Transcript Maximizing the Benefit of the Carey Guides

Maximizing the Benefit of
the Carey Guides
A Hands-On Workshop
“Practitioners Helping Practitioners”
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 Manager
Carey 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 probationers
Carey 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
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
The Carey Group, Inc.
Response to stages
PERMANENT EXIT
Avoid Demoralization
Relapse
Maintenance
Provide Information
Relapse Prevention
Pre-Contemplation
Action
ENTER
HERE
Practical Strategies
TEMPORARY
EXIT
Contemplation
Increase Ambivalence
BY: Prochaska & Diclemente
As an intervention
Carey 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
Reminder:
Risk, Need, Responsivity
•
Risk is the who
•
Need is the what
•
Responsivity is the how
Focus on the Medium and High Risk
Extreme
High
Risk
“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.
High and
Medium
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 Series
Volume I: Theoretical Rationale
Low Risk
© 2007 The Carey Group; www.thecareygroup.com; 651-226-4755
19
Potential Impact on Recidivism
80
70
60
50
40
30
20
10
0
Recidivism Rate in
relation to LSI scores
H
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xt
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Ex
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ed
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m
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iu
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M
Lo
w
M
Lo
w
Likely recidivism rate
with most effective
correctional intervention
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The Big Four
Criminogenic Need
Response
History 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.
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The Next Four
Criminogenic Need
Response
Family 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
Better
outcomes
60%
Recidivism Reductions as a Function of
Targeting Multiple Criminogenic vs.
Non-Criminogenic Needs*
50%
40%
30%
20%
10%
0%
-10%
6
-20%
Poorer
outcomes
5
4
More criminogenic
than noncriminogenic needs
3
2
1
0
-1
-2
-3
More noncriminogenic than
criminogenic needs
(Andrews, Dowden, & Gendreau, 1999; Dowden, 1998)
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Need Principle
By assessing and targeting criminogenic needs
for change, agencies can reduce the
probability of recidivism
• Non-Criminogenic
Criminogenic
•
•
•
•
•
Anti social attitudes
Anti social friends
Substance abuse
Lack of empathy
Impulsive behavior
•
•
•
•
•
The Carey Group, Inc.
Anxiety
Low self esteem
Creative abilities
Medical needs
Physical conditioning
2
Responsivity
Reminder:
• Average recidivism reduction/gain
–Inappropriate treatment -.06
–Unspecified treatment .13
–Appropriate treatment .30
The Carey Group, Inc.
© 2006 The Carey Group
2
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
© 2007 The Carey Group; www.thecareygroup.com; 651-226-4755
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2
Responsivity Principle
Offender Characteristics:
Other considerations:
 Motivation
• Anxiety
 Learning Style
• Depression
 Gender
• Mental Illness
• Intelligence
 Age
 Culture
© 2007 The Carey Group; www.thecareygroup.com; 651-226-4755
27
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What Does Work
Features of Effective Interventions:
– Target criminogenic
risk and need
– Cognitive/behavioral
in nature
– Incorporate sociallearning practices
– Balanced
integrated
approach to
sanctions and
interventions
– Incorporate the
principle of
responsivity
– Therapeutic
integrity
How people change
• Social Learning Theory
– The most powerful theory on behavioral
shaping
Theories to Treatment
© 2007 The Carey Group; www.thecareygroup.com; 651-226-4755
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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
Skill
Stated Knowledge
THOUGHTS
FEELINGS
More likely
aware
COGNITIVE STRUCTURE
(THINKING PATTERNS)
BELIEFS AND ATTITUDES
Underneath
The surface
Remember……
• It works best when it contains
behavioral components
– Use of role plays
– Practice skill
– Report on application outside of
classwork
The Carey Group, Inc.
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
0.35
Percentage
of Reduced
Recidivism
0.29
0.3
0.25
0.2
0.15
0.1
0.07
0.05
Percentage
of Increased
Recidivism
0
Non-Behavioral (n=83)
Behavioral (n=41)
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
Emotional Regulation
Social Skills
Use when….
Offender is impulsive, acts without thinking, and
can’t seem to control his/her reactions when
certain events trigger a response
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
Use when….
Red Guide Topics
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)
Use when….
Red Guide Topics
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
0.35
Percentage
of Reduced
Recidivism
0.29
0.3
0.25
0.2
0.15
0.1
0.07
0.05
Percentage
of Increased
Recidivism
0
Non-Behavioral (n=83)
Behavioral (n=41)
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)
Dosage and Intensity
• Treatment should be:
– At least 100 hours of direct service (200300 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
The Carey Group, Inc.
Continuum of Application….
It’s not just one thing
What
risk/need
assessment
case plan
supervision cognitive/behav comm.
referral
strategies
programming supports eval.
criminogenic motivational strength responsivity specialization, fidelity basic
modifying for
needs
interviewing based
intensity, dosage
needs
outcomes
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
Case Plan Example
• Insert
Video Tape Example
• Note to trainer: this is a work in process
and will be inserted when done
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
Questions
• What to do when you get stuck?
• Feedback to TCG
• Other thoughts/questions?
For more information
www.thecareygroup.com
877-89CAREY
“Practitioners Helping Practitioners”