1. Evidence-based Practices Juvenile Justice & Mental Health
Presented by
The California Institute for Mental Health
Bill Carter LCSW

2. 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.

3. 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.

4. 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

5. 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.

6. 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 )

7. Criminal Sanctions versus Treatment

8. Top 5 Predictors of Criminality
Antisocial Values
Antisocial Peers
Poor self-control/self- management/ prosocial problem solving skills
Family Problems
Past Criminality

9. 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)

10. 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

11. 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)

12. 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

13. 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

14. 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

15. Evidence-based Practices with Strong Juvenile Justice Outcomes
Parent Training
Family Therapy
Cognitive Behavioral Therapy
Mentoring
Out-of-Home Care
What Doesn’t Work

16. 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

17. 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.

18. 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.

19. 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

20. 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

21. 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

22. 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.

23. 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

24. 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

25. 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

26. 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

27. 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.

28. 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

29. 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

30. 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

31. 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

32. Bonus Slides!

33. 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

34. 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/