Ka Upane - "into the light" A brief skills group for short-serving offenders

Hannah Cleland
Clinical Psychologist, Department of Corrections

Juanita Ryan
Director of Programmes and Interventions, Department of Corrections

Author biographies:
Hannah Cleland is a clinical psychologist in the Hamilton Psychologists’ Office. She has been with the Department for four years and has developed expertise in working in the prison and community settings. Hannah’s particular expertise is engaging in group-based intervention with high-risk and versatile offenders, first at the Tai Aroha residential Treatment programme and more recently in the Ka Ūpane programme (for which she led the initial development and pilot).

Juanita Ryan is the Director of Programmes and Interventions at National Office. Before this she was a principal psychologist in Hamilton. She has spent the last eight and a half years working for the department, first in a frontline role and then moving into management roles. Prior to this Juanita worked as a psychologist in an educational and training centre for clinical psychology students and in a mental health setting
.


Introduction

Reducing re-offending by 25% (RR25%) is the Department of Corrections’ main goal. In order to achieve this challenging goal there must be a focus on working together, working strategically and working creatively. The Ka Ūpane programme was born out of this need for creativity – to meet a need with a group that was missing the opportunity to access services. Ka Ūpane can be translated as “to take a step upwards”. For the programme this relates to the transitioning from a place of darkness into a place of enlightenment – climbing from “not-knowing” to “knowing”. *

The Ka Ūpane programme was developed for high-risk offenders, particularly with current or previous violent convictions, serving prison sentences of less than two years duration. This group of offenders is often characterised by rapid cycling in and out of prison, often so quickly that they are unable to engage in treatment (Research and Analysis Team, Department of Corrections, 2013). The importance of providing interventions to reduce the risk of re-offending with high-risk offenders has been well documented (Andrews & Bonta, 2010). However, criteria for access to prison-based treatment programmes for high-risk offenders currently requires a sentence of more than two years. This makes much of the treatment available for high-risk offenders unsuitable for offenders with short sentences. The lack of opportunity to engage short-serving high-risk offenders in treatment has resulted in a lack of research regarding effective approaches for this group.

Cognitive behavioural therapy (CBT) has been well documented as an effective mode of treatment for offenders, with recent adaptations including the introduction of dialectical behaviour therapy (DBT modality). The effectiveness of using DBT to treat emotional instability, poor impulse control, interpersonal problems, anger management and chronic self-harming behaviour has also been well documented (Bohus, et al., 2004 as cited in California Department of Corrections and Rehabilitation, 2011). DBT is a cognitive behavioural approach designed for treating individuals with severe emotional and behavioural dysregulation and often used for people diagnosed with Borderline Personality Disorder (BPD) (Linehan, 1993). This approach has largely been used within mental health settings, although recent research suggests positive results using this approach with offenders to improve institutional aggressive and impulsive behaviour (Shelton et al., 2009). DBT uses techniques to increase self-regulation and focuses on developing adaptive behaviours to regulate emotions and to enhance balanced thinking and behaviours.

The following paper provides insight into the planning and implementation of the Ka Ūpane programme, including reflections and steps for future developments.

Rationale

It was identified as part of the RR25% initiative that short-serving prisoners were cycling in and out of prison before having the opportunity to engage in interventions to address their offence-related needs (Research and Analysis Team, Department of Corrections, 2013). Of particular note were high-risk short-serving violent offenders, who would have been eligible for the Special Treatment Unit Rehabilitation Programme (STURP) if their sentences had been longer than two years duration. Data gathered from a Corrections Analysis and Reporting System (CARS) report for the Central Region as of July 2015 (the time of planning and implementation), identified that there were 93 high-risk short-serving prisoners who met the criteria for assessment and/or treatment with a departmental psychologist. Of the 93 offenders, 24 were housed at Waikeria Prison. In an attempt to mitigate this issue, a pilot programme (Ka Ūpane) was developed to provide a brief skills-based group intervention for this population. The over-arching goal for the pilot was to provide meaningful and empirically supported treatment to high-risk violent, short-serving offenders.

Process

Identification and suitability

Potential participants for the group were identified either from the list on CARS, through direct referrals from case managers or psychologists, or from those identified from prison waitlists. The majority of referrals were from Waikeria Prison, although some were from Spring Hill Corrections Facility and the prisoners were transferred following a positive assessment of suitability.

From the beginning of the programme, men from any of the three prisons within the Central Region (or beyond) were considered; however, groups were only run at Waikeria Prison where the programme was initially piloted. A segregated group was also run as this group often has even greater restrictions on access to programmes, irrespective of the often high need and risk profile of these prisoners.

Eligibility criteria for Ka Ūpane:

  • prison sentence between four months and two years in duration
  • RoC*RoI score above 0.7
  • no current or historical sexual offences
  • index or previous violent offence, or other serious offending.

Assessment

A psychological assessment which assessed responsivity factors was completed for each potential participant. Although there was an expectation that participants would display a level of motivation and capacity to benefit from the programme, it was also expected that responsivity challenges would be present due to the nature of the offender group. Key assessment areas included adequate motivation to engage in the group (desire to make pro-social changes), willingness to comply with group kawa (protocol/etiquette – e.g., not to use violence in the group), no evidence of substance dependence (can return negative drug tests), and cognitive capability to participate. If participants were motivated to engage in treatment, but did not meet the criteria for Ka Üpane, they were prioritised for individual psychological treatment.

Once eligible participants had been identified as suitably motivated, three psychometric measures were administered for both evaluative purposes and to inform treatment planning. The measures included: Treatment Readiness, Responsivity and Gain Scale: Short Version (TRRG:SV) to help screen motivation; Psychological Inventory of Criminal Thinking Style (PICTS) to assist in determining any cognitive changes prior to and following treatment; and Criminal Attitudes to Violence Scale (CAVS) to provide further information about attitudinal areas to address. These three measures were also administered at the end of treatment as a means of measuring change.

Group structure

Ka Ūpane groups run for a two-hour period twice weekly. Each group is comprised of three participants and one psychologist, and runs for an eight-week period, approximating 16 group sessions in total. Upon completion of the programme, participants are given the opportunity to complete the eight-week cycle a second time to consolidate their skill acquisition and to provide mentoring opportunities to newer participants. Participants need to have enough time remaining on their sentence to commence a second cycle, and are also re-assessed in terms of their motivation to continue and to role-model pro-social behaviour to other participants.

In addition to group sessions, each participant has the opportunity to engage in one hour-long individual session per fortnight. Individual sessions are designed to support participants during the programme, including, but not limited to, increasing motivation to change, further teaching of content, discussing group dynamics, addressing positive or problematic behaviour within the group, practising skills (particularly where specific skill deficits exist), a more specific focus on their individual offending pattern and the subsequent development of a safety plan.

The group was set up as a rolling programme with new participants joining the programme when others leave through graduations or exits from the group. The rolling group was chosen as the most effective way of ensuring men on short sentences did not need to wait until the start of a new programme, increasing the likelihood of group participation prior to release. When a new participant joined the group, part of the initial session focussed on group kawa and the existing participants had the opportunity to share a skill with the new member that they thought would be useful in the beginning stages. The more senior participants were also given the opportunity to be role models within a rolling group structure which assisted in reinforcing the skills through the use of verbal rehearsal.

Session outlines

The 16 group sessions are broken down into four main topics based on the need to develop adaptive skills in the following areas:

  1. Core mindfulness, which focuses on the present moment, increasing self-control skills and promoting self-awareness
  2. Emotion regulation, which works to identify and describe emotions and focusses on reducing vulnerability to negative emotions and increasing positive emotions
  3. Tolerating distress, which teaches skills in distraction, self-calming, and helping to accept reality
  4. Interpersonal skills, which focuses on developing assertiveness, interpersonal effectiveness, and managing conflict in a respectful manner.

Each topic has a corresponding set of skills:

Mindfullness

  • Using your wise mind
  • Self-awareness
  • Self-control
  • Muscle relaxation
  • Visualisation
  • Observing the breath
  • Observational skills
  • Practising a non-judgemental approach.

Emotion Regulation

  • Identifying emotions
  • Purpose of emotions
  • Expressing emotions
  • Primary and secondary emotions
  • How to change unpleasant emotions
  • How to promote healthy emotions
  • Recording and monitoring emotions.

Distress Tolerance

  • DISTRACT
  • IMPROVE
  • Self-soothe
  • Half Smiling Face
  • Thinking of the pros and cons of different situations
  • Accepting reality for what it is
  • Observing the breath
  • Having awareness skills
  • Using time-out.

Interpersonal Effectiveness

  • Communication styles
  • Listening skills
  • Assertive communication
  • Listening skills
  • Problem solving
  • Resisting persuasion
  • Managing negotiation
  • Practising having positive relationships
  • How to give and receive feedback.

Like many groups, a key element of Ka Üpane is to present content in a manner that is enjoyable, memorable and provides an opportunity to practise. The goal of skill development is the generalisation of these skills from the group room to the prison unit, and then eventually to environments outside the prison. Group sessions incorporate creative approaches such as role plays, workshops, and poster development, and teaching is often facilitated through various interactive learning activities.

Each participant is given a Ka Üpane handbook at the beginning of the programme. The handbook covers all programme content, incorporates between-session tasks, and has extra information for those who want to learn more. A semi-structured handbook was developed so that psychologists administering the group had specific skills to follow, but could use their own ideas and style to deliver each skill. The emphasis is on introducing the content and practising the skill in a way that works for each unique group. Like in other pilot programmes, it is expected that if Ka Ūpane is endorsed as a core departmental programme, the handbook will change over time as other ideas and research inform practice.

Reflections on the pilot groups

As mentioned previously, 93 men were initially identified as meeting the criteria for assessment and/or treatment. However, this quantity included those with sexual offences, who were not eligible. Therefore the numbers were further examined and eligible offenders screened for interest and suitability to the programme. At the time of programme recruitment 33 offenders were given the opportunity to meet with a psychologist to determine their interest in engaging in Ka Ūpane and to determine whether they would be suitable with regard to responsivity factors. Out of the 33 offenders identified as potentially suitable, 22 were assessed (11 were transferred prior to assessment). Nine were accepted into the programme. Of those 13 offenders who were not accepted: 8 were not motivated for treatment, 2 were motivated but their sentences were ending too soon (e.g., prior to the half-way point of the next available programme), one offender was not willing to commit to working on his violence, another declined to engage in a group but requested individual treatment, and another did not meet the criteria due to mental health issues that would likely impact on group functioning. Of the 8 participants who reported a lack of motivation to engage in treatment, the majority stated that because their sentence was short they preferred to complete their time without engaging in any interventions. These men were offered the opportunity to engage in other services (e.g., Short Motivational Programme, or individual work with a psychologist), however these were also declined.

Participant outcomes

An overview based on the two eight-week programmes run between August-October and October-December 2015, totalling nine participants, is outlined below:

Ethnicity

Māori = 7

European = 2

Age

18-20=3

21-25=2

26-30 = 2

31-35 = 0

36-45 = 2

Risk (RoC*RoI)

High = 7

Very High = 2

Prison information

Mainstream = 4

Segregated = 5

Sentence lengths

0-4 months = 0

5-9 months = 3

9-12 months = 2

12-24 months = 4

Graduation status

Graduated programme = 7

Self-exited = 2

Returned as graduate = 4

Of the nine men who began the programme, seven graduated, with two men self-exiting. One of the men who withdrew stated he did not like being part of a group, and during his engagement presented as anxious in the group setting. The other was given the opportunity to attend a Drug Treatment Unit (DTU) at another prison and after discussing this with the DTU facilitator selected the DTU as his preferred option.

Of the seven who graduated, three were released within a month of their completion date, one was transferred to another prison to attend a DTU, and the remaining three all chose to return to complete the programme for a second round.

Individual treatment and safety planning

All participants engaged in fortnightly individual sessions. Five of the seven graduates completed a safety plan either prior to or just following their graduation from the programme, focusing on their personal pattern of offending, especially violence, and ways to mitigate risk. The two participants who did not complete a safety plan were transferred immediately following their graduation ceremonies.

The initial plan for recording information and evaluating the programme was for psychometric measures (TRRG:SV, PICTS, CAVS) to be used in both the assessment and at the end of the programme. For a number of reasons (e.g., tight time-frames, participants being transferred from Waikeria prior to the completion of the psychometrics) there has not been consistency in gaining pre and post psychometric results for all participants, therefore evaluation of these results is not possible. Psychometric data would aid evaluation and has been highlighted as an important focus moving forward. A focus on completing post-treatment psychometrics is essential in gaining an accurate measure of programme efficacy. It is recommended that the psychologist schedules the re-administration of psychometrics within the last week of group, rather than waiting until the eight weeks are completed.

Custody staff and offender feedback on the programme

Throughout the programme, unit staff were asked for updates regarding the behaviour of the participants, electronic file notes were checked to provide information and staff attending graduation ceremonies also provided useful reflections. Although a stronger focus on formal evaluation is necessary to assess the effectiveness of the programme, overall, staff gave positive accounts of participants using skills within the unit.

Situational and contextual factors

Ka Ūpane had support from the prison director, principal case managers, principal corrections officers, programme managers, movements co-ordinators and unit staff. The development of good working relationships and a shared understanding of the benefits of targeting short-serving prisoners resulted in the programme implementation being rapid and manageable.

The regular movement of short-servers between prison sites meant two of the participants were transferred before they could complete the full programme. Other factors proved difficult at times, such as: the location of group rooms, the ability for prisoners to be brought to group on time, distractions of other prisoners outside the room during sessions, and unavoidable prison/unit procedures (e.g., misconduct hearings, prison lockdowns). However, support from prison management and regular communication with prison staff alleviated or resolved these issues.

Participant factors

A number of participants were highly motivated to engage, had been requesting treatment but were not suitable for other internal programmes, and expressed their gratitude for the opportunity.

Some potential participants were ambivalent about engaging in treatment, and others declined as they “just wanted to do the time”. As the group progressed, and participants reportedly shared their experiences with others, the programme appeared to gain momentum and the number of prisoners deciding to engage increased. While not formally explored, it appeared that there were fewer people declining as the programme progressed.

Group factors

Ka Ūpane is a rolling programme, allowing members to join the group at different stages, and using a model where programme members use their learning to help newer participants. Considering the short time period of the programme – only eight weeks – there is minimal time for the content to be covered, and a rolling aspect requires extra time to reflect on previous learning to teach newer participants key skills. There is also limited time for the development of group cohesion, therefore the introduction of new participants proved to be somewhat disruptive to the workings of the group. On the other hand, a rolling programme allows for a higher number of participants to engage in treatment, rather than waiting for a new programme to start. As a reflection, it appears that the rolling group is a useful structure to continue to explore, as it allows the greatest opportunity for participants to engage, even though it provides some disruption to the group. If there were sufficient numbers of participants, it may also be useful to consider running the group with increased numbers and two facilitators. The facilitation combination could be comprised of two psychologists, or a psychologist and a programme facilitator.

Conclusions

In an attempt to provide a programme to meet the needs of short-serving, high-risk offenders, the Ka Ūpane programme was developed and rolled out in August 2015. The programme was effectively implemented at Waikeria Prison with the support of prison management and staff working in collaboration with Hamilton South Psychologists’ office. The use of a brief DBT-focussed skill development group was an opportunity for offenders to improve their skills in emotion management, interpersonal skills, decision making, tolerating crises and distressing situations, accepting reality, and improving self-awareness and self-control through mindfulness techniques. Anecdotal evidence suggests that the programme has been meeting some of the need for interventions for short-serving offenders; however, more thorough investigation and evaluation would provide useful direction.


References
Andrews, D.A., & Bonta, J. (2010). The psychology of criminal conduct (5th ed.). Matthew Bender & Company, Inc., New Providence, NJ.

Bohus, M., Haaf, B., Simms, T., Limberger M., Schmahl, C., Unckel, C., et al. (2004). Effectiveness of inpatient Dialectical Behavior Therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42, 487-499.

Californian Department Of Corrections and Rehabilitation (2011). Dialectical Behavior Therapy: Evidence for implementation in juvenile correctional settings. California: Office of Research, Juvenile Justice Research Branch.

Linehan, M. M. (1993). Cognitive-behavioural treatment of borderline personality disorder. New York: Guilford Press.

Research and Analysis Team (2013). Department of Corrections, New Zealand

Shelton D., Sample, S., Kesten, K.L., Zang, W. & Trestman, R.L (2009). Treatment of impulsive aggression in correctional settings. Behavioural sciences and the Law, 27, 787-800.