Multidimensional Assessment and Intervention for Drug Abusing Juvenile Offenders

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Multidimensional Assessment and Intervention for
Drug Abusing Juvenile Offenders

• Cynthia L. Rowe, Ph.D., Gayle A. Dakof, Ph.D.,
• Howard A. Liddle, Ed.D.
• Center for Treatment Research on Adolescent Drug
  Abuse
• University of Miami Miller School of Medicine

Presented at the American Psychological
Association Annual Convention Panel on Using
Assessment to Improve Drug Abuse Treatment for
Offender Populations Washington, DC August
21, 2005
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(No Transcript)
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Multiple Interacting Problems of Juvenile
Offenders

• Serious substance abuse 60 - 80 of
  incarcerated samples
• Violent offenses 70 of repeat offenders
• Co-occurring mental health problems 75 have a
  DSM disorder CD and SUD
• Family disruption, conflict, and chaos
• School problems 85 suspended/80 LD
• Negative peers/ gang involvement
• High-risk sexual behavior

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Antisocial Behavior Over Time

• Early childhood risk sets the stage
• Antisocial behavior compromises emotional and
  social development
• Long-term deficits across domains
• Assessment/intervention during adolescence may
  halt the progression of antisocial behavior

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Multiple Interacting Risk Factors

• Serious drug abuse and delinquency in
  adolescence is predicted by problems early in
  life
• Emotional reactivity, trauma, and loss
• Aggression/impulsivity
• Family disruption, violence and conflict
• Parenting deficits and psychopathology
• Peer rejection
• School failure and misbehavior

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Instead of helping, we are writing off these
young Americans, we are releasing them without
attending to their needs for substance abuse
treatment and other services, punishing them
without providing help to get back on
track. -- Joseph A. Califano, CASA, 2004
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Assessment and Intervention in the Juvenile
Justice System

• Youth screened at Juvenile Assessment Center
• Screening conducted to determine level of risk
• Youth at lowest risk placed in diversion
• Comprehensive assessments conducted with
  moderate and high risk youth to assist in
• Determining disposition/placement
• Treatment planning
• Determining level of probation supervision
• Tracking treatment outcomes

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DJJ System Challenges

• JACs and facilities overcrowded/understaffed
• Assessments not conducted with all teens at
  risk due to limited resources
• Assessments vary in quality and scope
• Validated instruments only recently being used
• Services for youth in JJ settings are limited
• Coordination/follow-through between JJ
  facilities and treatment programs is difficult
• Most drug abusing juvenile offenders dont
  receive the interventions they need

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Four of every five children and teen arrestees in
state juvenile justice systems have some
involvement with drugs and alcohol
Only 3.6 percent of these juvenile justice
involved youth receive any type of treatment
CASA 2004
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I have been there. I have witnessed the
deplorable conditions forced upon these young
people. The system must be changed to address
the needs of these juveniles and prevent them
from living a life crime and drug addiction.
- Charles W. Colson, Founder and Chairman of the
Board, Prison Fellowship, the world's largest
outreach to prisoners, ex-prisoners, crime
victims and their families.
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Multidimensional Assessment and Intervention

• Multifaceted problem requires multicomponent
  assessment and intervention strategy
• Families and other systems are primary
  contexts for development and change
• Effective interventions go beyond a
  unidimensional theory of change
• Multidimensional approaches address risk and
  protective factors within the individual teen,
  the family, peer network, and school, court,
  and other systems

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State-of-the-Art Assessment

• Multiple domains assessed criminal behavior,
  school, substance use, family, mental health,
  employment, peers, free time, services used
• Comprehensive, evidence-based instruments
  GAIN, CASI-A, MAYSI, WAJA, POSIT, PEI
• Scores on each scale indicate risk level based
  on national norms with a range of samples
• Assessment data used to determine targeted
  domains in treatment

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State-of-the-Art Intervention Multidimensional
Family Therapy

• Integrative family-based drug treatment
• Addresses multiple risk factors
• Multisystemic assessment intervention
• Flexibility in different service settings
• Well specified, adaptable protocols
• Now recognized as a Best Practice (NIDA,
  USDHHS, Drug Strategies, CSAT)

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MDFT Assessment and Intervention

• Problems
• are multidimensional

• Multidimensional problems
• require multidimensional
• conceptualizations

Parent(s)
MDFT
Adolescent
Family
Extrafamilial

• Multidimensional
• conceptualizations yield
• multi-systems interventions

• MDFT assesses and intervenes
• into multiple systems of
• development and influence

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Integrated Assessment and Intervention in MDFT

• MDFT assessment involves integrating data from
  multiple sources and perspectives
• Data from standard instruments
• Family interaction and behavior
• School and court records and reports
• Assessment of neighborhood/community
• Assessment is an ongoing process that continues
  to inform evolving treatment plan
• Assessment and intervention are seamless

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MDFT Cross-Systems with Drug Abusing Juveniles in
Detention

• Comprehensive assessment with youth immediately
  upon entry to detention
• Assessment guides treatment plan
• MDFT therapist intervenes with youth in detention
  and parents in their home
• Continue MDFT after release, building upon
  foundation established in detention
• Incorporate HIV/STD prevention
• Target multiple domains of functioning

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Summary and Conclusions

• Drug abusing juvenile offenders have multiple
  deficits - pose serious challenges to juvenile
  justice and treatment systems
• Youth at greatest risk for chronic problems have
  multiple risk factors early in life
• Comprehensive assessment and intervention are
  needed in the juvenile justice system
• MDFT uses an integrative, multi-component
  assessment and intervention strategy
• MDFT has significant potential as a cross-systems
  approach with this population

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Resources for Working with Drug Abusing Juvenile
Offenders

• Barnoski, R. (2002). Monitoring vital signs
  Integrating a standardized assessment into
  Washington States Juvenile Justice System. In R.
  Corrado et al. (Eds.), Multi-problem violent
  youth. IOS Press.
• CASA (2004). Criminal neglect Substance abuse,
  juvenile justice and the children left behind.
• Dennis, M. L. (1998). Global Appraisal of
  Individual Needs (GAIN) manual Administration,
  Scoring and Interpretation. Bloomington, Il
  Lighthouse Publications.
• Grisso, T. (1998). Forensic evaluation of
  juvenile offenders A manual for practice.
  Sarasota, FL. Professional Resource Press.
• Hoge, R., Andrews, D. (1996). Assessing the
  youthful offender Issues and techniques. New
  York Plenum Press.
• Liddle, H. (2002). Multidimensional Family
  Therapy Treatment (MDFT) for adolescent cannabis
  users. Volume 5 of the Cannabis Youth Treatment
  (CYT) manual series. Rockville, MD Center for
  Substance Abuse Treatment, Substance Abuse and
  Mental Health Services.
• Meyers, K., McLellan, A. T., Jaeger, J. L.,
  Pettinati, H. M. (1995). The development of the
  comprehensive addiction severity index for
  adolescents (CASI-A) An interview for assessing
  multiple problems of adolescents. Journal of
  Substance Abuse Treatment, 12, 181-193.
• NIDA (1999). Principles of Drug Addiction
  Treatment A research-based guide. (NIH
  publication 99-4180, pp.35-47). Rockville, MD.
• OJJDP (1995). Guide for implementing the
  comprehensive strategy for serious, violent, and
  chronic juvenile offenders. Washington, DC
  OJJDP.
• Rahdert, E. (ed.). (1991). The Adolescent
  Assessment/Referral System Manual. DHHS Pub. No.
  (ADM) 911735. Rockville, MD U.S. Department of
  Health and Human Services, NIDA.
• Winters, K. C. Henly, G. A. (1989). The
  Personal Experience Inventory Test and user's
  manual. Los Angeles, CA Western Psychological
  Services.

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Acknowledgements

• We gratefully acknowledge the National Institute
  on Drug Abuse for supporting this work through
  many grants, including the Criminal Justice Drug
  Abuse Treatment Studies (CJDATS Grant No. 5 U01
  DA16193 P50 DA H. Liddle, PI).
• We are also indebted to the many therapists and
  the teens and families who participated in
  studies to develop and test MDFT over the past 20
  years.
• Please see our website for more information on
  the Centers program of research
  www.miami.edu/ctrada or contact me at
  crowe_at_med.miami.edu for more details.