W. Amory Carr

Targeting Criminal Recidivism in Mentally Ill Offenders: Structured Clinical Approaches

Decreasing criminal recidivism in justice-involved individuals with mental illness, is among the most consistently desired outcomes by programs, policy makers and funding agencies. Evidencebased practices with track records of effectiveness in treating mental illness and co-occurring substance abuse, while important clinically, do not necessarily address criminal recidivism. Addressing recidivism, therefore, may require a more targeted criminal justice focus. In this paper, we describe recent challenges to decriminalization approaches and review factors associated with recurrent criminal behavior. In particular, we focus on structured clinical interventions which were created or adapted to target the thoughts and behaviors associated with criminal justice contact.

Structured Assessment of Correctional Adaptation (SACA) A Measure of the Impact of Incarceration on the Mentally Ill in a Therapeutic Setting

Clinicians have observed that psychiatric patients with correctional histories evidence attitudes and behaviors that seem adaptive in penal environments but are maladaptive in mental health settings. This study sought to assess the reliability and concurrent validity of a rating scale designed to measure correctional adaptation using a sample of 64 patients from a state psychiatric hospital. Scale ratings were obtained through structured interviews, whereas predictor variables were gleaned from chart review and selfreport. The scale demonstrated good interrater reliability (ICC = .83) and acceptable internal consistency (α= .67). Of the variables evaluated, two were significantly correlated with Structured Assessment of Correctional Adaptation (SACA) total scores, total months sentenced to prison or jail (r = .26), and frequency of disciplinary tickets while in prison or jail (r = .31). Stepwise regression analyses revealed only the latter variable significantly predicted SACA score (R = .31), F(1, 58) = 6.27, p < .05. Clinical implications of these findings, the scale, and the construct of correctional adaptation are discussed.

Predictors and treatment outcomes of perceived ward atmosphere among therapeutic community residents

Poor retention has been an impediment to the effectiveness of therapeutic communities (TCs) for substance use disorders. We assessed the impact of the residents perception of the therapeutic environment through the Ward Atmosphere Scale (WAS) on TC retention and examined predictors of the WAS in order to better understand this construct. Among a sample of admissions (N=123) to a 9-month residential TC, forward entry logistic regression analyses using WAS, demographic and clinical variables revealed that heightened perceptions of the orderliness of the therapeutic environment (i.e., the WAS domain of system maintenance) best predicted treatment completion. Furthermore, scores on WAS variables were best explained by the formal therapeutic elements of the TC (as measured by the Survey of Essential Elements Questionnaire) using linear regression. Efforts to improve the residents perception of these aspects of the ward atmosphere may assist in improving TC completion rates.

An Exploration of the Relationship Between Criminal Cognitions and Psychopathy in a Civil Psychiatric Sample

The relationship between psychopathy and thinking styles that support and maintain a criminal lifestyle is examined using the Psychopathy Checklist: Screening Version (PCL:SV; Hart, Cox, & Hare, 1995) and the Psychological Inventory of Criminal Thinking Styles (PICTS; Walters, 1995). These measures are administered to a sample of 75 patients recruited from a state psychiatric hospital in the northeastern United States. Correlational analyses indicate that the PICTS General Criminal Thinking, Self-Assertion/Deception factor scale, and several criminal thinking style scales are significantly related to psychopathy. The significantly associated criminal thinking scales include Entitlement (r = .44) and Superoptimism (r = .43) with Factors 1 and 2 of the PCL:SV, respectively. Multiple regression analyses reveal that these two criminal thinking scales are the strongest predictors of Factors 1 and 2 of the PCL:SV, respectively. Implications for the cognitive basis of the construct of psychopathy, as well as potential treatment interventions, are discussed.

Prediction of Institutional Misconduct Among Civil Psychiatric Patients Evaluating the Role of Correctional Adaptations

Research has shown that psychiatric patients with criminal histories report attitudes reminiscent of the prison culture that predict therapeutic alliance. This study examined the impact of these “correctional adaptations” on the behavior of a sample of 75 discharged civil psychiatric patients whose medical charts were reviewed for incidents of institutional misconduct including cigarette dealing, drug use, and weapons possession. Patients had been previously administered the Psychopathy Checklist–Screening Version (PCL-SV), Brief Psychiatric Rating Scale (BPRS), and Structured Assessment of Correctional Adaptation (SACA). Of the sample, 53% (n = 40) committed at least one act of misconduct, with an average of M = 2.8 (range = 0–18, SD = 4.27) incidents. Bivariate analyses revealed a significant relationship between incidents and the total SACA score, r s (74) = .33, p = .004. Ordinal regression analyses showed the SACA to be significantly predictive of misconduct, regardless of arrest history.

The Impact of Personality Disorders on Legally Supervised Community Treatment: A Systematic Literature Review

Mental health needs are common among community corrections offenders and many are enrolled in some form of supervised or mandated treatment. One category of mental health problem which may be germane to both treatment completion and recidivism among those in legally supervised treatment is the diagnosis of Personality Disorder (PD). This systematic review reports on sixteen studies comprised of full or mixed legally-supervised samples of offender in community-based treatment and examines the impact of PDs on treatment completion. These studies were difficult to compare because of the differences in program setting, definition of treatment completion, definition of PD, method of PD assessment and type of treatment, among other variables. The impact of antisocial personality disorder in treatment was a common focus, and other PDs were rarely assessed. The relevance of DSM PD categories to offender management in community corrections as well as the limitations of the current PD diagnostic categories is discussed.

Reducing criminal recidivism with an enhanced day reporting center for probationers with mental illness

ABSTRACT Offenders with mental illness (OMI) represent a significant portion of the community corrections population (e.g., probation, parole) for whom innovative interventions that target criminal recidivism must be assessed. This retrospective, quasi-experimental study compared recidivism outcomes of OMI probationers discharged from an enhanced day reporting center (DRC) with a comparable sample of probationers matched by propensity score (N = 227). Cox proportional hazard regressions demonstrated that participants of the DRC were significantly less likely to be reconvicted after discharge from the program, 2(2, N = 227) = 5.9, p = .02. Furthermore, DRC completers demonstrated a 40% reduction in risk of reconviction postdischarge compared to the matched sample.