Factors Predicting Dropout From the Reasoning and Rehabilitation Program With Mentally Disordered Offenders

Abstract

Studies evaluating the implementation of cognitive skills programs with mentally disordered offenders (MDOs) have reported high dropout rates, but little is known about the factors associated with treatment noncompletion. The authors analyzed data from the first randomized controlled trial of the Reasoning and Rehabilitation (R&R) program with MDOs to determine predictors of treatment dropout. Patients with psychotic disorders were recruited from medium-secure hospitals in the United Kingdom. Fifty percent of the 44 participants allocated to receive R&R prematurely terminated treatment. Program dropout was significantly predicted by scores on the Clinical and Risk Management scales of the Historical, Clinical, Risk Management—20, Factor 2 scores of the Psychopathy Checklist—Screening Version, antisocial personality disorder (ASPD), psychopathy, and recent violence. Psychopathy, ASPD, and recent violence emerged as the strongest predictors of dropout in multivariate analyses. Strategies to improve treatment retention should be targeted at MDOs who display high levels of impulsivity, poor behavioral controls, and antisocial or psychopathic traits.

A Multi-Site Controlled Trial of the R&R2MHP Cognitive Skills Program for Mentally Disordered Female Offenders

“…However, the finding is inconsistent with that of a previous study reporting the reverse with poorer problem-solving skills being associated with program drop-out [39]. The present study did not obtain PCL-R scores which have been found to be an important marker of risk associated with drop-out [17]. It is a priority to identify predictors of treatment drop-out and develop methods to maintain engagement as this will have import-ant implications for the selection of participants for group program and the management of offenders.…”

“…Third, other characteristics may have influenced out-come that were not investigated, in particular IQ [39] self-esteem [47], impulsivity [48,49] and psychopathy [17] have been associated with non-completion rates. Fourth, four of the five outcome measures were self-report and we aimed to minimize a positive bias by these being administered by researchers who had not been involved in treatment provision.…”

“…Subsequent controlled studies of the R&R program have supported these findings [15,17,18] and a multi-site randomized controlled trial conducted by Cullen et al [18] in medium secure services has reported specific improvements in social-problem solving post-treatment and at 12 month follow-up. However only half of those allocated to receive R&R completed the program; dropout was predicted by "high risk" patients presenting with psychopathy, antisocial personality traits and violent behaviour [17]. This is a serious concern because non-completers have been reported to have higher rates of recidivism than completers or non-starters [19][20][21].…”

“…Whilst ETS and R&R were not designed to meet the complex needs of MDOs, uncontrolled pilot studies indicated they were effective in improving thinking styles and social problem-solving in this population [14][15][16]. Subsequent controlled studies of the R&R program have supported these findings [15,17,18] and a multi-site randomized controlled trial conducted by Cullen et al [18] in medium secure services has reported specific improvements in social-problem solving post-treatment and at 12 month follow-up. However only half of those allocated to receive R&R completed the program; dropout was predicted by "high risk" patients presenting with psychopathy, antisocial personality traits and violent behaviour [17].…”

Sailing uncharted seas without a compass: A review of interventions in forensic mental health

“…Although the R&R program was not designed to meet the complex needs of MDOs there is some empirical support for its effectiveness with this subgroup of offenders (e.g., Clarke et al, 2010;Cullen, Soria, Clarke, Dean, & Fahy, 2011;Cullen et al, 2012). However, in Cullen et al's (2012) study, only half of those allocated to the treatment condition completed the program.…”