Appendix 1 Cognitive-Behavioral Program Standards.pdf

Department of Corrections

Program

Treatment

Standards

Original Effective Date:

New Effective Date:

May 23, 2017

Supersedes:

Units Affected:

DAI Institutions DJC Facilities DCC Facilities

WCCS Facilities Contracted Providers WRC

Program: Cognitive-Behavioral Program Standards

I. References:

See attached reference list.

II. Definitions and Acronyms:

Cognitive-Behavioral Program (CBP): An evidence-based program that teaches specific strategies or techniques to enable participants to (1) identify the specific thoughts that support criminal behavior (self-observation); (2) recognize the pattern and consequences of thinking; (3) utilize reasoning, problem-solving, self-talk, and social interaction skills as a means of controlling and changing thinking; (4) recognize and evaluate potential choices and make a conscious decision to change or not to change a behavior. This program combines two types of cognitive interventions: cognitive restructuring (changing the thinking patterns, attitudes, and beliefs that lead persons to offend) and cognitive skills training (learning and practicing reasoning, problem-solving, and social skills).

Corrections Offender Management Profiling for Alternative Sanctions (COMPAS) Assessment:

COMPAS is a 4th generation actuarial risk/needs assessment tool that provides an indication of how likely an offender is to recidivate both generally and violently post-assessment. COMPAS also provides a pre-trial risk measure intended to inform bond and other pre-trial decisions. In addition to risk, COMPAS also provides information relative to the level of criminogenic need in the offender’s life. A vast array of criminogenic needs are assessed including criminal thinking/personality, antisocial associates, family/marital, substance abuse, employment, education, financial, leisure/recreation, social isolation, etc.

Core Content: Required components of a program that must be provided to all participants and are considered fundamental to program fidelity.

Criminogenic Needs: Aspects defined by the DOC COMPAS assessments that are identified as an area of risk for re-offending due to criminal/problematic areas in an individual’s life.

DOC: Wisconsin Department of Corrections.

Dosage: The total accumulation of programming hours received via groups, individual sessions, and targeted intervention tools in alignment with risk level.

Enrollment: The process of moving participants from a waitlist to an active Cognitive-Behavioral Group roster.

Participant: A person, adult or juvenile, under the care, custody, or supervision of the Wisconsin DOC who is receiving program services.

Final Participant Evaluation: An evaluation based on the participant’s performance completed by staff.

Each program may have their own standard measurements, including participant self-evaluation, as defined by program guidelines.

Program Facilitator: An Individual who delivers programming and evaluates participant performance.

Program Site Manager: A staff member with supervisory designation who will provide programmatic supervision to ensure program integrity and a professional level of practice by CBP facilitators.

Supplemental Content: An addendum to core program curriculum which will enhance the content and/or address responsivity issues. All supplemental content will be subject to a site-specific approval process.

Supplemental Content is an addition to the Core Content, and should not replace any of the existing curriculum.

III. Purpose and Scope of Service:

Cognitive-behavioral program services protect the community from criminal behavior by evaluating, treating, and reducing the offender’s risk of reoffending.

IV. Purpose of Standards:

Standards for cognitive-behavioral assessment and treatment are necessary to achieve the following objectives:

A. Increase the effectiveness and consistency of service delivery throughout DOC;

B. Carefully consider fiscal and human resources;

C. Identify subordinate goals, objectives, and outcomes to form the basis of a policy and procedure guide;

D. Guide curriculum development and implementation;

E. Identify offender risk, needs, and responsivity factors and incorporate them into all aspects of treatment and treatment design;

F. Maximize service benefit by ensuring continuity of care;

G. Utilize evidence-based practices to continually improve program quality and effectiveness.

V. Service Standards:

Assessment and Evaluation:

A. Evidence-based practices shall be utilized for assessing and evaluating offenders for cognitive-behavioral needs, risk of reoffending, and responsivity factors.

i. Initial Evaluation:

1. Criminogenic needs: (Andrews, 2007)

a. Assessed by qualified and trained DOC staff using COMPAS.

b. Primary criminogenic needs include:

1. Anti-social cognition;

2. Anti-social companions;

3. Anti-social personality characteristics or temperament;

4. Family and/or marital problems

c. Consideration will be given to the additional needs of substance abuse, employment, school, and leisure/recreation.

ii. Reevaluation may be conducted using the current standards for assessment when new information emerges that that may result in a change of risk level or program need.

B. Adult Cognitive Needs Scales (as defined by COMPAS) Driving Program Placement:

i. Core Assessment:

1. Criminal Thinking Self-Report

2. Criminal Personality

3. Cognitive-Behavioral

4. Criminal Opportunity

5. Criminal Associates and Peers

6. Criminal Involvement

ii. Legacy Assessment:

1. Criminal Thinking Observation

2. Negative Social Cognition

3. Reentry Cognitive-Behavioral

4. Prison Misconduct

5. Criminal Involvement

iii. Reentry Assessment:

1. Criminal Thinking Observation

2. Criminal Personality

3. Negative Social Cognition

4. Reentry Cognitive-Behavioral

5. Prison Misconduct

6. Criminal Involvement

C. Youth Cognitive Needs Scales: (as defined by COMPAS) Guiding Development of Treatment Plan and

Release Expectations:

i. Youth Assessment:

1. Aggression

2. Anti-social Peers

3. Anti-social Opportunity

4. Common Drugs

5. Drugs and Delinquency

6. Family Discontinuity

7. Few Pro-Social Activities

8. Hard Drugs

9. Impulsivity

10. Inconsistent Discipline

11. Negative Social Cognitions

12. Lack of Remorse

13. Low Empathy

14. Low Family Emotional Support

15. Manipulative

16. Parental Conflict

17. School Behavioral Problems

18. Violence Tolerance

19. Youth Rebellion

ii. Youth Reentry Assessment:

1. Anger

2. Cognitive-Behavioral

3. Criminal Thinking Observations

4. Low Empathy

5. Low Self-Efficacy/Optimism

6. Negative Social Cognitions

7. Social Environment

8. Social Isolation

D. Level of Risk: The risk level is determined by the “COMPAS Risk Level Recommendation” unless the

“Actual Risk Level Recommendation” is provided, which overrides the COMPAS Risk Level

Recommendation. This indicator is found in the COMPAS application: located under COMPAS

Assessment/Assessment Summary/Supervision Recommendation Summary. Risk will be prioritized in the order of high, moderate, low, when combined with identified cognitive-behavioral programming needs as noted in section D. Cognitive-Behavioral Needs. Offenders will be separated by risk level for program delivery purposes.

E. Program Needs: COMPAS Criminogenic Scales and Case Information will be used to assign cognitive-behavioral programs. Those identified as highly probable or probable on any single cognitive-behavioral scale will be identified as an individual with a CBP need. Division-specific policies and procedures may influence program placement decisions for specialized populations. As a general rule, the following terms and cut points are utilized when describing the COMPAS criminogenic needs scores. Scores are described as follows:

i. Highly Probable/High: Core, Legacy, Reentry and Youth Scores of 8-10 on cognitively-based scales listed in criminogenic needs.

ii. Probable/Medium: Core, Legacy, Reentry Assessments score of 5-7 on cognitively-based scales listed in criminogenic needs.

iii. Unlikely/Low: Core, Legacy, Reentry Assessments score of 1-4 on cognitively-based scales listed in criminogenic needs.

F. Responsivity Factors and Special Populations: A thorough assessment of all population groups considers factors that may interfere with or enhance an offender’s response to program intervention.

Facilitators should be mindful of responsivity factors of individual participants. However, responsivity factors should not be used to create homogeneous groups. Program Site Coordinators may choose to develop accommodated groups. Responsivity factors to consider are included (but not limited) to the following characteristics:

i. Responsivity Factors:

1. Specific criminal characteristics

2. Age

3. Culture

4. Reading level

5. Comprehension ability

6. Mental health

7. Developmental disability

8. Physical disability

9. Medication management

10. Limited English Proficiency (LEP)

11. Motivation level

12. Learning style

13. Other commitments

14. Socioeconomic status/barriers

15. Social supports

ii. Special populations: May require use of population specific tools or resources when available/applicable. Special populations may include (but are not limited to):

1. Gender

2. Criminal history

3. Participants repeating a program

4. Participants in an advanced practice, aftercare, or relapse program

G. Enrollment and Eligibility: Enrollment and eligibility criteria will include the following:

i. CBP Criminogenic Need

ii. Risk/Dosage Requirement

iii. Responsivity Factors

iv. Consideration of Program Length and Release Date

H. Evaluation: Evaluation of participant program progress will include:

i. Comparison of pre-test and post-test scores on program content exam

ii. Comparison of pre-test and post-test scores on an instrument which measures attitudinal change.

iii. Staff observation of offender demonstration of knowledge acquisition through treatment and application of learned skills.

VI. Cognitive-Behavioral Curricula:

A. CBP shall meet Risk, Need, Responsivity principles of Evidence-Based Practices.

B. Non-exhaustive List of Cognitive-Behavioral Programs outlined in Appendix I.

C. Any existing and/or new program proposals to meet the Cognitive-Behavioral Needs of offenders within the DOC shall possess:

i. Formalized manual or structured lesson plans and materials

ii. Individual assessment(s) and evaluation(s) of the Offender

iii. Criminogenic Targets

iv. Based on cognitive-behavioral research with offender populations

D. In addition, all programs must include the following Core Content Areas:

i. Cognitive restructuring: evaluating, identifying and changing thoughts, attitudes, and /or beliefs that lead to offending - behaviors.

ii. Cognitive skills training: goal development, reasoning, problem-solving and decision-making, and practicing social skills.

iii. Guided skills practice (homework, in-class practice, modeling)

iv. Self-Risk Management (a document, examination or presentation that demonstrates the ability to identify personal risks and apply pro-social options)

v. Approved supplemental content may be used to reinforce existing curriculum.

VII. Staff Standards:

A. To ensure the quality and effectiveness of services, staff delivering CBP shall have necessary training, licensure, and supervision necessary per curriculum specifications.

i. All individuals providing CBP programming shall obtain and document 18 hours of continuing education training in CBP and clinical service delivery every biennium. Continuing education includes courses, seminars, conferences, workshops, and other training experiences approved by the Department of Corrections or an accrediting body.

ii. CBP Providers shall continue to supplement their educational and professional experience through consultation with other professionals who have relevant expertise in the field.

B. Staff Qualifications for Program Facilitators

i. Facilitators are required to successfully complete the approved curriculum-specific CBP

Facilitator Training prior to conducting group sessions.

1. Facilitators may serve in the lead facilitator role upon successful completion of formal

CBP Facilitator Training with the endorsement of trainers.

2. Staff required to co-facilitate prior to formalized training are expected to attend the first available approved site-specific CBP Facilitator Training. Untrained co-facilitator duties are limited to assisting and observing the group, and shall not include serving as the lead facilitator.

ii. Facilitators must demonstrate knowledge, understanding, and skills in:

1. Managing group dynamics while including active use of modeling and role-play.

2. Addressing responsivity issues specific to the groups they will be facilitating.

3. Using positive reinforcement with ratio of four positive reinforcements to one corrective sanction.

4. Recognizing the adverse effects of punishment and sanctions.

C. Additional Qualifications Recommended for at least One Member of Co-facilitation Teams:

i. Minimum of an Associate’s degree in a human service/related field.

ii. Certified training in group facilitation techniques.

iii. Certified training in the approved site-specific CBP curriculum.

iv. At least two years of experience in facilitating cognitive-behavioral programming.

v. At least two years of experience working with correctional clients.

D. Program Site Manager(s)

i. Program Site Managers shall coordinate/plan assigned programs for an institution and/or community corrections setting. Training and experience in approved site-specific programming is required. These individuals will oversee program delivery in the following areas:

1. Conducting assessments and pre/post evaluations of cognitive-behavioral attitudinal change.

2. Providing CBP individual and group intervention with target population(s).

3. Case management including treatment planning, general knowledge of social services and appropriate referrals, record keeping, mandatory reporting requirements, confidentiality rules and regulations as they apply to the specific population, and knowledge of professional ethical standards.

4. Assuring program updates, curricula, and policy revisions are distributed to program facilitators.

5. Monitoring fidelity of program delivery through structured group observation conducted at least quarterly.

6. Collecting, tabulating, and disseminating quantitative data and other program-designated measurements.

VIII. Quality Assurance Standards:

A. Cognitive-Behavioral programs shall maintain a program/curriculum manual which shall be updated a minimum of once every two years, or whenever these standards are amended or revised.

B. Program supervisors shall document and ensure that staff meet and maintain educational, training and professional development, and consultation/offender staffing requirements.

C. Programs shall be regularly observed and documentation shall reflect the quality of service delivery using standardized observation tools to assist in program consultation.

D. Participant satisfaction surveys shall be administered periodically throughout programming and used to inform program delivery practices.

E. Pre- and post-testing shall be conducted to measure knowledge acquisition, behavioral, and attitudinal changes, and skill application.

F. Regular collection of data and review of documentation for quality will be conducted.

G. Results of quality assurance efforts shall be maintained by the institution or region and made available to the Evidence-Based Program Standards Subcommittee or other designated DOC body upon request.

H. The formal CBP service standards shall be reviewed by the appropriate oversight body at a minimum of every 5 years.

I. Approval of new programs shall follow the division-specific process which will include a review of program proposal and pilot before implementation. As these division-specific processes are implemented, the Evidence-Based Program Manager will provide oversight consistent with current research on effective intervention.

Appendix I: Non-Exhaustive List of Current WI-DOC Cognitive-Behavioral Programs

I. Definitions:

Closed Group: A group with structured lessons which are completed in a specified order in which all participants start and end on the same specified dates.

Semi-Closed Group: A group with a specified start/end point which allows participants to enroll at various interval(s) of a program.

Open-Ended: An ongoing group that does not have a specific start date or end date. Participants may begin at any time.

II. Examples of Criminality-Focused Cognitive-Behavioral Programs:

A. Moral Reconation Therapy (MRT): An open-ended, self-paced, systematic, cognitive-behavioral, 16-step program designed to enhance self-image, promote growth of a positive, productive identity, and facilitate the development of higher stages of moral reasoning. Reconation: the term "conation" was used to describe the conscious process of decision- making and purposeful behavior before the term "ego" was introduced in the

1930s. The term “reconation” is an attempt to have participants reevaluate their decisions.

1. Objective: Programming for offenders with chronic substance abuse problems, anger management, and domestic violence issues.

2. Population: Male, female, and juvenile offenders with anti-social personality characteristics

3. Program location: DAI & DCC sites

4. Group Type: open-ended

5. Group Size: 8-15

6. Providers: MRT- trained/certified facilitators

7. Duration: 20-32 groups

8. CBP Outcome Criteria: Complete 12 in-group assignments with facilitator’s approval.

9. Currently offered to: Adult Male and Female Offenders

B. Moving On: A Cognitive-Behavioral Program which integrates Motivational Interviewing, Social Learning

Theory, and Relational Theory. The program design reflects nine guiding principles: relational, strength-based, trauma-informed, respect for differences, enhancing motivation and self-efficacy, building formal and informal supports, providing a framework for continuous services, working collaboratively to establish program outcomes, and evaluation. There are six modules to the Moving On curriculum: Orientation, Listening and Being Heard, Building Healthy Relationships, Expressing Emotions, Making Connections, and

Transitions.

1. Objective: Develop personal strategies that support change efforts, build social capital (natural supports and professional supports), and enhance self-efficacy (rewrite personal narrative). The program is designed to target needs specific to women.

2. Population: Adult Female Offenders

3. Program location: TCI, RECC, MWCC, WWRC

4. Group Type: Groups can be open or close-ended. The program allows for continuous intake.

5. Group Size: 10-12

6. Providers: Moving On-trained staff. Motivational Interviewing training is recommended for facilitators.

7. Duration: 24 sessions, 2 hours each, 2-3 sessions per week.

8. CBP Outcome Criteria: Complete all modules and show proficiency in application of skills.

9. Currently offered to: Adult Female Offenders

C. Juvenile Cognitive Interventions Program (JCIP): A three-phase cognitive restructuring program designed to motivate participants to assume responsibility for changing their anti-social thinking and behaviors. Phase I

(Choices) and Phase II (Changes) are delivered at the juvenile institutions with a Families Counts component.

Phase III (Challenges) is a self-paced application that is completed individually by youth in the community under the guidance of an assigned agent. An 8-week Relapse Program may be recommended for youth who return to the institution due to revocation or a new offense.

1. Objective: Identify thinking patterns and beliefs influencing behavior, develop and practice interventions for past thinking, goal-setting, and problem-solving.

2. Population: Juvenile offenders

3. Program location: DJC sites

4. Group Type: closed

5. Group Size: 8-12 participants

6. Providers: One JCIP- trained facilitator

7. Duration: Two phases completed at DJC site with 12 lessons per phase, two hours per lesson. (Third phase completed individually with agent in community as assigned.)

8. CBP Outcome Criteria: Complete all lessons and homework, Cycle of Offending, and Plan for Change with facilitator’s approval.

9. Currently offered to: Juvenile Offenders

D. Thinking for a Change: A program which focuses on cognitive-behavioral changes through three components: Cognitive Self-Change, Social Skills, and Problem-Solving Skills. Cognitive Self-Change teaches individuals a concrete process for self-reflection aimed at uncovering anti-social thoughts, feelings, attitudes, and beliefs. Social Skills instruction prepares group members to engage in pro-social interactions based on self-understanding and consideration of the impact of their actions on others. Problem-Solving

Skills integrate the two interventions to provide group members with an explicit step-by-step process for addressing challenging and stressful real-life situations.

1. Objective: Cognitive restructuring, social skill development, and problem-solving

2. Population: Adult Offenders

3. Program location: DAI & DCC sites and may be offered at DJC sites in the future

4. Group Type: closed

5. Group Size: 8-12

6. Providers: Thinking for a Change- trained/certified facilitators

7. Duration: 25 lessons, 2 hours each

8. CBP Outcome Criteria: Complete 25 lessons and required homework.

9. Currently offered to: Adult Male and Female Offenders

III. Offender Secondary/Ancillary/Trait-Focused and Offense-Specific Cognitive-Behavioral Programs:

A. Anger Control Training (ACT): An evidence-based program that combines group discussion, exercises, and role playing to address the emotional, cognitive, and behavioral needs of offender populations exhibiting anger and aggression. ACT teaches self-control techniques to effectively manage anger and aggression.

1. Objective: Cognitive-Behavioral Program, Conflict Resolution/Interpersonal Skills, Violence Prevention

2. Population: Offenders with a history of serious aggression

3. Program location: DAI Sites

4. Group Type: Closed

5. Group/Classroom size: 8-10

6. Providers: ACT- trained facilitators

7. Duration: 2 times per week for 10 weeks

8. CBP Outcome Criteria: Complete 10 lessons and homework for Anger Control and show proficiency in application of skills.

9. Currently offered to: Adult Male Offenders

B. Aggression Replacement Training (ART): An evidence-based program that combines group discussion, exercises, and role playing to address emotional, cognitive, and behavioral issues for juveniles in corrections.

It consists of three components: Skillstreaming that develops pro-social skills; Anger Control Training (ACT) which teaches self-control techniques to handle anger and aggression; and Moral Reasoning which exposes youth to moral dilemmas to advance reasoning capability.

1. Objective: Cognitive-Behavioral Program, Conflict Resolution/Interpersonal Skills, Group Therapy, Violence Prevention

2. Population: Juveniles with a history of serious aggression and anti-social behavior, as well as other clinical behavioral disorders

3. Program location: DJC sites

4. Group Type: closed

5. Group/Classroom size: 8-10

6. Providers: ART- trained facilitators

7. Duration: 3 times per week for 10 weeks

8. CBP Outcome Criteria: Complete 10 lessons and homework for Anger Control, Skillstreaming, and

Moral Reasoning with facilitator’s approval.

9. Currently offered to: Juvenile Offenders

C. Cognitive-Behavioral Interventions for Offenders Seeking Employment (CBI-EMP): An evidenced-informed curriculum created by the University of Cincinnati Corrections Institute. This intervention relies on a cognitive-behavioral approach to teach participants strategies for identifying and managing high risk situations related to obtaining and maintaining employment. Heavy emphasis is placed on skill-building activities to assist with cognitive, social, emotional, and coping skill development for the work environment

1. Objective: Cognitive restructuring, social skill development, and problem-solving with a focus on employment-related contexts

2. Population: Adult Male and Female Offenders

3. Program location: DAI and DCC sites

4. Group Type: Semi-closed—Stand Alone and Integrated Orientations Approved

5. Group/Classroom size: 8-10

6. Providers: CBI-EMP- trained facilitators

7. Duration: Several Delivery Options—31 lessons/24 lessons/16 lessons/12 lessons

D. Dialectical Behavioral Therapy (DBT): A Cognitive-Behavioral Program that emphasizes the psychosocial factors and aspects of an individual’s personality in order to reduce intense emotional and behavioral responses to stress. DBT is divided into 5 modules of programming addressing areas of: Mindfulness, Distress Tolerance, Interpersonal Relationships, and Emotional Regulation. A fifth module, entitled Walking the Middle Path, is applicable to juvenile offenders only and is required for that population only. It is not applicable to adult offenders or inmates.

1. Objective: Emphasizes the psychosocial aspects of treatment. For offenders who are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family, and friend relationships.

2. Population: Adult male and female offender populations with emotional regulation challenges; juvenile male and female offenders with emotional regulation challenges; and individuals diagnosed with

Borderline Personality Disorder, eating disorders, substance abuse disorder, and depression.

3. Program location: DAI, DCC, and DJC sites

4. Group Type: semi-closed

5. Group Size: 6-8

6. Providers: DBT- trained and/or certified facilitators for group; licensed clinicians for individual sessions

7. Duration: 90-120 minutes per session/group (usually once per week), plus a one hour individual session per week. If necessary, group sessions may be broken out into two or three sessions of shorter duration.

9. Currently offered to: Adult Male of Female Offenders or Inmates, Juvenile Offenders

E. Thinking for a Change for Domestic Violence Offenders: A program which focuses on cognitive-behavioral changes through three components: Cognitive Self-Change, Social Skills, and Problem-Solving

Skills. Cognitive Self-Change teaches individuals a concrete process for self-reflection aimed at uncovering anti-social thoughts, feelings, attitudes, and beliefs driving interpersonal violence. Social Skills instruction prepares group members to engage in pro-social interactions based on self-understanding and consideration of the impact of their actions on others. Problem-Solving Skills integrate the two interventions to provide group members with an explicit step-by-step process for addressing challenging and stressful real-life interpersonal relationship situations.

1. Objective: Cognitive restructuring, social skill development, and problem-solving with a focus on domestic and interpersonal violence

2. Population: Adult Male Offenders

3. Program location: DAI Sites during Pilot Project—DCC Interest

4. Group Type: closed

5. Group Size: 8-12

6. Providers: Thinking for a Change for Domestic Violence- trained/certified facilitators

7. Duration: 25 lessons, 2 hours each

8. CBP Outcome Criteria: Complete 25 lessons and required homework and demonstrate skill proficiency

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