Best Practices; the route to successful reentry programming
Shane Kent
SPEA-J 439 Crime and Public Policy
School of Public and Environmental Affairs, IUPUI
Jeremy Carter
In the past three decades, the US has seen a nearly 500% increase in prison population (Kazemian & Travis, 2015). With at least 95% of inmates eventually returning to the community, there is a need for reentry programs to ensure they do not recidivate (“NRRC Facts & Trends | CSG Justice Center,” n.d.). Evidence-based research has been slowly but effectively progressing the “what works” of prison programming. With such a myriad of programs in many areas of programming, it can be difficult to discover what works and what doesn’t. With evidence-based research, corrections administrators can know which programs to invest in that will have the strongest impact on recidivism throughout each area of programming. Based on the evidence reviewed in this policy paper, it can be concluded that some programs have greater outcomes.
Review of Relevant Reentry Literature
Substance Abuse
Substance abuse has become a sizable problem in prisons. Substance abuse in prisons is relatively high, and it stems from drug use outside of prison. According to an article by Mumola and Karberg (2006), nearly 642,000 state prisoners were considered drug dependent a year before their incarceration, and only 15% received professional treatment in prison. The need for substance abuse treatment is urgent. In fact, nearly 80% of state prisoners reported that they have a history of drug use (Ndrecka, 2014).
Substance abuse can stem from nearly every criminogenic factor, and therefore treatment programming comes from an array of focuses. These can include employment, education, mental and physical health, and more. Substance abuse programming can and has focused on many of these factors with programs such as counseling, group therapy, methadone maintenance, shock incarceration, substance abuse education, 12 step programs, Therapeutic communities, and cognitive behavioral therapy (Zhang, Roberts, & McCollister, 2009). Research has concluded through several findings that behavioral-only therapies have little to no effect, but programs that have maintenance prescriptions along with the behavioral or psychological treatment has shown promising results (McMurran, 2007), (Zhang et al., 2009). The research shows that programs such as therapeutic communities and cognitive behavioral therapy have shown promising results.
Therapeutic communities involve inmates living in the same treatment community to promote role models, positive social relationships, support from treatment staff and counselors, and help with the transition from prison back to the community (Pan, Scarpitti, Inciardi, Lockwood, 1993). According to a report from the CDATE project, there were 35 intensive studies including nearly 1000 participants (Lipton et al., 2002a). These studies showed a positive correlation between Therapeutic Communities and a reduction in recidivism. This conclusion is also confirmed in a meta-analysis by Lees et al, (2004). Although there is definitive proof that Therapeutic Communities reduce recidivism, most studies fail to show long-term outcomes. Most studies for Therapeutic Communities only follow the participants for around 1 to 2 years after release and some studies follow even less (Prendergast et al., 2004). The important factor that is missing from the majority of these studies is action taken post-release. Because most of these studies are based on short term outcomes, it can be difficult to determine how participants will fare in the long term. The few studies that have followed participants of therapeutic communities to examine effects in the long term have discovered no difference in recidivism rates among those who did not participate in programs. There was no difference long term unless a post-release program was completed (Knight, Simpson, & Hiller, 1999). This is confirmed in another study by Pelissier et al, (2000) that showed those who completed an aftercare program were both less likely to be rearrested or relapse into drug use. According to a study of therapeutic community programming in California, the effect of a post-release program on recidivism declines in its effectiveness over time (Zhang, Roberts, & McCollister, 2009). In fact, the difference over the course of 5 years is nearly the same as those who never completed a post-release program (Zhang et al., 2009). The findings show that after 5 years, the program has no effect, but that does not make it useless. According to the study, the difference in time served from incarceration compared to those who did not complete a post-release program virtually pays for the program based on money saved from not having to house these offenders. The effects of all programs will diminish over time, and this should not be seen as a failure of therapeutic communities. The results show a reduction in recidivism that lasts long enough to save the state more than enough money to continue the programming. The results also show a need for post-release or aftercare treatment. According to Knight et al (1999) and by Pelissier et al (2000), including an aftercare program resulted in a longer reduction of recidivism, but that number was still nearly identical to the control group after 5 years. Post-release programs cause a longer reduction in recidivism, but another reason for the results could stem from program intensity. Although much longer treatment programs show promise, the focus of these programs is for high-risk offenders (McMurran, 2007). The other issue with programs that last longer is cost. An obvious factor when budgeting programs for correctional institutions. This is why these programs should have a risk-needs assessment with checkups at each stage of programming to determine the intensity or duration of a program and if certain offenders need longer treatment. This will help determine if more intensive programming is needed to save money on those who do not require it. It should also help weed out the high-risk offenders that are in such need of these programs. Whether or not there is a budget for more intensive programming with evidence based practices is unknown, but regardless therapeutic communities show great promise.
Cognitive Behavioral Therapy
Cognitive behavioral therapy has been a staple of evidence based practices. Cognitive behavioral therapy focuses on the idea that “pro-social” thinking can be taught (Wilson & Davis, 2006). It is the focus of Cognitive behavioral therapy to correct dysfunctional and criminogenic thinking patterns (Lipsey, Chapman, & Landenberger, 2001). Even with the knowledge of what can work, many programs still fail due to poor implementation. Even though a program might be evidence based, it can still have little to no effect or even a negative effect on recidivism. Such programs should have no basis on the programs merits, but it should draw attention to proper implementation.
Project Greenlight implemented their program using evidence based principles such as addressing dynamic risk factors, focusing on the needs of the participant, and engaging with behavioral, skills-oriented, or multimodal treatment approaches (MacKenzie, 1997). Project Greenlight used evidence based research to implement cognitive skills programming that is consistently used and has led to reductions in recidivism (Wilson & Davis, 2006). The program was designed as a short intensive intervention that focused on cognitive behavioral therapy and then helped offenders transition into community with an exit plan (Wilson & Davis, 2006). The plan included a step by step outline that was overseen by a case manager (Wilson & Davis, 2006). It would help link the offenders to employment, education, housing, substance abuse post-release programs and more (Wilson & Davis, 2006). Many factors were changed from the original program, resulting in outcomes that were worse than those in the control group (Wilson & Davis, 2006).
There are many possible reasons why such an evidence based and individually focused program failed. Project Greenlight went through many changes before being implemented. One of these changes was program intensity. Project Greenlight was a short, intensive intervention. This change was made to the programming because it was financially viable for corrections officials and policy makers alike (Wilson & Davis, 2006). The program was originally designed to be a 3-year program (Wilson & Davis, 2006)g. The intensity of a program is a major contributor to success or failure. The Greenlight re-entry program selected participants that were roughly 100 days from returning to the community (Wilson & Davis, 2006). This is simply not enough time compared to the original program to discover individual risk and adjust program intensity accordingly.
Not only was Project Greenlight shorter than originally planned but it was already designed with little emphasis on post-prison programming or aftercare (Wilson & Davis, 2006). The program relied on standard parole supervision and gave a step by step exit plan for success (Wilson & Davis, 2006). Project greenlight already lacked program intensity but coupled with no transitional help might have been the reason it did poorly. On top of this, the class sizes were double what the expected and normally acceptable number was (Wilson & Davis, 2006). According to Porporino and Fabiano (2000), “poor implementation of any of several different elements of the cognitive-behavioral program can have detrimental consequences”. The program failed to follow the original guidelines or the principles of cognitive behavioral therapy. Project Greenlight should not act as an example of cognitive behavioral therapy programs, but as an example that even evidence based programs can fail if implemented poorly.
Cognitive Behavioral can be successful when implemented correctly. According to a meta-analysis by Wilson, Allen, and Makenzie (2000), Cognitive Behavioral Therapy programs reduced recidivism by nearly 30 percent. The same meta-analysis examined 20 different studies of cognitive behavioral therapy programs and found that they all had positive effects. The only limitation of the meta-analysis was the studied programs only used group therapy. This is hardly significant as most prison programs work in group environments. The positive effects of cognitive behavioral therapy are further confirmed in a meta-analysis by Pearson and Colleagues (NA). Pearson and Colleagues meta analyses covered behavioral and cognitive behavioral therapy programs by examining 69 research studies. The meta-analysis discovered that cognitive behavioral programs were more successful than behavioral programs. The reduction in recidivism found in Pearson’s meta-analysis was roughly 30 percent which is the same result as Wilson, Allen, and Makenzie (2000). The difference between both analyses besides Wilson, Allen, and Makenzie’s focus on group therapy settings is that Pearson classified programs with a focus on social skills training and problem-solving programs as cognitive behavioral programs. A third meta-analysis examining 14 cognitive behavioral studies exceeded the positive results found from the first two with important findings. The meta-analysis by Lipsey et al (2001), found that cognitive behavioral programming nearly halved the recidivism rate compared to the control group. The studies examined with the largest effects were from offenders on probation or parole and not incarcerated (Lipsey, Chapman, & Landenberger, 2001). These results only measured a maximum of 6 months posttreatment but the recidivism effects nonetheless are still substantial with a mean recidivism rate of .15 compared to .52 of the controlled variable (Lipsey et al., 2001). The studies with the least effect where mostly studies that focused on long term outcomes and used larger sample sizes (Lipsey et al., 2001). The lower recidivism improvement is simply a factor of the research looking at long term outcomes. Short-term outcomes are always going to look better than long term as the recidivism rate goes up due to time out of programming. The only limitation that could bring Lipsey’s results into question is that most of the studies that showed a significant reduction in recidivism were demonstration programs set up by the researchers due to time constraints. Nonetheless cognitive behavioral programs show a decrease in recidivism and programs can be specialized to target sex offenders, drug offenders, and other areas of offending.
Sex Offenders
Sex offender treatment is a difficult but much needed area of programming. Sexual abuse survivors face a myriad of problems after being victimized such as mental disorders like depression, and high risk sexualized behaviors (Wilson, 2010). Survivors face a higher chance of future victimization, sexually transmitted diseases, as well as cognitive, social, and academic difficulties (Lalor & McElvaney, 2010), (Wurtele & Kenny, 2010). Although this has spurred many studies and treatment programs to help reduce sexual abuse rates, the results have been inconsistent (Grady, Edwards, & Pettus-Davis, 2017). This inconsistency has been regardless of a program’s similarities to other successful programs, with many programs simply resulting in no effect whatsoever (Abracen e al, 2011). More recent meta analyses by Duwe and Goldman (2009) showed the same mixed results but a positive effect on recidivism was noticed from most programs. This was especially true on programs that included cognitive behavioral therapy along with relapse prevention with a 5 to 10 percent reduction in recidivism. Sex offender programming is difficult to gauge with a multitude of methodological problems including “the use of non-experimental designs, non-matched samples, potential selection bias, small sample sizes, and short and/or non-standardized follow-up periods” (Duwe & Goldman, 2009). It is reported that 84 percent of all studies did not use random assignment or matching techniques which has led to the problem of selection bias Harkins et al (2007). What this means is even the programs that showed a reduction in recidivism could be simply because of selection bias.
The problem is not that sex offender programming does not work, as a recent study in Minnesota has shown promise while ensuring the use of randomized experimental designs and other methods to remove selection bias (Duwe & Goldman, 2009). Duwe and Goldman studied SOTP otherwise known as the Transitional Sex Offender Treatment Program, an in-prison treatment program including therapy, chemical abuse or CD treatment, family/support education, and psychoeducational programming, that was individualized via treatment plan. Results of the program showed a reduction in general recidivism by 12 percent, and 27 percent for sexual recidivism. Aftercare is an important part of increasing intensity of treatment and further reducing the recidivism rate. This was a limitation of the Minnesota study, as program effectiveness would have increased. This is because those who do not receive in-prison treatment usually receive aftercare programming. According to Aytes et al (2001), “Prior research has shown that community-based treatment significantly lowers the extent to which sex offenders recidivate, particularly with regard to sex offenses”. Thus, the prison based treatment results of the Minnesota study makes a stronger case for in-prison treatment than the results show. Another study that supports sex offender treatment is a meta-analysis by Hanson et al (2002). The analysis examined 43 sexual offender treatment outcome studies. The study found that sex offenders who completed treatment recidivated at a rate of 12.3 percent compared to 16.8 percent of the control group. The same study also found that more recent cognitive behavioral therapy of sex offenders found a more modest 9.9 percent recidivism rate compared to 17.4 percent from the control. Sex offender treatment works, especially with the inclusion of cognitive behavioral therapy. There is a need for more research, especially considering aftercare.
Education and Employment
Education and literacy rates in prison are low with a staggering 19 percent of prisoners being completely illiterate and 21 percent being functionally illiterate (Petersilia, 2003). Not only that but only 49 percent of parolees has a high school diploma (Ndrecka, 2014). Proper education gives people the job skills required succeed in the workplace. Especially now more than ever, education has almost become a necessity to succeed and find well-paying jobs.
Early research by Martinson and Lipton et al (1975) concluded that offenders were willing to participate, but there was no significant effect of education programming on recidivism. Unfortunately, due to possible implementation issues, the results remain questionable (Duwe & Clark, 2014). Recent studies examining ABE or Adult Basic Education programs found roughly the same results. In a 2010 study on adult basic education programs found that although there was a higher rate of employment for those who completed the program, there was no significant effect on recidivism (Cho and Tyler, 2010). A significant effect on recidivism was found from the same sample of offenders in another study by Anderson, (1995) that found college level and vocational programs significantly reduced recidivism. The same result was also found in a 2005 study by Batiuk and colleagues which showed that college level programming was the only type of educational programming to have any significant effect.
The reduction in recidivism can be attributed to several factors. The first being that the more an offender increases their education, the easier it is to find a job that likely pays more. The reason that only college level programming is showing effectiveness could be due to job competition. Offenders are already less likely to obtain a job by having felonies. Along with the fact that only 19.6 percent of citizens 25 years and older do not have a GED or high school diploma, offenders transitioning back to society have to compete with high school graduates with clean backgrounds (U.S. Bureau of the Census, 2003). This leaves offenders transitioning back into society with low paying and temporary employment. Those who have completed college level programs simply stand a much better chance at obtaining long term employment. Not only that, but according to Uggen, (1990), maintaining employment may be the biggest factor when it comes to reducing recidivism. Inmates who earned post-secondary degrees were shown to work more hours than the control group (Duwe & Clark, 2014).
What the studies on education show is that long term employment is a key factor in reducing recidivism. Educational programs help inmates become qualified for employment but do not necessarily help offenders find employment. The transition from prison back to the community can be a stressful time with parole checkups, finding employment, housing, transportation, and attending possible aftercare programs. Employment programs try to reduce recidivism by attempting to ensure employment. EMPLOY is a program in Minnesota that helps inmates find employment 60 to 90 days before release and assists offenders in finding employment for up to a year after release (Duwe, 2015). Study of the EMPLOY program found a significant reduction in recidivism by increasing employment odds and increasing hours worked, therefore increasing wages.
Work release programs are strange in that they show mixed results with no study showing a largely significant impact on recidivism. Even though all but one state uses work release programs today, only 8 evaluations of work release programs have been published (Duwe, 2015). Out of the 8 studies on work release programs, only 3 showed any reduction in recidivism, and reported that the findings were only modest (Duwe, 2015). Although recidivism rates did not show any significant reduction, employment rates were higher than those in the control group. This is according to a study by Lamb and Goertzel (1974) as well as Witte (1977).
Besides employment and recidivism, work release programs try to remain viable by saving money. They do this by taking a portion of the earnings from inmates to help cover the cost of the program. A study of Washington’s work release program by Drake (2007) showed that the program gained $3.82 per dollar of cost. Even if there is only a modest benefit in recidivism, there is a significant increase to employment and with a program that frees bed space and more than pays for itself it can be easy to see why it is currently being used in 49 states. The cost benefits were even greater in a study on Minnesota’s work release program. Like the rest of the studies, recidivism was mixed and insignificant, while employment saw an increased benefit. The cost avoidance as reported by Drake (2007) and Petersilia (1996) was nearly $700.00 per participant. The cost avoidance would have been much higher if 42.5 percent of those on work release did not receive a technical violation revocation. According to the study, the cost avoidance lost because of technical violation revocations amounted to nearly $750,000.
What these studies on employment programs show is that employment cannot produce a large reduction to recidivism, because employment is only one of many criminogenic need. According to Duwe, (2015), offenders on work release programs have little time to focus on other types of programming. Work release programs should introduce cognitive behavioral therapy, substance abuse treatment, or other targeted treatments before the work release program is scheduled to begin (Duwe, 2015). Using EMPLOY, MnDOC is planning on adding a 90 day employment readiness training program with the hope of reducing revocation and possibly reduce recidivism (Duwe, 2015). Although the plan does show promise in reducing revocation and therefore increasing cost avoidance, the reduction on recidivism will likely be unchanged as no alternative programming will be included to target other criminogenic needs. Employment and educational programming are promising programs that have shown reductions in recidivism among other benefits, but this area of programming needs more evaluation as well as the inclusion of other types of programming to further increase benefits.
Supervision
Policy Implications
Throughout the research examined in this paper, there was a reoccurring theme. That theme was cognitive behavioral programming. Not only did cognitive behavioral programming cause a reduction in recidivism in prison, but it had an even greater effect post-release. Cognitive behavioral programs can be used specifically to address every criminogenic factor and therefore finds itself reducing the recidivism rate of every program it is coupled with. Besides itself, every area of focus examined in this paper concluded that a greater reduction could or has been made with the inclusion of cognitive behavioral programming.
Correctional Administrators should emphasize a focus on including cognitive behavioral therapy in all areas of treatment programming. With a proven track record of successful recidivism reduction when implemented correctly, cognitive behavioral therapy guarantees a reduction to recidivism. Implementation, whether standalone or with another program should look at using a risk/need assessment to determine program intensity thus bringing focus to high risk offenders and saving money on low risk offenders. Programming should also think about including cognitive behavioral programming as a post-release intervention as well.
With every area of programming, there are limitations. Many of the limitations were found from the Greenlight Project study. Program intensity is a major factor in reentry programs and cognitive behavioral therapy is no different. One of the changes Project Greenlight made was a shortened program length. As stated in the research, the program originally intended to be 3 years long, but ended up being much less than a year. Another limitation is class size. The doubled class size of Project Greenlight is one of possible reasons the program failed. The final limitation is cost. Smaller class sizes and greater intensity costs more money. More professionals are needed to not only run these programs but also follow participants post-release. The cost is also part of the equation when deciding to add cognitive behavioral programming to another program. Project Greenlights problems were a cause of attempting to make the program cost viable. Adding a well implemented cognitive behavioral program might not be viable considering cost avoidance. With programs that have a high cost avoidance such as employment, there are major time constraints for offenders trying to participate in the program as well as maintain a full-time job and follow parole requirements.
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