and review what they have or have not learned. What they have or have not gained and what they would like to work on during the following two weeks. Following the individual's review, the remainder of the group will be encouraged to give feedback to the individual regarding her review, progress or lack of progress. During this group, two way dialogue is not permitted and each program participant should be encouraged to process "feedback" over the weekend

63 •

•

and, if necessary, share any concerns/feelings or issues during the following week, in her psychotherapy session. This group should be facilitated by the program participant with program participant's being responsible for time keeping individual reviews, encouraging feedback and giving same in addition to the start and closure of the group. Staff members may give feedback, if necessary, but should, as much as possible, assume an inactive role.

IV. INDIVIDUAL CARE:

Daily Logs

GOAL

• To increase the accurate expression of self.

OBJECTIVES

• To promote a more complete understanding of the process the individual goes through in dealing with her issue or any issue.

• To have the program participant be able to review past situations and learn from past experience how to handle present situations.

• To help the program participant experience their own growth process after re-reading their past experiences.

• To have the program participant recognize the role that fantasy plays in their personal functioning, cycle of behaviour and crime cycle;

OUTCOMES

1. The program participant will complete the daily log on a regular basis.

2. The primary team member will rate the degree of understanding the program participant exhibits in the log and record their progress throughout the program.

3. The primary team member will rate the degree of insight the program participant demonstrates in regards to their understanding of present experience as it relates to past experience as documented in the log.

4. The program participant will rate their own experience with the log as to its utility in documenting growth and change.

64 •

• The daily log is a daily description of thoughts, feelings and fantasy. It is a tool designed to help understand daily life patterns. They are written on a daily basis by the program participant and are shared with the Primary Team Member.

Fantasy material is dealt with primarily in the psycho-dynamic component of the program whereby violent, non-violent, sexual and non-sexual fantasies are reviewed in order to identify reinforcing and extinguishing behaviours and strategies.

TREATMENT PROCESS

The process of treating program participants is facilitated by various ongoing review procedures.

Review Meetings

Members of the ITPFO meet weekly to discuss program participant difficulties as identified by the daily monitoring of program participants. This gives an opportunity for team members to identify problems that program participants may be having both within and outside of the program context, as well as to bring staff up to date on each individual program participant. Being aware of such issues may assist team members in their interactions with particular program participants and therefore facilitate the

1111 treatment process (see also Section VII, Assessment and Care Planning).

ITPFO Steering Committee

The ITPFO Steering Committee is chaired by the Program Director and is made up of the members of the ITPFO Team. The committee meets weekly to discuss ongoing program issues and to address any difficulties that are affecting the program. These include questions related to delivery or module content; staff issues; program participant issues; program completion and referral screening. The aim is to facilitate the smooth operation of the program and to ensure that issues are dealt with on an ongoing basis. Any difficulties that cannot be resolved within this context, but are not urgent in nature, are brought to the annual Program Retreat. Emergency Steering Committees and Program Retreats may also be held when necessary to deal with substantive emergency issues.

65 •

X. PROGRAM EVALUATION AND DEVELOPMENT

Ongoing evaluation of the program is necessary in order to provide the most effective service possible. Program evaluation is much more than assessing whether, or not, a program works (i.e. Treatment Outcome). It is necessary to also establish a framework to help evaluate other central issues. For example, even a successful program may be improved. Additionally, the components of a program may not actually be responsible for any observed treatment gains.

There are several aspects of a program which may be implemented in order to conduct a "Program Evaluation."

1) Program Retreat 2) Treatment Component Outcome Evaluation 3) Updated Literature Review 4) Resource Analysis 5) Treatment Component Delivery Evaluation 6) Discharge Analysis 7) Documentation Analysis 8) Implementation of Change 9) Long-term Treatment Outcome Research

• PROGRAM RETREAT

Program retreats are held on an annual basis and provide staff with the opportunity to review the various components of the program and to provide direction for the remainder of the program. Any problems that may have arisen throughout the course of the program are brought to the retreat for discussion. Retreat participants will also determine whether the problem has been satisfactorily resolved or if further action is needed. In addition to reviewing the specific components of the program, the retreat allows staff to voice any concerns they may have. Lastly, it has been proposed that Emergency Retreats be held when substantive problems occur that require the immediate attention of ITPFO team members.

TREATMENT COMPONENT OUTCOME EVALUATION

In order to evaluate the efficacy of such a program, it is necessary to measure degrees or amounts of change in the people involved in treatment. This is a difficult task and while every effort is made to provide specific measurable data, we must also rely heavily on subjective data, i.e. the member's opinion of changes made as a result of the program and also the therapists' evaluation and impressions.

66 •

es no Y 1 2 3 4

• Various tables have been constructed for each component or module in order to determine which outcome variables are generally achieved, not achieved or found not applicable for each particular group (see below). For instance, one of the outcome objectives for the Interpersonal Group Psychotherapy component is a "decrease in score on the Depression Proneness measure." In cases where a program participant receives a low score on the Depression Proneness measure on both the pre-test and the post-test, the program participant has not achieved a true reduction in score. Thus, it would be appropriate to mark the item as "not applicable" in these instances. The group therapist for the component is also required to tabulate the specific number of program participants who have achieved each outcome objective.

The following tables are intended to be prototypes for forms that various members of the treatment team would be responsible for completing. The completed forms are intended for use in evaluation of each module in terms of program participant success within each of the modules.

Auditing Aid In order to clarify the use of the tables in this section, this diagram and the

accompanying explanation is provided. The diagram is not intended to be used as an auditing tool; it is simply an aid to understanding.

Goal achieved?

41111 Need Improvement? yes

no

Checking box 1 indicates that the set goal has been achieved, but that further improvement is still needed. For example, an inmate might have the goal of speaking up more in group. He may have managed to achieve this goal without becoming as participatory as staff would like. Therefore, the set goal has been met, but further improvement is still seen as desirable.

Checking box 2 indicates that the goal set for a particular issue has not been met and that improvement is needed.

Checking box 3 indicates that the goal has been met and that no improvements are necessary at this time.

Checking box 4 indicates that no goal had been set for a particular issue and that no improvement is needed. For example, an inmate who does not have a drug problem would not need to improve her score on the drug dependence subscale of the MCMI-II.

67

•

Unit: Group #: Date:

Interpersonal Group Psychotherapy

•

Date of Scheduled Audit Actual Date of Audit (Week: (Week 21) Person Responsible for Audit: Group

Therapist/Psychologist

NA = Item is not applicable in those instances where no imurovement was needed. COMPONENT OUTCOME Program articipant ID Total

Key:Y=achieved; N=not achieved; NA=not applicable

1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of 15

Interpersonal Group Psychotherapy 1. Satisfactory attendance. 2. Sharing relevant experiences. 3. Actively supporting others. 4. Cohesive group member. 5. *Overall improvement in

IVIMPI-II profile. 6. *Lowered score on

Depression Proneness measure.

To be completed by Group Therapist: *To be completed by Psychologist:

Name: Name:


6 8 •


Rational Emotive Behavioral Therapy

•


Person Responsible for Audit: REBT Module Facilitator /Psychologist

NA = Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Program participant ID Total I


1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 4 out 0 1 2 3 4 5 of15

REBT 1.Satisfactory attendance. 2.Active participation. 3.Proper use of REBT in Crime Cycle. 4. *Decrease in scale scores on Jones Irrational Belief Test. -Demand for Approval -High Self-Expectations -Blame Proneness -Frustration Reactive -Emotional Irresponsibility -Anxious Overconcern -Problem Avoidance -Dependency -Helplessness for Change -Perfectionism 5.Can identify and correct in-ational beliefs. 6. *Less extreme score on Personal Reaction Inventory.

6 9 •

7. *Increased score on Interpersonal Tolerance measure. 8. *Je ss extreme score on Nowicki-Strickland Locus of Control.

1 1 1 1 I

9.*Lowered score on Fear of Negative Evaluation measure. 10.*Decrease in scale scores on Personal Data Form. -Acceptance -Frustration

-Injustice

-Achievement -Worth

-Control -Certainty -Catastrophizing

•

To be completed by REBT Module Facilitator: *To be completed by Psychologist:

e Name: Name:


70 •


Communications


Facilitator/Psychologist NA --- Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Programicarticipant ID Total


1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of 15

Communications 1.Satisfactory attendance. 2.Adequate verbal & listening skills. 3.Awareness of paralinguistic skills. 4.Appropriate conflict resolution skills demonstrated. 5.*Decreased score on Social Avoidance & Distress measure. 6. *Increased score on Social Skills Survey. 7. *Less extreme scores on Social Expression Scale. -Overassertive - Actual -Underassertive - Actual -Overassertive - Ideal -Underassertive - Ideal -Deviation - Actual -Deviation - Ideal 8.*MCMI-II profile improved.

- To be completed by Module Facilitator:

Name:

Signature:


Name:

Signature: AUTOBIOGRAPHY

71 •

Group#: Unit: • Date:

•



NA = Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME ProgramTarticipant ID Total I

KerY=achieved; N=not achieved; NA=not applicable

1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of 15

Autobiography

1.Satisfactory attendance. 2.Completes & presents autobiography. 3.Connects thoughts, feelings & behaviors to personal events. 4.Demonstrates recognition of relationship between past & present functioning. 5.Demonstrates level of trust.


Name:

Signature:


Name:

Signature:

72 •


WOIVIEN OVERCOMING VIOLENCE MAINTENANCE (WOVE) MODULE

•



NA = Item is not applicable in those instances where no improvement was needed.

COMPOlVENT OUTCOME Program articipant 1D 1 Total 1


1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of 15

WOVE 1. Satisfactory attendance.

2. Satisfactory participation. 3. Comprehends subject material.

To be completed by Module Facilitator: Name: Signature:

73 •


Thinking Errors

•


Person Responsible for Audit: Module Facilitator/ Psychologist

NA = Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Program9articipant 11) Total

Key:Y=achieved; N=not achkved; NA=not applicable

1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of15

Thinking Errors _ 1. Satisfactory attendance. 2. Active participation. 3. Comprehends 5 basic thinldng

errors, satellite errors and thinking fallacies.

4. Identifies which thinldrig en-ors lead to criminal thinking,

5. Challenges, disputes & changes her thinking errors.

6. Applies knowledge of thinldng errors to other modules.

7. *Decrease in score on Perceived Stress Scale.

8. *Increased score on Personal Distress measure.

To be completed by Module Facilitator: Name: Signature:

*To be completed by Psychologist: Name: Signature:

Intimacy and Relationships Module 74 •

Unit: Group #: Date: •

•



NA = Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Program articipant ID Total l


1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 4 5 of15

Intimacy & Relationships 1.Satisfactory attendance. 2. Satisfactory participation. 3.Decides to change lier relationship style. 4.Comprehends how maintaining current relationship style affects relapse prevention techniques. 5. *Increased score on Sexual Knowledge Inventory.

6. *Decrease in scale scores on Sexual Attitude Smvey. , -Rape Myth Acceptance -Adversarial Sexual Beliefs


Name:

Signature:


Name:

Signature:

75 •

Anger Management Unit: Date: Group #: •

•

I Date of Scheduled Audit Actual Date of Audit (VVeek: ) (VVeek 21) Person Responsible for Audit: Module Facilitator/ Psychologist

NA = Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Program participant ID Total


1 2 3 45 6 7 8 9 1 11 1 11 # out 0 1 2 3 45 of15

Anger Management 1. Satisfactory attendance. 2. Active participation. 3. Demonstrates an understanding

of the causes, signs, and associated feelings of anger.

4. Comprehends relapse prevention techniques.

5. Practices appropriate anger management skills.

6. *Decrease in scale scores on the Buss-Durkee: -Assault

-Indirect -Irritability -Negativism -Resentment -Suspicion -Verbal -Guilt 7. *Lowered score on Acceptance of Interpersonal Violence measure. 8. *MCMI-11 profile improved. 9. *Decrease in score on Speilberger Self-Analysis (Trait Anger) measure.

To be completed by Module Facilitator: *To be completed by Psychologist:

Name: Name:


76 •


• Crime Cycle and Relapse Prevention

•

Date AuditAudit pAecrtsuoanl DR ae tsep oonf sAi bui de i tfo(rWAeue Audit: Module) Facilitator I

I

NA=Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Program participant ID Total


1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of15

Crime Cycle and Relapse Prevention 1. Satisfactory attendance. 2. Active participation. 3. Understands crime cycle. 4. Understands feeling, fantasy,

and thinlçing errors are part of the crime cycle.

5. Comprehends effective internal and external deterrents.

6. Awareness of interventions & responsibility for crime cycle.

7. Understands crime cycle as a tool to assist in relapse prevention.


Name:

Signature:

77 •


VICTIMIZATION, PERSONAL HEALING AND EMPATHY • AWARENESS MODULE

•

Date of Scheduled Audit Actual Date of Audit (Week: _ ) (Week 21) Person Responsible for Audit: Group

Therapist/Psychologist

NA=Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Programyarticipant 11) Total


1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of 15

Victimization Awareness Module

1. Satisfactory attendance.

2. Active participation. 3. Understands the meaning of empathy. 4. Demonstrates an awareness of the victim's feelings. - 5. Demonstrates her awareness of empathy through role-play. 6. Develops an awareness of the impact violence has on its victims. 7. *Increase in Overall Interpersonal Reactivity Score: -Perspective Talçing

-Empathic Concern

-Fantasy


Name:

Signature:


Name:

Signature:

7 8 •


• Review, Examine, Challenge, Assess and Prepare (RECAP)

•

Date of Scheduled Audit Actual Date of Audit (Week: I ) I (Week 21) Person Responsible for Audit: Module Facilitator I

NA=Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Programyarticipant lD Total

Key:Y=achkved; N=not achieved; NA=not applicable

1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of15

RECAP 1. Satisfactory attendance. 2. Active participation.

3. Demonstrates an awareness of presented concepts as demonstrated during the program and daily living.

4. Understands her responsibility for requesting help if and when he needs it


Name:

Signature:

79 •


• Program Participant/Therapist Review of Bi-Monthly Progress

•

I Date of Scheduled Audit Actual Date of Audit (Week: ) I (Week 21) Person Responsible for Audit: Group Therapist

NA=Item is not applicable in those instances where no improvement was needed. COMPONENT OUTCOME Program participant ID Total

_ Key:Y=achieved; N=not achieved;

NA=not applicable 1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out

1 2 3 4 5 of15 Program participant/Therapist Review of Weekly Progress 1. Satisfactory attendance. 2. Active participation. 3. Program participant provides

accurate and insightful reviews of their week.

4. Program participant responds to feedback in a progressively more accepting fashion.

5. Program participant provides accurate and insightful feedback to other program participants.


Name:

Signature:

80 •


• Individual Care - Daily Logs

•

Dateeekof2S1c)heduled Audit pAecrtusoanl DRaetsepoonfsAibuideitfo(Wr Aenedki:t: prim ) Team Members I

I

NA=Item is not applicable in those instances where no imnrovement was needed. COMPONENT OUTCOME Program participant ID Total


1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 # out 0 1 2 3 4 5 of15

Individual Care - Daily Logs 1. Satisfactory completion. 2. Exhibits satisfactory degree of

understanding and progress. 3. Understands present

experience as it relates to past experience.

4. Program participant rates their experience with the daily log as being usefid.

To be completed by Primary Team Member:

Name:

Signature:

81 •

UPDATED LITERATURE REVIEW

Researchers within the social science field are continually conducting studies and producing research papers on the treatment of borderline and/or anti-social, personality disordered female offenders within a correctional setting. Therefore, in order to keep abreast of the changes and developments in the treatment of criminal conduct, Program Directors are expected to review the psychological, psychiatric and criminological literature on a regular basis. Appropriate articles should be read as they are published.

Other methods of keeping up to date with current research include close liaison with researchers in the field. Two such local research organizations are the Institute of Mental Health, Law and Policy at Simon Fraser University, and the B.C. Institute of Family Violence. Attendance at relevant local, national, and international conferences is also expected. If the Program Director is not able to attend, other staff members may be assigned as necessary.

RESOURCE ANALYSIS

Another step involved in Program Evaluation and Development is the periodic analysis of resources, which essentially refers to the Psychologists and Group Therapists who are directly involved with the delivery of modules or components. The

II> Program Director is expected to complete the table below according to the following staff requirements of: training, experience, supervision, and staff turnover. The actual outcome for each variable is determined and subsequently assessed. If the actual outcome is deemed unsatisfactory, it will be targeted for change. Lastly, it is important to note that identifying an area for change does not necessarily indicate that staff members are not performing as they should. For instance, ongoing training is generally desirable and may not imply that a staff member is deficient in some area.

•

82

•

Audit of Staffing

Date of scheduled audit: Actual audit date: Program: Person responsible for audit: Program Director

Staff Requirements Actual Outcome (yes/no) Targeted for change (yes/no)

Adequately trained? Acceptable level of

experience? Supervisory participation?

Availability of supervision?

Staff turnover?

Signature: :

Date: (d/m/y):

•

83 •

Another essential component of the modules is the staff debriefing sessions. e Once again, the Program Director will complete this form through consultation with each of the appropriate ITPFO staff members.

Staff Debriefing Sessions

Date of Scheduled Audit Actual Date of Audit (Week: ) 1 (Week 21) Person Responsible for Audit: Program Director I Outcomes:

(1) Satisfactory attendance. (2) Active participation. (3) Therapist found debriefing helpfiil in terms of advancing the therapy process. (4) Therapist found debriefing useful in terms of dealing with countertransference.

ITPFO Staff by Outcomes Improvement Comments Treatment Component Achieved Needed

(Yes/No) (Yes/Igo)

1234

Psychotherapy Group: 1. 2.

REBT Group: 1. 2.

Communications: 1.

2.

Autobiography: 1.

2.

WOVE: 1.

2.

Thinking Errors: 1.

2

Intimacy & Relationships: 1.

2.

Anger Management:

84

•

•

1.

2.

Victimization Awareness Module: 1. 2.

RECAP 1 , 2.

•

To be completed by Program Director:

Name:

Signature:

•

85 •

•

•

TREATMENT COMPONENT DELIVERY EVALUATION

In addition to monitoring the outcome objectives of the component, it is necessary to evaluate whether the program is being delivered in the manner in which it was intended. One week following the end of a component, group therapists are expected to assess component delivery according to the following criteria: number of cancellations, number of flextimes, program delivered in full, adequate resources, completion of treatment evaluation tables. Also, group therapists are required to tabulate the actual outcome data for each objective, and to determine whether the objective should be targeted for change. Problems inevitably arise throughout the course of a program, so this method allows problems to be readily identified and subsequently addressed.

Date of scheduled Actual audit date: week audit: week 22 Group number:

Person responsible for audit: Group therapist Module: Actual Outcome Targeted for change (yes/no)

Psychodynamic group # of cancellations

# of flextime's delivered in full?

adequately resourced? TX evaluation tables

completed?

Signature:

Date (d/m/y):

86

•

•

•


Person responsible for audit: Group therapist Module: REBT Actual Outcome Targeted for change (yes/no) # of cancellations



completed?

Signature:

Date (d/m/y):


Person responsible for audit: Module Facilitator Module: Actual Outcome Targeted for change (yes/no)

Communications # of cancellations



completed?

Signature:

Date (d/m/y):

87 •

•

•


Person responsible for audit: Module Facilitator Module: Actual Outcome Targeted for change (yes/no)

Autobiography # of cancellations



completed?

Signature:

Date (d/in/y):


Person responsible for audit: Module Facilitator Module: WOVE Actual Outcome Targeted for change (yes/no) # of cancellations



completed?

Signature:

Date (d/m/y):

88 •

•

•


Person responsible for audit: Module Facilitator Module: Thinking Actual Outcome Targeted for change (yes/no)

Errors # of cancellations



completed?

Signature: :

Date: (d/m/y):


Person responsible for audit: Module Facilitator Module: Relationships Actual Outcome Targeted for change (yes/no)

# of cancellations # of flextime's

delivered in full? adequately resourced? TX evaluation tables

completed?

Signature: :

Date: (d/m/y):

89 •

•

•


Person responsible for audit: Module Facilitator Module: Anger Actual Outcome Targeted for change (yes/no)



completed?

Signature: :

Date: (d/m/y):


Person responsible for audit: Module Facilitator Module: Relapse Actual Outcome Targeted for change (yes/no)

prevention # of cancellations



completed?

Signature: :

Date: (d/m/y):

90 •

•

•


Person responsible for audit: Module Facilitator Module: Crime Cycle Actual Outcome Targeted for change (yes/no)



completed?

Signature: :

Date: (d/m/y):


Person responsible for audit: Module Facilitator Module: Empathy Actual Outcome Targeted for change (yes/no) # of cancellations



completed?

Signature: :

Date: (d/m/y):

91 •

• Date of scheduled Actual audit date: week audit: week 22 Group number:

Person responsible for audit: Module Facilitator Module: RECAP Actual Outcome Targeted for change (yes/no) # of cancellations



completed?

Signature: :

Date: (d/m/y):

•

92 •

• DISCHARGE ANALYSIS

The Discharge Analysis is comprised of four parts: an audit of program completers versus noncompleters, an audit summary of discharges, the reasons for voluntary premature discharge, and reasons for involuntary premature discharge. The following forms have been designed to capture data on the aforementioned categories and are briefly described below.

Discharge analysis form

One measure of the success of a program is the percentage of completers versus noncompleters. This is because the most desirable outcome in terms of the best use of available resources would be that all participants complete the program. This information can therefore be of assistance in reviewing selection procedures through the analysis of the characteristics of those who do not complete the program.

It is also important to know the reasons for noncompletion of the program. It is possible that those who drop out of the program due to emotional difficulty with program content are qualitatively different from those who are asked to leave because of their disruptive behaviour. Identifying what kinds of premature withdrawals are most frequent may help to identify areas for change in treatment content and delivery. •

93

•

•

•

The following table is designed as a prototype form to be used by program directors in collecting data on this measure of treatment success.

Ongoing scheduled audit Person Responsible: Program Director date: week 22 of each group

Group data Cumulative data Group completer involuntary voluntary total program total voluntary total

# s discharges discharges completions withdrawals involuntary withdrawals

n % n n % n % n % n % 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 .

Totals to date

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•

Audit Summary of Discharges. This table is designed to assess the rate of completions in the program. For those who did not complete, it is important to know if the decision was arrived at by the program participant or by the treatment team. Notably, the assessment of this variable may assist in program participant selection for program participation.

AUDIT SUMMARY OF DISCHARGES

Date of Actual audit date (VVeek: ) scheduled audit: Group number: (week 22 ) Person responsible for audit: Program Director

Performance Indicator Outcome (n)

Program Completion Program Withdrawal

Voluntary Involuntary

Total

Signature:

Date (d/m/y):

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Audit of Reasons for Voluntary Premature Discharge. Analyzing what kinds of reasons e that program participants give for choosing to discontinue may help to pinpoint areas for change both in selection procedures and in various aspects of the program itself. For example, if program participants are deciding that they do not wish to forego their release eligibility for the duration of the program, it may be necessary to consider changes to various aspects of that criteria of the program.

A. VOLUNTARY PREMATURE WITHDRAWALS Date of Ongoing/final review week 22 scheduled audit: Group number: 1 week post- Person responsible for audit: Program Director discharge

Reasons (please tick as many as apply) Program Emotional Incom- Release Disinterest Other

participant issues patibles (please specify) FPS

Signature: :

Date: (d/im/y):

•

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Audit of Reasons for Involuntary Premature Discharge. Another important aspect of

• premature withdrawal from the program is the discharges that are decided upon by the treatment team. Such information may be useful in the selection process or in future decision-making about premature discharge decisions.

B. INVOLUNTARY WITHDRAWALS

Date of Actual audit date (VVeek: ) scheduled audit: Group number: (week 22) Person responsible for audit: Program Director

Reasons (please tick as many as apply) Program Significant Lack of Security Other

participant noncompliance participation D/A=drugs/alcohol (please FPS with group V=violence specify)

norms M=management problem

Signature: :

Date: (d/m/y):

•

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•

e

(7) DOCUMENTATION ANALYSIS

The following audits are to provide a check that ongoing critical documentation is being maintained. The audits are conducted at three intervals as per the documentation produced at pre-program and post-program. The Program Director randomly selects three program participants from each group, and these same program participants are to be audited at three points in time.

Pre-Program Assessments

Date of Scheduled Audit: Actual audit date: (Week 6) Program #:

Person responsible for audit: Document Program Program Program Action

participant participant participant Taken #1 #2 #3 Yes/No FPS FPS FPS

Adequate Documentation Yes/No Letter of Acceptance to Program Consent for Treatment Clinical Profile Complete Pre-testing Package administered ITPFOT Review

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Date of Scheduled Audit: (Week 11)

Actual audit date: Program #:

I Person responsible for audit:

Actual audit date: Program #: Person responsible for audit:

Date of Scheduled Audit: (Week 21)

•

•

Mid-Program Assessments

Document Program Program Program Action participant participant participant Taken #1 #2 #3 Yes/N

o

Adequate Documentation Yes/No Progress Notes

Post-Program Assessments

Document Program Program Program Action participant participant participant Taken #1 #2 #3 Yes/No

Adequate Documentation Yes/No Psychological Treatment Review Program Completion Progress Summary

Complete Post-testing Package administered.

Actuarial Risk Assessment (PCL-R)

ITPFOT Final Review

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•

• IMPLEMENTATION OF CHANGE

The various audits contained within this section ask Group Therapists, Program Directors, Psychologists, etc. to determine which outcome variables should be targeted for change in the future. With the completion of several audits over time, staff will be able to consolidate the results and will subsequently be able to identify any weaknesses of the specific components, modules or staff sessions. After identifying problematic areas, the members of the ITPFO will bring these concerns to the Program Retreat in order to address these issues and propose alternative solutions. Programs do not exist within a vacuum, rather they must continually be reviewed, evaluated and changed in order to incorporate advances made in relevant psychological and criminological research, as well as adapting to the dynamic nature of the inmate population.

XI. APPENDICES

100 •

•

•

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• BCCW Intensive Treatment Program For Female Offenders

(ITPFO

INFORMED CONSENT

, understand that I am being given an opportunity to participate in the Intensive Treatment Program For Female Offenders. The purpose of this program is:

To provide an environment conducive to the prevention of aggressive and violent behaviours.

To provide "self-help" skills in the recognition of aggressive, anti-social and self-destructive patterns of behaviours.

To promote insight and understanding of aggressive, violent ,and self-destructive behaviours.

To promote the use of "self-help" skills to prevent such egocentric, narcissistic, aggressive, violent behaviours becoming abusive to society, others or self.

To provide orientation to those clients/offenders who may require a longer term treatment program.

I understand that the evaluation process will include screening interviews and pre and post psychological testing and the information, data could be used for research, statistical purposes. Any information gathered would be used anonymously.

I understand that the treatment consists of a block of sessions based on Rational Emotive Behavioural Therapy and a number of other cognitive/didactic therapies. These sessions are supported by an ongoing- nondirective group psychotherapy component.

I am aware that the BCCW Intensive Treatment Program For Female Offenders staff includes a clinician/psychotherapist and co -therapist. In addition, I also recognize that other clinical, professional personnel may also be in attendance as deemed necessary.

I am aware that the program is approximately 20 weeks long and is offered from approximately 0830 to 1515 four (4) days a week. I also understand that Wednesdays have been set aside for me to do program homework, and that additional homework assignments may have to be completed outside these hours.

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I am aware that this program is considered an institutional work placement and as such

11, is subject to the rules and regulations governing work placements.

I understand that the fi nal Clinical Review Report will include the interpretation of the Pre/Post Psychometric testing battery.

Signed witnessed by

date date

•

HOUSE RULES/EXPECTATIONS

• To follow all rules/regulations of BCCW Institution.

103 •

• • To follow all aspects of the BCCW Intensive Treatment Program.

• No breach of confidentiality.

• No continual abuse of therapy (i.e. continual lack of cooperation with program, other program participants, or staff.

• That one-to-one discussions with other program participants or staff are brought back to group.

• Institutional dress code should be adhered to at all times.

• All furniture is to be respected, treated properly and kept in good repair.

• Program participants are expected to advise ITPFO staff of anticipated absences from Program and the reasons for said absences

Serious disorderly conduct may result in suspension or withdrawal from the Program or other disciplinary measures.

•

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Parenting

Goal:

To leam positive parenting behaviours. To leam how to cope with the challenges of parenting from within the institution and in the community. To expose the participant to the available resources provided by the community and the institution.

Objectives:

To teach the program participant effective parenting behaviours.

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