Psychiatr Q DOI 10.1007/s11126-014-9296-4 ORIGINAL PAPER
Juvenile Delinquency Treatment and Prevention: A Literature Review Jessica May • Kristina Osmond • Stephen Billick
Ó Springer Science+Business Media New York 2014
Abstract In the last three decades there has been ample research to demonstrate that instituting Multisystemic Therapy for serious juvenile offenders, keeping them in the community with intensive intervention, can significantly reduce recidivism. When there is recidivism, it is less severe than in released incarcerated juveniles. Multisystemic Therapy provides 24 h available parental guidance, family therapy, individual therapy, group therapy, educational support and quite importantly a change of peer group. In New York City, there is the new mandate through the Juvenile Justice Initiative to implement interventions to keep juvenile offenders in the community rather than sending them to be incarcerated. However, this paper aims to examine how teaching prosocial values in early childhood can reduce the incidence of first-time juvenile delinquency. Programs such as the Perry School Project will be discussed to demonstrate that although somewhat expensive, these innovative programs nonetheless are quite cost-effective as the cost to society of adjudication, incarceration and victim damages are significantly greater. Along with teaching prosocial 0020 values, there has been renewed interest in early identification of youth at risk for developing Antisocial Personality Disorder. An update is given on the status of both promising approaches in early intervention to prevent serious juvenile delinquency and hence adult criminality. Keywords Juvenile delinquency Multisystemic Therapy Perry preschool project Early childhood intervention programs
J. May Hofstra NSLIJ School of Medicine, Hempstead, NY, USA K. Osmond Mt. Sinai Medical Center, New York, NY, USA S. Billick (&) NYU School of Medicine, 901 5th Avenue, New York, NY 10021, USA e-mail: [email protected]
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Current Treatment of Delinquency and Historical Development Recognizing the developmental aspect of juveniles as distinct from adults, the first juvenile justice system was established in 1899 in Illinois and which then led to the creation of the first child and adolescent psychiatry clinic in 1909, in Chicago. This clinic was specifically created to aid the newly formed family courts in their adjudication of wayward youth. Eventually all 50 states adopted these special courts to handle juvenile delinquency outside of the adult criminal courts. The goal of these courts was to help the youth return to a healthy path of development. Hence, there was no sentencing, only adjudication of the youth for their betterment. Until In re Gault, children and adolescents in family court had few of the safeguards afforded to adults charged with crimes. They now have all of legal rights except for a jury of their peers. Since the 1970s, with the dramatic rise in violent crime committed by adolescents, many juveniles have been returned to the jurisdiction of adult criminal courts. Society was outraged to see juveniles murder and rape and be released from custody at the age of 21 years, and further to have the juvenile records sealed. In some jurisdictions, the juvenile may begin in family court and be waived up to adult criminal court. In other states, such as New York, adolescents who commit specific crimes of violence or with a weapon are immediately sent directly to adult criminal court. Society has sought to reduce juvenile crime with longer incarceration in juvenile detention facilities and some in adult prisons, with only modest success. Unfortunately when released, incarcerated juveniles have been fully educated to be better criminals. Spending time with more experienced criminals provides an unwanted fertile environment for teaching adolescents exactly that which we do not want them to learn [1].
Prediction of Delinquency and Recidivism Multiple studies show that the best predictor for delinquent behavior in the future is delinquent behavior in the past. These youths continue their delinquency with no guide to change their behavior, thus there is no break in the chain. A study by Abram et al. highlights this point. His study follows almost 2,000 juvenile delinquents who were interviewed and assessed 3 years after being detained at the Cook County Juvenile Temporary Detention Center. Interviewers used the Child and Adolescent Functional Assessment Scale (CAFAS) to determine the functionality of the participants based on their responses during the semi-structured interview. Participants received scores in eight different categories, including; their home, work/school, community, behavior, mood, selfharm behavior, substance use, and thinking. The participant’s scores then indicated the level to which they were impaired or not at all impaired. Based on these interviews, almost 30 % of juvenile delinquents had marked or severe impairment across all domains. Almost all participants had severe impairments in at least one domain [1].
Restorative Justice In an article by Bergseth and Bouffard, these researchers explain another type of treatment for juvenile delinquents, called Restorative Justice (RJ) [2]. RJ lies in the middle of two competing theories for juvenile delinquent treatment, which are punishment and restoration. One of this program’s main goals is to restore justice to the victim as well as the community. Crimes committed by the juvenile delinquent are revisited, and many times the
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victim must be confronted. This structure does do some therapeutic work for the juvenile delinquent; including taking responsibility for the wrongs they have committed, and learning how to be held accountable. However, as documented below, when RJ is compared to Multisystemic Therapy (MST), RJ is one-dimensional. The duration of this program is very short, with each participant receiving at least one session with a program facilitator. Consequently, the juvenile delinquent learns much less about becoming prosocial in this short time frame. RJ only involves one factor of the delinquent’s life, which is their crime. RJ had a large focus on the victim, which may be an important aspect, but is certainly not the only factor requiring being addressed in understanding the complexity of delinquent behavior. One of the critical complaints of RJ is that it may not significantly decrease juvenile delinquent recidivism rates for all types of offenders. Analysis revealed that the RJ program only yields a significant reduction in future criminality amongst male, first-time offenders who were under the age of 14. Bergseth and Bouffard state that the younger age that the delinquents are when referred to and treated with RJ, the longer the time frame will be before reoffending. However, when it comes to more serious offenders, who are generally older juveniles who have committed more serious crimes, RJ may not be as successful in producing change in the juvenile delinquents themselves. Thus, more lengthy treatment programs which address more dysfunctional aspects of the juvenile delinquent’s life are essential when treating juvenile delinquency. However, research shows that RJ is better than detention.
Stop Now, Act Later SNAP (Stop Now, Act Later) is a study on delinquent adolescent boys ages 6–11 years old in Ontario, Canada. The program was 12 weeks long and had two components. The first was the Transformer Club, which was for the delinquent boys. The main goal was to help participants through the group therapy process by identifying their bad behavior and helping to control and manage their anger. The second component was the SNAP meeting, group therapy intended for the parents. Positive feedback from the groups included positive communication with other parents and separately with the delinquent boys, and the increased feeling of support for both the parents and the boys from their peer groups. In SNAP all of the family members are seen separately in their appropriate groups, without specific family therapy. The SNAP program may be detrimental as it can promote delinquent behavior by putting the boys together during Transformer Club where inadvertently, a delinquent may receive social support for his past delinquency. The SNAP program took place at the delinquent’s school instead of their family home. This may limit both convenience and adherence to the therapy. Upon completion of the program, qualitative interviews conducted with each family revealed an overall improvement in anger management and social skills amongst participants [6]. It is important to note however, that this study had a relatively high attrition rate, as only 37 % of the original SNAP participants consented to the final interview assessment of the program.
Scared Straight Scared Straight represents a distinct contrast to the previously mentioned intervention programs. Unlike the other programs, which strive to prevent the reoccurrence of delinquency through therapy and parental support, Scared Straight attempts to deter adolescents
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from initial delinquent behavior by exposing them to the harsh realities of life as a prison inmate. The program hypothesized that these adolescents will be scared into leading a life free from future criminal activity. The delinquent is brought to an adult prison, given tours, and receives direct exposure and interpersonal interactions with currently convicted felons. However, from a meta-analysis of the current literature concerning the effects of Scared Straight on juvenile delinquency [9], concluded that programs of this nature do not successfully prevent future delinquency. Unfortunately, this exposure actually appears to increase the likelihood of future criminal behavior.
Evidence-Based, Researched Multisystemic Therapy In the last three decades there has been ample research to demonstrate that instituting MST for serious juvenile offenders, keeping them in the community with intensive intervention, significantly reduces recidivism. When there is recidivism, it is less severe than in released incarcerated juveniles. According to a study by Borduin et al. [3] 4 years after juvenile delinquents were treated with either MST or an individual therapy plan, MST participants had a significantly lower recidivism rate. MST participants had a rate of recidivism of 22.1 %. This is significant, especially when compared to the individual therapy group which had a recidivism rate of 71.4 %. Interestingly, even those that participated only temporarily in the MST program also had a reduced recidivism rate of 46.6 % compared to the control delinquent group. Based on findings such as these, in New York City, there is the new mandate through the Juvenile Justice Initiative to implement interventions, like MST, which keep juvenile offenders in the community rather than sending them to be incarcerated (New York City) [7]. When taking into account all the experiences and systems involved in creating or producing delinquency, it makes sense that the treatment must also be multifactorial. In the literature, one is not able to pinpoint a single universal MST rigid treatment plan. This is due to MST’s commitment to the individual and their family, school, problems, behaviors, and the therapist’s recognition that each case may be handled differently. MST is an intensive therapy program which focuses on numerous aspects of the delinquent’s life; family, school, social and any other unique factors which may relate to the individual delinquent’s behaviors [8]. MST focuses on prosocial activity and less association with deviant peers. It has been implemented and researched in dozens of research trials and case studies, and repeatedly received significant ratings in both effectiveness and efficacy [4]. According to a study by Tighe et al. [11], one of the main goals of MST is to decrease the juvenile delinquents association with other delinquent youths, while facilitating familial support through communication and guided problem solving. Some of the main praises of MST are highlighted in Tighe’s qualitative study. Insights from participants included appreciation that the family finally had time to talk with each other as well as for the nonblaming approach taken by the therapist. Delinquent individuals also stated they were more clearly able to see and recognize how their behaviors were affecting their family. Both family members and delinquents reported a decrease in delinquent behavior, improved familial relationships, and an increased interest and understanding of the delinquent’s role in creating their own future, and taking responsibility for their actions [11]. Despite these positive results from MST research, it has proven difficult to implement it as a treatment plan into standard practice and policy today due to comparative ease of other methods, potential higher initial cost, increase of commitment on state and individual levels and failure to see future community gains.
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Early Interventions for Delinquency and Adult Criminality Prevention However as certain studies appear to show, preventing juvenile delinquency is far superior to trying to correct it later. As with other commonly used preventative public health measures, early intervention for children at high risk for delinquency may prove key. By focusing proactive efforts on adolescents with specific risk factors for juvenile delinquency, including antisocial behavior, society would be spared the financial burden of incarceration, victim damages and alternative treatments for reducing delinquency recidivism. The quality of life for the youth at risk for delinquency and the quality of life of individuals in society would both be greatly improved. Additionally, applying proactive programs to at-risk populations of a younger age has been shown to be even better. One such long term study has been the Perry Preschool Project which teaches children prosocial values and provides their families with support from the community during the child’s early, formative years. Early childhood interventions can include center-based education for the child, support programs for the family members or they include elements of both. The systematic literature review conducted by Hirokazu Yoshikawa in 1995 succeeded in creating a consolidated list of 40 early childhood programs [12]. However, of these 40 programs only 11 investigated the effects of early intervention on the subjects’ future delinquency and antisocial behavior. Although of all of these eleven programs, which evaluated the effects on juvenile delinquency and antisocial behavior, only four of these programs examined the results in the long term and incorporated both family support and educational efforts. As it has been previously observed, children exposed to multiple risk factors face a heightened risk for future delinquency [5]. Therefore, it is suggested that intervention programs that target multiple risk factors may yield superior results [12]. The first program to meet these criteria was the Perry Preschool Program, mentioned above, which involved 123 3 and 4 years old children. Each child received approximately 12 h of preschool education per week for seven and a half months each year for 2 years. The teachers were also required to conduct weekly home visits. Lasting ninety minutes, these home visits involved both the child and their mother. Follow ups were conducted with the children at the ages of 14, 19, 27 and 40 years. When compared with non-program participants, children enrolled in the Perry Preschool Program exhibited a significant reduction in adult and lifetime criminality at all time points studied. Upon follow up at age 40, it was found that only 28 % of the Perry Preschool Program participants had served jail time versus 52 % of the control participants [10]. Additionally, the Perry Preschool Program model has become one of the most commonly used curriculums in the Head Start program offered to low-income families. It is important to note that Head Start does not directly evaluate the effect of their programs on juvenile delinquency or antisocial behavior. Instead, Head Start strives to assess each participant’s ‘school readiness.’ However, as they begin to integrate educational pre-K childcare and family support services, an effect on reducing juvenile delinquency would be an expected favorable by-product. Preliminary results from Head Start’s assessment show positive effects on the social-emotional and cognitive development, as well as parenting practices. However, follow up was only conducted at the 1st grade time point and longer term follow up would be necessary to properly assess the lasting effects of the Head Start programs. Additionally, although support programs were made available to each parent it was unclear if every parent did in fact take advantage of these classes. This study also did not contain a ‘‘no-program’’ control group. Children who were not selected for the Head
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Start program were permitted to enroll in a non-Head Start childcare program or preschool, which may or may not have offered some similar integrative experience for the child. Another program, the Syracuse University Family Development Program featured 108 families and also featured high quality daycare and weekly home visits. However, unlike the Perry Preschool Program model, parents were offered very early support beginning prenatally and continuing into elementary school. Follow up was conducted at 13 and 16 years of age and yielded comparable results to the Perry Preschool Program, with a significant reduction in future delinquency. At follow up only 6.2 % of program youths were in probation versus 22 % of control participants. These results suggest that prenatal care for families, especially for those with certain identified risks for juvenile delinquency development such as low socioeconomic status, should prove advantageous. Unfortunately, longer term follow up data has not yet been obtained to assess how the Syracuse project may have affected adult criminality amongst the participant children. Unlike the first two early intervention projects, The Yale Child Welfare Project represents a significantly smaller scale program. With only 17 families participating in the study, each family received a personal ‘team’ of professionals to assist, beginning during the pregnancy and ending at 2.5 years of age. Families were paired with a pediatrician, home visitor, childcare worker and developmental examiner to assist the parents throughout the course of the program. When behavior was assessed at a 10 years follow up, program children were depicted as well adjusted for school and male children exhibited less antisocial behavior than their non-program counterparts [12].
Cost Effective Savings to Society with MST and Early Intervention Prevention Programs When comparing the cost to society, it has been shown that both MST and the Perry Preschool Program yield substantial returns on the initial investment. According to Osher et al. [8], the net program cost for MST was near $4,743 for each participant. However, this investment eventually goes on to save taxpayers and crime victims $131,918 for each MST participant. A similar projection is made with the Perry Preschool Program, which costs $14,716 and yields $105,000 per participant in savings [8]. Results from the Syracuse University Family Development Program found a heightened cost to the criminal justice system for non-program participants. Based on data collected at their longer term follow up, researchers found the costs totaled $186 per program participant versus $1,985 per control individual. These programs represent a stark contrast to other intervention programs such as Scared Straight programs and juvenile boot camps, which yield respectively a cost of $24,531 and $3,587 instead of providing a savings to society as did the previously discussed programs [8]. A review of the literature shows that in the past there have been a variety of methods for treating juvenile delinquency. However, it becomes apparent that only a select few are successful at reducing recidivism and producing positive changes for society. MST has become the research-documented gold standard for treating juvenile delinquents in a highly cost effective manner. MST successfully reduces recidivism and the severity of recidivism. However, the ultimate goal for society should be to prevent juvenile delinquency altogether. Studies, such as the Perry Preschool Program suggest that early intervention programs produce positive effects on reducing future delinquency and are highly cost effective for society. By combining early education programs with support programs, the Perry Preschool Program is able to target multiple risk factors, including antisocial
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behavior, for future delinquency. Therefore the Perry Preschool Program serves as the most promising investment for reforming society’s treatment of youth most at risk for delinquent behavior.
A rational and Logical Approach to Prevention and Treatment of Delinquency Based on this established evidence-based research, society would be wise to institute widespread prevention programs modeled on the Perry Preschool Program. Additionally, for those youths who do commit delinquent acts, MST should be the widespread treatment of choice.
References 1. Abram KM, Choe JY, Washburn JJ, Romero EG, Teplin LA. Functional Impairment in Youth Three Years after Detention. Journal of Adolescent Health 44(6):528–535, 2009. 2. Bergseth KJ, Bouffard JA. Examining the effectiveness of a restorative justice program for various types of juvenile offenders. International Journal of Offender Therapy and Comparative Criminology. http://ijo.sagepub.com/content/early/2012/07/16/0306624x12453551. 2012. 3. Borduin CM, Mann BJ, Cone LT, Henggeler SW, Fucci BR, Blaske DM, Williams RA. Multisystemic treatment of serious juvenile offenders: long-term prevention of criminiality and violence. Journal of Consulting and Clinical Psychology 63(4):569-–578, 1995. 4. Henggeler SW, Sheidow AJ. Empirically supported family-based treatments for conduct disorder and deliquency in adolesents. Journal of Marital and Family Therapy 38(1):30–58, 2012. 5. Hoeve M, Stams GJ, Van Der Put CE, Dubas JS, Van Der Laan PH, Gerris JRM. A meta-analysis of attachment to parents and deliquency. Journal of Abnormal Child Psychology 40:771–785, 2012. 6. Lipman EL, Kenny M, Brennan E, O’Grady S, Augimeri L. Helping boys at-risk of criminal activity: qualitative results of a multi-component intervention. BMC Public Health 11:364, 2011. 7. New York City Administration for Children’s Services. Juvenile justice initiative. NYC.gov. http:// www.nyc.gov/html/acs/downloadsproviders_newsletter/2012Jan25/slides/JJI_Presentation.pdf. 2012. 8. Osher DM, Quinn MM, Poirer JM, Rutherford RB. Deconstructing the pipeline: using efficacy, effectiveness, and cost-benefit data to reduce minority youth incarceration. New Directions for Youth Development 99:91–120, 2003. 9. Petrosino A, Turpin-Petrosino C, Buehler J. Scared Straight’ and other juvenile awareness programs for preventing juvenile delinquency. Cochrane Database of Systematic Reviews 2:CD002796, 2009. 10. Schweinhart LJ, Montie J, Xiang Z, Barnett WS, Belfield CR, Nores M. The high/scope perry preschool study through age 40 summary, conclusions, and frequently asked questions. High/Scope Educational Research Foundation, pp. 194–215, 2005. 11. Tighe A, Pistrang N, Casdagli L, Baruch G, Butler S. Multisystemic Therapy for young offenders: families’ experiences of therapeutic processes and outcomes. Journal of Family Psychology 26(2):187–197, 2012. 12. Yoshikawa H. Long-term effects of early childhood programs on social outcomes and deliquency. The Future of Children 5(3):51–75, 1995.
Jessica May, BA is a current first year medical student enrolled at Hofstra NSLIJ School of Medicine. She has received her BA in Neuroscience and Behavior from Columbia University. Kristina Osmond, MSN is a practicing nurse at Mt. Sinai Medical Center working in the NICU. Stephen Billick, MD is a child, adolescent and adult clinical and forensic psychiatrist currently practicing in New York City. He is a clinical professor of psychiatry at NYU School of Medicine.
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Juvenile Delinquency Treatment and Prevention: A Literature Review Jessica May • Kristina Osmond • Stephen Billick
Ó Springer Science+Business Media New York 2014
Abstract In the last three decades there has been ample research to demonstrate that instituting Multisystemic Therapy for serious juvenile offenders, keeping them in the community with intensive intervention, can significantly reduce recidivism. When there is recidivism, it is less severe than in released incarcerated juveniles. Multisystemic Therapy provides 24 h available parental guidance, family therapy, individual therapy, group therapy, educational support and quite importantly a change of peer group. In New York City, there is the new mandate through the Juvenile Justice Initiative to implement interventions to keep juvenile offenders in the community rather than sending them to be incarcerated. However, this paper aims to examine how teaching prosocial values in early childhood can reduce the incidence of first-time juvenile delinquency. Programs such as the Perry School Project will be discussed to demonstrate that although somewhat expensive, these innovative programs nonetheless are quite cost-effective as the cost to society of adjudication, incarceration and victim damages are significantly greater. Along with teaching prosocial 0020 values, there has been renewed interest in early identification of youth at risk for developing Antisocial Personality Disorder. An update is given on the status of both promising approaches in early intervention to prevent serious juvenile delinquency and hence adult criminality. Keywords Juvenile delinquency Multisystemic Therapy Perry preschool project Early childhood intervention programs
J. May Hofstra NSLIJ School of Medicine, Hempstead, NY, USA K. Osmond Mt. Sinai Medical Center, New York, NY, USA S. Billick (&) NYU School of Medicine, 901 5th Avenue, New York, NY 10021, USA e-mail: [email protected]
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Current Treatment of Delinquency and Historical Development Recognizing the developmental aspect of juveniles as distinct from adults, the first juvenile justice system was established in 1899 in Illinois and which then led to the creation of the first child and adolescent psychiatry clinic in 1909, in Chicago. This clinic was specifically created to aid the newly formed family courts in their adjudication of wayward youth. Eventually all 50 states adopted these special courts to handle juvenile delinquency outside of the adult criminal courts. The goal of these courts was to help the youth return to a healthy path of development. Hence, there was no sentencing, only adjudication of the youth for their betterment. Until In re Gault, children and adolescents in family court had few of the safeguards afforded to adults charged with crimes. They now have all of legal rights except for a jury of their peers. Since the 1970s, with the dramatic rise in violent crime committed by adolescents, many juveniles have been returned to the jurisdiction of adult criminal courts. Society was outraged to see juveniles murder and rape and be released from custody at the age of 21 years, and further to have the juvenile records sealed. In some jurisdictions, the juvenile may begin in family court and be waived up to adult criminal court. In other states, such as New York, adolescents who commit specific crimes of violence or with a weapon are immediately sent directly to adult criminal court. Society has sought to reduce juvenile crime with longer incarceration in juvenile detention facilities and some in adult prisons, with only modest success. Unfortunately when released, incarcerated juveniles have been fully educated to be better criminals. Spending time with more experienced criminals provides an unwanted fertile environment for teaching adolescents exactly that which we do not want them to learn [1].
Prediction of Delinquency and Recidivism Multiple studies show that the best predictor for delinquent behavior in the future is delinquent behavior in the past. These youths continue their delinquency with no guide to change their behavior, thus there is no break in the chain. A study by Abram et al. highlights this point. His study follows almost 2,000 juvenile delinquents who were interviewed and assessed 3 years after being detained at the Cook County Juvenile Temporary Detention Center. Interviewers used the Child and Adolescent Functional Assessment Scale (CAFAS) to determine the functionality of the participants based on their responses during the semi-structured interview. Participants received scores in eight different categories, including; their home, work/school, community, behavior, mood, selfharm behavior, substance use, and thinking. The participant’s scores then indicated the level to which they were impaired or not at all impaired. Based on these interviews, almost 30 % of juvenile delinquents had marked or severe impairment across all domains. Almost all participants had severe impairments in at least one domain [1].
Restorative Justice In an article by Bergseth and Bouffard, these researchers explain another type of treatment for juvenile delinquents, called Restorative Justice (RJ) [2]. RJ lies in the middle of two competing theories for juvenile delinquent treatment, which are punishment and restoration. One of this program’s main goals is to restore justice to the victim as well as the community. Crimes committed by the juvenile delinquent are revisited, and many times the
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victim must be confronted. This structure does do some therapeutic work for the juvenile delinquent; including taking responsibility for the wrongs they have committed, and learning how to be held accountable. However, as documented below, when RJ is compared to Multisystemic Therapy (MST), RJ is one-dimensional. The duration of this program is very short, with each participant receiving at least one session with a program facilitator. Consequently, the juvenile delinquent learns much less about becoming prosocial in this short time frame. RJ only involves one factor of the delinquent’s life, which is their crime. RJ had a large focus on the victim, which may be an important aspect, but is certainly not the only factor requiring being addressed in understanding the complexity of delinquent behavior. One of the critical complaints of RJ is that it may not significantly decrease juvenile delinquent recidivism rates for all types of offenders. Analysis revealed that the RJ program only yields a significant reduction in future criminality amongst male, first-time offenders who were under the age of 14. Bergseth and Bouffard state that the younger age that the delinquents are when referred to and treated with RJ, the longer the time frame will be before reoffending. However, when it comes to more serious offenders, who are generally older juveniles who have committed more serious crimes, RJ may not be as successful in producing change in the juvenile delinquents themselves. Thus, more lengthy treatment programs which address more dysfunctional aspects of the juvenile delinquent’s life are essential when treating juvenile delinquency. However, research shows that RJ is better than detention.
Stop Now, Act Later SNAP (Stop Now, Act Later) is a study on delinquent adolescent boys ages 6–11 years old in Ontario, Canada. The program was 12 weeks long and had two components. The first was the Transformer Club, which was for the delinquent boys. The main goal was to help participants through the group therapy process by identifying their bad behavior and helping to control and manage their anger. The second component was the SNAP meeting, group therapy intended for the parents. Positive feedback from the groups included positive communication with other parents and separately with the delinquent boys, and the increased feeling of support for both the parents and the boys from their peer groups. In SNAP all of the family members are seen separately in their appropriate groups, without specific family therapy. The SNAP program may be detrimental as it can promote delinquent behavior by putting the boys together during Transformer Club where inadvertently, a delinquent may receive social support for his past delinquency. The SNAP program took place at the delinquent’s school instead of their family home. This may limit both convenience and adherence to the therapy. Upon completion of the program, qualitative interviews conducted with each family revealed an overall improvement in anger management and social skills amongst participants [6]. It is important to note however, that this study had a relatively high attrition rate, as only 37 % of the original SNAP participants consented to the final interview assessment of the program.
Scared Straight Scared Straight represents a distinct contrast to the previously mentioned intervention programs. Unlike the other programs, which strive to prevent the reoccurrence of delinquency through therapy and parental support, Scared Straight attempts to deter adolescents
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from initial delinquent behavior by exposing them to the harsh realities of life as a prison inmate. The program hypothesized that these adolescents will be scared into leading a life free from future criminal activity. The delinquent is brought to an adult prison, given tours, and receives direct exposure and interpersonal interactions with currently convicted felons. However, from a meta-analysis of the current literature concerning the effects of Scared Straight on juvenile delinquency [9], concluded that programs of this nature do not successfully prevent future delinquency. Unfortunately, this exposure actually appears to increase the likelihood of future criminal behavior.
Evidence-Based, Researched Multisystemic Therapy In the last three decades there has been ample research to demonstrate that instituting MST for serious juvenile offenders, keeping them in the community with intensive intervention, significantly reduces recidivism. When there is recidivism, it is less severe than in released incarcerated juveniles. According to a study by Borduin et al. [3] 4 years after juvenile delinquents were treated with either MST or an individual therapy plan, MST participants had a significantly lower recidivism rate. MST participants had a rate of recidivism of 22.1 %. This is significant, especially when compared to the individual therapy group which had a recidivism rate of 71.4 %. Interestingly, even those that participated only temporarily in the MST program also had a reduced recidivism rate of 46.6 % compared to the control delinquent group. Based on findings such as these, in New York City, there is the new mandate through the Juvenile Justice Initiative to implement interventions, like MST, which keep juvenile offenders in the community rather than sending them to be incarcerated (New York City) [7]. When taking into account all the experiences and systems involved in creating or producing delinquency, it makes sense that the treatment must also be multifactorial. In the literature, one is not able to pinpoint a single universal MST rigid treatment plan. This is due to MST’s commitment to the individual and their family, school, problems, behaviors, and the therapist’s recognition that each case may be handled differently. MST is an intensive therapy program which focuses on numerous aspects of the delinquent’s life; family, school, social and any other unique factors which may relate to the individual delinquent’s behaviors [8]. MST focuses on prosocial activity and less association with deviant peers. It has been implemented and researched in dozens of research trials and case studies, and repeatedly received significant ratings in both effectiveness and efficacy [4]. According to a study by Tighe et al. [11], one of the main goals of MST is to decrease the juvenile delinquents association with other delinquent youths, while facilitating familial support through communication and guided problem solving. Some of the main praises of MST are highlighted in Tighe’s qualitative study. Insights from participants included appreciation that the family finally had time to talk with each other as well as for the nonblaming approach taken by the therapist. Delinquent individuals also stated they were more clearly able to see and recognize how their behaviors were affecting their family. Both family members and delinquents reported a decrease in delinquent behavior, improved familial relationships, and an increased interest and understanding of the delinquent’s role in creating their own future, and taking responsibility for their actions [11]. Despite these positive results from MST research, it has proven difficult to implement it as a treatment plan into standard practice and policy today due to comparative ease of other methods, potential higher initial cost, increase of commitment on state and individual levels and failure to see future community gains.
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Early Interventions for Delinquency and Adult Criminality Prevention However as certain studies appear to show, preventing juvenile delinquency is far superior to trying to correct it later. As with other commonly used preventative public health measures, early intervention for children at high risk for delinquency may prove key. By focusing proactive efforts on adolescents with specific risk factors for juvenile delinquency, including antisocial behavior, society would be spared the financial burden of incarceration, victim damages and alternative treatments for reducing delinquency recidivism. The quality of life for the youth at risk for delinquency and the quality of life of individuals in society would both be greatly improved. Additionally, applying proactive programs to at-risk populations of a younger age has been shown to be even better. One such long term study has been the Perry Preschool Project which teaches children prosocial values and provides their families with support from the community during the child’s early, formative years. Early childhood interventions can include center-based education for the child, support programs for the family members or they include elements of both. The systematic literature review conducted by Hirokazu Yoshikawa in 1995 succeeded in creating a consolidated list of 40 early childhood programs [12]. However, of these 40 programs only 11 investigated the effects of early intervention on the subjects’ future delinquency and antisocial behavior. Although of all of these eleven programs, which evaluated the effects on juvenile delinquency and antisocial behavior, only four of these programs examined the results in the long term and incorporated both family support and educational efforts. As it has been previously observed, children exposed to multiple risk factors face a heightened risk for future delinquency [5]. Therefore, it is suggested that intervention programs that target multiple risk factors may yield superior results [12]. The first program to meet these criteria was the Perry Preschool Program, mentioned above, which involved 123 3 and 4 years old children. Each child received approximately 12 h of preschool education per week for seven and a half months each year for 2 years. The teachers were also required to conduct weekly home visits. Lasting ninety minutes, these home visits involved both the child and their mother. Follow ups were conducted with the children at the ages of 14, 19, 27 and 40 years. When compared with non-program participants, children enrolled in the Perry Preschool Program exhibited a significant reduction in adult and lifetime criminality at all time points studied. Upon follow up at age 40, it was found that only 28 % of the Perry Preschool Program participants had served jail time versus 52 % of the control participants [10]. Additionally, the Perry Preschool Program model has become one of the most commonly used curriculums in the Head Start program offered to low-income families. It is important to note that Head Start does not directly evaluate the effect of their programs on juvenile delinquency or antisocial behavior. Instead, Head Start strives to assess each participant’s ‘school readiness.’ However, as they begin to integrate educational pre-K childcare and family support services, an effect on reducing juvenile delinquency would be an expected favorable by-product. Preliminary results from Head Start’s assessment show positive effects on the social-emotional and cognitive development, as well as parenting practices. However, follow up was only conducted at the 1st grade time point and longer term follow up would be necessary to properly assess the lasting effects of the Head Start programs. Additionally, although support programs were made available to each parent it was unclear if every parent did in fact take advantage of these classes. This study also did not contain a ‘‘no-program’’ control group. Children who were not selected for the Head
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Start program were permitted to enroll in a non-Head Start childcare program or preschool, which may or may not have offered some similar integrative experience for the child. Another program, the Syracuse University Family Development Program featured 108 families and also featured high quality daycare and weekly home visits. However, unlike the Perry Preschool Program model, parents were offered very early support beginning prenatally and continuing into elementary school. Follow up was conducted at 13 and 16 years of age and yielded comparable results to the Perry Preschool Program, with a significant reduction in future delinquency. At follow up only 6.2 % of program youths were in probation versus 22 % of control participants. These results suggest that prenatal care for families, especially for those with certain identified risks for juvenile delinquency development such as low socioeconomic status, should prove advantageous. Unfortunately, longer term follow up data has not yet been obtained to assess how the Syracuse project may have affected adult criminality amongst the participant children. Unlike the first two early intervention projects, The Yale Child Welfare Project represents a significantly smaller scale program. With only 17 families participating in the study, each family received a personal ‘team’ of professionals to assist, beginning during the pregnancy and ending at 2.5 years of age. Families were paired with a pediatrician, home visitor, childcare worker and developmental examiner to assist the parents throughout the course of the program. When behavior was assessed at a 10 years follow up, program children were depicted as well adjusted for school and male children exhibited less antisocial behavior than their non-program counterparts [12].
Cost Effective Savings to Society with MST and Early Intervention Prevention Programs When comparing the cost to society, it has been shown that both MST and the Perry Preschool Program yield substantial returns on the initial investment. According to Osher et al. [8], the net program cost for MST was near $4,743 for each participant. However, this investment eventually goes on to save taxpayers and crime victims $131,918 for each MST participant. A similar projection is made with the Perry Preschool Program, which costs $14,716 and yields $105,000 per participant in savings [8]. Results from the Syracuse University Family Development Program found a heightened cost to the criminal justice system for non-program participants. Based on data collected at their longer term follow up, researchers found the costs totaled $186 per program participant versus $1,985 per control individual. These programs represent a stark contrast to other intervention programs such as Scared Straight programs and juvenile boot camps, which yield respectively a cost of $24,531 and $3,587 instead of providing a savings to society as did the previously discussed programs [8]. A review of the literature shows that in the past there have been a variety of methods for treating juvenile delinquency. However, it becomes apparent that only a select few are successful at reducing recidivism and producing positive changes for society. MST has become the research-documented gold standard for treating juvenile delinquents in a highly cost effective manner. MST successfully reduces recidivism and the severity of recidivism. However, the ultimate goal for society should be to prevent juvenile delinquency altogether. Studies, such as the Perry Preschool Program suggest that early intervention programs produce positive effects on reducing future delinquency and are highly cost effective for society. By combining early education programs with support programs, the Perry Preschool Program is able to target multiple risk factors, including antisocial
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behavior, for future delinquency. Therefore the Perry Preschool Program serves as the most promising investment for reforming society’s treatment of youth most at risk for delinquent behavior.
A rational and Logical Approach to Prevention and Treatment of Delinquency Based on this established evidence-based research, society would be wise to institute widespread prevention programs modeled on the Perry Preschool Program. Additionally, for those youths who do commit delinquent acts, MST should be the widespread treatment of choice.
References 1. Abram KM, Choe JY, Washburn JJ, Romero EG, Teplin LA. Functional Impairment in Youth Three Years after Detention. Journal of Adolescent Health 44(6):528–535, 2009. 2. Bergseth KJ, Bouffard JA. Examining the effectiveness of a restorative justice program for various types of juvenile offenders. International Journal of Offender Therapy and Comparative Criminology. http://ijo.sagepub.com/content/early/2012/07/16/0306624x12453551. 2012. 3. Borduin CM, Mann BJ, Cone LT, Henggeler SW, Fucci BR, Blaske DM, Williams RA. Multisystemic treatment of serious juvenile offenders: long-term prevention of criminiality and violence. Journal of Consulting and Clinical Psychology 63(4):569-–578, 1995. 4. Henggeler SW, Sheidow AJ. Empirically supported family-based treatments for conduct disorder and deliquency in adolesents. Journal of Marital and Family Therapy 38(1):30–58, 2012. 5. Hoeve M, Stams GJ, Van Der Put CE, Dubas JS, Van Der Laan PH, Gerris JRM. A meta-analysis of attachment to parents and deliquency. Journal of Abnormal Child Psychology 40:771–785, 2012. 6. Lipman EL, Kenny M, Brennan E, O’Grady S, Augimeri L. Helping boys at-risk of criminal activity: qualitative results of a multi-component intervention. BMC Public Health 11:364, 2011. 7. New York City Administration for Children’s Services. Juvenile justice initiative. NYC.gov. http:// www.nyc.gov/html/acs/downloadsproviders_newsletter/2012Jan25/slides/JJI_Presentation.pdf. 2012. 8. Osher DM, Quinn MM, Poirer JM, Rutherford RB. Deconstructing the pipeline: using efficacy, effectiveness, and cost-benefit data to reduce minority youth incarceration. New Directions for Youth Development 99:91–120, 2003. 9. Petrosino A, Turpin-Petrosino C, Buehler J. Scared Straight’ and other juvenile awareness programs for preventing juvenile delinquency. Cochrane Database of Systematic Reviews 2:CD002796, 2009. 10. Schweinhart LJ, Montie J, Xiang Z, Barnett WS, Belfield CR, Nores M. The high/scope perry preschool study through age 40 summary, conclusions, and frequently asked questions. High/Scope Educational Research Foundation, pp. 194–215, 2005. 11. Tighe A, Pistrang N, Casdagli L, Baruch G, Butler S. Multisystemic Therapy for young offenders: families’ experiences of therapeutic processes and outcomes. Journal of Family Psychology 26(2):187–197, 2012. 12. Yoshikawa H. Long-term effects of early childhood programs on social outcomes and deliquency. The Future of Children 5(3):51–75, 1995.
Jessica May, BA is a current first year medical student enrolled at Hofstra NSLIJ School of Medicine. She has received her BA in Neuroscience and Behavior from Columbia University. Kristina Osmond, MSN is a practicing nurse at Mt. Sinai Medical Center working in the NICU. Stephen Billick, MD is a child, adolescent and adult clinical and forensic psychiatrist currently practicing in New York City. He is a clinical professor of psychiatry at NYU School of Medicine.
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