Targeting Interventions by Risk, Need, Responsivity DOUGLAS B. MARLOWE, JD, PHD
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1 Targeting Interventions by Risk, Need, Responsivity DOUGLAS B. MARLOWE, JD, PHD
2 Risk Principle Not necessarily a risk for violence or dangerousness Complicated progsis or lesser amenability to treatment Risk level intensity of supervision and vice versa Mixing risk levels is contraindicated
3 Progstic Risk Factors Current age < 25 years Delinquent onset < 16 years Substance abuse onset < 14 years Prior rehabilitation failures Prior felony convictions or incarceration History of violence Antisocial Personality Disorder or Psychopathy Familial history of crime or addiction Criminal or substance abuse associations
4 Need Principle Clinical syndromes or impairments (diagsis) Cause crime ( crimigenic ) or interfere with rehabilitation ( responsivity ) Addiction is crimigenic and mental illness can interfere with response to rehabilitation Need level intensity of supervision and vice versa Mixing need levels is contraindicated
5 Risk & Needs Matrix High Needs Low Needs High Risk Supervision Treatment Pro-social habilitation Adaptive habilitation Supervision Pro-social habilitation (Adaptive habilitation) Low Risk Treatment (Pro-social rehabilitation) Adaptive rehabilitation Secondary prevention Diversion
6 Shaping Behavior Don t expect too much Learned helplessness, ratio burden, ceiling effects Don t expect too little Habituation, complacency Proximal vs. distal goals Phase specificity What was once distal becomes proximal
7 Specific Responsivity All needs are t created equal Order and timing of intervention is critical: 1. Responsivity needs: interfere with rehabilitation 2. Crimigenic needs: cause or exacerbate crime 3. Maintenance needs: degrade rehabilitation gains 4. Humanitarian needs: cause distress
8 Phase Structure Type 1 Case Responsivity mos. 200 hrs. Continuing Care 1. Housing assistance 2. Stabilize cravings, withdrawal, anhedonia 3. Mental health tx Crimigenic 1. Vocational or educational counseling & assistance 2. Therapy / recovery *3. Medical or dental tx *4. HIV/STD prevention *5. Overdose prevention & reversal *Humanitarian Needs 1. Addiction treatment 2. Delinquent peer affiliations 3. Pro-social regimen; structure 1. Criminal thinking 2. Adaptive problem-solving Maintenance
9 Phase Structure Responsivity mos. ~ 150 hrs. Continuing Care 1. Housing assistance 2. Stabilize cravings, withdrawal, anhedonia 3. Mental health tx Crimigenic 1. Vocational or educational counseling & assistance 2. Therapy / recovery *3. Medical or dental tx *4. HIV/STD prevention *5. Overdose prevention & reversal *Humanitarian Needs 1. Addiction treatment 2. Delinquent peer affiliations 3. Pro-social regimen; structure 1. Criminal thinking 2. Adaptive problem-solving Maintenance Type 2 Case
10 Phase Structure Responsivity ~ 12 mos. ~ 100 hrs. Continuing Care 1. Housing assistance 2. Stabilize cravings, withdrawal, anhedonia 3. Mental health tx Crimigenic 1. Vocational or educational counseling & assistance 2. Therapy / recovery *3. Medical or dental tx *4. HIV/STD prevention *5. Overdose prevention & reversal *Humanitarian Needs 1. Addiction treatment 2. Delinquent peer affiliations 3. Pro-social regimen; structure 1. Criminal thinking 2. Adaptive problem-solving Maintenance Type 3 Case
11 Phase Structure Responsivity 6-12 mos. ~ hrs. Continuing Care 1. Housing assistance 2. Stabilize cravings, withdrawal, anhedonia 3. Mental health tx Crimigenic 1. Vocational or educational counseling & assistance 2. Therapy / recovery *3. Medical or dental tx *4. HIV/STD prevention *5. Overdose prevention & reversal *Humanitarian Needs 1. Addiction treatment 2. Delinquent peer affiliations 3. Pro-social regimen; structure 1. Criminal thinking 2. Adaptive problem-solving Maintenance Type 4 Case
12 Phase Structure Responsivity 1. Housing assistance 2. Stabilize cravings, withdrawal, anhedonia 3. Mental health tx Crimigenic 1. Addiction treatment 2. Delinquent peer affiliations 3. Pro-social regimen; structure 3 6 mos hrs. Continuing Care Type 5 Case 1. Vocational or educational counseling & assistance 2. Therapy / recovery *3. Medical or dental tx *4. HIV/STD prevention *5. Overdose prevention & reversal 1. Criminal thinking 2. Adaptive problem-solving Maintenance *Humanitarian Needs
13 Treat or Punish? Substance Dependence or Addiction
14 Treat or Punish? Substance Dependence or Addiction 1. Triggered binge response 2. Cravings or compulsions 3. Withdrawal symptoms
15 Treat or Punish? Substance Dependence or Addiction 1. Triggered binge response 2. Cravings or compulsions 3. Withdrawal symptoms Abstinence is a distal goal
16 Treat or Punish? Substance Dependence or Addiction 1. Triggered binge response 2. Cravings or compulsions 3. Withdrawal symptoms Substance Abuse Abstinence is a distal goal
17 Treat or Punish? Substance Dependence or Addiction 1. Triggered binge response 2. Cravings or compulsions 3. Withdrawal symptoms Abstinence is a distal goal Substance Abuse Abstinence is a proximal goal
18 Treat or Punish? Substance Dependence or Addiction 1. Triggered binge response 2. Cravings or compulsions 3. Withdrawal symptoms Abstinence is a distal goal Substance Abuse Abstinence is a proximal goal Responsivity Needs Dual diagsis Serious functional impairments
19 Treat or Punish? Substance Dependence or Addiction 1. Triggered binge response 2. Cravings or compulsions 3. Withdrawal symptoms Abstinence is a distal goal Substance Abuse Abstinence is a proximal goal Responsivity Needs Dual diagsis Serious functional impairments
20 Pre-Disposition Assessment Require assessment of risk and need before disposition E.g., as part of a pre-sentence investigation (PSI) Use immunity especially at pre-adjudication stage Valid, reliable, & culturally unbiased instruments Substance abuse vs. dependence diagsis guides treatment conditions and response to technical violations involving new drug use Automate the if/then decisions
21 Case Analysis 1. WHO is the participant (need sequence)? 2. WHERE is the participant (phase of the program)? 3. WHICH behaviors are we responding to (proximal or distal)? 4. WHAT is the response choice and magnitude? 5. HOW do we explain and deliver the response?
Targeting Interventions by Risk, Need, Responsivity DOUGLAS B. MARLOWE, JD, PHD
Targeting Interventions by Risk, Need, Responsivity DOUGLAS B. MARLOWE, JD, PHD Risk Principle Not necessarily a risk for violence or dangerousness Complicated progsis or lesser amenability to treatment
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