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Given the considerable variation in treatment effectiveness observed across Improving Access to Psychological Therapy (IAPT) services, the purpose of this study is to explore client- and service-related variables that predict successful treatment outcomes and clients’ dropout. Clinician-rated clients’ motivation to change was also explored as a potential predictor for both outcome variables.

A convenience sample of 1,135 (F = 752; Mage = 39.4) was collected from three IAPT services in the North West of England. The study adopts a quasi-experimental, observational design. The analysis involves the description of patients’ socio-demographic and clinical characteristics and the development of three outcome prediction models, using hierarchical logistic regression.

After adjusting for confounders, employment status and motivation to change as rated by clinicians were predictive of both recovery and reliable improvement. The higher number of IAPT re-referrals was negatively associated with recovery and positively with dropouts. Clients who indicated low motivation to change and received low intensity treatment at their last session presented a higher likelihood to dropout.

Given that the evaluation of clients’ motivation to change was solely reliant on clinical judgement, as no validated measure was used, further robust research is recommended to draw sensible conclusions.

This is the first study evaluating clinician-rated motivation to change as a significant predictor of treatment outcomes and dropouts within the IAPT setting. Further research implications are discussed.

The purpose of this paper is to consider the enrolment at university and the subsequent possible dropout as a piece of the school-to-work transition and ask whether it improves or worsens the labour market outcomes a few years after graduation from the high school.

The analysis exploits data from the upper secondary graduate survey by ISTAT on a cohort of high school graduates and investigates the effect of dropping out four years after graduation. The labour market outcomes of university dropouts are compared to the outcomes of high school graduates who never enrolled at university. A propensity score matching approach is applied. The model is also estimated on the subsamples of males and females.

The findings show that spending a period at university and leaving it before completion makes the transition to work substantially more difficult. Both the probability of being NEET and getting a bad job increase in the case of dropout, while no relevant effect is found on earnings. Moreover, the impact of university dropout tends to be more harmful the longer the spell from enrolment to dropping out. Separate estimates by gender point out that females appear to be relatively more affected in the case of dropping out without a fallback plan.

While the existing studies in the literature on the school-to-work transition mostly focus on the determinants of the dropout, this paper investigates whether and how the employment outcomes are affected by dropping out in Italy. Moreover, university dropouts are compared to high school graduates with no university experience, rather than to university graduates. Finally, evidence on the mechanisms driving the effect of dropping out is provided, by considering timing and motivations for dropping out.

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.

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.

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.

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.

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.

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.

The treatment of severe and chronic substance dependence is challenged by high rates of treatment attrition, highlighting the need to identify factors that hinder treatment retention. The paper aims to discuss this issue.

The present study examined certain neurocognitive and personality traits in relation to treatment retention in a sample of 46 residents of an Australian therapeutic community (TC). The traits examined were previously found to be associated with problematic substance use in non-clinical samples and were also previously shown to differentiate TC clients from social drinkers. The hypothesis was thus that traits that appear to be risk factors for addictions are also likely to impact on TC treatment retention.

Group comparisons of those retained for more than the recommended 90 days vs those who left treatment prematurely showed that after controlling for the influence of depression, those who left treatment prematurely reported significantly higher levels of trait impulsivity, punishment sensitivity and executive cognitive dysfunction. There was a very high rate of alexithymia in the sample (52 per cent), but alexithymia was unrelated to retention.

The final sample size was less than planned but reflected the strict participation criteria and temporal limitations of this study. No statistical assumptions were violated and the reliability indices of the scales completed by clients ranged from acceptable to excellent. Another limitation was that dropout cannot be assumed to mean relapse, as the reasons for client dropout were not available.

Findings highlight the important roles of trait factors in TC treatment retention in addition to the motivational and interpersonal factors identified in previous work.

The purpose of this paper is to summarize research conducted in long-term residential rehabilitation centers, including therapeutic communities (TCs), in order to further clarify the effectiveness of this treatment approach and to evaluate the quality of TC research conducted in the period 2000-2013.

The composite search engine UQ database Summon were used to find articles with “Therapeutic Community” as title words, and the search was limited to adult participants, peer-reviewed articles, published between January 2000 and June 2013 in the English language. The review was conducted using Cochrane Collaboration methods and reported under the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines.

In total, 25 studies met inclusion criteria for the review and represented data from n=5,923 participants in the USA, Australia, Spain, England, and Belgium. Evidence supports the TC approach for a diverse range of individuals who misuse a range of substances. Several studies reported a relationship between retention and outcomes however dropout from treatment is a widespread issue. A paucity of research using multiple time points precludes any firm conclusions regarding the optimal length of treatment in a TC. There is a lack of research on the interplay between individual and community-level factors on client well-being, retention, and longer term outcomes.

This review highlights the need for TC research that includes multiple time points and follow-up assessments, and measures of change in theoretically meaningful constructs alongside standard measures of demographics, substance use, and psychiatric symptoms.

The reporting format of TC research should be better standardized in order to create a better basis for research comparison. More standardized reporting would also allow for effect size analysis, and create a more efficacious evidence base.

This updates the systematic review body of research.

The purpose of this paper is to investigate the relationship between personality disorder (PD) treatment readiness and dropout from three community-based offending behaviour group programmes.

At the pre-programme stage, measures of PD and treatment readiness were administered to 186 offenders participating in either a cognitive skills programme, a general violence programme or a programme for domestically abusive men. Demographic and risk data were also obtained from the offender assessment system. At a one-year follow-up, comparisons were made between the risk, personality and treatment readiness profiles of programme completers and non-completers.

It was hypothesised that PD would be associated with low levels of treatment readiness at the pre-group stage and that both low levels of treatment readiness and PD would predict subsequent programme non-completion. Only antisocial personality disorder (ASPD) was associated with low overall treatment readiness, although antisocial, paranoid, schizoid, negativistic and borderline traits were associated with the facet of low self-efficacy. Non-completion was not predicted by younger age or recidivism risk scores and was most strongly predicted by the presence of a cluster A PD, as well as ASPD, low pre-group motivation and mixed race and white ethnicity.

Paranoid and antisocial personality pathology present important obstacles to effective offending behaviour group work in the community. This illustrates that further consideration needs to be given to these important responsivity factors in future delivery and evaluation of these programmes.

The study provides a detailed analysis of factors associated with non-completion of three community-based offending behaviour programmes in the UK.

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

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

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.

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

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.

The purpose of this paper is to systematically review quantitative research since 2000 on the effectiveness of residential therapeutic communities (TCs) for the treatment of substance-use disorders with reference to substance-use, crime, mental health and social engagement outcomes.

A systematic search with broad inclusion criteria resulted in the review of 11 studies. The studies investigated community-based TCs, as well as TCs modified for prisoners, prisoners transitioning to community living and TCs for individuals with co-occurring substance-use and mental health issues.

Results were analysed by comparing the findings of the studies under investigation, of which three studies investigated within-subjects outcomes, four compared TC treatment with a no-treatment control condition and four compared TC treatment with another treatment condition. Conclusion: consistent with previous systematic reviews of TCs, outcomes varied across studies but indicated TCs are generally effective as a treatment intervention, with reductions in substance-use and criminal activity, and increased improvement in mental health and social engagement evident in a number of studies reviewed.

Variability in outcomes suggests further TC research and research syntheses focusing on a second key research question in the evaluation of complex interventions – how the intervention works – could play an important role in understanding TC effectiveness, and for whom it is effective and in what contexts.

Although there is some variability in treatment populations included in this review, evidence reported in other studies suggests individuals with severe substance-use disorders, mental health issues, forensic involvement and trauma histories, will benefit from TC treatment. This is supported by the literature which has found a general relationship between severity of substance use and treatment intensity (Darke et al., 2012; De Leon et al., 2008) with outcomes further enhanced by self-selection into treatment and appropriate client-treatment matching (see De Leon, 2010; De Leon et al., 2000, 2008). The weight of evidence gleaned from multiple sources of research, including randomised control trials and field outcome studies (De Leon, 2010) suggests TCs are an important and effective treatment for clients in improving at least some aspects of their quality of life, specifically mental health and social engagement, and in reducing harmful behaviours, including substance-use and crime. Variability in treatment setting and populations reflect the real-world setting in which TC treatment is delivered, providing a multifaceted treatment modality to a complex population in variable circumstances.

The strength of the current study is that it provided a broad evaluation of TC effectiveness across a range of outcomes (substance-use, criminal activity, mental health and social engagement), and is therefore valuable in updating the current literature and providing context for future research in this area. It aimed to address a key question in evaluating complex interventions: whether they are effective as they are delivered. Findings suggest that TC treatment is generally effective for the populations of concern in reducing substance use and criminal activity and contributing to some improvement in mental health and social engagement outcomes.

This article presents the Impulsive Lifestyle Counselling program, a time-limited psychoeducational approach to increasing patient awareness of antisocial personality disorder and its consequences.

This article describes the ILC program, a program developed as an add-on to treatment for substance use disorders, gives examples of issues and patient-counsellor interactions in the ILC sessions.

During the ILC sessions the patients engaged with the counsellors in diverse ways, reflecting the varying levels of psychopathology and overall functioning and barriers and incentive for lifestyle changes.

Patients with substance use disorder and comorbid antisocial personality disorder can receive better care with brief counselling that focuses on antisocial behavior and thinking. More diverse evidence-based treatments are needed for this disorder.