A MODEL OF ENGAGEMENT FOR CORRECTIONAL PRACTICE

<p>Despite recent advances in correctional rehabilitation, rates of treatment attrition remain high and low efficacy rates suggest improvements in treatment development and delivery are needed. Treatment engagement is an important concept which remains poorly understood. In order to enhance understanding and facilitate higher levels of engagement in treatment, robust theoretical models need to be developed. In light of this, two key questions need to be answered; (1) what is engagement? And (2) what are the underlying causal mechanisms which facilitate or hinder engagement? I explore the contributions of current conceptualisations and models of correctional treatment engagement. I explain how evolutionary psychology, agency, norms and the therapeutic alliance can contribute to our theoretical understanding. These concepts are then integrated to form the Model of Engagement for Correctional Practice. Engagement is conceptualised as a set of adaptive, goal-directed behaviours occurring as a result of the dynamic interactions between contextual, psychological and social processes. I argue that these factors influence the nature of the therapeutic alliance and subsequently participant engagement. The model is then evaluated in terms of critical features required for a robust theory of engagement. I then suggest some practice principles and guidelines to demonstrate how this model can be applied to enhance treatment engagement.</p>

A MODEL OF ENGAGEMENT FOR CORRECTIONAL PRACTICE

<p>Despite recent advances in correctional rehabilitation, rates of treatment attrition remain high and low efficacy rates suggest improvements in treatment development and delivery are needed. Treatment engagement is an important concept which remains poorly understood. In order to enhance understanding and facilitate higher levels of engagement in treatment, robust theoretical models need to be developed. In light of this, two key questions need to be answered; (1) what is engagement? And (2) what are the underlying causal mechanisms which facilitate or hinder engagement? I explore the contributions of current conceptualisations and models of correctional treatment engagement. I explain how evolutionary psychology, agency, norms and the therapeutic alliance can contribute to our theoretical understanding. These concepts are then integrated to form the Model of Engagement for Correctional Practice. Engagement is conceptualised as a set of adaptive, goal-directed behaviours occurring as a result of the dynamic interactions between contextual, psychological and social processes. I argue that these factors influence the nature of the therapeutic alliance and subsequently participant engagement. The model is then evaluated in terms of critical features required for a robust theory of engagement. I then suggest some practice principles and guidelines to demonstrate how this model can be applied to enhance treatment engagement.</p>

Sexbots as Synthetic Companions: Comparing Attitudes of Official Sex Offenders and Non-Offenders

This is the first Italian study to examine views on sexbots of adult male sex offenders and non-offenders, and their perceptions of sexbots as sexual partners, and sexbots as a means to prevent sexual violence. In order to explore these aspects 344 adult males were involved in the study. The study carried out two types of comparisons. 100 male sex offenders were compared with 244 male non-offenders. Also, sex offenders were divided into child molesters and rapists. Preliminary findings suggest that sex offenders were less open than non-offenders to sexbots, showed a lower acceptance of them, and were more likely to dismiss the possibility of having an intimate and sexual relationship with a sexbot. Sex offenders were also less likely than non-offenders to believe that the risk of sexual violence against people could be reduced if a sexbot was used in the treatment of sex offenders. No differences were found between child molesters and rapists. Though no definitive conclusion can be drawn about what role sexbots might play in the prevention and treatment of sex offending, this study emphasizes the importance of both exploring how sexbots are both perceived and understood. Sex offenders in this study showed a high dynamic sexual risk and, paradoxically, despite, or because of, their sexual deviance (e.g. deficits in sexual self-regulation), they were more inclined to see sexbots as just machines and were reluctant to imagine them as social agents, i.e. as intimate or sexual arousal partners. How sex offenders differ in their dynamic risk and criminal careers can inform experts about the mechanisms that take place and can challenge their engagement in treatment and intervention.

A Resident-Led Intervention to Increase Initiation of Buprenorphine Maintenance for Hospitalized Patients With Opioid Use Disorder

BACKGROUND: Hospitalized patients with opioid use disorder (OUD) are rarely started on buprenorphine or methadone maintenance despite evidence that these medications reduce all-cause mortality, overdoses, and hospital readmissions. OBJECTIVE: To assess whether clinician education and a team of residents and hospitalist attendings waivered to prescribe buprenorphine increased the rate of starting patients with OUD on buprenorphine maintenance. DESIGN, SETTING, PARTICIPANTS: Quality improvement study conducted at a large, urban, academic hospital in Maryland involving hospitalized patients with OUD on internal medicine resident services. INTERVENTION: We developed a protocol for initiating buprenorphine maintenance, presented an educational conference, and started the resident-led Buprenorphine Bridge Team of residents and attendings waivered to prescribe buprenorphine to bridge patients from discharge to follow-up. MEASUREMENTS: The percent of eligible inpatients with OUD initiated on buprenorphine maintenance, 24 weeks before and after the intervention; engagement in treatment after discharge; and resident knowledge and comfort with buprenorphine. RESULTS: The rate of starting buprenorphine maintenance increased from 10% (30 of 305 eligible patients) to 24% (64 of 270 eligible patients) after the intervention, with interrupted time series analysis showing a significant increase in rate (14.4%; 95% CI, 3.6%-25.3%; P = .02). Engagement in treatment after discharge was unchanged (40%-46% engaged 30 days after discharge). Of 156 internal medicine residents, 89 (57%) completed the baseline survey and 66 (42%) completed the follow-up survey. Responses demonstrated improved resident knowledge and comfort with buprenorphine. CONCLUSION: Internal medicine resident teams were more likely to start patients on buprenorphine maintenance after clinician education and implementation of a Buprenorphine Bridge Team.

The impact of family engagement in opioid assisted treatment: Results from a randomised controlled trial

Background: Family interventions in substance use disorders (SUD) treatment is limited despite the evidence for benefits. Providing family interventions is hampered by patient resistance, social stigma, logistics and factors related to the capacity of the treatment programmes. Aims: The purpose of the study was to examine the association between family engagement in treatment, and opioid use defined by percentage negative opioid screen and rate retention in treatment defined by completion of study period. Methods: Data from a 16-week outpatient randomised controlled trial (RCT) of 141 adults with opioid use disorder (OUD) receiving Opioid Assisted Treatment (OAT) using buprenorphine/naloxone film (BUP/NX-F) was, used to examine the association between family engagement in and opioid use and rate of retention in treatment. Multiple logistic regression was, applied to examine the independent prediction of family engagement on opioid use and rate retention in treatment. Results: Family engagement was significantly associated with retention in treatment (Spearman’s rho 0.25, p < 0.01) and was subsequently found to increase the likelihood of retention in treatment by approximately 3-fold (adjusted odds ratio (OR) 2.95, 95% CI 1.31–6.65). Conclusion: Family engagement in treatment is an independent predictor of retention in treatment but not opioid use in adults receiving OAT. It is, recommended that SUD treatment programmes integrate family related interventions in mainstream treatment. Delivering a personalised multicomponent family programme using digitised virtual communications that has been increasingly utilised during the Covid-19 pandemic is highly suggested.