Structured Activity Programs Research Articles

Shared Activities as a Protective Factor Against Behavioral and Psychological Symptoms of Dementia and Caregiver Stress.

Most persons with dementia experience behavioral and psychological symptoms (BPSD). While there is evidence that structured activity programs can be beneficial for persons with dementia and their caregivers, it is not well understood how joint engagement in shared activities affects BPSD and caregiver stress. The purpose of this study was to examine the moderating effect of doing a shared activity on the BPSD and caregiver stress. This study used an intensive longitudinal observational design in which caregivers completed baseline and once-a-day diary surveys for 21 days. Caregivers were asked whether they did a pleasant noncare activity with their relative, the presence of 8 BPSD, and their stress level. A moderation model in a structural equation model examined the relationship between these variables. Our sample consisted of 453 caregivers (87.4% female, 51.4% non-Hispanic White, mean age 53 years [standard deviation {SD}: 14]) and person living with dementia whose mean age was 79 years (SD: 9). On days when the caregivers engaged in a shared activity together with person living with dementia, there was a significant decrease in the BPSD (estimate -0.038, standard error [SE] = 0.016, 95% confidence interval [CI]: -0.069, -0.007, p value = 0.018). The effects of engaging in a shared activity decreased the impact of caregiver stress by 0.052 (estimate -0.052, SE = 0.018, 95% CI: -0.087, -0.017, p value = 0.004). At the between-person level, no differences were found in BPSD across caregivers who engaged or did not engage in shared activities. The results of our study indicate that doing a shared activity is associated with reduced BPSD among persons with dementia and may buffer the impact of caregiver stress on BPSD. Shared activities should be considered a key intervention component for dementia caregivers.

One step at a time: Physical activity is linked to positive interpretations of ambiguity.

BackgroundExtensive research has established a clear positive relationship between physical activity (PA), even in small amounts, and psychological well-being, including benefits for emotional and mental health (e.g., decreased depression). However, little research has examined the relationship between PA and decision-making within emotionally ambiguous contexts. The purpose of the present cross-sectional study was to examine the relationship between reported amount and intensity of PA and interpretations of emotional ambiguity.MethodsAdults (n = 611) recruited through Amazon’s Mechanical Turk were assessed on their interpretations of ambiguous and clear (unambiguous) emotional stimuli and reported habitual PA and exercise.ResultsMore positive ratings of ambiguity were associated with greater amount of vigorous activity (p = .002), but not with moderate activity (p = .826) or walking (p = .673). Subsequent analyses demonstrated that this relationship between vigorous PA and positive interpretations of ambiguity was most pronounced when comparing individuals who reported any amount of vigorous PA to those who reported no vigorous activity at all.ConclusionsOur findings suggest that higher amounts of vigorous, but not moderate, PA are associated with more positive interpretations of ambiguity, and that even small amounts of PA seem to be sufficient to promote this more positive valence bias when compared to individuals conducting no vigorous PA at all. Future work should examine the longitudinal effects of PA among individuals participating in structured activity programs.

Diagnosing and Treating Depression in Patients with Alzheimer's Disease.

Although cognitive and functional impairment are the hallmark features of Alzheimer’s disease (AD), neuropsychiatric symptoms associated with AD account for increased rates of disability and profoundly impact the quality of life of both patients and their caregivers. This narrative review of current evidence provides practical guidance in diagnosing and managing depression in patients with AD using pharmacological and nonpharmacological interventions. After apathy, depression is the second most common neuropsychiatric symptom in AD. Diagnosing late-life depression (LLD), particularly in those affected by AD, is complicated because older patients may not meet the criteria for a major depressive disorder. Clinically, late-life depression and dementia can be indistinguishable. Although these two entities are now thought to be related, the pathologic mechanisms remain unclear. Evidence suggests that LLD may be a prodromal symptom of neurodegenerative disease. The various geropsychiatric measures currently used to diagnose, rate the severity of, and monitor the progress of treatment for depression are imperfect. Neuroimaging represents a promising avenue toward understanding the complex pathophysiologic relationships between dementia and LLD, and will support the pursuit of biomarker-driven diagnosis and treatment. Nonpharmacologic interventions to relieve depression in persons with cognitive impairment and dementia include emotion-oriented therapies, behavioral and cognitive-behavioral modification programs, and structured activity programs. Sensory-stimulation therapies and multisensory approaches show some promise for successfully treating depression in patients with dementia, but further rigorous research is needed to establish their validity. Clinical consensus and research appear to support selective serotonin reuptake inhibitors as a first choice for the pharmacological treatment of depression in patients with dementia. However, initial support for these therapies remains variable, and further investigation is needed. Extra care is required in prescribing to this population because of the generally high level of medical and psychiatric comorbidity and the potential difficulty in assessing the cognitively impaired patient’s response.

The Effects of Structured Physical Activity Program on Social Interaction and Communication for Children with Autism.

The purpose of this study was to investigate the effects of structured physical activity program on social interaction and communication of children with autism spectrum disorder (ASD). Fifty children with ASD from a special school were randomly divided into experimental and control groups. 25 children with ASD were placed in the experimental group, and the other 25 children as the control group participated in regular physical activity. A total of forty-one participants completed the study. A 12-week structured physical activity program was implemented with a total of 24 exercise sessions targeting social interaction and communication of children with ASD, and a quasi-experimental design was used for this study. Data were collected using quantitative and qualitative instruments. SSIS and ABLLS-R results showed that an overall improvement in social skills and social interaction for the experimental group across interim and posttests, F = 8.425, p = 0.001 (p < 0.005), and significant improvements appeared in communication, cooperation, social interaction, and self-control subdomains (p < 0.005). Conversely, no statistically significant differences were found in the control group (p > 0.005). The study concluded that the special structured physical activity program positively influenced social interaction and communication skills of children with ASD, especially in social skills, communication, prompt response, and frequency of expression.

A Case Study on Staff Perspectives of Programming in a Forensic Mental Health Treatment Facility

This paper examines staff impressions of and insights regarding programming at a forensic mental health facility in the Southeastern United States. The facility studied for this research provides services for adult males who are incompetent to proceed to trial or not guilty by reason of insanity. The facility underwent an overhaul of services, transitioning from a voluntary referral-based activity program to a compulsory, structured activity program. This transition offered a unique opportunity to explore staff perceptions of the differences between the two programs. This paper describes the results from a series of focused interviews conducted with employees. The following themes were identified as key issues across staff interviews: (a) value of therapeutic activities, (b) accessibility, (c) choice, (d) participation, and (e) structure. These frontline perspectives offer valuable insights into programming issues for this population. Subscribe to TRJ

EFFECTIVENESS OF STRUCTURED ACTIVITY PROGRAMME ON COGNITIVE FUNCTION AMONG INMATES OF THE DESTITUTE HOME

Abstract:Current trends in health care practice emphasis on cost effective consolidative approach of pharmacological and life style modification. This can help mentally challenged individual and destitute to obtain the optimum level of functioning. The study aimed to determine the effectiveness of structured activity programme on cognitive function, self-esteem and behaviour among mentally ill destitute home inmates. Study was conceptualized based on Albert Bandura's Triadic reciprocity of determinism. An evaluative approach using pre-test post-test design was used for the study. The samples were selected based on the sampling criteria and a total of 50 samples were recruited for the study with the mean age of 41.98±13.13. Study findings revealed that structured activity programme was effective in improving the cognitive function of mentally ill destitute. This suggests structured activities can be used in institutionalized or hospital setting to improve the cognition of mentally ill clients.

Effectiveness of Structured Activity Programe on Self Esteem Among Inmates of the Destitute Home

Advances in health care practice resulted in increased cost of health care services. This emphasised on cost effective integrated approach of pharmacological and life style modification. This can help mentally ill individual and destitute to obtain the optimum level of functioning. This study aimed to determine the effectiveness of structured activity programme on cognitive function, self esteem and behaviour among mentally ill destitute home inmates. The Study was conceptualized based on Albert Bandura's Triadic reciprocity of determinism. An evaluative approach using pre test post test design was used for the study. The samples were selected based on the sampling criteria and a total of 50 samples were recruited for the study with the mean age of 41.98±13.13. This Study findings to reveal that structured activity programme was effective in improving the self esteem of mentally ill destitute. This suggests the structured activities can be used in institutionalized or hospital setting to improve the self esteem of mentally ill clients.

Does a Structured Gardening Programme Improve Well-Being in Young-Onset Dementia? A Preliminary Study

Introduction: Young-onset dementia affects about 1 in 1500 people aged under 65 years in the United Kingdom (UK). It is associated with loss of employment, independence and an increase in psychological distress. This project set out to identify the benefits of a 2 hours per week structured activity programme of gardening for people with young-onset dementia. Method: A mixed methods (qualitative and quantitative) study of therapeutic gardening for people with young-onset dementia, measuring outcomes for both participants with young-onset dementia and their carers, was used. Twelve participants were recruited from a county-wide mental health service for older adults, based on onset of dementia being before the age of 65 years (range 43–65 years). Of these, two participants dropped out and one died during the project. Measures included the Mini Mental State Examination (MMSE), Bradford Well-Being Profile, Large Allen Cognitive Level Screen (LACLS) and Pool Activity Level (PAL). Findings: Over a 1-year period the carers of the people with young-onset dementia found that the project had given participants a renewed sense of purpose and increased well-being, despite cognitive functioning continuing to decline during this period. Conclusion: This study suggests that a meaningful guided activity programme can maintain or improve well-being in the presence of cognitive deterioration.

Using Objective, Real-Time Measures to Investigate the Effect of Actual Physical Activity on Affective States in Everyday Life Differentiating the Contexts of Working and Leisure Time in a Sample with Students

Multiple studies suggest that physical activity causes positive affective reactions and reduces depressive mood. However, studies and interventions focused mostly on structured activity programs, but rarely on actual physical activity (aPA) in daily life. Furthermore, they seldom account for the context in which the aPA occur (e.g., work, leisure). Using a prospective, real-time assessment design (ambulatory assessment), we investigated the effects of aPA on affective states (valence, energetic arousal, calmness) in real-time during everyday life while controlling for the context. Eighty-seven undergraduates students (Age: M = 24.6; SD = 3.2, females: 54%) participated in this study. aPA was assessed through accelerometers during 24-h. Palmtop devices prompted subjects approximately every 45 min during a 14-h daytime period to assess their affective states and the context. We analyzed within- and between-person effects with hierarchical modeling (HLM 6.0). Multilevel analyses revealed that both aPA and context influenced subsequent affective states. The interaction of aPA and context did predict energetic arousal only. State levels of affects did not differ between men and women. For both men and women, aPA in everyday life has an effect on individual’s affective states. For valence and calmness, it seems to be independent of the context in which the aPA occur. For energetic arousal, men reported to have lower feelings of energy and women reported to have more feelings of energy during leisure time compared to working episodes.

버츄 프로젝트에 근거한 부모-자녀간 의사소통능력향상 프로그램의 효과 연구: S시 어머니를 중심으로

This study has developed on Virtues Project program, which enhances parent communication abilities. The purpose of this study is to verify the improvement on parent communication skills after taking a program. To obtain effective children educational direction, we have offered assistance to the parents that understanding the importance of the parental instruction, improvement of the relationship between parents and children. To enhance the parent communication ability, this program is consisted of five virtue strategies, structured activity programs and various self-examination for attending parents to the program rather than listening the lecture. This program is consists of six session with two hours each session for six weeks. I have studied 26 subjects and they were divided into experiment group and control group. According to this study, this program works on improving parent communication skills. Namely, experiment group showed significant enhancement of communication abilities compared to that of control group.

Relationships between Eating Behaviors and Irrational Eating Beliefs: Use of the Subscale of the Irrational Eating Beliefs Scale Measuring Avoidance of Changing Eating Habits

Objective: To assess perceptions mothers have about eating and physical activity behaviors of their preschool-aged child. To determine the feasibility of using stay-at-home mothers to provide nutrition and physical activity programming in the home. Design, Setting and Participants: Focus groups were conducted with mothers. A survey examining nutrition and physical activity behaviors and attitudes was administered before the focus group. Outcome Measures and Analysis: Questions were tested for face and content validity. Focus groups were audiotaped and handwritten notes were taken. Audiotapes were transcribed and analyzed. Themes were determined by analyst triangulation. Results: Twenty-four mothers participated. Parents of picky eaters were more likely to show interest in a homebased nutrition program. Others thought that preschools would be more effective at influencing their child's eating behaviors than themselves. Mothers were most interested in a program that was structured, organized, flexible, and provided as a kit with supporting materials. Parents showed less interest in physical activity programming and believed their children were receiving adequate levels. When discussing gross motor development, mothers showed great interest for information. They preferred the information be targeted to them versus their child. Overall, there was little interest in a structured activity program. Conclusions and Implications: Formative research with this audience demonstrated that eating behaviors, particularly picky eating, were more of an issue than physical activity. However, mothers were very receptive to the term gross motor development. Targetingmessages to address physical activity is essential in reaching this audience. Funding: National Institute of Child Health and Human Development.

The feelings club: randomized controlled evaluation of school-based CBT for anxious or depressive symptoms

Children with anxious or depressive symptoms are at risk of developing internalizing disorders and their attendant morbidity. To prevent these outcomes, school-based cognitive-behavioral therapy (CBT) has been developed, but few studies include active control conditions. We evaluated a preventive CBT program targeting internalizing symptoms relative to an activity contrast condition post-intervention and at 1-year follow-up. One thousand one hundred and thirty-nine children from Grades 3-6 from a diverse sample of schools, were screened with the Multidimensional Anxiety Scale for Children and Children's Depression Inventory. Those with t>60 on either measure were offered participation in a randomized 12-week trial, school-based group CBT versus a structured after-school activity group of equal duration. We explored several therapeutic elements as potential predictors of change. One hundred and forty-eight children participated (84 boys, 64 girls; 78 CBT, 70 contrast; 57% Caucasian) and 145 completed the program. Self-reported anxious and depressive symptoms decreased significantly over time (η(2)=.15 and .133, respectively), with no group by time interaction. There was a trend toward fewer children meeting diagnostic criteria for an anxiety disorder on the Anxiety Disorders Interview Schedule at 1-year post-CBT than post-contrast (6/76 versus 12/69). Positive reinforcement of child behavior was associated with change in anxiety symptoms; checking homework was understood with change in depressive symptoms. Findings suggest that children with internalizing symptoms may benefit from both school-based CBT and structured activity programs. Replication, longer follow-up, and further studies of therapeutic elements in child CBT are indicated. ISRCTN Registry identifier: ISRCTN88858028, url: http://www.controlled-trials.com/.

Interventions for Increasing Physical Activity at Child Care

Experts agree that physical activity is critical to children's health and development. Child care is an ideal setting that could be used to increase physical activity given the large number of young children enrolled. To effectively address physical activity at child care, it is necessary to understand what strategies are most effective. This article reviews existing intervention studies targeting physical activity conducted within a child care setting (including preschools, nursery schools, and day care). Given the limited work in this setting, liberal criteria were used that allowed for inclusion of studies with diverse outcomes (physical activity, physical activity-related, motor skills) and a variety of research designs (randomized control, quasi-experimental, single group). Searching six databases, 1355 studies were located, and 19 met inclusion criteria. Half of the studies that assessed intervention impact on physical activity reported significant findings. All five studies measuring motor skills and eight assessing physical activity-related outcomes demonstrated generally positive findings. Although the variety of outcome measures and research quality made it difficult to draw conclusions, findings do provide encouragement that regularly provided, structured physical activity programs can increase the amount and intensity of physical activity that children receive and improve children's motor skills. These studies also demonstrate that the organized child care setting provides multiple targets for intervention beyond structured activity programs; however, additional studies are needed to explore such opportunities.

EFFECTIVENESS OF AN EXERCISE TRAINING PROGRAM ON YOUTH WITH ASPERGER SYNDROME

Although exercise training programs are effective in improving physical fitness and motor competence in typically developing youth, insufficient data of the impact of interventions are available in youth with Asperger syndrome (AS). The purpose of this study was to examine the efficacy of an exercise program as part of an ongoing vocational training program for adolescents with AS on motor competence and physical fitness. Twenty adolescents with AS (mean age = 16.8yrs) were enrolled in this study. A quasi-experimental nonequivalent-control-group design with a follow-up measurement over a period of six months was followed. The intervention group received a 12-week physical exercise program focusing on improving motor competence and physical fitness. The structured activity program was applied 3 days a week for 1 hour. Data collection included pre-, post-, and follow-up evaluations using the Movement Assessment Battery for Children (M-ABC-II) and the EUROFIT physical fitness test together with training diaries and comments from teachers and guardians. Two 2X3 repeated measures ANOVAs indicated improved motor competence and physical fitness that was sustained over time. The exercise training program was successful with adolescents with AS and implementation of similar programs is therefore recommended.

Therapeutic Effects of an Outdoor Activity Program on Nursing Home Residents with Dementia

Objective: The purpose of this one-year pilot study was to obtain preliminary information on the effects of an outdoor activity program, in comparison to an indoor activity program, on sleep and behavior in nursing home residents with dementia. Structured activity programs have been shown to improve dementia-related behavior problems, and there are some indications that improved behavior is associated with improved sleep. Previous research has shown that sleep disturbance is common in nursing home residents, and that limited exposure to light bright enough to entrain circadian rhythms contributes to their sleep problems. Thus, we expected to see improvements in behavior in both the outdoor and indoor activity groups, but improvements in sleep in the outdoor activity group only. Methodology: A two-group (outdoor program, indoor program) two phase (baseline, intervention) design was used. Subjects were randomized to the outdoor or indoor program groups. Sleep and behavior disturbance were assessed over a 10-day period at baseline (usual activity conditions, which were expected to include little or no time spent outdoors) and at intervention (daily structured activity program offered outdoors or indoors). Sleep was assessed with wrist actigraphs with photocells, which also allowed for monitoring of light exposure. Behavior disturbance was assessed with the Cohen-Mansfield Agitation Inventory. Both activity programs were offered Monday-Friday over a 2 week period, included similar content and were offered by research project staff. The analytical approach emphasized primary changes between baseline and intervention measures of sleep and behavioral symptoms in the two activity groups. Because this was a pilot study, the significance level was set a priori at p< 0.10. Findings: The outdoor activity group experienced significant improvements in maximum sleep duration. Both groups showed significant improvements in total sleep minutes. There also was a significant improvement in verbal agitation in the outdoor activity group.

A structured activity programme reduces depressive symptoms in moderately depressed older men with coronary heart disease, but not women

A structured activity programme reduces depressive symptoms in moderately depressed older men with coronary heart disease, but not women

Human exposure to indoor residential cyfluthrin residues during a structured activity program.

Estimations of absorbed daily dosage (ADD) of chemicals following contact with treated surfaces may be required for risk assessment and risk management. Measurements of ADD based upon biomonitoring are a more reliable data than estimates of ADD from environmental measurements since they require fewer default assumptions. Study participants performed a structured activity program (SAP) 24-h after an application of Tempo((R)) 20 WP (cyfluthrin; 3-(2,2-dichloroethenyl)-2,2-dimethyl-cyclopropanecarboxylic acid cyano(4-fluoro-3-phenoxy-phenyl)-methyl ester) on a medium pile, plush nylon carpet. Measurements of total cyfluthrin residue and transferable cyfluthrin residue (cotton cloth and CDFA roller; personal sock and short dosimetry) were made at 3, 7, 12, 23, 47.5, and 407.5 h. Total cyfluthrin residue extracted from (Soxhlet extraction) carpet was 11.1+/-2.7 microg/cm(2) 1 h prior to the SAP. Transferable cyfluthrin residue obtained through analysis of cotton cloths rolled with a weighted 30-pound cylinder was 0.11 microg/cm(2). Cyfluthrin residues from socks and shorts were 0.74+/-0.23 and 0.15+/-0.03 microg/cm(2), respectively. Urine was collected at 12-h intervals during a 72-h period following the SAP and was analyzed for the cyfluthrin biomarker, 4-fluoro-3-phenoxybenzoic acid (FPBA). The mean cyfluthrin equivalents excreted were 8.4+/-5.7 microg/person (yielding an absorbed dosage of 0.10 microg/kg; n=7). The elimination half-life was 16+/-5 h. All predicted ADDs based upon environmental measurements overestimated the ADDs measured by urinary excretion.

Loss of abdominal fat and improvement of the cardiovascular risk profile by regular moderate exercise training in patients with NIDDM

Non-insulin-dependent diabetes mellitus (NIDDM) is associated with an increased cardiovascular risk. Glycaemic control alone is often insufficient to control diabetic dyslipidaemia and other cardiovascular risk factors associated with NIDDM. The present trial was designed to evaluate the effects of physical activity as an adjunct to standard diabetes therapy on the lipid profile, blood pressure, glycaemic control, weight and body fat. Sixteen well-controlled (HbA1c 7.5%) patients with NIDDM participated in a regular aerobic exercise training programme at 50-70% maximal effort over 3 months. Thirteen age- and sex-matched patients with NIDDM served as a control group. The 3-month intervention with an increase in physical activity from 92 (mean +/- SD) +/- 79 to 246 +/- 112 min per week (p < 0.001) by means of a structured activity programme resulted in significant improvement of plasma lipids with a 20% decrease in triglycerides (p < 0.05), unchanged total cholesterol and increases in high-density lipoprotein and high-density lipoprotein-3 subfraction of 23% (p < 0.001) and 26% (p < 0.001), respectively. Systolic and diastolic blood pressure decreased significantly from 138 +/- 16 to 130 +/- 17 mm Hg (p < 0.05) and 88 +/- 10 to 80 +/- 10 mmHg (p < 0.001), respectively. Resting heart rate decreased from 81 +/- 13 to 74 +/- 14 beats per minute (p < 0.001), waist-hip circumference ratio decreased from 0.96 +/- 0.11 to 0.92 +/- 0.10 (p < 0.001) and body fat decreased from 35.3 +/- 7.2 to 33.0 +/- 8.0% (p < 0.001). These effects occurred independently of changes in body weight and glycaemic control, which did not change during the study. This study shows that improvement in physical fitness by introducing regular physical exercise as part of the treatment programme in patients with NIDDM results in a significant amelioration of their cardiovascular risk profile.

The Effects of a Structured Curriculum on Nutrition and Fitness Knowledge and Attitude in an Introductory College Weight Training Class

With the health care system's increased emphasis on disease prevention as opposed to treatment, many wellness efforts are directed at adult audiences, often emphasizing fitness or nutrition. Substantial evidence exists that providing knowledge may change attitude and affect the lifestyles of younger persons, and that incorporating both exercise and nutrition provides a more well-rounded understanding of disease prevention. The purpose of this study was to assess the effects of a structured nutrition and fitness curriculum on nutrition and fitness knowledge and nutrition and fitness attitude in an introductory college weight training class. The study involved 99 college students registered for four sections of an introductory college weight training class. Subjects were mostly male (68%), freshmen and sophomores (78%), with an average age of 18.6. Two classes were randomly assigned to each of the two treatments -- exercise/ education (experimental) or exercise only (control). The experimental group received fifteen 30-minute lessons in nutrition (6) and fitness (9), comprising half of their class time over an eight week period; the control group received no educational units, but used all class time exclusively for exercise. The four dependent variables (fitness knowledge, nutrition knowledge, fitness attitude, and nutrition attitude) were measured using three existing instruments, which had been adapted for the purposes of this project. The instruments were administered in a pre-test post-test experimental design, using repeated measures analysis of variance to determine the differences between the groups on the four variables. For both fitness knowledge and nutrition knowledge, the total sample exhibited a significant increase (p<.0001), while the experimental group demonstrated a significantly greater increase (p<.0001) than did the control group. The total sample demonstrated a significant increase for both fitness attitude (p<.000l) and nutrition attitude (p<.01), with no significant difference between the two groups. Although the increase in nutrition attitude was somewhat greater for experimental subjects than for control subjects, the difference did not reach statistical significance. Results indicate that participation in weight training alone positively impacted on all variables, suggesting that involvement in physical activity may have caused subjects to seek more information and change their attitudes in a positive direction. It is suggested that the knowledge acquired by experimental subjects, while not associated with a greater increase in attitude score, may in fact serve as a resource and/or provide motivation after participation in a structured activity program has ended.

Short-term Effects of Probation Programs: An Evaluative Study

Five specialised programs within one probation agency were evaluated in terms of their short-term effects upon offender clients. The programs were (1) a psychoeducational training course for drink-driving offenders; (2) a structured activity program for offenders with convictions for autocrime; (3) a probation Day Centre; (4) a cognitive training package; and (5) a groupwork program for women offenders. Evaluative material included (a) descriptive information on the aims and contents of programs; (b) criminological data on clients; (c) monitoring data on attendance and dropout rates; and (d) pre- and posttest performance on a range of knowledge, attitudinal, and skills-based measures. Clients on each program were compared with control samples in custody or on Community Service Orders in a quasi-experimental design. Results are interpreted in the light of meta-analytic reviews of offender treatment-outcome research.