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Crime, Violence and Managing Client and Public Safety

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Title: Crime, Violence and Managing Client and Public Safety


1
Crime, Violence and Managing Client and Public
Safety
  • Michael L. Dennis, Ph.D.,
  • Chestnut Health Systems, Bloomington, IL
  • Part of the continuing education workshop,
    Advancing the Field of Adolescent Substance
    Abuse Treatment, Hamden, CT, April 22, 2005.
    Sponsored by the Department of Children and
    Families Substance Abuse Division. The content of
    this presentations are based on treatment
    research funded by the Center for Substance Abuse
    Treatment (CSAT), Substance Abuse and Mental
    Health Services Administration (SAMHSA) under
    contract 270-2003-00006 using data provided by
    the CYT and AMT grantees (TI11320, TI11324,
    TI11317, TI11321, TI11323, TI11874, TI11424,
    TI11894, TI11871, TI11433, TI11423, TI11432,
    TI11422, TI11892, TI11888). The meta analysis of
    juvenile offender intervention data was adapted
    from an earlier presentation by Mark Lipsey with
    his permission. The opinions are those of the
    author and do not reflect official positions of
    the consortium or government. Available on line
    at www.chestnut.org/LI/Posters or by contacting
    Joan Unsicker at 720 West Chestnut, Bloomington,
    IL 61701, phone (309) 827-6026, fax (309)
    829-4661, e-Mail junsicker_at_Chestnut.Org

2
Goals of this Presentation
  • To summarize the need for measuring substance
    use, crime and violence and its correlates
  • To examine the utility of the GAINs Substance
    Problem for assessing the risk of relapse and
    recidivism
  • To summarize the results of meta analyses of
    effective programs for juvenile offenders by
    Lipsey and colleagues

3
Adolescent Present with a Broad Range of Past
Year Illegal Activity and Violence
100
95
93
93
86
85
90
82
81
81
80
78
74
80
71
69
68
65
70
60
50
40
30
20
10
0
OP/IOP (n560)
LTR (n390)
STR (n594)
Any illegal activity
Property crimes
Interpersonal crimes
Drug related crimes
Acts of physical violence
Source Adolescent Treatment Model (ATM) data
4
Substance Abuse Treatment (particularly
residential) Reduces Illegal Activity
60
STR\t,s,ts
LTR\t,ts
50
OP\s
40
Intake
3
6
9
12
Months from Intake
\a Source Adolescent Treatment Model (ATM)
data Levels of care coded as Long Term
Residential (LTR, n390), Short Term Residential
(STR, n594), Outpatient/Intensive and Outpatient
(OP/IOP, n560). T scores are normalized on the
ATM outpatient intake mean and standard
deviation. Significance (plt.05) marked as \t for
time effect, \s for site effect, and \ts for time
x site effect.
5
Background
  • Substance use and crime are inter-related.
  • Self-report method is valid and useful for
    predicting treatment placement, relapse and
    recidivism.
  • Typically, substance use measures have been used
    to predict placement and relapse, while
    criminological measures have been used to predict
    recidivism.
  • This is one of the first adolescent studies to
    look at the ability of substance use and
    criminological measures combined to predict
    placement, relapse, and recidivism in the same
    population or study.

6
Location of CYT/ATM Treatment Sites
  • Adolescent Treatment
  • Model (ATM) Sites
  • Chestnut Health Systems, Bloomington, IL
  • Dynamite Youth, New York, NY
  • Four Corners Regional Adolescent Center/
    University of Oklahoma Shiprock, NM
  • Friends Institute/Epoch Counseling, Catonsville,
    MD
  • Mountain Manor, Baltimore, MD
  • Public Health Institute/Thunder Road, Oakland, CA
  • Rand Corp./Phoenix Academy/Group Homes, Santa
    Monica, CA
  • University. of Arizona/IMPACT, Phoenix, AZ
  • University of Arizona/La Cañada/7-Challenges/Drug
    Court, Tucson, Az
  • University of Miami/MDFT/The Village, Miami, FL
  • Cannabis Youth Treatment (CYT) Sites
  • Chestnut Health Systems, Madison County, IL
  • Childrens Hospital of Phil., Philadelphia, PA
  • Operation PAR, St. Petersburg, FL
  • Univ. of Conn. Health Center, Farmington, CT

Sponsored by Center for Substance Abuse
Treatment (CSAT), Substance Abuse and Mental
Health Services Administration (SAMHSA), U.S.
Department of Health and Human Services
7
Evaluation
  • Target Population Adolescents entering
    substance abuse treatment.
  • Inclusion Criteria 12 to 22 year old adolescents
    who present for substance abuse treatment and
    received at least 2 outpatient sessions or 1 week
    of residential treatment.
  • Data Sources Self-report measures of diagnosis
    and outcome collected with the Global Appraisal
    of Individual Needs (GAIN).
  • Participants 2007 adolescents recruited from 14
    sites around the U.S. and interviewed at 3, 6, 9
    and 12 months later (98 completed 1 plus
    interview 92 completed 12 month interview).

8
Intensity of Juvenile Justice System Involvement
Row
Low
Hi
Severity
0
10
20
30
40
50
60
70
80
90
100
Detention 14 days (n433)
Probation/parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data
9
Intensity by Level of Care
Row
Total
Step Down OP
Outpatient/IOP
Long Term Residential
Short Term Residential
0
10
20
30
40
50
60
70
80
90
100
Detention 14 days (n433)
Probation/ Parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data
10
Demographic Characteristics
Row
Source CYT ATM Data
11
Demographics by Intensity
Col
100
90
80
70
60
50
40
30
20
10
0
Female
Caucasian
African
Hispanic
Native
Other
American
American
Detention 14 days (n433)
Probation/parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data
12
Demographics by Intensity (continued)
Col
Detention 14 days (n433)
Probation/ Parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data
13
Substance Use Characteristics
Row
Source CYT ATM Data
14
Substance Use Disorder Diagnosis by Intensity
Col
Detention 14 days (n433)
Probation/ Parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data a\
Self report for past year
15
External Diagnoses by Intensity
Col
Detention 14 days (n433)
Probation/ Parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data
16
Internal Diagnoses/Problems by Intensity
Col
Detention 14 days (n433)
Probation/ Parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data \b n1838
because some sites did not ask trauma questions
17
Pattern of Co-occurring Disorders by Intensity
Col
Detention 14 days (n433)
Probation/ Parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data
18
Legal Characteristics
Row
Source CYT ATM Data
19
Crime/Other Problems by Intensity
Focus of JJ Detention
Col
Stress Can lead to higher rates of health problems
Also higher incidents of Running away
100
90
80
70
60
50
40
30
20
10
0
Detention 14 days (n433)
Probation/ Parole and urine monitoring 14 days
(n472)
Other detention, parole, or probation (n374)
Other current arrest or JJ status (n303)
Past arrest or JJ status (n170)
Past year illegal activity (n298)
Source CYT ATM Data
20
Substance Problem Scale (SPS)
  • The SPS (alpha.88) is a count of 16 past year
    symptoms based
  • on
  • three common screening questions (S9c-e),
  • two questions related to substance induced
    psychological or health disorders (S9f-g),
  • lay versions of the DSM-IV/ICD-9 criteria for
    substance abuse (S9h-m),
  • Lay versions of the DSM-IV/ICD-9 criteria for
    substance dependence (S9n-u).
  • The latter also forms the Substance Dependence
    Subscale (SDS
  • alpha.82). The SPS symptom count severity is
    triaged as Low
  • (0 past year symptoms), Moderate (1 to 9
    symptoms) or High (10
  • to 16 symptoms) severity.

21
  • S9. When was the last time that . . . (code 1 if
    past year, 0 if before or never)
  • c. you tried to hide that you were using
    alcohol or drugs?
  • d. your parents, family, partner, co-workers,
    classmates or friends complained about your
    alcohol or drug use?
  • e. you used alcohol or drugs weekly?
  • f. your alcohol or drug use caused you to feel
    depressed, nervous, suspicious, uninterested in
    things, reduced your sexual desire or caused
    other psychological problems?
  • g. your alcohol or drug use caused you to have
    numbness, tingling, shakes, blackouts, hepatitis,
    TB, sexually transmitted disease or any other
    health problems?
  • h. you kept using alcohol or drugs even though
    you knew it was keeping you from meeting your
    responsibilities at work, school, or home?
  • j. you used alcohol or drugs where it made the
    situation unsafe or dangerous for you, such as
    when you were driving a car, using a machine, or
    where you might have been forced into sex or
    hurt?
  • k. your alcohol or drug use caused you to have
    repeated problems with the law?
  • m. you kept using alcohol or drugs even after
    you knew it could get you into fights or other
    kinds of legal trouble?

22
  • Substance Dependence Scale (SDS alpha82) based
    on DSM-IV/ICD-9
  • S9. When was the last time that (code 1 if past
    year, 0 if prior to past year or never)
  • n. you needed more alcohol or drugs to get the
    same high or found that the same amount did not
    get you as high as it used to?
  • p. you had withdrawal problems from alcohol or
    drugs like shaking hands, throwing up, having
    trouble sitting still or sleeping, or that you
    used any alcohol or drugs to stop being sick or
    avoid withdrawal problems?
  • q. you used alcohol or drugs in larger amounts,
    more often or for a longer time than you meant
    to?
  • r. you were unable to cut down or stop using
    alcohol or drugs?
  • s. you spent a lot of time either getting
    alcohol or drugs, using alcohol or drugs, or
    feeling the effects of alcohol or drugs (high,
    sick)?
  • t. your use of alcohol or drugs caused you to
    give up, reduce or have problems at important
    activities at work, school, home or social
    events?
  • u. you kept using alcohol or drugs even after
    you knew it was causing or adding to medical,
    psychological or emotional problems you were
    having?

23
Crime and Violence Scale (CVS)
  • The CVS (alpha.90) is a count of 29 past year
    symptoms from two subscales
  • The General Conflict Tactic Subscale (GCTS
    alpha .88) - based on the National Family
    Violence Survey and work by Murray Strauss.
  • The General Crime Subscale (GCS alpha .86) -
    based on the National Household Survey on Drug
    Abuse lay terms for the Uniform Crime Report
    categories.
  • CVS symptom count severity is triaged as
  • Low (0 to 2 past year symptoms),
  • Moderate (3 to 6 symptoms), or
  • High (7 to 29 symptoms) severity.

24
  • The General Conflict Tactic Subscale (GCTS
    alpha.88) based on the
  • National Family Violence Survey and work by
    Murray Strauss.
  • E8. During the past 12 months, have you had a
    disagreement in which
  • you did the following things?
  • a. Discussed it calmly and settled the
    disagreement?
  • b. Left the room or area rather than argue?
  • c. Insulted, swore or cursed at someone?
  • d. Threatened to hit or throw something at
    another person
  • e. Actually threw something at someone?
  • g. Slapped another person?
  • h. Kicked, bit, or hit someone?
  • j. Hit or tried to hit anyone with something
    (an object)?
  • k. Beat up someone?
  • m. Threatened anyone with a knife or gun?
  • n. Actually used a knife or gun on another
    person?

25
  • General Crime Subscale (GCS alpha.86) based on
    the National Household Survey
  • on Drug Abuse lay terms for the Uniform Crime
    Report categories.
  • L3. During the past 12 months have you ..
  • a. purposely damaged or destroyed property
    that did not belong to you?
  • b. passed bad checks, forged (or altered) a
    prescription or took money from an employer?
  • c. taken something from a store without paying
    for it?
  • d. other than from a store, taken money or
    property that didnt belong to you?
  • e. broken into a house or building to steal
    something or just to look around?
  • f. taken a car that didnt belong to you?
  • g. used a weapon, force, or strong-arm methods
    to get money or things from a person?
  • h. hit someone or got into a physical fight?
  • j. hurt someone badly enough they needed
    bandages or a doctor?
  • k. used a knife or gun or some other thing
    (like a club) to get something from a person?
  • m. made someone have sex with you by force when
    they did not want to have sex?
  • n. been involved in the death or murder of
    another person (including accidents)?
  • p. intentionally set a building, car or other
    property on fire?
  • q. driven a vehicle while under the influence of
    alcohol or illegal drugs?
  • r. sold, distributed or helped to make illegal
    drugs?

26
Distribution of SPS by CVS Risk Groups
40
Percent of Total (n2007)
20
Crime and Violence Scale
Substance Problem Scale
0
High
High
Mod.
Mod.
Low
Low
Source CYT ATM Data
27
Validation of the SPS and CVS subgroups
  • Endorsement of each items and subscales increased
    with the shift from low to moderate to high.
  • For the Substance Problem Scale (SPS) severity
    subgroups
  • Shifting from low to moderate was associated with
    sharp increases in the screener questions (c-e),
    continued use in spite of getting into fights or
    legal problems (m), and time spent on
    getting/using/recovering from substance use (s).
  • Shifting from moderate to high was associated
    with more of the above and greater increases in
    the substance dependence and substance induced
    disorder symptoms.
  • For Crime/Violence Scale (CVS) severity
    subgroups
  • Shifting from low to moderate was associated with
    increased oral violence, property crime, and drug
    related crime.
  • Shifting from moderate to high was associated
    with even more of these things, as well as more
    physical violence and interpersonal (aka violent)
    crimes.
  • Next we looked at their predictive validity
    separately and together

28
Probability of Being Placed in Residential
Treatment at Intake
100
80
Crime/ Violence did not predict residential
placement
Probability of Residential Placement
60
40
20
Crime and Violence Scale
Substance Problem Scale
0
High
High
Mod.
Mod.
Low
Low
Source CYT ATM Data
29
Probability of Using at Month 12
100
(Intake) Crime/ Violence did not predict relapse
80
Probability of Using at Month 12
60
40
20
Crime and Violence Scale
Substance Problem Scale
0
High
High
Mod.
Mod.
Low
Low
Source CYT ATM Data
30
Subsequent Violence, Victimization, and Illegal
Activity (by self and others) is one of the Major
Environmental Predictors of Relapse
Baseline
Family
.32
.77
.18
Conflict
Recovery
Environment
-.54
-.13
Risk
.17
.58
.74
Family
.22
.32
-.09
Substance-
Cohesion
Substance
.43
Related
Use
.32
Problems
.82
.19
.11
Social
.19
-.08
.22
Social
Support
Baseline
Baseline
Risk
Model Fit CFI.97 to .99 RMSEA.04 to .06
.21
Baseline
Source Godley et al (2005)
31
Crime/Violence and Substance Problems Interact
to Predict Recidivism
Probability of 12 month recidivism
100
80
60
40
20
Crime and Violence Scale
Substance Problem Scale
0
High
High
Mod.
Mod.
Low
Low
Source CYT ATM Data
32
Discussion of SPS and CVS
  • The GAINs SPS and CVS scales appears to be face
    valid, internally consistent and to have good
    construct validity.
  • While placement in residential treatment focuses
    on substance use severity, CVS helps to predict
    relapse. This suggests the need to consider
    crime and violence more closely in placement
    decisions.
  • Conversely, SPS helps to predict recidivism.
    This suggests the potential benefits of screening
    for substance use problems in juvenile justice
    settings.
  • The next step is to combine these variables with
    other factors in a multivariate model.
  • We also need to replicate these findings,
    preferably with a sample not presenting for
    treatment and with urine and record checks.

33
The Effectiveness of Programs for Juvenile
Offenders

  • N of
  • Offender Sample Studies
  • Preadjudication (prevention) 178
  • Probation 216
  • Institutionalized 90
  • Aftercare 25
  • Total 509

Source Adapted from Lipsey, 1997, 2005
34
Most Programs are actually a mix of components
  • Average of 5.6 components distinguishable in
    program descriptions from research reports

Intensive supervision Prison visit Restitution Com
munity service Wilderness/Boot camp Tutoring Indiv
idual counseling Group counseling Family
counseling Parent counseling Recreation/sports Int
erpersonal skills
Anger management Mentoring Cognitive
behavioral Behavior modification Employment
training Vocational counseling Life
skills Provider training Casework Drug/alcohol
therapy Multimodal/individual Mediation
Source Adapted from Lipsey, 1997, 2005
35
Most programs have small effectsbut those
effects are not negligible
  • The median effect size (.09) represents a
    reduction of the recidivism rate from .50 to .46
  • Above that median, most of the programs reduce
    recidivism by 10 or more
  • The nothing works claim that rehabilitative
    programs for juvenile offenders are ineffective
    is false

Source Adapted from Lipsey, 1997, 2005
36
Some Programs Have Negative or No Effects on
recidivism
  • Scared Straight and similar shock incarceration
    program
  • Boot camps mixed had bad to no effect
  • Routine practice had no or little (d.07 or 6
    reduction in recidivism)
  • Similar effects for minority and white (not
    enough data to comment on males vs. females)
  • The common belief that treating anti-social
    juveniles in groups would lead to more
    iatrogenic effects appears to be false on
    average (i.e., relapse, violence, recidivism for
    groups is no worse then individual or family
    therapy)

Source Adapted from Lipsey, 1997, 2005
37
Some programs have large effects
  • One-fourth of the studies show recidivism
    reductions of 30 or more, that is, a recidivism
    rate of .35 or less for the treatment group
    compared to .50 for the control group
  • Features associated with Larger effects
  • Administered to higher risk juveniles
  • One of the more effective program types
  • Implemented well (Amount of service above the
    overall median and no indication of service
    delivery problems)
  • Juveniles were under proactive juvenile justice
    system supervision

Source Adapted from Lipsey, 1997, 2005
38
Program types with average or better effects on
recidivism
  • BETTER THAN AVERAGE AVERAGE OR BETTER
  • Preadjudication
  • Interpersonal skills training Drug/alcohol
    therapy
  • Parent training Employment/job training
  • Tutoring Group counseling
  • Probation
  • Cognitive-behavioral therapy Drug/alcohol
    therapy
  • Family counseling Interpersonal skills training
  • Mentoring Parent training
  • Tutoring
  • Institutionalized
  • Behavior management Family counseling
  • Cognitive-behavioral therapy Group counseling
  • Employment/job training
    Individual counseling
  • Interpersonal skills training

Source Adapted from Lipsey, 1997, 2005
39
Cognitive Behavioral Therapy (CBT) Interventions
that Typically do Better than Practice in
Reducing Recidivism (29 vs 40)
  • Aggression Replacement Training
  • Reasoning Rehabilitation
  • Moral Reconation Therapy
  • Thinking for a Change
  • Interpersonal Social Problem Solving
  • Multisystemic Therapy
  • Functional Family Therapy
  • Multidimensional Family Therapy
  • Adolescent Community Reinforcement Approach
  • MET/CBT combinations and Other manualized CBT
  • NOTE Generally little or no differences in mean
    effect size between these brand names

Source Adapted from Lipsey et al 2001, Waldron
et al, 2001, Dennis et al, 2004
40
Implementation is Essential (Reduction in
Recidivism from .50 Control Group Rate)
Thus one should optimally pick the strongest
intervention that one can implement well
Source Adapted from Lipsey, 1997, 2005
41
Impact of the numbers of Favorable features on
Recidivism
Source Adapted from Lipsey, 1997, 2005
42
Lipseys Conclusions
  • Research shows that intervention programs can be
    very effective for reducing the recidivism of
    juvenile offenders, even in routine practice
  • Program selection and strong implementation are
    critical otherwise effects quickly slide to zero
    (or worse)
  • What evidence we have about the effects of
    programs in routine practice indicates that most
    are not very effective there is plenty of room
    for improvement

43
Resources and References
  • Copy of these slides and handouts
  • http//www.chestnut.org/LI/Posters/
  • References cited
  • Dennis, M. L., Godley, S. H., Diamond, G., Tims,
    F. M., Babor, T., Donaldson, J., Liddle, H.,
    Titus, J. C., Kaminer, Y., Webb, C., Hamilton,
    N., Funk, R. (2004). The Cannabis Youth
    Treatment (CYT) Study Main Findings from Two
    Randomized Trials. Journal of Substance Abuse
    Treatment, 27, 197-213.
  • Dennis, M. L., Titus, J. C., White, M., Unsicker,
    J., Hodgkins, D. (2003). Global Appraisal of
    Individual Needs (GAIN) Administration guide for
    the GAIN and related measures. (Version 5 ed.).
    Bloomington, IL Chestnut Health Systems. Retrieve
    from http//www.chestnut.org/li/gain
  • Dennis, M.L., White, M.K. (2003). The
    effectiveness of adolescent substance abuse
    treatment a brief summary of studies through
    2001, (prepared for Drug Strategies adolescent
    treatment handbook). Bloomington, IL Chestnut
    Health Systems. On line Available at
    http//www.drugstrategies.org
  • Dennis, M. L. and White, M. K. (2004).
    Predicting residential placement, relapse, and
    recidivism among adolescents with the GAIN.
    Poster presentation for SAMHSA's Center for
    Substance Abuse Treatment (CSAT) Adolescent
    Treatment Grantee Meeting Feb 24 Baltimore,
    MD. 2004 Feb.
  • Godley, M. D., Kahn, J. H., Dennis, M. L.,
    Godley, S. H., Funk, R. R. (2005). The
    stability and impact of environmental factors on
    substance use and problems after adolescent
    outpatient treatment. Psychology of Addictive
    Behaviors.
  • Lipsey, M. W. (1997). What can you build with
    thousands of bricks? Musings on the cumulation of
    knowledge in program evaluation. New Directions
    for Evaluation, 76, 7-24.
  • Lipsey, M.W. (2005). What Works with Juvenile
    Offenders Translating Research into Practice.
    Adolescent Treatment Issues Conference, February
    28, Tampa, FL
  • Lipsey, M.W., Chapman, G.L., Landenberger, N.A.
    (2001).  Cognitive-Behavioral Programs for
    Offenders.  The ANNALS of the American Academy of
    Political and Social Science, 578(1), 144-157
  • Waldron, H. B., Slesnick, N., Brody, J. L.,
    Turner, C. W., Peterson, T. R. (2001).
    Treatment outcomes for adolescent substance abuse
    at four- and seven-month assessments. Journal of
    Consulting and Clinical Psychology, 69(5),
    802-812.
  • White, M. K., Funk, R., White, W., Dennis, M.
    (2003). Predicting violent behavior in adolescent
    cannabis users The GAIN-CVI. Offender Substance
    Abuse Report, 3(5), 67-69.
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