Treatment Engagement From the Perspective of the Offender

• Author: Danielle Sturgess,Jessica Woodhams,Matthew Tonkin
• Published date: 01 December 2016
• Date: 01 December 2016
• DOI: http://doi.org/10.1177/0306624X15586038
• Subject Matter: Articles

International Journal of

Offender Therapy and

Comparative Criminology

2016, Vol. 60(16) 1873 –1896

© The Author(s) 2015

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DOI: 10.1177/0306624X15586038

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Article

Treatment Engagement

From the Perspective of

the Offender: Reasons

for Noncompletion and

Completion of Treatment—

A Systematic Review

Danielle Sturgess1, Jessica Woodhams1,

and Matthew Tonkin2

Abstract

A systematic review of the reasons why detained adult offenders fail to attend or

successfully complete treatment programme(s) was conducted. An initial search of

the literature identified 2,827 articles, which following evaluation against explicit

inclusion/exclusion criteria and a quality assessment was reduced to 13 studies.

Extracted data from the 13 studies were synthesised using a qualitative approach.

Despite the 13 studies being heterogeneous in design, there was consensus on the

reasons offenders gave for completion/noncompletion of treatment. The majority

were consistent with the factors outlined in the Multifactor Offender Readiness

Model (MORM) and included a perceived lack of self-efficacy, negative perceptions of

treatment, staff and peers, an inability to regulate emotions, and a lack of perceived

choice and control. A lack of opportunity to engage in established, professionally

run, groups, as well as perceived inadequate support from members of staff, was also

associated with poor engagement and noncompletion of treatment.

Keywords

treatment readiness, treatment engagement, offender, MORM

1University of Birmingham, UK

2Birmingham City University, UK

Corresponding Author:

Danielle Sturgess, Forensic Psychologist in Training, School of Psychology, University of Birmingham,

Frankland Building, Edgbaston, Birmingham B15 2TT, UK.

Email: DXS239@bham.ac.uk

586038IJOXXX10.1177/0306624X15586038International Journal of Offender Therapy and Comparative CriminologySturgess et al.

research-article2015

1874 International Journal of Offender Therapy and Comparative Criminology 60(16)

Background

Engagement and Noncompletion of Treatment

The completion by offenders of evidenced-based treatment is thought to increase pub-

lic safety through reduction in recidivism (Polaschek, 2012). However, rehabilitation

through treatment is dependent on the offenders’ engagement in treatment, which has

been identified as characteristically low (McMurran, 2002). Low engagement includes

poor attendance, attending treatment but making little contribution, engaging in inap-

propriate/disruptive behaviour, poor cooperation with treatment facilitators, and/or

failing to complete various tasks, including homework (Howells & Day, 2007).

Noncompletion refers to the premature cessation of treatment (Howells & Day, 2007).

It can take one of three forms: expulsion due to inappropriate behaviour, an adminis-

tratively based exit due to the offender being transferred or released from their current

environment for reasons unrelated to programme attendance/engagement, and patient

initiated dropout, in which the offender actively chooses to stop attending treatment

(Wormith & Olver, 2002). For simplicity, throughout this review, the terms low

engagement and noncompletion will be used interchangeably.

Rates of noncompletion of treatment range quite dramatically depending on type of

offender and their residing environment. Meta-analysis has revealed that within insti-

tutional settings, including prison and secure hospitals, the rate of noncompletion for

cognitive behavioural interventions is 14.66%, but reaches 45.45% in community

samples (McMurran & Theodosi, 2007) suggesting retention is harder to achieve in

the community (Ashford, Wong, & Sternbach, 2008; Cullen, Soria, Clarke, Dean, &

Fahy, 2011). In terms of offender type, rates of up to 86% are reported for sexual

offenders (Larochelle, Diguer, & Laverdiere, 2011) and between 12% and 34% for

violent offenders (Hornsveld, 2005).

Noncompletion is associated with an increased risk of recidivism when compared

with offenders who complete treatment and even when compared with untreated

offenders (Day, Casey, Ward, Howells, & Vess, 2010; McMurran & Theodosi, 2007).

Other aversive outcomes associated with treatment noncompletion include increased

length of stay in secure hospital settings (Long, Dolley, & Hollin, 2013) which in turn

is associated with significant costs of up to £749 (US$1,206) per day, totalling approx-

imately £273,000 (US$439,530) per annum, per patient (Durcan, Hoare, & Cumming,

2011).1 Not only does noncompletion waste valuable resources, but it also prevents

new admissions from benefiting from such services (McMurran, Huband, & Duggan,

2008).

Noncompletion of treatment also has a negative impact on staff morale (Howells &

Day, 2007), which itself is associated with reductions in staffing levels and an increase

in patients’ risk of violence (Totman, Hundt, Wearn, Paul, & Johnson, 2011).

Furthermore, poor staff morale can negatively affect the therapeutic alliance between

staff and offenders, which is an essential component for offender engagement in treat-

ment (Ward, Day, Howells, & Birgden, 2004). Thus, noncompletion of treatment

results in what can be considered a vicious circle of disengagement within secure

services.