What we know about positive behaviour change 8

The key principles of effective case management are:

– Reliability

This may seem an obvious thing to say but simple reliability is very hard to deliver. It is a dimension that is often insufficiently valued in the workplace. There are many ways in which institutions can make the ‘customer’ feel insignificant and powerless, but one the most commonly encountered phenomena is a lack of punctuality by the service provider. Too many people in helping services find themselves waiting to be seen, or having appointments changed with no notice etc.

Reliability is not just about timekeeping however:
 Reliability is about good listening – does the worker show that they have heard and
understood what the offender is trying to communicate, or does their response suggest they have reinterpreted the offender’s experience and needs into their own frame of reference?
 Reliability is about a framework of attention in which the offender can be confident. Many years ago, the practice of probation officers and social workers was compared and it was noted that a strength of probation practice was that offenders were given set appointments often for several months ahead. On the other hand, many social workers ended their appointments with clients without setting a new date for the next meeting. Social work clients therefore felt in constant danger of being forgotten whereas the offenders knew they were being held in a process over time. Even probation teams however are rarely organised to maximise reliability of service delivery. Allocation of cases to a single worker builds in risk to reliability of service compared with a situation where the offender knows he is working with a team of people. In the latter case, the absence of a probation officer on leave, sickness or because of some other work demand is much less threatening to the offender’s experience of reliability of service, because other members of the team can be available for him/her. Nonetheless, most cases have been allocated to an individual worker.
 Reliability is about being able to survive set backs. In offender management, a common experience is that there is some kind of relapse – a new offence leading to imprisonment for example – at which point the case can often be transferred to another team and the work the offender has done with their original worker can then be treated as of no real value as if the offender has to start again from the beginning with their recovery.

What we know about positive behaviour change 7

5. The quality of support through a journey of change is the second
most important thing…………

Too great a focus on the design of intervention programmes to the exclusion of other factors misunderstands the nature of change when tackling human problems. It is not simply that problems are almost always too complex to be resolved by a single intervention and require a multi-dimensional approach, but also that change is a process that occurs over time and, as indicated above, through changing circumstances and emotional states. It is therefore best understood as a
‘journey’, and can be characterised as follows:

This kind of representation necessarily simplifies real life – change is far from an ordered process but this fact underlines the importance of case management to ensure individuals in trouble do not just experience one thing after another, but are supported through the ups and downs and complexities of change to retain a sense of direction and progress towards recovery / desistance. The absence of such a force for continuity through the change journey can be a serious problem. I heard a vivid
example of such a failure when the mother of a prisoner described how, having successfully completed a course to tackle his offending issues and developed a release plan that would build on his progress, his improvement earned him a reduced risk categorisation in the prison system. This led him to be moved to a less secure prison a long way from his home, with the consequence that family visits stopped and his release plan broke down.

The evidence suggests then that good case management plays a significant part in achieving good outcomes.

What we know about positive behaviour change 6

Of course I am cheating when I say that the quality of an organisation is the ‘one single thing’ that makes the most difference, because the quality of an organisation is made up of a whole range of factors. The most accessible (if not always the most readable) development of this idea has been published by the Institute of Behavioural Research in the University of Texas. (http://www.ibr.tcu.edu/) They have specified the components of organisational life that contribute to effectiveness:

This in turn reinforces the opening point – linear thinking would suggest that organisational effectiveness is the most important factor, and programme design of less significance. In truth, appropriate evidence based programme design is for example, one of the crucial elements of organisational effectiveness.

What we know about achieving positive behaviour changes 5

4. The organisation is the most important thing……….

It may be that one of the by-products of hierarchical organisations is that the focus of critical attention tends to keep scrutiny on the practitioners and not on the managers. It is an interesting and not uncommon tendency for senior managers to behave as though other senior managers do not require supervision – practitioner and team leaders may receive supervisory attention but more senior managers are deemed ‘expert’ enough to get on with their job without direct and regular supervision. Similarly, the activity of practitioners is subject to considerable scrutiny and control on the common sense basis that this is about what the service user experiences. Research is focussed on this dimension of an organisation and where organisations see themselves as a ‘learning organisation’, they can often simply mean that the practitioners are continuously improving practice based on the evidence of effectiveness.

It has been more unusual for the activity of managers to be subject to the same level of scrutiny and pressure to deliver an evidence based approach. What the evidence does tell us is that the single most important factor determining the effectiveness of service delivery, is the quality of the organisation itself, and this is in turn heavily dependent on the behaviour of managers.

This can be summarised by the following slide:

This is derived from research into substance misuse services, but there is no reason to think that there is anything distinctive about these kinds of services. The four to seven fold difference in effectiveness between the best and worst services is a far greater differential than any differences in outcome that can be obtained by changing the nature of a treatment intervention.

 

What we know about achieving positive behaviour changes 4

3. Professional input needs to be as interested in positive assets as in problems………….

The parallels between ‘recovery’ in the context of addictions and ‘desistance’ in the context of offending are very close – both intervention systems seem to have simultaneously come up against the importance of this framework and it means that interventions should increasingly:

– Give as much attention to the recovery capital / social assets of the individual in trouble as they have in the past devoted to their problems

– Establish an approach to interventions that seeks to establish a working partnership between service and service user – the offender is not a recipient of interventions but a designer of a desistance plan, assisted by the professional.

– Seeks to ensure that support for desistance is in place that will continue after
professional intervention has ended.

– The desistance plan should not only seek to reduce the offending but should also seek to develop new ways of living about which the offender can be proud

What we know about achieving positive behaviour changes 3

2. People recover in a social setting not a ‘clinical’ setting…………..

I have spent much of my career focussing on the finer points of professional interventions in the life of offenders. It has been easy to lose sight of the reality that professional interventions are not the most important feature of desistance from crime (or recovery from substance misuse). I used to be too defensive about this reality, perhaps because it was sometimes used to attack the effectiveness of professional services, (and therefore ironically contributed to the misconception that it was seeking to challenge i.e. that professional services were the central issue for discussion).

It took experience of the recovery movement in the development of drug treatment to put this issue into perspective for me. It is the truth that much of our attention and study will relate to the operation of professional services, but these services in practice are useful in so far as they contribute to a process of recovery or desistance rather than as if they were the means of producing change in individuals. What people who have struggled with human problems know, if they have come through them, is that:
– They did not change in the therapy group, the change programme, the therapeutic
institution, but in their lives and the social setting that gave their lives meaning.
– Almost all of them will have recovered in company with other people in some way, and not alone as if they had been prescribed antibiotics.
– They have recovered not by stopping bad things happening in their life but by changing and discovering new things.

What this means is that the relationship between professionalised services and the social settings in which people live is not a secondary issue about which we should be aware when focussing on delivering a formal change programme, but a central issue that should fundamentally steer the design of change interventions.

What we know about achieving positive behaviour changes 2

Much attention in recent years has been on desistance theory, which has tried to incorporate the consequences of what I have just outlined. (Hence for example:
Bringing Sense and Sensitivity to Corrections: From Programmes to ‘Fix’ Offenders to
Services to Support Desistance from What Else Works? Creative Work With Offenders, P 61-85, 2010, Jo Brayford, Francis Cowe, and John Deering, eds)
“Desistance theory and research, which examine why and how individuals with a history of offending stop their criminal behaviours, typically lack attention to organized practice frameworks that facilitate desistance. Developments in motivational theory and practice, which have been influential in corrections, are consistent with elements of the desistance paradigm; however, to date they are used as methods for modifying applications of the risk-management paradigm. This chapter focuses on the features of a more integrative correctional practice framework that is evidence-based in being attentive to the interplay of
factors that assist individual offenders in their ongoing, challenging efforts to desist from their criminal behaviour. This proposed model relies on ‘sense and sensitivity’. ‘Sense’ must be used in deciding how to incorporate a broad range of evidence on desistance into the design and delivery of services to offenders; and ‘sensitivity’ must be involved in how probation/parole officers gradually guide offender’s self-initiated change, rather than forcing and shaping change within a time-limited predetermined intervention. The supervision model must give priority to offenders’ goals and preferences; what they value; their personal experiences; and their emotional, social/interpersonal, and identity concerns.” (F Porporino)

This way of thinking is of course challenging. You may notice that the excerpt above makes no reference to the victims of crime when it says ‘the supervision model must give priority to offenders’ goals and preferences…..’ Advocates for victim centred justice may be ready to be outraged by such a statement, but we must not read into the text, meanings it does not assert – it does not say that the supervision model must give priority to offenders’ goals and preferences over those of victims.

This is a different way of stating what I was getting at, at the outset of this writing. Dividing human behaviour into categories and then listing bullet points to guide interventions strategies is what I regard as a ‘linear’ approach. We all have to start there but also we must go further if we are to make an impact on human behaviours.

What we know about achieving positive behaviour changes 1

1. You can’t solve human problems by linear models…………..

All human problems are complex and shifting in nature. Not only are they hard to define in a specific way, their nature is dependent on the meanings that individuals attach to what they experience.
‘Crime’ for example, is a very loose word and includes a vast range of behaviours. ‘Theft’ may seem more specific but this includes planned, impulsive, individual and group etc., etc., behaviours. For one person, a shoplifting offence may mean access to illegal drugs, whilst for another a family meal, or a means of communicating distress.
It is odd therefore that public debate about crime still tends towards a search for a single response that will stop it. For example, discussion of ‘punishment’ skates over the undoubted fact that imprisonment is one person’s punishment but another person’s security and route to food and shelter.
It is crucial therefore from the outset to say what may seem obvious:
– any effective response to crime has to be multi-dimensional. If I say, as I later argue, that the ‘health’ of a service providing organisation is the most important determinant of positive outcomes, it is not the same as saying that healthy organisations will produce reductions in re-offending. Equally, cognitive behavioural programmes may be the interventions with the strongest evidence base but whilst they may therefore be a necessary component of actions to produce reduced re-offending, they are not a sufficient response.
– any effective response to crime has to be dynamic. Given that offending behaviour is individual, occurring in the context of the changing circumstances of human lives and affected by the developing emotional and intellectual functioning of the perpetrators, responses have to be shifting over time as people’s lives and understandings change. They also have to be negotiated with the perpetrators, (not, for the purposes of this discussion, because the perpetrators have rights to influence how they are treated – that is clearly an arguable and complex issue), but in order to ensure that the interventions are appropriate to the problem as it is today, tomorrow, next week etc.

As in other academic disciplines, therefore, whilst we may start with simple propositions that are linear in nature (a+b=c; offending + anger management programme = no more offending), students of offending behaviour must understand more complex models of thinking akin to systems theories, chaos theories, patterning, liquid mechanics etc.

 

Postscript 2

This fundamental truth about the fluidity of human existence is what George Eliot understood and captured in the epilogue to Middlemarch that I have already quoted, and that Bacon was grappling with in his essay on truth, also already quoted. Just after my retirement, I was thinking about this and tried to capture the point in the following poem:
Making my Mark. – reflections on a career’s end

 

Dragged by the moon, pushed by the weight

Of timeless swells; now with grandeur

Now kicking and spitting, flailing

Wildly, I threw myself in spate

Against the unyielding rocks, pure

Or selfish, it mattered nothing.

 

I dreamt of carving noble shapes

Such as would suggest the divine,

The creative face of nature

Displayed to all on rocky capes,

Harsh contours smoothed to gentle lines

Melody from the ocean’s roar.

 

On the shores of the wide wide world

Here I saw the promise of worth

Hewed by the chaos of my seas.

Yet now my tide ebbs, my soul hurled

At the cruel cliffs, and sapping firths,

My energies dulled; on my knees.

 

Futility? Or should I hope

The need to create beauty be

Met not by my wild thrashing

But by vapours from the broad scope

Of my unconscious being, the

Unseen green fields fertilising?
July 2011

It does not mean that I think the whole business of working with the troubled and the difficult is always contingent and so individualised as to resist any attempt to define what is effective. The conclusion that follows in the next series of posts, therefore tries to put a stake in the sands of time!

 

Postscript 1

It is apparent now that aspirations for Family Court work to stay within the Probation Service were unfulfilled, just as to write of Probation as a social work service is anachronistic. I suppose it may to some seem that this whole tale of professional development has led to a series of cul de sacs – an understanding of the nature of work with offenders swept away by the tide of progress and policy aspirations misplaced. Naturally enough, it does not seem that way to me. A dispassionate review of the work of CAFCASS over the last ten years or so would be unlikely to lead many to rejoice in the positive progress that has been made. Probation seems to be rediscovering truths long hidden by successively Bottoms and McWilliams famous non-treatment paradigm, and the ‘What works’
movement.

I don’t however want to end this story with a long self justification. That would be to miss an important point about the whole business of intervention in the lives of people in trouble. It is one of the stresses of this work that achievement is always provisional and shifting – we do not build monuments, but seek to influence and encourage changes. Staff would sometimes complain that if a doctor cured a patient’s pneumonia, that would be deemed a success and no-one would suggest that
if the patient was ill again 3 years later that the earlier treatment had failed; whereas if a probation officer helped an offender to stop re-offending, but three years later they committed a further offence, the probation officer’s intervention would be deemed a failure. We intervene in particular moments in a shifting world with people who are constantly developing and changing, who work and are made redundant, who lose relatives as they age and die, who have children and find they can’t cope, who feel stuck and depressed at times etc. Similarly, the organisations that work with people are human institutions that may have continuities of culture, and role but are also like anything human, changing constantly.