Juvenile Justice Reform and Juvenile Justice Reform and Best Practices in Juvenile Best Practices in Juvenile

SystemsSystemsNAMI 2005 Annual ConventionNAMI 2005 Annual Convention

Austin, TexasAustin, Texas

Eric W. Trupin, Ph.D.Eric W. Trupin, Ph.D.Department of Psychiatry and Behavioral SciencesDepartment of Psychiatry and Behavioral Sciences

University of WashingtonUniversity of WashingtonSchool of MedicineSchool of Medicine

Status of Mental Health System Status of Mental Health System

and Evidence-Based and Evidence-Based TreatmentsTreatments

President’s Commission reports President’s Commission reports public mental health system is “in a public mental health system is “in a shambles” shambles” (President’s New Freedom Commission (President’s New Freedom Commission Report, 2004)Report, 2004)

90% of public mental health services 90% of public mental health services do not deliver treatments programs do not deliver treatments programs or services that have empirical or services that have empirical support support (Elliot, 1999; Henggeler et al., 2003)(Elliot, 1999; Henggeler et al., 2003)

Status of Mental Health System Status of Mental Health System

and Evidence-Based and Evidence-Based TreatmentsTreatments

More than 550 different psychotherapies More than 550 different psychotherapies exist as well as an increasing number of exist as well as an increasing number of empirically supported programs for multi-empirically supported programs for multi-problem youth problem youth (Kazdin, 2003)(Kazdin, 2003)

Many of the above treatments, services Many of the above treatments, services and programs are “evidence-based and programs are “evidence-based practices” practices” (Hoagwood, Burns, et.al. 2001)(Hoagwood, Burns, et.al. 2001)

Startling discrepancies between high Startling discrepancies between high quality clinical promise and poor clinical quality clinical promise and poor clinical practice practice (Hoagwood, et. al. in press)(Hoagwood, et. al. in press)

Evidence-Based Treatments Evidence-Based Treatments Poorly DisseminatedPoorly Disseminated

Simplistic strategies for understanding Simplistic strategies for understanding process of implementationprocess of implementation

Lack of attention to theories and methods Lack of attention to theories and methods from other fields (Marketing, anthropology, from other fields (Marketing, anthropology, organizational behavior) that could organizational behavior) that could enhance methods for adopting new enhance methods for adopting new approachesapproaches

Characteristics of Empirically Characteristics of Empirically Supported Treatments with Supported Treatments with

ChildrenChildren Focus on the development of skills, not on Focus on the development of skills, not on

catharsis or insightcatharsis or insight Utilization of manuals emphasizing Utilization of manuals emphasizing

adherence and fidelityadherence and fidelity Consistent supervision of cliniciansConsistent supervision of clinicians Homework or out-of-session workHomework or out-of-session work Focus on problems and solutions, rather Focus on problems and solutions, rather

than changing personalitythan changing personality Active engagement and empowerment of Active engagement and empowerment of

family or caregiverfamily or caregiver

FactsFacts Seventy percent of the nation’s mental Seventy percent of the nation’s mental

health dollars for children and adolescents health dollars for children and adolescents are spent on out-of-home placements.are spent on out-of-home placements.(Burns & Friedman, 1990)(Burns & Friedman, 1990)

No scientific evidence indicates that the No scientific evidence indicates that the most restrictive and expensive out-of-home most restrictive and expensive out-of-home placements (psychiatric hospitalization, placements (psychiatric hospitalization, criminal justice detentions) bring out criminal justice detentions) bring out desired clinical outcomes.desired clinical outcomes.(Sondheimer et al., 1994)(Sondheimer et al., 1994)

FactsFacts Traditional office-based outpatient Traditional office-based outpatient

mental health care shows little mental health care shows little evidence of effectiveness with children evidence of effectiveness with children with serious emotional disorders. with serious emotional disorders. (Weisz, (Weisz, Weiss, and Donenberg, 1992)Weiss, and Donenberg, 1992)

Emerging community-based services Emerging community-based services are being disseminated without the are being disseminated without the necessary support and consistent necessary support and consistent supervision needed by community-supervision needed by community-based clinicians.based clinicians.

0

10

20

30

40

50

60

70

80

90

% of Caseload Qualifying as "SED"*

Prevalence of Serious Emotional Disturbance (SED) in Washington State

* Percent of Cases "Not different from" the profile of an SED child, based upon f ive clinical and environmental indices; α = .01

Increased FocusIncreased Focus

Numbers of detained youth have Numbers of detained youth have tripled in last 2 decadestripled in last 2 decades

50-80% have Psychiatric or 50-80% have Psychiatric or Substance Use Disorders, or bothSubstance Use Disorders, or both

1 in 3 African American males, ages 1 in 3 African American males, ages 16-27, are in jail, correctional 16-27, are in jail, correctional facilities, on probation or parolefacilities, on probation or parole

Increased FocusIncreased Focus

Over 70% recidivism rates common Over 70% recidivism rates common for juvenile offendersfor juvenile offenders

Costs to keep youth in secure Costs to keep youth in secure facilities: New York: $85,000. facilities: New York: $85,000. Louisiana: $50,000.Louisiana: $50,000.

6 states spend more on prisons and 6 states spend more on prisons and detention facilities than on public detention facilities than on public colleges and universitiescolleges and universities

Recidivism RatesRecidivism Rates

58% of youth released from 58% of youth released from Washington’s Juvenile Rehabilitation Washington’s Juvenile Rehabilitation Administration in 1999-2000 were Administration in 1999-2000 were convicted of new felonies or convicted of new felonies or misdemeanors within 18 months. misdemeanors within 18 months. (Source: Washington State Institute for Public Policy)(Source: Washington State Institute for Public Policy)

45% were convicted of a new 45% were convicted of a new felonyfelony

Legal MandatesLegal Mandates

Results of case law:Results of case law: The right of access to careThe right of access to care The right to receive care that is orderedThe right to receive care that is ordered The right to a professional medical The right to a professional medical

judgmentjudgment Federal Individuals with Disabilities Federal Individuals with Disabilities

Education Act (IDEA)Education Act (IDEA) Conditions of Confinement LitigationConditions of Confinement Litigation

Legal MandatesLegal Mandates

Civil Rights of Institutionalized Persons Civil Rights of Institutionalized Persons Act (CRIPA) – 1997Act (CRIPA) – 1997 US Attorney General can investigate and US Attorney General can investigate and

litigate on conditions of confinement in state litigate on conditions of confinement in state operated institutionsoperated institutions

Special Litigation Section investigates for Special Litigation Section investigates for patterns or practices of violations of patterns or practices of violations of residents’ federal rights (not specific cases)residents’ federal rights (not specific cases)

Methods include settlements, consent Methods include settlements, consent decrees decrees

Standards Utilized in Department Standards Utilized in Department of Justice Investigationsof Justice Investigations

Screening/Initial AssessmentScreening/Initial Assessment Specialized Mental Health Specialized Mental Health

AssessmentAssessment Treatment PlanningTreatment Planning Case ManagementCase Management Mental Health CounselingMental Health Counseling

Standards Utilized in Department Standards Utilized in Department of Justice Investigationsof Justice Investigations

Management of Psychotropic Management of Psychotropic MedicationsMedications

Crisis ManagementCrisis Management Suicide PreventionSuicide Prevention Physical RestraintPhysical Restraint Chemical RestraintChemical Restraint

Youth Development/Treatment ProgramsYouth Development/Treatment Programs Institutional Practices Raising Mental Institutional Practices Raising Mental

Health ConcernsHealth Concerns

Difficulties estimating Difficulties estimating prevalence of mental health prevalence of mental health

disorders among youth in the disorders among youth in the juvenile justice system juvenile justice system

Regional variationRegional variation Use of standardized assessment tools limitedUse of standardized assessment tools limited Under-sampling of certain populationsUnder-sampling of certain populations Youths’ report of mental health status may vary as a Youths’ report of mental health status may vary as a

function of how long and in what environment they have function of how long and in what environment they have been incarceratedbeen incarcerated

Youth, families, and institutional staff may be suspicious of Youth, families, and institutional staff may be suspicious of researchresearch

Inconsistent scope and quality of records to provide Inconsistent scope and quality of records to provide historical information supporting diagnoseshistorical information supporting diagnoses

““Mental Health and Juvenile Mental Health and Juvenile Justice: Building a Model for Justice: Building a Model for Effective Service Delivery”Effective Service Delivery”

Coordinated by Policy Research AssociatesCoordinated by Policy Research Associates Focus on determining the mental health Focus on determining the mental health

status of youth, extent to which services are status of youth, extent to which services are available and meeting needs, and level of available and meeting needs, and level of satisfactionsatisfaction

Multiple sites (Texas, Louisiana, and Multiple sites (Texas, Louisiana, and Washington)Washington)

Sampled from different “levels” of juvenile Sampled from different “levels” of juvenile justice system (Detention, Secure, Group justice system (Detention, Secure, Group Homes)Homes)

Used standardized data collection instrumentsUsed standardized data collection instruments

Preliminary ResultsPreliminary Results

76.7% of participants met screening 76.7% of participants met screening criteria for a mental health or criteria for a mental health or substance use disordersubstance use disorder

Of those that met screening criteria, Of those that met screening criteria, 85.8% met criteria for at least 1 85.8% met criteria for at least 1 diagnosisdiagnosis 64.5% met criteria for a substance use 64.5% met criteria for a substance use

disorderdisorder

Characteristics of Empirically Characteristics of Empirically Supported TreatmentsSupported Treatments

Focus on the development of skills, Focus on the development of skills, not on catharsis or insightnot on catharsis or insight

Continuous assessment of progressContinuous assessment of progress Homework or out-of-session workHomework or out-of-session work Focus on problems and solutions, Focus on problems and solutions,

rather than changing personalityrather than changing personality Recognition of the importance of Recognition of the importance of

therapeutic relationshiptherapeutic relationship

Stages of Intervention with Stages of Intervention with Youth Engaging in Criminal Youth Engaging in Criminal

BehaviorBehavior Prevention of escalation of criminal Prevention of escalation of criminal

behaviorbehavior DiversionDiversion MentoringMentoring Community-Based Treatment ProgramsCommunity-Based Treatment Programs

TransitionTransition Dialectical Behavior TherapyDialectical Behavior Therapy Families In TransitionFamilies In Transition

Early InterventionEarly Intervention

Targets youth who are beginning to Targets youth who are beginning to engage in antisocial behavior and are at engage in antisocial behavior and are at a high risk of having that behavior a high risk of having that behavior continue and escalate into more serious continue and escalate into more serious criminal activitycriminal activity

Focus is on identifying and intervening Focus is on identifying and intervening with negative influences in youths’ lives with negative influences in youths’ lives that contribute to antisocial behavior.that contribute to antisocial behavior.

Diversion ProgramsDiversion Programs

Designed to minimize negative impacts of Designed to minimize negative impacts of incarcerationincarceration

Divert youth involved in first-time or minor Divert youth involved in first-time or minor offenses into treatment, rather than secure offenses into treatment, rather than secure facilitiesfacilities

Target risk factors for recidivism, such as parent-Target risk factors for recidivism, such as parent-child conflict and poor problem solving skillschild conflict and poor problem solving skills

Can include assessment, counseling, tutoring, Can include assessment, counseling, tutoring, job training, substance abuse treatment, job training, substance abuse treatment, community service, restitution, psychoeducation community service, restitution, psychoeducation

Examples of Diversion Examples of Diversion Programs in King County, Programs in King County, WashingtonWashington

Prime Time ProjectPrime Time Project Community Juvenile Accountability Act Community Juvenile Accountability Act

(CJAA)(CJAA) Chemical Dependency Diversion Chemical Dependency Diversion

Alternative (CDAA)/Juvenile Drug CourtsAlternative (CDAA)/Juvenile Drug Courts Mental Health Disposition Alternative Mental Health Disposition Alternative

(MHDA) (MHDA) Treatment CourtTreatment Court

Community Based Community Based Treatment Treatment

Provide rehabilitation services to Provide rehabilitation services to youth and families in their homes youth and families in their homes and communities.and communities.

Views families as partners in creating Views families as partners in creating an environment that supports an environment that supports change.change.

Functional Family Therapy Functional Family Therapy (FFT)(FFT)

A program designed to prevent the A program designed to prevent the escalation or continuation of violent escalation or continuation of violent or serious externalizing behavior.or serious externalizing behavior.

Targets youth at risk of incarceration Targets youth at risk of incarceration or other out-of-home placement due or other out-of-home placement due to behavior.to behavior.

Family behavioral intervention.Family behavioral intervention.

Phases of FFTPhases of FFT

1. Motivation and Engagement1. Motivation and Engagement Goals: develop alliance, reduce negativity, Goals: develop alliance, reduce negativity,

minimize hopelessness, reduce dropout, minimize hopelessness, reduce dropout, increase motivation for changeincrease motivation for change

2.2. Behavior ChangeBehavior Change Goals:Goals: develop and implement develop and implement

individualized change plans, change presenting individualized change plans, change presenting delinquency behavior, build relational skillsdelinquency behavior, build relational skills

3.3. GeneralizationGeneralization Goals: maintain and generalize change, relapse Goals: maintain and generalize change, relapse

prevention, engage community supports prevention, engage community supports

FFT OutcomesFFT Outcomes

FFT significantly reduces recidivism FFT significantly reduces recidivism for juvenile offendersfor juvenile offenders In Washington State, youth treated by In Washington State, youth treated by

competent FFT therapists had a 38% competent FFT therapists had a 38% reduction in felony recidivism at 18-reduction in felony recidivism at 18-months post-releasemonths post-release

Multisystemic Therapy Multisystemic Therapy (MST)(MST)

Targets youth engaged in serious Targets youth engaged in serious antisocial behavior and their familiesantisocial behavior and their families

Based on of the idea that behavior is Based on of the idea that behavior is determined by the various systems determined by the various systems that affect and individual, including that affect and individual, including the family, school, peer group, and the family, school, peer group, and community. community.

MST ContinuedMST Continued

Goal is to change the systems that create Goal is to change the systems that create and sustain high-risk behavior. and sustain high-risk behavior. Therapist works with family to identify function Therapist works with family to identify function

of problematic behavior and the factors that of problematic behavior and the factors that contribute to it.contribute to it.

Therapist works to change factors that Therapist works to change factors that contribute to and reinforce problematic contribute to and reinforce problematic behaviorbehavior

Therapy takes place in the youth’s natural Therapy takes place in the youth’s natural environment. environment.

MST: Parents are seen as key MST: Parents are seen as key agents of changeagents of change

A major goal is to enhance parents’ ability A major goal is to enhance parents’ ability to monitor manage youth’s behavior, and to monitor manage youth’s behavior, and give effective rewards and consequences. give effective rewards and consequences.

MST OutcomesMST Outcomes

Randomized controlled trials with Randomized controlled trials with youth post-incarceration indicate youth post-incarceration indicate that MST is effective at reducing that MST is effective at reducing number of re-arrests, number of days number of re-arrests, number of days incarcerated, peer-directed violence, incarcerated, peer-directed violence, and increasing family cohesion and and increasing family cohesion and the number of youth who did not the number of youth who did not recidivate at all.recidivate at all.

MST Outcomes: RecidivismMST Outcomes: Recidivism

In a randomized study of 200 In a randomized study of 200 juvenile offenders, youth who juvenile offenders, youth who participated in MST had a lower participated in MST had a lower (22.1%) rate of recidivism than did (22.1%) rate of recidivism than did youth who participated in individual youth who participated in individual therapy (71.4%) at 4-year follow-up. therapy (71.4%) at 4-year follow-up. (Borduin, Mann, Cone, Henggeler, Fucci, Blaske, & Williams, 1995)(Borduin, Mann, Cone, Henggeler, Fucci, Blaske, & Williams, 1995)

Treatment Within Juvenile Treatment Within Juvenile Justice SettingsJustice Settings

Juvenile Rehabilitation Juvenile Rehabilitation Administration’s Integrated Administration’s Integrated

Treatment ModelTreatment Model

Used in JRA’s residential programsUsed in JRA’s residential programs Framework for treatment planning Framework for treatment planning

across continuum of careacross continuum of care

Parameters of the Integrated Parameters of the Integrated Treatment Model (ITM)Treatment Model (ITM)

Cognitive-behavioral basisCognitive-behavioral basis Family-focusedFamily-focused Evidence-based approaches Evidence-based approaches

implementedimplemented Skill-basedSkill-based

Integrated Treatment Model: Integrated Treatment Model: AssessmentAssessment

Identification and prioritization of treatment Identification and prioritization of treatment needs is a major goalneeds is a major goal

Use of standardized, valid diagnostic measures Use of standardized, valid diagnostic measures (Diagnostic Interview Schedule for Children)(Diagnostic Interview Schedule for Children)

Treatment heirarchy is established, targetingTreatment heirarchy is established, targeting Threats of harm to self or othersThreats of harm to self or others Physical or sexual aggressionPhysical or sexual aggression Escape ideation or attemptsEscape ideation or attempts Treatment-interfering behaviorsTreatment-interfering behaviors Motivation and engagementMotivation and engagement Quality-of-life interfering behaviorsQuality-of-life interfering behaviors Significant treatment considerations Significant treatment considerations

Integrated Treatment Model: Integrated Treatment Model: Methods of ChangeMethods of Change

Behavior Modification: Reinforcement, Behavior Modification: Reinforcement, punishment, shaping, extinction, contingency punishment, shaping, extinction, contingency management, cue removal and exposuremanagement, cue removal and exposure

Coaching and role playingCoaching and role playing Motivation enhancementMotivation enhancement ValidationValidation Cognitive restructuringCognitive restructuring Skills training (Dialectical Behavior Therapy)Skills training (Dialectical Behavior Therapy)

Components of Integrated Components of Integrated Treatment ModelTreatment Model

Dialectical Behavior TherapyDialectical Behavior Therapy Substance abuse treatmentSubstance abuse treatment Relapse preventionRelapse prevention Sex-offender treatmentSex-offender treatment Aggression-replacement therapyAggression-replacement therapy Functional family therapyFunctional family therapy Family Integrated TreatmentFamily Integrated Treatment

Dialectical Behavior Dialectical Behavior TherapyTherapy

Developed by Marsha Linehan for the Developed by Marsha Linehan for the treatment of Borderline Personality treatment of Borderline Personality Disorder (BPD)Disorder (BPD)

Goal is to reduce problems Goal is to reduce problems associated with emotional associated with emotional dysregulationdysregulation

Emotional DysregulationEmotional Dysregulation

The inability to monitor, evaluate, and The inability to monitor, evaluate, and change emotional responseschange emotional responses

ImpulsivityImpulsivity Intense emotional responsesIntense emotional responses Slow return to normal after emotional Slow return to normal after emotional

arousalarousal

Emotional Dysregulation Emotional Dysregulation

A hallmark symptom of Borderline A hallmark symptom of Borderline Personality DisorderPersonality Disorder

Also related to a range of problems Also related to a range of problems commonly seen in the Juvenile Justice commonly seen in the Juvenile Justice PopulationPopulation Substance abuse, depression, anxiety, poor Substance abuse, depression, anxiety, poor

impulse control, poor anger managementimpulse control, poor anger management DBT: a promising treatment for juvenile DBT: a promising treatment for juvenile

offenders?offenders?

What is DBT?What is DBT?

Emphasis on mindfulnessEmphasis on mindfulness Behavioral therapy componentsBehavioral therapy components

Goal-focused interventionsGoal-focused interventions Behavior chain analysis is used to identify Behavior chain analysis is used to identify

antecedents and consequences of antecedents and consequences of behavior, and to prompt consideration of behavior, and to prompt consideration of alternative courses of actionalternative courses of action

Recognition that one needs to change Recognition that one needs to change one’s behavior in order to change one’s one’s behavior in order to change one’s feelingsfeelings

DBT SkillsDBT Skills

Core Mindfulness Core Mindfulness Emotion Regulation Emotion Regulation Distress ToleranceDistress Tolerance Interpersonal EffectivenessInterpersonal Effectiveness

Dialectics: Acceptance vs. Dialectics: Acceptance vs. ChangeChange

ValidationValidation Patients’ emotional, cognitive, and behavioral Patients’ emotional, cognitive, and behavioral

responses are understandable in the context of responses are understandable in the context of the environment and the patient’s skill levelthe environment and the patient’s skill level

Patient may not have created his/her Patient may not have created his/her problems, but he/she is responsible for problems, but he/she is responsible for solving themsolving them

Therapist coaches patient on more Therapist coaches patient on more effective behavioral responseseffective behavioral responses

DBT in Juvenile Justice DBT in Juvenile Justice SettingsSettings

Delivered through groups, individual Delivered through groups, individual therapy, and daily interactions with therapy, and daily interactions with staffstaff

Teaches behavioral analysis, Teaches behavioral analysis, cognitive restructuring, skills cognitive restructuring, skills coachingcoaching

Integrated into the culture of the Integrated into the culture of the institutioninstitution

Is DBT effective in juvenile Is DBT effective in juvenile justice settings?justice settings?

Outcome research is limitedOutcome research is limited Girls in mental health cottage who received Girls in mental health cottage who received

DBT had significantly lower 12 month DBT had significantly lower 12 month felony recidivism rate than those who were felony recidivism rate than those who were residents of the cottage before the DBT residents of the cottage before the DBT program began(10% vs. 24%). program began(10% vs. 24%). (WSIPP, 2002)(WSIPP, 2002)

Punitive actions by staff in mental health Punitive actions by staff in mental health cottage decreased when cottage began cottage decreased when cottage began implementing DBT. implementing DBT. (Trupin, Stewart, Beach & Boesky, 2002)(Trupin, Stewart, Beach & Boesky, 2002)

Transitioning Youth From Transitioning Youth From Incarceration to the Incarceration to the

CommunityCommunity How can we give youth with co-How can we give youth with co-

occurring disorders the skills they will occurring disorders the skills they will need to avoid recidivating?need to avoid recidivating?

Family Integrated Transitions Family Integrated Transitions (FIT)(FIT)

A family- and community-based A family- and community-based treatment for youth with co-occurring treatment for youth with co-occurring mental health and substance abuse mental health and substance abuse diagnoses who are being released diagnoses who are being released from secure institutions in from secure institutions in Washington State’s Juvenile Washington State’s Juvenile Rehabilitation AdministrationRehabilitation Administration

FIT targets the multiple FIT targets the multiple determinants of antisocial determinants of antisocial

behaviorbehavior Multisystemic Therapy framework to Multisystemic Therapy framework to

change the systems that create the change the systems that create the reinforcement contingencies for behaviorreinforcement contingencies for behavior

Dialectical Behavior Therapy to promote Dialectical Behavior Therapy to promote emotional and behavioral regulationemotional and behavioral regulation

Motivational Enhancement Therapy to Motivational Enhancement Therapy to promote engagement in treatmentpromote engagement in treatment

Relapse Prevention to give youth skills to Relapse Prevention to give youth skills to promote sustained abstinencepromote sustained abstinence

Family Integrated Transition Family Integrated Transition (FIT): Target Population(FIT): Target Population

Ages 11 to 17 at intakeAges 11 to 17 at intake Substance abuse or dependence disorder Substance abuse or dependence disorder

ANDAND Axis I Disorder OR currently prescribed Axis I Disorder OR currently prescribed

psychotropic medication OR demonstrated psychotropic medication OR demonstrated suicidal behavior in past 6 monthssuicidal behavior in past 6 months

At least 4 months left on sentenceAt least 4 months left on sentence Residing in service areaResiding in service area

Effects of Participation in FIT Effects of Participation in FIT on Recidivismon Recidivism

Recidivism of youth who participated Recidivism of youth who participated in FIT was compared with recidivism in FIT was compared with recidivism of youth were eligible for FIT, but of youth were eligible for FIT, but lived outside of the service arealived outside of the service area

At 18 months post-release, felony At 18 months post-release, felony recidivism was 34% lower for FIT recidivism was 34% lower for FIT clients (27%) than for comparison clients (27%) than for comparison youth (41%).youth (41%).(Washington State Institute of Public Policy, 2004)(Washington State Institute of Public Policy, 2004)

Cost-Effectiveness of FITCost-Effectiveness of FIT

Savings in criminal justice costs: Savings in criminal justice costs: $11,749$11,749

Savings in avoided criminal Savings in avoided criminal victimizations: $16,466victimizations: $16,466

Total savings per participant: $28,215Total savings per participant: $28,215 Total cost per participant: $8,968Total cost per participant: $8,968 Benefit to cost ratio: $3.15Benefit to cost ratio: $3.15

(Washington State Institute of Public Policy, 2004)(Washington State Institute of Public Policy, 2004)

How do the different How do the different approaches to treating youth approaches to treating youth in the juvenile justice system in the juvenile justice system compare with each other? compare with each other?

-12%

-13%

-31%

-14%

-4%

-8%

10%

-5%

-2%

-1%

-31%

-25%

-18%

-37%

-27%

-5%

0%

-4%

-14%

13%

-17%

-15%

-12%

10%

-80% -60% -40% -20% 0% 20% 40%

Early Childhood Education for Disadvantaged Youth (N = 6)

Seattle Social Development Project (N = 1)

Quantum Opportunities Program (N = 1)

Children At Risk Program (N = 1)

Mentoring (N = 2)

National Job Corps (N = 1)

Job Training Partnership Act (N = 1)

Diversion with Services (vs. Regular Court) (N = 13)

Diversion-Release, no Services (vs. Regular Court) (N = 7)

Diversion with Services (vs. Release without Services) (N = 9)

Multi-Systemic Therapy (N = 3)

Functional Family Therapy (N = 7)

Aggression Replacement Training (N = 4)

Multidimensional Treatment Foster Care (N = 2)

Adolescent Diversion Project (N = 5)

Juvenile Intensive Probation (N = 7)

Intensive Probation (as alternative to incarceration) (N = 6)

Juvenile Intensive Parole Supervision (N = 7)

Coordinated Services (N = 4)

Scared Straight Type Programs (N = 8)

Other Family-Based Therapy Approaches (N = 6)

Structured Restitution for Juvenile Offenders (N = 6)

Juvenile Sex Offender Treatment (N = 5)

Juvenile Boot Camps (N = 10)

Lower Recidivism Higher Recidivism

The number in each bar is the "effect size" for each program, which approximates a percentage change in recidivism rates.

The length of each bar are 95% confidence intervals.

Type of Program, and the Number (N) of studies in the Summary

Source: Meta-analysis conducted by the Washington State Institute for Public Policy

The Estimated Effect on Criminal Recidivism for Different Types of Programs for Youth and Juvenile Offenders

Economic Estimates From National ResearchFor Adult & Juvenile Justice and Prevention Programs

Pre

ven

tio

n

Pro

gra

ms

Juve

nil

e O

ffe

nd

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s

-$20,000 $0 $20,000 $40,000 $60,000 $80,000 $100,000

Net Gain Per Person in ProgramBreak-EvenPoint

Net Loss

Drug CourtsTher. Commun. w/AftercareIn-Prison Non Res.Drug TX

Sex Off. Prog, Cog. Beh..Intensive Super, no TX

Int Super, w/TXAdult Basic Ed.Vocational Ed.

Intensive Super. ProbationFunctional Family

TherapyMultiSystemic TherapyAggression Replacemnt Trng

Coordinated ServicesScared Straight Programs

Intensive Super. ParoleTreatment Foster Care

Boot Camps

Nurse Home VisitationEarly Childhood EducationSeattle Soc. Devlp. Project

Quantum OpportunitiesJob Training Part. Act

Mentoring

Ad

ult

Off

end

erP

rog

ram

s

Implementation ChallengesImplementation Challenges Conflicting roles of the juvenile justice Conflicting roles of the juvenile justice

system: punishment versus treatmentsystem: punishment versus treatment Variable commitment to treatment among Variable commitment to treatment among

institution staffinstitution staff Challenges of conducting treatment Challenges of conducting treatment

outcome research with incarcerated youthoutcome research with incarcerated youth Intensive training and supervision needsIntensive training and supervision needs Logistical difficulty in implementing family Logistical difficulty in implementing family

based treatments in rural settingsbased treatments in rural settings

““Vision without action is a Vision without action is a daydream. Action without daydream. Action without vision is a nightmare.”vision is a nightmare.”

Japanese ProverbJapanese Proverb