Readiness Enhancement Management Strategies (REMS): a proof of concept and evaluation feasibility study of staff training to improve service engagement by people with personality difficulties.

One third of people diagnosed with PD do not complete treatment and non-completion is associated with poorer clinical outcomes. Equipping staff to be better able to engage this client group is important, and web-based, self-directed learning is a potentially cost-effective way to train staff. This study examined the implementation of a web-based training programme called Readiness Enhancement Management Strategies (REMS) in three types of service. Completion rates were 94.4% in community health services; 92.3% in prison offender health services; and 46.5% in probation services. Staff found the content of REMS acceptable and useful. This study demonstrated that staff in NHS and criminal justice settings can complete REMS, but staff in probation services are challenged by time pressures and limited computer access. Staff at probation sites were less familiar with PD issues compared with the NHS staff. A web-based staff training programme called Readiness Enhancement Management Strategies (REMS) was developed to promote the engagement of people with personality difficulties in treatment. This 'proof of concept' study examined the REMS implementation process, its acceptability and the feasibility of using service data for future evaluation. Staff in six services working with people diagnosed with personality disorder or undiagnosed people with personality difficulties were eligible to participate: two community health services, two prison offender health services and two probation services. Of 92 eligible staff, 74 were available to undertake REMS. These staff completed knowledge and acceptability surveys and rated service user engagement with treatment. The proportion of treatment sessions attended by service users was collected for a 30-week period. REMS completion rates were community - 94.4%, prison - 92.3% and probation - 46.5%. Three quarters of participants rated REMS as 7 out of 10 or higher. All teams were able to provide service data for the study period. REMS can be implemented by National Health Services (NHS) staff in community and prison settings, but technology issues need to be resolved in probation services. REMS may be useful for NHS staff working with difficult to engage clients, and an evaluation is a feasible prospect.

Alcohol-related offending in male special hospital patients.

In a sample of 61 male Special Hospital patients, 11 (18%) were identified as having alcohol-related problems prior to admission. Ten of these alcohol-abusers were interviewed to gather further information about their drinking, offending, and the relationship between the two. Alcohol abusers showed more serious criminality than non-abusers, having significantly more previous convictions and being responsible for a disproportionately high number of offences of murder and manslaughter. Alcohol-related problems appear to have developed quickly in adolescence culminating in the index offence at around 30 years of age. At this time, the mean self-reported weekly alcohol consumption was 240 units (one unit = 8.5gm alcohol). All but one man admitted to a relationship between alcohol and crime, and most showed motivation to change their future drinking behaviour.

Young offenders and alcohol-related crime: what interventions will address the issues?

Although most young offenders will grow out of both drinking and crime, interventions aimed at reducing crime through reducing drinking or reducing drinking so as to reduce health and social problems are important for some offenders. Where the aim is to reduce crime by reducing drinking, it is essential to assess carefully the relationship between the two in each person to ensure that this is logical. Since most adolescents drink and since controlled drinking is achievable by younger people with fewer alcohol-related problems, moderation rather than abstinence is a realistic goal for most young offenders. Behavioural self-control training is one type of intervention which can effectively encourage moderate drinking, but this has to be conducted in ways that will engage young offenders' interest, for example through self-help manuals, developing peer interventions and using simulated bar settings. In addressing the questions of which types of people commit which types of crime and what part alcohol plays in setting the conditions for crime to occur, studying the effects that young offenders expect alcohol to have under various conditions may contribute to the development of cognition modification components of interventions and enable better matching of clients with programmes.

Developing a range of services for prisoners with alcohol-related problems: a response to Eisenman.

Eisenman's 1990 criticisms of a published pilot study of the use of self-help manuals with prisoners who have alcohol-related problems are addressed. Self-help manuals may be of value where other interventions are not applicable. Completion of the extended study should provide quantitatively based conclusions.

Strategies of self-control in male young offenders who have reduced their alcohol consumption without formal intervention.

Fifty-one imprisoned male young offenders who reported having stopped or reduced their alcohol consumption without formal intervention were studied to discover which self-control strategies they used to help them change their drinking behaviour. Change was precipitated by adverse consequences of drinking, particularly crime and violence. The most commonly used strategies involve social change: finding alternative activities, avoiding heavy-drinking friends, and avoiding situations where heavy drinking typically occurs. Next most frequently used strategies involve setting limits: restricting drinking time, expenditure on drink, and alcohol consumption. Finally, rate control, including beverage changes from stronger to weaker or non-alcoholic drinks, is a commonly reported strategy. The implications for the design of intervention programmes are discussed.

Evaluation of a self-help manual for young offenders who drink: a pilot study.

Adolescent offenders have been identified as heavy drinkers, in some cases drinking being causally related to offending. Forty-five male young offenders who drink were selected from the population of a Young Offenders Centre. They were matched for age and self-reported alcohol consumption, then allocated to one of three conditions: no intervention; minimal intervention (given a behavioural self-help manual to read alone); and group intervention (manual read aloud in groups). At 15-month follow-up, there were no significant differences in reconviction rates in the three conditions. Information useful in the design of future studies was gained, and recommendations are made.

Consistency of alcohol self-report measures in a male young offender population.

The consistency among a number of measures of self-report of alcohol consumption in imprisoned male young offenders was studied by asking 56 young offenders to report, based on a 'typical week', how many days they had consumed alcohol, how many days they were drunk and how much alcohol they had consumed. They were asked to rate their confidence in the accuracy of their self-report and to complete the short EPQ-R, which contains a Lie Scale. Results show that self-report in this population is reliable over time and that different indices of alcohol consumption correlate significantly with each other. Young offenders report a moderate degree of confidence in their accuracy of self-report and the mean EPQ-R Lie Scale score is within 1 standard deviation of the norm for a comparable sample.

Services for prisoners with alcohol-related problems: a survey of U.K. prisons.

Offenders have been identified as heavy drinkers who admit to a relationship between drinking and offending. Many prisoners express a desire to reduce their alcohol consumption. The extent of alcohol interventions in U.K. prisons was unknown and so a postal survey was conducted to gather basic information about current work. Of all responding establishments, 91% claimed to provide services for prisoners with alcohol-related problems and 58% gave details of these services. Services are provided mainly by probation officers/social workers, prison officers and Alcoholics Anonymous. Group and individual interventions are described. Service development has been haphazard, lacking central co-ordination. A case is made for appointment of a central facilitator responsible for staff training, establishing a communications network, encouraging new interventions to match clients' needs, encouraging closer links with community workers and guiding evaluative research.

The Short Alcohol Dependence Data (SADD) questionnaire: norms and reliability data for male young offenders.

The Short Alcohol Dependence Data (SADD) questionnaire was administered to 100 male young offenders. The mean score was 8.09. Eighty subjects were available between 19 and 40 days later for retest. Of these, 44 were given the original SADD, resulting in a test-retest correlation of 0.87. The remaining 36 young offenders were given at retest a version of the SADD reworded to eradicate difficult words and ambiguous items. The test-retest reliability using the reworded SADD was 0.88 and the split-half reliability of the reworded SADD was 0.85. Thus, the SADD is shown to be reliable over time and the reworded SADD is a satisfactory alternative to the original SADD with this population.