Journal of Medical Systems

, Volume 36, Issue 3, pp 1031–1042 | Cite as

Design and Development of a Telephone-Linked Care (TLC) System to Reduce Impulsivity among Violent Forensic Outpatients and Probationers

  • Anne H. Berman
  • Ramesh Farzanfar
  • Marianne Kristiansson
  • Per Carlbring
  • Robert H. Friedman


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.


IVR systems System design Forensic psychiatry Criminal justice Impulsivity Telemedicine 



Different phases in the development of the forensic TLC system were presented at the 6th Annual International Association of Forensic Mental Health Services (IAFMHS) conference in Amsterdam, Holland (June 14-16, 2006) and the 8th IAFMHS conference in Vienna, Austria (July 14-16, 2008), as well as at the 10th International Congress of Behavioral Medicine (ICBM) in Tokyo, Japan (August 27-30, 2008). The design and development of the forensic TLC system was funded by Swedish National Psychiatry Development Funds (1,000,000 SEK), the National Board of Health and Welfare (486 000 SEK), the Soderstrom-Königska Foundation (250 000 SEK), Stockholm CountyALF-funds (300 000 SEK), and the Swedish Research Council for Working Life and Social Research (60 000 SEK). The Stockholm Center for Dependency Disorders also supported the project (400 000 SEK). Many thanks go to Marie Cassel and Gunnar Wiklund for extensive assistance with script development of the TLC forensic system. Thanks also to David Wahlund for systems theory, initial programming efforts, and script development, to Ariel Abergel, Jonathan Nisell and Can Nguyen Minh for programming contributions, as well as Alf Bergstrand, Anna Sandberg and Per Åkerman from TeliaSonera AB for continued systems support during project development. We also acknowledge Pia Jelbring, Patrick Backgård, Kristina Marklund and Gabor Szaló for their empirical and theoretical contributions along the way.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Anne H. Berman
    • 1
  • Ramesh Farzanfar
    • 2
  • Marianne Kristiansson
    • 3
  • Per Carlbring
    • 4
  • Robert H. Friedman
    • 2
  1. 1.Karolinska Institutet, Department of Clinical NeuroscienceCenter for Psychiatric ResearchStockholmSweden
  2. 2.Medical Information Systems Unit (MISU)Boston University Medical CampusBostonUSA
  3. 3.Department of Clinical Neuroscience, Center for Research in Psychiatry, Social and Forensic Psychiatry Research Program Karolinska Institutet/National Board of Forensic MedicineDept of Forensic Psychiatry in StockholmHuddingeSweden
  4. 4.Department of PsychologyUmeå UniversityUmeåSweden

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