Treatment of Gang Members Can Reduce Recidivism and Institutional Misconduct Author(s): Chantal Di Placido, Terri L.

Simon, Treena D. Witte, Deqiang Gu and Stephen C. P. Wong Reviewed work(s): Source: Law and Human Behavior, Vol. 30, No. 1 (Feb., 2006), pp. 93-114 Published by: Springer Stable URL: http://www.jstor.org/stable/4499461 . Accessed: 18/07/2012 14:12
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Law and Human Behavior, Vol. 30, No. 1, February 2006 (@ 2006) DOI: 10.1007/s10979-006-9003-6

Treatment of Gang Members Can Reduce Recidivism and Institutional Misconduct'

Chantal Di Placido,2,4 Terri L. Simon,2 Treena D. Witte,2 Deqiang Gu,2 and Stephen C. P. Wong2'3
Published online: 12 May 2006

Gang violence creates serious safety and security concerns in the community and prisons. Treated gang and nongang members recidivated significantly less in a 24-month follow-up than their untreatedmatched controls. Treatmentconsisted of high intensity cognitive-behavioral programs thatfollow the risk, need, and responsivity principles (Andrews & Bonta, 2003). The treated gang members who recidivated violently after treatment received significantly shorter sentences (i.e. they committed less serious offences) than their untreated matched controls. Untreatedgang members had significantly higher rates of major (but not minor) institutional offences than the other three groups. Correctional treatment that follows the risk, need and responsivity principles appears able to reduce recidivism and major institutional misconduct. Effective correctional treatmentshould be considered as one of the approaches in the management and rehabilitation of incarcerated gang members.
KEY WORDS: gangs; treatment; recidivism; institutional misconduct.

The effect of gangs on public safety is a growing concern. In addition to conflicts with other gangs, gang members are involved in a disproportionate amount of nonviolent and violent criminal activity (Decker & Van Winkle, 1996; Huff, 1996). Many of these gang members are eventually convicted and incarcerated. Although incarcerated, they are responsible for approximately one-quarter to one half of all management problems in prison (Camp & Camp, 1985, as cited in Fong, Vogel, & Buentello, 1995; Knox, 2000; see also Foss, 2000; Nafekh & Stys, 2004; NGCRC, 1999; Sheldon, 1991) and are more likely than nongang members to be involved in prison violence, even after controlling for history of violence and other
1Some of the data in this paper was previously presented in poster sessions at the 2002 Canadian Psychological Association's Annual Convention in Vancouver, BC, Canada, and the 2004 Violence and Aggression Symposium in Saskatoon, SK, Canada. 2 Research Unit, Regional Psychiatric Centre, Saskatoon, Saskatchewan, Canada. 3 Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. 4To whom correspondence should be addressed at Research Unit, Regional Psychiatric Centre, 2520 Central Avenue, P.O. Box 9243, Saskatoon, Saskatchewan Canada; e-mail: diplacidocj@csc-scc.gc.ca. 93
0147-7307/06/0200-0093/0 ? 2006 American Psychology-Law Society/Division 41 of the American Psychological Association

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background factors (Gaes, Wallace, Gilman, Klein-Saffran, & Suppa, 2002). Institutional gang-related crimes often are also underreported because of the reluctance of many witnesses to come forward. The majority of gang affiliated offenders will eventually re-enter society where they likely will again become a concern to public safety. Needless to say, it is important to reduce gang violence both inside prisons and in the community. Institutionally based measures used to reduce gang-related prison violence are reviewed below.

Separating and Isolating Gangs and Their Members Increasingly, separation of rival gangs has been used to reduce intergang violence (Knox, 2000), and can be useful, at times, to avert all-out gang wars. However, one such separation led to the gangs seizing control of the prisons and resulted in increased levels of violence against both inmates and staff (Parry, 1999). After a gangrelated riot in a Canadian prison, gang members were dispersed to reduce their influence within one prison and, paradoxically, enabled them to establish themselves in prisons where they had no presence before (Warick, 2004). Based on anecdotal reports there have been some successes in reducing gang related violence by putting gang leaders and members in segregation (Parry, 1999; Ralph & Marquart, 1991). However, such approaches could paradoxically enhance gang cohesiveness by increasing self-identification (Kassel, 1998) and implementation is costly. There is no well-conducted evaluation on the effectiveness of these strategies (Decker, 2001). Isolated gang members are unlikely to receive any services or interventions that might reduce their risk to re-offend in the long term.

Dissociating From the Gang Encouraging dissociation from gangs is an obvious management strategy. However, many gang members consider dissociation difficult and dangerous (Decker & Lauritsen, 1996), particularly in a prison environment where physically getting away from gang influences is often not feasible. Renouncing one's membership is often viewed as "an act of betrayal" (Fong et al., 1995, p. 46) and can result in threats of death (Bonner, 1999; Danitz, 2002; Fong, 1990). No doubt, gangs use fear of retaliation to control their members' allegiance. Some jurisdictions place dissociated gang members in a separate facility (Carlson, 2001), but relatively few correctional facilities have this option. Some gang members have, however, successfully left their gangs (Decker, 2003; Fong et al., 1995; NGCRC, 1999). For example, Fong et al. (1995) reported that about 1-5% of prison gang members were able to dissociate from their gangs. Those who dissociated tended to hold lower ranks and appeared less inclined towards violence. To date, no empirical evaluation has been undertaken to assess the efficacy of the dissociation approach to gang management (Decker, 2001, 2003; Fleisher & Decker, 2001; Knox, 2000).

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Correctional Treatment It has been suggested that correctional treatment programs should be provided to gang members as an alternative to static or administrative gang management approaches such as isolation and segregation (Carlson, 2001; Davis & Flannery, 2001; Fleisher & Decker, 2001). Toller & Tsagaris (t1996)reported a program at a correctional facility in Ludlow, Massachusetts, developed to improve the management of gang activity. The program was deemed successful: only 17 of 190 gang members were returned to segregation for gang activity after a 2-year follow-up. Foss (2000) described a psychotherapeutic gang intervention program that encourages participants to accept responsibility/accountability for their offending behavior. The Connecticut Department of Corrections also offers a program for gang members who wish to renounce their association, which includes interacting with members from other gangs, signing a renunciation form, and learning about cultural awareness, anger management, and other skills (Gaseau, 2002). Similarly, the Colorado Department of Corrections offers an incentive-based, cognitive-behavioral program for gang members. Successful completion results in a transfer to a less restrictive facility. The program was considered to be successful (Gaseau, 2002). Other programs designed specifically for gang members were reported to be under development, for example, by the Federal Bureau of Prisons (Carlson, 2001). However, no systematic evaluation of these programs with the use of appropriate comparison groups has been carried out. Measures of success appear to be limited to mostly anecdotal evidence.

Role of Correctional Treatment to Reduce Risk of Recidivism There is a substantial body of evidence, including a number of meta-analytic reviews, indicating that well-designed and implemented correctional programs can reduce the risk of recidivism (see Harland, 1995; Losel, 1995; McGuire, 1995 for summaries). The guidelines or principles of effective treatment-the risk, need, and responsivity principles, and the requirement to maintain program integrity, have been derived from this body of evidence, the so-called "What Works" literature (Andrews, 1995: Andrews & Bonta. 2003; McGuire & Priestley, 1995). Treatment programs that follow the risk-need-responsivity principles have the largest effect size and are more likely to be effective in reducing recidivism. Official sanctions tend to have a negative effect on recidivism (Andrews et al., 1990).

Risk Principle The risk principle states that treatment is most effective when it is applied to those who have an appreciable risk of offending; that is, treat high risk rather than low risk offenders (Andrews & Bonta, 2003). However, the contrary and incorrect view is often expressed-that is, treatment with more serious, "hardened," highrisk offenders is ineffective. Meta-analyses of interventions with serious offenders support the risk principle (Lipsey & Wilson, 1998).

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Need Principle The need principle states that criminogenic needs (the dynamic or changeable characteristics that contribute to an individual's criminal activities such as criminal attitudes and criminal associates) must be assessed, identified and targeted in order for treatment to be effective (Andrews & Bonta, 2003). Criminal associates is one of the most important criminogenic factors for gang members. Other factors such as violent lifestyle, substance abuse, and interpersonal aggression, will likely be prominent criminogenic needs as well (see Goldstein, 1993). Effective treatment will lead to positive changes in the criminogenic needs, resulting in risk reduction. Responsivity Principle The responsivity principle states that treatment effectiveness can be maximized if the delivery of treatment is adjusted to accommodate the clients' idiosyncratic characteristics such as cognitive abilities, level of motivation, readiness for treatment, cultural background and so forth (Andrews & Bonta, 2003; see also Wong & Hare, 2005). For example, Goldstein (1993) discussed interventions specific to gang members, taking into consideration factors that affect responsivity. One of the most daunting responsivity factors in correctional treatment is to provide treatment to clients who appear unmotivated or not ready to change. Gang members will likely have many treatment responsivity issues such as low motivation and lack of trust, which may lead to early dropout of the program. The negativity expressed by a gang member's compatriots may make treatment participation difficult even for those who want to change. Treatment Programs at the Regional Psychiatric Centre The Regional Psychiatric Centre (RPC) in Saskatoon, Saskatchewan, is a maximum-security, accredited, forensic mental health hospital operated by the Correctional Services Canada (CSC). The RPC offers high intensity, cognitivebehavioral treatment programs designed for high risk high need offenders and offenders with significant responsivity issues. The programs utilize an interdisciplinary team approach, follow the principles of effective correctional treatment, and emphasize relapse prevention skills delivered via individual and group therapy which includes psychoeducational groups. Additional groups or programs may also be offered as required (e.g. employment and education programs, chaplain services and traditional aboriginal healing approaches, substance abuse programming, occupational therapy, and so forth). Referrals to the programs come from other correctional institutions and are screened for suitability on the basis of the program inclusion criteria. Upon discharge, offenders may be released directly to the community, transferred back to the referring institution, or to a different institution. Although the treatment programs do not require gang members to renounce their membership before participating in treatment, the programs do educate offenders that avoiding criminal peers (e.g. other gang members) is important to reduce their risk of reoffending.

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The objectives of this study are to evaluate the efficacy of treatment of gang members in reducing institutional misconduct and recidivism in the community. The currently available management strategies for incarcerated gang members, such as isolation, separation, and dissociation may be necessary to manage a difficult and volatile population of offenders. However, the empirical evidence on their effectiveness has not been established and they are not always appropriate to address institutional management problems and public safety concerns. The empirical demonstration that correctional treatment could significantly improve the institutional and community behaviors of gang members would mean that treatment could be a viable and effective intervention to bring about both short- and long-term behavioral improvements of gang members.

METHOD Study Design The study is a retrospective-prospective investigation of the efficacy of the treatment of gang members. It can be described as a 2 x 2 design with gang membership (gang and nongang) and treatment (completed and not completed treatment) as the two main conditions. Gang membership and whether or not the participant completed treatment5 were determined using official records maintained by CSC. The four groups: untreated gang members, treated gang members, untreated nongang members and treated nongang members were matched on age at index conviction, length and type of index conviction, number of prior nonviolent and violent convictions, and race. There are three outcome (dependent) measures: first, all, nonviolent, and violent official criminal code reconvictions following release to the community, and second, the rate of officially documented major and minor institutional infractions after the offender was discharged from the RPC. The third outcome variable is the length of sentence of the first violent conviction after the offender's community release, which, we argue, reflects the seriousness of the reconviction. Participants The four matched groups of offenders are untreated gang members (UG; n = 40), treated gang members (TG; n = 40), untreated nongang members (UNG; n = 40), and treated nongang members (TNG; n = 40; see Table 1). Participants were selected from a pool of 1,824 male adult federally sentenced offenders (serving sentences > than 2 years) consecutively admitted to the RPC between January 1, 1990 and December 31, 2000.6 One hundred thirty-three offenders were first identified as gang members from the pool. Treated gang (TG) or treated nongang (TNG)
5For ease of writing and discussion, the "not completed treatment" group is referred to as the untreated group. 6Admissions for remand court assessments were excluded from the pool of admissions from which the participants were selected.

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Di Placido, Simon, Witte, Gu, and Wong Table 1. Matching Variables and Risk Measure for the four Groups Gang members M (SD) Treated Untreated 23.27 (4.36) 73.95 (81.12) 3.20 (3.16) 15.55 (10.83) 0.15 (.43) Nongang members M (SD) Treated 25.01 (4.35) 68.08 (81.69) 2.88 (3.07) 16.85 (12.67) 0.08 (.27) Untreated 24.28 (3.79) 65.20 (82.10) 2.88 (2.80) 15.40 (10.37) 0.03 (0.16) F(3, 156) 1.11 0.10 0.15 0.21 0.83

-7.30 (6.90) -5.95 (6.97) -6.50 (7.27) -8.33 (7.51) 0.83 All reported F values are not significant. Note. aPrior sexual convictions are listed separately to indicate the small number. However, prior violent and sexual convictions are combined in all other analysis. bThe reported values for the four groups all correspond to a probability of 66.66% recidivism, the highest risk group among five risk groups (Cormier, 1997). The GSIR scores were not matched but compared after the matching.

Matching variables Age at index Index sentence (months) Prior convictions(#) Violent Nonviolent Sexuala Risk measure GSIR Totalb

24.17 (4.57) 72.35 (82.69) 3.18 (2.78) 16.93 (11.74) 0.10 (.50)

participants were those who successfully completed one of the following programs: the Aggressive Behavioral Control (ABC) Program, the Clearwater Sex Offender (Clearwater) Program, or the Psychiatric Rehabilitation (PsyReh) Program (see Appendix), as indicated in their discharge reports by the program staff. Untreated or only partially treated participants (UG and UNG) were those who did not complete treatment at the RPC for a variety of reasons (e.g. voluntary withdrawal from the program, noncompliance with program rules), or those who were admitted for assessments only, for example, for parole release considerations. Twenty-eight gangs are represented in the sample. The majority of the gang members (61.3%, n = 49) belong to Aboriginal street gangs which include Indian Posse (n = 20), Manitoba Warriors (n = 16), and Other (n = 13). Eleven of the 80 gang members (13.8%) belong to motorcycle gangs (e.g. Hell's Angels, Rebels), and the remaining 20 (25.0%) belong to a variety of other gangs (e.g. Blood-Crips, White Supremacist Groups). There are no significant differences between the TG and UG groups for type of gang affiliation, X2(4, N = 80) = 1.42, ns. Thirty percent (n = 24) of the gang sample are non-Aboriginal and 70% (n =56) are Aboriginal or other minority. This is similar to the distribution of gang members (n=573) in CSC correctional institutions in the prairie region of Alberta, Saskatchewan, and Manitoba where 31.4% are non-Aboriginal and 68.6% are Aboriginal (Correctional Services Canada, 2001). Ralph, Hunter, Marquart, Cuvelier, and Merianos (1996) also found that gang members were more likely to belong to a minority group. Of the treated groups (n = 80), 78.8% completed the ABC Program, 7.5% the Clearwater Program, and 13.8% the PsyReh Program. The mean length of stay at the RPC was 238.46 days (SD = 117.52, range = 93-862) for the treated groups (n = 80) and 90.80 days (SD = 74.34, range 6-371) for the untreated groups (n = 80). Of the total sample, 17.5% (n = 28) were serving a sentence for a nonviolent conviction and 82.5% (n = 132) for a violent conviction.

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Procedure All data including gang affiliation, demographic information, and psychiatric diagnoses (DSM-III, IV; American Psychiatric Association, 1980, 1994) were collected from the Offender Management System (OMS), except where otherwise specified. OMS is a national electronic database on federal offenders maintained by CSC. Offender information is entered into the OMS by correctional or treatment staff. When necessary, institutional paper files were also accessed to collect missing information. Outcome variables include all, nonviolent, and violent reconvictions (after first release to the community posttreatment) and major and minor institutional offences. As well, sentence length of the first violent conviction after discharge from the RPC was used as a proxy indication of the seriousness of offending. It would be ideal if treatment could lead to no recidivism, however, it could still be considered a positive outcome of treatment if the seriousness of the recidivism was reduced. One of the fundamental principles of the Canadian Criminal Code (CCC: Martin's Annual Criminal Code. 2005, section 781.1) is that a sentence must be proportionate to the gravity of the offence. However, a multitude of other factors such as aggravating and mitigating factors, plea bargains, and so forth may influence the sentences imposed. Nonetheless, there is evidence that offence seriousness can be estimated by the length of sentence the offender received. Bdlanger (2001) used 1999-2000 sentencing information for Canadian adults (n = 37,514) sentenced and incarcerated for one criminal code conviction and found that the more serious forms of assault resulted in longer imposed sentences. The mean sentence length (in days) received for three types of assault in descending order of severity as defined by the CCC were 483, 114, and 50, for aggravated assault, assault with a weapon/causing bodily harm, and common assault, respectively. In addition, the mean sentence lengths (in days) for offences against the person was 220 versus 100 for offences against property. As well, Campbell (1993) rank ordered the mean sentence length received for a variety of CCC infractions in a sample of over 150,000 offenders. For eight major CCC violations against the person, the longest sentence length received was for murder, followed by attempted murder, manslaughter, kidnapping/abduction, criminal negligence, robbery, sexual assault, and assault (in descending order).7 It appears that, in general, more serious offences received longer sentences. Reconvictions were collected from the Canadian Police Information Centre, a computerized information system operated by the Royal Canadian Mounted Police to provide Canadian criminal justice agencies with information on crimes
7In addition, three raters were provided with a list of eight violent CCC violations (murder, assault, attempted murder, kidnapping/abduction, sexual assault, robbery, criminal negligence, and manslaughter) and asked to rank the perceived seriousness of each offence from 1 to 8, with 1 being the most serious and 8 being the least serious. The ratings were correlated with average sentence lengths reported by Campbell (1993) and B61anger (2001). For sentence lengths reported by Campbell (1993), correlations for the three raters were -0.66 (p = .08), -0.85 (p <.01), and -0.85 (p <.01). For sentence lengths reported by B6langer (2001), correlations for the three raters were -0.79 (p = .06), -0.83 (p <.05), and - 0.85 (p < .05). The significant negative relationships between perceived offence seriousness and actual imposed sentence lengths provide additional evidence for the validity of using sentence length as an outcome measure.

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(violations of the CCC) and criminals (Canadian Police Information Centre, n.d.). The identities of criminal record entries are verified by fingerprinting. Reconvictions were collected in September 2003 and categorized as nonviolent (all crimes excluding violent and sexual convictions) or violent (nonsexual and sexual convictions against the person, except noncontact sexual convictions such as exhibitionism). Court adjudicated convictions (not charges) were used to calculate the number of prior convictions and reconvictions; multiple convictions occurring in one sentencing date were counted separately. Institutional offences were collected from the OMS in September 2003. All institutional offences committed after discharge from the RPC to the data collection date were used to calculate a rate (number of offences per month of federal incarceration). Institutional offences are formally adjudicated in institutional court and entered into the OMS. They are categorized as minor (e.g. possession of an unauthorized item, disobeying a written rule or order) or major (fighting/making threats, dealing in contraband) by the charging correctional officer. Three participants from the UG group and one from the UNG group died after the sample was selected; their data collection dates were their decease dates. All analyses were performed using SPSS, Version 11. Assessment of Gang Membership Since April 1996, identification of possible gang membership of offenders in CSC has been based on a specific set of guidelines. These guidelines include observation of ongoing association with other known gang member(s), arrested while participating in a criminal activity with known gang member(s), criminal involvement in a gang activity, and displaying common and/or symbolic gang identification, tattoos or paraphernalia. Evidence must be derived from reliable sources of information including legitimate community or institutional sources, police information, tangible written, electronic or photographic evidence which states or suggests gang membership, self-declaration of gang membership, or a judicial finding that the person is a gang member (Correctional Services Canada, 1996). Prior to April 1996, each institution's intelligence officer used their personal knowledge of gang information available locally and a set of similar but less structured criteria to determine gang affiliation. This information is entered in the OMS by the institutional intelligence officer. Identification of gang membership for this study was determined by manually reviewing information in the OMS for each potential participant regarding gang affiliation. Matching of the Four Groups After gang membership and treatment status were determined for the pool, forty untreated gang members (UG) were matched to 40 treated gang members (TG). The matching variables include type and length of index conviction, age at index conviction, number of prior nonviolent and violent convictions, and race. The index conviction is defined as the conviction for which the offender was serving the sentence when he was admitted to the RPC. A large database was created and

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the matching was done manually by the first author before collecting recidivism and institutional offence information.8 Forty untreated nongang members (UNG) and 40 treated nongang members (TNG) were then matched to the UG and TG groups using the pool of participants. The remaining 53 identified gang members could not be mafched. Seven out of the original 160 participants were replaced as further file investigation revealed they no longer met the above matching criteria (e.g. file information indicating some involvement with a gang when they were not identified as a gang member in the OMS). General Statistical Information on Recidivism Scale (GSIR) The risk levels of each group were determined using the GSIR (Bonta, Harman, Hann, & Cormier, 1996). The GSIR, originally developed in 1972 by Nuffield and colleagues, is a 15-item scale designed to assess the risk of general offending. Items are based on static factors such as marital status, criminal history, and employment status. The items are rated using weighted scores. A lower score corresponds to a higher risk of recidivism. The instrument has been reliably associated with recidivism (Bonta et al., 1996; Cormier, 1997). The GSIR was rated on all participants except those whose scores were available from the OMS. Inter-rater reliability was established using 18.5% (n = 10) of the scores available on OMS (r = -0.86, p <.01). RESULTS Matching Variables, Risk Measure, Demographics and Psychiatric Diagnoses Analysis of variance (ANOVA) between the four groups (N = 160) indicate no significant differences on any the matching variables or the risk measure (GSIR; see Table 1). There are also no significant differences between groups on any of the following demographic variables. For occupation, 42.5-67.5 % of the four groups are classified as unskilled laborers, 5.0-12.5% skilled laborers, 2.5-5.0% other or unknown, and 25.0-42.5% have no occupational history, X2(15, N= 160) = 13.67, ns. For marital status, 42.5-65.0% of the sample are unmarried and living alone, 27.5-55.0% married or living with partners, and 2.5-7.5% separated, divorced, or widowed, X2(9, N= 160) = 10.48, ns. For education, 15.0-37.5% had less than high school, 40.057.5% had some high school, 15.0-27.5% completed high school or equivalent, 2.57.5% had some postsecondary education, and 2.5% of each group are unknown, X2(12, N= 160) = 10.19, ns. The majority of the sample (80.0-87.5%) have an Axis I diagnosis of alcohol/substance use disorder, X2(3, N= 160) = 1.28, ns. Other Axis I diagnoses include mood disorders (2.5-12.5%), schizophrenia and other psychotic disorders (0-12.5%), disorders usually first diagnosed in infancy, childhood, or adolescence (0-5.0%), anxiety disorders (0-2.5%), adjustment disorders (0-2.5%), and
8Please contact the first author for details of the matching process.

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Di Placido, Simon, Witte, Gu, and Wong

mood and anxiety disorders (0-2.5%). The Axis II diagnosis of antisocial personality disorder (APD) is also prevalent [50.0-62.5%; X2(3, N= 160)- 1.82, ns]. Other Axis II diagnoses include other personality disorders (0-17.5%) and various degrees of mental retardation (0-12.5 %). There are thirteen participants (8.1%) in the total sample (N = 160) who do not have either an Axis I or II diagnosis. Posttreatment Recidivism At the time of data collection, 10.6% (n = 17) of the total sample had not been released and were excluded from the outcome analyses. They are distributed in the groups as follows: UG= 6, TG = 4, UNG = 4, TNG = 3. An ANOVA for those included in the outcome analyses (n = 143) also indicate no significant differences between groups for each of the matching variables and the risk measure. Figures 1 and 2 depict survival analyses for the four groups for nonviolent and violent convictions, respectively. There are eight participants who have a follow-up period of less than 2 years. Their mean follow-up is 13.72 months (SD = 5.77). There are significant differences between the four groups for all recidivism (Wilcoxon [Gehan] = 9.77, p < .05). The TG group recidivated significantly less than the UG and UNG groups (Wilcoxon [Gehan] = 4.53, p < .05 and 5.66, p < .05, respectively). As well, the TNG group recidivated significantly less than the UG and UNG groups (Wilcoxon [Gehan] = 4.06, p < .05 and 5.05, p < .05, respectively). Neither the TG and TNG groups nor the UG and UNG groups are significantly different. The results for nonviolent recidivism are quite similar to that of all recidivism; there are significant differences between the groups (Wilcoxon [Gehan] = 13.01,
1.0
0.9 L

CfD

o > 0.6 --

Treated. Gang...

0'5 0.4 --

-Treated

Gang Members

Untreated GangMembers
- Treated Non-gang Members

Untreated Non-gangMembers 0.3 -I 0 6 12 Time in Months Post-Release 18 24

Fig. 1. Survival analysis for nonviolent recidivism by group.

Treatment Efficacy with Gang Members

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1.01

0.9.
o 0.8
C, .0 I. 0.7 0.7 0.6
0.5 T Treated Gang Members

--

=
0.4

...
--

Untreated Gang Members

- Treated Non-gang Members

...Untreated Non-gangMembers
0.30 6 12 18 24

Time in Months Post-Release

analysisfor violent recidivism group. by Fig.2. Survival

p <.01; see Fig. 1). Pairwise comparisons show that the TG group recidivated significantly less than the UNG group (Wilcoxon [Gehan] = 9.42, p < .01) and the UG group (Wilcoxon [Gehan] = 3.61, p = .06). As well, the TNG group recidivated less than the UNG group (Wilcoxon [Gehan] = 8.02, p < .01). There is no difference between the TG and TNG groups or between the UG and UNG groups. The TG and TNG groups survived at very similar rates. The UG and UNG groups are also indistinguishable. For violent recidivism, there is no significant overall difference between the groups. However, the two treated groups have the least steep slope, followed by the UNG group, and then the UG group, which has the steepest slope (see Fig. 2). A Cox regression shows that using pretreatment incarceration time as a covariate9 has no effect on all, nonviolent, or violent convictions (all three B = .00, ns). A two-way ANOVA (Treated/untreated x Gang/nongang), covarying pretreatment incarceration time, for the number of all, nonviolent, and violent reconvictions using a 2-year follow-up (n = 135) shows a significant main effect for treatment for nonviolent and all reconvictions, F(1, 134) = 4.15, p < .05 and 4.98, p < .05, respectively. There is no significant main effect for gang membership or a Gang x Treatment interaction.
9Pretreatment incarceration duringthe indexsentencewasusedto investigatethe effect of incarcertime between ation as a deterrentfor re-offending it is not contaminated RPC treatment.Correlations as by of incarceration time and the occurrence any,non-violent,or violent were not significant pretreatment incarceration (r = - 0.08, ns; r = - 0.08, ns; and r = - 0.12, ns, respectively).The mean pretreatment times (in months)for the groupsare UG = 32.41(SD = 37.09,n = 34), TG = 37.34(SD = 22.09,n = 36), difUNG = 33.57(SD = 35.96,n = 36), and TNG = 48.04(SD = 57.17,n = 37), and are not significantly ferent,F(3, 139)= 1.13,ns.

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Di Placido, Simon, Witte, Gu, and Wong

40
V ? 0 O

Cl: 95%
Upper Lower

UG
52.09 14.42

TG
20.20 3.75

UNG TNG
17.96 4.55 13.82 .86

30

20

10

0
UG (n = 16) TG (n = 10) UNG (n = 15) TNG (n = 14)

Groups
Fig. 3. Mean length of sentence for first violent reconviction by group.

In addition, there is a significant relationship between the number of days at the RPC and the occurrence of any posttreatment conviction (r = - 0.19, p < .05) or a nonviolent conviction (r = - 0.22, p < .01), and a marginal relationship with the occurrence of a violent conviction (r = - 0.15, p = .08) for those offenders released at the time of data collection. A longer stay at the RPC is associated with fewer posttreatment convictions. The base rates after 24-month follow-up (n = 135) for all recidivism are: UG = 64.5%, TG=50.0%, UNG=69.4%, TNG=58.3%; for nonviolent recidivism: UG = 48.4%, TG =37.5%, UNG = 61.1%, TNG = 44.4%; and for violent recidivism: UG = 51.6%, TG = 31.3%, UNG = 44.4%, TNG = 38.9%. Sentence Length of First Violent Reconviction There is a significant overall difference between the groups for sentence length of the first violent reconviction within 2 years posttreatment, F(3, 51) = 4.52, p <.01.10 Post hoc multiple comparisons indicate that the sentence length (in months) for the UG group (M= 33.25, SD = 35.35) is significantly longer than the other three groups (TG, M=11.98, SD= 11.50, p <.05; UNG, M= 11.25, SD = 12.11, p < .01; TNG, M = 7.34, SD = 11.22, p < .01; see Fig. 3).
'OExamination showed one outlier in the UNG group with a sentence length of 192 months. With the outlier, there is no significant overall difference between the groups, F(3, 52) = 1.85, ns; omitting the outlier reveals a significant overall difference, F(3, 51) = 4.52, p < .01. Inclusion of the outlier increased the mean sentence length of the UNG group, thus strengthening the expected outcome but increasing the variance such that no overall between group significance was found.

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A two-way ANOVA, covarying pretreatment incarceration time, reveals significant main effects for gang membership, F(1, 54) = 5.41, p < .05, and treatment, F(1, 54) = 5.27, p < .05, and no Gang x Treatment interaction. There is no relationship between mean sentence length of first violent conviction and number of days at the RPC with (r = - .11, ns) or without the outlier (r = - .06, ns). The sentence length of the combined treated groups (TG, TNG, n=24; M = 9.27, SD = 11.33; CI = 4.49 to 14.06) is only one third of the sentence length of the combined untreated groups (UG, UNG, n=32; M=27.90, SD =41.09; CI = 13.01 to 42.71; t[37.09] = 2.44, p < .05, two-tailed) and less than one-half with the outlier removed from the untreated groups, n = 31; M= 22.61, SD = 28.60; CI = 12.12 to 33.10; t(41.18) = 2.37, p < .05, two-tailed. Posttreatment Institutional Offences The mean number of months of federal incarceration posttreatment up to the data collection date for each group is UG = 50.02 (SD = 34.85: n = 39), TG = 36.48 = 37), UNG = 36.17 (SD= 35.68: n = 39), and TNG = 26.23 (SD =34.24: (SD=22.11: n=35). An ANOVA shows a significant difference between the <.05, therefore rates were used to compare the groups groups, F(3, 146)-= 3.38, p on institutional offences. Ten participants were released to the community directly from the RPC and, therefore were excluded from the analyses. There is a significant difference between groups for rate of major institutional offences posttreatment, F(3, 146)] = 3.34, p < .05. Post hoc multiple comparisons indicate that the UG group (M=0.25, SD = 0.62) has significantly higher rates than the other three groups (TG, M=0.08, SD=0.11, p<.05; UNG, M=0.04, SD=0.08, p<.01; TNG, M=0.04, SD =0.10, p < .01; see Fig. 4). The rate of minor institutional offences is also significantly different between the four groups, F(3, 146) = 4.65, p < .01. Unexpectedly, the rate per month is highest for the TG group (M = 0.29, SD = 0.39), followed by the UG group (M = 0.20, SD = 0.21), with the TNG and UNG groups at the lowest rates (TNG, M=0.12, SD=0.18; UNG, M=0.10, SD =0.16). Post hoc multiple comparisons show that both the TNG and UNG groups have significantly lower rates (both p <.01) than the TG group. There is no significant difference between the TG and UG groups. A two-way ANOVA shows no Gang x Treatment interaction for major or minor institutional offences. DISCUSSION We report a retrospective-prospective study that evaluated the efficacy of institutional-based treatment programs for gang-affiliated male offenders who had, in addition to their gang affiliations, significant official records of violent and nonviolent criminal behaviors. Treated gang and nongang groups were compared to matched untreated gang and nongang comparison groups. The four groups were matched to the extent that there was no significant difference between the groups in a wide range of demographic and criminality markers such as age, marital status, racial, educational, or employment backgrounds, psychiatric diagnoses and criminal

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0.4

95% CI Upper Lower

UG .45 .05

TG .12 .05

UNG TNG .08 .07 .01 .02

95% CI: Upper Lower

UG TG UNG TNG .27 .42 .15 .18 .14 .17 .05 .06

C 0

0.3

S0.1

0UG TG UNG TNG UG TG UNG TNG

Major

Minor

Type of InstitutionalOffence for the Groups

Fig. 4. Comparison of posttreatment institutional offence rates by group.

history variables as well as the level of risk of recidivism assessed by a validated risk measure, the GSIR. It is very unlikely, though not impossible, that any difference in recidivism and institutional misconduct observed could be attributed to preexisting group differences. Statistically controlling for pretreatment incarceration time among the groups, a potential confound, did not affect the results. The matched comparison-group design was chosen because of the retrospective nature of the study. Ideally, the random assignment of participants to a treated and an untreated or treatment as usual control group is a more powerful design and is preferable to that of a matched control design. However, it is not defensible operationally or ethically to admit gang members with significant records of violence to the RPC and not provide them with the best treatment available as opposed to no treatment or treatment as usual before releasing them to the community. Some programs are available in prisons for violent offenders including those with gang affiliation. We did not compare treatment at the RPC with treatment in prison because the environment in a prison is obviously qualitatively different from that of a mental health center mandated to provide treatment to offenders. Overall criminal recidivism was significantly reduced, as assessed by survival analyses, in both treated groups compared to the untreated comparison groups. For those who recidivated, the first violent conviction was less serious (measured by the length of the imposed sentence) in the treated groups compared to the untreated comparison groups. The treated groups also had lower rates of major institutional infractions (but not minor infractions) than the comparison groups. Overall, the

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results are consistent with the general conclusion that cognitive-behavioral treatment designed according to the risk, need and responsivity principles, and delivered to gang members within a forensic mental health facility can reduce the likelihood and seriousness of criminal recidivism in the community, and the rate of major institutional misconduct while incarcerated. The untreated matched comparison gang and nongang groups were not truly untreated as they simply received a shorter duration of treatment than the treated groups or were admitted for assessment only. There is a negative correlation between length of treatment and recidivism: longer duration of treatment is related to lower recidivism, a putative dosage-response relationship. Given that the untreated comparison groups were treated to a certain extent, the observed results would likely be a conservative estimate of what could be observed in a truly untreated comparison group. It could also be argued that there might be qualitative differences between the treated and the comparison groups given that some members of the comparison groups were admitted for assessment only or chose to or were required to leave the program. These possibilities could not be ruled out entirely, but the lack of any differences in the matched variables between the four groups would argue against such suppositions. As well, the characteristics of treatment noncompleters or dropouts at RPC have been investigated quite extensively in sex offenders and violent offenders. Treatment noncompleters were more likely to have more extensive criminal histories, higher risk of recidivism, diagnoses of antisocial personality disorder, be younger, single, less educated and so forth compared to completers (see Beyko & Wong, 2005: Ogloff, Wong & Greenwood, 1990; and Wormith & Olver, 2003). In this study, there were no differences between the four groups on any of the variables that generally differentiate completers from noncompleters as indicated above. The differences in outcome between the treated and untreated groups, therefore, are more likely attributable to the completion or noncompletion of treatment rather than to other demographic or risk variables. A 3 (treatment type) x 2 (gang membership) design with assessment only, treatment completion and treatment noncompletion as the three treatment types by gang and nongang, may provide answers to the putative qualitative differences among the groups. However, assembling comparison groups in this manner using the present data would destroy the matching of the groups and may introduce other unknown errors into the comparison. The number of assessment only cases (about 5% of sample) is also too small for any meaningful comparison. In addition, it could be argued that the treatment the participants received, and the relationship of treatment duration to the lowering of recidivism could be attributed not so much to treatment, but rather to nothing more than the length of incarceration: that is, a longer period of incarceration produced lower recidivism. We have shown that the length of pretreatment (that is, pre-RPC admission) incarceration is not related to recidivism. Only the period of stay at the RPC, which, arguably, could be equated to the amount of treatment the participants received, is negatively related to recidivism. As well, the observed reduction of recidivism with treatment was unchanged when the length of pretreatment incarceration was statistically controlled in the analyses.

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Our sample consisted of a number of offenders with mental disorders that, on admission to the RPC, would be treated and stabilized. In most cases, these offenders also have other significant criminogenic needs such as substance abuse, criminal attitudes and beliefs, and would be treated similar to their non-mentally disordered counterparts. It is possible that gang members who suffer from some form or degree of mental disorder may play a different role in the gang organization such as acting more as a follower or runner than a leader. Treatment of those with mental disorders with a co-occurrence of violence and other criminogenic factors would involve treatment to manage their disorder as well as treatment to reduce risk of recidivism. The fact that the present sample consists of both non-mentally disordered as well as mentally disordered offenders should not be considered as an anomaly. Rather, the sample is a reasonable reflection of the reality of most forensic populations that usually consist of a small but significant number of mentally disordered offenders. Inclusion of a small number of mentally disordered offenders in the present sample would likely increase the generalizability of the results. We have tried to address potential alternative interpretations of the observed results. We are reasonably assured that the observed reductions in recidivism and institutional misconduct likely are attributable to the interventions the participants received in the treatment programs, rather than to other uncontrolled factors. Having ruled out, as much as possible, other nontreatment related explanations of the results, we can now turn to a discussion of the implications of the results. Magnitude of the Reduction in Recidivism Treatment of gang members reduced their risk to recidivate compared to untreated gang members. The reduction in violent recidivism using a 2-year follow-up was 20% between the TG and UG groups, and 6% between the TNG and the UNG groups. For nonviolent recidivism, the corresponding reductions were 11 and 17%. These are quite large effects. In comparison, the difference between the effect of aspirin and a placebo in preventing heart attacks is about 3% (Steering Committee of the Physicians' Health Study Research Group, 1988). In addition, for those who violently offended in the community, treatment appears to reduce the seriousness of the offence measured in terms of sentence length of the first violent conviction after discharge from the RPC. Those who recidivated and did not complete treatment received sentences three times longer on average compared to those who recidivated and did complete treatment. The institutional behaviors of treated gang members also improved; there was significantly less major institutional misconduct such as fights and assaults. Treatment can have a positive effect on the criminal and institutional behaviors of gang members. The only exception is the relatively high rate of minor institutional misconduct displayed by treated gang members. It is possible that infractions of institutional rules such as disobeying verbal orders given by correctional staff could be survival tactics that a gang member uses to impress and convince his compatriots that he is still "solid" and "one of them." Another possibility is that treated gang members might have used nonphysically aggressive coping strategies such as sarcasm, passive-aggressive behaviors, and so forth to deal with various situations

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rather than acting out in a physically aggressive manner. Although these methods of coping are not ideal, the consequences are less serious. The human and operational cost of a minor institutional infraction is definitely lower than that of a major infraction. The impact of treatment on nongang members is quite similar to that of gang members; treatment reduces the risk of recidivism for nongang members. However, the treatment effects on institutional misconduct for nongang members were not as clear-cut. There appears to be only small differences between the treated and untreated nongang groups. It should be pointed out that the UNG group was not truly untreated, they received some 3 months of treatment. Such a dose of treatment may be sufficient to reduce their risk of institutional misconduct but may not be enough of a "dosage" to impact on the risk of recidivism postrelease. Cost of Treating Versus Not Treating Gang Members There is a very high cost associated with crime (Rajkumar & French, 1997) such as the cost of processing, adjudicating, and incarcerating offenders. Processing and incarcerating gang members will likely cost more as they generally require more specialized facilities to segregate and isolate them from each other. We have yet to take into account the human cost of crime (e.g. to victims and their families) in the estimation. Cohen (1998) estimated that the monetary value of saving a high-risk youth is in the order of $1.7 to $2.3 million. The present groups of offenders, though not in their youth, are still very young, in their mid-20s. They already have had long and serious criminal careers with almost 20 criminal convictions and are serving average sentences of about 6 years. Without intervention, they will likely have even longer and more violent criminal careers. The estimated cost of maintaining one offender in treatment at the RPC for 12 months is in the region of $150,000. The relatively low cost of providing treatment to a gang member (approximately $100,000: mean stay in treatment of about 8 months) definitely outweighs the estimated large financial and human cost of not providing effective treatment. Logistics of Treating Gang Members Participation in a treatment or "self-improvement" program is probably less threatening to a gang member and likely more acceptable to his peers than trying to persuade the individual to dissociate outright from the gang. The repercussions from outright dissociation are obviously perceived as highly risky and are often a deterrent to dissociate, in particular, within a closed institutional environment where there is nowhere to hide. A neutral label can be used to describe a treatment program to encourage participation and to minimize the perception that participants are turning "soft." Program managers must also be sensitive to the fact that gang members, who wish to change, will have to perform a delicate balancing act and walk a very fine line in their effort to move away from gang activities. At times, what may appear to be relapses, such as being verbally abusive towards staff, may be survival tactics to buy some interim acceptance by peers in situations where they have to show solidarity in order to survive. Like any changes, risk reduction can be

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slow and arduous. Providing treatment to gang leaders or even rank and file gang members is very challenging for treatment staff as they have to attend to a myriad of clinical, operational, and responsivity issues. For example, ensuring the compatibility of various gang members and responding to issues such as lack of motivation and non-compliance are key in order to facilitate program participants to complete treatment. We are developing a set of clinical guidelines for the treatment of incarcerated gang members to assist clinicians to be more effective in providing treatment to this very challenging group of offenders.

Program Portability An obvious question to ask is whether a specialized forensic treatment approach for gang members delivered within a forensic mental health facility could be replicated in a regular nonspecialized prison setting. The answer to this question is a conditional "yes," that is, the results should be replicable if the key treatment conditions are replicated in similar prison programs. Briefly, the key treatment conditions are (1) to carry out a comprehensive assessment and identification of criminogenic needs; (2) to establish a functional working alliance and trust between clinically skilled staff and the offenders in order to motivate offenders to engage in treatment; (3) to use ecologically and culturally sensitive teaching and therapeutic approaches to address the offenders' criminogenic needs; (4) to provide the offenders with a supportive environment to practice and generalize the new skills; and (5) to provide an exit strategy to the offenders, that is, a realistic process for the offenders to work their way to lower and less restrictive custodial settings or community release programs (also see Wong & Hare, 2005). Generally speaking, most prison settings are punitive and restrictive in nature and even fewer prisons have the resources or commitment for such a treatment approach. This is not to say that prisons must be what they are, and that changes could not be made. The closer that a setting, be it prison or not, approximates the above treatment requirements, the more likely the results could be replicated. Limitations There are a number of additional limitations to consider when interpreting the results. We have not factored in the level of entrenchment of gang members. Obviously, highly entrenched gang members such as those who hold "high offices" within the gang and have invested more time in gang activities are different from newcomers. For example, Gaes et al. (2002) found that core gang members were more likely to commit violent misconduct in the institution compared to peripheral members, who in turn, were more likely to commit violent misconduct than unaffiliated offenders. However, we have found that gang entrenchment is quite difficult to measure because of the lack of a reliable index of entrenchment. In addition, we were not able to monitor the incidences of gang dissociation or whether the convictions after release to the community were gang related, as the records available to us did not have such information.

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CONCLUSION Overall, the results suggest that appropriate correctional treatment that follows the risk, need and responsivity principles can reduce gang violence both in correctional institutions and the community, and effective correctional treatment should be considered as one of the approaches in the management and rehabilitation of incarcerated gang members. APPENDIX: PROGRAM DESCRIPTIONS The ABC Program is a 6-8-month program designed for impulsively and/or chronically aggressive offenders with extensive histories of crimes of violence and/or significant institutional management problems. The program objectives are to decrease the frequency and intensity of aggressive behaviors and the risk of recidivism, in particular, violent recidivism. The ABC Program uses a cognitive-behavioural approach and is based on social learning theory emphasizing relapse prevention. Criminogenic factors such as criminal attitudes, beliefs, interpersonal aggression, cognitive distortions. and substance abuse are addressed in offence cycle and psychoeductional groups, as well as in individual therapy. Educational upgrading, work and life skills, and issues such as relationships with significant others, family dynamics, community support, and early abuse are addressed where appropriate. The program also recognizes the importance of matching program delivery to the responsivity of the clients such as cognitive and language functioning, cultural background, and treatment readiness or motivation. Each participant is required to develop a detailed relapse prevention plan at the end of the program. Treatment evaluations of the ABC Program (without distinctions between gang and nongang members) have showed significant reductions in the rate of institutional offending (Vander Veen, Usher-Liber, Wong. & Gu, 1999) and recidivism (Polvi & Gordon, 2001: Wong, The Clearwater Program is an 8 month program designed to provide cognitivebehavioural treatment to medium-high to high-risk sex offenders with special treatment needs such as significant minimization and denial of their sexual offences, highly deviant sexual preferences and/or aggression, or other paraphilia(s). The primary objectives of the program are to reduce sexually aggressive and deviant behaviors and the risk of sexual and nonsexual recidivism. Individual and group (both offence cycle and psychoeducational) therapy similar to that of the ABC Program are used in the treatment. The need to pay special attention to clients' responsivity issues and development of relapse prevention plans are also similar to that of the ABC Program. Program evaluation (without distinctions between gang and nongang members) have shown a significant reduction in sexual recidivism using a matched control group design (Nicholaichuk, Gordon, Gu, & Wong, 2000). The ABC and Clearwater Programs have been accredited by a panel of international experts convened by CSC to provide independent evaluation of the design and operation of CSC treatment programs. The evaluation is based on the degree of

1999).

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compliance to eight criteria derived from the "What Works" principles of effective correctional programs. The PsyReh Program is primarily designed to provide treatment to offenders who are suffering from or have had major mental illnesses that require active intervention or maintenance and monitoring. The PsyReh Program is modeled after Liberman's Psychiatric Rehabilitation approach (Liberman & Foy, 1983). Most offenders also have other comorbid conditions such as substance abuse or violence and aggression problems. Interventions can include sychotropic medication, group and individual therapy, occupational and recreational therapy, and so forth. Interventions to reduce the risk of violence and aggression, where necessary, are similar to that of the ABC and Clearwater Programs but are modified to suit the responsivity of this group of offenders. No matched controls program evaluation has been carried out. General recidivism in a 38-month follow-up of a sample of 43 patients was 48.9% (Wilde & Wong, 2000).

ACKNOWLEDGMENTS The authors to acknowledge the support of Correctional Services Canada to the current research. The views expressed in this paper represent those of the authors and not necessarily Correctional Services Canada. The authors also thank Brenda Maire for her contribution to the data collection. We dedicate this article to all the staff at the Regional Psychiatric Centre who have made positive contributions to the treatment of these very challenging clients. In particular, we wish to recognize the staff of the Aggressive Behavioral Control Program who provided treatment to the majority of these clients, and to Heather Middleton, Program Director, who provided leadership to the program for many years.

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