Texas Forensic Mental Health Conference Presenter: Dr. Salter Presentation: What Works #6

1. What Works?What Works?
Reducing Criminal OffendingReducing Criminal Offending

2. Reasons for IncarcerationReasons for Incarceration
PunishmentPunishment
Justice for VictimJustice for Victim
IncapacitationIncapacitation
Impact on Potential OffendersImpact on Potential Offenders
Reduction of RecidivismReduction of Recidivism

3. Impact of More Severe Sanctions onImpact of More Severe Sanctions on
RecidivismRecidivism
Incarceration vs. ProbationIncarceration vs. Probation
Intermediate Sanctions vs.Intermediate Sanctions vs.
Standard SupervisionStandard Supervision
(Smith, 2002)(Smith, 2002)

4. Characteristics of StudiesCharacteristics of Studies
117 Studies117 Studies
N = 442,471N = 442,471
(Smith, 2002)(Smith, 2002)

5. Impact of Incarceration onImpact of Incarceration on
RecidivismRecidivism
N = 268,806N = 268,806
68% American Studies68% American Studies
No Change in RecidivismNo Change in Recidivism
or Slight Increase in Recidivismor Slight Increase in Recidivism
(Smith, 2002)(Smith, 2002)

6. High Quality vs. Low Quality StudiesHigh Quality vs. Low Quality Studies
High QualityHigh Quality
 Random AssignmentRandom Assignment
 Comparison Group DesignsComparison Group Designs
AgeAge
Criminal HistoryCriminal History
Antisocial ValuesAntisocial Values
(Smith, 2002)(Smith, 2002)

7. Random Assignment StudiesRandom Assignment Studies
2 Studies2 Studies
Incarceration Vs CommunityIncarceration Vs Community
Slight increases in recidivismSlight increases in recidivism
(Smith, 2002)(Smith, 2002)

8. Intermediate SanctionsIntermediate Sanctions
Electronic MonitoringElectronic Monitoring
FinesFines
RestitutionRestitution
Intensive SurveillanceIntensive Surveillance
Scared StraightScared Straight
Drug TestingDrug Testing
Boot campBoot camp
(Smith, 2002)(Smith, 2002)

9. Intermediate Sanctions vs. StandardIntermediate Sanctions vs. Standard
SupervisionSupervision
N = 66,500N = 66,500
American Studies 80%American Studies 80%
Slight Decrease in RecidivismSlight Decrease in Recidivism
Or No DifferenceOr No Difference

10. Boot Camps Vs. RestitutionBoot Camps Vs. Restitution
Scared StraightScared Straight No ImpactNo Impact
Boot campsBoot camps No ImpactNo Impact
RestitutionRestitution 5% Decrease5% Decrease
(Latimer et al., 2001; MacKenzie et al., 2001)(Latimer et al., 2001; MacKenzie et al., 2001)

11. Same FindingsSame Findings
 Juveniles vs. AdultsJuveniles vs. Adults
 Men or Women (maybe)Men or Women (maybe)
 White or Minority Race (few studies)White or Minority Race (few studies)
 Low and High Risk OffendersLow and High Risk Offenders
(Smith, 2002)(Smith, 2002)

12. WomenWomen
More Severe PunishmentMore Severe Punishment
May Increase Recidivism in Women MoreMay Increase Recidivism in Women More
than Menthan Men
(Smith, 2002)(Smith, 2002)

13. ExceptionException
Intensive Supervision plus treatmentIntensive Supervision plus treatment
Slight decrease in recidivism (10%)Slight decrease in recidivism (10%)
(Smith, 2002)(Smith, 2002)

14. Incarceration: More or LessIncarceration: More or Less
N = 107,165N = 107,165
90% American Studies90% American Studies
Mean Time for More: 31 MonthsMean Time for More: 31 Months
Mean Time for Less: 13 MonthsMean Time for Less: 13 Months
Slight Increase in RecidivismSlight Increase in Recidivism
(Smith, 2002)(Smith, 2002)

15. Impact of Length of IncarcerationImpact of Length of Incarceration
Difference in TimeDifference in Time Mean Effect SizeMean Effect Size
Between More & LessBetween More & Less (Weighted for Sample(Weighted for Sample
GroupsGroups Size)Size)
1.1. < 6 Months< 6 Months -.01-.01
2.2. 7 to 12 Months7 to 12 Months -.02-.02
3.3. 13 to 24 Months13 to 24 Months .03.03
4.4. > 24 Months> 24 Months .06.06
(Smith, 2002)(Smith, 2002)

16. Impact of Treatment Vs. SanctionsImpact of Treatment Vs. Sanctions
(Andrews, 1998)(Andrews, 1998)
-0.1
-0.05
0
0.05
0.1
0.15
0.2
Treatment
Sanctions

17. Impact of Treatment Vs. SanctionsImpact of Treatment Vs. Sanctions
Young OffendersYoung Offenders
-0.02
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Criminal
Sanctions
Treatment
Dowden & Andrews, 1999

18. Impact of Appropriate Vs.Impact of Appropriate Vs.
Inappropriate TreatmentInappropriate Treatment
(Andrews, 1998)(Andrews, 1998)
-0.1
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Combined Tx
Appropriate
Inappropriate
Sanctions

19. Type of TreatmentType of Treatment
0
0.05
0.1
0.15
0.2
0.25
0.3
Non Behavioral
Cognitive
Behavioral
Andrew, 1994

20. Type of Treatment & Young OffendersType of Treatment & Young Offenders
0
0.05
0.1
0.15
0.2
0.25
Non Behavioral
Cognitive
Behavioral
Dowden & Andrews, 1999

21. ““All meta-analyses on offender treatmentAll meta-analyses on offender treatment
have a positive mean effect size.”have a positive mean effect size.”
(Losel, 1995)(Losel, 1995)

22. Appropriate TreatmentAppropriate Treatment
 Higher Risk More IntensiveHigher Risk More Intensive
 Targets Criminogenic NeedsTargets Criminogenic Needs
 Uses Cognitive-Behavioral TreatmentUses Cognitive-Behavioral Treatment
 Implement Treatment As DesignedImplement Treatment As Designed
(Andrews, 1998)(Andrews, 1998)

23. Targeting Criminogenic NeedsTargeting Criminogenic Needs

24. Criminogenic NeedsCriminogenic Needs
CriminogenicCriminogenic Non CriminogenicNon Criminogenic
Antisocial AttitudesAntisocial Attitudes Self-EsteemSelf-Esteem
Antisocial FriendsAntisocial Friends AnxietyAnxiety
Substance AbuseSubstance Abuse DepressionDepression
ImpulsivityImpulsivity

25. Targeting Criminogenic NeedsTargeting Criminogenic Needs
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Targets 1 - 3
Noncriminogen
ic Needs
Targets 4 - 6
Criminogenic
Needs
Gendreau, French & Taylor, 2002

26. Self Esteem Vs. Criminogenic NeedsSelf Esteem Vs. Criminogenic Needs
-0.1
-0.05
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Self Esteem
Criminogenic
Needs

27. What WorksWhat Works
 Higher Risk OffendersHigher Risk Offenders
 At least 2 sessions per weekAt least 2 sessions per week
 Smaller groupsSmaller groups
 Implementation MonitoredImplementation Monitored
 Staff Trained on Cognitive-Behavioral TxStaff Trained on Cognitive-Behavioral Tx
 Higher Proportion of Treatment CompletersHigher Proportion of Treatment Completers

28. Programming That Doesn’t WorkProgramming That Doesn’t Work
PsychodynamicPsychodynamic
Non-directive/Client-centeredNon-directive/Client-centered
Disease ModelDisease Model
(Andrews, 1998)(Andrews, 1998)

29. Impact of Cognitive Self-ChangeImpact of Cognitive Self-Change
ProgramProgram
 LengthLength New Accusations After YearsNew Accusations After Years
Of Time (Mo.)Of Time (Mo.) 11 22 33
No treatmentNo treatment 49%49% 71%71% 77%77%
1 – 61 – 6 54%54% 67%67% 80%80%
7 +7 + 25%25% 42%42% 46%46%
(Bush, 1995)(Bush, 1995)

30. How Many Programs AreHow Many Programs Are
Appropriate?Appropriate?
Correctional Program Assessment InventoryCorrectional Program Assessment Inventory
Scores (CPAI)Scores (CPAI)
50 correctional programs50 correctional programs
(Latessa & Holsinger, 1998)(Latessa & Holsinger, 1998)

31. How Many Programs AreHow Many Programs Are
Appropriate?Appropriate?
29.4
31.3
27.4
11.7
0
5
10
15
20
25
30
35
Unsatis. NI Satis. Very
Satis.
(Latessa & Holsinger, 1998)(Latessa & Holsinger, 1998)

32. ATSA Collaborative StudyATSA Collaborative Study
N = 43 studiesN = 43 studies
 All treated between 1965 – 1999All treated between 1965 – 1999
 80% treated after 198080% treated after 1980
 9,316 subjects9,316 subjects
 23 Institutional programs23 Institutional programs
 16 Community programs16 Community programs
 3 both3 both

33. ATSA Collaborative StudyATSA Collaborative Study
Recidivism DataRecidivism Data
TreatedTreated UntreatedUntreated OddsOdds
RatioRatio
Only currentOnly current
programsprograms
SexualSexual 9.9%9.9% 17.3%17.3% .60.60
GeneralGeneral 32.3%32.3% 51.3%51.3% .57.57

34. Psychopathy: TreatmentPsychopathy: Treatment

35. • Program for personality disordered offendersProgram for personality disordered offenders
• "Maxwell Jones" Therapeutic Community"Maxwell Jones" Therapeutic Community
• Minimum 2 yrs in programMinimum 2 yrs in program
• Mean follow-up after release = 8 yrs, 4 monthsMean follow-up after release = 8 yrs, 4 months
• Psychopaths defined by PCL-R score of 27Psychopaths defined by PCL-R score of 27
• PCL-R coded from files only (r = .96)PCL-R coded from files only (r = .96)
• 176 treated patients; 146 untreated patients176 treated patients; 146 untreated patients
• Mean time to failure = 47 monthsMean time to failure = 47 months
(Rice, Harris, & Cormier, 1992)
Psychopathy and Recidivism After Treatment

36. Psychopathy & TreatmentPsychopathy & Treatment
NonNon
PsychopathsPsychopaths
TreatedTreated 22%22%
UntreatedUntreated 39%39%
(Harris, Rice et al., 1994)(Harris, Rice et al., 1994)

37. Psychopathy & TreatmentPsychopathy & Treatment
PsychopathsPsychopaths
TreatedTreated 77%77%
UntreatedUntreated 55%55%
(Harris, Rice et al., 1994)(Harris, Rice et al., 1994)

38. Psychopathy, Treatment, and ReconvictionsPsychopathy, Treatment, and Reconvictions
in HMP Servicein HMP Service
•Tx anger-management, social skills
•24-month reconviction rate
(Hare, Clark, Grann, & Thornton, 2000)Hare, Clark, Grann, & Thornton, 2000)

39. 0
10
20
30
40
50
60
70
80
90
Low Fac I High Fac 1
Untreated
Treated
PercentReconvicted2-Year Post-release Reconviction Rates in the
English Prison Service
Hare, Clark, Grann, & Thornton (2000)

40. Cost of RecidivismCost of Recidivism
 To TaxpayersTo Taxpayers
 To VictimsTo Victims

41. Computing Cost of RecidivismComputing Cost of Recidivism
Police InvestigationPolice Investigation
AdjudicationAdjudication
CorrectionsCorrections
Medical Care of VictimsMedical Care of Victims
Mental Health Care of VictimsMental Health Care of Victims
Property DamageProperty Damage
Reduced Future EarningsReduced Future Earnings
(Aos, 1999)(Aos, 1999)

42. Computing Victim Cost ofComputing Victim Cost of
RecidivismRecidivism
Medical CareMedical Care
Mental Health CareMental Health Care
Property DamageProperty Damage
Reduced Future EarningsReduced Future Earnings
Pain and SufferingPain and Suffering
Loss of LifeLoss of Life
(Aos, 1999)(Aos, 1999)

43. Cost Effectiveness of CorrectionalCost Effectiveness of Correctional
ProgrammingProgramming
Every $1 Spent on Correctional ProgrammingEvery $1 Spent on Correctional Programming
Taxpayers Save $5Taxpayers Save $5
Victims Save $7Victims Save $7
(Aos, 1999)(Aos, 1999)

44. Cost Effectiveness of Vocational andCost Effectiveness of Vocational and
Basic Education ProgramsBasic Education Programs
For Every $1 SpentFor Every $1 Spent
Taxpayers save between $1.71 & $3.23Taxpayers save between $1.71 & $3.23
(Aos et al., 1999)(Aos et al., 1999)

45. Cost Effectiveness of Cognitive-Cost Effectiveness of Cognitive-
Behavioral Treatment ProgramsBehavioral Treatment Programs
For Every $1 SpentFor Every $1 Spent
Taxpayers Save Between $2.54 and $11.48Taxpayers Save Between $2.54 and $11.48
(Aos et al., 1999)(Aos et al., 1999)

46. ““We found the largest and most consistentWe found the largest and most consistent
returns are for programs designed forreturns are for programs designed for
juvenile offenders.”juvenile offenders.”
(Aos et al., 1999, p. 6)(Aos et al., 1999, p. 6)

47. Cost Effectiveness of ProgrammingCost Effectiveness of Programming
for Juvenilesfor Juveniles
For Every $1 Spent on Juvenile ProgramsFor Every $1 Spent on Juvenile Programs
Tax Payers Save Between $7.62 & $31.4Tax Payers Save Between $7.62 & $31.4
(Aos, 1999)(Aos, 1999)

48. Cost/Benefit of Adolescent NonCost/Benefit of Adolescent Non
Offender ProgramsOffender Programs
ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers &
AloneAlone VictimsVictims
QuantumQuantum $.09$.09 $.13$.13
Big BrothersBig Brothers $1.30$1.30 $2.12$2.12
(Aos, 1999)(Aos, 1999)

49. Cost/Benefit of Adolescent NonCost/Benefit of Adolescent Non
Offender ProgramsOffender Programs
ProgramProgram Cost/Cost/ EffectEffect
ParticipantParticipant SizeSize
QuantumQuantum $18,292$18,292 -.42-.42
Big BrothersBig Brothers $1,009$1,009 -.05-.05
(Aos, 1999)(Aos, 1999)

50. Cost/Benefit of AdolescentCost/Benefit of Adolescent
Supervision ProgramsSupervision Programs
ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers &
AloneAlone VictimsVictims
 DiversionDiversion $7.62$7.62 $13.61$13.61
 IntensiveIntensive
ProbationProbation .90.90 1.491.49
 Boot CampBoot Camp .42.42 .26.26
(Aos, 1999)(Aos, 1999)

51. Cost/Benefit of AdolescentCost/Benefit of Adolescent
Treatment ProgramsTreatment Programs
ProgramProgram TaxpayersTaxpayers Taxpayers &Taxpayers &
AloneAlone VictimsVictims
ARPARP $19.57$19.57 $31.40$31.40
Multi-SystemicMulti-Systemic 8.388.38 13.4513.45
Functional FamFunctional Fam 6.856.85 10.9910.99
Multi Tx FosterMulti Tx Foster 14.0714.07 22.5822.58

52. Cost/Benefit of AdolescentCost/Benefit of Adolescent
Treatment ProgramsTreatment Programs
ProgramProgram Cost/Cost/ EffectEffect
ParticipantParticipant SizeSize
AggressionAggression
ReplacementReplacement
TrainingTraining $404$404 -.26-.26
Multi-SysMulti-Sys
Family TxFamily Tx $4,540$4,540 -.68-.68
(Aos, 1999)(Aos, 1999)

53. What Does It Take to Break EvenWhat Does It Take to Break Even
Depends on the CostDepends on the Cost
Percent Reduction toPercent Reduction to
Break EvenBreak Even
AggressionAggression
ReplacementReplacement
TrainingTraining 1.4%1.4%
Multi-SystemicMulti-Systemic
Family TherapyFamily Therapy 10.2%10.2%