Research Related to Offender Institutional Behavior and Reoffending Risk

The evidence base for what works for the subgroup of offenders with more serious cognitive deficits, particularly research related to reducing recidivism, is sparse. One researcher noted that the majority of research has been based on professional opinion and commentary, with few well- controlled studies and systematic reviews. There are, however, a growing number of promising practices that have proven effective with individuals with special needs (e.g., cognitive deficits) outside correctional settings that can assist offenders with special needs by improving reintegration.

Derived from this body of work, a framework for interventions with offenders with cognitive deficits, therefore, can be proposed that summarizes recommendations related to institutional correctional practices. Many of these practices are already incorporated into general correctional programs that focus on self-management skills including training on cognitive skills, such as planning, consequential thinking, problem-solving, decision-making, and emotion management skills to reduce aggression.

The executive functioning problems associated with more serious cognitive deficits, such as limited working memory, inability to follow verbal instructions, and lack of retention of the sequences of daily living, can require the use of innovative intervention responses. Management of offenders with cognitive deficits requires a comprehensive strategy that begins with initial screening, and, if feasible, an enhanced assessment for those identified with deficits that would identify functional strengths and deficits, in conjunction with a comprehensive assessment of criminogenic needs that is part of any well- developed correctional plan.

Interventions. Offenders with cognitive deficits with a substantial antisocial history are likely to manifest the same criminogenic risk factors that are typical of offender populations, but their behavior is further complicated by their neurological problems. Dynamic (i.e., changeable) criminal risk factors should be addressed in correctional programs to reduce their impact. Since the 1990s, cognitive behavioral interventions have become the preferred approach to correctional programs based on a large body of research support. For lower risk offenders with cognitive deficits and less substantial criminal histories, the focus would be on improving adaptive function in preparation for optimal independence on release.

Due to the wide range and complexity of deficits among those with neuropsychological disorders, it is impossible to recommend one specific intervention. For complex and lifelong disorders, there is a need for approaches that are problem-specific, flexible, and targeted toward the individual’s strengths and needs. Recognizing that there is no one size fits all approach to interventions for these individuals, the following general suggestions would apply to adapting group programs focused on reducing recidivism as well as to group programs that aim to improve prosocial reintegration for offenders with more serious cognitive deficits.

Adaptations and accommodations in group programs include:
- smaller group size (limited to six to eight participants);
- structured, well-organized sessions where expectations are made clear and repeated;
- close monitoring by facilitators to avoid potential interpersonal conflicts;
- teaching only one or two concepts per session;

- shortening sessions and increasing the overall length of the program;
- minimizing classroom distractions;
- repetition of material and frequent review;
- use of clear, simple, and concrete language;
- period use of multimedia learning tools (i.e., videos);

- a focus on structured problem-solving training, to a competent level of skill acquisition, without the expectation of a high level of cognitive expertise; and
- provision of one-to-one coaching sessions as an adjunct to the group program.

In addition, the correctional environment should include:
- staff training on strategies for working effectively with offenders with cognitive deficits;
- provision of continuity of care through detailed prerelease planning; and
- case management provisions that broker and coordinate specialized services such as stable housing, vocational training and job placement, and consolidation of family and/or community support on release.

For some individuals with cognitive deficits, group programs, even when adapted, may be inappropriate and ineffective. In these cases, individual therapy or adding a coaching component to programs may be more practical. Such coaching sessions would be geared toward increasing transferability of skills from the classroom to real-world functioning. Frequent practice of skills that are incorporated into daily activities in multiple settings enables individuals with neuropsychological difficulties to transfer knowledge learned from one setting to another.

Use of Medication. There is limited evidence supporting the use of psychoactive medications as a first-line treatment for individuals with serious cognitive deficits. There is, however, a substantial literature supporting use of stimulant medication with individuals with attention-deficit/hyperactivity disorder. Medical professionals caution that people with FASD have been shown to have atypical responses to medications, and the literature recommends that providers closely monitor individuals for side effects, proper administration of medication, and responses to medications. If medication is used, providing close follow-up, using low doses, monitoring side effects, and adjusting dosages rather than treating side effects are also strongly suggested.

Staff Training. Staff training to raise awareness about neuropsychological disorders in inmate populations and to suggest strategies to address challenging behavior is frequently recommended throughout the literature. Such training can help staff recognize the characteristics of offenders with neuropsychological disorders and learn to apply skills that are appropriate to an offender’s level of functioning. Recommended content for such staff training sessions have been developed for FASD and traumatic brain injury that could provide helpful guidelines for developing staff training for other neuropsychological disorders as well. These guides include information on the causes and consequences of brain injury in the offender population and describe how these offenders may be affected by problems related to their deficits. They also provide management strategies for criminal justice professionals in relation to specific challenges common to those with these disorders.