scholarly journals Exploring Mechanisms of Change in the Rehabilitation of High-Risk Offenders

2021 ◽  
Author(s):  
◽  
Julia A. Yesberg

<p>The success or failure of many different types of treatment is often measured by one type of outcome. For example, treatment for substance abuse might be judged to have failed if a patient “goes on a bender” some time after completing the programme. The same is true for offender rehabilitation. Treatment success or failure is usually determined by whether or not an offender is reconvicted of a new offence in a specified follow-up period. We know from the literature that offender rehabilitation can have modest but significant effects on reducing recidivism. Yet we know little about what brings about these reductions (i.e., how the treatment worked). This thesis explores possible mechanisms of change in offender rehabilitation. I propose that although a reduction in recidivism is an important long-term outcome of treatment, there are a number of additional outcomes that have the potential to explain not only if but how treatment works and why it is unsuccessful in leading to a reduction in reoffending for some offenders.  Study 1 is a typical outcome evaluation of New Zealand’s rehabilitation programmes for high-risk male offenders: the High Risk Special Treatment Units (HRSTUs). I compared the recidivism rates of a sample of HRSTU completers with a comparison sample of high-risk offenders who had not completed the programme (a between-subjects design). I found that relative to the comparison group, treatment completers had significantly lower rates of four different indices of recidivism, varying in severity. The remainder of the thesis explored possible mechanisms of change within the HRSTU sample (a within-subjects design). Study 2 examined immediate outcomes of treatment, which I defined as within-treatment change on dynamic risk factors. I found that offenders made significant change on the Violence Risk Scale during treatment, but there was no significant relationship between treatment change and recidivism. Studies 3 and 4 examined intermediate outcomes of treatment, which I defined as barriers (risk factors) and facilitators (protective factors) that influence the process of offender re-entry. Study 3 validated an instrument designed to measure these factors: the Dynamic Risk Assessment for Offender Re-entry (DRAOR). I found that the tool had good convergent validity and reliably predicted recidivism above a static risk estimate. Study 4 used the newly validated DRAOR to test an explanation for the lack of a direct relationship between treatment change and recidivism. I tested whether treatment change had an indirect relationship with recidivism through its influence on the re-entry process. I found that treatment change was related to a number of re-entry outcomes; however, only two models could be tested for mediation because the re-entry outcomes themselves lacked predictive ability. Nevertheless, findings from Study 4 suggest the re-entry process is an area worthy of further investigation.  Taken together, the findings from this thesis highlight the importance of considering alternative treatment outcomes in addition to whether or not a programme leads to a reduction in long-term recidivism outcomes. Answering the question of how treatment works requires an exploration into possible mechanisms of change. This thesis was only a preliminary investigation into such mechanisms; however, the findings have both practical and theoretical implications for the way we conceptualise how treatment programmes work. Developing a greater understanding of mechanisms of change in offender rehabilitation has the potential to lead to the design and delivery of more effective programmes.</p>

2021 ◽  
Author(s):  
◽  
Julia A. Yesberg

<p>The success or failure of many different types of treatment is often measured by one type of outcome. For example, treatment for substance abuse might be judged to have failed if a patient “goes on a bender” some time after completing the programme. The same is true for offender rehabilitation. Treatment success or failure is usually determined by whether or not an offender is reconvicted of a new offence in a specified follow-up period. We know from the literature that offender rehabilitation can have modest but significant effects on reducing recidivism. Yet we know little about what brings about these reductions (i.e., how the treatment worked). This thesis explores possible mechanisms of change in offender rehabilitation. I propose that although a reduction in recidivism is an important long-term outcome of treatment, there are a number of additional outcomes that have the potential to explain not only if but how treatment works and why it is unsuccessful in leading to a reduction in reoffending for some offenders.  Study 1 is a typical outcome evaluation of New Zealand’s rehabilitation programmes for high-risk male offenders: the High Risk Special Treatment Units (HRSTUs). I compared the recidivism rates of a sample of HRSTU completers with a comparison sample of high-risk offenders who had not completed the programme (a between-subjects design). I found that relative to the comparison group, treatment completers had significantly lower rates of four different indices of recidivism, varying in severity. The remainder of the thesis explored possible mechanisms of change within the HRSTU sample (a within-subjects design). Study 2 examined immediate outcomes of treatment, which I defined as within-treatment change on dynamic risk factors. I found that offenders made significant change on the Violence Risk Scale during treatment, but there was no significant relationship between treatment change and recidivism. Studies 3 and 4 examined intermediate outcomes of treatment, which I defined as barriers (risk factors) and facilitators (protective factors) that influence the process of offender re-entry. Study 3 validated an instrument designed to measure these factors: the Dynamic Risk Assessment for Offender Re-entry (DRAOR). I found that the tool had good convergent validity and reliably predicted recidivism above a static risk estimate. Study 4 used the newly validated DRAOR to test an explanation for the lack of a direct relationship between treatment change and recidivism. I tested whether treatment change had an indirect relationship with recidivism through its influence on the re-entry process. I found that treatment change was related to a number of re-entry outcomes; however, only two models could be tested for mediation because the re-entry outcomes themselves lacked predictive ability. Nevertheless, findings from Study 4 suggest the re-entry process is an area worthy of further investigation.  Taken together, the findings from this thesis highlight the importance of considering alternative treatment outcomes in addition to whether or not a programme leads to a reduction in long-term recidivism outcomes. Answering the question of how treatment works requires an exploration into possible mechanisms of change. This thesis was only a preliminary investigation into such mechanisms; however, the findings have both practical and theoretical implications for the way we conceptualise how treatment programmes work. Developing a greater understanding of mechanisms of change in offender rehabilitation has the potential to lead to the design and delivery of more effective programmes.</p>


2019 ◽  
Vol 63 (15-16) ◽  
pp. 2672-2692
Author(s):  
Julia A. Yesberg ◽  
Devon L. L. Polaschek

Offender rehabilitation is typically thought to have been successful if a higher proportion of a sample of treatment completers avoids being reconvicted for an offence than a comparison sample. Yet, this type of evaluation design tells us little about what brings about these outcomes. In this study, we test whether change in dynamic risk factors during treatment is a recidivism-reducing mechanism in a sample of high-risk offenders. We also examine the extent to which change after treatment—in the period of reentry from prison to the community—mediates this relationship. We found that although individuals made statistically significant change during treatment, this change was not significantly related to recidivism. We did, however, find tentative support for an indirect relationship between treatment change and recidivism, through change that occurred during reentry. These findings signal the importance of the reentry period for understanding how change in treatment is related to long-term outcomes.


2009 ◽  
Vol 98 (3) ◽  
pp. 164-168 ◽  
Author(s):  
J. Virkkunen ◽  
M. Venermo ◽  
J. Saarinen ◽  
J. Salenius

Background and Aims: The ability to predict post-operative mortality reliably will be of assistance in making decisions concerning the treatment of an individual patient. The aim of this study was to test the GAS score as a predictor of post-operative mortality in vascular surgical patients. Material and Methods: A total of 157 consecutive patients who underwent an elective vascular surgical procedure were included in the study. The Cox proportional hazards model was used in analyzing the importance of various preoperative risk factors for the postoperative outcome. ASA and GAS were tested in predicting the short and long-term outcome. On the basis of the GAS cut-off value 77, patients were selected into low-risk (GAS low: GAS < 77) and high-risk (GAS high: GAS > = 77) groups, and the examined risk factors were analyzed to determine which of them had predictive value for the prognosis. Results: None of the patients in the GAS low group died, and mortality in the GAS high group was 4.8% (p = 0.03) at 30 days' follow-up. The 12-month survival rates were 98.6% and 78.6% (p = 0.0001), respectively, with the respective 5-year survival rates of 76.7% and 44.0% (p = 0.0001). The only independent risk factor for 30-day mortality was the renal risk factor (OR 20.2). The combination of all three GAS variables(chronic renal failure, cardiac disease and cerebrovascular disease), excluding age, was associated with a 100% two-year mortality. Conclusions: Mortality is low for patients with GAS<77. For the high-risk patients (GAS> = 77), due to its low predictive value for death, GAS yields limited value in clinical practice. In cases of patients with all three risk factors (renal, cardiac and cerebrovascular), vascular surgery should be considered very carefully.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Karl August Brensing ◽  
Anna Ochsmann ◽  
Heyder Omran ◽  
Gerhard Lonnemann ◽  
Helmut Reichel ◽  
...  

Abstract Background and Aims Hemodialysis (HD) patients with atrial fibrillation (AF) are at high risk for cardio-vascular events, severe bleeding and rapid vascular/valvular calcification. Thus, higher than low standard dialysate Mg (d-Mg) may improve outcome by less arrhythmic or calcification impact, but clinical data are missing. Our study evaluated applied d-Mg, risk-factors and antithrombotic therapies on long-term outcome in a large representative German HD-cohort. Method We used pseudonymized benchmarking data (2013-2018) of 16226 adult chronic HD patients (informed consent) from DNeV dialysis network. Diagnoses were coded by “International Classification of Diseases (ICD)” and drugs via “Anatomical Therapeutical Chemical (ATC)” codes. Risk scores (Carlson Comorbidity Index=CCI, CHA2DS2-VASc and HAS-BLED) were tested for de-novo outcome prediction. Results At baseline, 2752 (17%) HD-patients had coded AF. CHA2DS2-VASc (4.0/SD1.5) and HAS-BLED (3.2/0.9) estimated high risk for embolism/bleeding. Standard dialysate-Mg (sd-Mg; 0.5 mmol/L) was used by 1317 (48%), d-Mg 0.75 had 331 (12%), d-Mg &gt;1.0 had 134 (5%) and 970 (35%) patients changed from 0.5 to 0.75 during the study period (change group). Median study time was 2.1 yrs (Range=R: 0.01–6 yrs.). Overall 6-yr mortality was high (63%; Kaplan Meier median survival of 2.9 yrs. Unchanged d-Mg levels were significantly (p&lt;0.02) related to survival: Patients on sd-Mg had lower median survival (2.7 yrs.) than on 0.75 (3.1 yrs; p&lt;0.05) or &gt;1.0 (3.4 yrs; p=0.02). The change group had the same survival (3.1 yrs) as the 0.75 group (p&lt;0.03 vs. 0.5). Cox-Regression (multivariate, sd-Mg=ref.) revealed d-Mg &gt;1.0 (hazard ratio=HR 0.74), d-Mg 0.75 (HR 0.79), serum albumin (HR 0.93), age (HR 1.04) and CCI (HR 1.06) as independently related to mortality (p=0.002). Sd-Mg had higher (p&lt;0.05) cerebral adverse events (5.2%) than 0.75 (1.8%) and &gt;1.0 group (3.7%). Apart from dialysis-related heparin-supply four main approaches regarding anti-coagulation were identified: No therapy, VK-OAC, Heparin or only Aspirin/Clopidogrel (Asp/Clop): VK-OAC and Asp/Clop had same median survival (2.8 yrs) both better (p&lt;0.001) than no therapy (1.3 yrs) or Heparin (1.6 yrs), but VK-OAC had higher bleeding rates (6.4%; p&lt;0.001) than Asp/Clop (3.5%). Cerebral adverse events (3,8% in 6 yrs) were much lower than estimated and similar for all four regimes (R: 3.9-4.4%). Conclusion Use of higher d-Mg in HD-patients with AF significantly improved survival and cerebral outcome, is a feasible cost-effective approach and has more relative impact than well established survival risk-factors such as age, comorbidity (=CCI) and serum albumin. Our data warrant prospective trials comparing higher d-Mg levels with anti-thrombotic drugs and/or left atrial appendage occlusion for better evidence. So far, therapy of HD patients with AF should base on implementation of higher d-Mg, prefer Asp/Clop as best anti-thrombotic drugs and clearly avoid more harmful VK-OAC.


Brachytherapy ◽  
2012 ◽  
Vol 11 (4) ◽  
pp. 250-255 ◽  
Author(s):  
Nathan Bittner ◽  
Gregory S. Merrick ◽  
Wayne M. Butler ◽  
Robert W. Galbreath ◽  
Jonathan Lief ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document