The Effects of Brief Motivational Interviewing on Treatment Outcomes among Partner Violent Offenders who Engage in Heavy Episodic Drinking
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1 The Effects of Brief Motivational Interviewing on Treatment Outcomes among Partner Violent Offenders who Engage in Heavy Episodic Drinking 000 Cory A. Crane ESRC Seminar Series Rochester Institute of Technology July 21, 2014
2 Acknowledgements Mentors Christopher Eckhardt Caroline Easton Maria Testa Kenneth Leonard Collaborators Jaye Derrick Susan Devine Stephanie Godleski Samuel Hawes Rebecca Houston Ash Levitt Dolores Mandel Lindsay Oberleitner Corey Pilver Brian Quigley Rita Samper Robert Schlauch Joel Sprunger Andrea Weinberger Funding R01 DA (PI: Easton) T32 AA (PI: Leonard)
3 Agenda Background: Intimate partner violence (IPV) IPV intervention efforts Motivational interviewing (MI) Readiness to change and IPV Current Research MI and readiness to change MI and problematic alcohol Future directions for MI among IPV offenders
4 Why We Care Prevalence (e.g., Archer, 2000) 23-28% of females (Desmarais et al., 2012) 19-22% of males (Desmarais et al., 2012) Consequences (e.g., Coker et al., 2002) Physical Psychological Social/Interpersonal Vulnerable Populations Domesticviolenceresearch.org
5 How do we intervene? Many available tools Mandatory Arrest Probation week Batterer Intervention Program (BIP) Group (90%), individual, couples Educational programs (Duluth) Skills training (CBT) Supplemental Programming (anger, psychiatric, substance)
6 Is Intervention Successful? Attendance and completion Predictive of future violence (Babcock & Steiner, 1999) < 50% attend a first session (Cadsky et al., 1996 ) 25% satisfy all treatment requirements (Cadsky et al., 1996 ) Recidivism Small ES for BIPs and IPV reduction (Babcock et al., 2004) Association of Tx and subsequent IPV (Feder and Wilson, 2005) Low compliance with treatment and treatment may not reliably reduce violence
7 Obstacles to Successful Intervention Insufficient treatment dose Ongoing legal involvement Biological / cognitive impairment Transportation, time, and cost of treatment Problems establishing a therapeutic alliance Limited resources (e.g., training, personnel, funding) Competing substance use and mental health needs Incongruity between client and treatment goals Insufficient motivation to conform to probationary guidelines Limited engagement in external efforts to facilitate change Motivation to Change
8 Does Motivation Matter? Substance Abuse-Domestic Violence (SADV) Intervention Sample: 78 male IPV perpetrators with substance use diagnoses mandated to a 12-week individual treatment program Measures: Motivation to change (stage of change) Timeline Follow Back Interview (IPV & Alcohol use) Analyses: Multilevel Growth Curve Modeling (HLM) Hypothesis: Offenders in later stages of change will a) Report lower IPV during Tx b) Evidence a weaker association between alcohol and IPV during Tx
9 SADV: Legal Factors Stage of change was moderated associated the with alcohol-ipv in the expected relationship direction as expected
10 Can we Improve Outcomes? Motivational Interviewing: A client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. (Miller & Rollnick, 2002) Carl Rogers Humanistic approach Motivation: Readiness, Willingness, Ability Ambivalence: a realistic assessment of the costs and benefits of change Spirit of MI: Autonomy, Collaboration, Evocation
11 MI for IPV Research supports MI as a method for improving outcomes among IPV offenders Treatment complinace (Taft et al., 2001) Treatment engagement (Musser et al., 2008) Cognitive change (Kistenmacher & Weiss, 2008) Recidivism (Woodin & O Leary, 2010) Questions remain Effectiveness of minimal dosing Potential for different effects based upon risk factors
12 The Current Study Evaluation of a single session brief motivational interview (BMI) on Tx outcomes among 82 male IPV offenders at 6-month follow-up Hypotheses: At 6-months post-adjudication, relative to males in a control group, males assigned to the BMI group will: 1. Have higher rates of Tx compliance 2. Have lower rates of subsequent criminal recidivism 3A. The relationship between condition and Tx compliance will be moderated by preprogram readiness to change. 3B. The relationship between condition and recidivism will be mediated by Tx attendance.
13 Initial assessment (baseline questionnaires) Sociodemographics Revised Conflict Tactics Scale (α =.81) I punched or hit my partner with something that could hurt. Dyadic adjustment Scale (α =.85) How happy are you in your relationship all things considered? Safe at Home Inventory (α =.79) There is nothing wrong with the way I handle situations but I get into trouble anyway. Alcohol and Drug Use Disorder Identification Tests (α =.82;.80) Assignment to condition Brief Motivational Interviewing(BMI) Control (alternative computer task) Questions and compensation Follow-up data collection Method
14 Procedure: BMI BMI: A minute BMI session Discuss responses to 1-2 items from the SAH Listen for and attend to change talk Help detect and resolve ambivalence Conclude with a change plan if applicable Therapist achieved 92% compliance with MI principles on MITI Sample Excerpts T: You said that you can t be happy in a relationship if things continue as they have. C: No way, neither would she. Breaks me up. T: Her happiness is important to you. Tell me more about that. C: Used to be great together. Made each other happy. I wish it was like that now. T: Things were happier before and it seems hard to get there now. C: No, I don t have to pay but it takes time, you know? So long as it helps, I guess. T: Even though the program may be inconvenient, you are staying open-minded.
15 Brief Motivational Interviewing (BMI) for IPV Motivation to Change: Partner well-being Avoid incarceration Avoid damages and fines The opinions of one s peers More satisfactory/less conflictual partnership Resistance to Change: Confrontational intervention Social skills deficits Goals: Establish rapport Elicit change talk Develop discrepancies Investment in Tx expectation of + outcomes Encourage Tx compliance Encourage nonviolence
16 Demographic Data Variable Control (n = 34) Mean SD Treatment (n = 48) Mean SD t df p Age Relationship Length Children Satisfaction Partner Violence Physical Psychological Readiness to Change Precontemplation Contemplation Preparedness Maintenance
17 Results: Compliance TxCompliance: Completed or in good standing with BIP. Temporal Effects of BMI Session Attendance Data Session Control BMI χ 2 (1, N = 74) p-value Intake 83.9% 97.9% % 73.3% % 53.3% % 24.4% % 15.5% BMI was associated with greater attendance at earlier sessions
18 Results: Compliance Time between referral and BIP Intake BMI (M = 3.19 weeks, SD =.34 weeks) Control (M = 5.88 weeks, SD =.95 weeks) Mann-Whitney U = 357.5, z = 2.44, p =.02 Number of sessions attended BMI (M = 12.2, SD = 1.5) Control (M = 8.3, SD = 1.8) Mann-Whitney U = 499.5, z = 1.71, p =.09 Hypothesis 1 Supported. BMI men, relative to controls: 1) had higher rates of successful completion of, or good standing in, a Tx 2) were more likely to attend initial Tx sessions 3) began Tx in a more timely manner 4) attended more sessions, though only marginally significant
19 Sessions Attended Percent in Good Standing Results: Compliance Hypothesis 3A Supported. Condition moderated: 1) the relationship between readiness and Tx compliance 2) the relationship between readiness and session attendance Control Treatment Readiness to Change Low High Condition X Readiness, p =.08 Readiness to Change Low 4 High 2 0 Control Treatment Condition X Readiness, p =.03
20 Results: Recidivism Recidivism: 3 groups: χ 2 (2, N = 81) = 2.24, p =.33 (Fisher s Exact) 2 groups: χ 2 (1, N = 82) = 1.95, p =.16 Probation Violations: BMI (M = 3.13, SD =.56) Control (M = 3.24, SD =.76) Mann-Whitney U = 779.5, z =.37, p =.71 Hypothesis 2 Rejected. BMI and control participants: 1) evidenced comparable rates of criminal recidivism 2) committed an equivalent number of probation violations
21 Alcohol and IPV BMI is associated with Tx compliance among low readiness clients. What about other at risk groups? Alcohol and IPV Alcohol problems predict poor Tx compliance (Cadsky et al., 1996) Half of IPV offenders abuse alcohol (Stuart et al., 2003) Offenders are mandated to separate IPV and substance Tx programs (Babcock et al., 2004)
22 MI among Problematic Drinking IPV Offenders Hypothesis: Binge drinkers assigned to BMI will attend more sessions and be less likely to drop out of treatment relative to binge drinkers assigned to the control condition Sample: 60 male offenders No Binge Binge Control BMI Procedure: Identical Measures: Alcohol Use Disorder Identification Test (AUDIT; Saunders et al., 1993) Follow-up: Sessions attended and drop out Data Analysis: Linear regression (sessions attended) Logistic regression (drop out)
23 Results Sessions Attended Estimate * SE p Drop Out Estimate * SE p Binge Condition Interaction * Unstandardized estimates. Note. Models control fro age, drug use, readiness to change, satisfaction, and prior arrests.
24 Overall Conclusions Pretreatment factors as indicators of treatment compliance Individualized assignment to treatment protocols Proximal effects of BMI BMI and high risk offenders Larger sample Substance diagnosed offenders Integration of substance abuse and IPV treatment techniques Alternative BMI goals: Alcohol and substance use Looking beyond BMI for recidivism Collateral informants Extended follow-up periods BME vs. BMI
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