‘nothing works’ in secure residential youth care?
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Children and Youth Services Review 35 (2013) 1941–1945
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Children and Youth Services Review
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‘Nothing works’ in secure residential youth care?
F.A. Souverein b, G.H.P. Van der Helm ⁎,a, G.J.J.M. Stams b
a Leiden University of Applied Sciences, Youth Expert Centre, P.O. Box 382, 2300 AJ Leiden, The Netherlandsb University of Amsterdam, Graduate School of Child Development and Education, Nieuwe Prinsengracht 130, 1018 VZ Amsterdam, The Netherlands
⁎ Corresponding author. Tel.: +31 648133745.E-mail address: [email protected] (G.H.P. Van de
0190-7409/$ – see front matter © 2013 Elsevier Ltd. All rihttp://dx.doi.org/10.1016/j.childyouth.2013.09.010
a b s t r a c t
a r t i c l e i n f oArticle history:Received 5 May 2013Received in revised form 19 September 2013Accepted 19 September 2013Available online 29 September 2013
Keywords:Secure residential youth careEffectivenessRecommendations
A debate about the effectiveness of secure residential youth care is currently going on. While some continue tosupport secure residential youth care, others conclude that ‘nothing works’ in secure residential youth care,and argue that non-residential treatment is superior to secure residential treatment. This article reviews recentresearch on this topic. The conclusion is that evidence for the effectiveness of non-residential treatment foryouth with severe behavioural problems and/or criminal behaviour is sparse if considered as an alternative forsecure residential youth care. Secure residential treatment shows amodest, but positive effect. We need to over-haul the myth that ‘nothing works’ in secure residential youth care, and focus on how to optimise the effects ofsecure residential youth care.
© 2013 Elsevier Ltd. All rights reserved.
1. Introduction
A debate is being conducted about the effectiveness of secure resi-dential youth care (Marshall & Burton, 2010; Van der Helm, Wissink,Stams, & De Jong, 2012), although firm scientific evidence is hard to ob-tain because of ethical problems which preclude the use of randomisedcontrol trials (De Swart et al., 2012). While some researchers show thatsecure residential youth care can work (De Swart et al., 2012; Koehler,Losel, Akoensi, & Humphreys, 2013; Schubert, Mulvey, Loughran, &Loyosa, 2012), other researchers claim that ‘nothing works’ in secureresidential youth care (e.g. Davidson-Arad & Golan, 2007; Peterson-Badali & Koegl, 2002; Wortley, 2002) or at least that non-residentialtreatment is superior to residential treatment (e.g., French & Cameron,2002; Kendrick, Steckley, & McPheat, 2011). Drawing on Goffman(1961) and Sykes (1958), Zimbardo (2007) concludes in his book ‘theLucifer effect’ that residential care cannot be effective since power in-equalities cause unprofessional behaviour of detention staff. However,the results of his classic study are currently being questioned (Haslam& Reicher, 2012). Hermanns (2010, 2012) and also Hanrath (2009,chap. 11, 2013) take Zimbardo's argument further and consider deten-tion not to be compatible with treatment, and argue that incarceratingadolescents increases recidivism. They contend that positive resultscan only be achieved by a change of policy, e.g., replacing residentialcare with non-residential alternatives, in particular ‘wraparound care’.
Wraparound care is based on using the available child and familystrengths in a planning process that results in a unique set of communityservices and natural supports (Grundle, 2002). However, two recent re-views indicate that there is still not enough empirical support for the ef-fectiveness ofwraparound care due to seriousmethodological limitations
r Helm).
ghts reserved.
of the intervention studies examining the effects of wraparound care(Suter & Bruns, 2009; Walter & Petr, 2011). On the other hand,although one cannot conclude that wraparound care is a viable alterna-tive for residential care, there is some preliminary empirical evidence tosuggest that multidimensional treatment foster care (MTFC) could be analternative for incarceration of juvenile delinquents (e.g., Chamberlain,Leve, & DeGarmo, 2007; Eddy, Whaley, & Chamberlain, 2004). Moreover,Andrews and Bonta (2010) showed that non-residential treatment basedon the ‘what works principles’ of judicial interventions is far more effec-tive than residential treatment of juvenile delinquents based on theseprinciples.
It is time to evaluate theweight of evidence.What are the argumentsof those who believe that (secure) residential youth care is ineffectiveand ‘nothing can work’? On the other hand, which evidence supportsthe effectiveness of secure residential youth care? We need to bear inmind that secure residential youth care not only serves treatmentgoals, but also serves to protect society (Bullock, Little, & Millham,1998; Hagell & Jeyarajah-Dent, 2006). To weigh the evidence for the ef-fectiveness of secure residential youth care, we searched for evidence ofrecent meta-analyses and systematic reviews, which we will present inthis review. This article focuses on weaknesses and strengths of secureresidential youth care.
2. Negative consequences of incarceration: coercion and repression
Ample literature exists on negative consequences of incarceration.Sykes (1970), called this ‘the pains of imprisonment’, more recently re-searchers refer to ‘derivational characteristics’ (Gover, MacKenzie, &Armstrong, 2000). Probably the most derivational characteristic ofbeing locked up concerns coercion that inevitably accompanies securecare (Hermanns, 2012). In a review, Pritikin, (2009) shows that coer-cionmost likely increases anti-social behaviour and recidivism. A recent
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meta-analysis indicates that the effectiveness of interventions deterio-rates as the amount of coercion increases (Parhar, Wormith, Derkzen,& Beauregard, 2008). Interventionswith punishment as themain objec-tive often have counterproductive effects: a significant increase of delin-quency is observed instead of a decline in anti-social behaviour (Lipsey,2009). In addition, neurobiological research on punishment substanti-ates these negative research outcomes (e.g., Kandel, Schwartz, &Jessel, 1991).
However, the studies by Pritikin (2009) and Parhar et al. (2008) didnot discriminate between coercion and repression. Coercion in a secureresidential contextmay be part of the structure and control that are nec-essary to set boundaries and prevent chaos and anarchy. Coercion, how-ever, can easily transform into repression due to (extreme) powerimbalance (Lammers & Stapel, 2011; Lammers, Stapel, & Galinsky,2011; Zimbardo, 2007). Repression refers to extreme punitive powerof group workers, lack of safety, lack of privacy, injustice, unfair treat-ment, and incremental rules (e.g., group punishment).
Research, however, shows that within residential care, staff mem-bers in some cases are able to establish an open group climate, that is,coercion without repression (Van der Helm, Boekee, Stams, & Van derLaan, 2011). Group climate refers to a shared perception of the wayone ought to think, feel and behave in an environment or situation(after Schein, 1993; Van der Helm, Klapwijk, Stams, & Van der Laan,2009; Van der Helm et al., 2012). In an open group climate equalityand mutual respect, together with autonomy and responsibility are im-portant goals. Moreover, responsivity from group workers can consti-tute a counterbalance for dehumanisation and subsequent repression(Vander Helm, 2011). An open climate and responsivity can lead tomu-tual trust and meaningful interpersonal contact and feelings of safety(VanderHelm et al., 2009). This open group climate results in higher in-ternal locus of control and greater treatmentmotivation, which are twokey factors playing a role in treatment effectiveness. An open group cli-mate facilitates one the most important educational and rehabilitative(sentencing) aims of secure residential care, namely, successful reinte-gration into society through restoring the bond with society that wasdamaged by anti-social behaviour (Van der Helm et al., 2011, 2009).
3. Deviancy training
A second argument against residential care is deviancy training.Treating deviant youth together can worsen their problems, becausethey can reinforce one another's aggressive and deviant behaviours bymeans of deviancy training (e.g., Dishion, McCord, & Poulin, 1999;Dishion, Poulin, & Burraston, 2001). Evidence for this claim, however, ismixed and recent studies, including ameta-analysis, found little supportfor contagious effects of aggression or deviant behaviour in residentialgroup settings (Handwerk, Field, & Friman, 2000; Mager, Milich, Harris,& Howard, 2005; Rhule, 2005;Weiss et al., 2005). Moreover, some stud-ies indicate that youth can also have a positive influence on each other(e.g., Lee, Chmelka, & Thompson, 2010). Lee and colleagues found thatadolescents showing less aggression and delinquency were often fromthe same group. Positive peer relationships can serve as an importantprotective factor for youth placed in residential care (Devine, 2004).
Handwerk et al. (2000) found that education and family style resi-dential care that is based on behavioural learning principles can bufferagainst potential detrimental effects. Sinclair and Gibbs (1998) foundthat potential damaging effects can be mitigated, even for high-riskpopulations, when residential centres are small, staff agrees on aimsandmethods, andmanagers feel in control of admissions. Thesefindingsreflect those of Brown, Bullock, Hobson, and Little (1998), who empha-sise beneficial effects for youth placed in settingswhere there is congru-ence between structure and culture. Groeneweg, der Helm, and Stams(2011) found that if group workers gave youth positive feedback thiswas associated with a decline in criminal cognitions, which indicatesthat the negative effects of residential care may be overcome. Thesefindings again highlight the importance of an open living group climate.
Hermanns (2012), in his plea against residential care, however,states that the possible positive effects gained within the confinementof the institution are not generalisable outside youth prison; a positivegroup climate has no effect on behavioural problems and recidivism ofjuvenile offenders. Nevertheless, recent research demonstrates the op-posite. Schubert et al. (2012) show that youths' positive perceptions ofthe institutional environment are related to a significant decline in re-cidivism and externalising problems when these youths are releasedover and above individual factors and facility characteristics. Koehleret al. (2013) show careful residential interventions to bemodestly effec-tive (see further).
4. Interventions within residential care
Hermanns (2012) further states that there are no available ‘evidencebased’ residential interventions, and that we therefore need to focus onthe promising methods outside the walls of residential institutions.However, it seems that only few of these ‘promising’ non-residentialmethods can really be regarded as ‘evidence based’, and have provento be more effective than residential interventions (De Swart et al.,2012). Moreover, the fact that there are few known ‘evidence based’ in-terventions during detention does not automaticallymean that ‘nothingworks’. It should be kept in mind that effectiveness of residential care isnegatively affected by the fact that youth within residential care oftenhave a long history of treatment and care that was not effective in re-ducing their problems (Harder, 2011; Harder, Knorth, & Zandberg,2006).
Several studies have shown that youth may indeed profit from resi-dential care (De Swart, 2011; Harder, 2011; Nijhof, 2011; Van Dam,Nijhof, Scholte, & Veerman, 2010; Van der Helm, 2011). Recent reviewsand meta-analyses show small but positive effects of residential treat-ment (De Swart et al., 2012; Garrido & Morales, 2007; Gatti, Tremblay,& Vitaro, 2009; Knorth, Harder, Zandberg, & Kendrick, 2008; Lipsey,2009; Loughran et al., 2009). The most recent review by Koehler showsimprisonment to have a negative effect on juvenile recidivism, butwhen treatment is the main goal of detention results become positive(odds 1.34, see also Lipsey, 2009). When cognitive behavioural therapywas used odds rose to 1.73, andwhen treatmentwas delivered accordingto the Risks, Needs and Responsivity principles fromAndrews and Bonta(2010), results were even more positive (odds 1.90, a reduction of 16%recidivism according to Koehler et al., 2013). These results are promisingand so beforewe can truly conclude that ‘nothingworks’, future researchshould first investigate the issue of effective residential interventions(Marshall & Burton, 2010).
Future studies should also focus on the effectiveness of aftercare. Arecent meta-analysis (James, Stams, Asscher, Van der Laan, & De Roo,2013) does show promising results for the effectiveness of aftercare.The results indicate that well-implemented individual aftercare can con-tribute to the effectiveness of residential care and can reduce recidivism.
5. Reformation and detention
Finally, in his presentation at the conference of the Council for the Ad-ministration of Criminal Justice and Protection of Juveniles, Hermanns(2012) concluded that detention and treatment are incompatible, thathumans simply cannot be reformed by detention. Remarkably, the nextlecture of the conference proved the exact opposite. In the next speech,Ploeg (2012) focused on theNorwegian prison-island Bastøy and provid-ed substantial evidence that detention and treatment may very well gotogether. Ploeg described that the inmates face important responsibilitiesand challenges themselves, and that they are trained and helped to takeresponsibility for their own actions, life and future. The guards serve asgood and motivational role models, and operate by clear rules and stan-dards. Bastøy is a success story; there has been no incident of aggressionor violence in the past four years, only one of the 3285 persons on leavecame back too late during the probation period, and everyone released in
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2011 found housing and education orwork. In Norway, the percentage ofrecidivism for residential care in the justice system is notmore than 20%,which is equal to the percentage of recidivism after community services.The director of Bastøy attributes its success to the good relationship(responsivity) between the staff and inmates, the way conflicts are han-dled, the good attitudes of the staff and the fact that they portray as goodrole models.
6. Discussion
Overall, it seems that the arguments against effectiveness of residen-tial care are disputable. The current scientific evidence does not lead tothe conclusion that ‘nothing works’ within (secure) residential youthcare, and that it should be replaced by non-residential forms of treat-ment. Moreover, De Swart et al. (2012) conducted a meta-analysis ex-amining the effectiveness of institutional care over the past threedecades, only including (quasi) experimental studieswith a comparablecontrol group. They compared institutional evidence-based treatment(EBT) with non-institutional EBT, institutional care as usual (CAU)with non-institutional CAU, institutional CAU with non-institutionalEBT and institutional EBT with institutional CAU. Only the last compar-ison yielded a significant effect (d = .34), showing that institutionalcare can be equally effective as non-institutional care, and it is promis-ing to provide youth with EBT during their residential stay (see alsoWeisz, Jensen-Doss, & Hawley, 2006). So even though the effect maybe modest, something works within residential care.
We can further learn from Australia where attempts have beenmade by the government to abolish residential care. In a critical elucida-tion regarding the situation in Australia, Ainsworth and Hansen (2005)state that a child care and protection system has to have some residen-tial treatment programmes that are capable of dealing with the mostcomplicated and difficult youth, often with long histories of neglect,maltreatment and abuse resulting in aggression, substance abuse, crim-inal behaviour and prostitution. The closure of more than 50% of (semi-secure) residential centres in the child care and protection services sec-tor in Australia has not resulted in better services for a significant groupof highly disturbed and disruptive youth. These youth primarily havebeen transferred to foster care or to residential care in the juvenile jus-tice system (i.e., youth prison). Ainsworth andHansen (2005) state that“even if community based options are expanded and foster care treat-ment programmes are vigorously promoted and foster care as an alter-native to detention gets underway, some residential education andtreatment programmes will still be needed.” Chamberlain (2003) andWalker, Hill, and Triseliotis (2002) show that when treatment fostercare or regular foster care repeatedly fail (as these services inevitablydo in a number of cases), they often transfer the young person to a se-cure residential facility. For most of these youth a history of multipledisrupted foster care placements is highly demotivating and common-place. Ainsworth and Hansen note that it is unrealistic to expect fostercare to be able to manage some of these very difficult and disturbedyouth. Even Barth (2005), who takes a more modest position regardingthe situation in Australia, states that ‘residential care is often needed as aservice response to a perceived crisis’.
A large scaled evaluation study of four semi-secure residential treat-ment facilities in the Netherlands (Van Damet al., 2010) showed that ofthe 514 youth treated within these residential care facilities 335 (65%)were diagnosed with one or more DSM-classification(s). Besides, 99%had externalising problems (e.g., problems at school and anti-social be-haviour), 89% had internalising problems (e.g., suicide attempts andself-mutilation), 66% suffered from substance abuse, and 40% had prob-lemswith sexual inappropriate behaviour (e.g., prostitution). Almost allof them (99%) grew up in troubled families, often growing up with sin-gle parents in violent and abusive households. With regard to their en-vironment, 67% indicated that they had a delinquent peer group and16% was abused by someone outside the family. Moreover, 33% was
not in school or had no work at the time of omission, and 3% washomeless.
We cannot and must not abandon these troubled adolescents. Theyare in need of a structured and (highly) supervised environment. Non-residential care is often not an option as too many protective factorslack in the immediate surroundings of the youngsters. In the absenceof residential programmes, the alternative is a deplorable transfer ofthese vulnerable youth to services for the homeless or to the juvenilejustice system (French & Cameron, 2002; Raine, 2013, chap. 10). A17 year old girl stated in an interview conducted by the Leiden YouthExpert Centre (Van der Helm, 2011): ‘I lived in 17 families and thereaf-ter in nine institutions and two youth prisons, I trust no one’. This canonly be viewed as a morally undesirable and socially unjust outcome.
7. Detrimental consequences of ‘nothing works’
Even more importantly, we need to stop propagating the currentconception that ‘nothing works’ in residential youth care, because itcan have far reaching negative consequences. This notion of ‘nothingworks’ can have important implications for the motivation of thoseworking with troubled youth in secure care and detention. It can evenresult in a self-fulfilling prophecy. With a negative conception that‘nothing works’ the staff can be more inclined to behave oppressive.As a result the youth will often respond negative to the staff (transac-tional processes; Patterson & Bank, 1989) and the living climate can de-teriorate (Van der Helm et al., 2011). It further seems plausible to inferthat juveniles who have internalised the ‘nothing works’ conception ofthe staff and lost their faith in treatment will respond negatively to fur-ther treatment. This is supported by the results obtained by Van derHelm (2011, 2012), who found that youngsters reporting less treatmentmotivation also experienced a negative living group climate and devel-oped more anti-social and criminal cognitions (see also Groeneweget al., 2011). ‘Nothing works’ cognitions can thus have far reaching un-desirable consequences for youth, staff and eventually for society.
So, for all secure residential institutions that nowadays put a tre-mendous effort in improving treatment programmes and making thetransition from “imprisonment to treatment” (Van der Helm, 2012),and for the youth depending on residential care, it neither seems rea-sonable nor fair to continue to embrace the myth that ‘nothing works’.For adolescents with severe behavioural problems and/or criminal con-duct there is no all-embracing solution, there never has been, but im-proved scientific insight in ‘what works’ can help.
8. Implications and recommendations
To improve treatment programmes offered by residential youth careand to make a transition from ‘imprisonment to treatment’we can relyon research and evidence-based improvements (Van der Helm, 2012).Creating an open, responsive living group climate with a minimalamount of repression is of paramount importance. Social workersmust be continuously trained, supported and monitored to reduce theamount of repression and to create an open living group climate. Thegroup workers need to find the right balance between control and flex-ibility (Van der Helm et al., 2011). Workers often experience problemsin their relationship with incarcerated youth and tend to take reactancepersonally (Van der Helm et al., 2012). Especially with very difficult andsocially alienated youth,whodisplay norm transgressing and aggressivebehaviour, group workers have a tendency to take a strict and repres-sive approach (Harder, Kalverboer, & Knorth, 2011). Given that almostall youth in residential care have externalising problems, it is importantthat group workers are trained to adequately respond to challengingand even anti-social behaviour (Harder, 2011; Knotter, Wissink,Moonen, Stams, & Jansen, 2013). The training ‘Top PM’ (Training of pro-fessionals in Prison climate Management) supported by research in ajuvenile correctional facility (Training manual TOP PM, n.a.; Van derHelm et al., 2011) can improve the capabilities of creating such an
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open climate. General and specific treatment methods, cognitive thera-pies (De Swart, 2011), and motivational interviewing (Harder, 2011)can further contribute to successful residential care.
Attention should further be given to ‘institutional working climate’,which includes the organisational structure, leadership style, workload,team functioning, and motivation, commitment and satisfaction of thestaff. Research on this topic is still in its infancy, but research byLambert, Altheimer, Hogan, and Barton-Belessa (2011) shows detri-mental effects of a repressiveworking climate on groupworkers regard-ing sick-leave and burn-out. Lambert and colleagues also state thatrepressive behaviour of group workers spills over to their families. Be-sides, research by Mackay and de Weerd (2012) and Van Miert (2012)shows that ‘institutional working climate’ is reflected in the ‘livinggroup climate’ (often designated as parallel processes).
Education is also very important for adolescents with severe behav-ioural problems. Youths themselves indicate that they often suffer fromboredom and lack of perspective resulting in feelings of uselessnesswhen they cannot go to school (Van der Helm & Austmann, 2012). Fur-ther, the skills and certificates that can be obtained can help youth laterin lifewhen they are released. Learning how to read can already contrib-ute to a better perspective and finding employment so that the risk ofrecidivism is reduced (e.g. Brunner, 1993; Pinker, 2011; Steurer, 1996;Vacca, 2008).Moreover, hope and the perspective of a better life are im-portant elements of an open group climate and have been shown tocontribute to treatment motivation (Van der Helm et al., 2012).
Finally, all residential treatment is not delivered equally, and the re-sults are correspondingly. Grietens and Hellinckx (2004) conducted asecond-order research synthesis of five meta-analyses about the effec-tiveness of residential care. They stress that the outcomes highly de-pend on the quality of programme implementation, and that severalprogramme characteristics were important predictors of variation in ef-fect sizes (i.e., monitoring treatment implementation, duration of treat-ment, administration of the treatment by mental health professionals,and the age of the programme). To improve residential care we needto focus more on the ‘what works’ principles of judicial interventions(Andrews & Bonta, 2010). We need to make sure that we deliver goodand suited care so that the care that we offer can really be effective.
9. Conclusion
In the end (De Swart et al., 2012), the question is not whether insti-tutional or non-institutional care should be preferred, but how to opti-mise the effects of evidence based treatment for youth who are inneed of institutional and non-institutional care. Moreover, we mustalso not forget that secure residential youth care not only serves treat-ment goals, but also serves to protect society (Bullock et al., 1998;Hagell & Jeyarajah-Dent, 2006). We need to revise the myth that ‘noth-ing works’, and focus on what does work to make sure that if we dosomething it is the right thing to do, not only with regard to publicspending and crime reduction, but also for those children who deservea second, a third or a fourth chance in our civil society (Elias, 2000).
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