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Article

Hayley Stokes, Louise Dixon and Anthony Beech

This study aims to use pre‐treatment assessment scores to predict the drop out of 103 incarcerated male violent perpetrators undertaking a long‐term aggression programme…

Abstract

This study aims to use pre‐treatment assessment scores to predict the drop out of 103 incarcerated male violent perpetrators undertaking a long‐term aggression programme, namely the Cognitive Self Change Programme (CSCP), in six English prisons. A hierarchy of best predictors of attrition in this sample is developed. Results found eight out of the 46 assessment variables analysed had a significant association with treatment drop out. Further to this, discriminant function analysis predicted group membership with 80% accuracy, successfully distinguishing perpetrators who dropped out of the programme from those who completed it. The findings support the use of identifying risk factors pre‐treatment to predict drop out and offer a practical way to identify group members who are likely to drop out of the CSCP in addition to identifying markers for programme improvement. The need for further research to increase our understanding of the underlying causal explanations that link specific assessment items to treatment dropout is discussed.

Details

Journal of Aggression, Conflict and Peace Research, vol. 1 no. 1
Type: Research Article
ISSN: 1759-6599

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Article

Laura Aslan

It is common for people to view dropping out of substance misuse treatment as an unsuccessful attempt at recovery. The existing literature emphasises that those who drop

Abstract

Purpose

It is common for people to view dropping out of substance misuse treatment as an unsuccessful attempt at recovery. The existing literature emphasises that those who drop out of treatment do worse than those who complete their treatment programme. More recently, however, those who discharge early are faring better than ever before.

Design/methodology/approach

In total, 13 service users who discharged early from three residential therapeutic communities were interviewed over the phone to discuss life after treatment. Interview transcripts were analysed using thematic analysis and found four main themes evidencing that “unsuccessful” really can be successful.

Findings

The study unearthed significant findings in the area of motivation for continued recovery in that 85 per cent of the sample were actively accessing further substance misuse treatment after leaving the service early. Five participants who had entered treatment as opiate users were all abstaining from Class A drugs at the time of interview; indeed 100 per cent of the sample were opiate free. Furthermore, self-reported psychological health had improved following discharge by 78 per cent.

Practical implications

Recent changes in policy and treatment design within drug treatment services may explain such positive outcomes in that a more responsive programme allows people to gain skills and make changes in a shorter time frame.

Social implications

Indeed, improved early discharge procedures and increased links to aftercare and follow on treatment may have impacted on this finding.

Originality/value

This study therefore proposes the notion of “right dose of treatment” as opposed to “time in treatment” and highlights the importance of exit procedures and aftercare.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 36 no. 2
Type: Research Article
ISSN: 0964-1866

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Article

James Binnie and Zoe Boden

Research demonstrates that non-attendance at healthcare appointments is a waste of scarce resources; leading to reduced productivity, increased costs, disadvantaged…

Abstract

Purpose

Research demonstrates that non-attendance at healthcare appointments is a waste of scarce resources; leading to reduced productivity, increased costs, disadvantaged patients through increased waiting times and demoralised staff. The purpose of this paper is to investigate non-attendance and implemented interventions to improve practice.

Design/methodology/approach

A mixed methods service audit took place in a primary care psychological therapies service. Existing service guidelines and reporting systems were reviewed. A cross-sectional design was used to compare a year’s cohort of completers of cognitive behavioural therapy (CBT) (n=140) and drop-outs (n=61).

Findings

Findings suggested contrasting guidelines and clinically inaccurate reporting systems. The overall service did not attend (DNA) rate was 8.9 per cent; well below rates suggested in the literature. The drop-out rate from CBT was 17 per cent. The most influential factor associated with CBT drop-out was the level of depression. The level of anxiety, risk ratings and deprivation scores were also different between completers and drop-outs. The main reasons given for non-attendance were forgetting, being too unwell to attend, having other priorities, or dissatisfaction with the service; again these findings were consistent with prior research.

Originality/value

A range of recommendations for practice are made, many of which were implemented with an associated reduction in the DNA rate.

Details

Mental Health Review Journal, vol. 21 no. 3
Type: Research Article
ISSN: 1361-9322

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Article

Alina Morawska and Matthew Sanders

Despite the importance of increasing engagement and minimising attrition and dropout in parenting interventions, there is a paucity of empirical evidence examining…

Abstract

Despite the importance of increasing engagement and minimising attrition and dropout in parenting interventions, there is a paucity of empirical evidence examining factors related to engagement and participation. The range of factors examined in relation to engagement is generally limited in scope and variety, focusing on variables of convenience rather than utilising a theoretically‐driven approach.The aim of this article is to review the factors related to parental engagement with interventions and to describe strategies and implications for improving engagement with parenting interventions. Several policy and practice implications are identified: (1) Poor parental engagement may threaten or compromise the capacity of parenting programmes to deliver valued outcomes. Viable engagement strategies need to be a core part of prevention and early intervention parenting programmes; (2) Agencies delivering parenting services need a proactive engagement strategy, which includes strategies to prevent dropout, as well as strategies to actively respond to parental disengagement; (3) Research is needed to test the efficacy and robustness of different engagement enhancement strategies. Empirical tests are needed to test the effectiveness of different engagement strategies in order to ensure that the most efficient, cost‐effective and efficacious approach is used in order to engage parents. Investment of research effort to improve parental engagement is likely to have a high yield in terms of programme efficiency, utility and cost effectiveness. We conclude that research examining how to improve engagement and decrease non‐completion is needed to strengthen the population level value of parenting programmes as preventive interventions.

Details

Journal of Children's Services, vol. 1 no. 1
Type: Research Article
ISSN: 1746-6660

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Article

Luís Janeiro, Eugénia Ribeiro, Luís Faísca and María José Lopez Miguel

A better therapeutic alliance at the beginning of treatment for addictive behaviours has been found to prevent dropout. The purpose of this paper is to evaluate how the…

Abstract

Purpose

A better therapeutic alliance at the beginning of treatment for addictive behaviours has been found to prevent dropout. The purpose of this paper is to evaluate how the development of therapeutic alliance dimensions was associated with the dropout prevention.

Design/methodology/approach

A total of 23 participants presented a substance use disorder related to heroin or cocaine and were in three distinct treatment phases of a therapeutic community. Each participant filled in the therapeutic alliance measures once a week after mini-groups. A naturalistic prospective research design was used to collate 198 repeated alliance measures.

Findings

Participants who presented stable bond development at higher levels tended to stay in treatment, whereas those who developed stable bonds at lower levels tended to drop out. The goals and tasks dimension increased significantly across the phases and was not associated with dropout.

Practical implications

To prevent dropout, therapists should pay special attention to residents who manifest difficulties in establishing stable and secure bonds and not overestimate the impact of the goals and tasks alliance dimension, as it is not a failsafe indicator of treatment retention.

Originality/value

The alliance dimensions were differentiated (bond, goals and tasks) and studied throughout the treatment, pointing out the importance of therapeutic relationship dynamic variables to prevent dropout.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 39 no. 2
Type: Research Article
ISSN: 0964-1866

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Article

Shona Adams and Steven Allan

Human Givens (HG) Rewind technique is a graded trauma-focused exposure treatment for post-traumatic stress disorder and trauma. The purpose of this paper is threefold…

Abstract

Purpose

Human Givens (HG) Rewind technique is a graded trauma-focused exposure treatment for post-traumatic stress disorder and trauma. The purpose of this paper is threefold: first, to describe the technique; second, to provide an outline of its potential benefits; and third, to present some preliminary evidence.

Design/methodology/approach

This paper provides an overview of HG therapy and describes the stages of HG Rewind trauma treatment and its potential benefits. Similarities and differences between Rewind and other Cognitive Behavioural Therapy techniques are explored. Possible underlying mechanisms are discussed.

Findings

Preliminary evidence suggests that Rewind could be a promising trauma treatment technique and that HG therapy might be cost effective. The findings highlight the need for further research and a randomised controlled trial (RCT) on Rewind is warranted.

Practical implications

During the rewind technique, the trauma does not need to be discussed in detail, making treatment potentially more accessible for shame-based traumas. Multiple traumas may be treated in one session, making it possible for treatment to potentially be completed in fewer sessions.

Social implications

This UK-based treatment may be cost effective and make treatment more accessible for people who do not want to discuss details of their trauma.

Originality/value

This is the first description of HG Rewind in the peer-reviewed literature. Alternative explanations for mechanisms underlying this trauma treatment are also presented.

Details

Mental Health Review Journal, vol. 24 no. 2
Type: Research Article
ISSN: 1361-9322

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Article

Victoria Defelippe, Anna Schlütter, Annelen Meriaan, Bjorn Winkens, Veronika Kavenská, Gary Saucedo Rojas and Matteo Politi

Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of…

Abstract

Purpose

Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of these rehabilitative trajectories are subject to “drop-out”. In addition, “drop-out” is a significant risk factor for relapse. There is an urgent demand for effective treatment, which would enable patients to reduce abuse and prevent relapse. Takiwasi is an addiction treatment centre that combines traditional Amazonian plant medicine with conventional western medicine and psychotherapy. The purpose of this paper is to explore whether socio-demographics factors, such as education level and occupation, psychiatric comorbidities and primary drug use, are associated with treatment non-completion of Ayahuasca (AYA)-assisted addiction therapy.

Design/methodology/approach

Data on the first treatment episode of 121 patients were collected from the patient database from the years 2012 to 2017. To determine whether there is an association between the variables of interest and treatment non-completion, a χ2 analysis and a logistic regression analysis were performed.

Findings

Of the 121 patients analysed, 48.2 per cent completed their treatment, whilst 51.8 per cent did not. Students compared to those who are employed showed significantly higher odds for treatment non-completion (p=0.006; OR=3.7; 95% CI=1.5–9.6). Other variables in the multivariable analysis showed no significant relationship with treatment non-completion. While several limitations restricted the study, the findings suggest that the AYA-assisted treatment in Takiwasi may benefit from additional support for patients who are students. Moreover, it is advised to conduct more long-term follow-up of patients in order to gain better insight into the outcome of treatment at an AYA-assisted treatment centre.

Originality/value

It appears that AYA-assisted therapy in a therapeutic community is a feasible type of treatment for addiction, for which further studies should elucidate the role of motivation in relation to socio-demographic factors and type of addiction in the risk of treatment non-completion.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 40 no. 2
Type: Research Article
ISSN: 0964-1866

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Article

Grazia Zuffa

Following the example of many northern European countries, harm reduction strategies were introduced in Italy at the beginning of the 90s in response to the spread of…

Abstract

Following the example of many northern European countries, harm reduction strategies were introduced in Italy at the beginning of the 90s in response to the spread of HIV/Aids. The peculiarities of Italian culture and tradition led to the adoption of a ‘Latin’ model, while in northern countries the culture of pragmatism and evidence‐based practices, together with a long tradition of public health policy were determinant in promoting harm reduction. In Italy, the ‘social perspective’ on the drug problem adopted by a large part of professionals working in public services and by most non‐governmental organisations (NGOs), has prompted a synergy between ‘cure’ and ‘care’ (ie. treatment and harm reduction), leading to the ‘integration’ of harm reduction and the traditional drug‐free work on addiction. As a result, since the mid 90s, public services and therapeutic communities have been cooperating to build a complex system of low to high threshold facilities. Until the 90s, most NGOs only ran drug‐free programmes in therapeutic communities, but from then onwards many began running harm reduction programmes as well, especially street units and needle exchange programmes, secondary prevention units at rave parties, drop‐in centres, and low‐threshold detoxification centres. Similarly, there has been an increase in methadone maintenance in public services, after the ‘retention in treatment’ of clients was established as the primary objective in the effort to protect users from drug related death and HIV infection. Though harm reduction interventions are far from being fully implemented, data shows that in the past 15 years the harm reduction/treatment system has reduced health risks for drug users and has been instrumental in referring a remarkable number of injecting drug users into treatment programmes. In the mean time, drugs of choice, patterns of use and ways of drug consumption have substantially changed. Now the question is, will the Italian approach be able to address these new challenges?

Details

Drugs and Alcohol Today, vol. 8 no. 3
Type: Research Article
ISSN: 1745-9265

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Article

Anthony Beech, Nick Freemantle, Caroline Power and Dawn Fisher

– The purpose of this paper is to examine the potential biases in research designs used to assess the efficacy of sex offender treatment.

Abstract

Purpose

The purpose of this paper is to examine the potential biases in research designs used to assess the efficacy of sex offender treatment.

Design/methodology/approach

In all, 50 treatment studies (n=13,886) were examined using a random effects meta-analysis model.

Findings

Results indicated a positive effect of treatment for both sexual (OR=0.58, 95%, CI 0.45-0.74, p < 0.0001), and general recidivism (OR=0.54, 95%, CI 0.42-0.69, p < 0.0001), indicating that the likelihood of being reconvicted after treatment was around half compared to no treatment. RCTs showed no significant effect for sexual or general, recidivism. Significant effects were found for non-RCT designs (i.e. incidental cohort, completers vs non-completers designs). Assignment based on need (i.e. giving treatment to those who were high-risk) indicated a negative effect of treatment.

Practical implications

The results highlight the importance of considering study design when considering treatment efficacy.

Originality/value

The current research reports studies identified up until 2009, and examined both published, and unpublished, research originating from a variety of samples employing a random effects model. Consequently, it can be argued that the results are both original and are reflective not only of identified studies, but are also representative of a random set of observations drawn from the common population distribution (Fleiss, 1993). The results of the study suggest that what is required in future research is methodological rigour, and consistency, in the way in which researchers measure the effectiveness of sexual offender treatment.

Details

Journal of Aggression, Conflict and Peace Research, vol. 7 no. 4
Type: Research Article
ISSN: 1759-6599

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Book part

Sarah Brown

In the evaluation of most interventions in criminal justice settings, evaluators have no control over assignment to treatment and control/comparison conditions, which…

Abstract

In the evaluation of most interventions in criminal justice settings, evaluators have no control over assignment to treatment and control/comparison conditions, which means that the treated and comparison groups may have differences that lead to biased conclusions regarding treatment effectiveness. Propensity score analysis can be used to balance the differences in the groups, which can be used in a number of ways to reduce biased conclusions regarding effectiveness. A review of propensity scoring studies was conducted for this chapter, where the limited number of evaluations of criminal justice interventions using these methods was identified. Due to the small number of these studies, research was also reviewed if propensity scoring had been employed to evaluate interventions that are similar to those in criminal justice systems. These studies are used as examples to demonstrate how the methods can be used to evaluate criminal justice interventions, the different ways propensity scores can be used to analyse treatment and comparison group differences, and the strengths and limitations of this approach. It is concluded that, while not appropriate for all interventions/settings, propensity score analysis can be useful in criminal justice arenas, at least to investigate the comparability of treatment and comparison groups, with suspected non-comparability being a common weakness of traditional quasi-experimental studies and frequently cited limitation in terms of drawing efficacy conclusions from such evaluations.

Details

Perspectives on Evaluating Criminal Justice and Corrections
Type: Book
ISBN: 978-1-78052-645-4

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