Financial, family, and social factors impacting on cardiac rehabilitation attendance

Background
Attendance in phase 2 cardiac rehabilitation program after acute myocardial infarction is poor.

Objective
To identify and explore the demographic factors that influence peoples’ decisions to attend cardiac rehabilitation programs.

Methods
A descriptive-interpretive design was used. Semi-structured interviews were conducted with 10 people post infarction in Victoria, Australia after their first scheduled appointment to attend outpatient cardiac rehabilitation. The interview transcripts were thematically analysed.

Results
The perceived relevance of cardiac rehabilitation related to the context of people’s lives, namely their financial, family and social situation, and how important program outcomes were seen to be relevant to this context.

Conclusion
The findings of this study suggest that there are a proportion of people unlikely to attend outpatient cardiac rehabilitation programs following an AMI despite encouragement to attend. It may be unrealistic to aim for 100% referral and uptake into cardiac rehabilitation programs and therefore an inappropriate endpoint by which to evaluate such programs.

Outpatient cardiac rehabilitation attendance in England

Abstract
PURPOSE:
Cardiac rehabilitation is an effective but underprovided treatment for patients recovering from acute cardiac events. The geographical spread of provision has not been investigated recently in any country. This study aimed to investigate the level of participation in cardiac rehabilitation programs of patients following myocardial infarction or revascularization (eligible patients) and the geographical equity of attendance.
METHODS:
Questionnaire data were collected from all cardiac rehabilitation centers in England for the year 2003/2004. The number of patients attending rehabilitation was compared with eligible patients across the 9 Government Office Regions of England as indicated by Hospital Episode Statistics.
RESULTS:
Nationally, 29% of eligible patients attended rehabilitation, while within various regions, the proportion of eligible patients participating in rehabilitation ranged between 14% (95% CI, 13.2-14.3) and 37% (95% CI, 36.6-37.6). Participation also differed significantly by primary cardiac event: myocardial infarction, 25%; percutaneous coronary intervention, 24%; and coronary artery bypass surgery, 66% (P < .001).
CONCLUSION:
The participation rate of eligible patients in cardiac rehabilitation was low in all regions. There were large differences between regions with widely varying incidence of attendance in different parts of the country.

UnitingCare West Outreach Services and the Good Lives Model of offender rehabiliation

UnitingCare West is a not-for-profit community services organisation committed to achieving justice, hope and opportunity for all, and works to support and empower in particular those most in need in the WA community. Through its program Outreach Services, it delivers a specialist re-entry service for sex offenders and men serving life and indeterminate sentences. The program has recently been reviewed by Dr Andrew Day from the Centre for Offender Reintegration, Deakin University with input from Dr Tony Ward, University of Victoria, Wellington, New Zealand. In this paper we describe the aims of the review, the process and findings and our ongoing work in developing a rationale for the service that is underpinned by the Good Lives Model (GLM) of offender rehabilitation. More generally, the presentation will seek to understand the needs of offenders who re-enter the community following long-term imprisonment in relation to those areas of need identified in the GLM.

Reducing the risk of re-offending among Australian indigenous offenders : what works for whom?

This paper discusses the application of the “what works” approach to the rehabilitation of indigenous Australian offenders. It is suggested that those from indigenous cultures may not share some of the theoretical assumptions that underpin the “what works” approach, potentially leading to discussion about the cultural appropriateness of rehabilitation programs. Finally, some options are presented about how cultural differences might be understood in ways that facilitate the further development of rehabilitation programs for indigenous peoples.

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 offender readiness to change problems with anger

It is widely acknowledged that offender rehabilitation outcomes can be improved by attending to responsivity issues, including the readiness and motivation of offenders to undertake and engage in treatment. The measurement of responsivity, readiness and motivation in offenders, however, has received relatively little research attention. In this paper we focus on anger management programmes and evaluate the utility and psychometric properties of a measure of stages of change in relation to changing anger - the Anger Readiness to Change Questionnaire (ARCQ). Using data from a large sample of offenders undergoing anger management interventions, we investigated the construct validity, convergent validity and predictive validity of the ARCQ. We conclude the ARCQ may have utility as a measure for selecting offenders who are suitable for anger management interventions.

Pathways to sex offending

The research of the thesis aimed to contribute to the theoretical understanding of the various pathways that offenders follow in committing sexual offences. Using grounded theory a theoretical model was generated which described four major pathways to sexual offending. Quantitative analyses revealed that offenders who take different pathways differ significantly in respect of their risk of recidivism, demographic variables, rape myth acceptance and aggression. The portfolio considered the limitations of sex offender treatment programs for treating sex offenders with histories of childhood sexual abuse and presented four case studies.

Interventions to improve empathy awareness in sexual and violent offenders : conceptual, empirical, and clinical issues

Interventions that seek to increase empathy are a common feature of programs offered to sexual and violent offenders. Yet, there is little empirical evidence to suggest that they contribute positively to program outcomes. This paper explores the rationale for the delivery of empathy training with violent offenders, describes some of the most commonly used approaches, and reviews the current evidence base relating to effectiveness. It is concluded that while there are strong theoretical grounds for identifying empathy deficits as an important area of criminogenic need, there are considerable difficulties in establishing the extent to which the interventions offered in this area might be considered to be successful in reducing risk.

Rehabilitation : beyond the risk paradigm

Providing a succinct summary and critique of the scientific approach to offender rehabilitation, this volume for students of criminology, sociology and clinical psychology gives a comprehensive evaluation of both the Risk-Need-Responsivity Model and the Good Lives Model." "Rehabilitation is a value-laden process involving a delicate balance of the needs and desires of clinicians, clients, the State and the public. Written by two internationally renowned academics in rehabilitation research, this book argues that intervention with offenders is not simply a matter of implementing the best therapeutic technology and leaving political and social debate to politicians and policy-makers.

Representation of female offender types within the pathways model of assault

Research into the heterogeneity of female violent offending is sparse, even though females constitute a growing part of the prisoner population. There is evidence that the majority of female violent offenders display over-controlled traits related to uncharacteristic offending. This hypothesis was explored through a multivariate model, the Pathways Model of Assault, with interview data from 17 female assault offenders. Five different offence types were displayed, reflecting the same offence styles as male offenders. However, only two participants displayed an over-controlled offence type. Qualitative differences within the data suggested that offender rehabilitation should be tailored specifically for different gender needs in addition to the needs suggested by the different offence types.

A good lives model of clinical and community rehabilitation

Aims of the paper. The aim of this paper was to introduce the Good Lives Model, originally developed for offender rehabilitation, to the clinical rehabilitation community. We argue that this model has considerable promise, both as a ‘thinking tool’ and as an integrative framework emphasizing the centrality of the person in clinical and community rehabilitation for complex and chronic health conditions.

Key findings and implications. The essential features of a good rehabilitation theory are first outlined. These are the general principles and assumptions that underpin a theory, the aetiological assumptions and the intervention implications. The Good Lives Model for clinical rehabilitation is then described in terms of these three components of a good rehabilitation theory.

Conclusions and recommendations. The Good Lives Model has considerable promise as a tool for integrating many diverse aspects of current best practice in rehabilitation while maintaining the individual client as the central focus. At the same time it is provisional and further theoretical development and empirical support is required.

On a clear day you can see forever : integrating values and skills in sex offender treatment

The topic of sex offender rehabilitation frequently evokes fierce reactions, ranging from strident demands for harsher sentences contrasted with calls for more imaginative and compassionate sentencing options. There seems to be a polarization of positions centred on the question of offenders' moral standing: are they moral strangers or fellow travellers? This fundamental disagreement about offenders' moral status is at the core of a number of independent, although related current practice and research issues confronting the field, namely: (1) risk management versus strength-based treatment approaches; (2) the utility of utilizing individually tailored versus manual-based programmes for offenders; (3) focusing on the technical aspects or therapy as opposed to relationship and therapist factors (what has been called process issues); and (4) the conflict between protecting the community versus promoting the interests of offenders. In this paper I suggest that an approach to sex offender treatment based on a combination of human rights theory (an ethical resource) and strengths-based approaches can help us navigate our way through the above dilemmas in a way that addressees both the needs of offenders and those of the community.

Evolutionary psychology and the rehabilitation of offenders : constraints and consequences

The mainstream view in criminology and correctional psychology is that evolutionary perspectives have little to offer researchers or practitioners and may in fact lead to overly reductionist and crude responses to the complex issue of crime and its consequences. However, in our view all the major evolutionary approaches to the explanation of human behavior have something of value to contribute, with niche construction providing a particularly useful lens upon crime and its management. In this paper we analyze the concept of rehabilitation and describe the key features of effective rehabilitation. We argue that niche construction is responsive to the cognitive versatility and behavioral flexibility of human beings and can also accommodate the important role of social and cultural scaffolding in the rehabilitation process.

Rehabilitation, etiology, and self-regulation : the comprehensive good lives model of treatment for sexual offenders

In this paper, we draw upon two sets of theoretical resources to develop a comprehensive theory of sexual offender rehabilitation named the Good Lives Model-Comprehensive (GLM-C). The original Good Lives Model (GLM-O) forms the overarching values and principles guiding clinical practice in the GLM-C. In addition, the latest sexual offender theory (i.e., the Integrated Theory of Sexual Offending; ITSO) provides a clear etiological grounding for these principles. The result is a more substantial and improved rehabilitation model that is able to conceptually link latest etiological theory with clinical practice. Analysis of the GLM-C reveals that it also has the theoretical resources to secure currently used self-regulatory treatment practice within a meaningful structure.

Desistance from sex offending : motivating change, enriching practice

In this article we draw from desistance research and a strength-based rehabilitation theory, the Good Lives Model (GLM), to present a richer way of intervening with sex offenders. First, we define the concept of desistance and outline some of the major research findings concerning the factors that help offenders to cease offending. Second we briefly describe current best practice sex offender treatment and discuss its efficacy. Third, we explore the relationship between desistance research and the GLM, arguing that the GLM provides a useful conduit for desistance ideas into sex offender treatment programs. Fourth, we briefly consider the treatment implications of an integrated desistance-GLM approach.