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Traditionally evaluators of offending behaviour programmes have examined group-level mean change in treatment targets without acknowledging the potential variability of change at an individual level. Clinically significant change, although used widely in the therapy literature generally, has only recently been examined within forensic therapeutic contexts. This chapter provides an overview of key concepts, and the published literature in which clinically significant change has been examined within forensic samples is reviewed. It is concluded that although this technique has the potential to validate programme theory, it is yet to be used to its full potential within a forensic context.

172 adult male prisoners were assessed before and after intervention in a UK prison‐based therapeutic community using psychometric measures of psychological well‐being and offence‐related risk. All mean scores changed significantly in the expected direction. For men tested after 12 months or more, concurrent changes occurred in both domains. Significant relationships were also found between parole board assessments of risk reduction and psychometric changes. The study suggests that interventions with offenders can target offence‐related risk and mental health as clinically compatible treatment targets. Interventions with offenders may need to focus on improvements in mental health to enhance participants' readiness to address risk.

With the increased need for quantitative measures of accountability and effectiveness in the therapeutic setting, standardised outcome measures have come to the fore. This study aimed to assess the psychometric quality of the Clinical Outcomes in Routine Evaluation (CORE‐OM) used with an Irish population of adult victims of childhood abuse. The study indicated that the outcome measure was a useful tool in a forensic therapeutic setting, despite issues regarding the CORE's factor structure. The study also found that the service assessed matched the benchmarks laid down by the CORE systems group regarding levels of change brought about by therapeutic interventions, further indicating the benefits of CORE. The study discusses these issues and possible recommendations for aiding better integration of CORE's findings within therapy and broader clinical practice.

The purpose of this single-case experimental design paper is to examine the efficacy of the high-dosage Life Minus Violence – Enhanced (LMV-E) programme with a small sample of four violent women in custody. All participants were undertaking LMV-E as one component of their treatment pathway in an Offender Personality Disorder (OPD) treatment service for women with personality disorder. The methodology employed an AB baseline design with a six-month baseline period, nine-month treatment period and six-month follow-up. Levels of direct and indirect aggression were recorded throughout the baseline, intervention, and follow-up period. In the follow-up period, women were engaging in further treatment. Psychometric measures linked to treatment domains were used to explore clinically significant and reliable change following the intervention. Clinical and reliable change was indicated in some treatment domains for each participant following the intervention. The pattern of these reductions varied between the women. The patterns of findings are discussed and recommendations presented.

The methodology employed an AB baseline design with a six-month baseline period, nine-month treatment period and six-month follow-up. Levels of direct and indirect aggression were recorded throughout the baseline, intervention and follow-up period. In the follow-up period, women were engaging in further treatment. Psychometric measures linked to treatment domains were used to explore clinically significant and reliable change following the intervention.

Clinical and reliable change was indicated in some treatment domains for each participant following the intervention. The pattern of these reductions varied between the female offenders. The patterns of findings are discussed and recommendations presented.

The LMV-E programme was associated with some positive improvements in treatment domains measured in a small sample of female violent offenders. Improvements to some degree were most commonly found in the domains of anger, emotional control and components of criminal thinking. It would be clinically useful to examine characteristics of individuals that appear to benefit most from particular interventions.

There are no existing published findings related to the implementation of LMV-E with females. Therefore, this paper provides preliminary contribution to the evidence base in this area.

Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. The purpose of this paper is to present individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy.

Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-2014. Outcomes were compared to 2012-2013. A patient satisfaction questionnaire was administered and functional outcomes were collated.

Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliable improvement increased from 2012-2013; 81 per cent reliably improved, 44 per cent made a clinically significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted. The service met a number of NICE quality standards concerning the “relational” aspects of care.

Clinical effectiveness is evaluated through one outcome measure thereby limiting conclusions. The longer term effectiveness of the service remains unclear. Narrow demographic information limits an assessment of any systematic biases in findings. Little is known about treatment drop-outs.

A number of recommendations concerning data collection and future service evaluations are made.

Returning to paid or unpaid activities has a high public health impact.

This paper contributes towards the evidence base for using psychological therapies with clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness (i.e. practice-based evidence).

There is no specific recommended treatment for the co-morbid presentation of post-traumatic stress disorder (PTSD) and substance use disorder in the United Kingdom (UK). Seeking Safety (SS), a group-based treatment that targets symptoms of both disorder, has emerging evidence in the USA but lacks evidence from UK-based samples. The purpose of this study was to explore UK service users’ experience of attending SS and evaluate its impact on mental health symptomology and substance misuse.

A mixed method approach was used to evaluate the acceptability of SS for a small sample (n = 7) of adult users of a substance misuse service in the UK. Thematic analysis was used to explore their experiences, derived from individual semi-structured interviews. The authors also calculated the number of participants who achieved reliable and/or clinically significant change in mental health symptomology and substance misuse from data routinely collected by the service.

Seven overarching themes emerged: strengthening the foundations of the self, the evocation and management of emotions, safety and validation provided relationally, readiness and commitment, content and delivery, Seeking Safety is Not an Island and ending. Most participants with data available both before and after the group made reliable (three out of four) and clinically significant (two out of three) change for depression and anxiety symptomology; however, this was less evident for PTSD symptomology with two out of three making reliable change and one out of three making clinically significant change.

To the best of the authors’ knowledge, this was the first study exploring the experiences of UK attendees of a SS group as an approach to treating comorbid PTSD and substance misuse.

The Behavior Problems Inventory-Short Form (BPI-S) is a shorter version of the Behavior Problems Inventory-01. In this paper, BPI-S population norms are reported from a total administrative population of adults with intellectual disability (ID). To facilitate the use of the BPI-S in clinical services to assess behavior change, the purpose of this paper is to describe how to use BPI-S clinically significant and reliable change (RC) scores.

Data were gathered on 265 adults with ID known to services. Proxy informants completed the BPI-S on challenging behaviors over the previous six months. Clinically significant cut-off values and RC scores were calculated using the Jacobson and Truax’s (1991) method.

BPI-S clinical reference data are presented to provide benchmarks for individual and group comparisons regarding challenging behavior. Examples demonstrate how to use clinical norms to determine change.

Behavior change is a major goal of researchers and practitioners. Data from the present study can make the BPI-S a valuable tool for determining change in challenging behavior following service input or intervention.

Whilst well used in research, the BPI-S may be less extensively used in practice. This present study provides data to enable researchers and practitioners to use the BPI-S more widely in assessing clinical outcomes, such as intervention research and service evaluation.

This study aims to describe and to compare the reliability and accuracy of different methods of measuring psychiatric symptom changes in the context of substance use.

A group of 60 patients in routine methadone treatment were followed‐up during a “watchful wait” period of four to six weeks. Diagnoses of common mental disorders meeting International Classification of Diseases (ICD‐10) criteria were established using the CIS‐R structured diagnostic interview. Brief questionnaires for depression (PHQ‐9) and anxiety (GAD‐7) were used to measure symptom changes between test and retest. It was hypothesised that the accuracy of symptom changes measured using brief questionnaires may be compromised by methodological artefacts such as poor specificity, regression to the mean and measurement error. These assumptions were tested empirically.

It was demonstrated that measuring change using conventional cut‐offs in brief symptom questionnaires tends to overestimate the prevalence of common mental disorders and the rates of improvement. Using higher cut‐off scores calibrated in samples of alcohol and drug users, in combination with a reliable change index results in more conservative and reliable estimates of symptom change.

This paper presents a considered discussion on the relative merits and limitations of alternative psychiatric symptom measurement methods. These methodological recommendations may be of interest to research and clinical practice concerned with evaluating changes in comorbid depression and anxiety. Important questions are also raised about the modest degree of symptom changes typically observed during a watchful wait period.

The purpose of this paper is to evaluate the clinical effectiveness of a brief CBT intervention within a primary care adult mental health service.

In total, 92 participants with mild to moderate mental health difficulties were provided with five sessions of brief CBT. Clinical improvement was measured using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment, mid-treatment and post-treatment, and on the Beck Depression Inventory-II (BDI-II) at pre-treatment and post-treatment.

The planned five sessions of CBT were completed by 48.9 percent (n=45) of participants. Treatment completers with full clinical data (n=31) showed large statistically significant improvements on the CORE-OM and BDI-II from pre-therapy to post-therapy. Of treatment completers and non-completers with post-therapy and mid-therapy CORE-OM data, respectively (n=34), 61.8 percent showed reliable and clinically significant change. No statistically significant differences were found between treatment completers (n=45) and non-completers (n=47) in their pre-therapy clinical scores or socio-demographic characteristics.

Brief CBT can be a clinically effective primary care intervention but needs to be implemented in a way that ensures high treatment engagement across a range of service users.

This paper contributes to the evidence base of a primary care psychological intervention and demonstrates the importance of assessing treatment completion when evaluating clinical effectiveness.

In the UK, the mental health treatment requirement (MHTR) order for offenders on probation has been underused. A MHTR service was established to assess the effectiveness of a partnership between a probation service, a link worker charity and an independent mental healthcare provider. Short-term structured cognitive behavioural interventions were delivered by psychology graduates with relevant work experience and training. Training for the judiciary on the MHTR and the new service led to a significant increase in the use of MHTR orders. The paper aims to discuss these issues.

A total of 56 (of 76 MHTR offenders) completed treatment in the first 12 months. A single cohort pre-post follow-up design was used to evaluate change in the following domains: mental health and wellbeing; coping skills; social adjustment; and criminal justice outcomes. Mental health treatment interventions were delivered under supervision by two psychology graduates who had relevant work experience and who were trained in short term, structured, cognitive behavioural (CBT) interventions.

Clinically significant changes were obtained on measures of anxiety and depression, and on measures of social problem solving, emotional regulation and self-efficacy. Ratings of work and social adjustment and pre-post ratings of dynamic criminogenic risk factors also improved. This new initiative has addressed the moral argument for equality of access to mental health services for offenders given a community order.

While the current initiative represents one of a number of models designed to increase the collaboration between the criminal justice and the mental health systems, this is the first within the UK to deliver a therapeutic response at the point of sentencing for offenders with mental health problems. The significant increase in the provision of MHTR community orders in the first year of the project has been associated with a decrease in the number of psychiatric reports requested that are time consuming and do not lead to a rapid treatment.