Verbal feedback in therapeutic communities: pull-ups and reciprocated pull-ups as predictors of graduation

Treatment engagement in a prison-based Therapeutic Community: A mixed-methods approach

Given the high proportion of inmates with histories of substance use disorders in the era of mass incarceration, many correctional institutions have integrated the prison-based Therapeutic Community (TC) into their programming. While most evaluations provide evidence of lowered rates of relapse and recidivism, the majority of TC graduates still have negative outcomes post-release. Filling an important gap in the TC treatment literature, we analyze quantitative measures of treatment engagement alongside qualitative narratives from prison-based TC residents, providing an essential look into the black box of TC treatment mechanisms. Quantitative results show more between-person variation than within-person change, reflecting trivial increases in treatment engagement throughout time in the program. Qualitative results unpack these findings, pointing to processes of selection bias, heterogeneous treatment effects, and program fidelity lapses. In combination, our mixed data identify tangible modifications to program implementation that could strengthen desired post-release outcomes.

Completion rates and psychosocial intervention effectiveness in an Australian substance use therapeutic community

BACKGROUND

Program attrition is a major problem in substance use treatment. It is not clear which client and treatment variables are related to successful completion. This study aimed to identify client variables associated with Therapeutic Community (TC) completion. A secondary aim was to investigate changes in entry and exit scores on psychosocial outcome measures.

METHODS

Retrospective quantitative analysis of data collected from 193 Australian TC residents, over 3.5 years. Variables measured included: demographics; Depression, Anxiety, Stress Score (DASS-21) and World Health Organisation Quality of Life 8 questions (WHOQOL-8).

RESULTS

Completion rates were 30.6%. High Money WHOQOL-8 scores, suggestive of minimal financial stressors, positively predicted completion. Multivariate analyses showed that negative predictors of completion were: amphetamine being primary substance of concern, aggression, high Relationship WHOQOL-8 scores, suggestive of positive relationships, and younger or older age. Those in the program demonstrated clinically significant psychological improvement and significant improvement in all quality of life scores over time. The degree of psychometric improvement was most pronounced in those who completed the course, with the exception of depression, stress, and money problems.

CONCLUSION

The findings provide an understanding of specific predictors of program completion which may help to identify high-risk clients and inform program improvement. Early attrition rates may be reduced by monitoring and supporting high-risk clients. Overall, psychometric improvement occurred amongst both completers and non-completers overtime but is most prominent amongst course completers, with the exception of depression, stress, and money problems. Future research could potentially focus on amphetamine users and shortened TC programs, focusing on acute psychosocial intervention.

Semantic Networks, Schema Change, and Reincarceration Outcomes of Therapeutic Community Graduates

BACKGROUND

Therapeutic community (TC) clinical theory assumes that peer interaction forms a framework for social learning that will displace ingrained cognitive schema that underlie substance abuse. There has been no direct test of this hypothesis.

METHODS

We analyzed the content of a large corpus of written affirmations (pushups) and corrections (pull-ups) exchanged between 2342 male TC graduates. We encoded the content of the written communications as semantic networks of words, in which words that appear in the same brief document are connected and are referred to as word combinations. Loss of combinations and gain of combinations each measured an aspect of change in word combination patterns across time. These measures were used in a multivariable Cox model to predict the hazard of reincarceration for residents while controlling for race, age, score on the Level of Service Inventory-Revised and the total number of pushups and pull-ups sent to peers.

RESULTS

Residents' reincarceration risk varied significantly with changes in word combinations used over the course of treatment. The implications of the model were visualized to reveal the complicated nature of the interaction terms included in the model. The visuals suggested that residents who changed their expression patterns the least - lost and gained few word combinations - had the highest reincarceration risk after graduation.

CONCLUSIONS

The results suggest that TC success, in terms of increasing time to reincarceration, depends on how residents change their interaction patterns through the treatment process. Merely interacting with others does not explain success; but whether those interactions change does explain outcomes, which may imply that more fundamental changes are occurring.

Warren K, V. Linley J. Behavioral and demographic predictors of staff ratings of role model status in a corrections-based therapeutic community for women

Purpose

– The purpose of this paper is to examine personal and social network characteristics that predict staff ratings of therapeutic community (TC) resident role model status.

Design/methodology/approach

– In all, 49 incarcerated female residents tracked interactions with peers, including verbal affirmations and corrections, during a 12-hour period. Two weeks later, staff members were surveyed about their view of participants as role models. Poisson regression was used to analyze resident interactions and demographics as predictors of role model status.

Findings

– The number of corrections given to peers was positively related to staff ratings of role model status (B=0.234, SE=0.088,p=0.008). The number of affirmations given was negatively related to staff ratings (B=−0.112, SE=0.051,p=0.028). Resident phase was positively related to staff ratings (B=0.256, SE=0.102,p=0.012). These values did not significantly change when controlling for affirmations and corrections received from peers, non-programmatic interactions between residents, or resident demographics.

Research limitations/implications

– These results imply that TC staff judge role model status by resident actions in the community rather than demographics or peer reactions. External validity is limited by the single site, case study design, and the fact that only female TC residents were sampled.

Originality/value

– This study is the first to track resident peer interactions over the course of a day and to link those interactions to role model status.

Short-Run Prosocial Behavior in Response to Receiving Corrections and Affirmations in Three Therapeutic Communities

Therapeutic communities (TC s) have a strong record of maintaining a high quality social climate on prison units. One possible reason for this is the system of mutual monitoring among TC residents, based on the assumption that peer affirmation of behavior in accord with TC norms and peer correction of behavior contrary to TC norms will lead to increased resident prosocial behavior. Laboratory experiments have demonstrated that such peer monitoring can lead to cooperation, but there has been no quantitative test of this hypothesis in an actual TC. In this article we test this assumption by using the affirmations that residents of three different TCs send as a measure of prosocial behavior following the reception of peer affirmations and corrections. At all three facilities residents send more affirmations following the reception of both affirmations and corrections, with this relationship being stronger and longer lasting after receiving affirmations. No other variable consistently predicts the number of affirmations that residents send to peers. These findings imply that mutual monitoring among TC residents can lead to increased levels of prosocial behavior within the facility, and that prosocial behavior in response to peer affirmations plays a key role.