Evidencebased Practices Juvenile Justice

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Evidence-based Practices Juvenile Justice
Mental Health

• Webcast Training
• October 25, 2005
• Presented by
• The California Institute for Mental Health
• Bill Carter LCSW

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Juvenile Justice Mental HealthA Complicated
Picture

• Prevalence of MH Disorders in Youth in the
  Juvenile Justice is extremely high compared to
  general population est.
• 66 of Boys in JJ
• 75 of Girls in JJ
• 15 of General Population
• Mental Health Disorders are weak risk factors
  for criminal behavior.

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Juvenile Justice Mental HealthA Complicated
Picture

• Conclusions
• Do not treat Mental Health Disorders (generally)
  with the primary goal of reducing criminal
  behavior.
• Do treat Mental Health Disorders to reduce
  suffering and promote health.
• Do treat Mental Health Disorders to enable youth
  to participate effectively programs that reduce
  criminality.

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Disproportionate Minority Representation

• Two-Thirds Youth in confined in America are
  minority Youth. Minority Youth represent
  One-Third of the youth population.
• African-American Youth are 6x, Latino Youth 3x
  more likely to be incarcerated after arrest than
  White Youth.
• 97-98 African American Youth represented
• 15 of youth population
• 26 of youth arrested
• 31 of youth referred to juvenile court
• 44 of youth detained

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Disproportionate Minority Representation

• In California - Compared to white youths,
  minority youths are 2.8 times more likely to be
  arrested for a violent crime, 6.2 times more
  likely to wind up in adult court, and 7 times
  more likely to be sent to prison by adult court.

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What Reduces Criminal Behavior?

• Not a single reviewer of studies of the effects
  of official punishment (custody, mandatory
  arrests, probation, increased surveillance, etc.)
  has found consistent evidence of reduced
  recidivism
• At least 40 and up to 60 of the studies of
  correctional treatment services reported reduced
  recidivism rates relative to various comparison
  conditions, in every published review
• ( Source Edward Latessa PhD. Chair Dept
  Criminology, University of Cincinnati )

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Criminal Sanctions versus Treatment
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Top 5 Predictors of Criminality

• Antisocial Values
• Antisocial Peers
• Poor self-control/self-management/ prosocial
  problem solving skills
• Family Problems
• Past Criminality

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Risk Factors for Violence
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Introduction to Values-Driven Evidence-Based
Practices in 3 minutes or less. . .

• No Consensus Definition of EBP
• Every Practice Wants to be an EBP
• Be Skeptical
• Become a Knowledgeable Consumer of EBP Information

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Introduction to Values-Driven Evidence-Based
Practices in 3 minutes or less. . .

• Defining Evidence Based Practices
• the integration of the best research evidence
  with clinical expertise and patient values
  (Institute of Medicine)

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Introduction to Values-Driven Evidence-Based
Practices in 3 minutes or less. . . Selecting a
Practice

• Specific to local needs and goals
• Consistent with client/family (cultural) beliefs
  and values
• Endorsed, supported, valued by agency staff
• Cost to use
• Cost to learn
• Level of science

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Introduction to Values-Driven Evidence-Based
Practices in 3 minutes or less. . . Levels of
Evidence

• Effective-achieves child/family outcomes, based
  on controlled research (random assignment), with
  independent replication in usual care settings
• Efficacious-achieves child/family outcomes, based
  on controlled research (random assignment),
  independent replication in controlled settings
• Not effective- significant evidence of a null,
  negative, or harmful effect
• Promising-some positive research evidence,
  quasi-experimental, of success and/or expert
  consensus
• Emerging -recognizable as a distinct practice
  with face validity or common sense test

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Introduction to Values-Driven Evidence-Based
Practices in 3 minutes or less. . . Fidelity

• Adopting-Implementing with fidelity to the
  program principles and practices
• Most likely to result in outcomes similar to
  those reported in research
• Adapting-Applying the practice with adjustments
  from the prescribed program
• AdoptValidateAdaptEvaluate

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Evidence-based Practices with Strong Juvenile
Justice Outcomes

• Parent Training
• Family Therapy
• Cognitive Behavioral Therapy
• Mentoring
• Out-of-Home Care
• What Doesnt Work

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Evidence-based PracticesParent Training Programs

• Effective parent training practices for younger
  children (3-8 yrs), inc.but are not limited to
• Incredible Years
• Strengthening Families
• Positive Parenting Program (Triple P)
• Risk Factors Problematic Parenting Styles
  (permissive, inconsistent, harsh, coercive, low
  monitoring) early conduct problems early school
  failure

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Evidence-based PracticesParent Training Programs

• Incredible Years (Selected, Indicated)
  Videotape vignettes. Choose from multiple
  programs to train parents, teachers /or
  children.
• Triple P (Universal, Selected, Indicated)
  Includes several levels of intervention assoc.
  w/levels of risk.
• Strengthening Families (Selected,Indicated)
  Concurrent Parent Child Training, followed by
  Parent/Child Group. Specifically adapted to
  multiple ethnic populations. AOD outcomes.

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Evidence-based PracticesParent Training Programs

• Outcomes vary by practice but include
• Reduction of harsh critical parent beh.
• Increased use of positive parent beh. ie praise
• Increase in effective limit setting natural
  consequences, T.O., ignoring, etc.
• Increase in family problem solving
  communication
• Decreased child conduct probs, and increase
  positive child beh w/family.
• Decreased maternal depression.

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Evidence-based PracticesParent Training Programs

• Adolescent Transitions Program is a Promising
  Practice for youth 11-18 yrs
• School-based (Universal, Selected, Indicated)
• Twelve Group Four Family Meetings
• Social Learning Theory Skill Development
• Outcomes
• Reduces Negative Parent/Child Interaction
• Decreases Antisocial Behavior at School
• Reduces Smoking at 1 Yr Follow Up

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Evidence-based Practices Family Therapy

• There are several Effective family therapy
  practices for older children and adolescents
  including but are not limited to
• Multisystemic Family Therapy
• Functional Family Therapy
• Brief Strategic Therapy
• Multidimensional Family Therapy
• Risk Factors Familial hopelessness,
  negativity/blaming poor communication lack of
  warmth/bonding problematic parenting styles

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Evidence-based Practices Family Therapy

• Practices included strategies, in the context of
  family interaction, that
• Promote Hope Motivation
• Improve family skills in parenting,
  communication, problem solving, etc.
• Improve familys ability to meet the
  interpersonal needs of each member
• Outcomes vary some by practice but include
• Reduces youth recidivism, drug/ETOH use, violent
  behavior, family conflict.
• Improves family communication
• Improves parenting

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Evidence-based Practices Family Therapy

• Multisystemic Family Therapy Functional Family
  Therapy Extremely strong evidence. Blue Prints
  for violence prevention model program.
• Brief Strategic Family Therapy Multidimensional
  Family Therapy have stronger evidence with
  specific ethnically diverse populations and
  stronger AOD outcomes.

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Evidence-based Practices Cognitive Behavioral
Therapy

• Promising Practices
• Aggression Replacement Training (ART)
• Thinking for a Change
• Anger Management for Substance Abuse and Mental
  Health Clients
• Risk Factors Weak socialization, problem
  solving, self-regulation Antisocial /or
  limiting belief system Weak or absent personal,
  interpersonal and social-cognitive skills for
  pro-social behavior

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Evidence-based Practices Cognitive Behavioral
Therapy

• Aggression Replacement Training
• Skillstreaming
• Anger control training (Individually EFFECTIVE)
• Moral reasoning
• Thinking for a Change
• http//www.nicic.org/WebPage_220.htm
• Anger Management for Substance Abuse and Mental
  Health Clients
• San Francisco Treatment Research Center
• http//www.kap.samhsa.gov/products/manuals/pdfs/an
  ger1.pdf

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Evidence-based Practices Mentoring Programs

• Big Brothers Big Sisters (Selected Intervention)
  is a mentoring program established by research as
  effective.
• Children 6 yrs 18
• Risk Factors Early display of conduct, AOD and
  school problems

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Evidence-based Practices Mentoring Programs

• Big Brothers Big Sisters distinguishes itself
  from other mentoring programs by instituting a
  proven set programmatic components
• Orientation - Matching
• Volunteer Screening - Supervision
• Youth Assessment
• Outcomes 46 drug 20 ETOH use reduction 1/3
  less likely to hit superior academic
  performance improved family, peer relationships

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Evidence-based Practices Out-of-Home Care

• Multidimensional Treatment Foster Care is an
  Effective alternative to residential care
  Incarceration
• Targets Adolescents with Delinquency and their
  Families.
• Risk Factors Antisocial Peers, Problematic
  Parenting, Weak Social Skills, etc.

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Evidence-based Practices Out-of-Home Care

• Outcomes
• Fewer arrests (less than half the rate of the
  control group)
• Fewer days incarceration and group home placement
• Greater completion of treatment - fewer AWOLs
• Improved school performance
• Less hard drug use
• Improved emotional well being

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Evidence-based Practices Out-of-Home Care

• Youth is placed in a Therapeutic Foster Home
• One youth per home
• 24/7 support for foster parent and natural
  parents
• Youth receive weekly individual therapy with
  focus on developing effective
• Problem solving skills-Social skills-Emotional
  regulation skills
• Foster Parent and Team Meetings Weekly
• Parent Daily Report Child Behavior / Foster
  Parent Stress
• Parents attend weekly family therapy with focus
  on effective parenting and family management
• Public school, with daily monitoring of
  attendance and performance
• Strict Adherence to Roles Foster Parent, Care
  Manager, Individual Therapist, Family Therapist,
  Skills Trainer, Recruiter/Caller

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What Doesnt Work Ed Latessa PhD

• Good relationship with Offender Prime Goal
• Fostering Positive Self-regard
• Self-actualization thru self-discovery
• Medical Model Approaches
• Radical non-intervention
• Targeting low risk offenders
• Chemotherapies
• Punishing Smarter

• Talking Cures
• Non-directive client-centered approaches
• Psychoanalytic Approaches
• Increasing Cohesiveness
• Targeting non-crime producing needs
• Programs w/ intense group interaction w/o regard
  for personal responsibility
• Unstructured Rehab Programs

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Conclusions

• Assess Level of Risk Do not mix Youth of
  different Risk Levels
• Be Clear About Desired Outcomes -Target Criminal
  Behavior
• Prioritize Addressing Needs of Minority Youth
• Choose Practices with scientific support
  Effective, Efficacious, or Promising.
• Choose Practices that Address Local Priorities
  and Values
• Implement and Monitor Practices for Fidelity

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Bonus Slides!
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Finding EBPs

• Office of the Surgeon General
• http//www.surgeongeneral.gov/index.html
• Strengthening Americas Families (OJJDP CSAT)
• http//www.strengtheningfamilies.org
• SAMHSA Model Programs
• http//www.modelprograms.samhsa.gov
• A Roadmap to Mental Health Services for
  Transition
  Age Young Women A Research Review California
  Womens Mental Health Policy Council
• http//www.cimh.org/downloads/TAY_Final_Report_4-2
  1-05.pdf/
• National Institute of Mental Health
• http//www.nimh.nih.gov/publicat
• Promising Practices Network- Children, Families
  Communities
• http//www.promisingpractices.net

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Finding EBPs

• National Clearinghouse on Child Abuse and Neglect
  Information
• http//nccanch.acf.hhs.gov/
• The California Child Welfare Clearinghouse for
  Evidence-based Practice
• http//www.chadwickcenter.org/Clearinghouse.htm
• Evidence-Based Practices in Mental Health
  Services for Foster Youth California Institute
  for Mental Health
• http//www.cimh.org/downloads/Fostercaremanual.pdf
  
• National Clearinghouse on Child Abuse and Neglect
  Information
• http//nccanch.acf.hhs.gov/
• The California Child Welfare Clearinghouse for
  Evidence-based Practice
• http//www.chadwickcenter.org/Clearinghouse.htm
• SAMHSAs National Mental Health Information
  Center (Adult MH Toolkits)
• http//www.mentalhealth.org/cmhs/communitysupport/
  toolkits/
• The Guide to Community Preventive Services
  Systematic Reviews and Evidence-Based
  Recommendations (Public Health Resources)
• http//www.the communityguide.org/