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Article
Publication date: 4 November 2014

Sarah-Jane Archibald, Colin Campbell and Derval Ambrose

Evidence has shown associations between personality disorder (PD) and poor treatment outcomes. The purpose of this paper is to: first, establish which risk assessment…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Originality/value

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.

Details

Journal of Forensic Practice, vol. 16 no. 4
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 2 December 2014

Lynne Magor-Blatch, Navjot Bhullar, Bronwyn Thomson and Einar Thorsteinsson

The purpose of this paper is to systematically review quantitative research since 2000 on the effectiveness of residential therapeutic communities (TCs) for the treatment

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Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 35 no. 4
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 19 March 2021

Fadly Syah Arsad and Noor Hassim Ismail

The purpose of this study was to assess tuberculosis (TB) treatment outcomes among new smear-positive pulmonary tuberculosis (PTB) patients and identify the risk factors…

Abstract

Purpose

The purpose of this study was to assess tuberculosis (TB) treatment outcomes among new smear-positive pulmonary tuberculosis (PTB) patients and identify the risk factors of unsuccessful treatment outcomes in Kepong district, Kuala Lumpur, Malaysia.

Design/methodology/approach

A retrospective cohort study was conducted using registry-based data from the Tuberculosis Information System (TBIS) between 2014 and 2018. Simple random sampling was used to select 734 males and 380 females from the TBIS registry. Smear-positive PTB patient's sociodemographic, clinical and behavioral characteristics were extracted and analyzed. Logistic regression was used to find the possible independent risk factors for unsuccessful treatment outcomes.

Findings

The treatment success rate was 77.20% (n = 860) which was still below the target set by the WHO (>90%). In total, 254 patients showed an unsuccessful treatment outcome: 106 died, 99 defaulted, 47 not evaluated and 2 showed treatment failure. Unsuccessful treatment outcome was significantly associated with older age, male gender, non-citizen, unemployment and being HIV positive.

Originality/value

The study focuses on all these contributing factors of unsuccessful treatment outcome for a better risk assessment and stratification of TB patients and identify effective surveillance and management strategies to strengthen the control programs of tuberculosis in Kepong district.

Details

Journal of Health Research, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0857-4421

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Book part
Publication date: 23 November 2011

Daniel L. Millimet

Researchers in economics and other disciplines are often interested in the causal effect of a binary treatment on outcomes. Econometric methods used to estimate such…

Abstract

Researchers in economics and other disciplines are often interested in the causal effect of a binary treatment on outcomes. Econometric methods used to estimate such effects are divided into one of two strands depending on whether they require unconfoundedness (i.e., independence of potential outcomes and treatment assignment conditional on a set of observable covariates). When this assumption holds, researchers now have a wide array of estimation techniques from which to choose. However, very little is known about their performance – both in absolute and relative terms – when measurement error is present. In this study, the performance of several estimators that require unconfoundedness, as well as some that do not, are evaluated in a Monte Carlo study. In all cases, the data-generating process is such that unconfoundedness holds with the ‘real’ data. However, measurement error is then introduced. Specifically, three types of measurement error are considered: (i) errors in treatment assignment, (ii) errors in the outcome, and (iii) errors in the vector of covariates. Recommendations for researchers are provided.

Details

Missing Data Methods: Cross-sectional Methods and Applications
Type: Book
ISBN: 978-1-78052-525-9

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Article
Publication date: 15 May 2009

Emma Wolfe, Jane Ogden and Leigh Clare

A repeated measures cohort study was conducted to investigate the impact of attending a day treatment programme on physical and psychological state, and to assess which…

Abstract

A repeated measures cohort study was conducted to investigate the impact of attending a day treatment programme on physical and psychological state, and to assess which baseline factors predicted level of recovery. Physical and psychological outcomes of treatment were analysed for 116 patients admitted to the treatment programme between 1996 and 2006 and were found to be in line with previous day care evaluations, with the majority of patients showing improvements on all measures. A multiple regression analysis revealed several factors to be predictive of treatment outcomes including patient demographics, comorbidities and traumatic life events. In particular, those patients who benefited most from the treatment had a lower body mass index at admission, stayed longer at the unit, were older, less likely to have other physical and psychiatric comorbidities, particularly obsessive compulsive disorder or a history of sexual abuse, and whose most predominant eating disorder problem was characterised by low weight.

Details

Mental Health Review Journal, vol. 14 no. 1
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 2 September 2014

Ciska Wittouck, Anne Dekkers, Wouter Vanderplasschen and Freya Vander Laenen

Problem solving courts are a result of the therapeutic jurisprudence movement. Drug treatment courts (DTCs), for instance, aim to divert substance using offenders away…

Abstract

Purpose

Problem solving courts are a result of the therapeutic jurisprudence movement. Drug treatment courts (DTCs), for instance, aim to divert substance using offenders away from the criminal justice system (CJS) to (drug) treatment services. DTCs are associated with reduced criminal offending and substance use. Psychosocial outcomes of DTCs, such as employment, health and family relations, received only little attention. The paper aims to discuss these issues.

Design/methodology/approach

This paper focuses on the outcomes regarding substance use and psychosocial variables of a Belgian DTC situated in the Ghent region, which were investigated by a naturalistic evaluation study with a pre- post-design using judicial files.

Findings

The results show that Ghent DTC clients were diverted to drug treatment and financial counselling services. Next the Ghent DTC produced beneficial outcomes regarding employment. Contrary to criminal offending (De Keulenaer and Thomaes, 2013), substance use was not significantly reduced in the Ghent DTC sample. Yet more compliance with opioid maintenance treatment was observed. Information on more client centred outcomes such as health and social relations was lacking, precluding a full outcome measurement of psychosocial variables.

Research limitations/implications

Future DTC studies should address more client centreed outcomes by gathering information through DTC clients and treatment services instead of solely relying on judicial data sources. In addition, DTCs should develop a clear and uniform registration system regarding these outcomes.

Originality/value

Since the therapeutic jurisprudence movement continues to expand, discussion regarding the roles and tasks of the CJS as well as treatment and counselling services is vital. Each actor should maintain its own role and task, regarding monitoring and substantive work, to insure a “problem solving approach” that is in line with the recovery philosophy.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 35 no. 3
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 13 June 2016

Georgina Capone, Thomas Schroder, Simon Clarke and Louise Braham

The purpose of this paper is to review quantitative research since 1999 evaluating the effectiveness of democratic therapeutic community (DTC) treatment for individuals…

Abstract

Purpose

The purpose of this paper is to review quantitative research since 1999 evaluating the effectiveness of democratic therapeutic community (DTC) treatment for individuals with personality disorders (PD) with reference to interpersonal and offending risk outcomes.

Design/methodology/approach

A systematic search resulted in the review of ten studies. All of the studies investigated DTCs treating PD in community, inpatient residential and forensic settings. Only peer-reviewed, English-language articles employing a quantitative design were included.

Findings

The majority of studies were conducted poorly and of low methodological quality, with limitations located in the representativeness of participants, limited use of control and comparison groups, follow up periods and controls for confounders. Heterogeneity remained in use of measures and limited consideration was given to the validity of interpersonal measures used. While improved interpersonal outcomes post DTC treatment were noted in forensic and residential settings, results were mixed in day and mini TC settings. Inconsistent findings in offending risk outcomes were also indicated. A study with increased methodological rigour indicated residential treatment had limited effects on interpersonal outcomes, when compared to combination treatment (residential TC and step-down treatment).

Originality/value

The study provided an evaluation of the limitations of DTC research across a range of settings and highlighted a combination of residential TC and step-down treatment may achieve superior outcomes to residential TC treatment alone in a community inpatient population. Recommendations are made for future research to contribute to the treatment of PD.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 37 no. 2
Type: Research Article
ISSN: 0964-1866

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Book part
Publication date: 13 May 2017

Jasjeet S. Sekhon and Rocío Titiunik

We discuss the two most popular frameworks for identification, estimation and inference in regression discontinuity (RD) designs: the continuity-based framework, where the…

Abstract

We discuss the two most popular frameworks for identification, estimation and inference in regression discontinuity (RD) designs: the continuity-based framework, where the conditional expectations of the potential outcomes are assumed to be continuous functions of the score at the cutoff, and the local randomization framework, where the treatment assignment is assumed to be as good as randomized in a neighborhood around the cutoff. Using various examples, we show that (i) assuming random assignment of the RD running variable in a neighborhood of the cutoff implies neither that the potential outcomes and the treatment are statistically independent, nor that the potential outcomes are unrelated to the running variable in this neighborhood; and (ii) assuming local independence between the potential outcomes and the treatment does not imply the exclusion restriction that the score affects the outcomes only through the treatment indicator. Our discussion highlights key distinctions between “locally randomized” RD designs and real experiments, including that statistical independence and random assignment are conceptually different in RD contexts, and that the RD treatment assignment rule places no restrictions on how the score and potential outcomes are related. Our findings imply that the methods for RD estimation, inference, and falsification used in practice will necessarily be different (both in formal properties and in interpretation) according to which of the two frameworks is invoked.

Details

Regression Discontinuity Designs
Type: Book
ISBN: 978-1-78714-390-6

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Article
Publication date: 30 November 2021

Irini Verbist, Dale Huey and Hazel Bennett

Given the considerable variation in treatment effectiveness observed across Improving Access to Psychological Therapy (IAPT) services, the purpose of this study is to…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Originality/value

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.

Details

Mental Health Review Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1361-9322

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Book part
Publication date: 13 May 2017

Luke Keele, Scott Lorch, Molly Passarella, Dylan Small and Rocío Titiunik

We study research designs where a binary treatment changes discontinuously at the border between administrative units such as states, counties, or municipalities, creating…

Abstract

We study research designs where a binary treatment changes discontinuously at the border between administrative units such as states, counties, or municipalities, creating a treated and a control area. This type of geographically discontinuous treatment assignment can be analyzed in a standard regression discontinuity (RD) framework if the exact geographic location of each unit in the dataset is known. Such data, however, is often unavailable due to privacy considerations or measurement limitations. In the absence of geo-referenced individual-level data, two scenarios can arise depending on what kind of geographic information is available. If researchers have information about each observation’s location within aggregate but small geographic units, a modified RD framework can be applied, where the running variable is treated as discrete instead of continuous. If researchers lack this type of information and instead only have access to the location of units within coarse aggregate geographic units that are too large to be considered in an RD framework, the available coarse geographic information can be used to create a band or buffer around the border, only including in the analysis observations that fall within this band. We characterize each scenario, and also discuss several methodological challenges that are common to all research designs based on geographically discontinuous treatment assignments. We illustrate these issues with an original geographic application that studies the effect of introducing copayments for the use of the Children’s Health Insurance Program in the United States, focusing on the border between Illinois and Wisconsin.

Details

Regression Discontinuity Designs
Type: Book
ISBN: 978-1-78714-390-6

Keywords

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