Who receives substance abuse treatment in the ‘real world’ of the prison? A register-based study of Finnish inmates

Assessing and targeting substance abuse-related treatment needs according to evidence-based practice has become the norm in most prison administrations. Not everyone with a need will, however, receive support in practical settings. Drawing on Finnish prison registers, we show that of all prisoners released in 2011, 60% were assessed as having a need for substance abuse-related support. Of these, 22% received an intervention in prison. Two multivariate models were used to examine the factors related to selection into interventions. The main factors associated with receiving an intervention with evidence-based programmes were a longer sentence, Finnish nationality, younger age and treatment motivation. The predictors for any substance abuse interventions (including non-evidence-based) were the same, with the exception that motivation was no longer a significant predictor, and female gender remained significant. The selective use of motivation as an entrance criterion for interventions can be a means of systemic adaptation to a combination of a high prevalence of substance abuse problems and a lower prevalence of treatment motivation in the prison population. We discuss how our results might reflect a Scandinavian way of doing evidence-based, prison-based drug treatment—one that stresses rehabilitation as a goal in itself in addition to reducing recidivism. Most prisoners, however, do not receive any intervention at all.     

Substance use disorders in forensic psychiatric patients

There is a lack of detailed information on the role of substance use disorders (SUD) as a substantial factor in offences and treatment in forensic psychiatric patients. The aim of this study was to get a better understanding of these specifics. Clinical records of 193 male patients admitted to a Dutch forensic psychiatric hospital were scrutinized on anamnestic, diagnostic and risk assessment data. One of the central findings was that the prevalence of SUDs was high. Patients with an SUD had a more extensive criminal history, unstable and deviant lifestyle and higher risk of violent behavior than patients without a substance use disorder. No differences were found in duration of treatment, aggressive incidents and leave. Another important finding was that a distinction could be made between patients with substance use as a primary criminogenic risk factor and patients with substance use as a secondary risk factor. Although substance use is identified as a general risk factor, this study supports the idea of sub categorization of patients with an SUD and emphasizes the need for a different treatment approach. Further study is needed to identify specific treatment approaches, based on more differentiated profiles of these patients.     

Training parenting plan evaluators: Looking towards the future

Standards of practice for parenting plan evaluations continue to evolve, informed by advances in research and the development of innovative, evidence-based approaches to assessment and intervention. Parenting plan evaluators are asked to inform the court, parents, and other professionals on how to address the complex needs of increasingly diverse families amid reorganization, high conflict, and crisis. How can we attract and properly train new mental health professionals to do important work in an increasingly strained adversarial system? How can evaluators keep up with these advances over the course of their careers? How can they deepen and refine their skills to work with a diverse array of individuals, family constellations and an enormous range of family circumstances? And how can evaluators care for their own well-being and their colleagues? In this article, the authors describe a multi-dimensional approach to training both new and experienced custody evaluators that includes imparting baseline knowledge on how to conduct quality parenting plan evaluations as a starting point. We discuss a variety of modalities and approaches that can enable evaluators to deepen and expand their skills over the years, contribute to the diverse community of family law professionals, and manage the exceptional demands of working in this field.     

Psychotherapy for Psychological Injury: A Biopsychosocial and Forensic Perspective

This article reviews the predominant psychological approaches to therapy and other treatments in the field of psychological injury. Mostly, they concern cognitive behavior therapy and its variants. However, because of the simultaneous physical injuries or physiological effects that accompany these types of injury, practitioners should adopt an integrated biopsychosocial approach in treatment (Sperry, L., Treatment of chronic medical conditions: Cognitive-behavioral therapy strategies and integrative treatment protocols. Washington, DC: American Psychological Association, 2006; Treatment of chronic medical conditions: Cognitive-behavioral therapy strategies and integrative treatment protocols. Washington, DC: American Psychological Association, 2009). The paper presents a componential model of therapy that integrates the cognitive-behavioral, biopsychosocial, and forensic approaches. More research needs to be undertaken that takes into account the difficulties of conducting therapy with individuals who are expressing psychological injury. This will help in the quest to formulate evidence-based but flexible practice guidelines. The paper concludes with a model that may serve to scaffold the numerous psychotherapies that are available into a more coherent framework.     

The Evidence-Based Policing Matrix

The next phase of evidence-based policing requires both scholars and practitioners to move from lists of specific studies about “what works” to using that information strategically. This requires developing generalizations or principles on the nature of effective police strategies and translating the field of police evaluation research into digestible forms that can be used to alter police tactics, strategies, accountability systems, and training. In this article, we present a tool intended for such use: the Evidence-Based Policing Matrix. The Matrix is a consistently updated, research-to-practice translation tool that categorizes and visually bins all experimental and quasi-experimental research on police and crime reduction into intersections between three common dimensions of crime prevention—the nature of the target, the extent to which the strategy is proactive or reactive, and the specificity or generality of the strategy. Our mapping and visualization of 97 police evaluation studies conducted through December 31, 2009, indicate that proactive, place-based, and specific policing approaches appear much more promising in reducing crime than individual-based, reactive, and general ones. We conclude by discussing how the Matrix can be used to guide future research and facilitate the adoption of evidence-based policing.     

Setting the legal standard of care for treatment and evidence-based medicine: a case study of antenatal corticosteroids

This article argues that liability for negligent medical treatment should be predicated upon a standard of care reflecting what is medically and scientifically reasonable. Legal science (jurisprudence) and medical science (evidence-based medicine) should be reconciled to improve patient care and outcomes. The use of antenatal corticosteroids in obstetrics during the 1990s illustrates how most jurisprudence for setting the standard of care for treatment is ill equipped to meet the fundamental aims of tort law. The proliferation of evidence-based medical practice provides a unique opportunity for the law to encourage best medical practice when setting the standard of care for treatment. It is argued that, eventually, the law should recognise clinical practice guidelines as the prima facie standard of care for treatment. This will provide legal certainty, appropriate medical practitioner accountability, and ultimately improve patient care and outcomes.     

The Transportability of Contingency Management in Problem-solving Courts

Problem-solving (PS) courts continue to proliferate throughout the country, providing an ideal setting for understanding the factors affecting the use of rewards, a key part of one evidence-based practice (EBP), contingency management (CM). This study uses the concept of transportability to explore how justice practitioners implement CM. Based on roughly 400?h of ethnographic fieldwork, conducted over 34?months in six PS courts, we examine the implementation and adaptation of CM. While decisions to adopt and implement practices are concentrated at the managerial level of organizations, the implementation processes used by frontline workers provide key insight into how EBP may become an everyday workplace practice. This study finds frontline workers adapting CM principles to their environments. While it might appear as though CM implementation strays from the original evidence-based construct, local adaptations provide a foundation for understanding the factors that affect the transportability of CM into routine practice.     

Female Perpetrated Dyadic Psychological Aggression Predicts Relapse in a Treatment Sample of Men with Substance Use Disorders

This study examined whether female-to-male (FTM) psychological aggression predicted men’s relapse of substance use disorder (SUD) 6 months following substance use treatment. Men diagnosed with either a substance abuse or dependence disorder who had recently begun an SUD treatment program participated in the study with their female relationship partners (N = 173). Logistic regression was used to examine the relationship between baseline FTM psychological aggression and SUD relapse when controlling for baseline demographic, dyadic, substance abuse- and treatment-related variables, as well as frequencies of other male- and female-perpetrated aggressive dyadic behaviors. Higher frequencies of severe, but not minor, forms of FTM psychological aggression uniquely predicted an increased risk of relapse at 6 months follow-up. These data add to the developing research program highlighting the negative sequelae of female-perpetrated psychological aggression and also provide an empirical basis for targeting specific dyadic behaviors in the context of SUD treatment and relapse prevention.     

Medical Marijuana Registries: A Painful Choice?

Though the medical use of marijuana is legal in thirty-three states, it remains illegal under the federal Controlled Substances Act. Any marijuana use can subject individuals to severe criminal and civil penalties under federal law. States that condition patient access and treatment on registration in a state database impose real risks on their citizens. Although many scholars have written about the tension between federal and state treatment of marijuana, this is the first article to examine marijuana patient registry privacy and fundamental rights issues. This article first reviews the relationship between marijuana use and patient treatment, with a focus on health-care and privacy rights under state and federal law. The article then explains how marijuana registries compare to broader patient registries, such as contagious disease and other medical condition patient registries, and the unique issues presented by marijuana patient registries. It then discusses the elevated risk to constitutional, privacy, and fundamental rights that may result if states do not carefully construct marijuana registries. The article concludes by proposing principles for how both states and dispensaries should approach marijuana registries in order to provide health benefits and avoid harm to patients.     

Medical treatment of dementia patients at the end of life: can the law accommodate the personal identity and welfare problems?

This article considers whether two significant philosophical objections to autonomy-based legal approaches to decision-making for incompetent individuals could be accommodated by the law. These philosophical objections are known as the personal identity and welfare problems. The article first sets out the autonomy-based approaches and their objections. Next, the present legal position is briefly canvassed in a comparative vein. Finally, the article suggests how the personal identity and welfare problems might be accommodated were legislators minded to do so, by proposing specific statutory amendments to the recent English legislation on advance decisions and evaluating their viability, particularly in light of the European Convention on Human Rights.     

Assistive technology as support for the exercise of legal capacity

Exercising legal capacity refers to engaging in legal transactions and relationships and is essential for the full inclusion of people with disabilities in society. The United Nations Convention on the Rights of Persons with Disabilities has enumerated the right to legal capacity on an equal basis and has created a state obligation to provide access to support for the exercise of legal capacity. This article examines the use of assistive devices as support for decision-making in exercising legal capacity for individuals with physical and cognitive impairments; for example, the use of voice recognition programmes, screen readers, and screen enlargement applications to support people with mobility and sensory impairments to use online portals essential for legal actions such as banking. It also discusses the experimental use of cognitive assistance, including computer or electrical assistive devices, to facilitate communication for people with cognitive impairments including those with no external signs of consciousness. It highlights the diversity of options for ‘support for the exercise of legal capacity’ showing how they can assist people with various disabilities. Finally, the article examines the boundaries of the state obligation to provide such support, including issues of practical implementation and resource allocation.     

The nanny state or responsible government?

The use of statutory regulation of medical treatments is always contentious. This is particularly so in the case of assisted reproductive technologies (ART), and the treatments offered through IVF and related procedures. These technologies challenge traditional understandings of the family and motherhood, but also raise questions about the status of the human embryo and how it should be treated. This article argues that governments do have a role to play in the regulation of ART, in addition to the professional guidelines governing such treatments. It looks at three different types of statutory regulation in the Australian context.     

Arbitration Effect

Arbitration is changing the United States justice system. Critics argue that arbitration leads to claim suppression. Proponents argue that, compared with courts, arbitration is cheaper and less formal. These claims have not been empirically tested. In particular, whether and how arbitration impacts individuals’ decision to sue remains an open inquiry. This article for the first time shows, in a series of experiments, the impact of arbitration agreements on individuals' decisions to sue. This article calls it the “arbitration effect.” First, we test whether the arbitration effect exists; that is, if arbitration agreements negatively impact individuals' decision to sue. Second, we experimentally test individuals' decisions to opt out of arbitration agreements. Lastly, we assess whether any type of information can “cure” the arbitration effect. The results establish that individuals are less likely to sue in arbitration as opposed to court, hence the arbitration effect. Such an effect, however, does not exist at the contracting stage, meaning that individuals do not shun arbitration when given the option. Further, none of the fundamental attributes of arbitration, as touted by the U.S. Supreme Court, nor win-rates and class actions mitigate the arbitration effect. Equally, informational nudges do not reduce the effect, and individuals do not ascribe negative attributes to firms forcing mandatory arbitration. For decades, courts and lawmakers grappled with issues related to arbitration. The article provides much-needed data on arbitration. Findings cast serious doubts on the ongoing efforts—market-based, judicial, or regulatory—aiming to change the arbitration course.     

Translating research into evidence-based practice in juvenile justice: brand-name programs,meta-analysis,and key issues

Objectives

To investigate the utility of two main approaches for translating research into evidence-based practice in juvenile justice: (a) brand-name programs that are identified by lists of various expert groups and come with implementation and quality assurance packages offered by program developers; and (b) results of large-scale meta-analyses that offer a number of generalized strategies (or generics) for improving existing programs.

Methods

Informed by prospect theory, a first-stage analytic decision-tree model was developed that included three comparable evidence-based programs (two brand names and one generic). Implementation success was a key factor, and analyses were conducted under two conditions.

Results

Under the first condition, where brand-name programs have a large advantage in implementation success over generic programs, it was found that the brand-name programs had the highest expected values. Under the second condition, which considered the role of Lipsey et al.’s (2010) Standardized Program Evaluation Protocol, it was found that all three programs produced highly favorable expected values.

Conclusions

Brand-name programs and meta-analyses represent two rigorous and transparent approaches for advancing evidence-based practice in juvenile justice. State governments should consider the merits of both approaches through a decision-tree model, paying particular attention to implementation success as well as financial costs and benefits derived from rigorous cost–benefit analysis.     

Working with sex offenders: Best practice in enhancing practitioner resilience

Abstract

The systematic and widespread treatment of sex offenders is a comparatively recent innovation in the human services field. Consequently, research considering the impact of such work on providers and organisations is still in its infancy. The first swathe of international research, published throughout the 1990s, identified a range of deleterious effects for treatment providers, ranging from mild anxiety to severe psychological morbidity. More recent findings indicate a considerably more optimistic psychological future. This paper seeks to provide the reader with an overview of the relevant literature, together with its shortcomings, and introduce the Model of Dynamic Adaptation (MDA), a framework through which variables associated with both positive and negative outcomes may be grouped and managed. It is proposed that understanding and managing the MDA can support both individuals and organisations in achieving their goals in good psychological health, through the development and implementation of informed, evidence-based, best practice strategies.     

Correctional Treatment Programmes for Young Offenders in Europe: A Survey of Routine Practice

This article presents the results of an international survey of European correctional treatment programmes for young offenders. Questionnaires gathering data on programmes’ design, implementation, structure, and evaluation were collected from 112 programme administrators in 25 European Union countries. Results demonstrated that although there was a commitment to young offender rehabilitation in almost every country, programmes adopted many different approaches and were implemented with varying levels of adherence to evidence-based principles of ‘best practice.’ The majority of programmes adopted a cognitive-behavioural approach, and clinical discretion was prioritised over systematised, empirically validated assessment instruments. Most programmes were administered by centralised government agencies; however, process and outcome evaluation was rare. These findings suggest a strong need for improved systematic evaluation in most European countries.     

Can Us-Type Court Management Approaches Work In Civil Law Systems? Experiences From The Balkans And Beyond

The benefit of applying modern management approaches to court operations to ensuring access to justice, timely and transparent dispositions, and increased public trust in courts is recognized in many countries. In the USA, the art of applying modern management techniques to court operations has evolved over the past 30 years into a now solidly established profession. Since the underlying principles and techniques of modern court management, such as case flow management, goal-oriented performance measures, workload assessments, customer surveys, etc., are derived from general management concepts they are not tied to a particular legal system or framework and can be successfully applied in non-US systems if they are properly adjusted. Interested in the positive results of court management in the USA, researchers and practitioners in several European countries have been looking at the applicability of the approaches used in the USA to improve their own ability to manage court processes more efficiently.Since court management has become a main staple of reforming court operations in the USA, it is not surprising that US-funded development assistance in the Balkan states and other countries often involves transferring court management US-style into the newly evolving democracies as part of rule of law or commercial sector development assistance. These projects frequently introduce, among others, case flow management techniques that sometimes seem to be in conflict with underlying legal principles or procedural laws, and often defy the local legal culture. The US-funded assistance programs are often introduced parallel to efforts funded by European and other donors, which may take and suggest different approaches to the host country. As a result, confusion and insecurity about which approaches are appropriate for a particular country can arise and impede much needed reforms or lead to legislative and regulatory changes that do not mesh well or even conflict with other parts of the legal framework.This article reviews the role of US-based court management approaches in recent court reform efforts under way in Serbia, Bosnia, and Croatia and, in light of lessons learned there and in other countries, assesses the reform processes applied and their status. It also outlines how these court management approaches fit into non-US court systems, how they can be adjusted according to individual country needs and what the main obstacles are that such reform efforts generally face.     

Current and Promising Pharmacotherapies for Substance Use Disorders among Justice-Involved Populations

Growing recognition of the biological underpinnings of substance use disorders (SUDs) has led to increased acceptance of pharmacotherapy-based treatments for general populations and, more recently, for individuals under criminal justice supervision, including those in correctional settings. This paper focuses on pharmacotherapies that have been approved by the United States Food and Drug Administration (FDA) for treatment of alcohol use disorder and opioid use disorder. For alcohol use disorder, these medications are disulfiram, naltrexone, and acamprosate; for opioid use disorder, these are methadone, buprenorphine, and naltrexone. Promising pharmacotherapies for stimulant use disorder are also briefly summarized. The paper concludes with three “lessons learned,” specifically: (1) treatment and policy should reflect the fact that substance misuse and addiction is a medical disorder, (2) interventions for SUDs should be integrated into primary care, and (3) reductions in substance use among pharmacotherapy-treated patients do not necessarily lead to concomitant reductions in crime (nor should this be the primary rationale for providing such treatment).     

The prognostic value of the PCL-R in relation to the SUD treatment ending

Scientific research about patients with substance use disorders (SUD) treated within the context of forensic compulsory addiction treatment is seldom available. Scientifically supported surveys regarding the treatability of SUD patients are rare. Some authors claim that the Psychopathy-Checklist-Revised (PCL-R) has value for predicting therapeutic success. PCL-R scores rely on extensive interview data and a detailed review of criminal records and social history. The scores reflect 1) the affective and interpersonal psychological traits; and 2) socially deviant conduct. This study was conducted by the forensic professional clinic at the hospital for Psychiatry and Neurology Hildburghausen. We assessed 102 male patients using the PCL-R. This investigation evaluated the Total score of the PCL-R and the score of Factor 1 and Factor 2 in relation to the end of treatment by court order. The results showed significant differences between patients who completed treatment and those who did not. Patients that dropped out of treatment had a higher score in PCL-R. With the use of the PCL-R it is possible to make a quantitative statement about which patients will complete treatment.     

Towards rational and evidence-based crime policy

Rational crime policy constitutes a basic goal for society. If, however, evidence-based, cost-efficient crime prevention is the standard, there is little indication that current policies—including programs, laws, and court decisions—are rational. To support that assessment, this article uses an evaluation research perspective to highlight five prominent problems with extant crime policies: (1) a lack of empirical assessment of the need for them; (2) a range of design issues, including gaps between crime theory and policy, and, most notably, the pursuit of silver bullet solutions; (3) a range of implementation issues, including disjunctures between ideal and actual practice; (4) the lack of rigorous impact evaluations and the sometimes misplaced emphasis on them; and (5) a scarcity of cost-efficiency analyses for guiding investment decisions. It then discusses the implications of these problems and suggests steps that can be taken to place crime policy on a more evidence-based foundation.