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The Millfields unit is one of three medium secure hospital services on the Offender Personality Disorder (OPD) pathway, for the assessment and treatment of high-risk offenders who are likely to meet criteria for this diagnosis. This study has designed an audit to examine influencers of patient engagement within Millfields, whose treatment approach is that of an adapted therapeutic community (TC). The purpose of this study was to explore themes raised by patients in relation to engagement, drivers for and barriers to engagement and to make recommendations for improvement.

The first author engaged in ward and group observations, a review of each patient’s medical records, unstructured discussions with staff and semi-structured interviews with each patient exploring their experiences of therapy, relationships with staff, understanding of and engagement with the treatment model, attitudes towards peers and aspirations for the future. Themes were generated from the transcription of interviews and subsequent mind mapping.

In total, 12 of the 13 patients engaged in the semi-structured interviews. Six main themes were identified as being important influencers of engagement: the ward atmosphere, authenticity of engagement, perception of staff investment in the treatment, preferential treatment of senior residents, responses to boundary crosses and violations and the level of understanding a patient had of his treatment.

Research into engagement with psychosocial therapies in patients who have personality disorders has recently been published by Tetley et al. (2012) and Jinks et al. (2012). This study specifically focusses on TC engagement and male offenders with personality disorders.

Well-documented ethnic disparities exist in the identification and provision of quality services among children receiving community-based mental health services. These disparities extend to parent treatment engagement, an important component of effective mental health services. Currently, little is known about differences in how providers support parents’ participation in treatment and the degree to which parents actively participate in it. The purpose of this paper is to examine potential differences in both provider and parent in-session participation behaviours.

Participants included 17 providers providing standard community-based mental health treatment for 18 parent-child dyads, with 44 per cent of the dyads self-identifying as Hispanic/Latino. In-session participation was measured with the parent participation engagement in child psychotherapy and therapist alliance, collaboration, and empowerment strategies observational coding systems.

Overall, results indicate significantly lower levels of parent participation behaviours among Hispanic/Latino families compared to their Non-Hispanic/Non-Latino counterparts. No significant differences were seen in providers’ in-session behaviours to support parent participation across Hispanic/Latino and Non-Hispanic/Non-Latino families.

These findings contribute to the literature on ethnic differences in parent treatment engagement by utilising measures of in-session provider and parent behaviours and suggest that further investigation is warranted to documenting and understanding ethnic disparities in parents’ participation in community-based child mental health treatment.

This paper contributes to the evaluation of differences in parent treatment engagement through demonstrating the utility of an in-session observational coding system as a measure of treatment engagement.

This paper seeks to highlight the findings from a research project on improving treatment engagement for clients with personality difficulties.

The authors provide an overview of the studies conducted to date. These are a systematic review of the literature examining non‐completion of psychosocial treatment by people with personality disorder, a systematic review of assessments to measure treatment engagement, and a Delphi survey of both staff and patients' views on factors that impact on engagement in psychosocial treatment for this client group.

Poor engagement with psychosocial treatment is an issue for clients with personality disorder and rates of non‐completion are high. Discontinuation of treatment is associated with adverse clinical outcomes. Although a number of assessments exist for measuring engagement, none can be described as comprehensive and few are adequately validated. Engagement factors identified from the survey were broadly in keeping with previous work, but additional factors specific to this client group were identified. A treatment readiness model for people with personality difficulties is described.

Research outputs from the project are a set of specifications for good practice in facilitating engagement, and a web‐based training package aimed at helping staff improve their understanding of their clients' engagement issues.

The findings will be useful to service managers as well as clinicians working directly with people with personality difficulties. Improving client engagement will improve clinical outcomes and service cost‐efficiency.

The aim of this paper is to investigate reasons for treatment non‐attendance for dual diagnosis women in secure psychiatric settings.

A semi structured interview was used to investigate patients' reasons for session non attendance on the day of non participation across four wards. Reasons for non attendance were grouped using the mulifactorial offender readiness model (MORM) categories of affective, volitional, behavioural, cognitive and external. Assignment of responses to categories was undertaken by a two person team and inter rater reliability was assessed.

Patients' rates of attendance varied by ward and level of security (low vs medium); and diagnosis. Systematic enquiry about the reasons for non attendance led to increased session attendance. Reasons for non attendance were cognitive reflecting negative evaluations of treatment and treatment outcomes. Psychological therapies and educational sessions were deemed the most important along with one‐to‐one clinician appointments.

Issues of treatment engagement and the timing of treatment interventions are major issues in the care of secure psychiatric patients, particularly those with a primary diagnosis of personality disorder. Findings highlight the importance of systematic enquiry about reasons for non attendance and suggest potential interventions designed to improve engagement.

Although support exists for the effectiveness of treatment for personality disordered offenders there is limited knowledge about the processes underlying the therapeutic change. The purpose of this paper is to explore the treatment experiences of six male psychopathic offenders who attended a social skills treatment component implemented within a high-secure personality disorder treatment service.

Interview transcripts were analysed by the lead researcher (first author) using interpretative phenomenological analysis (IPA) who compared and contrasted findings to develop superordinate themes across the group. External auditing analysis was conducted by the second author.

Several themes were identified that may indicate the unique ways this client group experienced treatment. These related to the importance of “group cohesion” with treatment progression and shared learning experiences, the significance of “therapeutic alliance” with treatment providers and perceived effectiveness of treatment, and the conflict participants experienced when acquiring and applying skills from their engagement in treatment. Participants identified aspects of the treatment component that facilitated the effectiveness of treatment and were effective in meeting their needs and some that would benefit from improvement.

Positive group dynamics are important. Operational staff inclusion within the facilitation team is beneficial. Attentiveness to participants’ specific responsivity needs is required. Supporting skill application post-treatment is important.

These findings add to the evidence base in relation to factors that support personality disordered offenders’ engagement within treatment. Areas that validate treatment delivery are highlighted, as are suggestions for change to maximise treatment gain for psychopathic and personality disordered offenders.

Purpose – Despite growing efforts to treat depression, engaging low-income and minority mothers continues to challenge providers. To address this issue, we conducted focus groups to identify responsive strategies for improving engagement of low-income and racially diverse mothers at high risk for depression.

Methods – Three focus group discussions (one prenatal, two postpartum) with 21 low-income and racially diverse mothers were held to determine their definition of depression, attitudes about depression treatment, and perceived barriers to treatment. Discussions took approximately 60 minutes and were audio-recorded. Detailed notes were taken during the discussions. The notes and audio recordings were analyzed using qualitative methods.

Results – Identification of the source of distress, assessing women's perception of treatment and their related costs and benefits, and addressing cultural and financial barriers to treatment emerged as key themes for improving engagement among participants.

Conclusion – To be responsive to women's depression care needs, treatments should be informed by patient perceptions and needs, while addressing barriers to care.

This paper provides a clinical practice overview of the challenges that can arise when working with dangerous and severe personality‐disordered patients in a high secure hospital. Poor engagement and treatment readiness, mistrust, paranoia and dominant interpersonal styles are all clinical features that affect treatment delivery. The paper discusses the impact of these features, and suggests how clinicians can engage effectively with individuals who have personality disorders in regard to therapy in general.

The purpose of this paper is to explore the range of personality disorder diagnoses and levels of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R) associated with treatment discontinuation in a sample of adult male prisoners.

Data from 92 male offenders in a high secure prison personality disorder treatment unit was analysed. PCL-R and personality disorder diagnoses were predicted as being related to increased treatment dropout.

Having a diagnosis of narcissistic personality disorder was related to treatment dropout, but PCL-R total scores were not. There was a trend for a diagnosis of antisocial personality disorder being associated with remaining in treatment.

The current study highlights that narcissistic personality disorder can be associated with treatment dropout, warranting further exploration as to why this is the case.

Managing responsivity issues for those presenting with a personality disorder diagnosis could be effective in maximising treatment engagement from this specific offender group.

Although treatment dropout has been explored previously, this is the first study to explore treatment dropout at a specialised unit designed specifically to provide treatment for this client group.

Evidence has shown associations between personality disorder (PD) and poor treatment outcomes. The purpose of this paper is to: first, establish which risk assessment method (i.e. structured professional judgement or actuarial) is most reliable for predicting treatment outcomes for individuals with PD. Second, determine whether individuals identified as high risk are more likely to have poorer treatment outcomes. Third, determine if engagement in treatment helps to reduce risk assessment scores.

In total, 50 patients were recruited from a medium secure forensic PD service. Their risk was assessed using one structured professional judgement instrument (the HCR-20) and one actuarial instrument (the RM2000). The study used a retrospective cohort design.

Overall, the HCR-20 was a better predictor of treatment outcome than the RM2000. Personality-disordered offenders with high HCR-20 scores are at an increased risk of adverse treatment outcomes.

This investigation used a small, non-randomised sample of male patients with PD at one South East England medium secure unit. The data were over-represented by white British males. Future research should compare PD offenders with non-PD offenders to investigate what factors best predict poorer treatment outcomes.

The findings indicate that structured professional judgement approaches are more effective predictors of risk than actuarial measures for assessing patients with PD. This study therefore adds value to forensic services and to the risk assessment debate.

Many individuals in drug treatment courts (DTCs) have co-occurring mental health and substance use disorders (COD), which can negatively impact treatment engagement, behavioral health and criminal justice outcomes. This paper aims to report results of DTC participants with a COD, who received a 12-month wraparound treatment intervention called MISSION-Criminal Justice (MISSION-CJ) alongside DTC to improve treatment engagement and behavioral health outcomes and reduce reincarcerations.

In this pre-post, single-group pilot, 48 clients enrolled and 81% completed 12-month follow-up assessments (N = 39) and weekly MISSION-CJ fidelity for type and intensity of services delivered. Generalized linear mixed models (GLMMs) were computed with a fixed term for fidelity (e.g. high or low MISSION-CJ), time and a fidelity x time interaction term.

Among participants, at 12 months, 81% of the participants remained engaged in treatment at study completion, and 89% had high MISSON-CJ fidelity. Clients demonstrated significant reductions from baseline to 12 months in average nights in jail (B = −0.1849511, p < 0.0344), mental health symptoms via the Behavior and Symptom Identification Scale (BASIS) total and subscale scores (B = −0.121613, p < 0.0186) and trauma symptoms on the PTSD Checklist-5 (PCL-5) (B = −0.928791, p < 0.0138). High MISSION-CJ fidelity further improved criminal justice, and behavioral health outcomes.

This was the first reported 12-month MISSION-CJ trial. While feasible to implement, given the design limitations, future research should include a large randomized controlled trial.