Preliminary Outcomes for an Intervention That Addresses Criminogenic Risk Factors Among Justice-Involved People with Serious Mental Illnesses

Background and Purpose: The mental health services field has spent almost 30 years developing interventions for justice-involved people with serious mental illnesses (SMI). However, none have been able to achieve a sustained impact on future justice system involvement. Correctional research has developed a class of interventions that reduces justice involvement by up to fifty percent by targeting the risk factors most closely associated with criminal behavior (i.e. criminogenic risk factors). In order to optimize the effectiveness of these interventions for use with this population, they need to be adapted to address the specific treatment needs of this people with SMI. This paper presents preliminary findings on the effectiveness of a correctional intervention that targets criminogenic risk factors, which was adapted specifically for use with people with SMI.

Methods: A small-scale efficacy study used an RCT design to examine the newly adapted correctional intervention’s impact on treatment targets (impulsivity, criminal thinking and attitudes, and interpersonal problems solving) and outcome (levels of aggression) among people with SMI incarcerated in prison. Thirty-four adult men with SMI (i.e. schizophrenia spectrum and major affective disorders) completed both baseline and 3-month follow-up interviews during the randomized control phase of the study (N=17 experimental group, N=17 control group). Treatment targets were measured using the Social Problem-Solving Inventory Revised-Long (SPSI:R-L), the Barrett’s Impulsivity Scale (BIS), and the Measure of Criminal Attitudes and Associates (MCAA). Outcomes were measured using the Aggression Questionnaire Short-form (AQ-short). T-tests and ANCOVAs were used to examine differences between the experimental and control groups at three-month interviews. Cohen’s d was used to calculate effect sizes for between-group differences.

Results: Analysis of baseline differences between the experimental and control groups found no significant differences between the groups on treatment targets and outcomes. Furthermore, analyses of differences between the experimental and control group on treatment target and outcomes scores at three-month interviews found significantly greater decreases in impulsivity levels among the experimental group with a large effect size (d = .84; p<.001). While not statistically significant, promising trends were also found for the between-groups analysis based on levels of aggression and criminal thinking and attitudes. The change score for the experimental group for aggression and criminal thinking and attitudes were -4.53 and -4.83 respectively, as compared to -2.53 and -1.46 among the control group.

Conclusion and Implications:

This is one of the first studies to examine the outcomes associated with a correctional intervention targeting criminogenic risk factors among people with SMI. The experimental intervention’s impact on levels of impulsivity in this study is particularly noteworthy, because this treatment target is associated with the largest reductions in criminal justice recidivism among the general population of individuals involved in the criminal justice system. While the results of this analysis are preliminary, they are promising and support further research on the use of correctional interventions that target criminogenic risk factors with people with SMI.