156 Chapter 5 on mentoring interventions among forensic populations (Duwe, 2018b; Duwe & King, 2013; Raposa et al., 2019; Tolan et al., 2014). Interestingly, the per-protocol analyses showed that effects on criminal behavior were similar, and even slightly stronger, in patients who did not start with the additive intervention, compared to those in patients fully adhering. Based on our qualitative study, in which patients who were unwilling to start reported that they had enough social relationships and that they did not need assistance to improve their social network, we hypothesize that patients with no compliance could have been more self-sufficient in developing and maintaining social connections, as they refused to start with the intervention (Swinkels et al., 2023a). Future research on patient characteristics between compliance groups, which was beyond the scope of the current study, should aim to reveal which patients are more likely to adhere to and benefit from the intervention. Strengths and limitations This study has several strengths. To the best of our knowledge, this is the first study to examine an additive informal social network intervention among forensic psychiatric outpatients with complex needs. A rigorous study design was used, as we were able to examine a relatively large forensic population in an RCT with multiple measurements over a long follow-up period (18 months). Furthermore, a broad range of treatment outcomes were examined including various sources, such as self-report and observer-rated instruments, as well as official medical records. The study was conducted in day-to-day clinical practice, which increased the ecological validity and generalizability of the study methods and results. Moreover, the overall study dropout rate was lower than expected (i.e., 21%) and the overall response rates on the six assessments from baseline to 18 months follow-up was evenly distributed between the treatment groups (i.e., 79% in TAU+FNC vs. 82% in TAU), minimizing bias due to missing outcome data. The informal social network intervention was developed based on clearly defined aspects of befriending and mentoring programs, and delivered by an informal care institute with longstanding experience in the delivery of volunteer-based interventions (i.e., recruitment, training, matching, and supervision of volunteers). This study also has a number of limitations. Despite its rigorous design and the relatively large forensic population we were able to include, this study is still a relatively small trial. Thus, findings of this study should be interpreted with caution and more research is recommended to confirm these results. As mentioned, the overall engagement of patients in the intervention was low (although expected) and varied over the 18-month follow-up
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