Evidence Based Sex Offender Treatment: Applying the Responsivity Principle Seth L. Wescott, LMLP Bruce M. Cappo, Ph.D., ABPP April 11, 2014 Overview Responsivity defined Impact on treatment Clinical Associates Non Traditional Treatment Outcome Data & Further areas of study 1
Origins of Risk/Need/Responsivity Andrews & Bonta (1990) What Works model of correctional treatment Risk Match the Level of Intervention to Level of Risk (Who) Need Assess and Target Criminogenic Needs (What) Responsivity Deliver Treatment Consistent with Strengths, Learning Style, Motivation, Personality of Offender (How) My spellcheck doesn t like responsivity Factors that affect treatment success Intelligence Cognitive Abilities Motivation Denial Cognitive Distortions Mental Health Issues/Diagnoses (Psychopathy) Culture (and subculture) Language 2
Common mistakes Treatment providers often misinterpret responsivity issues as risk factors Empathy Denial Motivation Treatment providers often focus on responsivity issues instead of risk issues Offenders who present with responsivity issues are not necessarily high risk Resistance should be embraced as a natural part of the process Treatment Suffers Responsivity Issues Resistance Treatment Failure 3
When a Responsivity Issue Arises Treatment may become oppositional & adversarial Models & Reinforces unhealthy communication Group members may fear disclosure Group is de railed from primary objectives & re focused on the shiny object of The resistance becomes the focus Predictors of Sexual Recidivism Predictors of Sexual Recidivism: An Updated Meta Analysis (Hanson & Morton Bourgon, 2004) Ruth Mann, PhD; R. Karl Hanson, PhD; David Thornton, PhD ATSA 2008 4
Predictors of Sexual Recidivism Predictors of Sexual Recidivism: An Updated Meta Analysis (Hanson & Morton Bourgon, 2004) Ruth Mann, PhD; R. Karl Hanson, PhD; David Thornton, PhD ATSA 2008 Treatment Failure is Usually Predictable Reluctant Angry Cynical Oppositional/Defiant Failure 5
Possible Candidates for a Non Traditional Approach Individuals with high psychopathy Individuals with a significant history of: Past treatment refusals Past treatment drop outs or terminations Excessive manipulation/triangulation of treatment or management staff Predatory behaviors Repeated violence within the institution/diverse criminal history Poor institutional behavior (excessive disciplinary reports) Intimidation of peers or staff Especially heinous/violent crime The Issue Surfaces Pre Treatment Assessment Record review, initial interview, collateral information During Treatment Behaviors Responsivity issues manifest in group Control the group, Intimidate others Act as the expert, leader, alpha Voice displeasure easily/stay silent (let their body language do the talking) In either case, decision is made to alter the course of treatment 6
Time for an Intervention Meeting with a management staff member Frame the meeting as an attempt to determine treatment needs Gauge the client s investment, engagement, responsivity issues Allow the concept of non traditional treatment to be the client s idea Re frame treatment toward a business like approach Key Components Individualized Engagement Task Focused 7
Clinical Associates Facility Based Non Traditional Sex Offender Treatment Program September 2011 March 2014 First used with clients who had elevated Psychopathy Applied to clients who struggled with: Engagement Motivation Hostility Clinical Associates Outcomes FY12 FY14 Total Number of Participants Discharged 487 Total Number of Program Completions 452 (93%) Total Number of Traditional Program Completions 387 (80%) Total Number of Non Traditional Program Completions 65 (13%) Total Number of Custody/MH Transfers 35 (7%) Total Number of Terminations 0 8
Components of Non Traditional Treatment What it is Individualized Shorter in duration Task Focused Matter of fact What it is not A Privilege A Fast Track Insight Oriented Traditional Therapy Goals of Non Traditional Treatment Keep the client engaged Focus on criminogenic behavioral changes so that they may live their life without legal interference and reduce problems 9
Tasks to be completed/expectations Autobiographical Timeline Instant Offense Processing Sexual History Processing Sexual History Disclosure Polygraph Successful Living Plan Identification of Criminogenic Risk Factors Identification of Strengths, Skills, Support Not Included in Non Traditional Treatment Cognitive Programming such as Thinking for a Change (T4C) Group Therapy or Group Processing Abstract concepts such as: Empathy Denial 10
Non Traditional Format Clients are seen once a week for two hours Sessions are scheduled so as to not interfere with traditional treatment (lessens distractions) Sessions are structured, with an agenda Clients work at their own pace, no timeframe as long as they remain engaged Resist the urge to put them back in a group Therapeutic Approach Therapist has specialized training in psychopathy and special populations Motivational Interviewing Features that enhance engagement Empathy, warmth, respect Open ended questions Flexibility Consistency Confidence Fairness 11
Individualized Treatment Therapist provides feedback on assignments/tasks Minimal efforts to elicit introspection Processing is used to determine/find coping strategies, problemsolving skills, pro social ways of living Discharge from treatment (completion) occurs following the completion of all necessary program requirements (no benchmarks) Discharge Recommendations Typically include a Non Traditional Community Based Referral Client meets with the therapist and occasionally the parole officer Treatment is individualized and focused on criminogenic risk factors Maintenance and monitoring polygraphs used to ensure compliance May include referral for other services (substance abuse treatment) Includes management strategies while incarcerated 12
Clinical Associates Slot Utilization * Projected by end of FY14 Areas of Further Study Survival Statistics Community Based Follow Up for 1, 3, 5 years Community Based Non Traditional Treatment How much treatment is enough? Analysis of Tasks/Components of Non Traditional Treatment Should there be a minimum threshold for completion? 13
Questions Seth L. Wescott, LMLP wescott@clinical assoc.com Bruce M. Cappo, Ph.D., ABPP cappo@clinical assoc.com Clinical Associates, P.A. 8629 Bluejacket St Suite 100 Lenexa, Kansas 66214 913 677 3553 913 6773 3282 fax 14