Effectiveness of the IDAP Treatment Program for Male Perpetrators of Intimate Partner Violence

Abstract

Despite substantial problems with intimate partner violence (IPV) worldwide, the empirical support remains weak for the effectiveness of recidivism-reducing interventions for IPV perpetrators. We conducted a controlled study of the effectiveness of the Integrated Domestic Abuse Program (IDAP), a manual-based group intervention for adult male IPV offenders. A consecutive series of 340 convicted male IPV offenders who began IDAP in the Swedish Prison and Probation Services 2004 to 2007 were compared with 452 contemporary, convicted male IPV offender controls. We obtained follow-up reconviction data from the National Crime Register and used Cox regression to model the effectiveness of IDAP versus regular treatment. Treated and control subjects were all followed until March 2, 2011, for an average time-at-risk of 4.6 years (median 4.4, SD = 1.0). Twenty-five percent (n = 84) of IDAP participants recidivated in any violence versus 23% of controls (n = 104); corresponding figures for IPV specifically were 19% (n = 65) and 19% (n = 84), respectively. Intention-to-treat analyses adjusted for individual baseline risk and follow-up time suggested marginally and non-significantly lower reconviction rates in IDAP participants versus controls (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = [0.69, 1.23] for any violence and HR = 0.92, 95% CI = [0.66, 1.28] for IPV, respectively). Hence, possible recidivism-reducing effects of IDAP in this cross-cultural validation were small and impossible to secure statistically. To remedy the frustrating lack of proven effective treatments for IPV offenders, better interventions should be developed and tested. Such efforts could benefit from improved knowledge about IPV-specific, causal risk factors and more powerful treatment combinations.

Keywords

intimate partner violence treatment outcome correctional services recidivism

Introduction

Intimate partner violence (IPV), widely defined as threats, violence, or abuse between adults who are or have been in an intimate relationship, is a serious, global public health concern (e.g., Campbell, 2002; Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006) accountable for tremendous personal and societal costs. Although causality remains uncertain, IPV victims more often suffer from various health problems (Bonomi et al., 2006; Romito, Molzan Turan, & DeMarchi, 2005); gastrointestinal symptoms, chronic pain, depression (Campbell, 2002); and suicide attempts (Devries et al., 2011).

One possible step in reducing IPV is to prevent identified offenders from recidivating by providing effective treatment. However, systematic reviews of the effectiveness of IPV perpetrator treatment based on cognitive behavior therapy (CBT) in preventing reoffending suggest, at best, small effects (Feder & Wilson, 2005; Feder, Wilson, & Austin, 2008; Smedslund, Dalsbø, Steiro, Winsvold, & Clench-Aas, 2007). In addition, no difference in treatment effect has been found between programs based solely on CBT as compared with the Duluth model, such as the Integrated Domestic Abuse Program (IDAP; Babcock, Green, & Robie, 2004) addressed in the present study. However, treatment effects may vary considerably across populations and settings (Hendricks, Werner, Shipway, & Turinetti, 2006) and data from prisons and from outside North America are particularly scarce (e.g., Smedslund et al., 2007).

The IDAP

IDAP is a manual-based treatment program aimed at reducing reoffending among men who used threats, violence, or other controlling behavior against a female partner or former partner. The program originates from the Duluth Domestic Abuse Intervention Project (DAIP; Pence & Paymar, 1993); takes a pro-feminist, psychoeducational approach to violence; and focuses on men’s general use of power and control over women. This is in turn based on the belief that the primary cause of domestic violence is patriarchal ideology and the more or less explicit societal sanctioning of male use of power and control over women. The main goals of treatment are to make male offenders take full responsibility for their abusive behavior and acknowledge gender inequalities (Pence & Paymar, 1993). The program consists of 27 offender group sessions organized into nine modules and at least 8 individual sessions.

We conducted, to our knowledge, the first controlled quantitative study of IDAP effectiveness outside Anglo-Saxon countries. A consecutive sample of adult male IPV offenders who started IDAP (n = 340) in Swedish Prison and Probation Services (SPPS) 2004 to 2007 were compared with 452 concomitant IPV offender controls who did not begin IDAP. Both groups were followed up until March 2, 2011, regarding new convictions for any violent recidivism and IPV, respectively. We also controlled statistically for baseline recidivism risk that might confound the association between treatment status and recidivism.

Method

Setting

Feminism has a quite strong standing in the Swedish society and IPV crimes are generally regarded as severe offenses. Crime, self-reported crime victimization, and crime clearance rates in Sweden are similar to those in other Nordic countries (such as Denmark, Finland, and Norway) and average among other European countries (e.g., Bondeson, 2011). In contrast, public fear of crime and punitive attitudes are less pronounced than the European average, probably contributing to milder criminal policies, including substantially lower imprisonment and police numbers per capita than the European mean level (Bondeson, 2011). Swedish citizens have since long had a quite strong treatment-oriented rehabilitative stance regarding convicted lawbreakers (Bondeson, 2011).

Prisons are relatively small in Sweden, only one has more than 400 places, and most are low or medium security facilities. Staffing levels are high and prisons are essentially free from narcotics; both factors likely contribute to less antagonistic interactions between prisoners and staff (Bondeson, 2011). The Swedish Prison and Probation Service (SPPS) implements sentences and attempts to reduce offender crime and substance misuse recidivism by offering remedial education, work skills training, and psychological treatment programs addressing cognitive, emotional, and behavioral risk factors. SPPS staff daily manage approximately 5,000 inmates in 50 prisons and a caseload of 12,500 parolees/probationers across 34 probation offices throughout the country (http://statistik.kriminalvarden.se, retrieved December 14, 2013). About 10% to 15% of these (a large majority of whom are men) are estimated to be IPV offenders.

Clients eligible for IDAP had all been convicted of violence against a current or former intimate partner, were assessed as having medium or high recidivism risk, and were motivated to change at least some IPV-related problems such as jealousy or anger. They also had to understand Swedish or English language reasonably well. If the client had current substance misuse or severe mental health problems, he was usually prioritized for disorder-specific psychotherapeutic and pharmacological therapy before admission to IDAP.

The National Client Placement Unit of the SPPS attempts to place convicted IPV prisoners with a remaining sentence time of 6+ months in focused wards that provide IDAP and have available openings in such groups. We included IDAP participants (n = 340) from specialized wards at six prisons and 12 probation offices across Sweden. The 452 control clients were 162 non-participants (36%) recruited from the same six prisons and 12 probation offices as the treated offenders but also 290 (64%) additional clients from another 20 prisons/remand prisons and 17 probation offices. For prisoners and parolees, IDAP participation is not mandatory but rather offered to all eligible clients. In contrast, treatment for probationers is largely court mandated and a part of the sanction.

IDAP: Establishment, Content, and Integrity in the SPPS

In collaboration with the U.K. Home Office, IDAP treatment was initiated in Sweden in 2000 and fully implemented in 2004. The program was only modified with respect to language and slightly modernized remakes in Swedish of original video clips used to illustrate problem behavior and stimulate discussion. IDAP was accredited for continued use by the SPPS in December 2006 following review by a panel of external scientific advisors. The majority of professionals selected to become IDAP instructors (treatment providers) were psychologists, social workers, or those who had other behavioral science university degrees. IDAP instructors acquired client group experience under supervision through audio/video recordings of randomly selected group sessions. Supervising educators provided feedback to IDAP instructors to improve therapeutic skills and maintain program fidelity. Following satisfactory completion of two IDAP group programs and a follow-up training course, instructors were certified. Treatment fidelity was further secured during the study period through systematic educator reviews of randomly selected recorded IDAP group sessions and biannual face-to-face group supervision meetings for instructors. IDAP instructors at risk of failing to reach sufficient quality of their client work were supported with further supervision and training but could ultimately be decertified.

SPPS policy states that IDAP treatment should be preceded by a recidivism risk evaluation with the Spousal Assault Risk Assessment guide (SARA; Kropp, Hart, Webster, & Eaves, 1995) to ascertain that clients at medium or high risk of reoffending are prioritized for program inclusion according to the risk principle (Andrews & Bonta, 2010a). Before treatment, all clients should also self-report current alcohol and drug use with standardized tests, the Alcohol Use Disorder Identification Test (AUDIT; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001) and the Drug Use Disorder Identification Test (DUDIT; Berman, Bergman, Palmstierna, & Schlyter, 2005).

Based theoretically on CBT and social learning theory, IDAP is a group program with 27 two-hour-long sessions divided across nine different themes such as non-violence, non-threatening behavior, and accountability. IDAP has an open admission format: Clients are continuously enrolled into a group as space permits. To inform both instructors and the client, group work is preceded by three individual sessions involving assessment of current IPV, motivation for IPV-related behavioral change, and orientation about the IDAP process. Video clips are used to illustrate problematic behaviors and inspire discussions and participant homework assignments. Exercises and role-play help in acquiring strategies to avoid using violence or controlling behavior; for example, by improved recognition of one’s own anger and women’s fear, taking time-outs, and dealing with jealousy, criticism, and conflict. An individual mid-program session aims at evaluating treatment progress and, after the completion of all group sessions, another individual session sums up group work and plans for the future. A concluding series of four to six individual booster or risk management sessions encourages the IDAP participant to establish an action plan with personal goals and steps toward attaining these.

Participants

Treatment group

We consecutively included all SPPS clients who finished IDAP (prematurely or as completers) between January 1, 2004, and December 31, 2007. Clients were included if they had committed offenses that involved IPV: gross violation of a woman’s integrity (n = 129, 38%). First enacted in 1998, this offense is defined by the Swedish Penal Code as a pattern of repeated violation of victim integrity aimed at severely damaging the self-esteem of a woman with whom the male offender lives, or previously lived, in a close relationship including marriage or cohabitation. Gross violation of a woman’s integrity includes less serious but repeated acts such as illegal threats, harassment, violation of a restraining order, property destruction, and assault, together judged as one serious offense. Other IPV offenses beyond gross violation of a woman’s integrity included illegal threats, (aggravated) assault, and harassment (overall n = 211, 62%). The latter offenses were characterized by a single or only a few more severe acts during a brief period of time. IPV offenders convicted of a sexual crime were instead offered a concurrent sexual offense-specific program within the SPPS.

Following an intention-to-treat approach, we defined the treatment group as all participants who entered IDAP (i.e., both treatment completers and non-completers) and were either conditionally released from prison or served a probation sentence during this period. When a client served several sentences, and/or participated in more than one treatment round, we used information from the earliest sentence and treatment round. Thirty-two IDAP-treated individuals (9%) also participated in other accredited SPPS treatment programs during the study period, mainly briefer motivational programs and interventions against substance misuse.

The resulting treatment group consisted of 340 adult men: 158 (46%) were initially imprisoned and followed up on mandatory parole from prison, whereas 182 (54%) served a probation sentence. Participant mean age at inclusion was 38.9 years (SD = 10.3 years, range = 19-66). Clients released from prison had served an average of 255 days (SD = 157 days, range = 63-1,033).

Control group

Among all paroled clients released from prison or put on probation between January 1, 2004, and December 31, 2007, we selected all adult men convicted of the specific IPV offense, gross violation of a woman’s integrity, who neither participated in IDAP nor in the related, accredited SPPS program for sexual offenders (n = 452). Data precluded matching on IPV expressed in homicide, illegal threats, (aggravated) assault, and so forth, because neither the SPPS nor the national crime statistics supply victim details needed for delineating the offender–victim relationship. Similar to the IDAP treatment group, we allowed these 452 control subjects to participate in other SPPS programs during the study period (n = 25, 6%); again, these were primarily brief motivational programs and substance misuse interventions.

Out of the 452 control individuals, 372 (82%) were initially imprisoned and followed from their mandatory parole from prison. Another 80 (18%) were not detained but directly put on probation. The mean age at inclusion was 40.2 years (SD = 11.1 years, range = 19-75). Control clients serving a prison sentence did so for 130 days on average (SD = 84 days, range = 6-782).

Procedure

From a longitudinal, administrative SPPS register, we obtained data on clients’ treatment program participation, timing, length, and completion. Twenty-one out of 340 IDAP starters (6%) lacked a formal notation on treatment completion; however, they were judged as completers as they had participated in at least 24 out of 27 IDAP group therapy sessions.

Follow-up and Time-at-Risk

For both treated and control clients (total n = 792), follow-up started at release from prison (IDAP and control prisoners), the day probation began (control clients on probation), or IDAP participation ended (IDAP clients on probation) up to February 1, 2011. Time-at-risk, during which clients were reconvicted or not, was defined as the observation period between start of follow-up and end of follow-up. The mean time-at-risk for all clients was 4.6 years (SD = 1.0 year, median = 4.4, range = 3.1-7.1 years).

Recidivism

Recidivism was defined as a reoffense occurring after the start of follow-up leading to reconviction and a new SPPS sentence, registered up to March 2, 2011. We used register-based information about offense dates and associated reconvictions for crime against a (former) partner, IPV (including violation of a restraining order), and any violent recidivism (including IPV). Any violent recidivism included (attempted and completed) homicide, assault, robbery, illegal threats, threats/violence against an officer, rape and other sexual crimes, arson, gross violation of integrity/a woman’s integrity, intimidation, and illegal coercion. Aggravated versions of these offenses were also counted whenever applicable. As no systematically collected victim data were available from SPPS registers, court records were obtained for all individuals who recidivated in violent crime where partner victimization was possible but not certain. Hence, we did not retrieve records for offenses obviously directed against present or former partners (that is, gross violation of a woman’s integrity or violation of restraining order). Acquired records (n = 113) were examined and violent reoffenses coded dichotomously as directed toward a former or current intimate partner or not.

Confounding Factors

To control for baseline variations in individual recidivism risk that could confound the association between treatment participation and relapse in crimes, one of the authors, blinded to recidivism data, manually extracted data on seven empirically based risk factors for both treatment and control clients from SPPS client administrative and sentence planning registers (see Table 1). Risk factors were selected from a systematic review by Hanson, Helmus, and Bourgon (2007) as well as the two IPV-specific risk assessment decision aids with the best predictive validities: SARA (Kropp et al., 1995) and Dangerousness Assessment (DA; Campbell, 1995; Messing & Theresa-Thaller, 2013).

Table 1.

Prevalence of Baseline Risk Factors Across IDAP Treatment and Control Groups, Treatment Completers and Non-Completers, and Reconviction Status in a Treatment Effectiveness Study of Convicted Male IPV Offenders in Sweden.

	IDAP Treatment Versus Controls		IDAP Treatment		Any Violent Reconviction		Intimate Partner Violence Reconviction
	Treatment (n = 340)	Control (n = 452)	Completers (n = 249)	Dropouts (n = 91)	Yes (n = 188)	No (n = 604)	Yes (n = 149)	No (n = 643)
Baseline Risk Factor	%	%	%	%	%	%	%	%
Any crime conviction in past 5 years	43.2	38.7	37.4	59.3***	67.0	32.5***	65.8	34.8***
Any previous conviction of IPV	30.4	19.9***	26.9	40.0**	47.2	17.8***	48.4	19.3***
Any previous conviction of a sexual offense	2.7	1.3	1.2	6.6***	4.3	1.2***	2.7	1.7
Young age (below 21) at first known crime	13.8	11.1	10.8	22.0***	25.5	8.1***	22.2	10.0***
Any previous conviction of violation of restraining order	11.2	5.5***	9.2	16.5	12.8	6.5***	14.1	6.5***
Current alcohol abuse/dependence	55.0	48.9*	53.0	60.4	67.6	46.5***	68.5	47.6***
Current drug abuse/dependence	19.7	14.8*	15.7	30.8***	32.5	12.1***	26.2	14.8***

Note. We consecutively included all eligible adult, male intimate partner violence (IPV) offenders who began the Integrated Domestic Abuse Program (IDAP) in the Swedish Prison and Probation Service (SPPS) 2004 to 2007 and followed them until March 2, 2011. The seven empirically derived, potentially confounding risk factors were extracted from SPPS administrative register data and court files.

p < .05. **p < .01. ***p < .001 in Pearson’s χ² tests comparing each of the seven risk factors across IDAP treatment and control groups, treatment completers and non-completers, any violent reconviction status, and IPV reconviction status, respectively.

Hence, the seven included risk factors were any criminal conviction in the past 5 years; any previous conviction of IPV, a sexual offense, or violation of a restraining order, respectively; young age (below 21 years) at first known crime; alcohol abuse/dependence; and drug abuse/dependence. Risk factors were coded as present (1) or absent (0) and summarized without weighting into a risk index score ranging from 0 to 7 points.

Statistical Analysis

We used Pearson’s χ² tests to validate the confounder character of the seven individual risk factors described above by examining associations with treatment condition (IDAP vs. control groups), completer versus non-completer status, and outcome (recidivism and non-recidivism in any violent crime and IPV, respectively; see Table 1). We also used Cox’ proportional hazard modeling to assess the hazard of recidivism as a function of IDAP treatment status while controlling for offender age and confounder risk scores at inclusion and varying follow-up periods. All statistical analyses were performed with SAS®, version 9.2. Based on the expected small treatment effects suggested from previous studies, power calculations indicated a 5.1% chance to reach statistical significance at the p = .05 level (two-sided test) despite the relative large population included.

Results

Program Completion

A total of 249 clients (73%) who began IDAP treatment were coded as completers, resulting in a 27% (n = 91) drop-out rate. IDAP completers participated in an average of 27 group sessions (SD = 4.99) and 13 individual sessions (SD = 14.39), whereas non-completers on average took part in 11 group sessions (SD = 7.19) and 4 individual sessions (SD = 6.36). Thirty-six percent (n = 122) of the treatment clients began their IDAP participation in prison and 64% (n = 218) when on parole or probation. There was no significant difference in completion rates between those who started the program in prison as compared with probation (χ² = 0.008, p = .09).

Violent Recidivism

The violent recidivism rate during follow-up, defined as a new probation or prison sentence (all handled by the SPPS), for those who began IDAP treatment was 25% (n = 84) versus 23% (n = 104) for the control group. Among IDAP participants, the recidivism rate was 18% (n = 46) for treatment completers and 42% (n = 38) among non-completers.

IPV Recidivism

More specifically, 19% (n = 65) of IDAP participants recidivated in violence against a partner or former partner during follow-up and so did 19% of controls (n = 84). Among treatment completers, 15% (n = 37) recidivated in partner violence compared with 31% (n = 28) of clients who dropped out of IDAP treatment.

Adjusted Recidivism Risks

When adjusting for age at release, individual confounding, and follow-up time, the hazard ratio (HR) for the full treatment group (intention-to-treat analysis) compared with controls was 0.92 (95% confidence interval [CI] = [0.69, 1.23]) for any violent reconviction (see Figure 1). This corresponded to a marginal and statistically non-significant recidivism reduction for treated clients. Similarly, for IPV, reconvictions for all IDAP participants versus controls also yielded an HR of 0.92 (95% CI = [0.66, 1.28]). Per protocol subanalyses solely with those 249 men who completed treatment compared with untreated controls suggested stronger associations, albeit still not statistically significant, both for any violent recidivism (HR = 0.72, 95% CI = [0.51, 1.02]) and IPV (HR = 0.74, 95% CI = [0.50, 1.09]; Figure 1).

Figure 1.

Relative risk (HR) of reconviction in any violence and Intimate Partner Violence (IPV) for IDAP treatment participants compared with controls among convicted male IPV offenders in Sweden.

Discussion

We conducted a controlled effectiveness study of IDAP treatment on violent recidivism among convicted adult male IPV offenders within the Prison and Probation Services in Sweden, a different sociocultural context than most previous studies. We followed up a consecutive 2004 to 2007 sample of 340 clients who began IDAP and 452 concomitant control clients who did not until March 2011. A total of 249 IDAP participants(73%) completed their treatment whereas 91 (27%) dropped out. In intention-to-treat analyses adjusting for individual baseline risk and varying follow-up time, we failed to statistically secure a possible marginal risk reduction for those entering IDAP compared with control clients. This held both for general and IPV reconvictions, respectively. IDAP completers had a further reduced (but still non-significant) recidivism risk compared with controls. Our results were mainly in line with previous, non-Scandinavian, effectiveness research on interventions for IPV offenders (e.g., Smedslund et al., 2007; Stover, Meadows, & Kaufman, 2009) including Duluth model-inspired treatments.

However, we evaluated effectiveness based on data from IDAP’s first four years as an active program within the SPPS. Program fidelity seems related to effectiveness (e.g., Lowenkamp, Latessa, & Smith, 2006) and “effectiveness” of treatment programs diminishes when delivered in routine practice as opposed to “efficacy” demonstrated under optimal conditions (e.g., Koehler, Lösel, Akoensi, & Humphreys, 2013). Hence, ongoing efforts since 2007 to improve implementation of IDAP in Sweden’s Prison and Probation Services, to assure program fidelity and further improve adherence to the risk, needs, and responsivity principles (Andrews & Bonta, 2010a) may have made it more likely to ascertain possible program effectiveness today.

This study had several limitations. First, observational intervention studies always run the risk of comparing the most motivated individuals (participants) with the least motivated (non-participants or dropouts); this could inflate the perceived effect of an intervention. Although we attempted to handle selection problems by controlling for literature-based baseline risk factors that might confound the association between IDAP treatment and recidivism, we could not exclude possible residual confounding from risks such as lower educational level (Wormith & Olver, 2002), personality, general cognitive functioning, and client motivationfor change. However, previous treatment studies suggest that improved similarity between treatment and control groups (i.e., beyond the studied intervention), either through greater quantity, detail, and quality of available confounder data or through randomization, decreases observed effects (Babcock et al., 2004; Latimer, 2001). This indicates that such enhanced study designs are unlikely to prove effectiveness of IDAP beyond that suggested in the present study.

Second, official records of violence against partners only reflect a small proportion of the actual occurrence (e.g., Garner & Maxwell, 2009). Most IPV is not reported to the police (e.g., Swedish National Council for Crime Prevention, 2002) and conviction rates are low (Garner & Maxwell, 2009). However, as underreporting of recidivism is likely to be approximately equally distributed across treatment and control groups, this should not affect the magnitude of the observed associations, only the precision of estimates (i.e., entail wider CIs).

Third, the reliance on dichotomous outcome measures may be overly conservative. For example, Gondolf (2000) reported that individuals’ quarterly reassault rates decreased progressively during follow-up; this could be interpreted as a delayed impact of the intervention or just following the spontaneous violence cessation rate found in non-clinical samples. Specifically, a core minority of men who repeatedly reassaulted their partners were responsible for more than half of all reassaults during a 30-month follow-up (Gondolf, 2000). Hence, although all IPV is unacceptable, a harm reduction perspective on IPV would suggest that reducing the total amount of reoffending could be seen as a relative program success.

Fourth, correctional interventions appear more effective in reducing recidivism when they focus on higher risk clients (the risk principle; Andrews & Bonta, 2010a), address individual risk factors that contribute to antisocial behavior (i.e., the criminogenic needs principle; Andrews & Bonta, 2010a, 2010b; Babcock et al., 2004), and adapt interventions to participants’ learning styles (the responsivity principle; Andrews & Bonta, 2010a). Despite the general adherence to the risk principle within the SPPS, that is, to prioritize treatment to clients with higher recidivism risk, use of structured professional risk assessments with SARA was reported only in a minority of cases. Hence, we had limited ability at the time of the present follow-up study, several years after client inclusion, to retrospectively ascertain if higher risk offenders had been selected for inclusion according to the risk principle.

Fifth, treatment evaluations repeatedly suggest that offenders who fail to complete treatment programs are at higher risk to recidivate than treatment completers (reviewed by Stover et al., 2009). In their meta-analysis, McMurran and Theodosi (2007) even stated that non-completers are “made worse” (p. 341) by the incomplete intervention. The drop-out rate in the present study was 27%, quite similar to previous reports that 30% or more of participants who begin treatment drop out before completion (Olver, Stockdale, & Wormith, 2011; Stith, Rosen, & McCollum, 2003). Consequently, treatment dropouts constitute a problem also in IPV offender treatment. Hence, increased knowledge of why certain individuals do not complete treatment and the best way to handle this problem is needed. An influential typology for IPV offenders or “batterers” (Holtzworth-Munroe & Stuart, 1994) suggested three subgroups: the relationship/family-only batterer, the borderline/dysphoric, and the generally violent/antisocial batterer. Following this framework, Huss and Ralston (2008) studied treatment completion, immediate treatment response, and domestic violence–related reconvictions across batterer subtypes. Unsurprisingly, generally violent/antisocial IPV offenders had the lowest treatment completion rate (50%) and the highest recidivism rate (39%). Family-only batterers, in contrast, more often completed treatment programs (78%) and also had the lowest recidivism rates (11%). Daly, Power, and Gondolf (2001) found that lower education, unemployment, not being court ordered to attend treatment, and alcohol misuse among perpetrators predicted fewer attended treatment sessions. Together, these two reports suggest that more generally antisocial or substance abusing IPV offenders are less likely to complete treatment. This held also in our study where non-completers had more severe crime histories and were more often diagnosed with substance misuse than completers.

Based on the current marginally positive, non-significant findings of IDAP effectiveness on criminal reconvictions, should we continue to provide this program? Our results support prior conclusions from systematic reviews that IDAP is not a satisfactory IPV offender treatment. Important empirical support to program development could be provided with causally informative research designs delineating if truly causal IPV risk factors are addressed in IDAP and other IPV offender interventions. Improvements in program structure and content are also critical, perhaps through integration of substance misuse treatment modules (e.g., Wilson, Graham, & Taft, 2014) including pharmacotherapy. Finally, future evaluations should use designs that make treatment and control groups as similar as possible apart from the intervention(s), within a well-controlled observational study using propensity score matching or as a randomized controlled trial (RCT). For example, we currently link individual, anonymized SPPS data on program participation, client characteristics, and motivation to change with longitudinal nationwide registry information on educational, vocational, psychiatric, and criminal history in offenders, their parents, and siblings.

Conclusion

This cross-cultural test of the IDAP program for male IPV offenders within the SPPS suggested, at best, marginal reductions of violent and IPV recidivism. None of the effects were possible to secure statistically. The findings support conclusions from systematic reviews regarding IDAP’s poor effects on continued violent behavior, and suggest an urgent need to develop improved interventions for IPV offenders.

Footnotes

Authors’ Note

This study was approved by the regional ethics review board in Stockholm, Sweden, Dnr 2010/1609-31/5.

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support was indirectly provided by the Swedish Prison and Probation Service through the authors’ employments there. However, the funder had no influence on study design, analyses, conclusion, and decision to publish.

Author Biographies

Ulrika Haggård, MSW, PhD, worked as a researcher with the Swedish Prison and Probation Service at the time of the study and has long clinical experience with forensic psychiatric evaluations and violence risk assessments. Her research interests include interpersonal violence, mental health, risk assessment, and treatment outcomes.

Ingrid Freij has a BSc degree in psychology and was a research assistant in the Swedish Prison and Probation Service at the time of the study. Her professional interests comprise risk assessment and treatment effectiveness.

Maria Danielsson has a BSc degree in statistics and works as a statistician in the Swedish Prison and Probation Administration. She is interested in organizational factors related to treatment effectiveness among convicted criminal offenders.

Diana Wenander holds an MSc degree in social sciences and a BA degree in psychology. She worked with evaluation and treatment of intimate partner violence offenders for 7 years in the Swedish Prison and Probation Service and was a research assistant at the time of the study.

Niklas Långström, MD, PhD, is a board-certified child and adolescent psychiatrist and professor of psychiatric epidemiology at Karolinska Institutet in Stockholm, Sweden. He is national scientific advisor to the Swedish Prison and Probation Administration. He researches causal risk factors for and interventions against sexual and non-sexual violent crime.

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