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Examining the Effects of Structured and Non-Structured Therapeutic Activity Programming in a Forensic Mental Health Treatment Facility: North Florida Evaluation and Treatment Center (NFETC) is an evaluation and treatment center for individuals with mental illnesses who are involved in the criminal justice system. NFETC offers services to adult males who are either incompetent to proceed to trial or have been judged to be not guilty by reason of insanity. In 2005, DCF implemented a system of structured programming in their state forensic psychiatric hospitals. Resident programming went from a referral based activity program (approximately 6 hours per week for each resident) to a structured activity program (approximately 24 hours per week for each resident). In the previous system, a resident's involvement in the referral based activity program was initiated by the residents' counselor and based on the resident's interests. In the current structured TAP program, all residents now average 24 hours per week of activity involvement. Resident attendance is mandatory for those well enough to attend programming. Despite the importance decreasing length of stay (LOS) has on state legal and criminal systems, little research exists on the role recently implemented structured programming plays in resident LOS. This study contains Retrospective Quantitative analyses on the relationships between facility programming and resident demographics, criminal charges, mental health diagnoses, LOS, and attendance and participation rates; as well as Qualitative analyses on program offerings and staff impressions of the current structured programming at NFETC. The results suggest that, despite many differences between the samples of residents receiving the two programs, there is a therapeutic value to the activity programs offered regardless of the program setting. With consideration of staff perspectives and quantitative findings, the current program can be restructured to provide additional benefit. The benefits of activity programming in general were evident in the results of the analyses run separately for each program. Within the Referral based programming, residents with lower participation levels had an increased LOS. Within the structured TAP programming, residents with lower participation levels had an increased LOS and residents with high participation levels had a decreased LOS. These results indicate that involvement in therapeutic activities, regardless of programming format, may be beneficial in decreasing LOS. The Qualitative staff interview component of the current research provided additional insight into issues related to the prior and current program offerings at NFETC, much of which were supported by the Quantitative data. Qualitative findings included staff impressions of both programs as well as issues regarding LOS, value of therapeutic activities, accessibility, attendance, resident choice, internal motivation, safety, program content, and resident participation. The issues, if addressed, have the potential to streamline the program at NFETC into a more effective and useful therapeutic element. These Quantitative and Qualitative findings should serve as suggestions for a program revamping at NFETC. / Public Health

Since it was first articulated, the Risk-Need-Responsivity model (RNR; Andrews, Bonta, & Hoge, 1990) has been extensively researched and is regarded as an empirically supported model for providing effective correctional treatment. It is comprised of three core principles: the risk principle, which provides direction for who should receive treatment; the need principle, which identifies intermediate treatment targets; and the responsivity principle, which states how treatment programs should be structured. The RNR model is purported to be relevant for all offender populations, including female offenders (Dowden & Andrews, 1999a), juvenile offenders (Dowden & Andrews, 1999b), violent offenders (Dowden & Andrews, 2000), and sexual offenders (Hanson, Bourgon, Helmus, & Hogdson, 2009). Yet, the majority of RNR research has examined the risk and need principles, and the responsivity principle remains understudied. The responsivity principle includes two sub-principles: general and specific (Andrews, & Bonta, 2010). The current research explored the general responsivity principle, which states that programs should use theoretically relevant models for individual change, specifically cognitive-behavioral and cognitive-social learning models (Andrews & Bonta, 2010). The following techniques are consistent with these models: "role-playing, modeling, repeated practice of alternative behaviors, cognitive restructuring to modify thoughts/emotions, skills building, or reinforcement" (Andrews & Bonta, 2010, p. 50). Despite empirical support, the RNR model has received minimal application to juveniles, and it has not been widely tested in the substance abuse treatment context. Additionally, it is not clear whether adherence to the RNR model is relevant for reducing substance use outcomes in youth. Adolescent substance abuse treatment programs were designed to address substance use among juveniles, and have been widely researched to determine their effectiveness; yet their effectiveness remains understudied among juvenile offenders. These studies include examinations of specific treatment interventions used, such as Multisystemic Therapy. Many of these interventions are considered to be "evidence-based treatment" (EBT), but there is a wide variety of repositories that classify interventions as "evidence-based" with varying criteria used to classify them. The juvenile drug treatment court model (JDTC) was specifically developed to address substance use and crime among juvenile offenders; however, findings from empirical studies have not demonstrated a strong treatment effect. To address these gaps in the literature, secondary analyses were conducted on data collected from 132 adolescent outpatient substance abuse treatment programs (AOPs) and 10 juvenile drug treatment courts nationwide. This research was an application of the general responsivity principle in the AOP and JDTC context to determine the impact of responsivity adherence on the odds of rearrest and substance use severity. The analyses also included an examination of evidence-based treatment (EBT) in both samples to determine the influence of EBT use scores on the odds of rearrests and substance use severity scores. To examine the AOP sample, multilevel models were used to examine the individual- and program-level impact of responsivity adherence and EBT use. To examine the JDTC sample, multivariate analyses were used to examine the individual-level impact of responsivity adherence and EBT use. Overall, responsivity adherence was not significantly associated with rearrests among AOP participants, nor was it significantly associated with substance use severity scores. Additionally, the odds of rearrest were significantly greater among individuals who received interventions with a higher EBT use score; though, there was no association between the average EBT use scores across programs and the odds of rearrest. There was no significant association between individual- and program-level EBT use scores and substance use severity. Among JDTC participants, an increase in responsivity adherence was associated with an increase in the odds of rearrest and substance use severity. A similar association emerged between EBT use scores and both outcomes, wherein increases in EBT use scores were significantly associated with an increase in the odds of rearrest and substance use severity. The results of the analyses suggest the need for further specification of both general responsivity adherence and "evidence-based" treatment for use in future research and theory; specifically, further elaboration of the general responsivity-adherent techniques and clear criteria for classifying interventions as "evidence-based treatment." The findings also imply that certain types of treatment interventions are more compatible with the JDTC model than other interventions. Additional analyses suggest the possibility that general responsivity adherence and evidence-based treatment may not be unique constructs. Future research may benefit through exploring evidence-based treatment as a criterion for adherence to the general responsivity principle. / Criminal Justice