VISITING EXPERTSʼPAPERSWOMENʼS RISK FACTORS AND NEW
TREATMENTS/INTERVENTIONS FOR ADDRESSING THEM:EVIDENCE-BASED INTERVENTIONS IN
THE UNITED STATES AND CANADA
Patricia Van Voorhis, Ph.D.

I. INTRODUCTION
By the end of the 1990s and well into the next decade, U.S. policy makers and practitioners wereexpressing a growing concern for dramatic increases in the number of women entering the U.S.
criminal justice systems (Buell, 2011). Increases in the number of women coming into prisons were
especially troubling. Between 1977 and 2004,the female incarceration rate grew by a staggering 757%.
This was twice as high as the growth in the male incarceration rate over the same period (Frost,Greene& Pranis,2006). Female community correctional populations also surged,30% between 1995 and 2010
in comparison to men where the comparative increase was 8.4% (Glaze & Bonczar, 2011).
Changes in United States sentencing policies were largely to blame for this increase. A number ofstates had promoted mandatory sentencing for drug offenders and reductions in funding for mental
health services (see Austin et al.,2001;M auer,Potler & Wolf,1999). Under the Clinton administration,social welfare reform legislation also led to increases in the number of women arrested and brought
before U.S.criminal courts. Women were not necessarilycommitting more violent crimes,but the legal
changes were more likely to address womenʼ
s offending behavior than menʼs,and they were also more
likely to affect the safety nets that were keeping them out of legal involvements (e.g., welfare andcommunity mental health services). Therefore, these laws were especially hard on women and thementally ill (Austin et al., 2001).
The rapid influx of female offenders drew strong attention to existing practices for dealing with
their offenses and treating the issues that brought them to court in the first place (Buell et al., 2011).
Indeed, correctional policies and procedures were ill-equipped to address the unique needs of women
offenders. Many scholars observed that there was an appalling lack of research on which to build
correctional approaches for women (Chesney-Lind, 1997;2000;Girls Incorporated, 1996;Holtfreder etal.,2004;Morash,Bynum,& Koons,1998;Van Voorhis& Presser,2001). Research informing innovative
practices was based almost exclusively on samples of male offenders, and all aspects of the correctional experience,including rules,treatment programs,and procedures for identifying offender risk
levels and program needs,were based on a male model. As a result the field of correctional treatment
was more relevant to men than to women. Women offenders were,at best,assumed to have the sameneeds as men―at worst they were ignored.
In the United States this situation is slowly changing. Largelythrough initiatives funded bythe U.S.
Federal government, new programs, policies, and assessments have been developed specifically for
women offenders. The National Institute of Corrections (NIC),an agency within the U.S.Departmentof Justice, was the primary driver of these changes. NIC improved correctional practices for womenin many ways. This paper focuses on the new assessments for women offenders and the new programs
that have emerged over the past 10 years.
By assessments we mean the assessments (or tests)that are designed to identify the needs that mustbe accommodated or addressed by a correctional agency. These are crucially important,because if we
Professor Emerita, University of Cincinnati. Authorʼs Note:Please address correspondence to Patricia Van Voorhis.
Email:Patricia.VanVoorhis＠uc.edu.

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153RD INTERNATIONAL SENIOR SEMINARPARTICIPANTSʼPAPERS
do not have a good picture of the needs ofeach correctional client,we do not know what services would
be most beneficial to them. Simply put,what we donʼt see we do not treat.When we do not appropriately assess clients,we do not know their needs and ultimately will fail to appropriately match clients toprograms and services. In such situations, some clients receive services that they do not need andothers do not receive services that they do need. This is expensive, because valuable program andtreatment resources are not used to their full potential. American correctional agencies have struggled
to solve the problem of mismatching clients to services and resources. The advent of good correctionalrisk and needs assessments has gone far toward correcting this problem.
At the same time, it is of little use to know what a client needs, if we have no programs andresources to address those needs. So the second part ofthis paper discusses new developments designed
to improve services and programs for women offenders. The two,assessments and programs/services
go together. The assessments tell us what is needed and the programs address identified needs.
Prior to the interest in gender-responsive approaches, a good deal of correctional research andinnovation had already taken place in the United States, Northern Europe, and Canada. Thesedevelopments went far beyond the role of simply punishing offenders to placing a high priority on
offender rehabilitation and behavioral change. Correctional agencies had a strong sense for what
needed to be done to change offender behavior. Programs were not successful in 100% of all cases,but
they could at least achieve reductions in recidivism that affected 20-30% of the correctional population(Andrews et al., 1990). M ost of this research was conducted on men, however, and that fact proved
somewhat problematic to the task of developing meaningful programs for women offenders.
Even so,it is important to recognize that two fundamental principles guided and continue to guidecorrectional treatment practices in the above-mentioned countries:
First, in order to achieve meaningful reductions in recidivism, it is necessary to confine
intensive services to medium and high risk offenders. This is known as the risk principle.
Taking it a step further, the research typically finds that directing intensive services to lowrisk clients makes them worse, and does so for many reasons;Second,in order to achieve success in changing offenders behavior,it is essential to target therisk factors for future offending. As with medical treatments, it makes little sense to target
a factor which is not relevant to a particular disease. This is known as the needs principle.
A. Gender-Responsive Risk Assessments and the Risk Factors They Identify1
We cannot address the risk and the needs principles without assessment tools for doing so. The
most important theme of any U.S.correctional assessment is the notion of risk. Risk assessments havebeen used since the 1950s. And “risk”is defined to mean risk of some offense-related outcome.
Therefore,risk assessments identify oneʼs risk of recidivism (new offense),risk of a prison misconduct,
or risk of violation of a condition of supervision. These assessments all involve the use of statisticallyderived assessments that predict an offenderʼ
s likelihood of recidivism or an inmateʼs likelihood ofserious misconducts. They provide a risk score that determines the custody level of oneʼs prisonassignment if incarcerated or level of community supervision if on probation or parole. Higher risk
offenders are assigned to higher security correctional facilities or more intensive levels of community
supervision and to more intensive correctional programming.
Our most recent risk assessments,conceptualize risk as the accumulation of risk factors or offenderneeds that are related to future offending. Since the assessments identify an array of predictive needs,
they also served as a valuable tool for triaging offenders into programs most likely to turn them awayfrom lives of crime. The early construction validation studies for these assessments were also basedlargely on male offender samples (e.g.,see Brennan,1998;Blanchette & Brown,2006;Holtfreder et al.,
2004;Van Voorhis et al.,2010)and validated on women much later than their initial construction (e.g.,
see Andrews et al., 2001;Holsinger et al., 2003;Manchak et al., 2009;Smith et al., 2009). By way of
1For purposes of this paper and discussion, the term risk factor refers to individual needs known to correlate with future

offending.

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RESOURCE MATERIAL SERIES No. 90
example, one such assessment, the Level of Service Inventory-Revised (Andrews & Bonta, 1996)
identified the following risk factors:
Criminal history
Employment/education
Financial
Housing/neighborhood situation
Alcohol/drug use
Family/marital
Emotional stability (mental health)Use of leisure time
Antisocial friends
Antisocial thinking
While the above list of risk factors, which will be referred to as gender-neutral risk factors2, may
seem comprehensive, gender-responsive scholars note the absence of assessment scales pertaining torelationships, depression, parental issues, self-esteem, self-efficacy, trauma, and victimization (Blanchette & Brown, 2006;Bloom et al., 2003;Brennan, 1998;Farr, 2000;Hardyman & Van Voorhis, 2004;
Reisig et al.,2006;Van Voorhis & Presser,2001). M ost troubling,is the fact that gender-neutral risk/needs assessments serve as a guide to program recommendations through the widely accepted andempirically supported needs principle (see Andrews & Bonta,20101984;Andrews,Bonta,& Hoge,1990;
Gendreau, 1996). As such, the omission of gender-responsive risk factors3 from current assessments
risked inattention to essential programming for women (Hannah-Moffat, 2009).
Research conducted byfeminist scholars pointed toward a pathways perspective to explain womenʼscriminal behavior. Qualitative studies of women offenders revealed lives of extreme poverty,limited
educational assets, mental illness (e.g., depression, anxiety, post-traumatic stress disorder), past andongoing abuse, self-medicating drug and alcohol abuse, dysfunctional and abusive intimate relationships,low levels of self-efficacy(self-confidence),and parental stress (see Arnold,1990,Browne,M iller& M aguin, 1999;Chesney-Lind & Rodregues, 1983;Daily, 1992;Gilfus, 1992;Owen, 1998;Richie, 1996).
A number of scholars were conceptualizing these risk factors in terms of “
womenʼ
s pathways tocrime”(Chesney-Lind & Rodrigues,1992;Daly,1992,1994). For example,a number of pathways wereconfirmed in Salisbury and Van Voorhisʼexamination of women probationers in Missouri (Salisbury& Van Voorhis, 2009):
i.

The Child Abuse Pathway found that self-reported child abuse was related to later probation
revocations and incarcerations through a pathway where child abuse led to depression andanxiety. Substance abuse was associated with the depression and ultimately linked tooffense-related failures. This pathway was also seen in M cClellan, Farabee and Crouchʼs(1997) longitudinal study of women offenders. A number of scholars document the cooccurance of substance abuse, mental health and abuse in women offenders (Langen &Pelissier, 2001; M essina, Grella, Burdon, & Prendergast, 2003; Peters, Strozier, M urrin, &Kearns, 1997).

ii. The Relational Pathway observed that some womenʼs paths to new offenses began withunhealthy intimate relationships,characterized by a limited personal power,low self-efficacy,
abuse, depression, and substance abuse. Prevailing models of psychotherapy for women
recognize that womenʼs identity, self-worth, and sense of empowerment are defined by thequality of relationships they have with others (Gilligan,1982;Kaplan,1984;Miller,1976;M iller& Stiver, 1998). Correctional scholars have also noted that many women offenders engage inco-dependent relationships that facilitate their criminal behavior (Koons,Burrow,M orash,&
Bynum, 1997;Ritchie, 1996). Because of the high rates of abuse, trauma, and neglect experienced by female offenders,their ability to recognize and achieve healthy,mutually empower2Genderneutral risk factors are risk factors that work as risk factors for both male and female offenders.
3Genderresponsive risk factors are risk factors for women but not men.

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153RD INTERNATIONAL SENIOR SEMINARPARTICIPANTSʼPAPERS
ing relationships is severely limited (Covington,1998).Family support and conflict also factor
into womenʼ
s relational concerns.
iii. The social and human capital pathway observed that some womenʼs paths to crime began withlimited support from families, unhealthy intimate relationships, and limited educational
accomplishments. Poverty is highly relevant to this pathway (Bloom, Owen, & Covington,
2003;Holtfreter, Reisig, & M orash, 2004).
Apart from the pathways research, additional concerns cited problems associated with mental
health, self-efficacy, and parenting:i.

Mental health:The mental health needs of female offenders differ substantially from those ofmale offenders. Depression, anxiety, and self-injurious behavior are more prevalent amongfemale offenders than male offenders (Belknap & Holsinger,2006;Bloom,Owen,& Covington,
2003;McClellan, Farabee, & Crouch, 1997;Peters, Strozier, Murrin, & Kearns, 1997), as are
phobic diagnoses (Blume, 1997), and co-occuring diagnoses such as depression and substanceabuse (Bloom et al.,2003;Blume,1997;Holtfreter & M orash,2003;Owen & Bloom,1995).One
study noted that rates of such diagnoses are nearly four times the rates for men (Blume,1997).
Stress,depression,fearfulness,and suicidal thoughts/attempts have shown to be predictors of
womenʼ
s recidivism (Benda,2005;Blanchette & Motiuk,1995;Brown & M otiuk,2005),but not
for menʼs recidivism (Benda, 2005). However, current risk/needs instruments either ignore
mental health,focus scales heavily toward psychotic disorders,or combine all symptoms into
a global scale. All approaches run the risk of masking the impact of womenʼ
s mental healthissues.

ii. Self-esteem and self-efficacy:Studies, mostly of male offenders, overwhelmingly indicate thatlow self-esteem,which was often aggregated into a categorydenoted “personal distress,”is nota risk factor for recidivism (see Andrews & Bonta, 2010 for a summary). However, thegender-responsive literature closely relates self-esteem to the notion of“
empowerment,”which
has been targeted by a number of correctional programs for women. Empowerment denotes
the process of increasing womenʼ
s self-esteem and internal locus of control (i.e.,the belief that
their lives are under their own power and control) (Task Force on Federally Sentenced
Women, 1990). These needs are often cited by correctional treatment staff, researchers, andwomen offenders themselves as critical to their desistance (Carp & Schade, 1992; Case &Fasenfest, 2004; Chandler & Kassebaum, 1994; Koons, Burrow, M orash, & Bynum, 1996;
M orash, Bynam, & Koons, 1998;Prendergast, Wellisch, & Falkin, 1995;Schram & Morash,
2002;Task Force on FederallySentenced Women,1990).Self-efficacy,distinct from self-esteem,4is oneʼsʼconfidence in achieving specific goals. Obviously self-efficacy is also relevant to thenotion of empowerment. Closely related to self-esteem, self-efficacy has been suggested as
playing a key role in womenʼ
s offending behaviors (Rumgay, 2004).
iii. Parental stress:Approximately 70 percent of women under correctional supervision have atleast one child under the age of 18,with an average of 2.11 children (BJS,1999). This coupledwith womenʼs economic marginalization and substance abuse often leads to stress and overwhelmed feelings about being able to take care of and provide for their children (Greene,
Haney, & Hurtado, 2000). M aternal demands may contribute to recidivism especially when
they are accompanied by:1) poverty, 2) substance abuse problems, and 3) minimal support.
Some studies with mothering offenders have detected a relationship between parental stressand crime (Ferraro & Moe,2003;Ross,Khashu,& Wamsley,2004). Similarly,Bonta,Pang,&
Wallace-Capretta (1995)found that women offenders who were parenting children alone weresignificantly more likely to be reconvicted than women raising children with partners.
Additionally,studies investigating the relationship between child contact and womenʼs prisonadjustment, find that stress associated with limited contact was related to higher levels of
4Although selfefficacy and self-esteem are conceptually distinct,our own studies found the two scales to have a veryhighcorrelation. As a result our studies only use the self-efficacy measure. Self-efficacy and self-esteem are empiricallyredundant.

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RESOURCE MATERIAL SERIES No. 90
mental illness (Houck & Loper, 2002;Tuerk & Loper,2006). Parental stress is perhaps at its
greatest among women who are threatened with the loss of child custody, a fairly common
occurrence since the passage of the Adoption and Safe Families Act of 1997.
In putting forward this research,a number of authors voiced concern for the fact that even the mostrecent gender-neutral assessments were created for men and applied to women with limited attention
to relevance and only later concern for validity. Additionally,the foundational research and even the
more recent validity studies did not test the factors that are put forward in the gender-responsive
literature (Blanchette & Brown,2006;Reisig et al.,2006;Taylor & Blanchette,2009).Thus,regardlessof whether gender-neutral assessments such as the LSI-r or the Northpointe Compas (Brennan,
Dieterich & Oliver,2006)were valid for women.it was not clear that they would be the assessments wewould have if we had started with women instead of men. Another objection regarded the treatment
priorities set forward by the proponents of the LSI-r and the prevailing models of evidence-based
correctional treatment. The authors asserted that treatment targeted to “the big 4”(i.e., a. criminal
history;b. criminal personality;c. criminal thinking, and d. criminal associates)should be prioritizedover other risk factors. They also recommended attention to “Central 8”(the big 4 plus family/marital,
education/employment, substance abuse, and leisure/recreation). All were key factors on the LSI-r(Andrews & Bonta,1996)and later the LS/CMI (Andrews et al.,2004)and referred to as “
criminogenic
needs.”
In supporting a more gender-responsive approach, scholars suggested that the gender-responsive
risk factors either were:(i)not typically seen among men;(ii) typically seen among men but occur at
a greater frequency among women;or (iii) occurred in equal frequency among men and women, but
affected women in uniquely personal and social ways that should be reflected in current correctional
assessments (e.g.,Chesney-Lind & Shelden,1992;Farr,2000;Funk,1999;Gavazzi,Yarcheck,& ChesneyLind, 2006;Holsinger, 2000;Holtfreter & Morash, 2003;Reisig et al., 2006;Salisbury & Van Voorhis,2009).
In response, the National Institute of Corrections (NIC) collaborated with the University ofCincinnati (UC)to conduct a multi-site research project to develop gender-responsive assessments for
women. The research built from two perspectives on offender rehabilitation:a)research by Canadianscholars Donald Andrews, Paul Gendreau, James Bonta, and others which stressed the importance ofassessing and treating dynamic risk factors (see Andrews & Bonta, 2010;Gendreau, Little & Goggin,
1996);and b)research by feminist criminologists (e.g.,Joanne Belknap,Kathleen Daly,Meda ChesneyLind, Barbara Bloom, Barbara Owen, and Stephanie Covington)stressing the importance of womenʼ
sunique “pathways”to crime.
Keeping to the prevailing correctional priorities in the U.S., it was important to demonstrate thatthe gender-responsive needs discussed above were,in fact,risk factors,predictive of future offending.
As noted above, correctional policy makers were not interested in the treatment of needs that, while
extremely unfortunate,were nevertheless unrelated to womenʼs criminal behavior. Therefore,the key
research questions of the NIC Womenʼ
s Classification Study were: (i) are gender-responsive needs
pertaining to trauma/abuse,mental health,self-efficacy,parenting,and relationships relevant to future
offending and other adverse correctional outcomes and (ii)does the addition ofgender-responsive items
to the gender-neutral items contained on current dynamic risk assessment instruments improvepredictive validity?
Using these foundations,the development of the Womenʼs Risk/Needs Assessment (WRNA)was a
joint effort of policy makers (representatives from NIC),researchers (scholars from the University ofCincinnati),and correctional treatment specialists (counselors,therapists,substance abuse counselors,and educators)from the M issouri Department of Corrections. This team drafted a series of questions
that became the WRNA. The assessment initially was tested in three sites (Maui, Missouri, andM innesota). M ore recently, the assessment was revalidated beginning in 2010 at three prison sites(Rhode Island, Missouri and Ohio), four probation sites (Ohio, Missouri, M innesota and Iowa), andRhode Island, Kentucky, Missouri and Ohio.
These studies found that some risk factors were shared by men and women (e.g., antisocial

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153RD INTERNATIONAL SENIOR SEMINARPARTICIPANTSʼPAPERS
associates and substance abuse)but that the gender responsive needs were also risk factors for future
offending. The importance of these factors varied by correctional setting, whether the sample was aprison sample,a probation sample or a prerelease sample. The scientific reports appear on a website
for the University of Cincinnati (www.UC.edu/womenoffenders)but a summary of the important risk
factors is given in Figure 1.
Figure 1
Risk Factors by Correctional Setting
Prisonsa

Pre-Releaseb

Probationc

Risk Factors that are Similar for Men and Women
Criminal history
Antisocial friends
Substance abuse

Criminal history
Employment/financial
Antisocial friends
Substance abuse

Criminal history
Employment/financial
Antisocial friends
Substance abuse

Gender-Responsive Risk Factors, Predictive for Women
Anger
Depression
Psychosis
Abuse
Unhealthy relationships

Housing safety
Anger
Depression
Psychosis
Abuse
Unhealthy relationships
Parental stress

Housing safety
Anger
Abuse
Parental stress

Gender-responsive Strengths
Self-efficacy

Family support
Self-efficacy

Educational assets
Family support
Self-efficacy
Parental involvementa The factors listed in this column were predictive of serious prison misconducts.
b The factors listed in this column were predictive of arrests/failures on parole.
c The factors listed in this column were predictive of arrest/failures on probation.

In addition to identifying the risk factors associated with offense-related outcomes in specificcorrectional settings,we also did not see the relevance of“
the big 4”to women offenders. That is,our
research does not recommend that antisocial attitudes,antisocial friends,and antisocial personality be
the most important treatment targets for women. If we had to choose a big 4 for women,it generally
would be employment/financial, substance abuse, parenting issues, and anger. Moreover, antisocial
thinking was seldom correlated with/predictive of womenʼsʼoffense-related outcomes. This was true
whether we used the UC/NIC measures of antisocial thinking or alternative measures. However,othercognitive processes, such as anger and self-efficacy, were highly predictive.
In sum,the NIC/UC research confirmed the earlier qualitative research and other studies conducted
on women offenders. In addition, the NIC/UC studies found that the gender-responsive needs madestatistically significant contributions to the earlier, gender-neutral assessments, indicating that theaddition of the gender-responsive risk factors made the whole process ofrisk assessment more accurate
for women then it would have been without the womenʼs needs.
B. Translating the Gender-Responsive Research into Practice
The effort to translate the womenʼs research and the assessment into practice required the further

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RESOURCE MATERIAL SERIES No. 90
development of the assessments, a case management model, specific programs, and the correctional
staff training protocols for all of the above. This section describes the Womenʼs Risk/Needs Assessment (WRNA)(Van Voorhis et al.,2010),the Women Offender Case M anagement Model (Van Dieten,
2008), and a number of programs designed to specifically address the risk factors discussed above.
These were developments occurring primarily in the United States and Canada from 2005 to thepresent.
Guiding all of these innovations was a policy document also funded by the National Institute ofCorrections. Recognizing the paucity of research on women offenders,NIC funded a broad review ofstrategies deemed appropriate to women offenders ― Gender Responsive Strategies: Research, Practiceand Guiding Principles for Women Offenders (Bloom et al., 2003). Among other contributions the
document identified six Gender-Responsive Principles for Women that guided most of the practices
developed later:i.

Gender Makes a Difference: Correctional practice must recognize that a broad spectrum ofsocial and environmental disparities exist between male and female offenders.

ii. Environments Must be Based on Safety, Respect, and Dignity: M ost women offenders havesuffered extensive physical,emotional,and sexual abuse. Correctional environments should betrauma-informed. They should be safe and trustworthy settings which facilitate behavioral
change and do not retraumatize women.
iii. Relationships are Central to Women: Correctional policies and practices should recognize theimportance of relationships in womenʼ
s lives and the fact that women, by nature, arerelational. Correctional practices should promote healthy relationships.
iv. Services Must be Comprehensive, Integrated, and Culturally Relevant: Holistic and culturally
sensitive services should address the intersection of needs commonly observed among women
offenders, rather than addressing each need in isolation of others.
v. Provide Opportunities to Improve Womenʼ
s Socio-Economic Status: Most women offenders livein extreme poverty, and many are single parents of minor children. Financial independence
should be a primary goal.
vi. Collaborate with Community Resources: A network ofcommunityresources should be available
to collaborate with correctional agencies and provide “wrap-around”services to women
offenders.
The following innovations were designed through U.S.government funding (primarily the National
Institute of Corrections) to address women offenders in ways that were consistent with the six
principles listed above.
1. The Womenʼs Risk Needs Assessment (WRNA)(Van Voorhis et al., 2010):
The WRNA,describe above,contains approximately 150 question on the following scales: criminal
history, antisocial thinking, educational needs, employment/financial, housing safety, antisocial
friends, anger/hostility, mental health history, current symptoms of depression, current symptoms of
psychosis,abuse/trauma,PTSD,substance abuse,relationship dysfunction,parental stress,and family
conflict. It also taps the following strengths: family support, self-efficacy, relationship support,
educational assets, and parental involvement.
The assessment is designed to assist in the development ofindividualized treatment plans for female
offenders. The intent is to help correctional practitioners to identify womenʼ
s risk factors and to linkthem to appropriate programs and services.To date it has been implemented in 23 jurisdictions within
the United States.
How is this assessment administered? What are our biggest challenges to training staff to administer the WRNA? The most important point to recognize in this regard is that the WRNA asks about48

153RD INTERNATIONAL SENIOR SEMINARPARTICIPANTSʼPAPERS
very private matters. Questions are far more personal than the questions required ofother correctional
assessments required. For example, prison inmates and community correctional clients were notaccustomed to be asked about trauma and abuse,intimate relationships,or parenting issues. To obtainvalid information from offenders, staff training had to stress the importance of having trustworthyinterviewers and good therapeutic relationships. Recognize,also that the interviewers typicallyare nottrained psychologists or social workers. Their training was in a helping,social services profession,but
typically not to the level of trained social workers or psychologists. Therefore it was essential to train
staff in the skills needed to develop clientsʼtrust. We encouraged interviewers to be empathic,
congruent, honest, and approachable. The interviewers had to demonstrate respect for the offenders
and be open to the information provided by offenders (Benjamin, 2001). We also had to remind them
about what constituted good listening skills.
In U.S. correctional agencies this as not as easy as it might seem. The goals of punishment andtreatment often conflict. Correctional counselors must maintain therapeutic relations while at thesame time setting limits, and imposing sanctions when rules are not adhered to.
A strategy called M otivational Interviewing (M iller and Rollnick (2002) was very relevant to thetask of training the WRNA Interviewers. The goal of motivational interviewing is to motivate
offenders to change. This is done by presenting a method of interacting with offenders that seeks tohelp offenders uncover and explore their own ambivalence to change. It is an alternative to arguing,
threatening,and other forms of coercion which seeks to draw out the offenderʼs intrinsic motivation tochange. Motivational Interviewing operates from five key skills:(i.)expressing empathy,(ii.)identify
client discrepancies (how bad behavior impedes life goals), (iii.) rolling with resistance (rather thanarguing),(iv.)supporting self-efficacy,and (v.)re-enforcing “change talk”. All of these strategies seek
to help offenders see the benefits of change. If the offender talks about steps she is going to take inorder to change,we call this “change talk”and reinforce it even if she is discussing a very small step.
If the client voices resistance,we accept it rather than argue with the client. Arguing with clients only
causes them to be more resistant.
2. Women Offender Case M anagement M odel (WOCM M)(Van Dieten, 2008)
The interview and the assessment are of little value if they are not used to plan a meaningful courseof treatment or therapy. In recent years a good deal of work has been done in the United States andCanada to develop structured processes of case planning and case management. There are now
deliberate efforts to train correctional counselors in how to do this properly. One approach that is
specific to women offenders is the Women Offender Case Management Model (Van Dieten,2008). Thiscase management process was also funded by NIC in collaboration with the WOCMM designers,Orbis
Partners of Canada. WOCMM works with correctional practitioners to develop comprehensive casemanagement skills for working with women offenders.
M otivational Interviewing (Miller and Rollnick,2002)is also embedded within the WOCMM model
because it is useful for purposes of counseling as well as interviewing. The WOCM M approach also
trains correctional staff to use strength-based and relationship-focused approaches with female
offenders. This is in keeping with emerging research on positive psychology(Seligman,2002,Sorbello
et al., 2002; van Wormer, 2001), which was finding many advocates among feminist criminologists(Blanchette & Brown, 2006;Bloom et al., 2003;Morash et al., 1998;Schram & M orash, 2002). The
strength-based models remind counselors that they should not always be dwelling on an offenderʼs
deficits, but should be building from strengths as well. For example, in addition to addressing an
offenderʼs substance abuse,we should also work with her strengths. If she has a supportive family,isan involved parent,possesses educational assets and self-efficacy,these are just as important for caseplanning purposes as her risk factors.
Finally,WOCMM requires the development of a network of community services. M ost correctional
agencies do not have the resources to address all of the risk factors noted in the assessments. In recent
years, for example, corrections has become the largest provider of mental health in the U.S. (Adams& Farrandino,2008). This should not be happening. The need to partner with mental health agencies
is obvious though not always successful. WOCM M sites are required to partner with educational,
employment,child welfare,substance abuse and social service agencies to address all ofthe risk factors

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RESOURCE MATERIAL SERIES No. 90
noted on the WRNA and addressed by the WOCMM . WOCMM was evaluated recently and found tohave favorable reductions in womenʼ
s recidivism (Orbis Partners, Inc., 2010).
3. Gender-Responsive Programs:
In addition to the assessment and the case management models,a number of specific programs havebeen developed to address some of the gender-responsive risk factors noted above (see Figure 2).
At the outset, there are reasons for selecting the programs shown in Figure 2. First, they areevidence-based. That is, evaluation research has found them to be effective in changing offender
behavior. Experimental studies found that women in these programs had lower post-program
recidivism than similar women who did not receive the program. Second,most of the programs listed
in Figure 2,are highly structured,with structured curricula detailed in staffmanuals,and rigorous staff
training requirements.
Figure 2
Gender-Responsive Interventions for Women Offender Populations
ProgramDeveloper

Theoretical Foundations
Relational
TraumaTreatment Targets

Beyond Trauma

Stephanie Covington

Coping with trauma
Cognitive skills
Healthy relationships
Self-efficacy
Sexuality
Body image
Spirituality
Support systems

Dialectical Behavioral
Therapy
Forever Free

M arsha Linehan

Cognitive-behavioral

M ental Health Systems, Inc.

Cognitive-behavioral

Helping Women
RecoverStephanie Covington

Relational
TraumaHolistic addiction

M oving On

Orbis Partners, Inc.
(Marilyn Van Dieten)

Relational
Cognitive-behavioral

Seeking Safety

Lisa Najavitz

Relational
TraumaHolistic addiction
Cognitive-behavioral

Substance abuse
Coping with trauma
PTSD (Post-traumatic stress disorder)

Women Offender Case
M anagement M odel
(WOCMM)

Orbis Partners, Inc.
(Marilyn Van Dieten)

Relational
TraumaCognitive-behavioral
Positive psychology(strength-based)

Case management and re-entry
Family and social support
Health and well-being

Coping and other skills
Motivational enhancement
Substance abuse
Healthy relationships
PTSD (Post-traumatic stress disorder)
Anger management
ParentingSelf-efficacy
Substance abuse
Coping with trauma
Healthy relationships
Self-worth
Sexuality
Body image
Spirituality
Support systems
Healthy relationships
Self-efficacy
Self-defeating thoughts
Antisocial attitudes
Cognitive skills
Stress management
Wrap around services
Using and knowing oneʼs community

Note: Although this program was not developed with an underlying gender-responsive perspective, it includes many of its
elements. Also effective with male offending populations.

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153RD INTERNATIONAL SENIOR SEMINARPARTICIPANTSʼPAPERS
One of the gender-responsive principles noted in Gender Responsive Strategies: Research, Practiceand Guiding Principles for Women Offenders (Bloom et al.,2003)advocated for wrap around services.
M ultimodal services are recommended for most offender populations (see Lipsey, 2009), but a very
popular program model tailors the notion to women offenders. Moving On (Van Dieten & M acKenna,2001)teaches women to access and mobilize varied communityresources. Consistent with the emerging
profiles of women offenders, Moving On also works with women to enhance strengths, build healthy
relationships,and target self-defeating thoughts. The program uses a cognitive behavioral psychological treatment modality. A matched comparison group study was recently completed among probationers in Iowa and found significant reductions in recidivism (Gehring et al., 2010).
Advocating for an approach to substance abuse that recognizes its co-occurrence with mental healthand trauma, Stephanie Covington developed a womenʼ
s substance abuse program, Helping Women
Recover: A Program for Treating Addiction (Covington,2008).The program builds from four perspectives on womenʼ
s addiction: these accommodate the importance of womenʼs pathways to crime,
relationship issues, and addictions co-occurring with mental health issues and trauma. Attention is
given to self-efficacy and the impact of sexism and trauma upon perceptions of the self and the self in
relationship with others. Program modules also discuss families of origin, healthy support systems,
sexuality,body image,and spirituality. A second program Beyond Trauma (Covington,2003)provides
information on trauma and its effects and then moves to the development of coping skills. Bothprograms use cognitive-behavioral approaches and exercises, along with psychoeducation, guided
imagery, and expressive art techniques. A recent randomized experimental study of both programs
administered sequentially found significantly lower return to prison rates for women in the twogender-responsive programs than those in the standard therapeutic model(M essina et al.,2010). Effects
on intermediate outcomes pertaining to psychological well-being have also been favorable (Covington
et al., 2008;M essina et al., 2010).
Two additional programs for addressing abuse and trauma, Seeking Safety (Najavits, 2002) andDialectical Behavioral Therapy (Linehan, 1993), were not developed specifically for offender populations. As such there are numerous studies, but all speak to favorable intermediate outcomes,such as
reductions in suicide attempts and drug use and improvements in treatment retention, mental health,and PTSD symptoms. Seeking Safety is a cognitive behavioral program for co-occurring disorders of
trauma/PTSD and substance abuse. Evaluation research shows favorable intermediate outcomes,but
it was not possible to locate any evaluations of the programʼs impact on offense-related outcomes(Najavits et al., 1998;Najavits et al., 2006). DBT is also a cognitive-behavioral approach involving
skills training, motivational enhancement and coping skills. The impact of DBT has been tested in a
number of treatment settings and found to have a number of positive intermediate outcomes (for asummary of evaluation findings, see Dimeff et al., 2002).
Another substance abuse program for women, Forever Free, targeted gender-responsive risk factors, such as self-efficacy, healthy relationships, abuse and trauma, and parenting. Forever Free
included a voluntary aftercare program. Services were multimodal and evaluation results showed thatthe program significantly reduced drug use and recidivism (Prendergast et al.,2002;Hall et al.,2004).
4. Improving Correctional Environments for Women:
An additional gender-responsive principle discussed in Gender Responsive Strategies: Research,
Practice and Guiding Principles for Women Offenders (Bloom et al.,2003)concerned the importance of
assuring that correctional environments are based on safety,respect,and dignity.Recognizing that the
majority of incarcerated women offenders have been abused as children and adults, authorities muststrive for correctional environments that do not re-traumatize women. Of course this is difficult incorrectional agencies that were designed for purposes of punishment, underfunded, and built toreplicate facilities and practices used for male offenders. As programs move toward gender-responsiveorientations, however, it has become important to guide agencies in the development of genderresponsive milieus.
Prison assessments have become very valuable in this regard. Such assessments involve teams ofoutside experts (e.g.,psychologists,medical practitioners,policy makers,and administrators)evaluating specific prisons for their adherence to gender-responsive principles. The most well-known assess-

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RESOURCE MATERIAL SERIES No. 90
ment of this type is a structured tool developed by NIC cooperatively with the Center for Effective
Public Policy (CEPP). This tool, the Gender-Informed Practices Assessment (GIPA) (Center for
Effective Public Policy, 2010)evaluates prisons on 12 domains shown in Figure 3.
The GIPA process involves the outside experts in a week-long site visit that includes focus groups
with administrators, staff, and inmates. Observations are made of the prison architecture, treatment
programs,staff meetings,classification procedures,disciplinary procedures,medical and mental healthfacilities, living quarters, educational classrooms, and other functions. GIPA team members preparecomprehensive reports, with recommendations in pertinent to all of the domains noted in Figure 3.
When used to its full potential, the GIPA is the starting point for strategic planning of a wide rangeof improvements to the evaluated agencies and facilities.
Figure 3
Gender-Informed Practices Assessment (GIPA) Domains (CEPP, 2010)
Domain 1: Leadership and Philosophy
Addresses the extent to which executive leadership and facility management demonstrate commitment to both
evidence-based and gender-informed practice for women offenders in critical ways.
Domain 2: External Support
Examines the external support from system stakeholders, funders, and community partners for the agencyʼ
smission regarding gender-informed and evidence-based practices for women.
Domain 3: Facility
Examines multiple aspects of a facilityʼ
s location, physical design, and conditions with regard to their genderappropriateness for women.
Domain 4: Management and Operations
A frequent challenge to administrators responsible for female offenders is the integration of gender-informed
practices in every aspect of operations with the facilityʼs security requirements.
Domain 5: Staffing and Training
A well-run facility is grounded in a workforce that is committed to the facilityʼ
s mission, and hired and trained
to carry out the daily requirements of gender-informed practice. In difficult budget times, agency and facility
leadership are challenged to value and maintain a commitment to gender-responsive training and staff development.
Domain 6: Facility Culture
Examines the facility environment and assesses the extent to which inmates and staff feel physically andemotionally safe and respected.It also explores the “reporting culture”of formal and informal methods to reportsexual, physical, and emotional abuse.
Domain 7: Offender M anagement
The offender management domain examines the gender-appropriateness and clarity of rules and expectations,themethods for motivating positive behaviors, and the disciplinary practices of the facility.
Domain 8: Assessment and Classification
Examines gender-informed procedures for determining custody level, assessing dynamic risks and needs, andidentifying vulnerable and predatory inmates (PREA draft standard).
Domain 9: Case and Transitional Planning
Appropriate case and transition planning involves a process of addressing inmatesʼindividual and unique needs,
particularly those that impair humane prison adjustment and those that are related to future offending (i.e.,risk
factors, criminogenic needs). The role of case management in this process is to match women to programs andservices according to their assessed need for such services.
Domain 10: Research-Based Program Areas
Examines each of the core programs of the facility along six dimensions:gender-responsive intent,evidence-based
foundation, availability of manuals and treatment guides, use of clear criteria for program eligibility, efforts tomonitor outcomes, and quality assurance.

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153RD INTERNATIONAL SENIOR SEMINARPARTICIPANTSʼPAPERS
Domain 11: Services
Reviews six critical service areas with regard to important attributes of gender-informed practice.The six areas
are medical, mental health, transportation, food, legal services, and victim services.
Domain 12: Quality Assurance and Evaluation
Explores the extent to which the agency and facility use quality assurance methods to review and improve allfunctional units.

II. CONCLUSION
In sum, a number of innovations have been developed in the United States and Canada to better
address the needs of women offenders. M ost of those presented in this paper have been successfully
tested in experimental research and could be considered to meet the standard of evidence-based(M acKenzie, 2006).
Although,these approaches are specific to women,there are a number of evidence-based guidelines
initially identified in research on male offenders which on later investigation were found to apply towomen as well. These should be mentioned as well. Most importantly,perhaps,the risk principle has
been found to apply to both men and women.The risk effect (an interaction between risk and intensive
treatment)has been found in evaluations of two intensive gender responsive programs (Gehring et al.,2010;Orbis Partners, 2010) and one evaluation of gender-neutral halfway houses across the State of
Ohio (Lovins et al., 2007). That is, even with women, high risk offenders have better treatment
outcomes in intensive programs than low risk offenders. M oreover, what too often gets ignored inpolicy formulations of the risk principle is the fate oflow risk offenders who have worse outcomes evenin state of the art, “evidence-based,”programs than they might have had if we had not intervened or
brought them further into the justice system. By definition, low risk offenders have many pro-social
influences in their lives. These women may need less intensive interventions for fewer needs,but theyalso will benefit, where possible, from ongoing contact with the prosocial influences in their lives(Salisbury et al., 2009). Even so, policy makers must recognize and respond to the fact that high risk
women, in the aggregate, are not as dangerous or as likely to recidivate as high risk men.
Second, many of the innovative programs noted in Figure 2 conform to a cognitive-behavioral
psychological modality which, with appropriate modifications, is successful with both males andfemales (Blanchette & Brown,2006). Of course,policy makers and practitioners must also continue tovalue the importance of treatment integrity and constructive therapeutic relationships, regardless ofgender (see Van Voorhis & Salisbury, 2013).
In closing, it is important to note that although strong innovative practices have been funded anddeveloped,we experienced many setbacks. Women offenders were neglected for decades,in research,correctional policies and practices. Even with gender-responsive,evidence-based approaches it is still
difficult to secure the interest of policy makers and practitioners to bring forward meaningful change
for women offenders. These challenges will be discussed in the Wednesday presentation to UNAFEI.

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