Therapeutic Community Interventions Research Articles

Interventions to reduce harms related to drug use among people who experience incarceration: systematic review and meta-analysis

Mortality, suicide, self-harm, and substance use are elevated among people who are incarcerated. There is a wide range of heterogeneous interventions aimed at reducing these harms in this population. Previous reviews have focused on specific interventions or limited their findings to drug use and recidivism and have not explored interventions delivered after release from prison. Our aim is to examine the effect of interventions delivered to people who use drugs during incarceration or after release from incarceration, on a wide range of outcomes. In this systematic review and meta-analysis, we searched Embase, MEDLINE, and PsycINFO databases up until Sept 12, 2023 for studies published from Jan 1, 1980 onwards. All studies evaluating the effectiveness of any intervention on drug use, recidivism outcomes, sexual or injecting risk behaviours, or mortality among people who use psychoactive drugs and who were currently or recently incarcerated were included. Studies without a comparator or measuring only alcohol use were excluded. Data extracted from each study included demographic characteristics, interventions, and comparisons. Pooled odds ratios and risk ratios were calculated using random-effects meta-analyses. We identified 126 eligible studies (47 randomised controlled trials and 79 observational studies) encompassing 18 interventions; receiving opioid-agonist treatment (OAT) in prison reduced the risk of death in prison (one study; hazard ratio 0·25; 95% CI 0·13-0·48), whereas receiving OAT in the first 4 weeks following release reduced risk of death in the community (two studies; relative risk 0·24; 95% CI 0·15-0·37). Therapeutic community interventions reduced re-arrest at 6-12 months (six studies; odds ratio [OR] 0·72; 95% CI 0·55-0·95) and reincarceration at 24 months (two studies; OR 0·66; 95% CI 0·48-0·96). There was scarce evidence that OAT and syringe service provision are effective in reducing injecting risk behaviours and needle and syringe sharing. There are effective interventions to reduce mortality and recidivism for people who use drugs who have been incarcerated. Nonetheless, there are also substantial gaps in the research examining the effect of interventions on risk behaviours and mortality during incarceration and a need for randomised designs examining outcomes for people who use drugs after release. Australian National Health and Medical Research Council.

EFFECTIVENESS OF THE THERAPEUTIC COMMUNITY INTERVENTION PROGRAM OF THE DEPARTMENT OF HEALTH-TREATMENT AND REHABILITATION CENTER (DOH-TRC)

This study aimed to assess the effectiveness of the Therapeutic Community Intervention Program operated by the Department of Health-Treatment and Rehabilitation Center (DOH-TRC) in the Philippines. The research focused on four components of the program, namely the Residential, Outpatient, Aftercare, and Recovery Home programs. The study determined the areas of success and those requiring improvement to enhance the overall effectiveness of each program. Structured questionnaires and surveys were administered to two groups of respondents-program staff and patients-who had received the respective intervention programs. The survey questions were designed to evaluate the effectiveness of various aspects of the programs, such as treatment plan individualization, program implementation fidelity, program structure, family involvement, patient support systems, post-treatment monitoring, relapse prevention, and post-recovery support. The statistical analysis revealed significant insights into the effectiveness of each program. The Residential and Recovery Home programs received high mean scores, indicating that staff and patients perceived them as highly effective. However, the Outpatient and Aftercare programs demonstrated areas requiring attention and improvement. The Outpatient Program showed that family support, patient anxiety towards reintegration into the community, and the absence of a program for patient and family interaction were significant concerns. For the Aftercare Program, areas of concern included the lack of a structured patient monitoring system and financial support for staff assigned to monitor aftercare patients. The findings offered valuable insights into areas that needed enhancement to ensure optimal patient outcomes. Based on the data findings, a comprehensive action plan was developed to improve the effectiveness of the Therapeutic Community Intervention Program. The action plan involved specific key performance indicators, activities, budget allocations, timelines, personnel involvement, and continuous quality improvement efforts tailored to each program. The study provided information on the advantages and disadvantages of the Therapeutic Community Intervention Program implemented by DOH-TRC. By implementing the proposed action plan, the center can further improve the effectiveness of its Residential, Outpatient, Aftercare, and Recovery Home programs, ultimately leading to better patient outcomes and contributing to the programs overall success in combating substance abuse and promoting lasting recovery. Continuous evaluation and improvement will be essential to ensure the program remains responsive to the evolving needs of its participants and consistently delivers high-quality care. KEYWORDS: Rehabilitation, Residential Program, Outpatient Program, Aftercare Program, Recovery Home Program

The effectiveness of a day hospital mentalization-based therapy programme for adolescents with borderline personality traits: Findings from Touchstone-Child and Adolescent Mental Health Service.

Individuals with borderline personality disorder (BPD) are at a substantial risk of harm to themselves and others, experience high levels of functional impairment and typically are high users of tertiary healthcare to address their mental health concerns. As indicators for BPD typically emerge in adolescence, a day therapy service in Bentley, Western Australia, Touchstone Child and Adolescent Mental Health Service (CAMHS), was developed as an intensive intervention for adolescents with indicators for BPD and its associated symptomology. Touchstone utilizes mentalization-based therapy (MBT) in a therapeutic community setting, where the current study sought to document the anecdotal outcomes using the data provided at Touchstone, to enable a greater understanding of this treatment approach for adolescents with indicators for BPD. Forty-six participants attended the Touchstone programme between 2015 and 2020. The programme involved 6months of MBT (group and individual), occupational therapy, education and creative therapies. Measures of self-injury, mood and emergency department presentations were collected pre- and post-programme. Results indicate that participants show a reduction in non-suicidal acts and thoughts, as well as a reduction in negative moods and feelings from pre-Touchstone to post-Touchstone. There is also a decrease in participant presentation to tertiary emergency departments for mental health concerns. The current study shows evidence for the efficacy of Touchstone as an MBT therapeutic community intervention to reduce symptoms of emerging BPD and effectively reduce presentations to emergency departments for mental health presentations, alleviating pressure on tertiary hospitals and reducing economic impact of adolescents within this demographic.

Interventions for drug-using offenders with co-occurring mental health problems.

Interventions for drug-using offenders with co-occurring mental health problems.

Violence prevention in psychiatry: an umbrella review of interventions in general and forensic psychiatry

Relative risks of violence in psychiatric patients are high compared to the general population and existing evidence in non-psychiatric populations may not translate to reductions in violence in psychiatric populations. We searched 10 databases including Medline, EMBASE, CINAHL and Scopus, from inception until August 2015 for systematic reviews and meta-analyses of violence prevention interventions in psychiatry. Reviews were included if they used a hard outcome measure (i.e. police or hospital recorded violence, or reincarceration) and contained randomized or non-randomized controlled studies. Five reviews met our inclusion criteria (n = 8876 patients in total), of which four received a GRADE rating of ‘low’ or ‘very low’. Three randomized studies (n = 636) reported that therapeutic community interventions may reduce reincarceration in drug-using offenders with co-occurring mental illness (‘moderate’ GRADE rating). The lack of intervention research in violence prevention in general and forensic psychiatry suggests that interventions from non-psychiatric populations may need to be relied upon.

Therapeutic Community Treatment of an Inmate Population with Substance Use Disorders: Post-Release Trends in Re-Arrest, Re-Incarceration, and Drug Misuse Relapse.

This systematic literature review maps the evidence for the effectiveness of the therapeutic community interventions (TCI) in reducing re-arrest, re-incarceration or drug misuse following release from prison, including the extent to which these effects are retained over time. The databases searched for the review included PsychINFO, Medline and Scopus and reference lists from relevant articles published between 2007 and 2014. Only quantitative studies that examined the effectiveness of TCI for a prisoner population with drug dependence at the time of initial incarceration were considered. Fourteen studies were identified for inclusion in the review. Three-quarters of the studies reported TCI were effective in reducing rates of re-incarceration. About 70% of studies that examined follow-up rates of drug misuse relapse found TCI effective in reducing rates of drug misuse amongst participants. TCI participation reduced re-arrests events in 55% of the studies. Results suggest TCI effective in the short-term rather than longer term for reducing rates of re-incarceration among participants, and to a slightly lesser extent, drug misuse relapse.

Effects of a Therapeutic Community on Korean Substance Abusers in Prison

ABSTRACT. This study tested the effectiveness of a therapeutic community (TC) intervention on imprisoned Korean substance abusers. Volunteer participants from 2 Korean prisons were randomly assigned to either the experimental group (n = 24) with the TC intervention or a control group (n = 24) with optional supportive sessions. Pretest and posttest data were collected on measures of abstinence self-efficacy and problem-solving skills. Participants in the TC intervention showed significant increases in abstinence self-efficacy and problem-solving skills, whereas those in the control group did not. The differences in abstinence self-efficacy for the TC were found for 2 of 3 subscales: Problem-Solving Confidence and Approach-Avoidance Style but not Self-Control. Further study is needed to replicate these findings with larger Korean prison populations and to establish the relationship between these skill dimensions and subsequent drug use and criminal recidivism for this population. Nevertheless, the findings suggest potential benefits of using a TC intervention with imprisoned Korean substance abusers.

A therapeutic community for personality disorder in a high secure intellectual disability service: inception and early experiences

PurposeThis paper seeks to explain the reasons for use of a therapeutic community for personality disorder in a high secure intellectual disability service.Design/methodology/approachThe paper describes the rationale for, and early experiences of, a therapeutic community intervention for people with mild intellectual disability and personality disorder in a high secure setting.FindingsNo empirical findings are reported. Evaluation is being undertaken and will be reported in due course.Originality/valueThe therapeutic community approach has not been applied in forensic intellectual disability before, and this paper therefore describes an original and, in many ways, radical intervention.

Evaluation of a therapeutic community intervention for men with intellectual disability and personality disorder

PurposeTherapeutic Community (TC) approaches have not been applied to individuals with intellectual disability. This paper aims to present preliminary evaluation of a planned TC service intervention in a secure setting for men with mild intellectual disabilities and personality disorder over a period of 12 months.Design/methodology/approachThe TC intervention group (n=11) was compared on repeated measures of violent incidents, seclusion hours, and informant and self‐report clinical outcome measures collected six months prior to, six and 12 months post the start of the intervention. The TC group was also compared with a pragmatic control group (n=10) receiving treatment as usual (TAU).FindingsClinical changes in the predicted direction were evident, with the TC group showing comparatively less pathology both over time and in relation to the comparison group. However, change was more likely for clinical scales measuring internalising problems, than for externalising problems. The mean number of violent incidents did not reduce over time. There was nevertheless a strong trend towards reduction in seclusion hours in the TC treatment group over time, with significant differences between groups also being observed at the six and 12 months stage.Research limitations/implicationsThe sample size is small. The literature suggests a minimum of 18 months in TC treatment, so this is an interim evaluation. The planned evaluation period is two years, although attrition may affect the numbers of participants in the study after this period.Practical implicationsTC treatment is consistent with the core principles of involvement and choice. The findings of this preliminary service evaluation are promising in terms of the TC approach being a potential mode of treatment suitable for a proportion of patients with learning disability in secure conditions.Originality/valueTC approaches are innovative in forensic learning disability. No previous evaluations of TC based interventions have been published in this field, and this paper contributes to an evidence base.

Linguistic Analysis to Assess the Effect of a Mindfulness Intervention on Self-Change for Adults in Substance Use Recovery

ABSTRACT Substance use is a pervasive health problem. Therapeutic community (TC) is an established substance abuse treatment but TC environments are stressful and dropout rates are high. Mindfulness-based TC (MBTC) intervention was developed to address TC stress and support self-change that could impact treatment retention. Self-change was assessed through feeling and thinking word-use in written stories of stress from 140 TC residents in a historical control group and 253 TC residents in a MBTC intervention group. Data were collected 5 times over a 9-month period. Linguistic analysis showed no differences between the groups over time; however, over all time points, the MBTC intervention group used fewer negative emotion words than the TC control group. Also, negative emotion (P < .01) and anxiety (P < .01) word-use decreased whereas positive emotion word-use increased (P < .05) over time in both groups. Descriptive data from linguistic analyses indicated that sustained self-change demands participation in mindfulness behaviors beyond the instructor-guided MBTC intervention.

The Effectiveness of Interventions for Drug-Using Offenders in the Courts, Secure Establishments and the Community: A Systematic Review

Interventions for drug-using offenders are employed internationally to reduce subsequent drug use and criminal behavior. This paper provides information from a systematic review of 24 randomized controlled trials (RCTs) conducted between 1980 and 2004. Thirteen of the 24 trials were included in a series of meta-analyses, and tentative conclusions are drawn on the basis of the evidence. Pretrial release with drugs testing and intensive supervision were shown to have limited success when compared to routine parole and probation, with effect sizes favoring routine parole and probation. Therapeutic community interventions showed promising results when compared to dispensation of treatment to individuals as usual, reducing risk of future offending behavior. A few studies evaluated the effectiveness of assertive case management and other community-based programs, but due to the paucity of information few inferences could be drawn from these studies. Little is known about the cost and cost effectiveness of such interventions, and the development of established protocols is required.