The application of the transtheoretical model to offender populations : some critical issues

Purpose : Over the past two decades, the transtheoretical model (TTM) of change has become perhaps the most widely used model of behaviour change in the treatment of addictive and/or problem behaviours. More recently, the stages of change component of the TTM has been adopted for use in forensic settings. This paper aims to review the application of the TTM model to offender populations.

Arguments : The application of the TTM to offenders raises a number of issues regarding the process of behaviour change for offenders attending treatment programmes. It is argued that while the TTM has been designed to account for high frequency behaviour (e.g. smoking, alcohol misuse), offending behaviour may be less frequent and the process of change less cyclical. Moreover, it is suggested that the most important issue in a treatment context is the proper integration of the TTM constructs. There have been few empirical tests of this aspect of the model.

Conclusion : While the TTM may have some value in explaining how rehabilitation programmes help offenders to change their behaviour, the stages of change construct is, by itself, unlikely to adequately explain the process by which offenders desist from offending.

Symptoms of trauma, perceptions of discrimination, and anger a comparison between Australian indigenous and nonindigenous prisoners

Although the need for the development and provision of culturally appropriate rehabilitation programs for offenders is widely acknowledged, there is a lack of empirical data that can be used as a basis for the development of new programs. This article reports the findings of a comparison of indigenous and nonindigenous male prisoners on a range of measures relevant to the experience of anger by indigenous prisoners in Australia. The results suggest that indigenous participants are more likely to experience symptoms of early trauma, have greater difficulties identifying and describing feelings, and perceive higher levels of discrimination than nonindigenous prisoners. The implications of this work for the development of culturally appropriate and effective anger management programs for indigenous male prisoners are discussed.

The rehabilitation of indigenous prisoners : an Australian perspective

The massive problems experienced by Indigenous Australians in their encounters with the criminal justice system have been well documented and widely discussed. This paper applies the Risk, Needs and Responsivity Model of rehabilitation to Indigenous offenders. While much of the review is devoted to a discussion of Australian Indigenous offenders, the issues raised are likely to be relevant to Indigenous groups from other countries and, possibly, ethnic minority offenders more generally. We concluded that whilst the model clearly has value, rehabilitation programs would benefit from a careful consideration of issues relating specifically to the Risk, Needs and Responsivity of Indigenous offenders.

Assessing treatment readiness in violent offenders

Although violent offenders are widely considered to be difficult to engage in therapeutic change, few methods of assessing treatment readiness currently exist. In this article the validation of a brief self-report measure designed to assess treatment readiness in offenders who have been referred to violent offender treatment programs is described. The measure, which is an adaptation of a general measure of treatment readiness developed in a previous work, displayed acceptable levels of convergent and discriminant validity and was able to successfully predict treatment engagement in violent offender treatment. These results suggest that the measure has utility in the assessment of treatment readiness in violent offenders.

Alcohol use and negative affect in the offence cycle

Introduction : It is commonly acknowledged that, for many offenders, alcohol use is strongly associated with criminal behaviour. The belief held by many professionals that the two phenomena are associated, probably in a causal way, has led to the inclusion of alcohol use as a ‘criminogenic need’ in many settings where rehabilitation programmes are used to reduce recidivism. However, the mechanisms and pathways involved in the alcohol–crime link remain poorly understood.

Argument and conclusion : This paper reviews the literature relating to alcohol–offending links and draws some inferences about the role of alcohol use as a criminogenic need in offender rehabilitation. It is proposed that the bi-directional relationship between alcohol use and negative affective states is important in understanding the offence cycle, and that deficits in self-regulation not only characterize both alcohol misuse and negative affect but are also implicated in the offending behaviour itself.

Knowledge-in-practice in the caring professions : multidisciplinary perspectives

Contents:  Ideas of knowledge in practice / Struan Jacobs -- Information, knowledge, and wisdom in medical practice / P. B. Greenberg -- The practice of the psychiatrist / Alex Holmes -- Social work knowledge-in-practice / Heather D'Cruz -- Disability : a personal approach / Lisa Chaffey -- Knowledge in the making : an analytical psychology perspective / Joy Norton -- Knowledge to action in the practice of nursing / Alison Hutchinson, Tracey Bucknall -- The risky business of birth / Frances Sheean and Jennifer M. Cameron -- Skills for person-centred care : health professionals supporting chronic condition prevention and self-management / Sharon Lawn and Malcolm Battersby -- Knowledge and reasoning in practice : an example from physiotherapy and occupational therapy / Megan Smith ... [et al.] -- Using knowledge in the practice of dealing with addiction : an ideal worth aiming for / Peter Miller.

Supporting self-management of chronic health conditions : Common approaches

Objective : The aims of this paper are to provide a description of the principles of chronic condition self-management, common approaches to support currently used in Australian health services, and benefits and challenges associated with using these approaches.
Methods : We examined literature in this field in Australia and drew also from our own practice experience of implementing these approaches and providing education and training to primary health care professionals and organizations in the field.
Results : Using common examples of programs, advantages and disadvantages of peer-led groups (Stanford Courses), care planning (The Flinders Program), a brief primary care approach (the 5As), motivational interviewing and health coaching are explored.
Conclusions : There are a number of common approaches used to enhance self-management. No one approach is superior to other approaches; in fact, they are often complimentary.
Practice implications : The nature and context for patients’ contact with services, and patients’ specific needs and preferences are what must be considered when deciding on the most appropriate support mode to effectively engage patients and promote self-management. Choice of approach will also be determined by organizational factors and service structures. Whatever self-management support approaches used, of importance is how health services work together to provide support.

The role of focus groups in a randomised controlled trial : the ADEPT study

In a recent study we developed a decision aid for prenatal testing of fetal abnormalities. The effectiveness of the decision aid compared with a pamphlet in increasing women's informed choice and decreasing conflict was evaluated using a cluster randomised controlled trial, A DEcision aid for Prenatal Testing for fetal abnormalities (ADEPT) [ISRCTN22532458]. Challenged with the need to ensure that the decision aid best suited the needs of women and health professionals involved General Practitioners (GPs), we explored the potential of both quantitative and qualitative methodologies to inform the development phase. In this article we discuss our rationale for, and provide some insights regarding our experience of, using qualitative methods during the development phase of the decision aid.

Evaluation of a decision aid for prenatal testing of fetal abnormalities : a cluster randomised trial [ISRCTN22532458]

Background: By providing information on the relative merits and potential harms of the options available and a framework to clarify preferences, decision aids can improve knowledge and realistic expectations and decrease decisional conflict in individuals facing decisions between alternative forms of action. Decision-making about prenatal testing for fetal abnormalities is often confusing and difficult for women and the effectiveness of decision aids in this field has not been established. This study aims to test whether a decision aid for prenatal testing of fetal abnormalities, when compared to a pamphlet, improves women's informed decision-making and decreases decisional conflict.

Methods/design: A cluster designed randomised controlled trial is being conducted in Victoria, Australia. Fifty General Practitioners (GPs) have been randomised to one of two arms: providing women with either a decision aid or a pamphlet. The two primary outcomes will be measured by comparing the difference in percentages of women identified as making an informed choice and the difference in mean decisional conflict scores between the two groups. Data will be collected from women using questionnaires at 14 weeks and 24 weeks gestation.

The sample size of 159 women in both arms of the trial has been calculated to detect a difference of 18% (50 to 68%) in informed choice between the two groups. The required numbers have been adjusted to accommodate the cluster design, miscarriage and participant lost – to – follow up.

Baseline characteristics of women will be summarised for both arms of the trial. Similarly, characteristics of GPs will be compared between arms.

Differences in the primary outcomes will be analysed using 'intention-to-treat' principles. Appropriate regression techniques will adjust for the effects of clustering and include covariates to adjust for the stratifying variable and major potential confounding factors.

Discussion: The findings from this trial will make a significant contribution to improving women's experience of prenatal testing and will have application to a variety of maternity care settings. The evaluation of a tailored decision aid will also have implications for pregnancy care providers by identifying whether or not such a resource will support their role in providing prenatal testing information.