“Practitioners Helping Practitioners” Maximizing the Benefit of the Carey Guides A Hands-On...
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Transcript of “Practitioners Helping Practitioners” Maximizing the Benefit of the Carey Guides A Hands-On...
“Practitioners Helping Practitioners”
Maximizing the Benefit of the Carey Guides
A Hands-On Workshop
Introductions and Goals
• Objectives– Understand the purpose of the Guides– Understand the theory behind the Guides– Understand how to use them properly– Understand their limitations– Demonstrate effective use behaviorally
Assumption
• All participants have been trained in evidence based practices concepts
• We will do a short recap of the key elements around risk, need, and responsivity
Discussion
– When you are going to greet your next appointment, what preparation thoughts are running through your head? What is your objective?
– How much do you prepare?– How do you use the case plan?– How much do you control the interview
objective?– How much impact are you having?
Agenda
• Introductions and Goals • Why Carey Guides? • Theory linkage between EBP and Carey
Guides• How to best utilize
– Blue Guides – Criminogenic Needs – Red Guides – Case Planning
• Practice sessions• Remaining Q and A
Goal One of Five
• Why Carey Guides? • Theory linkage between EBP and Carey
Guides• How to best utilize
– Blue Guides – Criminogenic Needs – Red Guides – Case Planning
• Practice sessions• Remaining Q and A
Why Carey Guides?
• Most commmon question after ebp training:– “Ok, Ok, I get it. I understand that I have
to target criminogenic needs. But…..”• “How do I do this when I only have 15 minutes
with a probationer. How can I change their behavior during that time?”
• “How am I supposed to do this when I don’t have resources to send them to?”
• “How realistic is this? They aren’t motivated”
For the Case ManagerCarey Guides are Designed
to:• Target your intervention in 1-1 session
on the top criminogenic needs
• Structure your interview and give a clear purpose/objective
• Avoid subject wandering
• Aid in your case planning and management (place on the case plan)
• Be readily available at a moment’s notice when the need arises
For the probationersCarey Guides are Designed
to:
• Be simple and easy to understand
• Be used for juvenile and adult; male and female (with clinical adjustments by case manager)
• Be used as homework/assignment or completed in lobby prior to appointment
• For the pre-contemplative offender
Stages of Change
• Reminder of the likely motivation level of offender
• Circumstances required for change to occur
• Expect gradual, non-linear change
• Expect relapse
• Avoid discouragement
The Carey Group, Inc.
More Effective if Strength Based
• Some Key Reminders:– Focus on strength, not pathology/deficits– Need for strong bond between case
manager and client– Needs and goals influenced by offender– Aggressive outreach by case manager– Case manager assists ability to learn,
grow, and change– Use praise and reinforcements
Response to stages
ENTERHERE
TEMPORARYEXIT
Relapse
Maintenance
Pre-Contemplation
Contemplation
Action
PERMANENT EXIT
BY: Prochaska & Diclemente
Provide Information
Increase Ambivalence
Practical Strategies
Relapse Prevention
Avoid Demoralization
As an interventionCarey Guides are Designed
to:
• Be used:– As a sole, standalone intervention– As a way to reinforce what is being
learned in other programming (extend circumstances whereby learning is applied)
– As an ad hoc intervention when a behavior or attitude emerges (teaching moment)
Example as a sole, standalone intervention
• Use it as a sole intervention when the offender:– Can’t get into a program (due to lack of
availability, time constraints, fees, other reasons)
– Does not appreciate why they need a program (ie, use it as a motivation enhancement technique) and you want to prepare him/her for a referral
Example as a way to reinforce what is being
learned in other programming
• Use it as reinforcement when the offender:– Has graduated from a program that addressed
the criminogenic need and you can reinforce what they learned
– Needs to demonstrate to you that he/she learned what they needed to learn in the program from which they graduated from
– Went through a program but didn’t graduate (but still learned skills)
Example as an ad hoc intervention when a
behavior or attitude emerges
• Use it as an ad hoc intervention when the offender:• Experiences an event that exposes a problem
solving deficit • Acts inappropriately around a criminogenic need• Is in potential violation of his/her supervision
• Look for teachable moments!
Goal Two of Five
• Why Carey Guides? • Theory linkage between EBP and Carey
Guides• How to best utilize
– Blue Guides – Criminogenic Needs – Red Guides – Case Planning
• Practice sessions• Remaining Q and A
Low Risk
High andMedium
Risk
ExtremeHigh Risk
“We have no evidence in the literature that intensive human services with the highest risk, extremely egocentric, offenders will reduce re-offending.”
Don Andrews, Ph.D.Summary of the LSI-R.
Training Video SeriesVolume I: Theoretical Rationale
“Supervision resources directed toward low-risk offenders do not reduce their risk of re-offending and may even have a negative effect.”
Latessa, E. (2004). Understanding the risk
principle: How and why correctional interventions can
harm low risk offenders. Topics in Community Corrections –
20004. 19© 2007 The Carey Group; www.thecareygroup.com; 651-226-
4755
Focus on the Medium and High Risk
20
Potential Impact on Recidivism
01020304050607080
Recidivism Rate inrelation to LSI scores
Likely recidivism ratewith most effectivecorrectional intervention
20
The Big FourCriminogenic Need ResponseHistory of anti-social behavior Build non-criminal alternative
behaviors to risky situations
Anti-social personality Build problem solving, self management, anger management, and coping skills
Anti-social cognition Reduce anti-social cognition, recognize risking thinking and feelings, adopt an alternative identity
Anti-social companions Reduce association with criminals, enhance contact with pro-social
Source: Ed Latessa, Ph.D. 21
The Next FourCriminogenic Need ResponseFamily and/or marital Reduce conflict, build positive
relationships and communication, enhance monitoring/supervision
Substance abuse Reduce usage, reduce the supports for abuse behavior, enhance alternatives to abuse
School and/or work Enhance performance rewards and satisfaction
Leisure and/or recreation Enhance involvement and satisfaction in pro-social activities
Source: Ed Latessa, Ph.D. 22
-20%
-10%
0%
10%
20%
30%
40%
50%
60%
6 5 4 3 2 1 0 -1 -2 -3
Recidivism Reductions as a Function of Targeting Multiple Criminogenic vs.
Non-Criminogenic Needs*
(Andrews, Dowden, & Gendreau, 1999; Dowden, 1998)
Better outcomes
Poorer outcomes
More criminogenic than non-criminogenic needs
More non-criminogenic than criminogenic needs
23
The Carey Group, Inc.
24
Need Principle
By assessing and targeting criminogenic needs for change, agencies can reduce
the probability of recidivism
Criminogenic
• Anti social attitudes• Anti social friends• Substance abuse• Lack of empathy• Impulsive behavior
• Non-Criminogenic
• Anxiety• Low self esteem• Creative abilities• Medical needs• Physical conditioning
The Carey Group, Inc.
© 2006 The Carey Group 25
Responsivity
Reminder:
• Average recidivism reduction/gain
–Inappropriate treatment -.06
–Unspecified treatment .13
–Appropriate treatment .30
© 2007 The Carey Group; www.thecareygroup.com; 651-226-4755
Responsivity Principle• Styles & modes of service must be matched to
the learning styles & abilities of the offender
Matching the characteristics of the individual offender to the intervention (treatment, program, supervision); AND
Matching the personnel delivering the service to the population
26
26
© 2007 The Carey Group; www.thecareygroup.com; 651-226-4755
Responsivity Principle
Offender Characteristics:
Motivation
Learning Style
Gender
Age
Culture
Other considerations:
• Anxiety
• Depression
• Mental Illness
• Intelligence
27
27
What Does Work
– Target criminogenic risk and need
– Cognitive/behavioral in nature
– Incorporate social-learning practices
– Balanced integrated approach to sanctions and interventions
– Incorporate the principle of responsivity
– Therapeutic integrity
Features of Effective Interventions:
Social Learning involves….• A role model the individual can relate to• Direct instruction• Demonstration• Role play• Positive reinforcement• Feedback• Skill practice• Transfer of skill• Use of sanctions and rewards• Relapse planning
© 2007 The Carey Group; www.thecareygroup.com; 651-226-4755
31
Key components of Positive Reinforcement
• Noticing (most of us don’t notice behavior unless it is negative)
• Praise progress, any progress
• The more attention you pay to a behavior, the more it will be repeated
BEHAVIOR
THOUGHTS
FEELINGS
COGNITIVE STRUCTURE
(THINKING PATTERNS)
BELIEFS AND ATTITUDES
SkillStated Knowledge
More likely aware
UnderneathThe surface
The Carey Group, Inc.
Remember……
• It works best when it contains behavioral components
– Use of role plays
– Practice skill
– Report on application outside of classwork
Treatment should be Behavioral
• Use rewards and punishers effectively
• Train, practice, rehearse offenders in pro-social alternatives
• Completion criteria should be based on acquisition of prosocial skills
Behavioral vs. Non-Behavioral
0.29
0.07
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Non-Behavioral (n=83) Behavioral (n=41)
Percentage of Increased Recidivism
Percentage of Reduced Recidivism
Source: Andrews, D.A.1994. An Overview of Treatment Effectiveness.Research and Clinical Principles, Department of Psychology, Carleton University.*The n refers to the number of studies
Goal Three of Five
• Introductions and Goals • Why Carey Guides? • Theory linkage between EBP and Carey
Guides• How to best utilize
– Blue Guides – Criminogenic Needs – Red Guides – Case Planning
• Practice sessions• Remaining Q and A • Wrap Up
Blue Guides: Criminogenic Needs
Blue Guide Topics Use when….
Anger Offender displays quick temper that leads to negative behavior
Creative Thinking Offender lacks ability to think creatively to address challenges in life
How to Operate in the Family To be filled in by author
Problem Solving/Decision Making Offender tends to think in black and white; few options considered when encounters events that require good decisions
Thrill Seeking Offender has need for adrenaline and excitement in life and this leads to choices that include anti-social activity
Anti-Social Peers Offender’s primary peer group is one that reinforces anti-social thinking and is involved in the legal system
Blue Guides: Criminogenic Needs
(continued)Blue Guide Topics Use when….
Emotional Regulation Offender is impulsive, acts without thinking, and can’t seem to control his/her reactions when certain events trigger a response
Social Skills Offender is inadequate in social skills causing him/her to avoid circumstances that may be good for them (eg, recreational outlets, developing pro-social friends, etc.)
Anti-Social Thinking/Values Offender possesses a set of values and beliefs that justifies illegal behavior
Empathy Offender is unable to put him/herself in other’s shoes or understand how his/her behavior affects others
Moral Reasoning Offender ‘s motivation revolves around pleasure and pain instead that which reinforces community accountability
Substance Abuse Offender is currently abusing or dependent on substance abuse
Red Guides: Challenging Case Management Topics
Red Guide Topics Use when….
Aftercare, Reentry, and Transition Offender is being released from a residential facility and is need of a support system
Domestic Violence Offender has a history of physically or emotionally abusing family members
Female Offenders Female offenders who have criminogenic needs
Lethality Offenders who have a history of behavior that causes physical harm to others and who seem to have internal drive to do so
Meth User Offender who has a current history of using or dealing in meth and seem to prefer meth over other drugs
Revocations Offenders who are brought back to court or parole hearing on a revocation
Use of Rewards and Sanctions All cases
Red Guides: Challenging Case Management Topics (continued)
Red Guide Topics Use when….
Case Planning PO is working with offender is medium or high risk
Dosage and Intensity PO is determining how much treatment to require for an offender
Impaired Driving PO is working with a drunk driver who is at least medium risk
Maximizing Strengths PO is seeking to use strengths of offender to motivate; most cases
Motivational Interviewing Techniques
All cases
Sex Offending To be filled in by author
What Makes an Effective Corrections Professional?
To be filled in by author
Red Guides: Challenging Case Management Topics (continued)
Red Guide Topics Use when….
Co-occurring Illness Offender is suffering from both mental illness and substance abuse
Engaging the Pro-Social Others Offender is in need of a set of pro-social community supports
Involving the Family To be filled in by author
Mental Health Offender is suffering from a mental illness
Offender Typologies To be filled in by author
Use of Behavioral Techniques PO is seeking to apply role plays, practice, and rehearsal techniques
Generic tips for best results• Know the linkages between your case plans and the
Carey Guide most suited for the situation– Exercise – simulated case plan
• Know the client, formulate case plan, connect to programming, integrate Carey Guides in sessions
• Can be utilized in individual and group sessions– Exercise – simulated group usage of guide
• Include support network in exercises that make sense for them
• Exercises can be utilized more than once with a client – in the beginning as a baseline and then later to gauge progress
Homework or in lobby?Use as homework when….. Use in lobby when…..
The offender is responsible enough to do it as assigned
You don’t have confidence that the offender will bring the homework assignment in the next session
There is not an urgency to take to take advantage of a teachable moment
There was a fresh incident for which the use of a guide would be timely
The offender processes information best when given an opportunity to think about it
The offender’s learning style is such that they need to talk through what they are thinking as opposed to writing
The offender needs writing or reading assistance
They work best when you…• Have engaged with the offender
• Are strength based
• Use praise and encouragement
• Don’t use it as a form of punishment but as a teaching tool
• Don’t rush it; process it over multiple sessions (divide tool into parts)
• Do the behavioral part of the exercises (each contain at least one role play)
Behavioral vs. Non-Behavioral
0.29
0.07
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
Non-Behavioral (n=83) Behavioral (n=41)
Percentage of Increased Recidivism
Percentage of Reduced Recidivism
Source: Andrews, D.A.1994. An Overview of Treatment Effectiveness.Research and Clinical Principles, Department of Psychology, Carleton University. 46
Limitations
• Be aware of dosage
• Best research results when have structured, groups. May work in a group but it is untested
• Don’t expect immediate change (keep in mind dosage, length and intensity requirements, and relationship factors)
The Carey Group, Inc.
Dosage and Intensity
• Treatment should be:– At least 100 hours of direct service (200-
300 hours for high risk)– Be 3-9 months long (6-18 months for high
risk) depending on risk level
• Intensive treatment (not including aftercare) that last too long (12-36 months) might begin to see diminishing results
risk/need supervision cognitive/behav comm.assessment case plan referral strategies programming supports eval.
criminogenic motivational strength responsivity specialization, fidelity basic modifying for needs interviewing based intensity, dosage needs outcomes
Continuum of Application….It’s not just one thing
What
How
Goal Four of Five
• Introductions and Goals • Why Carey Guides? • Theory linkage between EBP and Carey
Guides• How to best utilize
– Blue Guides – Criminogenic Needs – Red Guides – Case Planning
• Practice sessions• Remaining Q and A • Wrap Up
Example of Case Plan with the Carey Guide
• Note to trainer: Use this case plan or use actual case plan from that jurisdiction
Practice Exercise One: Blue Guides• Case example-Standalone:
– Select a role play partner; determine who will be PO and who will be offender
– Read case example: Jeremy
– Review the worksheet completed by offender
– Conduct an interview using motivational interviewing techniques
Practice Exercise Two: Blue Guides• Case example- Reinforcement:
– Select a role play partner; determine who will be PO and who will be offender
– Read case example: Theo
– Review the worksheet completed by offender
– Conduct an interview using motivational interviewing techniques
Practice Exercise Three: Blue Guides
• Case example- Teachable Moment:– Select a role play partner; determine who will
be PO and who will be offender
– Read case example: Monique
– Review the worksheet completed by offender
– Conduct an interview using motivational interviewing techniques
–
Practice Exercise Four: Red Guides• Case example- Co-occurring illness
– Select a role play partner; determine who will be PO and who will be offender
– Read case example: Rodney
– Review the worksheet completed by offender
– Conduct an interview using motivational interviewing techniques
Goal Five of Five
• Why Carey Guides? • Theory linkage between EBP and Carey
Guides• How to best utilize
– Blue Guides – Criminogenic Needs – Red Guides – Case Planning
• Practice sessions• Remaining Q and A