by Interim Secretary Johnnie Goddard
When the Kansas Department of Corrections set a goal to achieve and sustain recidivism reduction over fifteen years ago, it was quickly evident that a key component of any change had to be implementation of evidence-based programming, with strong fidelity, including independent evaluations.
Risk, needs and responsivity (RNR) became a permanent part of the agency conversation, with staff trained in and often speaking of these principles. The challenge was to identify how to implement these principles, in case management and programming, as well as every interaction between staff and offenders. Working with various partners, including the University of Cincinnati Corrections Institute (UCCI), Kansas has managed to reduce recidivism from 55% for offenders released in 1999 to 35% for offenders released in 2012.
In addition to strengthening capacity for case management and core correctional practices among caseload carriers (unit team counselors in facilities, parole officers in the field) and staff (state, community partner and contract) delivering programs and services; KDOC has used two key strategies to increase positive outcomes from programming: First and foremost, the use of vigorous evidence-based curricula; and, second, hiring and developing a cadre of in-house Program Providers, supported by Fidelity Coaches and ongoing independent evaluations.
Traditionally, like many corrections agencies, programming related to substance misuse, sexual offending, and other risk and need areas were delivered predominantly by contract providers, who bid through a state purchasing process, and were required to design their own programs as part of the bidding process. To increase a direct role in developing, implementing and monitoring evidence-based models, the KDOC made a decision to gradually establish and sustain nearly thirty in-house Program Providers, and provide them ongoing training and coaching in the use of strong curricula, so that these Program Providers have become the backbone of program delivery in Kansas. While some services, including GED/vocational training and sex offender treatment, continue to be delivered by contract providers, the implementation of this model has created a culture where programming is part of case management and overall offender management, with KDOC staff integrally involved in the delivery and quality assurance of programming.
Meanwhile, to support the work of these Program Providers, KDOC set out to find and become proficient in delivering the most evidence-based curricula available. A key partner in this effort has been UCCI, where research is reviewed, and skilled experienced corrections professionals develop curricula that target behaviors which research show directly correlate to reoffending. One such curriculum is the UCCI Cognitive-Behavioral Interventions for Substance Abuse Curriculum (CBI-SA). This curriculum – referred to in Kansas as the Substance Abuse Program (SAP) – integrates the core components of any cognitive behavioral intervention with focus on substance abuse, and encompasses a therapeutic strategy designed to change the cognitions that influence maladaptive behavior. It is designed for offenders that are moderate to high need in the area of substance abuse, as assessed by a validated risk/need instrument (in Kansas the Level of Services Inventory – Revised [LSI-R]). The curriculum can be delivered as a stand-alone substance abuse intervention, or incorporated into a larger program, particularly those designed for clients in the corrections system. The recommended group size is no more than 10 participants with one facilitator, and no more than 20 participants with two or more facilitators. The curriculum takes 4-6 months to deliver, depending on the pace of the group, and includes modules on Motivational Enhancement, Cognitive Restructuring, Emotional Regulation, Social Skills, Problem Solving and Relapse Prevention. This intervention relies on a cognitive behavioral approach to teach participants strategies for avoiding substance abuse. The curriculum places heavy emphasis on skill building activities to assist with cognitive, social, emotional, and coping skill development.
The KDOC was drawn to the SAP curriculum because of many years of data showing that over two-thirds of offenders admitted to Kansas prisons were misusing drugs or alcohol prior to incarceration, and three-fourths of revocations from parole involved misuse. An analysis of the population being revoked for behavior related to misuse revealed a population that was more moderate than high risk, and as high (if not higher) in the domains related to anti-social thinking/cognitive distortions as the domain related to drugs and alcohol. Of most significance, this population had without exception multiple episodes of prior treatment, in the community and/or during prior incarcerations. This group was treatment resistant using the traditional treatment modalities.
The KDOC worked closely with UCCI to implement SAP. All facilitators were trained by UCCI, in a rigorous session that involved numerous teach-backs, which required demonstration of proficiency in the curriculum. Over a period of three years SAP was implemented in all seven male facilities in Kansas, and all sites received multiple fidelity observations, with follow up feedback and coaching. With time, strong facilitators were trained as trainers after at least two rounds of delivering the full curriculum, in order to sustain the use of SAP throughout the KDOC.
Extensive data were tracked regarding SAP participants, and at the end of three years an independent evaluation was completed in January 2016. The evaluation found that across all risk levels, SAP completers had a 7.5% lower recidivism rate than the comparison group, 28.7% for the treatment group, 36.3% for the comparison group. More importantly, high risk offenders performed 15.8% better, with completers having a recidivism rate of 32.3%, compared to 48.1% for the comparison group. Also, SAP completers with one additional program performed better than SAP completers with no other programming (attesting to the dosage principle). These results are consistent with the evidence-based principles emerging from research. SAP targets moderate and high risk offenders, focusing on the particular risk/need area of substance misuse, consistent with the risk and need principles. The responsivity principle suggests that the use of cognitive behavioral interventions is the most effective approach with the offender or criminally-justice involved population. Traditional treatment modalities, with cathartic insightful talk-therapy approaches, have less impact on offenders with higher levels of criminal thinking, in terms of reducing their substance misusing behavior. Including SAP as a means of addressing criminal thinking, and teaching and practicing replacement thinking and behavior as a key tool in helping offenders achieve sustained recovery will improve outcomes.
The KDOC has implemented Advanced Practice (Advance Practice is a curricula developed by UCCI to provide a structured way for group members to continue to practice the skills they have learned in core programming in a progressively more challenging way through the use of more difficult situations with increased pressure) for SAP (and other cognitive behavioral programming), so that SAP participants are able to add hours of practice and skill building, either as a supplement while they are going through SAP, and/or as aftercare to SAP. This allows the successful completers to continue building skills, and to develop new “muscle memory” in problem solving, responding to risky situations, coping, and pro-social thinking and acting. The KDOC has seen successful completion rates of over 80% in SAP, and reports from facilitators and participants alike indicate it provides useful information and tools in helping offenders in recovery from addiction, dependence and substance misuse.
The SAP curriculum has now been implemented at the women’s prison in Kansas, where program staff are also addressing trauma and gender-responsivity. Also, the KDOC implemented a similar cognitive behavioral interventions curriculum developed by UCCI for sex offender treatment, Cognitive Behavioral Interventions for Sexual Offending (CBI-SO), in January 2015. The work is ongoing with that curriculum, but the department anticipates good outcomes for the same reasons SAP has yielded positive results. Both of these initiatives involve data collection, and all sites will include fidelity observations with feedback and coaching. As part of the overall quality assurance work in Kansas, data is being collected on fidelity observations, so that providers can see how they compare to other sites, and see their own progress over time. All of this data regarding fidelity observations will be available for independent evaluations of SAP for females (and follow up for males), and for SOP, so we can continue to identify the impact of these curricula and related strategies.