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Original Research
SAGE Open
October-December 2024: 1–12
ÓThe Author(s) 2024
DOI: 10.1177/21582440241306821
journals.sagepub.com/home/sgo
An Evaluation of the Healthy
Relationships Program for Male
Adolescents in Juvenile Detention:
A Mixed Method Approach
Rae-lee Warner
1
, Kristie Dellar
2
,
and Lynne Roberts
1
Abstract
Currently, there is limited empirically published Australian studies on effective rehabilitative programs in youth justice. This
study used a mixed-methods approach to evaluate the Healthy Relationships program which was designed to challenge atti-
tudes relating to intimate partner violence for male adolescents in detention in Western Australia. Paired group analyses
compared pre and post measures of attitudes towards intimate partner violence and traditional gender roles and stereotypes
for the total sample (N= 65). Given the significant overrepresentation of First Nations youth in detention, additional analyses
were also run separately for this group (n= 51). Participation in the Healthy Relationships program was expected to reduce
participant endorsement of attitudes supporting intimate partner violence and endorsement of attitudes supporting tradi-
tional gender roles and stereotypes. Results supported our expectations for the total sample and the First Nations youth
sample, indicating significant improvements across all outcomes following program participation. Qualitative analysis of parti-
cipant program feedback further supported the quantitative results and identified the importance of the therapeutic alliance
and incentives-based learning approaches. The findings contribute to the ‘‘what works’’ literature and provide insights into
factors that improve positive treatment outcomes for youth in detention. Suggestions for program improvements and future
research directions are discussed.
Plain language summary
The purpose of this study was to evaluate the effectiveness of the Healthy Relationships program developed for
adolescent male offenders in custody. Participants attitudes towards intimate partner violence and traditional gender
roles and stereotypes were compared pre and post program completion, with a separate analysis conducted for First
Nations youth given the significant overrepresentation of this population in custody and the need for culturally-
appropriate programs. Results indicated significant reductions in attitudes supportive of intimate partner violence and
attitudes endorsing gender roles and stereotypes for the total sample and First Nations youth sample, providing support
for the effectiveness of the program. Participant feedback provided additional insights into the components of the
program that made it more effective, including facilitator style of delivery and resources used. Our study contributes to
the ‘‘what works’’ literature for youth offenders and offers unique insights into to what makes criminogenic programs
effective from the perspective of participants. Though our sample was limited to Western Australian youth, the findings
could be used to assist in the design of culturally safe and effective programs for male adolescents involved in the justice
system. Suggestions for program improvements and future research directions are discussed.
1
Curtin University, Perth, WA, Australia
2
Department of Justice, Perth, WA, Australia
Corresponding Author:
Kristie Dellar, Department of Justice, 3 Walcott Street, Mount Lawley, WA 6050, Australia.
Email: Kristie.Dellar@justice.wa.gov.au
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Keywords
First Nations youth, healthy relationships, violence, aggression, program, effectiveness
A Note on Terminology
Within this article the term ‘‘First Nations’’ is used to
refer to Aboriginal and Torres Strait Islander peoples.
This is in recognition that Aboriginal and Torres Strait
Islander peoples were the First people of Australia and
are the oldest living culture in the world (Malaspinas
et al., 2016).
Violence in intimate partner relationships is a signifi-
cant social and public health concern that affects adoles-
cents worldwide. The types of relationships individuals
experience during adolescent years can have implications
for development and functioning in adulthood. Healthy
relationships, inclusive of intimacy and support, are
associated with positive outcomes for life functioning
and wellbeing (Benham-Clarke et al., 2023; Collins et al.,
2009). Collins et al. (2009) found that healthy romantic
relationships in adolescence (e.g., those that involved
dating someone for longer than a month) can lead to
commitment and higher quality relationships in early
adulthood and quality romantic relationships were asso-
ciated with positive self-worth. Kanksy and Allen (2018)
conducted a longitudinal study on the impact of roman-
tic relationships during adolescent years. They found
that the quality of the relationship, as opposed to dura-
tion, predicted future mental health functioning.
Specifically, higher support in the romantic relationships
predicted fewer negative externalizing behaviors directed
towards their partner, by age 26 (Kanksy & Allen, 2018).
Similarly, Lambert et al. (2014) conducted a study using
8,679 high school students and found that even when
accounting for negative factors, having strong social
relationships—with peers, family, and at school, were
positively correlated with adolescent happiness.
In contrast to healthy relationships are those charac-
terized by severe conflict, leading to violence within rela-
tionships. Unhealthy relationships inclusive of low-
quality interactions (e.g., antagonism), lower sense of
control and lack of ‘‘authenticity’’ can lead to increased
conflict and controlling behaviors (Benham-Clarke et al.,
2023; Collins et al., 2009). Family violence, which
includes any act of physical, psychological, or sexual vio-
lence, was reported as one of the most prevalent crime
types in a study conducted in Australia (State of
Victoria, 2016). The effects of family violence can extend
indirectly to children, which can result in intergenera-
tional trauma (Boxall et al., 2020). Adolescent family
violence significantly impacts family members (who are
the victims) and can increase risk of violent behavior in
adulthood for the perpetrators (Boxall et al., 2020). Risk
factors for adolescents perpetrating interpersonal vio-
lence include witnessing parent-to-parent violence, expo-
sure to violence in the community, suffering abuse as a
child, and experiencing mental health challenges (Boxall
& Morgan, 2020; Ehrensaft et al., 2003). There are addi-
tional factors influencing antisocial behaviors and vio-
lence that are linked to an individual’s exosystem
including socioeconomic status, ethnicity due to racism,
being a child in care, and the neighborhood one grows
up in (Benham-Clarke et al., 2023; Taquette & Monteiro,
2019).
Adolescent family violence significantly overlaps with
adolescent dating violence (violence perpetrated against
an intimate partner), and victimization. Global estimates
indicate around one in five adolescents reported experi-
ences of dating violence (Gracia-Leiva et al., 2019;
Wincentak et al., 2017). Common forms of dating vio-
lence are physical, sexual, psychological, and verbal
abuse (Daff et al., 2021; Wincentak et al., 2017). The
type of violence can differ, with girls more likely to use
physical violence, and boys more likely to use sexual vio-
lence, against their partners (Daff et al., 2021). Although
dating violence perpetrated by both adolescent partners
is more common than ‘‘unidirectional’’ dating violence;
male-on-female violence continues to have a higher pre-
valence than female-on-male violence and female victims
are nearly always more severely affected than their male
counterparts (e.g., feeling fearful and trapped; Daff
et al., 2021). Ackard et al. (2007) found adolescent dat-
ing violence to be positively correlated with binge eating
and suicide ideation for male youths, and smoking mari-
juana and high depressive symptoms for female youths.
Studies have identified other increased risks including
substance abuse, mental health issues, risky sexual beha-
viors, poorer academic results, and isolation (Daff et al.,
2021; Taquette & Monteiro, 2019; Wincentak et al.,
2017). Consequently, engagement in adolescent dating
violence is associated with numerous negative outcomes
for both partners.
Patriarchal principles can lead to gender inequalities
within relationships. Specifically, male dominance has
been found to contribute to adolescent dating violence.
Barros and Schraiber (2017) found that women report
more occurrences of violence against them than their
male partners acknowledge having perpetrated, indicat-
ing that men may trivialize or minimize violence, believ-
ing the behavior is warranted in some situations. Gender
studies further explain that this trivialization is likely due
to an historically constructed and valued way to solve
conflict and acculturate women to a subordinate role in
2SAGE Open
the relationship (Barros & Schraiber, 2017). In contrast,
Collins et al. (2009) found that adolescent dating violence
is less frequent in cultures with more egalitarian or
gender-equal attitudes. In relationships that are viewed
as egalitarian, couples perceive the support to be more
than a mother provides, this is even when the relationship
experiences conflict (Collins et al., 2009). Conversely,
perceptions of inequality within relationships have been
repeatedly found to negatively affect emotional function-
ing (Collins et al., 2009).
In Australia, First Nations women are at the greatest
risk of experiencing violence at the hands of their part-
ners (both black and white). First Nations women are 35
times more likely to be hospitalized due to family vio-
lence (up to 80 3in remote areas) and 11 times more
likely to die from sustained injury, compared to non-
First Nations women (Hill, 2019). Furthermore, Stolen
Generation survivors (children who were forcibly
removed from their families), tend to stay longer in vio-
lent relationships due to not wanting their children to
grow up in a fractured family (Aboriginal and Torres
Strait Islander Healing Foundation, 2017). First Nations
youth are also significantly overrepresented in the
Australian justice system, accounting for approximately
50% of young people in detention or under community
supervision on any given day (Australian Institute of
Health and Welfare, 2021). Despite well-intentioned
efforts and significant investments, the gap between First
Nations and non-First Nations youth continues to
widen. Prior to colonization, First Nations peoples lived
in an egalitarian hegemony society, where the rights of
men and women were balanced with specific and valued
gender roles and responsibilities. Hill (2019) postulates
that this negative impact on First Nations women is a
continuing effect of colonization as the acculturation
effects resulted in First Nations women being dependent
on men for basic needs, due to the patriarchal rules of
the western society.
A group at risk of perpetrating adolescent dating vio-
lence in the future is youth in juvenile detention. Male
youth in detention centers tend to present with multiple
risk factors which make them susceptible to perpetrating
violent offences, including family and intimate partner
violence (both are closely linked; Daff et al., 2021).
There are also higher rates of youth with cognitive
impairments in detention, which may further compound
the risk factors due to difficulties with learning, impulsiv-
ity, and consequential thinking. A study by Dellar et al.
(2022) reported 29% of youth detainees in Western
Australia had a diagnosed cognitive impairment, with
Fetal Alcohol Spectrum Disorder (FASD) being the
most common. Male youth in detention may not have
experienced seeing or having healthy relationships and
may lack the motivation and skills to engage in healthy
relationships. A treatment program delivered in deten-
tion centers may assist in reducing the likelihood of vio-
lence, once a young person returns to the community
(Boxall & Morgan, 2020). Additionally, Collins et al.
(2009) described a phenomenon called ‘‘selective partner-
ing,’’ postulating that at-risk youths tend to choose part-
ners with similar psychological and physical aggression
to oneself. Therefore, skills development and challenging
attitudes may lead to better choices in partners and ado-
lescence may be the most effective time to provide sup-
port, as it is a critical time for establishing norms, values,
and behaviors (Armytage & Ogloff, 2017).
Systematic reviews, meta-analyses, and research
syntheses have identified several key factors of effective
treatment programs for addressing risk factors in youth.
A systematic review conducted by Pooley (2020) found
that the most effective youth offending programs were
based on theory, had high fidelity (replication), and con-
sidered cultural backgrounds. For example, First
Nations youth perceive a support program as credible,
when someone with shared cultural factors (place, lan-
guage, history, or beliefs) implements these programs
(Fazal, 2014). Effective programs also incorporate the
Risk-Need-Responsivity (RNR) model (Bonta &
Andrews, 2017), with collaborative inter- and intra-
agency coordination (referrals and services), and encour-
age good practitioner-client relationships (Pooley, 2020).
Evidence suggests that youths want to work with practi-
tioners who have faith in them, empathize with them,
and recognize their strengths (Pooley, 2020). Cognitive-
behavioral approaches that provide psychoeducation,
teach social skills, and include various techniques such as
modelling, role-playing, performance feedback and
transfer training, are effective in addressing risk factors
associated with adolescent dating violence (Armytage &
Ogloff, 2017; Lipsey, 2009). The use of incentives or con-
tingency management as part of treatment approaches
has been found to enhance positive outcomes (Stewart
et al., 2014; Wodahl et al., 2017). Finally, ongoing eva-
luation of programs has been found to improve effective-
ness, due to adaptations from findings (Armytage &
Ogloff, 2017; Pooley, 2020).
Healthy Relationships Program
The Healthy Relationships program was developed to
address adolescent dating violence and is grounded in
the RNR framework (Bonta & Andrews, 2017). The pro-
gram has been delivered to male youths in custody in
Western Australia since 2016 and was evaluated in the
current study (DoJ, 2021). Commensurate with evidence
on best-practice, Healthy Relationships is a Cognitive
Behavioral Therapy (CBT) based program that includes
psychoeducation, skills practice, and healthy relationship
Warner et al. 3
modelling. The program explicitly aims to challenge atti-
tudes relating to acceptance of couples’ violence, male
role norms, and attitudes towards women, to improve
interpersonal interactions and reduce violence within
relationships (DoJ, 2021). An additional overarching
aim of the program is to reduce recidivism. The program
was developed in consultation with First Nations
Welfare Officers working in custody and uses First
Nations Australian resources within its delivery activi-
ties. Psychologists and Social Workers employed in the
DoJ’s Youth Justice Psychological Clinical Programs
team facilitate the program delivery.
Treatment programs delivered in detention centers
were found to be effective across a wide range of coun-
tries when they adhered to the RNR principles (Bonta &
Andrews, 2017; Vitopoulos et al., 2012). The RNR model
is founded on three key principles that guide effective
assessment and rehabilitation of offenders (Bonta &
Andrews, 2017; Taxman et al., 2006). The risk principle
assumes that criminal behavior can be predicted. The
level of treatment intensity should match the level of risk;
the higher the risk, the more intensive and extensive the
program; with low-risk individuals needing minimal sup-
port (Bonta & Andrews, 2017; Vitopoulos et al., 2012).
The Healthy Relationship Program used the Youth Level
of Service/Case Management Inventory (YLS/CMI;
Hoge & Andrews, 2003) tool to assess risk and partici-
pants needed to score Moderate or higher to be accepted
into the program. The need principle relates to programs
targeting criminogenic risk factors (treatment needs)
associated with recidivism such as antisocial attitudes
(Bonta & Andrews, 2017; Vitopoulos et al., 2012). The
need component was achieved by addressing crimino-
genic factors known to increase risk of youth intimate
partner violence, such as attitudes supportive of violence
and traditional gender roles and stereotypes. The final
principle, responsivity, relates to the type of program and
tailoring the delivery to the needs and learning styles of
the participants (Bonta & Andrews, 2017). Responsivity
was addressed through program flexibility and respon-
siveness of facilitators to adjust to participant’s specific
needs, for example, utilizing more visual tools (videos) to
accommodate for participants with FASD and other cog-
nitive impairments.
Evaluating the effectiveness of criminal justice pro-
grams is essential to ensure that resources are being
directed to the programs delivering the most culturally
sound and effective outcomes. Given the significant over-
representation of First Nations youth in the Australian
justice system, there is also an urgent need to evaluate
and identify evidence-based and culturally appropriate
programs. The current study aimed to evaluate the effec-
tiveness of the Healthy Relationships Program in reduc-
ing attitudes endorsing intimate partner violence and
gender roles and stereotypes. It was expected that partici-
pation in the program would lead to a decrease in atti-
tudes supportive of intimate partner violence for both
First Nations and non-First Nations participants.
Participation in the program was also expected to lead to
a decrease in attitudes endorsing traditional gender roles
and stereotypes for both groups.
Method
Research Design
This study employed a mixed methods approach to eval-
uate the Healthy Relationships program, with quantita-
tive data as the primary source with qualitative data used
to provide supplementary information about the pro-
gram. The quantitative component used a within-
participants design to compare the results on pre-
program questionnaires to results on the questionnaires
following program participation. The first paired-group
analysis compared pre- and post-program scores on the
Acceptance of Couples Violence Scale and the Attitudes
towards Women Scale. The second analysis included a
bivariate regression with treatment readiness as the inde-
pendent variable, which was used to predict the criterion
variable, treatment engagement. Post-program scores on
Acceptance of Couples Violence and Attitudes Toward
Women scales were included as additional covariates.
Qualitative data was used to further explain the level of
treatment engagement, as this data relates to partici-
pants’ perceptions of the program. Our research team
included both First Nations (RW) and non-First Nations
(LR and KD) researchers.
Sample
The data was provided by the Western Australian
Department of Justice (DoJ) and included pre and post
program assessment data for 65 male adolescents aged 14
to 18 years (M= 17.1, SD = 1.09) who participated in
the Healthy Relationships program between November
2016 and June 2021. Program facilitators are responsible
for collecting the data during the pre- and post-group
interviews and entering the data into the Departmental
database. Not all participants who complete a pre-group
interview are deemed suitable for participation in the
program for a variety of reasons, the most common of
which include low treatment readiness and motivation,
cognitive impairments limiting ability to engage, or not
enough time left in custody prior to release to be able to
complete the program. The final sample in the current
study therefore only included participants with full pre
(Time 1) and post (Time 2) data. A sensitivity analysis
conducted in G*Power indicated the sample had
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sufficient power to detect small to medium effects sizes
for planned analyses.
Measures
Acceptance of Couples Violence (ACV) Scale. The ACV
(Foshee et al., 1998) measures the level of acceptance for
violence within relationships and includes three attitudi-
nal subscales (i) male-on-female violence, (ii) female-on-
male violence and (iii) general relationship violence. The
ACV is an 11 item self-report measure that is scored on
a 4-point Likert scale with 1 = strongly disagree to
4=strongly agree. An example item is ‘‘violence between
dating partners can improve the relationship.’’ The ACV
is administered pre and post program participation to
assess the level of acceptance of violence within intimate
partner relationships. Possible scores for the full scale
range from 11 to 44, with higher scores indicating more
acceptance of violence within intimate relationships.
Previous studies have found good internal consistency
(full scale a= .80). In our study, the internal consistency
was strong for Time 1 (a= .88) and Time 2 (a= .94).
Attitudes Toward Women (ATW) Scale. The ATW
Adolescent version (Galambos et al., 1985) measures par-
ticipants’ attitudes regarding women’s roles and rights in
society or relationships. The 12 item self-report measure
is scored on a 4-point Likert scale with 1=disagree
strongly to 4 = agree strongly. An example item is ‘‘boys
are better leaders than girls.’’ Scores range from 12 to 48
with higher scores indicating less traditional attitudes
toward women. The ATW scale is administered at both
pre and post program participation stage, to assess parti-
cipants endorsement of attitudes supporting traditional
gender roles and stereotypes. Previous studies have found
good internal consistency (female a= .72 and male
a= .78; Galambos et al., 1985). Within our study, fol-
lowing an exploratory factor analysis (EFA; Promax
rotation) only four items were extracted with an
Eigenvalue greater than 1.00. A second EFA was con-
ducted, forcing a 1-factor solution. Five items were
removed to increase the internal consistency of the scale,
resulting in Cronbach’s alpha at Time 1 (a=.81) and
Time 2 (a=.84).
Treatment Readiness Questionnaire (TRQ). The TRQ
(Casey et al., 2007) measures participants’ readiness for
change. There are four components (i) attitudes and
motivation, (ii) emotional reaction, (iii) offending beliefs,
and (iv) efficacy. The scale is a 20 item self-report mea-
sure, using a 5-point Likert scale with 1 = strongly dis-
agree to 5 = strongly agree. An example item is
‘‘generally I can trust other people.’’ Possible scores
range from 20 to 100, with higher scores indicating a
higher degree of readiness to participate in a treatment
program. For our study, internal consistency was high
(a= .82). The TRQ is administered prior to program
participation to assess level of treatment readiness and
motivation. In line with the RNR model, caution is
applied to young people who score low on the TRQ (\
60), and consideration is given to preparatory work (i.e.,
motivational interviewing) that may be required to
increase treatment readiness prior to inclusion.
Treatment Engagement Questionnaire (TEQ). The TEQ
(Casey et al., 2007) is a self-report scale measuring parti-
cipant perception of the treatment program, including
treatment setting and therapy context. It consists of three
factors (i) alliance with facilitators, (ii) group process/
dynamics, and (iii) confidence—participant’s self-
confidence to change offending behavior. The TEQ is
administered to participants after program participation
to assess their level of engagement in the program and
identify if any of the three factors were particularly influ-
ential in level of engagement. The self-report measure is
scored on a 5-point Likert scale with 1 = strongly dis-
agree and 5 = strongly agree and total score ranges from
17 to 85, with higher scores indicating higher perceived
engagement with the treatment program. An example
item is ‘‘I have gained a better understanding of my
problem with offending.’’ Internal consistency for the full
TEQ in our study was a= .76.
Participant Feedback Questionnaire. The participant feed-
back questionnaire comprised the qualitative component
of the study. The questionnaire includes seven open-
ended questions which were used to illuminate the parti-
cipants’ perceptions of the program, including facilitator
alliance. An example question was ‘‘what did you learn
from the program?.’’ In the final session of the program,
participants are given the opportunity to provide their
feedback on the program and facilitators. This process is
completed prior to the post-group assessment interviews
and therefore only includes participants who have com-
pleted the entire program.
Procedure
The Healthy Relationships Program was available to
male youths in Western Australia aged 14 years and
above who were in custody and were rated as Moderate
or higher on the YLS/CMI risk assessment tool (Hoge &
Andrews, 2003). Participants were referred to the pro-
gram by their custodial case manager if they had enough
time remaining in custody to complete the program (i.e.,
minimum 6 weeks). Following the referral, facilitators of
the Healthy Relationships Program completed a pre-
group assessment interview with the youth to determine
their suitability and motivation to participate.
Warner et al. 5
Participation in the program was on a voluntary basis
and in line with the RNR model, youths were prioritized
if they had higher level of risk or if they had not engaged
in any prior treatment programs. Facilitators made the
final decision for program inclusion based on (i) group
dynamics, (ii) security risk, (iii) level of cognitive func-
tioning, (iv) scores on pre-assessment measures, and (v)
treatment need.
Program delivery consisted of eight closed-group ses-
sions (two per week; 1.5-hours each). The program was
delivered over approximately 5 weeks, inclusive of pre
and post assessment and graduation. Qualitative data
were collected in the final session and post quantitative
data were collected approximately 1 week after program
participation. A post-program interview was scheduled
where youths were returned the work completed during
the sessions (e.g., accomplishments and strategies
learned) and provided with feedback on how well they
progressed through the program.
Results
All data was analyzed using SPSS version 22.0 software.
Assumptions testing was conducted prior to each analy-
sis to ensure appropriate conclusions could be drawn
from the data. Ninety-six participants commenced the
program, of which 65 completed the ACV at Time 1 and
Time 2, with 40 completing the Attitudes Towards
Women measure at Time 1 and Time 2. It is noted that
another measure was used previously but discontinued
due to participants experiencing difficulties understand-
ing the items. Due to the small sample sizes, full scales
rather than subscales were used in all analyses. Eleven
participants did not complete the Treatment Readiness
Questionnaire and were therefore excluded from the
regression analysis.
Pre and Post Program Comparisons
Two one-tailed paired samples t-tests were conducted to
compare pre- and post-program scores on the
Acceptance of Couple Violence and Attitudes Towards
Women scales (see Table 1). On average, participants
post-program Acceptance of Couple Violence scores
were a significant 1.32 points lower than pre-program
scores (95% CI [0.03, 2.61]); a small effect size. On aver-
age, participants post-program Attitudes Towards
Women scores were a significant 1.75 points lower than
pre-program scores (95% CI [0.82, 2.67]); a medium
effect size. As expected, the results indicated that partici-
pation in the program resulted in significantly lower atti-
tudes endorsing intimate partner violence and attitudes
endorsing traditional gender roles and stereotypes.
First Nations Youth. An exploratory analysis examining
differences between First Nations (n= 51) and non-First
Nations (n= 14) youths was not feasible due to varying
group sizes resulting in low power. Instead, paired sam-
ples t-tests were deemed feasible to analyze only First
Nations participant data. To do this, three one-tailed
boot-strapped paired samples t-tests were conducted to
compare pre- and post-program scores on ACV and
ATW scales. On average, participants post-program
ACV scores were 1.21 points lower than pre-program
scores (95% CI [20.11, 2.58]). This difference showed a
small effect size but was not statistically significant. On
average, participants post-program ATW scores were
1.40 points lower than pre-program scores (95% CI
[0.36, 2.39]). This difference showed a medium effect size
and was statistically significant (see Table 1 for full
results).
Regression Analysis
A bivariate regression was conducted to estimate the
proportion of variance in treatment engagement that
was accounted for by treatment readiness. Assumptions
of normality, linearity, multicollinearity and homosce-
dasticity were met, and multivariate outliers were not of
concern as Mahalanobis distance did not exceed the criti-
cal value for any case in the data file. Contrary to expec-
tations, results showed that TRQ scores accounted for a
Table 1. Paired Groups Results for Full Sample and First Nations Only Sample on Pre and Post Assessment Measures.
Pre Post
Group and measure NM SD M SD t p d 95% CI
Full sample
Acceptance of couples violence 65 21.52 6.15 20.20 6.62 2.04 .043 0.25 [0.01, 0.50]
Attitude towards women 40 16.40 3.17 14.65 3.72 3.80 .002 0.60 [0.26, 0.93]
First Nation youths only sample
Acceptance of couples violence 30 22.76 5.91 21.54 6.39 1.68 .099 0.23 [20.04, 0.51]
Attitudes towards women 51 16.66 3.12 15.26 3.42 2.53 .017 0.46 [0.08, 0.83]
Note. N = number of participants; M= mean; SD = standard deviation; t=t-test; p= significant value; d= Cohen’s d; CI = confidence interval.
6SAGE Open
non-significant 2.7% of the variability in post-program
scores on TEQ (R
2
= .027, adjusted R
2
=2.038, F(1,
15) = .409, p= .532). To evaluate whether treatment
readiness could account for a significant portion of the
variance of attitude change, beyond that already
accounted for by pre-program scores, two multiple
regressions analyses were performed.
Acceptance of Couple Violence. On step 1 of the hierarch-
ical multiple regression analyses, pre-programs scores on
Acceptance of Couple Violence accounted for a signifi-
cant 47.2% of the variance in post-program scores,
R
2
= .472, F(1, 52) = 46.54, p\.001. On step 2,
Treatment Readiness was added and accounted for an
additional non-significant 2.9% of the variance in post-
program scores, R
2
= .482, F(1, 51) = 2.96, p= .091. In
combination, Treatment Readiness and pre-program
scores on Acceptance of Couple Violence accounted for
50.1% of variability in Acceptance of Couple Violence
post-program scores, R
2
= .50, adjusted R
2
= .48, F(2,
51) = 2.96, p\.001. The regression coefficients can be
seen in Table 2.
Attitudes Towards Women. On step 1 of the second hier-
archical multiple regression analyses, pre-program scores
on Attitudes Towards Women accounted for a signifi-
cant 57.9% of the variance in post-program scores,
R
2
= .579, F(1, 29) = 39.84, p\.001. On step 2,
Treatment Readiness was added and accounted for an
additional non-significant 1.1% of the variance in post-
program scores, R
2
= .56, F(1, 28) = .73, p= .40. In
combination, treatment readiness and pre-program
scores on Attitudes Towards Women accounted for 59%
of variability in Attitudes Towards Women post-
program scores, R
2
= .59, adjusted R
2
= .56, F(2,
28) = 20.10, p\.001. The regression coefficients can be
seen in Table 3.
Qualitative Analysis
To see how participants perceived the Health
Relationships Program, a conventional content analysis
(Hsieh & Shannon, 2005) was used to inductively code
participants responses into categories from the seven
open-ended questions. Familiarization occurred by read-
ing through the responses, units were condensed, then
organized into meaningful clusters that lead to the cate-
gories used. Data was limited, with 20 participants who
responded to the seven questions. Thirteen categories
were developed, and Table 4 provides an overview of
questions with multiple categories of responses. One of
the question’s responses were cross coded by two
researchers. Cohen’s kappa was calculated and reflects
good inter-rater reliability (K=.65; Fleiss et al., 1979).
The feedback from program participants further sup-
ports the quantitative data in demonstrating the benefits
of participating in the Healthy Relationships program.
Most participants reported a positive experience of the
Table 2. Hierarchical Multiple Regression Predicting Post-Test Scores on the Acceptance of Couples Violence Scale.
Variable b95% CI bsr
2
p
Step 1
Acceptance of couple violence .73 [0.51, 0.94] .69 .47 \.001
Step 2
Acceptance of couple violence .74 [0.52, 0.95] .70 .48 \.001
Treatment readiness 2.11 [20.25, 0.19] 2.17 2.2 .091
Note. b = unstandardized regression coefficient; CI = confidence interval; b= standardized regression coefficient; sr
2
= squared semi-partial correlations;
p= significance.
Table 3. Hierarchical Multiple Regression Predicting Post-Test Scores on the Attitudes Towards Women Scale.
Variable b95% CI bsr
2
p
Step 1
Attitudes towards women .91 [0.61, 1.20] .76 .57 \.001
Step 2
Attitudes towards women .93 [0.63, 1.23] .78 .60 \.001
Treatment readiness 2.04 [20.61, 0.06] 2.10 2.01 .400
Note. b = unstandardized regression coefficient; CI = confidence interval; b= standardized regression coefficient; sr
2
= squared semi-partial correlations;
p= significance.
Warner et al. 7
program in terms of learning about and gaining skills to
develop and maintain healthy intimate partner relation-
ships. Consistent with the quantitative data and prior
research (see De Boer et al., 2023), the feedback high-
lighted the impact that the therapeutic alliance has on
participants experience and engagement in the program.
As one participant noted, ‘‘the facilitators were very
respectful and understanding at all times, thank you.’’
Consistent with the literature on incentive-based learning
systems (Stewart et al., 2014; Wodahl et al., 2017), parti-
cipants frequently commented on the positive benefits of
incorporating incentives into the program. Program
duration emerged as a theme as participants expressed a
desire for the program to run over a longer duration of
time. Participants also expressed a desire for the program
to be more intensive to allow more opportunity to learn
about the concepts covered. In addition, when asked for
‘‘Any other comments/feedback?,’’ participants thanked
the facilitators and expressed how much they enjoyed the
program, for example, one participant wrote ‘‘this pro-
gram was deadly (cool), I appreciate everything, cheers.’’
Discussion
The current research sought to evaluate the effectiveness
of the Healthy Relationships program in reducing parti-
cipants endorsement of attitudes supporting violence in
relationships and traditional gender stereotypes. As
expected, comparisons of pre- and post-program data
showed statistically significant reductions in participants
attitudes endorsing intimate partner violence and tradi-
tional gender roles and stereotypes. First Nations youth
benefited from participation in the program, with signifi-
cant reductions in attitudes supportive of traditional gen-
der stereotypes. Although non-significant, the results
also showed a reduction in endorsement of attitudes sup-
porting intimate partner violence for First Nations
youth, indicating promising results. Contrary to expecta-
tions, results showed that treatment readiness did not sig-
nificantly predict treatment engagement and was not
found to account for a significant variance of change,
beyond that already accounted for by pre-program
scores. This indicates that within our sample, participants
were found to benefit from the Healthy Relationships
Program irrespective of their score on the Treatment
Readiness Questionnaire, which supports Casey et al.’s
(2007) recommendation that treatment readiness scores
should not be used to exclude participants from treat-
ment programs. Collectively, the results provide empiri-
cal support for the effectiveness of the Healthy
Relationships program in reducing risk factors associated
with adolescent dating violence, namely, attitudes sup-
portive of intimate partner violence and attitudes endor-
sing traditional gender roles and stereotypes.
Qualitative analysis of participant feedback supported
the quantitative findings, indicating that participants
Table 4. Results from Content Analysis of Participant Feedback Questionnaire.
Category Definition N(%) Example
What participants learned from the program
Emotions Participants learnt about emotions and how to
handle situations.
5 (26.3) How to ‘‘regulate and control my emotions and
actions’’
Relationships How to have healthy relationships. 8 (42.1) ‘‘How to have a healthy relationship and how to
deal with issues in an easier way’’
Skill development Developing Skills to assist with improving
relationships.
11 (57.9) ‘‘I’ve learnt to see the signs from the cycle of the
four steps and how to make things better
before it gets out of hand’’
What participants liked about the program
Relationships Learning about relationships. 6 (33.3) ‘‘I like that you teached me how the world is
with man and woman relationships’’
Videos Videos used in the program, including music
videos.
13 (61.9) ‘‘That we got to play music videos’’
Incentives Incentives used as part of the program. 6 (28.6) Ost and music and wow stuff (prizes)’’
What participants thought of the program facilitators
Helpful The facilitators were helpful. 8 (47.5) ‘‘.they are good at what they do they are
helpful and now I’ve learnt a few things I didn’t
know’’
Skillful Facilitators were good at delivering the program. 6 (40.0) ‘‘use (you) are a good team and use (you) know
how to work with young people keep it up’’
Respectful Facilitators were respectful. 7 (46.7) ‘‘.the facilitators were very respectful and
understanding at all times, thanks’’
Note. Responses could be coded into multiple categories.
8SAGE Open
found the program to be beneficial. Participant feedback
highlighted the importance of the therapeutic alliance
and the use of incentive-based systems for positive pro-
gram outcomes. These findings are consistent with prior
research that identified the importance of practitioner-
youth relationships which are grounded in understand-
ing, recognition, and trust (see De Boer et al., 2023). This
is particularly relevant for First Nations youth and may
provide some insight into the effectiveness of the Healthy
Relationships program for First Nations youth. Prior
research with First Nations youth has emphasized the
importance of developing relationships with program
facilitators (Stewart et al., 2014). Many participants com-
mented on how respectful and skillful the facilitators
were and how helpful they found the program. Although
the facilitators of the Healthy Relationships Program
may not have shared any cultural factors (as they were
white women), the participants’ positive feedback, as
seen in qualitative data, is likely linked to Pooley’s (2020)
findings that youths want to work with practitioners who
have faith in them, empathize with them, and recognize
their strengths; this also links to the responsivity aspect of
the RNR model.
The delivery of culturally appropriate programs is
paramount. Considering the over representation of First
Nation youths in detention centers, particularly in
Australia, the positive results from our study are promis-
ing. A review of the qualitative data showed that there
were no negative comments about the program or the
facilitators. Although participants provided positive
feedback, some adjustments may improve outcomes.
One inclusion could be to have at least one First Nation
facilitator delivering the program, as First Nation youths
may perceive a program to be more credible if the facili-
tator shares some cultural factors (Fazal, 2014); and if
possible, a male facilitator might be appropriate to bal-
ance the gender aspect for First Nation youths.
Following participation in the Healthy Relationships
program, youth reported less acceptance for violence in
relationships. This suggests that they may be less likely
to get involved, or stay with, a partner who accepts vio-
lence within relationships, as evidenced by Collins et al.’s
(2009) theory that at-risk youth select partners with simi-
lar psychological and physical aggression to oneself.
Participation in the Healthy Relationships program was
found to increase participant attitudes towards women
as being more equal, in terms of their rights and respon-
sibilities within society and relationships. The real-world
implications may mean less frequency of violence within
relationships, as evidenced by Collins et al. (2009) find-
ings that adolescent dating violence was less frequent in
relationships when couples viewed the relationships as
more egalitarian.
Strengths and Limitations
The major strength of our study is that it evaluated a spe-
cific identifiable program, within the area of youth jus-
tice, in Australia. As identified by Armytage and Ogloff
(2017), very few specific program evaluations have been
published in this field to date which limits the ability to
effectively review, compare, and assess available treat-
ment options. Our study can inform future evaluations
of youth justice programs and the development of new
measures or methodologies for collecting rich data from
First Nations and detention center youth. We assessed a
population that can be difficult to access, for research
purposes, due to their high-risk nature from an ethical
standpoint. As the program was seen to benefit youths in
this sample, the Healthy Relationships Program could be
recommended for use in other youth detention centers,
and with some adjustment (around gender considera-
tions) the program could be transferrable to female youth
in detention. The program could also be delivered to
youth in the community as there are no detention-specific
elements of the program that could not be replicated in
community settings. This would allow the program to
reach a larger range of justice-involved youth and may
assist in reducing the likelihood of ending up in detention
for intimate-partner related offending.
While the results of our study provide empirical sup-
port for the effectiveness of the Healthy Relationships
program, there are limitations that are important to dis-
cuss in contextualizing the results and providing recom-
mendations for future research. There was no control
group in our sample, which limits the ability to assert
that the program was solely responsible for the observed
improvements. Although a control group would be use-
ful for comparison purposes, it is acknowledged that this
is not currently a feasible option in the detention center
where the Healthy Relationships program is delivered.
The unique demographics and relatively small sample
size may limit the generalizability of our results to the
wider population. However, the responsivity principle of
the RNR model suggests that the program may be effec-
tive in other jurisdictions if the delivery of the content is
adapted for the learning styles and needs of the target
population. For example, using localized terminology
and population-specific resources. Longitudinal research
is needed to assess the long-term impact of participation
in the program and observed changes over time. This is
an endeavor that should be undertaken, as healthy rela-
tionships are linked to positive self-worth and general
competency in self (Collins et al., 2009). Additionally,
skills developed through forming healthy relationships
may mitigate risk factors for other antisocial behaviors,
further reducing recidivism (Miller et al., 2015). The
Healthy Relationships program was initially designed to
Warner et al. 9
challenge attitudes, rather than change attitudes. The risk
aspect of the RNR framework denotes that the higher
the level of risk, the higher the dose needed for change.
To sustain attitude change, considerations of dose effect
may be needed when developing future programs, by
increasing their intensity (number of sessions in the same
timeframe) or extensity (extend the duration of the pro-
gram), or scaffolding programs. This could be done once
the youth return to their community or as a consecutive
program whilst still in the detention center.
The measures used to collect data require further
consideration. The Attitudes Towards Women scale’s
construct validity for this sample was compromised,
as five items had to be removed from the scale which
only initially contained 12 items. The Attitudes
Towards Women scale was developed with a sample of
adolescents from the United States mid-west rural and
suburban areas. Participants were mostly Caucasian
from lower to middle socioeconomic status; age range
11 to 17 years (Galambos et al., 1985). American scales
may not translate well in Australia, particularly with
the high number of First Nations participants, with a
large number from regional areas. Moreover, gender
stereotypes may not be recognizable for First Nations
youths, as prior to colonization, First Nations culture
was an egalitarian society and had specific and valued
gendered roles. Although many First Nations cultural
understandings have been fragmented, due to coloni-
zation, the underlining mechanisms of the culture still
exist within communities, though they may be invisible
through a western cultural lens (Hill, 2019). There is a
need to direct research funding into developing appro-
priate measures, to ensure program assessment is
grounded in cultural understandings that lead to
improved outcomes for First Nations youths and
youths in detention centers. Resourcing a more appro-
priate measure for this sample is recommended and if
one does not exist a new measure that is ecologically
balanced for the identified group (First Nations youth
and youths in detention centers) needs to be devel-
oped. Consideration should be given to design a scale
that assesses differences in traditional gender roles, or
a better theoretical or philosophical reason for vio-
lence in relationships for First Nations youths.
Qualitative data provided valuable insights from the
perspectives of program participants into what they iden-
tified as beneficial for their engagement in the program.
Further qualitative research, potentially utilizing First
Nation research methodologies (Martin, 2017), could
further increase understanding of participants’ experi-
ences of the program and assist in identifying specific
program characteristics that contribute to positive out-
comes. Yarning sessions, semi-structured or open inter-
views would be culturally appropriate, as First Nation
culture relies on oral communication for information
sharing and society functioning (Hill, 2019). It would
also be beneficial to conduct interviews with participants
who opt to withdraw from the program, to identify
potential barriers to program completion and improve-
ments that could be implemented to improve program
participation and engagement.
Conclusion
The findings from our study support the continuation of
the Healthy Relationships Program and contribute to
the ‘‘what works’’ literature on effective risk reduction
approaches for justice-involved youth. However, longitu-
dinal research is needed to assess the long-term impacts
of participation in the program. Longitudinal program
evaluations should be prioritized, as effective and cultu-
rally appropriate programs are needed, particularly to
address the overrepresentation of First Nations youth in
detention centers. However, a program that can chal-
lenge attitudes relating to violence in relationships, and
which has the potential to increase relationship skills and
reduce recidivism, is a promising step in the right
direction.
Acknowledgment
We acknowledge the participation and assistance of the
Department of Justice in the conduct of our research. The
research reported cannot be considered as either endorsed by
the Department of Justice or an expression of the policies or
view of the Department. Any errors of omission or commission
are the responsibility of the researchers.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Ethical Approval
Ethical approval for this research was obtained from the
Department of Justice Research Application and Advisory
Committee (RAAC; Project ID 480) and Curtin University
Human Research Ethics Committee (Approval Number
HRE2021-0240).
ORCID iD
Kristie Dellar https://orcid.org/0000-0001-5788-6592
10 SAGE Open
Data Availability Statement
Raw data were generated at the Department of Justice in
Western Australia. Derived data supporting the findings of this
study are available from the corresponding author KD on
request
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