The development of the Kimihia Violence Prevention programme: An offence focused programme for women with high and complex needs
Principal Facilitator, East Coast Programmes Team, Department of Corrections
Author biography:Emma is a registered psychologist. She trained in the forensic field in the UK, where she worked within a dedicated programmes unit for the National Probation Service. She took up a position with the New Zealand Department of Corrections in 2005 as a psychologist/senior psychologist in the Hawkes Bay. In 2018 she took on the role of principal facilitator for East Coast Programmes. Emma has experience in risk assessment, as an individual and group therapist, and in the supervision of group programmes, with a particular interest in programmes for women.
The Kimihia Violence Prevention Programme (Kimihia) is a rehabilitation programme aimed at assisting women with high and complex needs to address their offending behaviour. It was developed in response to the increased numbers of women being convicted of serious offending and given custodial sentences. The programme has a violence prevention focus and is suitable for those women whose risk, complex personality features and behaviours would prevent them from attending other established women’s programmes such as Kowhiritanga. The programme is facilitated by two psychologists.
Kimihia was developed as an extension to existing departmental programmes and based on research about what works with women with high and complex needs. The programme was piloted at Auckland Regional Women’s Correctional Facility (ARWCF) from 6 March to 28 June 2018. The implementation of the pilot programme was a dynamic process with a focus on responsivity within the theoretical framework. In practice this meant that the content was modified to best meet the needs of the women as the pilot progressed.
The development of the programme was a consultative process and involved input from a number of stakeholders, perhaps most importantly, incarcerated women who had completed a women’s programme. During this consultation process the name Kimihia was gifted to the project.1
Kimihia name and significance
The name Kimihia is derived from Kimihia He Huarahi Oranga - Creating Pathways for Wellbeing. This concept focuses on women examining their perception of their future and how their hopes and dreams can inform an understanding of present circumstances and self esteem.
Kimihia He Huarahi Oranga focuses on three areas which embody the programme’s aim of creating healing pathways for women; oranga wairua (spiritual wellbeing), oranga hinengaro (mental wellbeing) and oranga tinana (physical wellbeing).
1 Thanks to all stakeholders, in particular to Whaea Pare Rauwhero, Kaitiakai, ARWCF for naming the programme.
On 28 August 2017 the Department of Corrections launched Wahine – E rere ana ki te Pae Hou, Women’s Strategy 2017-2021. The strategy outlines three main priority areas for women:
- Providing women with interventions and services that meet their unique risks and needs
- Managing women in ways that are trauma-informed and empowering
- Managing women in a way that reflects the importance of relationships to women.
This strategy complements Corrections’ overall strategy by applying a women-specific focus to its overall goal of reducing re-offending.
While women represent a small proportion of the population managed by the Department of Corrections, over the last decade there have been considerable changes to the women’s prison population in New Zealand. The Women’s Strategy highlights an increase in the number of women being imprisoned, which has risen by more than 150% since 2002, and an increase of 120% of women serving community sentences. An increase in recidivism for women has also been recorded, as well as an increase in risk categorisation with 63% of women being classed as medium or high risk in 2014/15 compared to 47% at the start of the decade. There has also been an increase in Māori women’s overrepresentation in prison between 2005/06 (57%) and 2014/14 (64%) (McGlue, 2017).
While overall women commit less serious crime, and pose a lower risk to the community, there continues to be a small but challenging group of recidivist high risk/need women who carry out a small but significant portion of violent crime. These women have been conceptualised as “aggressive antisocial women” with high risk/high need profiles, and an extreme risk of recidivism. Such women are the target group for the Kimihia programme.
Prior to the development of Kimihia, the Department had two rehabilitation programmes aimed at addressing the offending needs of women: the Kowhiritanga Programme and the Short Rehabilitation Programme for Women (SRP-W). Kowhiritanga and the SRP-W are aimed at addressing the rehabilitative needs of women both in prison and in the community and are based on cognitive behavioural and relapse prevention principles. The SRP-W is available to women of low to moderate risk and is delivered by a sole programme facilitator, while Kowhiritanga can be delivered to women of any risk band by a psychologist and a facilitator, and to low to moderate risk women by two facilitators. Allocation to these programmes is based on a number of factors which include risk level and length of sentence. An adapted version of the SRP-W – the SRP-Special – is also available once or twice a year for women who have offended against children.
Kimihia was developed for those women whose psychological risk profile and complexity would make them unsuitable for any of the existing Departmental programmes.
Development and consultation process
The development of the programme was a collaborative process and involved a number of hui where input from cultural advisers, custodial and case management staff, psychologists and programmes staff was collected. During this process it became clear that there was a need for Kimihia to sit within a larger holistic wrap-around service. It was agreed that the wider service needed to attend to both the evidence-based rehabilitative needs of women and factors beyond. Such additional needs include mental health issues, trauma and victimisation, lack of support networks, parenting stress, financial disadvantage, employment difficulties and gambling issues. (King, 2011; Bevan & Wehipeihana, 2015).
As such, the Kimihia Programme is viewed as a significant therapeutic component of a four phase process, with each phase having its own specific focus:
Phase One: Responsivity Component. Preparing for intervention. Commencement of whānau engagement and building support networks. Behavioural management.
Phase Two: Group Component. Kimihia Violence Prevention Programme. This phase is four months long and consists of group and individual treatment. It includes the identification of reintegration needs early on which are linked into the offender plans of the women.
Phase Three: Maintenance Component. Continuation of intervention based on ongoing treatment needs. This also includes a continuation of whānau engagement.
Phase Four: Release Component. Wrap-around services, consultation provided to Community Probation Service andcommunity reintegration.
One of the most important aspects of the consultation process was interviewing a number of women who had previously completed the Kowhiritanga programme. These women would have been potential candidates for Kimihia had it been available at the time they engaged in treatment. The women indicated that they found engaging in Kowhiritanga beneficial. In particular, they enjoyed the use of pūrākau (ancient legends/stories) throughout the programme and found the work on thinking and relationships beneficial. This feedback was used to inform the content for Kimihia.
Theoretical underpinning of the programme
The pilot manual for Kimihia built on the content of the Kowhiritanga and SRP-W programmes with the aim of being more responsive to women with high and complex needs. This takes into account possible personality factors and high levels of anti-social behaviour and cognitions.
The need for appropriate interventions to be developed and provided for high risk individuals is well documented in the context of the Risk, Needs and Responsivity principles (Andrews & Bonta, 2017). These principles posit that for effective recidivism reduction, it is crucial that interventions are matched to levels of risk, specific evidence based rehabilitation needs, and are responsive to the target group.
Whilst there has been much debate around the rehabilitation needs of women versus those of men, it is asserted that men and women have the same dynamic risk factors and that the differences between the two lie in their responsivity needs. Therefore, the gender-specific focus of Kimihia is appropriate in this context. The content of the pilot Kimihia manual has a focus on the “Big Five” rehabilitation needs identified as relevant for women. These are: criminal history, anti-social peers, antisocial cognitions, anti-social personality patterns and substance abuse (Wilton, 2012). As the pilot was rolled out it became evident there was a need to consider the “Central Eight” risk factors which added family/marital factors, work/school factors and leisure and recreation as relevant treatment targets (Andrew & Bonta, 2017).
The programme is based on an evidence-based and integrative approach, incorporating the Risk Needs Responsivity (RNR) model, John Livesley’s Integrated Model for managing personality disorder, and trauma-informed practice principles as primary theoretical foundations for the programme design. Specifically, the programme has been developed to ensure that it addresses the “Central Eight” treatment needs using methods which take into account the personality features of the target group in the context of their traumatic past experiences. These models and methods are currently used in the Special Treatment Unit Rehabilitation Programme - Revised (STURP-R) and the men’s High Risk Personality Programme (HRPP) and are considered an effective approach to provide group-based treatment in a high risk population with complex personality presentations.
Approaches and models incorporated into the programme include; Livesley’s integrated model of personality disorder (2012), Cognitive Behavioural Therapy, Cognitive Self Change, Dialectical Behavioural Theory (DBT), Narrative Therapy and Relapse Prevention as well as a number of cultural concepts which will be discussed further in the cultural components section.
Kimihia has a focus on addressing violent behaviour and also incorporates trauma-informed practices; practices which are influenced by an understanding of the impact of traumatic events on an individual’s life and development. It is important to note that trauma-informed practice represents high quality, empowering practice and is not specific to the treatment of trauma.
The Women’s Strategy indicates that across their lifetime, 52% of women in prison have post traumatic stress disorder and therefore we have an obligation to deliver programmes in a manner which is appropriate to the special needs of trauma survivors (Harris & Fallot, 2001a in Wilson, Fauci & Goodman, 2015). Practical applications of trauma informed practice in Kimihia include empowering women as the experts in their own lives, and facilitators showing understanding of the women’s behaviour and the challenges they face.
Additionally, being responsive to Māori in the context of offence-focused intervention is a key focus of the programme and cultural content is woven throughout with a strong focus on Te Whare Tapa Wha and the use of pūrākau. Further Māori concepts may also be included in the final version of the manual.
The Kimihia Violence Prevention Programme consists of four modules which are based on Livesley’s integrated framework:
Module One: Engagement and Safety. Welcome, norm setting, identity, goal setting, motivation, navigating conflict, and mindfulness.
Module Two: Emotional Control/Regulation. Emotions and aggression, distress tolerance, impulse control, cognitive behavioural model, strategy of choices, thinking styles and problem thinking, beliefs and core values.
Module Three: Exploration and Change. Problem solving, communication, relationships, support networks, preventing violence, and substance abuse.
Module Four: Integration and Synthesis. Safety planning, goal setting and graduation.
As well as the group programme content, the programme incorporates:
- Individual therapy sessions
- Progress meetings (across phases 1, 2 and 3)
- End of module reviews, with case management attendance encouraged
- Whānau hui (across phases 1, 2 and 3 and at module reviews)
- Case consultation and staff support (e.g. Right Track).
It is anticipated that a maintenance aspect of the programme will also be offered to graduates. This will focus on addressing any remaining treatment needs and may involve linking with other relevant programmes such as drug treatment programmes and domestic violence treatment programmes.
A key aspect of the consultation process involved agreement around cultural processes. Guidelines for cultural processes were drawn up and include the following crucial aspects of setting up, running and closing the programme:
Pre programme stage:
- Consult kanohi ki te kanohi (face-to-face) with local kaitiaki, Māori and Pasifika governance groups
- Consult with local iwi regarding the use of relevant local pūrākau in session content
- Consult with prison and probation staff
- Engage with cultural supervisor and cultural adviser (if not the same person) and begin the cultural supervision process
- Engage with whānau at the earliest stage possible.
Commencement of the programme:
- Liaise with kaitiaki, local governance groups and site staff to plan the mihi whakatau in the context of local tikanga
- Ensure the relevant people from the consultation process and significant site staff are invited to the mihi whakatau
- Ensure that the mihi whakatau and the programme as a whole embody Te Tokorima a Maui (the five kaupapa values of the Department).
During the programme:
- Ensure that regular cultural supervision takes place and the delivery of key cultural concepts are discussed and explored within this context
- Maintain links with kaitiaki, governance groups and site staff
- Encourage and maintain links with participants’ whānau/supports.
Conclusion of the programme:
- Consult with the local kaitiaki, governance groups and site staff to develop a plan for the mihi whakamutunga in the context of local tikanga
- Ensure that the relevant people from the consultation process are invited to celebrate the success of the wāhine
- Ensure that whānau are included in this process to celebrate the success of their whānau member at the programme’s conclusion.
Additionally, being responsive to Māori in the context of offence-focused intervention is a key focus of the programme and cultural content is woven throughout with a strong focus on Te Whare Tapa Wha and the use of pūrākau. Other concepts which are incorporated throughout the programme include; moemoeā – hopes for the programme, the wayfinding waka journey, development of a kawa, cultural identity, respecting whānau and whakapapa links, te aratika – the right path, takarangi – wellbeing/self and whakapapa, and cultural differences in expression of emotion.
Further Māori concepts may also be included in the final version of the manual.
Eligibility and assessment for Kimihia pilot (group phase)
Potential participants for the pilot programme were identified using the following criteria:
- Index violent offence and/or significant history of violent offending
- RoC*RoI above 0.5 or
- RoC*RoI under 0.5, but with personality factors or behaviours which would preclude them from participating in Kowhiritanga
- On the psychological services waitlist.
- Current or previous sexual offending
- Offending against children
- Women with non-association orders or in relationships with other participants
- Women who were unable to be in the group treatment space due to prison operations. For example, women classified as maximum security are unable to mix with other women and therefore cannot be in a group setting with them
- Insufficient time to complete
- Cognitive deficits.
Due to the complex personality factors and needs of the target group, it is recommended that the maximum number of participants attending the programme does not exceed six.
Women were selected for assessment based on their risk level, offence type and presentation. Key assessment areas were criminogenic risk factors (e.g. antisocial thinking, associates), and non-criminogenic needs (where relevant to rehabilitation). There was also a focus on levels of motivation, desire to make pro-social changes, and willingness to engage in all aspects of the programme and adhere to the protocols established within the group.
Those women assessed as eligible and motivated were then asked to complete psychometric tests which could provide a baseline measure in terms of attitudes and personality features. The tests measured: personality traits and psychopathology, violence risk, anti-social cognitions, symptoms of trauma, and rehabilitative and reintegrative needs. A portion of the test was also administered at the end of the programme as a means of measuring change.
The Kimihia pilot commenced at ARWCF on 6 March 2018 and the mihi whakamutunga/graduation was held on 28 June 2018. Five women began the programme and four women graduated. Whilst these numbers may appear low, it is recommended that the maximum number of participants on the programme should not exceed six. This is due to the complex needs and personalities of the target group as well as their levels of unpredictability and potential risk of violent behaviour. All participants had convictions for violent offending and were a mix of high and low security prisoners.
Facilitators observed that the participants generally presented with entrenched anti-social thinking, and their treatment needs were related more to cognitions than the management of emotions. They also had a high level of need associated with their re-integration – as identified by the Level of Service/Case Management Inventory assessment tool (LS/CMI). The LS/CMI is an integrated assessment and case management tool which measures risk and need factors and can be used to aid the planning of interventions. As the programme was rolled out, the content was adapted to be responsive to the participants, and treatment was widened to include four phases - one of which was the group component. Therefore the final manual incorporates a number changes to the pilot version.
The proposed content and flow of each module in the final manual is fairly consistent with the draft version. However, the manual has been edited to include more information and guidance with regard to the session objectives. Furthermore, there were a number of noteworthy changes, based on the pilot and/or high risk-high need population. These include: Less emphasis on dialectical behaviour therapy (DBT), offence mapping and timelines being completed during individual sessions, more role plays and skills practice added and the concept of the wayfaring waka journey being woven throughout each module. One of the biggest changes to the content was the inclusion of cognitive self-change components, an approach that targets cognitions which underpin violent behaviour. This was included in response to the levels of anti-social thinking displayed by the participants and was woven throughout the programme. In addition, responses from the women identified that they found more abstract concepts difficult to grasp and therefore many original exercises needed to be simplified.
During the pilot a number of group factors also influenced the delivery of content. These included: Gang involvement, estrangement from whānau, institutionalisation and persistent life patterns. As a result, content was tailored to be responsive to these factors.
Cultural concepts such as Te Whare Tapa Wha, the whānau engagement model, the wayfinding waka journey and pūrākau, which are woven throughout the programme, were reportedly well received by participants. Each person’s perception of the outcome of treatment and the quality of the therapeutic relationship was captured in real time during the treatment phase with the Group Session Rating Scale (GSRS). Participants completed the GSRS at the end of each session and the results were very promising. The GSRS enables participants to rate each group treatment session in terms of how it met their needs in four areas:
- Relationship: The level to which the participant felt they were understood and respected by the group therapists
- Goals and Topics: The level to which they felt that the session content fit with their perceived needs
- Approach or method: Whether the approach of the therapists was a good fit for the participant
- Overall: The level to which the participant felt part of the group during each session.
Although this measure is not directly linked to violent recidivism, it is linked to successful psychotherapeutic outcomes and the participants consistently rated that their needs were being met on each aspect. One programme area which received reduced scores was the Good Lives Model content, so this was removed from the manual.
Learning from the pilot programme has been consolidated and the manual has been reviewed and revised. Any amendments made will be based on the experiences of both group members and facilitators whilst continuing to be evidence based. Information relating to the comparison of psychometric measures administered pre and post programme will be examined as part of a full evaluation of the programme to be completed in the near future. These results will also likely inform any amendments to programme content.
It is anticipated that the women who completed Kimihia will also now be moved to Phase Three of the service as a whole, which will involve identifying outstanding treatment needs and facilitating access to ongoing intervention. This phase will also continue to look at reintegration needs, outstanding criminogenic and non-criminogenic treatment, strengthening support networks and whānau engagement. The completed version of the Kimihia manual is currently being reviewed and once finalised the programme can be implemented in all women’s prison sites.
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