the effectiveness of a brief stage based intervention, stacey bowden and katie-marie jervis

THE EFFECTIVENESS OF A BRIEF STAGE-BASED INTERVENTION

Stacey Bowdenand

Katie-Marie Jervis

2

Overview

Why people changeStages of Change and Brief

InterventionsCurrent researchMethodResults Implications for treatment/further

researchConclusions

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)

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

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

IntroductionBackground to behavioural change:

Why do people change? (Miller & Rollnick, 2002)

How do people change?(Prochaska & DiClemente, 1992 & 1998)

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

The Transtheoretical Model

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)

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.

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?

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

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).

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)

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

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

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

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

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

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

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

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

Limitations Sample size

No matched control group

Self report questionnaire

Limitations of TRRG:SV (see Sutton, 2001)

No standardized manual

Where to from here? Stacked groups

Repeat study with more participants

Conclusion Readiness subscale showed significant

changes and there was a trend in the right direction for responsivity

Further research

Questions

Stacey Bowden, Trainee Psychologist stacey.bowden@corrections.govt.nz

Katie-Marie Jervis, Trainee Psychologist katie-marie.jervis@corrections.govt.nz