Changes in the Risk of Sexual Reoffending: The Role and Relevance of Perceived Self-Efficacy and Adult Attachment Styles in Correctional Treatment

According to the Risk-Need-Responsivity (RNR) model, treatment effectiveness increases when treatment addresses all three associated core principles. While researchers have focused on the risk and need principles, responsivity remains under-investigated. The theoretical foundation of the RNR model and former research indicates low perceived self-efficacy and inadequate adult attachment styles as potential responsivity factors that can impede treatment of the underlying risk factors. This study assesses firstly whether these factors predict treatment attrition, and secondly changes in the assessed risk of sexual reoffending. Participants were N = 146 men sentenced for sexual offenses in a German social-therapeutic correctional facility. Younger age, higher number of previous convictions, and higher scores on the interpersonal facet of the Psychopathy Checklist-Revised are associated with a higher risk of treatment attrition. Unemployment prior to incarceration was found to be an aggravating factor, whereas substance abuse emerged as a mitigating factor, according reducing the risk of reoffending. Neither pre-treatment self-efficacy nor attachment styles revealed as responsivity factors in this study. Future studies should examine if the consideration of these factors during treatment might impact treatment outcomes.

A Qualitative Analysis of Attrition in Parent-Child Interaction Therapy

Parent-child interaction therapy (PCIT) is one of the strongest evidence-based treatments for young children with behavior problems. Despite the efficacy of PCIT, many families fail to complete treatment, with attrition rates ranging from 30 to 69 percent. Preliminary research on attrition in PCIT treatment studies has linked maternal distress, negative verbal behavior (critical and sarcastic comments towards the child), lower socioeconomic status (SES), and fewer child major depressive disorder (MDD) diagnoses with premature termination from PCIT. However, more research is still needed to identify the range of reasons for treatment discontinuation. The purpose of the present study was to explore the range of reasons for premature termination from PCIT by conducting in-depth interviews with parents who discontinued PCIT using a qualitative design methodology. Results yielded eight themes, which were organized into three constructs: child-directed interaction (CDI) successes, difficulties with treatment, and the need for more clarity and orientation. Several existing treatment strategies that emerged from the data could be applied to PCIT to further enhance it and potentially reduce dropout (e.g., reconceptualizing dropout from PCIT, micro-orienting strategies used in other cognitive and behavioral therapies and dialectical behavior therapy). Understanding the reasons why parents drop out of PCIT and exploring different adaptations that can be made can further enhance this evidence-based treatment and increase its accessibility.

Predicting Attrition and Engagement in the Treatment of Young Offenders

Premature treatment termination in offender treatment is linked to negative consequences for clients, practitioners, and the criminal justice system. Therefore, identifying predictors of treatment attrition is a crucial issue in offender rehabilitation. Most studies on this topic focus on adult offenders; less is known about adolescent offenders. In our study, therapy attrition and engagement were predicted via logistic and linear regression to examine the link between pretreatment variables, engagement, and treatment failure in 161 young offenders treated in a social-therapeutic unit in Germany. Engagement could be predicted by motivation, disruptive childhood behavior, low aggressiveness, and higher age. In turn, low motivation, substance abuse, and young age predicted attrition, but their impact diminished when engagement was added to the model with only substance abuse remaining significant. The effect of substance abuse on attrition disappeared, when the offender's initial motivation was high. Implications for assessment and treatment planning are discussed.

Relationships Between Treatment Delivery, Program Attrition, and Reoffending Outcomes in an Intensive Custodial Sex Offender Program

Retention of sex offenders to the completion of treatment is critical to program adherence to risk need responsivity (RNR) principles; however, it is also important to consider the potential interaction between attrition and treatment outcomes such as reoffending. The first aim of this study was to evaluate the influence of changes to treatment delivery in a residential sex offender treatment program (SOTP), including introduction of rolling groups and systematic emphasis on positive therapist characteristics, on likelihood of program noncompletion ( n = 652). Pooled regression modeling indicated that these operational interventions were associated with a significantly increased likelihood of program completion. We also examined whether variance in rates of participant attrition was related to reoffending outcomes for program completers ( n = 494). Incidence of attrition within completing participants' treatment cohorts had a significant negative association with hazard of sexual reoffending that was not accounted for by pretreatment risk. Results are discussed in terms of their implications for treatment delivery processes that aim to optimize both participant retention and treatment effectiveness.

Mental health stigma in depressed Latinos over the course of therapy: Results from a randomized controlled trial

OBJECTIVE

The current study examined the course, correlates, and predictors of mental health stigma among depressed, Spanish-speaking Latinos that were receiving treatment. This population faces significant disparities in mental health treatment and carries high levels of mental health stigma.

METHOD

The study utilized data generated from a randomized clinical trial (N = 46) that evaluated the efficacy of Behavioral Activation and Supportive Counseling for depression among Latinos.

RESULTS

Mental health stigma decreased over time; these decreases were more pronounced among individuals who were randomized to Supportive Counseling. Mental health stigma was positively associated with depressive symptoms and therapeutic alliance over time. Mental health stigma was not related to treatment attrition.

CONCLUSIONS

These preliminary findings indicate that mental health stigma continues to be relevant among individuals who are actively participating in treatment. Receiving mental health treatment may be sufficient to dispel some of the stigmatizing views endorsed by underserved clinical populations.

Predicting Time Spent in Treatment in a Sample of Danish Survivors of Child Sexual Abuse

The aim of this study was to identify significant predictors of length of time spent in treatment. In a convenience sample of 439 Danish survivors of child sexual abuse, predictors of time spent in treatment were examined. Assessments were conducted on a 6-month basis over a period of 18 months. A multinomial logistic regression analysis revealed that the experience of neglect in childhood and having experienced rape at any life stage were associated with less time in treatment. Higher educational attainment and being male were associated with staying in treatment for longer periods of time. These factors may be important for identifying those at risk of terminating treatment prematurely. It is hoped that a better understanding of the factors that predict time spent in treatment will help to improve treatment outcomes for individuals who are at risk of dropping out of treatment at an early stage.

Transdiagnostic Motivational Enhancement Therapy to Reduce Treatment Attrition: Use in Emerging Adults

Improving outcomes of youth with mental health (MH) needs as they transition into adulthood is of critical public health significance. Effective psychotherapy MH treatment is available, but can be effective only if the emerging adult (EA) attends long enough to benefit. Unfortunately, completion of psychotherapy among EAs is lower than for more mature adults (Edlund et al., 2002; Olfson, Marcus, Druss, & Pincus, 2002). To target the high attrition of EAs in MH treatment, investigators adapted a developmentally appropriate brief intervention aimed at reducing treatment attrition (TA) in psychotherapy and conducted a feasibility study of implementation. The intervention employs motivational interviewing strategies aimed at engaging and retaining EAs in outpatient MH treatment. Motivational enhancement therapy for treatment attrition, or MET-TA, takes only a few sessions at the outset of treatment as an adjunct to usual treatment. Importantly, it can be used for TA with psychotherapy for any MH condition; in other words, it is transdiagnostic. This article presents the first description of MET-TA, along with a case example that demonstrates important characteristics of the approach, and then briefly describes implementation feasibility based on a small pilot randomized controlled trial.

Treatment Attrition of Probationers With Mental Illness From an Enhanced Day Reporting Center

Treatment completion is an important outcome for both mental health and criminal justice agencies tasked with managing offenders with mental illness in the community. Previous research has shown that greater degrees of criminogenic risk factors (e.g., specific criminal history variables) predict treatment non-completion among legally mandated populations. However, most studies were conducted with offenders without mental illness. In this study, demographic (e.g., age, gender), clinical (e.g., psychiatric diagnosis), and criminogenic risk factors (measured using the Level of Service Inventory-Revised [LSI-R]) were compared by treatment completion status using 167 probationers with mental illness treated at an enhanced day reporting center. Bivariate and multivariate (i.e., forward entry logistic regression) analyses revealed that while the LSI-R total score was unrelated to treatment completion, higher scores on the LSI-R Alcohol and Drug use subscale (odds ratio [OR] = 1.25, 95% confidence interval [CI] = [1.01, 1.54]) and older age (OR = 1.04, 95% CI = [1.00, 1.09]) were significantly predictive of non-completion.

Predicting Treatment Attrition Among Seriously Violent Offenders: An Application of the Directionality Model

Treatment completion by violent offenders results in fewer victims and less violence in society. As researchers and members of society, we have a compelling interest in finding ways to keep violent male offenders in effective treatment programs. This study examines file-rated predictors of treatment attrition from an institutionally based program for persistently violent offenders. Each of the three prediction models of institutionally based treatment attrition included the predictors of motivation for assistance and prior treatment dosage: (a) the past criminal behavior model, (b) the recent antisocial behavior model, and (c) the non-antisocial instability model. Recent antisocial behavior did not improve the prediction of treatment attrition over the past criminal behavior model. Motivation for assistance did not make a contribution in the recent antisocial behavior or the non-antisocial instability models while prior treatment dosage consistently contributed to the prediction of attrition across the models. Recent non-antisocial behavior is important to offender treatment attrition.

Enhancing treatment participation in CAMHS among families of conduct problem children: effectiveness study of a clinician training programme

BACKGROUND

  The effectiveness of a training programme targeting structural and therapy process strategies to enhance treatment attendance among families of conduct problem children was evaluated across three community mental health clinics.

METHOD

  Utilising a staggered multiple-baseline design, referrals prior to clinician training were compared to posttraining referrals (N = 221).

RESULTS

  In comparison to service as usual, children and their families referred after the training initiative had significantly higher treatment attendance (66% vs. 83%) and 79% less likelihood of attrition, though findings were mixed for child's mental health.

CONCLUSIONS

  The findings provide initial support for the effectiveness of the clinician training programme in increasing treatment involvement.