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Overcoming problems associated with the utilisation of RCTs in forensic settings

TCP. Overcoming problems associated with the utilisation of RCTs in forensic settings. Treatment Change Project. Jane Clarbour, Cynthia McDougall and Amanda Perry for the Treatment Change Design Team (TCDT). Acknowledgements. TCP. Treatment Change Project.

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Overcoming problems associated with the utilisation of RCTs in forensic settings

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  1. TCP Overcoming problems associated with the utilisation of RCTs in forensic settings Treatment Change Project Jane Clarbour, Cynthia McDougall and Amanda Perry for the Treatment Change Design Team (TCDT). RCT in the Social Sciences: Challenges and Prospects

  2. Acknowledgements TCP Treatment Change Project Treatment Change Project: Evaluating cognitive behavioural programs in prisons Treatment Change Design Team Cynthia McDougall Roger Bowles Jane Clarbour Amanda Perry David Richardson Jeremy Miles Catherine Hewitt Padraic Monaghan Ben Cross RCT in the Social Sciences: Challenges and Prospects

  3. RCTs in the UK Criminal Justice System TCP Treatment Change Project • Review of RCT literature in UK CJS (Farrington & Welsh, 2003) • RCTs at height of popularity in 1960s in the UK CJS • Clarke and Cornish (1970’s) disillusionment with RCTs in the CJS following their study of the Kingswood training school RCT • Therapeutic community • Traditional regime  2 year follow up = no difference in reconviction rates RCT in the Social Sciences: Challenges and Prospects

  4. RCTs in the UK Criminal Justice System TCP Treatment Change Project Martinson (1974) doctrine that Nothing Works: • Led to policy change in CJS and reduction of RCTs to evaluate CBT programmes What Works literature of 1980’s • Led to increasing use of accredited CBT programmes • Increasing number of evaluations using pre-to-post test design Department of Health/Home Office 2000 White Paper Part IIReforming the Mental Health Act suggested: “There is a need to undertake long term randomised trials with long term follow up” (section 6.53) RCT in the Social Sciences: Challenges and Prospects

  5. Problems encountered TCP Treatment Change Project • Feasibility studies (Farrington & Jolliffe, 2002; Farrington et al., 2001). • Young offenders had education disrupted • Institutional staff • Insufficient case flow • Few people assessed RCT in the Social Sciences: Challenges and Prospects

  6. Background to current RCT TCP Treatment Change Project Research on Cognitive Behavioural Programmes in 1990s • Positive results on reconviction rates Research in 2000-2004 • Mixed results unsure whether ETS and R&R courses are effective for all. RCT in the Social Sciences: Challenges and Prospects

  7. Aims of the current project TCP Treatment Change Project • To evaluate ETS courses. • Which offenders benefit from treatment and under what conditions? • What effect do programmes have on prison behaviour of those who complete & dropout from participation? RCT in the Social Sciences: Challenges and Prospects

  8. The study TCP Treatment Change Project Evaluation of ETS treatment programme undertaken within H.M. Prison Service Cognitive-behavioural programme 10 prisons Target group Young & Adult male offenders Normal IQ On remand/sentenced Eligible to complete Enhanced Thinking Skills (ETS) RCT in the Social Sciences: Challenges and Prospects

  9. Waiting-list control design (Time) RCT in the Social Sciences: Challenges and Prospects

  10. Waiting-list control design (Time) RCT in the Social Sciences: Challenges and Prospects

  11. Ethical considerations TCP Treatment Change Project • Unique identification number • Waiting list control avoids withholding treatment • BUT random allocation considered unethical if release date is before start of treatment hence cohort design RCT in the Social Sciences: Challenges and Prospects

  12. Random Allocation Model RCT in the Social Sciences: Challenges and Prospects

  13. Design TCP Treatment Change Project Randomised control trial Experimental group • Individuals randomly allocated to start course immediately Waiting list control group • Individuals randomly allocated to start the next course PLUS: Additional cohort group • Individuals prioritised by treatment managers as requiring treatment immediately RCT in the Social Sciences: Challenges and Prospects

  14. Example: Joe Bloggs TCP Treatment Change Project • 25 years old • Convicted of Burglary and Theft (prolific offender) • Referral to psychology department from sentence planning • Highly motivated to attend ETS course • Release Date (4 weeks after completion of course) RCT in the Social Sciences: Challenges and Prospects

  15. Problems in random allocation TCP Treatment Change Project • Formation of the group • Group Dynamics (e.g., motivational factors) • Operational decisions (e.g., security issues) • Offender characteristics (e.g., release dates) • Static factors (e.g., prison population) RCT in the Social Sciences: Challenges and Prospects

  16. Reasons for non-completion TCP Treatment Change Project • Change in prisoner status (e.g., mains to VP). • Removed from course due to behaviour • Transferred to another prison • Released • Deselected from course RCT in the Social Sciences: Challenges and Prospects

  17. Summary TCP Treatment Change Project • Despite advantages of RCT, few have been conducted. • Acknowledgement of the practical and ethical implications in a forensic setting • BUT  333 individuals have been randomly allocated so far…. one of the largest trials to be conducted RCT in the Social Sciences: Challenges and Prospects

  18. Centre for Criminal Justice Economics & Psychology Wentworth College Heslington York, YO1O 5DD E-mail:criminaljustice@cj.york.ac.uk Tel: +44 (0) 1904 434880 RCT in the Social Sciences: Challenges and Prospects

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