Diffusion of treatment interventions: exploration of ‘secondary’ treatment diffusion

Abstract

The present report presents outcome results from a randomized controlled effect study on extended Aggression Replacement Training (ART). In a pre–post design, a 30-hour ART intervention was found to significantly reduce behavioral problems and increase social skills. The control group did not demonstrate comparable changes, but still indicated improvement. Such control-group improvement may be caused by improper treatment and control group implementation (diffusion of treatment) and/or ‘secondary’ diffusion caused by participants in the treatment group affecting control group subjects by demonstrating changed behavior. Both mechanisms were explored, and it is concluded that the improvement observed in the control group was due to such ‘secondary diffusion’. Implications of these findings are discussed.     

Why do sexual offenders refuse treatment?

Abstract

Theories of offender motivation for treatment have proposed that external factors may be as important as internal factors in creating a state of readiness for treatment. This paper reports an exploratory study of the barriers to treatment for incarcerated sexual offenders. Qualitative and quantitative analysis of interview and questionnaire data from treatment refusers and accepters suggested that refusers were less aware of the effectiveness of treatment, reported seeing negative side effects of treatment in others and felt they had a higher social status in prison which could be damaged by attending treatment. While this study does not demonstrate a causal link between these experiences and the decision to refuse treatment, it seems reasonable to suggest that take-up of treatment could be increased by more sustained efforts to build relationships with treatment refusers and by the provision of accessible information about treatment and its potential benefits.     

Inconceivable? Deducting the costs of fertility treatment

This Article considers whether infertile taxpayers can deduct their fertility treatment costs as medical expenses under Internal Revenue Code section 213 and whether they should be able to deduct them. Internal Revenue Code section 213 defines medical expenses as "amounts paid-for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." This definition is interpreted by reference to a baseline of normal biological functioning, which includes reproductive functioning. Most people conceive and bear children without having to incur expenses for fertility treatment. Expenses incurred to approximate the baseline of normal reproductive health are deductible, even if the taxpayer winds up better off, with a child, after the fertility treatment. The medical profession recognizes that infertility is a disease or condition. Infertility is a loss, just as a broken leg is a loss. Fertility treatment costs are thus medical expenses under section 213. In addition, given the existence of the medical expense deduction, taxpayers should be able to deduct the cost of fertility treatments, including IVF, egg donor, and surrogate procedures, under either an "ability-to-pay" or consequentialist normative approach. Reproduction is extremely important to most people. In addition, allowing taxpayers to deduct the costs of fertility treatment will encourage infertile taxpayers to elect the most effective treatment option and reduce the rate of risky multifetal pregnancies. This Article concludes that fertility treatment costs are deductible as medical expenses under current law and should be deductible as medical expenses.     

The impact of sex offender’s interpersonal style,treatment readiness and the therapeutic alliance on treatment gain

The impact of internal responsivity factors and therapeutic process variables on intra-individual within-treatment gain in sex offenders has received little empirical attention. This study examined how (1) internal responsivity factors, including treatment readiness and interpersonal style, and (2) therapy process variables, including the therapeutic alliance and the presence of ruptures in the therapeutic relationship, impacted intra-individual within-treatment gain. Participants comprised 71 sex offenders who participated in group-based sex offender treatment programmes in prison or the community. Results showed that offender hostile-dominance and the affective and interpersonal characteristics of psychopathy, as measured by the Psychopathy Checklist: Screening Version Factor 1 score, negatively impacted treatment gain. Pre-treatment readiness, client ratings of the therapeutic alliance and whether or not there were ruptures in the therapeutic relationship had no association with within-treatment gain. The strength of the therapeutic alliance later in treatment did not moderate the relationship between offender interpersonal style, or psychopathy, and treatment gain.     

How voluntary must treatment of addicted patients be?

As for each medical treatment the principle of voluntariness also applies to the therapy of drug addicts. Indeed, under current drug influence or in an acute withdrawal situation a free will decision could not be possible. Also an excessive drug consumption over a longer period of time can lead to a severe personality disturbances. But from an--unreasonable--drug abuse one cannot conclude a general inability for making decisions of free will. For this reason the expressed will of the drug addict remains decisive. This applies also to juvenile addicts. Besides, one has to call in the parents as legal representatives. In case of consent to the therapy one should not be very exacting on the internal therapy readiness). It can also be awoken within the course of therapy (therapy to the therapy readiness). In case of a briefing in a withdrawal or penal institution a readiness to therapy is not required. But then there is only a state-obligation to offer therapies; for the single therapeutic measure the right of self-determination of the drug addict is further on valid.     

Cervical manipulation--how might informed consent be obtained before treatment?

This article discusses methods and mediums of obtaining informed consent in physiotherapy clinical practice, specifically in relation to cervical manipulation. Whilst cervical manipulation is a useful method of treatment for spinal joint pain and dysfunction, it has also been shown to be ineffective or even positively harmful. Legal precedents have set boundaries for informing patients of such adverse consequences. However, a degree of uncertainty exists in the physiotherapy profession, as in other health care professions, as to how to obtain informed consent in a busy clinical setting in order to discharge the legal duties owed. Obtaining meaningful informed consent in clinical practice raises issues of patient comprehension, memory and decision-making capacity. A large quantity of research directed at enhancing patient understanding has been undertaken in recent years. The important findings are that a variety of communication methods and mediums need to be employed in both providing information and assessing patient understanding. A combination of verbal, written and audiovisual information provides patients with maximum opportunity to be involved in treatment decisions.     

Adolescents and mental disorder: who consents to treatment?

Although English law recognises that developing adolescents may acquire the capacity to make decisions about medical treatment themselves it does not address the problem of mentally disturbed or disordered adolescents. This article examines the nature of adolescent refusal of treatment and suggests that a line be drawn between three categories of adolescent disturbance--the competent young person who refuses treatment that an adult too may refuse, the rebellious teenager whose refusal is triggered by simple teenage angst, and the mentally ill teenager whose refusal is triggered by mental illness. It suggests that adolescent autonomy needs to be more fully understood and the Mental Health Act more readily used in treating young people.     

Punishment or therapy? The ethics of sexual offending treatment

Abstract

The claim that sex offender treatment is a form of punishment and as such cannot be covered by traditional ethical codes is a controversial one. It challenges the ethical basis of current practice and compels clinicians to rethink the work they do with sex offenders. In this paper I comment on Bill Glaser's defence of that idea in a challenging and timely paper and David Prescott and Jill Leveson's rejection of his claims. First, I consider briefly the nature of both punishment and treatment and outline Glaser's argument and Prescott and Levenson's rejoinder. I then investigate what a comprehensive argument for either position should look like and finish with a few comments on each paper.     

Can a 12-step program work in methadone maintenance treatment?

Three consecutive, professionally led (as opposed to self-help) groups following the 12-step program (TSP) were integrated into a methadone maintenance treatment (MMT) program that included 32 heroin-addicted individuals in recovery. This report describes our experience in meeting the challenges that arose and our conclusions regarding the therapeutic potential of this integration. A professional therapeutic staff guided the groups. In-depth interviews of 10 participants and the reflections of the group leaders provided data for learning about the groups' experience. Initially the participants rejected the concepts of Step 1, powerlessness and unmanageability of life. The assimilation of Step 4 (defining character defect) also aroused some resistance. The participants eventually adopted the pragmatic aspects of TSP, including its terminology. The establishment of a common language of recovery helped to create group coherence and a sense of belonging, and helped to meet the needs of those who felt stigmatized by both the nonaddicted and addicted population undergoing nonmethadone recovery. TSP could be adapted to various aspects of daily life, produced a sense of self-efficacy, and stimulated motivation for change. Therapeutic implications are discussed.     

Dosage of treatment to sexual offenders: are we overprescribing?

A sample of 337 offenders who received treatment in a variety of sex offender treatment programs in the Ontario region of Correctional Service Canada between 1993 and 1998 were divided based on the highest intensity sex offender programming that they received (low, moderate, and high). The three groups were compared with reference to a variety of actuarial risk assessment measures, criminogenic factors, and the number and type of treatment programs completed. It was hypothesized that the high-intensity group would have more criminogenic risk factors, higher actuarial scores, and participate in more treatment programs than both the moderate- and low-intensity groups. The results indicate that in general, the hypotheses were supported. Nonetheless, the results suggest that the low-intensity group may be receiving too much sex offender-specific treatment.