An Examination of a Modified START NOW Dialectical Behavior Therapy-Based Intervention and a Behavioral Level System on Male Inmate Misbehavior, Aggressive Behavior, and Suicide Precaution Status

Abstract This study employed a quasi-experimental design to evaluate the impact of a modified START NOW program + behavioral level system (BLS) in a self-contained therapeutic community (SCTC) on inmate misbehavior at a correctional facility. The SCTC included a modified START NOW manualized mental health treatment, recreation groups, process groups as needed, and a level system on which to base the attainment of privileges. Inmate data was evaluated at 3-months pre- and post-SCTC to determine if there were differences in the number of mental health referrals for misbehavior, referrals to the restrictive housing unit, write-ups, instances of spontaneous use of force by correctional officers, and placement on suicide precaution status compared with a control group of inmates who were placed in restrictive housing during the same time frame. Analyses examined differences between these two groups comparing variables from pre-intervention to post-intervention timepoints. Both the modified START NOW + behavioral intervention group and the control group improved significantly from pre-to-post intervention on the number of placements in restrictive housing and number of write-ups for misbehavior but did not significantly improve on the remaining outcome measures. Study strengths and limitations are discussed.