A realist analysis of treatment programmes for sex offenders with intellectual disabilities.

BACKGROUND: The resources used in treatment for sex offenders with intellectual disabilities have had much research attention, but less has been written about how participants are expected to respond (programme mechanisms). METHODS: A realist evaluation of seven programmes from the UK, Canada, USA, Switzerland and Germany was conducted. In semi-structured interviews, programme designers elucidated how they are intended to work. The data analysis was driven by the realist concern to expose programme mechanisms and intended outcomes. RESULTS: Two main outcomes are increasing risk management capacities and cultivating prosocial identities. These are achieved through developing insights into a person's risks, work on (sexual) self-regulation skills, sexual boundaries and personal values and by developing meaningful social roles and positive relationships. CONCLUSIONS: Over time, there have been changes to some of the treatment resources used. However, there were little differences in terms of the intended programme mechanisms and outcomes, which remained surprisingly consistent.

The Application of the Good Lives Model to Women Who Commit Sexual Offenses.

PURPOSE OF REVIEW: Despite increased studies which have identified the treatment needs of women who commit sex offenses, there are no empirically derived treatment models based upon a comprehensive theoretical paradigm. RECENT FINDINGS: Although current treatment models include similar goals and approaches, there are some important distinctions. The following article provides an overview of two treatment models, gender-responsive treatment and gendered strength-based treatment. These models were then examined to determine whether they could be integrated within a comprehensive theoretical rehabilitation framework such as the Good Lives Model. The Good Lives Model provides a comprehensive theoretical framework that allows for integration of the gender-responsive and gendered strength-based treatment models. These treatment models utilize strength-based approaches, risk-need-responsivity principles, cognitive behavioral techniques, and relational processes to foster change.

The Pursuit of Primary Human Goods in Men Desisting From Sexual Offending.

The good lives model proposes at least 10 primary human goods that are thought to be common to all individuals which, when secured, contribute to enhanced well-being and life satisfaction. Prosocial attainment of primary human goods is thought to promote desistance from crime. However, individuals convicted of sexual offenses face significant obstacles upon their reentry into the community that likely undermine their ability to obtain such goods. The current study explored the pursuit and attainment of primary human goods in a U.S. sample of men convicted of sexual offenses. We interviewed 42 men released into the community to examine the extent to which they desired and pursued primary human goods. Results highlighted that participants valued many of the human goods outlined in the good lives model, but their means to achieve them were restricted considerably by their correctional status. "Interpersonal relationships" and "life/survival" emerged most frequently during the interviews and were identified as the two most important goods. We discuss the negative impact of recent policies on participants' ability to pursue and attain human goods as well as the value of attending regular treatment in obtaining the goods of "knowledge" and "community." Implications for policy and directions for future research are provided.

The Virtuous Circle: A Grounded Theory Exploration of the Good Lives Model.

Sexual offenses evoke strong emotional responses and frequently elicit demands from society that offenders be indefinitely incarcerated or treated until they are deemed safe, which may impact the provision of therapeutic treatment for offenders. However, in recent years, there has been a proposal to move toward a positive, strengths-based treatment approach, namely the Good Lives Model (GLM). The present study used semi-structured interviews and a constructivist grounded theory approach to examine the experience of 13 men who were voluntarily engaging in or had completed a GLM community-based treatment program. A conceptual model emerged which outlines the process the men underwent, the factors they identified as crucial for change, and the perceived gains. The model extends previous work by exploring the process from the clients' perspective. Implications for future research, prevention, and treatment are discussed.

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.

Youth who sexual offended: primary human goods and offense pathways.

There has been an increased focus on understanding youth sexual offending in recent years, but there has been limited empirical research on the causes, pathways, and treatment of youth who have sexually offended-especially within a non-Western context. The Good Lives and Self-Regulation Models have often been used to understand and rehabilitate adult sexual offenders, but (unfortunately) there is scant research on youth who sexually offended using these models. The present study aims to describe the different primary goods that are associated with youth sexual offending behaviors in an Asian context. In addition, the study sought to explore whether the age of victim (child vs. nonchild) and nature of sexual offense (penetrative vs. nonpenetrative) influenced the youth's engagement in offense pathways. The results suggest that pleasure, relatedness, and inner peace were the primary human goods that were most sought after by a sample of 168 youth who sexually offended in Singapore. In addition, offender classification (in relation to the age of victim and nature of sexual offense) influenced the pathways to sexual offending. Therefore, these findings have important clinical implications for assessment, management, and intervention planning for youth who sexually offended.

The good lives model (GLM): an evaluation of GLM operationalization in North American treatment programs.

The good lives model (GLM) has become an increasingly popular theoretical framework underpinning sex offender treatment programs, and preliminary research suggests that the GLM may enhance the efficacy of programs that adhere to the Risk, Need, and Responsivity (RNR) principles. However, this potential rests on the appropriate operationalization of the GLM in practice. Operationalized appropriately, the GLM aims to facilitate risk reduction alongside equipping clients with the tools to live personally meaningful and fulfilling lives. However, misguided operationalization of the GLM could result in ineffective treatment and ultimately higher rates of reoffending. This article presents findings from a multisite study exploring how the GLM has been operationalized and the degree to which the GLM has been integrated in a sample of 13 North American treatment programs. A comprehensive coding protocol was developed that included items related to program aims and client induction/orientation, assessment, intervention planning, intervention content, and intervention delivery. Each site was visited and items were rated through a review of program documentation, interviews with program directors/managers, and observations of treatment groups. Findings from inductive (how the GLM was operationalized) and deductive (the extent to which the GLM was integrated) analyses are presented and GLM consistent and inconsistent practices are highlighted. The article concludes with suggestions for ways in which program responsiveness to the GLM could be enhanced.

Validation of the Good Lives Assessment of Domains in an Adult U.S. Sample.

This article offers initial validation of the Good Lives Assessment of Domains (GLAD). Data were collected from an electronic survey of 1,484 American adults. Participants were recruited via paid research panels using quotas set to match the U.S. population on Age, Race/Ethnicity, Sex/Gender, Education, and Household Income. Participants responded to a set of items including 48 original items to assess perceptions of life satisfaction in the 11 domains described in the GLM and the 5 Satisfaction with Life Scale (SWLS) items. Factor Analysis indicated 45 final items that loaded onto 9 unique factors, with all loadings ranging between 0.391 and 0.854 with acceptable model fit (RMR = 0.070, CFI = 0.866, RMSEA = 0.063). Cronbach's Alphas demonstrated acceptable reliability, with items achieving alpha scores greater than .7 in all individual domains and for overall GLAD scores. The correlation between GLAD and SWLS scores was .610 (p < .001). An Independent samples T-test found a significant mean difference (t = 4.360, p < .001, mean difference = 8.15737) in GLAD scores between respondents who reported no engagement in crime and deviance and those who reported engagement in crime and deviance.

Toward a Practice Framework for Throughcare Reintegration Programs.

Practice frameworks for programs supporting people to transition between prison and community are a critical resource for service agencies, researchers and policy makers. Although reintegration programs are often commissioned with reference to Risk-Needs-Responsivity and the Good Lives Model, these frameworks lack specificity for practical program design. Following recent meta-theoretical guidelines, we articulate a practice framework for reintegration programs over three levels: (1) principles and values; (2) knowledge related assumptions; and (3) intervention guidelines. Level 1 is drawn from the capability approach, which frames the goal of increasing the substantive freedom of individuals. Level 2 is drawn from desistance theory, which grounds claims that sustained cessation of offending is enabled by changes in people's self-labels and narrative, relationships with friends and family, access to resources, and community participation. Level 3 is drawn from throughcare service design and structures practice into seven domains. This framework has potential to reduce rates of reincarceration.

Integrating Strength-Based Approaches Into Cognitive Behavioral Therapy for Those Who Sexually Offend.

Research suggests that cognitive behavioral therapy (CBT) can decrease recidivism for those who sexually offend. The use of CBT for the treatment of those who sexually offend is recommended as part of the responsivity principle of the risk-needs-responsivity model. However, in recent years there has been a movement in the field to incorporate elements of positive psychology and strengths-based approaches such as the Good Lives Model into correctional treatment to increase motivation, retention, and program engagement. This article will explore how to effectively integrate strengths-based approaches into CBT interventions for individuals who have sexually offended.

The Role of Personal Resilience and Interpersonal Support in Building Fulfilling and Prosocial Lives: Examining the Good Lives Model among Young Women Four Years after Youth Detention.

Despite growing interest in strength-based rehabilitation frameworks, relevant internal/external resources that are likely to facilitate the rehabilitation of detained female adolescents (DFA) have been understudied. This study aims to fill this gap by studying the role of young women's personal resilience and interpersonal support in building fulfilling and prosocial lives 4 years after youth detention, thereby examining the strength-based good lives model (GLM). Forty-nine former DFA (Mage = 20.75) completed questionnaires about resilience, support, Quality of Life (QoL), and offending. Hierarchical multiple regression analyses showed that young women with more resilience displayed higher QoL and less offending, while more support was associated with higher QoL only. The relationship between resilience and QoL/offending did not depend upon the level of support. Overall, our results support the applicability of the GLM to former DFA, showing evidence for the importance of both internal and external resources in building fulfilling and prosocial lives.

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.

How the Good Lives Model Can Complement Mentalization-Based Treatments for Individuals Who Have Offended With Anti-Social Personality Disorder and General Forensic Mental Health Needs: Practice Update.

Limited research to date has focused on strengths-based rehabilitative approaches, such as the Good Lives Model (GLM) and the additive benefits such approaches have in ameliorating mental health needs of those in contact with forensic services. Mentalization-based therapies (MBTs) may be an effective treatment in forensic settings. This article aims to provide an overview of how GLM theory can integrate MBT within forensic settings. The review provides a conceptual overview of the many commonalities between GLM and MBT principles and provides information about how MBT can be embedded within forensic communities adhering to GLM principles. The article closes by offering an overview of the evidence of MBT approaches for individuals with anti-social personality disorder (ASPD) and those in contact with forensic services.

Reorienting Locus of Control in Individuals Who Have Offended Through Strengths-Based Interventions: Personal Agency and the Good Lives Model.

Having an external locus of control has been associated with a range of well-supported risk correlates of offending behavior. Further, individuals with an internal locus of control orientation are suggested to be more open to engaging in treatment and are also considered more likely to have successful treatment outcomes. In forensic settings, where individuals are subject to external controls and have little personal autonomy, it is important to consider what treatment approaches might be most successful in reorienting individuals' locus of control. The Good Lives Model (GLM) proposes a strengths-based approach to the rehabilitation of individuals who have offended. Within the GLM, an external locus of control is suggested to be associated with a deficit in the primary good of agency. In this article, we will provide a brief overview of the literature on locus of control and its hypothesized role in offending behavior. We will discuss how an external locus of control orientation is related to personal agency and how strengths-based models, such as the GLM, may assist with reorienting locus of control in individuals who have offended through promoting personal agency.

Longitudinal Network Structure and Changes of Clinical Risk and Protective Factors in a Nationwide Sample of Forensic Psychiatric Patients.

In this study, we investigated network configurations of 14 Clinical risk and protective factors in a sample of 317 male forensic psychiatric patients across two time points: at the time of admission to the forensic psychiatric centers (T1) and at the time of unconditional release (T2). In terms of network structure, the strongest risk edge was between "hostility-violation of terms" at T1, and between "hostility-impulsivity" at T2. "Problem insight-crime responsibility" was the strongest protective edge, and "impulsivity-coping skills" was the strongest between-cluster edge, at both time points, respectively. In terms of strength centrality, "cooperation with treatment" had the highest strength centrality at both measurement occasions. This study expands the risk assessment field toward a better understanding of dynamic relationships between individual clinical risk and protective factors and points to the highly central risk and protective factors, which would be the best for future treatment targets.

Offense-Related Issues in Forensic Psychiatric Treatment: A Thematic Analysis.

Characteristics unique to forensic psychiatric treatment include coming to terms with the offenses committed, the long duration of treatment and the assessment of the risk of repeat offending. This study describes the views of both patients and staff on the significance of the patient's offense as a part of forensic psychiatric rehabilitation. Eight forensic psychiatric patients and eight forensic psychiatric nurses from two forensic psychiatric hospitals in Finland participated in this study. Data were gathered by means of thematic interview and analyzed by means of thematic analysis. The findings suggest that patients and professionals alike concur that ascertaining the factors with a bearing on the offense, and working through the offense and the factors leading up to it, constitute an essential aspect of forensic treatment. This, in turn, has a bearing on the planning and administration of a treatment plan consisting of both medical and psychosocial support and interventions intended to enable patients to live independent, fulfilling lives, thus reducing the likelihood of reoffending. The findings of this study can be used as part of the development of international, standardized treatment models for clinical forensic psychiatric practices.

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.

Taking the Good Life to the Institution: Forensic Service Users' Perceptions of the Good Lives Model.

Previous literature has highlighted a number of concerns about forensic care and rehabilitation by those who use the services. The Good Lives Model (GLM) is a strength-based, humanistic approach to offender rehabilitation that has been largely overlooked by forensic mental health practitioners. This study explored the impact of a brief GLM program on forensic service users' perceptions of rehabilitation, both within and beyond therapeutic programs, using a thematically linked, multiple-case study research design. Pre-post comparisons of participants' perceptions of rehabilitation suggested three different outcomes: definite change, subtle change, and no change. Possible factors associated with participants' divergent experiences included level of exposure to the GLM, readiness to change, and practitioners' adherence to the GLM and experience with the model. The importance of attending to the wider system for successful implementation of this innovative approach is highlighted.

Psychological treatment of sex offenders: recent innovations.

This article describes recent innovations in the psychological treatment of sex offenders. These recent innovations include the incorporation of Andrews and Bonta's RNR Principles, Ward's "Good Lives Model," and Miller and Rollnick's Motivational Interviewing into a strength-based approach. An example of a strength-based treatment program is described and treatment outcome evaluations are summarized.

Addressing criminality in childhood: is responsivity the central issue?

The responsivity principle is the third element of the now well-established risk-need-responsivity (RNR) model of offender rehabilitation. Accruing evidence suggests it is often sacrificed in intervention programs. We aim to demonstrate the central importance of this principle when designing offender interventions by describing the results of a successful, highly responsive intervention for very young children (aged 7 upward) who have offended. A small slice of the offending population as a whole, child offenders are nevertheless tomorrow's serious, violent, and prolific lawbreakers, yet little is understood about what reduces their risk. Recent developments on responsivity are reviewed, before presenting the evaluation indicating significant and sustained drops in risk of recidivism. In-program factors such as the nature and dosage of interventions are examined, alongside outcome data. The article discusses how RNR and other models might apply to this particularly young and underresearched age group.