the effectiveness of a brief stage based intervention, stacey bowden and katie-marie jervis
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THE EFFECTIVENESS OF A BRIEF STAGE-BASED INTERVENTION
Stacey Bowdenand
Katie-Marie Jervis
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2
Overview
Why people changeStages of Change and Brief
InterventionsCurrent researchMethodResults Implications for treatment/further
researchConclusions
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Puna Tatari -Special Treatment Unit (STU)
Opened August 2008
Puna Tatari is a AA/AB (low/medium) security unit
Nine month intensive rehabilitation program (STURP; Department of Corrections, 2007) for high risk offenders
Co-facilitation model
Offenders often placed in Starter Groups prior to treatment (approximately 8 weeks in length)
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Starter group The main aims of the starter group are to:
Introduce participants to group activities
Motivate them to participate in group work
Increase cohesion
Increase skills in managing behaviour
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The Effectiveness of a Brief Staged-Based Intervention
Little research into the effectiveness of brief interventions with offenders; especially stage based ones
To evaluate the effectiveness of the starter group program:
measures of readiness and responsivity to change from pre-treatment to post-treatment were compared for those prisoners receiving the starter group program
Treatment gain was also measured at post-intervention
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IntroductionBackground to behavioural change:
Why do people change? (Miller & Rollnick, 2002)
How do people change?(Prochaska & DiClemente, 1992 & 1998)
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How People Change
The Transtheoretical Model (TTM) (Prochaska & DiClemente, 1992 & 1998)
Integrative framework intended to help develop effective interventions for a range of problem behaviours
The Stages Of Change (SOC) within the model is the key organizing construct
Motivational readiness to change can be identified across differing stages
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The Transtheoretical Model
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Stage of Change construct
Supporting research:
Addiction (Velicer, Botelho & Prochaska, 1998)
Weight control (Logue, Jarjoura, Sutton, Smucker, Baughman, Capers, 2004; O'Hea et al, 2004)
Smoking cessation (Prochaska et al., 1998b)
Offender rehabilitation which, when applied within a therapeutic setting, has helped in decreasing such unhealthy or risky behaviours (Williamson, Day & Howell, 2004; Tierney & McCabe, 2002)
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SOC Construct and Offender Populations
The SOC model has been widely used to understand treatment readiness in offenders referred for substance abuse and sexual offending(Tierney & McCabe, 2002)
Stage-based interventions can significantly increase the motivation of high risk violent offenders to complete intensive rehabilitation(Murphy & Baxter, 1997; Stewart, Hill & Cripps, 2000; Williamson, Day & Howell, 2004)
Additionally, the Criminal and Justice Institution (2006) has made recommendations for implementing stage-based interventions for high risk youth.
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Limitations of the SOC Model
Ineffective for long-term behaviour change (Adams & White, 2004)
Arbitrary nature of the timelines
Lack of distinction between stages (Sutton, 2001)
Offenders behaviour too complex?
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Assessing Motivation and Measuring Change Research has supported the utility of the
assessment of motivation in predicting risk in offenders (Stewart & Millson, 1995)
Motivation (low, moderate, high) amongst other factors has been related to release failure
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Instruments for assessing therapeutic change and
treatment gain Stages of Change Readiness and Treatment
Eagerness Scale (SOCRATES; Miller & Tonigan, 1996)
Readiness to Change Questionnaire (RCQ; Rollnick, Heather, Gold, & Hall, 1992)
University of Rhode Island Change Assessment (URICA)
Treatment Readiness, Responsivity and, Gain Scale: Short Version (TRRG:SV) by Serin, Kennedy & Milloux (2005).
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Using Brief Interventions to Facilitate Change
Brief interventions (15 sessions) have been proven to be effective and have become increasingly valuable in the management of individuals with problem behaviour (World Health Organisation, 2001)
Studies have been conducted world wide to show that brief interventions are often as effective as more extensive treatments in enhancing both motivation and behaviour change:
Drinking (Kahan et al., 1995; Wilk et al., 1997; Moyer et al., in press;)
Aggressive behaviour in students (Grossman et al., 1997)
Phobias (Ost et al., 2001)
Cannabis use (Martin et al., 2008)
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Method Selection Process
Male offenders in STU RoC*RoI > 0.7
Participant Demographics
19 Male in total Two samples over two time periods Sample 1: 11 participants Sample 2: 8 participants The mean age of participants was 32 years old (range
18-53) Sentences being served ranged from 2.8 years to 20.2
years
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Method Measures
TRRG:SV by Serin, Kennedy & Milloux (2005) Readiness, Responsivity and Gain
Procedure Measure administered pre and post treatment
Inferential Measures
Inter-rater Reliability
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Scores Across all Domains for all Participants in Treatment
Note: 1 indicates the 11 original participants (first starter group) plus 8 (second starter groups) participants, 2 indicate the final 11 participants (original 8 plus 3 new attendees in first starter group) plus 8 (second starter group), 3 indicate those 8 participants who completed both pre- and post-treatment measures in the first intake and all participants in the second intake.
Domain N Mean SD Range Treatment Readiness Readiness – Pre 191 12.21 3.69 6-22 Readiness – Post 192 15.79 3.39 9-23 Readiness – Change 163 4.00 2.66 0-7 Treatment Responsivity Responsivity – Pre 191 13.11 3.62 5-20 Responsivity – Post 192 15.63 2.52 10-21 Responsivity – Change 163 3.00 1.72 1-7 Treatment Gain Total Gain 112 16.79 3.31 12-22
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Mean Scores at Pre and Post Treatment for Readiness and Responsivity
Dependent Variable Pre-Treatment 1 Post Treatment 2 Pre-Post mean change M SD M SD
Readiness Problem recognition 1.47 0.84 1.84 0.96 0.37 Benefits of treatment 1.47 0.61 1.84 0.69 0.37 Treatment interest 1.16 0.60 1.68 0.67 0.53 Treatment distress 1.63 0.83 2.26 0.73 0.63 Treatment goals 1.84 0.76 2.21 0.71 0.37 Treatment behaviours 1.53 0.61 2.26 0.45 0.74 Motivational consistency 1.68 0.75 2.16 0.37 0.47 Treatment support 1.37 0.68 1.42 0.69 0.05 Responsivity Callousness 2.42 0.61 2.37 0.50 -0.05 Denial 2.11 0.88 2.16 0.90 0.05 Procrastination 1.58 0.69 1.95 0.40 0.37 Intimidation 1.32 0.95 1.47 0.61 0.16 Power and control 1.37 0.90 1.95 0.78 0.58 Rigidity 1.68 0.82 2.00 0.67 0.32 Victim stance 1.42 0.61 1.74 0.65 0.32 Pro criminal views 1.53 0.61 1.79 0.42 0.26
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Mean Treatment Gain scores for each Domain for the Final 19 Participants
Treatment Gain M SD Evidence of increased skills from programme 2.05 0.71 Disclosure 2.00 0.58 Application of knowledge 1.89 0.57 Application of skills 2.21 0.63 Emotional understanding 2.26 0.65 Appropriateness of behaviour 2.11 0.57 Participation 2.16 0.37 Therapeutic Alliance 2.11 0.57
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Statistical Analyses Mann Whitney U test to analyse the
reliability of observed difference in each domain
Trend of improvement from the pre- to post-treatment in Readiness was marginally significant (P < .05, two tailed test)
Trend of improvement for Responsivity was non-significant (P > .05, two tailed test) Although non-significance was found, the mean
scores indicate that the trend of improvement was in the right direction; in that all but one item indicated improvement
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Discussion Programme Drop out
Four (21%) participants dropped out of the programme
Two participants were removed from the unit because of drug involvement
One was removed because of underlying mental health issues that needed to be addressed first
One participant decided to exit the programme in hope of completing a more suitable programme centred on gambling addiction
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Implications for Facilitators in Later Treatment
This study provided insight into individual treatment needs for each participant This allowed the STURP facilitators to design individual treatment
plans for the participants prior to them commencing the STURP.
Participants low scoring on the callousness, denial and treatment support subsections High risk participants have very entrenched beliefs related to their
offending
Often see themselves as the victims which entrenches their denial
A goal for facilitators is to move offenders into a position of acceptance therefore making them more responsive to treatment
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Limitations Sample size
No matched control group
Self report questionnaire
Limitations of TRRG:SV (see Sutton, 2001)
No standardized manual
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Where to from here? Stacked groups
Repeat study with more participants
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Conclusion Readiness subscale showed significant
changes and there was a trend in the right direction for responsivity
Further research
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Questions
Stacey Bowden, Trainee Psychologist [email protected]
Katie-Marie Jervis, Trainee Psychologist [email protected]