90 Chapter 3 maintaining contact with patients through phone and e-mail. When researchers fail to reconnect with patients, network members will be contacted and home visits will be planned. A final important concern is the risk of nonadherence to intervention and treatment drop-out. To account for this risk, postponing the moment of randomization was considered. Unfortunately, the characteristics of the social network intervention do not allow this adjustment since the referral process (i.e., selection, intake, and matching) of the intervention is complicated and time-consuming. Circumstances of patients might change during the referral period, therefore randomization must be performed as soon as possible after inclusion. Close cooperation with informal care will be used to enlarge the accessibility and attractiveness of the social network intervention. During the course of the study, at follow-up assessments, patients will be actively encouraged to participate in the intervention by researchers. Besides, when patients tend to drop-out professionals will be asked to motivate patients. Patients who drop-out during the study will still be included in the follow-up measures, allowing us to examine profiles of treatment success and failure. Finally, several methodological limitations should be considered. In order to promote generalizability of data and to examine which patients might benefit from the intervention, researchers chose to make the study accessible for a wide range of forensic patients. Consequently, this leads to a heterogeneous study sample, which makes it difficult to achieve high internal validity. Furthermore, many changes in important areas of life, such as hospitalizations, relapses in substance (ab)use or criminal behavior and changes in work, living environments and close relationships are expected to occur regularly during the study. These changes might influence the intervention and outcome measures. To account for these confounding factors, multiple participant and intervention characteristics will be recorded throughout the course of the study. Besides, the RCT design enables controlling for confounding factors between groups. CONCLUSION This study will examine the effectiveness of the addition of an informal social network intervention to treatment as usual with a RCT design. It is expected to contribute to the development of evidence-based interventions for (outpatient) forensic psychiatric populations. If effectiveness is shown, forensic mental healthcare could be optimized by collaborating with informal care or other community initiatives.
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