Prison-based Therapeutic Community Research Articles

The prison-based Therapeutic Community: Resident recommendations for program improvement

IntroductionThe prison-based Therapeutic Community (TC) is widely used within correctional institutions to address substance use disorders (SUDs). While most evaluations of the prison-based TC find the program to be effective, recent mixed evidence and the continued surge of the opioid crisis call for deeper investigation into program operations, barriers to engagement, and sources of treatment effect heterogeneity. Notably lacking from prior evaluations, and critical to our understanding of variable program engagement, is first-hand experiences and perceptions from program participants. MethodsTo assess prison-based TC resident perceptions of the program and their recommendations for improvement, we utilize data from the Therapeutic Community Prison Inmate Network Study (TC-PINS), a longitudinal data collection effort conducted in one prison-based TC unit within a Pennsylvania state prison. Specifically, we assess resident responses to the open-ended item “What can the TC do better?” Analyzing 470 responses to this question by 177 residents, two independent coders identified seven substantive categories of recommended changes or improvements to their TC program. ResultsResidents provided tangible recommendations for improvement of their prison-based TC program based on their experiences and perceptions. Importantly, a number of their recommendations directly counter the intended model of the TC, which highlights imperative issues underlying the translation of the TC model within the prison environment. Resident suggestions include enhanced structure, increased individualization, expanded curriculum, stricter enforcement of rules, and improved or more experienced staff. Additionally, many question the coercive nature of TC program participation within this prison system. ConclusionsResident recommendations for program improvement unveil important sources of treatment effect heterogeneity and highlight tangible program changes that can be implemented to reduce barriers to treatment engagement. We provide suggested changes to this prison-based TC based on resident perceptions and discuss both the importance and relative ease of eliciting this critical participant feedback.

Documenting prison therapy: Insider audience perspectives on The Work (2017)

This article is an audience ethnography, focusing on the documentary The Work (dir Jairus McLeary and Gethin Aldous, US, 2017), which depicts a four-day therapeutic programme involving men from the community and men from a high security prison. The film was screened to audiences of people who live and work in an English prison-based therapeutic community. Previous prison-based audience studies have highlighted the significance of the media text and the characteristics and experiences of the audience, but have not specifically addressed the salience of the context in which the media is consumed. By conducting the research in an atypical penal environment, the intention is to illuminate how consumption is affected by different penal contexts. The audience offered macro, meso and micro level responses to the documentary. At a macro level, they recognised the reforming intentions of the film, but also revealed the limitations of popular culture, with its emphasis on spectacle. At a meso level, the audience offered a sophisticated and expert analysis of the content and omissions of the film’s representation of therapeutic processes and cultures. At a micro level, those serving prison sentences used the content of film as therapeutic material, reflecting on their own emotions and experiences, while the prison staff used the content to explore their professional identities. The audiences viewed the film through a therapeutic habitus, and media consumption was a way of enacting and reinforcing the expectations and practices of therapeutic community life. By highlighting the salience and variability of penal contexts, the study extends prison-based audience scholarship, but also highlights a factor that should be considered in the planning and design of media and arts programmes in prison.

Effectiveness of the Therapeutic Community Model in Addiction Treatment: A Retrospective Pilot Study in French Prisons.

In France, addiction care in prison usually consists of nurses' interventions, medical care and socio-educational programs, but new alternatives have arisen, namely the therapeutic community (TC) model. This pilot study aims to evaluate the effectiveness of this prison-based TC in comparison with classic and socio-educational care offered in French prisons. To compare these three types of prison-based care, two detention centers' files were screened for use of multiple drugs, willingness to participate and absence of psychiatric comorbidities incompatible with group therapy. A custom questionnaire was built based on the fifth version of the Addiction Severity Index. It investigates medical status, employment and support, primary addiction status, legal status, social/familial status and psychiatric status through various items. Our sample only consisted of male repeat offenders with a mean age of 37.7 ± (9.1) years. Primary addiction status improvement was observed for all care studied but was more important in TC than in classic care. Self-esteem and social/familial status saw significant improvement throughout TC care. The TC model represents an alternative to classic and socio-educational care in French prisons. More studies are needed to assess the extent of the benefits provided on both the medical side and economic side.

Rapport and Relationship Building in a Therapeutic Community: Examining the Dynamic Between Correctional Officers and Incarcerated Persons

Correctional officers (COs) are vital to prison safety. While focused on security, some believe COs should also be trained to engage in the rehabilitation of incarcerated persons by offering motivation and support. This study examined incarcerated persons’ perceptions of COs working in a prison-based therapeutic community (TC). Data were gathered through qualitative interviews with individuals detained in a state correctional system for men. Findings revealed several themes related to incarcerated persons’ perceptions of COs’ knowledge toward treatment, their experiences and interactions with COs, and recommendations about how to improve the role of COs as therapeutic agents of change. Practical opportunities for implementing correctional research and practice using a positive criminology perspective are considered.

Are reoffense outcomes consistent with inmate and staff perceptions of therapeutic community practice? A mixed-methods analysis

Mixed methods were used to assess recidivism and program fidelity in a prison-based therapeutic community (TC). Propensity score matching on demographic, general risk, and substance dependency ratings resulted in 83 TC participants being compared with 104 inmates on recidivism. Scales were used to rank TC use of community, feedback, confrontation, and other areas by a purposeful sample of senior TC inmates (n = 20), In addition, qualitative open-ended interview questions on TC programming features, quality, and operation were asked of the 20 TC inmates and TC staff (n = 14). General and violent recidivism were less for the TC group. Inmate scale ratings confirmed the presence of key TC features, as did open-ended responses.

Therapeutic community work with people who have sexually offended: responding to developments in research and practice

Purpose This paper aims to review the clinical approach adopted in prison-based therapeutic communities (TCs) for working with residents who have committed sexual offences. It reviews recent research and practice developments and explores the implications for TCs. Design/methodology/approach This paper describes a “think tank” review process which explores and reviews practice. This paper discusses the current approach adopted by TCs when working with those who have sexually offended and explores changes in clinical approach which could be considered in the light of current developments. Findings This paper explores the implications for TCs of the recent research and wider practice developments in interventions for those who have sexually offended. Practical implications This paper presents clinical options for working with those who deny their offence and undertaking victim empathy and offence disclosure work. It makes recommendations regarding staff training and support. It also discusses the strengths of the TC approach and how these can be built upon. Social implications This paper makes recommendations concerning how practice could be improved which promotes safety and public protection and enhances resident well-being. Originality/value There has been no recent review of TC clinical practice for working with those who have sexually offended.

Providing Treatment in a Prison-Based Therapeutic Community for Those Who Have Committed Sexual Offences.

This article explores some of the difficulties inherent in managing risk in those who have committed sexual or other violent offences and how this may impact on their ability to re-integrate into the community. It discusses the work undertaken at HMP Grendon, a prison-based therapeutic community (TC), to address these difficulties and help residents develop a pro-social lifestyle starting in custody and continuing on release. The article aims to describe how the TC model offers a containing and adaptive environment, and how this can provide opportunities to address offence-related behaviour, which is not always possible in other prison settings. Furthermore, it describes some of the difficulties inherent in undertaking work of this nature, in the need for an accurate understanding of the relevant areas of risk, and the tensions developing a therapeutic relationship with individuals with complex needs. Methods of assessment of risk and need are discussed, and how they are used in a collaborative manner to have the most accurate picture of what will help residents to maintain their pro-social lifestyle on release.

The impact of Covid-19 on a prison-based Therapeutic Community

The impact of Covid-19 on a prison-based Therapeutic Community

Network Integration within a Prison-Based Therapeutic Community

Abstract Prison-based therapeutic communities (TCs) are a widespread, effective way to help incarcerated individuals address substance abuse problems. The TC philosophy is grounded in an explicitly relational paradigm that entails building community and conditioning residents to increasingly take responsibility for leadership therein. Although TCs are based on cultivating a network that continuously integrates new residents, many common structural features can jeopardize TC goals and are hence discouraged (e.g., clustering, homophily). In light of this tension, analyzing the TC from a network perspective can offer new insights to its functioning, as well as to broader questions surrounding how networks integrate new members. In this study we examine a men’s TC unit in a Pennsylvania prison over a 10-month span. Using data on residents’ informal networks, we examine: (1) how well individuals integrate into the TC network across time, (2) what predicts how well residents integrate into the TC, and (3) how well the TC network structure adheres to theoretical ideals. Results suggest that individual integration is driven by a range of hypothesized factors and, with limited exceptions, the observed TC is able to foster a network structure and integrate residents consistent with TC principles. We discuss the implications of these results for evaluating TCs and for understanding the process of network integration.

Are prison-based therapeutic communities effective? Challenges and considerations.

The purpose of this paper is to detail the impact and efficacy of Her Majesty's Prison and Probation Service ((HMPPS) Therapeutic Communities (TCs) (both democratic and hierarchical). This paper outlines recent developments in the TC literature, to provide readers with an up-to-date overview of the outcomes of prison-based TC treatment, while highlighting the strengths and challenges of this treatment approach. Trends within the research are discussed, and the authors draw attention to any gaps in the current knowledge. This paper uses a narrative literature review approach to review the most current literature around the effectiveness of prison-based TCs in HMPPS. Academic literature published predominantly from 2010 onwards is discussed because of limited literature review publications on this topic post-2010. To obtain literature, searches of relevant databases were conducted, and/or clinical leads at prison sites were contacted for relevant publications. There is a body of research which demonstrates that TCs are an effective form of treatment for people with an offending history and personality difficulties. Evidence indicates that Democratic TC treatment plays a part in reducing reoffending rates, as well as improving psychological features. Further research is needed in a number of areas, specifically with female offenders and individuals who undertake treatment in hierarchical TCs in the UK. It is also suggested that TC treatment aftercare may help to further the positive outcomes identified. To the best of the authors' knowledge, there is no up-to-date review of the impact and efficacy of HMPPS TC treatment. This paper reflects on available research within the current context of TC treatment and provides an original overview of the current UK TC practice. It has value in recommending areas for further research and consideration.

Social distancing in a social therapy environment

Purpose This paper aims to describe the impact of the COVID-19 pandemic on a prison-based therapeutic community (TC). Design/methodology/approach The paper takes the form of a case study where the authors reflect on their current practice, using the findings of research on social isolation and the overarching TC principles to explore the effect of the pandemic on the TC at HMP Grendon. The authors consider how the residents and staff adjusted to the change as the parameters changed when the social distancing rules were imposed and how they adapted to the prolonged break to therapy. Sections in the paper were written by a resident and an operational member of staff. The authors conclude with their thoughts on how to manage the consequences the lockdown has brought and start to think about what returning to “normality” might mean. Findings The paper describes the adjustments made by the residents and staff as the UK Government imposed the lockdown. The authors, including a resident and an operational member of staff comment on the psychological and practical impact these adjustments had. The thought is given to the idea of “recovery”, returning to “normality” and how this study can be best managed once restrictions are lifted. Research limitations/implications At the time of writing, there are no confirmed cases of COVID-19 at HMP Grendon. The measures and commitment from all staff and residents in the prison to keep the prison environment safe may in part account for this. This paper explores the effects of lockdown on the emotional environment in a TC and highlights the consequences that social isolation can have on any individual. To the authors’ knowledge, there is currently no research undertaken on the impact of lockdown/social isolation on a TC. This research would be useful, as the authors postulate from reflections on current practice that the effects of the lockdown will be greater in a social therapy environment. Originality/value HMP Grendon started in 1962, as this time there have been no significant events that have meant the suspension of therapy for such a sustained period. It is, therefore, important that the impact of such is considered and reflected upon.

Network integration within a prison-based therapeutic community

Prison-based therapeutic communities (TCs) are a widespread, effective way to help incarcerated individuals address substance abuse problems. The TC philosophy is grounded in an explicitly relational paradigm that entails building community and conditioning residents to increasingly take responsibility for leadership therein. Although TCs are based on cultivating a network that continuously integrates new residents, many common structural features can jeopardize TC goals and are hence discouraged (e.g., clustering, homophily). In light of this tension, analyzing the TC from a network perspective can offer new insights to its functioning, as well as to broader questions surrounding how networks integrate new members. In this study we examine a men’s TC unit in a Pennsylvania prison over a 10-month span. Using data on residents’ informal networks, we examine: (1) how well individuals integrate into the TC network across time, (2) what predicts how well residents integrate into the TC, and (3) how well the TC network structure adheres to theoretical ideals. Results suggest that individual integration is driven by a range of hypothesized factors and, with limited exceptions, the observed TC is able to foster a network structure and integrate residents consistent with TC principles. We discuss the implications of these results for evaluating TCs and for understanding the process of network integration.

New on the Block: Analyzing Network Selection Trajectories in a Prison Treatment Program.

Personal network change is largely driven by transitions between the groups and organizations where people spend their day-to-day lives. But, how do entrants choose which relationships to pursue among the numerous possibilities a new environment offers? We expect newcomers will use the same mechanisms as longer-tenured members, although this will take time as they acclimate and form initial relationships that support future ties. Thus, our goal is to understand how the network selection processes used by new organizational members shift in importance as time in the organization grows. We focus on network selection via homophily, propinquity, formal relations, and endogenous network processes. For each mechanism, we distinguish between change in the strength of the mechanism and opportunities to enact the mechanism. We evaluate expected changes using network data from a prison-based therapeutic community (TC). This setting is ideal because the structured nature of TC entry and exit generates regular membership turnover and removes confounds present in studies of more familiar contexts (e.g., schools). Results show that the relative importance of network selection mechanisms varies over tenure, with homophily dominating early on and endogenous network processes catching up later. We discuss implications of these findings for new member socialization and broader patterns of inequality.

Testing an Interactionist Theory of Treatment Engagement in a Pennsylvania Prison-Based Therapeutic Community

The prison-based Therapeutic Community (TC) is a promising substance use treatment program that emphasizes peer influence. Although program evaluations demonstrate positive results, the cognitive, behavioral, and social processes that define the prison-based TC are largely unknown. The TC model presumes that residents increase their treatment engagement and willingness to change through peer interactions and role modeling, but this process has received virtually no research attention. This study explores these peer-driven mechanisms by examining self, reflected, and peer appraisals of willingness to change of 177 male TC residents, predicting within-person changes in treatment engagement by changes in appraisal measures. Results suggest that self, peer, and reflected appraisals converge over time in treatment. In addition, fixed effects models demonstrate that changes in reflected appraisals are most predictive of changes in treatment engagement. Such results, consistent with symbolic interactionist perspectives, inform prison-based programming and contribute to research on individual-level trajectories of desistance and recovery.

Evaluating peer-influence processes in a prison-based therapeutic community: a dynamic network approach

BackgroundThe Therapeutic Community (TC) is a common treatment modality for incarcerated individuals with substance use disorders. TCs rely on peer group processes to promote lasting behavioral and identity change, yet prior research has not adequately tested the peer influence mechanisms underlying the theoretical model. This study applied dynamic network analysis to estimate peer influence processes central to TC philosophy. MethodsA stochastic actor-oriented model (SAOM) was applied to ten months of social network data collected from prisoner surveys within a TC unit (N = 62) in a medium-security Pennsylvania prison. Respondents (N = 177, 84% of unit) completed at least one prison survey and provided network and community role model nominations. ResultsAlthough residents’ levels of treatment engagement were significantly correlated with their nominated peers, estimates of peer influence for treatment engagement were non-significant in longitudinal network models. Nor were estimates of peer influence significantly greater for peers perceived as community role models. Rather, inmates connected with peers who were of similar treatment engagement as themselves (i.e., a peer selection process), and the latter primarily resulted from racial homophily in the TC social network. ConclusionsInconsistent with the desired treatment model, treatment engagement diffusion was not evident in the sampled TC. Results suggested that highly-engaged residents clustered together at the center of the TC’s social structure but had little impact on less-engaged and peripheral inmates. The relatively short (i.e., four-month) program length and moderate-to-low treatment fidelity likely contributed to the lack of peer influence processes.

Treatment engagement in a prison-based Therapeutic Community: A mixed-methods approach

Given the high proportion of inmates with histories of substance use disorders in the era of mass incarceration, many correctional institutions have integrated the prison-based Therapeutic Community (TC) into their programming. While most evaluations provide evidence of lowered rates of relapse and recidivism, the majority of TC graduates still have negative outcomes post-release. Filling an important gap in the TC treatment literature, we analyze quantitative measures of treatment engagement alongside qualitative narratives from prison-based TC residents, providing an essential look into the black box of TC treatment mechanisms. Quantitative results show more between-person variation than within-person change, reflecting trivial increases in treatment engagement throughout time in the program. Qualitative results unpack these findings, pointing to processes of selection bias, heterogeneous treatment effects, and program fidelity lapses. In combination, our mixed data identify tangible modifications to program implementation that could strengthen desired post-release outcomes.

Effectiveness of prison-based therapeutic community in Japan: Using propensity scores adjusting confounding factors

Effectiveness of prison-based therapeutic community in Japan: Using propensity scores adjusting confounding factors

Treatment within a prison-based Therapeutic Community (TC): Experiences of extended assessment services, the impact of TC treatment, and interventions at HMP Grendon

Treatment within a prison-based Therapeutic Community (TC): Experiences of extended assessment services, the impact of TC treatment, and interventions at HMP Grendon

Exploring how prison-based drug rehabilitation programming shapes racial disparities in substance use disorder recovery

Prison-based therapeutic community (TC) programming is derived from the perspective that drug addiction is primarily symptomatic of cognitive dysfunction, poor emotional management, and underdeveloped self-reliance skills, and can be addressed in a collaborative space where a strong ideological commitment to moral reform and personal responsibility is required of its members. In this space, evidence of rehabilitation is largely centered on the client's relationship to language and the public adoption of a “broken self” narrative. Failure to master these linguistic performances can result in the denial of material and symbolic resources, thus participants learn how to use TC language to present themselves in ways that support existing institutionalized hierarchies, even if that surrender spells their self-denigration. This research examines the interview narratives of 300 former prisoners who participated in a minimum of 12 months of prison-based TC programming, and described how programming rhetoric impacted their substance abuse treatment experiences. While many of the respondents described distressing experiences as TC participants, White respondents were more likely to eventually embrace the “addict” label and speak of privileges and reintegrative support subsequently received. Black respondents were more likely to defy the treatment rhetoric, and either fail to complete the program or simulate a deficit-based self-narrative without investing in the content of those stories. The following explores the significance of language and identity construction in these carceral spaces, and how treatment providers as well as agency agendas are implicated in the reproduction of racial disparities in substance abuse recovery.

Donning the Cloak of Wisdom: Giving Back to a Prison-Based Therapeutic Community

Creating hopeful possibilities for the lives of men with a known history of perpetrating sexual abuse is perhaps one of the most challenging tasks in the fields of criminal justice and social rehabilitation. Prison in many ways represents the least optimistic setting for such a task. The dangerous and deadening environment of such institutions seems anathema to generating the audacity and vitality required to drive a restorative agenda. The context for this article is a prototypical prison-based sex offender program set in a purposefully therapeutic community. The article recounts a series of uplifting ideas, events, and encounters that inspired often unlikely but productive collaborations among the residents of this community. These events provided the beginnings of an enduring library of stories recounting the valuable and hard-won wisdom attained and shared among inmates, and bestowed upon those still to start the journey.