Evidence-based Practices Juvenile Justice & Mental Health Webcast Training October 25, 2005...

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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)

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

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

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

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.

• 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.

• 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

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

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.

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/

Evidence-based Practices Juvenile Justice & Mental Health Webcast Training October 25, 2005...

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