The primary objectives of the Violence Reduction Program (VRP) are to decrease the frequency and intensity of violent behaviors, to decrease or eliminate the antisocial beliefs and attitudes that support the use of aggression and violence, and to assist the program participants to acquire appropriate interpersonal and cognitive skills that are effective in reducing the risk of recidivism, in particular, violent recidivism.

The VRP is designed such that the program can be implemented in a variety of institutional and treatment settings. Effective implementation depends on a thorough appraisal of the treatment environment, target population, resources, staffing, existing treatment interventions and other considerations that may be unique to the implementation site. Such a review conducted with key personnel preferably onsite will determine what will be needed to implement the VRP. A step-by-step staff training and implementation protocol along with a detailed VRP Implementation Checklist have been developed to further guide VRP implementation. Formal staff training is also required.

The VRP is designed to address the treatment needs of high-risk violent offenders, including those with personality disorder. The program designers recognize that violent offenders constitute a highly heterogeneous group with respect to their criminogenic needs and responsivity. For example, they may be non-compliant, resistant to treatment, lacking in motivation, have a history of institutional misconduct, suffer from mental disorders, members of gang/security threat groups, etc. They often have a multitude of criminogenic need areas such as substance use, criminal peers, antisocial/anti-authority attitudes, impulsivity, lack of social support and so forth. The program design, although structured and goal oriented, is intended to be flexible enough to accommodate the heterogeneity of criminogenic needs and responsivity factors in this client group.

The VRP uses best practice principles based largely on the "What works" literature of effective correctional treatment. The program uses cognitive behavioral approaches and social learning principles within a relapse prevention model to assist participants to make changes. The various VRP program modules are designed to address treatment targets that are characteristic of violent prone forensic clients. In addition, the VRP uses a modified version of the Stages of Change Model to guide the selection of intervention strategies that are appropriate for clients with different levels of motivation and compliance.

The VRP is delivered in a 3-phase format and is based on an incremental learning approach, that is, learning takes place in small steps and reinforcement of small incremental improvements is the key. There are different tasks and objectives for both participant and program deliverers in each of the 3 phases. Phase 1 is focused on enhancing the client's understanding of the origins and maintenance of aggressive behaviors, identification of treatment targets, and the development of therapeutic/working alliance. Motivational Interviewing techniques are used throughout the program but are particularly important in Phase 1 and are used to increase the participant’s motivation and commitment to the program. Phase 1 work, which may take a substantial amount of program time, is essential in engaging difficult and resistant clients in the treatment process. Programs without such flexibility will not be as effective with these clients. Phase 2 objectives focus on the acquisition of relevant skills to restructure thoughts, feelings, and behaviors that are associated with destructive patterns and cycles that culminate in aggression and/or violence. Phase 3 focuses on relapse prevention and the generalization of skills across situations to mitigate the risk of future violence.

Some programs are highly scripted and the material has to be presented in a certain chronological order, that is, participants must complete so many modules in so many weeks in a certain specific order. This type of approach to program delivery may not be suitable for some clients who are highly resistant to treatment or who may have other types of idiosyncratic responsivity concerns. In short, one size does not fit all. Progression through the VRP is dependent upon achieving specific module and phase objectives. This objective-based design allows for flexibility that is essential in the treatment of a heterogeneous group of these individuals. The VRP is also designed to allow for the incorporation of existing interventions such as Dialectical Behavioral Therapy (DBT) or substance abuse interventions within the 3-Phase format.

The focus on breaking destructive patterns associated with aggression and violence are highlighted and addressed throughout the program. The incremental learning principle uses small improvements as building blocks to bring about more significant changes. The strengthening of the small improvements MUST take place both inside and outside the formal treatment sessions. Informal day-to-day contacts and interactions between clients and support, complementary or custodial staff are often crucial as these staff tend to spend much more time with the clients than the core treatment staff. The VRP recognizes the important roles of both the core treatment and support staff and provides the necessary training for both of them. In essence, treatment should take place 24/7 and not just within formal treatment groups or individual sessions.

Delivery Format 
        
The VRP Program is primarily designed for delivery in a group format. However, the VRP Program can also be delivered in a one-on-one format to participants that are not amenable to group programming, such as those who are highly disruptive, have significant mental health issues or are cognitively compromised.   

Length of Program

Program length depends on a number of factors such as level of resource, client complexity and needs, number of sessions that can be delivered per week, etc. Generally speaking, with high risk and seriously personality disordered clients, the VRP program can be delivered in approximately 6 months. The programming time may cary. When working with a heterogeneous group of participants, one cannot expect that everyone would progress at the same rate and finish together.

In summary, the VRP is designed to meet the treatment needs of a heterogeneous group of violence prone forensic clients. It can be implemented in a variety of mental health and prison settings.

Assessment of Pre-treatment Risk, Identifying Treatment Targets and Post-treatment Changes in Risk

Each participant is assessed using the Violence Risk Scale (VRS); other assessment tools can be used as needed to identify cognitive functioning or other responsivity issues. The VRS is an integral part of the VRP and is used to identify risk of violence, treatment targets, treatment readiness and risk change. Six static and 20 dynamic VRS variables are rated guided by the VRS manual. The total rating of the 26 variables is a measure of the risk of violent recidivism. The VRS dynamic variables that are rated as being linked to violence are the individual’s treatment targets. The individual’s readiness for treatment for each treatment target is then assessed using a modified version of the Stage of Change Model (Prochaska et al, 1992) to establish a, pre-treatment baseline measure (e.g. at the contemplation stage pre-treatment). Following treatment, the Stage of Change for each treatment target is re-assess (e.g. now at the action stage). Risk reduction is indicated by progression through the stages of change (from contemplation to action) and is translated into a quantitative reduction in violence risk. While the pre-treatment stage of change can also be used to guide the selection of appropriate intervention strategies matched to the level of treatment readiness, the post-treatment risk level and the stage of change can be used to guide post-treatment risk management. For a more detailed description of the VRS and the scoring procedures, see Wong & Gordon (2006). Psychology, Public Policy, and Law, 12(3), 279-309.

Four program manuals have been developed for the VRP:

• Program Management Manual

        The Program Management Manual provides an outline of the rationale and theoretical bases of the program, describes the program design, and addresses the management issues in the implementation of the program, such as staff training and resource considerations.

• Facilitator Manual

        The VRP Facilitator Manual provides the purpose, rationale, objectives, suggested interventions, and group work and assignments for each of the VRP modules. Also included in the manual are participant handouts to illustrate and supplement the session content as well as session and module evaluation forms.

• Supplementary Facilitator Manual 

        The VRP Supplementary Facilitator Manual provides additional materials, activities and handouts that can be used to extend and supplement information contained in the VRP Facilitator Manual.

• Participant’s Workbook 
        
        The VRP Participant’s Workbook provides the content of the VRP in easy to understand (Grade/Primary 5-6 level), and user-friendly language to the participants to facilitate their comprehension of the program. The Participant’s Workbook follows the same format as the Facilitator Manual and is intended to clarify and supplement the material covered in-group and/or individual sessions.

• Violence Risk Scale 

        The VRS is an integral part of the VRP as described above. A software program has been developed for the collection of VRS data and for the collection and management of other treatment related data.

Staff Training

        Formal training is required to implement and deliver the VRP. The VRP training package includes VRS training, in-depth examination of the VRP manuals, program implementation considerations, mock treatment delivery exercises, and examination of a number of clinical strategies and processes to manage and treat special needs clients (e.g. clients suffering from psychopathy), and to assist members of the treatment team to work together effectively. The cost of staff training is based on the number of participants and selected training components. Please contact the authors for more detailed information.