Treating offenders with mental retardation and developmental disabilities.Offenders with mental retardation mental retardation, below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. and developmental disabilities developmental disabilities (DD),
n.pl the pathologic conditions that have their origin in the embryology and growth and development of an individual. DDs usually appear clinically before 18 years of age. (MR/DD MR/DD Mental Retardation and Other Developmental Disability ) are a growing population in the corrections field due to several important influences. First, deinstitutionalization de·in·sti·tu·tion·al·i·za·tion
The release of institutionalized people, especially mental health patients, from an institution for placement and care in the community. in the 1970s led to a flood of individuals with MR/DD into the community. They were usually housed in larger group settings such as group homes. As years passed, the wisdom of meeting individual needs in more normal settings, such as family homes, spread. This movement has integrated the population much more in local communities. With this has come growing expectations that this population will behave in a manner expected by all citizens; offensive behavior is quickly noticed and more often prosecuted than in the past.
Second, the offender with MR/DD often has committed a sex offense, and laws have become more stringent in identifying and prosecuting sex offenses A class of sexual conduct prohibited by the law.
Since the 1970s this area of the law has undergone significant changes and reforms. Although the commission of sex offenses is not new, public awareness and concern regarding sex offenses have grown, resulting in the . What at one time might have been excused due to a disability is now legally challenged. Also, court personnel are becoming more educated about offenders with MR/DD and better understand when offenders are manipulating the system and using their disability as an excuse. Better questions are asked by prosecutors that highlight the offenders' intent. As a result of the growing population of offenders with MR/DD, there is now a burden of looking for Looking for
In the context of general equities, this describing a buy interest in which a dealer is asked to offer stock, often involving a capital commitment. Antithesis of in touch with. viable treatment options other than prison as the primary sanction. This population typically has done poorly in prison, and nationally, effective treatment while incarcerated incarcerated /in·car·cer·at·ed/ (in-kahr´ser-at?ed) imprisoned; constricted; subjected to incarceration.
Confined or trapped, as a hernia. has been lacking. Keeping these offenders in the community gives more treatment options to the courts. Treatment can be effective, but takes a knowledge of how the systems of MR/DD, mental health and corrections work. Historically, there has been very little collaboration among the three systems.
Characteristics That Influence Treatment
The population of individuals with MR/DD is characterized as having multiple needs, but with many contradictions. For example, these offenders can be extremely charming, yet very shallow; extremely endearing en·dear·ing
Inspiring affection or warm sympathy: the endearing charm of a little child.
en·dear , yet very domineering dom·i·neer·ing
Tending to domineer; overbearing.
domi·neer ; very charismatic, yet actively and passively control people in a variety of situations; very friendly, yet also very ruthless; very cooperative, yet very stubborn and manipulative ma·nip·u·la·tive
Serving, tending, or having the power to manipulate.
Any of various objects designed to be moved or arranged by hand as a means of developing motor skills or understanding abstractions, especially in ; and extremely hardworking, yet noncompliant. These contradictions often make treatment a challenge for staff and providers.
According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the American Association American Association refers to one of the following professional baseball leagues:
Personality disorders are a group of mental disturbances defined by the fourth edition, text revision (2000) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and mental health problems. These problems can often be severe and require medications. These medications, however, pose a problem because many of the offenders with mental retardation also have some type of substance abuse problem, which further complicates the situation.
Treatment is at times very difficult because gross deficiencies in adaptive behavior occur. These deficiencies make it very hard for these offenders to use community resources and handle such tasks as banking, using public transportation or handling shopping needs. Community deficits typically accompany social skills deficits, where these offenders have difficulty solving problems and dealing with problem situations such as handling a complaint constructively. These social deficits often get this population noticed and often contribute to a variety of crimes. This population has a higher proportion of social crimes such as sexual offending, arson, property damage and burglary compared to the general population of offenders. (1) These crimes against others often occur because the offender with MR/DD does not have the social skills to know how to handle or resolve certain social situations. As an example, one offender with MR/DD detailed as a teenager how he was always being rejected by girls because he did not fit in, wear the right clothes or say the right things. His frustration led him to the only age group that would pay attention to him--underaged girls. This made it very easy, when he was going through puberty puberty (py`bərtē), period during which the onset of sexual maturity occurs. , to look to the young girls as the only ones he could relate to in getting his sexual needs met.
Often, the thought process of this population can be compared with Swiss cheese. These offenders are adept in certain areas where they appear very normal, but in other areas they have gaping gap·ing
Deep and wide open: a gaping wound; a gaping hole.
Adj. holes that show up as gross deficits of learning and responding. They often have an extreme difficulty generalizing from one situation to another. What is learned in one environment needs to be retaught in another. For example, knowing how to sort items at work would not necessarily transfer to sorting clothes at home. Along with the lack of generalization gen·er·al·i·za·tion
1. The act or an instance of generalizing.
2. A principle, a statement, or an idea having general application. comes the inability to discriminate important cues. In treating this population, providers often forget that the offender may not know what to target in any given situation. For example, going to a church setting means the offender needs to know to be quiet, sit appropriately in the pew and follow the service program.
This population has many thinking errors (as do many offenders). However, given their limitations, they often need concrete, repetitious rep·e·ti·tious
Filled with repetition, especially needless or tedious repetition.
repe·ti , simple terms to understand the error in their thoughts. They also have a hard time following how thoughts and feelings connect, often just understanding basic feelings such as anger, sadness, tiredness and happiness. They have a need to learn to identify basic feelings and then process how feelings and thoughts can influence one another.
Treating an Offender With MR/DD
Treatment approaches that work with this population are borrowed from literature and experience working in a community corrections environment with this population for the past 12 years. One program that has used such treatment approaches is o.k. Alvis House in Columbus, Ohio Columbus is the capital and the largest city of the American state of Ohio. Named for explorer Christopher Columbus, the city was founded in 1812 at the confluence of the Scioto and Olentangy rivers, and assumed the functions of state capital in 1816. , which is a 15-bed intermediate-care facility for the mentally retarded Noun 1. mentally retarded - people collectively who are mentally retarded; "he started a school for the retarded"
developmentally challenged, retarded . It houses offenders from potentially all counties in Ohio This is a list of the eighty-eight counties in the U.S. state of Ohio. The Ohio Constitution allows counties to set up a charter government as many cities and villages do, but only Summit County has done so. and provides long-term care long-term care (LTC),
n the provision of medical, social, and personal care services on a recurring or continuing basis to persons with chronic physical or mental disorders. to address their mental retardation, mental health and corrections needs. The team that works with these individuals comprises a program director, qualified mental retardation professional, recreation therapist, doctor, psychiatrist, psychologist, nurse, community service coordinator, as well as counselors, direct care workers, student interns This article or section is written like an .
Please help [ rewrite this article] from a neutral point of view.
Mark blatant advertising for , using . and volunteers. This type of team approach is essential in working with this population since they have such diverse needs that extend to many areas.
In working with this population, a level system, especially in the form of a token economy Noun 1. token economy - a form of behavior therapy that has been used in some mental institutions; patients are rewarded with tokens for appropriate behavior and the tokens may be cashed in for valued rewards , works very effectively. These offenders need concrete ways to see that their behaviors are influencing others, both in a pro-social manner and in an antisocial antisocial /an·ti·so·cial/ (-so´sh'l)
1. denoting behavior that violates the rights of others, societal mores, or the law.
2. denoting the specific personality traits seen in antisocial personality disorder. manner. Alvis House institutes a daily point system that allows consistent and immediate feedback for behaviors and gives staff an opportunity to model responsible behavior for the offenders. Pro-social alternatives are emphasized more than antisocial behaviors so that residents buy into the program and have motivation for change. Each level reached has more privileges but also more responsibilities. As offenders prepare to leave Alvis House, they are weaned wean
tr.v. weaned, wean·ing, weans
1. To accustom (the young of a mammal) to take nourishment other than by suckling.
2. off the points and given common social rein-forcers such as praise and positive feedback.
Since such a high percentage of MR/DD offenders have committed sexual crimes, there must be a strong counseling program to address breaking their pattern of offending and developing more healthy sexual outlets. Breaking the cycle of offending children, for example, demands that offenders admit their crimes, see how their crimes hurt an innocent child and figure out ways to prevent such violations in the future. Good sex offender sex offender n. generic term for all persons convicted of crimes involving sex, including rape, molestation, sexual harassment and pornography production or distribution. treatment can take several years to take root in these offenders, as they do not seem to learn at the same rate and often go through significant initial resistance. An offender new to treatment will often say, "If that child had not approached me as he had, I would not be in this mess." Sex offender treatment must be repetitious, confrontational and concrete for this type of offender to realize the need to make changes.
This population often needs sex education. Offenders with MR/DD may not understand basic terms such as sexual anatomy, consent and steps in a healthy dating relationship, so it is important to have a curriculum that is visual and to which they can relate. At Alvis House, staff use Life Horizons I and II to discuss these issues. (2) Offenders can learn over time that they can make healthy choices in social/sexual situations. One of the keys is for the offender to realize that intimacy involves sharing emotions and feelings rather than just a physical exchange. Most of the Alvis House offenders have never had a successful dating relationship, let alone a girlfriend. They need to be taught step by step how the process works.
Anger management is an essential area for these offenders to gain more control over their rage and their need to get even with others. Like an onion, layers of anger are peeled away to get to core issues. At Alvis House, individualized in·di·vid·u·al·ize
tr.v. in·di·vid·u·al·ized, in·di·vid·u·al·iz·ing, in·di·vid·u·al·iz·es
1. To give individuality to.
2. To consider or treat individually; particularize.
3. behavior programs are often written to give staff and clients ways to channel the offenders' anger and rage. Individual and group counseling reinforce these plans and help residents solve problems and accept constructive feedback. They learn they can control their anger appropriately. Homework assignments are essential so they can practice better ways to cope when in uncomfortable situations. When the offenders are handling tempers appropriately, staff give a lot of verbal praise and extra pro-social points. Residents learn that anger is not a wrong emotion, but one that needs to be channeled in careful ways. One offender stated, "I always used my anger to intimidate in·tim·i·date
tr.v. in·tim·i·dat·ed, in·tim·i·dat·ing, in·tim·i·dates
1. To make timid; fill with fear.
2. To coerce or inhibit by or as if by threats. others, I did not know it could be used in positive ways."
Offenders with MR/DD can learn to positively identify thinking errors and replace them with healthier thoughts. However, the traditional common language found in cognitive-behavior programs should be simplified and defined for this population. At Alvis House, simple concepts from the EQUIP Program (3) are borrowed. Offenders in group sessions learn to identify their thinking errors through role play and group confrontation. The thinking errors are posted in the room and replacement thoughts go right alongside them to show that healthier thoughts are possible. The thinking error concept is incorporated into all the offender groups and therapies to show that thinking is never in isolation of any important life area or skill.
Vocational training is extremely important with this population because having something productive during the day cuts down on behavior issues and improves the offenders' feeling of self-worth. It also competes with a variety of other impulsive im·pul·sive
1. Inclined or tending to act on impulse rather than thought.
2. Motivated by or resulting from impulse.
im·pul thoughts that can lead directly to behavioral issues. However, these offenders often are rejected from traditional jobs sites, and the sex offender often will be rejected from programs that traditionally serve the MR/DD population. Programs must be creative in setting up vocational training to serve this population. At Alvis House, an in-house vocational training program called Candlelites meets vocational needs. The offenders are taught the art and craft of making candles or soaps and accept donations from the community for their products. The residents then use the money they earn through the program to buy recreational equipment and other needed supplies for their use. Such creative thinking is essential to the development of effective vocational plans.
There are often tremendous medical issues that accompany working with this population. These medical issues are usually a product of homelessness and poor personal care for many years. Offenders who need major dental work and/or major surgeries may have been neglected for years. It is essential to have good nursing care 24 hours a day, seven days a week that could potentially intervene in a crisis situation. Fragile medical situations typically have to be resolved before mental health treatment can take place. It is important to have both a psychiatrist and a medical doctor at the disposal of the program. Medication must be monitored very closely due to the potential for seizures and other adverse drug interactions.
An often ignored area in programs for MR/DD offenders is substance abuse education and treatment. There have been providers in the fields that feel that those with MR/DD should be allowed to drink without any limits being placed on their usage. Also, many of these offenders have been homeless and using on the streets. It is essential to have both substance abuse education and counseling available to promote abstinence abstinence: see fasting; temperance movements. for those who are dependent. At Alvis House, the ways in which substances have negatively influenced most life skill areas are explored. One of the Alvis House offenders drank beer irresponsibly for 30 years prior to entering the program. Although he understood how alcohol had interfered with his life, he was not sure he could give it up. After several years of treatment, he was willing to admit that it might be possible to go through life without drinking. This offender was very scared because alcohol had always been the center of his life. He now had to learn to live in a new way.
Due to the multiple needs of this specialized population, it is essential that the burden of paying for these services is shared among the systems representing MR/DD, mental health and corrections. Not a single system can bear the brunt of what it takes to successfully treat this population. Networking and sharing resources are essential and a team effort is vital to promoting safety plans and coordinated treatment. There have been several models in Ohio that have had some success in training professionals to work with this population. One such model, Partners in Justice, has brought corrections professionals and MR/DD professionals together to learn from one another and to build teams. So far, there are 27 local teams from counties across Ohio that have committed to serving this population. This type of training at the state level is essential and should include department heads, MR/DD and mental health case managers, probation officers probation officer
1. An official usually attached to a juvenile court and charged with the care of juvenile delinquents.
2. An official charged with supervising convicts at large on suspended sentence or probation. , judges, police personnel and others who officially intervene with this population. Cuyahoga County, in northern Ohio, has been very successful in bringing all these entities together and having the judges support this effort. They have learned to make better use of community resources, which has resulted in a decrease in recidivism recidivism: see criminology. .
Effective models of treatment should be relayed to all counties, especially rural counties. This growing population is both a drain on resources and a constant safety risk to the community. These risks need to be shared by all involved systems to identify early treatment needs and then find creative ways to fund and staff needed programs. Without treatment, offenses get repeated and continue to drain all involved systems.
(1) Simpson, M.K. and J. Hogg hogg
castrated male sheep usually 10 to 14 months old. Also used to describe an uncastrated male pig. . 2001. Patterns of offending among people with intellectual disability: A systematic review. Part I. Journal of Intellectual Disability Research, 45(October):384-396.
(2) Kempton, W. 1991. Life Horizons I and II. Santa Monica Santa Monica (săn`tə mŏn`ĭkə), city (1990 pop. 86,905), Los Angeles co., S Calif., on Santa Monica Bay; inc. 1886. Tourism and retailing are important, and the city has motion-picture, biotechnology, and software industries. , Calif.: Stanfield and Co. For more information, call 1-800-421-6534.
(3) Gibbs, J.C., G.B. Potter and A.P. Goldstein. 1995. The Equip Program: Teaching youth to think and act responsibly through a peer-helping approach. Champaign, III.: Research Press.
Randy Shively, Ph.D., is vice president of clinical services at Alvis House in Columbus, Ohio, and is also a licenced psychologist with a private practice where he specializes in the treatment of the mentally retarded and developmentally disabled. He has 20 years of experience working with offenders.