Justice-Involved Veterans and Moral Reconation Therapy

NCT ID: NCT02524171

Last Updated: 2023-07-27

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 344 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-04-04
• Study Completion Date: 2021-03-30

Brief Summary

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

Detailed Description

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

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

Conditions

Antisocial Personality Disorder; Substance Use Disorder

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Moral Reconation Therapy (MRT)

MRT is a group-based cognitive-behavioral intervention to restructure antisocial thinking. Patients will receive two groups per week of this intervention for approximately 12 weeks, in addition to the usual care they receive in the mental health residential rehabilitation treatment program.

Group Type: EXPERIMENTAL

Moral Reconation Therapy (MRT)

Intervention Type: BEHAVIORAL

MRT is a group-based cognitive-behavioral intervention to restructure antisocial thinking. Patients will receive two groups per week of this intervention for approximately 12 weeks, in addition to the usual care they receive in the mental health residential rehabilitation treatment program.

Usual Care (UC)

Usual care provided by the mental health residential rehabilitation treatment programs, which patients in both groups are in.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Moral Reconation Therapy (MRT)

MRT is a group-based cognitive-behavioral intervention to restructure antisocial thinking. Patients will receive two groups per week of this intervention for approximately 12 weeks, in addition to the usual care they receive in the mental health residential rehabilitation treatment program.

Intervention Type: BEHAVIORAL

Other Intervention Names

MRT

Eligibility Criteria

Inclusion Criteria

• Veterans who

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

Exclusion Criteria

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

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

VA Office of Research and Development

FED

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Daniel M. Blonigen, PhD MA

Role: PRINCIPAL_INVESTIGATOR

VA Palo Alto Health Care System, Palo Alto, CA

Locations

Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR

North Little Rock, Arkansas, United States

VA Palo Alto Health Care System, Palo Alto, CA

Palo Alto, California, United States

VA Bedford HealthCare System, Bedford, MA

Bedford, Massachusetts, United States

Countries

United States

References

Timko C, Booth BM, Han X, Schultz NR, Blonigen DM, Wong JJ, Cucciare MA. Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users. Rural Ment Health. 2017 Apr;41(2):110-122. doi: 10.1037/rmh0000065.

Reference Type: RESULT

PMID: 29051795 (View on PubMed)

Blonigen DM, Cucciare MA, Timko C, Smith JS, Harnish A, Kemp L, Rosenthal J, Smelson D. Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration. BMC Health Serv Res. 2018 Mar 7;18(1):164. doi: 10.1186/s12913-018-2967-3.

Reference Type: RESULT

PMID: 29514649 (View on PubMed)

Blonigen DM, Smith JS, Javier S, Cucciare MA, Timko C, Nevedal AL, Filice N, Rosenthal J, Smelson D. Implementation Potential of Moral Reconation Therapy for Criminal Recidivism in Mental Health Residential Programs. Psychiatr Serv. 2022 Aug 1;73(8):856-863. doi: 10.1176/appi.ps.202100089. Epub 2022 Jan 26.

Reference Type: RESULT

PMID: 35080418 (View on PubMed)

Blonigen DM, Cucciare MA, Byrne T, Shaffer PM, Giordano B, Smith JS, Timko C, Rosenthal J, Smelson D. A randomized controlled trial of moral reconation therapy to reduce risk for criminal recidivism among justice-involved adults in mental health residential treatment. J Consult Clin Psychol. 2022 May;90(5):413-426. doi: 10.1037/ccp0000721. Epub 2022 Apr 11.

Reference Type: RESULT

PMID: 35404638 (View on PubMed)

Ward M, Baldwin N, Blonigen DM. Assessing the impact of combat trauma on the severity, expression, and course of posttraumatic stress disorder in justice-involved veterans. Psychol Trauma. 2025 Jun 2:10.1037/tra0001950. doi: 10.1037/tra0001950. Online ahead of print.

Reference Type: DERIVED

PMID: 40455528 (View on PubMed)

Timko C, Vest N, Cucciare MA, Smelson D, Blonigen D. Substance use and criminogenic thinking: Longitudinal latent class analysis of veterans with criminal histories. J Subst Abuse Treat. 2022 Dec;143:108893. doi: 10.1016/j.jsat.2022.108893. Epub 2022 Oct 1.

Reference Type: DERIVED

PMID: 36215912 (View on PubMed)

Gibbon S, Khalifa NR, Cheung NH, Vollm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev. 2020 Sep 3;9(9):CD007668. doi: 10.1002/14651858.CD007668.pub3.

Reference Type: DERIVED

PMID: 32880104 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

IIR 14-081

Identifier Type: -

Identifier Source: org_study_id