ERIC ED519241: Evidence-Based Interventions for Juvenile Offenders and Juvenile Justice Policies that Support Them. Social Policy Report. Volume 25, Number 1

2011·0.33 MB·English

by  ERIC

sharing child and youth development knowledge
volume 25, number 1
2011
Social Policy Report
Evidence-Based Interventions for
Juvenile Offenders and Juvenile Justice
Policies that Support Them
Scott W. Henggeler & Sonja K. Schoenwald
Family Services Research Center
Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
Abstract
I
n a context where more than 1,000,000 American adolescents are processed
by juvenile courts annually and approximately 160,000 are sent to residential
placements, this paper examines “what works” and “what doesn’t work” in
reducing the criminal behavior of juvenile offenders and presents examples
of government initiatives that have successfully promoted the adoption,
implementation, and sustainability of evidence-based interventions for juvenile
offenders. In general, the vast majority of current juvenile justice services has little
empirical support or exacerbates antisocial behavior. These include processing by
the juvenile justice system (e.g., probation), juvenile transfer laws, surveillance,
shock incarceration, and residential placements (e.g., boot camps, group homes,
incarceration). On the other hand, several effective treatment programs have
been validated in rigorous research. Effective programs address key risk factors
(e.g., improving family functioning, decreasing association with deviant peers),
are rehabilitative in nature, use behavioral interventions within the youth’s natural
environment, are well specified, and include intensive support for intervention fidelity.
Although only 5% of eligible high-risk offenders are treated with an evidence-based
intervention annually, inroads to the larger scale use of evidence-based treatments
have been made in recent years through federal (e.g., Office of Juvenile Justice and
Delinquency Prevention, Substance Abuse and Mental Health Services Administration)
and state (e.g., Washington, Ohio, Connecticut, Florida) policy initiatives. Based on
our experience transporting an evidence-based treatment within the context of these
initiatives, recommendations are made to facilitate stakeholder efforts to improve the
quality and effectiveness of rehabilitative services available to juvenile offenders.
Social Policy Report From the Editors
Volume 25, Number 1 | 2011
In this issue of Social Policy Report, Henggeler and Schoenwald succinctly
ISSN 1075-7031
www.srcd.org/spr.html summarize the research regarding what works—and what doesn’t—in treating
juvenile offenders. The list of ineffective interventions is disheartening,
Social Policy Report
is published four times a year by the particularly because of their common use. Yet the strong evidence in support
Society for Research in
of some community-based interventions such as multisystemic therapy (MST)
Child Development.
and the successful implementation of these interventions is suggestive of
Editorial Team a shift in policy and practice that supports positive outcomes for youth
Samuel L. Odom, Ph.D. (Lead editor)
offenders. Henggeler and Schoenwald use their experiences with MST to
[email protected]
explore important issues regarding the uptake of an evidence-based practice
Kelly L. Maxwell, Ph.D. (Issue editor)
[email protected] in a decision-making context that considers multiple factors, only one of
Donna Bryant, Ph.D. which is empirical evidence of effectiveness. They offer insightful guidance
[email protected]
about the complexities in establishing an intervention’s effectiveness,
implementing it with fidelity, and collaborating with various stakeholders to
Director of SRCD Office for bridge the science-practice gap.
Policy and Communications
Martha J. Zaslow, Ph.D. Peter Panzarella, an administrator from the Connecticut Department of
[email protected] Children and Families, describes the complexities in implementing evidence-based
practices at the state level and working with stakeholders from multiple service
Managing Editor
systems. Samantha Harvell notes in her commentary that the zeitgeist seems right
Amy D. Glaspie
[email protected] for expanding evidence-based practices in juvenile justice. With limited resources
and an increasing appreciation of evidence-based practices, policymakers at all
Governing Council
levels—federal, state, and local—are more closely examining interventions for
Greg Duncan Melanie Killen
juvenile offenders. Scott Henggeler and Sonja Schoenwald’s review of research
Arnold Sameroff Richard Lerner
Ann Masten Kenneth Rubin regarding evidence-based interventions will certainly inform those examinations
Nancy Hill Elizabeth Susman and discussions. Christopher Slobogin’s commentary provides a legal perspective
Oscar Barbarin Thomas Weisner
of juvenile justice issues and suggests that a major paradigm shift is needed
Patricia Bauer Susan Lenon, ex officio
Marc H. Bornstein Lonnie Sherrod, ex officio before community-based interventions will ever become used widely.
Jennie Grammer Martha J. Zaslow, ex officio Together, the article and commentaries provide a rich description of the
multi-layered issues regarding policies and practices for juvenile offenders. The
Policy and Communications Committee
Bonnie Leadbeater John Murray collective picture portrayed is both daunting and hopeful—daunting in the sense of
Barbara Fiese Sam Odom the immense challenges still faced in implementing evidence-based interventions for
Oscar Barbarin John Ogawa
juvenile offenders even when there is solid evidence of the effectiveness of particular
Brenda Jones Harden Cassandra Simmel
Anna Johnson Louisa Tarullo interventions over others, yet hopeful because of the success of interventions like
Tama Leventhal Martha J. Zaslow MST that have been implemented well in a variety of policy contexts through strong
Joseph Mahoney Lonnie Sherrod, ex officio
partnerships between researchers and policymakers.
Publications Committee
Ann Easterbrooks Anne Pick
Patricia Bauer Jonathan Santo — Kelly L. Maxwell (Issue Editor)
Margaret Burchinal Lonnie Sherrod Samuel L. Odom (Lead editor)
Noel Card Fons van de Vijver Donna Bryant (Editor)
Greg Duncan Karen Brakke, ex officio
Richard Lerner W. Andrew Collins, ex officio
Susan Goldin-Meadow Nancy Eisenberg, ex officio
Velma McBride Murry Jeffrey Lockman, ex officio
Social Policy Report V25 #1 2 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them
Evidence-Based Interventions for
Juvenile Offenders and
Juvenile Justice Policies that
Support Them
A
s Gendreau, Smith, and Theriault (2009) of youth referred to juvenile court were subsequently
contend, there is a general consensus waived to criminal court.
among research-oriented psychologists The most serious and costly outcome of a court
and criminologists about “what works” referral following arrest is residential placement (e.g.,
and “what doesn’t work” in reducing detention center, wilderness program, residential treat-
the criminal behavior of juvenile of- ment center, correctional institution, group home).
fenders. Yet this knowledge has had relatively little pen- Approximately 160,000 juvenile offenders were placed
etration into the general public, media, politicians, and in 2007 (Puzzanchera & Kang, 2010). National data on
policymakers. Indeed, Greenwood (2008) concluded that length of stay are not available for all juveniles in resi-
only about 5% of juvenile offenders have the opportunity dential placements, but the median length of stay for
to benefit from programs with proven effectiveness. youth placed by the juvenile justice system is about 4
This paper has two broad purposes. The first is to months (Snyder & Sickmund, 2006). Although length of
contrast those juvenile justice interventions and poli- stay varies with the seriousness of the offense in the ex-
cies that have been proven effective with those that pected direction, crimes against persons (e.g., robbery,
have not—and then to describe the likely bases of their assault) had been committed by about only 35% of placed
relative success or failure. The second purpose is to pres- offenders. In fact, about 20% of placed youth had com-
ent examples of federal and state initiatives that have mitted technical violations of probation or parole (e.g.,
successfully promoted the large-scale adoption, imple- not attending school, missing curfew, testing positive for
mentation, and sustainability of evidence-based inter- cannabis) or status offenses (e.g., ungovernability, run-
ventions for juvenile offenders. This work illustrates that ning away). Again, black youth were overrepresented in
collaboration among those who develop and implement correctional placements. Hispanic youth were also over-
such interventions and those who develop and implement represented in residential placements, at a rate lower
policy can help bridge the science-service gap. than blacks but higher than non-Hispanic whites.
Extent of Juvenile Arrests and What Works, What Doesn’t, and Why
Residential Placements The following summary is based on conclusions from sev-
Law enforcement agencies arrested 2,111,200 juveniles eral excellent comprehensive reviews published during
in 2008 (Puzzanchera, 2009). About 25% of the arrests the past decade. These include reviews commissioned by
pertained to violent (i.e., robbery, rape, aggravated the government such as the Blueprints for Violence Pre-
assault, murder, and manslaughter) or property (i.e., vention series (Elliott & Mihalic, 2004) and the Surgeon
burglary, larceny-theft, motor vehicle theft, and arson) General’s report on youth violence (U.S. Public Health
index offenses. Females comprised 30% of the arrested Service, 2001), volumes published by leaders in the field
population, and black youth were overrepresented in of delinquency and criminal justice (e.g., Greenwood,
juvenile arrests (Hispanic ethnicity was included in the 2006; Howell, 2003), journal reviews (e.g., Eyberg, Nel-
white racial category). Of the youth eligible for process- son, & Boggs, 2008), meta analyses (Drake, Aos, & Miller,
ing in the juvenile justice system due to their arrest, 66% 2009; Lipsey, 2009) as well as several more circumscribed
were referred to juvenile court and 10% were referred reviews of specific types of interventions and policies.
directly to criminal (adult) court. A small percentage
Social Policy Report V25 #1 3 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them
Ineffective Programs and Policies Surveillance. Surveillance includes probation and
parole, which can be intensive or not, and is implemented
Until the 1990s the conclusion that “nothing works”
by professionals within the juvenile justice system. Proba-
(e.g., Lipton, Martinson, & Wilks, 1975) was generally
tion and parole are practiced in virtually every jurisdic-
accurate—rigorous research had not supported a myriad
tion in the nation. Overall, current evidence is mixed
of rehabilitation efforts for juvenile offenders. Although
regarding the effects of probation and parole on juvenile
effective interventions have been developed and validat-
offending. For example, Drake et al. (2009) found no
ed during the past 20 years, it remains
average effect in their meta-analysis,
the case that the vast majority of cur-
whereas Lipsey (2009) found a slight
rent services utilized in the juvenile Although effective
favorable effect in his meta-analysis.
justice system have not proven effec-
interventions have In a qualitative review, Howell (2003)
tive or simply have not been evalu-
concluded that intensive supervision,
ated. Key examples follow.
been developed and
by itself, does not reduce reoffend-
Processing in the juvenile
ing but can be effective when linked
justice system. Following an arrest, validated during
with a therapeutic program. Though
several juvenile justice stakeholders
(e.g., juvenile court intake officer, the past 20 years, not clearly detrimental, in contrast
with other interventions and policies
district attorney, judge) can decide
it remains the case described in this section, surveillance
whether the youth should be of-
is included here because of its wide-
ficially processed through the court
that the vast majority
spread use and lack of strong empirical
system, released without referral for
support.
services, or diverted from the system of current services
Shock incarceration interven-
to a variety of community-based
utilized in the juvenile tions. Scared Straight is the best
services. Petrosino, Turpin-Petrosino,
known of the shock incarceration
and Guckenburg (2010) recently
justice system have
programs. Juvenile offenders are
completed a meta-analysis of 29
brought into adult prison and sup-
controlled studies comparing juvenile not proven effective or
posedly “scared” out of their delin-
justice processing with either release
without services or processing to a simply have not been quency through threats, bullying, and
intimidation by inmates. As detailed
diversion program (diversion programs
evaluated. in the aforementioned reviews (e.g.,
varied widely in the types of services
Drake et al., 2009; Greenwood, 2006;
offered). Overall, analyses showed
Howell, 2003), evaluations have shown
that juvenile court processing tended
that such interventions increase the criminal behavior of
to increase criminal behavior, especially when compared
juvenile offenders.
with diversion to community services.
Residential placement. As indicated previously,
Juvenile transfer laws. All states have mecha-
about 160,000 youth are placed annually in residential
nisms for handling juveniles in criminal court (Adams
facilities such as boot camps, group homes, detention
& Addie, 2010)—through prosecutor discretion laws,
centers, residential treatment centers, and wilderness
statutory exclusion laws for certain types of offenses,
camps. The primary intentions of most of these place-
and judicial waiver laws; and fewer than half of waived
ments are to provide an opportunity for rehabilitation
cases involve person offenses. Redding (2010) reviewed
and to protect community safety by removing the youth
six large-scale studies and all found that transfer to
from home. Residential placements, however, have failed
adult court was associated with higher recidivism rates
on both counts. Reporting on results from a large-scale
among juveniles convicted of person and property of-
survey of youth in residential placement, Sedlak and
fenses when contrasted with counterparts adjudicated
McPherson (2010) concluded that despite great needs,
in juvenile court. Thus, rather than acting as a deter-
mental health, substance abuse, and educational ser-
rent, transferring juveniles for trial and sentencing in
vices are deficient for many youth. Moreover, across the
adult criminal court had the unintended consequence of
comprehensive reviews cited previously, the authors have
increasing their criminal activity.
concluded that a wide variety of placement services for
Social Policy Report V25 #1 4 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them
juvenile offenders ultimately increase their criminal previously. Key features of these three models are dis-
activity, and do so at high social and economic cost. cussed next, and more complete descriptions and reviews
Such findings within the juvenile correctional system of corresponding research are provided by Henggeler and
are consistent with the negative effects of adult incar- Sheidow (in press).
ceration on reoffending (Nagin, Cullen, & Jonson, 2009) Functional family therapy. Functional family
as well as with findings for residential treatment of therapy (FFT; Alexander & Parsons, 1982) is a family- and
youth in the mental health system (U.S. Department of community-based treatment that was one of the first
Health and Human Services, 1999). Given that residen- evidence-based treatments developed in the field. Six
tial placements will continue to exist, albeit hopefully FFT outcome studies (four randomized clinical trials, and
limited to only the most serious juvenile offenders, a two quasi-experimental) have been published, with par-
pressing need exists to develop and validate institution- ticipants ranging in clinical severity from status offend-
based services or community-institution linked services ers to youth presenting serious antisocial behavior. Most
that better meet the needs of this very high-risk group of these evaluations demonstrated favorable decreases
of adolescents and their communities. in antisocial behavior for youths in the FFT conditions
In sum, a number of juvenile justice interventions (Henggeler & Sheidow, in press). During the past decade,
and policies that are intended to reduce the criminal FFT has become one of the most widely transported evi-
behavior of delinquents have had the unintended conse- dence-based family therapies, with 270 programs world-
quence of increasing youth antisocial behavior. As de- wide, treating more than 17,500 youth and their families
scribed subsequently, we regard such findings as a logical annually (http://www.fftinc.com). In FFT, the presenting
and expected outcome of the interplay between well- problem is viewed as a symptom of dysfunctional family
established risk factors for offending and the nature of relations. Interventions, therefore, aim to establish and
the interventions provided in the preceding services. maintain new patterns of family behavior to replace the
Before describing this perspective, however, several dysfunctional ones. In addition, FFT integrates behavioral
programs are presented that have proven effective in (e.g., communication training) and cognitive behavioral
reducing the criminal activity of juvenile offenders. interventions (e.g., assertiveness training, anger manage-
ment) into treatment protocols—though always maintain-
ing a relational focus. Central to the implementation of
Effective Programs
FFT is the phase-based nature of intervention protocols,
The Blueprints initiative (http://www.Colorado.edu/
with initial emphases on engaging and motivating family
cspv/blueprints/modelprograms.html) reviewed research
members, followed by extensive efforts at individual-
on 600 delinquency, drug, and violence prevention and
and family-level behavior change, and concluding with
intervention programs. Only 11 of these met the fol-
interventions to sustain such behavior change. FFT also
lowing criteria
has an intensive
for effective-
training and
ness: evalua-
tion through an Functional family therapy, multisystemic therapy, certification
protocol aimed at
experimental
and multidimensional treatment foster care were maintaining pro-
design, evidence
gram standards
of a significant
identified in the Blueprints initiative as effective
and therapist
deterrent ef-
adherence.
fect, successful interventions for juvenile offenders.
Multisys-
replication at
temic therapy.
multiple sites,
Multisystemic
and sustain-
therapy (MST; Henggeler, Schoenwald, Borduin, Rowland,
ability of favorable outcomes for at least a year. Of those
& Cunningham, 2009) is a community- and family-based
programs intervening with juvenile offenders, only three
treatment that focuses on youth with serious clini-
met these criteria—functional family therapy, multisys-
cal problems (e.g., violent juvenile offenders, juvenile
temic therapy, and multidimensional treatment foster
sexual offenders, substance abusing juvenile offenders,
care. These same intervention models are cited as effec-
and youth with serious emotional disturbance) at high
tive in virtually all of the comprehensive reviews noted
Social Policy Report V25 #1 5 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them
risk for out-of-home placement. MST is one of the most theory, which include behavioral principles (i.e., learning
extensively validated (i.e., consistent decreases in reoff- through overt reward and punishment) and the impact of
ending and residential placements) and widely transport- the natural social context on learning. As with MST and
ed evidence-based psychosocial treatments (Henggeler, FFT, many of the specific intervention techniques
in press). There are 21 published outcome studies (19 used in MTFC are derived from behavior therapy (e.g.,
randomized trials and two quasi-experimental studies), development of behavioral management plans) and cog-
the majority conducted with serious juvenile offenders nitive behavioral approaches (e.g., problem solving skills
and their families; and the intervention is delivered to training). Moreover, these interventions are implemented
more than 17,000 youth and families annually. Consistent within a social ecological framework that emphasizes the
with Bronfenbrenner’s theory of social ecology (1979), critical role of parental supervision and monitoring in
youth are viewed as nested within multiple systems (e.g., engaging the youth in prosocial peer activities, disengag-
family, peer, school, neighborhood) that have direct ing him or her from deviant peers, and promoting posi-
(e.g., parenting practices) and indirect (e.g., neighbor- tive school performance. Foster and biological parents
hood context affects parenting practices) influences are both intensively involved in implementing these
on behavior. This perspective fits well with research on treatment elements. Importantly, these emphases have
the development of conduct problems, where antisocial been supported by mechanism of change research (Eddy
behavior is viewed as multidetermined (Liberman, 2008). & Chamberlain, 2000; Leve & Chamberlain, 2007) show-
Similarly, MST interventions are comprehensive and flex- ing that MTFC effects on youth antisocial behavior were
ible—with the capacity to address pertinent factors at the mediated by improved foster parent supervision and
individual (e.g., cognitive biases), family (e.g., affective discipline, decreased association with deviant peers, and
and instrumental relations), peer (e.g., prosocial versus increased completion of school work. MTFC also includes
antisocial nature of peer associations), school (e.g., aca- extensive consultation and technical assistance to sustain
demic performance), and community (e.g., availability of program fidelity.
prosocial activities for youth) levels. Importantly, mecha-
nism of change research from several MST clinical trials Bases of Success and Failure
(Henggeler, in press) has supported the roles of improved
The commonalities of effective programs in contrast with
family functioning and decreased association with devi-
the commonalities of ineffective programs and policies
ant peers in producing favorable outcomes for juvenile
provide a useful framework in understanding the bases of
offenders. In addition, MST has an intensive quality
success and failure of juvenile justice programs.
assurance and improvement system to sustain program
Effective programs specifically address key risk
standards and treatment fidelity, and numerous aspects
factors. Decades of correlational, longitudinal, and
of this system have been validated (Schoenwald, 2008),
experimental research have built a strong case for a
including the link between therapist treatment fidelity
multidetermined ecological conceptualization of juve-
and desired youth and family outcomes.
nile offending. Several comprehensive reviews (e.g.,
Multidimensional treatment foster care. Multidi-
Howell, 2003; Liberman, 2008; Loeber, Burke, & Pardini,
mensional treatment foster care (MTFC; Chamberlain,
2009) have summarized findings that support a relatively
2003) was developed to provide a community-based
consistent array of individual, family, peer, school, and
foster care alternative to state detention and group care
neighborhood constructs as risk factors for antisocial
facilities, particularly for cases in which other intensive
behavior. The evidence-based treatments discussed
in-home and out-of-home services have failed. Seven
previously take full advantage of this research—focusing
research trials (five randomized and two quasi-exper-
their interventions on key aspects of the youth’s social
imental) have evaluated MTFC for youth with serious
ecology, such as building more effective family function-
antisocial behavior who cannot be maintained in their
ing, disengaging youth from deviant peer networks, and
home, and several adaptations have been examined
enhancing youth school performance. On the other hand,
for youth presenting other types of challenging clinical
ineffective programs and policies largely ignore these
problems. MTFC programs have been transported to more
risk factors (e.g., minimal attention to building family
than 50 sites in the U.S. and internationally (http://www.
competency) or, worse, provide services that directly
mtfc.com), treating about 1,300 youths and families an-
conflict with risk factor research. For example, aggre-
nually. MTFC is based on the principles of social learning
Social Policy Report V25 #1 6 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them
gating antisocial youth together for extended periods of • Target known risk factors for offending: Such is a
time, as is common in most of the aforementioned juve- clear focus of FFT, MST, and MTFC, and as noted
nile justice interventions, provides ample opportunity for previously in the descriptions of these models,
peer contagion and deviancy training (e.g., modeling and mechanism of change research has verified the
rewarding of deviant behavior by peers; Dodge, Dishion, value of this focus.
& Lansford, 2006). • Interventions should be behavioral in nature:
Effective programs are rehabilitative in nature MTFC is explicitly behavioral, and MST and FFT
and use behavioral intervention techniques within the include behavioral techniques within a broader
youth’s natural environment. FFT, MST, and MTFC each systems-theory conceptual framework.
use behavioral and cognitive behavioral intervention • Interventions should be individualized to the
techniques, though often within a systemic conceptual strengths and weaknesses of the offender. The
framework, to improve the functioning of the youth and evidence-based treatments follow this principle
family members. In addition, these treatment models are and take it one step further—interventions are
specifically community-based, with practitioners aiming also individualized to the strengths and weak-
to ameliorate identified problems where they occur—in nesses of the key systems in which the youth is
home, neighborhood, and school settings. In contrast, embedded.
ineffective services typically deliver interventions outside • Interventions should be delivered mainly to
the youth’s natural environment—in residential facilities, high-risk offenders. MTFC and MST are specifi-
probation offices, prisons, courts, and so forth. Although cally designed and validated as alternatives to
these interventions might be behavioral in nature (e.g., residential placement, and FFT is often provided
cognitive behavioral therapy provided by residential ther- to repeat offenders.
apist), they fail to fully consider the real world context to Purely quantitative analyses have generally drawn
which the youth will return. similar conclusions. For example, Lipsey (2009) concluded
Effective programs are well specified and in- that three factors emerged from his meta-analysis as
clude intensive support for intervention fidelity. In a major correlates of program effectiveness: a therapeutic
field where “nothing works” was a longstanding conclu- intervention philosophy, serving high risk offenders, and
sion, the purveyors of the effective programs have been the quality of implementation. The first two of these fac-
determined to sustain the quality and effectiveness of tors are similar to those noted above, and, as also noted
their treatments as transported to community settings. previously; the three family-based models place tremen-
Intervention, training, and quality assurance manuals and dous emphasis on providing the types of training and
protocols are well specified, and therapist and program ongoing quality assurance needed to sustain the fidelity of
performance are routinely monitored for fidelity of program standards and therapist adherence.
implementation, youth outcomes, and corrective action if Lipsey draws a conclusion, however, with which
necessary. Although the interventions provided by ineffec- we disagree—that treatment programs can be effec-
tive programs delivered in juvenile justice contexts might tive within institutional environments. In no case has an
also be manualized, such specification is not necessarily institution-based program proven more effective than
useful in the absence of supportive research. a community-based program in a rigorous evaluation.
Indeed, Magellan Health Services (2008) recently provided
How Do These Bases of Success Fit with the a compelling case for minimizing the use of residential
Conclusions of Other Reviewers? programs for youth: (a) clinical gains between admission
Several reviewers have used qualitative and quantitative and discharge are often not sustained when youth return
methods to delineate the central features of effective to the real world; (b) many youth in residential treatment
versus ineffective programs for juvenile offenders. As de- show serious adverse effects, perhaps linked with their
scribed by Howell (2003), perhaps the most influential has intensive exposure to disturbed peers (Dodge, 2008);
been the work of Canadian researchers—Andrews, Bonta, and (c) residential programs are much more costly than
Gendreau, and Ross with their American colleagues Cullen community-based counterparts.
and Latessa. These investigators have concluded that ef- In sum, the nature of effective services for juvenile
fective programs follow four general principles. offenders is relatively well established and these contrast
considerably with the status quo of the vast majority of
Social Policy Report V25 #1 7 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them
services provided to juvenile offenders across the ed into knowledge, products, or services that are made
nation. Indeed, together, the evidence-based treatment accessible in the marketplace.
programs serve about 35,000 youth and families annually, Some have suggested the influence of science in
about 30,000 of whom reside in the U.S. Based on statis- different realms of policy-making can be accounted for
tics from MST Services (http://www.mstservices.com), in part by the extent to which the practices of an indus-
the MST purveyor organization, about 50% of referrals to try rely on empiricism. For example, Biglan and Taylor
MST programs are from juvenile justice. A similar per- (2000) identified the influence of empirical evidence on
centage applies to FFT (James Alexander, personal com- policymakers as a factor contributing to the favorable
munication, November 2, 2010), and a slightly smaller effectiveness of efforts to reduce tobacco use relative to
percentage to MTFC (Patti Chamber- those directed toward reducing violent
lain, personal communication, No- crime. Efforts to control tobacco use
vember 2, 2010). Thus, about 15,000 emerged in the public health field,
youth in the juvenile justice system … fewer than 5% which has a history of basing its
are treated with an evidence-based practices on empirical evidence; and
of eligible high-risk
treatment annually. If 160,000 juve- political leaders often defer to health
nile justice youth are placed annually care professionals when formulating
juvenile offenders in
(Puzzanchera & Kang, 2010) and we public policy relevant to health.
assume that an equal number are at the U.S. are treated In contrast, the agencies man-
high risk of placement, then fewer dated to do something about antiso-
than 5% of eligible high-risk juvenile with an evidence- cial behavior may or may not have an
offenders in the U.S. are treated with empirical tradition. Crime control pol-
based treatment
an evidence-based treatment annual- icies are often set by elected officials
ly. As discussed next, however, inroads annually. without training in empirical methods
to the larger scale use of evidence- or a command of the evidence related
based treatments have been made in to crime control. Thus, although scien-
recent years by virtue of both federal tific evidence that a prevention or
and state policy initiatives within and intervention program has demonstrat-
outside of the juvenile justice sector, some of which ex- ed meaningful effects on crime may be one valuable coin
plicitly called for the use of evidence-based interventions of the juvenile justice policy-making realm, it is not the
and others that did not. coin for at least two reasons: (1) other powerful drivers
of decision-making are likely to remain in play even as
Interfaces of Policy and Evidence-Based evidence is introduced; and (2) the bearers of evidence
Intervention Promulgation: may not be adept at making the evidence relevant to
Multisystemic Therapy as an Example decision makers and stakeholders who are not trained in
Observers of public policy often note that the role of empirical methods (Melton, 1997; Morris, 2000).
scientific evidence is often limited in the development of Accordingly, to better align juvenile justice policy
public policy. This should not be surprising, given differ- and effective interventions, those who generate the evi-
ences in the epistemology of policy-making and science dence need to better understand the context and modus
(Hoagwood, 2010). Policy decisions, which often affect operandi of those who will hopefully use it. How policy-
sizeable proportions of a population, are driven by politi- makers and system administrators become aware of and
cal values and agendas, influenced by both irrational and use research results in decision-making, and why some
rational factors and by the benefactors of the status quo, organizations are more effective than others at broker-
and can change quickly as agendas and coalitions shift ing research for policy and practice purposes are topics
(Melton, 1997; Morris, 2000). Science values the applica- of interest to both federal and philanthropic research
tion of rational methods to derive reliable and valid funding organizations such as the W.T. Grant Foundation
answers to specific questions, is inherently slower and (2010). Similarly, the academic discipline of policy re-
more conservative than policy-making, and rarely has a search focuses explicitly on the uptake, implementation,
large effect on the public until it is proactively translat- and impact of specific policies (for example, the impact
of Medicaid waivers on access, quality, and cost of health
Social Policy Report V25 #1 8 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them
or mental health care). To our knowledge, such research distinct entities relate primarily to securing the safety of
has not been conducted on the impact of federal and the community and deterring juveniles from future illegal
state juvenile justice policies on the availability of acts. The goals of evidence-based interventions typi-
evidence-based interventions to youth and families, nor cally pertain to the attenuation if not amelioration of the
on the extent to which the policies have been informed behavioral, emotional, and functional problems of youth
by evidence. Unfortunately, such a review is also beyond with or at high risk of developing a particular disorder or
the scope of this paper. configuration of clinical problems. To the extent an
There are, however, several resources that docu- intervention can be shown empirically to deter youth
ment federal and state legislative, policy, and regulatory from future criminal acts, it can serve both juvenile
activity related to juvenile justice. For example, the justice system and individual health goals.
National Juvenile Justice Network (NJJN, 2010a; This simultaneous conferral of both individual and
http://www.njjn.org) monitors state juvenile justice public benefit is a hallmark of public health goals and the
legislation. Our review for this paper of the NJJN inven- strategies used to achieve those goals. A public health
tory of legislation enacted between 2005–2010 reveals perspective assumes that both a specific target popula-
considerable activities, some focused specifically on tion and the general population benefit from a treatment
reducing incarceration and out-of-home placement of for the target population. This perspective has informed
youth, some on increasing the availability of community- the strategies used to transport MST. The public health
based services for such youth, and a very few on increas- benefits demonstrated in randomized trials of MST were
ing the availability of empirically-supported interven- significantly decreased recidivism and thereby increased
tions for such youth. In addition, at least two recent community safety, and decreased out-of-home place-
policy developments at the federal level may establish a ments and costs. The demonstrated benefits of MST to the
context for a more scientific approach to the treatment youth and families served included keeping the youth at
of youth in the juvenile justice system: the Juvenile home while reducing the symptoms and behavior prob-
Justice and Delinquency Prevention Reauthorization Act lems that invited trouble with the law. Although we have
as well as administration policies designed to extend the not empirically evaluated the extent to which making
concept of comparative effectiveness—and associated explicit both the individual (youth and family) and public
funding priorities—beyond the realm of health care to benefit of MST has contributed to its demand, research on
other educational and social programs (Lewis, 2010). public health campaigns suggests this might be the case.
The remaining sections of this paper provide Specifically, the success of social marketing strategies de-
examples from the transport and implementation of signed to influence a variety of health behaviors indicates
MST that illustrate the impact state and federal policies that tailoring information and activities about an innova-
can have on the uptake, implementation, and sustain- tion to the interests, attitudes, and beliefs of the distinct
ability of evidence-based interventions. We consider groups of potential consumers can improve the uptake of
implications of this experience for the development of the innovation (Andreasen, 1995; Grier & Brant, 2005).
dissemination and implementation strategies that are A reasonable inference from social marketing
sufficiently robust and flexible to detect and address research is that the benefit of an intervention that mat-
policy-related barriers to the adoption and implementa- ters most to distinct groups of end-users—the youth and
tion of evidence-based practices for youth. family, each agency in the juvenile justice system (courts,
prosecution, defense, probation, corrections) and pay-
ers—likely varies, and empirical evidence about the
Evidence-Based Interventions and Juvenile Justice Goals
effects of the intervention should address these distinct
Policy development and enactment occurs and interacts
interests. In addition, experts in criminology (Cullen,
at multiple levels of the geopolitical context—federal,
Myer, & Latessa, 2009) predict that evidence of lasting
state, regional, county, and municipal. Within each
treatment effects and cost effectiveness or savings will
of these realms the term “juvenile justice system”
become increasingly necessary in corrections policy and
subsumes distinct agencies that have different func-
industry as state budget deficits and the adult corrections
tions—police, prosecuting attorneys, defense attorneys,
population simultaneously increase. If, however, the first
judges, probation and corrections. The overarching
evidence of effectiveness appears so far out on the time
goals of the juvenile justice system comprised of these
horizon that current stakeholders and their constituents
Social Policy Report V25 #1 9 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them
may not experience the benefit, political will and empirically evaluated this proposition. The final section
practical constraints will likely reduce interest in uptake of this paper describes the variation in states’ approaches
(McCarthy & Kerman, 2010). to expanding the use of MST, including variations in the
It seems reasonable to suggest, then, that to centralization of their efforts (Schoenwald, 2010.)
increase the use of evidence and evidence-based inter-
ventions in juvenile justice, prevention and treatment Match and Mismatch of Intervention and Policy
researchers would do well to proclaim: (1) the extent Laws and the regulations that emanate from them can
to which interventions convey one or more concrete be used to provide at least a “floor” and “ceiling” for
public health benefits (e.g., decreased truancy rates at local and individual variations in a practice (Ferlie &
a school, increased community safety, decreased cost Shortell, 2001) and are among mechanisms used to sup-
to taxpayer); (2) the expected duration of intervention port public health strategies (Thornicroft & Tansella,
effects; and (3) cost-related implications (e.g., effec- 1999). Mandates can, for example, terminate funding for
tiveness, savings benefit). If the data necessary to do demonstrably ineffective programs like boot camps for
so are not available from efficacy or effectiveness trials juvenile offenders. Conversely—with or without changes
of the intervention, then a first step in the transport in law—policies, regulations and budgetary actions often
process is to seek out and collaborate affect clinical practices. In our experi-
with stakeholders willing to attempt ence, legal mandates, regulations, and
an implementation to generate such To the extent policies affect MST implementation
data. In this way, researchers and and outcomes through their impact on
policymakers together begin to build evidence-based service parameters, service funding,
the evidence base about the public the definition of the target population
interventions are cost
health benefit and cost implications of eligible for service, and the time and
an intervention. We have had the good scale on which services are enacted.
effective, they should
fortune of engaging in this kind of Service parameters. Some ex-
collaboration with states interested in increasingly be amples of service parameters affecting
variants of MST for target populations implementation are: personnel allowed
with which it had not previously been among solutions to to deliver the service (physicians,
tested (Rowland et al., 2005; Schoen- licensed social workers, etc.); medi-
government budget
wald, 2010). cal necessity criteria governing client
Finally, adjudicated youth are problems eligibility for the service; require-
typically in the legal if not also physi- ments regarding treatment session
cal custody of the juvenile justice (Cullen et al., 2009). duration, frequency, and participants;
system. The system’s legal mandate to and length of the treatment episode.
serve these youth is extremely costly, Sources of such requirements include
because “service” often consists of referral, funding, and collateral agen-
incarceration, residential treatment, and other out-of- cies. For example, even when a referring juvenile justice
home placements. Tight state and county budgets can agency and Medicaid payer endorse the short duration
motivate cost-cutting solutions. To the extent evidence- (4-5 months) of MST, a judge or probation chief may
based interventions are cost effective, they should require a youth to stay in treatment for a year-long term
increasingly be among solutions to government budget of probation—a major aberration of MST protocols.
problems (Cullen et al., 2009). Although the fragmenta- Funding. Legal mandates activated in the absence
tion of treatment financing in health and mental health of sufficient resources to implement a treatment can cor-
care also characterizes to some degree treatment within rupt its implementation and sustainability. Four funding
juvenile justice systems (Cartwright, Kitsantas, & Rose, issues seem critical to policies designed to support the
2009), the relatively greater central authority and legal import and implementation of evidence-based treatments
accountability for youth in juvenile justice custody like MST. (1) If it is more profitable for a local provider
could facilitate more rapid uptake and greater reach of organization to deliver a treatment of unknown effec-
evidence-based interventions once an initial implemen- tiveness (e.g., residential treatment) to a specific target
tation is successfully sustained, although we have not
Social Policy Report V25 #1 10 Evidence-Based Interventions for Juvenile Offenders
and Juvenile Justice Policies that Support Them