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Adapting Programs to Incorporate EBPs for CJ-Involved Clients

Adapting Programs to Incorporate EBPs for CJ-Involved Clients. Merrill Rotter, MD Medical Director, EAC TASC Mental Health Programs Associate Clinical Professor, Albert Einstein College of Medicine merrill.rotter@gmail.com. Why Incorporate EBPs. Engagement Clinical Improvement

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Adapting Programs to Incorporate EBPs for CJ-Involved Clients

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  1. Adapting Programs to Incorporate EBPs for CJ-Involved Clients Merrill Rotter, MD Medical Director, EAC TASC Mental Health Programs Associate Clinical Professor, Albert Einstein College of Medicine merrill.rotter@gmail.com

  2. Why Incorporate EBPs • Engagement • Clinical Improvement • Decrease Untoward Behavior • Improved quality of life • Decreased recidivism (re-arrest)

  3. RNR and EBPs Responsivity Engagement CBT intervention Needs The Central Eight

  4. Risk • Match treatment intensity to level of risk • Needs • Treat the offender, not the offense • Responsivity • Modality must be one to which offender is responsive • CBT • Engagement

  5. Responsivity Principle

  6. Responsivity:Tailoring Treatment • General • Responsive to learning styles • e.g. CBT • Specific • Responsive to socio-biological personality factors • Engagement

  7. Why focus on engagement? • Treatment outcome and premature termination predicted by engagement • Treatment outcome related to patient effort • Manner of therapist related to engagement and effort

  8. Engagement Challenges • Motivation • Motivational Interviewing • IMR Goal Setting • Focus on Recovery • CJ culture Adaptation • SPECTRM Intervention

  9. Trauma • Consequences • Isolation • Hypervigilance • Emotional reactivity • Intervention principles • Safe environment • Processing of Trauma • Identification of coping strategies

  10. Cultural Competence • Cultural Proficiency • Meaning of symptoms, illness, stressors • Meaning of treatment • Relationship with professionals • Overcoming mistrust • Communication • Rapport • Disclosure • Using “natural” community support

  11. Incarceration as Cultural Adaptation These walls are kind of funny. First you hate 'em, then you get used to 'em. Enough time passes, gets so you depend on them. That's institutionalized.

  12. AKA: The Inmate Code Do Your Own Time Mind Your Own Business Trust No One Show Respect Ignore Others’ Infractions Don’t Steal Don’t Snitch Don’t Show Weakness Don’t Stare

  13. Promote Cultural Re-adaptation by • Connecting • Developing trust through shared experience • Exploring • Challenging prison and jail attitudes • Changing • Introducing new problem solving skills

  14. Three Principles • CONNECTING • Be willing to listen and learn: Where were you and what was it like? • EXPLORING • Be aware of differences and similarities in the two cultures: What are the cues? • CHANGING • Be neutral: Is it working for you here?

  15. Needs PrincipleThe Central Eight • History of antisocial behavior • Antisocial personality pattern • Pleasure seeking, restless, aggressive • Antisocial cognitions • Attitudes supportive of crime • Antisocial Associates • Family support • Leisure Activities • School/work • Substance Abuse

  16. Needs - Interventions • Substance Abuse • Integrated Treatment • People, places and things • Family support • Multi-family therapy • School/Work • Supported Employment • Homelessness • Housing first • Antisocial Cognitions/Associates/Character • Monitoring • Cognitive behavioral interventions

  17. Cognitive-Behavioral InterventionsCJ-Involved Populations • Introspection skills • Cognitive Restructuring • Problem Solving • Identification of cognitions • Cost-benefit analysis • Social Skills • Conflict Resolution • Moral Reasoning/Community Responsibility

  18. Cognitive-Behavioral AdaptationsCJ-Involved Populations • Thinking for a Change • National Institute of Corrections • Lifestyle Change Journaling • The Change Companies • Reasoning and Rehabilitation • Moral Reconation Therapy

  19. Cognitive-Behavioral InterventionsCJ-Involved PopulationsMH Program adaptations • Target symptoms • Frustration intolerance • Social skills • Misperception of environment • Examples • Forensic DBT • Jail - decreased anger, aggression and incidents • Community - decreased re-arrests in stalker-focused program

  20. RNR

  21. Merrill Rotter, MD Medical Director, EAC TASC Mental Health Programs Associate Clinical Professor, Albert Einstein College of Medicine merrill.rotter@gmail.com

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