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The ways in which societies react to those who break criminal laws show major historical changes. In most civilized countries, corporal punishment and the death penalty have been replaced by prison sentences, ﬁnes, and a broad range of diversion programs, alternative sanctions, and community treatment (Tonry 1998). The latter include, for example, restitution, offender–victim mediation, social training courses, community service, intensive supervision, electronic monitoring, boot camps, day treatment centers, and other alternatives to institutionalization and routine probation.
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Although the scope of criminal justice interventions has broadened, the ‘right way’ forward for crime policy is still controversial in many countries. The respective opinions are related to general political attitudes. They emphasize diﬀerent aims in reactions to criminal behavior, such as compensation by the guilty, safety of the public, deterrence of other people from similar crimes, and prevention of future law breaking in the oﬀender. The last aim is central to oﬀender rehabilitation and relates to similar concepts such as resocialization or correctional treatment. These concepts refer to educational, psychological, and medical measures that are delivered in a systematic way to reduce the risk of recidivism and contribute to (re-) integration in society.
During the 1960s and early 1970s, this idea became a centerpiece of crime policy in many countries. However, the concept of rehabilitation was also criticized from diﬀerent perspectives that emphasized the other aims mentioned above. In the mid-1970s, a comprehensive review of oﬀender rehabilitation pro- grams concluded that the majority of available studies were methodologically too weak to prove treatment success (Lipton et al. 1975). Although this and other reviews revealed various positive eﬀects, the slogan of ‘nothing works’ in oﬀender rehabilitation became widespread. However, the 1990s saw a re-emergence of the issue of oﬀender rehabilitation. Among other reasons, this was due to systematic research integrations via meta-analyses that led to a more diﬀerentiated discussion in research and practice (McGuire 1995, Palmer 1992).
1. General Eﬃcacy
There are now hundreds of evaluations of oﬀender treatment that include an untreated comparison group. The outcomes diﬀer somewhat depending on the age of oﬀenders, previous criminality, oﬀense types, modes of treatment, criteria of success, length of follow-up, and other issues. For example, various studies of sexual oﬀender treatment revealed sexual reoﬀending rates between 3 percent and 44 percent with a mean of 18.8 percent (Hall 1995). The respective data for untreated control groups were 6 percent to 75 percent with a mean of 26.8 percent. Therefore, a single study cannot be generalized, and it is necessary to base research syntheses on common measures of eﬀect size (ES). Such an indicator is the correlation coeﬃcient phi or r. Table 1 summarizes the results of a number of recent meta-analyses on oﬀender rehabilitation.
Although eﬀects diﬀer according to study samples and methods of computation, all mean ESs are positive. However, they are generally small. A realistic estimate of overall eﬀectiveness is only approximately 0.10 or a little less. Taking the example of a control group with 50 percent reoﬀending, such an eﬀect size of 0.10 would indicate a reduction to 40 percent recidivism. This is a 10 percentage points or 20 percent diﬀerence in comparison with the untreated group. Such a small eﬀect may well be relevant in terms of cost utility. A realistic evaluation of correctional programs also has to take into account that the optimum ES is not 1. Depending on the recidivism rate in the untreated group, 0.30 may already represent the maximum possible eﬃcacy.
2. Diﬀerent Types Of Program
Most research reviews reveal signiﬁcant diﬀerences between kinds of programs: the largest eﬀects come from theoretically well-founded, multimodal, cognitive-behavioral, and skill-oriented programs. Also promising are family-oriented programs in ambulatory treatment for serious juvenile oﬀenders and clearly structured therapeutic communities in the institutional treatment of adult oﬀenders. Successful interventions ﬁt the level of oﬀenders’ risk, address criminogenic needs precisely (instead of vague personality changes), and take into account the speciﬁc learning styles of the oﬀenders (responsivity principle). Such programs are founded on empirical knowledge about the causes and development of the respective criminal behavior and are not just derived unspeciﬁcally from psychotherapeutic ‘schools.’ They address, for example, motivation for change, self-control, crime-related beliefs and attitudes, social skills, interpersonal problem-solving, self-critical thinking, moral reasoning, anger management, victim awareness, and coping with risk situations for relapse (e.g., Ross and Ross 1995). Cognitive-behavioral and relapse prevention approaches are not only most appropriate for the treatment of ‘ordinary,’ violent, and personality disordered oﬀenders but also for sexual oﬀenders (Marshall et al. 1998). Here, combinations with hormonal measures seem to be relatively successful as well.
Eﬀect sizes in the most appropriate programs can be twice as high as the average. In contrast, unstructured case work, traditional psychodynamic, and nondirective approaches show smaller eﬀects than the overall mean. Relatively low-structured, self-governing, permissive therapeutic communities and milieu therapy also seem to range at the lower end of eﬀectivity. The same holds for merely formal variations in punishment or probation; diversion without any educational or psychosocial component; deterrence, boot camps, and other measures of smarter punishment or intermediate sanctions. Aversive behavioral methods for sex oﬀenders are also not successful. In some studies, the eﬀects of inappropriate treatment are even negative.
3. Methodological Issues
Methodological features explain a substantial part of outcome variance. For example, studies with random assignment tend to produce smaller eﬀects than quasiexperimental designs. There are also smaller eﬀects in studies with larger samples, higher statistical power, and low rates of attrition between subject assignment and outcome measurement. Juridically-proven recidivism shows somewhat smaller eﬀects than measures of institutional adaptation or attitude change. Outcome criteria with good reliability and longer follow-up periods also tend to be associated with smaller eﬀects.
Although the number of evaluations with reasonable methodological quality has increased, there are still very few well-controlled studies on speciﬁc modes of treatment and speciﬁc oﬀender groups. This is particularly the case for the institutional treatment of serious adult oﬀenders, psychopaths, and sex oﬀenders. In these cases, it can be rather diﬃcult to form equivalent control groups that do not receive any kind of treatment. So far, evaluations often address diﬀerent degrees or modes of treatment and not an all-or- none dichotomy.
4. Program Integrity And Intensity
A certain treatment label may be misleading with respect to what actually happens in a program. However, high integrity (reliability) of program delivery is necessary for good outcomes. Naturally, this holds only for programs that are successful in principle. Low integrity may result from, for example, weakly-structured programs with no treatment manuals, organizational barriers and staﬀ resistance, or insuﬃcient staﬀ training and supervision. Although psychosocial interventions are basically an individual process and not a standardized technique, it is important to assess and monitor program implementation systematically. Doing this may be one reason why studies in which researchers were involved in program delivery show better eﬀects than other evaluations.
Treatment intensity and dosage also relate to outcome. Lipsey and Wilson (1998), for example, found that the duration of treatment correlated positively with eﬀect size, whereas the mean number of hours a week correlated negatively with outcome. The latter result may be due to problems of implementation and some satiation in very compact programs.
5. Oﬀender Characteristics
The eﬃcacy of rehabilitation programs depends not least on the characteristics of the oﬀenders. For example, child molesters seem to beneﬁt more from sex oﬀender treatment than rapists. In juvenile oﬀenders, Lipsey and Wilson (1998) found that samples with mixed prior oﬀense types (including violent oﬀenses) had better outcomes than those containing primarily property oﬀenders. Eﬀects were also larger when all oﬀenders had prior sentences. These and other data suggest that serious and violent oﬀenders may beneﬁt more from treatment than less serious ones. This is plausible when considered in light of the risk principle: oﬀenders with various prior oﬀenses are more often at risk of life-long persistent antisocial behavior. In contrast, oﬀenders with fewer prior oﬀenses more often belong to the type of adolescence limited antisocial behavior. In these cases, natural protective factors in everyday life counteract recidivism in the untreated control groups as well.
However, the ﬁnding that high-risk groups beneﬁt most from rehabilitation programs cannot be generalized to very high-risk cases such as psychopaths. These oﬀenders lack the interpersonal and motivational characteristics that are essential for successful treatment, and thus rarely show a good outcome (Losel 1998). This would indicate that a nonlinear, U-shaped function may be an adequate description of the relationship between risk and treatment eﬃcacy. It is in particular the low-risk and very high-risk cases that show the weakest eﬀects.
The need principle and responsivity principle can be applied adequately only when a systematic assessment of the oﬀender is performed. This should be based not only on static variables such as oﬀender age or criminal history but also on dynamic characteristics that are accessible to change. A thorough assessment is necessary for adequate placement decisions, for example, in the case of dangerous oﬀenders. This should also reduce the number of treatment dropouts. Most studies have shown that the latter group is particularly at risk for reoﬀending.
6. Setting Characteristics
Overall, there seem to be larger eﬀects in community programs than in institutional treatment. As a result, custody should be the last resort (for ﬁnancial reasons as well). However, placement in a closed setting is normally confounded with a higher risk of reoﬀending. Sweeping assumptions that successful treatment is not possible within prison or other institutional settings are not supported by empirical research. Negative incarceration eﬀects may depend on personal, situational, and organizational moderators that can be addressed at least partially by adequate programs. In cases of drug use and other dangerous lifestyles, institutions may even have some protective eﬀects. The alternative therefore of ‘community vs. institution’ is too undiﬀerentiated. The systematic assessment of risk can contribute to a stepwise reduction of custody to accompany positive developments in the oﬀender (e.g., Quinsey et al. 1998).
7. Organizational Climate And Regime
Perhaps, it is not institutionalization by itself but the quality of regime and social climate that accounts for positive or negative eﬀects. Although institutional features vary widely even under similar formal conditions, they have not yet been investigated to any great extent. A regime that is emotionally and socially responsive as well as structured, norm-oriented, and controlling is most promising. From process research on general psychotherapy, it is known that the relations between clients and therapists are very important for eﬃcacy. Similarly, correctional programming requires well-selected, speciﬁcally trained, highly motivated, and continuously supervised staﬀ. Attitudes and competencies that are not in line with the aims and content of a program may not only lower treatment integrity but even counterbalance potential eﬃcacy.
8. Aftercare And Relapse Prevention
Even intensive rehabilitation programs make up only a small part of the factors that impact on the clients’ thinking and behavior. It is therefore necessary to deliver services that consolidate the competencies acquired during treatment, to provide control over risks, and to cope with crises that may arise afterwards. Without such measures, treatment eﬃcacy often can be demonstrated only during short follow-up periods. Although systematic programs of through-care, aftercare, and relapse prevention are particularly emphasized for the treatment of drug-addicted and sexual delinquents (Annis 1986, Laws 1999), they are relevant for other violent and personality-disordered oﬀenders as well. Thorough planning and monitoring of relapse prevention refers to type and intensity of services, cooperation routines between the institutions, probation oﬃcers, and other staﬀ involved. These multiagency networks are very important for preventing recidivism (Spencer 1999).
9. Natural Protective Factors
Even without any rehabilitation program, a subgroup of high-risk oﬀenders desists from criminal behavior. In these cases, natural protective mechanisms make delinquent behavior less attractive. Although our knowledge about such processes is still rudimentary, various personal and social resources have repeatedly shown a protective function against criminality: for example, bonds to nondeviant family members or other reference persons; cognitive competencies, school achievement, and planning for the future; nondeviant peer groups; work motivation, vocational skills, and employment; or a supportive and prosocial intimate partner. Such protective factors are relevant for positive turning points in criminal careers. Therefore they need to be assessed and integrated into program planning and delivery.
10. Community Features
Individual and microsocial risk and protective factors also interact with the broader social context. Therefore community features such as the concentration of poverty, unemployment, multiproblem families, violence, drug use, and other deﬁcits in ‘social capital’ must be taken into account in oﬀender rehabilitation. If, for example, a program promotes vocational skills, it may be particularly successful in communities with low unemployment rates (Sherman et al. 1997). In other contexts, the skills acquired will be less useful. Counterproductive inﬂuences may result from neighborhoods with high criminality and violence. In a community in which peers and neighbors model and reinforce deviant behavior, it is more diﬃcult to preserve program eﬀects than in a social context with less negative inﬂuences. Oﬀender treatment and relapse prevention should therefore be integrated into broader community programs of crime prevention.
11. Conclusions And Perspectives
During the last decade, there has been growing evidence that some programs of oﬀender rehabilitation work and others are promising. However, there is still a lack of methodologically sound evaluation, particularly of complex programs and multiple services for speciﬁc adult and serious oﬀender groups and of the service delivery in everyday practice. More process data are needed on the content of program delivery, staﬀ characteristics, and dimensions of the institutional regime. It is also necessary to assess control group conditions in a similar way. The dropout problem must be tackled more eﬀectively. Adequate assessment procedures, program modules on motivation, and ﬂexible procedures of case management are suggested here. Outcome evaluation should not rely primarily on one-shot studies but refer to a theoretically-based chain of various change measures, including longer follow-up periods. Last but not least, practice-oriented evaluations must place oﬀender rehabilitation programs in their wider social context.
Although more systematic research is needed, empirical program evaluations and experiences from practice already suggest guidelines for eﬀective rehabilitation. These include, for example:
(a) Realistic expectancies regarding possible eﬃcacy.
(b) Theoretically sound concept (social learning, multimodal approach).
(c) Systematic assessment of oﬀenders’ risk and matching to service level.
(d) Appropriate targeting of speciﬁc criminogenic needs and not unspeciﬁc personality characteristics.
(e) Teaching of self-control, nondeviant thinking, and social skills.
(f ) Consequence in applying reinforcement.
(g) Matching of program type, oﬀender, and staﬀ.
(h) Thorough selection, training, and supervision of staﬀ.
(i) Development of a supportive institutional climate and regime.
(j) Neutralization of criminogenic social networks.
(k) Strengthening of ‘natural’ protective factors.
(l) Attainment of high program integrity and adequate intensity.
(m) Dynamic assessment and monitoring of oﬀender change.
(n) Provision of systematic through-care, aftercare, and relapse prevention.
(o) Continous process and outcome evaluation of the program.
Countries such as Canada, England, and Scotland use similar guidelines for program accreditation. Naturally, we cannot expect that one speciﬁc type of program will emerge as the gold standard for successful oﬀender rehabiliation. However, the current empirically-based knowledge on ‘what works’ is promising in securing service quality for both the society and the oﬀender.
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