What Do We Know About Rehabilitation?

The "what works" discourse essentially boils down to teasing out the factors and treatment programs that help reduce the recidivism of known offenders. Traditionally, therefore, the main goal and primary indicator of a successful rehabilitation program is whether program participants achieve a lower recidivism rate than non-participants do. However, talking about "what works" is not as straightforward as might be expected. There are thousands of existing evaluations on rehabilitative efforts (Wormith et al., 2007: 881) and it would be almost impossible to simply review each and every one of these reviews and decipher what the best practices are for youth. Meta-analytic studies help to overcome this daunting task by synthesizing the results of many studies at once.

Meta-analyses first select a sample of evaluation studies that meet certain methodological standards. Criteria for inclusion in a meta-analysis might include factors like sample size, pre-program and post-program outcomes, the presence of a control group, etc. A study selection process that focuses on methodological rigour and program characteristics ultimately makes it easier to summarize results and compare rehabilitative efforts across time and space. The subsequent process of coding information from individual studies is conducted much like the systematic coding of individual survey responses from a representative sample from the general population (see Howell, 2003: 198). The outcome variable in meta-analytic studies is called an "effect size," which in the case of rehabilitation refers to whether (and how much) the treatment worked in reducing recidivism when compared with the control group that received no treatment. A larger effect size indicates that there was less recidivism among the treatment groups compared with the control groups. A negative effect size indicates a negative impact (i.e., more recidivism among the treatment groups when compared with control groups). Essentially, an effect size is the mean difference between the treatment and control groups (Aos et al., 2001: 38). The next section of this report reviews the findings from meta-analyses, beginning with three of the most influential meta-analyses to date, which continue to be widely cited in current literature (Cullen, 2007).

Promising Programs

It is important to mention that different programs work for different types of offenders. For example, providing employment opportunities has been shown to work in reducing recidivism, but only for people who were more than 26 years old (Webster, 2004: 118). Recall that the focus of this report is treatment for serious and violent youth who have already been adjudicated. It is well beyond the scope of this report to review the vast literature on all individual programs that are currently in operation, but the following are some of the most promising due to rigorous evaluations. For clarity, programs have been broken down into those that have been tested in the community and those that have been tested in institutional settings, although the programs are not limited to these settings.

Cognitive-behavioral Therapy

Cognitive-behavioral therapy (CBT) is an approach that is used on its own or as part of another program. It uses

. . . exercises and instruction that are designed to alter the dysfunctional thinking patterns exhibited by many offenders [e.g., a focus on dominance in interpersonal relationships, feelings of entitlement, self-justification, displacement of blame and unrealistic expectations about consequences of antisocial behavior (Walters 1990)] (Lipsey and Cullen, 2007: 302).

CBT helps people become aware of the existence of these dysfunctional thinking patterns, or "automatic negative thoughts, attitudes expectations and beliefs, and to understand how these negative thinking patterns contribute to unhealthy feelings and behaviors" (Wolfe, 2007: 66). As such, CBT focuses on one of the most robust correlates of crime, anti-social attitudes. Moreover, correctional staff can be trained to conduct CBT in a relatively short period of time (Hubbard, 2007: 6). Qualified staff help youth transform negative thoughts into positive ones, and with the emphasis on the connection between thoughts and behaviors, this helps change behavior as well (Wolfe, 2007: 66). Some of the behavioral techniques used by CBT include role playing, reinforcement and modeling (Hubbard, 2007: 7). This can be related to the RNR model, since using a multitude of techniques is important to meeting the responsivity principle of the RNR model because it allows for a larger scope of varying learning needs/styles to be met for different offenders (Hubbard, 2007: 2).

Meta-analyses of CBT have indicated reductions in recidivism ranging from eight per cent to 32 per cent compared with control groups, although these studies generally include mixed samples of adults and juveniles (Lipsey and Cullen, 2007: 308). As noted above, programs that have included CBT have also fared well during evaluation research. However, it is clear that more research needs to be done on the type of programming that is implemented within correctional settings. This is but one of many research questions that remain to be answered by future research. The next section discusses some of the other questions that remain regarding rehabilitation efforts.