Program Accreditation and Correctional Treatment

Transcription

1 Substance Use & Misuse ISSN: (Print) (Online) Journal homepage: Program Accreditation and Correctional Treatment Douglas S Lipton, David Thornton, James McGuire, Frank J Porporino & Clive R Hollin To cite this article: Douglas S Lipton, David Thornton, James McGuire, Frank J Porporino & Clive R Hollin (2000) Program Accreditation and Correctional Treatment, Substance Use & Misuse, 35:12-14, To link to this article: Published online: 03 Jul Submit your article to this journal Article views: 65 View related articles Citing articles: 7 View citing articles Full Terms & Conditions of access and use can be found at Download by: [University of Leicester] Date: 27 October 2015, At: 04:19

2 Substance Use & Misuse, 35(12-14) , 2000 Program Accreditation and Correctional Treatment Douglas S. Lipton, Ph.D., * David Thornton, Ph.D.,2 James McGuire, Ph.D.,3 Frank J. Porporino, Ph.D.,4 and Clive R. Hollin, Ph.D.5 National Development and Research Institutes, Inc. (NDRI), New York, New York 10048, USA Her Majesty s Prison Service, London, U.K. University of Liverpool, Liverpool, U.K.? Associates, Ottawa, Canada University of Leicester, Leicester, U.K. ABSTRACT In the correctional field. treatment program accreditation requires the support of correctional administrators and program providers for successful introduction. How accreditation criteria are developed and a support structure for the process in corrections is achieved is in itself an interesting story. Her Majesty s Prison Service has, in 3.5 years. accelerated the effectiveness of correctional treatment programming. established a platform for program integrity, obtained acceptance by the institutional leadership, and increased pride and morale among prison officers. In this article we describe the development, structure, content, and benefits of correctional treatment program accreditation as it has occurred in England and Wales. *To whom correspondence should be iddressed at 8 Appletree Lane. East Brunswick, NJ 08816, USA Telephone. (732) FAX (732) douglas lipton@ rnciworld corn I705 Copyright by Marcel Dekker. Inc ww w.dekker.corn

3 1706 LIPTON ET AL. Key words. Accreditation; Correction; Treatment programs; England INTRODUCTION Within the past decade, accreditation for health care has been adopted in a number of countries. Accreditation, originally perceived as a vehicle to enable organizational development, is found to be increasingly of interest to more diverse groups, including governments, in regulating and promoting quality (Scrivens 1997). Newer systems are based upon the experience of the mature health care accreditation systems of the Joint Commission on Accreditation of Health Organizations (JCAHO) in the United States, the Canadian Council on Health Facilities Accreditation, and the Australian Council of Health Care Standards. These mature accreditation systems have demonstrated their responsiveness to the changing needs of the health care systems in which they operate. Furthermore, evaluations of the effects of accreditation clearly show that benefits to persons served accrue rapidly, and that accredited institutions perform more effectively than unaccredited ones in terms of patient survival, time spent in care, and staff morale. In the past decade, these accreditation systems have responded to the decline of the role of the hospital in health care delivery (and the rise of health maintenance organizations [HMOs]), and the demands of governments and the public for greater information about quality of health care. These accreditation systems have also responded to pressure for greater knowledge of clinical effectiveness by introducing indicators of clinical performance, and are examining different outcome measures with an eye toward achieving standard performance criteria. The structure and financing of many health care systems have been reformed in a number of countries. In some countries quality assurance of health care has been accepted, for the first time, as a government responsibility (e.g., Switzerland, Spain, the Republic of China, Taiwan, and Italy) and these countries have enacted this responsibility into legislation during the period between 1990 and Spain and Taiwan have adopted forms of accreditation to strengthen their quality assurance programs and, in Taiwan, health insurance payments to hospitals are contingent upon hospitals having received accreditation. There are obvious parallels with the correctional treatment systems in several countries. In Canada, Scotland, England, and Wales, government agencies (Correctional Services Canada in 1998, The Scottish Prison Service in 1998, and Her Majesty s Prison Service [HMPS] in 1996, respectively) have taken on the responsibility of accrediting treatment programs. Correctional Services Canada and The Scottish Prison Services have observed the correctional treatment accreditation process developed by

4 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT I707 HMPS and have already or are now adopting many of its features as their accreditation systems become operational. In the United States, however, there are independent correctional systems in each of the 50 states, 5 territories, and the District of Columbia. In addition. the Federal Government operates a correctional system under the Department of Justice s Bureau of Prisons. None has adopted an accreditation system for its correctional treatment programming, although a few have taken steps in that direction, notably in Oregon (Ickes, 1998). Note that several states utilize outside agencies such as the American Correctional Association (ACA) or the JCAHO for the purpose of accrediting aspects of their facilities and institutional activities. The activities often involve review of the safety, physical plant, health services, food services, and similar functions, but almost never include a review of the quality of treatment programming. Recently, however, the ACA has joined with the Therapeutic Communities of America in the development of a set of standards for in-prison therapeutic community (TC) treatment for drug users. At the time of this writing (March 1999), these standards are still under review. An early version of the standards for in-prison TCs exist (Therapeutic Communities of America, 1997), and is going into its second phase of development and field testing (De Leon, 1999). In addition, a number of states have adopted the use of their state alcohol and drug abuse agency as the certifying body for their correctional programs and the drug and alcohol counselors who are employed by the department of corrections. GOVERNMENT ACCREDITATION SYSTEMS It is well recognized that accreditation systems in health care, whether government or private, require the support of the medical profession for their successful introduction. Likewise, in the correctional field, accreditation requires the support of correctional administrators and program providers. How accreditation and a strong support structure for the process in corrections is achieved is in itself an interesting and encouraging story. In this article we will describe the development, structure, and content of correctional treatment program accreditation in the United Kingdom as the exemplar. The United Kingdom is struggling with the conflict between accreditation and the management philosophy of continuous quality improvement in health care. National, governmental accreditation was reviewed and effectively rejected by the government at the end of the 1980s (Scrivens, 1997). However, after the introduction of the health services reforms, which

5 1708 LIPTON ET AL. created a distinction between health care purchasers and providers, mild encouragement was offered to the development of independent accreditation systems. This was then followed by a commitment on the part of the National Health Service (NHS) Executive, the government body responsible for the NHS, to a management-led NHS, which espoused the principles associated with continuous quality improvement. In consequence, the NHS in the United Kingdom has evolved a range of accreditation systems that operate across the health service. Although there are accreditation systems that are restricted to the work of professional groups, such as the pathologists, or service areas such as medical records, there are two whole hospital systems: the King s Fund for acute hospitals, and the Hospital Accreditation Programme that assesses small community nonacute hospitals. The United Kingdom is now considering whether the various accreditation systems for health care should be run by government or whether accreditation should remain an activity conducted by independent bodies which are used at the discretion of health providers and purchasers, as is done in the United States (Scrivens, 1997). In the correctional realm, however, HMPS in England and Wales developed a model accreditation system that has, in 3.5 years markedly accelerated the effectiveness of correctional treatment programming. The accreditation system has been accepted, with rare exceptions, by the institutional and administrative leadership of HMPS, and it has created increased pride and morale among the prison officers. To examine this phenomenon and determine how the program accreditation system works, we start with the performance-based measurement system that is in place in HMPS in England and Wales. THE KEY PERFORMANCE INDICATOR SYSTEM Ministers and managers in part judge the effectiveness of the Prison Service using key performance indicators (KPIs) (Hutton, 1998). Each year the Prison Service agrees to a contract with the Home Secretary, and the Home Secretary agrees to give the Prison Service a budget in exchange for running the Prison Service to certain standards that are defined by targets for each KPI. The contract stands as long as the operating conditions (e.g., the size of the prison population) is within an anticipated range. The head of the Prison Service is responsible for seeing that the targets are met. This generates pressure down the line through area managers to institutional heads to manipulate the resources to ensure that the targets are met. Furthermore, when additional funding is available, it is frequently allocated on the basis of a return defined in terms of KPI

6 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT I709 performance. Nondelivery of some promised performance standard may lead to resources being removed. These performance-based measures focus on particular criteria that the government believes represent both governmental and public concerns. Targets are established for each of the KPIs. The targets are in past based on judgments as to reasonableness derived from historical and comparative precedent, and in part on empirical evidence. KPI 1: Escapes. As one might expect, escapes are a major priority for the HMPS. The target in financial year (FY) 1997 (April 1, 1997 to March 31, 1998) was 23 per The overall rate was reduced to 16 per 10,000. KPI 2: Assaults on officers. This has been one of the most difficult to reduce. The target is 90 per 1000 officers, but the HMPS experienced a rate of 96 per KPI 3: Positive mandatory random drug testing. The target is 24% positive, and the rate was reduced to 19% positive in FY KPI 4: Overcrowding. This refers to the number of prisoners held in cells intended for fewer numbers. The target for each institution is below 14%. It was kept to no higher than 12.1 /0 on a 12-month rolling average. KPI 5: Purposeful activity. Ths refers to activity for inmates mainly in terms of time spent in workshops, prison industry, and classrooms. The target was set at 22.5 hours, and the rolling average activity level achieved in FY 1997 was hours. KPI 6: Time out of cell. This refers to those inmates on standard or enhanced regimes unlocked for at least 10 hours of weekdays. The target was set at 60% and 60.06% was achieved in FY KPI 7: Number of completions by prisoners of programs accredited as effective in reducing re-offending. The target (set in 1996) was 2,200 prisoners completing Offending Behavior Programs, and 2,240 actually completed such programs in FY The number of prisoners targeted for completing Sex Offender Treatment Programs was 670, and the performance level was achieved as 67 1 inmates successfully completed such programs in FY KPI 8: Cost per place. This refers to keeping expenditures per inmate per year below the target level set at f24,610. The performance level achieved in FY 1997 was E KPI 9: Staff Training. This refers to keeping the average number of days of training above the target of 6 days per year. In FY 1997, for example, staff averaged 7.8 days of training.

7 1710 LIPTON ET AL. As noted above, leverage is achieved by Home Office providing a budget to the Prison Service through the Head of the Service through the management hierarchy to the Prison Governors based on how well each facility achieved its target level. The KPI related to treatment program accreditation is KPI 7. AT first it was defined simply as the number of prisoners completing Offending Behavior Programs, and the number of offenders completing Sex Offender Treatment Programs (see above). In an effort to concentrate resources on efective interventions, in late 1996 the KPI 7 was rewritten and is now defined as the number of completions by prisoners of programmes accredited as efective in reducing re-ofending. Thus, for a prison (or Young Offender Institution) to be able to count completions under this KPI, two things must have happened: first, the program must have been accredited; second, the prison must have been audited as running the program properly. A program s having been accredited means that, in the view of the General Accreditation Panel (GAP), the program would be likely to reduce reconviction rates if the program was delivered as specified, and this is the leverage created by the system to facilitate and sustain improvement in the Prison Service s treatment programming. The knowledge regarding which kinds of programs are effective derives form the What Works literature. This fairly substantial body of research has enabled the GAP to establish what an effective program should contain, and has offered practical guidance on how to implement such programs to achieve maximum effectiveness. (A listing of this literature is appended to the reference list at the end of the article.) Initially, based on program evaluations and meta-analytic research examining the effectiveness of correctional programming, the Prison Service in England and Wales introduced cognitive skills programming into a number of prisons during By mid-1998, more than 60 such institutions in HMPs were running such programs. The members of the GAP, assisted by support staff, designed the system and wrote the Criteria for Accrediting Programmes. The document explains how to prepare an application for a program to be accredited and describes in some detail the criteria that the GAP will use in judging applications. The GAP also reviews the criteria each year and modifies them based on experience and changing knowledge as the GAP deems necessary. The GAP, consisting of seven members, is chaired by DT, this article s co-author. He and the other members of the GAP evaluate the application that programs submit for accreditation in terms of 10 criteria that are outlined below. Following the review, the applicant is sent correspondence explaining any shortcomings on each of the criteria, and suggesting actions the applicants should undertake to overcome the shortcomings that were identified.

8 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT 1711 The KPI 7 Program Audit The KPI 7 program audit is a separate process. The GAP reviews the program audit reports submitted by the staff members of the Program Development unit who annually review programs that have been accredited in the past to ensure that levels of quality across all dimensions are sustained. These staff persons are themselves very experienced clinicians and other professions who have served for several years in roles such as senior psychologists or at higher levels at many of Her Majesty s prisons in both service delivery, administrative, and treatment supervisory positions. Panel staff members attend the GAP sessions and comment during audit reviews when asked about their findings, giving detailed testimony, as it were, to justify their scoring. All items on the audit form are scored, and the sum is the Implementation Quality Rating (IQR). Each prison which purports to run an accredited program, and to have it counted under KPI 7, must have an annual program audit which supplies an IQR. The KPI 7 rating for a prison establishment takes into account both the number of prisoners completing the program and the IQ R. Of programs that are centrally coordinated by the Prison Service Program Development unit, a member of the audit staff rates each item during a visit to the program. For programs that are contracted to be delivered by external organizations, the Program Development unit contracts with a highly experienced external auditor to visit the program and conduct the audit. PREPARING FOR ACCREDITATION To be accredited a program needs demonstrably to meet the tough criteria that research has indicated and the GAP have stipulated are required if re-offending is to be reduced. Preparing an application for accreditation is itself a significant task. In practice, very few programs fully meet the accreditation criteria. In fact, preparing an application normally involves upgrading the quality of the program. Part of the work usually requires running the program on a pilot basis so that the evidence needed by the GAP to judge its value can be gathered. An application for a program to be accredited must contain a detailed description of the program that makes clear how closely it meets the criteria given below. Applicants are asked to append to the application the following documents: The Program Munuul. This refers to the document that specifies each part of the program in sufficient detail so that any trained and competent professional following it would deliver what was essentially the

9 1712 LIPTON ET AL. same program. Either this manual or the staff manual should also explain how offenders are to be selected for the program. The StafManual. This is a similar document specifying the procedures for selecting, training, supporting and supervising staff who will be involved with the program. This manual should also include documentation of a procedure for evaluating the competence of staff to run the program. Promotional Material. This refers to material used to publicize and explain the program to staff and inmates. Copies of evaluation and monitoring materials. Of particular note here are any outcome reports that contrast outcomes of inmates receiving treatment with those who have not. A statement of the minimum standards which the program would need to reach for it to operate as intended and a description of the procedures to be used to check that these standards are being met. In England and Wales, as in the United States, the responsibility for parole and probation lies in the countries, and not with HM government. Responsibility for the supervision of prisoners following release thus lies with an independent agency (the Probation Service). Only those offenders sentenced for 12 months or more are liable to such supervision, which is governed by the National Standards for the Supervision of Offenders in the Community (Home Office, 1995). It is an affirmation that sentence planning forms the basis of effective throughcare. The sentence plan is drawn up by Prison Service staff in consultation with both probation staff assigned to the institution and the supervising officer. Hence, in any standards or guidelines produced by HMPS, the guidance for throughcare is just that, guidance. The KPIs that provide leverage to HMPS institutions do not apply to the counties. Nevertheless, the systems do work together cooperatively, for the most part with thoroughly dedicated and committed staff, though the counties struggle with large caseloads and small budgets as they do in the United States. The GAP establishes that throughcare is an essential but not sufficient part of the process of successful rehabilitation, and that therefore, the minimum acceptable contribution to throughcare by the applicant program must involve the following elements. The provision of guidelines to support sentence planning and selection for programs. Appropriate supporting work that is identified at the end of the program (this includes work which might take place inside or outside prison). Individual objectives that are identified for the offender to pursue at the end of the program. The accreditation requirements set forth that these

10 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT 1713 objectives should be chosen so that pursuing them strengthens and builds on the progress made in the program. Moreover, the objectives should apply both inside and outside prison, and the objectives should be reviewed in the report by a supervising probation officer at the end of the license period. These objectives should be discussed and agreed upon with the supervising (throughcare) probation officer, preferably through a handover session which also involves the offender, but on the telephone if necessary. Where possible, it is often desirable to involve family members in this handover discussion. These objectives, when appropriate, may be supported by specific conditions of release issued by the parole board. The applicants must provide that appropriate documentation (normally including sentence planning documentation) used to record participation in the program, progress, an assessment of risk, and an identification of remaining treatment needs will be available to the parole board (if relevant) and at other points where risk-based decisions have to be made (e.g., temporary release) as well as to the supervising probation officer. In addition, it is highly desirable for key program elements to be reliably continued and reinforced in the community. Where this is the anticipated follow-up to the program, the GAP may regard a lesser dose of prison-based treatment as acceptable. Applicants are asked to describe how the minimum throughcare requirements will be met, and what kind of post-release treatment has been contracted for. Relevant post-release treatment may be provided by involving family members in the program, by a booster program, by (individual or group-based) work on the identified objectives, and by (individual or groupbased) relapse prevention. Appropriate post-release treatment includes drug use testing in the case of offenders with serious drug use problems. The GAP affirms that the results of pilot work or other evidence of effectiveness must also be provided for the throughcare portion of the offender s program. THE ACCREDITATION CRITERIA The GAP considers programs that are submitted for accreditation in terms of 10 criteria. To accredit a program, the GAP needs to be persuaded that these criteria meet a preset standard; five of the criteria are regarded as essential and must be fully met (criteria 1, 2, 8, 9, and 10). Criterion 3 must be at least partially met.

11 1714 LIPTON ET AL. The origins of these criteria are to be found in the outcomes of largescale meta-analytic reviews of the research literature on the effectiveness of treatment with offenders. Since 1985, a series of such meta-analyses has been published, covering a very broad spectrum of types of interventions, applied to offenders of widely varying ages, in both prison and community-based settings. There is now a general consensus among researchers in the field regarding those features of interventions, and particularly of structured programs, which are most likely to succeed in reducing recidivism among persistent offenders. These conclusions are based on a set of meta-analytic findings now encompassing more than 1,500 primary research studies. The features that contribute to the effectiveness of interventions include aspects of client selection and allocation, program intensity, appropriateness of methods, style of delivery, and manner of monitoring quality of implementation and client progress. For reviews of this literature, see, for example, Andrews, 1995; Gendreau, 1996; Harland, 1996; Lipton et al., 1997; Lipton, 1998; McGuire, 1996a; Sherman et al., 1997; Vennard et al., The 10 criteria are described below. The core definition of each is given in italics. This is followed by an explanation of the elements that the GAP examines in deciding whether the criterion has been met. 1. Explicit, Empirically-Based Model of Change There should be an explicit model of how the program is supposed to work. There should be evidence to justify the assumptions in this model. There is now a large body of evidence regarding factors that contribute to or reduce recidivism. It is anticipated that this knowledge base will be a starting point for the development of any new program. The applicant is asked to explain how, in the light of this knowledge, the proposed program is expected to reduce recidivism. To enable the GAP to judge whether this criterion is met, the applicant is asked to include a brief, clear summary of how the program is supposed to work (about 1,000 words) which explains: (a) who the program is for, which criminogenic factors the program seems to change, and the central methods used to do ths; (b) what is achieved during each major phase of the program; and (c) why this combination of targets and methods is appropriate for these offenders drawing on relevant theory and research. Following this 1,000-word summary, the applicant is asked to supply a supporting appendix containing a more detailed review of relevant evidence and theoretical argument. The purpose of the 1,000-word summary is to explain the central concepts in the model of change, whereas the appendix is intended to provide evidence that justifies the assumptions in the model.

12 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT 1715 Applicants are told that they may employ the services of an academic or a consultant with relevant research background in preparing this material. The Panel takes into account three factors when judging whether criterion 1 is met: (a) the internal coherence of the model, (b) the model s plausibility in the light of existing research, and (c) the consistency between the model and the program. Because there is now a large body of evidence regarding factors that contribute to or reduce recidivism, it is anticipated that the applicant will use this knowledge base as a starting point for the development of any new program. Thus, the applicant should explain how, in the light of this knowledge, the proposed program is expected to reduce recidivism. 2. Targeting Criminogenic Needs The program should be designed to change factors that have been shown to be closely linked to the offending oj those taking part. Criminogenic needs are relatively stable, but nevertheless potentially changeable features of individuals that make them more inclined to offend. Targeting a criminogenic need involves three elements-there must be reasonable grounds for supposing that: (1) At least some of the factors targeted by the program are criminogenic for the kinds of offending that the program seeks to address; (2) the offenders who participate in the program manifest these criminogenic factors; and (3) offenders who complete the program will have improved on these factors. To meet this criterion the applicant must supply evidence that all three elements will apply when the program is implemented as intended. Evidence that a factor is criminogenic may come from studies which correlate this factor with recidivism, or from studies indicating that programs which target this factor tend to reduce reoffending, or from a theoretical model which is grounded in evidence. Evidence that program participants manifest these criminogenic factors may involve either surveys indicating that these needs are common among those typically beginning the program, or description of some procedures that select participants by virtue of their manifesting these factors. Note that this means that either the program manual or the staff manual must contain a clear description of how inmates are to be assessed and selected for the program. A normal procedure might be to use sentence planning to identify potential candidates for a program, and to follow this by a more sophisticated assessment designed to ensure that those selected are likely to benefit from it. The program manual should describe this process in sufficient detail, e.g., by the use of certain diagnostic instruments, to convince the GAP that it will identify offenders who are suitable for the program.

13 1716 LIPTON ET AL. In summary, to enable the GAP to judge that this criterion is met, the applicant is asked to indicate (1) which factors the program seeks to change; (2) the grounds on which these factors are considered to be criminogenic; (3) how participants are selected to ensure that the factors apply to them; (4) which parts of the program purports to change each factor; and (5) evidence that offenders who complete the program actually change in the intended way. Factors that have been identified as criminogenic (i.e., enhancing the probability of recidivism among men and women) include: antisocial attitudes and feelings strong ties to and identification with antisocial/criminal models weak ties to and identification with prosocial/non-criminal models difficulty with self-management, decision-making, and prosocial interpersonal skills dependency on alcohol/drugs contingencies favoring criminal over prosocial behavior adverse social or family circumstances. The Panel accepts that a factor targeted by a program is criminogenic for general re-offending if it appears on this list. Where this is the case, applicants may therefore just refer to the above list. If, on the other hand, the factor purported to be a criminogenic need is not on the list, then the applicant is asked to provide a coherent explanation of how the factor would be expected to make someone more likely to re-offend, and evidence that the assessed level of this factor predicts future offending, or, if there is no evidence about the correlation with future offending, then the applicant is asked to provide evidence indicating a correlation with past offending. This evidence will be considered acceptable to the GAP as long as it is supplemented by at least one of the following: Evidence that programs which target this factor typically reduced reoffending; qualitative or process studies of offending which implicate the same factor; or evidence from studies of analogous behavior in other populations that have implicated this factor. 3. Responsivity The methods used to target these criminogenic factors should be ones to which those participating in the program are responsive. The conditions necessary for these methods to operate efectively should be specijied as part of the program. In judging the degree to which this criterion is met, the GAP will have regard to both the extent to which the program s design caters for the

14 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT 1717 responsivity factors listed below and to direct evidence that participants are actually responsive to the program. The application must make clear the extent to which each of the following responsivity factors have been built into the program s design: Use of structured methods which engage the offender s active participation Fit between program style and participating offender s learning styles (for example, very high structure for those offenders with a low conceptual level; or less use of confrontation for anxious offenders with low self-esteem) Use of a range of different methods Selective use of positive and negative incentives Participants being adequately motivated to change (which might be addressed either through selection or motivated participants or through program elements designed to enhance motivation) Appropriateness of materials to the age, gender, and culture of participants Appropriate staff style showing (confidence, warmth, sensitivity to needs of participants; being fair; setting consistent standards; not condoning or colluding with delinquency; and demonstrating in their own behavior the kinds of attitude and conduct which offenders should emulate) Well-trained, motivated, and committed staff Protreatment attitudes being held by those staff and inmates with whom the offender will mix outside any specific treatment groups Opportunities for the skills/attitudes/behaviors learned in treatment to be successfully employed outside specific treatment groups The participants home community (the supervising probation officer and other agencies supplying support services; family and friends, etc.) to have a protreatment attitude (i.e., support and involvement rather than hostility, indifference, or ignorance). The application should explain how each of these features is attended to within the program. Because several of these features depend on the characteristics of participating inmates, it is essential for each program to have explicit inclusion and exclusion criteria. In addition, the GAP also wants to see direct evidence of participants responsiveness. Relevant evidence includes attendance rates; indicators of attention, interest, and participation during sessions; and completion rates, reasons for noncompletion, and deselection criteria. If the program scored badly on any of these three points, then the application should provide a clear and convincing explanation of why this

15 1718 LIPTON ET AL. does not matter (for example, that many of the dropouts re-entered the program and eventually completed it). 4. Effective Methods Programs should emploj) methods that have been consistently e8ective with offenders. Whichever efective method(s) are employed the standards necessary for that method to be used properly should be built into the program s design. A number of methods have repeatedly proved effective with offenders. These include cognitive-behavroral techniques grounded in social learning theory and structured therapeutic communities for drug-dependent offenders. A program will be accepted as cognitive behavioral if the primary treatment methods involves an appropriate combination of the following techniques: cognitive restructuring, training in self-monitoring, selfinstructional training, training in problem-solving techniques, role-reversal and role-rotation, modeling, role playing, graduated practice with feedback, contingency management, behavior therapy, and behavior m~dification.~ To count, however, the model of change must justify these techniques using social learning theory and the way in which the techniques are applied to modify criminogenic factors must make sense within social learning theory. The incidental use of some of these procedures when employed within a different theoretical perspective will not be enough to justify describing the program as cognitive behavioral. A program will be accepted as a structured concept-based therapeutic community if it combines: A concept of right living into which the community socializes participants A hierarchical set of phases with entry to later phases dependent on progress in displaying right living Privileges and incentives attached to demonstrated progress A comprehensive set of small groups which work through a structured curriculum examining right living across different life areas Regular small and community groups which examine and challenge participants current functioning in relation to the standard of right living Late-phase participants themselves carrying the concept of rightliving and having a central role in socializing earlier-phase entrants. This criterion is not intended to preclude the use of techniques drawn from other theoretical orientations as long as they are well defined and there

16 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT 1719 is substantial quantitative research evidence that reductions in recidivism are likely to ensue. Thus, if a program does not use either of these methods then the application should provide a combination of theoretical argument and analysis of quantitative research to justify the use of the proposed method with offenders. The GAP will then consider the plausibility of this material. Applications which seek to justify themselves through this route may take more than one GAP meeting to review because the GAP may wish either to carry out their own literature search and review, or to commission independent work of this kind-something which might take place between GAP meetings. Regardless of the method adopted, to be given 2 points on this criterion the program has to involve an appropriate application of the chosen techniques. This would include: Thoughtful integration of the different components/methods used The methods being designed to change both how the offender thinks and to lead the offender to practice the behavioral expression of this new way of thinking Appropriateness of specific techniques to particular treatment target Appropriate instruments being used to measure/monitor the effectiveness with which the techniques are being used Procedures for ensuring that those employing the techniques are competent in their use. 5. Skills Oriented Programs should teach.skills tliut will make it eusirr to avoid criminal activities and to engage sucwssfidly in legitimate oms. Possible examples would include: teaching basic educational skills, e.g., literacy; vocational training; employability skills (that actually leads to attaining and retaining employment); self-management skills; and interpersonal problem-solving, decision-making, and other cognitive skills. Applicants should be aware that teaching a skill is more than merely a matter of providing new information. It involves establishing new patterns of thinking and behaving which increases the ability to cope with situations. Applications for accreditation are asked to describe which skills are taught; how they are taught. including the sequence and duration; the levels of skills imparted; how levels of skills achieved will be evaluated; and how improvement in skills will be assessed.

17 I720 LIPTON ET AL. The applicant is also asked to describe why this skill would make it easier to avoid criminal activities, or to pursue legitimate activities successfully. If the value of the skills depends on the situation to which participants will be released, then the applicants is asked to provide evidence that it is reasonable to expect that participants will be released to those circumstances. 6. Range of Targets Given the complexity of criminal behavior the GAP will be looking for programs that address a range qf conceptually distinct criminogenic.factors in an integrated and mutually reinforcing way. Applicants for accreditation are asked to describe the range of factors addressed in a way that brings out how well they complement each other. If a program concentrates on a narrow range of factors, say, just two, then the applicant would need to provide to the GAP exceptionally clear evidence that they were both powerful criminogenic factors, central to the offending of those taking part in the program, and that participants offending was not subject to other major criminogenic factors. Applicants should also consider the wide range of factors that may be obstacles to an offender developing acceptable social functioning, viz. employment, housing, social skills, mental health, family relations, and drug and alcohol misuse. A particular program is likely to address only some of these problems, but the application will need to explain why the program should be expected to be effective given the range of unaddressed obstacles typical in participating offenders. 7. Dose The amounts, intensity, sequencing, and spacing of treatment should be related to the seriousness and persistence of offending and to the range and seriousness of the criminogenic factors typical of participants. An applicants for accreditation is asked to explain why the amount of treatment provided in the program would be expected to produce sustained effects. Treatment dosage should take into account risk, i.e., the seriousness and persistence of participants offending, and the range of criminogenic factors that they typically manifest. Applicants in their application are asked to consider the following elements: 1. The amount of treatment time provided for each program target. 2. Whether other programs of the proposed length and intensity have affected recidivism when applied to this kind of offender.

18 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT Whether follow-up data indicate that participants show changes in criminogenic factors that are sustained over time. As a guideline, very low-risk offenders, those who have only been convicted for a few minor offenses, should generally not be given a place on programs because the likelihood of their reconviction IS in any case low. Medium-risk offenders, including those who have committed serious offenses, but who do not offend at a very high rate, will probably need something on the order of hours of treatment time, normally over a 46 month period. Highly repetitive offenders may require at least 9 months in-prison residential treatment, preferably months in length, and this treatment is likely to need to be reinforced by a booster program run in the community (see Throughcare section). Applicants are cautioned not to apply these guidelines in a mechanical way. The number of session hours required to achieve sustained change will depend on the specific program methods; on the responsiveness and motivation of the participants; the amount of homework (out-of-session activities) which participants actually engage in; the sequencing of sessions within the program; the phasing of the program such as the amount of time spent on engagement, ongoing treatment, and re-entry planning; the extent to which new learning is reinforced across sessions; and on how well designed the sessions themselves are. Each kind of treatment method specifies its own recommendation or guidelines with respect to content, dosage, sequencing, phasing, ways of sustaining motivation, and reinforcement, so generalizations as to hours or days to be spent on any one or several components are to be viewed only in the broadest sense. 8. Throughcare4 Progress made in prison need.\ to be reinfked and strengthened by rehabilitative effbrt in the community. Effective throughcare is a vital element in rehabilitation. Responsibility for the supervision of prisoners following release lies with an independent agency (the Probation Service). In England and Wales, only those sentenced for 12 months or more are liable to such supervision, which is governed by the National Standards for the Supervision of Offenders in the Community (Home Office, 1995). The Standards state that: Sentence planning forms the basis of effective throughcare. The sentence plan will be drawn up by Prison Service staff in consultation with both seconded probation staff and the supervising officer. The supervising officer should provide information

19 I722 LIPTON ET AL. about the offender s home circumstances, community resources and programs which might be suitable on release. (7.9) All pre-discharge and parole assessment reports should be based on an interview with the offender and should include a risk assessment. (7.19) Reports should also include... a plan of supervision incorporating an assessment of likely response to supervision and proposals for managing this, including frequency of contact... and... the need for specialist license conditionts). (7.23) The supervision plan should be a continuation of the sentence plan and should take into account the work undertaken by and with the offender in custody... The plan should: 0 identify the offender s motivation, pattern of offending, relevant problems/needs, the risk of re-offending or serious harm to the public and the requirements of the license of parole conditions; 0 identify work to be done to make offenders aware of the impact of the crimes they have committed on their victims, themselves and the community; 0 describe the purpose and desired outcomes of the supervision for the offender; 0 set out an individual program which addresses the objectives for supervision and individual circumstances of the case, sets individual objectives for the offender and methods to be tried; 0 identify a time scale for achieving each objective in the program. (7.34) One month before the end of the supervision period the prison will send to the supervising officer for completion a feedback report. This should be completed and returned to the establishment as soon as possible. (7.44). The GAP has therefore defined what would be a minimum acceptable contribution to throughcare as well as indicating what would be desirable. 9. Ongoing Monitoring Programs should have a built-in commitment for monitoring their operations, and correcting and improving their performance when it deviates from required standards.

20 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT 1723 The GAP sees program monitoring and self-correction as a continuous process. The applicant is asked to describe how the program will monitor itself and self-correct as necessary. Thus, the applicant is asked to provide minimum acceptable forms of monitoring and self-correction as part of the program itself. The applicant is asked to cover conditions that support the proper operation of the program, reliable delivery of the program, and the maintenance of treatment integrity. Two kinds of monitoring are required: local monitoring procedures, and KPI 7 program audit. The purpose of local monitoring is to allow management to self-correct problems and improve performance. Such a function is believed to be critical for sustaining effective programs, and the applicant is asked to specify the form it will take as part of the program. KPT 7 program audit is a separate process. Each prison which purports to run an accredited program, and to have it counted under KPI 7, must have an annual program audit which supplies an IQR. The KPI 7 count for an establishment takes into mcozint both the number of prisoners completing the program and the IOR. The KPI 7 program audit process must be agreed to by the GAP. An initial form of this audit will be accepted as part of the accreditation process, but the panel can subsequently require changes in the audit process if they judge that it is not providing adequate information on the quality of implementation. The applicant is asked to specify its forms of monitoring for at least supporting conditions, program integrity, treatment integrity, and throughcare. Supporting conditions include: staff selection procedures; staff training: support and supervision of staft ongoing (booster/developmental) training for experienced staff; clearly defined competencies at which the above are aimed; resources and facilities; reliable availability of staff and inmates; management structure, accountability, and involvement, which includes taking proper responsibility for the proper operation of the program; committed leadership; sufficient priority when resources are tight to avoid sessions being cancelled or disrupted; and availability of an informed and objective consultant to advise managers and those involved in delivering the program on treatment integrity issues. Program integrity includes staff continuity, sessions delivered when planned by appropriate numbers of trained staff, participants attendance at sessions, and program completion rates. Treatment integrity includes competent and appropriate use of the techniques specified; correspondence with the treatment manual; exclusion of materials and activities which might interfere with the intended mechanism

21 1724 LIPTON ET AL. of change; adherence to guidelines for style of delivery; and appropriate selection (inclusion and exclusion) of participating offenders. Applicants for accreditation are asked to provide definitions of the minimum acceptable standards for all of these items, and procedures for checking that these standards are being met. The applicant for accreditation is also asked to specify the way monitoring data will be used locally to improve the operation of the program, including the kinds of institutional mechanisms required. In addition, arrangements for the required annual audit must also be specified. In addition to audit standards, the applicant needs to specify which appropriately knowledgeable and reliable agency, independent of implementing establishments, would do the audit and how audit reports would be provided to the GAP. As noted earlier, where an external contractor provides treatment programming, an external auditor contracted for this by the Program Development unit of the Prison Service conducts the audit. 10. Ongoing Evaluation A commitment to the ongoing evaluation of its effects should be built into the program. To meet this criterion the applicant must specify evaluation studies that will at minimum cover the following: 1. Measurement of changes occuring in prisoners in those attitudes, behaviors or skills which are relevant to the program s treatment targets 2. Quality of implementation 3. Factors influencing response to the program 4. The effect involvement in the program has on staff 5. The impact of the program on re~onviction.~ The GAP will judge if the proposed evaluation research is credible.6 The GAP will also agree to a timetable by which it will need to have received acceptable reports of the various specified studies. At the GAP S discretion, accreditation may be withdrawn from a program if this research is not provided on the required time scale. The applicants for accreditation should specify the minimum acceptable evaluation procedures. Mechanisms for feeding back the results to those responsible for managing and delivering the program should be specified. These should include an annual evaluation report that would be made available to the GAP.

22 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT I725 SCORING THE CRITERIA When the GAP receives an application from a program seeking accreditation, each member reads the application and all appendices, then scores the program according to whether it fails, partially meets, or fully meets each criterion. The program is then given 2 points for each criterion that is fully met, 1 point for each criterion that is partially met, and 0 for each criterion that is not met. Because there are 10 criteria, this means that a program can be given a score which can be anywhere between 0 (all criteria failed) to 20 (all criteria fully met). To be accredited a program must receive at least 17 points. In addition, the program must have received 2 points for criteria 1 (Explicit, Empirically-Based Model of Change); 2 (Targeting Criminogenic Needs); 8 (Throughcare); 9 (Ongoing Monitoring), and 10 (Ongoing Evaluation). The program must also have received at least 1 point for criterion 3 (Responsivity). The GAP interprets the terms fully met, partially met, and failed, as follows. Fully met means that overall, the program is consistent with the flavor and intent of the criterion-there is a reasonably good match to the criterion in most essential respects. Thus to get a fully met rating, a program does not need to perfectly match the criterion in all respects. Panel members pay more attention to the spirit of the criterion rather than trying to apply the criterion definition in a legalistic way. Partially met means that the criterion is met in some respects but that some important aspects of the criterion are not met. Alternatively, it might mean that most aspects of criterion are met to some extent, but only to an insufficient degree. A rating of partially met is also appropriate when the GAP member judges that the intention behind the criterion was being flouted even though in a literal sense it had been met. Failed means that in most important respects the program fails to meet this criterion. It may, for example, show characteristics that are opposite to or contradictory to those specified by the criterion, or it might show a few of the required characteristics but only in a very tentative or inadequate form. The person chairing the GAP will normally nominate at least two members of the panel to consider a particular program in detail and to present their view of the program to the GAP as a whole. The GAP normally seeks to establish a consensus as to wheter each criterion is fully or partially met. In the event of a disagreement, the majority view will be taken. If necessary the person chairing the GAP exercises a deciding vote.

23 1726 LIPTON ET AL. Occasionally, an application has insufficient information for the GAP to determine whether some criteria apply. In that event, the applicant may (1) be advised to submit a new application to the next GAP meeting, (2) accept a visitor from the GAP, or (3) the applicant may be asked by telephone to provide the required information to at least two GAP members who will advise on whether these criteria have been met. After reviewing an application for accreditation, a letter to the applicant is prepared that summarizes the comments of the GAP members on each criterion. The letter also makes recommendations and suggestions to the applicant that may assist in the resubmission for accreditation. In every case in which an applicant has failed to reach the requisite 17 points during the GAP S review, the applicant may resubmit an application for the next GAP review cycle taking into account the detailed comments on each criterion that the GAP provides to the applicant. EVIDENCE FOR THE SUCCESS OF ACCREDITATION Preliminary research data have been gathered by the Offending Behaviour Programme Unit7 of HMPS with the intention of comparing the post-release recidivism rates for programs that have been accredited over the last 3.5 years with similar programs that have not yet gone through the accreditation procedure. The initial findings based on a few programs appear to be quite positive, though it must be noted that the findings are still tentative. The value of accreditation is also evidenced by the adoption of a similar approach by probation services in England and Wales. During , the Inspectorate of Probation, a division of the Home Office with responsibility for scrutinizing the quality of probation services, undertook a thematic review that focused on what works in offender supervision. This entailed a survey of existing probation programs to judge the extent to which they drew on research findings regarding impact of recidivism. The resulting report (Underdown, 1998) has led to the introduction of procedures similar to those created by the prison service, in which specially designed programs are appraised by an independent panel of experts and their quality of implementation is monitored. At the time of writing, it is anticipated that this departure may lead in due course to the establishment of a joint prison-probation accreditation process. Substance Abuse Treatment Accreditation in HMPS With respect to accreditation for treatment of substance users in HMPS, until recently all such programs were monitored by the Prison Health

24 PROGRAM ACCREDlTATION AND CORRECTIONAL TREATMENT 1727 Service. The programs providing such treatment were not provided standardized guidelines nor were they judged by performance-based criteria, and were considered under a separate sphere of governance. However. within the last year the situation has altered considerably with the substance user programming coming under the purview of the Regimes Directorate. Funding for new substance user programs is now being allocated on the condition that they be accredited within 3 years. The new trend in government-imposed accreditation of using perfonlance-based criteria, instead of taking the more traditional route of the study of structures and processes, is likely to also inform substance user treatment accreditation in corrections. Its objectives, while not yet clear in the short term, will likely allow the creation of a system enabling HMPS substance user treatment providers to generate a higher quality of care, informed by research-based information about methods that work with offenders. KPIs for substance abuse treatment will be established, facilitating the standardization of treatment process information, and the collection and evaluation of treatment outcome information with HMPS inmates who have gone through substance user treatment programs. DISCUSSION AND CONCLUSIONS In recent years, with experience maturing in the correctional and health fields, there has been an explosion of interest and activity in the area of accreditation and quality assurance. This phenomenon has been international in scope, and has become particularly relevant where resources are diminishing or where competition for scarce resources has become acute. Greater demands have been placed on health and correctional systems because they have to meet the needs created by population pressures (particularly in third-world countries), new conditions (AIDS, resistant strains of tuberculosis, large proportions of drug offenders), and increasing rates of violent offenders, gang-related and drug-use-related crime. Accreditation activities offer a great deal to such systems because a focus on standard setting, monitoring, and systematic analysis based on demonstrated (research-based) effectiveness combined with the leverage of performance-based criteria can help improve overall system effectiveness as well as improve the performance of primary institutions, be they hospitals or prisons (Brown, 1995). One of the correctional accreditation issues with which we must contend, however, is that currently in the United States, the concept of accreditation does not deal with treatment integrity and quality. but with safety and management systems and procedures. Because of accreditation,

25 1728 LIPTON ET AL. correctional facilities are cleaner, safer for both staff and offenders, and better and more professionally managed... [and] has led to improved living and working conditions in correctional facilities (Branham, 1998, p. 92). Hence, most correctional administrators view the concept of accreditation through a management lens, and even these management standards promulgated by the ACA and other organizations have been under scrutiny. DiIulio (1987), for example, claims: Neither ACA nor any other group has accumulated anything that even remotely resembles a body of proven knowledge about how to manage prisons well (pp ). And,... there is no discernable consensus among correctional practitioners that ACA s voluminous publications and accreditation activities are based on an accurate assessment of how best to operate prisons (p. 249). DeLand (1998), the former executive director of the Utah Department of Corrections, argues that the primary recognized benefit of accreditation has been defense against lawsuits, and even for this purpose the ACA s national standards have been inadequate. He urges the use of internal audits rather than outside accreditation panels, and encourages utilizing the research, competence, expertise, and judgment within each state agency for the development of rational policies and procedures (DeLand, 1998). Thus, there are detractors to using accreditation standards as currently set forth; the image that the word accreditation conveys is tarnished, and itself probably needs rehabilitation. Notwithstanding the lack of consensus or support for accreditation generally in the United States, offender program accreditation as developed in England emerges from a sophisticated research base and borrows its principles from tested academic theories, and from clinical and correctional experience of success. The primary goals of offender program accreditation lie in: Mutual acknowledgment of the value in preserving the integrity of quality programs that have already been developed and are in operation Provision of meaningful, consistent, focused guidelines for innovative program development that target offender needs where there is still limited evidence of what works with these types of offenders Discouragement of continued operation of programs that have no substantiated basis as effective models of intervention for offenders. There is an impressive array of correctional programs and alternative punishments that have emerged over the last 15 years. They have developed in many instances without careful scientific evaluation as to their effectiveness in reducing re-offending, and emerged during a time without an accreditation system in place in the United States. Consequently, some continue to operate on the basis of belief, some on the basis of anec-

26 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT I729 dotal feedback from graduates, and some continue despite a plethora of negative evidence as to their success, e.g., boot camps. Although the lack of evidence in support of boot camps has not entirely discouraged their use as correctional treatment interventions, it has motivated providers to diminish some of their militaristic flavor in order to improve effectiveness, and to introduce components that have clear records of effectiveness in correctional settings, such as the therapeutic community approach and cognitive skill training. Still, as a general rule, there are no accreditation standards for boot camps at any statewide level or nationally. Likewise, programs attempting to be sensitive to certain offender categories such as female offenders and aboriginal offenders have also been developed, but for the most part have never experienced careful scientific evaluation as to their effectiveness, and they certainly have not been subject to examination for accreditation purposes. This is also true for specialized programs such as those for sex offenders, domestic violence offenders, and drunk drivers that have also been developed in the last 20 years. We now have an accumulation of evaluation research outcomes showing which kinds of methods consistently appear most effective. We have, however, no way of ensuring the integrity of the program delivery, the quality of the treatment, its currency with the known best practices, and the training and competence of the service providers. There is an inherent accountability in a model of best practices where program efforts are acknowledged and validated against a meaningful set of criteria agreed to by experts in the field. The public and the government have the right to be reassured that interventions are being implemented according to the best evidence of what works in order to reduce the risk of reoffending. (Porporino, 1997, p. 3.) Offender program accreditation criteria enforced by an expert panel and backed up by an adequately budgeted and thoughtful audit system can help develop programs of excellence and preserve program integrity. The accreditation system can ensure, with the leverage of a set of performance standards supported by senior management, that programs do not deteriorate or stagnate, that they continue to produce effective results, and that the interests of the society and inmate community are both served. For correctional systems to achieve and maintain all of the potential benefits of program accreditation, it should become a routine activity within state and federal correctional agencies. The institutionalization of program accreditation programs with strong audit components is essential. The mechanisms to ensure quality treatment delivery must be integrated into the overall system and the application of performance-based management should be used for leverage. Still the actual implementation of quality control through program accreditation requires much more than the acquiescence and cooperation of the correctional power structure.

27 1730 LIPTON ET AL. Implementation at the state and federal levels requires support from all three governmental branches-the executive, legislative, and judicial. Moreover, support is needed from the media in order to help citizens be more aware of the value of this effort and its implications for greater efficacy and safety. As a head of a state correctional service recently said, There are many positive arguments for accreditation, not the least of which are those that relate to the enhancement of our credibility with the public, the media, legislatures and the courts (Stalder, 1998, p. 2). Even as successful treatment programs require well-trained persons for effective treatment delivery, the value and utility of program accreditation to sustain the effectiveness of offender programs, as well as the methods used in quality assurance, need to be part of the curricula in the academies and schools of higher learning and that train future professionals and policy makers. ACKNOWLEDGMENTS The authors gratefully acknowledge the contributions of colleagues Linda Blud Ph.D., Danny Clark, and Jenny Roberts and the staffs of the General Accreditation Panel and the Offending Behaviour Programme Unit of Her Majesty s Prison Service. This paper reflects the opinions of the authors, and should not be construed as reflecting either the policies or the opinions of the organizations where the authors are employed. REFERENCES ANDREWS, D. A. (199.5). The psychology of criminal conduct and effective treatment. In J. McGuire (Ed.), What Works: Reducing Re-offending: Guidelines,from Research and Practice. Chichester: John Wiley & Sons. BRANHAM, L. S. (1998). Accreditation: An inside look at accreditation. Corrections Today 60(5): BROWN, L. D. (1995). Lessons learned in institutionalization of quality assurance programs: An international perspective. Znt. J. Qual. Health Care 7(4): DELAND, G. W. (1998). Rethinking the value of accreditation. In Point Counterpoint: Correctional Issues (p. 3). Lanham, MD: ACA. DE LEON, G. (1999). Personal communication, March 30, DIIULIO,.I. J. (1987). Governing Prisons: A Comparative Study of Correctional Management. NY: Free Press. GENDREAU, P. (1996). Offender rehabilitation: What we know and what needs to be done. Criminal Justice Behav. 23: HARLAND, A. T. (Ed.) (1996). Choosing Correctional Options That Work: Defining the Demand and Evaluating the Supply. Thousand Oaks, CA: Sage Publications. HOME OFFICE (199.5) National Standards for the Szrpervision of Offenders in the Community. London: Home Office Publications Branch. HUTTON, M. (1998). The KPI files. Prison Service News 16(16.5): 1&11. ICKES, S. J. (1998). Personal communications, July , and November 3, 1998.

28 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT 1731 LIPTON, D. S., PEARSON, F. S., CLELAND, C., and YEE. D. (1997), Synthesizing Correctional Treatment Outcomes: Preliminary CDA TE Findings. Paper presented at the 5th Annual National Institute of Justice Conference on Research and Evaluation in Criminal Justice. Washington, DC, July. LIPTON, D. S. (1998). Therapeutic community treatment programming in corrections. Psychol. Crime Law 4(3): McGUIRE, J. (1996a). Community-based interventions. In C. R. Hollin (Ed.), Working with Offenders: Psychological Practice in Ofender Rehabilitation. Chichester: John Wiley & Sons. McGUIRE, J. (1996b). Cognitive-Behavioural Approaches: An introductory course on theory and research. 2nd ed. Liverpool: University of Liverpool, Department of Clinical Psychology. PORF ORINO, F. J. (1997). Dewloping program accreditation criteria for the Correciional Service of Canada: Issues and suggested approach. Report to International Panel on Accreditation of Correctional Programs, October SCRIVENS, E. (1997). Recent developments in accreditation. Int. J. Qual. Health Care 7(4): SHERMAN, L., GOTTFREDSON, D., McKENZIE. D., ECK, J., REUTER, P., and BUSHWAY, S. (1997). Preventing Crime: What Works, What Doesn t. What s Promising. Washington, DC: Office of Justice Programs. STALDER, R. L. (1998). Accreditation: A Good Value for Corrections. In Point Counterpoint: Correctional Issues (p. 2). Lanham, MD: ACA. THERAPEUTIC COMMUNITIES OF AMERICA (1997). Therapeutic Communities in Correctional Settings: The Standards Development Project. Phase I, Final Report. Washington, DC: Therapeutic Communities of America. UNDERDOWN, A. (1998). Straregiesfor Effective Oflender Supervi,sion: Report of the HMIP What Works Project. London: Home Office. VENNARD, J., SUGG. D., and HEDDERMAN, C. (1997). Changing Offenders Atiitudes and Behaviour: What Works.? (Home Office Research Study No. 171.) London: HMSO. Meta-Analyses and Reviews of Correctional Treatment Effectiveness Studies ANDRES, D. A., ZINGER, l., HOGE, R. D., BONTA, J., GENDREAU, P., and CULLEN, F. T. (1990). Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. Criminology 28: ANGLIN, M. D., and HSER, Y.-H. (1990). Treatment of drug abuse. In M. Tonry and J. Q. Wilson (Eds.), Drugs and Crime (pp ). Chicago, IL: University of Chicago Press. FARRINGTON, D. P. (1983). Randomized experiments on crime and justice. In N. Morris and M. Tonry (Eds.), Crime and Justice: A Review of Research, Vol. I (pp ). Chicago, IL: University of Chicago Press. GARRETT, C. J. (1985). Effects of residential treatment on adjudicated delinquents: A metaanalysis. J. Res. Crirn Delinquency 22: 4: ; and Meta-Analysis of the Efects of Institutional and Community Residential Treatment of Aqudicated Delinquents. Doctoral Dissertation, University of Colorado, Dissertation Abstracts International 45, 2264 (University Microfilms International No ). GENDREAU, P., LITTLE, T., and GOGGIN, C. (1996). A meta-analysis of the predictors of adult offender recidivism: What works! Criminology 34(4):

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30 PROGRAM ACCREDITATION AND CORRECTIONAL TREATMENT 1733 TOBLER, N. (1986). Meta-analysis of 143 adolescent drug prevention programs: quantitative outcome results of program participants compared to a control or comparison group. J. Drug Issues 16(4): TOLAN, P., and GUERRA. N. (1994). Efiecfiveness of Violence Prevention and Treatment Programs. Paper presented at the Annual Meeting of the American Society of Criminology. Miami, FL. WEISBURD, D.. SHERMAN, L., and PETROSINO, A. J. (1990). Registry of randomized criminal justice experiments in sanctions. Rutgers University School of Criminal Justice, 15 Washington Street, Newark. NJ. WELLS-PARKER, E., BANGERT-DROWNS, R., McMILLEN, R.. and WILLIAMS, M. (1994). A meta-analysis of remedial interventions with DUI offenders. Social Science Research Center, Mississippi State University, 103 Research Park, P.O. Box 5287, Mississippi State. MS. WELLS-PARKER, E., and BANGERT-DROWNS, R. (1990). Meta-analysis of research on DUI remedial interventions. Alcohol Drugs Driving 6(34): WHITEHEAD, J. T.. and LAB. S. P. (1989). A meta-analysis of juvenile correctional treatment. J. Res. Crime Delinquency 26: A booster program provides a brief period of treatment (typically less than 2 weeks long) to clients after they are released from institutional custody, usually for the purpose of rein forcing program teachings and philosophy. Criterion 1 is Explicit, Empirically-Based Model of Change, 2 is Targeting Criminogenic Needs, 3 is Responsivity, 8 is Throughcare, 9 is Ongoing Monitoring, and 10 is Ongoing Evaluation. A fine source for the distinctions among these treatment methods and techniques may be found in McGuire s Cogni/ivr-Behaviourcrl Approaches (1996b). Throughcare as used in the United Kingdom is what is called in the United States both aftercare and parole, and is carried out by the county probation services. Criminologists generally conclude that in the aggregate, rearrest is the most reliably reported measure of recidivism, notwithstanding the wide gap between offense and arrest. Although some individuals are innocent of the crime charged, using only reconviction or reincarceration understates the true recidivism rates because of those who reoffend, not all are arrested, prosecuted. go to trial, or become incarcerated. Nevertheless, the GAP chooses to use reconviction rates just because it is a more conservative measure. eliminating acquittals, discharges, and nol-pros from the numerator. Rearrest figures are also vulnerable to the police rounding up all the usual suspects. The GAP takes into account that various types of changes have different temporal demands. Formerly called the Programme Development Unit. Richard L. Stalder is Secretary of the Department of Public Safety and Corrections for the State of Louisiana. THE AUTHORS Clive R. Hollin received his Ph.D. in Clinical Psychology, and then worked as a prison psychologist, and taught at the Universities of Leicester and

31 1734 LIPTON ET AL. Birmingham. He now holds a chair in Criminological Psychology at the University of Leicester. His research focus is the treatment of offenders. He sits on several accreditation panels concerned with treatment programs to reduce offending. He has published 150 academic articles and 15 books, and edits the journal Psychology, Crime, & Law. Douglas S. Lipton directed research for the New York City Department of Corrections, served with several state agencies focusing on offender treatment, directed drug abuse research for New York state, and served as director of NDRI of New York city where he (and Frank Pearson) completed a comprehensive meta-analysis of 30 years of correctional treatment studies, and directed the national evaluation of prison substance abuse treatment programs. He has written more than 200 articles and 6 books in this field. He is on the new Joint Accreditation Panel in the United Kingdom. James McGuire directs the Clinical Psychology training program at the University of Liverpool. He obtained his doctorate from University of Leicester, and taught at several universities. He carries out assessments of offenders for criminal courts and has conducted research in prisons, probation services, adolescent units, and secure hospitals on the effectiveness of offender treatment. He consults widely and serves on the HMPS Accreditation Panel. He is author of 7 books and more than 60 publications. Frank J. Porporino has served the correctional field for 25 years. He began as a prison psychologist and after receiving his Ph.D., rose to be Director General of Research for Correctional Service of Canada. He introduced Reasoning and Rehabilitation Program throughout Canadian corrections. Upon retirement, he formed a training company, T3 Associates, that disseminates the reasoning and rehabilitation model, and does research and technical assistance. He has been a member of the HMPS General Accreditation Panel since its outset. David Thornton holds a Ph.D. from University of Exeter, and has worked in forensic psychology since 1972, specializing in risk assessment and in the evaluation of correctional programs. Since 1990, he has led HMPS team responsible for developing and implementing correctional programs throughout England. He also consults for police and probation services, and for similar organizations in the United States and Canada. He has guided the development of program accreditation in both England and Canada.