“Catching People Doing Things Right”
(c) 2004, Robert Crumb. All Rights Reserved.
c) 2004, Robert Crumb. All Rights Reserved.
Collaborative Behavioral Management for Drug-Involved Parolees:
Step’n OutRhode Island Research Center – Peter Friedmann, Magdalena Harrington, Traci C. Green, Jennifer Clarke,
Randall Hoskinson.Advancing Correctional Excellence, George Mason University – Faye Taxman, Anne Giuranna Rhodes.Connecticut Research Center – Linda Frisman, Mark Litt, Susan Pease, Eleni Rodis.Mid-Atlantic Research Center – Dan O’Connell, Steven Martin, James Inciardi.Pacific Coast Research Center – William Burdon, Michael Prendergast. National Institute on Drug Abuse – Bennett Fletcher.Friends Research Institute – Elizabeth Katz
CJ-DATS is funded by NIDA in collaboration with SAMHSA, CDC, NIAAA, and BJA
Benefits of Integration Uncertain in Community Corrections
• Widely assumed integration is good• Integration will increase intensity of supervision
– More contacts (directly or indirectly)• Literature on intensive parole supervision (Petersilia &
Turner, 1993)
↑surveillance ⇒ ↑detection of technical violations ⇒↑sanctioning ⇒ ↑revocation*
• For integration to work, POs need behavioral management tools other than just sanctions
*(DSMB monitored closely in Step’n Out)
Collaborative Behavioral Management (CBM)
• Parole more meaningful if based on theory and evidence, not just surveillance and punishment– Translate NIDA’s community reinforcement approach to give POs
tools to reinforce pro-social behavior– Translate role induction principles to align & coordinate parole
with addiction treatment• Apply rewards and sanctions fairly & consistently
– Currently, rewards are foreign to parole culture– Adversarial relationships and parolees’ perception that the
system is “out to get them” does not facilitate behavioral change• Rewards related to recovery serve as bridge reinforcement
until natural reinforcers (e.g. paycheck, etc.)
Theoretical Foundations• Role Theory
– Integration ⇒ ↓ discrepant expectations • Procedural Justice Theory
– Clear, fair and equitable rules ⇒ ↑ compliance• Learning Theory
– Reinforced behavior is repeated– Reinforcement ideally immediate & reliable
• Collaboration ⇒ ↑ immediacy & reliability of reinforcers
Basic Principles of CBM• Agreement among all parties about most
important goals• Weekly behavioral contract with client for
target behaviors– Help client plan and take small, feasible steps
towards goals• Focus on good behavior and reinforce it
– “Catch People Doing Things Right”• Apply rewards and sanctions fairly and
consistently
Target Behaviors
• Four levels– Red: Target behaviors directly related to public
safety (i.e. lead to immediate arrest)– Orange: Target behaviors related to substance use– Yellow: Target behaviors directly related to achieving
abstinence (e.g., session attendance)– Green: Target behaviors that support recovery
• Differ in the extent to which they receive rewards and sanctions
Technology•Organize key information for managing offender progress•Provide decision support (eg. reminders, suggest rewards, etc.)•Minimize human limitations: memory, conflicting perceptions, etc.•Improve fidelity
Rewards
Points
GREEN
YELLOW
ORANGE
RED
Compliance
Points Accelerate with Continuous Compliance
0
50
100
150
200
250
Max. points /objective
Max. points /week
Max. totalpoints
1 2 3 4 5 6 7 8 9 10 11 12Week of CBM
0
10
20
30
40
50
60
1 2 3 4 5 6 7 8 9 10 11 12
Points Earned
Small Material Reward
Medium Social Reward
Week
Small Social Reward
No.
Acc
umul
ated
Poi
nts
Medium Material Reward
Graduated Rewards
• Local authorities approved menu of rewards relevant to recovery
• Offender selects rewards that are meaningful to him/her
• PO/counselor give rewards at point milestones
Graduated Rewards: SmallSocial Material
•Public recognition of client with cake•Coffee while client waits for drug screen•Help from PO in searching want ads•Ask family member to cook favorite meal•Assistance with job application•Comfortable chair in group session•Ride to treatment•Reduce wait time to see PO•Handwritten letter from PO and counselor specifying accomplishments to date•Handwritten letter from parole supervisor and/or treatment program director specifying accomplishments to date•Telephone call from PO / counselor to partner, parent, friend to say how well she/he is doing•Telephone and quiet space to call re: jobs
•Bus tokens or passes•Manicure or haircut•Gym pass•Gift certificate for phone card•Voucher for toiletries•Gift certificate for meal w/ children•Condoms•Food before group•Long-distance call from office•Candy bar•Toys, diapers, baby food•H/C gift certificate•Gift certificate to take sponsor for coffee or lunch•Gift certificate for gasoline•Purchase of fine paper for resume
or cover letter
Graduated Rewards: MediumSocial Material
•PO attends 30 day chip ceremony at AA•Organized group outing honoring client•Recognition Circle (PO, counselor, others present handwritten notes of recognition)•Opportunity to act as Group Leader•Designated parking for “Client of the Week”•Come to staff meeting & give feedback•Methadone take home privilege•Out of state travel•Mock interview to practice interviewing skills•Certificate of Attendance at treatment•Call from the PO to the client’s partner or friend asking them to give a massage•Step’n Out medallion•Secretary time to type resume/cover letter•Different format of contact (e.g., phone contacts alternating with in person contacts)•“Bye” week (i.e., miss a single session or urine test without consequences)
•Waiver of supervision fee•Access to a personal trainer•Gift certificate for shoes/apparel•Tickets to a sporting event•Gift certificate for child care•Magazine subscription•Monetary help for driver’s license•Rebates for treatment•Tickets to take children to zoo•Partial payment of rent or utilities•Gift certificate for groceries•Partial payment toward equipment for work or books for school•Payment toward clothes for interview•Partial payment of tuition for GED or other training program•Partial payment for prescribed medications or doctor’s visits•Partial payment of fines or restitution
Graduated Rewards: LargeSocial Material
•Letter to Department of Children and Families reporting progress in treatment•Letter to Judge or Parole Board requesting that a specific condition of parole be relaxed (e.g., that the client be released from home monitoring)•Certificate of program completion (“aftercare diploma”)•Letter from Judge, Parole Chair, or a Senior Correctional Officer (with a copy in file) commending for perfect or near perfect attendance to date•Decrease reporting frequency•Decrease frequency of UA testing
NA
Non-compliant
Reward
Point
Graduated Sanctions
Problem-Solving
Enter ResetPeriod
Arrest/Revocation
GREEN
YELLOW
ORANGE
RED
1
HeldNon-Compliance
Graduated SanctionsInfractions in 30 days Examples
One •Verbal Reprimand•Written Documentation
Two •Written Reprimand•Increased UA screening
Three •Tighten Curfew•Modify Treatment Conditions
Four •Electronic Monitoring•Daily Reporting
Five •Intensive Treatment Required•Report to Parole Board
Sanctions reset after two weeks of full compliance
Step’n Out Study Design
Informed Consent, Baseline Interview, Randomization
Screen: 12+weeks parole w/drug treatment mandate, moderate-to-high risk recidivism
CBM•Co-located team approach –initial & biweekly triad session•Initial session role induction•Weekly behavioral contract•Points and rewards with reset (SNOCONE)•Graduated sanctions
Traditional Parole•Separate parole and treatment according to local standards•Usual sanctions
3- and 9-month follow-up interviews, chart and admin. data
Sites
Final NWilmington, DE 258Bridgeport, CT 74Portland, OR 69Richmond, VA 85Providence, RI 32Hartford, CT 51
Final Recruitment
Screened 623Randomized 569Reached Initial Session 4763-month FUs: 437 (91.8%)9-month FUs: 325 (85.1%)
Study Population CBM Control
Mean Age 34 34Male 83% 81%White 55% 58%LCSF high risk 63% 62%Lifetime -arrests 11.2 (11) 11.8 (14)-treatment episodes 2.6 (2.9) 2.2 (2.2)
Primary heroinPrimary stimulant
24%27%
22%26%
Modeling Count Data
• Siméon-Denis Poisson in 1838 work “Research on the Probability of Judgments in Criminal and Civil Matters“– Assumes sample mean and variance are equal
• The negative binomial distribution is an alternative to the Poisson when varianceexceeds the sample mean– Much more conservative approach subject to Type
II error
Variable N Mean VarAll Crime 428 9.98 1085
Violent 428 0.556 51.8Property 428 0.474 22.6
Primary Drug
396 9.23 1005
Challenging Data Modeling
Overall Crime
1911
52
2495
58
‐250
250
750
1250
1750
2250
2750
Crimes committed People engaged in crime
Self‐reported criminal involvement over 9 months follow up
Coun
t
intervention
control
RR .79 ZIP; P<.001RR .75 ZINB; P=.49
Violent Crime
7 4
231
5
0
50
100
150
200
250
Crimes committed People engaged in crime
Self reported crime over 9 months follow up
Coun
t
intervention
control
RR .04 ZIP; P<.001RR .01 ZINB
P for ZINB=.002, alpha is NS, so ZIP model is OK
Property Crime
17
6
186
12
0
20
40
60
80
100
120
140
160
180
200
Crimes committed People engaged in crime
Self reported crime over 9 months follow up
Coun
t
intervention
control
RR .18 ZIP; P<.001RR .08 ZINB
P for ZINB=.01, alpha is NS, so ZIP model is OK
Primary Problem Drug Use
1377
40
2280
46
0
500
1000
1500
2000
2500
Days of drug use People reporting drug use
Coun
t
intervention
control
RR .67 ZIP; P<.001RR .71 ZINB; P<.43
Gender interaction*:1) women reduced more than
men 2) women in the CBM group
reduced more than men in CBM and control groups.
*CAUTION!: Small Ns and effect driven by the heavy drug use in the tails of the distributions
Marijuana Use
1329
37
1816
41
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Days of drug use People reporting drug use
Coun
t
intervention
control
RR .74 ZIP; P<.001RR .70 ZINB; P=.49
Opiate Use
1230
33
1449
29
0
200
400
600
800
1000
1200
1400
1600
Days of drug use People reporting drug use
Coun
t
intervention
control
RR .80 ZIP; P<.001RR .85 ZINB; P<.76
Stimulant Use
2110
59
1549
51
0
500
1000
1500
2000
2500
Days of drug use People reporting drug use
Coun
t
intervention
control
RR 1.20 ZIP; P<.001RR 1.19 ZINB; P=.65
Parole Violations
0
1
2
3
4
Mean no. parole
violations/100 days at
risk
3 month 9 month
Control CBM
CBM Integrated & Intensified Parole
same day parole and treatment(2.2 vs. 1.2 days)†total parole sessions (13 vs. 10)*face to face parole (9 vs. 8)†
*P<.10 compared to traditional parole group†P<.001 compared to traditional parole group
CBM Improved PO-Client Relationships
At 3-month follow-up, parolees reported:relationship with PO*
PO Probationer relationship scale45-item measure of offender perception of relationship with PO (Skeem and Taxman, in press).
therapeutic alliance with PO and counselor*Working Alliance Inventory: 14-item measure of therapeutic alliance (Horvath & Greenberg, 1989)
*P<.001 compared to traditional parole group
CBM Feasible and Acceptable
• Adaptable to local standards– Delaware adapted to group contacts– Rewards approved locally to suit local standards
• perception of value of direct collaboration• Helped PO see importance of communication
– few had thought about this as an issue • e.g. telling offender what to do vs. helping them learn to do it
• Contract provides structure / dialogue for contacts• Decision support systems helpful, but need
improvement
Promising Intervention
• Evidence-based contracting, CRA/CM can be adapted to CJ settings
• Lower than expected event rates– Research volunteer effect– Decreased study power
• Among those who re-offend, CBM:crime, primary drug useparole intensity with no change inviolations or arrests
rapport and therapeutic alliance
• Integrated parole/treatment feasible and acceptable
• Community supervision practice can be based on sound theory and evidence
• PO-parolee relationships crucial to reentry– CBM shows one way to facilitate better
therapeutic alliance• Research needed to examine impact of
CBM with evidence-based treatment
Implications