What is the evidence for this practice?

How are decisions made about what type of treatment a person participates in when incarcerated?

This infographic (below) represents the assessment process for an individual at the intersection of criminal and legal involvement.  When an individual is found guilty of a crime and then sentenced to jail, current best practices involve the person participating in a Risk/Need/Responsivity assessment. Some parts of this assessment are very well evidenced; however there some spin-off’s of the assessment I have questions about – particularly the part that determines what specific treatment modalities to offer.

The assessment is done in order to find out (among other things) three categories of things:

1. What the individuals “Risk” is to engage in future illegal activity?
2. What are the 8 “Need” areas that could result in future illegal activity and should be targeted for treatment?
   • History
   • Thinking/beliefs
   • Personality
   • Peers/Social
   • Supports
   • Harmful substance use
   • Family/marital
   • Relationships
   • School/work
   • Recreation
3. What are the unique characteristics of a person so that treatment can be tailored to fit the client’s needs – “Responsivity”
   • Level of motivation
   • Mental health needs
   • Unique strengths
   • Learning style
   • Mental health needs
   • Etc…

Some agencies in MA then use this assessment to then assign specific CBT protocols that the person has to participate in; which are somehow determined to address the specific need areas (look at the middle part of the picture above, highlighted in yellow).

Their thinking/process looks something like this:

1. Person scores Very High on assessment –> that means that they will have to complete 250+ hrs of treatment (dosage rule)
2. The person’s need areas that were scored high were (for example):
   • Antisocial cognition
   • Antisocial peers
   • Antisocial personality
   • Substance Use
   • Family/Marital
   • Leisure/Recreation
3. Then the client has to participate in a series of set curriculums that are somehow determined to address the specific need areas. (need rule)
   • During groups, the facilitator considers the person’s characteristics (responsivity rule)

I am curious about the scientific process used to measure, and then determine, if a specific protocol can be used to address a specific RNR need area (e.g., “cognition” vs. “personality” vs. “substance misuse”).  After ten years in the field, I remain confused by this process.  Here in MA, some state agencies make determinations that says specific protocols only address certain need areas …. (insert confused face with a question mark above my head) 😊. I am genuinely confused – how do you work with someone to support their recovery from harmful substance use, without addressing how one thinks, who one hangs out with, what type of social supports they have and what they do with their spare time?

Analogous to this line of thinking is like going to the gym to exercise. Its as if I went to the gym and wanted to work out my different muscle groups – I would do exercises that target specific areas of the body. This makes perfect sense for the body but that is not how the mind/psychology works.

Is there a scientific process here? I have reached out to a number of research agencies and will update this blog post as I learn more.

Basically, I am dubious of this logic and am concerned agencies are making decisions without good guidance – which has significant consequences for people and the community.  I contend that if someone is going to be incarcerated then they should be provided scientifically driven interventions that help the participants and ultimately the community. 

Despite my concern, I hold open the door that maybe I am wrong and there are scientific strategies to make these determinations.  I have reached out to a number of research agencies and will update this blog post as I learn more.