Moral Reconation Therapy Research Articles

Moral Reconation Therapy

Moral Reconation Therapy (MRT) is a manualized treatment commonly used in correctional settings to address perceived moral failing and associated problematic behaviors (e.g., substance use and criminal conduct). Many social work students are introduced to MRT as a treatment modality during field placements in correctional contexts. As a group modality that draws from cognitive-behavioral interventions and 12-step recovery programs, MRT has been touted as a cost-effective and evidence-based intervention. However, there are substantial reasons to question MRT’s appropriateness as an intervention taught to social work practicum students. Using several of the CSWE EPAS standards as guideposts, this paper addresses several key areas of concern with regard to the role of MRT in the training of social work students. Through our analysis of MRT’s curriculum, we identify areas of concern with regard to MRT’s ability to teach social work students how to ethically practice, engage diversity and difference in practice, or utilize research to inform practice. Despite the widespread use of MRT in correctional counseling contexts, we conclude that MRT is unsuitable for use in accredited social work field placements. Educators and accreditation agencies should critically evaluate the treatment models social work students learn and practice in field placements.

“The Broker of Reality”: A Scoping Review of Moral Reconation Therapy

ABSTRACT Purpose This scoping review aims to identify the evidence-based literature supporting Moral Reconation Therapy (MRT), a cognitive-behavioral treatment program created in 1987 and implemented in correctional-treatment settings across the US. Social work students and practitioners are among MRT’s facilitators. Method We analyze the reliability and validity of the most recent meta-analysis of MRT, covering studies published between 1988 and 2010. We then identify 669 potential publications on MRT published between 2011 and 2021. Results Our search across Google Scholar and eleven academic databases yielded zero peer-reviewed studies on MRT’s effectiveness or outcomes. Discussion We explore themes that emerged from the exclusion criteria to describe how MRT’s evidence claims are not supported by peer-reviewed research. Social workers should be prepared to assess the reliability, quality, and rigor of evidence supporting the interventions they use. This review offers interesting challenges and learning opportunities for social work students learning about social work research.

A randomized controlled trial of moral reconation therapy to reduce risk for criminal recidivism among justice-involved adults in mental health residential treatment.

Moral reconation therapy (MRT) is a cognitive-behavioral intervention to reduce risk for criminal recidivism. Despite being implemented widely in correctional settings, there are no randomized controlled trials of MRT, and its effectiveness for reducing recidivism among justice-involved adults in noncorrectional settings is unknown. In a pragmatic trial, 341 justice-involved patients (95.3% male; 57.8% White/non-Hispanic) admitted to one of three mental health residential treatment programs were randomly assigned to usual care (UC) or UC plus two MRT groups per week for 12 weeks. Follow-ups were conducted at 6- and 12-month postbaseline (71.3% and 74.8% retention, respectively). Primary outcomes were criminal thinking and criminal associates. Secondary outcomes were legal problem severity, days incarcerated in the past 30, rearrested/charged (per official records), substance use, and employment and family/social problems. The study design, analysis, and outcomes were preregistered (ClinicalTrials.gov; ID: NCT02524171). Patients in both conditions improved over time on most outcomes. In intent-to-treat analyses, the rate of change in outcomes over time did not differ by condition, nor did the prevalence of being rearrested and charged within 1 year of baseline (UC = 20.2%, MRT = 24.9%; OR = 1.14; 95% CI [0.67, 1.94], p = .63). MRT engagement was low; 37% of those randomized to MRT received a minimum dose-that is, completed at least Step 3. In per-protocol analyses, this subgroup, relative to UC, improved more on criminal associates, days incarcerated, legal problem severity, and alcohol use severity. In this study, MRT was not more effective than UC at reducing recidivism risk for patients in mental health residential treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Implementation Potential of Moral Reconation Therapy for Criminal Recidivism in Mental Health Residential Programs.

Criminal recidivism is common among patients in mental health residential treatment programs. Moral reconation therapy (MRT) has empirical support for reducing criminal recidivism by modifying antisocial cognitions and behaviors; however, its implementation potential in noncorrectional settings has been rarely studied. This potential was examined in a three-site effectiveness-implementation trial of MRT for justice-involved veterans receiving residential mental health treatment in the U.S. Veterans Health Administration. Semistructured interviews were conducted with 36 veterans who received MRT and 13 residential program staff who were involved in its implementation during the trial. Interviews were guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and a focus on patient engagement and context. Content analysis was used to identify facilitators of and barriers to MRT implementation in residential mental health treatment. Participants viewed MRT as unique and complementary to usual residential care, with benefits beyond recidivism reduction. However, time intensity of the MRT curriculum, challenges in adapting its content and format, and long-term costs of maintaining MRT were viewed as barriers to implementation. To facilitate implementation, participants suggested streamlining the MRT curriculum, adding motivational components, and establishing partnerships in- and outside the health care system. The findings suggest strategies and modifications to MRT, which, if shown to be effective, may facilitate its wider implementation in mental health residential treatment programs.

Recidivism Treatment for Justice-Involved Veterans: Evaluating Adoption and Sustainment of Moral Reconation Therapy in the US Veterans Health Administration.

Moral Reconation Therapy (MRT), an evidence-based intervention to reduce risk for criminal recidivism among justice-involved adults, was developed and primarily tested in correctional settings. Therefore, a better understanding of the implementation potential of MRT within non-correctional settings is needed. To address this gap in the literature, we evaluated the adoption and sustainment of MRT in the US Veterans Health Administration (VHA) following a national training initiative in fiscal years 2016 and 2017. In February 2019, surveys with 66 of the 78 VHA facilities that participated in the training were used to estimate the prevalence of MRT adoption and sustainment, and qualitative interviews with key informants from 20 facilities were used to identify factors associated with sustainment of MRT groups. Of the 66 facilities surveyed, the majority reported adopting (n = 52; 79%) and sustaining their MRT group until the time of the survey (n = 38; 58%). MRT sustainment was facilitated by strong intra-facility (e.g., between veterans justice and behavioral health services) and inter-agency collaborations (e.g., between VHA and criminal justice system stakeholders), which provided a reliable referral source to MRT groups, external incentives for patient engagement, and sufficient staffing to maintain groups. Additional facilitators of MRT sustainment were adaptations to the content and delivery of MRT for patients and screening of referrals to the groups. The findings provide guidance to clinics and healthcare systems that are seeking to implement MRT with justice-involved patient populations, and inform development of implementation strategies to be formally tested in future trials.

Placing a Spotlight on Rural Homelessness: Identifying the Barriers and Facilitators to Successfully Supporting Homeless Families within Rural Communities

ABSTRACT This mixed-method study examined a rural homeless shelter serving families (a historically understudied population) and explored what factors (i.e., demographic, mental health, and social) influence whether an individual was successful in graduating shelter programming. Survey data was collected from 92 participants. Regression analysis tested demographics and a range of factors as predictors for successfully graduating the program. Findings indicated that education, social support, and income influenced one’s ability to successfully graduate. Additionally, qualitative interviews (N = 11) highlighted programmatic supports (i.e., case management, parenting classes, and moral reconation therapy) along with sociocultural barriers concerning successful program completion.

Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration

BackgroundMoral Reconation Therapy (MRT) is a cognitive-behavioral intervention aimed at reducing risk for criminal recidivism by restructuring antisocial attitudes and cognitions (i.e., “criminogenic thinking”). MRT has empirical support for reducing risk for criminal recidivism among civilian offenders. Recently, a version of MRT was developed for military veterans; however, no randomized controlled trials (RCT) have been conducted with the veteran-specific protocol, and the effectiveness and implementation potential of MRT outside of correctional settings has not been established.MethodsUsing a Hybrid Type 1 RCT design, this study will test the effectiveness of MRT to reduce risk for criminal recidivism and improve health-related outcomes among justice-involved veterans entering mental health residential treatment at three US Veterans Health Administration (VHA) Medical Centers. Upon admission to the treatment program, justice-involved veterans will complete a baseline assessment, be randomized to usual care (UC) or UC + MRT, and be followed 6 and 12 months post-baseline. A process evaluation will also be conducted to identify barriers and facilitators to implementation of MRT in residential treatment.DiscussionThe primary aim of this study is to evaluate the effectiveness of MRT with justice-involved veterans. If MRT proves effective in this trial, the findings can provide large healthcare systems that serve veterans with an evidence-based intervention for addressing criminogenic thinking among justice-involved adults, as well as guidance on how to facilitate future implementation of MRT in non-correctional settings.Trial registrationThis trial is funded by the VA Health Services Research & Development Program (IIR 14–081) and is registered with ClinicalTrials.gov (ID: NCT02524171).

Cognitive-behavioral treatments for criminogenic thinking: Barriers and facilitators to implementation within the Veterans Health Administration.

Cognitive-behavioral treatments for criminogenic thinking (i.e., antisocial cognitions, attitudes, and traits) are regarded as best practices for reducing criminal recidivism among justice-involved adults. However, the barriers and facilitators to implementation of these treatments within large health care systems such as the Veterans Health Administration (VHA) are largely unknown. To address this gap, we conducted qualitative interviews with 22 Specialists from the VHA's Veterans Justice Programs who had been trained in a cognitive-behavioral treatment for criminogenic thinking (i.e., Moral Reconation Therapy [MRT], Thinking for a Change [T4C]). The time-intensiveness of these treatments emerged as a barrier to implementation. Potential solutions identified were patient incentives for treatment engagement, streamlining the curriculum, and implementing the treatments within long-term/residential programs. At the program level, providers' stigma/bias toward patients with antisocial tendencies was seen as a barrier to implementation, as were time/resource constraints on providers. To address the latter, use of peer providers to deliver the treatments and partnerships between justice programs and behavioral health services were suggested. At the system level, lack of recognition of criminogenic treatments as evidence based, and uncertainty of sustained funds to support ongoing costs of these treatments emerged as implementation barriers. To address the latter, a train-the-trainers model was suggested. Our findings serve as a guide for implementation of criminogenic treatments for providers and policymakers in VHA and other large health care systems, which are increasingly called upon to provide care to justice-involved adults in the community. (PsycINFO Database Record

Drug Court Effectiveness and Efficiency: Findings for Virginia

ABSTRACTIn 2011, the Office of the Executive Secretary of the Supreme Court of Virginia contracted with the National Center for State Courts to conduct a comprehensive, statewide evaluation of adult drug courts. The results provide evidence of the effectiveness and cost-efficiency of Virginia’s adult treatment drug courts. When compared to the business-as-usual alternative, drug courts saved taxpayers an average of $20,000 per participant. Further, programs employing Moral Reconation Therapy (MRT) produced significantly lower probabilities of recidivism, and those that employed written sanction guidelines reported significantly higher odds of graduation for participants with no prior felonies than programs that did not.

Cognitive Behaviour Therapy in Forensic Setting: An Overview

The increase in need of treatment services in prison has been in great demand. The augmented number of crimes ranging from petty crimes to serious heinous crimes in last two decades brought in the requirement of mental health facilities in prisons at the surface level. Growth in prison facilities and prisoner populations has outstripped the slower growth in mental health services, and become the need of an hour to appoint the trained and experienced therapist to reduce the rate of recidivism. Psychotherapy one of the facility in forensic setting, has been proved as an efficient method in recidivism. Among the various therapies administered on offenders, Cognitive Behavioural Therapy (CBT) includes numerous programs like anger management therapy, moral reconation therapy, reasoning and rehabilitation, soft skill training, substance abuse training, relapse prevention therapy etc. are considered as the important component of the mental health facilities in the prisons, correctional and observation homes with an aim to increase the community re-entry of the offenders. CBT in prison focuses on cognitive functioning and behaviour especially on developing skills for living in harmony with the community and engaging in behaviours that contribute to positive outcomes in society. In the light of the available applications of CBT on forensic population, the heed of this article is to provide an overview of the effectiveness in crime reduction and training the offenders for becoming an acceptable member of the society.

Reducing Jail Recidivism for Women With Co-Occurring Disorders

Reducing Jail Recidivism for Women With Co-Occurring Disorders

A Meta-Analysis of Moral Reconation Therapy

This study reports on a meta-analysis of moral reconation therapy (MRT). Recipients of MRT included adult and juvenile offenders who were in custody or in the community, typically on parole or probation. The study considered criminal offending subsequent to treatment as the outcome variable. The overall effect size measured by the correlation across 33 studies and 30,259 offenders was significant (r = .16), indicating that MRT had a small but important effect on recidivism. Moderator analyses were conducted to detect the possible factors affecting the relationship between MRT and recidivism. Moderators included setting, age, gender, research design, sample size, type of recidivism, follow-up period, publisher, and year of publication. Moderator analysis demonstrated that MRT was more successful with adult than juvenile offenders in institutional settings as opposed to the community, and where researchers in the primary studies used randomization to allocate participants to either a treatment or control condition. The treatment effect size was greater when the type of recidivism used was rearrest rather than rearrest followed by conviction or reincarceration. The benefits of MRT were strongest with a relatively short follow-up period. MRT was more successful for relatively small samples and for large samples rather than medium-sized samples. The effect size was smaller for studies published by the owners of MRT than by other independent studies. The effect size was also smaller for studies published after 1999.

A Quantitative Review of Structured, Group-Oriented, Cognitive-Behavioral Programs for Offenders

Prior reviews and meta-analyses have supported the hypothesis that offender rehabilitation programs based on cognitive-behavioral principles reduce recidivism. This article quantitatively synthesizes the extant empirical evidence on the effectiveness of structured cognitive-behavioral programs delivered to groups of offenders. The evidence summarized supports the claim that these treatments are effective at reducing criminal behavior among convicted offenders. All higher quality studies reported positive effects favoring the cognitive-behavioral treatment program. Specifically, positive reductions in recidivism were observed for moral reconation therapy, reasoning and rehabilitation, and various cognitive-restructuring programs. The evidence suggests the effectiveness of cognitive skills and cognitive restructuring approaches as well as programs that emphasize moral teachings and reasoning.

The Effect of Moral Reconation Therapy on the Recidivism of Youthful Offenders

A randomized experimental design was used to test the effect of moral reconation therapy on the recidivism rates of youth offenders. The sample consisted of youth offenders who were incarcerated in a county jail in Maryland ( N = 256). A survival analysis compared the risk of recidivism of the treatment and control groups. The risk of recidivism for the treatment group was not significantly different from the risk of recidivism for the control group. A supplemental analysis compared a high implementation treatment group with the randomized control group. Individuals in the high implementation treatment group received a minimum of 30 days of treatment. Consistent with earlier results, group differences were not statistically significant.

The Effectiveness of Cognitive Behavioral Treatment for Adult Offenders: A Methodological, Quality-Based Review

Previous research on cognitive skills treatment programs has not included a comprehensive review of the effectiveness of these programs in reducing recidivism. This article reviews recent recidivism studies for two rehabilitation programs: Moral Reconation Therapy, which attempts to reduce recidivism by increasing the moral reasoning abilities of offenders, and Reasoning and Rehabilitation, which aims to educate offenders to change underlying criminogenic thoughts and attitudes. Using the Maryland Scale for Scientific Rigor, these studies were evaluated for their methodological strength and for the program’s success in reducing the recidivism of offenders. In considering the findings and the strength of the methods for each program, this review concludes that Moral Reconation Therapy and Reasoning and Rehabilitation programs appear to be successful approaches to reducing recidivism.

Treating Drug Offenders with Moral Reconation Therapy: A Three-Year Recidivism Report

70 male felony offenders treated with the cognitive behavioral approach of Moral Reconation Therapy during and after incarceration were assessed for rearrests and reincarceration 38 months after their release. They were compared to a nontreated control group of 82 male felony offenders. Recidivism in the treated group was 24.3% as compared to 36.6% for the control group. Analysis showed that steps completed significantly correlated with rearrests and recidivism and that the correlation between number of aftercare sessions and recidivism approached significance.

Treating Drunk Drivers with Moral Reconation Therapy: A Three-Year Report

115 DWI-convicted male inmates were treated with the cognitive behavioral system of Moral Reconation Therapy during their incarceration. Three years after their release, subjects' postrelease arrest and reincarceration records were collected. In the treated group, 24 subjects participated in an extended aftercare program and were compared to a control group of 65 DWI-convicted inmates who did not enter treatment due to limited bed space. Analysis showed reincarceration rates of 36.9% for the 65 controls, 22.6% of the 115 treated subjects, and only 16.7% of the 24 aftercare clients.

Treating Drunk Drivers with Moral Reconation Therapy: A Two-Year Recidivism Study

115 DWI-convicted male inmates were treated with Moral Reconation Therapy during incarceration. Nearly two years after their release, subjects' postrelease arrest records were collected. Treatment group data were compared to a control group of 65 inmates who applied but did not enter treatment as bed space was limited. Analysis showed that 10.4% of the treatment group obtained additional DWI arrests after release compared to 15.6% of the control group. 14.3% of treated subjects received additional sentences compared to 21.5% of nontreated controls. Results were also analyzed for a group of 24 treated subjects who continued to participate in treatment after release. This aftercare group showed a postrelease DWI rate of only 4.2% and reincarceration rate of 8.3%.

Relationship of DUI recidivism to moral reasoning, sensation seeking, and MacAndrew alcoholism scores.

115 convicted male DUI offenders were treated with Moral Reconation Therapy during their incarceration. Postrelease recidivism status (arrests) was correlated with the pretest, posttest, and change scores on the MacAndrew Alcoholism Scale, Sensation Seeking Scale, Life-purpose scores, and Moral Reasoning scores. Analysis showed that recidivism correlated positively and significantly with the pretest scores on the MacAndrew scale and approached significance with both pre- and posttest scores on the Sensation Seeking Scale. Recidivism status correlated negatively and significantly with scores on the highest levels of moral reasoning (Scale 6 pretest and posttest and Principled Reasoning pretest).

Treating drunk drivers with moral reconation therapy: a one-year recidivism report.

115 convicted drunk drivers were treated with Moral Reconation Therapy during their incarceration. Postrelease recidivism (rearrest) and convictions of these treated subjects was compared to a control group of 65 convicted drunk drivers who did not receive treatment due to limited bed space. Analysis showed a rearrest rate of 20% for the treated group during the first year of the program's operation compared to 27.6% for the control group during the same period. Subjects who participated in a structured aftercare program after release showed only a 4.3% recidivism rate.