Montana sex offender treatment association requirements

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Table 2. Dropouts scored significantly higher on the HCR and its respective subscales compared to treatment completers Table 3. Conversely, low and medium risk levels were reported for the majority of completers Table 3. Table 4. As indicated by Table 3 , completers and dropouts differed significantly on psychopathy, with dropouts scoring significantly higher compared to completers. Dropouts tended to have increased PCL-R scores, with approximately one third of this group reaching the cut-off of In comparison, only 5.

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Nearly one third of dropouts In contrast, approximately twice the proportion of completers As reported in Table 3 , completers and dropouts differed significantly on the internal SAPROF subscale, with dropouts scoring significantly lower compared to completers. Overall, the majority of offenders Most dropouts In addition, the data showed that approximately twice the proportion of completers received high protection ratings, compared to dropouts.

As described above, previously reported predictors of treatment attrition were entered into a logistic regression with treatment completion status as the binary outcome variable. Compared to the constant alone, the overall model improved the prediction of completion status by Analysis of the individual contributions of the predictors showed violent offender type, substance abuse, and PCL-R Facet 1 emerged as significant predictors of treatment dropout, when all other predictors were held constant.

Table 5.

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In order to identify the model with the best fit, a stepwise backward elimination per likelihood-ratio-test was conducted see Table 6 , Figure 2. Overall, the new model correctly classified Interpretation on the variable level showed that violent offender type, unemployment, substance abuse, HCR sum score, and PCL-R Facet 1 significantly predicted treatment dropout. Table 6. Figure 2.

Predictors for the treatment dropout of the model with the best fit. The current study examined determinants of treatment dropout in a male offender sample undergoing treatment in a social-therapeutic correctional facility in Germany. First, dropouts and completers were compared on several demographic, criminogenic risk and protective variables.

Second, empirical-driven predictor variables were entered into two logistic regression models predicting treatment dropout. Several findings emerged from the analyses. Risk estimates based on the HCR scores indicated that medium to high-risk offenders serving sentences for sexual and non-sexual violent crimes are the typical clientele of social-therapeutic treatment.

Especially among non-sexual violent offenders the proportion of high-risk offenders seemed particularly high compared to the sexual offender group. Having in mind that only non-sexual offenders may be selected before admission to the social-therapeutic facility, the overrepresentation of high-risk non-sexual violent offenders may indicate that social-therapeutic resources are indeed allocated to those who need them most [according to the RNR-model by Bonta and Andrews 5 ].

However, analyses revealed that dropouts from social-therapeutic treatment demonstrated significantly higher levels on both recidivism risk and psychopathy measures. Therefore, a relatively high number of those offenders with high risk and high need for treatment could not be kept in therapy.

These findings are in line with previous research demonstrating that non-completers are high-risk and high-need individuals and that psychopaths were proportionally overrepresented in groups of treatment or program dropouts 15 , Except for unemployment, the univariate analyses yielded no significant differences between dropouts and completers on demographic variables and substance abuse. Recent studies have indeed found significant relationships between these variables and treatment dropout [i.

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However, the lack of concordance with earlier research is not surprising, as an absence of consistent findings seems eminent to the field of attrition research 11 and may be explicable by differences in risk levels, types of treatment programs, populations under study, or ways in which dropout was operationalized.

Motivational and external protective factors as assessed by the SAPROF did not significantly differentiate between the two groups. In line with the prediction, increased dropout rates were found among those who were unemployed, incarcerated for violent offenses, and scored high on risk HCR , and psychopathy all four facets of the PCL-R.

These findings corroborate previous research showing that unemployment, violent offenses, risk and psychopathy were consistently associated with dropout 2. The higher manifestation of internal resources such as self-control, coping skills, intelligence, or empathy in the completer group might indicate that these factors are important prerequisites for treatment adherence. For example, research indicates that internal attributes like intelligence and self-control positively influence psychosocial adjustment and are able to prevent antisocial behavior 49 , While protective factors are still understudied, currently published research suggests risk-reducing effects on recidivism 23 , 47 and that improvements in the domain of protection may also translate into reductions in treatment dropout rates The model with the best fit after stepwise backward elimination per likelihood-ratio-test indicated five variable as significant predictors of treatment dropout: violent index offense, unemployment, substance abuse, HCR sum score, and PCL-R Facet 1 interpersonal deficits.

Surprisingly, substance abuse was inversely related to treatment dropout. Each predictor will be discussed in more detail below. Offenders with high psychopathic traits are particularly challenging to treat because they represent an offender group that responds poorly to treatment, displays low motivation and disruptive behaviors, and has usually high treatment dropout rates 15 , 16 , 51 , Their treatment requires special attention as some programs might even hinder a positive therapy outcome [e.

In the present study, PCL-R Facet 1 interpersonal deficits emerged as a significant predictor of treatment dropout. This finding suggests that the interpersonal problems e. Multiple reasons may be discussed. These offenders may have more problems to establish meaningful relationships compared to offenders with low or medium scores. In a study by Olver and Wong 16 higher scores on the PCL-R Facet 2 affective deficits significantly predicted treatment dropout in a sample of sexual offenders. The authors argued that affective deficits may impede the formation of strong therapeutic bonds.

Arguably, this can be posited for both interpersonal problems and affective deficits.

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  5. Inmates with interpersonal deficits subsumed under PCL-R Facet 1 are exhausting and unpleasant in contact and can deteriorate the atmosphere of the facility. These interpersonal deficits may thus be harmful to the establishment of a strong therapeutic alliance as they undermine mutual trust. The relationship between patient and therapist is known to be an important factor to achieve positive treatment outcomes In a sample of sexual offenders, DeSorcy et al. Further research is needed to investigate therapeutic alliance in psychopaths, since the relationship between psychopathy and dropout can be moderated by treatment alliance.

    Another reason for the elevated dropout rates among offenders with higher psychopathic traits may be explained by higher rates of behavioral problems. In a sample of 44 high-risk offenders admitted to a forensic psychiatric hospital, PCL-R Facet 1 and 2 significantly predicted interpersonal physical aggression The findings suggest that scoring high on PCL-R Factor 1 increases the likelihood to engage in violent behavior. This in turn may translate into increased back-transfer to general prison if the institution worries that an offender poses a danger to fellow inmates.

    O'Brien and Daffern 52 investigated the role of psychopathy in treatment dropout in an Australian violent offender sample. The authors found that psychopathy moderated the level of treatment participation and violent reoffending: offenders with high psychopathy scores, who engaged with treatment or completed it, had similar violent recidivism rates compared to those offenders with low psychopathy scores.

    In contrast, those who scored high on the construct but engaged poorly in treatment or did not complete it demonstrated higher rates of violent recidivism. The abovementioned findings have important implications, as appropriate interventions and successfully retaining psychopathic offenders in treatment appeared to be related to therapeutic improvement and reduced risk of sexually and violently reoffending Findings by Olver et al. Being incarcerated for a non-sexual violent index offense significantly predicted treatment dropout.

    This finding was in line with previous research showing that prior violent offenses were related to increased treatment dropout and recidivism across treatment programs 2. Unlike sexual offenders, violent offenders are not automatically admitted to social therapy but must undergo an application process—although deviations due to the occupancy situation in Hamburg prisons are possible. It is likely that, among the violent offender applicants, the SothA-HH purposefully selected those with the highest risk status. A rationale behind the selection of high-risk offenders may be that the latter group has the highest need for treatment [cf.

    RNR-model; 5 ]. The results showed that it remained difficult to retain non-sexual violent offenders in treatment, emphasizing the need for future research to study responsivity issues as avenues for interventions 5 to mitigate the risk for treatment dropout. These may include ways of motivational interviewing, low-threshold group interventions for preparation of specific therapy or very individualized forms of single therapy if there are sufficient resources.

    Due to the steadily increasing proportion of non-sexual violent offenders in the last few years 25 , research about new developments and improvements of treatment programs as well as techniques particularly devised for non-sexual violent offenders is warranted. Whereas unemployment per se is unlikely to cause treatment attrition, it may be part of a larger pattern of lifestyle instability and antisocial behavior, as also evidenced by group differences on Facets 3 and 4 of the PCL-R.

    It is plausible that those individuals unable to keep a job will probably show more interpersonal problems as well as a less stable therapeutic commitment as both make similar demands on the individual such as regular attendance, responsibility, the acceptance of rules and authority, and display of pro-social behavior. Thus, an individual who previously quit or lost his jobs frequently due to impulsive, irresponsible, rule-violating, or aggressive behavior may display similar behavior in a therapeutic context, which is likely to result in the premature termination of treatment.

    Based on these considerations, a specific targeting of criminogenic needs such as self-control, anger issues, or lack of perseverance may provide positive improvements for both employability and treatment outcomes. Moreover, treatment approaches based on the Good Lives Model GLM would focus on employment and education issues, in order to equip individuals with the capabilities to achieve outcomes which were considered as desired and beneficial by the majority of the society Tentative findings by Ullrich and Coid 23 as well as Yoon et al.

    Substance abuse emerged as a significant predictor of treatment dropout, but, paradoxically, was inversely related to the criterion variable: offenders who had a diagnosis of substance abuse were less likely to drop out of social-therapeutic treatment. This is remarkable considering that substance abuse is a risk factor and has previously repeatedly been linked to treatment dropout in violent offenders 2 , 12 , In drug abuse treatment programs, dropout is actually considered a risk factor, as it increases the likelihood of a relapse Similar to the present results, the meta-analysis of Olver et al.

    Additionally, a study with incarcerated sexual offenders also found that treatment completers were more likely to suffer from substance use disorder The divergence in findings between sexual and violent offenders suggests that the relationship between dropout and substance abuse may be modulated by offender group.

    At present, we can only speculate why substance abuse is inversely related to treatment dropout. The finding may be explained by an increased allocation of resources to offenders with substance abuse. Being known as high-risk and difficult-to-treat individuals, offenders with substance abuse issues may have received additional treatment offers and were treated with particular attention to their needs.

    For example, the inmates of SothA-HH have access to an additional treatment for offenders with substance abuse. Future research is needed to investigate the role of substance abuse in predicting treatment dropout. Every predictor for dropout already discussed is a component of the HCR Therefore, an index as well as prior violent offense, psychopathic traits, substance abuse, and employment instability may contribute to a high risk indicated by HCR sum score. Additionally, high HCR sum scores can indicate clinical risk factors such as lack of insight, antisocial, and hostile attitudes or impulsivity, but also risk factors such as noncompliance and an antisocial environment that make a future without renewed violent delinquency unlikely.

    At the same time, all these factors probably contribute in part to making it more difficult to cooperate with and adapt to a social-therapeutic correctional facility. Several limitations should be noted and addressed by future research. First, data on the reasons for dropout could not be obtained.

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    This could threaten the validity of the results, if participants who exit the SothA-HH due to a systemic factor, such as administrative transfer, were accidentally categorized as dropouts. It could render interpretation of the results difficult, as dropout due to administrative reasons cannot be explained in terms of offender characteristics or behavior but rather external circumstances beyond the offender's control.

    Despite this being theoretically problematic, exits due to systemic factors happen only rarely in practice and their number in the present sample should be negligible. Future research would benefit from more detailed information on dropout reasons as they could provide a better understanding of the nature of treatment attrition and its relationship to the independent variables under investigation.

    Second, the generalizability of the findings is limited to the present population. Although, the participation rate is with Moreover, cross-validation with a different sample is advised when assessing the model's performance in practice. This is of particular importance, as social-therapeutic treatment is distinct to the German penal system, posing a threat to external validity if transferring results to international contexts. Finally, the current study could not investigate if dropout from a social-therapeutic facility did in fact translate into the assumed higher recidivism rates.

    Future research should test this hypothesis to reach a better understanding of the relationships between diverse risk and protective factors, dropout, and recidivism risk. Despite some limitations, the present study provides important insights into the relationship between numerous variables and treatment dropout.

    The results support the notion that dropouts represent a high-risk and high-need offender group with pronounced risk and psychopathy scores, violent offense histories, and higher unemployment rates. Violent index offense, unemployment at the time of incarceration, HCR sum score, PCL-R Facet 1, and, surprisingly, absence of substance abuse disorder were identified as significant predictors of treatment dropout, raising important considerations for treatment practice.

    Further research is necessary to determine how these variables contribute to treatment dropout, and to examine which variables exert a possibly confounding influence on the relationship between unemployment and treatment dropout. Even though findings regarding the relationship between dropout and protective factors remain inconclusive, further research should investigate if reductions in treatment dropout may be achieved if programs were adapted to address strengths as well as deficits. IN wrote the initial draft of the manuscript in constant consultation with FB.

    FB, IN, ES, and PB had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of data analysis.

    All authors have contributed to, read, and approved the final version of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.