why a strengths-based approach
TRANSCRIPT
2015/05/01
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Liam E. Marshall, PhD
Research & Academics and Provincial Forensics
A Strengths-Based Treatment
Program for Sexual Offenders
Introduction
• What is a Strengths-Based Approach and why
use it?
– Ethical considerations
• What does a Strengths-Based Approach look
like?
– Overview & Specifics
• Can it work?
– Outcome from our use of SBA
Why a Strengths-Based Approach?
• Typically, treatment clients are volunteers
• Mentally ill and offender clients are typically
coerced into treatment
– Legal coercion vs Psychological coercion
• Universal Declaration of Ethical Principles for
Psychologists, Clients have the right to:
– Dignity; respect; self-determination; humane
treatment, including a focus on strengths (Birgden,
2015)
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Why a Strengths-Based Approach
• Recidivism studies are fraught with issues that make
true recidivism unclear
• Recidivism studies are done on treatment as it was
done 10 or more years ago
• Sometimes treatments are later found to be harmful
• A Strengths-Based Approach focused on improving
well-being and life satisfaction will, at least, do no
harm
• More enjoyable and less stressful for therapists
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Adverse Childhood Experiences
• Significantly higher rates of ACEs in offenders,
especially sex offenders, and mentally ill, than
“norms”
• In particular, abuse (emotional, physical, sexual),
neglect, parental separation or divorce
• Number of ACEs strongly related to poorer mental
and physical health, including suicide attempts,
depression, obesity, and victimization
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Prisons are not rehabilitative
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Separation from families and
social networks
Stigma & labelling
Anti social subculture &
norms
Lack of activity Curtailment of
autonomy
Courtesy of Dr. Ruth Mann, NOMS
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Re-
settle
Address attitudes
and thinking
Address drug & Alcohol problems
Rehabilitative culture; Rehabilitative
staff prisoner relationships
Safety & Decency
Hierarchical features of a rehabilitative prison
Courtesy of Dr. Ruth Mann,
NOMS
Problems with “Problem-Focused” treatment
• Limits options
• Ignores unique capabilities & strengths
• Focus is on what “not to do” rather than “what to do”
• Leads to prescribed treatment instead of
individualized treatment
• Looking for problems to explain behaviours
• Looking for cause and effect
• Typically takes control away from patient/client
• Leads to labeling
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• >.60 = unacceptably low level of reliability
• .60-.70 = low reliability (projective measures)
• .70-.80 = moderate reliability (classroom multiple
choice tests)
• .80-.90 = moderate-high reliability (achievement or
intelligence tests)
• .91-1.00 = high reliability (measurement errors have
virtually no effect)
Given the importance of the labels applied to sexual offenders in
terms of their implications for the sexual offender and society,
reliabilities of at least .90+ are needed
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Reliability of labels Reliability of Labels Applied to Sex Offenders
• Sadist: kappa = .14 (Marshall et al., 2002)
• Pedophile: kappa = .65 (Levenson, 2004); .55
(Perillo et al. 2014)
• Psychopath: kappa = .39 (Murrie et al., 2008)
– Well trained raters: .95; versus State experts
= .29; versus defendant experts = .14
(Rufino et al., 2012)
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Strength-Based Approach (SBA)
• Empowers and motivates patients/clients
• Requires trusting and workable relationships
• Requires collaboration
• Instills a sense of hope
• Helps client build on existing strengths
• Does not catastrophize when things go wrong –
part of the process
• Helps patient/client recognize that change is an
ongoing process
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• Problem focused
• Inconsistent with a CBT, RNR, or RP approach
• Does not require therapists to be soft on clients
• Does not take the responsibility for change away
from the client
• Is no more costly to run than other approaches
• Is not a cure
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What a Strengths-Based Approach is not
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• A positive/motivational approach to change
• Focus is on strengths while also not ignoring with
deficits
• Grounded in Risk/Needs/Responsivity, Motivational
Interviewing, Desistance, and Positive Psychology
Theory
• More enjoyable and safer for the therapist and client
• A positive approach to making positive changes
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What a Strengths-Based Approach is Examples of strengths not usually recognized
“in regione caecorum rex est luscus” Desiderius Erasmus (1500)
• Homeless patient telling other group members the
best shelters for various things
• Colluding with other group members
• Not offending at every opportunity
• Reluctantly attending a treatment group
• Attention seeking
• Falling in love with the therapist
• Punching a wall
• Bragging/denying/manipulating/arguing
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Components of a Strengths-Based Approach
Pre Treatment Issues
– Intake Assessments
– Interview
Treatment Program
– Approach, Targets,
Post-Treatment Issues
– Assessment
– Report
• Other Considerations
– Non-treatment staff, Environment
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A Strengths-Based Approach
Pre-Treatment Issues
• RISK:
– STATIC-99, STATIC-99R, VRS-SO, RRASOR, MnSOST-R, PPG, Polygraph, etc.
• NEEDS:
– STABLE-2000, STABLE-2007, SONAR, PPG, Polygraph, , SAPROF
• RESPONSIVITY:
– URICA, Treatment Readiness Scale (Serin & Kennedy, 1997)
Conclusion: 1 Strengths-Based measure available.
SBA Intake Assessment
• Build rapport first: Offer to answer questions, talk about what they want
• Invite client to be part of treatment on their own terms
• Allow client to make decision on whether or not to enter treatment, empower them
• Do not push too hard, you are forcing client into a corner
• Express empathy and optimism
• Outline costs and benefits for client of entering treatment
• Overcome typical resistance issues: – Pressure to enter treatment, treatment efficacy (lack of), lack of
trust in professionals, previous bad experiences/safety
SBA Pre-Treatment Interview
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A Strengths-Based Approach
Treatment Program
• Self-Esteem
• Hope
• Guilt
• Empathy
• Coping
• Relationships
• Healthy sexuality
• Motivation
• Approach goals
• Knowledge
• Agency
• Autonomy
• Mastery
• Relatedness
• Creativity
• Mindfulness
• Relaxation
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Strengths-Based Approach Topics
Behavioural Progression Model, Adapted From CSC
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Background
Factors •Exposure to SA as a child •Anger •Attitudes and Goals Supportive of SA •Attachment and Relationship difficulties •Emotional self-regulation problems •Poor coping skills and style •Empathy deficits
Immediate
Factors •Increased Stress, Anxiety, Depression, Loneliness, Emotional Arousability, Anticipation •Cognitive Struggle and Dissonance •Escalation in emotions •Increased substance abuse
Offending
Post Offence Fear
Shame
Self-Loathing
Cover-Up Attempts,
Cognitive Distortions,
Increased Immediate
Factors
Trigger: Change for the worse
Trigger: Opportunity & Disinhibition
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POSITIVE/MOTIVATIONAL PROGRAM
(ROCKWOOD PSYCHOLOGICAL SERVICES)
MOTIVATION &
ENGAGEMENT PRIMARY TREATMENT
FUTURE LIFE
STRATEGIES
1. LEAD-UP
2. AUTOBIOGRAPHY
Goals and Optional Exercises
• Orientation to treatment
• Enhancing self-esteem
• Reducing shame
• Improving coping and
mood management
3. EMPATHY
• Letters/Diary entry
4. OFFENCE ANALYSIS
• Background Factors
• Immediate Factors
RELATIONSHIP SKILLS
Nature and advantages of
intimacy
Problems of loneliness
Attachment styles
Communication
Jealousy
SEXUALITY
Healthy sexual functioning
Maximizing sexual
satisfaction
Reducing deviant interests
o behavioural strategies
o Pharmacological
5. GOOD LIFE PLANS
• Goal setting
6. SELF-MANAGEMENT
7. WARNING SIGNS
FOR SELF AND
OTHERS
8. SUPPORT GROUPS
Professionals
Family and friends
Colleagues
9. FUTURE PLANS
Accommodation
Employment
Leisure
Rockwood Offender Programs
Dosage matters
• Preparatory – typically 6
weeks
• Regular – typically 4
months
• Deniers - typically 4
months
• Maintenance - typically 3
months
• 2-3 sessions of max 2 ½
hours per week
• Open-ended
• 8-10 offenders
• 1 therapist in each group
• Mix of all types of sex
offenders in same group
• Entry to program as close
to intake as possible
• No individual sessions
unless special
circumstance
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WHAT IS EFFECTIVE?
MUST:
1. Address criminogenic targets
2. Employ empirically sound procedures
3. Deliver treatment in known effective
ways
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Criminogenic Issues in Sex Offenders Based on Mann, Hanson, & Thornton, 2010
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Sexual factors
- sexual interests in children
- Sexual interest in violence
Relationship problems
- lack of intimacy
- insecure attachment
- emotional loneliness
Low self-esteem/shame
Cognitive factors
- emotional congruence with
children
- hostility towards women
- lack of concern for others
- offence supportive attitudes
Self-regulation issues
- emotional dysregulation
- behavioral dysregulation
- sexual (preoccupation)
Treatment Approaches Traditional Approaches
• Psychoanalytic
• Behavioural
• Cognitive
• Relapse-Prevention
• Cognitive-Behavioral
New Directions
• Risk/Needs/Responsivity (Andrews et al.)
• Good Lives Model (Ward et al.)
• Motivational Interviewing (Miller & Rollnick)
• Positive Psychology (Seligman et al.)
Good lives model (Tony Ward et al.)
Primary goods: 1. Life: healthy/optimal functioning, sexual
satisfaction
2. Knowledge
3. Mastery: in work and play
4. Agency: autonomy and self-directiveness
5. Inner peace: freedom from turmoil and stress
6. Relatedness: intimate, romantic, kinship, community
7. Spirituality: meaning and purpose in life
8. Happiness
9. Creativity
Good lives model cont.
Depends: internal conditions (skills and capacities) and external conditions (opportunities and supports)
Treatment:
1.Determine with each client personal goals and priorities in order to generate a specific good lives model suitable to him
2.Assist, if necessary, in acquiring the skills and attitudes necessary to work toward goals
3.Help identify ways to create opportunities to realize goals
4.Work with the client to identify support people who will assist in realizing goals
Positive Psychology Features
• What is good about life is as important as what is bad and therefore deserves equal attention
• Life is about more than avoiding or undoing problems
• Strength focus – not deficits
• Hope theory
– Goals, Pathways, Agency
• Aim is for a more fulfilling life
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DEGREE OF MANUALIZATION
No direction Guide Highly detailed manual
IMPLICATIONS OF THIS CHOICE
1) TARGETS
Lack of specification of targets
Choice of targets Fixed and specific targets
2) PROCEDURES FOR EACH TARGET
None specified Choice Single and specified
3) NUMBER OF TREATMENT SESSIONS
Unspecified Dependent on each client’s needs
Fixed number
4) STRUCTURE
Fully unstructured Treatment targets repeatedly addressed
Fully modularized
5) TREATMENT STYLE
Idiosyncratic Psychotherapeutic Psychoeducational
6) CLIENT INVOLVEMENT
Client choice only Collaboration Therapist choice only
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Next 4 slides
courtesy of
Dr. J. Levenson,
Lynn University,
Florida
Features that Enhance Treatment Effectiveness
• Empathy
• Warmth
• Respect
• Genuineness
• Supportive
• Directive
• Flexible
• Encourages Participation
• Rewarding
• Attentive
• Trustworthy
• Use of humor
• Emotionally Responsive
Features that Reduce Treatment Effectiveness
• Aggressive Confrontation • Rejection • Manipulative/Lack of
boundaries • Lack of interest • Critical • Sarcastic • Hostile/Angry/Rigid • Cold/Unresponsive • Dishonest • Judgmental • Authoritarian • Defensive • Nervous/Uncomfortable
Therapists are relatively poor at evaluating
their own therapeutic characteristics and
style.
• In 34 of 47 studies (72%) clients’ estimates
of therapist features correlated with
beneficial treatment effects.
• Therapist ratings were related to outcome in
only 4 of 15 studies (26%). (Free, Green, Grace, Chernus, & Whitman, 1985; Orlinsky et al., 1994)
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Client’s perceptions of the therapist
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1. See therapist as crucial but also value procedures
2. Quality of the program = the skills of the therapist
3. Good therapists are: honest, respectful, nonjudgmental, available, caring, confident, competent, and persuasive, encourage discussion, listen, display leadership and strength, and maintain order
4. Do not respond to therapists who are critical, devaluing, or confrontational
5. Clients want therapist to supportively challenging them in a caring manner
6. Clients desire to participate in decision making (work collaboratively) and they wish to attain mastery and feel competent
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CLIENTS’ PERSPECTIVES (Drapeau, 2005)
• Moos’ Group Environment Scale (GES) • 10 Subscales, has norms, well used
– Expressiveness – Cohesion – Task Orientation – Self-Discovery – Leader control – Innovation – Anger & Aggression – Leader Support – Independence – Order & Organization
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Group Climate
Beech & colleagues 1997; 2005
• Cohesion and Expressiveness subscales were
significantly related to the composite measure of
treatment gains
• Cohesion includes involvement, participation,
commitment to the group, and concern and friendship
for each other
• Expressiveness measures the encouragement of
freedom of action and the expression of feelings
Marshall, Serran, & Davis, 2009
• Open-ended groups - better group climate, & faster
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GROUP CLIMATE
• Warmth
• Empathy
• Rewarding
• Directive
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Therapist features related to significant
treatment-induced changes
Three approaches have typically been used:
a) Confrontational approach
b) Unchallenging approach
c) Motivational approach
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Treatment Strategies
• Motivate change through understanding and acceptance.
• Encourage clients to view themselves as a whole person with strengths who has engaged in an unacceptable behaviour.
• Be encouraging and supportive but set necessary limits, respond firmly, and challenge behaviours.
• A positive approach to treatment motivates clients to make positive changes.
• Therapists place responsibility for change in hands of clients but assist clients in finding ways to make changes.
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Motivational Approach
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• Not inherent part of our clients
• Observable behaviours
• Fluctuates
• Influenced by therapist’s behaviour
(therapist confronts: resistance goes
up!)
• Resistance is a signal to change
strategy
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Resistance to change
• Confrontation-Denial
• Blaming
• Premature focus
• Labelling
• Question-Answer
• Expert
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Some common traps that can cause resistance
• Back off
• Warmth, empathy, optimism &
genuineness
• Listen, respect and reflect what you
hear
• Emphasise personal control and choice
- and mean it!
• Offer options
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Responding to resistance
Positive reinforcement • Link to specific behaviour
• Give immediately after behaviour
• Tell clients exactly what they did that was appropriate and why
it was appropriate.
• Make sure they understand exactly what behaviour should be
repeated and why.
• Reinforcement needs to be proportional to the level of effort
that the behaviour took to perform.
– A major gain deserves strong reinforcement. A small gain
deserves a little recognition.
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Behavioural methods
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What to reinforce
• Statements of responsibility.
• Statements of motivation/intention to change.
• Self esteem, perspective taking, empathy, concern
for others, etc.
• New skills or attitudes.
• Achievement of any other treatment goal
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Measuring Outcomes from our SBA
groups
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Area Under the Curve (AUC) calculation – from signal
detection theory/research
• AUC of <.50 = worse than chance – not a good predictor
• AUC of .50 = chance (flipping a coin) – no predictive
value
• AUC of >.50 = better predictor than chance
• AUCs of (Rice & Harris, 2005):
– .56-.63 = small predictor
– .64-.71 = moderate predictor
– .72+ = large predictor
Results – How to Interpret AUC Predictors of Recidivism Total N = 535; Recidivists N = 30 • Age: AUC = .37 • Sentence length: AUC = .43 • STATIC-99: AUC = .47 • PCL-R: AUC = .62
• Therapist post-treatment rating: AUC = .64* – Based on a rough scale: 5 points, post treatment is the
sexual offender High, High-moderate, Moderate, Low-moderate, or Low risk for future sexual offending.
– Only statistically significant predictor of recidivism in our study
• With more differentiation over topics and dimensions (Intellectual Understanding & Acceptance/Demonstration) perhaps predictive power would be even better 50
INSTRUCTIONS FOR THERAPIST RATINGS
• 10 topics based on known criminogenic factors and treatment engagement issues.
• Rated on each of the two categories
– intellectual understanding
– acceptance/demonstration
• Ratings are based on your considered opinion of how well he is functioning on each topic
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Rating Levels • Level 4 = Optimal Functioning
– Significantly better than average
– Should rarely be given to offenders
– Scale can be used without a level 4, if desired
• Level 3 = Normative (THIS IS THE GOAL OF TREATMENT) – Average functioning
– Mostly achieves target of treatment
– Might still have a little work to do, but no worse than non-offenders
– This is the target of treatment
• Level 2 = Approaching Normative – Approaching average functioning
– Starting to understand and see value in topic/category
– May achieve level 3 post-treatment
• Level 1 = Unsatisfactory – Needs to redo treatment component
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Information for Rating
• Levels should vary across topics
• Levels should vary between categories
• Avoid “halo” and opposite (“pitchfork”) effect
• When learning to use, have therapists complete separately and then discuss differences – aiming for inter-rater agreement 8-9 times out of 10 (i.e., does not have to be perfect agreement)
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Procedural Issues
• When to score the TRS-2?
– Halfway through treatment program. So as to guide the rest of time treatment to the most important issues.
– At or near the end of treatment.
• Using the TRS-2 prior to the end of treatment aids in determining whether the participant has satisfactorily completed treatment.
• The TRS-2 forms the bases of our reports.
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Targets Intellectual
Understanding
Acceptance/
Demonstration
1 Sense of Agency
Believes in ability to control own life
Takes responsibility for making life changes
Can identify steps to achieve goals 2 General Empathy
Can perceive the emotions of others
Is able to put self in other’s shoes
Responds with appropriate emotion to other’s emotions
Attempts to comfort others - when possible and
appropriate 3 Prosocial Attitudes
Espouses pro-social attitudes
Cooperates with supervisor/supervision
4 Adequate Coping Skills/Styles
Responds to stressors with appropriate emotionality
Faces problematic issues
Is able to problem solve
5 Adequate Intimacy Skills
Values others
Appropriately self-discloses
Able to make friends with others
Has realistic beliefs about relationships
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Targets Intellectual
Understanding
Acceptance/
Demonstration 6 Positive Self-Esteem
Has a realistic belief in own abilities
Engages in positive self-talk
Does not use either self-deprecating or derogatory humour
7 Good General Self-Regulation
Can adapt to changing circumstances
Not impulsive or overly negative
Sees value of, and has the capacity for some degree of
stability in life
8 Good Sexual Self-Regulation
Doesn’t use sex to cope
Is not preoccupied with sex
Has normative sexual interests
9 Understands Risk Factors
Has an awareness of actual and possible risk factors and
situations
Able to take feedback from others 10 Quality of Future Plans
Has realistic plans for future
Has adequate community supports
Engages in and recognizes the value of leisure activities
Has employable skills or is financially independent
TRS-2 Results - Inter-rater reliability
• Two raters given TRS-2 information package with little consultation
• N = 32 offenders
• Scale Total – Intraclass Correlation Coefficient
– Intellectual Understanding - .90
– Acceptance Demonstration - .96
– Total Scale - .95
– All significant @ p < .001
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Predictive Validity • Retrospective study – TRS-2 scored from treatment
reports by rater blind to results but aware of sexual offender issues
• Randomly selected 96 of 535 sexual offenders, including 21 sexual recidivists, released for a Mean of 5.84 years (SD = 3.60). M Age = 42.98, SD = 11.84
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Type of Recidivism N This Study
Revocation 5 5.3%
Non-sexual non-violent 9 9.6%
Violent recidivism 3 3.2%
Sexual recidivism 21 22.3%
Predictors of Recidivism from 2009 outcome evaluation
Total n = 96; Recidivists n = 21
• Age: AUC = .55, p = .53
• Sentence length: AUC = .62, p = .10
• STATIC-99: AUC = .53, p = .74
• PCL-R: AUC = Unknown, only 29 Ss had PCL-R scores
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Mean TRS-2 Scale Scores
N Mean SD Range
TRS-2 Total 94 49.68 6.11 34-59
TRS-2 Intellectual Understanding
94 26.52 3.22 18-31
TRS-2 Acceptance /Demonstration
94 23.16 3.12 15-29
61 62
N Intellectual
Understanding
Acceptance/ Demonstration
Total 95% CI – Total Score
Lower Bound
Upper Bound
No Failure 57 .67** .66** .66** .54 .79
Revocation 5 .60 .67 .63 .39 .88
Non-sexual non-violent
9 .55 .52 .54 .29 .74
Violent 3 .62 .74 .73 .00 1.00
Sexual 21 .75** .78*** .77*** .65 .89
* p < .05, ** p < .01, *** p < .001
NOTE: Except for “No Failure”, all scales are reverse scored so that higher scores indicate greater probability of recidivism. For “No Failure”, higher scores indicate greater probability of no failures.
Predictive Validity - AUCs
TRS-2: Rater familiar with correctional program issues but blind to results
95% Confidence Interval
AUC Sig. Lower Bound
Upper Bound
TRS TOTAL .77 < .001 .65 .89
INTELLECTUAL UNDERSTANDING
.75 < .01 .62 .87
ACCEPTANCE /DEMONSTRATION
.78 < .001 .66 .90
Sexual Recidivists v Non-Recidivists
M SD p
INTELLECTUAL UNDERSTANDING
Recidivist 24.09 3.60
Non-Recidivist
27.17 2.74 < .001
ACCEPTANCE / DEMONSTRATION
Recidivist 20.47 3.47
Non-Recidivist
23.89 2.60 < .001
TRS TOTAL Recidivist 44.57 6.85
Non-Recidivist
51.07 5.07 < .001 64
Other Rockwood Programs
Recidivism
Program Treated Comparison
Preparatory 1% 5%
Deniers 2.5% 13.5%
Anger
Management
Reductions in State & Trait anger,
greater motivation for change
Domestic
Violence
Improved dynamic risk factors &
improved responsibility taking
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Rockwood Main SOTP
Refusers 3.8%
Drop-outs 4.2%
Completions 95.8%
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Outcome for Rockwood Program - 2005
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Reoffence Treated*
(N = 535) Expected**
Sexual 3.2% 16.8%
General 13.6% 40.0%
*Mean follow-up = 5.4 years
**Based on Static-99 and S.I.R.
Outcome for Rockwood Program - 2009
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Reoffence Treated*
(N = 535) Expected**
Sexual 5.6% 23.8%
Violent 8.4% 34.8%
*Mean follow-up = 8.4 years
**Based on Static-99 (revised 2003)
Example outcomes: Facility “A”
Pre
• Few programs running, no structure, no oversight, outdated approach, conflict between medical and allied health staff
• Low staff morale and difficulty recruiting
Strategy: provide training to interested staff members, implement one intervention, then expand
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Example outcomes: Facility “A”
Post
• Every Allied Health team member running at least one criminogenic need-related group intervention with evaluation and reporting processes in place
• Medical staff (physicians & nurses) also running groups
• Clients’ perspectives canvassed
• Achievement of targets of treatment
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Nursing run self-esteem program Social Self-Esteem Inventory (Lawson, Marshall, & McGrath, 1979)
N M SD
Pre-treatment
24 116.33 30.2
Post-treatment
24 128.33 28.7
t (23) = 2.34, p < .03, Norm Mean = 132, SD = 21
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Emotional Self-Regulation Treatment
Group
Helen Chagigiorgis, PhD (C.Psych)
Jeff Robinson, M.A.
Liam E. Marshall, PhD
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Old Program Results: STAXI-II (N = 34)
STAXI-II M SD %ile M SD %ile Diff t p.
State Anger 22.1 9.7 80th 20.1 7.1 75th 2 1.3 .20
Trait Anger 21.8 7.7 90th 20.3 6.2 75th 1.5 1.8 .09
Anger Expression
- Out 18.1 5.1 90th 17.5 4.2 90th 0.6 0.8 .46
Anger Expression
– In 19.5 5.3 90th 17.8 3.7 75th 1.7 1.9 .06
Anger Control
– Out 21.7 6.2 25th 20.4 5.4 20th 1.3 1.4 .18
Anger Control
– In 21.3 6.7 40th 19.7 5.7 35th 1.6 1.7 .91
Anger Index 42.5 17.1 80th 43.2 14.0 80th -0.7 -0.3 .78 73
Old New Program
STAXI-II M SD %ile M SD %ile t p.
State Anger 22.1 9.7 80th 22.4 9.9 80th -.22 .83
Trait Anger 21.8 7.7 90th 23.5 7.6 95th -.83 .41
Anger
Expression - Out
18.1 5.1 90th 18.8 5.0 95th -.37 .71
Anger
Expression - In 19.5 5.3 90th 20.0 5.7 90th -.5 .62
Anger Control -
Out 21.7 6.2 25th 19.4 5.4 15th 1.6 .12
Anger Control -
In 21.3 6.7 40th 21.0 4.9 30th 2.1 .06
Anger Index 42.5 17.1 80th 49.0 15.1 90th -1.6 .11
Old Program versus New Program
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STAXI-II M SD %ile M SD %ile t p
State Anger 21.3 8.3 80th 17.6 4.6 60th 2.7 < .01
Trait Anger 23.5 7.5 95th 19.9 7.7 75th 3.0 < .01
Anger
Expression - Out
19.2 5.4 95th 16.8 5.2 85th 2.9 < .01
Anger Expression - In
19.6 5.5 90th 17.3 4.9 60th 2.3 < .05
Anger Control - Out 19.2 5.8 15th 22.2 5.3 25th -2.6 < .01
Anger Control - In
19.0 5.0 30th 22.5 5.1 50th -3.1 < .01
Anger Index 48.5 14.8 90th 37.4 14.5 70th 3.7 < .001
STAXI-II RESULTS: NEW PROGRAM
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Results: Stage of Change (URICA)
6
14
1
23
2
14
0
5
10
15
20
25
Pre-Contemplation Contemplation Action
Baseline After Treatment
Nu
mb
er
of
Pa
rtic
ipa
nts
76
77
Clients’ Perspectives: Domestic Violence group (Group Evaluation Form-Revised, Marshall, Serran, & Cameron, 2010)
Scale
Scale
Alpha
Possible
Range Mean SD Range %
Facilitator .88 4-20 18.59 1.74 15-20 92.5%
Group .87 6-30 27.59 3.25 19-30 91.9%
Total .92 10-50 46.18 4.88 35-50 92.4%
Overall
Facilitator Na 1-5 4.77 0.53 3-5 95.4%
Overall
Group Na 1-5 4.62 0.80 2-5 92.4%
Would you recommend this group to others? = 97% said Yes.
Factor Analysis of whole scale: 1 factor accounting for 59% of
variance 78
Therapist Post-Treatment Ratings Domestic Violence Group
TRS-2*
Mid
Treatment
Post
Treatment t Sig
Intellectual
Understanding
21.62
(3.07)
27.44
(3.58)
7.11 < .001
Acceptance /
Demonstration
18.19
(2.86)
23.44
(3.78)
5.33 < .001
Total Score 39.81
(5.59)
50.87
(7.15)
6.67 < .001
*Marshall & Marshall, 2011
2015/05/01
14
79
Group Referrals Entered
Group
Completed
Group
Total
Hours
In-
process
Sexual Offending 34 24 1616 7
Sexual Offending – Adapted 19 13 1304 5
SEXUAL OFFENDING TOTALS 75 53 37 2920 12
Anger Management 80 70 35 1964 16
Anger Management – Adapted 30 20 13 400 2
Aggressive Behaviour Modulation 73 24 952
ANGER MANAGEMENT TOTAL 110 163 72 3316 18
DOMESTIC VIOLENCE 41 25 12 1002 6
SUBSTANCE ABUSE 205 148 145 2498 44
DBT FOR PTSD 101 73 66 1566 16
TOTAL 532 462 332 11,302
GROUP TRACKING DATA • 255 individuals were referred to one or more of
the core groups in the fiscal year • 212 men became residents in the fiscal 2009-
2010 year • Average number of core groups each potential
resident was referred to = 2.08 • Average number of core groups entered by each
actual resident = 1.83. – Residents entered 88% of the core groups to which
they were referred
• Average number of core groups completed by each actual resident = 1.45 – Residents completed more than 79% of the core
groups which they entered. 80
GROUP SATISFACTION (all groups) – Assessed immediately post group completion or removal
81
N Mean SD Min Max Possible
Range
Facilitator 727 13.42 2.13 4 15 3-15
Content 728 21.39 3.94 5 25 5-25
TOTAL 714 34.87 5.80 10 40 8-40
Liam E. Marshall, PhD
Research & Academics and Provincial Forensics
A Strengths-Based Treatment
Program for Sexual Offenders