WHICH CRIMINOGENIC NEED CHANGES ARE MOST IMPORTANT IN PROMOTING DESISTANCE FROM CRIME AND SUBSTANCE USE?

Juvenile Justice-Based Interdisciplinary Collective Care: An Innovative Approach

Mental health concerns among juvenile-justice-involved youth (JJIY) continue to be a major health crisis in the United States (US). While scholarship has explored mental health concerns among JJIY, and the link to negative life outcomes, there are gaps in the existing research, particularly in effective interventions and models aimed at addressing both the mental health concerns and criminogenic risk contributing to recidivism and other negative life outcomes of this population. In this paper, we present Justice-Based Interdisciplinary Collective Care (JBICC), an innovative framework to address both the mental health needs and delinquent behavior of youth offenders. The model bridges community partners, with the purpose of informing future interventions, implementations, and research in this area. Increased justice-based interdisciplinary collective collaboration between the juvenile justice system and community programs/organizations would be a major benefit to youth offenders and their families. We also focus on the need for cultural responsiveness to be interwoven throughout all aspects of treatment. JBICC offers an opportunity to expanded services outside traditional settings and methods to ensure that youth offenders and their families receive validating and culturally responsive access to services.

Modeling Recovery Housing Retention and Program Outcomes by Justice Involvement among Residents in Virginia, USA: An Observational Study

Living in recovery housing can improve addiction recovery and desistance outcomes. This study examined whether retention in recovery housing and types of discharge outcomes (completed, "neutral," and "negative" outcomes) differed for clients with recent criminal legal system (CLS) involvement. Using data from 101 recovery residences certified by the Virginia Association of Recovery Residences based on 1,978 individuals completing the REC-CAP assessment, competing risk analyses (cumulative incidence function, restricted mean survival time, and restricted mean time lost) followed by the marginalization of effects were implemented to examine program outcomes at final discharge. Residents with recent CLS involvement were more likely to be discharged for positive reasons (successful completion of their goals) and premature/negative reasons (e.g., disciplinary releases) than for neutral reasons. Findings indicate that retention for 6-18 months is essential to establish and maintain positive discharge outcomes, and interventions should be developed to enhance retention in recovery residents with recent justice involvement.

The associations between social determinants of health, mental health, substance-use and recidivism: a ten-year retrospective cohort analysis of women who completed the connections programme in Australia

BACKGROUND

Women with substance-use issues are overrepresented in prison. Research on women's recidivism often focuses on offending behaviour rather than the health and social circumstances women are experiencing when reimprisonment occurs. This study examines the relationship between social determinants of health (SDOH), mental health, substance-use and recidivism among women exiting prison with histories of substance-use.

METHODS

A retrospective cohort study of women exiting prison who completed the transitional support programme "Connections" between 2008 and 2018. Recidivism was measured up to two years post-release. Women's support needs were measured at baseline (4 weeks pre-release) and follow-up (four weeks post-release). Ongoing needs in relation to well-established SDOH were calculated if: (1) at baseline women were identified as having a re-entry need with housing, employment, finances, education, domestic violence, child-custody and social support and (2) at follow-up women reported still needing help in that area. Women's self-reported substance-use and mental health since release were captured at follow-up. Descriptive statistics were calculated for all measures. Associations between SDOH, mental health, substance-use and recidivism were estimated by multiple logistic regression, adjusting for potential confounders. We also evaluated the mediating effects of mental health on the relationship between SDOH and substance-use.

RESULTS

Substance-use was associated with increased odds of recidivism (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1-2.9; p = 0.02). Poor mental health (AOR 2.9, 95% CI 1.9-4.6; p =  < 0.01), ongoing social support (AOR 3.0, 95% CI 1.9-5.0; p =  < 0.01), child-custody (AOR 1.9, 95% CI 1.0-3.3 p = 0.04), financial (AOR 2.0, 95% CI 1.3-3.2; p =  < 0.01) and housing (AOR 1.8, 95% CI 1.1-2.9; p = 0.02) needs were individually associated with increased odds of substance-use. Mediation analysis found mental health fully mediated the effects of ongoing housing (beta efficiency (b) = - 033, standard error (SE) 0.01; p = 0.05), financial (b = 0.15, SE 0.07; p = 0.05), child-custody (b = 0.18, SE 0.01; p = 0.05) and social support (b = 0.36, SE 0.1; p = 0.05) needs onto substance-use, and partially mediated the effects of domestic violence (b = 0.57, SE 0.23; p = 0.05) onto substance-use.

CONCLUSION

This study underscores the critical importance of addressing the interplay between SDOH, mental health, substance-use and recidivism. An approach that targets SDOH holds the potential for reducing mental distress and substance-use, and related recidivism.

Strategies for supervising people with mental illnesses on probation caseloads: results from a nationwide study

Probation officers are tasked with supervising the largest number of people living with mental illnesses in the criminal legal system, with an estimated 16-27% of individuals on probation identified as having a mental health condition. While academic research has recently focused on building the evidence base around the prototypical model of specialty mental health probation, less focus has been directed to the individual components of specialized mental health caseloads and other strategies agencies use to supervise people with mental illnesses. More specific information about these strategies would benefit probation agencies looking to implement or enhance supervision protocols for people with mental illnesses. This article describes the results from a nationwide study examining (1) probation agencies' mental health screening and identification methods; (2) characteristics of mental health caseloads, including eligibility criteria, officer selection, required training, and interfacing with service providers; and (3) other strategies agencies use to supervise people with mental illnesses beyond mental health caseloads. Strategies for identifying mental illnesses varied, with most agencies using risk needs assessments, self-report items asked during the intake process, or information from pre-sentencing reports. Less than a third of respondents reported using screening and assessment tools specific to mental health or having a system that tracks or "flags" mental illnesses. Results also showed wide variation in mental health training requirements for probation officers, as well as variation in the strategies used for supervising people with mental illnesses (e.g., mental health caseloads, embedded mental health services within probation, modified cognitive behavioral interventions). The wide variation in implementation of supervision strategies presents (1) an opportunity for agencies to select from a variety of strategies and tailor them to fit the needs of their local context and (2) a challenge in building the evidence base for a single strategy or set of strategies.

Substance use and criminogenic thinking: Longitudinal latent class analysis of veterans with criminal histories

INTRODUCTION

The objective of this study was to inform clinical practice by identifying distinct subgroups of US veterans with criminal histories in residential mental health treatment. The study characterized veteran patients on their alcohol and drug use and criminogenic thinking. We also examined predictors and outcomes of subgroup membership.

METHODS

Participants were 341 veterans with a criminal history in residential mental health care. A parallel latent growth trajectory model characterized participants' alcohol and drug use and criminogenic thinking at treatment entry and at 6- and 12-month follow-ups.

RESULTS

The study identified four distinct classes: 53 % Normative Improvement, 27 % High Criminogenic Thinking, 11 % High Recurrence (of substance use), and 9 % High Drug Use. Compared to the Normative Improvement class, prior to treatment entry, patients in the High Recurrence class were less likely to be on parole or probation, and patients in the High Criminogenic Thinking class were more likely to be chronically homeless. Compared to the Normative Improvement class, at follow-ups, patients in the High Drug Use and High Criminogenic Thinking classes were more likely to recidivate, and patients in the High Drug Use class were more likely to report unstable housing. Depression scores were higher (nearly double) in the High Drug Use, High Recurrence, and High Criminogenic Thinking classes at follow-ups compared to the Normative Improvement class.

CONCLUSIONS

That the Normative Improvement class entered mental health residential treatment with relatively low alcohol and drug use and criminogenic thinking, and sustained these low levels, suggests that treatment does not need to be broadened or intensified to improve these domains for these patients with criminal histories. In contrast, findings for the High Drug Use, High Recurrence, and High Criminogenic Thinking classes, which composed 47 % of the sample, suggest that more integrated and sustained treatment may be needed to reduce recidivism, depression, and homelessness among these patients.

Disparities in substance use treatment retention: An exploration of reasons for discharge from publicly funded treatment

Although Delaware is the seventh smallest state in the country (including Washington, D.C.) in terms of population size, it has the second highest drug overdose death rate. The Delaware Division of Substance Abuse and Mental Health has increased attention in identifying disparities in treatment outcomes. We explored reasons for discharge from publicly-funded treatment in Delaware with special attention to populations at risk for health inequities, with a focus on covariates of treatment non-completion. Using secondary data collected from publicly-funded treatment providers, we analyzed data from individuals that were admitted to substance use treatment between 2015 and 2019 and had been discharged in 2019. We did this by using logistic and multinomial regression, focusing on non-completion treatment outcomes such as failure to meet requirements, loss of contact, and treatment refusal. Clients who were Black or African American, compared to white clients, were more likely to be lost contact with, administratively discharged, or marked as failing to meet treatment requirements than having a completed treatment discharge. Women were 30% less likely than men to have "failed to meet treatment requirements" compared to completing treatment. Further investigation is needed into these patterns. While treatment quality cannot be assessed using this data, the results point to a need for closer study of disparities in treatment related to race, ethnicity, gender, employment, criminal justice involvement, and type of drug used. Treatment providers should be made aware of culturally informed care, as well as client-created goals, in order to reduce disparities in exit from treatment.

Prediction of reoffending risk in men convicted of sexual offences: development and validation of novel and scalable risk assessment tools (OxRIS)

BACKGROUND

Current risk assessment tools have a limited evidence base with few validations, poor reporting of outcomes, and rarely include modifiable factors.

METHODS

We examined a national cohort of men convicted of sexual crimes in Sweden. We developed prediction models for three outcomes: violent (including sexual), any, and sexual reoffending. We used Cox proportional hazard regression to develop multivariable prediction models and validated these in an external sample. We reported discrimination and calibration statistics at prespecified cut-offs.

FINDINGS

We identified 16,231 men convicted of sexual offences, of whom 14.8% violently reoffended during a mean follow up of 38 months, 31.4% for any crime (34 months), and 3.6% for sexual crimes (42 months). Models for violent and any reoffending showed good discrimination and calibration. At 1, 3, and 5 years, the area under the curve (AUC) was 0.75-0.76 for violent reoffending and 0.74-0.75 for any reoffending. The prediction model for sexual reoffending showed modest discrimination (AUC = 0.67) and good calibration. We have generated three simple and web-based risk calculators, which are freely available.

INTERPRETATION

Scalable evidence-based risk assessment tools for sexual offenders in the criminal justice system and forensic mental health could assist decision-making and treatment allocation by identifying those at higher risk, and screening out low risk persons.

Psychometric properties of the Parma Scale for the treatment evaluation of offenders with mental disorder: A new instrument for routine outcome monitoring in forensic psychiatric settings

PURPOSE

Routine Outcome Monitoring (ROM) is still poorly implemented in the routine forensic psychiatric practice. As reliable ROM instruments are lacking, the aims of this research was to assess the psychometric properties of the Parma Scale (Pr-Scale) and its sensitivity to measure scores' longitudinal changes.

METHODS

Interrater and test-retest reliability, internal consistency and concurrent validity were investigated in offenders with mental disorder. Scores' longitudinal changeability was examined after a 3-month period using the Wilcoxon test for repeated measure.

RESULTS

Sixty male adult patients were recruited in this study. Our findings showed good to excellent interrater and test-retest reliability, concurrent validity and internal consistency for the Pr-Scale. Pr-Scale scores also display a moderate to large changeability over time.

CONCLUSIONS

Our results support the clinical use of the Pr-Scale in forensic psychiatric settings as reliable ROM instrument.

Association of Incarceration With Mortality by Race From a National Longitudinal Cohort Study

Importance

The association between incarceration and long-term mortality risk is unknown and may contribute to racial disparities in overall life expectancy.

Objective

To determine whether incarceration in the US is associated with an increase in mortality risk and whether this association is different for Black compared with non-Black populations.

Design, Setting, and Participants

This generational retrospective cohort study used data from the National Longitudinal Survey of Youth 1979, a nationally representative cohort of noninstitutionalized youths aged 15 to 22 years, from January 1 to December 31, 1979, with follow-up through December 31, 2018. A total of 7974 non-Hispanic Black and non-Hispanic non-Black participants were included. Statistical analysis was performed from October 26, 2019, to August 31, 2021.

Exposures

Time-varying exposure of having experienced incarceration during follow-up.

Main Outcomes and Measures

The main outcome was time to death. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs, adjusted for baseline sociodemographic, economic, and behavioral risk factors. Models were evaluated for the full cohort and stratified by race.

Results

Of the 7974 individuals included in our sample, 4023 (50.5%) were male, and 2992 (37.5%) identified as Black (median age, 18 [IQR, 17-20] years). During a median follow-up of 35 years (IQR, 33-37 years), 478 participants were incarcerated and 818 died. Unadjusted exposure to at least 1 incarceration between 22 and 50 years of age was 11.5% (95% CI, 10.4%-12.7%) for Black participants compared with 2.5% (95% CI, 2.1%-2.9%) for non-Black participants. In the multivariable Cox proportional hazards model with the full cohort, time-varying exposure to incarceration was associated with an increased mortality rate (adjusted HR [aHR], 1.35; 95% CI, 0.97-1.88), a result that was not statistically significant. In the models stratified by race, incarceration was significantly associated with increased mortality among Black participants (aHR, 1.65; 95% CI, 1.18-2.31) but not among non-Black participants (aHR, 1.17; 95% CI, 0.68-2.03).

Conclusions and Relevance

In this cohort study with 4 decades of follow-up, incarceration was associated with a higher mortality rate among Black participants but not among non-Black participants. These findings suggest that incarceration, which was prevalent and unevenly distributed, may have contributed to the lower life expectancy of the non-Hispanic Black population in the US.

Employment Perceptions of Parolees: The Role of Perceived Barriers and Criminal Thinking

This study explored offenders' perception of their barriers to employment and investigated the role of criminal attitudes in parolees recently released from prison. An analysis of open-ended responses from offenders indicated that they perceived having a criminal record as the largest barrier to employment. Structural equation modeling, utilizing a cross-sectional design, indicated moderate support for a model of criminal thinking as a predictor of perceived barriers and of self-efficacy. Survey results also found that criminal attitudes have a positive direct relationship with perception of barriers in work and education, with perception of barriers increasing as criminal thinking increases. Furthermore, criminal thinking has a negative direct relationship with job search self-efficacy, with job search self-efficacy decreasing as criminal thinking increases. Criminal thinking also had an indirect relationship with career aspirations through job search self-efficacy. Findings have implications for vocational programming for parolees.

The Long-Term Changes in Dynamic Risk and Protective Factors Over Time in a Nationwide Sample of Dutch Forensic Psychiatric Patients

The long-term changes of dynamic risk and protective factors have rarely been studied in forensic psychiatric patients. We utilized a latent growth curve analysis to investigate trajectories of risk and protective factors over time in all 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from any of 12 Dutch forensic psychiatric centers (FPCs). The study covered the period from juridical observation until unconditional release. Moreover, we investigated whether these trajectories differ between patients depending on their psychiatric diagnosis namely substance use disorders (SUD), psychotic disorders, and cluster B personality disorders (PDs). In addition, we also investigated whether SUD may influence changes in risk and protective factors in a group of psychotic and cluster B PDs patients, respectively. Overall, findings suggest that all changes in dynamic risk and protective factors could be depicted by two phases of patients' stay in the FPCs. Specifically, most changes on dynamic risk and protective factors occurred at the beginning of treatment, that is, from the time of juridical assessment up to the time of unguided leave. Moreover, the moment of unguided leave could be considered the 'turning point' in the treatment of offenders. We also found that SUD and psychotic patients changed the most in the first phase of their stay, while cluster B PDs patients changed the most in the second phase. However, SUD did not modify changes in risk and protective factors in psychotic and cluster B PDs patients. These findings may help improve offender treatment and crime prevention strategies.

Risk assessment tool floundering? Let's ask the client to self-predict

Self-prediction by criminal justice involved clients has not been typically implemented in risk assessment procedures, yet clients have unique self-knowledge that may add to the assessment of risk. The Transition Inventory is an eight scale self-prediction measure that addresses areas that are a precursor to antisocial and criminal activity (e.g., "Drugs or alcohol will be a problem for me"). The Transition Inventory was administered to 131 paroled clients (primary drug-related offenses), 104 of whom were of minority/ethnic status. Predictive validity was demonstrated by the Transition Inventory incrementally predicting supervision failure. Individual scale construct validity was demonstrated by predicting later assessed corresponding measures, with the Leisure scale having the most robust predictive relationship. Self-prediction may promote greater predictability and stronger client engagement in the assessment process.

Childhood trauma as a predictor of reoffending in a Northern Irish probation sample

BACKGROUND

It is well-documented that there is a high prevalence rate of childhood trauma experiences among the prison population, and studies have found a link between childhood trauma and later acts of violence.

OBJECTIVE

The aim of the current study was to investigate whether childhood trauma (i.e., physical, sexual, emotional abuse and physical neglect) among offenders who have served a life sentence in Northern Ireland was associated with general and violent reoffending patterns. The study also explored the relationship between childhood trauma resulting from the sectarian conflict "The Troubles" in the region and its impact on reoffending.

METHOD

The casefiles of 100 offenders were coded for trauma experiences and official reoffending data was extracted. Logistic regression analysis was performed to explore the relationship between trauma and reoffending.

RESULTS

The most common form of childhood trauma were emotional abuse and/or emotional neglect (n = 43), conflict-related trauma (n = 43) and physical abuse (n = 40). Only age (OR .91) and conflict-related trauma (OR 5.57) emerged as significant predictors (p < .05) of general reoffending at any time post release. Similarly, only age (OR .92) and conflict-related trauma (OR 4.57) emerged as significant predictors (p < .05) of violent reoffending. Although it did not reach significance (p =  .09), childhood physical abuse was related to an increase in the odds of violently reoffending, of a large magnitude (OR 4.09).

CONCLUSIONS

Conflict-related trauma significantly predicted general and violent reoffending among offenders with previous violent convictions.

Inpatient violence in forensic psychiatry: Does change in dynamic risk indicators of the IFTE help predict short term inpatient violence?

Inpatient violence is a form of recidivism in forensic psychiatric treatment and is stated as an adverse outcome of treatment and a predictor for recidivism after release from the institution. Dynamic Risk Indicators (DRI) are critical key indicators that can predict inpatient violence, but little is known about the effects of change in DRI during forensic psychiatric treatment on the prediction of inpatient violence. This study examines the effects of change in DRI on the prediction of short-term inpatient violence using the Instrument for Forensic Treatment Evaluation (IFTE). A group of 96 patients is followed from entering a high secure forensic hospital until their fifth measurement approximately three years later. The outcome measure is defined as any inpatient violence six months after measurement five. Repeated measures are used to study whether there was a difference in change in DRI between the group of patients who did or did not committed inpatient violence. Binary logistic regression is used to establish the extent to which changes in DRI add to the predictive power of the last measurement. At the group level, the extent of change in DRI did not discriminate between the two patient groups. A large part of the 96 patients already scored low on DRI when entering the hospital and did not (need to) change. At all five measurements violent patients had significant higher scores on DRI than nonviolent patients. Logistic regressions showed that the last measurement predicts inpatient violence sufficiently, the change in DRI during the first four measurements did not contribute to this prediction. The change in dynamic risk indicators does not help to predict short term inpatient violence. The last measurement is the most practical predictor for short term inpatient violence, but because of the dynamic nature of these indicators it is necessary to frequently monitor these indicators to detect imminent risks.

Building Recovery Capital: The Role of "Hitting Bottom" in Desistance and Recovery from Substance Abuse and Crime

The aim of this article is to explore the role of "hitting bottom" as a motivation to initiate a recovery process and desistance from crime and substance use disorders (SUDs), and in building recovery capital (RC). Researchers and practitioners have long been interested in why and how offenders desist from crime. Desistance and recovery from crime and SUDs have also been linked to negative turning points, such as hitting bottom, which represents multidimensional suffering with physiological, familial, social, and criminal implications. The deleterious outcomes of SUDs cause individuals to lose their social and personal resources and hit bottom. According to the conservation of resources model, in the context of actual or potential loss of resources, individuals strive to maintain, protect, and build them. Thus, hitting bottom not only provides the initial motivation for change, but also drives individuals to build personal resources. The prospects for successful recovery are dependent upon the individual's personal and social resources, or RC. This article represents a first step in examining the role of hitting bottom in building RC in the process of long-term recovery. The conclusions may have theoretical as well as practical implications.

Evaluating concurrent validity of criminal justice and clinical assessments among women on probation

BACKGROUND

Women in the criminal justice (CJ) system experience complex and comorbid medical, psychiatric, and substance use disorders, which often contribute to CJ involvement. To identify intersections between CJ and health needs, we calculated Spearman r correlations between concurrent CJ and clinical assessments from women on probation in Connecticut who were enrolled in a clinical trial. We examined longitudinal trends in CJ risk scores over 9 years of observation (2005-2014), modeling time to probation recidivism with shared gamma frailty models and comparing contiguous time points by Wilcoxon matched-pairs signed rank tests.

RESULTS

Women (N = 31) were predominantly white (67.7%) with at least some high school education (58.1%) and mostly unemployed (77.4%) and unstably housed (83.9%). Most met clinical criteria for severe substance use and/or psychiatric disorders. Concurrent measures of substance use, mental health, social support, partnerships, and risk by the Level of Service Inventory-Revised (LSI-R) and clinical assessments were not significantly correlated. The LSI-R personal/emotional sub-score, however, positively correlated with the Addiction Severity Index psychiatric composite score (r = 0.40, 95% CI 0.03-0.68, p = 0.03). After adjusting for age, race and number of previous events, having some high school education versus none marginally decreased the hazard for probation recidivism and having > 5 inpatient psychiatric admissions versus none increased the hazard of probation recidivism 7-fold (HR 7.49, 95% CI 1.33-42.12, p = 0.022). Women with 0-1 recurrent probation terms (n = 16) had a significantly lower mean LSI-R score than those with 2-4 recurrent probation terms (35.9 [SD 6.4] versus 39.2 [SD 3.0], p = 0.019), but repeated LSI-R scores did not change over time, nor vary significantly beyond the group mean.

CONCLUSIONS

In this small, quantitative study of women on probation, widely used CJ assessment tools poorly reflected women's comorbid medical, psychiatric, and substance use needs and varied minimally over time. Findings illustrate the limitations of contemporary CJ assessment tools for women with complex needs. The field requires more comprehensive assessments of women's social and health needs to develop individualized targeted case plans that simultaneously improve health and CJ outcomes.

Housing Experiences among Opioid-Dependent, Criminal Justice-Involved Individuals in Washington, D.C

Residential mobility and type of housing contributes to an individual's likelihood and frequency of drug/alcohol use and committing criminal offenses. Little research has focused simultaneously on the influence of housing status on the use of drugs and criminal behavior. The present study examines how residential mobility (transitions in housing) and recent housing stability (prior 30 days) correlates with self-reported criminal activity and drug/alcohol use among a sample of 504 addicted, treatment-seeking opioid users with a history of criminal justice involvement. Findings suggest that those with a greater number of housing transitions were considerably less likely to self-report criminal activity, and criminal involvement was highest among those who were chronically homeless. Residential mobility was unassociated with days of drug and alcohol use; however, residing in regulated housing (halfway houses and homeless shelters) was associated with a decreased frequency of substance use. The finding that residing at sober-living housing facilities with regulations governing behavior (regulated housing) was associated with a lower likelihood of illicit substance use may suggest that regulated housing settings may influence behavior. Further research in this area should explore how social networks and other related variables moderate the effects of housing type and mobility on crime and substance use.

Alone on the Inside: The Impact of Social Isolation and Helping Others on AOD Use and Criminal Activity

Because addiction is a socially isolating disease, social support for recovery is an important element of treatment planning. This study examines the relationship between social isolation, giving and receiving social support in Alcoholics Anonymous during treatment, and post-treatment outcomes among juvenile offenders court-referred to addiction treatment. Adolescents (N = 195) aged 14 to 18 years were prospectively assessed at treatment admission, treatment discharge, 6 months, and 12 months after treatment discharge. The influence of social isolation variables on relapse and severe criminal activity in the 12-months post-treatment was examined using negative binomial logistic regressions and event history methods. Juveniles entering treatment with social estrangement were significantly more likely to relapse, be incarcerated, and commit a violent crime in the 12-months post-treatment. Giving help to others in Alcoholics Anonymous during treatment significantly reduced the risk of relapse, incarceration, and violent crime in the 12-months post-treatment whereas receiving help did not.

Cognitive-Behavioral Therapy Efficacy for Reducing Recidivism Rates of Moderate- and High-Risk Sexual Offenders: A Scoping Systematic Literature Review

This literature scoping review compared recidivism rates of moderate- and high-risk sexual offenders who received cognitive-behavioral therapy (CBT) oriented treatments. Ten empirical studies from 2001 to 2014 were selected for review that met the following criteria: (a) Treatment program included a CBT-based intervention with a comparative intervention; (b) participants included adult, male, moderate- and high-risk sexual offenders only; and (c) follow-up data for up to 12 months. Data were analyzed using a summative metric for recidivism rate comparisons ( N = 3,073 for CBT and N = 3,588, for comparison approaches). Sexual offense recidivism rates varied from 0.6% to 21.8% (with CBT) and from 4.5% to 32.3% (with comparison intervention). The within-sample median rate of violent recidivism with a history of sexual offense was 21.1% (with CBT) versus 32.6% (comparison). Sexual offenders had a general felonies (within-sample) median recidivism rate of 27.05% (with CBT) versus 51.05% (comparison). The evidence supports the conclusion that CBT in its various forms is an efficacious treatment modality to prevent offense recidivism by sexual offenders. Suggestions for future research are considered.

Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users

There is a need to understand the determinants of both substance use and criminal activity in rural areas in order to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders -- the Risk-Need-Responsivity (RNR) model -- to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model's focus on offenders to assessing rural-dwelling individuals using stimulants (N=462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used Generalized Estimating Equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at six months, and even more at three years, post-baseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model's criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.

People's reasons for wanting to complete probation: Use and predictive validity in an e-health intervention

The criminal justice system tends to emphasize external contingencies (e.g., fees, jail time) to motivate offender compliance. However, people's reasons for desistance vary considerably. This study evaluated the acceptability, utility, and predictive validity of questions that ask about people's reasons for wanting to successfully complete probation. Substance-using probationers (N=113) participated in a web-based computer intervention that targeted substance use and treatment initiation. Questions around seven dimensions of reasons for completing probation were developed to provide tailored feedback during the web-based program. A principle components factor analysis found that survey items loaded onto two distinct factors. Factor one, "Tangible Loss" focused on external and present-focused reasons. Factor two, "Better Life" focused on internal and future-focused reasons. There was a significant negative association between Better Life scores and days of substance use after two months (β=-0.31, SE=0.13, p<0.05). There was a significant positive association with Better Life scores and days of treatment attendance (β=1.46, SE=0.26, p<0.001). Tangible Loss scores were no associated with substance use and treatment attendance. These findings may help to create more effective motivational tracks in e-health interventions, and may complement traditional motivation measures with an explicit focus on people's stated reasons for wanting to complete probation.

A Multisite Randomized Block Experiment on the Seamless System of Care Model for Drug-Involved Probationers

This multisite randomized block experiment examines the efficacy of the seamless system of care for probationers (an integrated probation model combined with substance abuse treatment intervention onsite at a probation office). The sample consists of 251 drug-involved probationers randomized into probation with referral to community treatment or the seamless system of care. Key outcomes are examined over a 1-year period by recidivism risk level. When compared with probationers in the control group, the findings are that those in the seamless system of care group had fewer drug use days overall, less alcohol consumption, improved treatment initiation and adherence, but a higher number of days incarcerated. Low-risk seamless system participants had the most favorable outcomes compared with other study conditions. This study demonstrates the importance of tailoring interventions to the risk level of the probationer, and that the seamless system works better for lower risk offenders with substance use disorders.

Using the Behavior Change Technique Taxonomy v1 to conceptualize the clinical content of Breaking Free Online: a computer-assisted therapy program for substance use disorders

BACKGROUND

In recent years, research within the field of health psychology has made significant progress in terms of advancing and standardizing the science of developing, evaluating and reporting complex behavioral change interventions. A major part of this work has involved the development of an evidence-based Behavior Change Technique Taxonomy v1 (BCTTv1), as a means of describing the active components contained within such complex interventions. To date, however, this standardized approach derived from health psychology research has not been applied to the development of complex interventions for the treatment of substance use disorders (SUD). Therefore, this paper uses Breaking Free Online (BFO), a computer-assisted therapy program for SUD, as an example of how the clinical techniques contained within such an intervention might be mapped onto the BCTTv1.

METHOD

The developers of BFO were able to produce a full list of the clinical techniques contained within BFO. Exploratory mapping of the BCTTv1 onto the clinical content of the BFO program was conducted separately by the authors of the paper. This included the developers of the BFO program and psychology professionals working within the SUD field. These coded techniques were reviewed by the authors and any discrepancies in the coding were discussed between all authors until an agreement was reached.

RESULTS

The BCTTv1 was mapped onto the clinical content of the BFO program. At least one behavioral change technique was found in 12 out of 16 grouping categories within the BCTTv1. A total of 26 out of 93 behavior change techniques were identified across the clinical content of the program.

CONCLUSION

This exploratory mapping exercise has identified the specific behavior change techniques contained within BFO, and has provided a means of describing these techniques in a standardized way using the BCTTv1 terminology. It has also provided an opportunity for the BCTTv1 mapping process to be reported to the wider SUD treatment community, as it may have real utility in the development and evaluation of other psychosocial and behavioral change interventions within this field.

Sexual Offenders' Perceptions of the Client-Therapist Relationship: The Role of Risk

The therapeutic alliance has been shown to be integral to treatment outcomes even in forensic settings. There is still a relative dearth of research examining factors related to the formation of the therapeutic alliance in sex offender treatment specifically. Using a sample of 202 incarcerated male sexual offenders participating in sex offender treatment, this study examined whether perceptions of the client-therapist relationship from the perspective of male sexual offenders varied by risk for sexual and general recidivism. Overall, we found a significant negative relationship between risk for sexual recidivism and bond formation. However, when therapist subscale scores on the Working Alliance Inventory were considered by therapist gender, higher risk sexual offenders perceived poorer bonds with their female therapists, relative to their male therapists. Findings are discussed as they pertain to therapeutic relationships and responsivity issues in sex offender treatment.

Love and Service in Adolescent Addiction Recovery

This article is one of the first to examine the relationships among a specific combination of "spiritual virtues" (helping others and the experience of divine love) and outcomes related to criminal involvement, sobriety, and character development among adolescents. One-hundred ninety five adolescents with substance dependency court-referred to residential treatment were assessed at intake, discharge, and 6 months post-treatment. Higher service to others predicted reduced recidivism, reduced relapse, and greater character development. Experiencing divine love enhanced the effect of service on recidivism. Greater attention to spiritual virtues might improve treatment for youth involved with alcohol, drugs, and certain forms of crime.

Beyond recidivism: changes in health and social service involvement following exposure to drug treatment court

Background

The majority of Drug Treatment Court (DTC) research has examined the impact of DTCs on criminal recidivism. Comparatively little research has addressed the association between DTC participation and engagement with community-based health and social services. The present study investigated changes in participant involvement with outpatient healthcare and income assistance within a DTC cohort. We hypothesized that involvement with community-based (outpatient) health and social services would increase post-DTC participation, and that service levels would be higher among program graduates and offenders with histories of co-occurring mental and substance use disorders.

Methods

Participants were 631 offenders at the DTC in Vancouver, Canada (DTCV). Administrative data representing hospital, outpatient medical care, and income assistance were examined one-year pre/post program to assess differences over time. Generalized estimating equations were used to investigate the association between changes in service use and program involvement. We also examined the relationship between level of service use and offender characteristics.

Results

Members of the cohort were disproportionately Aboriginal (33 %), had been sentenced 2.7 times in the 2 years preceding their index offence, and 50 % had been diagnosed with a non substance-related mental disorder in the five years preceding the index offence. The mean number of outpatient services post DTCV was 51, and the mean amount of social assistance paid was $5,897. Outpatient service use increased following exposure to DTCV (Adjusted Rate Ratio (ARR) = 1.45) and was significantly higher among women (ARR = 1.47), program graduation (ARR = 1.23), and those previously diagnosed with concurrent substance use and mental disorders (ARR = 4.92). Overall, hospital admissions did not increase post-program, although rates were significantly higher among women (ARR = 1.76) and those with concurrent disorders (ARR = 2.71). Income assistance increased significantly post program (ARR = 1.16), and was significantly higher among women (ARR = 1.03), and those diagnosed with substance use disorders (ARR = 1.42) and concurrent disorders (ARR = 1.72).

Conclusions

These findings suggest that the DTCV was a catalyst for increased participant engagement with community health and social supports, and that rates of service use were consistently higher among women and individuals with concurrent disorders. Research is needed to investigate the potential link between health and social support and reductions in recidivism associated with DTCs.

General Responsivity Adherence in Juvenile Drug Treatment Court

Although the number of juvenile drug treatment courts (JDTC) in operation has increased since the first JDTCs were implemented in the 1990s, research continues to lag regarding the effectiveness of the treatment interventions that are provided. The purpose of the present study was to explore how the risk-need-responsivity models’ general responsivity principle could be used to inform the effectiveness of the interventions provided to 1,176 participants in nine JDTCs in the United States. Responsivity adherence was measured using the number of general responsivity-adherent techniques included in each intervention. The results indicated that an increase in general responsivity adherence was associated with an increase in substance-use severity score, which suggests that the effect of the JDTC model on treatment outcomes could vary by the type of interventions provided to participants. In addition, the findings suggest the need to further specify adherence to the general responsivity principle, particularly among substance-involved juvenile offenders.

Motivational tools to improve probationer treatment outcomes

BACKGROUND

Motivational interviewing (MI) is a promising practice to increase motivation, treatment retention, and reducing recidivism among offender populations. Computer-delivered interventions have grown in popularity as a way to change behaviors associated with drug and alcohol use.

METHODS/DESIGN

Motivational Assistance Program to Initiate Treatment (MAPIT) is a three arm, multisite, randomized controlled trial, which examines the impact of Motivational interviewing (MI), a motivational computer program (MC), and supervision as usual (SAU) on addiction treatment initiation, engagement, and retention. Secondary outcomes include drug/alcohol use, probation progress, recidivism (i.e., criminal behavior) and HIV/AIDS testing and treatment among probationers. Participant characteristics are measured at baseline, 2, and 6 months after assignment. The entire study will include 600 offenders, with each site recruiting 300 offenders (Baltimore City, Maryland and Dallas, Texas). All participants will go through standard intake procedures for probation and participate in probation requirements as usual. After standard intake, participants will be recruited and screened for eligibility.

DISCUSSION

The results of this clinical trial will fill a gap in knowledge about ways to motivate probationers to participate in addiction treatment and HIV care. This randomized clinical trial is innovative in the way it examines the use of in-person vs. technological approaches to improve probationer success.

TRIAL REGISTRATION

NCT01891656.

Does substance misuse moderate the relationship between criminal thinking and recidivism?

PURPOSE

Some differential intervention frameworks contend that substance use is less robustly related to recidivism outcomes than other criminogenic needs such as criminal thinking. The current study tested the hypothesis that substance use disorder severity moderates the relationship between criminal thinking and recidivism.

METHODS

The study utilized two independent criminal justice samples. Study 1 included 226 drug-involved probationers. Study 2 included 337 jail inmates with varying levels of substance use disorder severity. Logistic regression was employed to test the main and interactive effects of criminal thinking and substance use on multiple dichotomous indicators of recidivism.

RESULTS

Bivariate analyses revealed a significant correlation between criminal thinking and recidivism in the jail sample (r = .18, p < .05) but no significant relationship in the probation sample. Logistic regressions revealed that SUD symptoms moderated the relationship between criminal thinking and recidivism in the jail-based sample (B = -.58, p < .05). A significant moderation effect was not observed in the probation sample.

CONCLUSIONS

Study findings indicate that substance use disorder symptoms moderate the strength of the association between criminal thinking and recidivism. These findings demonstrate the need for further research into the interaction between various dynamic risk factors.