Transferring The Principles of Effective Treatment Into A ''Real World'' Prison Settingl

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Transferring the Principles of Effective Treatment into a ''Real World'' Prison Setting
Guy Bourgon and Barbara Armstrong
Criminal Justice and Behavior 2005 32: 3
DOI: 10.1177/0093854804270618
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10.1177/0093854804270618
CRIMINAL JUSTICE AND BEHAVIOR
Bourgon, Armstrong / EFFECTIVE TREATMENT IN A PRISON SETTING
ARTICLE
TRANSFERRING THE PRINCIPLES

OF EFFECTIVE TREATMENT INTO
A REAL WORLD PRISON SETTING
GUY BOURGON
Corrections Research, Public Safety and Emergency Preparedness Canada
BARBARA ARMSTRONG
St. Lawrence Valley Correctional and Treatment Centre
The principles of risk, need, and responsivity have been empirically linked to the effectiveness of
treatment to reduce reoffending, but the transference of these principles to the inside of prison
walls is difficult. Results from a sample of 620 incarcerated male offenders482 who received
either a 5-week, 10-week, or 15-week prison-based treatment program and 138 untreated com-
parison offendersfound that treatment significantly reduced recidivism (odds ratio of .56;
effect size r of .10) and that the amount of treatment (e.g., dosage) played a significant role
(odds ratios between .92 and .95 per week of treatment; adjusted effect size r of .01 and .02).
These results indicate that prison-based treatment can be effective in reducing recidivism, that
dosage plays a mediating role, and that there may be minimum levels of treatment required to
reduce recidivism that is dependent on the level of an offenders risk and need.
Keywords: recidivism; treatment; dosage; cognitive-behavioral; prison
A considerable body of evidence has accumulated regarding the

effectiveness of correctional treatment to reduce recidivism. Evi-
dence suggests that effective correctional treatment programs follow a
number of general principles. Among the most important are risk,
need, and responsivity (Andrews & Bonta, 1998; Andrews, Bonta, &
AUTHOR NOTE: The authors wish to acknowledge Michael Cote, Superintendent;

Gerald Stump, Deputy Superintendent; and all the staff at Rideau Correctional &
Treatment Centre for their support, hard work, and dedication to deliver and evaluate
quality treatment programs. A special thanks to Paul Gendreau, Jim Bonta, and Karl
Hanson for their feedback on earlier versions of the manuscript. Lastly, the authors
CRIMINAL JUSTICE AND BEHAVIOR, Vol. 32 No. 1, February 2005 3-25
DOI: 10.1177/0093854804270618
2005 American Association for Correctional and Forensic Psychology

4 CRIMINAL JUSTICE AND BEHAVIOR
Hoge, 1990; Andrews, Dowden, & Rettinger, 2001; Bonta, 1997;

Gendreau, 1996). The risk principle contends that the higher risk
offenders should receive the greater dosage of treatment. The need
principle states that treatment should target offenders criminogenic
needs. Criminogenic needs of offenders are those needs that when
changed alter the probability of recidivism. For example, antisocial
attitudes and criminal companions are commonly observed crim-
inogenic needs. Noncriminogenic needs (e.g., anxiety, depression)
demonstrate little functional relationship to criminal conduct. Finally,
the responsivity principle proposes that treatment is more likely to be
effective if it is a cognitive-behavioral treatment program (modeling,
graduated practice, role-playing, and high levels of reinforcement for
prosocial behaviors) and if there is matching of the style of service
delivery with offenders learning style. Andrews and Bonta (1998)
refer to these two processes as general and specific responsivity,
respectively.
Supporting evidence for these principles of effective treatment was
first presented in a meta-analysis of the offender treatment literature
by Andrews and his colleagues (Andrews, Zinger, Hoge, Bonta,
Gendreau, & Cullen, 1990). Andrews, Zinger, et al. (1990) catego-
rized studies into appropriate treatment (adherence to the principles of
risk, need, and responsivity) and inappropriate treatment. They found
a mean effect size (r) of .30 for appropriate treatment and .06 for
inappropriate treatment. Converting the effect sizes using Rosenthals
(1991) binomial effect size indicates that appropriate treatment
reduced recidivism by 30%, whereas inappropriate treatment
increased recidivism by 6% (Andrews & Bonta, 2003). Since then, the
general pattern of findings has been replicated in an expanded meta-
analysis of the treatment literature by Andrews and his colleagues
wish to mention the early pioneers, Hugh Marquis, Paul Gendreau, and Mike Cote,
who set the stage for treatment services to flourish at Rideau. The views expressed are
those of the authors and are not necessarily those of the Ministry of Correctional Ser-
vices of Ontario or of the Department of the Solicitor General of Canada. Correspon-
dence regarding this article can be addressed to either the first author at Public Safety
and Emergency Preparedness Canada, Corrections Research, 340 Laurier Ave. West,
Ottawa, Ontario Canada, K1A 0P8, e-mail: bourgog@sgc.gc.ca; or the second
author at St. Lawrence Valley Correctional and Treatment Centre, 1809 Highway 2
East, Brockville, Ontario, KGD 7N2, e-mail: Barb.Armstrong@jus.gov.on.ca.

Bourgon, Armstrong / EFFECTIVE TREATMENT IN A PRISON SETTING 5
(Andrews & Bonta, 2003; Andrews, Dowden, & Gendreau, 1999) and
by other reviewers of the literature (Lsel, 1995; Redondo, Sanchez-
Meca, & Garrido, 1999). Andrews and Bonta (1998) also found that
each of the principles contributed to the effect on recidivism. Adher-
ence to the risk principle was associated with an effect size (r) of .11,
which is consistent with the results reported by Lipsey and Wilson
(1998) for serious young offenders. Adherence to the need and
responsivity principles yielded effect sizes (r) of .25 for each principle
(Andrews & Bonta, 1998). More importantly as the number of princi-
ples evident in a program increased, the larger the effect size (rs of .03,
.18, and .29).
An important element of these principles is the matching of level of
service to the risk and need profile of the offender (Andrews & Bonta,
1998). The difficulty is how to translate level of service or dosage
into practical terms. As to what is the most appropriate dosage of treat-
ment, there is little empirical evidence or even practical advice
(Hollin, 2001). Only Lipsey (1995), in his review of treating juvenile
offenders, offered any practical advice, noting that an adequate dos-
age appears to be 100 or more contact hours.
It is a challenge for proponents of effective correctional treatment
services to demonstrate how the principles of effective treatment can
be put into place efficaciously in a real world setting, particularly in
prisons. Some cynics have argued, with some justification, that the
implementation of these principles in the real world is unrealistic
(Lab & Whitehead, 1990). Extensive surveys of the quality of correc-
tional treatment programs in prison and probation settings have
uncovered numerous problems in prison-based treatment programs
(Gendreau & Goggin, 1997; Gendreau, Goggin, & Smith, 1999). In
fact, Andrews and Bonta (2003) reported the effect of appropriate
treatment delivered inside a prison (mean effect size of .17) to be
smaller than appropriate treatment delivered in the community (mean
effect size of .35).
The present article evaluates an attempt to integrate the demands of
the principles of effective correctional treatment for a heterogeneous
sample of incarcerated male adult offenders. The principles guided
the delivery of treatment via an extensive assessment of risk and need
factors, cognitive-behavioral treatment programs that varied in dura-

tion, and the matching of the level of treatment to the offenders risk/
need profile.
The assessment of the offender included a validated risk instrument
and a specialized assessment that evaluated and identified specific
criminogenic needs, the influence of noncriminogenic needs on the
offenders criminal behavior, and relevant responsivity factors. Based
on this information, staff recommended offenders to participate in one
of three different lengths of treatment programs (a 5-week, 10-week,
or 15-week program). These recommendations attempted to follow
the principles of effective correctional treatment in that the dosage
of recommended treatment be a function of risk (e.g., longer program
for higher risk offenders) and need (e.g., longer programs for
offenders with more/severe criminogenic needs).
In summary, the present study has three goals. The first goal is to
evaluate the overall effectiveness of a prison-based treatment to
reduce recidivism. The second goal is to examine the influence of
dosage on treatment effectiveness (e.g., reduced recidivism). The
third goal is to evaluate the efficacy of staff to assign offenders to vary-
ing dosages of treatment.
METHOD
SETTING
Rideau Correctional & Treatment Centre (RCTC) is a medium

security provincial facility within the eastern region of Ontario.
RCTC houses offenders who are serving sentences of less than 2 years
and has three separate units. The Correctional Centre has 204 beds,
the Assessment Unit (AU) has 44 beds, and the Treatment Centre (TC)
has four dormitories with 16 beds each for a total of 64 beds. Within
each dormitory of the TC, a different treatment program was pro-
vided. One dormitory each delivered a 5-week and a 15-week pro-
gram, and in each of the two remaining dormitories, a 10-week pro-
gram was delivered. The three programs maintained a similar
intensity (5 days per week, usually two group sessions per day with
each session approximately 2 to 2.5 hours long) but differed in scope
and length (longer programs could address more needs in greater

detail). Complete details of intake, assessment, treatment referral and

treatment programs are described below.
PARTICIPANTS
Between September 1997 and December 1999, a total of 767

offenders (all male) were identified as potential treatment candidates
through the initial screening by classification staff. No benefits or
rewards were provided to offenders for completing treatment or par-
ticipating in the study. One hundred and forty-seven offenders had not
been discharged from the institution for at least a period of 1 year
when a 1-year postrelease follow-up was completed in October of
2000. Therefore, recidivism data was available on a sample of 620
offenders, all of whom had been released for a minimum of 1 year.
The mean age of the sample was 32.1 years (SD = 9.6), ranging
from 18 to 62 years. Full-time employment prior to custody was
reported for 29.1% (n = 180) of the offenders, and 10.5% (n = 65)
reported part-time employment. Most of the offenders were either sin-
gle (36.6%, n = 225) or married/living common-law (38.1%, n = 234),
with 25.2% (n = 155) divorced or separated. The mean sentence length
was 297 days (SD = 171). Almost all of the offenders (96%, n = 595)
had a prior conviction on their record with only 4% (n = 25) being first
time offenders. Close to half (44.0%, n = 273) of the offenders were
serving time for at least one violent offense, and a majority (74.0%,
n = 459) had at least one violent conviction at some point in their crim-
inal history.
PROCEDURES
Admission to Institution
All offenders arriving at RCTC were assessed for risk to reoffend and
screened for criminogenic needs with the Level of Service Inventory
Ontario Revision (LSI-OR: Andrews, Bonta, & Wormith, 1995, in
press) by ministry classification officers prior to arrival. The LSI-OR
is a recent modification of the well-known and widely used Level of
Service InventoryRevised (LSI-R; Andrews & Bonta, 1995). The
subscales of the LSI-OR include Criminal History, Employment/Edu-

cation, Peers, Leisure/Recreation, Family/Marital, Criminal Orien-

tation/Attitude, Substance Abuse, and Antisocial Pattern. Scores on
the LSI-OR have predicted violent and nonviolent recidivism among
male and female inmates and probationers (Girard, 1999; Girard &
Wormith, 2004; Rettinger, 1998) The average score from the LSI-OR
was 22.8 (SD = 6.2), with 14.4% (n = 89) of the sample considered
very high risk (LSI-OR score of 30 or more), 55.3% (n = 343) con-
sidered high risk (LSI-OR score between 20 and 29), 28.4% (n =
176) considered moderate risk (LSI-OR score between 10 and 19),
and 1.9% (n = 12) considered low risk (LSI-OR score between 0 and
9).
Classification staff at RCTC interviewed all new admissions within
a 2-week period. In addition to reviewing the LSI-OR and file infor-
mation, the intake interview assisted in identifying offenders in need
of treatment. If the offender had enough time left on his sentence and/
or was amenable to assessment, he was referred to the assessment unit
for additional assessment on measures of risk and need. As offenders
had varying time left to serve on their sentences, some offenders had
insufficient time to complete even the shortest program. Therefore,
they were not referred to the assessment unit nor did they receive any
treatment.
Assessment for Treatment Protocol
The assessment unit conducted a formal assessment where offend-

ers were asked to complete the following battery of self-report instru-
ments. A general social history questionnaire was administered that
gathered detailed information about criminal history, residence,
employment, education, family, marital status, substance abuse,
aggression, interpersonal relationships, and other demographic infor-
mation (e.g., psychiatric disability, literacy deficits, language and/or
cultural barriers). Four tests that tapped need/responsivity factors
were also administered. These four tests were as follows.
The Criminal Sentiments Scale (CSS; Andrews & Wormith, 1984).

This scale provided a measure of antisocial attitudes, which contains
three subscales: Attitudes Towards Law, Courts, and Police; Toler-

ance for Law Violations; and Identification with Criminal Others. The
scale has shown to be internally consistent and has demonstrated both
convergent validity with criminal risk measures and criterion-related
validity with various offense-based criteria (Andrews & Wormith,
1984, Simourd, 1997; Simourd & Van De Ven, 1999).
The Paulhus Deception Scale (PDS; Paulhus, 2000). This scale

provided a measure of social desirability and consists of two
subscales. The Impression Management scale assesses the test takers
tendency to impress the test administrator toward social conventional-
ity, and the Self-Deceptive Enhancement scale assesses an individ-
uals tendencies to various egocentric and self-serving biases (e.g.,
overconfidence and self-inflation). The PDS has shown to be inter-
nally consistent and demonstrated discriminant and concurrent valid-
ity with other measures of social desirability (Paulhus, 2000).
The Attitude Towards Correctional Treatment (ACT; Baxter,

Burchill, & Tweedale, 1992). This scale provided an index of motiva-
tion with five subscales: Motivation/Perceived Need of Treatment,
Perceptions of Treatment, Perceptions of Staff, Optimism/Pessimism,
and Comfort/Discomfort in Group. One published study reported the
scale to be internally consistent and demonstrated significant relation-
ship with treatment outcome as rated by program leader (Baxter,
Marion, & Goguen, 1995).
The Beck Depression Inventory (BDI; Beck & Steer, 1987). This
scale provided a measure of depression and assisted in screening for
suicidal ideation and risk. Psychological services were provided to
those deemed at high risk for suicide.
Psychology staff reviewed the test results, the LSI-OR, the social
history questionnaire, and all file information to synthesize the infor-
mation into a risk/need report. This risk/need report summarized the
offenders risk to reoffend and the needs that should be targeted by the
treatment programs. In addition, staff included a recommendation for
the offender to complete a particular length treatment program. Staff
recommendations were based on their clinical impression of all avail-
able information. Recommendations were, in theory, to be empiri-

cally guided within the framework of the principles of effective treat-

ment as outlined earlier. Of the 620 offenders in this evaluation, the
assessment unit assessed a total of 490 offenders of which 474 entered
treatment and 16 did not. A total of 130 offenders were not assessed,
eight of which entered treatment and 122 did not. Thus, a total of 482
offenders entered treatment and 138 offenders did not. The most com-
mon reason for not being assessed by the assessment unit or not partic-
ipating in treatment was insufficient time left on their sentence, as
64% (n = 88) were sentenced to less than 185 days. For the offenders
who were not assessed by the Assessment Unit, the identification of
needs was based on the LSI-OR and file review only, and these
offenders did not have a specific treatment length recommendation.
Offenders were provided with feedback on their assessment. Staff
and offender would mutually agree to a program length and when that
would begin. Although every effort was made to match recommended
treatment program length to what program the offender was admitted
to, time available to the offender was of practical concern. What treat-
ment program the offender was admitted to was significantly related
to their treatment recommendation (r = .47, p < .001) and sentence
length (r = .43, p < .001).
Treatment programs. The 5-week, 10-week, and 15-week correc-

tional treatment programs are comprehensive structured cognitive-
behavioral programs. A more detailed description of the three pro-
grams can be found in Armstrong et al., 1999. Essentially, the pro-
grams focus on assisting offenders to change negative attitudes and
behaviors, to acquire new skills, and to accept personal responsibility.
An integral part of the programs was the personal identification of the
kind of thinking that promoted antisocial, negative behavior for that
offender (e.g., using drugs, committing crimes, and/or acting aggres-
sively) and learning how to replace such thinking with more positive,
prosocial thinking. Skill acquisition was also emphasized through
modeling, graduated practice, and role-playing of several key skills
(e.g., relapse prevention, anger management, problem solving,
prosocial activities, and lifestyle choices). The three programs shared
the same psychological approach (cognitive-behavioral), skills, and
programming language.

Having three programs of varying duration allowed for offenders to

be placed in the most appropriate treatment program according to the
principles of effective correctional treatment. The 5-week program
delivered approximately 100 hours of programming over 5 weeks, the
10-week program delivered approximately 200 hours of program-
ming over 10 weeks, and the 15-week program delivered approxi-
mately 300 hours over 15 weeks. In this manner, the longer treatment
program can add more interventions (e.g., further examination and
identification of thinking patterns, role plays, and skill practice) tar-
geting criminogenic needs and enhancing the breadth and depth of the
treatment. These programs adhered to the principles of effective treat-
ment as they scored the highest among all programs evaluated by
Gendreau, Smith, and Goggin (2001) with the Correctional Program
Assessment Inventory (CPAI), a widely used measure of treatment
quality.
DATA AVAILABLE FOR EVALUATION
All demographic information and LSI-OR scores were gathered

from file information and/or offender interviews. Demographic infor-
mation included age, marital status, literacy level, employment, past
treatment exposure, formal psychiatric disability/diagnosis, and crim-
inal history. Scores on the Criminal Sentiments Scale, the Paulhus
Deception Scale, and the Beck Depression Inventory administered in
the assessment unit were recorded. The presence of each of the five
criminogenic needs (i.e., substance abuse, anger/aggression, domes-
tic violence, criminal attitudes, and criminal at-risk lifestyle) and
four noncriminogenic needs (i.e., anxiety/depression, coping skills,
childhood victimization, and other) as noted by either the assessment
unit staff or file review was recorded. Lastly, the program recommen-
dation (i.e., 5-, 10-, or 15-week) found in the risk/need report was
recorded. Recidivism data was gathered using the Offender Manage-
ment System (OMS) of Ontario. A uniform 1-year postinstitutional
release follow-up period was utilized for all offenders. Recidivism was
defined as any incarceration as a result of a new conviction or supervi-
sion related breach (e.g., parole revocation) during the 1-year follow-
up period.

PLAN OF ANALYSIS
Treatment effectiveness was evaluated by comparing recidivism

rates of treated and untreated offenders with chi-square and logistic
regression. Logistic regression is recommended when the outcome is
dichotomous (i.e., recidivism) and the researcher wishes to statisti-
cally control various factors (e.g., different levels of risk and need).
Logistic regression also provides a desirable effect size indicator, the
odds ratio, which is not affected by variance across sampling methods,
unequal sample sizes, or marginal distributions (Haddock, Rindskopf,
& Shadish, 1998). An odds ratio of 1 equals no effect, whereas odds
ratios less than 1 indicate effective treatment (e.g., reductions in recid-
ivism). An odds ratio of .50 corresponds to absolute differences in
recidivism rates of approximately 15% (i.e., 40% versus 25%).
To examine the dosage (e.g., length of treatment) required for
offenders of different levels of risk/need, a series of post hoc analyses
on specific subsamples of offenders were performed. Finally, a for-
ward stepwise multiple regression analysis was chosen to evaluate the
contributions of risk, need, and responsivity factors (e.g., noncrimino-
genic needs, literacy, and psychiatric disability) to length of treatment
recommended by staff. It was expected that criminogenic risk and
need factors would be the most salient factors related to treatment
length recommendations.
RESULTS
OFFENDER NEEDS
Two types of needs were identified: criminogenic and noncrimino-

genic needs. The most frequent criminogenic need identified was sub-
stance abuse (97.7% of the sample were identified as having substance
abuse problems, n = 606), followed by anger/aggression (64.4%, n =
385), domestic violence (27.3%, n = 163), criminal attitudes (32.5%,
n = 193), and criminal at-risk lifestyle (44.2%, n = 264). In
20.8% (n = 129) of the offenders, only one criminogenic need was
identified, 27.1% (n = 168) had two criminogenic needs, 29.8% (n =
185) had three, 15.8% (n = 98) had four, and 6.5% (n = 40) had all five

criminogenic needs identified. On average, 2.60 (SD = 1.17) crimin-

ogenic needs were identified.
Noncriminogenic needs identified were anxiety/depression
(39.0%, n = 231), coping skills deficits (78%, n = 464), childhood
physical or sexual victimization (41%, n = 243), and other (e.g.,
bereavement; 5.7%, n = 34). There were no noncriminogenic needs
identified in 17.6% (n = 109) of the offenders, 31.1% (n = 193) of
offenders had only one noncriminogenic need, 30.3% (n = 188) had
two, 18.9% (n = 117) had three, and 2.1% (n = 13) had all four. On
average, the offenders had 1.57 (SD = 1.05) of these noncriminogenic
needs.
TREATMENT EFFECTIVENESS
Of the 620 offenders, 482 offenders were admitted into a treatment

program (Treated Group); 235, 173, and 74 offenders were admitted
into the 5-, 10-, and 15-week program, respectively. The treated group
included both treatment completers (n = 408) and incompleters (n =
74 with 24, 31, and 19 offenders who did not complete the 5-, 10-, and
15-week program, respectively). On average, the treated group partic-
ipated in 7.45 weeks of treatment (SD = 3. 76), with a range of 1 to 15
weeks. The untreated group consisted of 138 offenders who were not
admitted into treatment. Although the assessment unit assessed only
16 of these offenders, all were identified to be in need of treatment by
classification staff. However, because of insufficient time available,
they received no alternative forms of treatment and served the remain-
der of their sentence in the correctional center until release.
The difference in recidivism between the treated group (150/482 =
31.1%) and the untreated group (57/138 = 41.3%) was statistically
significant, 2(1, N = 620) = 5.00, p < .05 with an effect size (r) of .10.
For the entire sample of 620, recidivism was significantly related to
LSI-OR (r = .28, p < .01, 95% confidence interval [CI] of .21 to .35)
and the number of criminogenic needs (r = .15, p < .01, 95% CI of .07
to .23). For those offenders who were assessed by the assessment unit
(n = 490), recidivism was significantly related to the number of
criminogenic needs (r = .19, p < .01, 95% CI of .10 to .27), the number
of noncriminogenic needs (r = .15, p < .01, 95% CI of .06 to .24), and
treatment length recommendation (r = .25, p < .01, 95% CI of .16 to

.33) as noted in the risk/need report. Partial correlations, controlling

for LSI-OR, revealed that recidivism was still significantly related to
the number of criminogenic needs (r = .09, p < .05, 95% CI of .00 to
.18) and to treatment length recommendation (r = .14, p < .01, 95% CI
of .05 to .23) but not to the number of noncriminogenic needs (r = .08,
p > .05, 95% CI of .01 to .17).
Therefore, the logistic regression examining treatment effective-
ness entered both the LSI-OR and the number of criminogenic needs
into the analysis. The results revealed that the LSI-OR (B = .091, Wald =
30.6, p < .01), the number of criminogenic needs (B = .247, Wald =
8.15, p < .01), and treatment (B = .574, Wald = 6.17, p < .05) were
significant predictors of recidivism. Based on the logistic regression
results, treatment was found to have an odds ratio of .563, with a 95%
CI of .358 to .886. Thus, the recidivism rate of the treated group after
statistically controlling for risk and need was calculated at 28.4%,
with a 95% CI of 20.1% to 38.4%, a reduction of 12.9% from
the untreated comparison group. The adjusted effect size (r) based on
the logistic regression controlling for risk and need was calculated to
be .13.
THE EFFECT OF LENGTH OF TREATMENT

(E.G., DOSAGE) ON RECIDIVISM
Two logistic regression analyses were used to evaluate the effect of

treatment length on recidivism. Length of treatment was defined as
the number of weeks of treatment an offender completed, which
ranged from 0 to 15. In the first analysis (n = 620), the LSI-OR score,
the number of criminogenic needs, and treatment length were entered.
The logistic regression found the LSI-OR (B = .095, Wald = 34.6, p <
.01), the number of criminogenic needs (B = .226, Wald = 7.36, p <
.01), and the length of treatment (B = .049, Wald = 5.58, p < .05) to be
significant predictors of recidivism. Based on this logistic regression,
each week of treatment (e.g., treatment length) was found to have an
odds ratio of .952, with a 95% CI of .913 to .992. Thus, the reduction
in recidivism for each week of treatment after statistically controlling
for risk and need was calculated to be 1.2%, with a 95% CI of 0.2% to
2.2%. The adjusted effect size (r) based on the logistic regression con-

trolling for risk and need was calculated to be .01 per week of
treatment.
A second logistic regression analysis (n = 490) entered the LSI-OR
score, the treatment length recommendation found in the assessment
units risk/need report (measure of need severity), and length of treat-
ment. As noted earlier, only 490 offenders had treatment length rec-
ommendations. Therefore, 130 offenders were omitted from the anal-
ysis, the majority of which were untreated. Once again, LSI-OR (B =
.085, Wald = 18.3, p < .01), treatment length recommendation
(B = .136, Wald = 14.6, p < .01), and length of treatment (B = .073,
Wald = 7.52, p < .01) were found to be significant predictors of recidi-
vism. Based on this logistic regression, each week of treatment was
found to have an odds ratio of .929, with a 95% CI of .895 to 1.002.
Thus, the reduction in recidivism for each week of treatment statisti-
cally controlling for risk and need was calculated to be 1.7%, with a
95% CI of 2.6% to 0%. The effect size (r) based on the logistic regres-
sion controlling for risk and need (based on recommendation) was
calculated to be .02 per week of treatment.
POST HOC ANALYSIS OF DOSAGE EFFECTS
A series of post hoc exploratory analyses examined how much

treatment (e.g., dosage) was enough to reduce reoffending. Of the
482 treated offenders, 74 were eliminated from the analysis because
they did not complete treatment for various reasons (e.g., noncompli-
ance, health problems, court transfers). These 74 dropouts completed,
on average, 3.95 weeks of treatment (SD = 2.87), with a 1-year recidi-
vism rate of 35.1%. An additional 7 participants were also eliminated
because they were not assessed by the assessment unit and, therefore,
did not have a treatment length recommendation. This left a total of
401 offenders with a treatment length recommendation, who had
completed either the 5-week, 10-week, or 15-week program.
Of the 211 offenders who completed the 5-week program, 83
offenders (39%) were recommended for the 5-week program; the
remaining offenders were recommended for the 10-week program
(45%, n = 94) or the 15-week program (16%, n = 34). Of the 135
offenders who completed the 10-week program, 107 (79%) were rec-

TABLE 1: Recidivism Rates and ns for Offenders Based on Amount of Treat-

ment Completed by Recommended Amount of Treatment
Recommended Treatment Program

Amount of
Treatment Received 5-Week Program 10-Week Program 15-Week Program
No treatment (%) 28 43.8 59.1

0 hours 14/50 28/64 13/22
5 weeks (%) 12 34 62
100 hours 10/83 32/94 21/34
10 weeks (%) 16.7 29.9 36.4
200 hours 1/6 32/107 8/22
15 weeks (%) 0 16.7 38.3
300 hours 0/2 1/6 18/47
ommended for that program, with 6 offenders (4%) recommended for

the 5-week program and 22 (16%) for the 15-week program. Most
(85%, n = 47) of the 55 offenders who completed the 15-week pro-
gram were recommended for that program. However, the 15-week
program also included 2 offenders (4%) recommended for the 5-week
program and 6 offenders (11%) recommended for the 10-week pro-
gram. Some offenders completed a treatment program longer than
what was recommended because staff had identified a unique issue
deemed serious enough to override the recommendation (e.g., severe
grief).
Recidivism rates were calculated for each combination of recom-
mendation and program actually completed (3 3) as well for compa-
rable untreated offenders (see Table 1). The untreated comparison
groups were defined by matching the risk and need levels of the
untreated offenders with the risk and need levels of the offenders who
were recommended for each length of treatment. This was necessary
because almost all of the offenders in the untreated group were not for-
mally assessed and did not have a treatment length recommendation.
Appropriate referrals to 5-week program. For the offenders who

were recommended for and completed the 5-week program (n = 83),
the untreated comparison group was defined as any untreated offender
who had an LSI-OR score of 22 or less and who were identified as hav-
ing a maximum of three criminogenic needs. This resulted in a sample

TABLE 2: Comparison of the LSI-OR, Number of Criminogenic Needs and

Recidivism Rates for Offenders Who Completed Their Recommended
Treatment Program and for Comparable Untreated Offenders
Criminogenic
Age LSI-OR # Needs
M (SD) M (SD) M (SD) Recidivism (%)
5-week appropriate
Recommended and
complete (n = 83) 35.0 (9.1) 17.1 (5.9) 1.69 (.80) 12.0
Untreated comparison
group (n = 50) 32.7 (11.6) 18.3 (3.0) 1.72 (.76) 28.0***
10-week appropriate
Recommended and
completed (n = 107) 30.5 (9.7) 22.6 (5.4) 2.84 (.98) 29.9
group (n = 64) 32.3 (10.9) 22.5 (4.9) 2.50 (.68)*** 43.8**
15-week appropriate
Recommended and
completed (n = 47) 30.9 (9.0) 25.1 (4.6) 3.40 (.92) 38.3
group (n = 22) 31.1 (10.4) 26.8 (4.4) 3.31 (.47) 59.1*
Note. LSI-OR = Level of Service InventoryOntario Revision.

*p = .10. **p = .06. ***p < .05.
of 50 untreated offenders. Comparisons between these 50 untreated

offenders and the 83 offenders who were recommended for and com-
pleted the 5-week program found no significant differences on the
LSI-OR, the number of criminogenic needs identified, or age (Table
2). A significant difference was found however, in recidivism, 2(1,
n = 133) = 5.37, p < .05, with those who were recommended for and
completed the 5-week program having a lower recidivism rate (12%)
than the comparison sample of untreated offenders (28%). A logistic
regression analysis found the LSI-OR (B = .114, Wald = 3.70, p < .05),
the number of criminogenic needs (B = .834, Wald = 7.10, p < .01),
and treatment (B = 1.222, Wald = 5.77, p < .05) were significant pre-
dictors of recidivism. The odds ratio of the 5-week treatment program
for offenders deemed appropriate for this level of treatment, was .295
with a 95% CI of .109 to .798.
Appropriate referrals to 10-week program. For the offenders

who were recommended for and completed the 10-week program (n =

107), the untreated comparison group was defined as any untreated

offender who had a LSI-OR score of 30 or less and at least two
criminogenic needs. This resulted in a sample of 64 untreated offend-
ers. No significant differences between groups were found on the LSI-
OR or age, but they did differ on criminogenic needs (see Table 2),
with those who completed treatment having more needs than those
who did not receive treatment. The difference in recidivism rates
approached significance, 2(1, n = 171) = 3.37, p = .07, with those who
were recommended for and completed the 10-week program having a
recidivism rate of 29.9% and the comparison sample of untreated
offenders a rate of 43.8%. A logistic regression analysis predicting
recidivism found the LSI-OR (B = .085, Wald = 6.63, p < .05) to be sig-
nificant but not the number of criminogenic needs (B = .005, Wald =
0.001, p > .05). The treatment effect approached significance (B =
.638, Wald = 3.46, p = .06). The odds ratio of the 10-week treatment
program for offenders deemed appropriate for this level of treatment
was .529, with a 95% CI of .270 to 1.035.
Appropriate referrals to 15-week program. For the offenders

who were recommended for and completed the 15-week program (n =
47), the untreated comparison group was defined as any untreated
offender with an LSI-OR of 20 or higher and who had at least three
criminogenic needs identified. This resulted in a sample of 22
untreated offenders. No significant differences were found between
the untreated offenders and the 47 treated offenders who were recom-
mended for and completed the 15-week program on the LSI-OR, the
number of criminogenic needs identified, or age. The difference in
recidivism rates between the treated (38.3%) and untreated offenders
(59.1%) was not significant, 2(1, n = 69) = 2.61, p = .10. A logistic
regression analysis found the LSI-OR (B = .124, Wald = 3.88, p < .05)
to be a significant predictor of recidivism, but the number of crimino-
genic needs (B = .298, Wald = 0.781, p = .37) and treatment (B = .668,
Wald = 1.48, p = .22) was not significant. The odds ratio of the 15-
week treatment program for offenders deemed appropriate for this
level of treatment was .513, with a 95% CI of .175 to 1.502.
Offenders completing 5-week program. Additionally, a post hoc

analysis was done on only those offenders who completed the 5-week

program. For offenders who were recommended and completed the 5-

week program (n = 83), the recidivism rate was 12%. For offenders
who completed the 5-week program but were recommended for the
10-week program (n = 94), the recidivism rate was 34%. For offenders
who completed the 5-week program but were recommended for the
15-Week program (n = 34), the recidivism rate was 62%. These rates
were significantly different, F(2, 208) = 17.1, p < .01. Post hoc t tests
found all groups to have significantly different recidivism rates from
one another.
High-risk/high-needs offenders. To further explore dosage and

type of offender, two final comparisons were made. The recidivism
rate for offenders who were recommended for the 10-week program
and completed either 10- or 15-week programs (29.2%) was com-
pared to the recidivism rate of the group of similar (e.g., LSI-OR score
of 30 or less and at least two criminogenic needs) untreated offenders
(43.8%). The recidivism rates were found to be significantly different
(2[1, n = 177] = 3.82, p < .05). Finally, the recidivism rate for offend-
ers who were recommended for the 15-week program and completed
the 5-week program (62%) was compared to the recidivism rate of
offenders who were recommended for and completed the 15-week
program (38.3%). These groups had significantly different recidivism
rates (2[1, n = 81] = 4.35, p < .05).
CORRELATES OF RECOMMENDED TREATMENT LENGTH
A forward stepwise multiple regression analysis was used to evalu-

ate the contributions of various factors to treatment length recommen-
dation made by the assessment unit staff. A total of 490 offenders were
provided with a treatment length recommendation, with 101, 251, and
138 offenders recommended for the 5-, 10-, and 15-week program,
respectively. The following variables, which were reviewed by assess-
ment unit staff for them to make treatment length recommendations,
were entered into the analysis: the LSI-OR score, the three scales of
the CSS, the two scales of the PDS, the five scales of the ACT, the BDI
score, the number of criminogenic and noncriminogenic needs, liter-
acy, and psychiatric disability. The regression analysis revealed an R
of .651, with the following variables entered into the equation in order

TABLE 3: Summary of Forward Stepwise Regression Analysis Predicting Treat-

ment Length Recommendation (as a Result of Missing Data, n = 259)
2
Variable B SE B R Change r Part
Number of criminogenic needs .198 .032 .330**** .248**** .498 .295

LSI-OR .029 .006 .275**** .095**** .494 .241
Beck Depression Inventory .012 .004 .145**** .034**** .280 .140
Psychiatric Disability .304 .116 .133*** .026*** .312 .125
Literacy .238 .104 .112*** .011*** .189 .109
ACT: Perceived Motivation
& Need .013 .006 .102*** .010*** .196 .098
Overall R .651
Note. LSI-OR = Level of Service InventoryOntario Revision. ACT = The Attitude

Towards Correctional Treatment scale.
***p < .05. ****p < .01.
of entry: the number of criminogenic needs, LSI-OR, Beck Depression

Inventory, psychiatric disability, literacy, and the Motivation/Perceived
Need scale of the Attitude Towards Correctional Treatment (see Table
3). No other variable added any significant contribution to recom-
mended treatment length.
DISCUSSION
Technology transfer, or the successful implementation of correc-

tional programs based on empirical evidence, is often a very difficult
proposition when designing, implementing, and carrying out treat-
ment programs for offenders (Gendreau, Goggin, & Smith, 1999).
This study outlined how the principles of effective treatment were
transferred to a real-world prison setting, resulting in significant
reductions in reoffending. The Method section (see Assessment for
Treatment Protocol and Treatment Programs subsections) described
how risk, need, and responsivity factors were utilized in three funda-
mental ways: (a) Different levels of service were provided via three
different length treatment programs; (b) an extensive assessment pro-
cess was utilized to risk, need, and responsivity factors; (c) staff used
this assessment in an attempt to match the level of service (e.g., length
of treatment) to the offenders level of risk and need.

The effectiveness of the treatment to reduce recidivism was evalu-

ated by comparing the recidivism rates of a sample of treated inmates
to a sample of untreated inmates. The treated group consisted of 482
inmates who completed an average of 7.45 weeks of treatment. Their
1-year recidivism rate was 31.1%. This was found to be significantly
lower than the 41.3% recidivism rate found for a comparison group of
138 untreated inmates. This 10% reduction in recidivism is virtually
identical to that reported for residential/prison-based treatment pro-
grams (Andrews & Bonta, 1998; Andrews, Zinger, et al., 1990; Lsel,
2001). In this evaluation, the odds ratio was chosen as a measure of
effect size. An odds ratio is a more appropriate measure than other
commonly used indices of effect size (see Haddock et al., 1998). The
effect of treatment was calculated with logistic regression and statisti-
cally controlled for risk and need. The odds ratio was found to be .563.
With this odds ratio, the recidivism rate for the treated group was cal-
culated to be 28.4% after controlling for risk and need, indicating a
slightly larger treatment effect size (r) of .13 compared to the unad-
justed effect size (r) of .10. These results demonstrate that treatment
delivered inside prison walls could be effective in reducing recidi-
vism. Moreover, the cost effectiveness of this modest reduction in
recidivism should not be overlooked. A number of reviews have
shown that the average cost benefit can range from $4,653 to more
than $80,000 per offender (Aos, Phipps, Barnoski, & Lieb, 2001;
Cohen, 1998; Cullen & Gendreau, 2000; Donato & Shanahan, 1999).
A unique aspect of the treatment reported here was the fact that
three different lengths or dosages of treatment were provided. In
this study, recall that the shortest (i.e., 5-week) program had 100 con-
tact hours, meeting Lipseys (1995) minimal standard, and the longest
(i.e., 15-week) had 300 hours, three times more than the minimal 100
hours. Overall, results demonstrated that length of treatment was sig-
nificantly related to reductions in recidivism. Specifically, each week
of treatment (approximately 20 hours of group) was estimated to have
an odds ratio of .952 and .929 in the two separate logistic regressions,
both of which statistically controlled for risk and need. In other words,
a reduction of 1.2% to 1.7% is expected for each week of treatment
received. Therefore, the results suggest a simple linear relationship
between dosage and effectiveness, with the more treatment the
average offender receives, the greater the reduction in recidivism.

However, the literature on effective correctional treatment has

clearly suggested that there is an interaction between risk/need and
treatment (Andrews & Bonta, 1998). At Rideau Correctional & Treat-
ment Centre, three different lengths of treatment were provided to
match longer periods of intervention to higher risk offenders and/or
offenders with more criminogenic needs. A series of post hoc analyses
examined dosage effects at different levels of risk/need. It appears
that for moderate risk offenders with few needs, the 5-week program
(or 100 hours) was sufficient to significantly reduce recidivism. On
the other hand, for offenders with high risk and multiple needs, the
post hoc analyses suggested that much longer programs are required
to significantly reduce recidivism. A 20% difference in recidivism
rates was observed for the highest risk/need offender group even
though the power of that comparison was restricted because of the
small sample size of the untreated comparison group. In addition,
those high-risk and multiple-needs offenders who received 15 weeks
recidivated at a significantly lower rate than similar offenders (e.g.,
those recommended for the 15-week program by the assessment unit)
who only received 5 weeks of treatment. In fact, the 5-week program
(e.g., 100 hours) appeared to have no effect on recidivism, with a
recidivism rate (62%) similar to the untreated 15-week comparison
group (59%). For the offenders deemed appropriate for the 10-week
program (i.e., either high risk or multiple needs but not both), it
appears that a minimum of 200 hours are required to significantly
reduce recidivism. Although these results require further exploration
and replication, there are considerable implications in regards to
treatment planning, offender assessment, and service delivery.
The implication for treatment planning suggests that administra-
tors and program designers need to provide different length treatment
programs rather than simply taking the one-size-fits-all approach.
Various treatment options are needed to accommodate the diversity of
offenders found within a prison.
With such treatment options, offender assessment and the match-
ing of offenders to an adequate dosage of treatment is critical.
Attention must be made to assess both risk and need to match an
offender to a treatment length that will affect recidivism and is also
cost effective. In the present study, the primary determinants of rec-
ommended length of treatment were the offenders risk to reoffend

and how many criminogenic needs he had, with noncriminogenic

needs and responsivity factors playing a significant, albeit lesser, role.
These results suggest that staff recommended offenders to different
lengths of treatment that was consistent with the principles of risk,
need, and responsivity. Indeed, maintaining the integrity of staff rec-
ommendations in accordance with the principles would be one of the
critical features of the overall service delivery.
In summary, this study demonstrated how to practically apply the
principles of effective correctional treatment inside a prison, that
treatment worked, and also provided evidence that dosage, or length
of treatment, plays a significant role in reducing recidivism. Post hoc
analyses tentatively suggest that 100 hours can be effective for offend-
ers of moderate risk or few needs, but this amount of treatment appears
to be insufficient for offenders with high risk and/or multiple needs.
These offenders appear to require lengthier treatment programs with a
minimum of 200 or more hours, and if the offender is both high risk
and multiple needs, the offender may require in excess of 300 hours of
treatment to affect recidivism.
Nevertheless, some caution is warranted. Offenders were not ran-
domly assigned, and a majority of untreated offenders were not fully
assessed. In addition, the different types of untreated offenders (e.g.,
the high-risk and need offenders) were operationally defined post hoc.
Although efforts were made to control for this, the potential selection
bias may have had some unknown influence on the results. An addi-
tional confound may be a result of the collaboration between staff and
offender in choosing which specific treatment program that offender
would participate in. Finally, risk, need, and treatment length are not
the only influences on reoffending. The three programs differed in
length and also differed in terms of breadth of treatment, with longer
programs likely being qualitatively different from the shorter pro-
grams. It is unlikely that completing the 5-week program three times
in succession is the same as completing the 15-week program. Never-
theless, future investigations should take into account treatment
length within the context of offenders risk and need levels. In doing
so, we may elucidate the nature of this complex relationship, allowing
us to expand our understanding of the delivery of effective correc-
tional programs.

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