R&R2 for Youths and Adults
with Mental Health Problems
A Prosocial Competence Training Program
This program was designed by Dr. Susan Young & Dr. Robert R. Ross for youths and adults whose offending behavior is associated with mental health problems or severe mental disorder. Mentally disordered individuals who, in addition to their mental health problems, evidence antisocial or criminal behavior require treatment that not only targets their mental health problems but also specifically targets their antisocial behavior.
Mentally disordered offenders are complex individuals with multiple problems such as mental illness, personality disorders, learning disability and substance misuse. In some cases brain damage has been associated with their criminal behavior and this may arise from physical abuse received in childhood, accidental injury, and/or violent behavior. Such events often result in diffuse damage or more severe traumatic brain injury and cognitive impairments are associated with both. Such impairments are often long lasting. Comorbid problems are often present and patients frequently have associated anxiety disorders and depression. Some individuals are detained under Mental Health legislation for many years and they may become institutionalized. They feel anxious about coping in the community where they often have limited social networks and support and lack a level of prosocial competence that could enable them to cope.
Many exhibit problems such as poor attentional control and processing speed. Deficits in memory and executive functioning are common, resulting in them having difficulty recalling verbal and visual information, poor organizational ability, poor planning ability, impulsivity and poor response inhibition.
Many also evidence the same cognitive characteristics as the general offender populations such as egocentricity, poor interpersonal problem solving skills, dysfunctional or self-defeating coping techniques, inadequate social skills, rigid and concrete thinking, thinking errors and inconsistent values. Although they may have been involved in many programs throughout their lives, many are resistant to treatment.
Several secure hospitals for mentally disordered offenders in Scotland, England, New York, Germany and Colorado are delivering the original R&R to mentally disordered offenders. Although no evaluations of post-hospital antisocial behavior have yet been conducted, there are some studies that have reported program-related improvements on psychometric measures Clarke, Cullen, Walwyn and Fahy (in press); Donnelly and Scott, 1999; Gretenkord, 2004). A large-scale, international evaluation of R&R is currently being undertaken that involves several secure hospital settings of the Maudsley Hospital in London and the Haina Hospital for mentally disordered offenders in Germany.
An R&R2 program specifically designed for such offenders and for youths with mental health problems was developed in a Canada/U.K. collaboration between Dr. Susan Young, Senior Lecturer in Forensic Clinical Psychology and Clinical Psychologist at the Institute of Psychiatry in London and Dr. Robert Ross, Professor of Criminology, University of Ottawa.. The program is designed to teach mentally disordered offenders, and other individuals with mental health problems in both inpatient and outpatient settings, functional coping strategies that can enable them to develop prosocial competence. The program teaches individuals neurocognitive skills in addition to the prosocial skills and values that are taught in R&R. The program has 16 sessions, each requiring 90 minutes of training and includes homework tasks. Sessions may be delivered once a week or more.
The program has been field tested in patients detained in medium security at the Maudsley Hospital in London and the Broadmoor Hospital in Kent in England. Initial results are summarized in the "News" section of this web-site.
The program is manualized and highly structured and there are clear instructions for the facilitator to follow in a Trainers Guide. A variety of innovative training techniques are used to engage the individual and to make the ‘training’ fun by incorporating games, individual and group exercises, role-playing, brainstorming, audiovisual material, and participants’ workbooks.
There are 15 sessions. Each session requires 90 minutes of training (with breaks) and includes out-of-class assignments. Sessions may be delivered once a week or more frequently.
The program kit includes a video of the program developer, Dr. Susan Young, modeling training in the program in a secure hospital setting.
Participants are given a Participants Workbook which provides a summary of each session that includes a review of what they have learned and their 'homework' assignment. It also provides a variety of exercises for them to complete during or after the sessions.
A novel feature of the program is the "PAL" (Participant’s Aide for Learning). Prior to attending the program, each participant is asked to select a PAL. A PAL may be a parent, friend, or member of staff. The PAL must be in regular contact with the participant and must be able to meet with the participant at least once per week.
The PAL component of the program is designed to maintain participants' motivation and attendance and to reinforce their acquisition and practicing of the skills they are learning in the sessions. The PAL serves as a prosocial model and makes suggestions about how the participant can introduce new techniques and skills into their everyday life. This helps the transfer of skills and makes the program seem more personal. The PAL has a Guidebook which defines the PAL's role, explains their role and provides helpful suggestions. The PAL helps to generalize the participants' skill acquisition from the classroom to their everyday living.
Another feature is the provision of a three-session follow-up or Booster Program. The purpose of these sessions is to remind participants of the skills they have learned from participating in the main program, to reinforce them in order to further consolidate these skills, and to provide them with additional and longer term support.