Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial.

Despite the serious and costly problems presented by juvenile sexual offenders, rigorous tests of promising interventions have rarely been conducted. This study presents a community-based effectiveness trial comparing multisystemic therapy (MST) adapted for juvenile sexual offenders with services that are typical of those provided to juvenile sexual offenders in the United States. Youth were randomized to MST (n = 67) or treatment as usual for juvenile sexual offenders (TAU-JSO; n = 60). Outcomes through 12 months postrecruitment were assessed for problem sexual behavior, delinquency, substance use, mental health functioning, and out-of-home placements. Relative to youth who received TAU-JSO, youth in the MST condition evidenced significant reductions in sexual behavior problems, delinquency, substance use, externalizing symptoms, and out-of-home placements. The findings suggest that family- and community-based interventions, especially those with an established evidence-base in treating adolescent antisocial behavior, hold considerable promise in meeting the clinical needs of juvenile sexual offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of multisystemic therapy through midlife: A 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders.

Objective: Although current evidence suggests that the positive effects of multisystemic therapy (MST) on serious crime reach as far as young adulthood, the longer term impact of MST on criminal and noncriminal outcomes in midlife has not been evaluated. In the present study, the authors examined a broad range of criminal and civil court outcomes for serious and violent juvenile offenders who participated on average 21.9 (range = 18.3–23.8) years earlier in a clinical trial of MST (C. M. Borduin et al., 1995). Method: Participants were 176 individuals who were originally randomized to MST or individual therapy (IT) during adolescence and averaged 3.9 arrests for felonies prior to treatment. Arrest, incarceration, and civil suit data were obtained in middle adulthood when participants were on average 37.3 years old. Results: Intent-to-treat analyses showed that felony recidivism rates were significantly lower for MST participants than for IT participants (34.8% vs. 54.8%, respectively) and that the frequency of misdemeanor offending was 5.0 times lower for MST participants. In addition, the odds of involvement in family-related civil suits during adulthood were twice as high for IT participants as for MST participants. Conclusions: The present study represents the longest follow-up to date of an MST clinical trial and demonstrates that the positive impact of an evidence-based youth treatment such as MST can last well into adulthood. Implications of the authors' findings for policymakers and service providers are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

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)     

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)     

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)     

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)     

Multisystemic Treatment: A Meta-Analysis of Outcome Studies.

Multisystemic treatment (MST) is a family- and home-based therapeutic approach that has been found to be effective in treating antisocial youths and that has recently been applied to youths with serious emotional disturbances. In light of the increasing dissemination of MST, this review examines the effectiveness of MST by quantifying and summarizing the magnitude of effects (treatment outcomes) across all eligible MST outcome studies. Included in a meta-analysis were 7 primary outcome studies and 4 secondary studies involving a total of 708 participants. Results indicated that across different presenting problems and samples, the average effect of MST was d = .55; following treatment, youths and their families treated with MST were functioning better than 70% of youths and families treated alternatively. Results also showed that the average effect of MST was larger in studies involving graduate student therapists (i.e., efficacy studies; d = .81) than in studies with therapists from the community (i.e., effectiveness studies; d = .26). In addition, MST demonstrated larger effects on measures of family relations than on measures of individual adjustment or peer relations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child psychopathy and protective factors: IQ and motivation to change.

Psychopathy in children and adolescents has received increased attention over the past decade. Researchers have been particularly interested in identifying who tomorrow's chronic and serious offenders might be. In addition, researchers have been increasingly interested in determining the etiology of the disorder so as to inform treatment programs. Despite this interest, few studies to date have investigated the protective factors for psychopathy in youth. The current study investigated 140 adolescent boys and girls and the potential protective mechanisms of intelligence and motivation to change. Findings indicated that motivation to change served as a protective factor for general and violent offending at varying levels of psychopathy. Motivation to change also served as a compensatory factor for psychopathy when examining high rates of violent offending. These findings suggest that the cognitive factor of motivation to change may very well be critical in examining developmental pathways to offending in youth and a key consideration for those youth scoring high on psychopathy scales and considering violence as a means of gain. (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)     

Federal standards for community registration of juvenile sex offenders: An evaluation of risk prediction and future implications.

The enactment of the Adam Walsh Child Protection and Safety Act in 2006 is an extension of current protective legislation aimed at establishing stricter sanctions for community-released sexual offenders. What largely separates the Adam Walsh Act from previous registration and notification laws is the crossing of traditional jurisdictional boundaries between adult and juvenile courts at the federal level. This article addresses several key concerns relating to the application of these federal standards to adolescent offenders. In addition to a review of the extant literature, we present findings from an exploratory evaluation that examines the ability of the Adam Walsh Act's classification system to predict future offending among a sample of 112 adjudicated juvenile sex offenders over a 2-year outcome period. Results indicate that offenders who met criteria for registration did not reoffend (sexually or nonsexually) at a significantly higher rate than those who did not meet registration criteria. Implications regarding appropriate risk assessment and management of youth sexual offenders are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparison of two community alternatives to incarceration for chronic juvenile offenders

The relative effectiveness of group care (GC) and multidimensional treatment foster care (MTFC) was compared in terms of their impact on criminal offending, incarceration rates, and program completion outcomes for 79 male adolescents who had histories of chronic and serious juvenile delinquency. Results show that boys who participated in MTFC had significantly fewer criminal referrals and returned to live with relatives more often. Multiple regression analyses showed that assignment to a treatment condition (i.e., GC or MTFC) predicted official and self-reported criminality in follow-up beyond other well-known predictors of chronic juvenile offending (i.e., age at 1st offense, number of previous offenses, age at referral).     

Family environments of adolescent sex offenders and other juvenile delinquents

This study compared the family environments of adolescent sex offenders and violent and nonviolent juvenile delinquents with a normative sample of adolescents. Differences between the juvenile delinquents and the normative sample were found on six of the ten subscales of the Family Environment Scale (i.e., cohesion, expressiveness, independence, intellectual-cultural orientation, active-recreational orientation, and control). No differences were found on four variables (i.e., conflict, achievement orientation, moral-religious emphasis, and organization). No differences were found among the three categories of juvenile delinquents. Implications of the findings for clinical intervention and further research are offered.     

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)     

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)     

Multisystemic therapy with violent and chronic juvenile offenders and their families: the role of treatment fidelity in successful dissemination

The effects of multisystemic therapy (MST) in treating violent and chronic juvenile offenders and their families in the absence of ongoing treatment fidelity checks were examined. Across 2 public sector mental health sites, 155 youths and their families were randomly assigned to MST versus usual juvenile justice services. Although MST improved adolescent symptomology at posttreatment and decreased incarceration by 47% at a 1.7-year follow-up, findings for decreased criminal activity were not as favorable as observed on other recent trials of MST. Analyses of parent, adolescent, and therapist reports of MST treatment adherence, however, indicated that outcomes were substantially better in cases where treatment adherence ratings were high. These results highlight the importance of maintaining treatment fidelity when disseminating complex family-based services to community settings.     

Long-Term Follow-Up to a Randomized Clinical Trial of Multisystemic Therapy With Serious and Violent Juvenile Offenders.

In this study, the authors examined the long-term criminal activity of 176 youths who had participated in either multisystemic therapy (MST) or individual therapy (IT) in a randomized clinical trial (C. M. Borduin et al., 1995). Arrest and incarceration data were obtained on average 13.7 (range = 10.2-15.9) years later when participants were on average 28.8 years old. Results show that MST participants had significantly lower recidivism rates at follow-up than did their counterparts who participated in IT (50% vs. 81%, respectively). Moreover, MST participants had 54% fewer arrests and 57% fewer days of confinement in adult detention facilities. This investigation represents the longest follow-up to date of a MST clinical trial and suggests that MST is relatively effective in reducing criminal activity among serious and violent juvenile offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family managment and deviant peer association as mediators of the impact of treatment condition on youth antisocial behavior.

The influence of family management skills (i.e., supervision, discipline, and positive adult–youth relationship) and deviant peer association on youth antisocial behavior was examined within the context of a randomized clinical trial contrasting multidimensional treatment foster care and services-as-usual group care. Participants were male adolescents with histories of chronic and serious juvenile delinquency who were mandated into residential care by the juvenile court. As hypothesized, family management skills and deviant peer association mediated the effect of treatment condition and accounted for 32% of the variance in subsequent antisocial behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger as a predictor of aggression among incarcerated adolescents.

This study examined the validity of trait anger as a predictor of aggressive behavior among juvenile offenders. Two standard self-report anger scales were administered to 65 recently incarcerated male adolescents. These youths were followed prospectively for physical and verbal aggression during 3 months of subsequent incarceration. Anger scores were not correlated with participant history of violent offending or staff ratings of anger. However, anger scores from both instruments were predictive of subsequent physical and verbal aggression. For example, the Trait Anger scale successfully classified 66% of juvenile offenders into high and low aggressive groups; receiver operating characteristic analysis obtained an effect size of .72. These results support the predictive validity of self-reported anger in identifying juvenile offenders at risk for institutional aggression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual offender recidivism revisited: A meta-analysis of recent treatment studies.

Meta-analyses were performed on 12 studies of treatment with sexual offenders (N?=?1,313). A small, but robust, overall effect size was found for treatment versus comparison conditions (r?=?.12). The overall recidivism rate for treated sexual offenders was .19 versus .27 for untreated sexual offenders. Treatment effect sizes across studies, however, were heterogeneous. Effect sizes were larger in studies that had higher base rates of recidivism, had follow-up periods longer than 5 years, included outpatients, and involved cognitive-behavioral or hormonal treatments. Cognitive-behavioral (p?p?