Mediators of change for multisystemic therapy with juvenile sexual offenders.

The mediators of favorable multisystemic therapy (MST) outcomes achieved at 12 months postrecruitment were examined within the context of a randomized effectiveness trial with 127 juvenile sexual offenders and their caregivers. Outcome measures assessed youth delinquency, substance use, externalizing symptoms, and deviant sexual interest/risk behaviors; hypothesized mediators included measures of parenting and peer relations. Data were collected at pretreatment, 6 months postrecruitment, and 12 months postrecruitment. Consistent with the MST theory of change and the small extant literature in this area of research, analyses showed that favorable MST effects on youth antisocial behavior and deviant sexual interest/risk behaviors were mediated by increased caregiver follow-through on discipline practices as well as decreased caregiver disapproval of and concern about the youth’s bad friends during the follow-up. These findings have important implications for the community-based treatment of juvenile sexual offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy.

Objective: A randomized trial assessed the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. Method: A 2 × 2 design encompassing 14 rural Appalachian counties included 2 factors: (a) the random assignment of delinquent youth within each county to a multisystemic therapy (MST) program or usual services and (b) the random assignment of counties to the ARC (for availability, responsiveness, and continuity) organizational intervention for implementing effective community-based mental health services. The design created 4 treatment conditions (MST plus ARC, MST only, ARC only, control). Outcome measures for 615 youth who were 69% male, 91% Caucasian, and aged 9–17 years included the Child Behavior Checklist and out-of-home placements. Results: A multilevel, mixed-effects, regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a nonclinical level and significantly lower than in other conditions. Total problem behavior was equivalent and at nonclinical levels in all conditions by the 18-month follow-up, but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate (16%) than youth in the control condition (34%). Conclusions: Two-level strategies that combine an organizational intervention such as ARC and an evidence-based treatment such as MST are promising approaches to implementing effective community-based mental health services. More research is needed to understand how such strategies can be used effectively in a variety of organizational contexts and with other types of evidence-based treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments.

Evaluated the effectiveness of juvenile drug court for 161 juvenile offenders meeting diagnostic criteria for substance abuse or dependence and determined whether the integration of evidence-based practices enhanced the outcomes of juvenile drug court. Over a 1-year period, a four-condition randomized design evaluated outcomes for family court with usual community services, drug court with usual community services, drug court with multisystemic therapy, and drug court with multisystemic therapy enhanced with contingency management for adolescent substance use, criminal behavior, symptomatology, and days in out-of-home placement. In general, findings supported the view that drug court was more effective than family court services in decreasing rates of adolescent substance use and criminal behavior. Possibly due to the greatly increased surveillance of youths in drug court, however, these relative reductions in antisocial behavior did not translate to corresponding decreases in rearrest or incarceration. In addition, findings supported the view that the use of evidence-based treatments within the drug court context improved youth substance-related outcomes. Clinical and policy implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissemination and effectiveness of multisystemic treatment in New Zealand: A benchmarking study.

The transportability of Multisystemic Therapy (MST) for the treatment of juvenile offenders in a community-based context was examined in the current study. Results of this New Zealand study showed that significant pre- to posttreatment improvements occurred on most indicators of ultimate (i.e., offending behavior) and instrumental (i.e., youth compliance, family relations) treatment outcomes. Reductions in offending frequency and severity continued to improve across the 6- and 12-month follow-up intervals. In comparison to benchmarked studies, the current study demonstrated a more successful treatment completion rate. Additionally, overall treatment effect sizes were found to be clinically equivalent with the results of previous MST outcome studies with juvenile offenders and significantly greater than the effect sizes found in the control conditions. The findings of this evaluation add to the growing body of evidence that supports MST as an effective treatment for antisocial youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What is so special about male adolescent sexual offending? A review and test of explanations through meta-analysis.

We tested special and general explanations of male adolescent sexual offending by conducting a meta-analysis of 59 independent studies comparing male adolescent sex offenders (n = 3,855) with male adolescent non-sex offenders (n = 13,393) on theoretically derived variables reflecting general delinquency risk factors (antisocial tendencies), childhood abuse, exposure to violence, family problems, interpersonal problems, sexuality, psychopathology, and cognitive abilities. The results did not support the notion that adolescent sexual offending can be parsimoniously explained as a simple manifestation of general antisocial tendencies. Adolescent sex offenders had much less extensive criminal histories, fewer antisocial peers, and fewer substance use problems compared with non-sex offenders. Special explanations suggesting a role for sexual abuse history, exposure to sexual violence, other abuse or neglect, social isolation, early exposure to sex or pornography, atypical sexual interests, anxiety, and low self-esteem received support. Explanations focusing on attitudes and beliefs about women or sexual offending, family communication problems or poor parent–child attachment, exposure to nonsexual violence, social incompetence, conventional sexual experience, and low intelligence were not supported. Ranked by effect size, the largest group difference was obtained for atypical sexual interests, followed by sexual abuse history, and, in turn, criminal history, antisocial associations, and substance abuse. We discuss the implications of the findings for theory development, as well as for the assessment, treatment, and prevention of adolescent sexual offending. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity.

A randomized clinical trial evaluated the efficacy of multisystemic therapy (MST) versus usual community services (UCS) for 48 juvenile sexual offenders at high risk of committing additional serious crimes. Results from multiagent assessment batteries conducted before and after treatment showed that MST was more effective than UCS in improving key family, peer, and academic correlates of juvenile sexual offending and in ameliorating adjustment problems in individual family members. Moreover, results from an 8.9-year follow-up of rearrest and incarceration data (obtained when participants were on average 22.9 years of age) showed that MST participants had lower recidivism rates than did UCS participants for sexual (8% vs. 46%, respectively) and nonsexual (29% vs. 58%, respectively) crimes. In addition, MST participants had 70% fewer arrests for all crimes and spent 80% fewer days confined in detention facilities than did their counterparts who received UCS. The clinical and policy implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders.

Multisystemic therapy (MST) delivered through a community mental health center was compared with usual services delivered by a Department of Youth Services in the treatment of 84 serious juvenile offenders and their multiproblem families. Offenders were assigned randomly to treatment conditions. Pretreatment and posttreatment assessment batteries evaluating family relations, peer relations, symptomatology, social competence, and self-reported delinquency were completed by the youth and a parent, and archival records were searched at 59 wks postreferral to obtain data on rearrest and incarceration. In comparison with youths who received usual services, youths who received MST had fewer arrests and self-reported offenses and spent an average of 10 fewer weeks incarcerated. In addition, families in the MST condition reported increased family cohesion and decreased youth aggression in peer relations. The relative effectiveness of MST was neither moderated by demographic characteristics nor mediated by psychosocial variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does the neighborhood context alter the link between youth's after-school time activities and developmental outcomes? A multilevel analysis.

This article examines links between different measures of after-school time activity participation (5 specific activities and breadth) on youth's developmental outcomes (anxiety/depression, delinquency, and substance use) over 6 years and whether these links are moderated by neighborhood-level variables. The sample (N = 1,315) of 9- and 12-year-old youth was drawn from the Project on Human Development in Chicago Neighborhoods (PHDCN), a multilevel, longitudinal study of youth from 80 Chicago neighborhoods. Findings revealed that different types of activities and patterns of participation over time were associated with outcomes for youth and that, to some extent, these outcomes varied with neighborhood characteristics. In brief, sports participation was associated with fewer anxious/depressed symptoms, higher average delinquency scores, and increased substance use-both average scores and growth over time. Participation in the arts and student government were negatively associated with average substance use and attenuated increases in usage over time. Participation in community-based clubs was positively associated with youth's anxiety/depression in violent neighborhoods only, whereas church groups were protective against substance use in nonviolent neighborhoods. The direction of the influence of breadth of participation was nonlinear for delinquency such that delinquency scores were highest among youth who engaged in an average number of activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations between neighborhood factors, parenting behaviors, peer deviance, and delinquency among serious juvenile offenders.

The present study examined relations among neighborhood structural and social characteristics, parenting practices, peer group affiliations, and delinquency among a group of serious adolescent offenders. The sample of 14-18-year-old boys (N = 488) was composed primarily of economically disadvantaged, ethnic-minority youth living in urban communities. The results indicate that weak neighborhood social organization is indirectly related to delinquency through its associations with parenting behavior and peer deviance and that a focus on just 1 of these microsystems can lead to oversimplified models of risk for juvenile offending. The authors also find that community social ties may confer both pro- and antisocial influences to youth, and they advocate for a broad conceptualization of neighborhood social processes as these relate to developmental risk for youth living in disadvantaged communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting relapse: A meta-analysis of sexual offender recidivism studies.

Evidence from 61 follow-up studies was examined to identify the factors most strongly related to recidivism among sexual offenders. On average, the sexual offense recidivism rate was low (13.4%; n?=?23,393). There were, however, subgroups of offenders who recidivated at high rates. Sexual offense recidivism was best predicted by measures of sexual deviancy (e.g., deviant sexual preferences, prior sexual offenses) and, to a lesser extent, by general criminological factors (e.g., age, total prior offenses). Those offenders who failed to complete treatment were at higher risk for reoffending than those who completed treatment. The predictors of nonsexual violent recidivism and general (any) recidivism were similar to those predictors found among nonsexual criminals (e.g., prior violent offenses, age, juvenile delinquency). Our results suggest that applied risk assessments of sexual offenders should consider separately the offender's risk for sexual and nonsexual recidivism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pregnancy rates among juvenile justice girls in two randomized controlled trials of multidimensional treatment foster care.

Preventing adolescent pregnancy is a national research priority that has had limited success. In the present study, the authors examined whether Multidimensional Treatment Foster Care (MTFC) relative to intervention services as usual (group care [GC]) decreased pregnancy rates among juvenile justice girls mandated to out-of-home care. Girls (13–17 years of age) with histories of criminal referrals (Mdn = 10) were randomly assigned to MTFC (n = 81) or GC (n = 85) as part of 2 randomized controlled trials. Pregnancy histories were assessed from baseline through 24 months. Fewer postbaseline pregnancies were reported for MTFC girls (26.9%) than for GC girls (46.9%)—an effect that remained significant after controlling for baseline criminal referrals, pregnancy history, and sexual activity. MTFC has previously been shown to decrease arrest and lock-up rates. The present findings support the long-term preventive effects of MTFC on adolescent girls’ pregnancy rates. Findings are consistent with the notion that programs that target delinquency by impacting general risk behavior pathways and contexts may more successfully prevent teen pregnancy than those that directly target sexual behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost–benefit analysis of multisystemic therapy with serious and violent juvenile offenders.

This study investigated the economics of multisystemic therapy (MST) versus individual therapy (IT) using rearrest data from a 13.7-year follow-up (Schaeffer & Borduin, 2005) of a randomized clinical trial with serious juvenile offenders (Borduin et al., 1995). Two types of benefits of MST were evaluated: The value to taxpayers was derived from measures of criminal justice system expenses (e.g., police and sheriff's offices, court processing, jails, community supervision), and the value to crime victims was derived in terms of both tangible (e.g., property damage and loss, health care, police and fire services, lost productivity) and intangible (e.g., pain, suffering, reduced quality of life) losses. Results indicated that the reductions in criminality in the MST versus IT conditions were associated with substantial reductions in expenses to taxpayers and intangible losses to crime victims, with cumulative benefits ranging from $75,110 to $199,374 per MST participant. Stated differently, it was estimated that every dollar spent on MST provides $9.51 to $23.59 in savings to taxpayers and crime victims in the years ahead. The economic benefits of MST, as well as its clinical effectiveness, should be considered by policymakers and the public at large in the selection of interventions for serious juvenile offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Take Care to Do No Harm: Harmful Interventions for Youth Problem Behavior.

Youth conduct problems, delinquency, and substance abuse pose serious consequences for the youth themselves, their victims and families, and the broader society. The widespread impact of these problem behaviors highlights the importance of preventing and treating them effectively. Despite this need, an emerging literature has demonstrated that certain intervention programs for these problem behaviors, particularly those that have used group-delivery formats, have produced iatrogenic effects. The potential for intervention to produce negative outcomes raises several ethical implications and dilemmas. In this article, the author provides illustrative examples of iatrogenic effects of interventions that target youth conduct problems, delinquency, and substance abuse; discusses the relevant ethical implications raised by these outcomes; and suggests recommendations to prevent, detect, and respond to their occurrence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial.

The primary purpose of this study was to conduct a randomized effectiveness trial of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) for physically abused youth (mean age = 13.88 years, 55.8% female, 68.6% Black) and their families. Eighty-six families being followed by Child Protective Services due to physical abuse were randomly assigned to MST-CAN or Enhanced Outpatient Treatment (EOT), with both interventions delivered by therapists employed at a community mental health center. Across five assessments extending 16 months post baseline, intent-to-treat analyses showed that MST-CAN was significantly more effective than EOT in reducing youth mental health symptoms, parent psychiatric distress, parenting behaviors associated with maltreatment, youth out-of-home placements, and changes in youth placement. Also, MST-CAN was significantly more effective at improving natural social support for parents. Effect sizes were in the medium to large range for most outcomes examined. Although fewer children in the MST-CAN condition experienced an incident of reabuse than did counterparts in the EOT condition, base rates were low and this difference was not statistically significant. The findings of this study demonstrate the potential for broad-based treatments of child physical abuse to be effectively transported and implemented in community treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of health-compromising behaviors among Minnesota adolescents: sociodemographic variations

OBJECTIVES: This study compared prevalence rates of health-compromising behaviors among boys and girls from different ethnic backgrounds in early, middle, and late adolescence and compared co-occurrences of such behaviors across gender and ethnic groups. METHODS: The study population included 123 132 adolescents in grades 6, 9, and 12. Adolescents completed a classroom-administered statewide survey focusing on high-risk behaviors, including unhealthy weight loss, substance abuse, suicide risk, delinquency, and sexual activity. RESULTS: Prevalence rates of most health-compromising behaviors differed by gender, increased with age, and tended to be highest among American Indian youth and lowest among Asian Americans. Strong associations were found between substance abuse and delinquency across all ethnic groups. Substance abuse and delinquency were associated with suicide risk across most ethnic groups. Covariations with sexual activity and unhealthy weight loss behaviors showed more ethnic variation. CONCLUSIONS: Prevention interventions should take into account the tendency for health-compromising behaviors to co-occur and should be sensitive to demographic and socioeconomic differences in behavior patterns.     

The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths.

This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When interventions harm: Peer groups and problem behavior.

This article explored developmental and intervention evidence relevant to iatrogenic effects in peer-group interventions. Longitudinal research revealed that "deviancy training" within adolescent friendships predicts increases in delinquency, substance use, violence, and adult maladjustment. Moreover, findings from 2 experimentally controlled intervention studies suggested that peer-group interventions increase adolescent problem behavior and negative life outcomes in adulthood, compared with control youth. The data from both experimental studies suggested that high-risk youth are particularly vulnerable to peer aggregations, compared with low-risk youth. We proposed that peer aggregation during early adolescence, under some circumstances, inadvertently reinforces problem behavior. Two developmental processes are discussed that might accounts fro the powerful iatrogenic effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial factors and high-risk sexual behavior: race differences among urban adolescents

Adolescence is a period of sexual experimentation. We examined psychosocial predictors of high-risk sexual behavior and condom use. The sample included 824 ninth-graders, most of whom are African American. We conducted separate analyses for whites and African Americans. Predictors included alcohol and substance use, delinquency, prosocial behaviors, and family and peer influences. We found that problem behaviors predicted high-risk sexual behavior, but the effects were stronger for white youth. We also found that friends' behaviors were more predictive than family influences, except for family conflict. In general, the models explained more variance for white youths than for African-American youths. The results suggest that problem behavior theory and social interactions theory may be most relevant for white youth and that other models may be necessary to explain high-risk sexual behavior among African-American youths.     

La consommation de substances psychoactives chez les délinquants juvéniles à haut risque de récidive: Enjeux psychométriques.

Substance abuse and criminal activity are closely related phenomena. Substance abuse is also one of the risks and needs linked to criminogenic factors and increases the risk of re-offending among adolescent offenders. Identification of this problem is therefore important in guiding interventions directed at such clients. The concomitant validity of an instrument used to screen problem consumption of alcohol and drugs among adolescents (DEP-ADO) and scale 5 (substance abuse) of the YLS-CMI (research version) was studied. Their convergence with a self-related delinquency questionnaire was also verified. Data were also collected on four occasions from adolescent offenders at high risk of re-offending (N = 99) who were receiving services at the Centre jeunesse de Montréal-Institut universitaire. The results support a close relation between substance abuse and self-related delinquency. The two instruments converge in identifying offenders who are problematic substance users. However, scale 5 of the YLS-CMI appears to lead to an overestimation of positive cases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence.

Examined the long-term effects of multisystemic therapy (MST) vs individual therapy (IT) on the prevention of criminal behavior and violent offending among 176 juvenile offenders at high risk for committing additional serious crimes. Results from multiagent, multimethod assessment batteries conducted before and after treatment showed that MST was more effective than IT in improving key family correlates of antisocial behavior and in ameliorating adjustment problems in individual family members. Moreover, results from a 4-year follow-up of rearrest data showed that MST was more effective than IT in preventing future criminal behavior, including violent offending. The implications of such findings for the design of violence prevention programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)