Michael P. McGrath
U.S. Probation
District of North Dakota
WITH UNPRECEDENTED NUMBERS of offenders captured in the criminal justice system, correctional agencies throughout the country look for methods to reduce their respective offender populations. Although historically confined to the academic realm, an established and growing body of literature supporting “what works” offers to correctional agencies empirically tested and specific interventions to assist in recidivism reduction. Each correctional agency is encouraged to examine the characteristics and composition of its particular situation and incorporate evidence-based practices (EBP) accordingly. Notwithstanding the efficacy of this approach, agencies still face the difficult task of implementation as each state and/or jurisdiction presents unique characteristics and challenges. Much like correctional interventions implemented on the individual level, a “one-size fits all” approach is not always realistic or even effective at the agency or system level.
Rural districts such as North Dakota have characteristics and challenges that must be overcome when implementing effective programming. Obvious factors like physical distance and isolation, lack of resources and potentially unique cultural and social dynamics may affect not only the rural offenders but also those who work in their reentry. Nested within many of our most rural and isolated areas in North Dakota are Native American reservation communities where much of our supervision activity is done, and implementing programming to meet their needs was also considered in incorporating EBP. The “rural issues,” however, should not discourage districts and agencies from forging ahead.
In 2007, the District of North Dakota, through the Research to Results (R2R) initiative of the Administrative Office of the United States Courts, received funding to implement evidence-based programming to meet the needs of our particular situation and offender population. The implementation of Cognitive Behavioral Therapy (CBT) was identified as the subject of our efforts and our “rural issues” gave rise to an unique approach to implementation. The lessons learned will hopefully encourage others and provide a blueprint, especially for those rural districts similar to North Dakota, to embrace evidence-based solutions for our very important problem.
Assessing the District of North Dakota
The body of literature outlining EBP identifies specific correlates of crime that present risk for recidivism (Andrews and Bonta, 2006). Correctional agencies can respond to the risk by targeting individuals most likely to offend with a response that addresses their most glaring need(s) (Cullen and Gendreau, 2000). Criminal thinking is one such factor that places an offender at risk to recidivate. Our cognitive structure is created by beliefs, patterns, and attitudes. More importantly, this structure influences behavior. Those who commit criminal acts possess a cognitive pattern that directs and reinforces their behavior; some offenders may believe certain behavior is normal and acceptable even though it violates social norms and/or laws (Taxman, Shepardson and Byrne, 2005). Probation officers often recognize these offenders who lack empathy toward their victim(s) and/or maintain a sense of entitlement. Not surprisingly, these offender types also have difficulty following court-ordered conditions. More importantly, their risk to re-offend, at least as measured by their cognitive structure, may not have changed as the term of supervision ends. Fortunately, criminal thinking patterns can be changed through CBT and the course of supervision presents an opportune period to see this through. Although the formats for CBT may vary, the aim is to restructure the criminal thinking pattern underlying criminal behavior. The older thoughts, feelings, and emotions associated with criminal behavior are replaced with those of a more prosocial variety (Cullen and Gendreau, 2000).
Generally, CBT is facilitated in a group format, which has proven to be quite effective (Wilson, Bouffard and Mackenzie, 2005). In fact, many of the R2R proposals included the implementation of CBT through a group format and this will prove beneficial to our system. This approach, however, does not necessarily suit all learning styles and/or personalities. These individual traits and characteristics are an important consideration when responding to risk (Andrews, Bonta and Hoge, 1990), and if not accounted for may impede effectiveness. For example, Listwan, Sperber, Spruance and Voorhis, (2004, p 6) suggest a group setting is not necessarily effective for all offenders as “the pressure of performing skills in front of peers and coaches who routinely evaluate and provide feedback on the use of the skills may further exacerbate anxiety.” They suggest that alternative methods for CBT need to researched sufficiently and made available. This does not suggest that a take-home study should replace a CBT group; rather, new approaches should be explored, not only to address the needs of certain offenders, but also those of correctional agencies that may, based upon unique circumstances, find it necessary to adopt alternative approaches. In any case, what appears to have emerged from the literature is that no single program or format necessarily stands above others; rather, the effectiveness of CBT rests upon certain underlying principles (State of Connecticut, 2005).
In addition to addressing personality traits that can impede effective responsivity, correctional interventions must consider ethnic and cultural differences (Andrews and Bonta, 2006). Correctional treatment approaches that attend to the specific customs and beliefs of Native American offenders are indeed rare. Utilizing approaches that build upon or promote cultural strength was important in our efforts, since one-half of the offenders in the District of North Dakota are Native American.
Perhaps most importantly, CBT groups that address criminal thinking are simply not available in many rural areas. Robertson (1997) suggests treatment availability, in general, may vary with community density and proximity to larger urban areas. The lack of available treatment options is exacerbated the more “rural” one gets, and for many North Dakota communities, and the reservations in particular, treatment options in general simply do not exist. In fact, the lack of CBT options was cited among North Dakota re-entry stakeholders as especially problematic. Further, lack of public transportation in rural communities is an obvious roadblock for offenders (Cebulak, 2004) and the issue surfaces consistently in the District of North Dakota.
Even with a specific program like CBT available, an effective group relies upon a skilled and experienced facilitator and willing participants. Rural areas are less likely to find and/or recruit effective treatment providers in general, and more importantly, unable to provide all of the necessary responses to address offender need (Wodahl, 2006). In many cases, officers often assume additional roles as they attempt to “fill in the gaps” of service (Weisheit, Falcone and Wells, 1994).
Additional factors unique to rural areas, such as close social connections among community members, might also discourage the use of treatment interventions by rural offenders (Wodahl, 2006; Weisheit, et al, 1999). Perhaps this issue is also important in reservation communities that are not only rural in nature, but also underpinned by different social, cultural and political factors. Clearly, the rural issues provide challenges for the officer, treatment provider, and offender when specific interventions are needed; this is especially the case when diverse populations exist in those rural areas. This does not, however, absolve districts or officers from familiarizing themselves with and implementing effective recidivism-reducing strategies.
Implementing CBT
To address the needs of its unique offender population, the District of North Dakota applied for and received funding to implement CBT. Our issues were twofold, addressing the needs of rural offenders in general, and specifically Native American offenders, who are nested inside of these rural areas. In response, the District of North Dakota contracted with the American Community Corrections Institute (ACCI) to provide the Adult Cognitive Life Skills Home Study Course.
This particular workbook incorporates historical fiction to demonstrate and adjust problematic thinking errors that often result in criminal behavior. Utilizing approaches that rest upon cultural strengths might be ideal especially for diverse populations and this approach was definitely considered when addressing our need to incorporate CBT. The workbook appeared an appropriate complement to the traditional story-telling methods important in Native American culture. Narratives are accompanied by a lesson or exercise meant to restructure and/or replace problematic thinking patterns. Units in the manual include: 1.) The Subconscious Mind; 2.) Crime and Laws; 3.) Human Needs; 4.) Anger Management; 5.) Consequences; 6.) Relationships; 7.) Leading and Managing Life; 8.) How to be Happy and Successful in Life; 9.) How to Change and Improve Life; and 10.) Drugs and Alcohol.
The course is meant to be completed with a coach or mentor, which is also a traditionally practiced approach in Native American healing (Archambeault, 2006). Using mentors or positive support structures might also address other risk factors. The ACCI Cognitive Life Skills Workbook was further attractive because of its apparent cost-effectiveness; the cost per booklet is less than $100. This is an especially important consideration in EBP implementation given the millions of offenders currently in the criminal justice system.
Wilson et al. (2005) suggest fidelity to the program has an important effect on the outcome for offenders. The obstructions to an effective group, such as problematic participants and quality facilitators, do not appear to be at issue with this format. Probation officers need only identify then refer the offender and the number of participants that can be simultaneously enrolled is unlimited. Further, research suggests that community-based interventions will increase the effectiveness of treatment and this program can be completed either inside and/or beyond the walls of an institution (Milkman and Wanberg, 2007). The ability to provide offenders with effective interventions in their community, especially where protective factors might exist, is important in our re-entry efforts. With this in mind, the benefit of placement outside of the community should be weighed against the overall recidivism-reduction effect, and this makes effective intervention difficult in areas with limited EBP options.
Evaluation and Results
In order to measure the effectiveness of the manual(s), the Texas Christian University Criminal Thinking Scale (TCU CTS), as approved by the Administrative Office, was administered before and at completion of the ACCI home study course. This scale consists of 37 questions designed to measure criminal thinking patterns in areas that include: entitlement, justification, power-orientation, coldheartedness, rationalization, and personal irresponsibility. If the program has been effective, offenders should record lower scores at the completion of the home study course. That is, participant criminal thinking, as it relates to the above-described areas, will have been reduced.
The preliminary results are promising, with reductions in each of the identified criminal thinking pattern categories of the TCU CTS. For example, in the area of entitlement, a reduction of 1.3 is recorded with the mean score for the pre-test of 17.0 and the post-test 15.7 (n=50). Similar results in other areas are also recorded: justification (2.5 reduction); power-orientation (1.3); cold-heartedness (2.3); criminal rationale (.9); and personal irresponsibility (2.2).
Also important in our evaluation were the positive responses from both participants and coaches alike. For example, one participant writes, “this workbook should be given to every criminal, every drug user, every person stuck in neutral in life.” Moreover, most participants indicated they would recommend this program to others. Evaluations from coaches/mentors have also shown encouraging results. One participating coach suggests the manual “is an amazing self-realization of your past, present, and possible future...it allows the user to reflect on thought and encourages healthy thought processes.”
Implementation Issues
Reiterated throughout the EBP literature is the importance of examining areas of implementation that can be improved upon. It is also important to share, with others, those programs that hold promise and how to best implement these; this is essentially the motive behind the R2R initiative. Although no area in particular slowed or was especially problematic in the implementation of the CBT, we recognize areas where improvement is needed, including: selection or identification of participants, a determination of the dosage each booklet provides and whether it meets the need of the offender(s), and addressing motivation to engage in and complete the manuals.
To refer an offender for an intervention meant to address criminal thinking, a problematic pattern in that area must be assumed. Currently, selection of participants is done without the assistance of an actuarial risk assessment instrument. Although this appears to place the “cart before the horse,” it became important in our situation to test the criminal-thinking manuals because of the above-described issues regarding the availability of rural intervention(s). We identified criminal thinking and CBT as a fairly common risk and intervention and used intuitive indicators of criminal thinking (such as criminal history). We do, however, recognize the importance of a risk/needs assessment in its ability to identify specific need (Andrews and Bonta, 2006). Additional booklets available through ACCI that address other criminogenic need(s) are also under exploration with an anticipation that the risk/needs assessment will identify specific risk areas and various manuals would be used in response. Historically, in this and many other districts, previous efforts at risk reduction have generally centered on what was available rather than what was needed. Officer familiarity with CBT and recognition of offenders’ needs are issues that must be overcome through both staff development and continued EBP implementation.
Once a criminal thinker is identified and the referral made, we cannot be certain what amount or dosage the booklet provides. Specific research questions that may be addressed include: Is the home-study an adequate replacement for a CBT group? Is it an effective approach for an offender with substantial or moderate needs in this area? Would the manual best serve a preparatory function for, or, in conjunction with a group itself? In short, we must ensure that the right amount of intervention supplied meets the need of the offender. These and other areas can be explored with the implementation of a risk assessment tool and as additional insights into this and other R2R initiatives are examined.
Notwithstanding the pleasantly surprising completion rates of this program, the issue of motivating offenders for this and any intervention for that matter, remains a fundamental concern for correctional agencies. Ambivalent attitudes toward change may be explored through “Motivational Interviewing(MI)” (Walters, Clark, Gingerich and Meltzer, 2007 ). This approach enhances motivation to change and should be explored as a means to improve participation and completion rates of the CBT program. In fact, the next step in our ongoing effort to incorporate evidence-based techniques into our practice includes the introduction of MI.
Coincidentally, MI is an approach that is especially interesting to the District of North Dakota as it appears to complement many Native American cultural values (Venner, Feldstein and Tafoya, 2006; Tomlin, Grover and Arquette, 2006). These core values emphasize listening, learning, and respect of others. Moreover, MI might enhance other traditional healing methods consistent with the principles of restorative justice (Tomlin et al., 2006). MI remains a promising strategy to use with offenders in general, and could eventually become a preferred approach to dealing with Native American offenders. Given the importance of motivating offenders to engage in change behavior and the important agency-level implications MI supports, the District of North Dakota, through the R2R initiative, will implement MI in the spring/summer 2008.
Continued Research and EBP Implementation
Historically, the question of whether “something is better than nothing” has emerged in our efforts to provide effective intervention within a rural probation setting. With the implementation of EBP, introducing effective and proven interventions that address specific offender need is the desired approach. Availability issues will undoubtedly persist because of the very nature of rural criminal justice. Systems, agencies and officers must adjust accordingly. Wodahl (2006) suggests that “policy-makers recognize the need to improve the availability of treatment services in rural areas” (p. 42). Perhaps inmates from rural areas should be targeted and prioritized within the prison systems, knowing that resources might be scarce at their re-entry point.
In the meantime, the above-described “rural issues” are not presented to excuse rural districts from utilizing evidence-based interventions that will reduce recidivism in their communities. Rural districts should look to the strengths of their situation and staff and use these elements to leverage effective offender programs and develop officers accordingly. For example, although rural districts are often defined by fewer numbers of officers, perhaps this allows the agency to mobilize and implement EBP programming and skill-sets more efficiently. Officer competency and “buy-in” of the EBP correctional principles might be one of, if not the, largest hurdle to overcome as the system moves forward. Officers might also harness the powerful, informal social controls that may exist in rural areas to provide not only effective collateral sources, but also environments conducive to offender change. To this end, it is essential that officers develop a fundamental knowledge of EBP and change models. In fact, rural correctional officers may require “more diverse training in order to fill in the service gaps of the communities they serve” (Wodahl, 2006, p 42), and training has definitely become a major undertaking in the District of North Dakota.
As we continue the implementation of the ACCI Lifeskills Workbook(s) and other EBPs, we recognize the importance of examining and developing insight into the above-described implementation issues. A host of new and important research questions have surfaced that may be addressed in the future. For now, we will continue to collect information on the booklet’s effectiveness at reducing criminal thinking. We look forward to introducing MI and the effect this endeavor will have on our agency, the officers and ultimately the offenders we supervise. We will continue to adjust to the rural and diverse nature of our caseloads, because, as Milkman and Wanberg (2007) suggest, interventions that attend to “diversity in both people and programming” hold the most promise for recidivism reduction. Empirically testing interventions that acknowledge and account for this diversity is imperative and the implications of this research are important at both the individual and agency or system level.
The R2R initiative provides considerable incentive and support for districts to pursue and implement EBPs that attend to the specific circumstances and needs of their offenders. Further, the initiative has provided an opportunity to make substantive changes in operation toward EBP, develop staff professionally, and contribute to that growing “body of literature.” Moreover, the implementation of EBP will conceivably reduce the risk of recidivism for our offenders, thereby making our communities safer. It is this sustained protection of the community that provides considerable incentive for both agencies and individuals alike to embrace this new approach.