Incentives and Sanctions Responses to Client Behavior

Transcription

1 Incentives and Sanctions Responses to Client Behavior National Association of Drug Court Professionals Skills Building Session Judge Christine Carpenter Helen Harberts, M.S., J.D. May 28, 2014

2 Basic Principles of Effective Behavior Modification Presented By: Judge Christine Carpenter

3 Terminology SANCTION REWARD GIVE Punishment Positive Reinforcement TAKE Negative Reinforcement Response Cost

4 Carrot and Stick Reduce undesirable behaviors and increase desirable behaviors No thinning for punishment Positive vs. negative reinforcement

5 Tangible Rewards Most important for reinforcement-starved participants Fishbowl procedure Symbolic rewards

6 Certainty Reliable detection is key Random drug testing twice per week, including weekends and holidays Sufficient detection windows & panels Community supervision Last supervisory burdens to be lifted Second chances

7 Celerity Timing is second most influential Interference from new behaviors Status hearings every 2 weeks until the case has stabilized Noncompliance hearings where indicated

8 Magnitude Habituation Effects Effective Zone Ceiling Effects EFFECTIVENESS MINIMAL MODERATE SEVERE MAGNITUDE OF SANCTION

9 Procedural Fairness Clearly communicated policies and procedures Presumptive consequences with flexible application Opportunity to be heard Respect and dignity

10 The Top Ten 1. Sanctions do not need to be painful, humiliating or injurious. 2. Responses are in the eye of the participant. Incarceration is not necessarily viewed as the harshest punishment. 3. Responses must be of sufficient intensity. Smart and graduated.

11 The Top Ten. 4. Responses should be delivered for every infraction. The opposite holds true. Try to maintain a four to one ratio. 5. Responses should be delivered immediately. 6. Undesirable behavior must be reliably detected. Key component #5. Abstinence is monitored by frequent alcohol and other drug testing. Drug testing protocols. Reliable treatment information. Up to date case management.

12 The Top Ten 7. Responses must be predictable and controllable. Written manual for participants and for team. Key Component #6. A coordinated strategy governs responses to participant s compliance. 8. Responses may have unintentional side effects. Written manual for participants and for team. Failure to specify particular behaviors that are targeted and the consequences for non-compliance can result in a behavior syndrome know as learned helplessness where a participant can become aggressive, withdrawn and/or despondent.

13 The Top Ten 9. Behavior does not change by punishment alone. Effects of punishment are transitory change ends when punishment ends. 10. Method of delivery is key. Fairness and the perception of fairness are required. Use empathy and motivational interviewing. Key Component #7. Ongoing judicial interaction with each drug court participant is essential.

14 The Basics Responses are jointly developed by the team in staffing. Importance of entire team present at staffing Responses to behavior are graduated. Use the courtroom as theater. Stay entire time? Order of docket? Microphones? Entire team present? Reward good behavior. More incentives than sanctions. Catch them doing the right thing.

15 Exercise/Discussion Developing Low/Moderate/High Magnitude Responses Currently in your program, how do you effectively implement responses according to best practice principles; and What changes do you need to make in your program to effectively apply these principles in everyday practice

16 Target Behaviors for Drug Courts Presented By: Helen Harberts, M.S., J.D.

17 Is this new? NOPE! This is 60+ years of behavioral science research. What is new..is how we can apply this concept to a resistant court involved population.

18 The research Has been done Is easy to understand Is easy to implement once you understand it. Is just kind of odd for those who are not used to doing it.

19 Why do this strange stuff in Court? Q: What is the problem? A: drug addiction Q: What s the solution? A: Treatment! Length of time in treatment is the key. The longer a patient stays in treatment: the better they do. Coerced patients stay longer. The purpose of sanctions and incentives is to keep participants engaged in treatment.

20 The person in front of you is not the enemy: The Disease Is We know from research that the addict will choose immediate rewards over long term goals. They are prone to poor decision making. We need to catch and redirect undesired behavior, and we need to detect desired behavior and reward, reward, reward to teach what they should be doing. This target shifts over time for them, and for us, requiring the ultimate in competence and proficiency.

21 The enemy is a difficult opponent

22 Target Behaviors Analysis Addict or abuser? Proximal or distal goal? Appropriate response: sanction or reward.

23 Target Behaviors The target can change over time Determine what goals are and if they are proximal or distal Response to a proximal goal should be sanction high and reward low. Response to a distal goal should be sanction low and reward high.

24 Quitting & Defiance Learned Helplessness Predictability Controllability Ratio Burden

25 Target Behaviors Proximal vs. distal behaviors (shaping) Phase-specific Capture good behavior

26 Abuse vs. Dependence Substance Dependence or Addiction 1. Binge pattern 2. Cravings or compulsions 3. Withdrawal symptoms } Abstinence is a distal goal Substance Abuse } Abstinence is a proximal goal Collateral needs } Regimen compliance is proximal Dual diagnosis Chronic medical condition (e.g., HIV+, HCV, diabetes) Homelessness, chronic unemployment

27 Addicts vs. Abusers: Proximal and Distal Behaviors Should we emphasize certain target behaviors during different phases of the program? What Behaviors? Why? How do we respond to show that emphasis?

28 Prognostic Risk Factors Current age < 25 years Delinquent onset < 16 years Substance abuse onset < 14 years Prior rehabilitation failures History of violence Antisocial Personality Disorder Psychopathy Familial history of crime or addiction Criminal or substance abuse associations

29 Risk & Needs Matrix High Risk Low Risk High Needs Accountability, Treatment & Habilitation Low Needs

30 Risk & Needs Matrix High Needs Low Needs High Risk Accountability, Treatment & Habilitation Low Risk Treatment & Habilitation

31 Risk & Needs Matrix High Needs Low Needs High Risk Accountability, Treatment & Habilitation Accountability & Habilitation Low Risk Treatment & Habilitation

32 Risk & Needs Matrix High Needs Low Needs High Risk Accountability, Treatment & Habilitation Accountability & Habilitation Low Risk Treatment & Habilitation Prevention

33 Practice Recommendations High Needs Low Needs High Risk Phase 1: stabilization Biweekly status hearings Treatment & supervision are proximal Restrictive consequences Positive reinforcement Counseling & medication Phase 1: abstinence & compliance Biweekly status hearings Abstinence & supervision are proximal Restrictive consequences Habilitation services Low Risk Phase 1: stabilization Noncompliance hearings Treatment is proximal Positive reinforcement Counseling & medication Phase 1: abstinence Noncompliance hearings Abstinence is proximal Zero tolerance Prevention services

34 Focus on three major themes: Engagement Co-occurring disorders Physical Mental Different risk and needs means different responses. (Who is sitting before you and what should you expect from them and when should you expect it?)

35 You can get sharply better outcomes by Using your skills to engage Using your skills to encourage Using your skills to instill HOPE Selling recovery Using every skill you have to keep them coming back in spite of the pain and agony they are enduring. Understanding that early recovery (up to several years) really stinks.

36 Motivation, memory, engagement- Public Defender Engagement

37 Public Defender teaching in the hallways of the courthouse before court

38 DA training & engaging before Court- Treatment Team and Defense Bar present

39 Treatment in the courtroom reinforce the message

40 This is very difficult work for drug court participants: l l l l l Suicidal BAD GOOD VERY GOOD Euphoric NORMAL BRAIN RANGE l l l l l l l l l l l l l Suicidal BAD GOOD VERY GOOD Euphoric RECOVERING BRAIN RANGE

41 Checklist for Your Consideration: Who are they (risk/need)? Where are they? (What phase in the program)? What are the behaviors we are responding to? (proximal or distal) What is the response choice and magnitude? How do we deliver and explain the response?

42 Exercise/Discussion Targeting your Interventions by Phase The team needs to identify specific goals for each phase and then respond to changes. Start with short term goals that lead to long term goals. Incentives and Sanctions should be at the appropriate cognitive and developmental level.

43 Resources/Wrap Up/Adjourn National Association of Drug Court Professionals Skills Building Session Judge Christine Carpenter Helen Harberts May 28, 2014

44 Examples of Incentives and Sanctions

45

46

47

48

49 Exercise #1: Principles of Behavior Modification As a small group, discuss the following Principles of Behavior Modification according to the following: 1) Currently in your program, how do you effectively implement responses according to best practice principles; and 2) What changes do you need to make in your program to effectively apply these principles in everyday practice: Certainty Celerity Magnitude Procedural Fairness 1. 2.

50 Exercise #2: Targeting Your Interventions By Phase Prioritizing Target Behaviors and Responses for High Risk/ High Need Participants Work as a group to identify the proximal (P) and distal (D) target behaviors for HIGH RISK / HIGH NEED participants within each timeframe outlined below. The following list of target behaviors is not intended to be exhaustive. To add additional target behaviors, use next page. Discuss how you will apply this in your jurisdiction upon your return. Target Behavior (P) or (D) Phase I Acute Stabilization Phase II Clinical Stabilization Phase III Pro-Social Habilitation Phase IV Adaptive Habilitation Phase V Continuing Care Abstinence/ Neg. Drug Tests Treatment Attendance Drug Testing Attendance Court Attendance Candor with Court Positive Attitude Probation Attendance GED/School Job Readiness/ Employment Child Support Payments Court Fees/Fines Compliance w/ Medication AA/NA Attendance New Friends/ Hangouts

51 Target Behavior (P) or (D) Phase I Acute Stabilization Phase II Clinical Stabilization Phase III Pro-Social Habilitation Phase IV Adaptive Habilitation Phase V Continuing Care

52 Exercise #2: Targeting Your Interventions By Phase: Prioritizing Target Behaviors and Responses for High Risk/ Low Need Participants Work as a group to identify the proximal (P) and distal (D) target behaviors for HIGH RISK / LOW NEED participants within each timeframe outlined below. The following list of target behaviors is not intended to be exhaustive. To add additional target behaviors, use next page. Discuss how you will apply this in your jurisdiction upon your return. Target Behavior (P) or (D) Phase I Acute Stabilization Phase II Clinical Stabilization Phase III Pro-Social Habilitation Phase IV Adaptive Habilitation Phase V Continuing Care Abstinence/ Neg. Drug Tests Treatment Attendance Drug Testing Attendance Court Attendance Candor with Court Positive Attitude Probation Attendance GED/School Job Readiness/ Employment Child Support Payments Court Fees/Fines Compliance w/ Medication AA/NA Attendance New Friends/ Hangouts

53 Target Behavior (P) or (D) Phase I Acute Stabilization Phase II Clinical Stabilization Phase III Pro-Social Habilitation Phase IV Adaptive Habilitation Phase V Continuing Care

54

55 INCENTIVES AND SANCTIONS SKILLS BUILDING SESSION NADCP ANNUAL CONFERENCE MAY 28, AM-12PM/2PM-5PM 9:00 9:45am / 2-2:45pm Plenary: Basic Principles of Effective Behavior Modification 9:45 10:15 / 2:45-3:15pm Exercise / Group Discussion: Developing Low/Moderate/High Magnitude Responses 10:15-10:30am / 3:15-3:30pm Break 10:30-11:15am / 3:30 4:15pm Plenary: Target Behaviors for Drug Courts 11:15 11:45 / 4:15-4:45pm Exercise: Targeting your Interventions by Phase 11:45 12:00pm / 4:45 5:00pm Wrap Up/Adjourn