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Evaluation of any given student's responsiveness to intervention depends not only on how effective the intervention is, but also whether the intervention was delivered as intended as well as in the appropriate format and according to the most useful schedule. These latter elements are referred to as treatment integrity and treatment intensity, respectively. The purpose of this chapter is to define and describe how treatment integrity and intensity can be incorporated in the evaluation of outcomes associated with individualized intervention delivery.

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.

In healthcare, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouse concerns about possible implications for patients’ health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In this chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research.

The main aim of this paper is to describe the content, structure and preliminary evaluation of a new Good Lives sexual offender treatment group (SOTG) for male mentally disordered offenders.

As evaluation and work on the SOTG is necessarily ongoing, case study descriptions of each patient who attended the SOTG and of their progress throughout SOTG are described.

Overall, the case study progress reports suggest that mentally disordered male patients made some notable progress on SOTG despite their differential and complex needs. In particular, attention to each patient's life goals and motivators appeared to play a key role in promoting treatment engagement. Furthermore, patients with lower intelligence quotient and/or indirect pathways required additional support to understand the links between the Good Lives Model (GLM) and their own risk for sexual offending.

Further evaluations of SOTG groups, that incorporate higher numbers of participants and adequate control groups, are required before solid conclusions and generalisations can be made.

Practitioners should consider providing additional support to clients when implementing any future SOTGs for mentally disordered patients.

This is the first paper to outline and describe implementation of the GLM in the sexual offender treatment of mentally disordered male patients group format. As such, it will be of interest to any professionals involved in the facilitation of sexual offender treatment within this population.

The purpose of this paper is to assess the effectiveness of day treatment programmes for adults with eating disorders by comparing, evaluating and synthesizing published pre- and post-treatment outcomes.

A systematic review was undertaken of publications containing quantitative outcome data relating to weight restoration among underweight patients, reduction in binge and purge/vomit symptoms, decrease in eating disorder psychopathology and improvement in psychological functioning.

This systematic review of pre- and post- treatment outcomes from 15 studies revealed large effect sizes relating to increase in Body Mass Index (BMI), reduction in symptoms and decrease in depression. Medium effect sizes were observed for improvement in self-esteem and reduction in anxiety and medium-large effect sizes were generally observed for attitude-change, although a small effect size was identified for perfectionism.

This systematic review indicates that day treatment for adults is effective in increasing BMI among underweight patients, reducing binge, purge/vomit symptoms and eating disorder psychopathology and improving psychological functioning. Further research is required to investigate whether gains are cost-effective and sustainable over the longer term, and how day treatment programmes can improve outcomes for patients who are vulnerable to non-response and drop-out.

To date, reviews of day treatment for adults with eating disorders have focused upon comparisons of treatment approach and structure and neglected to assess outcomes. Therefore this review fills a gap in existing literature

The purpose of this paper is to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses.

A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n=39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome.

Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions.

Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally run residential integrated treatments for justice involved persons who have dual diagnoses.

Results support the utilization of low-cost, community-based treatments for a highly marginalized population.

Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.

The contemporary focus on high fidelity implementation of research-based practices often creates tensions for educators who seek to balance fidelity with needed flexibility as they strive to improve learner outcomes. In an effort to improve how decisions are made such that flexibility is achieved while fidelity to core components is maintained, this chapter begins with a discussion of the role of fidelity in research and practice. Particular attention is given to current conceptualizations of fidelity that may help inform theoretically and empirically driven adaptations to research-based practices. Specifically, we describe adaptations based on the instructional context for implementation and the characteristics of the individual learners. A framework for adapting research-based practices is then presented with relevant examples from research designed to optimize learner responsiveness without sacrificing fidelity to core components. The chapter ends with implications and future directions for research and practice.

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.

The purpose of this paper is to determine reconviction outcomes for 2,882 male and female offenders with significant alcohol and other drug (AOD) criminogenic needs, serving custodial sentences in New South Wales, between 2007 and 2011, who participated in the Getting SMART and/or the SMART Recovery® programs.

A quasi-experimental research design utilized data from 2,343 offenders attending Getting SMART; 233 attending SMART Recovery© and 306 attending both programs, compared to a propensity score-matched control group of 2,882 offenders. Cox and Poisson regression techniques determined survival times to first reconviction and rates of reconvictions, adjusting for time at risk.

Getting SMART participation was significantly associated with improved odds of time to first reconviction by 8 percent and to first violent reconviction by 13 percent, compared to controls. Participants attending both programs (Getting SMART and SMART Recovery©), had significantly lower reconviction rate ratios for both general (21 percent) and violent (42 percent) crime, relative to controls. Getting SMART attendance was associated with significant reductions in reconviction rates of 19 percent, and the reduction for SMART Recovery© attendance (alone) was 15 percent, the latter figure being non-significant. In all, 20 hours in either SMART program (ten sessions) was required to detect a significant therapeutic effect.

Criminal justice jurisdictions could implement this two SMART program intervention model, knowing a therapeutic effect is more likely if Getting SMART (12 sessions of cognitive-restructuring and motivation) is followed by SMART Recovery© for ongoing AOD therapeutic maintenance and behavioral change consolidation. SMART Recovery©, a not-for-profit proprietary program, is widely available internationally.

Getting SMART and SMART Recovery© have not previously been rigorously evaluated. This innovative two-program model contributes to best practice for treating higher risk offenders with AOD needs, suggesting achievable reductions in both violent and general reoffending.

This article sets out to provide information regarding the evidence base for psychological treatments and to demonstrate that the number of mental health professionals who are available and competent to deliver these treatments is very small compared with the numbers of people who might benefit. The article also considers the prevalence of conditions that are amenable to psychological treatment and then explores how ‘stepped care’ may be one solution for providing available treatment resources in a way that is fairest and most effective for the population at large.