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Evidence-based Practices Juvenile Justice & Mental Health
Presented by The California Institute for Mental Health Bill Carter LCSW
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Juvenile Justice & Mental Health A 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.
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Juvenile Justice & Mental Health A 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.
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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
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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.
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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 )
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Criminal Sanctions versus Treatment
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Top 5 Predictors of Criminality
Antisocial Values Antisocial Peers Poor self-control/self- management/ prosocial problem solving skills Family Problems Past Criminality
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Risk Factors for Violence
Children Adolescents Strong Risk Factors General Offenses Weak Social Ties Substance Abuse Antisocial/Delinq Peers Gang Membership Moderate Risk Factors Being Male Low Family SES Antisocial Parents Aggression (Source: Youth Violence: A Report of the Surgeon General)
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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
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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)
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Specific to local needs and goals
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
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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
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Adopt—Validate—Adapt— Evaluate
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
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Evidence-based Practices with Strong Juvenile Justice Outcomes
Parent Training Family Therapy Cognitive Behavioral Therapy Mentoring Out-of-Home Care What Doesn’t Work
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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
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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.
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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.
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Evidence-based Practices Parent Training Programs
Adolescent Transitions Program is a Promising Practice for youth 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
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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
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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
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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.
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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
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Evidence-based Practices Cognitive Behavioral Therapy
Aggression Replacement Training Skillstreaming Anger control training (Individually EFFECTIVE) Moral reasoning Thinking for a Change m Anger Management for Substance Abuse and Mental Health Clients San Francisco Treatment Research Center manuals/pdfs/anger1.pdf
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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
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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
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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.
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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
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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
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What Doesn’t Work – Ed Latessa PhD –
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 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
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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
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Bonus Slides!
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Finding EBPs Office of the Surgeon General
Strengthening America’s Families (OJJDP & CSAT) SAMHSA Model Programs A Roadmap to Mental Health Services for Transition Age Young Women: A Research Review – California Women’s Mental Health Policy Council 05.pdf/ National Institute of Mental Health Promising Practices Network- Children, Families & Communities
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Finding EBPs National Clearinghouse on Child Abuse and Neglect Information The California Child Welfare Clearinghouse for Evidence- based Practice Evidence-Based Practices in Mental Health Services for Foster Youth – California Institute for Mental Health SAMHSA’s National Mental Health Information Center (Adult MH Toolkits) olkits/ The Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (Public Health Resources) communityguide.org/
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