Design and development of a Telephone-Linked Care (TLC) system to reduce impulsivity among violent forensic outpatients and probationers.

Forensic services face the challenge of reducing relapse among clients with a history of violent crime. An automated interactive voice response (IVR) service of the complex Telephone-Linked Care (TLC) type, with a focus on reducing impulsivity, could improve the adequacy of service responses to client needs. Theoretically based in Dialectical Behavior Therapy (DBT), Cognitive Behavior Therapy (CBT) and Motivational Interviewing (MI), the forensic TLC system offers interactive conversations on coping with the emotions of anger, shame and loneliness; activities of daily life such as getting out of bed, asking for help, visiting social services and taking medication; and other areas such as hearing voices, drinking alcohol and self-critical thoughts. We describe the user's flow through the system, with an in-depth synopsis of the hearing voices intervention. Issues regarding voluntary versus mandatory use of the system are addressed in connection with prospective introduction of the system in forensic settings.