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OBJECTIVE: Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention to reduce risk for criminal recidivism. Despite being implemented widely in correctional settings, there are no randomized controlled trials of MRT, and its effectiveness for reducing recidivism among justice-involved adults in non-correctional settings is unknown. METHODS: In a pragmatic trial, 341 justice-involved patients (95.3% male; 57.8% White/Non-Hispanic) admitted to one of three mental health residential treatment programs were randomly assigned to usual care (UC) or UC plus two MRT groups per week for 12 weeks. Follow-ups were conducted at 6- and 12-months post-baseline (71.3% and 74.8% retention, respectively). Primary outcomes were criminal thinking and criminal associates. Secondary outcomes were legal problem severity, days incarcerated in the past 30, rearrested/charged (per official records), substance use, and employment and family/social problems. The study design, analysis, and outcomes were preregistered (ClinicalTrials.gov; ID:NCT02524171). RESULTS: Patients in both conditions improved over time on most outcomes. In intent-to-treat analyses, the rate of change in outcomes over time did not differ by condition, nor did the prevalence of being rearrested and charged within one year of baseline (UC=20.2%, MRT=24.9%; OR=1.14; 95% CI[0.67,1.94], p=.63). MRT engagement was low; 37% of those randomized to MRT received a minimum dose–i.e., completed at least Step 3. In per-protocol analyses, this subgroup, relative to UC, improved more on criminal associates, days incarcerated, legal problem severity, and alcohol use severity. CONCLUSIONS: In this study, MRT was not more effective than usual care at reducing recidivism risk for patients in mental health residential treatment.

The stimulus sampling design (SSD) is a widely applied research paradigm in which participants evaluate a series of visual or auditory stimuli. Researchers are often interested in phenomena reflected by differences across stimuli, and recent simulation work suggests that more than 100 stimuli may be necessary to detect smaller effects. Unfortunately, administering a large number of stimuli to each participant may compromise the validity of responses due to individual differences in susceptibility to fatigue and distraction. The present work describes the application of planned missingness design strategies to maximize statistical power, while minimizing participant burden. A Monte Carlo simulation was conducted study to determine the number of raters per stimuli (RPS) and stimuli per rater (SPR) needed to ensure unbiased estimates of model parameters, as well as the desired statistical power and interval coverage. Recommendations for incorporating planned missingness strategies in SSDs are provided.