RESUMEN
Treatment completion is an important outcome for both mental health and criminal justice agencies tasked with managing offenders with mental illness in the community. Previous research has shown that greater degrees of criminogenic risk factors (e.g., specific criminal history variables) predict treatment non-completion among legally mandated populations. However, most studies were conducted with offenders without mental illness. In this study, demographic (e.g., age, gender), clinical (e.g., psychiatric diagnosis), and criminogenic risk factors (measured using the Level of Service Inventory-Revised [LSI-R]) were compared by treatment completion status using 167 probationers with mental illness treated at an enhanced day reporting center. Bivariate and multivariate (i.e., forward entry logistic regression) analyses revealed that while the LSI-R total score was unrelated to treatment completion, higher scores on the LSI-R Alcohol and Drug use subscale (odds ratio [OR] = 1.25, 95% confidence interval [CI] = [1.01, 1.54]) and older age (OR = 1.04, 95% CI = [1.00, 1.09]) were significantly predictive of non-completion.
Asunto(s)
Centros de Día para Mayores , Centros Comunitarios de Salud Mental , Criminales/psicología , Trastornos Mentales/terapia , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Poor retention has been an impediment to the effectiveness of therapeutic communities (TCs) for substance use disorders. We assessed the impact of the resident's perception of the therapeutic environment through the Ward Atmosphere Scale (WAS) on TC retention and examined predictors of the WAS in order to better understand this construct. Among a sample of admissions (N=123) to a 9-month residential TC, forward entry logistic regression analyses using WAS, demographic and clinical variables revealed that heightened perceptions of the orderliness of the therapeutic environment (i.e., the WAS domain of system maintenance) best predicted treatment completion. Furthermore, scores on WAS variables were best explained by the formal therapeutic elements of the TC (as measured by the Survey of Essential Elements Questionnaire) using linear regression. Efforts to improve the resident's perception of these aspects of the ward atmosphere may assist in improving TC completion rates.
Asunto(s)
Tratamiento Domiciliario/estadística & datos numéricos , Centros de Tratamiento de Abuso de Sustancias/organización & administración , Trastornos Relacionados con Sustancias/rehabilitación , Comunidad Terapéutica , Adolescente , Adulto , Femenino , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Percepción , Tratamiento Domiciliario/organización & administración , Trastornos Relacionados con Sustancias/psicología , Resultado del Tratamiento , Adulto JovenRESUMEN
Mental health needs are common among community corrections offenders and many are enrolled in some form of supervised or mandated treatment. One category of mental health problem which may be germane to both treatment completion and recidivism among those in legally supervised treatment is the diagnosis of Personality Disorder (PD). This systematic review reports on sixteen studies comprised of full or mixed legally-supervised samples of offender in community-based treatment and examines the impact of PDs on treatment completion. These studies were difficult to compare because of the differences in program setting, definition of treatment completion, definition of PD, method of PD assessment and type of treatment, among other variables. The impact of antisocial personality disorder in treatment was a common focus, and other PDs were rarely assessed. The relevance of DSM PD categories to offender management in community corrections as well as the limitations of the current PD diagnostic categories is discussed.
Asunto(s)
Internamiento Obligatorio del Enfermo Mental , Servicios de Salud Comunitaria , Trastornos de la Personalidad/terapia , Violencia Doméstica , Humanos , Programas Obligatorios , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/psicología , Delitos Sexuales , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/terapiaRESUMEN
In this study, the authors extend their evaluation of a structured instrument for assessing the persistence of attitudes and behaviors developed by mentally ill offenders during periods of incarceration (Structured Assessment of Correctional Adaptation; SACA) and seek to demonstrate further the clinical significance of the construct of correctional adaptation. The subjects, patients at a state psychiatric center, were administered the SACA, along with the Brief Psychiatric Rating Scale the Psychopathy Checklist: Screening Version and Working Alliance Inventory. Chart review captured relevant demographic, diagnostic, and correctional history variables. Results were analyzed comparing patients with and without incarceration histories. The SACA total score demonstrated strong interrater reliability and association with criminal history indices of validity. Patients with histories of incarceration were significantly more likely to score higher on the Correctional Adaptation measure and lower on the Bond subscale of working alliance. Controlling for symptom severity and psychopathy did not alter the negative relationship between correctional adaptation score and the Working Alliance Inventory.
Asunto(s)
Adaptación Psicológica , Hospitales Psiquiátricos , Prisioneros/psicología , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Lista de Verificación , Hospitalización , Humanos , Masculino , Auditoría Médica , Trastornos Mentales/terapia , Persona de Mediana Edad , New England , Psicoterapia , Adulto JovenRESUMEN
Decreasing criminal recidivism in justice-involved individuals with mental illness, is among the most consistently desired outcomes by programs, policy makers and funding agencies. Evidence-based practices with track records of effectiveness in treating mental illness and co-occurring substance abuse, while important clinically, do not necessarily address criminal recidivism. Addressing recidivism, therefore, may require a more targeted criminal justice focus. In this paper, we describe recent challenges to decriminalization approaches and review factors associated with recurrent criminal behavior. In particular, we focus on structured clinical interventions which were created or adapted to target the thoughts and behaviors associated with criminal justice contact.
Asunto(s)
Crimen/prevención & control , Trastornos Mentales/terapia , Enfermos Mentales/legislación & jurisprudencia , Terapia Cognitivo-Conductual , Servicios Comunitarios de Salud Mental , Derecho Penal , Humanos , Estados UnidosRESUMEN
The relationship between psychopathy and thinking styles that support and maintain a criminal lifestyle is examined using the Psychopathy Checklist: Screening Version (PCL:SV; Hart, Cox, & Hare, 1995) and the Psychological Inventory of Criminal Thinking Styles (PICTS; Walters, 1995). These measures are administered to a sample of 75 patients recruited from a state psychiatric hospital in the northeastern United States. Correlational analyses indicate that the PICTS General Criminal Thinking, Self-Assertion/Deception factor scale, and several criminal thinking style scales are significantly related to psychopathy. The significantly associated criminal thinking scales include Entitlement (r = .44) and Superoptimism (r = .43) with Factors 1 and 2 of the PCL:SV, respectively. Multiple regression analyses reveal that these two criminal thinking scales are the strongest predictors of Factors 1 and 2 of the PCL:SV, respectively. Implications for the cognitive basis of the construct of psychopathy, as well as potential treatment interventions, are discussed.
Asunto(s)
Trastorno de Personalidad Antisocial/diagnóstico , Lista de Verificación , Trastornos del Conocimiento/diagnóstico , Psicología Criminal , Determinación de la Personalidad/estadística & datos numéricos , Adolescente , Adulto , Anciano , Trastorno de Personalidad Antisocial/psicología , Trastornos del Conocimiento/psicología , Mecanismos de Defensa , Hospitales Psiquiátricos , Hospitales Provinciales , Humanos , Maquiavelismo , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prisioneros/psicología , Psicometría/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Reproducibilidad de los Resultados , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Pensamiento , Adulto JovenRESUMEN
Clinicians have observed that psychiatric patients with correctional histories evidence attitudes and behaviors that seem adaptive in penal environments but are maladaptive in mental health settings. This study sought to assess the reliability and concurrent validity of a rating scale designed to measure correctional adaptation using a sample of 64 patients from a state psychiatric hospital. Scale ratings were obtained through structured interviews, whereas predictor variables were gleaned from chart review and self-report. The scale demonstrated good interrater reliability (ICC = .83) and acceptable internal consistency (alpha= .67). Of the variables evaluated, two were significantly correlated with Structured Assessment of Correctional Adaptation (SACA) total scores, total months sentenced to prison or jail (r = .26), and frequency of disciplinary tickets while in prison or jail (r = .31). Stepwise regression analyses revealed only the latter variable significantly predicted SACA score (R = .31), F(1, 58) = 6.27, p < .05. Clinical implications of these findings, the scale, and the construct of correctional adaptation are discussed.