Elsevier

International Journal of Law and Psychiatry

Volume 28, Issue 6, November–December 2005, Pages 622-636
International Journal of Law and Psychiatry

Reducing violence in serious juvenile offenders using intensive treatment

https://doi.org/10.1016/j.ijlp.2004.07.001Get rights and content

Abstract

This study reports on the reduction in violent offending in a population of serious and violent juvenile offenders following an intensive institutional treatment program. The treatment group (N = 101) is compared to a similar group that was assessed but not treated (N = 147). All youth were sent to the program from a juvenile corrections institution where they had received the customary rehabilitation services. The results show a significant reduction in the prevalence of recidivism in the treated group after controlling for time at risk in the community and other covariates. The effects of non-random group assignment were reduced by including a propensity score analysis procedure in the outcome analysis. Untreated comparison youth appeared to be about twice as likely to commit violent offenses as were treated youth (44% vs. 23%). Similarly, treated youth had significantly lower hazard ratios for recidivism in the in the community than the comparison youth, even after accounting for the effects of non-random group assignment.

Introduction

With the increase in violent juvenile crime in the 1990s many states extended the trend of discarding psychologically based rehabilitation of juvenile offenders, opting instead for more punitive strategies (Tobert & Szymanski, 1998). States altered the conditions under which a juvenile may be tried in adult court, or extended the length of supervision possible under the juvenile court to younger children. The federal government offered incentives to hold juveniles more accountable, such as grants to build secure detention facilities or hire more prosecutors. In part, this response to the increase in juvenile violence represented a shift away from seeing juveniles as children in need of guidance, treatment, or habilitation. But to a greater extent, this shift reflects a belief that juvenile offenders, particularly serious and violent offenders, are unresponsive to rehabilitation efforts.

In 1974 Martinson published an influential report on the results of a three-year project to examine the effectiveness of correctional treatment programs (Lipton, Martinson, & Wilks, 1975). Titled “The Effectiveness of Correctional Treatment” study, it reviewed 231 reports and concluded that, in general, rehabilitation efforts had shown no appreciable effects on recidivism (Martinson, 1974). The finding that “nothing works” led Wilks and Martinson (1976) to question the usefulness of using any treatment in offender rehabilitation, and to recommend relying instead on the deterrent effects of punishment. The findings were endorsed as a valid reflection of the current state of the field by the National Academy of Science (Sechrest, White, & Brown, 1979).

A decade later, Lab and Whitehead completed a rigorous meta-analysis of reported outcome evaluations of juvenile correctional treatment programs and reached nearly the same conclusion (Lab & Whitehead, 1988, Whitehead & Lab, 1989). In their analysis of fifty-five studies involving eighty-five comparisons they found no significant trend in any treatment setting or modality, although system-based court diversion programs held the most promise. In the ten studies that involved residential or institutional treatment none showed significant positive results while four had no effect and two were significantly detrimental.

Asserting that if effective treatment of offenders were possible it surely would have been revealed after more than a century of investigation, Walker (1989) labeled the search for the “magic key” to effective treatment as “wishful thinking” and urged that public policies abandon the effort. States generally agreed. Over the past fifteen years every state has altered its statutory approach to juvenile offenders to provide for more severe and extended sanctions (Feld, 1993). Some jurisdictions adopted “no-frills” prisons in the name of increasing the deterrent impact of prison (Johnson, Bennett, & Flanagan, 1997). Others have urged the adoption of corporal punishment toward the same goal (Newman, 1995).

Despite the common sense appeal of increasing deterrent penalties, numerous studies have failed to show that increasing the harshness of sanctions is effective in reducing recidivism. In a series of meta-analytic studies, Cullen, Gendreau and their colleagues reviewed reports of 504 comparisons involving 442,471 mostly adult offenders (Cullen & Gendreau, 2000, Gendreau & Goggin, 1996, Gendreau et al., 1999, Gendreau et al., 2001, Smith et al., 2002). They found no support for the idea that punishment by itself reduces recidivism. In 26 studies (reporting 233 effect sizes) that compared the impact of longer terms of incarceration, longer terms were associated with a slight increase in recidivism. In the 31 studies (reporting 104 effect sizes) that compared institutionalization versus community treatment incarceration was associated with a slight increase in recidivism. Thus the empirical evidence for the effectiveness of harsher sanctions as a deterrent to crime shows a picture at least as dismal as the image of treatment programs offered by “nothing works” proponents.

The “nothing works” position is not without its critics. Bonta, Wallace-Capretta, and Rooney (2000) have pointed out that, of the studies reviewed by Martinson, 40% to 60% reported positive results with some offenders. Andrews and his colleagues have argued that analyses of studies aggregated by approach or setting without consideration of how well they adhere to clinically sound principles is misleading (Andrews et al., 1990). They have articulated three key principles of effective treatment; risk, need, and responsivity (Andrews & Bonta, 1998, Andrews et al., 1990, Hoge & Andrews, 1997). The risk principle proposes that higher risk individuals should receive more intensive treatment, while low-risk offenders should be provided fewer services. The need principle requires treatment to be focused on issues known to contribute to offending (criminogenic needs). Targeting worthy issues that are not criminogenic needs (such as low self-esteem) is not expected to be effective at reducing recidivism. Lastly, the responsivity principle requires that services be tailored to the personality and mental capabilities of the offender. In general, this means matching the treatment modality to the abilities of the offender population being treated. But it also includes fostering motivation and treatment compliance in reluctant offenders (Serin & Kennedy, 1997).

For the most violent and disruptive juveniles, however, there is little information on treatment approaches that reduce future violence. In one of the most complete reviews of treatment programs for seriously delinquent youth, Lipsey and Wilson (1998) reviewed the results of 200 studies of treatment efficacy with serious or violent delinquents. Only 11% of these studies, however, dealt with samples of delinquents who had prior indications of an aggressive history and only 4% dealt with delinquent samples that had predominantly committed prior crimes against persons. Using a broad definition of “institutionalized youth” that included many youth residing outside of secured correctional facilities, they found consistent treatment effects for interpersonal skills training programs and community-based, family-style group homes across 83 studies.

More recently Lipsey and his colleagues provided an update to this study with more detailed analysis of the data (Lipsey, Wilson, & Couther, 2000). Using a regression analysis they found that general program characteristics accounted for the greatest effect size among the 83 studies of “institutionalized” youth. Specifically, programs that were run by mental health administrators were more effective than those administered by juvenile justice staff. In addition, programs that were well established, more extended, and that treated more serious offenders produced greater treatment effect sizes.

In general, researchers have greater optimism for prevention programs and treatment of juveniles who can be safely maintained in the community. A notable example is the work of Bourdin, Henngeler, and their colleagues. In a series of studies they have demonstrated that the Multisystemic Treatment approach can be effective in treating juveniles in the community who have committed serious and violent offenses (Borduin, 1999, Borduin et al., 1995, Henggeler et al., 1991, Henggeler et al., 2002, Henggeler et al., 1997, Henggeler et al., 1992, Henggeler et al., 1993).

But in every jurisdiction there is a subgroup of juveniles whose crimes are so violent, or who are so unmanageable that courts are left with little alternative but to place them in some form of secured custody. And within this subgroup there is yet another subset of youth that are even difficult to safely manage in a secured setting. Is there a point at which some juveniles are simply too aggressive to be treatable? This question has not been well studied, in part because of the difficulty of working with this population. Many jurisdictions, however, have adopted security-minded policies that implicitly assume that some youth are too unmanageable to treat.

Addressing this group, Tate, Reppucci, and Mulvey (1995) conducted an extensive review of the available research on the treatment of violent juvenile delinquents. Noting that there was limited empirical research on the effectiveness of treatment approaches they found only one promising approach, Aggression Replacement Training, (Goldstein, Glick, Reiner, Zimmerman, & Coultry, 1986) that could be delivered in an institutional setting. The available evidence, however, showed that Aggression Replacement Training increased the youth's skills but did not demonstrate a decrease in aggressive behavior, either in the institution or after release. These authors concluded that no single approach had been proven effective with violent juveniles. They recommended, however, that treatment programs continue to be supported and centered around the more promising interventions in the area of social–cognitive treatments and approaches that are ongoing and emphasize interventions in multiple areas of the juvenile's life.

In this study we describe the results of an intensive treatment program designed to treat serious and violent juvenile offenders that have proven unmanageable and treatment refractive in the traditional juvenile corrections settings. Based in part on the Decompression model (Monroe et al., 1988, Van Rybroek & Caldwell, 2002) the program attempts to be highly responsive to the issues that generate treatment resistance in these youth. Although the change process remains unclear, this study describes the impact of the program on re-offense with particular attention given to serious violent crimes.

In 1995 the Wisconsin legislature established the Mendota Juvenile Treatment Center (MJTC) as part of a broad reform of juvenile justice legislation. Although most of the reforms increased penalties and accountability for juvenile offenders, MJTC was intended to provide mental health treatment to the most disturbed juveniles held in the state's secured correctional facilities. The program has a unique structure. Although operated under the administrative code of the Department of Corrections as a secured correctional facility, the program is housed on the grounds of a state mental health facility. The staff are employed, and the facility is operated, by the mental health facility. This organizational design allows for a clinical–correctional hybrid approach with violent juvenile delinquents that strives to create a synergy between security concerns and a core mental health philosophy.

The program differs from the customary services provided in the secured juvenile correctional institutions (JCIs) in several significant ways. First, the treatment program consisted of three units with 14 or 15 single-bed rooms, compared to cottages of up to 50 double-bunked youth in the conventional JCIs. The clinical staffing of MJTC is also much richer than that of the two much larger juvenile correctional institutions. During the study period MJTC had one psychologist, one social worker, and a half psychiatry position for every 20 youth. By contrast the JCIs had about one psychologist for every 75 youth, one social worker for every 40 youth, and one 8-h per week contracted psychiatrist for the institutional population of up to 500. Day-to-day administration of the MJTC program is the responsibility of a psychiatric nurse manager, while the JCI units are typically run by experienced security staff. Although most of the comparison group youth also received some mental health services in the usual corrections setting, on-unit programming was not controlled on a daily basis by mental health staff at the JCIs. Rather, mental health services were typically offered in weekly individual or group treatment sessions, and less frequent, brief medication evaluation sessions provided by contracted psychiatry staff.

The administrative code that provides the framework for operating Wisconsin's juvenile correctional institutions emphasizes the use of deterrent sanctions, often in the form of segregation, to manage aggressive and disruptive behavior and hold youth accountable for their behavior. The belief is that sanctions used in this way will simultaneously manage the youth while holding them accountable for their actions, and serve as a deterrent for future misconduct.

Sherman et al., 1992, Sherman, 1993 has articulated a theory of defiance to explain the behavior of a minority of offenders who react to deterrent sanctions with an increase in violent or other criminal behavior. In Sherman's view, defiant behavior is defined as more frequent, persistent or serious violations of rules or laws in response to a sanction for a rule or law violation. Defiant behavior may be provoked when the offender experiences the sanction as illegitimate, the offender has weak bonds to the sanctioning agent and community, and the offender denies their shame, and instead embraces their isolation from the sanctioning community.

The treatment model used on MJTC is based on the notion that defiant behavior can become cyclic when the defiant response to a sanction is itself sanctioned, resulting in more defiance and increasing sanctions. With each reiteration the young offender is further disenfranchised from conventional goals and values, and is increasingly “compressed” into a behavior pattern that is completely caught up with being actively and antagonistically defiant. The youth does not see an acceptable escape route from the cycle, and thus becomes trapped in a deteriorating behavior pattern. Inside the juvenile correctional institution the typical outcome is extended periods of segregation or other controls permitted under the juvenile administrative code. Following transfer to MJTC a variation of the “decompression” model described by Monroe et al. (1988) attempts to erode the antagonistic bond with conventional roles and expectations, and with authority figures and other potential sanctioning agents.

The Decompression model used on MJTC attempts to prevent the youth from withdrawing, or being withdrawn from treatment. Just as they have been removed from regular classrooms and society at large, seriously disruptive youth are often removed from treatment services due to their aggressiveness. Active treatment programming is often replaced by programs intended to control or manage the unruly behavior. As a result, it is not clear that the most aggressive youth obtain appropriate amounts of formal treatment. The approach used here attempts to merge security and treatment approaches when youths behavior becomes difficult and dangerous. When increased security measures are necessary, individualized treatment contact is also increased.

Section snippets

The population

The population studied here consists of a “treatment” sample of 101 youth who were treated on MJTC to the point of a recommended release, or who obtained the majority of their treatment and rehabilitation services while incarcerated from MJTC and were released when their commitment expired (usually due to aging out of the juvenile system). This sample is compared to a “comparison” group of 147 youth admitted to MJTC briefly for assessment or stabilization services and then returned to the

Variables

The outcome variables were drawn from public court records of filed charges. Data on the offenses included the type (i.e., non-violent misdemeanor, non-violent felony, violent misdemeanor, violent felony, violent felony with injury, and homicide), the number of offenses in each category, and the days at large before each offense type. Because the treatment program was intended to reduce interpersonal violence in a group of unusually severe and repeatedly violent youth, only offenses that

Re-offense outcomes

Analyses were designed to assess the extent to which MJTC treatment had an impact on several types of re-offense. To do this we first assessed the prevalence of offending over a uniform two-year follow-up period. Fig. 1 shows the percentage of re-offense for each group broken out by offense type for a uniform two-year follow-up time for each juvenile. Youth treated on MJTC had lower re-offense rates in each category. The difference in treatment and comparison group re-arrest rates are more

Discussion

These results indicate that the treatment approach used on MJTC appears to reduce the probability of re-offending and extend the time to first offense for treated youth. Further, the treatment program appears to have the greatest impact on serious violent offending, reducing the risk of such offenses by about half. Within the population of serious and violent juvenile offenders, those with the most extreme problems studied here appeared to be no less likely to respond to the treatment program.

Acknowledgment

This article was partially supported by grants from the Office of Justice Assistance, Office of Juvenile Justice and Delinquency Prevention, (Grant #'s: CG-97-ST-0001, CG-97-ST-0003, and CG-99-ST-0002).

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