Sunday, November 10, 2019

Specialized psychological treatment for offending: Treatment was associated with offense-specific & general recidivism reductions; those with consistent input from a qualified psychologist had best results

Does specialized psychological treatment for offending reduce recidivism? A meta-analysis examining staff and program variables as predictors of treatment effectiveness. Theresa A. Gannon et al. Clinical Psychology Review, Volume 73, November 2019, 101752.

• This meta-analysis examined psychological offense treatment and recidivism.
• Overall, 70 studies were identified; including over 55,000 individuals.
• Treatment was associated with offense-specific and general recidivism reductions.
• Programs with consistent input from a qualified psychologist had best results.

Abstract: A meta-analysis was conducted to examine whether specialized psychological offense treatments were associated with reductions in offense specific and non-offense specific recidivism. Staff and treatment program moderators were also explored. The review examined 70 studies and 55,604 individuals who had offended. Three specialized treatments were examined: sexual offense, domestic violence, and general violence programs. Across all programs, offense specific recidivism was 13.4% for treated individuals and 19.4% for untreated comparisons over an average follow up of 66.1 months. Relative reductions in offense specific recidivism were 32.6% for sexual offense programs, 36.0% for domestic violence programs, and 24.3% for general violence programs. All programs were also associated with significant reductions in non-offense specific recidivism. Overall, treatment effectiveness appeared improved when programs received consistent hands-on input from a qualified registered psychologist and facilitating staff were provided with clinical supervision. Numerous program variables appeared important for optimizing the effectiveness of specialized psychological offense programs (e.g., arousal reconditioning for sexual offense programs, treatment approach for domestic violence programs). The findings show that such treatments are associated with robust reductions in offense specific and non-offense specific recidivism. We urge treatment providers to pay particular attention to staffing and program implementation variables for optimal recidivism reductions.

Keywords: Offense treatmentMeta-analysisSexual offendingDomestic violenceGeneral violence

8.4. Future policy and practice directions

The outcomes of this meta-analysis are the first to suggest that specialized psychological programs that target various offending behaviors are effective. Although there was significant heterogeneity across the outcomes of individual studies, our review suggests ways that policy makers and program providers might optimize program outcomes. First, the results indicate that program developers should provide qualified psychologists who are consistently present in hands-on treatment; and second, facilitators should be provided with supervision opportunities that are similar across the program. Interestingly, less than one in five programs consistently used qualified psychologists in hands-on facilitation and the majority of these (83.3%; n = 10) were implemented in the 1970s, 1980s, or 1990s rather than more recently. The provision of supervision was more evenly spread. We recognize the significant pressures that policy makers face providing cost effective programs to large numbers of individuals (Gannon & Ward, 2014). As an indication of this, correctional systems in a number of international jurisdictions have been moving away from the direct involvement of psychologists as treatment providers, with therapeutic activities such as running manual-based groups being delegated to correctional program officers who may have little or no formal clinical training. Ironically, it seems that this variable is correlated with optimum behavioral change and yet qualified psychologist hands-on input is lacking in programs implemented in recent years. This may explain why we did not find more modern treatments to bring about improved outcomes (see also Lösel & Schmucker, 2005). Qualified psychological staff and regular supervision come at a clear financial cost. Program providers could consider the benefits of pruning down staff facilitation numbers as a compensatory financial strategy given that individual and co-facilitated programs seem to be equally beneficial. Program providers might also want to consider methods for tightly controlling program implementation given that we found single site treatments seemed to fare better than multisite treatments.

Further offense specific practice implications are available for those involved in sexual offense and domestic violence policy. Regarding sexual offense programming, the results indicate that best practice guidelines in this area should be revised to include (1) cautionary messages regarding polygraph use within the therapeutic context, and (2) further commentary on—and expansion of—the evidence base around behavioral reconditioning as a treatment tool. Those tasked with developing and managing programs for those who have been domestically violent should seek out the best educational materials possible and consider how such materials can be skilfully woven into program facilitation to produce optimal results.

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