Effectiveness of Therapeutic Interventions in Offender Treatment Programmes - Essay Example

?Introduction The practice of de alization has revolutionized the nature of study and researches that are carried on convicts with developmental infirmities, shifting the emphasis of research from organizations in particular to the society in general (Taylor and Lindsay 2005). Consequent to this practise, there have been noteworthy growth in the magnitude of studies on assessment, management, and provision systems of lawbreakers with developmental infirmity or mental disorder (Steele et.al 2006); a significant amount of this research shows that developments are beginning to support clinical work in the area of offenders with developmental disabilities. The essay will concentrate on bitterness and hostility, fire-setting and unsuitable sexual behaviour to illustrate the way in which advances support clinical work done in the field of offenders with developmental disabilities. I will discuss about evidence of these therapeutic interventions in offender treatment programmes citing instances where it has been effective or ineffective; in addition, some issues that should be taken into account when the evidence of these interventions is being evaluated such as gender and comorbidity will be discussed as well. Forensic Intellectual disability settings are facilities that provide improved Psychological treatment to offenders with intellectual impairments such as learning disability or any similar impairment of intellect and/or adaptive functioning that impedes their ability to adjust in the criminal justice system (Baroff, Gunn & Hayes 2004). Statistics indicate that roughly 20% to 30% of offenders in the criminal justice system have intellectual impairments that inhibit their ability to engage and benefit from programmes meant to reform their behaviour (Glyn and Talbot 2010). In this case, offenders with developmental disorders have a high propensity of offending and risk of re-offending, and they are overrepresented in specific crimes such as sex offenses and fire setting. There are a number of therapeutic interventions that have been devised specifically for this group of offenders; for instance, common offender treatment for the intellectual disability group include therapeutic group counselling sessions for men who have sexually abused. These group sessions last up to 2 hours each week for 16 weeks, and take the form of role-plays, interactive exercises, video and more formal teaching techniques on sex education and allied topics. Anger management programs have been effective with anger and aggression behaviour, and training has emphasized on cognition, expectation, and appraisal of situations. This approach has also emphasized combination of external factors, psychological arousal, and cognitive mediation that is fundamental to anger and aggression situations, in addition to relaxation techniques for easy interpretation by offenders with developmental disability. In the cases of fire setting, following a broadly cognitive–behavioural group based intervention resulted in positive results with the developmental disability group; this is a comprehensive treatment package that includes assertiveness and social skills training, coping skills training and covert sensitization to fire-related imagery. However, a number of barriers in the community such as social exclusion oftentimes limit the access to appropriate and quality Psychological therapies (NHS 2009); it is imperative that the group with Intellectual Disability receives improved Psychological treatment. Besides that, there is dire need for the development of a competent team of service providers with specific competencies in dealing with the intellectual disability group (Pereni 2004). These interventions will enable the members to adjust in the criminal justice system; it will also lessen the risk of re-offending and vulnerability of the group in the system. Forensic intellectual disability settings Forensic intellectual disability settings, as mentioned earlier refers to institutional facilities that provide Improved Psychological Treatment to individuals with all kinds of intellectual incapacitation that renders them unfit to participate effectively in the criminal justice system, to engage actively in, and to receive optimum benefits from the correctional programs designed to reform deviant behaviour. According to the Developmental Disabilities Assistance and Bill of Rights Act of 2000 in the US, developmental disability is an all-encompassing perception that encompasses other comparable terms that denote mental impedance and learning infirmity, in addition to intellectual infirmity. Overall, the term developmental disability refers to critical, life-long, infirmity of persons; this incapacity is inevitably associated to a mental or physical injury, or a combination thereof, and results to functional limitations (Hardy, Chaplin & Woodward 2007). In view of the above definition of developmental disability, it is possible to extract a number of characteristics that typically define the mental intellectual disability group; firstly, mental or physical impairment or a combination of both factors is a key feature of intellectual disability group in general (McBrien, Hodgetts & Gregory 2003). Mental impairment refers specifically to cognitive limitations to learning abilities, while physical impairments refer to deformations that inhibit effective psychomotor functioning levels and abilities (Holland, Clare & Mukhopadhyay 2002). Developmental disability cases are identifiable in early teenage life because many individuals oftentimes manifest developmental disability tendencies before they attain the age of 22. Apart from these, another crucial characteristic of intellectual disability is that it is more likely to continue indefinitely throughout an individual’s lifetime, but with improved psychological approach interventions, clinicians can considerably control the developmental disability group. Another key characteristic of developmental disability is that it results to functional limitations in three or more areas of major life activity; for instance, developmental disability results to risky and offending behaviour such as fire setting, offensive sexual behaviour, anger and aggressiveness. Intellectual disability in all cases reflects the individuals’ need for personalized and planned support interventions and assistance that may last as long as a whole lifetime for the individuals. In this case, forensic intellectual disability settings offer the most appropriate forms of personalized and planned support interventions and assistance that the intellectual deficiency groups need. However, the concept of mental disability is not limited to mental retardation per se, because it applies to a large proportion of other conditions that do not necessarily involve a significant intellectual inability or sub average functioning; for instance, developmental disability could also refer to autism, epilepsy, in addition to other neurological conditions. Characteristics of Forensic intellectual disability settings Forensic developmental disability settings include custodian options such as secure hospitals, institutions, and facilities for people with intellectual disabilities, special units for offenders with intellectual disability, and imprisonment. Non-custodian intellectual disability settings include the intermediate sanction programmes used in the US, which are community-based programmes that are oftentimes tougher than the usual parole but less strict and expensive than prisons. Several individuals who have committed relatively low-level sexual offences are usually referred to services in the community, because these individuals are relatively easier to manage in the community (Hogue et al 2006). Normally, intermediate sanction programmes entail intensive supervision, day reporting centres and house arrest, in addition to, electronic monitoring mechanisms; substance abuse treatment, and boot camps are also core aspects of these programmes. Secure hospitals provide indeterminate incarceration for intellectual disability persons under the mental health legislation, to convince the unlikeliness of reoffending before release. However, the secure hospitals do not provide ideal correctional environment for intellectual disability persons because they restrain the individuals away from the conventional society having no conceivable mental health therapy initiatives. Traditionally, medication, physical limitation, and transferal to other clinical areas are the main features that characterize these secure hospital settings for the intellectual disability persons. Despite efforts at de-institutionalization of the populace with intellectual infirmity, many western countries have not completed this process and as a result, many institutions and facilities for people with this disability are overcrowded. Apart from overcrowding, many institutions for individuals with intellectual disabilities are thoroughly understaffed, and/ or they lack an effective team of professionally trained staff to attend to the needs of the individuals. Nevertheless, insufficient ward space, fun areas, high noise levels, insufficient entertainment, lack of social activities, and a shortage of individual programme advances and growth, also bedevil the remaining institutions. Distinctive units for lawbreakers with mental incapacity exist in the society, on university grounds of prior mental infirmity bodies, and in reformatories. These units for criminals with the disability have limited right of entry to expert, behaviour control groups and suffer from lengthy waiting lists that limit the court’s opportunities to endorse behavioural supervision as a form for proclamation or security, or for the digression from the justice system. Unlike the rest of the forensic intellectual disability settings, imprisonment in institutions provides an entirely different experience to individuals with intellectual disability. A remarkable feature of incarceration in organizations is that reformatory services departments administer the facility, as opposed to health or disability facilities. Unlike the other settings, the main aim of incarceration in imprisonment facilities is retributive, with conceivably a slight lip-service focus to reintegration goals. Common offender treatment Common offender treatment for intellectual disability has taken the form of probation and parole with intensive supervision in any of the three programmes available- for juveniles or adults with intellectual disability, or for adults with mental health problems. Inter-agency cooperation is crucial for the success of the programmes, besides incorporation of other aspects such as intensive supervision, medication monitoring, personal and family counselling. In addition to that, substance abuse programmes, psychometric assessments, vocational training, and placement assistance are also determinant factors for the success of programmes under parole. Therapeutic interventions for the intellectual disability group include multi-systemic therapy that has been very effective especially with juvenile offenders, group treatment, and cognitive-behaviour therapy for sex offenders with intellectual disability. The intervention for fire setting especially for young offenders has traditionally taken the course of two broad and often combined education and cognitive behavioural therapy. Educational interventions provide young people with fire safety skills while cognitive behavioural interventions, specifically for young people with intellectual disabilities, focus on the psychological and social factors associated with fire setting (Tranah & Nicholas 2013). Treatment for intellectual disability persons with anger and aggression has also followed the cognitive-behavioural model developed by Novado; this methodology integrates the stress inoculation model and has mental restructuring, stimulation reduction, and behavioural skills exercise as its key strategies. A combination of group cognitive-behavioural practices such as self-monitoring, recreation and keeping fit or exercising have been very effective in bringing about declines in the intensities of rage and hostility in the intellectual disability group. Many studies have backed the cognitive-behavioural interventions’ effectiveness in treatment of Intellectual disability persons concerning proximal, self-report measures of the degree to which partakers experience rage and in informally authenticated procedures of prevalence. Moving further, as far as inappropriate sexual behaviour is concerned, treatment for intellectual incapacity has been in the form of behavioural management approaches, educational approaches, and cognitive-behavioural therapy among others. Several sex-offenders mediations for individuals with intellectual disability have traditionally followed multifaceted approaches, comprising of psych-informative, behavioural control and skill acquirement, in addition to relapse-inhibition mechanisms (Lindsay et al 2007). Behaviour modification In as far as, modification of behaviour is concerned, cognitive-behavioural intervention programmes modify intellectual disabilities related to anger and aggression through a broad psycho-informative elementary stage of six sessions and a treatment stage of 12 sessions. The 12 sessions of treatment stage entail mental reformation, stimulation lessening, and behavioural skill exercise that effectively leads to the conclusion that intellectual disability individuals with anger and aggression problems can productively involve and profit from cognitive-behavioural mediations focusing on the rage and reaction construct. On the side of fire-setting, interventions successfully modified conduct after a comprehensive 40 group based sessions that entail work on offence cycles; this led to the elucidation of precursor situational factors and causes, perceptions, sentiments and behaviour practiced at the time fires took place, in addition to the constructive or undesirable consequences of the fire setting conduct. Intellectual disability individuals with fire setting conduct also received training with reference to risks and dangers linked with setting fires, in addition to, teaching and practise of skills to augment future capacity to cope with emotive and relational difficulties allied to foregoing fire experiences (Taylor 2002). Nevertheless, treatment also involved realization of tailored plans to avert deterioration, and after assessment on fire-specific, fury, self-regard and hopelessness measures subsequent to treatment, there were considerable improvements in participants. Sexual offence behaviour modification programmes work by providing social proficiency, enhanced relationship abilities, and sex-education to intellectual disability individuals with sexual offences, in addition to, addressing non-standard sexual conduct and construction of a relapse-inhibition administration structure with support-staff (Rose et al 2002). Effectiveness of interventions There is considerable evidence of the success of most of these remedial interventions in mitigating the social dilemma of intellectual disability, to reduce the prevalence of offences and rate of offending in the group (Alexander, Crouch, Halstead & Piachaud 2006). For instance, case studies and researches comprising of individual and group therapy setups integrating a mixtures of cognitive-behavioural practises comprising of self-monitoring, recreation and teaching skills have generated positive results in anger and aggression reduction. Moreover, some researches have also recognized with certainty, the helpfulness of collective cognitive-behavioural rage management as compared to the waitlist organised settings in intellectual disability persons with anger and aggression problems (Novaco et.al 2002). Assessment of the effectiveness of this approach was accomplished by means of an aggravation inventory, role-plays of rage infuriating circumstances and weekly journals; in accordance with other researches, members of the group improved considerably when likened to the waiting list participants. Treatment for intellectual disability related to fire setting also registered positive results when assessed on the same scale as the one used for aggression and anger; the treatment successfully engaged the intellectual disability patients who reacted constructively to the group setting, displaying great levels of enthusiasm and commitment. A number of fire specific clinical assessments also reveal the effectiveness of the intervention in engaging the participants during the therapy process with successful result in curbing fire-setting behaviour. Similarly, cognitive-behavioural interventions in intellectual disability sexual offenders have yielded positive results such as changes in cognition and low re-offending rates (Mikkelsen 2004); an individual assessment standard using the QACSO attitude scale, a measure of locus of control, sexual behaviour and the law scale and victim empathy scale reveal that offenders did not re-offend at one-year follow up. Overall, there is a considerable amount of literature on research to substantiate the claims of the effectiveness of the remedial cognitive-behavioural interventions in intellectual disability clients (Lindsay 2004). Re-offending rate A remarkable decrease in the rate of re-offending in most of the cases participating in the cognitive-behavioural interventions is concrete prove of the success of these interventions in dealing with intellectual disability behaviour. Offenders generally respond positively to cognitive-behavioural interventions by reforming their cognition, and developing specific competencies of dealing with risk of re-offending, after completion of treatment. In terms of referrals, it was established that women are referred due to antisocial behaviours at the same rate just as men with intellectual disabilities (Wheeler 2009). Specific Issues for consideration There are a number of specific issues that should be taken into consideration when the evidence of intervention programmes in response to the prevalence of offences relating to intellectual disability individuals is being evaluated. Firstly, the gender issue is a very relevant variable that considerably affects the success of intervention programmes; unfortunately, previous studies of alleged or convicted criminal offenders have paid little or no attention at all to the particular characteristics of women with intellectual disabilities (Smith 2004; Department of Health n.d.). In addition to this, there is considerable evidence that is consistent with the findings that women with antisocial behaviour within the health and social care services are treated differently from men. Oftentimes, women with antisocial behaviour are more likely to be subject to intrusive interventions such as punishment or medication, and within the specialized hospital services (most of which are mixed gender), women are likely to become victims of sexual abuse by staff and other service users (Allen et al 2001). Overall, individuals with intellectual disabilities tend to be young, male and have experienced severe psychosocial disadvantage and offending from other family members. Another critical issue that should be taken into account when evaluating the interventions for individuals with intellectual disability is comorbidity, which clinicians oftentimes refer to as dual diagnosis in that individuals with intellectual disorders are more likely to be diagnosed with mental illnesses. For instance, women have been found to have high prevalence rates of personality disorders (Smith 2004); there is an increased possibility that the past abuse is an etiological validation variable for personality disorder diagnosis in people with intellectual disorders (Holland, Clare & Mukhopadhyay 2002). Apart from that, common mental illnesses that are prevalent in Intellectual disability individuals include psychosis, bipolar disorders, or depressive disorders; in addition to these, intellectual disability victims were also found to have developmental disorders, in addition to alcohol and drug dependency (Alexander 2010). Depression has been recorded at the rates of about 1%-5% in individuals with intellectual disability, corresponding to rates that exceed the rates equivalent to individuals in the general population by two or three times (O’Brien 2002). Most studies have also identified Schizophrenia among individuals with intellectual disability to have prevalence rates that are about twice as higher than those found in the general population are. Other complications commonly identifiable in individuals with intellectual disability include autism, attention deficit hyperactive disorder, anxiety/neurotic disorder, attention-deficit hyperactivity disorder, and manic-depressive disorder. Overall, studies have established a strong correlation between individuals diagnosed with intellectual disabilities who commit crimes and psychiatric disorders or allied mental disorders that affect cognitive functioning of individuals, in addition to problematic drug and/or alcohol dependency (Mottram 2007). Conclusion Ultimately, there has been considerable research that has yielded consistent findings in tandem with the conclusion that developments are beginning to show support for clinical work in the area of intellectual disability. Studies in anger and aggression, fire setting, and inappropriate sexual behavior illustrate clearly that clinical interventions have become the norm, rather than the exception in the area of intellectual disabilities. A number of assessments that are effective in delineating psychological variables have been developed, in addition to assessment of risk of future re-offending; treatment programmes for individuals with intellectual disability are becoming increasingly complex as well, due to developments in cognitive techniques. Forensic developmental disability settings are divided into custodian options and non-custodian options; custodian options encompass the secure hospitals, institutions, and special units for offenders with intellectual disability, while non-custodian intellectual disability settings include the intermediate sanction programmes. Unlike custodian options, non-custodian options are community-based programmes that are oftentimes tougher than the usual parole but less strict and less expensive than prisons. Forensic intellectual disability settings are designed to provide special services to individuals with intellectual disability, though not always with a correctional agenda in all cases as should be the case. Intellectual disability programmes have largely adopted cognitive-behavioural modification approaches that have been applied in specific instances such as in correcting individuals with fire setting behaviours, inappropriate sexual behaviour, and anger and aggression. Remarkably, intellectual disability treatment interventions have been surprisingly successful in behaviour modification; this has been evaluated based on improved cognition, and low levels of re-offence in the participants. 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