Hierarchical Therapeutic Community Research Articles

"The Whole Is Greater Than the Sum of the Parts": Prison Staff Perceptions of Domestic Violence Rehabilitation Programs.

This qualitative study is part of a mixed methods research project that examined the effectiveness of the primary rehabilitation program for domestic violence offenders in the Israeli Prison Services-the "House of Hope." The quantitative part of the study showed that the "House of Hope" program was effective in reducing recidivism among participating inmates. The purpose of this qualitative study was to describe the rehabilitation program according to the perspectives of the program staff. For this purpose, semistructured interviews were conducted with the department staff during the study as well as with past directors. The qualitative findings suggested that the success of the program probably stemmed from a synergistic combination of several components, for example, identifying the characteristics of domestic violence offenders and adjusting treatment programs to their needs, along with exposure to psychological treatment in varied therapies (cognitive behavioral therapy, psychoeducational, and psychodynamic) and formats (group therapy and individual therapy) during a 1-year stay in a hierarchical therapeutic community. Other components mentioned are staff professionalism, stability, and the program's location in a therapeutic-oriented prison that is architecturally designed and built to create a less stressful environment for the inmates and the staff.

Correctional interventions for women offenders: a rapid evidence assessment

Purpose – A Rapid Evidence Assessment (REA) determined the effectiveness of correctional programmes for women offenders and examined features of programmes providing the strongest outcomes. The paper aims to discuss these issues. Design/methodology/approach – Electronic databases and web sites were reviewed to identify literature focused on interventions with female offenders published since 2006, the end point of the last REA conducted in the area. The following retention criteria were applied: participants were over age 18; sample included women and results are reported separately for women; study included an appropriate comparison group; study included recidivism as an outcome measure. Studies’ methodological design quality was assessed using the Maryland Scientific Methods Scale. Findings – In total, one meta-analysis and 22 studies reflecting 17 unique samples, published from 2006 to December 2014, were identified. Overall, the best evidence suggests that the following programmes and approaches have an evidence base: first, substance abuse treatment, in particular in-custody or hierarchical therapeutic community programmes; second, gender-responsive programmes that emphasize existing strengths and competencies, as well as skills acquisition; and third, following in-custody programme treatment with participation in community follow-up sessions. There is also promising evidence for the use of community opioid maintenance among heroin addicted women. Originality/value – This review demonstrated that since 2006 the number of high-quality research studies assessing women’s correctional outcomes has grown considerably. The results provide guidance to programme designers and administrators on programmes for women offenders likely to be effective in promoting public safety goals and offender reintegration.

The Influence of Personality Disorders on Treatment Completion in a Hierarchical Therapeutic Community for Drug Abusers: A Prospective Study

One hundred and forty-four substance abusers entering consecutively a hierarchical therapeutic community, Phoenix House, Oslo, were followed prospectively 1.5 years through the entire programme. Using

Self-reported depression as a predictor of dropout in a hierarchical therapeutic community

Studies of the importance of depression for treatment outcome in hierarchical therapeutic communities are scarce. Therefore, a total of 144 substance abusers consecutively entering Phoenix House in Oslo were followed prospectively through an entire 18-month program. Using a structured interview and two self-report instruments, Millon Clinical Multiaxial Inventory and Symptom Checklist-90, 69% of the clients were depressive cases at the time of application. However, depression alone did not predict dropout during the following 1-year inpatient phase. Of the 36 clients who completed the drug-free inpatient year, 19% were depressive cases at this point. Thus being depressed after 1 year increased the risk for dropout five times compared to being nondepressed. The study demonstrates the need for a modification of the treatment model, which might include the use of antidepressant and/or individual psychotherapy, at least in the outpatient phase.

Why do drug abusers leave the therapeutic community? Problems with attachment and identification in a hierarchical treatment community

High drop-out rate is a major problem in all kinds of treatment modalities for drug abusers. With regard to the hierarchical therapeutic community, which is a very popular treatment model for substance abusers, the one year retention rate of 8-30% indicates that relatively few clients complete the programme. Attachment to and identification with co-residents, staff, and the treatment programme, are corner stones in the ideology of the hierarchical therapeutic community model. The retention rate of 8-30% may therefore indicate that the majority of clients have problems with attachment to and identification with each other and adherence to the programme. We therefore conducted a process-oriented and qualitative study, where we followed different samples of clients, in interaction with each other and with the staff, from intake until they dropped out or completed the programme. We wanted partly to evaluate how the actual model provided the conditions for learning new role behaviour, attachment to and identif...

Different intake procedures: The influence on treatment start and treatment response—A quasi-experimental study

Two hundred Norwegian substance abusers who consecutively applied for treatment in a hierarchical therapeutic community were divided into two different groups according to intake procedures: the intake group (IG) and the nonintake group (No-IG). Using a prospective design, we found that beginners in the program were more often infected with human immunodeficiency virus and that they used amphetamine more frequently and alcohol less frequently than nonbeginners. The type of intake procedure did not influence the percentage of those who started in the program, but it increased the number of clients who completed Phase 1, the 1-year inpatient phase of the program. Twice as many clients in the IG completed Phase 1 compared to those in the No-IG. From a clinical point of view, we conclude that the IG procedure should be offered to all applicants but that the model should be developed more as a role induction strategy, in which learning practical coping skills to adjust to the treatment program is essential.

HIV-positive drug abusers in a hierarchical therapeutic community: A prospective study

Of 200 substance abusers who consecutively applied for treatment at Phoenix House, Oslo, 79% (n=158) were HIV-tested. The prevalence of HIV-positive applicants was 10% (n=16). The HIV-positive clients were followed up prospectively through the total program, and a follow-up was undertaken 4 years after the start of treatment. Although the HIV-positive clients had a more frequent use of opiates and a longer alcohol career than the HIV-negative clients, more HIV-positive applicants began treatment. Moreover, 53% of the HIV-positive clients completed the 1-year inpatient phase of the program, against 27% of the HIV-negative clients. In the outpatient phase, however, the HIV-positive clients managed less successfully than the HIV-negative clients, and time in treatment could not predict outcome. These findings, together with the rather negative follow-up results, may indicate that inpatient programs such as the Phoenix House adequately serve the HIV-positives' needs for a safe and caring atmosphere but do not...

Changes in antisocial aggressiveness during treatment in a hierarchical therapeutic community. A prospective study of personality changes

Thirty-six consecutive substance abusers were examined at intake and after 1 year of residency in a hierarchical therapeutic community using the personality instruments Million Clinical Multiaxial Inventory (MCMI) and Basic Character Inventory. Two antisocial aggressiveness subgroups were identified: a no-increase group (n = 11) that had high intake scores on MCMI antisocial aggression, small changes during the stay and a high dropout rate (45%) as outpatients; and an increase group (n = 25) with lower scores at intake and a low dropout rate (20%). A high level of antisocial aggressiveness at intake was related to dropout in the no-increase group, and a high degree of increase in antisocial aggressiveness was related to dropout in the increase group. The results show the importance of monitoring antisocial aggressiveness during treatment.

Psychopathology and substance abuse as predictors of program completion in a therapeutic community for drug abusers: a prospective study

A total of 144 substance abusers entering consecutively a hierarchical therapeutic community, Phoenix House, Oslo, were followed prospectively 18 months through the entire program. Thirty percent completed the 1-year inpatient phase and 20% completed the total program. Using a structured interview and 3 self-report instruments, the Millon Clinical Multiaxial Inventory, Basic Character Inventory and Symptom Checklist-90, significant differences between dropouts and completers were found in 3 areas of pre-admission characteristics: gender, substance abuse and psychopathology. Completers were characterized by a greater percentage of females, a higher frequency of amphetamine use and a lower frequency of alcohol use and a higher frequency of histrionic and a lower frequency of schizotypal traits than dropouts. The study indicates the importance of paying closer attention to these factors during treatment.