Week 3 Implementation of ACT in Correctional and Forensic Settings PDF

Journal of Contextual Behavioral Science 22 (2021) 44–51 Contents lists available at ScienceDirect Journal of Contextual Behavioral Science journal homepage: www.elsevier.com/locate/jcbs Practical Innovations Implementation of ACT in correctional and forensic settings Amie Zarling *, Roxann Scheffer...

Journal of Contextual Behavioral Science 22 (2021) 44–51 Contents lists available at ScienceDirect Journal of Contextual Behavioral Science journal homepage: www.elsevier.com/locate/jcbs Practical Innovations Implementation of ACT in correctional and forensic settings Amie Zarling *, Roxann Scheffert Iowa State University, USA A R T I C L E I N F O A B S T R A C T Keywords: Acceptance and commitment therapy Implementation Corrections Forensics In this practical innovations article, we describe how a research-practitioner collaboration has led to statewide implementation of ACT-based programs within Iowa’s correctional system. We outline how ACT fits well with principles of effective correctional interventions, such as risk-needs-responsivity and core correctional practices. We contend that ACT is also well-suited to address the challenges inherent in correctional practice, such as establishing an effective working alliance with clients and navigating dual roles of control and support. The barriers to implementation, such as staff buy-in, correctional policies, and training are explored. We discuss the partnership and lessons learned throughout this journey, and identify remaining issues in our work to promote the fidelity and sustainability of ACT-based programs in corrections. 1. Correctional populations and evidence-based programming An estimated 6,410,000 persons were held in prisons or jails or were under probation or parole supervision in 2018 in the United States (Maruschak & Minton, 2020). Individuals who have been involved with the criminal justice system are often high risk for repeat criminal behavior, mental health problems, significant relationship distress, low social support, and severe substance abuse (e.g., Bui et al., 2019). However, the implementation of effective interventions and rehabilita­ tive programs for these individuals is often challenging due to the punishment and control-oriented culture of corrections. Although correctional policies and procedures have long vacillated between punishment and rehabilitation, the 1970s began an era of mass incar­ ceration and intense surveillance in the community, and correctional agencies evolved to focus on compliance, monitoring, and enforcing rules (e.g., Skeem & Manchak, 2008). Research over the last several decades has shown that this punitivelyoriented system is ineffective. Rather than enhancing public safety, approaches that emphasize surveillance and control without incorpo­ rating treatment actually decrease the chances that justice-involved in­ dividuals will be successful in desisting from criminal behavior (Viglione et al., 2018). In light of these findings, rehabilitative goals re-emerged during the 1990s and treatment programs were developed. However, these efforts did not relinquish the prior emphasis on control and pun­ ishment, but instead integrated treatment with these practices (e.g., Taxman, 2008). In support of the resurgence of rehabilitative ideals, researchers and stakeholders have aimed to help shift the pendulum toward rehabilita­ tion by identifying evidence-based practices (EBPs), which involve policies and practices that have been proven empirically to best meet pre-determined goals including successful completion of supervision and reduced risk of recidivism (Guevara & Solomon, 2009). After a period of time when the field of corrections was plagued by programs and paradigms based on “common sense” approaches and “correctional quackery” (Latessa et al., 2002), there is now a well-established body of research known as the “what works” literature. This literature indicates that programs adhering to the principles of risk, need, and responsivity (RNR; Andrews & Bonta, 2010) are the most effective at reducing recidivism. The risk principle states that the intensity of treatment should be matched to the client’s risk level, with high-risk clients receiving the most intense services. The need principle states that effective programs should target criminogenic needs or needs that are crime producing, such as the client’s psychological, social, and emotional functioning linked to the development and continuation of criminal behavior (e.g., antisocial attitudes, antisocial peers, substance abuse, unemployment). The responsivity principle refers to how service providers can maximize the client’s ability to learn from the rehabili­ tative intervention and states that effective programs should be (a) cognitive behavioral in nature (i.e., general responsivity), and (b) tailored to the learning style, cognitive ability, motivation, personality, and cultural background of the client (i.e., specific responsivity). Within the RNR framework, the importance of establishing an effective working alliance with the clients, which is characterized as “firm, fair, and caring,” remains central to influencing change among * Corresponding author. Iowa State University, Department of Human Development and Family Studies, 1358 Palmer Building, Ames, IA, 50011, USA. E-mail address: [email protected] (A. Zarling). https://doi.org/10.1016/j.jcbs.2021.09.006 Received 11 July 2021; Received in revised form 23 September 2021; Accepted 25 September 2021 Available online 29 September 2021 2212-1447/© 2021 Published by Elsevier Inc. on behalf of Association for Contextual Behavioral Science. A. Zarling and R. Scheffert Journal of Contextual Behavioral Science 22 (2021) 44–51 justice-involved individuals (e.g., Kennealy et al., 2012). This is similar to the therapeutic alliance in the general psychotherapy literature, which is deemed the quintessential integrative variable across all psy­ chological treatments (e.g., Wolfe & Goldfried, 1988). Consistent with this perspective, there has been a recent emphasis on Core Correctional Practices (CCPs; Dowden & Andrews, 2004), a set of skills for correc­ tional practitioners to help guide them how to establish high quality relationships with their justice-involved clients. CCPs include focusing on a working relationship between practitioner and client, prosocial modeling, effective reinforcement, effective disapproval, effective use of authority, structured skill building, cognitive techniques, and problem-solving. Indeed, CCPs have been shown to help the therapeutic potential of rehabilitation programs and enhance positive outcomes for justice-involved individuals (e.g., Chadwick et al., 2015). Consistent with RNR and CCPs, almost every review of EBPs in corrections recommends the application of cognitive-behavioral (CBT) programs, as they have shown the greatest impact on reducing repeat criminal behavior (e.g., Landenberger & Lipsey, 2005; Wilson et al., 2005). Within corrections, CBT programs vary in their purpose and emphasis; some are focused on life skills and preparing justice-involved individuals for life after prison, some are focused on the index criminal offense of the individuals, such as substance abuse or domestic violence, and some are focused on trauma or mental health needs. However, almost all programs implemented in correctional or forensic settings prioritize the reduction of future criminal behavior. Acceptance and commitment therapy (ACT; Hayes, Stroshal, & Wilson, 1999) is a cognitive-behavioral approach, and a unified model of human behavior change and psychological growth. ACT has recently been implemented with justice-involved individuals and there is tenta­ tive but increasing evidence for its effectiveness in correctional and forensic settings (Byrne & Ghráda, 2019; Zarling et al., 2019, 2020). Although the studies that have been done exhibit small sample sizes and/or methodological shortcomings, the application of ACT in correctional and forensic settings is relatively new and these smaller un-funded studies are needed before larger and funded studies can be implemented. Correctional settings pose unique challenges for interventions based on the ACT model. In fact, any EBP is going to face challenges in cor­ rections, and many experts have outlined the barriers and lessons learned during the adoption of EBPs in correctional settings (e.g., Latessa, 2004). Models exist for implementing EBPs in criminal justice systems, including those that outline the necessary components required for successful execution, such as fidelity, sufficient scale, and sustain­ ability (e.g., Alexander, 2011), and others that delineate how to assess organizational capacity that may affect the ability to move science-based findings into practice (e.g., Taxman & Belenko, 2012). However, despite this, there are far too few examples of successful implementation of EBPs in corrections. Drawing on experiences of a researcher-practitioner partnership and the statewide implementation of ACT in the Iowa Department of Cor­ rections (IDOC), this article aims to address some of these challenges of implementing EBPs as they relate to ACT specifically. While the chal­ lenges to each correctional or forensic location can be unique, this article aims to discuss some of the common features found in these settings as they relate to the implementation of ACT-based programs. First, we will give an overview of the project, outline how organizational capacity and initial buy-in was important to getting it off the ground, and describe the logistics of the ACT-based programs and how they integrate with RNR and CCP. We discuss correctional philosophy and policies and their impact on implementation, as well as methods and challenges of training staff and establishing fidelity and competency. We then give a summary of current evaluation and research efforts and needs for future research. 2. Overview of the project 2.1. History The IDOC, a nationally recognized leader in corrections for innova­ tion and implementation of evidence-based practices, covers the 99 counties in the state including 9 prisons and 8 judicial districts. The judicial districts are independent public agencies and each provide correctional supervision and services in a community setting as an alternative to jail or prison. This includes probation or parole supervi­ sion, as well as residential facilities that provide 24 h supervision of individuals on probation or work release. The IDOC central adminis­ trative office provides oversight and support services statewide for prisons and districts in areas such as training, research, assessments, programming, victim services, continuous quality improvement, and accreditation. See Fig. 1 for each location of the prisons, residential fa­ cilities, and community-based administrative offices. There are dozens of additional community-based implementation sites, such as probation and parole field offices, that are not depicted in Fig. 1. The original adoption of ACT-based programs within the IDOC began with programming for individuals convicted of domestic assault. Since 1991, state law indicates that the sentencing for these individuals in­ cludes a court order to complete a “batterers’ intervention program” (BIP) in lieu of incarceration. There are currently over 2000 BIPs in the U.S., and hundreds of thousands of individuals are ordered to BIPs each year by U.S. judges. The traditional BIP curriculum used nationwide is called the Duluth Model Men’s Nonviolence Classes (Pence & Paymar, 1993). In Iowa, BIPs usually occur in community-based corrections; however if the individual does not complete the program in the com­ munity (violating the court order) and/or has been convicted of do­ mestic assault 3 or more times, the person may be incarcerated and the programming would occur in the prison. In 2009, the IDOC central administration conducted an internal evaluation that revealed traditional domestic violence programming did very little to improve domestic assault recidivism compared to no treatment at all. It was then that the IDOC central office program coordinator, in conjunction with program coordinators from each dis­ trict, sought to develop a new BIP through a collaboration with uni­ versity researchers and clinical psychologists. Based on a study indicating preliminary success of an ACT group program treating aggression (Zarling et al., 2015), a new program was developed in consultation with criminal justice practitioners to serve as the BIP required by law. This effort spanned several years and also included input from victims of domestic violence as well as the participants Fig. 1. Iowa department of corrections: ACT implementation sites. 45 A. Zarling and R. Scheffert Journal of Contextual Behavioral Science 22 (2021) 44–51 themselves. By jointly developing procedures with stakeholders and partners, which included IDOC administrators, correctional practi­ tioners, funders (Department of Justice and the Center for Disease Control), and victim advocates, the goal of university researchers was to create an ACT-based intervention that was culturally responsive, ecologically valid, and acceptable to all stakeholders. After initial training and implementation of the domestic assault program, ACT became the preferred model of treatment delivery by both staff and participants. By 2015, ACT-based BIPs were running in all 8 districts. Additional ACT programs were then developed by the first author and implemented in the prison setting, as well as for other populations in need of correctional programming, such as justiceinvolved women in residential facilities. At the current time in Iowa, over 190 ACT-based groups are running across 25 field offices, 18 res­ idential facilities, and 9 prisons facilitated by approximately 300 staff members. In total, over 500 staff have been trained in the ACT model since 2010. Over 15,000 justice-involved individuals have participated in ACT-based programs since their inception a decade ago. It is important to note that the ACT-based programs discussed herein are part of a multi-faceted approach to treatment and rehabilitation within correctional services. They are just one of many services available to justice-involved individuals, including but not limited to regular contact with case managers, substance abuse treatment, and career/ employment or educational services. The ACT-based group programs are not meant to be a replacement for therapy or other psychological ser­ vices for individuals with severe mental illness or substance use. In­ dividuals are referred to psychologists (in the prison) or to outside providers (in the community) if they are assessed to have therapeutic needs that cannot be met with the ACT-based group programming, and/ or if the group environment is not suitable for their needs. the support of management and administration is important, similar buy-in is needed from line staff, so these challenges were addressed in several ways. First, we listened to line staff’s personal experiences and qualitative narratives of direct field applications. They became an invaluable partner in the treatment development process. Our experi­ ence aligns with research on organizational change that indicates when staff are included, they are more likely to understand, accept, and implement change (e.g., Taxman & Belenko, 2012). Second, resistance to the ACT philosophy usually dissipated after we listened to and vali­ dated the concerns of line staff, and when they experienced firsthand how it worked with clients. The most common observation of line staff was that the group participants were less resistant and more open to listening because the ACT-based program was not confrontational or forceful. Third, researchers and clinicians worked closely in collabora­ tion with line staff during the implementation of pilot groups. Ongoing supervision was done in a spirit of teamwork and collaborative problem-solving, which was essential to the success of the dissemination efforts. The result was curricula that closely reflected both researcher and practitioner expertise and interests. The line staff who facilitated the initial pilot groups became champions of the program, which helped greatly with overall acceptance and buy-in. In sum, the success of this project was due to trust between the correctional practitioners and the researchers/clinicians, and a heavy reliance on one another’s contributions to the project’s goals. There was a mutual desire of researchers and practitioners to improve program­ matic outcomes. Both sides were willing to collaborate and compromise and were willing to learn from the collaboration and make changes accordingly. The initial partnership focused on development and implementation, and was solidified and moved to one of dissemination and sustainability once initial outcome data showed the ACT-based programs were successful and reduced recidivism compared to tradi­ tional programming (e.g., Berta & Zarling, 2019; Zarling et al., 2019; 2020). For example, one year post-program, participants who completed the ACT-based program were re-arrested for domestic assault at half the rate of participants who completed the Duluth program (Zarling et al., 2019). Description of the ACT-Based Group Programs and Their Context. The ACT-based programs that have been implemented within the IDOC are based heavily on ACT principles, and designed with a specific focus on feasibility and transferability to the various correctional set­ tings. The group programs were designed so they can be facilitated by paraprofessional correctional staff and can be utilized with open (i.e., rolling admissions) or closed (i.e., cohort only) groups. Most groups do utilize the open format, allowing participants to join at any time. This method assists with buy-in because those that are further along in the program model what they have learned for the new participants, which helps reduce resistance. The groups are facilitated by two correctional staff and generally have 12–15 participants. Just as ACT as a therapy is transdiagnostic, its use in the correctional setting is extremely flexible and is applicable to a wide range of criminal justice populations. Groups are 90 min on average, and take place once a week in the community and twice a week in prison. Others have done a wonderful job writing about applying ACT material to correctional populations (e.g., Amrod & Hayes, 2013) so we won’t go into detail about each session here but rather highlight key pieces. The core ACT skills of the program are taught in 8 sessions, and most importantly focus on values identification and exploration first. Devel­ opmentally, a large portion of justice-involved individuals are delayed in the process of identifying their values and finding their purpose. The number of adverse childhood experiences in their histories is often astonishing, averaging about 4–5, which is significantly greater than most of the population. Many of them have suffered abuse, racial discrimination, poverty, violence, and family conflict, all of which have been shown to predict difficulty establishing purpose (e.g., Baglivo, et al., 2014). Justice-involved clients are typically fully engaged in values conversations and respond positively; many say they have never 2.2. Organizational capacity and initial buy-in The overall organizational capacity and readiness to change played a significant role in the implementation and support of ACT-based pro­ grams. Due to shrinking budgets available for treatment and the unique implementation barriers of correctional settings, it is critical that efforts for adding or improving programs be conducted in a context that is optimal for adopting, implementing, and sustaining change. As described above, as an organization, the IDOC was ready and willing to adopt a new domestic violence program. That required a massive statewide effort of coordination among all 8 judicial districts; the success of this effort provided the basis for a strong shift within the IDOC toward ACT-based programs. Initial implementation challenges did occur. Early meetings with stakeholder groups were often tense and lacking collaboration. A frequent concern at the beginning was that ACT would not hold the justice-involved individuals accountable. This concern was addressed by having conversations about what accountability means and how ACT promotes accountability in a different way than other programs. For example, traditional programs often “confront denial” and require that the program participants admit to their crime before they can continue. We examined the function of this method and explored the possibility that the participants admitting to their crime was in service of the staff’s own “sense-making,” as there is little empirical basis for this method predicting positive programmatic outcomes. Discussions about ACT and accountability focused on ACT’s goal to gradually chip away at experi­ ential avoidance and increase acceptance of difficult feelings (such as shame and guilt), and allow the justice-involved individuals to take accountability for their actions on their own values-based terms. Another challenge emerged with the resistance of line staff, who are the ones actually on the ground delivering the interventions but not involved in decisions about what programs to implement. They under­ standably expressed resistance to learning another program, some of which was specific to ACT and some of which was related to the fact that they already had to keep up on several other programs. Although having 46 A. Zarling and R. Scheffert Journal of Contextual Behavioral Science 22 (2021) 44–51 thought about or have previously been asked what is important to them. They appreciate the interactive nature of the conversation and how the process fosters a nonjudgmental and collaborative environment. Ulti­ mately, values exercises and conversations are viewed as ways to build client investment in the process of treatment. This is consistent with and complementary to motivational interviewing, which is an approach that has been successful with justice-involved individuals (McMurran, 2009). The core ACT skills are then supplemented with additional content such as substance use, parenting, relationship skills, and trauma. The nature and extent to which these topics are covered differs based on the population and setting. For example, men convicted of domestic violence receive program content traditionally used in “batterers inter­ vention” programming, such as identifying abusive behavior and prac­ ticing communication skills, while also engaging in more ACT-specific exercises such as confronting toxic masculinity (e.g., defusing from rigid beliefs about what it means to be a man), fatherhood (e.g., identifying the kind of parent one wants to be), and trauma history (e.g., awareness and acceptance of adverse experiences and how they impact life now). Incarcerated individuals who are nearing release from prison receive program content related to successful reintegration back into the com­ munity; sessions are focused on applying ACT skills when encountering opportunities and challenges that come with reentry like finding employment, establishing prosocial friendships (and avoiding antisocial peers), and dealing with strained family relationships. Finally, gender responsive ACT programming for justice-involved females includes more attention to criminogenic needs that have been shown to be particularly salient for women, such as parenting, mental health, re­ lationships, and substance abuse (e.g., Van Voorhis et al., 2010). ACT programs implemented within the IDOC have received high acceptability marks from both correctional staff and participants alike. Exit surveys from participants indicate that they rate the program favorably and often state that they wish they would have learned the program material a long time ago. They commonly report that the interaction and engagement is their favorite part of the program, and that they appreciated not being judged or lectured by the facilitators. Correctional practitioners, for their part, report that learning ACT and facilitating the program has positively influenced their lives, both personally and professionally, and reinvigorated their work in corrections. clients will have the same needs. The programs are modified depending upon the age, risk level, and behavioral health needs of participants. The responsivity principle refers to how service providers can maxi­ mize the client’s ability to learn from the program. General recom­ mendations are for justice-involved individuals to receive cognitive behavioral programming, and to have the program matched to their learning style and/or to have barriers to their learning addressed. The responsivity principle is where ACT’s flexibility is well-suited to the heterogeneity of justice-involved populations, compared to the one-sizefits-all model of traditional interventions. By design, ACT facilitators do not make assumptions about the causes of any one person’s behavior, but rather have the clients notice and identify the antecedents and consequences of their own individual behavior while using their per­ sonal experiences as fodder for group discussion and skills training. For criminal justice practitioners facilitating ACT programs, CCP principles provide complementary information on how to effectively work with justice-involved individuals. In particular, ACT focuses heavily on the facilitator stance (and relationship building with the participants), which corresponds nicely with CCPs’ extended guidance on how to develop a quality interpersonal relationship with justiceinvolved individuals. CCPs and ACT both encourage facilitators to possess relationship skills such as being warm, open, nonjudgmental, empathetic, flexible, and engaging. In addition, the specific CCPs of prosocial modeling, effective reinforcement, effective disapproval, and effective use of authority are all consistent with how ACT programs are facilitated. However, this is all easier said than done; unlike with traditional psychotherapy clients, justice-involved individuals are likely to be involuntarily enrolled in treatment or mandated to participate in programming (making them less motivated and more resistant), and their pervasive trauma histories make forming an alliance difficult. Moreover, unlike psychotherapists, practitioners who work with justiceinvolved clients in the correctional setting are expected to be both social worker and cop, referee and coach; they must balance being a facilitator of prosocial behavior change while also engaging in surveillance and rule enforcement (e.g., Lovins et al., 2018). We will discuss the working alliance and training correctional staff in more detail below. Where ACT and CCP may appear to diverge is in the area of specific programmatic techniques; in particular, cognitive restructuring and problem-solving are not explicit components of the ACT model. Rather than being a focus of ACT curricula, other techniques are used more frequently. Facilitators are encouraged to teach skills specific to ACT (acceptance, defusion, present moment awareness, discerning values, etc.) and notice how they work. For example, instead of cognitive restructuring, defusion is a skill taught in ACT to see thoughts as tran­ sient and questionable verbal events that need not contribute to criminal behavior. When training staff, it is key to focus on how ACT merges with CCP principles. Justice-involved individuals often do need legitimate problem-solving conversations, and practitioners are encouraged to continue to problem-solve things that can be solved and controlled (e.g., how to search for a job when one has a criminal record, how to get apply to get custody of one’s kids, etc.) instead of things that can’t be controlled (e.g., thoughts, emotions, the actions of other people, etc.). 3. Integrating ACT with RNR and CCP As outlined above, RNR and CCP are evidence-based principles that are designed to enhance therapeutic potential and integrity of correc­ tional programs. ACT complements these principles well and enhances their use. Per the risk principle, more intensive interventions should be reserved for higher-risk individuals, and intensive treatment for low risk individuals often increase failure rates (e.g., Sperber, et al., 2013). In addition, high risk and low risk individuals should not be mixed in the same group program, as this can result in a contagion effect (e.g., Lowenkamp et al., 2006). Thus, whenever possible, different dosages of treatment should be used depending on risk level, and high and low risk individuals should be in separate groups. We are currently implement­ ing various dosages of ACT-based programs within the IDOC and eval­ uating their differential impact based on risk level. For example, 12 session ACT programs for low moderate risk, 24 session ACT programs for moderate high risk, and 36 session ACT programs for high risk individuals. The need principle states that effective programs should target criminogenic needs or needs that are crime producing, as well as prioritizing interventions such that time is not spent on noncriminogenic needs (e.g., low self-esteem, creativity, medical needs, or physical conditioning). As mentioned above, different ACT programs have been implemented by the IDOC to address different populations and their various criminogenic needs, while also recognizing that not all 3.1. Correctional philosophy and policies Implementation of EBPs in correctional settings is challenging (e.g., Viglione, 2017), and ACT is no exception. A lot is required to fully embrace a model like ACT in a traditionally authoritarian and punitive environment. There are many aspects of correctional agencies that are not conducive to the philosophy of ACT, and initial efforts to dissemi­ nate ACT programs in the IDOC bumped up against challenges relating to rules and policies that were (or appeared to be) antithetical to ACT. For example, rules surrounding program attendance and behavior dur­ ing group sessions were stringent, and adherence was often difficult for clients. Often, program participants were penalized for displaying the exact behavior that initiated their need for in the program in the first 47 A. Zarling and R. Scheffert Journal of Contextual Behavioral Science 22 (2021) 44–51 place. For participants on probation or parole, some judicial districts had requirements for financial resources (e.g., payment being required before one can attend the program sessions), behavioral stability (e.g., following all probation/parole requirements), and sobriety (e.g., cannot attend the program under the influence). These were expectations that the justice-involved individuals frequently could not meet. Moreover, at times punishment for not following these rules (e.g., being administra­ tively dropped from the program) further exacerbated the aforemen­ tioned problems. In the prison, the group program participants often needed to sign a contract that included rules such as, “I must be completely honest in group and actively participate in group sessions to the satisfaction of staff.” The implementation of ACT-based programs in the prisons included revising these contracts to remove coercive language. From an ACT perspective, it is helpful if program rules follow the ACT model’s philosophy as closely as possible. Over the years, many adjustments and calibrations to the rules have been tested out at different IDOC sites where ACT-based programs are being implemented. For example, attendance policies for the BIP group in community cor­ rections often require payment to attend sessions (coupled with a maximum number of sessions that can be missed before being admin­ istratively removed from the program). Some sites have been successful at allowing the clients to attend group even if they cannot pay and then requiring payment in full before official completion. Another strategy is having a problem-solving session with a probation/parole officer prior to starting the program wherein they discuss all potential barriers to program attendance and generate a list of solutions. For example, if a lack of transportation is a potential barrier to getting to program ses­ sions, planning for that scenario by finding the nearest public trans­ portation options and/or by identifying prosocial friends or family to help. Finally, substance use is an ongoing challenge for many justiceinvolved individuals, and there is no easy solution to this problem. It is of course reasonable to require that clients not attend group sessions under the influence; however, instead of kicking them out of the pro­ gram when it happens, some options include recommending a substance use evaluation and/or making referrals to additional substance use re­ covery supports and resources while still attending the program. In the face of authoritarian policies and/or agency rules that must be followed, limited resources, and stressful duties, research shows that correctional staff often become controlling, punitive, and passiveaggressive, creating a parallel process of resistance alongside that of the justice-involved clients. This is true of most correctional settings and it is important to be aware of these dynamics when implementing ACT in these contexts. In addition to the ideas above, ACT trainings within the IDOC emphasize the development of skill-building in several key areas designed to help shift practitioners from a law enforcement/complianceoriented approach to a focus on promoting and supporting behavior change. The trainings are not just about teaching practitioners to administer the content of ACT programs, but also a method for increasing the practitioners’ psychological flexibility so their work with justice-involved clients is embedded within a warm, collaborative, and nonjudgmental relationship that will effectively promote prosocial behavior change. groups should be trained in the basics of group process and facilitation prior to the training components outlined below, such as by taking a course on group facilitation and observing groups already running by experienced facilitators. The ACT trainings for staff include multiple components designed to support implementation, including multi-day workshops, coaching/supervision, and booster trainings, all of which are in a feedback loop with ongoing assessment of staff competency and fidelity. We will discuss each below. 3.2. Initial training The initial multi-day training for correctional practitioners follows a similar format to most ACT workshops for beginners, and include experiential, didactic, role play, and discussion elements. An aspect of these trainings that stands out as both unique and important is a focus on helping the practitioners develop an effective working alliance with the justice-involved group participants. A foundation of the ACT model is that normal psychological processes produce problems, and these pro­ cesses apply equally to the facilitator and the participant alike. The client is never viewed as broken, or damaged, or beyond hope. Furthermore, the ACT perspective is one of empowerment and that a rich, meaningful, values-based human life is possible for all (Hayes et al., 2012). The ACT approach emphasizes the importance of the client and practitioner finding a common set of goals and values and building a relationship around them. Thus, correctional practitioners who facilitate ACT programs must be skilled in navigating these unique aspects of the working alliance. Unfortunately, there are many reasons that establishing this working alliance is difficult. First, justice-involved individuals are often courtmandated or otherwise involuntarily participating in treatment, and the working alliance is fundamentally different in this context. Second, criminal justice professionals are more likely to have a punitive pro­ fessional orientation instead of a human services-oriented approach and not all of them ascribe to rehabilitation as a correctional philosophy, or see relationship-building as part of their profession (e.g., Ferdik, 2018). Third, conflict between support-oriented and law enforcement roles can hamper the development of a strong working alliance with clients. Not surprisingly, power imbalances between practitioner and client can be a barrier to rapport-building. Finally, being open instead of guarded is sometimes viewed as allowing the justice-involved client an opportunity to take charge or manipulate, and it violates many practitioners’ attachment to their authority role. Thus, it is common for staff to be controlling, demanding, inflexible, and authoritarian in interactions with a client. As a result, clients may feel coerced, dig in their heels, and react against the imposed rules. Trainings for correctional staff, such as those on CCPs, emphasize strategies to shift from compliance-oriented to a focus on promoting and supporting behavior change, but research finds trained staff rarely use these skills in practice (e.g., Robinson et al., 2011). ACT is well-suited to address all these challenges, but high quality training and ongoing supervision are essential. Perhaps most impor­ tantly, practitioners must participate in experiential and not merely didactic trainings. In addition to teaching ACT programmatic content, these training events are designed to empower the practitioner by setting up a context in which they will be more aware of their own behavior and private events (and that of their clients), and contact a more stable sense of self or self-as-context that can be linked to greater psychological flexibility. ACT trainers focus on building relationships with the correctional trainees, listening to their perspectives and expe­ riences, and inviting them to try new skills and notice how they work. Trainers acknowledge and validate that staff may not believe it will work or may not feel comfortable taking a risk to try something new. Correctional practitioners are often fused with “Clients must do as I say,” or even “Clients must think the way I – a prosocial person – think,” which may be successful in the short run (avoidance of anxiety or vulnerability), but it also blocks contact with or creates insensitivity to 3.1.1. Training correctional staff The ACT-based programs implemented within the IDOC have been designed and packaged to accommodate flexible delivery by para­ professionals—in this case, correctional line staff, who are primarily non-clinicians with a diverse range of educational and lived experiences. Although it is common for practitioners to have an educational back­ ground in criminal justice, we have found that an educational back­ ground in human services, as well as previous training in traumainformed care and motivational interviewing, is preferable because these experiences facilitate a growth-mindset when working with justice-involved populations. To enhance efficiency and the effective­ ness of ACT training, practitioners who will implement the ACT-based 48 A. Zarling and R. Scheffert Journal of Contextual Behavioral Science 22 (2021) 44–51 other contingencies. For many criminal justice practitioners, psycho­ logical flexibility is noticing when interactions with clients are not working. Despite the urge to argue with clients and the appeal of lecturing them as a primary teaching tool, these strategies are seldom fruitful. We often ask line staff if they’ve ever been able to talk or lecture someone out of criminal thinking, and the answer is always no. ACT trainings help guide practitioners to let go of some control and notice what happens when they loosen their grip on authority and allow the client to respond freely and openly without attempting to direct or control their answers. Another such example is in cases of client noncompliance or “bad behavior,” such as being defiant, confrontational, or aggressive. It is important to keep in mind that the experiences of arrest, jail, court processes, and probation/parole or prison can all create additional trauma in the lives of justice-involved clients, triggering impulsive re­ actions and increasing risk for aggression. Despite (or because of) wit­ nessing this every day, these situations often hook practitioners and can instantly create a fused, automatic, and inflexible reaction. As trainers, we validate that situations of client noncompliance are frustrating, while also exploring them as opportunities and moments ripe for skill devel­ opment. Often, practitioners are simply working too hard in that they are trying to make the client think a certain way or give the client all the answers about what to do. Instead, they can explore the experiences and perspectives of their clients, without judgment or control efforts, and develop a response that is both meaningful and supportive. For practi­ tioners, this can be both relieving and empowering. This process does not require practitioners to cede their power, but rather to utilize it in a different way. By incorporating targeted discussions of difficult client relationships and interactions into training exercises, and applying defusion, accep­ tance, and values work to those situations, practitioners can gradually move from being overly punitive and harsh, to a fair and caring approach. In this way, ACT serves to help criminal justice practitioners navigate the multiple roles and identities that they must take on when working with justice-involved clients. Our findings also indicate that staff are applying ACT skills to their own lives, which may decrease their own difficulties with emotions and interpersonal problems that are inherent in this difficult line of work. Several additional recommendations can be made for training correctional staff in ACT. Adequate time should be spent on the differ­ ences and similarities between various correctional program philoso­ phies, as well as acknowledging and validating the difficulty of facilitating programs with seemingly conflicting philosophies. In the beginning of implementation efforts, staff often had to switch from one model to the other in the same day, which led to facilitator “drift” in both programs. Ideally, staff would not be facilitating both types of programs at the same time, but it’s inevitable that this might happen until a new program is fully integrated into the program offerings and previous programs are discontinued. Ample time should also be spent on the integration of ACT with RNR and CCP principles, as outlined above. Staff will be familiar with those concepts, and it is important to demonstrate how they fit within the ACT model in order to increase buyin for ACT-based programs. Importantly, trainers should respond to any staff resistance with validation and compassion. Although it can be difficult as a trainer to be on the receiving end of staff resistance, it also provides opportunities to model, shape, and reinforce psychological flexibility. The perspectives and motivation of line staff matter. Much training time can be spent working through staff reluctance or resistance, and that time is a worthwhile investment. We have found that pointing out the similar feelings of reluctance among both staff and clients is a point where perspective-taking can occur. These experiences, coupled with findings that ACT can help reduce stigmatizing attitudes among substance use counselors (e.g., Hayes et al., 2004), have led us to begin evaluating the effect of psychological flexibility training for correctional practitioners to help reduce the impact of negative attitudes and beliefs toward justice-involved individuals. 3.3. Supervision/coaching Another important aspect of effective training for correctional staff is ongoing supervision or coaching. The coaching system we set up is unique to ACT and had not already been in place within the IDOC, as other correctional programs did not have ongoing supervision as part of their implementation; therefore, the coaching component required extensive planning and trial and error to ensure effective implementa­ tion. After an initial multi-day pre-service training in ACT, new facili­ tators receive coaching during their first time facilitating the ACT program, which typically includes supervision over 24 sessions. The person who provides coaching is a correctional practitioner who is also an experienced ACT facilitator and has gone through the train-thetrainer process. Some criteria we consider when choosing trainers are staff members who are champions of ACT within the agency, those who excel at establishing relationships with justice-involved clients, those who are respected by their colleagues, as well as those who are invested and likely to stay with the agency. We also aimed to diversify trainers across the state in order to maintain geographic reach. Coaching for new ACT facilitators was integrated into the IDOC’s existing supervision structure to the extent possible. However, capacity for coaching and/or ongoing supervision is an area that should be considered by others who aim to implement sustainable ACT programs in correctional or forensic settings. Although ACT facilitators have noted overall satisfaction with coaching they received within the organization, sufficient time for ACT-specific supervision is usually not available. This finding points to the need for organizational changes to fully support the internal supervision and long-term success of the program. The IDOC is not unique in having this problem, as shortages in training and super­ vision capacity are well-documented barriers to implementation and sustainability of effective programs in correctional agencies. We addressed some of the challenges we encountered by utilizing virtual or audio recordings of group sessions, paying trainers to coach after hours or during retirement, and investing in building a bench of highly trained and motivated coaches. Finally, an additional training recommendation is the use of frequent booster trainings. Various booster sessions are provided throughout the year to provide a mechanism for refresher training and additional op­ portunities for practice. Trained staff within the IDOC have not been required to attend booster trainings, but many do so voluntarily. Our experience suggests expanding training opportunities via boosters is one way to increase staff’s comfort and proficiency in using more advanced skills, to keep connected with well-trained staff who can assist as coaches and champions of the program, and to meet regularly with folks who are invested in the programming. Additional workgroup meetings with these staff members are often scheduled to get updates on how each program is running, collect qualitative data on what is working and what isn’t, and ultimately to refine each program’s curricula to stay up to date based on both qualitative and quantitative data. 3.3.1. Fidelity and competency Fidelity measures and ongoing continuous quality improvement (CQI) are essential to the implementation and ongoing success of any program. Consistent associations have been observed between fidelity/ adherence to correctional treatment protocols, and criminal justice outcomes. In fact, some research suggests that criminal justice programs implemented without fidelity actually increase rates of recidivism (e.g., Barnoski, 2004; Latessa, 2018). However, resource constraints often limit the ability of correctional agencies to provide intensive program­ ming with high fidelity. To ensure adherence to the ACT programs, fidelity measures are ongoing within the IDOC. The Improving Outcomes With Action (IOWA) Tool was developed by the IDOC as a standardized model for reviewing correctional group programs. For ACT-based programs, an addendum to 49 A. Zarling and R. Scheffert Journal of Contextual Behavioral Science 22 (2021) 44–51 the IOWA Tool was added with competencies more specific to ACT (e.g., helps participants use willingness, mindfulness, and defusion in response to uncomfortable feelings; relies on experiential learning rather than advice-giving; and is non-defensive in responding to group members). In order to administer the IOWA Tool for ACT programs, the CQI specialist must be trained in ACT, as well as trained on the Iowa Tool itself. The IOWA Tool was designed for improving group facilitation skills by recognizing strengths as well as growth areas, and it consists of three sections: Program Implementation, Program Fidelity, and Facilitator Competence/Style. Program Implementation includes administrative and logistical issues outside of the facilitator’s control (i.e., adequate space, number of participants in group, adequately trained facilitators, etc.). An action plan is generated for that specific district or institution to address any administrative need/support areas that will assist facilita­ tors in effectively facilitating group. The Program Fidelity section ex­ amines how well facilitators followed the manual (e.g., to what extent did they deliver accurate program content), while the section on Facil­ itator Competence/Style involves how they delivered the program, such as following the responsivity principle and developing and maintaining an effective working alliance with clients. The CQI specialist rates ACT facilitators using a Likert rating scale (1 = Not Yet Demonstrating; 2 = Emerging Skill; 3 = Developed Skill; 4 = Advanced Skill). A CQI team defined those scores and provided examples demonstrated in each nu­ merical score as to provide inter-rater reliability. After the IOWA Tool is completed, a CQI specialist meets with the facilitator(s) and/or their supervisor to discuss strengths and areas for growth. Any criterion that is given a rating of a 1 or 2 are seen as growth areas and an action plan is created to increase skills in these areas. The action steps are developed by the CQI specialist in collaboration with the facilitator to ensure the action steps are acceptable. An example might be the facilitator struggled with how to lead the lesson demonstrating defusion, and an action step might consist of sitting in on a seasoned facilitator’s group who is skilled with that particular lesson. A timeframe is given to complete the action steps, and the IOWA Tool is repeated at minimum every 3 months if growth areas are identified or yearly if no growth areas are identified. Overall, data from the IOWA Tool completed on ACT-based programs across all sites indicate Program Fidelity is moderate to high (M = 3.36, SD = 0.09). Facilitator Compe­ tence/Style is slightly lower (M = 2.76, SD = 1.2), suggesting developing but acceptable competency. ” researchers are better able to provide a blueprint for effective in­ terventions and to support program implementation in other locations. Although some program models have been developed with the best of intentions, the field of corrections has a history of embracing in­ terventions prior to fully understanding the components that lead to their effectiveness (e.g., Duriez, et al., 2014). The goal is to identify these components in order to make sure that the quality of ACT correctional interventions keeps improving, leading to improved client lives, reduced recidivism, and increased public safety. Finally, another ongoing research project is the examination of how correctional practitioners’ psychological flexibility impacts program fi­ delity/competency in general, and the working alliance specifically. Our goal is to develop structured trainings that specifically focus on enhancing psychological flexibility for practitioners, thereby leading to more supportive (and less punitive) behaviors toward clients, and ulti­ mately enhance positive behavior change efforts with justice-involved clients. We plan to examine this not only with correctional staff who lead the ACT-based group programs, but also any probation or parole officer who manages a higher risk caseload in which they actively engage with their clients. Furthermore, the impact of setting (commu­ nity corrections vs. prison) on the development of an effective working alliance will be examined to account for the different challenges inherent in each context. Formal research has not yet begun on the training and imple­ mentation methods outlined above. Many are unique in that ACT is being implemented in non-mental health settings by paraprofessionals. There are a number of areas for future research related to these imple­ mentation strategies. First, the characteristics of the organization and what aspects predict successful implementation of ACT is a question for future work. The effectiveness of the primary training methods (initial multi-day workshops and supervision/coaching during first time facili­ tation) will need to be examined, preferably in a randomized controlled trial, to determine if paraprofessionals can reach a degree of proficiency as a result of these methods. Our experience aligns with the general finding in the literature that an initial multi-day workshop is not suffi­ cient for skill acquisition (e.g., Beidas et al., 2012), but we are testing out various iterations of these workshops to examine which components (e. g., role plays or “teach backs”) are needed to prep the trainee for the coaching phase. A related question is the extent to which ACT coaching for first time facilitators conducted by paraprofessionals (i.e., peer correctional practitioners) is comparable to coaching conducted by professional ACT trainers. Furthermore, assessing the effectiveness of booster trainings and how often staff should participate to maintain skill levels is needed. Finally, we do not take for granted that these ACT-based programs will be implemented as stipulated by researchers and clinicians, just because of sufficient empirical support, organizational interest, and provision of trainings. Although research-developed treatments for corrections can be effectively implemented (e.g., Thinking for a Change; Bush et al., 1997), achieving fidelity is challenging in practice, and greater understanding of fidelity–outcome associations is needed. Thus, the implementation of a fidelity/quality assurance system will require empirical evaluation to test key assumptions (e.g., that the IOWA Tool accurately assesses skill areas and that action steps promote facilitator fidelity and competency). Then, fidelity and competency will need to be linked to actual client outcomes, including quality of life as well as criminal justice factors (e.g., technical violations, rearrests, and incarcerations). 4. Future research In collaboration with the IDOC, we currently have 3 federal grants to evaluate the effectiveness of various ACT-based group programs. The first, funded by the Office on Violence Against Women, is randomized controlled trial of ACT and Duluth Men’s Nonviolent Classes for do­ mestic violence clients. Outcomes include traditional criminal justice outcomes (criminal charges) as well as reports of intimate partner violence from victims. This study took place in community-based cor­ rections and results are forthcoming. Additional grants from the Department of Justice are funding randomized controlled trials of ACTbased programs in the prison setting. Non-externally funded evaluations in progress include examining the effectiveness of different dosages of ACT according to risk level, as well as the effectiveness of a genderresponsive ACT program for justice-involved females. Finally, due to the COVID-19 pandemic, programming moved to a virtual format for community corrections. We are currently examining how outcomes from the virtual delivery of the ACT-based programs compare to in-person ACT programming. An important component of the aforementioned studies is examining mediators of treatment outcome to understand what makes them effective. The key elements to correctional programs, or the elements that drive recidivism reduction, are known as the “black box” of correctional programs (Latessa, 2004). By understanding the “black box, 5. Conclusion This paper describes the process of adapting, implementing, and sustaining ACT for use within the IDOC, thus illustrating some of the key issues involved in translating interventions to corrections. Overall, the adaptation of ACT to correctional settings is in its infancy. Our experi­ ence with the IDOC indicates that ACT represents an innovative 50 A. Zarling and R. Scheffert Journal of Contextual Behavioral Science 22 (2021) 44–51 approach that can be implemented within and alongside EBPs and principles of effective correctional intervention. As with all EBPs in these settings, effective implementation comes with many challenges. Orga­ nizational capacity, agency culture, and staff perceptions and charac­ teristics can complicate the implementation process. For the implementation of the ACT model within the IDOC, a researcherpractitioner collaboration was needed during all phases of the process. 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