A Better Way to Keep People From Going Back to Prison

A class on cognitive behavioral therapy (CBT) in 2017 at Turning Leaf, a nonprofit in Charleston, South Carolina, that helps former prisoners avoid reincarceration. (Photo via Rob Byko Photography)

Criminal justice in the United States is in desperate need of reform. The nation has the highest incarceration rate in the world. Twenty percent of all of the world's prisoners are found in this country. And despite the US spending $80 billion a year on incarcerating people, it fails at rehabilitation: Of the 600,000 people released from prisons each year, 67 percent of them are re-arrested within three years. Within nine years, it's 83 percent.

If the US is going to end mass incarceration, we must do more to keep people from returning to prison. There are hundreds of organizations across the country working on the problem, but they have yet to make meaningful progress. Reentry programs—efforts to integrate former prisoners with society outside of bars— are often found to be ineffective.

If you’ve ever tried to break a bad habit, you know why. Change is really hard, even under the best circumstances. People leaving prison attempt to change their whole lives with the cards stacked against them. They often return to the people and places that reinforce the behavior that got them into trouble in the first place. They use the coping skills they know—violence, drug use, quick money schemes—to deal with life’s difficulties. They often face limited transportation options, encounter unstable housing, possess few if any work skills, and struggle without the benefit of higher education.

Changing decades of behavior patterns that got people into trouble is extremely difficult. Unfortunately, most reentry programs don’t offer the intervention proven to do the most for the long-term success of people returning from prison. I learned this truth the hard way when I started Turning Leaf, a prison reentry nonprofit in Charleston, South Carolina.

We began in 2014 with a focus on helping men overcome external reentry challenges: securing identification, arranging transportation, finding a job, and setting up housing. That first year was a mess. We found people jobs, but they didn’t show up for work. We obtained transitional housing, and clients went AWOL. We paid for bikes that were pawned and ordered birth certificates that were never claimed. The experience sent me on a journey to better understand why people end up in prison, and what reentry service providers can do to help them out stay out.

I recognize that identity documents, transportation, housing, and work are important, but they have little, if anything, to do with why a person went to prison. Some reasons are societal and systemic: lack of access to quality education, exposure to neighborhood crime and violence, and inequitable application of the law for the poor. There are also individual-level risk factors that increase the chances a person will go to prison and repeatedly return.

To describe risk factors causally linked to criminal behavior, scientists use the term criminogenic needs. Examples of criminogenic needs include impulsivity, aggression, a lack of problem-solving and self-control skills, anti-social peers, negative attitudes about work and authority, and substance abuse. Unless reentry programs tackle these types of risk factors head on, their outcomes will continue to fall short. But how can programs address these complex issues?

Cognitive behavioral therapy (CBT) is one answer. Through CBT, people are taught to identify and manage thoughts that contribute to emotional problems, altering their behavior in the process. CBT is a highly effective treatment for depression, anxiety disorders, alcohol and drug use, marital problems, eating disorders, and severe mental illness. It has also been shown to reduce violence and other criminal behavior across populations and settings. Every $1 spent on delivering CBT to adult offenders yields a savings of $6.31 in avoided criminal justice and associated healthcare costs, with a 97 percent likelihood that its benefits will exceed the cost of providing the service, according to the Washington State Institute for Public Policy.

CBT is the most effective research-tested strategy to change criminal behavior. Yet organizations aimed at helping people succeed after prison haven’t traditionally included its methods among their services. Their failure to do so is holding them back from providing effective, evidence-based solutions to an incredibly destructive problem.

Admittedly, incorporating CBT into reentry services isn't easy. First, it requires organizations to think carefully about how to engage people returning home from prison for the time needed to deliver an effective CBT program.

At Turning Leaf, we found a solution for engagement. By founding a social enterprise—a screen-printing business—we can place the men we serve in a paying job. Employing participants allows staff to spend significant time with them, presenting many opportunities to provide CBT to a high-risk population in a safe and controlled community setting. In addition to hiring our participants, we pay them a cash stipend for attending daily group therapy classes. The stipend increases motivation and holds people to high standards of engagement. It respects each man’s time, signals a high value placed on therapy, and pays daily living expenses so they can participate in therapy needed during the critical transition from prison to the community. Turning Leaf participants complete 150 hours of CBT in the first 10 weeks of the program.

This methodology is working for us. Prior to starting the print shop and our CBT program, more than half of our graduates were re-arrested and even more were unable to maintain employment. Now we’ve flipped the script. Only 22 percent of graduates are ever re-arrested and 84 percent are maintaining their employment for six months or more. We went from an organization having minimal to no impact, to one that is reducing national re-arrest rates by two-thirds.

We’re not the only ones in the field who see the value in pairing CBT and transitional work. READI Chicago, launched in 2017, has a similar model. As one of the country’s largest anti-violence programs, READI works with individuals at the highest risk of gun violence in an 18-month program pairing transitional employment with CBT and personal development coaching. Another example is Roca Inc. It combines CBT with outreach, behavioral health services, and employment opportunities—including work in Roca’s social enterprise—to help men leave risky lifestyles and go to work.

In addition to integrating CBT and transitional work, Turning Leaf, READI Chicago, and Roca share another important program design feature: Each organization is both the CBT provider and the employer. To ensure high-quality, consistent delivery of services, these critical program components should not be referred out to partner organizations. The more tightly integrated CBT is into other aspects of the program, the more effective it will be. Ideally, work and therapy take place in the same building, making it easy for participants to transition between the two.

Organizations interested in incorporating CBT into their portfolio of reentry services should start by running group classes. Group facilitation maximizes staff time and creates more opportunities for participants to learn and practice new skills through collaborative activities and role-playing. Content is delivered via a scripted curriculum, which improves an organization’s ability to formalize training, standardize services, measure quality, and replicate positive outcomes.

Turning Leaf has a proprietary CBT curriculum that centers around 25 specific life skills such as “saying no,” “setting boundaries,” and “managing aggression.” In one common exercise, participants take turns role playing real-life situations that have caused them problems in the past. At a critical moment in the role-play, the person stops to review a skill that could lead to a better decision and acts out the new behavior. The facilitator and classmates then give feedback. It’s this process of watching, practicing, and receiving feedback that helps a person begin to think and act differently.

Training centers like the University of Cincinnati Corrections Institute specialize in developing cognitive behavioral curriculum for justice-involved populations. The Thinking for a Change curriculum from the National Institute of Corrections (NIC) is another good choice. It costs nothing, and NIC offers virtual training, also free, for facilitators.

In addition to offering group classes, organizations should deliver CBT to participants in one-on-one sessions that provide the same thinking, problem-solving, emotion regulation, and social skills as taught in a group setting. However, individual sessions should focus on a person’s biggest needs, which can lead to greater skill development and reduced risk of relapsing back into criminal behavior. One-on-one sessions also help participants more quickly learn and apply the concepts discussed in group sessions.

CBT skills can be delivered anytime, anywhere. Teaching can take place in a more formal setting, such as a weekly case management meeting, or in a more informal setting, like the lunchroom, the street corner, or passing in the hallway. For organizations working with people at the highest risk of violence and arrest, this strategy may be the only way to deliver CBT initially. For example, Roca relies on street outreach workers to engage its target population: young adults who aren’t ready to participate in structured programming. The outreach workers bring CBT skills to participants in their homes and neighborhoods. Over time, the young adults are encouraged to participate in Roca’s other more formal services, such as group CBT classes and work in the program’s social enterprise.

Another resource for one-on-one CBT delivery comes from the Connecticut Opportunity Project, where Dr. Luana Marques and her team at Community Psychiatry PRIDE have designed a skills-based cognitive-behavioral curriculum, The TEB Skills.

Organizations wanting to provide CBT must consider if they have the right people on staff to deliver services. Teaching cognitive behavioral skills to people returning home from prison doesn’t require a counseling degree. It also doesn’t require having a criminal background or shared life experiences. It is mainly important that all staff members are capable of respecting, and earning respect from, program participants. The ability of staff to develop caring and trusting relationships is vital to authentic engagement and helping people to change their lives.

Although a formal degree is not required, organizations must be prepared to make a significant investment in training. All staff should learn CBT skills and support one another in practicing, modeling, and teaching them to program participants. One training resource, Effective Practices for Community Supervision (EPICS), aims to help probation officers influence their clients’ behaviors, but much of its approach can be applied in a community organization context. Staff should also be trained on Core Correctional Practices and Motivational Interviewing. People teaching CBT groups must also learn best practices in classroom behavior management and facilitation.

It’s not easy to design and implement a CBT program. It has taken several false starts at Turning Leaf to find the formula that works for us and the group of men we serve. Despite the challenges, reentry organizations that put in the sweat equity to incorporate CBT into their services will see massive long-term payoffs. As a society, we have even more to gain. One person who leaves prison and doesn’t go back is a win. Hundreds of thousands of people who never return is a game-changer in the effort to reform our criminal justice system.

Read more stories by Amy Barch.