Motivational Interviewing (MI) is a client-centered, evidence-based counseling approach designed to enhance an individual's intrinsic motivation to change problematic behaviors. Originally developed in the 1980s for addiction treatment, MI has evolved into a widely recognized therapeutic method that has found significant application across diverse settings. In recent years, MI is increasingly being applied to criminal justice settings, where clients are often coerced into treatment, making it particularly valuable in forensic psychological contexts where traditional confrontational approaches may prove ineffective.

The forensic psychology field has witnessed a growing recognition of MI as a powerful tool for engaging offenders and facilitating meaningful behavioral change. Motivational interviewing is increasingly recognized as an effective approach in forensic settings, particularly for overcoming resistance by avoiding confrontation and fostering intrinsic motivation. This comprehensive exploration examines the theoretical foundations, practical applications, empirical evidence, and implementation considerations of MI within forensic psychological treatment settings.

Understanding Motivational Interviewing: Core Principles and Theoretical Foundations

The Spirit of Motivational Interviewing

At its foundation, MI is built upon a distinctive therapeutic spirit that fundamentally differs from traditional directive approaches. At its heart, MI is collaborative, evocative, and respectful of autonomy. This spirit represents more than just a set of techniques; it embodies a philosophical stance toward the therapeutic relationship that emphasizes partnership, acceptance, compassion, and evocation rather than confrontation or coercion.

The collaborative nature of MI positions the practitioner and client as equal partners working together toward change. Rather than the therapist assuming an expert role who prescribes solutions, MI recognizes that clients possess their own expertise about their lives, values, and circumstances. This collaborative stance is particularly important in forensic settings where power imbalances are already pronounced due to the mandated nature of many interventions.

Evocation, another central element of the MI spirit, involves drawing out the client's own motivations, strengths, and resources rather than imposing external motivations. This principle acknowledges that sustainable change comes from within and that individuals are more likely to commit to changes they themselves articulate. The officer respects the individual's autonomy (even though he/she may not agree with the choices the offender makes) and approaches the relationship as a collaborative one.

Core Principles: Partnership, Acceptance, Compassion, and Evocation

MI operates on four fundamental principles that guide the therapeutic process. Partnership emphasizes the collaborative relationship between practitioner and client, moving away from hierarchical expert-recipient dynamics. Acceptance involves showing genuine respect for the client's autonomy, affirming their strengths and efforts, and demonstrating accurate empathy. Compassion reflects the practitioner's active commitment to prioritizing the client's needs and welfare. Evocation focuses on eliciting the client's own motivations and resources for change rather than installing motivation from external sources.

These principles work synergistically to create a therapeutic environment where clients feel safe to explore their ambivalence about change, examine their behaviors without judgment, and develop their own arguments for transformation. In forensic contexts, where clients often enter treatment involuntarily and may harbor significant mistrust of authority figures, these principles become especially crucial for establishing therapeutic rapport and engagement.

The OARS Techniques: Foundational Skills

MI practitioners employ a set of core microskills collectively known as OARS: Open-ended questions, Affirmations, Reflective listening, and Summarizing. These techniques form the foundation of MI practice and enable practitioners to implement the MI spirit in concrete, observable ways.

Open-ended questions invite clients to elaborate on their experiences, thoughts, and feelings rather than providing simple yes/no responses. These questions encourage exploration and help clients articulate their own perspectives. For example, instead of asking "Do you think your substance use is a problem?" a practitioner might ask "What concerns, if any, do you have about your substance use?"

Affirmations recognize and acknowledge client strengths, efforts, and positive qualities. In forensic settings, where clients often receive predominantly negative feedback, affirmations can be particularly powerful. They build self-efficacy and reinforce positive behaviors and intentions. Effective affirmations are specific, genuine, and focus on client attributes rather than practitioner approval.

Reflective listening represents perhaps the most fundamental MI skill. Reflections demonstrate that the practitioner is actively listening and understanding the client's perspective. They range from simple restatements to complex reflections that add meaning or emphasize particular aspects of what the client has shared. Reflective listening helps clients feel heard and understood while also allowing them to hear their own thoughts reflected back, which can facilitate insight and self-awareness.

Summarizing involves periodically collecting and reflecting back key elements of the conversation. Summaries help organize the discussion, demonstrate comprehensive understanding, prepare for transitions, and reinforce important themes, particularly change talk. In forensic applications, summaries can be especially useful for highlighting discrepancies between clients' values and their current behaviors.

The Four Processes of Motivational Interviewing

MI within a forensic context describes four key processes to assist justice-involved clients: treatment engagement, focus, evoking intrinsic motivation, and change planning. These processes represent a natural progression in the MI approach, though they are not strictly linear and practitioners may move between them as needed.

Engaging involves establishing a helpful connection and working relationship with the client. In forensic settings, where clients are often mandated to participate, engagement can be particularly challenging but is essential for any subsequent progress. The engagement process focuses on building trust, demonstrating empathy, and creating a safe environment for honest discussion.

Focusing entails developing and maintaining a specific direction in the conversation about change. This process involves identifying particular behaviors or issues to address and maintaining attention on these targets throughout the intervention. In forensic contexts, focusing might involve negotiating between court-mandated goals and the client's own priorities.

Evoking draws out the client's own motivations for change. This process involves eliciting and strengthening change talk—client statements that favor change. Practitioners listen for and reinforce expressions of desire, ability, reasons, need, and commitment to change while responding strategically to sustain talk—statements that favor the status quo.

Planning involves developing commitment to change and formulating a concrete plan of action. This process becomes appropriate when the client demonstrates readiness to change and includes discussing specific steps, anticipating obstacles, and building confidence in the ability to implement the plan.

Theoretical Underpinnings: Self-Determination Theory and Stages of Change

MI draws upon several theoretical frameworks that inform its approach to behavior change. Self-Determination Theory posits that humans have innate psychological needs for autonomy, competence, and relatedness, and that satisfying these needs promotes motivation and well-being. MI's emphasis on respecting autonomy, building self-efficacy, and establishing collaborative relationships aligns directly with these principles.

The Transtheoretical Model's Stages of Change provides another important theoretical foundation. This model proposes that individuals move through distinct stages when changing behavior: precontemplation, contemplation, preparation, action, and maintenance. MI is particularly effective for individuals in the earlier stages who have not yet committed to change, helping them progress through ambivalence toward readiness for action.

Additionally, MI incorporates principles from cognitive dissonance theory and self-perception theory. By helping clients articulate their own arguments for change, MI creates cognitive dissonance between current behaviors and stated values or goals, which can motivate movement toward resolution through behavior change.

The Unique Context of Forensic Psychology and Criminal Justice Settings

Characteristics of Justice-Involved Populations

Justice-involved individuals present unique characteristics and challenges that distinguish them from voluntary treatment-seeking populations. Forensic practitioners face engaging a population of clients who are generally mandated or coerced into services they do not want and/or do not believe they need. This involuntary nature of participation fundamentally shapes the therapeutic dynamic and necessitates approaches specifically designed to work with resistance and ambivalence.

Many offenders enter treatment with significant histories of trauma, substance abuse, mental health issues, and adverse childhood experiences. Lifetime prevalence of alcohol and marijuana use among juvenile offenders is 80% and 85% respectively, with 40% consuming alcohol and 57% using marijuana in the past 6 months. These co-occurring issues complicate treatment and require integrated approaches that address multiple needs simultaneously.

Additionally, justice-involved populations often have extensive experience with authority figures and systems that have been punitive, judgmental, or dismissive. This history can create significant barriers to trust and engagement. Many offenders have developed defensive postures and coping mechanisms that served them in institutional or street environments but interfere with therapeutic progress. Understanding these contextual factors is essential for effectively applying MI in forensic settings.

The Challenge of Mandated Treatment

The mandated nature of most forensic interventions creates a fundamental tension between external coercion and the MI principle of respecting autonomy. Clients may attend sessions physically while remaining psychologically disengaged, going through the motions to satisfy legal requirements without genuine commitment to change. This presents a significant challenge for practitioners who must navigate the dual roles of supporting client autonomy while also ensuring compliance with legal mandates.

However, research suggests that coercion does not necessarily preclude effective treatment outcomes. Brief interactions can significantly influence client outcome, and recent evidence suggests that the relationship between an officer and the offender can be "a pivotal source of influence on the implementation of treatment mandates". The key lies in how practitioners approach the mandated context—acknowledging the involuntary nature while still creating space for autonomous choice within that framework.

MI offers strategies for working productively with mandated clients by explicitly acknowledging the coerced nature of participation, exploring the client's feelings about being required to attend, and identifying areas where the client does have choice and control. This approach validates the client's experience while still moving toward productive engagement.

Diverse Forensic Settings and Applications

MI has been implemented across the full continuum of criminal justice settings, each with its own unique characteristics and challenges. These settings include:

  • Correctional facilities and prisons: Secure institutional settings where MI can be used to enhance engagement in programming, prepare inmates for reentry, and address various criminogenic needs
  • Probation and parole supervision: Community-based settings where MI helps officers function as change agents rather than solely enforcement officers
  • Drug courts and specialty courts: Problem-solving court models where MI supports treatment engagement and compliance with court requirements
  • Forensic mental health facilities: Specialized settings serving individuals with mental illness involved in the criminal justice system
  • Juvenile justice facilities: Settings serving youth offenders where developmental considerations add additional complexity
  • Reentry programs: Transitional services supporting individuals returning to the community after incarceration

Each setting requires adaptations in how MI is implemented while maintaining fidelity to core principles and processes. Understanding the specific constraints, opportunities, and cultures of different forensic environments is essential for effective MI application.

Applications of Motivational Interviewing in Forensic Psychological Treatment

Substance Abuse Treatment Among Offenders

Substance abuse represents one of the most prevalent and significant issues among justice-involved populations, making it a primary target for MI interventions. Among the incarcerated population, the prevalence estimates of alcohol and other drug use disorders range from 10% to 51% and from 10% to 69%, respectively. The strong connection between substance use and criminal behavior makes addressing addiction a critical component of reducing recidivism and promoting successful community reintegration.

MI has demonstrated particular promise in substance abuse treatment with offender populations. Findings suggest MI reduces substance use, improves motivation and confidence to reduce use, and decreases risky behaviors. The approach is especially valuable for addressing the ambivalence many offenders experience about their substance use—they may recognize some negative consequences while also valuing the perceived benefits or feeling unable to imagine life without substances.

In forensic substance abuse treatment, MI can be used as a standalone brief intervention, as a pretreatment engagement strategy, or integrated throughout more intensive treatment programs. It helps clients explore their relationship with substances, examine discrepancies between their substance use and their goals or values, and develop intrinsic motivation for change rather than simply complying with external mandates to abstain.

In the correctional field, MI has been used for five main purposes: to reduce substance use; to improve engagement in treatment; to reduce criminal behavior and recidivism; to reduce HIV risk behaviors; and other purposes. This versatility makes MI a valuable tool across multiple domains of forensic intervention.

Enhancing Treatment Engagement and Retention

One of the most robust findings regarding MI in forensic settings concerns its effectiveness in improving treatment engagement and retention. MI is more effective in increasing session attendance and reducing dropout than interventions without MI. This finding has significant implications given that treatment non-completion is associated with poorer outcomes and potentially increased recidivism risk.

The engagement process in MI directly addresses many of the barriers that prevent justice-involved individuals from fully participating in treatment. By establishing a non-judgmental, collaborative relationship, MI helps overcome the mistrust and defensiveness that often characterize offender populations. The approach validates clients' experiences and perspectives while still creating space for exploring change, making it more likely that clients will remain engaged even when treatment becomes challenging.

Pre-treatment motivation is a good predictor of treatment engagement and retention, yet relatively few treatment programs in the criminal justice system have early phases that specifically address motivation. MI fills this critical gap by providing structured methods for enhancing motivation before or during the early phases of treatment.

Improved engagement and retention translate into greater exposure to treatment content and interventions, which in turn increases the likelihood of positive outcomes. For forensic programs, where resources are often limited and waitlists common, reducing dropout rates means more efficient use of available services and better outcomes for participants.

Reducing Recidivism and Criminal Behavior

Perhaps the most critical outcome in forensic interventions is the reduction of recidivism—the return to criminal behavior following intervention or incarceration. For official recidivism, evidence favored MI with a statistically significant reduction in recidivism rates. This finding represents a significant contribution to the evidence base supporting MI in forensic applications.

Research has demonstrated particularly promising results when MI is delivered with adequate dosage. MI demonstrated promising results in reducing substance use and recidivism, particularly after three or more sessions. This suggests that while brief MI interventions can be valuable, sustained engagement with MI principles and techniques may be necessary to achieve the most robust effects on criminal behavior.

One notable study found substantial effects on recidivism outcomes. Those prisoners in the MI intervention hade 21% less reconviction rates and 17% less re-imprisonment rates than non-participants. These findings highlight the potential of MI to contribute meaningfully to public safety goals while also supporting individual rehabilitation.

The mechanisms through which MI reduces recidivism likely involve multiple pathways. By enhancing engagement in treatment and addressing substance abuse, MI indirectly impacts criminogenic needs that drive offending behavior. Additionally, by fostering intrinsic motivation and self-efficacy, MI may help individuals develop the internal resources necessary to maintain behavioral changes over time and resist situational pressures to reoffend.

Addressing Violent Behavior and Intimate Partner Violence

MI has been applied to interventions targeting violent behavior, including intimate partner violence (IPV) offenses. In intimate partner violence intervention programs, client motivation and program adherence are common roadblocks to treatment effectiveness. The ambivalence many IPV offenders experience about their behavior—often minimizing, denying, or externalizing responsibility—makes MI's focus on exploring ambivalence particularly relevant.

In IPV interventions, MI can help offenders examine the discrepancies between their values (such as being a good partner or parent) and their violent behaviors. Rather than confronting denial directly, which often increases defensiveness, MI practitioners use reflective listening and strategic questioning to help clients articulate their own concerns about their behavior and its consequences.

For general violent behavior, MI addresses the underlying attitudes, beliefs, and emotional regulation difficulties that contribute to aggression. By enhancing motivation to develop alternative coping strategies and interpersonal skills, MI can support broader violence reduction efforts. The approach is particularly valuable when integrated with cognitive-behavioral interventions that teach specific skills for managing anger and resolving conflicts non-violently.

Supporting Rehabilitation and Reintegration Efforts

Successful reentry into the community following incarceration requires addressing multiple domains including housing, employment, relationships, and ongoing treatment needs. MI provides a framework for helping individuals navigate the complex challenges of reintegration while maintaining motivation in the face of inevitable obstacles and setbacks.

During the reentry process, individuals often experience ambivalence about various aspects of their transition. They may feel torn between old associates and new prosocial connections, uncertain about their ability to succeed in legitimate employment, or overwhelmed by the demands of complying with supervision requirements while meeting basic needs. MI helps individuals work through this ambivalence by exploring both sides of their conflicting feelings and ultimately strengthening their commitment to prosocial goals.

Probation officers are situated to function as change agents who prepare an offender motivationally to comply with conditions of probation, engage in special programs, and make other positive changes. When probation and parole officers incorporate MI into their supervision practices, they can more effectively support successful reintegration by building collaborative relationships and enhancing intrinsic motivation for compliance and change.

MI also supports rehabilitation by helping individuals develop a coherent narrative of change and a prosocial identity. Through the process of articulating their own reasons for change, values, and goals, clients begin to construct a new sense of self that is incompatible with continued criminal behavior. This identity transformation represents a crucial element of desistance from crime.

Integration with Cognitive-Behavioral Therapy and Other Evidence-Based Approaches

While MI can be used as a standalone intervention, it is frequently integrated with other evidence-based approaches, particularly cognitive-behavioral therapy (CBT). Sequential and stylistic integration of MI with existing CBT models is discussed and sample vignettes are provided to demonstrate the application of MI across the continuum of criminal justice care. This integration leverages the complementary strengths of both approaches.

MI can serve as a preparatory phase before CBT, enhancing readiness and engagement. Many offenders enter treatment in precontemplation or contemplation stages, not yet ready for the action-oriented focus of traditional CBT. Using MI initially helps move clients toward readiness for the skill-building and cognitive restructuring components of CBT.

Stylistic integration involves infusing the MI spirit and techniques throughout CBT delivery. Rather than using a purely didactic, expert-driven approach to teaching cognitive-behavioral skills, practitioners can employ MI-consistent methods that evoke clients' own insights, affirm their efforts, and respect their autonomy in applying new skills. This integration maintains client engagement and ownership of the change process while still delivering evidence-based CBT content.

MI also integrates well with other forensic interventions including the Risk-Need-Responsivity (RNR) model, which is the dominant framework for correctional treatment. The RNR model of correctional assessment and treatment is rooted in general personality and cognitive social learning theories, incorporating criminal behavior and the key risk, need, and responsivity factors involved in crime prevention. MI addresses the responsivity principle by tailoring interventions to individual characteristics and enhancing motivation to engage with treatment targeting criminogenic needs.

Addressing Co-Occurring Mental Health Issues

Many justice-involved individuals experience co-occurring mental health disorders alongside substance abuse and criminal behavior. MI provides a valuable approach for engaging individuals with mental illness in treatment, addressing medication adherence, and supporting recovery goals. The non-confrontational, empathic stance of MI is particularly important for individuals who may be experiencing symptoms that affect their insight, judgment, or emotional regulation.

For offenders with serious mental illness, MI can help explore ambivalence about treatment, medication, and symptom management. Rather than simply insisting on compliance with treatment recommendations, MI practitioners help clients examine their own experiences with symptoms and treatment, identify their personal goals for recovery, and develop intrinsic motivation for engaging in mental health services.

The approach is also valuable for addressing the stigma and shame many individuals experience related to mental illness. By creating a non-judgmental space for discussing mental health concerns, MI helps reduce barriers to seeking and continuing treatment. This is particularly important in correctional environments where mental illness may be viewed as weakness or where disclosure could create vulnerability.

Evidence Base: Research Findings on MI Effectiveness in Forensic Settings

Systematic Reviews and Meta-Analyses

The evidence base for MI in forensic settings has grown substantially in recent years, with multiple systematic reviews and meta-analyses examining its effectiveness. These findings highlight the importance of integrating MI into forensic settings, establishing its positive impact on numerous outcomes. The accumulation of research evidence provides increasingly robust support for MI as an evidence-based practice in criminal justice contexts.

Research shows that interventions incorporating MI are more effective than other approaches in preventing and reducing offending behavior, highlighting its importance in improving intervention outcomes. This comparative effectiveness is particularly important for resource allocation decisions and policy development in correctional systems.

Recent comprehensive reviews have examined MI across diverse offender populations and settings. The total sample size of the studies ranged from 25 to 528 individuals convicted of various offences, including intimate partner violence, violent crimes, sexual offences, property crimes, driving offences, and drug offences. This breadth of application demonstrates MI's versatility across different types of offending behavior and criminal justice contexts.

However, researchers have also noted important limitations in the existing evidence base. Considerable heterogeneity between the included trials precluded robust conclusions on the effectiveness of MI in criminal justice contexts and further research is required. This heterogeneity stems from variations in how MI is implemented, measured, and compared across studies, highlighting the need for greater standardization in future research.

Outcomes Across Different Domains

Research has examined MI's impact across multiple outcome domains relevant to forensic populations. The most consistently positive findings relate to treatment engagement and retention, with multiple studies demonstrating that MI increases attendance and reduces dropout compared to standard approaches. These engagement outcomes are particularly valuable given their role as mediators of other treatment effects.

For substance use outcomes, the evidence is generally positive though somewhat mixed depending on the specific substances, populations, and comparison conditions examined. Studies have found reductions in both alcohol and drug use among offenders receiving MI, with effects sometimes persisting at follow-up assessments. The variability in findings may relate to differences in MI dosage, practitioner training and fidelity, and the presence of other treatment components.

Recidivism outcomes, while showing promise, demonstrate more variability across studies. The positive meta-analytic findings for recidivism reduction are encouraging, but individual studies show a range of effects. This variability may reflect differences in follow-up periods, how recidivism is measured (arrests, convictions, technical violations), and the baseline risk levels of participants.

Other outcomes examined in the literature include HIV risk behaviors, employment outcomes, social support networks, and quality of life measures. While less extensively studied than substance use and recidivism, these outcomes are important for comprehensive assessment of MI's impact on offender rehabilitation and community reintegration.

Moderating Factors and Individual Differences

Research has begun to identify factors that moderate MI's effectiveness with offender populations. The influence of some moderating variables related to the psychosocial profile of offenders was also suggested. Understanding these moderators is crucial for tailoring MI interventions to maximize effectiveness for different subgroups.

One important moderator identified in research concerns psychopathic traits. Inmates with psychopathic traits showed higher substance use after receiving MI, thus evidencing a harmful effect. On the other hand, MI had a positive effect (lower consumption) in people with no (or few) affective psychopathic traits. This finding suggests that MI may not be universally beneficial and that screening for psychopathic traits may be important for treatment planning.

The levels of recovery capital also demonstrated a moderating effect. Specifically, unlike probationers and parolees with low RC, participants with higher RC (including fewer lifetime psychiatric problems and more social support) showed more favorable drug, legal and psychiatric outcomes after at least three MICM sessions. This suggests that individuals with greater resources and support may be better positioned to benefit from MI interventions.

Gender represents another potential moderator requiring further investigation. Gender differences may influence the effectiveness of motivational interviewing in forensic settings. Investigating these variations could provide valuable insights into how MI interventions can be adapted to meet the distinct needs of male and female offenders. The underrepresentation of women in forensic MI research limits our understanding of how the approach may need to be tailored for female offenders who often have distinct pathways to crime and treatment needs.

Dosage and Intensity Considerations

The question of how much MI is needed to achieve meaningful outcomes has important practical implications for program design and resource allocation. Research suggests that dosage matters, with some evidence indicating that multiple sessions may be necessary for optimal effects. The finding that MI shows particularly promising results after three or more sessions provides some guidance, though optimal dosage likely varies depending on the specific outcomes targeted and client characteristics.

Brief MI interventions (one to two sessions) have shown value for enhancing engagement and preparing clients for more intensive treatment. These brief interventions may be particularly cost-effective as pretreatment preparation or as adjuncts to other services. However, for outcomes like recidivism reduction and sustained behavior change, more extended MI involvement may be necessary.

The format of MI delivery—individual versus group, standalone versus integrated with other treatments—also affects dosage considerations. Individual MI allows for personalized attention to each client's unique ambivalence and motivations, while group MI can leverage peer influence and normalize the change process. Integrated approaches that infuse MI throughout other treatments provide ongoing motivational support rather than limiting it to a discrete intervention phase.

Methodological Considerations and Research Quality

The quality and rigor of research examining MI in forensic settings varies considerably. RCTs are considered the gold standard for evaluating the effectiveness of an intervention. While some high-quality randomized controlled trials have been conducted, much of the literature consists of quasi-experimental designs, pre-post comparisons, or studies with significant methodological limitations.

A critical issue in MI research concerns treatment fidelity—the extent to which MI is actually delivered as intended. The 'Motivational Interviewing Treatment Integrity code' (MITI) has evolved in recent years with the aim of standardizing the delivery of MI interventions. However, many studies do not include systematic fidelity assessment, making it difficult to determine whether observed effects (or lack thereof) reflect MI itself or variations in implementation quality.

Sample sizes in forensic MI research range widely, with some studies including fewer than 50 participants while others involve several hundred. Only three outcomes (session attendance, dropout, and recidivism) could be included in the meta-analysis as the remaining outcomes could not be analyzed due to the wide variability in the measures used. Despite the consistency of results and lack of heterogeneity of the meta-analyses, a larger number of studies would provide greater statistical power and generalizability.

Follow-up periods also vary substantially across studies, from immediate post-treatment assessments to multi-year follow-ups. Longer follow-up periods are particularly important for outcomes like recidivism, where effects may not emerge immediately. The field would benefit from more studies with extended follow-up to assess the durability of MI effects over time.

Benefits of Motivational Interviewing in Forensic Contexts

Enhanced Client Engagement and Therapeutic Alliance

One of the most significant benefits of MI in forensic settings is its capacity to enhance client engagement and build therapeutic alliance despite the mandated nature of participation. The collaborative, non-judgmental stance of MI helps overcome the mistrust and resistance that often characterize offender populations' interactions with authority figures and treatment providers.

The most effective relationship seems to involve a positive working alliance, balanced with aspects of procedural justice (i.e., firm but fair and respectful). MI naturally promotes this type of relationship by demonstrating respect for clients' perspectives and autonomy while still maintaining appropriate boundaries and expectations.

The quality of the therapeutic alliance has been consistently linked to treatment outcomes across diverse populations and intervention types. In forensic settings, where clients often have histories of negative experiences with helping professionals and systems, establishing a positive alliance is particularly challenging yet crucial. MI's emphasis on empathy, acceptance, and collaboration provides concrete methods for building these relationships even with highly resistant or defensive clients.

Enhanced engagement translates into better attendance, reduced dropout, greater participation in treatment activities, and ultimately improved outcomes. When clients feel heard, respected, and understood, they are more likely to invest in the treatment process and apply what they learn to their lives outside of sessions.

Addressing Ambivalence and Resistance

Ambivalence—simultaneously wanting and not wanting to change—is a normal part of the change process, yet traditional confrontational approaches often fail to address it effectively. MI recognizes ambivalence as expected and provides specific strategies for exploring and resolving it. Rather than viewing resistance as a character flaw or treatment obstacle, MI understands it as a natural response to the prospect of change and as information about the client's concerns and priorities.

By helping clients articulate both sides of their ambivalence, MI allows them to examine their conflicting feelings without pressure to immediately resolve them. This exploration often leads to increased awareness of discrepancies between current behaviors and important values or goals. As clients voice their own concerns about their behavior and reasons for change, they begin to build intrinsic motivation that is more sustainable than externally imposed mandates.

The MI approach to resistance—rolling with it rather than confronting it directly—prevents the escalation of defensiveness that can occur when clients feel attacked or judged. When practitioners respond to resistance with reflection and curiosity rather than argumentation, clients often soften their defensive stance and become more open to examining their behavior.

Fostering Intrinsic Motivation and Self-Efficacy

A fundamental benefit of MI is its focus on developing intrinsic motivation—motivation that comes from within based on personal values, goals, and desires—rather than relying solely on external motivators like avoiding punishment or satisfying legal requirements. While external motivators may produce short-term compliance, intrinsic motivation is more likely to sustain behavior change over time and across situations.

Through the process of articulating their own reasons for change, clients develop ownership of their change goals. This ownership increases commitment and persistence when faced with obstacles or setbacks. Rather than changing because they have to, clients begin to change because they want to, because it aligns with who they want to be and what they want for their lives.

MI also builds self-efficacy—confidence in one's ability to successfully change. By affirming strengths, highlighting past successes, and supporting autonomy, MI helps clients recognize their own capabilities and resources. This enhanced self-efficacy is crucial for initiating and maintaining behavior change, particularly in the face of the significant challenges many offenders encounter during rehabilitation and reentry.

Compatibility with Diverse Theoretical Orientations and Programs

MI's flexibility and compatibility with other approaches represents a significant practical benefit. Rather than requiring wholesale replacement of existing programs, MI can be integrated with cognitive-behavioral, psychoeducational, skills-training, and other evidence-based interventions. This compatibility makes MI accessible to programs with limited resources for complete redesign.

The MI spirit and techniques can enhance virtually any intervention by improving engagement, addressing motivation, and respecting client autonomy. Whether used as a standalone brief intervention, a preparatory phase, or an ongoing stylistic approach throughout treatment, MI adds value without necessarily requiring extensive additional time or resources.

This versatility extends across different theoretical orientations. MI is compatible with psychodynamic, humanistic, cognitive-behavioral, and other therapeutic frameworks. Practitioners from diverse backgrounds can learn and apply MI while maintaining their core theoretical orientation, making it an accessible addition to existing skill sets.

Reduced Defensiveness and Improved Communication

The non-confrontational nature of MI reduces the defensiveness that often impedes progress in forensic treatment. When clients don't feel attacked or judged, they are more able to honestly examine their behavior and its consequences. This openness facilitates more productive therapeutic conversations and allows for deeper exploration of issues.

MI's emphasis on reflective listening improves communication in both directions. Clients feel heard and understood, which builds trust and rapport. Practitioners gain clearer understanding of clients' perspectives, concerns, and motivations, which informs more effective intervention planning. This improved communication creates a positive cycle where increased understanding leads to better engagement, which leads to more honest disclosure, which further enhances understanding.

The reduction in defensiveness also allows clients to more readily acknowledge problems and accept responsibility for their behavior. Rather than needing to maintain a defensive posture to protect their self-esteem, clients can acknowledge difficulties while still feeling respected and valued. This acknowledgment is often a crucial first step toward meaningful change.

Supporting Long-Term Behavioral Change and Desistance

MI's focus on intrinsic motivation and self-efficacy supports long-term behavioral change rather than just short-term compliance. By helping clients develop their own reasons for change and confidence in their ability to change, MI creates a foundation for sustained effort even after formal treatment ends and external monitoring decreases.

The process of articulating change talk and commitment language in MI sessions appears to strengthen clients' resolve and increase the likelihood of follow-through. When clients hear themselves expressing desire, ability, reasons, and need for change, these statements can influence their subsequent behavior through self-perception processes. The more clients articulate arguments for change, the more they come to believe and act on those arguments.

MI also supports the development of a prosocial identity, which is increasingly recognized as central to desistance from crime. Through exploring values, goals, and the kind of person they want to be, clients begin to construct a narrative of themselves as someone who is changing, who has moved beyond their criminal past. This identity transformation provides ongoing motivation to maintain behavioral changes and resist pressures to return to criminal activity.

Cost-Effectiveness and Efficiency

From a systems perspective, MI offers potential cost-effectiveness benefits. By improving treatment engagement and retention, MI helps ensure that resources invested in treatment programs are not wasted on clients who drop out prematurely. The reduction in recidivism associated with MI translates into decreased costs related to re-arrest, prosecution, and re-incarceration.

Brief MI interventions can be delivered efficiently, making them feasible even in resource-constrained settings. A one- or two-session MI intervention requires relatively modest time investment but can yield meaningful improvements in engagement and outcomes. For settings where intensive treatment is not feasible, brief MI may provide a valuable alternative that still produces benefits.

Training in MI, while requiring initial investment, provides practitioners with skills applicable across diverse clients and issues. Once trained, practitioners can apply MI principles and techniques throughout their work rather than only in specific programs or with particular populations. This broad applicability enhances the return on training investment.

Challenges and Considerations in Implementing MI in Forensic Settings

Training Requirements and Practitioner Skill Development

Effective MI practice requires specialized training and ongoing skill development. While the basic principles of MI may seem straightforward, actually implementing them skillfully—particularly with challenging forensic populations—requires substantial practice and feedback. Eight critical stages in learning MI are considered sequential and outline the spirit, skills, and strategies necessary to become proficient in MI.

Many forensic practitioners come from backgrounds emphasizing confrontation, accountability, and directive approaches. Shifting to the collaborative, client-centered stance of MI can be challenging and may conflict with ingrained professional habits and beliefs. This spirit is difficult for some officers, particularly those who view their role primarily in terms of enforcement and surveillance rather than behavior change facilitation.

Effective MI training goes beyond one-time workshops to include ongoing coaching, feedback on recorded sessions, and opportunities for deliberate practice. Research on MI training suggests that workshop attendance alone is often insufficient to produce lasting changes in practitioner behavior. Sustained improvement requires follow-up support, performance feedback, and organizational reinforcement of MI-consistent practices.

The development of tools for assessing MI skill and fidelity has advanced considerably, providing methods for evaluating practitioner competence and ensuring quality implementation. However, implementing systematic fidelity monitoring in real-world forensic settings presents logistical and resource challenges that many agencies struggle to address.

Balancing Empathy with Accountability

One of the most significant challenges in applying MI in forensic settings involves balancing the empathic, accepting stance of MI with the legitimate need for accountability and public safety. Forensic practitioners often have dual roles—supporting client change while also monitoring compliance and protecting the community. These roles can create tension with MI's emphasis on autonomy and non-judgment.

Practitioners may worry that being too empathic or accepting will be perceived as condoning criminal behavior or failing to hold clients accountable. They may struggle with how to maintain MI spirit while still enforcing rules, imposing sanctions, or confronting problematic behavior. This tension is particularly acute when clients are actively engaging in risky or harmful behaviors.

However, MI and accountability are not inherently incompatible. MI can be used to explore clients' understanding of rules and consequences, examine their feelings about accountability measures, and support their autonomy in choosing how to respond to requirements. The key is being transparent about the dual role, acknowledging the limits of confidentiality and autonomy within the forensic context, and still maintaining respect and empathy within those constraints.

Some practitioners find it helpful to explicitly separate MI-focused conversations from accountability-focused interactions, making clear when they are wearing their "change agent" hat versus their "enforcement" hat. Others integrate the two by using MI to explore clients' responses to accountability measures and support their autonomy in deciding how to meet requirements.

Working with Deeply Ingrained Behaviors and Resistance

Many forensic clients present with deeply ingrained behavioral patterns, extensive criminal histories, and significant resistance to change. These clients may have been engaging in criminal behavior for years or decades, with criminal activity integrated into their identity, social networks, and lifestyle. Changing such entrenched patterns requires more than brief intervention, and even skillful MI may face significant limitations.

Some clients may use MI conversations strategically, saying what they think practitioners want to hear without genuine commitment to change. They may articulate change talk to satisfy requirements while maintaining no real intention of following through. Distinguishing between genuine ambivalence and strategic manipulation can be challenging, particularly for less experienced practitioners.

Additionally, some clients may be so entrenched in precontemplation—not seeing their behavior as problematic—that even skillful MI struggles to create movement. While MI is designed to work with resistance and precontemplation, there are limits to what can be accomplished when clients are firmly committed to maintaining their current behavior and see no reason to change.

For these challenging cases, MI may need to be combined with other approaches, extended over longer periods, or focused on smaller, more achievable goals. Practitioners must also recognize that not all clients will change, and that MI, like any intervention, has limitations in its effectiveness with certain individuals.

Organizational and Systemic Barriers

Implementing MI in forensic settings often encounters organizational and systemic barriers. Correctional and criminal justice agencies may have cultures that emphasize punishment, control, and confrontation rather than collaboration and behavior change support. Introducing MI into such environments requires not just training individual practitioners but often shifting organizational culture and values.

Workload demands in many forensic settings leave practitioners with limited time for the kind of extended, reflective conversations that characterize good MI practice. When caseloads are high and administrative demands extensive, practitioners may feel pressure to be more directive and efficient rather than taking time to explore ambivalence and evoke motivation.

Organizational policies and procedures may also conflict with MI principles. For example, requirements to confront denial, document specific content coverage, or follow rigid protocols may limit practitioners' ability to follow the client's lead and respond flexibly to emerging motivations. Addressing these systemic barriers requires engagement at administrative and policy levels, not just practitioner training.

Funding and resource constraints affect the ability to provide adequate training, ongoing coaching, and fidelity monitoring. While initial workshop training may be feasible, sustaining the ongoing support necessary for skill development and maintenance often proves challenging. Without organizational commitment to supporting MI implementation, initial training effects may fade over time.

Adapting MI for Diverse Populations

Forensic populations are diverse in terms of gender, race, ethnicity, age, cultural background, and other characteristics. Adapting MI to be culturally responsive and appropriate for diverse groups presents both challenges and opportunities. While MI's core principles are broadly applicable, the specific ways they are implemented may need to be tailored to different cultural contexts and individual characteristics.

Language and communication styles vary across cultures, affecting how empathy is expressed, how questions are received, and what constitutes respectful interaction. Practitioners must be aware of these cultural differences and adapt their MI practice accordingly while maintaining fidelity to core principles.

Gender-specific considerations are particularly important given the distinct pathways to crime and treatment needs of female offenders. Women in the criminal justice system have higher rates of trauma, mental illness, and victimization compared to male offenders. MI interventions may need to be adapted to address these specific needs and to create safety for discussing sensitive topics.

Age-related adaptations are necessary when working with juvenile offenders, who have different developmental needs and capacities compared to adults. MI with adolescents may need to account for their developing autonomy, peer influences, family dynamics, and cognitive development. Similarly, older offenders may have different concerns and motivations that require tailored approaches.

Measuring Outcomes and Demonstrating Effectiveness

Demonstrating MI's effectiveness in forensic settings requires appropriate outcome measurement, which presents several challenges. Many important outcomes—such as recidivism—may not be observable until months or years after intervention, making it difficult to establish clear causal links. Additionally, forensic clients are often receiving multiple services simultaneously, making it challenging to isolate MI's specific contribution to outcomes.

Selecting appropriate comparison conditions for evaluating MI is also complex. Comparing MI to "treatment as usual" may not adequately control for attention and time, while comparing it to other active treatments may not demonstrate superiority even if MI is effective. Determining what constitutes a meaningful effect size for different outcomes requires consideration of both statistical and practical significance.

Process measures—such as changes in motivation, readiness to change, or therapeutic alliance—can provide important information about MI's mechanisms of action but may not satisfy stakeholders primarily concerned with behavioral outcomes like recidivism. Balancing process and outcome measurement while maintaining feasibility in real-world settings requires careful planning and prioritization.

Ethical Considerations

Using MI in forensic settings raises several ethical considerations. The tension between respecting autonomy and working within a coercive system creates ethical complexity. While MI emphasizes client autonomy, forensic clients often have limited choices and face significant consequences for non-compliance. Practitioners must be honest about these constraints while still creating space for autonomous decision-making within them.

Informed consent takes on additional complexity in mandated treatment contexts. Clients should understand the nature of MI, its goals, and how information shared in sessions may be used. The limits of confidentiality must be clearly communicated, particularly regarding information about risk to self or others, ongoing criminal activity, or non-compliance with legal requirements.

There are also ethical questions about using MI's persuasive techniques in contexts where clients have limited choice. While MI is designed to evoke intrinsic motivation rather than impose external pressure, skilled MI can be quite influential. Practitioners must be mindful of the power differential and ensure they are supporting clients' own goals rather than manipulating them toward predetermined outcomes.

Finally, there are equity considerations regarding who has access to MI-enhanced services. If MI improves outcomes, ensuring equitable access across different populations, settings, and geographic areas becomes an ethical imperative. Resource constraints should not result in some groups receiving evidence-based MI interventions while others receive inferior services.

Best Practices for Implementing MI in Forensic Settings

Comprehensive Training and Ongoing Coaching

Effective MI implementation begins with comprehensive training that goes beyond basic workshop attendance. Best practice includes initial intensive training (typically 2-3 days) covering MI spirit, principles, and core skills, followed by ongoing coaching and feedback. This coaching should include review of recorded sessions, specific feedback on MI-consistent and MI-inconsistent behaviors, and opportunities for deliberate practice of challenging skills.

Training should be tailored to the specific forensic context, using examples and role-plays relevant to the populations and issues practitioners encounter. Generic MI training may not adequately prepare practitioners for the unique challenges of forensic work, such as managing dual roles, working with mandated clients, and addressing serious criminal behaviors.

Organizations should plan for ongoing skill development rather than treating training as a one-time event. Regular booster sessions, peer consultation groups, and access to MI experts for consultation help maintain and enhance skills over time. Creating communities of practice where practitioners can share experiences, troubleshoot challenges, and support each other's development strengthens implementation.

Fidelity Monitoring and Quality Assurance

Systematic monitoring of MI fidelity ensures that the intervention is being delivered as intended. This monitoring can use standardized tools like the MITI to assess practitioner competence and adherence to MI principles. Regular fidelity assessment provides data for quality improvement, identifies practitioners who may need additional support, and ensures that clients are receiving evidence-based services.

Fidelity monitoring should be implemented in a supportive, developmental manner rather than punitively. The goal is to support practitioner growth and program quality, not to criticize or penalize practitioners. Feedback should be specific, balanced (acknowledging strengths as well as areas for improvement), and actionable.

Organizations should establish clear benchmarks for acceptable MI fidelity and provide support for practitioners to achieve these standards. This might include additional training, individual coaching, or reduced caseloads to allow more time for skill development. When fidelity monitoring reveals systemic issues, organizational responses should address underlying barriers rather than focusing solely on individual practitioner performance.

Integration with Existing Programs and Services

MI is most effective when thoughtfully integrated with existing evidence-based programs and services rather than implemented in isolation. This integration should consider how MI can enhance engagement in other treatments, prepare clients for action-oriented interventions, and maintain motivation throughout the change process.

Clear protocols should specify when and how MI is used in relation to other services. For example, MI might be used as a preparatory phase before cognitive-behavioral treatment, as an ongoing stylistic approach throughout services, or as a targeted intervention when motivation wanes. These decisions should be based on client needs, program goals, and available resources.

Integration also requires coordination among different service providers. When clients are receiving services from multiple practitioners or agencies, communication about MI use ensures consistency and prevents conflicting approaches. Shared understanding of MI principles helps create a coherent treatment environment that reinforces motivation and change.

Organizational Support and Culture Change

Successful MI implementation requires organizational commitment and support. Leadership must champion MI, allocate resources for training and coaching, and create policies that support MI-consistent practice. This includes providing adequate time for MI conversations, reducing administrative burdens that interfere with client contact, and recognizing and rewarding high-quality MI practice.

Organizational culture change may be necessary to create an environment where MI can thrive. This involves shifting from purely punitive or confrontational approaches toward a balance of accountability and behavior change support. Leaders can model MI-consistent communication in their interactions with staff, creating a culture of respect, collaboration, and autonomy support throughout the organization.

Policies and procedures should be reviewed to identify and address conflicts with MI principles. For example, requirements to confront denial or follow rigid assessment protocols may need to be modified to allow for MI-consistent practice. Creating flexibility for practitioners to respond to client needs and follow the client's lead supports better MI implementation.

Adapting MI for Specific Populations and Contexts

While maintaining fidelity to core MI principles, adaptations may be necessary for specific populations or contexts. These adaptations should be thoughtful and evidence-informed, preserving the essential elements of MI while tailoring delivery to meet particular needs.

For clients with cognitive impairments or limited literacy, MI may need to be delivered more concretely with simplified language and more structure. For clients with serious mental illness, adaptations might address symptom management and medication adherence while being sensitive to how symptoms affect engagement and communication.

Cultural adaptations should consider communication styles, values, family structures, and cultural attitudes toward authority and help-seeking. Practitioners should develop cultural humility—an ongoing commitment to self-reflection and learning about clients' cultural contexts—rather than assuming expertise about any cultural group.

Gender-responsive adaptations for female offenders might address trauma, relationships, parenting, and other issues particularly salient for women. Creating safe environments for discussing sensitive topics and recognizing the impact of trauma on engagement and trust are important considerations.

Outcome Monitoring and Continuous Quality Improvement

Systematic outcome monitoring provides data for evaluating MI's effectiveness and identifying areas for improvement. This monitoring should include both process measures (engagement, motivation, therapeutic alliance) and outcome measures (substance use, recidivism, treatment completion) relevant to program goals.

Data should be used for continuous quality improvement rather than just accountability. Regular review of outcome data can identify trends, highlight successes, and reveal areas needing attention. When outcomes are not meeting expectations, data can help determine whether the issue relates to MI fidelity, client characteristics, organizational factors, or other variables.

Engaging practitioners in reviewing and interpreting outcome data builds investment in quality improvement and helps identify practical solutions to implementation challenges. Creating feedback loops where data inform practice modifications, which are then evaluated through continued monitoring, supports ongoing program refinement.

Future Directions and Research Needs

Expanding the Evidence Base

While the evidence base for MI in forensic settings has grown substantially, important gaps remain. There is a pressing need for more RCTs with larger, more diverse samples and extended follow-up periods to assess the long-term sustainability of behavioral change. Future research should prioritize methodologically rigorous studies that can provide definitive evidence about MI's effectiveness with different populations and for different outcomes.

Research is particularly needed with underrepresented populations. Most existing studies have focused on male offenders, leaving significant questions about MI's effectiveness with female offenders. Studies examining MI with specific offense types (sexual offenders, domestic violence offenders, white-collar criminals) would help determine whether adaptations are needed for different groups.

Comparative effectiveness research examining MI against other evidence-based approaches would help clarify when MI is most appropriate and for whom. Studies examining different MI formats (individual vs. group, brief vs. extended, standalone vs. integrated) would inform implementation decisions and resource allocation.

Understanding Mechanisms of Change

While research demonstrates that MI can be effective, less is known about how it works—the mechanisms through which it produces change. Exploration of potential mediators (e.g. motivation or readiness to change) of treatment adherence and effectiveness is recommended to identify effective intervention targets. Understanding these mechanisms would allow for more targeted interventions and potentially enhanced effectiveness.

Research examining the role of change talk, therapeutic alliance, self-efficacy, and other potential mediators would clarify MI's active ingredients. This understanding could inform training priorities, help practitioners focus on the most important elements, and guide adaptations for different populations or contexts.

Studies examining the relationship between MI fidelity and outcomes would help determine which specific MI behaviors are most important for effectiveness. This could lead to more efficient training that emphasizes high-impact skills and more focused fidelity monitoring.

Technology-Enhanced MI Delivery

Emerging technologies offer new possibilities for MI delivery in forensic settings. Computer-delivered interventions have grown in popularity as a way to change behaviors associated with drug and alcohol use. Technology-enhanced MI might include computer-based programs, smartphone applications, telehealth delivery, or automated text messaging interventions.

These technological approaches could increase access to MI, particularly in rural areas or settings with limited practitioner availability. They might also provide more consistent delivery and easier fidelity monitoring. However, research is needed to determine whether technology-delivered MI is as effective as in-person delivery and for which populations and outcomes it is most appropriate.

Hybrid approaches combining technology and human interaction might offer optimal balance of efficiency and effectiveness. For example, computer-based MI modules could be supplemented with brief practitioner check-ins, or smartphone apps could provide between-session support for in-person MI interventions.

Implementation Science and Dissemination

Moving MI from research to widespread practice requires attention to implementation science—the study of methods to promote the systematic uptake of research findings into routine practice. Research examining barriers and facilitators to MI implementation in forensic settings would inform dissemination strategies and help organizations successfully adopt MI.

Studies of different training models, coaching approaches, and organizational supports would identify best practices for MI implementation. Cost-effectiveness analyses would help make the case for investing in MI training and implementation. Research on sustainability—how to maintain MI practice over time—would address the common problem of initial enthusiasm followed by drift back to previous practices.

Examining system-level implementation, including policy changes needed to support MI practice, would help create environments where MI can thrive. This might include research on supervision practices, performance evaluation systems, and organizational cultures that support or hinder MI implementation.

Personalization and Precision Approaches

Future research might examine how to personalize MI interventions based on individual characteristics, needs, and preferences. Precision medicine approaches that match intervention intensity and type to individual risk and need profiles could enhance efficiency and effectiveness. Research identifying which clients benefit most from MI and which might need alternative or supplementary approaches would support more targeted implementation.

Adaptive interventions that adjust based on client response could optimize outcomes while minimizing resource use. For example, clients who respond quickly to brief MI might transition to other services, while those showing less response might receive more intensive or prolonged MI. Research on decision rules for these adaptations would support implementation of such approaches.

Conclusion

Motivational Interviewing has emerged as a valuable evidence-based approach for forensic psychological treatment, offering a client-centered alternative to traditional confrontational methods. Advocating for the integration of MI is crucial to enhance the effectiveness of interventions in criminal justice settings. The growing body of research demonstrates MI's effectiveness in enhancing treatment engagement, reducing substance use, and decreasing recidivism among justice-involved populations.

The core principles of MI—partnership, acceptance, compassion, and evocation—align well with the needs of forensic populations who often enter treatment involuntarily and with significant mistrust of authority figures. By respecting autonomy, building on strengths, and fostering intrinsic motivation, MI creates conditions for meaningful behavior change rather than mere compliance with external mandates.

Despite its promise, implementing MI in forensic settings presents significant challenges. These include the need for specialized training, tensions between empathy and accountability, organizational barriers, and the complexity of working with deeply entrenched behaviors. Addressing these challenges requires commitment at multiple levels—from individual practitioners developing their skills to organizational leaders creating supportive environments to policymakers allocating resources for evidence-based practices.

The future of MI in forensic psychology appears bright, with opportunities for expanding the evidence base, enhancing implementation, and leveraging technology to increase access. As research continues to refine our understanding of how MI works and for whom it is most effective, the approach will likely become increasingly sophisticated and targeted.

For forensic practitioners, MI offers a powerful set of tools for engaging challenging clients, addressing ambivalence, and supporting sustainable behavior change. For clients, MI provides a respectful, collaborative approach that honors their autonomy while supporting their efforts to change. For the criminal justice system, MI represents an evidence-based method for achieving the dual goals of public safety and offender rehabilitation.

As the field continues to evolve, maintaining fidelity to MI's core principles while adapting to diverse forensic contexts will be essential. The integration of MI with other evidence-based approaches, attention to cultural responsiveness, and commitment to ongoing quality improvement will help ensure that MI realizes its full potential in forensic psychological treatment.

Ultimately, the application of Motivational Interviewing in forensic settings reflects a broader shift toward more humane, effective, and evidence-based approaches to criminal justice. By recognizing the humanity of offenders, respecting their capacity for change, and providing skilled support for their rehabilitation efforts, MI contributes to a criminal justice system that is both more just and more effective in promoting public safety and individual transformation.

Additional Resources

For professionals interested in learning more about Motivational Interviewing and its application in forensic settings, several resources are available:

These resources can support practitioners in developing their MI skills, staying current with research, and connecting with others working to implement MI in forensic contexts. Continued learning and professional development are essential for maintaining high-quality MI practice and achieving optimal outcomes with justice-involved populations.