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Table 2 Result synthesis

From: How effective are interventions to improve social outcomes among offenders with personality disorder: a systematic review

Study Social outcome Intervention How intervention may impact participation and social outcome Effectiveness
Davidson et al. [33] Social functioning measured with SFQ CBT for personality disorder Therapy focuses on beliefs about self and others, and behaviours that impair social and adaptive functioning
Attitude and behaviour that blocks successful participation ‘challenged’ and reduced, which may result in improved social functioning.
No significant difference
Fortune et al. [35] Social functioning measured using WSAS MSU and community treatment in 3 teams.
One service helped explore local opportunities for participation (education, employment and other activities).
Unclear
Practical assistance/support to overcome barriers to accessing real world experiences of participation.
Real world experiences allow for developing skills and abilities in response to challenges in live settings that can be continued in future participation.
No significant difference
Krampen [37] Employment defined as being ‘on the job’ for at least two years Long-term integrative psychotherapy
Including:
Resource activating interventions, mastery-oriented interventions and consciousness-creating interventions
Not explicit which interventions (see additional file 1 for full detail) or treatment objectives relate to employment specifically.
Overall therapy objectives included enhanced social emotional skills, empathy and morality; increased impulse control and mastery; producing adaptive self-statements; reconstructed attachment ability, trust and social relationships and developing prosocial peer networks.
The above may build capacities to better cope with the social and emotional challenges of a work environment, and solve problems by modelling behaviour from prosocial networks.
Increased employment rate.
Difference can’t be attributed to intervention
Öhlin et al. [32] Employment
Either in competitive employment or ‘subsidised wage compensation’
Multi-modal treatment including employment advisors
‘Support radical lifestyle change’
Unclear how the intervention got participants into a job, and what role was played in sustaining this during and post intervention.
If participants were provided with practical assistance to gain and sustain employment this may involve embedding a new routine, experiencing work and learning adaptive skills to sustain this role.
Increased employment rate.
Difference can’t be attributed to intervention
Whitehead et al. [38] Mixed
University, prosocial leisure and relationship
Psychologist and other team members (e.g. Maori mentor) using Good Lives Model Motivation to engage and sustain change in participation is enhanced by producing cognitive dissonance between desired identity and current situation.
Interventions orientated around imparting values, attitudes, skills resources needed to make most of opportunities and overcome barriers
Staff practical support, information giving (e.g. finding course information) and orchestrating positive life events may enable the offender to initiate participation and then develop competences/identity to continue independently and generalise to other activities
Began participating
Difference can’t be attributed to intervention