Treatment Readiness as a Determinant of Treatment Participation in a Prison-Based Rehabilitation Program: An Exploratory Study

Abstract

The current study had three aims. First, it measured treatment readiness among offenders who entered the Prevention of Recidivism program. This is a prison-based rehabilitation program in the Netherlands that aims to lower re-offending rates among offenders with a prison sentence of at least for months and that is carried out during the final months of incarceration. Second, the study evaluated whether treatment readiness was associated with treatment participation. Third, the study examined whether treatment readiness measured with a validated instrument predicted treatment participation above and beyond a clinical assessment of treatment readiness, currently used as a criterion to include offenders in rehabilitation programs. To address these aims, data were used from the fourth wave of a research project studying the effects of imprisonment on the life of detainees in the Netherlands. Results indicated that treatment readiness as measured with a validated instrument was a significant predictor of treatment participation. Also, the current study showed that treatment readiness measured with a validated instrument improved the prediction of treatment participation above and beyond a clinical assessment of treatment readiness. Outcomes were discussed in light of study limitations and implications.

Keywords

treatment readiness treatment participation prison reducing recidivism correctional treatment inmates rehabilitation

Introduction

A large number of studies have shown that correctional treatment programs can contribute to the successful re-integration of ex-detainees in communities and decreases in re-offending rates (see, for example, Andrews, 1995; Andrews & Bonta, 1994; Andrews, Bonta, & Hoge, 1990; Cullen & Gendreau, 2001; Day & Howells, 2002; Gendreau, 1996; Gendreau, Little, & Goggin, 1996; Lipsey & Cullen, 2007; Lipsey & Wilson, 1993; Palmer, 1992). However, previous studies suggest that participation rates in correctional rehabilitation programs are rather low. This also applies to prison-based programs: Based on a recent meta-analysis by Olver, Stockdale, and Wormith (2011), approximately 80% of incarcerated offenders participated in such programs, while 20% of those who decided to participate failed to complete their program. If pre-program attrition (non-entry) was taken into account, non-participation rates were around 30%.

Offenders who fail to participate in or complete treatment programs return to their communities with an unchanged risk of future criminal behavior. This is highly undesirable, because offenders who do not participate in or complete treatment programs represent a high-risk group of offenders in terms of recidivism rates and are therefore in greater need for correctional treatment compared with low-risk or moderate-risk offenders (Nunes & Cortoni, 2006b; Polaschek, 2010; Wormith & Olver, 2002).

Several scholars have suggested that low participation rates in correctional treatment programs may be explained by a lack of treatment readiness among offenders (see, for example, Ward, Day, Howells, & Birgden, 2004). In other words, offenders may lack the ability and willingness to enter and successfully complete correctional treatment programs. However, the majority of studies that examined treatment readiness have focused on community-based treatment programs, while only a few studies have been able to adequately study treatment readiness among offenders in a prison-based setting (Bosma, Kunst, Reef, Dirkzwager, & Nieuwbeerta, 2014; Olver et al., 2011). Moreover, empirically validated and theory-based instruments have rarely been used in previous studies. Consequently, it is unknown whether detainees eligible for prison-based rehabilitation programs can be qualified as treatment ready and whether treatment readiness predicts program entry and completion. The current study aims to address these topics with regard to a prison-based treatment program in the Netherlands. Before we outline the theoretical framework of our study, we will briefly comment upon this program.

Prison-Based Treatment in the Netherlands

In the Netherlands, rehabilitation efforts are pooled under the Prevention of Recidivism program, a prison-based rehabilitation program meant for detainees with a prison sentence of at least 4 months who are willing to participate in treatment (based on the clinical judgment of a trained probation worker). During this program, which is carried out during the final months of a detainee’s prison sentence, an individual re-integration plan is carried out that fits in with the offender’s risk and need profiles. If indicated by risk assessment outcomes, the program contains behavioral interventions that are believed to be effective in reducing re-offending risk, such as cognitive skill training, substance abuse treatment, or job skill training (Dutch Prison Service & Dutch Probation Organizations, 2007; Van der Linden, 2004).

During the final part of their prison sentence, detainees who participate in the program can be placed in prison facilities with a lower security level and more opportunities to go on leave. Detainees who decide not to participate in the program will have to spend the remainder of their detention period in a fully guarded correctional facility with limited or no options to go on leave (Dutch Prison Service & Dutch Probation Organizations, 2007). Each year, around 5,000 Dutch inmates are eligible for participation in the program. This amounts to approximately 13% of the total inflow of detainees in Dutch correctional institutions (Bosma, Kunst, & Nieuwbeerta, 2013).

Recently, a study has been conducted describing participation and completion rates of the Dutch Prevention of Recidivism program (Bosma et al., 2013). This study covered the period 2008 to 2011 and was based on official registration data of the Dutch Ministry of Justice. Results showed that about half of the offenders eligible for participation—around 5,000 detainees—did not enter the program. Furthermore, around 20% of those who had entered the program did not complete it. Consequently, the overall rate of detainees who were eligible, and asked to participate in the Prevention of Recidivism program that successfully finished the Prevention of Recidivism program was only 40% (Bosma et al., 2013). In the next paragraph, we will argue that this may be due to a lack of treatment readiness.

Theoretical Framework: Treatment Readiness

Literature suggests that participation rates in prison-based rehabilitation programs may be best explained by focusing on an offender’s willingness and suitability to participate in treatment (see, for example, Howells & Day, 2003; Ward et al., 2004; Williamson, Day, & Howells, 2003). A theoretical model from which indicators of an offender’s treatment potential can be deduced is the multifactor offender readiness model (MORM; Ward et al., 2004). This model has been specifically developed for offender populations and uses a broad and multifactorial approach to explain treatment participation. The model is believed to be more promising compared with other motivation, readiness, or change models, such as the stages of change model by Prochaska and DiClemente (1984, 1986), because it does not exclusively focus on intrinsic motivational aspects and also takes into account individual characteristics and external circumstances (Casey, Day, Howells, & Ward, 2007; Ward et al., 2004).

The MORM is based on the notion that behavioral change can occur when an offender is treatment ready. Treatment readiness (Serin, 1998; Serin & Kennedy, 1997) can be defined as “the presence of characteristics within the client and/or therapeutic situation which is likely to endorse therapeutic engagement and, therefore, behavioral change” (Howells & Day, 2003). In contrast to the concept of treatment motivation, which exclusively deals with offenders’ willingness to participate, and the concept of treatment responsivity, which refers to the fit between client and program, treatment readiness is believed to be a much broader concept. The MORM captures treatment motivation, responsivity, and readiness (Ward et al., 2004). Offenders are considered treatment ready if they are willing (or motivated) to participate in treatment, are able to respond to treatment, find treatment meaningful, and have the capacities and are in a situation that makes them more likely to successfully enter a treatment program (Howells & Day, 2002, 2003; McMurran & Ward, 2010; Ward et al., 2004).

According to the MORM, an offender’s treatment readiness is determined by a number of internal (personal) characteristics and external (contextual) factors, which—if present—allow offenders to effectively participate in and benefit from correctional treatment programs (Ward et al., 2004). Internal factors are cognitive (e.g., beliefs about or attitudes toward treatment), affective (e.g., emotions or past experiences), volitional (e.g., personal goals), behavioral (e.g., personal skills), and personal (e.g., personality traits, social capacities) in nature. Examples of external factors are mandatory versus voluntary treatment, location of treatment (in prison or in the community), program and staff availability, support from family or friends, and program characteristics (program delivery, quality). These internal and external factors are believed to determine whether an offender will participate in and benefit from correctional treatment programs (McMurran & Ward, 2010; Ward et al., 2004).

Previous Research on Treatment Readiness and Treatment Participation

Several studies have shown that treatment readiness may be an important factor in explaining treatment participation (see, for example, Hiller, Knight, Broome, & Simpson, 1998; Howells & Day, 2006; Ward et al., 2004). However, as mentioned above, most studies have investigated treatment readiness for community-based correctional treatment programs. The number of studies that have been conducted among incarcerated offenders is rather limited. Nevertheless, the few studies that have been conducted indicate that offenders who are less ready to participate in prison-based treatment programs are more likely to not enter or not complete treatment (Bosma et al., 2014; Nunes & Cortoni, 2006a, 2006b; Ogloff, Wong, & Greenwood, 1990; Pelissier, 2007; Wormith & Olver, 2002).

For example, in an American sample of 251 individuals referred to prison-based sex-offender treatment, Pelissier (2007) found that offenders who had higher initial motivation scores (measured with the Stages of Change questionnaire; Prochaska & DiClemente, 1986) remained in treatment longer compared with those who were less motivated. Furthermore, offenders who completed their treatment program reported higher motivation scores at the end of their treatment program (Pelissier, 2007). A study by our own group in The Netherlands revealed that clinically judged treatment readiness did not predict entry in the Prevention of Recidivism program, but it did predict completion among those who had entered the program (Bosma et al., 2014). Finally, several studies have found that treatment readiness correlates with treatment engagement (Beyko & Wong, 2005; Wormith & Olver, 2002), correct behavior during treatment (Beyko & Wong, 2005; Wormith & Olver, 2002), and treatment progress (Ogloff et al., 1990; Wormith & Olver, 2002).

Unfortunately, the limited amount of previous research that focused on the relationship between treatment readiness and treatment participation in a prison-based setting is hampered by several shortcomings. First, almost all studies have been conducted in North America. This makes it difficult to generalize empirical findings to other geographic regions. Second, the operationalization of treatment readiness varied enormously. Several instruments have been developed to assess treatment readiness and/or motivational aspects, such as the Attitudes to Correctional Treatment Scale (Baxter, Marion, & Goguen, 1995), the Personal Concerns Inventory (Sellen, McMurran, Cox, Theodosi, & Klinger, 2006), and the Treatment Readiness Interview (Serin & Kennedy, 1997). Studies that have focused on treatment participation in intramural settings have, however, mainly used unstructured and/or non-validated measures. Three of the above-mentioned studies included a clinical assessment of treatment readiness (Bosma et al., 2014; Nunes & Cortoni, 2006a, 2006b): one used assessments made by researchers based on information included in treatment files (Ogloff et al., 1990), and two based treatment readiness on non-validated items included in a questionnaire (Beyko & Wong, 2005; Wormith & Olver, 2002). One of the studies discussed has used a standardized questionnaire to measure treatment readiness, the Pelissier (2007) study, in which treatment readiness was assessed using the Stages of Change questionnaire (Prochaska & DiClemente, 1986). None of these previous studies have, however, used an instrument developed to specifically assess aspects of the MORM. The current study aims to overcome these shortcomings by measuring treatment readiness with the Corrections Victoria Treatment Readiness Questionnaire (CVTRQ). The CVTRQ is explicitly based on the MORM, assesses its core aspects (Casey et al., 2007), and has strong psychometric properties (Casey et al., 2007; Day et al., 2009; McMurran & Ward, 2010).

The Current Study

As discussed, participation rates in the Dutch Prevention of Recidivism program are rather low (Bosma et al., 2013), especially compared with participation rates found in international studies (Olver et al., 2011). A previous study indicated that this may be related to a lack of treatment readiness among participants (Bosma et al., 2014). Currently, treatment readiness of potential Prevention of Recidivism participants is measured using a clinical assessment by a trained probation worker. Considering the relatively low participation rates, this measure may not be optimal.

Given the aforementioned, the current study aimed to examine treatment readiness among offenders who were eligible for the Dutch Prevention of Recidivism program. More specifically, we wanted to know (a) whether detainees eligible for this program were treatment ready, (b) whether treatment readiness was associated with treatment participation, and (c) whether treatment readiness measured with a validated instrument would predict treatment participation above and beyond clinically judged treatment readiness. A better understanding of the relationship between treatment readiness and treatment participation is important because it may help to improve program entry and completion and may increase the effectiveness of such programs.

To answer these questions, we used data from the Prison Project. This is a unique longitudinal research project about the consequences of incarceration in Dutch prisons.¹ Based on our previous work (Bosma et al., 2013), which indicates that many eligible offenders do not enter or complete the Prevention of Recidivism program, we expected that treatment readiness levels among respondents would be rather low. Based on previous research, it was hypothesized that treatment readiness would be positively related to treatment participation and completion. Finally, we expected that treatment readiness, as measured by the CVTRQ (Casey et al., 2007), would predict treatment participation and completion above and beyond clinically judged treatment readiness, because the CVTRQ assesses the core aspects of the MORM.

Method

Participants in the Prison Project included all male offenders who had entered the Dutch penitentiary system between October 2010 and March 2011, were between the age of 18 and 65, born in the Netherlands, and were not suffering from psychiatric disorders, which prevented them from participating. During their time in prison as well as after release, participants (N = 1,904) were asked questions concerning various aspects of their lives before, during, and after imprisonment. The study protocol was approved by the Ethical Committee for Legal and Criminological research of the VU University Amsterdam.

To investigate the influence of treatment readiness on participation and completion in prison-based rehabilitation programs, the current study used data from the Prison Project’s fourth wave, which took place 18 months after participants were first incarcerated. A total of 167 detainees were still incarcerated 18 months after initial imprisonment and could be approached to participate again (the remaining offenders had already been released). A number of 102 detainees (61.1 %) then decided to participate in the fourth wave, which meant they filled out a written questionnaire regarding various topics, such as their lives in prison, their physical and psychological well-being, and their attitudes toward the criminal justice system. Of the 102 detainees participating in the fourth wave, 92 (90.2%) met the inclusion criteria (sentence length) for the Prevention of Recidivism program. These detainees were asked to participate in the program and were therefore included in our study sample.

Dependent Variable

The dependent variable included in the current study’s models was program participation. To determine participation, the official Prevention of Recidivism registration system was consulted. In this administrative database, all activities regarding the participation and completion of the Prevention of Recidivism program are gathered. This registration system provides exact information regarding the status of an offender’s program candidacy or non-candidacy, program participation or non-participation, and completion or non-completion. Also, in-depth treatment information regarding the content of an offender’s individual treatment program is gathered. This system is accessible and used in every prison in the Netherlands.

Offenders were categorized by participation status: successful participants (offenders who successfully completed the program), non-participants (offenders who never entered the program), non-completers (offenders who did not complete the program), and still participators (offenders who at the time of data collection were still in the program and were still incarcerated). Because the system provides exact information, the researchers did not have to recode the data, to determine participation status. However, two groups were further examined by the first author of the current study: offenders who still participated and offenders who dropped out. This was done to make sure that the information the system provided was correct. In case of doubt, the second author was consulted. Outcomes showed that the information system was accurate and participation status was therefore adopted one-to-one.

Independent Variables

Treatment readiness was included in the current study as an independent variable. Currently, trained probation officers in The Netherlands base judgments about treatment readiness (yes or no) on their clinical experience. The assessment of treatment readiness is part of administering a structured risk assessment instrument carried out by trained probation officers. These probation workers receive 4 days of training in risk assessment. They assess a large number of static and dynamic items which results in a conclusion about an offender’s criminogenic risk and needs, and also responsivity aspects, one of which is treatment readiness. Assessments on treatment readiness were retrieved from participant’s personal files.

To assess all core aspects of the MORM, a Dutch version of the CVTRQ (Casey et al., 2007) was administered among study participants by trained research assistants. The CVTRQ is a 19-item self-report questionnaire that assesses an offender’s readiness to participate and engage in correctional treatment programs.² It is based on the MORM (Ward et al., 2004) and measures treatment readiness in a four-component structure: attitudes and motivation (“Treatment programs don’t work”), emotional reactions (“I feel guilty about my offending”), offending beliefs (“Others are to blame for my offences”), and efficacy (“I hate being told what to do”). The CVTRQ includes statements that can be rated on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree), with total scores potentially ranging from 19 to 95 (with a higher score indicating more treatment readiness). Research has shown that the CVTRQ is internally consistent and that it has high levels of convergent and discriminant validity (Casey et al., 2007). Furthermore, CVTRQ scores positively correlate with therapeutic engagement. This may indicate that it is also a predictor of treatment participation and completion (Day et al., 2009). The internal consistency of the Dutch version of the CVTRQ as administered in the current study was adequate, evidenced by a Cronbach’s alpha statistic of .70.

Background and Control Variables

Background characteristics included age, ethnicity (native vs. non-native), and current offense. Age was calculated from the prison registration systems by date of birth and the date of prison entry. Ethnicity was drawn from the risk assessment database (in line with Statistics Netherlands, a person is defined as having a non-native background if at least one of his or her parents was born abroad). The prison registration system was used to identify a detainee’s current offense.

Because our data collection took place at a set time—18 months after initial imprisonment—some offenders were not yet a candidate for or participant in the Prevention of Recidivism program. This meant that treatment readiness had sometimes been measured before an offender entered the program (n = 31, 33.7%). In other cases (n = 61, 66.3%), offenders had already participated in the program (or had declined participation/had not completed treatment). To prevent potential measurement bias, we will control for the time treatment readiness was assessed (before vs. after the moment of treatment entry).

Analysis

Means and standard deviations and frequencies and percentages were used to describe the characteristics of the research sample. Analyses of variance or chi-square tests, as appropriate, were conducted to investigate differences between the four participant groups. CVTRQ clinical scores and clinical judgments of treatment readiness were further examined to get an idea of participants’ average treatment readiness levels and the strength of the correlation between the two assessments methods.

To determine whether treatment readiness could explain variations in treatment participation and to determine whether the CVTRQ measure predicted treatment readiness above and beyond the clinical measure, two multivariate hierarchical logistic regression models were tested. To conduct these analyses, the four participant groups were collapsed into two groups of sufficient size: program participants (completers [n = 60] plus offenders who still participated [n = 9]) and non-participants (those who did not enter [n = 17] plus those who did not complete [n = 6]). The first step of our multivariate analyses was to test a model that contained all control variables and the clinical assessment of treatment readiness. To determine whether the CVTRQ measure of treatment readiness explained variations in treatment participation above and beyond the clinically assessed measure did, a second model was tested in which the CVTRQ was added.

Results

Descriptive Analyses

Table 1 summarizes relevant sample characteristics for successful program participants (n = 60), non-participants (n = 17), offenders who had participated but had not completed the program (n = 6), and participants who had not yet finished the program at the time of data collection (n = 9). As shown, there were no significant group differences reported regarding age, ethnicity, current offense, and the clinically assessed treatment readiness scores. Groups did, however, differ in the CVTRQ total treatment readiness score and the CVTRQ scale attitudes and motivation. As shown in Table 1, offenders who still participated in treatment (M = 68.3) differed significantly in treatment readiness scores from offenders who successfully finished treatment (M = 61.6) and offenders who did not participate (M = 58.5) or had not completed the program (M = 54.2). Significant differences were also reported between offenders who successfully participated compared with offenders who did not complete treatment. Scale-scores regarding their attitude and motivation toward treatment showed similar results. Again, offenders who were still in treatment scored higher (M = 4.1), compared with offenders who successfully finished treatment (M = 3.5) and offenders who did not participate (M = 3.5) or had not completed the program (M = 3.0). And again, offenders who successfully participated also differed significantly from those who did not complete treatment.

Table 1.

Group Characteristics (N = 92).

	1. Successful participants (n = 60)	2. Non-participants (n = 17)	3. Non-completers (n = 6)	4. Still participating (n = 9)	Total (N = 92)
	M (SD)/%	M (SD)/%	M (SD)/%	M (SD)/%	M (SD)/%	Statistics	Group Differences
Age when entered detention	31.7 (11.5)	33.9 (10.3)	29.7 (8.3)	37.3 (10.8)	32.5 (11.0)	F(3, 88) = .895, p = .45
Ethnicity						χ² (3, N = 92) = 1.184, p = .76
Native	68.3	58.8	50.0	66.7	65.2
Nonnative	31.7	41.2	50.0	33.3	34.8
Current offense						χ² (3, N = 92) = 2.553, p = .47
Violence	71.7	52.9	66.7	77.8	68.5
Other	28.3	47.1	33.3	22.2	31.5
Treatment readiness (CVTRQ)	61.6 (6.5)	58.5 (7.4)	54.2 (10.6)	68.3 (9.7)	61.2 (7.8)	F(3, 88) = 5.601, p = .00***	(1/3 1/4 2/4 3/4)
Attitudes and motivation	3.5 (0.5)	3.5 (0.5)	3.0 (0.7)	4.1 (0.6)	3.6 (0.6)	F(3, 88) = 5.480, p = .00***	(1/3 1/4 2/4 3/4)
Emotional reactions	2.9 (0.6)	2.6 (0.8)	2.6 (0.8)	3.4 (0.8)	2.9 (0.7)	F(3, 88) = 2.401, p = .07
Offending beliefs	3.4 (0.6)	3.1 (0.8)	3.0 (0.8)	3.4 (1.0)	3.3 (0.7)	F(3, 88) = 1.111, p = .35
Efficacy	3.2 (0.4)	3.2 (0.6)	2.7 (0.4)	3.3 (0.9)	3.2 (0.5)	F(3, 88) = 1.597, p = .20
Treatment readiness (clinical)						χ² (6, N = 92) = 10.167, p = .12
Offender is ready	58.3	47.1	16.7	77.8	55.4
Offender is not ready	30.0	23.5	66.7	22.2	30.4
Unknown	11.7	29.4	16.7	00.0	14.1

Note. Behind significant levels it is demonstrated which groups differed from one-another. For example, 1/3 means post hoc analyses showed there was a significant difference between Group 1 (successful participants) and Group 3 (non-completers).

CVTRQ = Corrections Victoria Treatment Readiness Questionnaire.

p < .05. **p < .01. ***p < .001.

Treatment Readiness

As shown in Table 1, the average treatment readiness (CVTRQ) score was 61.2 (SD = 7.8). In previous work (Casey et al., 2007), a score for a sufficient amount of treatment readiness was set at the 72th percentile. In the current study, this would imply a score of at least 68. As shown, average scores are lower than this, 79.3% of all respondents did not meet this number and would therefore, in a clinical setting, not be qualified as treatment ready.

As previously mentioned, treatment readiness as assessed with the CVTRQ, is measured by a four-component structure (attitudes and motivation, emotional reactions, offending beliefs, and efficacy). Mean scores on each scale can be found in Table 2. As shown, offenders show the lowest scores on the component emotional reactions (M = 3.0). Scores on the scale attitudes and motivation are somewhat higher (M = 3.6). This may imply that the earlier mentioned low overall treatment readiness scores are mostly caused by the emotional reactions offenders have toward their criminal behavior, such as feelings of guilt and shame.

Table 2.

CVTRQ Scores and Clinical Assessment Scores (Yes vs. No or Unknown; N = 92).

	Treatment ready	Not ready or Unknown	Total	Statistics
	M (SD)/%	M (SD)/%	M (SD)/%	Statistics
Treatment readiness (CVTRQ)	63.2 (7.3)	58.7 (7.7)	61.2 (7.8)	t(90) = −2.839, p = .00**
Attitudes and motivation	3.6 (0.5)	3.5 (0.6)	3.6 (0.6)	t(90) = −1.112, p = .28
Emotional reactions	3.0 (0.7)	2.6 (0.6)	2.9 (0.7)	t(90) = −3.109, p = .00**
Offending beliefs	3.4 (0.7)	3.2 (0.6)	3.3 (0.7)	t(90) = −1.875, p = .07
Efficacy	3.1 (0.5)	3.2 (0.6)	3.2 (0.5)	t(90) = .479, p = .64

Note. CVTRQ = Corrections Victoria Treatment Readiness Questionnaire.

p < .05. **p < .01. ***p < .001.

Treatment readiness was also measured using the clinical assessment of a probation worker. Based on this clinical assessment, 51 (55.4%) offenders were qualified as treatment ready, 28 (30.4%) offenders were qualified as not ready, and in 13 (14.1%) cases no clinical judgment had been made. Because we are interested in offenders who are considered treatment ready (following current rehabilitation practices), offenders for whom the clinical assessment of readiness was unknown were added to the group of offenders who were clinically assessed as not ready.

CVTRQ treatment readiness scores correlated moderately with clinical judgments about treatment readiness (r = .31, p = < .01). In Table 2, CVTRQ scores are presented for offenders who were clinically assessed as treatment ready and offenders who were not ready or whose readiness was unknown. As shown, the group of offenders who were clinically indicated as being treatment ready also scored significantly higher on the CVTRQ measure of treatment readiness (M = 63.2) than those who were not or whose readiness was unknown (M = 58.7). This was also the case for scores on the subscale emotional reactions, which was higher for offenders who were clinically regarded as being ready (M = 3.0) than those who were not or whose readiness was unknown (M = 2.6). No other significant results were reported.

Multivariate Analyses

To test whether treatment readiness was a significant determinant of treatment participation, a hierarchical logistic regression analysis was conducted. As mentioned, two groups were formed: program participants (completers plus offenders who still participated) and program non-participants (those who did not enter plus those who did not complete). Offenders who still participated during the data collection may still have dropped out of the program, but as they (n = 9) were already at the end of their program (each program ended within 2 months after data collection) and had already completed the content (specific treatment modules) of their program, they were considered successful participants. Offenders who dropped out of the program (n = 6) were considered non-participants, even though these offenders may in theory have completed almost every aspect of the treatment program (and dropped out at the end). An examination of their treatment trajectory has, however, shown that in five cases, these offenders stopped participation in the program almost immediately after the initial start. Only one offender actually participated in a treatment activity, but dropped out months before finishing the program (and leaving prison).

The results of the multivariate model are shown in Table 3. The results or our first multivariate model, which tested the relationship between the control variables, the clinical assessment of treatment readiness, and treatment participation, showed that the clinical assessment of treatment readiness was not a determinant of treatment participation. Other variables did not predict treatment participation either.

Table 3.

Hierarchical Logistic Regression Analysis Explaining Treatment Participation (N = 92).

	Model 1				Model 2
	B	SE	Odds ratio	p	B	SE	Odds ratio	p
Control variables
Age (18-57)	−0.01	0.03	0.99	.78	−0.01	0.03	0.99	.75
Ethnicity
Native (0-1)	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.
Nonnative (0-1)	0.87	0.59	2.40	.14	0.72	0.62	2.06	.25
Current offense
Violence (0-1)	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.
Other (0-1)	−0.76	0.55	0.47	.17	−0.73	0.56	0.48	.19
Time of data collection CVTRQ
Before program start (0-1)	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.
After program start (0-1)	0.20	0.53	1.22	.70	0.33	0.55	1.40	.54
Treatment readiness measures
Treatment readiness (clinical)
Offender is not ready/unknown (0-1)	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.
Offender is ready (0-1)	0.96	0.52	2.61	.06	0.62	0.55	1.85	.26
Treatment readiness (CVTRQ; 34-87)	—	—	—	—	0.08	0.04	1.08	.04*

Note. CVTRQ = Corrections Victoria Treatment Readiness Questionnaire.

p < .05. **p < .01. ***p < .001.

The second model, which tested whether inclusion of CVTRQ scores would improve the prediction of treatment participation, significantly predicted treatment participation above and beyond clinical judgments of treatment readiness. Odds ratio statistics showed that, for every point scored higher on the CVTRQ instrument, odds of successful participation (compared with non-participation) increased by 8%. Again, none of the control variables were significantly related to treatment participation. Adding the CVTRQ measure of treatment readiness to the first second model did significantly improve model estimates, evidenced by a significant increase in overall model statistics (χ² = 7.3 to χ² = 12.1; Nagelkerke R² = .112 to Nagelkerke R² = .182).

Discussion

The current study measured treatment readiness among offenders who entered a prison-based rehabilitation program in the Netherlands using an instrument based on a theoretical concept of treatment readiness. The general aim was to assess whether treatment readiness was associated with treatment participation and to test whether treatment readiness as assessed by a validated instrument would improve the prediction of treatment participation above and beyond clinical judgments of treatment readiness. Based on theoretical and empirical considerations, it was expected that treatment readiness was associated with treatment participation. It was also predicted that a validated instrument would be a determinant of treatment participation above and beyond a clinical assessment of treatment readiness made by a probation worker alone. To answer our research questions, official registration data and panel data from the fourth wave of a large-scale, longitudinal research project studying the effect of imprisonment on the life of detainees and their families in the Netherlands (the Prison Project) were used.

Results were in line with our expectations and showed that treatment readiness was a significant predictor of treatment participation. Offenders with a higher treatment readiness score, as measured by a Dutch version of the CVTRQ (Casey et al., 2007), were more likely to be among those offenders who successfully finished their treatment program. In addition, it was also shown that the CVTRQ predicted treatment participation above and beyond the clinical assessment of treatment readiness.

Our findings are in line with earlier work conducted that has indicated that treatment readiness may be an important determinant of treatment participation in prison-based correctional treatment programming (Bosma et al., 2013; Nunes & Cortoni, 2006a, 2006b; Ogloff et al., 1990; Pelissier, 2007; Wormith & Olver, 2002). However, these previous studies varied greatly regarding the operationalization of treatment readiness. A measure that was designed to specifically assess aspects of the MORM (Ward et al., 2004), such as the CVTRQ (Casey et al., 2007), had never been used. Therefore, the results of the current study are certainly in line with previous work, but are unique in providing an empirical validation of the importance of treatment readiness as operationalized by the MORM. Based on the current study, it appears vital to make sure that offenders are treatment ready to successfully engage them in treatment programs aimed at helping them desist from future criminal behavior. Not only has the current study identified that the overall treatment readiness among detainees engaged in the Prevention of Recidivism appears to be rather low, based on the instrument used it also seems that this is mainly so because offenders lack the emotional reactions necessary to be ready to engage, such as feelings of shame about their criminal behavior. This could provide important directions for practitioners working with offenders eligible for treatment. Another conclusion drawn from the current study is that it seems important to measure treatment readiness using a validated instrument such as the CVTRQ (Casey et al., 2007), as it appeared that this instrument could predict treatment participation above and beyond the clinical measure that is used in current rehabilitation practices in the Netherlands.

Limitations and Directions for Future Research

A number of limitations are worth mentioning. First, the sample size of this study was rather small. It is important to further examine treatment readiness with a larger sample of incarcerated offenders. Second, the study used a Dutch sample of male offenders, making it difficult to generalize findings to female offenders and to offenders from other geographic regions. Also, treatment readiness was measured when offenders were imprisoned for 18 months. Some offenders had not been participating in the treatment program, or were participating for shorter or longer periods compared with others. Although the study controlled for time of measurement, it cannot be ruled out that the time of data collection has influenced our results. Also, no repeated measure of treatment readiness was administered. This can be important, because previous studies have indicated that motivational aspects may change throughout treatment, depending on treatment experiences (De Leon, 1996). Therefore, to overcome these concerns, future studies should aim to measure treatment readiness before the start of a program, as well as during and possible even at the end of a program. Despite these shortcomings, the current study is a major step toward more knowledge on determinants of successful participation in prison-based treatment programs. In particular, the study advances earlier work by comparing the concept of treatment readiness measured with a validated instrument to the (currently used) clinical assessment of treatment readiness.

On a Final Note

To conclude, treatment non-participation is a major issue in correctional rehabilitation practice, which can result in a selective group of untreated offenders (Dowden & Serin, 2001; McMurran & Theodosi, 2007; Wormith & Olver, 2002). The vast amount of research that has focused on the effectiveness of correctional treatment programs (see e.g., Andrews, 1995; Andrews & Bonta, 1994; Andrews et al., 1990; Gendreau, 1996; Gendreau et al., 1996; Lipsey & Wilson, 1993), has indicated that correctional treatment should be directed at an offender’s risk and criminogenic needs (risk factors that predict future criminal behavior) to be effective. These principles were theoretically captured in the risk-need-responsivity model (Andrews et al., 1990), on which most rehabilitative programs in Western countries nowadays are based.

However, as treatment non-participation presents such a huge problem, it may be so that a sole focus on risk factors is not sufficient to encourage and motivate offenders to successfully engage in treatment programs (Ward & Gannon, 2006; Ward, Melser, & Yates, 2007). The good lives model (Ward & Brown, 2004), an alternative correctional rehabilitation model, supports this claim. This model recognizes that treatment readiness is an important prerequisite for effective rehabilitation (Ward & Brown, 2004; Ward & Gannon, 2006; Ward et al., 2007). Instead of solely focusing on risk, the model states that treatment should be directed at an offender’s personal goals, thereby contributing to the intrinsic motivation of the individual offender.

Although the current study is not aimed at testing the viability of either model, it does indicate that treatment readiness is an important determinant of treatment participation. If treatment readiness is not taken into account in correctional rehabilitation practices, (a selective group of) offenders will not participate in treatment programs, and risk and need causes cannot be addressed. This shows the relevance of assessing (and possibly enhancing) offenders’ readiness to engage in and fully benefit from treatment programs. Only then, re-offending rates can be effectively reduced.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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