the effects of brief motivational interviewing on treatment outcomes among partner violent offenders...
TRANSCRIPT
The Effects of Brief Motivational Interviewing on Treatment Outcomes among Partner Violent Offenders who
Engage in Heavy Episodic Drinking
000
Cory A. CraneESRC Seminar SeriesRochester Institute of TechnologyJuly 21, 2014
Jaye DerrickSusan DevineStephanie GodleskiSamuel HawesRebecca HoustonAsh LevittDolores Mandel
Acknowledgements
Christopher EckhardtCaroline EastonMaria TestaKenneth Leonard
Mentors
FundingR01 DA018284 (PI: Easton)T32 AA007583 (PI: Leonard)
CollaboratorsLindsay OberleitnerCorey PilverBrian QuigleyRita SamperRobert SchlauchJoel SprungerAndrea Weinberger
Background: – Intimate partner violence (IPV)– IPV intervention efforts– Motivational interviewing (MI)– Readiness to change and IPV
Current Research– MI and readiness to change– MI and problematic alcohol
Future directions for MI among IPV offenders
AgendaAgenda
Why We Care
• Prevalence (e.g., Archer, 2000)
– 23-28% of females (Desmarais et al., 2012)
– 19-22% of males (Desmarais et al., 2012)
• Consequences (e.g., Coker et al., 2002)
– Physical– Psychological– Social/Interpersonal– Vulnerable Populations
Domesticviolenceresearch.org
• Many available tools– Mandatory Arrest– Probation– 12-52 week Batterer Intervention Program (BIP)
• Group (90%), individual, couples
• Educational programs (Duluth)
• Skills training (CBT)
– Supplemental Programming (anger, psychiatric, substance)
How do we intervene?
• Attendance and completion– Predictive of future violence (Babcock & Steiner, 1999)– < 50% attend a first session (Cadsky et al., 1996 )– 25% satisfy all treatment requirements (Cadsky et al., 1996 )
• Recidivism– Small ES for BIPs and IPV reduction (Babcock et al., 2004)– Association of Tx and subsequent IPV (Feder and Wilson, 2005)
Low compliance with treatment and treatment may not reliably reduce violence
Is Intervention Successful?
• Insufficient treatment dose• Ongoing legal involvement• Biological / cognitive impairment• Transportation, time, and cost of treatment• Problems establishing a therapeutic alliance• Limited resources (e.g., training, personnel, funding)• Competing substance use and mental health needs• Incongruity between client and treatment goals• Insufficient motivation to conform to probationary guidelines• Limited engagement in external efforts to facilitate change
Motivation to Change
Obstacles to Successful Intervention
• Substance Abuse-Domestic Violence (SADV) Intervention
• Sample: 78 male IPV perpetrators with substance use diagnoses mandated to a 12-week individual treatment program
• Measures:– Motivation to change (stage of change)– Timeline Follow Back Interview (IPV & Alcohol use)
• Analyses: Multilevel Growth Curve Modeling (HLM)
• Hypothesis: Offenders in later stages of change will– a) Report lower IPV during Tx– b) Evidence a weaker association between alcohol and IPV during Tx
Does Motivation Matter?
• Stage of change was associated with IPV in the expected direction
• Stage of change moderated the alcohol-IPV relationship as expected
SADV: Legal Factors
• Motivational Interviewing: “A client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.” (Miller & Rollnick, 2002)
– Carl Rogers’ Humanistic approach
– Motivation: Readiness, Willingness, Ability
– Ambivalence: a realistic assessment of the costs and benefits of change
– Spirit of MI: Autonomy, Collaboration, Evocation
Can we Improve Outcomes?
• Research supports MI as a method for improving outcomes among IPV offenders– Treatment complinace (Taft et al., 2001)
– Treatment engagement (Musser et al., 2008)
– Cognitive change (Kistenmacher & Weiss, 2008)
– Recidivism (Woodin & O’Leary, 2010)
• Questions remain– Effectiveness of minimal dosing– Potential for different effects based upon risk factors
MI for IPV
• Evaluation of a single session brief motivational interview (BMI) on Tx outcomes among 82 male IPV offenders at 6-month follow-up
• Hypotheses: At 6-months post-adjudication, relative to males in a control group, males assigned to the BMI group will:1. Have higher rates of Tx compliance 2. Have lower rates of subsequent criminal recidivism 3A. The relationship between condition and Tx compliance will be
moderated by preprogram readiness to change.3B. The relationship between condition and recidivism will be
mediated by Tx attendance.
The Current Study
• Initial assessment (baseline questionnaires)– Sociodemographics– Revised Conflict Tactics Scale (α = .81)
• I punched or hit my partner with something that could hurt.– Dyadic adjustment Scale (α = .85)
• How happy are you in your relationship all things considered?– Safe at Home Inventory (α = .79)
• There is nothing wrong with the way I handle situations but I get into trouble anyway.– Alcohol and Drug Use Disorder Identification Tests (α = .82; .80)
• Assignment to condition– Brief Motivational Interviewing(BMI)– Control (alternative computer task)
• Questions and compensation
• Follow-up data collection
Method
• BMI: A 25-30 minute BMI session– Discuss responses to 1-2 items from the SAH– Listen for and attend to change talk– Help detect and resolve ambivalence– Conclude with a change plan if applicable– Therapist achieved 92% compliance with MI principles on MITI
Sample Excerpts T: You said that you can’t be happy in a relationship if things continue as they have. C: No way, neither would she. Breaks me up. T: Her happiness is important to you. Tell me more about that.
C: Used to be great together. Made each other happy. I wish it was like that now. T: Things were happier before and it seems hard to get there now.
C: No, I don’t have to pay but it takes time, you know? So long as it helps, I guess. T: Even though the program may be inconvenient, you are staying open-minded.
Procedure: BMI
Motivation to Change:– Partner well-being– Avoid incarceration– Avoid damages and fines– The opinions of one’s peers– More satisfactory/less conflictual
partnership
Resistance to Change:– Confrontational intervention– Social skills deficits
Goals:– Establish rapport– Elicit change talk– Develop discrepancies– ↑ Investment in Tx– ↑ expectation of + outcomes– Encourage Tx compliance– Encourage nonviolence
Brief Motivational Interviewing (BMI) for IPV
VariableControl (n = 34)Mean SD
Treatment (n = 48) Mean SD t df p
Age 33.9 12.0 34.0 11.8 -0.01 80 .99
Relationship Length 84.7 98.0 85.3 98.0 -0.03 80 .98
Children 2.8 1.6 3.3 1.8 -0.12 80 .22
Satisfaction 16.8 4.7 17.1 5.0 -0.30 .80 .77
Partner Violence
Physical 2.3 2.2 2.5 2.1 -0.39 80 .70
Psychological 1.6 1.2 1.5 1.0 0.44 80 .66
Readiness to Change
Precontemplation 28.9 5.1 28.5 4.7 0.43 80 67
Contemplation 23.7 7.9 23.3 7.7 0.23 80 .82
Preparedness 13.8 3.9 14.5 3.7 -0.89 80 .38
Maintenance 14.0 5.3 14.6 4.7 -0.56 80 .58
Demographic Data
• TxCompliance: Completed or in good standing with BIP.
• Temporal Effects of BMI
BMI was associated with greater attendance at earlier sessions
Results: Compliance
Session Attendance DataSession Control BMI χ2 (1, N = 74) p-value
Intake 83.9% 97.9% 5.30 .03
6 48.3% 73.3% 4.78 .03
13 31.0% 53.3% 1.33 .25
20 17.2% 24.4% 0.54 .46
26 13.8% 15.5% 0.04 .84
• Time between referral and BIP Intake– BMI (M = 3.19 weeks, SD = .34 weeks) – Control (M = 5.88 weeks, SD = .95 weeks)– Mann-Whitney U = 357.5, z = 2.44, p = .02
• Number of sessions attended– BMI (M = 12.2, SD = 1.5) – Control (M = 8.3, SD = 1.8)– Mann-Whitney U = 499.5, z = 1.71, p = .09
Hypothesis 1 Supported. BMI men, relative to controls: 1) had higher rates of successful completion of, or good standing in, a Tx2) were more likely to attend initial Tx sessions 3) began Tx in a more timely manner 4) attended more sessions, though only marginally significant
Results: Compliance
Hypothesis 3A Supported.Condition moderated:
1) the relationship between readiness and Tx compliance 2) the relationship between readiness and session attendance
Results: Compliance
Control Treatment0
10
20
30
40
50
60
70
80
90
LowHigh
Readiness to Change
Perc
ent i
n Go
od S
tand
ing
Control Treatment0
2
4
6
8
10
12
14
16
LowHigh
Readiness to Change
Sess
ions
Atte
nded
Condition X Readiness, p = .08
Condition X Readiness, p = .03
• Recidivism:– 3 groups: χ2(2, N = 81) = 2.24, p = .33 (Fisher’s Exact)– 2 groups: χ2(1, N = 82) = 1.95, p = .16
• Probation Violations: – BMI (M = 3.13, SD = .56) – Control (M = 3.24, SD = .76)– Mann-Whitney U = 779.5, z = .37, p = .71
Hypothesis 2 Rejected. BMI and control participants:1) evidenced comparable rates of criminal recidivism 2) committed an equivalent number of probation violations
Results: Recidivism
• BMI is associated with Tx compliance among low readiness clients. What about other at risk groups?
• Alcohol and IPV
– Alcohol problems predict poor Tx compliance (Cadsky et al., 1996)
– Half of IPV offenders abuse alcohol (Stuart et al., 2003)
– Offenders are mandated to separate IPV and substance Tx programs (Babcock et al., 2004)
Alcohol and IPV
• Hypothesis: Binge drinkers assigned to BMI will attend more sessions and be less likely to drop out of treatment relative to binge drinkers assigned to the control condition
• Sample: 60 male offenders
• Procedure: Identical– Measures:
• Alcohol Use Disorder Identification Test (AUDIT; Saunders et al., 1993)• Follow-up: Sessions attended and drop out
– Data Analysis: • Linear regression (sessions attended) • Logistic regression (drop out)
No Binge Binge
Control 15 14
BMI 20 11
MI among Problematic Drinking IPV Offenders
Results
Sessions Attended Estimate* SE p
Drop Out Estimate* SE p
Binge -7.59 2.82 .007 1.38 0.99 .162
Condition -0.19 2.71 .943 -1.29 1.09 .237
Interaction 10.74 4.18 .010 -2.75 1.56 .079
*Unstandardized estimates.Note. Models control fro age, drug use, readiness to change, satisfaction, and prior arrests.
Pretreatment factors as indicators of treatment compliance Individualized assignment to treatment protocols Proximal effects of BMI BMI and high risk offenders
Larger sample Substance diagnosed offenders
Integration of substance abuse and IPV treatment techniques Alternative BMI goals: Alcohol and substance use
Looking beyond BMI for recidivism Collateral informants Extended follow-up periods BME vs. BMI
Overall Conclusions
