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Reentry Programming And Female Offenders: Ralph Fretz, Ph.D., Research Director, Community Education Centers PLEASE DO NOT QUOTE OR CITE WITHOUT PERMISSION Case Example Ms. Jones was placed on parole after completing a term of incarceration incurred for possession of cocaine with intent to distribute. She violated her parole release as a result of testing positive during a drug screening and was ordered to attend residential program operated by Community Education Centers (CEC), a privately owned correctional treatment company that partners with Departments of Corrections and universities. A review of Ms. Jones’ Department of Corrections (DOC) folder indicated that she had an extensive criminal history dating back 20 years. The majority of her prior offenses revolved around her substance abuse problem. Theoretical Orientation Gender-Responsive Programming Program Evaluation Practical Application References 1. Ackerman, H.P. (1987). Therapy with women in jail: A manual for the mental health worker. Plantation, Florida: National Institute of Corrections Information Center. 2. Baird, S. (2003). "Treating female offenders." In B.K. Schwartz (ed.) Correctional Psychology; Practice, Programming, and Administration pp. 9-1 to 9-22: Civic Research Institute; Kingston, NJ 3. Bloom, B. & S. Covington (1998). Gender-specific Programming for Female Offenders: What is it and Why is it Important? Paper presented at the annual meeting of the American Society of Criminology, Washington DC, and November 11 to 14. 4. Bloom, B. & Covington, S. (2000). Gendered justice: Programming for women in correctional settings. Paper presented to the American Society of Criminology, San Francisco, CA. 5. Bonta, J., Andrews, D., and Wormith, S. (2005). The recent past and near future of risk and/or needs assessment. Crime and Delinquency. 52 (1), 7-27 6. Buell, M. (2005). Women in contact with the criminal justice system have specific needs. Corrections Today, 67(7): 28. 7. Campbell, S.W. (2005). Gender-responsive strategies project: jail applications. Gender-responsive strategies for women offenders. Washington, DC: National Institute of Corrections. 8. Chesney-Lind, M. (1997). The Female Offender: Girls, Women and Crime. Thousand Oaks, California: Sage Publications. 9. Coulson, G., Ilacqua, G., Nutbrown V., and Giulekas, F. (1996). Predictive utility of the LSI for incarcerated female offenders. Criminal Justice and Behavior, 23 (3): 427-439 10. Covington, S. (1999). Helping Women Recover. Jossey-Bass A Wiley Co. San Francisco, CA. 11. Covington, S. (2000). A Woman’s Way Through the Twelve Steps. Hazelden Center City, MN 12. Covington, S. (2004). Creating Gender-Responsive Services in Correctional Settings: Context and Considerations. Paper presented at the 2004 American Society of Criminology Conference November 17-20, Nashville, Tennessee. 13. Covington, S. S. & Bloom, B. E. (2006, in press). Gender-responsive treatment and services in correctional settings. To be published in Women in Therapy (E. Leeder, editor). 14. El-Bassel, N., Ivanoff, A., Schilling, A., Borne, D., & Gilbert, L. (1997). Skills building and social support enhancement to reduce HIV risk among women in jail. Criminal Justice and Behavior, 24(2), 205-233. 15. Gendreau, P., & Andrews, D. A. (2001). Correctional Program Assessment Inventory – 2000 (CPAI-2000). Saint John, Canada: University of New Brunswick. 16. Kerr, D. (1998, December). Substance abuse among female offenders: Efforts to treat substance-abusing women offenders must address underlying reasons for use. Corrections Today, 114-120.
The Case for A Gender-Responsive Approach
Jacey Erickson, Drexel University & Villanova School of Law
Angela Mims, Ed.D., Bo Robinson Assessment and Treatment Center
Introduction
Female offender incarceration rates have increased dramatically in the last decade (Covington & Bloom, 2004). An incarceration of any individual has a "ripple effect" on the person, family, and community. When a woman is incarcerated, this disruption frequently has a direct impact on her children; it is estimated that 79% of incarcerated women left behind children under the age of 18 (Campbell, 2005). Incarcerated women face multiple challenges as they go through the reentry process, as many female offenders have a history of serious substance abuse and mental health problems. Obstacles facing female offenders as they reenter society include financial difficulties, housing problems, and the stigma of being labeled an "ex-con".
Correctional facilities that house female prisoners have a societal obligation to control these offenders through incarceration and to prepare the women for their eventual release into the community. Research has shown that the successful reentry of female offenders must be based on recognizing their gender-responsive needs (Chesney-Lind, 1997; Baird, 2003; Bloom & Covington, 2000), a daunting task for any correctional program. Recent developments in female offender programming have suggested that effective treatment of female offender variables is possible as long as gender variables are incorporated into the program design and implementation (Covington & Bloom, 2004).
This article describes how effective female programming can be developed using evidence-based practices. The needs of male and female prisoners may have the same terms, such as substance abuse, but approaches to treating the same problems have to recognize relevant gender differences. While female offenders as a subpopulation have specific gender needs, each female offender has to be assessed and treated as an individual. In an effort to highlight gender responsive programming at the actual rather than theoretical level, the treatment of an incarcerated female will be described. To preserve anonymity, the case example is a composite of several actual offenders.
Assessment of female offenders' risks and needs
Assessing a woman offender's current risk for recidivism, her criminogenic needs, and her specific responsivity to treatment needs is the first step in developing an individualized treatment plan. A comprehensive assessment of female offenders should be developed using a multi-method format. No single instrument or data point should be the sole factor in determining the risk levels or dynamic/changeable factors (criminogenic) needs of female offenders. There has been some controversy about what instruments to use with women offenders to assess risk/needs. For example, Coulson et al (1996) have expressed concerns about the use of the Level of Service-Inventory-Revised (LSI-R) with female offenders, as they contend that the LSI-R may not adequately take into account female offenders' needs. However, Bonta, Andrews, and Wormith (2005) argued that the LSI-R and its newest version, the Level of Service/Case Management Inventory (LS/CMI), include male and female norms. In addition, the LSI has been validated with female offender populations, both in Canada and other countries.
Whichever instrument is selected by a program, it should be able to meet the following minimum standards: (a) it is accompanied by a manual that outlines the instruments' psychometric properties, including reliability and validity; (b) it has norms developed with females in the correctional system; and (c) it has been validated through peer-reviewed research. Programs are also obligated to develop local female norms for the instruments if the original test sample does not capture the unique properties of a particular population.
The assessment battery needs to take into account the differences between male and female offenders. For example, female offenders are more likely than male offenders to exhibit Post Traumatic Stress Disorder symptoms that stem from a history of emotional, sexual, and physical abuse (Covington & Bloom, 2006; Buell, 2003). Female offenders are more likely than their male counterparts to be the single-parent head of the household; therefore, parent-child concerns have to be assessed. Women are more likely than men to have committed their crimes in the context of their relationships with others (Campbell, 2005). The quality and quantity of the female offenders' relationships need to be evaluated through interview format, file review, and data from actuarially-based instruments.
Within one week of arrival at the program, her assigned counselor was informed that one of Ms. Jones' adult children had died from injuries sustained in a car accident. When the counselor informed her, the resident acted as if nothing had happened. Later that same day, the counselor asked her if she wanted to discuss her feelings about her recent loss. Ms. Jones looked perplexed and confused in response to the counselor's question. Additionally, Ms. Jones expressed that she did not understand why staff members and other female residents were offering their condolences to her.
Given Ms. Jones' statements, the counselor discerned that the loss of her child was so traumatic that the resident could not consciously acknowledge awareness of this loss. Ms. Jones' counselor called her supervisor to discuss Ms. Jones' reaction. The supervisor decided to immediately convene a meeting of the multidisciplinary team that was comprised of counselors, psychologists, Ms. Jones' parole officer, and the nurse.
The multidisciplinary team decided that the psychologist would again inform Ms. Jones of her child’s death and that her counselor would remain in the room after the psychologist spoke with her. When Ms. Jones was told of her child's death for a second time, she responded by talking about not only her current loss, but also the loss of a child over twenty years ago. Ms. Jones stated, "Now, all my children are gone." At this point, Ms. Jones began crying and spent a significant amount of time with her counselor to begin the grieving process.
After Ms. Jones met with her counselor, the assessment staff judiciously interviewed Ms. Jones and administered a series of self-report measures, including: a broad-band personality assessment instrument, an inventory to assess trauma symptoms, and a suicidality questionnaire. On these measures, Ms. Jones endorsed the following domains: depressive symptoms items on the personality inventory, trauma symptoms particularly items that suggested negative intrusive thoughts on the trauma inventory and the personality inventory, and feelings of loneliness and hopelessness on the suicidality questionnaire. During the clinical interview, Ms. Jones denied having suicidal thoughts. Ms. Jones also reported that she did not feel supported by others in her life. As part of her assessment, Ms. Jones was referred to the staff psychiatrist. After her initial psychiatric interview, Ms. Jones was prescribed anti-depressant and anti-anxiety medication.
This vignette illustrates not only an effective clinical team approach to a crisis, but also a comprehensive gathering of data that was used to design an individualized and gender-responsive treatment plan for Ms. Jones. The next section will describe gender-responsive programming using Ms. Jones' treatment as a case example.
A treatment program may profit from using a theoretical orientation that guides and structures the program's interventions. Theory-based approaches tie together assessment information into a cohesive treatment plan. Gender-responsive programs must be guided by current research-based theories of female offender treatment. A number of theories have been postulated that purport relevance to gender-responsive programming. This section will describe four well-defined and researched theories about women offenders. The descriptions of these four theories have been endorsed by prominent scholars on female offenders, including Covington and Bloom (2004) and Campbell (2005).
The Pathways theory hypothesizes that the differences in male and female development play a major role in the subsequent criminal behavior patterns of females. Due to their gender, women are at higher risk than men to have been physically and sexually abused. A significant association has been established between women offenders' childhood abuse histories and their development of delinquent and criminal behavior. Pathways theory suggests that programs should recognize and treat female offenders' abuse histories (Covington & Bloom, 2004).
Relational theory describes the different ways that males and females develop from childhood into adulthood, with respect to how the genders relate to others and the value that men and women place on relationships. It suggests that a woman's self-worth is affected by her relationships with others. Women offenders are often raised in households that included domestic violence, sexual abuse, and physical abuse; these family systems modeled and promoted highly dysfunctional relationships. As a result, women offenders tend to view their identity through a dysfunctional relationship lens. Programs that incorporate the relational theory recognize that correctional treatment should be delivered within the relational contexts of the female offenders. Treatment for female offenders has to include a therapeutic environment that is designed to model and promote healthy relationships (Covington & Bloom, 2004).
Addiction theory posits that female and male substance abusers differ along significant psychosocial dimensions. For example, female offenders tend to have more psychological and psychiatric problems than men, and female offenders' severe psychological problems often exacerbate an already serious substance abuse problem. Female offenders' patterns of drug use differ from male offenders along the following dimensions: females are more likely to be polydrug abusers and use cocaine as their drug of choice; women more often report depression or family pressures as the reason(s) for abusing drugs, while male offenders' drug use is usually tied into a general pattern of antisocial behavior; and women offenders tend to report that they use drugs to self-medicate their psychiatric symptoms, while male offenders are more likely to report that they use drugs for thrills and as a result of peer pressures. The different pathways and reasons for male and female drug use must be taken into account when treating substance abuse. Gender-responsive programs incorporate these differences into the organization of their treatment services. While substance abuse is considered a high-risk behavior for both genders; this risk factor for criminal behavior is more significant for women (Covington & Bloom, 2004).
Trauma theory hypothesizes that gender-responsive programs need to be sensitive to the fact that the majority of female offenders have been traumatized by abusive parents and abusive partners. Understanding how to avoid triggering trauma responses and not engaging in further traumatizing behaviors is a critical component of any gender-responsive program. Treatment environments that foster a sense of safety, dignity, and empowerment within positive relational contexts form the cornerstone of effective gender-responsive programming. These nurturing environments encourage women offenders to express their traumatic feelings, cope with their traumas, and move toward successful reentry into society (Campbell, 2005).
Relevant treatment targets for female offenders include the following: parent-child relationships, parent-child reunification, housing, employment, finances, domestic violence, substance abuse, and mental and physical health needs. Cognitive-behavioral treatment has been found to be as effective with female offenders as with male offenders (Kerr, 1998; El-Bassel et al, 1997). However, the delivery of the cognitive-behavioral services needs to occur in a gender-responsive environment. The delivery of services in programs such as the CEC program included in the case example, take into account not only gender, but also cultural backgrounds and racial issues. Treatment services are tailored to the demographics of the clients. For example, female offenders in Colorado often have different cultural, racial, and ethnic backgrounds than females in New Jersey; therefore, program modifications in CEC sites in these areas reflect such differences.
Gender-responsive programs should include all-female group sessions that focus on addiction recovery and coping with trauma, including sexual and physical abuse (Covington & Bloom, 2000). These services should be facilitated by a female counselor who works with the group members as they attempt to express and understand their life experiences. Group members work to support each other in a caring, nurturing environment. In these groups, confrontation must be de-emphasized, as support should be the primary mechanism of change.
Mutual-support groups including Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) can be very effective as adjunctive measures in treating substance abuse. All-female mutual-support groups serve a critical function for female offenders early in their recovery. The mutual-support groups further the development and maintenance of a therapeutic culture that encourages participation and empowerment in a safe environment.
The following description of Ms. Jones' treatment illustrates gender-responsive interventions.
Practical Application
The women's program that treated Ms. Jones includes a number of components that have been found to be effective with female offenders. Ms. Jones was housed in a female-only section of the facility and participated in all-female group sessions, mutual support groups, and lectures. The staff members of this program were primarily female with some staff members sharing similar histories to the female offenders. The therapeutic community is designed to be safe for Ms. Jones and others to discuss their feelings about their past traumas, relationships, children, substance abuse, and their future plans. The services are delivered using cognitive-behavioral therapy along with 12-step programming in a modified therapeutic community.
In terms of Ms. Jones treatment, after she was informed about her adult child's death, members of the treatment community, including the staff and other female offenders, approached Ms. Jones to offer her support. During group meetings, other female offenders spoke about their own feelings of loss in an effort to support Ms. Jones and to heal their own traumatic wounds. The counselor helped Ms. Jones connect her feelings of loss, abandonment, and other past traumas with her history of using drugs to medicate herself. The counselor, along with the staff psychiatrist, who prescribed Ms. Jones' psychotropic medication, also monitored Ms. Jones for signs of decompensation including suicidality. In addition, Ms. Jones' counselor conducted family meetings with Ms. Jones and her parents. These family meetings helped Ms. Jones reconnect with her parents, who had been estranged from her due to her history of antisocial behavior and substance abuse. During these meetings, Ms. Jones' parents were supportive of her desire to maintain sobriety and her plans to stay away from her criminal lifestyle and antisocial friends.
The program also promoted a sense of self-reliance in Ms. Jones by focusing on her strengths. The counselors, through group and individual sessions, highlighted the strength Ms. Jones’ had employed to survive the many traumas in her life. Ms. Jones was encouraged to identify her successes rather than focusing on what went wrong in her life. The delivery of a strength-based message is a delicate operation, as staff must sincerely express support for women offenders without being interpreted as patronizing.
An additional interaction between Ms. Jones and her counselor synthesized the elements of good treatment, in general, and gender-responsive programming, in particular. This interaction occurred immediately after Ms. Jones was informed for the second time that her adult child had died. During their individual session, Ms. Jones became angry at her counselor and accused her of not personally delivering the news of her child’s death. She stated, "You left it up to a stranger to tell me what happened. I will never forgive you for that."
At that moment, Ms. Jones' counselor was faced with a choice: she could tell Ms. Jones that she had, in fact, previously informed Ms. Jones of her child's death; or she could choose to not respond to Ms. Jones' accusation and continue to provide support. This therapeutic decision may have had far-reaching effects on her relationship with Ms. Jones. This situation is a clear example of a crisis being a potential opportunity and a danger for an offender and the counselor.
Ms. Jones' counselor chose to not respond directly to Ms. Jones' accusation. This decision, the correct one, is an example of effective treatment at a microcosm level. These therapeutic opportunities are played out many times a day and are examples of theory in action. Through her decision, Ms. Jones' counselor placed her own self aside for the good of the client. In other words, Ms. Jones' counselor could have chosen to confront Ms. Jones to "prove" that she had informed her about her child's death. Instead, the counselor stayed with Ms. Jones "in the moment." The counselor's decision permitted Ms. Jones to begin the grieving process and also relayed the message that she could handle Ms. Jones' expressions of negative affect, thereby providing Ms. Jones with a safe "holding environment" to express emotions without feeling judged.
This interaction also suggests that Ms. Jones felt "safe" enough with her counselor and the therapeutic environment to express her anger (probably related to the trauma of her losing a child and the traumatic memories of the death of her first child). Factors that contributed to the counseling relationship included the gender, race, and age similarities between the counselor and client and the fact that the counselor was a parent herself. (Campbell, 2005; Baird, 2003).
The counselor's intervention was consistent with her strong counseling experience and her use of her own relevant "life experience". Staff selection, training, and quality play a critical role in any organization including programs that operate gender-responsive treatment. When asked to articulate the reason for choosing not to respond to Ms. Jones, the counselor replied, "A couple things. We had talked about Ms. Jones and her possible reactions before I met with her. I remembered reading about similar situations in class, concerning people who deny that something bad has happened. It also did not feel right at the time to react. Ms. Jones was hurting from her loss and she needed someone to be there for her."
The need for program evaluation cannot be understated. Methods of program evaluation occur through ongoing assessment of the program systems and subsystems from both internal and external perspectives. Data for internal evaluations can be gathered through client and staff surveys. Conducting pre-test and post-test measures that can be compared with the client and staff surveys are another rich source of evaluation data. Outside auditors, who utilize instruments such as the Correctional Program Assessment Inventory 2000 (a well-researched inventory that quantitatively evaluates treatment programs along six relevant domains), can provide valuable information about the integrity of a program (Gendreau & Andrews, 2001). Furthermore, semi-structured interviews with female offenders and their family members add qualitative data to evaluations of programs. The qualitative data enriches and complements surveys and other instruments that produce quantitative data (Covington & Bloom, 2004).
Data for external evaluations can be gathered through recidivism studies and other measures, including female offenders' subsequent success in finding housing and employment; educational attainment; and improved financial status, family bonds, and mental and physical health.
The evaluation of Ms. Jones’ treatment was accomplished through the readministration of the battery of instruments that was originally completed during her orientation period. The results of Ms. Jones' evaluation were consistent with her counselor's evaluation of her progress, the psychiatric progress notes, and her family counselor's reports. Additionally, Ms. Jones’ program survey reflected positive sentiments.
When Ms. Jones' psychological test results were reviewed, some interesting results emerged. For example, Ms. Jones' drug scale score actually increased at the second testing. This development is not unusual in substance abusers who have gained insight into the severity of their substance abuse. The drug scale score increase suggested that Ms. Jones' denial about her drug problems had changed. On the trauma inventory, all of Ms. Jones' scales were lower during the second testing. In particular, Ms. Jones' Disruptive Thoughts scale was 30 points lower, a sign that she was experiencing traumatic thoughts less frequently and felt in better control of these thoughts.
On the second administration of the suicidality questionnaire, she reported feeling hopeful about herself, her hostility was markedly lower, and her self-evaluation had gone from primarily negative to primarily positive. An item analysis of Ms. Jones' suicidality scale indicated that she went from feeling no support from her parents to feeling very supported by them, a sign that the family meetings were productive. On the items that assess quality of friendships and feelings of isolation, Ms. Jones's item endorsement reflected a shift from feeling that she had no friends and was isolated from others to feelings that she had good friends and was not isolated; a sign that the program treatment community was supportive and nurturing.
At the time of her discharge, Ms. Jones was referred to a number of services that would assist her with her reentry needs. Ms. Jones' counselor followed up with Ms. Jones so that she connected with the referrals, including those given to address her medication needs. In consideration of her long history of substance abuse, which was highly correlated with her criminal behavior, Ms. Jones was referred to an intensive outpatient program as a condition of her subsequent parole release. Ms. Jones' parole officer was incorporated as a member of the treatment team so that he could be involved in Ms. Jones' discharge planning.
Conclusions and Future Directions
A number of relevant factors have to be taken into consideration for the development of effective gender-responsive programming. There are important differences between men and women in their pathways to criminal behavior. Correctional programs that do not take into account these gender differences will not be effective with women, and may even be detrimental.
Successful gender-responsive programs recognize that female offenders' treatment has to be supportive and nurturing, not confrontational. These programs recognize the importance of the provision of female-only services, particularly during the early stages of treatment when female offenders are most vulnerable. For female offenders, relationships form the backbone of their identity; therefore, a main vehicle for service delivery should be within the context of the therapeutic relationships that the female offenders have with the staff, each other, and their family members.
Gender-responsive programs benefit from the incorporation of the "what works" research into their design and implementation. Quality assurance mechanisms including outcome research provide critical information about the effectiveness of programs' interventions. Following an evidence-based approach, CEC has developed gender-responsive programs across the country. In an attempt to evaluate its female offender programs, CEC has undertaken outcome research through partnerships with university research departments and various Departments of Corrections. The research findings will be utilized to further enhance the effectiveness of CEC gender-responsive programming. The outcome research findings with large samples will be targeted for publication in peer-reviewed journals so that the information can be used to further the development of gender-responsive programming and ultimately reverse the alarming trend of female incarceration rates.