A systematic review of the reasons why detained adult offenders fail to attend or successfully complete treatment programme(s) was conducted. An initial search of the literature identified 2,827 articles, which following evaluation against explicit inclusion/exclusion criteria and a quality assessment was reduced to 13 studies. Extracted data from the 13 studies were synthesised using a qualitative approach. Despite the 13 studies being heterogeneous in design, there was consensus on the reasons offenders gave for completion/noncompletion of treatment. The majority were consistent with the factors outlined in the Multifactor Offender Readiness Model (MORM) and included a perceived lack of self-efficacy, negative perceptions of treatment, staff and peers, an inability to regulate emotions, and a lack of perceived choice and control. A lack of opportunity to engage in established, professionally run, groups, as well as perceived inadequate support from members of staff, was also associated with poor engagem...

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Treatment Engagement From the Perspective of the Offender Reasons for Noncompletion and Completion of Treatment—A Systematic Review

The community-based supervision of offenders from a positive psychology perspective

Inmates on preventive detention are a small and select group sentenced to an indefinite term of imprisonment. Mood disorders and substance abuse are risk factors for inmate violence and recidivism, so the prevalence of depression, anxiety, and substance abuse was examined in this cohort using psychometric tests. Completion of self-report questionnaires was followed by face-to-face clinical interviews with 26 of the 56 male inmates on preventive detention in Norway's Ila Prison. Substance abuse histories and information about the type of psychiatric treatment received were compiled. To assess anxiety and depression, the Hospital Anxiety and Depression Scale (HADS), the Clinical Anxiety Scale (CAS), and the Montgomery Asberg Depression Rating Scale (MADRS) were used. Scores on the MADRS revealed that 46.1% of inmates had symptoms of mild depression. The HADS depression subscale showed that 19.2% scored above the cut-off for depression (κ = 0.57). The CAS anxiety score was above the cut-off for 30.7% of the subjects, while 34.6% also scored above the cut-off on the HADS anxiety subscale (κ = 0.61). Almost 70% of all these inmates, and more than 80% of those convicted of sex crimes, had a history of alcohol and/or drug abuse. Mild anxiety and depression was found frequently among inmates on preventive detention. Likewise, the majority of the inmates had a history of alcohol and drug abuse. Mood disorders and substance abuse may enhance recidivism, so rehabilitation programs should be tailored to address these problems.

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Depression, anxiety, and history of substance abuse among Norwegian inmates in preventive detention: Reasons to worry?

Objective: There is a need to find effective treatments for individuals with antisocial and borderline personality disorder who are known to be difficult to engage and treat. Many of these individuals share considerable overlap with symptoms of ADHD, hence this study aimed to evaluate the Reasoning and Rehabilitation ADHD program (R&R2 ADHD) among patients with severe personality disorder. Method: A total of 31 males detained in a “dangerous and severe personality disorder” unit completed questionnaires at baseline and post treatment to assess social problem solving, violent attitudes, anger, ADHD symptoms, emotional control, and social functioning. A total of 16 patients participated in the group condition, and their scores were compared with 15 waiting-list controls who received treatment as usual. Results: In all, 76% of group participants completed the program. In contrast to controls, they showed significant improvements in scores with mainly medium effect sizes. Conclusion: R&R2 ADHD was effective in a small sample of severely personality-disordered offenders.

A Controlled Trial of a Cognitive Skills Program for Personality-Disordered Offenders:

Clients with personality disorder (PD) can encounter difficulties engaging in psychosocial therapy. One way to address this is to identify the factors that contribute to their low engagement. The Multifactor Offender Readiness Model (MORM), a model developed to explain poor treatment engagement in offenders, might guide the identification of engagement difficulties in clients with PD. In this study, we sought to validate and extend the MORM for clients with PD by identifying the perceived barriers to and facilitators of their engagement. A two-round Delphi Survey was employed to identify clients' and clinicians' levels of agreement on the factors that impair and promote engagement. Seventy-six clients and 55 clinicians were recruited from English specialist forensic and non-forensic personality disorder services. Our findings reveal that the perceived barriers to engagement for those with PD are in the most part congruent with the impediments outlined in the MORM. However, we do find some additional barriers relevant specifically to people with PD. A Treatment Readiness Model for Personality Disorder (TReMoPeD), which is an augmented version of the MORM, is presented. This model provides guidance for ways of taking action to improve a client's chance of engaging with services. Copyright © 2012 John Wiley & Sons, Ltd.

Barriers to and facilitators of treatment engagement for clients with personality disorder: a Delphi survey

Background Individuals deemed to be of high risk to others, and diagnosed with severe personality disorders have become the focus for developing clinical services in England. Such services often require highly secure accommodation and labour-intensive therapeutic interventions. There is, however, uncertainty about the capacity to engage such patients effectively in therapies.



Aim Here, we examine service evaluation monitoring data to identify the level of completion of therapeutic programmes in a high secure severe personality disordered population, and analyse reasons for failure to complete.



Method Guidelines for classifying reasons for non-completion were developed, based on the multifactorial offender readiness model (MORM). Electronic case notes were searched for references to non-completion, and recorded reasons for non-completion were classified.



Results Non-completion was at a relatively modest level. The main reasons for non-completion were: (1) affective: general distress of the patient or specific emotional reactions to previous offending, e.g. shame; (2) volitional: pursuing goals other than treatment; and (3) cognitive: negative self-efficacy beliefs and negative evaluations (low trust) of staff and the programme. External factors included exclusion from treatment and transfer to another unit.



Conclusion This study identifies specific readiness areas that might need to be addressed in efforts to improve engagement and retention in treatment. A wider range of methodologies is required for future studies. Copyright © 2010 John Wiley & Sons, Ltd.

Kerry Sheldon

Papers

An empirical evaluation of reasons for non-completion of treatment in a dangerous and severe personality disorder unit

Single case methodologies.

Assessment of Violence and Homicide