Identifying effective moderators of cognitive behavioural trauma treatment with caregiver involvement for youth with PTSD: a meta-analysis.

Children can develop post-traumatic stress disorder (PTSD) and mental health symptoms after traumatic events. This meta-analysis evaluated the influence of moderators of cognitive behavioural trauma treatment (CBTT) with caregiver involvement in traumatized children. A total of 28 studies were included, with 23 independent samples and 332 effect sizes, representing the data of 1931 children (M age = 11.10 years, SD = 2.36). Results showed a significant medium overall effect (d = 0.55, t = 2.478, p = 0.014), indicating CBTT with caregiver involvement was effective in treating PTSD (d = 0.70), with somewhat smaller effect sizes for internalizing, externalizing, social, cognitive and total problems (0.35 < d > 0.48). The positive treatment effect was robust; we found somewhat smaller effect sizes at follow-up (d = 0.49) compared to post-test (d = 0.57) assessments. Furthermore, several sample (i.e. child's age, gender, and trauma event), programme (i.e. the duration of treatment, number of sessions), study (i.e. control condition, type of instrument, informant, type of sample), and publication (i.e. publication year and impact factor) characteristics moderated the treatment outcomes of the child. In sum, the results of our meta-analysis might help to improve the effectiveness of cognitive behavioural trauma treatment for youth with PTSD, and guide the development of innovative trauma interventions that involve caregivers. Implications for theory and practice are discussed.

A qualitative inquiry on recovery needs and resources of individuals with intellectual disabilities labelled not criminally responsible.

BACKGROUND: Recovery is a widely accepted paradigm in mental health care, whilst the correctional and forensic-psychiatric field is still searching for foundations for its implementation. Knowledge regarding recovery of persons with intellectual disabilities in secure contexts is limited. This study assesses recovery needs and resources among persons with intellectual disabilities labelled not criminally responsible and investigates the impact of the judicial label on recovery processes. METHODS: A sample of 26 individuals was composed purposively, and in-depth interviews were conducted. Recurrent themes were identified using thematic analysis. RESULTS: Traditional recovery themes emerged from the narratives, next to aspects of recovery in a forensic or correctional context. However, the operationalization and proportional impact are specific for this sample. CONCLUSIONS: The social dimension overarches all other recovery dimensions. The integration of an explicit social rhetoric is imperative, including contextual, relational, interactional and societal dimensions. This offers pathways to reverse the traditional, paternalistic model of exclusion and classification.

Factors related to the quality of life of older prisoners.

PURPOSES: There is evidence of an increasing emphasis on the relevance of the quality of life-paradigm as an outcome measure for clients in geriatric, forensic, as well as correctional care. This paper aims to explore to what extent variables that were categorized according to the main areas of the Good Lives Model ('the self', 'the body' and 'social life') are related to the quality of life domains of older imprisoned offenders. METHODS: Data were collected by means of a structured questionnaire administered in individual interviews with 93 older prisoners aged 60 years and over in 16 prisons of the Dutch-speaking region in Belgium. Characteristics of the main GLM-areas were identified by specifically designed items as well three validated instruments (psychiatric disorders, loneliness, and frailty). Dependent variables consisted of the four sub-domains of the WHOQOL-BREF instrument which measures quality of life in four domains, namely: (1) physical health, (2) psychological health, (3) social relationships, and (4) environment. Structural equation modelling (SEM) was used for statistical analysis. RESULTS: Individual variables, such as satisfaction with activities, were related to the older prisoners' QoL in several domains simultaneously. Other than suicidal ideation, psychopathological symptoms had no significant relation to quality of life. CONCLUSIONS: Approaches enabling older prisoner to disclose their interests, experiences, and feelings are important in prison. Special attention should be given to psychiatric and age-related symptoms of older prisoners, since they may not be noted by the prison staff, as older prisoners seem to be poorer self-advocates as compared to their younger peers.

Choosing when choices are limited: The role of perceived afforded choice and autonomy in prisoners' well-being.

Although prison life is generally characterized by little choice and autonomy, there exists considerable variation in the number and type of choices offered to different prisoners. Based on self-determination theory, which maintains that perceived afforded choice and autonomy are of crucial importance for individuals' psychological functioning, we investigated the relation between choice, autonomy satisfaction, and subjective quality of life among prisoners. We drew on quantitative cross-sectional data gathered among 156 Belgian prisoners (Mage = 38.60, 88.5% men). Participants filled out questionnaires measuring perceived afforded choice, autonomy satisfaction, and quality of life. The main hypotheses were tested using structural equation modeling. Results showed that perceived afforded choice related to higher subjective quality of life within prison. This relation was partially accounted for by elevated levels of autonomy satisfaction. Supplementary analyses revealed that the benefit of choice emerged regardless of participants' valuation of choice, and that perceived afforded choice with regard to daytime activities (i.e., leisure activities, work, and education) yielded the strongest effect. Collectively, results suggest that enhancing perceived afforded choice and autonomy satisfaction may provide important avenues for promoting prisoner quality of life. These findings are discussed in light of the growing focus on strength-based approaches and psychological well-being within the prison context. (PsycINFO Database Record

Quality of life in persons with intellectual disabilities and mental health problems: an explorative study.

The field of intellectual disability (ID) is strongly influenced by the Quality of Life paradigm (QOL). We aimed at investigating whether or not the QOL paradigm also applies to clients with ID and cooccurring mental health problems. This paper aims at stimulating a debate on this topic, by investigating whether or not QOL domains are universal. Focus groups with natural and professional network members were organized to gather qualitative data, in order to answer two questions: (1) Are the QOL dimensions conceptualized in the model of Schalock et al. applicable for persons with ID and mental health problems? (2) What are indicators relating to the above-mentioned dimensions in relation to persons with ID and mental health problems? The results offer some proof for the assumption that the QOL construct seems to have universal properties. With regard to the second question, the study revealed that the natural and professional network members are challenged to look for the most appropriate support strategies, taking specific indicators of QOL into account. When aspects of empowerment and regulation are used in an integrated manner, the application of the QOL paradigm could lead to positive outcomes concerning self-determination, interdependence, social inclusion, and emotional development.

Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective.

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

Formerly Detained Adolescents' Narratives: On the Interplay between Quality of Life and Desistance.

In recent years, a growing trend to consider strengths and protective factors in studies on desistance from crime has emerged. The present study explores three formerly detained adolescents' narratives, aiming to tease out how Quality of Life (QoL) and desistance interact in pathways towards a "better life." The narratives suggest that the journey towards a better life is highly individual, and may unfold via multiple pathways characterized by an ambivalent relationship between QoL and desistance. Alongside the importance of individual aspects and social support, societal barriers and opportunities play a significant role in creating new chances to re-build a life and prosocial identities. This reflects earlier findings that desistance is not an individual responsibility. It is essential to support young people to overcome societal barriers that impede participation in society and living a good life. This research adds to growing evidence of strengths-based approaches to rehabilitation, such as the Good Lives Model (GLM).

Opening up the black box of recovery processes in persons with complex mental health needs: a qualitative study of place-making dynamics in a low-threshold meeting place.

BACKGROUND: The recovery processes of persons with complex mental health needs take a slow and unpredictable course. Despite the fact that a number of essential building blocks of recovery in this population have been identified (e.g. social relationships, treatment, personal beliefs), the actual process of recovery in persons with complex mental health needs largely remains a black box. The aim of this study was to gain insight into how the recovery processes of persons with complex mental health needs take place, by applying a relational geographical approach and scrutinizing the place-making dynamics of one low-threshold meeting place in Belgium engaging with this group. METHODS: Data collection took place during the height of the COVID-19 pandemic by means of 11 in-depth interviews with different involved actors (service users, staff members, volunteers) and analyzed thematically. RESULTS: Results showed how the daily practice of the meeting place is continuously reproduced through place-making rituals that create an inclusive space of hospitality, are fueled by creative processes and form an indispensable counterweight for service users' mental health needs. CONCLUSIONS: To further open up the 'black box' of recovery in persons with complex mental health needs, it is vital to focus our analytic gaze onto recovery as a dynamic and relational practice.

Systematic Aggression Registration in Forensic Psychiatric Care: A Qualitative Study on Preconditions for Successful Implementation.

Available research emphasizes the importance of getting a systematic overview of inpatient aggression in forensic psychiatric care. However, the same research does not focus on how systematic aggression registration should be introduced in clinical practice. To facilitate the use of systematic aggression registration instruments, it is very relevant to gain insight into the perspective of staff members on the introduction of these instruments in daily clinical practice. Additionally, preconditions for achieving a successful implementation can be considered. Therefore, this study aims to gain insight into the perspective of the staff members on the implementation of a systematic aggression registration instrument-that is, the MOAS-in a forensic psychiatric unit. Interviews (n = 8) and a focus group with staff members were carried out. Three main themes: (1) creating the most appropriate context for introduction, (2) choice for the MOAS as relevant instrument, and (3) perpetuating the use of the MOAS in clinical practice are scrutinized. The mentioned preconditions can be used as guidelines when implementing systematic aggression registration in clinical practice. We hope that this paper can inspire other forensic psychiatric facilities to introduce systematic registration of aggressive incidents.

On the biopolitics of humane drug policies: What can we learn from 19th century sobriety boards?

Background: In accordance with recommendations from The United Nations' Chief Executives Board of Coordination, several countries are in the process of reforming their punitive drug policies towards health-based approaches - from punishment to help. The Portuguese model of decriminalisation is generally seen as a good model for other countries and has been scientifically described in favourable terms, and not much scrutinised. Method: This article draws on foucauldian archaeological and genealogical approaches in order to understand and compare governance logics of the 19th century Norwegian sobriety boards and 21st century Portuguese commissions. In doing this, we problematize contemporary drug policy reform discussions that point to the "Portuguese model", which aims to stop punishing and start helping drug-dependent people, are problematised. Findings: The Portuguese commissions investigate whether drug-using people are dependent or not. Dependency, circumstances of consumption and their economy are considered when the commission decides on penalising, assisting, or treating the person, or a combination of all this. This model was studied alongside the Norwegian sobriety boards mandated by the Sobriety Act that was implemented in 1932. Sobriety boards governed poor alcoholics. Authorities from the sobriety movement were central in creating sobriety policies that culminated in sobriety boards. The Portuguese commissions have similarities to Norwegian sobriety boards. They make use of sanctions and treatment to govern people who use illicit substances to make them abstain, with the view that this is emancipatory for these people. The different apparatuses have distinct and different ways of making up, and governing their subjects. Conclusion: This article contributes to debates on drug policy reforms and aims to investigate whether they might produce biopower effects of governance masked by an emancipatory language. There is a need for critical studies on drug policy reforms to avoid policies that maintain divisions and control marginalised populations.

A Qualitative Study on Young Women's Lives Prior to and Four Years after Youth Detention: Examining the Good Lives Model's Aetiological Assumptions.

Detained female adolescents constitute a vulnerable, challenging, and understudied minority. Interventions for DFA are still dominated by risk management approaches with less focus on strength-based approaches such as the Good Lives Model (GLM). This study explored the functionality of DFA's behaviour prior to and four years after release from detention, using the GLM as the guiding theoretical framework. A theory-driven thematic analysis was conducted of 30 in-depth interviews with former DFA (Mage = 20.80), exploring the fulfilment of their basic human needs (e.g., relatedness, independence) before and after detention. Before detention, the young women experienced multiple problems trying to fulfil multiple human needs, often contributing to poor balance in their lives and their antisocial behaviour. Although external and internal obstacles to fulfilling human needs were still present at follow-up, important improvements were noted, e.g., in the scope of their human needs and the resources available to fulfil their needs. The findings provide additional insights into the issues experienced by young women in detention and indicate there are opportunities to assist these young women, through the development of appropriate resources and capacities which provide them with appropriate means for fulfilling their needs and moving towards a personally meaningful and prosocial life.

A qualitative exploration of service users' and staff members' perspectives on the roles of inpatient settings in mental health recovery.

BACKGROUND: Today, international mental health care increasingly focuses on creating recovery-oriented systems of support. This study aims to unravel the daily practice of an inpatient psychiatric ward that engages with persons with complex mental health needs. METHODS: 17 in-depth interviews were conducted with patients and staff of the ward. Data was analyzed by means of thematic analysis. RESULTS: Three important functions of the ward were identified in the participants' experiences. First, it functions as an asylum, a safe environment where patients can 'simply be'. Second, the ward is experienced as a particularizing space, as support is organized in an individualized way and patients are encouraged to reconnect with their own identity. Third, the ward functions as a transitional space towards a valuable community life, in which finding adequate housing is of central importance. CONCLUSIONS: The results show that inpatient forms of support tally with personal and social dimensions of recovery and fulfill important roles in recovery-oriented systems of support.

Linkage and continuity of care after release from prison: an evaluation of central registration points for drug users in Belgium.

PURPOSE: This paper aims to report the findings of an evaluation study concerning the Central Registration Points (CRPs) for drug users in Belgian prisons. CRPs support drug users to link with community-based services. DESIGN/METHODOLOGY/APPROACH: The study applied a multi-method approach that involved an exploratory literature review; a secondary analysis of the CRPs' databases; a qualitative study of the perceptions of a diverse sample of stakeholders with regard to the functioning of CRPs; and a prospective registration study. FINDINGS: One-third of the clients never attended an outpatient or residential substance abuse service before prison entry. This illustrates that the CRPs managed to reach clients who were not previously reached by (substance abuse) treatment services. All interviewed actors emphasized the added value of the CRPs in terms of informing, contacting, motivating and referring prisoners with a substance abuse problem. PRACTICAL IMPLICATIONS: Based on the research findings, two issues seem to be of paramount importance in the successful practice of CRPs: the confidentiality and specific expertise on (substance abuse) treatment. Given the complex situation of drug users in prison, an independent positioning and categorical assistance with drug-specific expertise seem to be essential. ORIGINALITY/VALUE: CRPs can be considered to be one of the "building blocks" that contribute to high-quality care and continuity of care for drugs users in detention.

The bumpy road to change: a retrospective qualitative study on formerly detained adolescents' trajectories towards better lives.

BACKGROUND: Currently, the risk-oriented focus in forensic youth care is increasingly complemented by a growing interest in strengths-based approaches. Knowledge on how detention and the subsequent period in the community is experienced by adolescents, and which elements are helpful in achieving better lives can contribute to this emerging field. The current study aimed to retrospectively explore adolescents' experiences from the moment they were detained until 6 to 12 months after they left the institution, identifying positive aspects and strengths. METHODS: In-depth interviews were conducted with 25 adolescents (both boys and girls, 15-18 years old) on average 8 months after discharge from a closed institution in Belgium. A thematic analysis was performed using NVivo 11. RESULTS: Five themes and corresponding subthemes were identified: (1) adolescents' own strengths and resilience, (2) re-building personally valued lives, (3) making sense of past experiences, (4) moving away from a harmful lifestyle, and (5) (in-)formal supports. Most adolescents are on their way to finding a new balance in life, however, for a subgroup of them, this is still fragile. Adolescents highly emphasize the importance of feeling closely connected to at least one person; to receive practical help with regard to finances, work and housing; and to be able to experience pleasure and joy in their lives. CONCLUSIONS: Adolescents' narratives suggest that starting a journey towards a normative good life often goes along with an initial difficult period because of a sense of loss with regard to their former life. This stresses the importance of targeting rehabilitation towards prosocial goals and enhancing adolescents' quality of life on those life domains that matter most for them. Furthermore, we stress the importance of helping adolescents in overcoming structural barriers as a first step in supporting them in their trajectories towards better lives.

Recovery of Offenders Formerly Labeled as Not Criminally Responsible: Uncovering the Ambiguity From First-Person Narratives.

The recovery paradigm is a widely accepted strength-based approach in general mental health care. Particular challenges arise when applying this paradigm in a forensic context. To address these issues, the present study examined recovery based on first-person narratives of offenders formerly labeled as not criminally responsible of whom the judicial measure was abrogated. Eleven in-depth interviews were conducted to obtain information on lived experiences and recovery resources of this hard-to-reach and understudied population. The interviews focused on recovery and elements that indicated a sense of progress in life. Key themes were derived from the collected data. Descriptions of recovery resources followed recurrent themes, including clinical, functional, social, and personal resources. Participants also reported ambiguous experiences related to features of the judicial trajectory. This was defined as forensic recovery and can be seen as an additional mechanism, besides more established recovery dimensions, that is unique to mentally ill offenders.

Governance of substance use as a by-product of policing in Norway: A historical account.

AIM: The aim of this article was to study governance of drug use in Norway through a historical account. METHOD: A genealogy was conducted through the study of documentation and legal texts from the 1600s until contemporary times. FINDINGS: Based on legal texts addressing people using substances (both drugs and alcohol) various strategies for governance of drug use appears. The first section describes the emergence of institutions where people with alcohol problems were confined in a system originating the Dutch discipline houses. The second section describes the poor laws of the 1800s and the practice of the local poorhouses. The third section takes a look at the Vagrancy Act of 1900 and the state-owned labour camp at Opstad. The fourth section discusses the establishment of the sobriety boards and their role in confining alcoholics at cure homes. The fifth section describes developments in post-world-war Norway, with increased attention to illicit substances. CONCLUSIONS: The terminology justifying interventions is increasingly medicalised. Descriptions of the "drunkard" that appeared in 18th-century legal texts as immoral and free are contrasted by a positioning of this character as being a slave to his drinking in 20th-century political discourses, or as substance-dependent patients in the 21st century, alongside concerted efforts to dissolve open drug scenes.

Family Support Groups for Family Members of Mentally Ill Offenders: Family Expectations and Experiences.

Family Support Groups (FSGs) are developed for family members of mentally ill offenders. This study investigates family treatment expectations and experiences of an FSG. Family members were interviewed before ( n = 20) and after ( n = 17) attending an FSG. Results show that family members hesitated or were curious about the FSG, expected to receive peer support and universality of problems, to receive information and advice and thought about the safety and respect of the group. Family members experienced the treatment as helpful because it was supportive, they gained new insights and they felt relieved and satisfied. Many family members see the guidance of the therapists and the differences in family and gender roles as an added value of attending an FSG. However, considering the limitations of the study, future studies should gain insight in and stress the importance of the meaning of therapeutic processes for family members confronted with different psychiatric disorders and/or situations.

How family members of mentally ill offenders experience the internment measure and (forensic) psychiatric treatment in Belgium: A qualitative study.

Mentally ill offenders in Belgium can be subjected to mandated care under an "internment measure" if they are viewed as a danger to society. This study investigated how family members of mentally ill offenders experience this internment measure and view the (forensic) psychiatric treatment of their relative. Semi-structured interviews were conducted with 24 relatives and analysed using Nvivo 11. Six different themes emerged: (1) the criminal offence and the internment measure as an additional stigma, (2) ambivalent feelings towards the judicial system, (3) prison is not the right place to be, (4) mental health support as an answer to problems, (5) fight a losing battle, and (6) while there is life there is hope. The experiences of family members indicate the need for improved treatment guidelines that allow earlier compulsory interventions to prevent crime and preferential admission to (forensic) psychiatric facilities rather than prisons. In addition, family members expressed the need for better communication from mental health professionals and the judicial system during the process and greater availability of peer support.

Disability Policy Evaluation: Combining Logic Models and Systems Thinking.

Policy evaluation focuses on the assessment of policy-related personal, family, and societal changes or benefits that follow as a result of the interventions, services, and supports provided to those persons to whom the policy is directed. This article describes a systematic approach to policy evaluation based on an evaluation framework and an evaluation process that combine the use of logic models and systems thinking. The article also includes an example of how the framework and process have recently been used in policy development and evaluation in Flanders (Belgium), as well as four policy evaluation guidelines based on relevant published literature.