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R&R2 FOR YOUTHS AND ADULTS

WITH MENTAL HEALTH PROBLEMS


A PROSOCIAL COMPETENCE TRAINING PROGRAM
Dr. Susan Young & Dr. Robert R. Ross

Program Outline

The "R&R2 Program For Youths and Adults with Mental Health Problems" (R&R2 MHP
program) is a multifaceted, cognitive behavioural group program designed to teach
individuals with mental health problems cognitive, emotional and behavioural
coping strategies that can enable them to develop prosocial competence.

Program Rationale: Many individuals with mental health problems benefit from
treatment to manage their symptoms. However, those individuals, who in addition to
their mental health problems, evidence disruptive, antisocial or criminal behavior
require treatment that not only targets their mental health problems but also
specifically targets their antisocial behavior.

Historically, most treatment programs for such individuals, including mentally


disordered offenders, have been ‘broad brush’ treatments that have not taken into
consideration the impaired cognitive, emotional, social skills and values of this
population that underly their antisocial life-style. These characteristics impede
their progress in rehabilitation, vocational advancement, educational achievement
and prosocial development. Moreover, although they may have been involved in many
programs throughout their lives, many youths and adults with mental health
problems are resistant to treatment.

Many individuals with mental health problems lack a level of prosocial competence
that would enable them to cope in non-institutional settings. Many exhibit
specific problems in their intellectual functioning such as poor attentional
control and processing speed. Deficits in memory and executive functioning are
common, resulting in difficulty in recalling verbal and visual information, poor
organizational ability, poor planning ability, impulsivity and poor response
inhibition.

Many evidence the same cognitive characteristics that have been identified in
antisocial individuals, including adolescent and adult criminal offenders, such as
egocentricity, poor interpersonal problem solving skills, dysfunctional or self-
defeating coping techniques, inadequate social skills, rigid and concrete
thinking, thinking errors and antisocial values.

Research Development: The R&R2 MHP program is based on the "Reasoning and
Rehabilitation" (R&R) program (Ross & Ross, 1986) that has been delivered over the
past 21 years to more than seventy thousand "at risk" and antisocial individuals
in seventeen countries. The efficacy of R&R has been demonstrated in numerous
independent, international evaluations and through comprehensive reviews, cost-
benefit analyses and meta-analyses.

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. Several studies have reported program-related improvements
on a variety of psychometric measures (Clarke, Walwyn, and Fahy, 2003; Donnelly
and Scott, 1999; Gretenkord, 2004). A large-scale, international evaluation of
R&R is currently being undertaken that involves several secure settings of the
Maudsley Hospital in London and the Haina Hospital for mentally disordered
offenders in Germany. These studies and the observations of the many R&R Trainers
delivering the program have yielded important insights about the value of an R&R
approach to treatment of individuals with mental health problems.
Program Targets: The R&R2 MHP program is a revised R&R program designed not only
for institutionalized mentally disordered offenders but also for youths and adults
with mental health problems in schools, in community residences or in hospitals.

The program was developed through a collaboration between Dr. Susan Young, Senior
Lecturer in Forensic Clinical Psychology and Clinical Psychologist at the
Institute of Psychiatry in London and Professor Robert Ross, University of Ottawa,
the author of the original R&R program. It has been successfully field-tested with
mentally disordered offenders in the U.K. at the Maudsley Hospital in London and
the Broadmoor Hospital in Berkshire between 2005 and 2007.

The program teaches neurocognitive skills in addition to the prosocial skills and
values that are taught in R&R. It is designed to help individuals whose mental
health problems are associated with low self-esteem, poor self-efficacy and low
self-motivation to realize that they can impose some measure of self control over
what they think and how they behave; can set realistic aims and goals; and can
learn skills that they can apply in their everyday lives which will enable them to
achieve prosocial competence.

Program Design: The program is manualized and highly structured and there are
clear instructions for the facilitator to follow. A variety of innovative training
techniques are used to engage the participants and to make the ‘training’ fun -
including games, individual and group exercises, role-playing, brainstorming and
audiovisual materials. The program has 16 sessions, each requiring 90 minutes of
training and includes homework tasks. Sessions may be delivered once a week or
more.

PAL’s: A 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, volunteer, 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 increases the transfer of
skills learned in the group training sessions and makes the program more personal.
The PAL helps to generalize the participants' skill acquisition from the classroom
to their everyday living.

Training Video: The program kit includes a video of Dr. Susan Young explaining
the theory and procedures and modeling several key sessions of the program as she
teaches the program in a secure hospital setting.

Booster Sessions: 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.

Trainer's Kit: The teaching methods and training techniques; the audio-visual
materials; the theoretical model and research basis of the program; and a manual
that provides detailed, step-by-step instructions for conducting the program are
presented in a "Trainer's Kit" that includes the following:

• A Program Handbook that articulates the development of the program and the
program principles and objectives;
• A Program Manual that provides complete guidelines and detailed instructions
for delivering the program;

• A CD that presents PowerPoint slides for each session;

• The CD also includes a number of Mystery Games for participants to practice


the thinking and problem-solving skills they are taught in the program;

• The CD also includes two MPEG movies that form the basis for in-class
exercises in applying various social cognitive emotional skills and values that
participants are being helped to develop;

• A DVD that provides a Training Video of Dr. Young teaching the program in a
setting for mentally disordered offenders;

• A Booster Program Manual – complete instructions for delivering the Booster


program;

• A variety of Stimulus Cards for in-class exercises:

Dilemmas Game cards


Non-verbal Emotion cards
Non-verbal Situation cards
Non-verbal Question cards
Goals cards

• Signs used to stimulate the participants' thinking and behaviour in the


sessions.

• Session Record Form (reproducible by Trainer);

• Program Report Form (reproducible by Trainer);

• A wallet-sized SARA card that lists the problem-solving steps that


participants are trained to follow in solving problems using the SARA problem-
solving technique;

The Trainer's Kit is contained in an attractive professional portfolio with a


zippered pocket and an adjustable shoulder strap.

Program Materials: The materials for delivering the program are included in a
package that includes the following:

• Participants Workbooks – each participant receives a workbook that


summarizes what is taught in each session and provides materials for in-session
exercises and instructions for homework.

• Booster Program Participants Workbooks

• PALs Guides – each PAL receives a manual of instructions for each session
and a guideline for his/her role in the program

• SARA cards – wallet-sized business cards for participants that list the
steps they have been taught to follow in solving problems.

• Certificates of Achievement
NOTE: to ensure quality control, Training Materials may be ordered only by
accredited Trainers who have a Trainer's Kit; and, on a one time only basis, by
individuals who have attended a training demonstration by Dr. Ross or Dr. Young
and are proceeding to seek accreditation.

Inquiries: Information on training requirements, accreditation and training


opportunities can be obtained through the Cognitive Centre of Canada:
cogcen@canada.com

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