This social science project identified what stops people from voluntarily signing up to free rehabilitation programs. These results may help other community programs to improve their services.

Summary

• Our partner is a justice agency seeking to improve the number of people signing up to voluntary rehabilitation programs
• I conducted fieldwork across New South Wales with clients and service providers working in mental health, domestic and family violence, and alcohol and other drug rehabilitation
• We found that many voluntary programs have hidden barriers that make signing up difficult and unappealing (friction costs)
• Programs can make it easier to sign-up, by reducing the number of steps, and simplifying referrals and eligibility requirements
• Programs can also make joining more appealing by personalising offers and making the immediate benefits clear
• Clients are most open to join new programs in the first 24 to 48 hours following their release from prison (fresh start effect)

Background

The following post summarises my team’s recent report.

The New South Wales Government has committed to reducing adult reoffending by five percent, by 2019. Reoffending refers to individuals who have been repeatedly charged and convicted of a criminal offence.

Twenty-three percent (23%) of adults exiting prison in New South Wales go on to be re-convicted within 12 months, and 56% of adult ex-prisoners will be re-convicted of another crime within 10 years.

What We Did

Our partner agency wanted to increase recruitment and sign-up of voluntary, criminogenic programs. That is, programs addressing behaviour change, such as domestic and family violence behaviour reform, alcohol and other drug rehabilitation, anger management, mental health counselling, and other health services.

Our partner wanted to know why people aren’t taking up free services, how this might vary across regions, and how to address client recruitment issues.

How We Did It

I conducted desktop research about the motivation and commitment requirements that impact people’s decisions to join new programs.

I interviewed 46 clients and experts about their experiences in voluntary programs. I also conducted site visits with service providers across metro and rural New South Wales.

• Thirty-five service providers: from the justice sector (solicitors, magistrates, restorative justice specialists, and prisoner advocacy workers); the health sector (alcohol and other drug counsellors, and mental health professionals); Aboriginal community-controlled organisations; and other not-for-profit service providers
• Two academic experts: provided insights on recidivism, crime prevention, and correctional justice
• Nine clients: currently in voluntary programs, living in the community whilst awaiting sentencing. They are participating in service delivery programs targeting criminogenic issues
• Five site visits: ethnographic research with service providers. I spoke with managers and staff about their services and, with consent, observed their interactions with clients.

What We Found

My fieldwork found that sign-up processes are cumbersome and off-putting, often requiring people to reshare their criminal history. Screening tools are often invasive and scary.

Clients have a hard time distinguishing services and trusting new programs, due to their past history where they were treated unfairly.

Clients feel they are set up to fail, due to strict requirements to demonstrate that they’ve changed very swiftly.

Case workers find it difficult to follow best practice, especially in times of high stress.

There are many implementation barriers that prevent recruitment and retention of clients. For example, clients lose eligibility for services if they have to go back to court. The reality of reoffending patterns is that people released from prison are often facing multiple court appearances, and they don’t get a chance to make progress in between.

My fieldwork informed recommendations to improve recruitment in voluntary programs.

Making behaviour change easy

Small details can make a task seem challenging, which could mean people put off taking action indefinitely (friction costs).

Our fieldwork suggests that reducing the barriers and difficulty of taking up services (friction costs) is the most effective way to establish engagement with clients. Appealing to the novelty of programs and simplifying choices also helps.

Reduce friction costs

Programs sometimes have complicated sign-up process protracted over several days or sometimes weeks. People are first contacted by service providers who explain the program. Clients will then be asked to consent to eligibility assessment. They might need to later approve consent for service providers to make enquiries on their behalf to other agencies as part of case management. Some programs will also require two assessments: one to prove eligibility, and another to record additional personal history and administrative details to begin case management.

Multiple screening tools and processes can be off-putting. Eligibility questionnaires can sometimes be long and invasive. Documentation is often double-handled, as case workers often record manual notes and fill-in paperwork with clients, to be later entered into an electronic database.

Casework potentially adds additional meetings in multiple places, on top of existing commitments to family and other service providers. Clients may have lost their driver’s licence or have limited public transportation options in rural areas. This difficulty and repetition makes joining the program unappealing.

How to reduce friction costs

Simplify eligibility processes. Use pre-filled forms that can be swiftly completed on the spot. Ideally, this might be done on a tablet or another portable electronic device that reduces manual entry.

Use default settings. Streamline processes, to enable providers to seek informed consent from clients as soon as they agree to participate in a program. This will enable providers to more easily and transparently make enquires about clients to other agencies. Clients opt-out rather than opt in as a default.

Reduce hassle for clients. Negotiate meetings to make case management easy, for example, case managers might meet client in convenient places. Providers might develop a process to minimise or combine appointments in liaison with other agencies

Appeal to scarcity

People may put off decisions, such as considering an offer, when an item or offer seems open-ended or freely available (scarcity heuristic). People attach a higher value to resources that are limited in quantity or time.

Clients responded positively to being offered a voluntary program as a special choice. For example, being shown they were especially chosen for an exclusive program from a limited pool of people. These clients discussed how their case worker explained that not everyone is offered this opportunity. Alcohol and other drug counselling service provider Lubna is of non-English speaking background working with predominantly Muslim clients. She emphasises to clients: “I work with your background. It’s not about me. It’s about you as an individual.”

Larissa and Watson are Anglo-Australian clinicians in metro Sydney who provide drug counselling. They say that highlighting personalised approach to case management is appealing.

Larissa: “Gear the program towards what they are telling you, where they are at in understanding their issues. Others are more ambivalent. So if the client is not interested, I would say: ‘Well, you know, these are your options…’“

Watson: “I think that’s just something you do generally with clients. Tailor the treatment plan during the initial suitability assessment.“

Personalise service deliver: Clients who were happy with the services they receive said they believed they had been especially matched to their own case worker whose job is to help them. Clients emphasised common aspects of their life journeys and the rapport their case workers had established (especially in finding common struggles), and being carefully matched along personal traits, including personality and age.

• Use a bespoke approach to optimise extrinsic and intrinsic motivation
• Personalise choices, showing why clients are being recommended for a program
• Bring attention to limited opportunity not offered to everyone
• Simplify decision-making to suit client’s circumstances.

Minimise choice overload

Too many options can overwhelm people and lead them to delay making a decision (choice overload).

Clients have trouble sorting information and making choices. There are too many programs and service providers to navigate. Some of the services may look very similar, for example voluntary options for alcohol and other drug rehabilitation via service providers as well as those mandated by magistrates.

Clients are likely already receiving services with other Government organisations or programs (Centrelink, Social Housing, and FACs). When facing possibility of joining another program, it will seem like yet another difficult set of decisions and actions they need to manage.

Simplify options, using a personalised set of narrow and clear choices makes a program more appealing. For example, use case history to identify the top few programs that are most relevant to client. Noel, an Aboriginal client in regional New South Wales, talks about how his case worker walked him through the pros and cons of different programs. Literally: his case worker drove him to different drug and other alcohol rehabilitation facilities to find one culturally appropriate.

“It’s close to home, and my first look around it looked good. It seemed really nice. Out here it’s quiet and it looked like people were good and stuff, there is a lot of space and it looks like it’s out of country, ‘cause it’s not close to town, so you don’t really think about grog.”

Reduce cognitive load, by facilitating coordination between providers and other services and stakeholders. This will minimise repetition and provide enhanced case management support. Visual goal mapping, motivational interviewing and other best practice methods may help clients figure out which program best suits their personal circumstances. Rather than looking at big life change, which often set clients up for failure, establish small goals.

Making joining attractive

People are more likely to pay more attention to information that is simple, accessible and innovative (salience). People are also more likely to respond to information that is personally relevant to them.

Programs can increase engagement by making services more appealing. For example, using personalised communication, highlighting the benefits of the program with a clear call to action, and address perceived risks to clients.

Increase salience

Our fieldwork shows some programs do not clearly communicate the aims or content of services. Clients were most motivated to join a program when they understood how specific skills, tools or content of services would help them navigate their legal and everyday troubles (extrinsic motives). As many clients have tried various programs in the past, programs have to create hope for achievable and meaningful change (intrinsic motives).

“Build rapport with the offender. You can do this quite quickly with an elevator pitch on how you will help them. You will either impress them, or not, in just 30 seconds. I say: ‘Hi, my name is Arthur. My job is to make you stay in the community and help you stay out of prison. Would you like to talk to me? I have 17 years’ experience as a lawyer. Are you comfortable with that? I need to ask you some questions. What I ask you, I don’t have to tell anyone. It stays between you and me. I won’t tell anyone.’ …For high risk people, he would have been through the system a few times and is institutionalised into custody. Show you care and give them hope. ‘But what if I could help you get a home, a bed, food. Work with me to change the patterns in your life.’”

– Arthur, justice sector, metro

How to use salience to simplify communication

Address salience using a script. Swiftly establish the benefits of the program, while also promoting a personalised service (personalisation). Use phone and mobile messages and improve other points of engagement.

Draw attention effectively. Personalise messages to draw attention to services. Highlight benefits through design of communication materials (such as enhanced letters and marketing).

Make joining appealing. Show why clients are being encouraged to join a specific program and how it’s relevant to their current predicament. Clients say good programs and case workers help “keep you on track,” “help you stay healthy,” and help them stay out of jail.

The diagram below highlights how to make messages more attractive for clients as well as stakeholders.

Use the framing effect

People draw different conclusions based on how the same information is presented (framing effect).

Service providers stress the importance of quickly picking up on language cues from clients and adopting this language into a “pitch.” This might mean using an informal tone or making jokes, but also being swift and direct about the benefits.

Have a clear call to action. The framing effect could be used to simplify information on websites and other public marketing materials, segmented for different stakeholders (see Figure 1).

Draw on the power of simplification. Use BI techniques when introducing the program. This includes highlighting what you want people to do, using plain English, breaking down steps people can take, and appealing to positive outcomes of joining a program (gain framing) (cf. BIU 2017).

Highlight the key message for clients as well as stakeholders using a person of influence or someone clients can relate to, or already trust (messenger effect) (see Figure 1).

Communicate rewards in the form of a two-minute “elevator pitch” for service providers, as part of the script. The aim is to swiftly establish the benefits, such as how completion of a program may be regarded in upcoming sentencing. Case workers might acknowledge other programs may not have worked and how the current program is different.

Address risk aversion

When people are facing an uncertain outcome, they will prefer to stick with a predictable but lower payoff, than risk an unknown reward (risk aversion).

Programs do not always clearly highlight the benefits they offer and therefore introduces a sense of risk. Clients are pre-occupied with the immediate risk of being sent back to jail and other concerns (such as finding secure housing or employment). As a result, they have limited mental and emotional bandwidth. The prospect of beginning a program is daunting, as they can range from 12 weeks to 12 months. Starting a new commitment draws energy from the legal hurdles ahead, and potentially steals time away from their brief window of freedom.

Appeal to aspects of the service that incentivise participants’ motivation and engagement

To establish and maintain engagement, reinforce benefits of the program at various times of service delivery. Sometimes programs underestimate the need to clearly list the benefits of joining. The presumption is that these will be self-evident or that clients are in always in a position to proactively seek and respond to help. Our fieldwork suggests that framing help around rehabilitation alone is not enough. Clients have tried other programs that didn’t help them in the past.

“The big question that offenders ask when they are offered a program is ‘Do I need to?’ It helps to frame the program, even if voluntary, as something that will help them with their court/parole orders – which are not voluntary.” – Sally, service provider, metro

Appealing to both personal goals (such as regaining control of their health) and external rewards (consideration for reduced jail sentence) optimise engagement.

Incentivise the process of joining and service provision.Promote how case managers can connect clients with relevant agencies to minimise social welfare concerns. Work development orders and help with referrals to other services are initial levers to engagement.

Draw attention to a positive self-image.Clarify that primary role of case management is to work on achievable goals that clients set themselves to get their health, lives, family back on track.

Reward desired behaviour. Promote that commitment and progress is provided as evidence for court hearing.

Harnessing the power of social norms

People will seek to avoid labels, stereotypes and values that leave them feeling as if they are outsiders (social stigma).

Addressing negative social norms around stigma has proved to be effective in engaging clients.

Redress social stigma

Clients have been made to feel judged as “failures” by past services and programs. They reject being defined primarily by their criminal behaviour. Service providers work hard break down social stigma.

“Offenders tend to shut down at any sign of judgement. That is, they don’t like being seen as an ‘offender’ with the assumptions that go with it. It is very hard to offer support in that context.” – Leah, service provider, interstate

“Stigma is biggest hindrance to establishing and retaining engagement. Stigma is deep-rooted. We need to build capacities in the community – how to break down stigma when seeking assistance for drug and alcohol, for domestic violence, for sexual health. Let’s look at the harm reduction side of things.”  – Lubna, service provider, metro

Assessment tools help law enforcement, justice workers and service providers identify who is eligible for different programs. However some of these inventories use invasive questions that reinforce criminality.

The screening process is sometimes disconnected from the work clients undertake in a program. Clients do not necessarily receive feedback despite answering intensive questions about their criminal history.

The assessment process is an opportunity for a case worker “to draw out the individual’s story as it has meaning to them” (Mason and Prior, 2008: 15). Motivational interviewing, interactive and collaborative methods are useful.

Assessment is often not culturally sensitive towards Aboriginal and Torres Strait Islander clients or other ethnic or religious minorities. Engagement can be increased by working with Aboriginal controlled programs, and minority community services, as well as a flexible delivery model, ranging from one-on-one to group sessions (see Centre for Innovative Justice, 2015:39). 

How to reduce social stigma during eligibility assessment

Reduce stigma by drawing on a behaviourally-informed screening tool to assist case management.

• Using behavioural science, the questions might be reduced and simplified, to focus on patterns of behaviour, and in turn, inform goal-setting and commitment to family and friends.
• Draw on a limited number of questions from the risk-need-responsivity model, validated through BI measures (test, learn and adapt questions) (cf. Casey et. al. 2014).
• Use a simplified template, checklists and visual feedback about patterns of behavioural, short-term goals and program outcomes.
• Make personalised recommendations that the client immediately understands.
• Use the tool to prompt best practice from case workers and to enhance clients’ self-esteem at the point of assessment

Encourage commitment. At the end of the assessment session, the tool might provide a meaningful measure that could be provided to the client as a type of commitment device. This could be writing down a goal that emerges from the assessment. Behavioural science shows that making commitments to family or friends increases the likelihood of achieving goals.

Use social norms. Mainstream programs do not meet the cultural and spiritual needs of minority clients. Consider culturally-relevant questions and measures that are meaningful to specific culturally and linguistically diverse groups.

Making a timely offer

People are more likely to change their habits during a period of transition (fresh start effect).

Offer programs at the optimum time when clients are open to change. Clients and service providers say the best time to approach clients is at a moment of reflection and weariness, when they are fed up over the cycle of being reimprisoned.

The first 24 to 48 hours after being released into the community in the case of pre-sentencing is an ideal time to engage people at high-risk of reoffending (see also Watson, 2005).

Pre-sentencing treatments are most effective where there is no delay between trial and treatment (Centre for Innovative Justice, 2015; Gondolf, 2012).

Leverage the fresh start effect

People who reoffend are not motivated by fear of incarceration. They don’t want to go to jail, but they are used to being sanctioned, which only further alienates them. To engage this cohort, it is important to hook into intrinsic motives to break the cycle of reoffending.

Proactively contacting clients when they are “ready for change” can make a world of difference (Centre for Innovative Justice, 2015:48).  Fatigue of losing many important relationships can open the door to change. Programs can draw on aspirations to reunite, reconcile or support clients and their family as a pathway for engagement.

Clients who are younger (under the age of 30 years) may have been in and out of trouble with the law, but, as participants observe, they might still think they can “game the system.” Clients who are older (especially in their 40s and 50s) have spent various stretches of time in and out of jail. They are weary of prison, but equally distrustful of programs. In either case, voluntary participation hinges on making contact early and showing the client a clear path to get back control of their lives. Lionel leads a men’s behavioural change program for violent perpetrators in metro Sydney. He appeals to clients’ hope for change:

“The main ‘hook’ is offering hope for the offender; that life doesn’t have to keep going the way that has been going and that it can change. The three criteria for acceptance into the program are: mission – a readiness to accept why the man is here. Conversation – an ability to talk about themselves. Goals – the desire to become a better man.”

How to prompt clients when they are most receptive to change

Prompt clients when they are most receptive to change, within 48 hours of release into the community. Addressing fatigue and loss can be an engagement entry point. Use the clients’ language, such as being “tired” of the cycle of reimprisonment, or wanting to “take control” their lives.

Offer social welfare referral to find stable housing and other support, as this otherwise preoccupies the clients’ “mental bandwidth.”

Appeal to client’s weariness of repeated patterns, such as:

• Being tired of the cycle of reoffending
• Exhaustion over constant re-imprisonment
• Needing to take back control of their lives

Discuss the client’s desire to reconnect with family (especially children and grandchildren),
where this is safe.

Leverage SMART goals (specific, measurable, achievable, relevant, and time-bound). In a typical 12-week program, a series of small goals would be best. This could be to attend at least 7 out of 10 sessions with a therapist to work on a family-related goal (such as reconnecting with children or grandchildren), or to reduce (rather than eliminate) alcohol and other drug use.

Implementation factors

People caught up in the criminal justice system are not dissimilar to other customers in New South Wales in that they are put-off engaging in programs by previous bad experiences that have generated negative emotional responses.

The people we interviewed have received various services throughout their lives, including voluntary rehabilitation programs or mandated, parole-related programs. They rarely remember the names of these programs, with the exception of well-known alcohol and other drug programs. Yet they recall vividly negative experiences – from asking for assistance and not receiving respectful responses, to feeling alone navigating bureaucracies and forms. This made them wary of starting over with new programs and new case workers.

The distrust was compounded by implementation barriers that make joining programs a big hassle.

Below is a summary of some implementation issues that emerged in our fieldwork and how to redress these barriers. Implementation issues need to be sorted first, before behavioural interventions can be most effective.

• Improving avenues for contacting clients. Clients are hard to contact because they are often homeless or in precarious housing. A solution might be to contact hard-to-reach clients through trusted stakeholders (such as lawyers and prisoner advocacy networks)
• Creating easy options to engage. Programs seem inaccessible, especially when clients have limited travel options. Having mobile and flexible case workers who can drive out to clients or accompany them to appointments makes it easier to engage clients
• Keeping referral pathways open. Referral programs can be limited if they come from only one source, such as police and Community Corrections. Referrals through exiting service providers, Aboriginal community-controlled organisations, and self-referral can be more powerful levers for change
• Producing easy-to-use tools for best practice. Best practice for case management is well documented, but this is often in dense manuals that are hard to recall on day-to-day
• Facilitating collaboration. Privacy provisions of some programs can sometimes hamper cooperation between service providers, court users and criminal justice stakeholders. Some programs will have privacy restrictions that means client history is withheld from service provider. Service providers stress the importance of case history, to better understand criminogenic patterns and to pre-empt any outstanding legal issues
• Working with Magistrates to consolidate charges. Clients are sometimes unable to complete programs due to other outstanding charges, which lead them back into the court system. Negotiating a more straightforward process to combine outstanding charges and pending court cases would enable clients to maximise their opportunity to fully commit to rehabilitation
• Establishing a representative justice programs advisory board made up of Aboriginal service providers and experts from rural and metro regions. Aboriginal service providers experience consultation fatigue, with multiple programs and services seeking their input after new programs are launched. Setting up an advisory body of various Aboriginal community-controlled organisations, legal representatives, community services and elders would lift this burden from ad hoc requests. Advisory members should be remunerated adequately
• Engaging stakeholders early on aims, roles and outcomes of new programs. When new programs are launched, misconceptions can quickly spread and lead to disengagement. For example, lawyers may not have visibility of certain programs or have the ability to refer their clients into a program. This closes a potential opportunity to engage clients.

Case management

People make decisions based on the information they have readily available, especially from intense memories, usually events that are unusual or which evoke an emotional state (availability heuristic). Clients have a negative perception of case workers based on personal or family experiences in the past. The table below demonstrates the negative and positive effects of behaviours displayed by case workers when engaging clients.

Table 2 Case worker behaviour effect on client engagement

Case worker behaviour	Effect on client engagement
	Negative	Positive
Displayed demeanour	Perceived arrogance leads to de-motivation E.g. “talking down” to clients, or being dismissive	Demonstrating empathetic listening increases trust E.g. “they show they are on your side”
Presentation of self	Dressing too business-like widens social distance to clients	Dressing, acting and talking in ways that are familiar to clients establishes a positive working alliance E.g. “we just clicked”
Communication	“Harassing” clients increases stress E.g. unhelpful or excessive contact during difficult times	Negotiating and agreeing on level of contact boosts support E.g. ring to remind about appointments or check up on outcomes in a helpful rather than judgemental manner
Commitment	Inconsistency leading to distrust E.g. being moved frequently from one worker to another lowers confidence in client that service is invested in  their success	Reflecting on overcoming similar problems the case worker has experienced in the past makes them an ally E.g. “Respect them and be on their level”

Build-in positive reinforcement. Clients are wary of poor services. At any given time they (or their family members) will already be clients of various government, health and community programs. Being approached to enter a new voluntary program may trigger distrust. Turning negative past experiences into goal-setting would help. For example, address what approaches to avoid in case management, and the client’s preferences for contact. Positive reinforcement at various points of case management can create more positive memories of service delivery. For example, providing weekly feedback on useful behaviours or thanking clients for showing up to appointments on time.

Make best practice easy to implement. For service providers, case management is emotionally and physically draining, so best practice is not necessarily top of mind in complex, day-to-day settings. A “working alliance” or “therapeutic alliance” approach uses personalised approach and focuses on the strengths of the client (Burnett and McNeill 2005:232). Making best practice a routine aspect of case management is pivotal to engagement (Trevithick, 2005; Miller and Rollnick, 2002; Lynch, 2006; Milkman and Wanberg, 2007; Britton and Farrant, 2008; McMurran and Ward, 2010). Using BI techniques can prompt best practice in an everyday setting. For example:

• Facilitate knowledge sharing and mentorship for case workers through less time-intensive methods. E.g. secure social messaging apps
• Document and share case studies of techniques that are achieving results

Provide checklists or case management aids that are simple to incorporate in daily work.

Next steps

Our findings have been used to expand New South Wales government understanding of how to best engage people who have a reoffending history in voluntary programs. We will continue to work in collaboration with relevant service providers and other agencies in the justice sector and beyond, to better address the barriers and enablers to increasing support and service delivery to at-risk cohorts.

I designed this infographic to promote our findings to busy practitioners and policymakers.

How Social Science Helped

• Research methods: qualitative interviews and ethnography of community services
• Theoretical insights: our recommendations are based on best practice literature
• Systemic reforms: a social science perspective helps to put individual troubles in broader cultural context. In this case, the institutional processes that prevent clients from taking advantage of rehabilitation programs.

Learn more

Read our report for discussion of the policy context, literature review of behavioural science on motivations, overview of the methods and participants, futher case studies, and references.