Saturday, June 20, 2009

On Rehabilitation

The idea of offender rehabilitation was one of the primary reasons why I got into the business that I'm in. I've always believed that: a) human change is always possible, b) not much separates me from the common criminal when it comes right down to it (the old adage of "but by the grace of God there goes I"), and c) restorative justice generically speaking should be a core principle of our criminal justice system. As a young person growing up, I never wanted to follow in my father's footsteps to become a medical doctor, but what I did inherit from my dad was a passion to work towards the restoration of broken human beings. I personally believe that true human change can only come through divine intervention, but this should not stop us from working towards the restoration of broken human beings here on earth, whether it be a physical, mental, social, or spiritual type of restoration. Early in college I developed a particular vocational calling for a career within the criminal justice system, working to seek the healing of the specific forms of brokeness that result from criminal behavior. Indeed, much brokenness flows from crime in a society. Victims are broken, neighborhoods/comunities are broken, and yes even offenders are broken. As I advanced in my academic training and in my self-awareness of my abilities, I learned that the best way that I could make a difference in this area was not necessarily by being on the "front lines" but instead by using my mind/intellect to shape policy through the use of my apparent apptitude in the area of research and statistics.

This essay is not intended to be a narcissistic recounting of my career development. The previous paragraph is backdrop to the question I've tried to answer up to this point in my career, and that is "how is the brokeness that results from crime best addressed by a criminal justice system?" The most fashionable answer to this question within the context of a correctional environment is to promote offender rehabilitation. I think it's important to recognize at the forefront that nobody (or at least nobody that I know) approaches this subject neutrally. Everyone starts out wanting to believe deep down that offender rehabiliation either can work or cannot work. Everyone has a gut on this. My gut has always been that offender rehabilitation can work. But my gut matters little in terms of what science has to say about it (it may matter in terms of how I interpret science but I'll get to that later). So you can imagine my satisfaction when at the beginning of my career I learned of the supposed strong body of evidence in the research literature supporting offender rehabilitation. Ahhh, my gut was confirmed by science. But as I've learned more over the years, become more sophisticated in my thinking, and allowed my inquisitive mind to wander, I've come to a point of skepticism concerning much of the scientific evidence supporting offender rehabilitation. In short, I think offender rehabilitation has been oversold. To borrow a phrase from the title of a recent essay, I am "rethinking rehabilitation". I'm not giving up on rehabilitation. And it's certainly difficult to argue with the evidence in support of some types of well-implemented rehabilitation strategies. But again, skepticism has crept in. In certain circles within criminology, to even introducing such skepticism inevitably leads to labels such as "Robert Martison", "obstructionist", "anti-scientific", etc. This unfortunate result is yet another red flag to me that points to something else outside of or in addition to science going on. So at the risk of being labeled as the second coming of Robert Martison (who coincidentally was widely misunderstood and misrepresented), here are some of my thoughts on why we should be skeptical of the body of research promoting offender rehabilitation and why we should not oversell the utility of offender rehabiliation:

1. If offender rehabilitation is effective in reducing crime, why haven't recidivism rates dropped significantly over at least the past 20 years? Just looking at the Dept. of Justice's two published recidivism studies as well as recidivism rates within my own state, recidivism rates have been surprisingly stable despite an increased movement towards rehabilitation, evidence-based practice, and "what works". Some counter this argument by saying that recidivism rates would be even higher without evidence-based treatment, but to believe this we would logically have to conclude that either: a) institutional management and other system factors affecting recidivism have gotten worse in direct proportion to the degree that our treatment programs have gotten better, or b) we have made virtually no improvement or decline in either. In terms of aggregate recidivism rates, are our treatment programs simply balancing out the effect of an otherwise declining correctional system? Or, despite the increased emphasis on implementing evidence-based treatment programs over the past 20 years, has nothing changed? One of these cases may be a possibility. But I doubt that many who work within the corrections profession sincerely believe this to be the case. I just fail to see a strong case for why a system can supposedly increasingly support evidence-based rehabilitation programs that were found to reduce recidivism and yet not realize any significant aggregate decrease in recidivism rates. Why the homeostasis in recidivism rates if offender rehabilitation is the answer?

2. Why are crime rates relatively invariant to an emphasis on treatment? Obviously a lot of factors impact crime rates. But part of the "nothing works" mantra in the late 70's to early 80's was a result of the observation that crime rates were skyrocketing during the 70's despite a strong rehabilitation emphasis within the American correctional system during the same time. Maybe it was just that the wrong types of rehabilitation strategies were being used at the time. But this is an unknown.

3. Why haven't prison populations gone down despite an increased correctional emphasis on rehabilitation? Again, I recognize that many factors affect the size of a jurisdiction's correctional population. But if we measure recidivism in terms of reincarceration, shouldn't there be some effect over time on reducing the correctional population? Or does the relative invariance of aggregate recidivism rates, crime rates, and prison population rates despite an emphasis on rehabilitation mean that rehabilitation is just maintaining the status quo in order to keep things from getting worse? Do we really believe (or have evidence to believe) that these aggregate system measures would explode in a negative direction absent rehabilitation? If rehabilition programs can't make a dent in our aggregate crime or prison rates, what good are they ultimately to a society? It seems to me that a connection must be made at the macro level for rehabilitation strategies, moving beyond individual program evaluation results.

4. The primary methodology that has been used by rehabilitation advocates in summarizing the impact of rehabilitation across the body of evidence is the meta-analysis. Meta-analyses, as used, are problemmatic on several levels. I don't want to go into a methodological discussion here (e.g., issues of publication bias, reliance on statistical significance testing, etc.), but a recent paper by Richard Berk in the Journal of Experimental Criminology does a nice job of explaining some of these issues. One of the basic problems is that those who make use of the meta-analysis tend rely on the flawed logic that there is power in the number of studies alone. It's almost as if research becomes a popularity contest. If there are 20,000 studies/evaluations of rehabilitation interventions and 19,000 of them find that the intervention reduced reoffending then it must work. But what if the vast majority of these 19,000 studies were flawed or, to put it bluntly, garbage. The old adage of "garbage in/garbage out" applies. You can put a bunch of junk studies into a meta-analysis and find a strong aggregate effect size favoring rehabilitation but this hardly seems like the type of evidence we want to rely on. I've looked into a lot of the individual studies that make up many of these meta-analyses, and what I find is that there is a lot of garbage there. I'm not the only one to make this observation, although others haven't used my terms. I'm simply amazed when I go to some of the source studies and see the weak methodologies and flawed analysis conducted in many of them.

5. Another problem with rehabilitation is that systems tend to have a difficult time taking it "out of the laboratory" and moving it to scale. several studies have found that treatment programs demonstrate stronger effect sizes when done on a small scale and under the close eyes of evaluators than when implemented system-wide. Implementation seems to fall apart when taken to scale. So what good is it if we can't take these programs to scale? This would be akin to a scientist discovering a drug that was effective in treating laboratory rats but that had no impact when taken out of the laboratory and used on sick patients in the real world. Implementation problems are always pointed to when programs are found not to work. But at what point do we begin to doubt that we can implement any better? Maybe we just can't. Maybe we're pushing at the margins.

6. Another observation from research is that programs tend to demonstrate stronger positive effects in quasi-experiments than in true randomized controlled experiments. Couple this with the fact that the vast majority of program evaluations are indeed quasi-experiments. There is a whole host of potential issues with quasi-experiments that can cast a shadow of doubt on the results. This gets back to the issues relating to the quality of the studies going into meta-analyses. David Farrington has a nice discussion in a paper in Journal of Experimental Criminology of this observation that there are few true random experiments and that the effect sizes tend to be weaker in random experiments. This finding certainly rings true among the program evaluations conducted within my home state's correctional system. When randomized experiments were used, the results (even of supposed evidence-based program models) were mostly a null effect. Maybe so much research finds support for rehabilitation because it is weak research, and when we do it right we get a more realistic answer.

7. My observation is that there is a general liberal tendency within criminology, where our researchers come to the "laboratory" already wanting to believe and expecting to find that rehabilitation will work. This should be recognized, as it has the potential to produce strong biases. We need to recognize that ideology plays a role and that research never simply speaks for itself. The art of interpretation is where research results are often finessed. I'm not saying that the researcher should come to the "laboratory" completely disinterested. This is precisely opposite my point, since I believe that no researcher can come to the "laboratory" as a "clean slate". I'm saying that there needs to be more "putting our cards on the table" up front. As an aside, this is where theory plays an important role in program evaluation.

8. Intuitively to me, it seems more realistic to think that people will change their behavior as a result of a major life turning point such as marriage, a career, family, schooling, etc. rather than through a program (or even a stacking of programs). Criminals are not so different from non-criminals, and my observation of the non-criminals that surround my social world is that they haven't come to make major changes in their lives as a result of a program or class but more often it is as a result of major life events. I just think that this is a more realistic view of how life works and how change comes to occur. So I guess what I'm saying is that once I really started to think about it, intuitively it makes sense to expect the impact of a rehabilitation program to only be modest at best. Let's don't throw common sense out.

These are but a few of my thoughts guiding my questioning of rehabilitation. Again, I want to say that I'm not giving up on rehabilitation. I've simply come to the point where I think there needs to be realistic expectations of what it can accomplish. We try to instill realistic expectations in offenders before they are released from prison, but perhaps we could use some realistic expectations ourselves. What other opportunites might we be ignoring by over-emphasizing rehabilitation?

I would offer some preliminary suggestions for what we may be able to replace an over-emphasis on rehabilitation with. First, I think deterrence-based approaches should not be ignored. The rehabilitation folks are quick to qualify the circumstances under which a treatment program can be expected to work, and yet deterrence strategies are often summarily dismissed. As early as we are in our understanding of the impact of rehabilitation, we are even earlier in our understanding of the impact of deterrence. This presents a unique opportunity for criminologists though. Under what circumstances can we use a deterrence-based approach and see a real effect? Selective incapacitation is another goal that I believe is worth working towards as a system. Tied up in this, however, is the requirement of having good prediction tools in place. Again, a perfect opportunity for criminologists is presented. Let's don't settle for simple research, but let's instead press to advance our research to a whole new plain of understanding where possible. Let's examine if we can make selective incapacitation work. I think there are good institutional management strategies that can be focused on and improved as well. Finally, I think we can find innovative ways to support informal social control mechanisms (e.g., marriage, family, employment, etc.) for offenders once they are out of prison. We can't force ex-offenders to get married, to get a job, or to integrate into their community in a way that will provide a social control net, but to borrow the title of a recent bestselling book on reforming healthcare, perhaps we can "nudge" them in this direction. We have to ask what else is out there. I believe it was in a recent issue of The Criminologist that Akiva Liberman pointed out that instead of limiting ourselves exclusively to evidence-based practices, we should be open to evidence-generating practices. How can we experiment with new ideas and set our experimental ideas up so that they have the possibility of generating the evidence to support them if the evidence is there? Evidence-generating practices seem more important to me now, at a time when I question whether evidence-based practices are really as evidence-based as purported.

As always, many of my blogs on this site do not stray from controversy, so why should this one be any different. I'm curious to hear others' takes on rehabilitation. Have we put too many eggs in one basket? Are we over-selling? How can we best fix the array of brokenness that results from crime?