Treatment programmes

Background: Cognitive skills programmes were introduced into HM Prison Service in the early 1990s. Rationale: criminal behaviour is a result of 'faulty thinking'; challenging this will reduce re-offending.

Aim: To assess the effectiveness (based on reconviction rates) of cognitive skills programmes.

Sample: 180 females started either the Enhanced Thinking Skills (ETS) programme (114) or Reasoning and Rehabilitation (R+R) (66), compared to 540 female offenders (Controls) who did not participate in such programmes.

Method: ETS and R+R delivered to female offenders in custody. Controls matched retrospectively (ethnicity, offence type, year of discharge, expected reconviction rate based on revised OGRS2). Programmes aimed at medium-high risk offenders, although less than one third of women so categorised. Programmes should compromise 36 sessions of 2.5 hours each; participants have to complete homework in between sessions and after the course ends.

Results: No statistically significant differences between programmes participants and controls on one- and two-year reconviction rates; either overall or within risk category comparisions - low/high risk. Evidence of effectiveness of programme not established.

Evaluation: Unsound to make any conclusions about effectiveness of programme when it was not delivered/completed; not designed for women; used with mostly low-risk women; R+R used typically with males with violent and sexual offences. Socail determinism (cognitions). Usefulness cannot be determined given methodological problems, programme content, incomplete delivery.

Background: The need for anger management programmes arose because of disruptive behaviour of prisoners. Developed in the UK in the late 1980s.

Aim: To assess the effectiveness of a brief group-based anger management programme.

Sample: 87 male prisoners, mean age 18-19. 62% of experimental group and 68% of control/non-treatment group had been convicted for a violent offence.

Method: Quasi- experiement. 50 in experimental group (received anger management), 37 controls (no treatment) group. Prisoners referred by prison officers. All pre-assessed. Prisoners completed an anger management questionnaire (53 items, using rating scales, e.g. 'I have found it hard to control my anger', 0=never, 2=more than once) and their behaviour was assessed on the wing by prison officerss using a wing-behaviour checklist (WBC) with a 3 point scale: 0=never shows behaviour, 2=often shows behaviour (e.g. throws items about cell/wing; comes to office swearing/shouting) two weeks' prior to programme. Measures taken again 8 weeks after the programme for both groups. The cognitive - behavioural programme comprised 12 one hour group sessions run over a 3 day period. Participants tasks: keep anger diaries, contribute to group discussions, act in role plays, watch videos, complete homework. Sessions addressed anger triggers, consequences of anger and behaviour, thoughts/feelings; all videotaped; feedback provided to trained facilitators to ensure consistency in delivery.

Results: Comparison of 'before' and 'after' scores: 1. WBC: significant differences with experimental group, i.e. angry behaviours had decreased following course completion. Internal reliablity of WBC was high. 2. Prisoners self-reports: indicated a significant decrease in anger following course completion. 3. Controls: no changes in scores on either measure.

Evaluation: Self-report measures, validity questionable (given likelihood of socially desirable responses; offenders have incentive to report improvement - consequences for parole, etc.) although WBC is an alternative data source and allows some check on validity (that is, if offenders self-report anger control improving, WBC scores should be in line/consistent). This triangulation also allows check on reliablity. Sample size fairly reliable, although gender, age and crime-type restricted. Social determinism/situational explanations of behaviour/nurture (anger management programme). Reductionist- does not investigate physiological factors(e.g. testosterone levels). Useful to maintain safer/less stressful environment (for both prisoners and staff).

Background: A high proportion of prison inmates have drug addictions/substance abuse problems on entry to prison.

Aim: To investigate the effectiveness of ear accupuncture in treating prisoners with a drug addiction.

Sample: 350 prisoners in six high security UK prisons.

Method: Field experiement. Participants were screened to ensure there had been no substance abuse in 30 days prior to experiment and allocated to either an experimental group (who received ear acupuncture and basic standard care) or a control group (no treatment, just basic standard care). Experimental group received ear acupuncture (fine needles inserted in ear and they relaxed for 40 minutes) twice a week for four weeks; seen in groups by two trained practitioners. Prisoners completed questionnaires (covering background information; Alcohol Dependency Scale) and submitted to drug screening tests; staff recorded observations and completed reports on incidents.

Results: Self reports of treated prisoners included sleeping better, improved psychological well being, feeling better able to cope, reduced cravings and health improvement. Observations by prison staff: noticed an overall calmer wing after treatment and noticed reduced demand for healthcare services. 70% reduction in drug-related incidents. 41% reduction in serious, drug related, incident reports. 42% reduction in positive mandatory drug testing results and 33% reduction in positive voluntary drug testing results.

Evaluation: Large sample and more objective data (incident reports etc) and controls (drug testing) means study is more reliable. Although all high security prisoners, reasonable to assume these findings are generalisable across other categories of prisoners. Social determinism/situational explanations of behaviour (effects of ear accupuncture). Useful technique beneficial beyond improvements relating to drug addiction also relatively inexpensive) and does not depend on prisoners being highly motivated.