evidence-based practices juvenile justice & mental health webcast training october 25, 2005...
TRANSCRIPT
Evidence-based Practices Juvenile Justice & Mental Health
Webcast Training October 25, 2005
Presented by The California Institute for Mental Health
Bill Carter LCSW
Juvenile Justice & Mental HealthA Complicated Picture
• Prevalence of MH Disorders in Youth in the Juvenile Justice is extremely high compared to general population est. – 66% of Boys in JJ – 75% of Girls in JJ– 15% of General Population
• Mental Health Disorders* are weak risk factors for criminal behavior.
Juvenile Justice & Mental HealthA Complicated Picture
• Conclusions – – Do not treat Mental Health Disorders
(generally) with the primary goal of reducing criminal behavior.
– Do treat Mental Health Disorders to reduce suffering and promote health.
– Do treat Mental Health Disorders to enable youth to participate effectively programs that reduce criminality.
Disproportionate Minority Representation
• Two-Thirds Youth in confined in America are minority Youth. Minority Youth represent One-Third of the youth population.
• African-American Youth are 6x, Latino Youth 3x more likely to be incarcerated after arrest than White Youth.
• ’97-’98 African American Youth represented: – 15% of youth population– 26% of youth arrested– 31% of youth referred to juvenile court– 44% of youth detained
Disproportionate Minority Representation
• In California - Compared to white youths, minority youths are 2.8 times more likely to be arrested for a violent crime, 6.2 times more likely to wind up in adult court, and 7 times more likely to be sent to prison by adult court.
What Reduces Criminal Behavior?
• Not a single reviewer of studies of the effects of official punishment (custody, mandatory arrests, probation, increased surveillance, etc.) has found consistent evidence of reduced recidivism
• At least 40% and up to 60% of the studies of correctional treatment services reported reduced recidivism rates relative to various comparison conditions, in every published review
( Source: Edward Latessa PhD. Chair – Dept Criminology, University of Cincinnati )
Criminal Sanctions versus Treatment
Top 5 Predictors of Criminality
• Antisocial Values
• Antisocial Peers
• Poor self-control/self-management/ prosocial problem solving skills
• Family Problems
• Past Criminality
Risk Factors for Violence
Children Adolescents
Strong Risk Factors Strong Risk Factors General Offenses Weak Social Ties
Substance Abuse Antisocial/Delinq Peers
Gang Membership
Moderate Risk Factors Moderate Risk Factors
Being Male General Offenses
Low Family SES
Antisocial Parents
Aggression (Source: Youth Violence: A Report of the Surgeon General)
Introduction to Values-Driven Evidence-
Based Practices in 3 minutes or less. . .
• No Consensus Definition of EBP
• Every Practice Wants to be an EBP
• Be Skeptical
• Become a Knowledgeable Consumer of EBP Information
Introduction to Values-Driven Evidence-Based Practices in 3 minutes or less. . .
• Defining Evidence Based Practices
…the integration of the best research evidence with clinical expertise and patient values (Institute of Medicine)
Introduction to Values-Driven Evidence-Based Practices in 3 minutes or less. . .
Selecting a Practice
• Specific to local needs and goals• Consistent with client/family (cultural) beliefs
and values• Endorsed, supported, valued by agency staff• Cost to use• Cost to learn• Level of science
Introduction to Values-Driven Evidence-Based Practices in 3 minutes or less. . .
Levels of Evidence• Effective-achieves child/family outcomes, based on
controlled research (random assignment), with independent replication in usual care settings
• Efficacious-achieves child/family outcomes, based on controlled research (random assignment), independent replication in controlled settings
• Not effective- significant evidence of a null, negative, or harmful effect
• Promising-some positive research evidence, quasi-experimental, of success and/or expert consensus
• Emerging -recognizable as a distinct practice with “face” validity or common sense test
Introduction to Values-Driven Evidence-Based Practices in 3 minutes or less. . .
Fidelity• Adopting-Implementing with fidelity to
the program principles and practices– Most likely to result in outcomes similar to
those reported in research
• Adapting-Applying the practice with adjustments from the prescribed program
• Adopt—Validate—Adapt—Evaluate
Evidence-based Practices with Strong Juvenile Justice Outcomes
• Parent Training
• Family Therapy
• Cognitive Behavioral Therapy
• Mentoring
• Out-of-Home Care
• What Doesn’t Work
Evidence-based Practices
Parent Training Programs
• Effective parent training practices for younger children (3-8 yrs), inc.but are not limited to: – Incredible Years– Strengthening Families– Positive Parenting Program (Triple P)
• Risk Factors –Problematic Parenting Styles (permissive, inconsistent, harsh, coercive, low monitoring); early conduct problems; early school failure
Evidence-based Practices
Parent Training Programs• Incredible Years – (Selected, Indicated)
Videotape vignettes. Choose from multiple “programs” to train parents, teachers &/or children.
• Triple P – (Universal, Selected, Indicated) Includes several levels of intervention assoc. w/levels of risk.
• Strengthening Families – (Selected,Indicated) Concurrent Parent & Child Training, followed by Parent/Child Group. Specifically adapted to multiple ethnic populations. AOD outcomes.
Evidence-based Practices
Parent Training Programs
• Outcomes vary by practice but include: – Reduction of harsh & critical parent beh. – Increased use of positive parent beh. – ie praise– Increase in effective limit setting – natural
consequences, T.O., ignoring, etc. – Increase in family problem solving &
communication– Decreased child conduct probs, and increase
positive child beh w/family. – Decreased maternal depression.
Evidence-based Practices
Parent Training Programs
• Adolescent Transitions Program is a Promising Practice for youth 11-18 yrs
• School-based (Universal, Selected, Indicated)
• Twelve Group & Four Family Meetings• Social Learning Theory – Skill Development• Outcomes
– Reduces Negative Parent/Child Interaction– Decreases Antisocial Behavior at School– Reduces Smoking at 1 Yr Follow Up
Evidence-based Practices
Family Therapy
• There are several Effective family therapy practices for older children and adolescents including but are not limited to: – Multisystemic Family Therapy – Functional Family Therapy – Brief Strategic Therapy – Multidimensional Family Therapy
• Risk Factors – Familial hopelessness, negativity/blaming; poor communication; lack of warmth/bonding; problematic parenting styles
Evidence-based Practices
Family Therapy• Practices included strategies, in the context of
family interaction, that – Promote Hope & Motivation– Improve family skills in parenting, communication,
problem solving, etc. – Improve family’s ability to meet the interpersonal
needs of each member• Outcomes vary some by practice but include:
– Reduces youth recidivism, drug/ETOH use, violent behavior, family conflict.
– Improves family communication– Improves parenting
Evidence-based Practices Family Therapy
• Multisystemic Family Therapy & Functional Family Therapy – Extremely strong evidence. Blue Prints for violence prevention model program.
• Brief Strategic Family Therapy & Multidimensional Family Therapy have stronger evidence with specific ethnically diverse populations and stronger AOD outcomes.
Evidence-based Practices
Cognitive Behavioral Therapy
• Promising Practices– Aggression Replacement Training (ART)– Thinking for a Change – Anger Management for Substance Abuse
and Mental Health Clients
• Risk Factors – Weak socialization, problem solving, self-regulation; Antisocial &/or limiting belief system; Weak or absent personal, interpersonal and social-cognitive skills for pro-social behavior
Evidence-based Practices Cognitive Behavioral Therapy
• Aggression Replacement Training – Skillstreaming– Anger control training (Individually EFFECTIVE) – Moral reasoning
• Thinking for a Change – http://www.nicic.org/WebPage_220.htm
• Anger Management for Substance Abuse and Mental Health Clients– San Francisco Treatment Research Center – http://www.kap.samhsa.gov/products/
manuals/pdfs/anger1.pdf
Evidence-based Practices Mentoring Programs
• Big Brothers Big Sisters (Selected
Intervention) is a mentoring program established by research as effective.
• Children 6 yrs – 18• Risk Factors – Early display of conduct,
AOD and school problems
Evidence-based Practices Mentoring Programs
• Big Brothers Big Sisters distinguishes itself from other mentoring programs by instituting a proven set programmatic components – Orientation - Matching – Volunteer Screening - Supervision – Youth Assessment
• Outcomes – 46% drug 20% ETOH use reduction; 1/3 less likely to hit; superior academic performance; improved family, peer relationships
Evidence-based Practices Out-of-Home Care• Multidimensional Treatment Foster Care
is an Effective alternative to residential care & Incarceration
• Targets Adolescents with Delinquency and their Families.
• Risk Factors – Antisocial Peers, Problematic Parenting, Weak Social Skills, etc.
Evidence-based Practices Out-of-Home Care
Outcomes• Fewer arrests (less than half the rate of
the control group)• Fewer days incarceration and group home
placement• Greater completion of treatment - fewer
AWOLs• Improved school performance• Less hard drug use• Improved emotional well being
Evidence-based Practices Out-of-Home Care
• Youth is placed in a Therapeutic Foster Home– One youth per home– 24/7 support for foster parent and natural parents
• Youth receive weekly individual therapy with focus on developing effective:– Problem solving skills-Social skills-Emotional regulation skills
• Foster Parent and Team Meetings Weekly• Parent Daily Report – Child Behavior / Foster Parent Stress• Parents attend weekly family therapy with focus on effective
parenting and family management• Public school, with daily monitoring of attendance and
performance• Strict Adherence to Roles: Foster Parent, Care Manager,
Individual Therapist, Family Therapist, Skills Trainer, Recruiter/Caller
What Doesn’t Work – Ed Latessa PhD –
• Talking Cures• Non-directive client-
centered approaches• Psychoanalytic
Approaches• Increasing Cohesiveness• Targeting non-crime
producing needs• Programs w/ intense group
interaction w/o regard for personal responsibility
• Unstructured Rehab Programs
• Good relationship with Offender = Prime Goal
• Fostering Positive Self-regard
• Self-actualization thru self-discovery
• “Medical Model” Approaches
• Radical non-intervention• Targeting low risk offenders• Chemotherapies• Punishing Smarter
Conclusions • Assess Level of Risk & Do not mix Youth of
different Risk Levels• Be Clear About Desired Outcomes -Target
Criminal Behavior • Prioritize Addressing Needs of Minority Youth • Choose Practices with scientific support:
Effective, Efficacious, or Promising. • Choose Practices that Address Local Priorities
and Values • Implement and Monitor Practices for Fidelity
Bonus Slides!
Finding EBPsOffice of the Surgeon General
http://www.surgeongeneral.gov/index.html
Strengthening America’s Families (OJJDP & CSAT) http://www.strengtheningfamilies.org
SAMHSA Model Programs http://www.modelprograms.samhsa.gov
A Roadmap to Mental Health Services for Transition Age Young Women: A Research Review – California Women’s Mental Health Policy Council http://www.cimh.org/downloads/TAY_Final_Report_4-21-05.pdf/
National Institute of Mental Health http://www.nimh.nih.gov/publicat
Promising Practices Network- Children, Families & Communities http://www.promisingpractices.net
Finding EBPsNational Clearinghouse on Child Abuse and Neglect Information
http://nccanch.acf.hhs.gov/The California Child Welfare Clearinghouse for Evidence-based
Practice http://www.chadwickcenter.org/Clearinghouse.htm
Evidence-Based Practices in Mental Health Services for Foster Youth – California Institute for Mental Health http://www.cimh.org/downloads/Fostercaremanual.pdf
National Clearinghouse on Child Abuse and Neglect Information http://nccanch.acf.hhs.gov/
The California Child Welfare Clearinghouse for Evidence-based Practice http://www.chadwickcenter.org/Clearinghouse.htm
SAMHSA’s National Mental Health Information Center (Adult MH Toolkits) http://www.mentalhealth.org/cmhs/communitysupport/toolkits/
The Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (Public Health Resources) http://www.the communityguide.org/