Evaluating START NOW: A Skills-Based Psychotherapy for Inmates of Correctional Systems

Kersten, Linda; Cislo, Andrew M.; Lynch, Miranda; Shea, Kirsten; Trestman, Robert L.

doi:10.1176/appi.ps.201400471

Cited by 20 publications

(25 citation statements)

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“…Peer support demonstrated positive effects on internalized stigma and personal recovery”. Similarly, for the manualised START NOW for offending behaviour the lead validation study [ 79 ] showed that in a retrospective cohort analysis of prisoners, the more sessions attended, the greater the benefit. In a secondary analysis of this non-randomised cohort study [ 80 ] the authors noted “unmeasured external forces concurrent to START NOW may have influenced later hospitalization (for example, other programming).” We believe this is particularly important for two reasons.…”

Section: Discussionmentioning

confidence: 99%

Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

et al. 2018

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BackgroundWe evaluated change in response to multi-modal psychosocial ‘treatment as usual’ programs offered within a forensic hospital.MethodsSixty nine patients with a diagnosis of schizophrenia or schizoaffective disorder were followed for up to four years. Patient progress was evaluated using the DUNDRUM-3, a measure of patient ability to participate and benefit from multi-modal psychosocial programs and the HCR-20 dynamic items, a measure of violence proneness. We report reliable change index (RCI) and reliable and clinically meaningful change (RMC). We assessed patients’ cognition using the MCCB, psychopathology using the PANSS. The effect of cognition and psychopathology on change in DUNDRUM-3 was examined using hierarchical multiple regression with age, gender, and baseline DUNDRUM-3 scores.ResultsThe DUNDRUM-3 changed significantly (p < 0.004, d = 0.367, RCI 32% of 69 cases, RMC 23%) and HCR-20-C (p < 0.003, d = 0.377, RCI 10%). Both cognition and psychopathology accounted for significant variance in DUNDRUM-3 at follow up. Those hospitalized for less than five years at baseline changed more than longer stay patients. Mediation analysis demonstrated that the relationship between cognition and change in violence proneness (HCR-20-C) was both directly affected and indirectly mediated by change in DUNDRUM-3.ConclusionsChange in response to multi-modal psychosocial programs (DUNDRUM-3) reduced a measure of violence proneness over four years. Forensic in-patients’ ability to benefit from psychosocial treatment appears to be a function of the outcome measure used, unit of measurement employed, degree of cognitive impairment, psychopathology, and length of stay. Lower risk of re-offending may be partially attributable to participation and engagement in psychosocial interventions.

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Section: Discussionmentioning

confidence: 99%

Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

et al. 2018

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“…Entirely available in the public domain, START NOW was originally designed for low-resource settings and as a psychotherapy for incarcerated individuals who present with mood dysregulation, impulsivity, aggression, and interpersonal discord. A retrospective cohort analysis of 850 patients in state prison demonstrated a significantly reduced risk of disciplinary infractions and future psychiatric inpatient days with a dose response effect [16,17]. Furthermore, START NOW has been associated with reduced risk of criminal recidivism in an evaluation of a specialized alternative-to-incarceration program for individuals with serious mental illness and co-occurring substance use disorder [18].…”

Section: Introductionmentioning

confidence: 99%

Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorder

et al. 2021

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Background Clinical trials provide consistent evidence for buprenorphine’s efficacy in treating opioid use disorder (OUD). While the Drug Addiction Treatment Act of 2000 requires physicians to combine medication-assisted treatment (MAT) with behavioral intervention, there is no clear evidence for what form or elements of psychotherapy are most effective when coupled with MAT to treat OUD. This investigation involves focus groups designed to collect patient opinions about a specific psychotherapy, called START NOW, as well as general beliefs about various elements of psychotherapy for treating OUD. Our analysis reveals trends about patient preferences and strategies for improving OUD treatment. Methods Subjects included patients enrolled in buprenorphine/naloxone MAT at our institution’s office-based opioid treatment program. All subjects participated in a single START NOW group session, which was led by a provider (physician or nurse practitioner trained and standardized in delivering START NOW). Consented subjects participated in satisfaction surveys and audio-recorded focus groups assessing individual beliefs about various elements of psychotherapy for treating OUD. Results Overall, 38 different focus groups, 92 participation events, and 44 unique subjects participated in 1-to-6 different START NOW session/audio-recorded focus group sessions led by a certified moderator. Demographic data from 36/44 subjects was collected. Seventy-five percent (33/44) completed the START NOW Assessment Protocol, which revealed self-reported behavioral trends. Analysis of all 92 START NOW Satisfaction Questionnaire results suggests that subjects’ opinions about START NOW improved with increased participation. Our analysis of audio-recorded focus groups is divided into three subsections: content strategies for new psychotherapies, implementation strategies, and other observations. For example, participants request psychotherapies to target impulsivity and to teach future planning and build positive relationships. Conclusions The results of this study may guide implementation of psychotherapy and improve the treatment of OUD, especially as it relates to improving the modified START NOW program for treating OUD. Our study also reveals a favorable outlook of START NOW with increased participation, suggesting that any initial reticence to this program can be overcome to allow for effective implementation.

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“…A treatment evaluation study of the original START NOW intervention in the United States showed that this approach is effective for difficult-to-manage, impulsive and aggressive detainees [63]. Analyses of a mixed-gender sample of inmates ( n = 946 participation events) indicated that START NOW was effective in reducing the number of disciplinary reports received.…”

Section: Introductionmentioning

confidence: 99%

START NOW - a comprehensive skills training programme for female adolescents with oppositional defiant and conduct disorders: study protocol for a cluster-randomised controlled trial

Kersten

Prätzlich

Mannstadt

et al. 2016

Trials

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BackgroundIn Europe, the number of females exhibiting oppositional defiant disorder (ODD) and conduct disorder (CD) is growing. Many of these females live in youth welfare institutions. Consequently, there is a great need for evidence-based interventions within youth welfare settings. A recently developed approach targeting the specific needs of girls with ODD and CD in residential care is START NOW. The aim of this group-based behavioural skills training programme is to specifically enhance emotional regulation capacities to enable females with CD or ODD to appropriately deal with daily-life demands. It is intended to enhance psychosocial adjustment and well-being as well as reduce oppositional and aggressive behaviour. We present the study protocol (version 4.1; 10 February 2016) of the FemNAT-CD intervention trial titled ‘Group-Based Treatment of Adolescent Female Conduct Disorders: The Central Role of Emotion Regulation’.Methods/designThe study is a prospective, confirmatory, cluster-randomised, parallel-group, multi-centre, randomised controlled trial with 128 institutionalised female adolescents who fulfil the diagnostic criteria of ODD and/or CD. Institutions/wards will be randomised either to provide the 12-week skills training as an add-on intervention or to provide treatment as usual. Once the first cycle is completed, each institution will run a second cycle with the opposite condition. Primary endpoints are the pre-post change in number of CD/ODD symptoms as assessed by a standardised, semi-structured psychiatric interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime, CD/ODD section) between baseline and the end of intervention, as well as between baseline and a 3-month follow-up point. Secondary objectives include pre-post change in CD/ODD-related outcome measures, most notably emotional regulation on a behavioural and neurobiological level after completion of START NOW compared with treatment as usual.DiscussionTo our knowledge, this study is the first to date to systematically investigate the effectiveness of an adapted integrative psychosocial intervention designed for female adolescents with ODD and CD in youth welfare settings.Trial registrationGerman Clinical Trials Register (DRKS) identifier: DRKS00007524. Registered on 18 December 2015 and with the World Health Organisation International Clinical Trials Registry Platform.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1705-6) contains supplementary material, which is available to authorized users.

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Evaluating START NOW: A Skills-Based Psychotherapy for Inmates of Correctional Systems

Abstract: START NOW was shown to be an effective treatment option for reducing disciplinary infractions by inmates.

Cited by 20 publications

References 21 publications

Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorder

START NOW - a comprehensive skills training programme for female adolescents with oppositional defiant and conduct disorders: study protocol for a cluster-randomised controlled trial

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