Design and Development of a Telephone-Linked Care (TLC) System to Reduce Impulsivity among Violent Forensic Outpatients and Probationers

Abstract

Forensic services face the challenge of reducing relapse among clients with a history of violent crime. An automated interactive voice response (IVR) service of the complex Telephone-Linked Care (TLC) type, with a focus on reducing impulsivity, could improve the adequacy of service responses to client needs. Theoretically based in Dialectical Behavior Therapy (DBT), Cognitive Behavior Therapy (CBT) and Motivational Interviewing (MI), the forensic TLC system offers interactive conversations on coping with the emotions of anger, shame and loneliness; activities of daily life such as getting out of bed, asking for help, visiting social services and taking medication; and other areas such as hearing voices, drinking alcohol and self-critical thoughts. We describe the user's flow through the system, with an in-depth synopsis of the hearing voices intervention. Issues regarding voluntary versus mandatory use of the system are addressed in connection with prospective introduction of the system in forensic settings.

Automated telephone interventions for problematic alcohol use in clinical and population samples: a randomized controlled trial

“…For this study, Swedish help-seekers from the general population and from clinical settings were recruited. The interventions used were modified versions of previously evaluated interventions [ 31 , 35 , 36 ].…”

eHealth in Treatment of Offenders in Forensic Mental Health: A Review of the Current State

“…Not many of the included studies discussed the development of their interventions. The ones who did discuss it pointed out the importance of iterative development with continuous evaluation cycles ( 37 , 53 , 59 ) and the incorporation of opinions, preferences, and characteristics of people ( 37 , 54 , 57 , 71 , 81 , 82 ). This is in line with recent insights into eHealth development, which state that a good development process requires iterative, evidence-based strategies that acknowledge the complex interrelations between people, technology, and the health-care context ( 85 , 86 ).…”

The Barratt Impulsiveness Scale-11 in Community and Incarcerated Samples: Motor and Nonplanning Impulsivity Effects on Criminal Recidivism

“…In fact, Nelson and Trainor (2007) suggest that variables such as impulsivity, aggression, violence, psychopathy, and substance abuse have a common biological background, and that interventions for these variables could be more effective if they focused directly on the impulsivity trait (Moeller et al, 2001). Accordingly, Berman et al (2012) state that an approach that targets impulsive behavior specifically, particularly for individuals with a history of violent acts, might be more effective in reducing violent criminal recidivism than separate interventions for related factors (i.e., substance abuse). According to these authors, an intervention targeting impulsivity can help individuals to identify, accept, and manage their personal distress, and this can lead to a better control of their impulsive feelings (i.e., lack of reflection).…”