“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




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





Reminder:Risk, Need, Responsivity

• Risk is the who

• Need is the what

• Responsivity is the how

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


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


© 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


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:

How people change

• Social Learning Theory

– The most powerful theory on behavioral shaping

Theories to Treatment

30© 2007 The Carey Group; www.thecareygroup.com; 651-226-4755

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


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


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




• 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)


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)


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)


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




• 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:


– Read case example: Theo



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



–

Practice Exercise Four: Red Guides• Case example- Co-occurring illness


– Read case example: Rodney



Goal Five of Five





Questions

• What to do when you get stuck?

• Feedback to TCG

• Other thoughts/questions?

“Practitioners Helping Practitioners”

For more information

www.thecareygroup.com877-89CAREY

“practitioners helping practitioners” maximizing the benefit of the carey guides a hands-on...

Documents