Running head: LIFE SKILLS PROGRAM FOR INCARCERATED WOMEN

Occupation-Based Life-Skills Program for Incarcerated Women: A Literature Review

Ashley Thayn

University of Utah
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Evidence-Based Practice

A literature review was conducted to better understand the existing programs and needs

for occupational therapy-based life skills training of incarcerated women. This literature review

was conducted by accessing online journals through the American Journal of Occupational

Therapy, University of Utah Library, and Google Scholar. The search terms included

combinations of the following terms: occupational therapy, women, offenders, inmates, prison,

incarceration, correctional facilities, corrections, criminal justice, forensics, jail, rehabilitation,

transitional programs, recidivism, occupational deprivation, trauma, substance abuse, and

treatment. Articles were reviewed for relevancy and evaluated for competency and proficiency

of information. The decision to accept or reject each article was determined by how directly

applicable the content was to this population. Forty-three articles including two dissertations

theses were accepted into this literature review and are referenced below.

Female Offender Characteristics and Deficits

Across the nation, women in prison tend to have tumultuous pasts with common themes

of trauma stemming from emotional, physical, or sexual abuse (Chapman, Specht, & Cellucci,

2005; Smith, 2017). Fallot and Harris (2002) report that consequences stemming from trauma

play out across the lifespan with women displaying challenges in “emotional control,

dissociation, depression, substance abuse, and difficulties maintaining safe, stable, and mutually

satisfying interpersonal relations” (as cited in Crewe, Hulley, & Wright, 2017, p. 4). The effects

of childhood sexual abuse lead to feelings and behaviors of powerlessness and learned

helplessness. This is associated with an increased difficulty with impulse control (Alloy &

Seligman, 1979; Pelissier & Jones, 2006).

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Poor impulse control combined with life traumas is a recipe that can lead to self-

medicating behaviors that result in a physical chemical dependence and changes of behavior

caused by addiction. Drug charges tend to be the top offense for women incarcerated in the

United States (Harrison & Karberg, 2003; Springer, 2010). According to Giordano (2000)

addiction destroys women’s lives mentally, physically, and spiritually. Substance abuse has been

defined by clinicians and scholars as “a total resignation from living” (Martin, Bliven, Boisvert,

2008, p. 81). This resignation is seen as a diminished ability to function in everyday fundamental

life-skills. Women in prison have a higher likelihood of “impoverished social networks, a lack of

structure and routine, poor motivation, and limited employment and leisure skills” (Buijsse,

Cann, Davis, 1999 as cited in Martin, Bliven, & Boisvert, 2008, p. 81). Female offenders also

display characteristics of dysfunctional living with antisocial attitudes and relationships,

maladaptive personality characteristics, diminished self-esteem, and decreased quality of life

which further perpetuate a life full of despair and loneliness (Giordano, 2000; Hunter, Lanza,

Lawlor, Dyson, & Gordon, 2016; Martin, Bliven, & Boisvert, 2008).

Furthermore, incarcerated women tend to be less educated, lacking a high school diploma

or General Education Diploma (GED) (Harlow, 2003). Furthermore, many have a history of

unstable employment prior to prison and tend to repeat this pattern when they leave prison

(Visher, La Vigne, & Travis, 2004). Due to the myriad of compounding problems incarcerated

women face that negatively affect their life skills before and after their release from prison, there

is a critical need for life-skills training within prison.

Effect of Occupational Deprivation in the Prison Setting

In some settings, prison disciplinary systems restrict personally meaningful instrumental

activities of daily living (IADL) in social participation, communication management, and health
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management and maintenance. The reasoning is because these types of restrictions serve as

punishment to provide motivation for females to change behavior (D. Tucker, personal

communication, October 11, 2018). These restrictions can take the form of revoked phone calls,

visitation with family and friends, gym access, and life-skills training during inaccessible times.

Such restriction from engaging in occupational activities “compounds temporal disorientation’

(Farnworth & Muñoz, 2009; as cited in Molineux & Whiteford, 1999, p. 194).

According to scholars, occupational deprivation impedes prisoner’s successful

reintegration back into the community. Whiteford (2000) and Molineux and Whiteford (1999)

noted that over time occupational deprivation diminishes an inmate’s ability to adaptively

respond to new environments. The authors argue that this obstacle could be treated through

occupationally-enriching prison environments (Whiteford, 2000; Molineux & Whiteford, 1999).

Furthermore, prisoners who experience a consistent and long-term lack of meaningful and

purposeful opportunities for work, education, skill acquisition, and social interaction in prison

environments could become so removed from the roles of community life that they lose the

capacity to structure their time to meet the challenges of community participation (Farnworth &

Muñoz, 2009; Haney, 2001; Nurse, Woodcock, & Ormsby, 2003; Whiteford, 1995; Whiteford,

1997). Furthermore, key deprivations transfer internally to personally feeling devalued as a

woman (Crewe, Hulley, & Wright, 2017).

Habits and routines. Prisoners have a great deal of free time. Those who are kept in

maximum security have even more free time and experience a life dominated by sleep and

passive leisure occupations participated in alone (Davidson, Hoge, Merrill, Rakfeldt, & Griffith,

1995; Delespaul, 1995; Harvey, Fossey, Jackson, & Shimitras, 2006; Farnworth & Muñoz, 2009;

Krupa, McLean, Eastbrook, Bonham, & Baksh, 2003). Additionally, researchers found that
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prisoners reported they were “inactive, bored, and just killing time” (Farnworth, 1998;

Farnworth, 2000; as cited in Farnworth & Muñoz, 2009, p.194). The use of time that elicits

boredom is associated with poor mental health (Farnworth, 1998; Farnworth, 2000; Farnworth &

Muñoz, 2009). Allison and Casey (2001) reported that the loss of habits and routines have a

compounding effect that can occur on physical health, such as greater rates of obesity (as cited in

Farnworth & Muñoz, 2009) as a result from antipsychotic medication side effects (Farnworth &

Muñoz, 2009).

Scholars report that effective functioning in personal roles stem from habits and routines

that are created from patterns of occupation (Davidson, 2007; Farnworth & Muñoz, 2009). This

is important because understanding how positions of status affect individuals and their view

themselves determine how they know themselves and experience meaning in their life roles

(Kielhofner, 2008; as cited in Farnworth & Muñoz, 2009).

Existing Life-Skills Programs in the Prison Setting

According to the Bureau of Justice Statistics, “work readiness programs are available in 88% of

federal and state facilities, and educational programs are available in 85% of facilities” (as cited

in Clark & Duwe, 2015, p. 385). Also, counseling programs, substance abuse treatment, and life-

skills programming, are available in 92% of correctional facilities (Clark & Duwe, 2015).

However, despite the wide availability of programs, decreasing numbers of prisoners are

receiving that training and education (Clark & Duwe, 2015; Mears, Lawrence, Solomon, &

Waul, 2002). Statistics show that the percentage of offenders who received secondary

educational programming decreased from 43% to 35%, those receiving vocational training went

from 31% to 27% of prisoners (Lynch & Sabol, 2001; as cited in Clark & Duwe, 2015, p. 385).

The reason for this is likely due to underfunding in prison programing in correlation with
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increasing prison populations (Warren, Gelb, Horowitz, & Riordan, 2008). Underfunding is

resultant from a lack of evidence showing the value and effectiveness of prison programs in

lowering recidivism.

Role of Occupational Therapy as a Solution to Recidivism

Recidivism refers to an offender’s return to criminal behavior resulting in rearrest,

reconviction, or return to prison (National Institute of Justice, 2014). According to Busuttil

(1989) occupational therapists working in the rehabilitative setting have served a major role in

former female offender’s rehabilitation process from substance abuse. The task was addressed

with education and practice to enabling former offenders to improve social skills, develop

healthy habits and daily routines, and use their free time to engage in healthy interests and

hobbies (as cited in Martin, Bliven, & Boisvert, 2008).

Furthermore, Farworth and Muñoz (2009) reported that while correctional settings offer

some work-based opportunities, these jobs can be repetitive, mundane, and not teach new skills.

Comparatively, offenders who were taught a creative marketable skill in making tote bags and

dog jackets were able to earn money, learn new employment skills, and gain practice in

important practice life-skills with interpersonal skills, following instructions, and self-discipline.

According to Clark and Duwe (2015), life-skill programs built on a cognitive-behavioral

foundation were shown to be significantly more effective in reducing recidivism. A cognitive-

behavioral approach addressed antisocial cognition and promoted skills in prosocial decision-

making (Clark & Duwe, 2015). Additionally, the program targeted maladaptive behaviors,

dysfunctional thinking, social skills, and anger management skills. Through modeling and

consistent reinforcement made this program more was effective in enabling women to improve

in positive behavioral outcomes which also transferred to significantly lowering recidivism

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(Clark & Duwe, 2015; Lipsey, Landenberger, & Wilson, 2007; Pearson, Lipton, Cleland, & Yee,

2002).

Current Status of Occupational Therapy in the Prison Setting

Eggers, Muñoz, Sciulli, and Hickerson (2006) noted that occupational therapists in the

United Kingdom and Australia have long addressed helping former offenders successfully

integrate back into society as part of their domain of practice. However, they highlighted the fact

that in the United States occupational therapists are much less frequently employed on the

corrections team (2006). Many states still do not employ occupational therapists (OTs) at all. In

fact, the Utah State Prison does not have an OT on staff. Indeed, occupational therapy is a

slowly growing field in corrections. Prisons across the United States over 90 occupational

therapists are on corrections staffs (Muñoz, Moreton, & Sitterly, 2016). These occupational

therapists focus on treatment interventions to address life-skills in goal setting, problem-solving,

prosocial interpersonal skills, coping strategies, communication, stress management, anger

management, wellness and health, parenting skills, financial literacy, job skills, and personal

management skills (Bush, Glick, & Taymans, 1997; Clark & Duwe, 2015; Muñoz et al, 2016;

Pearson, Lipton, Cleland, & Yee, 2002).

Research shows that engaging incarcerated women in occupation helps them develop

more positive views of themselves that has shown to have a positive impact on their recovery

and may aid in preventing future relapses (Leppard, Ramsay, Duncan, & Malachowski, 2018;

Peloquin & Ciro, 2013). Still, occupational therapy continues to be a needed presence and

perspective in U.S. prisons to provide an occupation-based approach to rehabilitation, treatment,

and education for offenders to make lasting changes and support their ability to successfully

reintegrate back into society.

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Summary

Incarcerated women face many challenges affecting their emotional state and difficulty

acquiring and maintaining positive, prosocial relationships. They have learned behaviors such as

heightened impulsivity and learned helplessness which for many have led to becoming entrapped

in addiction. Consequentially, this has resulted to a limited life-skills in personal management in

structuring their routines, completing higher education, maintaining stable employment,

financially literacy, effectively parenting, and engaging in wholesome leisure which has

negatively impacted their self-esteem and decreased their quality of life. Furthermore, women

leave prison not adequately equipped to be reintegrated back into society which further

perpetuates high recidivism rates.

Through personally volunteering, observing, and interviewing prison staff, volunteer

clergy, prisoners, mentors, and community rehabilitation staff in conjunction with conducting

this literature review it has become more apparent what specific deficits and challenges

incarcerated women face and how they need to be addressed. Through gaining an inside view

into the world of the women’s prisons, it is apparent there is many group-centered programs

already available to prisoners in areas of personal rehabilitation, counseling, job skills,

continuing education, substance abuse rehabilitation, anger management, public speaking, social

skills, and some life-skills classes. Although, the prison offers life-skill programs, there is still a

lack of individual interventions and application of life-skills that could be implemented into

practice.

An individualized, client-centered approach would be of greater value to prisoners and

the Utah Department of Corrections because it would incorporate professional assessments of

prisoner’s areas for growth and implement a client-centered treatment approach to holistically
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addressing their individual needs by educating them in strategies and skills to become successful

inside and outside of prison. An occupation-based program would target diminishing

impulsivity, maladaptive, antisocial behaviors, while increasing their perseverance, healthy

coping, problem-solving, social skills to overcome learned helplessness. Avenues of intervention

would be centered on specific life-skills training in planning and budgeting wages to pay for

personal expenses she accrues while in prison, engaging in a therapeutic gardening program, and

learning fitness maintenance strategies that will be available regardless of what their lock-down

time is schedule. These programs will serve as the vehicle used to address and practice healthy

patterns and habits of perseverance, problem-solving, and positive social skills that will influence

healthy coping strategies and overcome behaviors of learned helplessness.

This occupation-based program is compatible with both the mission of Epiphany

Fellowship to “help women caught in the cycle of poverty” and to “provide needed educational

opportunities and professional counseling” (SLIHN Epiphany Fellowship, n.d, para. 1).

Additionally, this program is also complementary with the Utah Department of Corrections

mission “to provide maximum opportunities for offenders to make lasting changes through

accountability, treatment, education, and positive reinforcement within a safe environment”, and

further meets their vision to “foster an environment rich in professionalism, compassion,

collaboration, and dedication” (Utah Department of Corrections, 2017, para. 1-2).

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