Approaching Correctional Treatment from a Programmatic Standpoint: Risk-Need-Responsivity and Beyond

Abstract

As jails and prisons have become de facto psychiatric facilities, there is a dire need to discuss best practices across the broad spectrum of correctional psychological care while also accounting for larger institutional and policy issues that can affect the implementation of such practices. Previous chapters in this volume have summarized the literature on preferred assessment and treatment options for specific offender subpopulations and/or diagnostic concerns. This concluding chapter discusses best practices in correctional psychology using a more programmatic perspective that expands on, but also encompasses, each of the topics presented in earlier chapters. That is, this chapter provides an overall structure and set of general guidelines for improving outcomes associated with mental health services in correctional settings, regardless of the presenting issue at hand. The discussion is centered largely on the atheoretical and empirically-supported Risk-Needs-Responsivity (R-N-R) model; however, we argue that several additional considerations—namely the treatment of severe mental illness, incorporating advances in technology, and working within inherent systematic constraints—are necessary for developing more comprehensive and ultimately more effective correctional psychology interventions. The chapter begins by highlighting the continuum of psychological services needed in correctional institutions ranging from the treatment of acute mental illness to long-standing, serious criminal behavior. The R-N-R prongs and a bi-adaptive approach for treating offenders with serious mental illness are reviewed, followed by a brief summary of existing off-the-shelf programs for addressing individual risk factors within these models (note: substance abuse and mental illness interventions are discussed more thoroughly elsewhere in this volume). The chapter then presents several technological innovations that appear promising in creating more efficiency within, and greater continuity between, correctional psychology programs, such as the use of videoconferencing and mobile SmartPhones apps. Next, we offer several recommendations for successfully implementing programmatic change and sustaining progress. These include individualizing treatment planning by conducting a proper assessment of risk level and need, and subsequently targeting all that apply to a particular offender; adopting longer-term interventions that adhere to a cognitive-behavioral framework; maintaining adequate training for all staff involved in psychological services from referral to delivery; developing collaborations with researchers and practitioners at local universities; remaining open to novel and emerging ideas; and implementing a standardized process of learning across programs whenever feasible. Finally, we acknowledge common policy and legislative challenges that correctional psychologists may face, and encourage clinicians and administrators to find creative ways to navigate these constraints and demands.