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with risk, responsivity, and recidivism. Criminal Justice and Behavior, 29(4),
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(August 2002): 447-471

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OFFENDER TREATMENT ATTRITION
AND ITS RELATIONSHIP
WITH RISK, RESPONSIVITY,
AND RECIDIVISM

J. STEPHEN WORMITH
MARK E. OLVER
University of Saskatchewan

This investigation examined factors contributing to attrition from correctional treatment and the
implication that treatment noncompletion may have for issues concerning risk, recidivism, and
responsivity. Participants included 93 violent offenders who had been referred to an intensive
treatment program in a maximum security correctional facility. Descriptive information, pro-
gram participation, and recidivism data were gathered from comprehensive institutional and
police records. Treatment noncompleters had less formal education and less employment history
in the community. They were more likely to be ofaboriginal ancestry and classified to maximum
security, scored more poorly on several treatment process variables, and were higher risk offend-
ers. Subsequent analyses demonstrated that very high-risk aboriginal offenders were particu-
larly vulnerable to dropping out of treatment (80%). The findings are discussed with respect to
the principles of risk and responsivity.

It is well established that practitioners in criminal justice agencies

can identify offenders who are most likely to reoffend if they
choose from what has become a wide array of risk prediction instru-

AUTHORS' NOTE: J. Stephen Wormith is forensic chair Departmentof Psychol-

ogy, University of Saskatchewan, and a consulting psychologistat the Regional Psy-
chiatric Centre, Saskatoon, Saskatchewan, Canada.Mark E. Olver is a doctoralstu-
dent in the DepartmentofPsychology, University ofSaskatchewan, and a researcher
at the Regional PsychiatricCentre, Saskatoon, Saskatchewan, Canada.The authors
would like to thank the stafffrom the Aggressive BehaviouralControlprogramat the
Regional PsychiatricCentrefor theircomments andfeedback on an earlierversion of
this article.
CRIMINAL JUSTICE AND BEHAVIOR, Vol. 29 No. 4, August 2002 447-471
© 2002 American Association for Correctional Psychology

447
448 CRIMINAL JUSTICE AND BEHAVIOR

ments to guide them in their assessments (Gendreau, Little, & Goggin,

1996; Grove, Zald, Lebow, Snitz, & Nelson, 2000; Hoge, 2002 [this
issue]). It has also been well demonstrated that correctional interven-
tions are effective in reducing recidivism when they focus on higher
risk clients and employ cognitive-behavioral approaches to address
the dynamic characteristics of offenders that contribute to antisocial
behavior (i.e., their criminogenic needs; Andrews et al., 1990; Lipsey
& Wilson, 1993). Consequently, public safety will increase when
higher risk offenders, who are identified with proven instruments, are
referred to and complete appropriately devised treatment. This is
commonly called "the risk principle" (Andrews, Kiessling, Robinson,
& Mickus, 1986). It also makes for sound public policy and fiscal
responsibility, because resource allocation remains an ongoing con-
cern in the criminal justice portfolio.
However, correctional policies and practices can contradict this
principle and sometimes do so unknowingly or unintentionally. One
means by which common practice undermines the risk principle is by
addressing the "wrong" type of client. This may occur in two ways.
One concerns a natural tendency for service providers to focus on low-
risk clients. It occurs regardless of whether the treatment agent is an
individual clinician, a volunteer association, a criminal justice agency,
or a for-profit enterprise and has been enshrined in the so-called
"YAVIS" client (young, attractive, verbal, intelligent, and skilled). It
is simply easier and more appealing to provide services to a highly
motivated, receptive, and accessible clients. Typically, these clients
come from the ranks of low-risk offenders. Repeatedly, intervention
efforts with these clients have proved, at best, to have no impact and, at
worst, to increase recidivism rates (Andrews & Kiessling, 1980;
Baird, Heinz, & Bemus, 1979; O'Donnell, Lydgate, & Fo, 1979). Yet
efforts to intervene with them continue and the results of these efforts
still prove to be iatrogenic in their effect (Bonta, Wallace-Capretta,
&

Rooney, 2000). Nonetheless, intelligent correctional policy and prac-

tice, with the assistance of good client assessment, is capable of over-
coming this kind of transgression of the risk principle.
The second phenomenon that interferes with correctional organiza-
tions' application of the risk principle concerns the frequent occur-
rence of clients' failure to complete treatment. Our particular concern
about client attrition affecting correctional agencies' adherence to the
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 449

risk principle is based on the assumption and observation that some of

the client characteristics that put the offender at risk for not complet-
ing treatment are also likely to put him or her at risk for recidivism.
Client motivation (Girard, 1999), denial (Hunter & Figueredo, 1999),
psychopathy (Ogloff, Wong, & Greenwood, 1990), unemployment
(Browne, Foreman, & Middleton, 1998), substance abuse (Browne
et al., 1998), antisocial attitudes (Gendreau et al., 1996), and intelli-
gence (Gendreau et al., 1996) are just a few of the more obvious candi-
dates. Our concern is that high-risk offenders who are referred for
treatment may be less likely to complete their program, and therefore,
their likelihood of recidivism may not be abated to its full extent.
In corrections, one might consider three kinds of attrition: client-
initiated dropout, agency-initiated expulsion, and administratively
based exit. The latter event occurs when an offender is released or
transferred, typically from prison, by a third party for reasons that
have nothing to do with the offender's need for treatment or perfor-
mance in it. For example, courts may overturn a conviction or sen-
tence, parole boards may release an offender, and correctional admin-
istrators may transfer an offender in the midst of treatment. Similarly,
a probationer may be transferred to another community by an employer
for reasons that are independent of his or her participation in treat-
ment. This kind of occurrence should be addressed, where possible,
administratively and is likely to require interagency communication
and cooperation.
Another common event in correctional treatment, staff-based exclu-
sion, occurs when an exclusionary criterion (e.g., client is expected to
be "too disruptive") is invoked to disallow a referred offender from
entering treatment. For reasons discussed above, it is likely that such a
strategy will result in selecting a treatment sample that excludes many
of the higher risk offenders. But this practice is a variation of the first
phenomenon, the practitioner's natural desire to treat the low-risk
offender, and should be addressed administratively by the agency.
In differentiating these two related but different phenomena, one is
reminded that getting higher risk offenders into treatment is one thing
and that keeping them there is another. This is illustrated by Burt's
(2000) recent study in which high- and moderate-risk offenders, as
identified by the Psychopathy Checklist-Revised (Hare, 1991), who
were referred and admitted to a violent offender treatment program
450 CRIMINAL JUSTICE AND BEHAVIOR

spent about 30% less time in treatment than low-risk offenders who
began the same program (p <.002). The focus of this study is on treat-
ment noncompletion via client-initiated dropout and agency-initiated
expulsion. Our practical experience suggests that these issues are
much more problematic to address and cannot be remedied simply
through corporate or organizational policy.

TREATMENT NONCOMPLETION

Offender noncompletion of treatment is endemic to all correctional

intervention and is particularly familiar to practitioners in the field.
However, with some notable exceptions, it has not received sufficient
attention in the offender treatment literature. One longstanding excep-
tion occurs in the field of correctional program evaluation whereby the
impact of attrition on the interpretation of treatment success has been a
concern to methodologists and correctional administrators for decades.
Treatment attrition has been the topic of considerable attention as a
methodological issue in program evaluation (Foster & Bickman,
1996; Marques, Day, Nelson, & West, 1994). For example, after con-
vincing a state agency to apply random assignment to a large sample
of offenders on parole, Berman (1973) lost two thirds of the program's
participants. The St. Louis Project was one of the first large treatment
studies of delinquent youth to demonstrate the relationship between
noncompletion and treatment quality on outcome (Feldman & Wodarski,
1983). Youth who failed to complete a high-quality program did not
improve on a series of prosocial behavioral observation measures as
much as those who did complete it, whereas those who did not com-
plete a low-quality program actually deteriorated considerably more
than those who did complete the program.
Based on a review of specialized correctional literature, it would
appear that treatment attrition among offenders is higher than it is for
many other kinds of clients. In the field of sex offender treatment,
noncompletion has been particularly problematic. For example, Abel,
Mittelman, Becker, Rathner, and Rouleau (1988) reported a 35%
noncompletion rate from their 30 weekly sessions of treatment. Three
quarters of the noncompleters refused or were unavailable for expla-
nation and presumably were client-initiated dropouts. About one half
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 451

of the remainder were agency-based expulsions for reasons of disrup-

tion, mental disorder, or alcohol abuse, whereas the other half were
administratively based exits, having moved out of state or been incar-
cerated for incidents prior to treatment. Elsewhere, Marques et al.
(1994) reported that 19% of the offenders who began California's in-
patient Sex Offender Treatment Evaluation Project (SOTEP) did not
complete the program. This occurred after an even larger group of
referred candidates withdrew prior to program startup. Of the SOTEP
noncompleters, 65% were client-initiated dropouts, whereas 35%
were agency-based expulsions. Interestingly, 40% of SOTEP non-
completers participated in the program for at least 1 year before exit-
ing, indicating that clients' long-term participation does not guarantee
their program completion but that program completion may be partic-
ularly problematic in longer programs. In Britain, Browne et al.
(1998) found a noncompletion rate of 37.5% among sex offenders on
probation who were referred to a community-based program. Not sur-
prisingly, antisocial personality disorder has been associated with
noncompletion of sex offender treatment within forensic settings
(Moore, Bergman, & Knox, 1999; Shaw, Herkov, & Greer, 1995).
Elsewhere, research on various sex offender populations suggests
that treatment attrition is related to clients' risk to recidivate. In their
meta-analysis of 61 sex offender recidivism studies, Hanson and
Bussibre (1998) found treatment noncompletion to be a robust and
significant predictor of sexual offense recidivism (mean weighted r =
.17). Hanson and Harris (2000) later investigated the dynamic predic-
tors of sexual recidivism in a sample of 208 sexual recidivists and 201
nonrecidivists and found that recidivists were more likely to have
dropped out of previous treatment.
Treatment noncompletion has been a concern among other special
groups of offenders, particularly violent offenders. In Britain, forensic
outpatient referrals to treatment over a 7-year period resulted in a 56%
nonattendance or noncompletion rate (Dalton, Major, & Sharkey,
1998), much of which was due to the noncompletion of referrals to an
anger-control program. About one half of these clients failed to attend
a single appointment. Hambridge (1990) reported a 25.6% nonattendance
and early dropout rate from a forensic outpatient service, whereas
Hird, Williams, and Markham (1997), reporting specifically on refer-
452 CRIMINAL JUSTICE AND BEHAVIOR

rals for anger management, cited a noncompletion rate of 82%. In an

outpatient batterer treatment program, Gondolf and Foster (1991)
reported attrition rates of 73% between initial inquiry into the pro-
gram and the intake assessment phase and a rate of 86% by the time
clients entered into counseling. After 12 sessions had passed, 93% of
the initial treatment referrals had dropped out, and at the end of the full
8-month program, only 1% of the men had successfully completed.
Treatment completion has also been a concern in a number of
related fields. It has long been an issue in the treatment of alcohol
(Kravitz, Fawcett, McGuire, Kravitz, & Whitney, 1999) and sub-
stance abuse, particularly when it occurs comorbid with mental disor-
der (Nuttbrock, Ng-Mak, Rahav, & Rivera, 1997). Treatment attrition
is problematic in the treatment of various psychiatric disorders, partic-
ularly depression (Tedlow et al., 1996) and anxiety-based problems,
such as panic disorder (Grilo et al., 1998). Moreover, a meta-analysis
of 125 outpatient psychotherapy studies revealed that dropout was
related to client demographic characteristics, such as belonging to an
ethnic minority, having a lower income, and being less educated, all of
which are common among the offender population (Wierzbicki

&
Pekarik, 1993).
Although some studies have examined personal and referral-based
characteristics of offender noncompleters (e.g., age, time on waiting
list), only a few have examined these clients, typically specific types
of offenders, in terms of their particular risk to the community and the
potential impact of their noncompletion on public safety. One exam-
ple is a study of British sex offenders in the community, on whom it
was demonstrated that noncompletion can be predicted using the
same risk factors that predict recidivism (Browne et al., 1998). These
variables included unemployment, alcohol/drug dependency, previ-
ous incarceration, and both violent and "noncontact" previous offenses
as well as deterioration and delinquent behavior during treatment.
A second study examined characteristics of batterers who failed to
complete their counseling (DeMarais, 1989). Completers were older,
more financially stable, and more likely to say that it was very impor-
tant to cease their abuse, whereas noncompleters were more likely to
be unemployed, to have an arrest record, to be in trouble because of
drinking, and to have initiated premarital abuse.
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 453

THEORETICAL CONSIDERATIONS

Treatment completion is implicated in at least a couple of the theo-

retical perspectives on client intervention that are commonly used in
corrections. Derived initially to conceptualize progress through sub-
stance abuse treatment, the transtheoretical model (Prochaska

&
Diclemente, 1983) is designed to assist the clinician in conceptualiz-
ing and guiding the client's progress through five stages of change
(precontemplation, contemplation, determination or preparation,
action, and maintenance). Although it has been suggested that the
application of the stages of change framework to the clinical correc-
tional setting could reduce attrition from treatment (Hemphill

&
Howell, 2000), there is some suggestion, at least among probationers,
that client stage is unrelated to program completion or short-term out-
come (Simourd & O'Connor, 2000). The development of "motiva-
tional interviewing" is a direct product of this model (Miller, 1983). It
occurred in response to the perception that if a client does not remain
motivated to stay in treatment, he or she is more likely to drop out and
relapse into the problematic behavior (Miller, 1989). It consists of a
series of strategies to confront the client in a manner that induces a
commitment to change without making him or her defensive and
likely to withdraw from treatment (Miller, 1983).
The "responsivity principle" is another tenet of effective correc-
tional intervention and carries implicit direction for treatment com-
pletion (Andrews et al., 1986). Originally, responsivity was conceptu-
alized with client outcome ultimately in mind. Service providers were
alerted to choose the most effective mode of treatment not only for the
general offender population but also for the individual client. But it
may also be viewed from a treatment completion perspective because
internal responsivity factors are defined as client characteristics that
interfere with or facilitate learning, and failure to acquire material is
likely to contribute to treatment attrition (Kennedy, 2000). As Van
Voorhis (1997) pointed out, offender classification not only must
focus on offender risk and need but also must consider other client
characteristics that contribute to a client's responsivity when the inter-
ventions are being planned. Similarly, the concept of therapeutic alli-
ance has emerged out of a long tradition of clinical practice, emphasiz-
ing the maintenance of a clinical connection with the client to maximize
454 CRIMINAL JUSTICE AND BEHAVIOR

the impact of treatment (Horvath & Symonds, 1991). To summarize

this perspective, the means by which responsivity may affect outcome
is by being sensitive to offender characteristics so that the design and
delivery of services are more likely to engage the client, increase treat-
ment completion, augment the acquisition of rehabilitative material,
and reduce recidivism.

THE CURRENT STUDY

The purpose of this study was to examine treatment attrition among

a group of federally incarcerated offenders who had been referred to a
specialized treatment facility. Because studies have found that the
noncompletion rate of anger management programs are particularly
high (Dalton et al., 1998; Hird et al., 1997), referrals to an inpatient
Aggressive Behavioural Control (ABC) program were reviewed. Spe-
cifically, treatment completion is investigated in terms of a variety of
descriptive and legal variables as well as offender risk. Two kinds of
attrition, client dropout and agency expulsion, are compared. The
relationship between risk, other client characteristics, and treatment
completion with recidivism is also reviewed in a 4-year follow-up of
the offender sample.

METHOD

SETTING AND PROGRAM

The Regional Psychiatric Centre (Saskatoon) is a specialized treat-

ment facility in the Correctional Service of Canada (CSC). It is a 200-
bed facility that is divided into five discrete units, each with its own
staff, admission criteria, and programs for violent offenders, sexual
offenders, domestic batterers, psychiatric offenders, and female offend-
ers. The current study was conducted on MacKenzie Unit, which is
designed for violent offenders. The unit's residents routinely partici-
pate in an ABC program. The program was recently accredited by
CSC's accreditation panel of external, international experts in the field
of violence programming.
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 455

PARTICIPANTS

Participants for the current study were 93 offenders admitted to

MacKenzie Unit between 1992 and 1997. They had an average age of
30.56 (SD = 6.52) years at the time of admission. With respect to mari-
tal status, 38% of the participants were single, 38% married or com-
mon law, 19% separated or divorced, and 5% widowed. Slightly more
than half (53%) were of aboriginal ancestry, with the remaining par-
ticipants being Caucasian (45%) or other ethnic descent (2%). Their
average level of academic attainment, including graduate equivalency
diploma credits, was Grade 10.04 (SD = 2.11). Almost all of the
offenders (96%) were serving time for a violent (nonsexual) offense,
and most (63%) had also been convicted of a nonviolent offense as
part of the current sentence. Seven offenders were serving life or
indefinite sentences. The remainder had an average sentence length of
69.99 (SD = 43.85) months. The group, including the life offenders,
had served an average of 43.58 (SD = 47.71) months at the time of their
admission to the Regional Psychiatric Centre (RPC). They were in
treatment at the RPC for an average of 6.40 (SD = 3.28) months. At the
time of admission to the treatment facility, 29% were classified as
maximum security, 67% as medium security, and 4% as minimum
security. One offender died while in custody, and a second offender
was deported upon release from prison. These two participants were
excluded from the recidivism portion of this study.

MATERIALS

The Statistical Information on Recidivism (SIR) Scale (Nuffield,

1982) was originally developed on a large sample of federally incar-
cerated offenders in Canada. The scale consists primarily of criminal
and personal history variables, which are largely static in nature. The
scale is a 15-item checklist with a range of scores from -27 (high risk)
to +30 (low risk). An offender is typically scored on the SIR Scale by
CSC case management staff (classification officers or parole officers)
upon admission to prison. In addition to a raw risk score, the SIR Scale
allows one to allocate offenders to a level of risk on a 5-point scale. In
the original study, recidivism rates, by risk level, ranged from 16% to
68%. Subsequent studies have upheld the predictive validity of the
456 CRIMINAL JUSTICE AND BEHAVIOR

instrument and demonstrated the stability of these recidivism rates by

risk level over time (Bonta, Harman, Hann, & Cormier, 1996;
Cormier, 1997; Hann & Harman, 1989; Nuffield, 1989; Wormith

&
Goldstone, 1984).
A data collection protocol was developed by the authors for this
study. This instrument included a wide range of legal, demographic,
and personal historical variables, many of which were coded in a sim-
ple dichotomous fashion and all of which were available from CSC
offender files. The legal measures included index offense, sentence
length, time served upon admission to treatment, and security classifi-
cation (maximum, medium, or minimum) upon admission to treat-
ment. The demographic measures included age at admission to treat-
ment, ethnic background (aboriginal-i.e., North American Indian
and Metis-or nonaboriginal) and marital status (married/common
law or other). Other historical measures included educational achieve-
ment (grade level) and occupational history (none to very little or
some to full-time).
A series of rating items was also created to evaluate participants'
performance in treatment. These process items included measures of
denial, motivation/effort, global improvement, and a series of treat-
ment behavioral items, including attendance, completion of home-
work, prosocial behavior on the unit, and attitude toward treatment.
All items were scored on a 5-point scale, except for global improve-
ment, which was on a 7-point scale, from -3 (substantialdeteriora-
tion) to +3 (substantialimprovement).

TREATMENT ATTRITION

Treatment attrition was coded as a dichotomous variable. It was

defined as any failure to complete the ABC treatment program suc-
cessfully and thus remain for the full duration of treatment (approxi-
mately 6 months). An optional relapse prevention component fol-
lowed the ABC program for patients who had successfully completed
the treatment but was not required for treatment completion. Total
length of time in treatment was calculated for all participants, and the
reason for discontinuing treatment (staff expulsion or client-initiated
dropout) was recorded for noncompleters.
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 457

PROCEDURE

A pool of participants was identified from an in-house database of

former clients of the facility who met the time and location criterion.
Client data were collected from three sources: an automated Offender
Information System, individual client files, and clinical records main-
tained by the facility. SIR Scale scores were retrieved from the data-
base (n = 44) or were calculated by the research team based on client
information on file if they were not found on the prisoner's record (n=
49).
Participants were identified as program completers or noncompleters
based on staff clinical notes. In all cases, these notes indicated quite
clearly whether an offender had actually completed the 6-month ABC
program. Some completers (n = 5), however, were admitted less than 1
month after the program began but were allowed to "catch up" on the
material and were declared successful completers by the treatment
staff.
Recidivism was assessed by accessing the Finger Print Service,
which is a national offender database maintained by the Royal Cana-
dian Mounted Police. This record comprises a reliable listing of all
charges, convictions, and dispositions of offenders in Canada. Partici-
pants were scored on the dichotomous variables, any charges and any
convictions, based on any notations on the Finger Print Service docu-
ments subsequent to the offenders' departure from treatment and
release from treatment and prison. The recidivism data were collected
in July 2000. The average follow-up time for the sample was 4.00 (SD
= 1.52) years following client release, with all participants being fol-
lowed up for between 1 and 6.68 years.

ANALYSES

Chi-square and t tests were used to compare completers and

noncompleters on a variety of historical, demographic, and treatment
process data. In addition, the SIR score and risk level were used to
compare differences between completers and noncompeters. Simi-
larly, client-initiated dropouts were compared to agency expulsions
on the same group of predictive variables. Then, standard multiple
regression analyses and two-way ANOVAs were conducted to exam-
458 CRIMINAL JUSTICE AND BEHAVIOR

me the relationship between client risk and treatment completion on

subsequent recidivism. Relationships between ethnic background,
risk, and treatment completion on recidivism were also examined by
means of correlations, t tests, and ANOVAs.

RESULTS

COMPLETERS AND NONCOMPLETERS

Thirty-five participants (37.6%) of the total sample did not com-

plete their treatment program (see Table 1). There was a substantial
difference between the amount of treatment received (in months) by
completers (M= 8.33, SD = 2.52) and noncompleters (M= 3.13, SD =
1.66), t(91) = 11.57, p <.001. Although they did not differ in terms of
age, completers and noncompleters differed on numerous other demo-
graphic measures. Noncompleters were more likely than completers
to be from maximum security (49% vs. 17%), X 2 ( 2 , N = 93) = 10.41, p <
.005, and more likely to be native offenders (66% vs. 45%), X 2(l N=
93) = 3.82, p < .04. Curiously, they were also more likely to report
being married or in a common law relationship (49% vs. 31%), X2(1,
N= 93) = 2 .8 6 ,p <.08. With respect to other characteristics, complet-
ers were more likely to have regular or full-time employment in the
community prior to admission (80% vs. 57%), X 2 (l, N= 93)= 4.83, p <
.03, and they reported a higher degree of academic attainment (grade
level) (M= 10.47, SD = 2.06, and M= 9.30, SD = 2.02, respectively),
t(88) = 2.61, p < .02.
Participants' distribution on the SIR Scale suggested that they were
a high-risk group of offenders, relative to the CSC population. Their
mean SIR score was -6.03 (SD = 8.02), and the distribution of scores
based on the SIR Scale risk levels was as follows: very low risk
(8.6%), low risk (4.3%), moderate risk (24.7%), high risk (29.5%),
and very high risk (40.9 %). As predicted, noncompleters scored sig-
nificantly lower (high risk) on the SIR Scale than did completers (M =
-9.29, SD = 7.38, andM= -4.07, SD = 7.80, respectively), t(91) = -3.19,
p <.002. Moreover, the SIR risk level was correlated with the partici-
pants' length of time in treatment (r = -. 27, p < .01), indicating that
high-risk offenders spent less time in treatment. Because there were
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 459

TABLE 1: Demographic, Treatment, and Risk Variables of Treatment Completers

and Noncompleters

Treatment Treatment
Completers Noncompleters
(n = 58) (n = 35)
Measure M SD % M SD % x2 ort

Demographics
Maximum security
level 17 49 10.41**
Aboriginal 45 66 3.82*
Married/common
law 31 49 2.86
Employed in
community 80 57 4.83*
Education level
(grade) 10.47 2.06 9.30 2.02 2.61*
Risk
Statistical Information
on Recidivism Scale
score -4.07 7.80 -9.29 7.38 -3.19**
Treatment measures
Length of treatment
(months) 8.33 2.52 3.13 1.66 11.57***
Denial 2.00 .93 2.96 .98 -4.19*
Motivation/effort 3.52 .82 1.59 .84 10.56***
Improvement 1.79 .67 .003 .72 11.88***
Attendance 4.01 1.04 2.57 .94 4.40***
Homework 4.04 .64 2.48 1.00 7.12***
Aggressive unit
behavior 2.11 .82 3.29 1.19 -4.95***
Attitude toward
treatment 3.67 .76 1.75 .76 11.49***
*p <.05. **p < .01. ***p < .001.

few offenders at the very low and low-risk levels, they were collapsed
into the moderate-risk group, creating three levels of risk for further
analyses.
Treatment completion was then analyzed in terms of risk level and
ethnic background, and the results are presented in Figure 1. The 3
(risk level: very low/low/medium, high, and very high) x 2 (ethnic
background: aboriginal and nonaboriginal) factorial ANOVA gener-
ated a significant interaction, F(2, 87) = 3.43, p <.04, as well as a main
effect on risk level, F(2, 87) = 6.51, p < .002. Post hoc comparisons
460 CRIMINAL JUSTICE AND BEHAVIOR

Completed Treatment (%)

100
Ethnic Background
EAboriginal ENonaboriginal

80

60 E--

40 E-

20

0
Moderate High Very High

Risk Category
Figure 1: Treatment Completion as a Function of Offender Risk Level and
Ethnicity.

revealed that the very high-risk aboriginal offenders were signifi-

cantly less likely to complete treatment than high- and moderate-risk
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 461

aboriginal offenders (Scheff6 mean difference = .56, p < .001, and

.55, p < .004, respectively), as well as very high-risk nonaboriginal
offenders, t(36) = 3 .21, p < .003.
Because it had been previously determined that security level was
also related to treatment completion and there was a significant risk
level by ethnic background interaction, security level (maximum vs.
medium/minimum) was analyzed in relation to risk level on treatment
completion, separately for the aboriginal and nonaboriginal samples
with substantially different results. For the aboriginal offenders, there
was a significant effect of risk level on treatment completion, F(2, 43) =
7.05, p <.002, but no relationship between security level and comple-
tion or a security by risk level interaction, F(1, 43) = .61, ns; F(2, 43) =
.001, ns. In fact, the risk level effect on completion was found sepa-
rately for both maximum and medium/minimum security aboriginal
offenders. For the nonaboriginal offenders, on the other hand, there
was a significant main effect of security on completion (M= .38, SD =
.51, and M = .87, SD = .51, respectively), F(1, 40) = 12.47, p < .001,
but no relation between risk level and completion or an interaction
between risk level and security, F(1, 40)= .53, ns; F(1, 40)= .06, ns.
Treatment completers were also compared to noncompleters on a
number of treatment process variables, with completers scoring sig-
nificantly more favorably on all of them. These included seven mea-
sures relating to offenders' performance in treatment: denial, motiva-
tion, rated improvement, attendance, completed homework, prosocial
behavior on the unit, and treatment attitude. These results are pre-
sented in Table 1. However, these treatment process measures were
highly intercorrelated (alpha = .73). When six process measures
(attendance was excluded because of missing data, n = 40), ethnic
background, and risk level (three levels) were submitted to a stepwise
multiple regression, three predictors emerged: rated improvement,
risk level, and treatment attitude (R= .81, adjusted R 2= .65), F(3, 89)=
58.11, p < .001. These results are presented in Table 2.

RISK, TREATMENT COMPLETION, AND RECIDIVISM

As anticipated, once the SIR scores had been calculated, the recidi-
vism rate for this group of offenders was quite high. Overall, 69%
were charged with at least one new offense, and 66% were subse-
462 CRIMINAL JUSTICE AND BEHAVIOR

TABLE 2: Multiple Regression Analyses on Treatment Completion and Recidivism

Independent Variable |3 Beta Significance

Multiple regression (stepwise method) on

treatment outcome
Improvement .285 .64 .001
Risk level (3) -. 103 -. 19 .004
Attitude toward treatment .008 .17 .042
Constant .499
R = .81 (Adjusted R = .65); F(3, 89)= 58.11,
p < .001
Multiple regression (enter method) on recidivism
(charged)
Statistical Information on Recidivism Scale
score -. 075 -. 49 .001
Treatment completion -. 028 -. 08 ns
Constant .570
R= .52 (Adjusted R = .25); F(2, 88) = 16.06,
p < .001
Multiple regression (enter method) on recidivism
(convicted)
Statistical Information on Recidivism Scale
score -. 028 -. 50 .001
Treatment completion -. 029 -. 09 ns
Constant .499
R= .51 (Adjusted R = .24); F(2, 88) = 15.30,
p < .001

quently convicted and sentenced during the follow-up period. More-

over, 41% had been suspended for a technical violation during this
period, typically because new charges had been laid.
SIR scores were highly related to recidivism outcome, as was the
three-level risk variable. Raw SIR scores and risk level correlated with
any charge at -. 51 and .46, respectively, and with any conviction, -. 51
and .48, respectively (all ps < .00 1). Treatment completion was also
correlated with outcome but to a lesser degree at -. 23 (p < .03) with
any charge and-. 19 (p <.08) with any conviction. However, treatment
completion was also correlated with the SIR score .32 (p < .001) and
risk level .34 (p < .001).
Therefore, two-way ANOVAs (completion by risk level) were per-
formed on the recidivism variables (any charge and any conviction),
with only risk level being significant, F(2, 85) = 8.98, p <.001; F(2,
85) = 11.85, p < .001, respectively. At all levels of risk, and particu-
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 463

% Recidivism (Any Charge)

100
- Treatment Group
20 Noncompleters Completers

80

60

40

20

0
Moderate High Very High

Risk Level
Figure 2: Recidivism Rate as a Function of Offender Risk Level and Treatment
Completion.

larly at high levels of risk, recidivism rates were higher for the
noncompleters (83% vs. 61%). Figure 2 displays these results. Using
464 CRIMINAL JUSTICE AND BEHAVIOR

the SIR score and treatment completion in a multiple regression on the

recidivism measures, using the Enter method, an R of .52 (adjustedR 2 =
.25), F(2, 88) = 16.06, p < .001, was produced with any charge as the
dependent variable; and an R of .51 (adjusted R 2 = .24), F(2, 88) =
15.30, p < .001, was produced with any convictions as the dependent
variable. These results are presented in Table 2.
When ethnic background was considered, the following results
were obtained. As suggested previously, aboriginals were less likely
to complete treatment than were nonaboriginals (53% vs. 73%), X2(1
N= 93) = 3.82, p <.06. They also scored more poorly on the SIR Scale
(M=-7.55, SD = 6.65, andM= -4.34, SD = 9.10, respectively, t(91) =
-1.96, p < .06, although they were no more likely to recidivate than
nonaboriginals (any charge = 71% vs. 67%), X 2 (1, N= 93) = 0.12, ns
(any conviction = 71% vs. 61%), X 2 (1 , N= 93) = 1.09, ns. Moreover, the
SIR Scale did not correlate with recidivism for aboriginals as well as it
did for nonaboriginals (e.g., r = -. 37 and -. 64, respectively, for any
charge, and r = -. 37 and -. 61, respectively, for any conviction). How-
ever, the differences in these significance levels were not significant (z
= 1.77,p <.08 for charges, andz= 1.64,p <.10 for convictions). When
ethnic background was included in the ANOVAs with risk level and
completion on recidivism, there was neither a main effect for ethnic
background nor an ethnic background interaction with risk level or
treatment completion on the recidivism outcome measures.
Finally, the type of noncompletion was examined by comparing
offenders who were expelled to those who elected to withdraw from
treatment. There were no differences between these two types of
noncompleters in terms of age, education, native ancestry, length of
sentence, time served, or SIR score. However, the expelled non-
completers were more likely to have come from maximum security
(60% vs. 9%), X 2 (l, N= 93) = 7.96, p < .005, whereas client-initiated
dropouts were more likely to be married or in a common law relation-
ship than the staff-initiated expulsions (73% vs. 37%), X 2 (1, N= 93) =
3.99, p <.05. On the treatment process variables, there were no differ-
ences between the expelled and dropout clients, except on their rated
unit behavior, the expelled offenders being rated as being more disrup-
tive on the unit (M= 3.67, SD = .96, and M = 2.27, SD = 1.01, respec-
tively), t(33) = -3.92, p < .001. However, in terms of outcome,
expelled offenders did not differ from dropouts either on their charge
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 465

rate (82% vs. 73%), X2(1, N= 93) = 0.35, ns, or their conviction rate
(78% vs. 64%), X 2 (1, N= 93) = 0.81, ns.

DISCUSSION

The results of this study confirm our suspicion about client attrition
impacting a correctional agency's attempt to adhere to the risk princi-
ple. It is quite evident that the in-house referral mechanism is targeting
moderate to high-risk offenders, relative to the CSC offender popula-
tion base, to be transferred to a specialized facility for appropriate
treatment. Given the distribution of index offenses, it also seems
apparent that the ABC treatment program is appropriate to the
criminogenic needs of the clientele. However, at least during the
period of this investigation, these efforts are being countered by the
amount and type of client attrition that occurred. More than one of
every three offenders who began the program failed to complete it.
Such a completion rate is far from ideal and deserves the attention of
program planners and service delivery staff. However, it is difficult to
evaluate the program's relative position in the correctional treatment
literature, which cites very diverse completion rates. On one hand, it
might be expected to have a high dropout rate because of its high-risk
clientele, intensive nature, and relatively long duration. On the other
hand, having a captive audience and being institutionally based with
contingencies, such as early release, being in force, one might expect a
relatively high completion rate. Within-agency statistics from similar
programs would provide the most appropriate means of making mean-
ingful comparisons. Regardless, even among a restricted sample of
moderate- to high-risk offenders, it was the higher risk offender who
tended to drop out, and this is an immediate cause for concern.
The study also demonstrated fairly clearly that treatment
noncompleters differ from completers on a variety of dimensions,
many of which would be expected by experienced correctional practi-
tioners. In addition to having more problematic risk scores,
noncompleters were at greater risk in criminogenic need areas, such as
having less education and employment background. This is consistent
with at least one previous study (Browne et al., 1998).
466 CRIMINAL JUSTICE AND BEHAVIOR

Although noncompleters displayed a significantly higher rate of

criminal charges than completers (83% vs. 61%), this difference was
accounted for by differences in client risk level. Therefore, one cannot
conclude that failure to complete the program per se caused an
increase in the recidivism rate, as the adjusted rates were marginally,
but not significantly, different (74% vs. 66%). Therefore, it is the
noncompleters' heightened risk level that puts them particularly at
risk for recidivism. Still, these results substantiate one's concern that
some of the highest risk clients are not receiving the full benefit of the
intervention. This was illustrated by the significant correlation
between risk level and length of time spent in treatment (r = -. 27).
This raises the question as to how one can minimize treatment attri-
tion among high-risk offenders. Some direction might be gleaned by
reviewing the differences between completers and both types of
noncompleters (expulsions and dropouts). Being aware of offenders
who are less likely to complete treatment may forewarn staff and sug-
gest various means of intervention. These differences include security
level and behavioral problems on the unit. However, there was little
difference between the two types of noncompleters, and in at least two
cases, it was difficult to determine whether the attrition was client or
staff initiated.
The finding that aboriginal offenders were less likely to complete
treatment was isolated to the very-high-risk aboriginal offenders. They
had a completion rate that was dramatically less (20%) than other
aboriginal offenders (76%) and even less than equally-high-risk,
nonaboriginal offenders (67%). Such findings invoke concerns about
the program's capacity to accommodate responsivity issues inherent
in the cultural heritage of its clientele. The fact that high-risk aborigi-
nal offenders were less likely to complete treatment could not be
explained by their security level. Two possible considerations include
the (preadmission) referral mechanism and the (postadmission) man-
ner in which these clients were addressed in treatment. For example,
very-high-risk aboriginal offenders may not be adequately screened
(they may be overreferred), or they may be inadequately briefed about
the ABC program and unprepared for its format, content, or demands.
They may also present special responsivity issues that are not being
addressed by the service providers. Regardless, these findings and
speculations require further investigation.
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 467

Increased attention to basic responsivity issues (e.g., culture, cog-

nitive ability) may be one way to help combat treatment attrition in
offender populations that are at risk for dropping out. In recent years,
some programs have begun to address different responsivity issues in
treatment. For instance, the RPC offers aboriginal-specific program-
ming (e.g., sweat lodges, healing circles) in addition to regular thera-
peutic services. A recent qualitative investigation comparing tradi-
tional (i.e., aboriginal) and Westernized (i.e., cognitive-behavioral)
treatments offered at the RPC demonstrated that both approaches have
therapeutic merit and concluded that an amalgamation of these two
treatment traditions may be ideal for some native offenders (Mason,
2001). However, these treatments were introduced at various points
during the study period, and their potential contribution to completing
the ABC program could not be examined. Nevertheless, an increased
sensitivity to cultural factors may be one potential means of reducing
treatment attrition in aboriginal offenders (via the responsivity
principle).
The finding that academic attainment was related to failure to com-
plete treatment leads to a couple of considerations. Should the pro-
gram be modified or provided in various formats, or should clients be
better prepared prior to beginning the program? Is the program too
sophisticated, demanding, or laden with complex material and assign-
ments (reading, homework) for candidates who do not have sufficient
academic training? Treatment programs can be conducted at a slower
pace, or offenders can receive individualized tutoring or instruction in
program material to compensate for cognitive deficits. More gener-
ally, is educational level a true dynamic predictor and therefore casu-
ally related to treatment completion? In this case, pretreatment aca-
demic training should contribute to the treatment readiness of
offenders who have deficiencies in their educational background. In
sum, by increasing our attention to responsivity issues, client dropout
may be effectively reduced and treatment services may be success-
fully provided to those client populations who present the greatest risk
and need. Already, the program has been modified to this end. The
program workbook has been rewritten to a Grade 5 level, individual-
ized tutoring is available to clients who have difficulty with the exer-
cises, the program material is available on audiotape, aboriginal pro-
gram officers have been hired to take an active role in offenders'
468 CRIMINAL JUSTICE AND BEHAVIOR

treatment, and native elders have been invited from the community to
participate in offenders' case conferences. However, collaboration
with management and staff from referring facilities to develop a
preadmission preparation strategy for referred offenders has yet to be
undertaken.
Some cautionary notes about the current study and its implications
are warranted. There is no doubt that the current participants represent
a specialized sample of offenders who were targeted for specific treat-
ment. As the specialized treatment facility in an agency whose catch-
ment area is geographically vast (2,000 miles), whose clientele is eth-
nically diverse, and whose mandate is legally specific (in Canada,
only the most serious offenders, those sentenced to 2 years or more,
represent the population base of CSC), the current sample may not be
characteristic of offenders targeted for treatment by other jurisdic-
tions. Moreover, the sample was limited to one group of offenders,
albeit an important one, who were referred to a violent offender pro-
gram. It is quite possible that different results might be found with a
different treatment target group, such as sex offenders, substance
abusers, or mentally disordered offenders. Nonetheless, the finding
that attrition is related to both the educational and ethnic background
of this specialized offender sample is very similar to the results of a
meta-analysis on psychotherapy dropout that was conducted on
diverse outpatient samples (Wierzbicki & Pekarik, 1993).
There may be some concern about the use of the SIR Scale to assess
risk in this sample. Although it has been shown to predict recidivism,
it has been criticized for its lack of criminogenic need items (Cormier,
1997), and its validity with native offenders has been questioned,
although some predictive relationships have been found (Wormith
&

Goldstone, 1984). Elsewhere, Robinson (1995) reported that treat-

ment had an impact on lower risk offenders, as defined by the SIR
Scale, but not the higher risk offenders, which is contrary to the risk
principle and other findings cited above. Nonetheless, the SIR Scale
proved to be highly predictive of criminal behavior in the current sam-
ple, in fact, more so than in most previous studies, in spite of the
restricted range of participants on the risk dimension. It was also reli-
ably predictive for aboriginal offenders. Although these results are
encouraging, the sample was too small and too nonrepresentative to
 Wormith, Olver/ OFFENDER TREATMENT ATTRITION 469

draw any conclusions about the general applicability of the SIR Scale
to aboriginal offenders.
Finally, this study was not intended to provide any evaluative com-
ments about the outcome of the ABC program, nor was it designed to
do so. Although the recidivism rates in this study might be considered
high, the following considerations must be acknowledged. Very lib-
eral criterion measures (any charge and any conviction) were used to
measure recidivism, the follow-up period was reasonably long (e.g.,
longer than that used for the original SIR Scale validation), and the cli-
ent group that had been referred to the program was at high risk as
determined by the empirically validated SIR Scale.

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