Getting it Right the First Time: Applying Research to Reduce Recidivism Presentation by: Karen...

Getting it Right the First Time:

Applying Research to Reduce Recidivism

Presentation by:Karen McGovern, RN, BScN, LLB

Manager, Hearings ProgramCollege of Nurses of Ontario

This session will:

• Explore issues of recidivism in regulatory discipline based on a retrospective study of CNO Discipline cases completed in the last five years;

• Consider study findings in the context of current research regarding criminal recidivism;

• Identify possible future directions for regulators

College of Nurses of Ontario

Retrospective Audit of Discipline Cases from 1998 - 2003

The Complaints ProcessInvestigations & Hearings

Department receives letter of complaint

Member notified of complaint

Complaint investigated

Member responds to complaint

Case report forwarded to Complaint Committee

Complaints Committee makes a decision about the complaint

Option:Case referred to

Discipline Committee

Option:Case referred toExecutive Committee forpurposes of incapacity

Option: Committee may:Take no actionRemind memberGive advice to memberIssue written cautionIssue oral cautionRefer to Quality AssuranceFrivolous and Vexatious

Complainant and member can requestreview by Health Professions Board

For the purposes of the audit:

• A recidivist is a licensee/member who has a prior Discipline finding

• Does not include prior complaints or reports where no action was taken or where screening committee took remedial approach (e.g. letter of caution, reminder)

Summary of Recidivism in Relation to Disciplined Members

Year

Total cases with

discipline outcomes

Number with prior

discipline action

Recidivism Rate

1998 20 1 5%

1999 26 1 4%

2000 42 2 5%

2001 34 2 6%

2002 40 2 5%

Total 162 8 Average= 5%

Findings – Rate of Recidivism

• Eight cases out of a total of 162 cases = 5%

• Criminal recidivism rate:

- in U.S. = 39-53%

- in Canada = 16.1%

Recidivism – Disciplined Members with Prior Discipline Action

Case Reference

Date Disposition Nature of Conduct

Case A 28/10/02 Suspension/reprimand Failing to comply with discipline order

10/11/98 Suspension/condition/reprimand

Falsifying a record


Verbal abuse

01/01/80 Revoke (member reinstated 26/01/81)

Poor interpersonal communication

Case B 12/06/02 Suspension/condition/reprimand

Misappropriating property


Collecting pay under false pretences


Case Reference


Case C 01/11/01 Revocation Failure to comply with discipline order


Failure to comply with College undertaking/providing false info to employer/public/colleagues

19/03/98 Letter of concern and Meeting with Member

Poor interpersonal communication/administered unauthorized treatments

25/03/97 Undertaking signed Mental health issues

Case D22/08/01

Suspension/conditionreprimand

Verbal & emotional abuse

23/01/91 Withdrawn No info on file

01/05/78 Revocation Reinstated 18/12/81


Case Reference


Case E 22/02/00 Suspension/condition/reprimand Theft of medications

11/09/90 Suspension/condition/reprimand Conviction for theft under $1000

22/03/82 Letter of caution Theft

Case F 21/11/00 Reprimand Breach of confidentiality

17/09/90 Condition/reprimand Unsatisfactory nursing practice

Case G 03/11/99 Suspension/condition/reprimand Boundary violation

03/04/98 Suspension/condition/reprimand Conflict of interest

20/09/88 Take no action Unsatisfactory nursing practice

Case H 20/05/98 Suspension/condition/reprimand Provided false information to employer/public/colleague

11/09/95 Suspension/condition/reprimand Verbal abuse

14/04/83 Reprimand Conviction for shoplifting

Findings – nature of misconduct

• All recidivists were disciplined at some point for matters involving conduct / moral turpitude

• There were no recidivists who were disciplined for practise/standards issues alone

• In six of the eight cases, the licensee/member’s subsequent discipline finding was in relation to conduct, not practice

Findings –matters similar to previous discipline

• Half of cases involved matters similar in nature to the prior discipline.

• In these four cases, the subsequent discipline finding was in relation to conduct e.g. abusive behaviour, theft/fraud/governance issues

Trends

• Conduct / moral turpitude, not practice, is the basis for the majority of cases in which licensees/ members commit repeated misconduct.

• Recidivists have problems with acting morally and ethically, rather than problems in respect of their practice

Making the connection between

regulatory and criminal recidivism

• Moral turpitude basis for behaviour

• Similar aims and methods used in addressing conduct

• Sentencing principles of public protection; deterrence, specific and general; and rehabilitation

Criminal Recidivism Research

• Since mid-1970’s, trend away from rehabilitation and towards punishment as best method to reduce recidivism – “get tough on crime”

• Belief that harsher punishment will deter re-offending

Solicitor General, Canada (2002)

• Findings showed that harsher criminal justice sanctions had no deterrent effect on recidivism; in fact, punishment produced a 3% increase in recidivism. Consistent across gender, age and ethnicity

• Imprisonment v. community sanctions produced a higher recidivist rate.

• Longer jail sentences were associated with higher recidivism rates

Implications

• Policies to reduce recidivism based on “getting tough on crime” have no empirical basis

• Imprisonment and other criminal justice sanctions should be used for aims other than reducing re-offending

• Alternative approaches to punishment need to be explored and strengthened

Alternatives to punishment

• Community service

• Restitution

• Monitoring/supervising/mentoring

• Restorative justice options

Restorative justice

• Process whereby parties with a stake in a specific offence resolve collectively how to deal with the aftermath of the offence and its implications for the future

• Requires that offender admits responsibility for the offence and is based upon volunteer participation

Types

• Victim offender mediation

• Family or community group conferencing

• Peacemaking or Sentencing circles

Benefits

• Like Alternate Dispute Resolution, involves the victim and stakeholders in the outcome, increasing satisfaction in the process

• Solicitor General study (1998) showed a reduction in recidivism when Restorative Justice was used compared to usual justice sanctions: 5.3% compared to 16.1%

Applications to the Regulatory Arena?

• Restitution

• Mediated resolutions after findings of misconduct are made

• Sentencing circles involving the client, employer, public, the regulator

Getting it Right the First Time: Applying Research to Reduce Recidivism Presentation by: Karen...

Documents

Transcript of Getting it Right the First Time: Applying Research to Reduce Recidivism Presentation by: Karen...