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Journal of Interpersonal

Violence
http://jiv.sagepub.com/

Assessing Treatment Readiness in Violent Offenders


Andrew Day, Kevin Howells, Sharon Casey, Tony Ward, Jemma C. Chambers
and Astrid Birgden
J Interpers Violence 2009 24: 618 originally published online 7 May 2008
DOI: 10.1177/0886260508317200
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Assessing Treatment
Readiness in Violent
Offenders

Journal of Interpersonal
Violence
Volume 24 Number 4
April 2009 618-635
2009 Sage Publications
10.1177/0886260508317200
http://jiv.sagepub.com
hosted at
http://online.sagepub.com

Andrew Day
University of South Australia

Kevin Howells
Nottingham University and University of South Australia

Sharon Casey
University of South Australia

Tony Ward
Victoria University

Jemma C. Chambers
University of South Australia

Astrid Birgden
Deakin University

Although violent offenders are widely considered to be difficult to engage in


therapeutic change, few methods of assessing treatment readiness currently
exist. In this article the validation of a brief self-report measure designed to
assess treatment readiness in offenders who have been referred to violent
offender treatment programs is described. The measure, which is an adaptation of a general measure of treatment readiness developed in a previous work,
displayed acceptable levels of convergent and discriminant validity and was
able to successfully predict treatment engagement in violent offender treatment. These results suggest that the measure has utility in the assessment of
treatment readiness in violent offenders.
Keywords:

readiness; responsivity; assessment; violence

he enormous social and economic costs associated with violent offending are such that the development and delivery of programs to reduce
the occurrence of violent crime has become a priority area for many governments. Although there is some evidence to suggest that violent crime in
some countries may be slowly decreasing (e.g., Moffatt & Poynton, 2006),
the number of offenders imprisoned for violent offenses has risen steadily
over the past few years. Australian statistics, for example, show that nearly

618
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half of the sentenced prison population has been convicted of crimes of violence, with nearly one in two (47%) having the most serious offense involving violence or the threat of violence, including offenses such as acts intended
to cause injury (14%), robbery/extortion (12%), sexual assault and related
offenses (11%), and homicide and related offenses (10%; Australian Bureau
of Statistics, 2004). Although it is difficult to obtain a true base rate for violent reoffending, the available data indicate that at least 20% of convicted
offenders will go on to commit further violent offenses after release from custody (Dowden & Serin, 2001), making the treatment and rehabilitation of
known offenders a particularly important area for service development.
Anger-management and violence-reduction programs aimed specifically
at this population have proliferated in recent years, despite a relatively limited evidence base from which to draw any conclusions about program
effectiveness. In the just published meta-analysis, Polaschek and Collie
(2004) identified only nine violent offender program evaluations that they
considered to be of sufficient methodological rigor to warrant inclusion. Of
these, only four studies reported rates of violent recidivism. More recently,
Polaschek, Wilson, and Townsend (2005) reported positive outcomes from
a New Zealand program, with 32% of the treatment group being reconvicted for a violent offense after release as compared to 63% of a matched
comparison group (matched on the basis of relevant characteristics such as
offense type and sentence). For those treated participants who were reconvicted, survival analysis revealed that the mean number of days to violent
reoffense was more than double that for the comparison group.
A particularly important issue in violent offender treatment concerns the
assessment and selection of appropriate candidates for treatment. Although
it is generally accepted that programs should target the higher risk offenders
(Andrews & Bonta, 2003), violent offenders are not a particularly homogeneous group in terms of their treatment needs (see Davey, Day, & Howells,
2005). There is a widely acknowledged need for individualized assessment
Authors Note: The authors would like to thank all the program participants who generously
gave their time to participate in this research for no personal benefit: Katherine Hawkins and
Rebecca Penrose, who assisted with data collection and entry, and particularly to program
facilitators from violence programs in the different states: Cherice Cieplucha, Julie Malone (New
South Wales), Linda De Haan, Piers Yates-Round, Lucy Cunningham, Shelly Hicks (Western
Australia), Steven Wright, Ann-Marie Martin (South Australia), and Annie Thomas (Victoria).
This research was supported by an Australian Research Council Research Grant in collaboration
with Corrections Victoria. The views expressed in this article are those of the authors and do not
necessarily reflect those of Corrections Victoria or other agencies. Correspondence concerning
this article should be addressed to Andrew Day, School of Psychology, North Terrace, Adelaide,
5000 South Australia; e-mail: Andrew.day@unisa .edu.au.

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Journal of Interpersonal Violence

and case formulation before treatment is offered to reduce the rates of inappropriate referral to treatment (e.g., Daffern, Howells, & Ogloff, 2007;
Wong & Gordon, 2004). Inappropriate referral can lead to low rates of
engagement in treatment and even program noncompletion or dropout.
Rates of attrition in many correctional programs appear to be quite high,
and Dowden and Serins (2001) findings that those who dropped out from
a Canadian correctional service program for violent offenders had the highest rate of violent reoffending (40%, compared with untreated [17%] and
treated [5%] groups) are a cause for much concern (see also McMurran &
Theodosi, 2004). That is not to say that high-risk offenders who are assessed
as likely to drop out of programs should not be offered treatment; rather,
they may require additional interventions designed to prepare them to
receive the type of intervention delivered in violent offender treatment (see
Day, Bryan, Davey, & Casey, 2006).
One potential way to minimize rates of attrition is to assess participants
before they enter the programs in terms of their ability to engage in a meaningful way with the program facilitators, materials, and other participants.
Howells and Day (2003) have suggested that many violent offenders will
struggle to do this, identifying a number of potential impediments that form
significant barriers to therapeutic engagement (including, for example, the
likelihood of comorbidity with other problems and the inferences that violent
people tend to make about the nature of their problems, such as I am right and
my reaction just or It is better to express anger than control it). In short, they
argued that many violent offenders are simply not ready for treatment.
It would therefore appear to be important to find ways of reliably predicting those offenders who will have difficulties engaging in treatment and, as a
consequence, be at increased risk of not completing programs. In this article
we report on the validation of a brief self-report measure that assesses treatment readiness in those offenders who are referred to violent offender treatment programs. In a recent study, Casey, Day, Howells, and Ward (2007)
described the psychometric properties of a new scale designed to measure
treatment readiness in offenders referred to cognitive skills programs. The
Corrections Victoria Treatment Readiness Questionnaire (CVTRQ) was internally consistent and displayed high levels of discriminant and convergent
validity and, from a practical perspective, provided a brief and easily administered measure, given that it has been designed to be used by staff with no specific professional qualifications. Importantly, scores on this measure were
shown to be positively correlated with therapeutic engagement, giving evidence of predictive validity.

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Items from the CVTRQ were derived from a theoretical model of offender
treatment readiness articulated by Ward, Day, Howells, and Birgden (2004),
which, it is suggested, represents a conceptual advance on other models of
readiness that draw solely on the transtheoretical model (TTM) of change
(see Wong & Gordon, 2004 for an application of the transtheoretical model
with violent offenders), given the limited support for the application of this
model with offender populations (see Casey, Day, & Howells, 2005). This
study examines the extent to which an offense-specific adaptation of treatment readiness questionnaire of Casey et al. (2007) is a valid and reliable
measure, which can be used to predict engagement in those attending violent offender treatment. The study builds on the previous work in three
ways. First, a brief semistructured readiness interview was given to participants prior to entering the program. The purpose of this was to establish
whether a face-to-face interview provides a better predictor of treatment
engagement than a self-report measure, given the suggestion that interviews
may provide a more reliable method of assessment with offender populations (Serin & Kennedy, 1997). Second, the measure was readministered at
the end of the program to establish whether levels of readiness changed
over the course of the program. If readiness does change over time, then the
measure may have the potential to be also used as a measure of change in
interventions designed to promote treatment readiness prior to program participation (see Day et al., 2006). Finally, data were collected on therapeutic
engagement not only at the midpoint of the program but also on completion
of the program. In addition, data regarding participant satisfaction with the
program were also collected at the end of program to provide an additional
outcome measure and to determine whether participants identified as being
higher in treatment readiness would report higher levels of treatment satisfaction. This allows for an examination of the extent to which the measure
predicts not only engagement but also treatment performance.

Method
Participants
Participants in the study were 96 convicted male offenders referred to a
semi-intensive or intensive violence (more than 100 hours) intervention
programs delivered in four Australian states (Victoria n = 48, Western
Australia n = 26, New South Wales n = 16, South Australia n = 6). These
programs aim to promote an understanding of violent offending, identify and

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Journal of Interpersonal Violence

challenge cognitive distortions that maintain offending, and develop an


understanding of the consequences of offending and an individualized relapse
prevention plan. At least one psychologist delivers programs, and models of
ongoing supervision and staff support are generally well developed. The
number of program facilitators involved in this research (approximately 25)
minimizes the potentially confounding effects of individual differences in
facilitator skill in promoting engagement. Preprogram assessments are comprehensive and include file review, clinical interview, and psychometric
assessment. Case formulation and identification of individual treatment goals
are an integral component of the more intensive programs. All participants
have committed a violent offense and have been assessed as of medium or
high risk of reoffending (see Howells, Heseltine, Sarre, Davey, & Day, 2004).
Of the original sample, 4 participants (4%) failed to complete the questionnaires, leaving 92 participants in the final sample. The ages of participants ranged from 18 to 44 years (M = 30.00, SD = 6.63), with 92 (95.7%)
participants receiving treatment in prison settings and 4 (4.3%) in a community setting. Mid- and posttest measures were collected only from 53
(54.6%) participants for two reasons. First, some participants did not complete the program and were unavailable for reassessment; others declined to
give their consent for the postprogram assessment. Second, some program
facilitators did not administer the postprogram questionnaires to their groups.
Comparisons between those who dropped out or for whom data was incomplete and those who completed the assessments, however, revealed no differences in terms of pretreatment levels of readiness, age, sentence length,
or offense type. Participation in the study was voluntary.

Materials
Participants in the program completed the following measures.
Violence Treatment Readiness Questionnaire (VTRQ). The VTRQ is a
20-item self-report questionnaire that assesses readiness to participate in and
engage with a violence program. The questionnaire is an adapted version of
the CVTRQ (Casey et al., 2007), with item wording changed to reflect violence rather than offending in general (e.g., I have not offended for some
time now was replaced with I have not acted violently for some time now).
The measure is reproduced in the appendix. Items in the CVTRQ can be
grouped into four components (attitudes and motivation, emotional reactions, offending beliefs, and efficacy) that map onto the Multifactor Offender
Readiness Model (MORM; Ward et al., 2004). Responses are made on a

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5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly


agree). Scores can range from 20 to 100, with higher scores, following the
recoding of negatively keyed items, considered indicative of a higher degree
of readiness to participate and engage in treatment.
Violence Treatment Readiness Interview (VTRI). The VTRI is a 24-item
semistructured interview designed to assess the extent to which an offender is
ready to participate in and engage with a violent offender rehabilitation
program. Based on the MORM (Ward et al., 2004), the interview consists of
four parts that examine how the individual feels generally (e.g., How would you
describe yourself?; How reliable are you?), about being a client of correctional
services (e.g., What do you think about being in corrections?; Does it upset you
to be here?), their beliefs and feelings about their offense(s) and violence (e.g.,
Do you see yourself as a violent person?; Have you ever sought help for problems with violence?), and their attitudes toward rehabilitation programs (e.g.,
Are you the sort of person who attends rehabilitation programs?; How motivated are you to attend a rehabilitation program?). Each question is asked by
the interviewer, who makes a rating (0, 1, or 2) on the basis of answers given;
follow-up questions and prompts are provided for use when responses are
insufficient or inconsistent. Scores can range between 0 and 48, with lower
scores indicating a greater degree of readiness to attend the program.
Paulhus Deception Scales (PDS). The PDS (Paulhus, 1998) is a 40-item selfreport questionnaire that purports to measure two constructs: self-deception
(20 items; the tendency to give honest, albeit self-deceived, but inflated selfdescriptions) and impression management (20 items; the tendency to give situationally defined inflated self-descriptions). Responses are made on a 1 (not
true) to 5 (very true) Likert-type scale, with the total score being an aggregate
of all items. Higher scores reflect greater socially desirable responding.
Loza-Fanous Self-Efficacy Questionnaire (SEQ). The SEQ (LozaFanous, 2004) is an 8-item self-report questionnaire that reflects an
offenders degree of confidence in his or her ability to successfully negotiate treatment tasks. Responses are made on a 5-point Likert-type scale
ranging from 1 (not at all confident) to 5 (extremely confident). A total
score is obtained by summing the ratings for each item, with higher scores
indicating increased levels of confidence. Loza-Fanous reports moderately
strong internal consistency reliability ( = .82) for this scale.
Readiness to Change Questionnaire (RCQ). The RCQ (Rollnick, Heather,
Gold, & Hall, 1992) is a 12-item questionnaire based on the study of Prochaska,
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DiClemente, and Norcross (1992) stages of change model, designed to identify


the stage of change reached by an excessive drinker of alcohol. The three stages
identified by the measure are precontemplation, contemplation, and action. To
adapt the measure for use with violent offenders, the wording of each item was
changed from alcohol to violence (e.g., My drinking is a problem sometimes
was changed to My violence is a problem sometimes). Responses are made on
a 5-point Likert-type scale from 1 (strongly disagree) to 5 (strongly agree), with
higher scores, after reverse coding negatively keyed items, indicative of
increased levels of readiness to change.
Serin Treatment Readiness Scale (STRS). The STRS is an 11-item selfreport questionnaire adapted from the semistructured interview of treatment
readiness (Treatment Readiness Rating Scale; TRRS) developed by Serin
(1998) and Serin and Kennedy (1997). Questions for the STRS were formulated using face validity with each question addressing one of the main
two components of each construct of the Treatment Readiness Rating
Scale. Participants are asked to choose the most applicable response regarding their violent offending and the management of that offending on a
5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly
agree). Items are summed to provide a total score of individual readiness
for treatment, with higher scores reflecting greater levels of readiness.
Processes of Change Questionnaire (PCQ). The PCQ (Prochaska,
Velicer, DiClemente, & Fava, 1988) is a 10-item self-report questionnaire
adapted from the Processes of Change-Short Form (Prochaska et al., 1988),
which was designed to assess how shifts in behavior occur during smoking
cessation. Item content was modified to reflect issues of violent offending
(e.g., When I am tempted to smoke I think about something else was modified to read When I am tempted to be violent I think about something else.),
with each item reflecting one of the 10 processes of change (i.e., consciousness raising, environmental reevaluation, self-reevaluation, social liberation,
dramatic relief, helping relationships, self-liberation, counterconditioning,
reinforcement management, and stimulus control). Respondents are asked to
think of any similar experiences they may be currently having or have had
in the previous month and then rate the frequency of the event on a 5-point
Likert-type scale from 1 (never) to 5 (always).
MacArthur Perceived Coercion Scale (PCS). The PCS (Gardner et al.,
1993; Monahan et al., 1995) is a 7-item self-report measure of perceived
coercion to attend treatment. Part of the MacArthur Admission Experience
Interview, the PCS assesses individual perceptions of freedom, influence,
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control, volition, and choice. Responses to each statement are made using
a true/false format, with each true response scored as 0 and each false
scored as 1. Higher scores indicate a greater level of perceived coercion.
Treatment engagement. A measure of treatment engagement was constructed using the protocol developed by Casey et al. (2007), which involved
factor analysis of three measures: the Penn Helping Alliance Rating Scale
(PHA; Luborsky, Crits-Christoph, Alexander, Margolis, & Cohen, 1983), a
measure of two types of alliance relating to the clients experience of the therapist and the clients sense of collaborative working; the Working Alliance
Inventory-Client Short-Form (WAI-C SF; Horvath & Greenberg, 1989;
Tracey & Kokotovic, 1989), a 12-item self-report measure of working
alliance, that consists of three subscales: goals, tasks, and bond; and the Group
Cohesion Scale (GCS; adapted from Riggs, Warka, Babas, Betancourt, &
Hooker, 1994), an 11-item self-report questionnaire designed to assess the
degree to which individuals believe in the shared efficacy of a group and the
ability of that group to achieve particular outcomes (see Bandura, 1977).
Responses to each of these measures are made on Likert-type scales from
strongly disagree to strongly agree. The subsequent 17-item measure, the
Treatment Engagement Scale (TES), comprised three subscales that incorporate client perceptions of and confidence in the treatment process and the
extent to which a therapeutic alliance is established. The Alliance factor (eight
items) describes the participantfacilitator relationship (e.g., The facilitators
and I trust one another); the Group Process factor (four items) describes participant beliefs about the efficacy of the group in terms of achieving treatment
goals (e.g., Some members of this group do not participate well); and the
Confidence factor (five items) reflects participant self-confidence in terms of
changing their offending behavior (e.g., I feel now that I am understanding my
problem with violence and can deal with it myself). Items were summed, following reverse scoring of negatively keyed items, to provide a total score of
treatment engagement with higher scores reflecting greater engagement.
Casey et al. reported strong internal consistency reliability ( = .90) for this
measure of engagement. The 17-item scale as developed by Casey et al. was
used to assess treatment engagement in the present study.
Therapy satisfaction. This 12-item scale (Oei & Green, 2004) asks questions relating to how participants felt about the therapy and the therapists in
the group program they attended (e.g., I am satisfied with the quality of
the therapy I received, My needs were met by the program, and The therapist was not negative or critical toward me). Items are rated on a 5-point
Likert-type scale from 1 (strongly disagree) to 5 (strongly agree). Items
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Journal of Interpersonal Violence

are summed, with higher scores indicating greater levels of therapy


satisfaction.

Procedure
Participants completed the battery of questionnaires at three points in the
program delivery. The VTRQ and VTRI were administered at the preprogram stage, together with the measures of convergent validity (SEQ, RCQ,
STRS) and discriminant validity (PDS, PCS). Measures of predictive validity (Working Alliance Inventory-Client Short-Form, Penn Helping Alliance
Rating Scale, and Group Cohesion Scale) were collected at the midprogram
stages and, together with the VTRQ, again at the postprogram stage. All
measures were given out in treatment groups and placed in a sealed envelope for posting back to the researchers. The scoring and analysis was conducted blind in so far as those conducting the analyses were not aware of
participants scores on the readiness measure.

Results
Preliminary Analyses
Prior to undertaking analyses, invalid self-report protocols were identified by applying the test manual cutoff scores for the impression management subscale of the PDS. No cases were identified as above the upper
cutoff scores (>12, faking good); using the lower cutoff (<1, faking bad),
five cases (6.3%) were identified. These five cases were removed, leaving
a total sample of 87 for subsequent analyses.

Descriptive Statistics
Descriptive statistics and internal consistency reliabilities for all measures
used in the evaluation (following deletion of invalid self-reports) are provided in
Table 1. Internal consistency reliability for the VTRQ at both pre- and posttest
was acceptable, although marginally lower than that found by Casey et al. (2007)
for the CVTRQ (.83). Mean scores on the PDS (Paulhus, 1998) were higher than
those reported by Paulhus for a prison population (8.44 vs. 7.50).

Construct Validity of the VTRQ


Construct validity of the VTRQ was assessed through convergent and discriminant validity. To assess for convergent validity, bivariate correlations
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Table 1
Descriptive Statistics for the Violence Treatment Readiness
Measure (Pre- and Posttest), Treatment Readiness Interview,
Loza-Fanous Self-Efficacy Questionnaire, Readiness
to Change Questionnaire, Serin Treatment Readiness Scale,
Paulhus Deception Scale, McArthur Perceived Coercion Scale,
Penn Helping Alliance Scale, Group Cohesion Scale,
and Treatment Engagement Scale (pre- and posttests)
Variables
Violence Treatment Readiness Measure (Preprogram)
Violence Treatment Readiness Measure (Postprogram)
Treatment Readiness Interview
Loza-Fanous Self-Efficacy Questionnaire
Readiness to Change Questionnaire
Serin Treatment Readiness Scale
Processes of Change Questionnaire
Paulhus Deception Scale
McArthur Perceived Coercion Scale
Working Alliance Inventory-Client Short Form
Penn Helping Alliance Rating Scale
Group Cohesion Scale
Treatment Engagement Scale (Midprogram)
Treatment Engagement Scale (Postprogram)
Therapy satisfaction

SD

Range

73.65
77.90
12.39
23.83
45.17
42.55
28.96
8.44
2.53
62.13
44.22
7.56
70.43
75.34
50.37

7.80
8.76
4.96
5.42
5.48
5.48
7.06
5.26
1.74
9.44
4.62
.95
10.81
11.13
7.17

55-95
53-99
4-23
12-40
27-59
29-55
11-49
1-23
0-6
19-84
23-55
4-10
33-93
51-93
29-60

.72
.76
.63
.81
.71
.79
.75
.81
.63
.91
.91
.65
.91
.92
.94

were conducted between the VTRQ and the Loza-Fanous Self-Efficacy


Scale (Loza-Fanous, 2004), PCQ (Prochaska et al., 1988), RCQ (Rollnick
et al., 1992), and STRS (adapted from Serin & Kennedy, 1997). In support
of convergent validity, Table 2 shows the VTRQ to be significantly positively correlated with all four measures. Discriminant validity was supported by the lack of significant association between the VTRQ and the
PDS (Paulhus, 1998) and its significant negative association with the PCS
(Gardner et al., 1993; Monahan et al., 1995).

Predictive Validity
Predictive validity, which refers to the association between a measure
and some theoretically related outcome or criterion, was examined by
exploring the relationship between scores on the VTRQ and the composite

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Table 2
Bivariate Correlations Between Violence Treatment
Readiness Questionnaire, Treatment Readiness Interview,
Loza-Fanous Self-Efficacy Scale, Readiness to Change
Questionnaire, Process of Change Questionnaire, Serin
Treatment Readiness Scale, and McArthur Perceived
Coercion Scale, Paulhus Deception Scale
Item

1. Treatment Readiness
Questionnaire
2. Treatment Readiness
Interview
3. Self-Efficacy
4. Readiness to Change
5. Processes of Change
6. Serin Treatment Readiness
7. Perceived Coercion
8. Paulhus Deception Scale
ns

1.00
.27 ns 1.00
.26* .37* 1.00
.55*** .35*
.15 ns 1.00
.51*** .27 ns .32**
.45*** 1.00
***
ns
***
.51
.29
.48
.62*** .47*** 1.00
.37**
.08 ns .30* .16 ns .16 ns .55*** 1.00
.03ns
.06 ns .26*
.07 ns .34**
.17 ns .03 ns 1.00

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

measure of midprogram treatment engagement (TES). The significant positive association between treatment readiness scores and treatment engagement, r(53) = .46, p < .001, supports the predictive validity of the VTRQ.
By comparison, the only measure of convergent validity significantly
related to midprogram treatment engagement was that which measured
self-efficacy, that is, SEQ, r(53) = .28, p < .05; neither the RCQ, r(53) =
.19, p > .05 nor the STRS, r(53) = .24, p > .05, were found to be significantly associated with scores on the measure of treatment engagement
(TES). Consistent with the underlying principles of the MORM (Ward
et al., 2004), midprogram scores of treatment engagement, as measured by
the TES, r(41) = .53, p < .001, were significantly positively associated
with scores on the therapy satisfaction scale.

Semistructured Interview Versus Self-Report Questionnaire


A further aim of the present study was to establish whether a face-toface interview would provide a better predictor of treatment engagement
than a self-report measure, given the possibility that interviews may provide a more reliable method of assessment with offender populations. First,
although the relationship between the two measures was nonsignificant,

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r(38) = .27, p > .05, the association was nonetheless in the desired direction and approached significance (p = .09). Furthermore, whereas scores on
the self-report measure were moderately and significantly related to scores
on the measure of treatment engagement, r(53) = .40, p < .01, the relationship between scores on the semistructured interview and treatment
engagement was nonsignificant, r(26) = .04, p > .05.

Treatment Readiness and Treatment Satisfaction


The next step in the analysis was to assess the extent to which treatment
readiness influenced perceived satisfaction with the program. Although the
sample size in this study was insufficient to calculate cutoff scores for identifying participants who are treatment ready, receiver operating characteristics analysis undertaken for the general readiness measure (see Casey et al.,
2007) suggested a preliminary cutoff score of 76. Using this score, pretreatment readiness scores were recoded into two groups, and an independent t-test was undertaken to determine whether differences in treatment
satisfaction existed. The findings revealed that participants higher in treatment readiness reported significantly higher levels of treatment satisfaction
(M = 48.40, SD = 7.79) than their low-readiness counterparts (M =
52.95, SD = 5.33), t(51) = 2.36, p < .05, and d = 0.68.

Changes Over Time


The final aims of the study were to examine whether both treatment readiness and engagement changed over the course of the program. Pairedsamples t-tests revealed significant changes with moderate effect sizes on
both scores. Postprogram scores on the VTRQ (M = 77.90, SD = 8.76)
were significantly higher than preprogram scores (M = 73.83, SD = 7.44),
t(52) = 3.08, d = 0.50, indicating that participation in the program had led
to an increase in readiness scores. Similarly, postprogram scores on the TES
(M = 75.00, SD = 10.57) were significantly higher than midprogram scores
(M = 69.27, SD = 10.74), t(41) = 3.41, d = 0.51, suggesting that levels
of engagement continue to increase across the duration of the program.

Discussion
In this article we have reported on the validation of a self-report measure
designed to assess treatment readiness in those offenders referred to semiintensive and intensive violent offender rehabilitation programs. The measure,
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Journal of Interpersonal Violence

the VTRQ, which is an offense-specific adaptation of a measure developed


by Casey et al. (2007), contains 20 items and can be easily and quickly
administered by staff with no professional training. The results of this
study, involving participants of violent offender treatment programs from
four separate state jurisdictions, provide preliminary data that suggest that
the total score on the VTRQ can be used to inform decisions about program
suitability. Although the sample size is relatively small for scale validation
and the main outcome measure was self-reported engagement with treatment rather than a behavioral measure of change, the VTRQ showed
acceptable levels of internal consistency, reliability, and construct validity.
Pretreatment scores were significantly correlated with treatment engagement. In addition, VTRQ scores were more strongly associated with therapeutic engagement than scores on two other measures, the STRS and the
RCQ, that have been used previously to assess treatment readiness in offenders. Finally, participants identified as being more treatment ready reported
higher levels of treatment satisfaction.
The construct of treatment readiness is theoretically rich, encompassing
not only individual difference factors (including cognitive, affective, behavioral, volitional, and identity domains) but also those relating to the external environment in which rehabilitative treatment is offered (Ward et al.,
2004). The study is important in so far as it provides further empirical support for the notion that the construct of readiness can be successfully operationalized. It has also been proposed that the construct of readiness is
broader than other individual difference factors that may also clearly impact
on treatment engagement (e.g., psychopathy, antisocial personality disorder, or motivation to change) as well levels of risk, criminogenic need, and
responsivity. Further work is required to examine the extent to which treatment readiness relates to these other constructs. Even within a relatively
homogeneous moderate- to high-risk population, the distribution of scores
(which ranged from 55 to 95) highlighted the broad spread of the treatment
readiness construct. An interesting direction for future research would be an
exploration of different offender subgroups to determine whether any one
group displays particularly low levels of treatment readiness.
A somewhat surprising finding was that scores on the self-report readiness measure were more highly correlated with treatment engagement than
scores derived from the semistructured interview. One possibility here is
that offenders are more likely to respond in socially desirable ways in faceto-face interviews than when they complete a questionnaire, thus compromising the validity of the interview. Clearly, it is important to consider
issues relating to impression management in any assessment of violent

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offenders, with the data collected in this study revealing that 6% of participants displayed a tendency to fake bad. It may be, given the possibility
of favorable parole decisions being associated with attendance at programs
that offenders seek to persuade assessors that they are indeed in need of
treatment. It should be noted that all measures used in the validation study
were self-report in nature that can raise questions about the veracity of participant responses. Although the authors acknowledge this possibility, the
relationship between scores on the readiness interview and two of the convergent validity measures (the RCQ; Rollnick et al., 1992 and SEQ; LozaFanous, 2004) were in the same direction as the self-report measure of
treatment readiness.
The results of this study also suggest that treatment readiness does increase
over the course of participation in programs. It is perhaps not surprising by the
end of treatment that participants are able to demonstrate changes in their attitudes and motivation, emotional reactions to their offenses, offending beliefs,
and efficacy; however, the data suggest that the VTRQ may have an additional
use as a measure of change in interventions designed to increase problem
awareness and motivation prior to entry in structured treatment programs.
Although the sample size in this study was insufficient to allow for confirmatory factor analysis, the four readiness subscales identified by Casey et al.
(2007) offer a clinically useful method of assessing which facets of readiness
may need to be addressed to improve readiness in particular individuals.
Although readiness did increase over the course of the intervention, it
was interesting to note that levels of therapeutic engagement (as measured
by the TES) also increased between the midprogram and postprogram points
of assessment. This suggests that for violent offenders the therapeutic alliance
continues to develop over the course of the program, in contrast to other
treatments where the alliance may develop relatively early on and then
remain stable. This finding illustrates the potential difficulties that violent
offenders experience in engaging in therapeutic change, and highlights the
need for facilitators to be sensitive to process issues throughout the treatment process. In addition, we note the strong positive correlation between
midprogram levels of treatment engagement and therapy satisfaction. This
finding underscores the importance of establishing the therapeutic alliance
early in the treatment process.
In conclusion, these results suggest that the VTRQ measure may assist
those who assess offenders with histories of violence for rehabilitation in
decision making around program eligibility and suitability. It may also
inform the design of interventions to improve treatment readiness in those
offenders who are unable to engage in violent offender treatment.

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17.
18.
19.
20.

8.
9.
10.
11.
12.
13.
14.
15.
16.

1.
2.
3.
4.
5.
6.
7.

Treatment programs are rubbish


I am not able to do treatment programs
Treatment programs are for wimps
I want to change
Stopping offending is really important to me
Treatment programs dont work
When I think about my last offense I feel
angry with myself
I feel ashamed about my violence
I am upset about being a corrections client
Being seen as an offender upsets me
I regret the offense that led to my last sentence
I feel guilty about my offending
Others are to blame for my violence
I dont deserve to be doing a sentence
I am to blame for my violence
When I think about my sentence I feel angry
with other people
I am well organized
I have not acted violently for some time now
I hate being told what to do
Generally I can trust other people
1
1
1
1

1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1

Strongly
Disagree

2
2
2
2

2
2
2
2
2
2
2
2
2

2
2
2
2
2
2
2

Disagree

3
3
3
3

3
3
3
3
3
3
3
3
3

3
3
3
3
3
3
3

Unsure

Appendix
The Violence Treatment Readiness Questionnaire (VTRQ)

4
4
4
4

4
4
4
4
4
4
4
4
4

4
4
4
4
4
4
4

Agree

5
5
5
5

5
5
5
5
5
5
5
5
5

5
5
5
5
5
5
5

Strongly
Agree

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Andrew Day works in the School of Psychology at the University of South Australia. He is
interested in clinical forensic psychology research and practice, and has worked both in the
United Kingdom and Australia.
Kevin Howells is from the Peaks Academic and Research Unit, Nottinghamshire Healthcare
Trust and University of Nottingham. He also works at the Centre for Applied Psychological
Research, University of South Australia.
Sharon Casey is Programme Director of the Forensic Psychology Masters Programme at the
University of South Australia.
Tony Ward is currently a professor of clinical psychology at Victoria University of
Wellington, New Zealand. His research focuses on rehabilitation issues and models, cognitive

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processes in offenders, and the offense process in sex offenders. His most recent book is
Rehabilitation: Beyond the Risk Paradigm, Routledge (2007, coauthored with Shadd Maruna).
Jemma C. Chambers completed her PhD at the University of Melbourne in 2006. She currently works in the United Kingdom.
Astrid Birgden is a forensic psychologist who develops offender rehabilitation services, particularly regarding sexual offenders and intellectually disabled offenders. She is currently
Director of a drug treatment prison in Sydney, Australia.

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