Justice-Involved Veterans and Moral Reconation Therapy (MRT)

July 19, 2023 updated by: VA Office of Research and Development

Improving Treatment Engagement and Outcomes Among Justice-involved Veterans

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).

Study Overview

Status

Completed

Conditions

Intervention / Treatment

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.

Study Type

Interventional

Enrollment (Actual)

344

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Arkansas
      • North Little Rock, Arkansas, United States, 72114-1706
        • Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
    • California
      • Palo Alto, California, United States, 94304-1207
        • VA Palo Alto Health Care System, Palo Alto, CA
    • Massachusetts
      • Bedford, Massachusetts, United States, 01730-1114
        • VA Bedford HealthCare System, Bedford, MA

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: 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.
Behavioral: 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.
Other Names:
  • MRT
No Intervention: Usual Care (UC)
Usual care provided by the mental health residential rehabilitation treatment programs, which patients in both groups are in.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Risk for Criminal Recidivism (Criminal Thinking)
Time Frame: 6 months (post-baseline)
The Psychological Inventory of Criminal Thinking Styles (56 items) was administered to assess criminal thinking. The measure includes scales of Mollification, Cutoff, Entitlement, Power Orientation, Super-optimism, Cognitive Indolence, and Discontinuity . Scores on these scales were summed to create a General Criminal Thinking score, which has been validated as an overall index of recidivism risk. Higher scores equate to more criminal thinking. Scores were converted to a T-score metric (M=50, SD=10), calculated in reference to norms from samples of incarcerated offenders.
6 months (post-baseline)
Risk for Criminal Recidivism (Criminal Thinking)
Time Frame: 12 months (post-baseline)
The Psychological Inventory of Criminal Thinking Styles (56 items) was administered to assess criminal thinking. The measure includes scales of Mollification, Cutoff, Entitlement, Power Orientation, Super-optimism, Cognitive Indolence, and Discontinuity . Scores on these scales were summed to create a General Criminal Thinking score, which has been validated as an overall index of recidivism risk. Higher scores equate to more criminal thinking. Scores were converted to a T-score metric (M=50, SD=10), calculated in reference to norms from samples of incarcerated offenders.
12 months (post-baseline)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Alcohol Use
Time Frame: 6 months (post-baseline)
The quantity and frequency of patients' self-reported alcohol use in the past 6 months, measured with the Timeline Follow-Back interview that was administered at the 6-month follow-up interview.
6 months (post-baseline)
Drug Use
Time Frame: 6 months (post-baseline)
The quantity and frequency of patients' self-reported drug use in the past 6 months, measured with the Timeline Follow-Back interview. It was administered at each time point to calculate for the past 6 months total number of days using any drugs (marijuana, cocaine, amphetamines, heroin, other opiates, benzodiazepines, barbiturates, inhalants, or hallucinogens).
6 months (post-baseline)
Criminal Associates
Time Frame: 6 months (post-baseline)
Scale A of the Measures of Criminal Attitudes and Associates (MCAA; Mills, Kroner, & Forth, 2002) was administered at each interview to quantify participants' associations with criminal peers, a strong predictor of criminal recidivism (Mills, Kroner, & Hemmati, 2004). Participants were asked to consider the four adults (excluding family, co-workers, or other residents in treatment) with whom they spend the most free-time. A count variable was created by summing the number of friends for which the participant answered yes to any of the questions of criminal involvement (possible range=0-4, where a higher score indicates a worse outcome)
6 months (post-baseline)
Employment Problem Severity
Time Frame: 6 months (post-baseline)
The Employment module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity.
6 months (post-baseline)
Alcohol Use Problem Severity.
Time Frame: 6 months (post-baseline)
The Alcohol module of the ASI was administered at each time point to assess problem severity in this domain, using composite score indices (ranging from 0 to 1); higher scores indicate greater problem severity. ASI composite scores such as this have long been used to provide internally-consistent evaluations of a patient in a particular problem area (Grahn & Padyab, 2020).
6 months (post-baseline)
Legal Problem Severity
Time Frame: 6 months (post-baseline)
The Legal Status module of the Addiction Severity Index (ASI; McLellan et al., 2006) was administered at each interview to assess legal problem severity. The latter is based on a composite index derived from five items: Are you presently awaiting charges, trial, or sentence? How many days in the past 30 have you engaged in illegal activities for profit? How serious do you feel your present legal problems are? (0=Not at all, 4=Extremely) How important to you now is counseling or referral for these legal problems? (0=Not at all, 4=Extremely) How much money did you receive from illegal sources in the past 30 days? These items were standardized and aggregated and yield scores ranging from 0 to 1; higher scores indicate greater problem severity of legal problems.
6 months (post-baseline)
Family/Social Problems
Time Frame: 6 months (post-baseline)
The Family/Social module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity.
6 months (post-baseline)
Alcohol Use
Time Frame: 12 months (post-baseline)
The quantity and frequency of patients' self-reported alcohol use in the past 6 months, measured with the Timeline Follow-Back interview that was administered at the 12-month follow-up interview.
12 months (post-baseline)
Drug Use
Time Frame: 12 months (post-baseline)
The quantity and frequency of patients' self-reported drug use in the past 6 months, measured with the Timeline Follow-Back interview. It was administered at each time point to calculate for the past 6 months total number of days using any drugs (marijuana, cocaine, amphetamines, heroin, other opiates, benzodiazepines, barbiturates, inhalants, or hallucinogens).
12 months (post-baseline)
Criminal Associates
Time Frame: 12 months (post-baseline)
Scale A of the Measures of Criminal Attitudes and Associates (MCAA; Mills, Kroner, & Forth, 2002) was administered at each interview to quantify participants' associations with criminal peers, a strong predictor of criminal recidivism (Mills, Kroner, & Hemmati, 2004). Participants were asked to consider the four adults (excluding family, co-workers, or other residents in treatment) with whom they spend the most free-time. A count variable was created by summing the number of friends for which the participant answered yes to any of the questions of criminal involvement (possible range=0-4, where a higher score indicates a worse outcome)
12 months (post-baseline)
Employment Problem Severity
Time Frame: 12 months (post-baseline)
The Employment module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity.
12 months (post-baseline)
Alcohol Use Problem Severity.
Time Frame: 12 months (post-baseline)
The Alcohol module of the ASI was administered at each time point to assess problem severity in this domain, using composite score indices (ranging from 0 to 1); higher scores indicate greater problem severity. ASI composite scores such as this have long been used to provide internally-consistent evaluations of a patient in a particular problem area (Grahn & Padyab, 2020).
12 months (post-baseline)
Legal Problem Severity
Time Frame: 12 months (post-baseline)
The Legal Status module of the Addiction Severity Index (ASI; McLellan et al., 2006) was administered at each interview to assess legal problem severity. The latter is based on a composite index derived from five items: Are you presently awaiting charges, trial, or sentence? How many days in the past 30 have you engaged in illegal activities for profit? How serious do you feel your present legal problems are? (0=Not at all, 4=Extremely) How important to you now is counseling or referral for these legal problems? (0=Not at all, 4=Extremely) How much money did you receive from illegal sources in the past 30 days? These items were standardized and aggregated and yield scores ranging from 0 to 1; higher scores indicate greater problem severity of legal problems.
12 months (post-baseline)
Family/Social Problems
Time Frame: 12 months (post-baseline)
The Family/Social module of the ASI was administered at each timepoint to assess problem severity in this domain, using composite score indices (range 0 to 1); higher scores indicate greater problem severity.
12 months (post-baseline)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

VA Office of Research and Development

Investigators

  • Principal Investigator: Daniel M. Blonigen, PhD MA, VA Palo Alto Health Care System, Palo Alto, CA

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 4, 2016

Primary Completion (Actual)

September 30, 2020

Study Completion (Actual)

March 30, 2021

Study Registration Dates

First Submitted

August 5, 2015

First Submitted That Met QC Criteria

August 11, 2015

First Posted (Estimated)

August 14, 2015

Study Record Updates

Last Update Posted (Actual)

July 27, 2023

Last Update Submitted That Met QC Criteria

July 19, 2023

Last Verified

July 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IIR 14-081

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Antisocial Personality Disorder

Clinical Trials on Moral Reconation Therapy (MRT)

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Mauritius

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe