Intensive Supervision Program (ISP) Multisystemic Therapy in WA Juvenile Justice

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Intensive Supervision Program
(ISP)Multisystemic Therapy in WA Juvenile
Justice
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Causal Models of Delinquency Drug Use
Condensed Longitudinal Model
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What is ISP?

• One of a number of new DoJ initiatives to reduce
  juvenile offending
• Intensive, community based approach to target
  known causes of juvenile offending
• Branch of JCS, based in community alongside CJS
  Mirrabooka, Cannington, Midland
• Each team consists of Supervisor, 3 Clinicians,
  Aboriginal Team Advisor.
• The ATA role is unique to MST but vital to the
  Australian model
• Based on Multisystemic Therapy (MST), data
  supports it as best treatment model for serious,
  repeat young offenders - Licensed by MST Services
  

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About ISP Target Group

• Young people aged 1017 who are engaged in JJ and
  meet all/some of the following
• Are at risk of placement in detention/remand due
  to delinquent behaviour
• Are returning to the community following
  placement in detention/remand
• Are placed on high end orders
• Have a history of chronic or violent offences
• Exhibit seriously disturbed anti social
  behaviours
• Known to engage in substance misuse

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About ISP Exclusionary Criteria

• No identified primary caregiver
• Young people in suicidal, psychotic or homicidal
  states
• Young people who engage exclusively in serious
  sexual offences
• Behaviour is more directly attributable to
  organic factors rather than environmental factors
  

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Issues faced by ISP Clients

• Sub-standard housing, no electricity or heating,
  lack of food, overcrowding, vandalism.
• Lack of positive male role models, drug
  use/selling, high debts, direct or vicarious
  violence.
• No phone or car in case of emergency.
• Removed from home community
• Young person and parents not in education or
  working.
• Intergenerational involvement with justice system
  

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About MST

• The program treats known causes of juvenile
  offending
• behaviour
• The program uses the strengths in all these
  systems
• to facilitate change

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Families As The Solution

• MST focuses on families as the solution.
• Families are full collaborators in treatment
  planning and delivery with a focus on family
  members as the long-term change agents.
• Giving up on families, or labeling them as
  resistant or unmotivated is not an option.
• MST has a strong track record of client
  engagement, retention, and satisfaction.

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About MST Aims

• Reduce offending and anti social behaviour
• Improve caregiver discipline practices
• Enhance family relationships
• Emphasis on parental empowerment
• Decrease youth association with deviant peers
• Increase youth association with pro social peers
• Improve youth school or vocational performance
• Develop a support network to help caregivers
  achieve and maintain changes
• Reduce substance misuse
• Target practical/welfare needs when presenting as
  barriers to intervention

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Researched MST Outcomes

• 25 70 lowering in recidivism in serious and
  violent young offenders at 1,2 and 4 year follow
  up
• Fewer arrests, fewer offences, and less detention
• Decreased behavioural problems at home and school
• Improved family relations and functioning
• Increased mainstream school attendance
• Excellent cross cultural validity
• Cost reductions Custody is significantly more
  expensive per child than the MST program.

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Research

• Henggeler, Rodick, Borduin, Hanson, Watson Urey
  (1986). Multisystemic treatment of juvenile
  offenders Effects on adolescent behaviour and
  family interactions. Developmental Psychology,
  22, 132-141.
• Results
• Conducted from 1978-1983 MST versus usual
  community services MST more effective in
  decreasing adolescent behavioural problems and
  improving family relations

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Research

• Brunk Henggeler Whelan (1987). A comparison of
  MST parent training in brief treatment of child
  abuse neglect. J of Consulting Clinical
  Psych, 55, 311-318.
• Results
• Randomly allocated families to home-based MST Vs
  parent training parents reported decreased
  psychiatiric symptomatology, reduced overall
  stress a reduction in the severity of
  identified problems observational measures
  favoured MST condition parents controlled their
  childrens behaviour more effectively, less
  passive noncompliance, parents more responsive

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Research

• Borduin, Henggler, Blaske Stein (1990).
  Multisystemic treatment of adolescent sexual
  offenders. International Journal of Offender
  Therapy and Comparative Criminology, 35, 105
  114.
• Results
• Randomly assigned to MST Vs office-based,
  individual, outpatient counseling (200 chronic
  juvenile offenders) self-report, other-report,
  family assessment sessions, recidivism at 4 yr
  follow up

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Research

• Continued
• Significantly fewer participants re-arrested for
  sexual crimes (1/8 Vs 6/8)
• Mean frequency of rearrest for nonsexual crimes
  also lower - MST (0.62) outpatient counseling
  (2.25)
• Family members who received MST reported
  increased family cohesion adaptability
• Observations indicated increased supportiveness
  decreased conflict-hostility
• Parents in MST showed greater reductions in
  psychiatric symptomatology

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About MST In Practice

• Low caseloads, 3-6 families per clinician, allows
  intensive service to be delivered (2-15 hrs each
  family per week)
• Treatment occurs daily to several times a week,
  with sessions decreasing as treatment progresses
• Treatment time limited, lasts 4-6 months, depends
  on seriousness of problems success of
  interventions
• Treatment delivered in families natural
  environment, including SCHOOL and other community
  places

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About MST In Practice

• Works with linked family issues (marital
  counselling, child management strategies)
• Clinicians are accountable for intervention
  activities
• Clinicians available 24-hours a day, 7 days
  flexible family friendly schedule
• Involves all relevant stakeholders
• Adheres to principles analytic process
• Uses CBT, Behaviour Therapy, pragmatic family
  therapy
• Quality assurance processes

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About MST Principles

• Primary purpose of assessment is to understand
  the fit between identified problems and their
  broader systemic context
• Therapeutic contacts emphasise the positive and
  use systemic strengths as levers for change
• Interventions are designed to promote responsible
  behaviour
• Interventions are present focused and action
  oriented, targeting specific and well-defined
  problems

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About MST Principles

• 5. Target sequences of behaviour
• 6. Interventions are developmentally appropriate
• 7. Interventions are designed to require daily or
  weekly effort by family members
• 8. Continuous evaluation from multiple
  perspectives
• 9. Promote treatment generalisation long-term
  maintenance of therapeutic change by empowering
  caregivers

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About MST Supervision Quality Assurance

• Principles
• Do Loop guides analysis to keep intervention
  systematic
• Weekly team supervision
• Weekly Supervisor consult with MST Services
• Weekly Team consult with MST Services
• Paperwork
• Client feedback (TAMS)
• Supervision feedback (SAMS)
• ATA feedback

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MST The Do-Loop
Referral Behaviour
Desired Outcomes Of Family and Other Key
Participants
Overarching Goals
MST Conceptualization Of Fit
Intermediary Goals
Assessment of Advances Barriers to Intervention
Effectiveness
Intervention Development
Intervention Implementation
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Examples of Referral Behaviours

• Primary reasons for referral to the ISP.
• Offending Behaviour aggravated burglary x 15
  also facing charges for fire lighting and
  assaulting a public officer
• Truancy mum reported that since son moved to
  fathers residence, he had been truanting and
  hadnt attended school fro five weeks.
• Misbehaviour at School The school reported that
  son often misbehaved in class, e.g., rude
  aggressive toward teachers, refused to work,
  climbed out of windows put no effort into his
  work.
• Aggressive Behaviours mum stated that son was
  regularly physically emotionally aggressive
  toward her brother, e.g., yelling, swearing,
  pushing, hitting, bullying, throwing objects,
  name calling intimidating.
• Substance Misuse son has admitted sniffing
  substances in the past. Also alcohol and cannabis
  daily. Occasional speed use.

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Examples of Concurrent Interventions

• Reducing aggression at home by increasing level
  and consistency of consequences by both parents
• Reducing substance misuse by increasing parental
  monitoring, reducing parental drug use and
  increasing engagement in pro-social activities
• Reducing offending by increasing contact with
  pro-social peer network.

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Examples of Overarching Goals

• Are specific, include key indicators of
  achievement are
• operationalised.
• 1. Reduce Aggressive Behaviours - son will reduce
  his aggressive behaviours (physical, verbal,
  intimidation) as evidenced by
• NO incidents of violence including NO yelling,
  swearing, hitting (with/without objects),
  pushing, threatening others, bullying, name
  calling, put downs, throwing things.
• NO new offences (in particular NO violence toward
  mum, brother, dad).
• Complying with parents requests without becoming
  aggressive.
• Not blaming others for his behaviour accepting
  responsibility for it.

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Examples of Overarching Goals

• 2. Improve Behaviour Performance at School son
  will improve his behaviour performance at
  school as evidenced by
• Attending school 5x per week unless sick
• NO truanting
• NO disruptive behaviour including NO talking out
  of turn, calling out to others, rushing work
  putting in no effort, being rude/aggressive to
  students (swearing, bullying) or teachers
  (backchatting), refusing to do work, getting
  detentions, climbing out of classrooms, or always
  getting out of his seat.

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Example of Conceptualisation of Fit

• Examines the fit of the behaviour in the
  environment looks
• at what drives the behaviour at various systems
  levels
• Individual
• Family
• Peer
• School
• Community
• - eliciting evidence for each.
• Problem behaviours are obtained from the
  overarching goals
• Example- sons truanting behaviours

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Example of Fit Circle
Parents unaware of the extent of Deans truanting
due to low communication with the school (family)
Dean able to access privileges at home when
truanting (family)
Deans Truancy
Dean dislikes attending certain classes as they
are too difficult for him (individual)
No serious consequences given at home (family)
Dean doesnt like catching the bus (individual)
Friends were frequently truanting displaying
antisocial behaviours (peers)
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Example of Intermediary Goals

• Intermediary goals are developed from the
  prioritised drivers.
• Prioritised Drivers
• 1. No serious consequences are given at home
  (family)
• 2. Parents unaware of the extent of sons
  truanting due to low communication with the
  school (family)
• 3. son dislikes attending certain classes as
  they are too difficult for him (school).
• Related Intermediary Goals
• Develop a behaviour management plan with dad and
  mum related to truancy (increasing parental
  alignment).
• dad and mum to increase their communication with
  the school by making an appointment to meet with
  the teachers.
• dad/mum to organise meeting with Deputy son to
  look at changing his subjects/using a teachers
  aide.

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Example of Developing Intervention

• Involve family, specific (who/ what/when/where)
  use MST principles.
• Driver No serious consequences given at home.
• IG Develop Behaviour Management Plan (BMP).
• parents to compile list of behaviours theyd like
  son to adhere to in/out of the home.
• Son to complete Reward List to determine which
  rewards/activities are most desirable/undesirable
  to him (to inform BMP).
• parents write rules for the BMP based on
  behaviours theyd like to see/not see using
  rewards/consequences from the list.
• Parents practice/Role play introducing BMP to
  son, preparing parents for likely negative
  reaction from him.
• Principles Action oriented, present focused,
  responsible behaviour, generalisation, daily
  effort.

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Example of Intervention Evaluation

• Some Advances
• parents met with the Deputy principal and sons 2
  teachers.
• School was able to change sons optional classes
  to those he liked, and tailored the work to suit
  his level
• mum phones school daily to check sons attendance
• parents began rewarding Dean for attending
  school.
• sons truancy decreased (during first week, only
  missed 3 classes).

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Variables of Evaluating ISP
Research Directions Evaluation

• Age
• Prior Education
• Family Function
• Drug Use Prior to Treatment
• Parental Forensic History
• Prior Accommodation
• Psych
• Parent/child Conflict
• Parental Monitoring
• Number of Offences
• Court Appearance
• Past legal involvement (eg orders, bond)

• Success in Achieving Overarching Goals
• Treatment Strategies
• ISP Hours Contact/Times contacted
• Offending During Treatment
• Offend Post 3 Month
• Drug Use Post Treatment
• Employ/training
• Improved Parenting/monitor