Clinical trial NCT02524171: Justice-Involved Veterans and Moral Reconation Therapy
Official title: Improving Treatment Engagement and Outcomes Among Justice-involved Veterans
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Antisocial Personality Disorder
Substance Use Disorder
Keywords: crime
mental health
substance abuse
homelessness
Veterans
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
First posted: 2015-08-14
Enrollment: 344
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to determine whether Moral Reconation Therapy (MRT) is effective for reducing risk of criminal recidivism and improving other health-related outcomes (substance use, mental health, housing, and employment problems) among justice-involved Veterans entering residential mental health treatment programs in the Department of Veterans Affairs (VA).

Detailed description: Approximately 146,000 Veterans are released each year from correctional settings; however, two thirds will likely reoffend and return to the justice system. Antisocial cognitions and behaviors are the strongest predictors of reoffending and are highly prevalent among justice-involved Veterans (JIVs). However, in the absence of treatments with demonstrated effectiveness with JIVs, no systematic approach to address antisocial cognitions and behaviors has been implemented in VA. Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention that aims to reduce antisocial cognitions and behaviors. MRT has the best empirical support for reducing risk for criminal recidivism among civilian offenders, and its associated mechanisms (improvements in interpersonal functioning and impulse control) have been linked to improvements in health-related outcomes that are also risk factors for recidivism (substance use, mental health, housing, and employment problems). However, no trials have been conducted with JIVs. Differences between JIVs and justice-involved civilians (e.g., prevalence of traumatic brain injuries; interpersonal problems) suggests prior research on MRT with civilians may not be generalizable, and prompted the VA's Veterans Justice Programs (VJP) and the developers of MRT to develop a Veteran-specific curriculum of this intervention.

Using the new Veteran-specific manual, the overarching objective of the current proposal is to implement and evaluate MRT as an intervention to reduce risk for criminal recidivism and improve health-related outcomes among JIVs in VA Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs). Using a Hybrid Type 1 design, this project will test the effectiveness of MRT in a multisite Randomized Controlled Trial (RCT) (Palo Alto, Little Rock, and Bedford VAs) and conduct a formative evaluation to facilitate future implementation of MRT in VA.

Eligibility criteria: Inclusion Criteria:

* Veterans who

  * (a) are entering a mental health residential rehabilitation treatment program (MH RRTP) at one of three study sites (Palo Alto, Little Rock, or Bedford VA), and
  * (b) had been arrested and charged and/or released from incarceration in the past 5 years prior to MH RRTP admission will be eligible for participation

Exclusion Criteria:

* The only exclusion criterion is being too cognitively impaired to understand the informed consent process and other study procedures.

Primary outcomes:
measure: Risk for Criminal Recidivism (Criminal Thinking)
timeFrame: 6 months (post-baseline)
measure: Risk for Criminal Recidivism (Criminal Thinking)
timeFrame: 12 months (post-baseline)
Secondary outcomes:
measure: Alcohol Use
timeFrame: 6 months (post-baseline)
measure: Drug Use
timeFrame: 6 months (post-baseline)
measure: Criminal Associates
timeFrame: 6 months (post-baseline)
measure: Employment Problem Severity
timeFrame: 6 months (post-baseline)
measure: Alcohol Use Problem Severity.
timeFrame: 6 months (post-baseline)
measure: Legal Problem Severity
timeFrame: 6 months (post-baseline)
measure: Family/Social Problems
timeFrame: 6 months (post-baseline)
measure: Alcohol Use
timeFrame: 12 months (post-baseline)
measure: Drug Use
timeFrame: 12 months (post-baseline)
measure: Criminal Associates
timeFrame: 12 months (post-baseline)
measure: Employment Problem Severity
timeFrame: 12 months (post-baseline)
measure: Alcohol Use Problem Severity.
timeFrame: 12 months (post-baseline)
measure: Legal Problem Severity
timeFrame: 12 months (post-baseline)
measure: Family/Social Problems
timeFrame: 12 months (post-baseline)
Other outcomes:
Locations:
city: North Little Rock
country: United States
facility: Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
state: Arkansas
city: Palo Alto
country: United States
facility: VA Palo Alto Health Care System, Palo Alto, CA
state: California
city: Bedford
country: United States
facility: VA Bedford HealthCare System, Bedford, MA
state: Massachusetts
Study officials:
affiliation: VA Palo Alto Health Care System, Palo Alto, CA
name: Daniel M. Blonigen, PhD MA
role: PRINCIPAL_INVESTIGATOR
References:
citation: Timko C, Booth BM, Han X, Schultz NR, Blonigen DM, Wong JJ, Cucciare MA. Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users. Rural Ment Health. 2017 Apr;41(2):110-122. doi: 10.1037/rmh0000065.
citation: Blonigen DM, Cucciare MA, Timko C, Smith JS, Harnish A, Kemp L, Rosenthal J, Smelson D. Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration. BMC Health Serv Res. 2018 Mar 7;18(1):164. doi: 10.1186/s12913-018-2967-3.
citation: Blonigen DM, Smith JS, Javier S, Cucciare MA, Timko C, Nevedal AL, Filice N, Rosenthal J, Smelson D. Implementation Potential of Moral Reconation Therapy for Criminal Recidivism in Mental Health Residential Programs. Psychiatr Serv. 2022 Aug 1;73(8):856-863. doi: 10.1176/appi.ps.202100089. Epub 2022 Jan 26.
citation: Blonigen DM, Cucciare MA, Byrne T, Shaffer PM, Giordano B, Smith JS, Timko C, Rosenthal J, Smelson D. A randomized controlled trial of moral reconation therapy to reduce risk for criminal recidivism among justice-involved adults in mental health residential treatment. J Consult Clin Psychol. 2022 May;90(5):413-426. doi: 10.1037/ccp0000721. Epub 2022 Apr 11.
citation: Gibbon S, Khalifa NR, Cheung NH, Vollm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev. 2020 Sep 3;9(9):CD007668. doi: 10.1002/14651858.CD007668.pub3.