Moral Reconation Therapy

MRT™
Moral Reconation Therapy™
By
Dr. Kenneth Robinson
Is Treatment Effective?
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Many do not comply
Many relapse
There is no cure
Rates are similar to other diseases
I.e. diabetes, heart disease, obesity
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Popular Treatment Approaches
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General Counseling
Lectures & Films
Confrontation
Relaxation
Milieu therapy
Group Psychotherapy
Rates of Medication Adherence
• Bipolar Disorder
• Over 6 to 12 mos
• 34% to 80%
• Schizophrenia
• 11% to 80%
• Cardiovascular
• Beta 46%
• Cholesterol 44%
• 43% to 53%
• Osteoporosis
Major Elements of Treatment
• MOTIVATION
• Insight
• Skills
Dynamic Needs That Must be
Addressed
• Strong correlation with • APD
committing a new crime • Antisocial Values
• Criminal Peers
• Low-self control
Moral Reconation Therapy
• MRT™ seeks to move clients from egocentric,
hedonistic (pleasure vs. pain) reasoning to
levels where concern for social rules and
others become important.
• Research of MRT™ has shown that as clients
pass steps, moral reasoning increases in adult
and juvenile clients.
MRT™ Focus
• Confrontation of beliefs,
attitudes, and behaviors
• Assessment of current
relationships
• Reinforcement of
positive behavior and
habits
• Positive identity
formation
• Enhancement of selfconcept
• Decrease in hedonism
• Development of
frustration tolerance
• Development of higher
stages of moral
reasoning
Unique Program Attributes
1. Open Ended and Self-Paced
2. Usable across Systems
3. Culturally neutral and encompasses a range of
learning styles
4. Utilizes an Inside-Out Process
5. Standardized curriculum provides facilitator
structure and accountability
6. Program emphasizes feedback and client
reflection
7. Enhances personal problem solving and selfdirection
8. Help clients identify their unique strengths
Conation
• A term derived from the philosopher
Rene DeCartes to describe the point
where body, mind and spirit are aligned
in decision making. Reconation refers to
altering the process of how decisions are
made.
Kohlberg’s Six Stages of Moral Reasoning
Level 3 (Post-conventional Morality)
STAGE 6: UNIVERSAL-ETHICAL PRINCIPLES
STAGE 5: SOCIAL CONTRACT
Level 2 (Conventional Morality)
STAGE 4: THE RULES ARE THE RULES, THE LAW IS THE LAW
STAGE 3: INTERPERSONAL CONCORDANCE (APPROVAL
SEEKING)
Level 1 (Preconventional Morality)
STAGE 2: INSTRUMENTAL RELATIVIST (BACKSCRATCHING)
STAGE 1: PUNISHMENT AND OBEDIENCE (PAIN VS.
PLEASURE)
Program Goals for MRT™
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Decrease high program dropout rates
Improve program completion rates
Increased treatment adherence
Provide integration of programming across the
continuum of treatment levels
• Reduction of relapse/recidivism
• Decrease technical violations
MRT™ Client Group Process
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MRT™ typically has groups of 5-15 client participants with
one facilitator or co-facilitators where desired.
Groups are designed to last approximately one and one half to
two hours.
Depending on client and site characteristics, groups are
usually held at least once or twice weekly.
Institutional settings typically have two or more meetings per
week with community-based sites having one meeting per
week.
Clients in MRT® typically prepare step exercises and tasks
prior to group attendance and process their exercises in group
or exercises are given to the facilitator for review and
approval.
MRT™ Client Group Process
• MRT is designed to be completed by the average
client in 20-30 sessions.
• Completion is defined when the client successfully
passes MRT's 12th Step.
• MRT is specifically designed for clients with openended groups where participants can enter at any
time and work at their own pace.
Client-Group Process Cont’d
• MRT can be used at any point in an client’s
treatment, but it is most often used as a re-entry
tool.
• Participants enter ongoing groups at any time,
begin the treatment process, and process
exercises and tasks sequentially as part of the
ongoing group process.
• This procedure facilitates the change process,
enhances the group process, and allows for
continuation of ongoing groups.
• The delivery of MRT is both highly structured and directive,
which gets clients engaged and keeps them on track.
• Achievements of each step in the program are clearly
understood and client progress can be documented at every
stage of the program.
• Clients quickly establish ownership of their participation in the
program because the program emphasizes feedback and client
reflection.
Why MRT™ Works
• Each step in the program involves completing
specific assignments and reporting on how they
completed the step.
• The program is culturally neutral and gender
sensitive.
• Standardized curriculum and facilitator training
ensures consistent program delivery and quality
assurance.
• Finally, MRT is extremely cost-effective compared
to other programs.
Moral Reconation Therapy (MRT®) was selected for inclusion on the National
Registry of Evidence-based Programs and Practices (NREPP) sponsored by the
Substance Abuse and Mental Health Services Administration in 2008.
NREPP is an on-line registry of mental health and substance abuse interventions
that have been reviewed and rated by independent reviewers. The registry was
created to assist the public in identifying approaches to preventing and treating
mental and/or substance use disorders that have been scientifically tested and that
can be readily disseminated to the field.
NREPP is one way that SAMHSA is working to improve access to information on
tested interventions and thereby reduce the lag time between the creation of
scientific knowledge and its practical application in the field.
A Meta-Analysis of Moral Reconation Therapy
by Myles Ferguson and J. Stephen Wormith
This study reports on a meta-analysis of moral reconation therapy
(MRT). Recipients of MRT included adult and juvenile offenders
who were in custody or in the community, typically on parole or
probation. The study considered criminal offending subsequent to
treatment as the outcome variable. The overall effect size measured
by the correlation across 33 studies and 30,259 offenders was
significant (r = .16). The effect size was smaller for studies published
by the owners of MRT than by other independent studies.
International Journal of Offender Therapy and Comparative Criminology, 2012,
XX(X) 1–31.
Virginia Adult Drug Treatment Courts
Cost Benefit Analysis
The multilevel analysis of the determinates of in-program
recidivism determined participants in drug court programs that
utilize Moral Reconation Therapy (MRT) have a significantly
lower probability of in-program recidivism than similar
participants from programs that do not use this treatment
approach.
Excerpted from Virginia Adult Drug Treatment Courts Cost Benefit Analysis: October 2012 by
Fred L. Cheesman, Ph.D., Tara L. Kunkel, MSW, et. al., National Center for State Courts,
Williamsburg, VA.
Virginia Adult Drug Treatment Courts
Cost Benefit Analysis
Overall Conclusions
• The 12 drug courts investigated have a robust and
sustained impact on the recidivism of participants
over and above that of the “business-as-usual”
alternatives.
• These results lead to lower outcome and
victimization costs, along with lower placement
costs, result in average savings of almost $20,000
per drug court participant. Consequently, the 12
drug courts are cost-effective.
Excerpted from Virginia Adult Drug Treatment Courts Cost Benefit Analysis: October 2012 by
Fred L. Cheesman, Ph.D., Tara L. Kunkel, MSW, et. al., National Center for State Courts,
Williamsburg, VA.
Virginia Adult Drug Treatment Courts Cost Benefit Analysis
Results from these analyses also suggest that drug court
programs that incorporate MRT are more effective at
reducing the incidence and frequency of post-exit
recidivism than drug court programs that do not.
REINCARCERATION RATES OF MRT TREATED FELONY OFFENDERS COMPARED
TO NON-TREATED CONTROLS ONE TO TEN YEARS AFTER RELEASE
(SHELBY COUNTY CORRECTION CENTER, MEMPHIS, TN 1987-1998)
70%
60%
50%
40%
CONTROLS
30%
TREATED
20%
10%
S
R
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Y
1
0
9
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S
Y
8
YEARS OF RELEASE
R
S
7
Y
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6
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5
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4
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3
Y
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2
1
Y
R
S
0%
COMBINED TAXPAYER AND CRIME VICTIM BENEFIT FOR EVERY
DOLLAR SPENT
SEX OFFENDER TREATMENT PROGRAMS
$.26
IN-PRISON THERAPEUTIC COMMUNITIES
$1.07
ADULT BASIC EDUCATION $2.40
IN-PRISON VOCATIONAL EDUCATION $3.23
REASONING & REHABILITATION $3.51
MRT $11.48
IN DOLLARS
CASE MANAGEMENT SUBSTANCE ABUSE
PROGRAMS ($.21)
ADULT INTENSIVE SUPERVISION
PROGRAMS $.52
SHOT TERM FINANCIAL ASSISTANCE FOR
INMATES LEAVING PRISON $.94
DRUG COURTS $2.18
JOB COUNSELING & JOB SEACH
FORINMATES LEAVING PRISON $4.00
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4
6
8
10
12
14
WORK RELEASE PROGRAMS, COMMUNITY-BASED SUBSTANCE ABUSE TREATMENT, LIFE SKILLS PROGRAMS,
CORRECTIONAL INDUSTRIES, IN-PRISON NON-RESIDENTIAL SUBSTANCE ABUSE TREATMENT AND OTHER
COGNITIVE BEHAVIORAL THERAPY WERE NOT INCLUDED DUE TO THE SCARCITY OF EVALUATIONS.
SOURCE: THE COMPARATIVE COSTS AND BENEFITS OF PROGRAMS TO REDUCE CRIME, A REVIEW OF
NATIONAL RESEARCH FINDINGS WITH IMPLICATIONS FOR WASHINGTON STATE, MAY 1999.
Thurston County (Olympia, WA Drug Treatment Court – Eight
(8) Study –
Recidivism: Drug Court versus Control Group
Thurston County (Olympia, WA Drug Treatment Court
– Eight (8) Year Study –
MRT SUSTAINED EFFECT
MRT Age Effects
Anchorage Drug Court
Recidivism Rate Comparison
33%
National Average
67%
37%
Comparison
Group
73%
2002 Opt Outs
2002 Graduates
63%
27%
Did not recidivate
Recidivated
100%
0%
2001 Opt Outs
40%
60%
75%
2001 Graduates
25%
0%
20%
40%
60%
Percentage
80%
100%
120%
data as of 2/03
MRT™ Works: Thurston Co, WA Drug Court
Program Treating Trauma & Depression
Findings indicate:
• MRT alone reduced depression 67%
• Impacted clinically significant self-esteem areas by 24%
• Reduced traumatic symptoms by 24%
Volusia County DWI Court
MRT in Drug Courts:
Comprehensive Review of Recidivism Outcomes &
Meta-analysis of Adult Court Results
MRT-Based Adult Drug Court Retention Rates
• 15 of the reviewed studies included retention and/or
graduation rates with a total of 2,504 participants included
in the research. The retention rates ranged from a high of
95.8% to a low of 52%. The average retention rate of all 15
studies is 69.1%. The range (+/- one standard deviation)
within which two-thirds of the programs’ retention rates fall
is from 55-79%.
• The Center for Court Innovation (Cissner & Rempel, 2005)
reported that the average of all American drug courts’
program retention rates was just over 50%.
• The MRT-based drug court implementations yield a
retention rate somewhat higher than non-MRT programs.
Bonneville County MH Court
• Began in 2002
• 1 of 5 National Learning Sites
• First graduate was a Drug Court Drop Out
Is MH Court Successful?
• 98% Decrease in Hospitalizations
• 85% Decrease in Jail Days in 3 years
• Six year outcome shows 75% arrest free.
MRT-Based Adult Drug Court Recidivism & Meta-analysis
• 6 of the 7 reviewed studies showed lower
recidivism rates in the MRT-treated
participants and the average recidivism of
all seven studies, including the sole study
with the negative results, was 21.64%. As
indicated in the meta-analysis, the effect
size was .2151. The MRT-based drug courts’
recidivism reduction (21.6%) compares
favorably to other drug courts (10-15%).
MRT-Based Juvenile Drug Court Outcomes
• A total of 19 studies reported on MRT-based
juvenile drug courts. The average retention rate
cited in the studies is 70.1%.3 of these studies
included appropriate comparison groups. The
combined recidivism of the MRT-treated juvenile
offenders in these 3 studies was 35.7% compared
to 52.7% in the comparison groups. This yields a
reduction in recidivism of 17%, much better than
the 6.5% average recidivism reduction reported
in a large study of juvenile drug court results.
(Mitchell, et al., 2012).
Why Juvenile MRT Works
•The delivery of Juvenile MRT is both highly structured and
directive, which gets clients engaged and keeps them on
track.
•Achievements of each step in the program are clearly
understood and client progress can be documented at every
stage of the program.
•Clients quickly establish ownership of their participation in
the program because the program emphasizes feedback and
client reflection..
Why Juvenile MRT Works
• The program is gender sensitive.
• Standardized curriculum and facilitator training
ensures consistent program delivery and quality
assurance.
• Finally, Juvenile MRT is extremely cost-effective
compared to other programs.
• Each step in the program involves completing
specific assignments and reporting on how they
completed the step
Lincoln County Juvenile Drug Court
• Reducing recidivism – The re-offend rate through April 2009 is
16%, but this only reflects one participant re-offending, which
far exceeds this objective of the program. Additionally, this
result compares to the average juvenile drug offender reoffense of 78%.
• Retaining clients in treatment – The positive outcome of
producing a 55% Retention Rate continues to be met, which
far exceeds the average of 28% reported in research for
substance abuse treatment programs.
Wellness Courts
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“Wellness Courts” are an offspring of drug courts typically targeted to
Native American groups and operated under tribal governance.
The Anchorage, AK Wellness Court began operation in 2001 and had
79 participants in 2001-2002 (De Long, 2003). Approximately 67% of
program participants were Native Alaskans. The re-arrest rate for
2001 participants (n=34) was 35% while the re-arrest rate for 2002
participants (n=45) was 20%. A matched comparison group showed a
re-arrest rate of 63%.
The Spokane Tribe implemented the Strong Heart Wellness Court
Program utilizing MRT in 1999 (Byrnes & Kirchner, 2003). The program
graduation rate is 58%. The reoffending rate, defined as a re-arrest
during program participation, was calculated for all clients and was
19%.
Wellness Courts Continued
• An unusual adaption of MRT in drug courts was the 2006
formation of an “alumni group” of drug court graduates
(McCabe, 2009) in the Anchorage, AK Wellness Court. The
program was an effort to maintain the ongoing support for
drug court graduates after their 18-month program period.
The MRT Steps (13-16) not usually required in basic MRT
were employed in the project. Results of the support
program showed that in the 2-year period following
graduation from drug court, participants in the alumni
group had a 0% re-arrest rate as compared to 13% of drug
court graduates who did not participate.
Family Courts
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Kirchner, Kirchner, & Glashow (2013) reviewed the outcomes of an MRTbased Missouri family court begun in 2004. The specialized family court
program focused on drug-abusing guardians of children. The program
showed a 52% retention rate. Recidivism (defined as violation of program
contracts) was 31%.
The Marion County (OR) Fostering Attachment Treatment Court (FATC)
began in 2006 as an effort to treat substance abusing parents of young
children. (Mackin, et al. 2013) reported that the program had 144
participants with only 26% being unsuccessful discharges. MRT is required
for all participants. Within 4 years of program participation, FATC clients
showed a 13% rate of losing parenting rights as compared to a matched
control group who showed a rate of 38%. After 2 years, participants
showed an average of 0.15 re-arrests per person as compared to 0.49 in
matched controls.
Veterans Courts
• Timko, et al. (2014) summarized efforts at
reducing recidivism in Veterans who become
enmeshed in criminal justice. Veteran’s
Courts, a relatively new phenomenon in drug
courts, are attempting to focus specialized
programming that address the unique
characteristics of this group. MRT is one of the
most frequently employed methods being
utilized.
MRT™ TRAINING OUTLINE
DAY 1
8:30-10:00 AM: Introductory Remarks-On the cutting edge of treatment; Introduction
and History of MRT™; Criminal Justice Statistics
10:00 AM – 10:15 AM: Break
10:15 AM – 12:00 PM: Characteristics of Effective Client Interventions; Introduction to
MRT-Problems in Treating Sociopaths and Other Treatment Resistant Groups;
Historical background of Antisocial Personality Disorder.
1:00 PM- 3:00 PM Evolution of APD treatment
3:00 PM- 4:30 PM Cognitive-Behavioral Treatment
DAY 2
8:30-10:00 Moral reasoning as an essential treatment variable. Moral reasoning as the
“missing element.” Dr. Lawrence Kohlberg’s moral reasoning levels.Methods of
measuring moral reasoning.
10:00 a.m.- 12:00 p.m. MRT® Personality Theory. How the personality forms.
Attitudes, Habits, Beliefs. The concept of the “Inner Self”. Defense mechanismsinsulators of the Inner Self. Identity formation: good and bad. Happiness as a
measurable construct.
1:00 p.m. – 2:00 p.m. Research on MRT. Effect on Recidivism & Rearrests. Relationship
of Moral Reasoning to Recidivism.
2:00 PM- 4:30 PM MRT Steps and Personality Stages; Disloyalty-the stage of most clients; low
moral reasoning, sociopathic beliefs and behaviors. (Steps 1 & 2)
DAY 3
8:30-10:00 a.m. Opposition-Low moral reasoning, confrontational, manipulative, and hostile.
(Step 3)
10:00 AM- 12:00 PM. Uncertainty-indecisive, no direction with rapidly swinging behavior and
moral judgments. (Step 4).
1:00 PM - 4:30 PM Injury-awareness of injury, feelings of inadequacy, worthlessness, low selfesteem. (Steps 5 & 6)
DAY 4
8:30-10:00 AM Nonexistence-no identity, unsure of control in life, no sense of direction. (Steps 7
& 8)
10:00 AM - 12:00 PM. Danger-has a sense of identity and personal goals. (Steps 9 & 10)
1:00 PM – 2:00 PM Emergency-goals not as self-serving and egocentric. Tries to do too much
out of commitment. (Step 11)
2:00 PM- 2:45 PM Normal-lives life in a manner that leads to the fulfillment of needs rather
easily. (Step 12)
2:45 PM – 3:30 PM Grace-reached by few people; feels at one with things, sees thing in totality.
(Steps 13-16)
3:30 PM – 4:00 PM MRT Treatment Elements. Confrontation of self explained as a process.
Assessment of relationships. Reinforcement of Appropriate Behavior. Building Positive Identity.
Enhancement of Self-Concept. Decrease Hedonism-Develop Tolerance of Delay of Gratification.
Development of Higher Stages of Moral Reasoning.
4:00 PM – 4:30 PM Conclusion, Wrap-up, Questions & Answers.
CONTACT INFO
• Correctional Counseling Inc.
• ccimrt@ccimrt.com
• 901-360-1564
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Ken Robinson
ccimrt@ccimrt.com
901-360-1564
www.ccimrt.com