Psychiatry and Behavioral Sciences
Policy Related Publications
15. Henggeler, S.W. (1994). A consensus: Conclusions of the APA Task Force report on innovative models of mental health services for children, adolescents, and their families. Journal of Clinical Child Psychology, 23(Suppl), 3-6.
18. Henggeler, S.W., & Schoenwald, S.K. (1994). Boot camps for juvenile offenders: Just say "no." Journal of Child and Family Studies, 3, 243‑248.
20. Henggeler, S.W., Schoenwald, S.K., Pickrel, S.G., Rowland, M.D., & Santos, A.B. (1994). The contribution of treatment research to the reform of children's mental health services: Multisystemic family preservation as an example. Journal of Mental Health Administration, 21, 229‑239.
23. Sondheimer, D., Schoenwald, S.K., & Rowland, M.D. (1994). Alternatives to the hospitalization of youth with a serious emotional disturbance. Journal of Clinical Child Psychology, 23(Suppl), 7-12.
26. Henggeler, S.W. (1997). The development of effective drug abuse services for youth. In J.A. Egerston, D.M. Fox, & A. I. Leshner (Eds.), Treating drug abusers effectively (pp. 253-279). New York: Blackwell Publishers.
29. Henggeler, S.W., Schoenwald, S.K., & Munger, R.L. (1996). Families and therapists achieve clinical outcomes, systems of care mediate the process. Journal of Child and Family Studies, 5, 177-183.
30. ** Henggeler, S.W., & Santos, A.B. (Eds.). (1997). Innovative approaches for "difficult- to-treat" populations. Washington, D.C.: American Psychiatric Press. (Book)
31. Henggeler, S.W., & Santos, A.B. (1997). Introduction, overview, and commonalities of innovative approaches. In S.W. Henggeler & A.B. Santos (Eds.), Innovative approaches for "difficult-to-treat" populations, (pp. xxiii-xxxiii). Washington, D.C.: American Psychiatric Press.
32. Henggeler, S.W., Schoenwald, S.K., & Pickrel, S.G. (1995). Multisystemic therapy: Bridging the gap between university‑ and community‑based treatment. Journal of Consulting and Clinical Psychology, 63(5), 709-717.
33. Munger, R.L. (1997). Ecological trajectories in child mental health. In S.W. Henggeler & A.B. Santos (Eds.), Innovative approaches for "difficult-to-treat" populations, (pp. 3-25) Washington, D.C.: American Psychiatric Press.
36. Santos, A.B., Henggeler, S.W., Burns, B.J., Arana, G.W., & Meisler, N. (1995). Research on field-based services: Models for reform in the delivery of mental health care to populations with complex clinical problems. The American Journal of Psychiatry, 152(8), 1111-1123.
43. Schoenwald, S.K., & Henggeler, S.W. (1997). Combining effective treatment approaches with family preservation models of service delivery: A challenge for mental health. In R.J. Illback, C.T. Cobb & H.M. Joseph, Jr. (Eds.), Integrated services for children and families: Opportunities for psychological practice (pp. 121-136). Washington, DC: American Psychological Association.
46. Becker, J.V., Alpert, J.L., Subia-BigFoot, D., Bonner, B.L., Geddie, L.F., Henggeler, S.W., Kaufman, K.L., & Walker, C.E. (1995). Empirical research on child abuse treatment: Report by the Child Abuse and Neglect Treatment Working Group, American Psychological Association. Journal of Clinical Child Psychology, 24(Suppl.), 23-46.
51. Henggeler, S.W. (1996). Treatment of violent juvenile offenders-We have the knowledge: Comment on Gorman-Smith et al. Journal of Family Psychology, 10, 137-141.
52. Henggeler, S.W., Rowland, M.D., Pickrel, S.G., Miller, S.L., Cunningham, P.B., Santos, A.B., Schoenwald, S.K., Randall, J. & Edwards, J.E. (1997). Investigating family-based alternatives to institution-based mental health services for youth: Lessons learned from the pilot study of a randomized field trial. Journal of Clinical Child Psychology. 26, 226-233.
59. Henggeler, S.W. (1997). Future Directions: Specification, validation and funding of ecologically based interventions for schools within communities. In J.L. Swartz & W.E. Martin (Eds.), Applied ecological psychology for schools within communities: Assessment and intervention (pp. 221-223). Hillsdale, NJ: Lawrence Erlbaum Associated, Inc.
67. Swenson, C.C., Henggeler, S.W., Schoenwald, S.K., Kaufman, K.L., & Randall, J. (1998). Changing the social ecologies of adolescent sexual offenders: Implications of the success of multisystemic therapy in treating serious antisocial behavior in adolescents. Child Maltreatment. 3(4), 330-338.
69. Brown, T.L., & Henggeler, S.W. (1998). Preventing restrictive placements. Reaching Today’s Youth, 2(4), 52-56.
211. Schoenwald, S.K., Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Journal of Psychiatric Services, 52(9), 1190-1197.
214. Schoenwald, S.K. (2002). Least restrictive alternative concepts as applied to children’s mental health: clarifications and propositions. Children’s Services: Social Policy, Research, and Practice, 5 (2), 95-98.
219. Randall, J., Halliday-Boykins, C.A., Cunningham, P.B., Henggeler, S.W. (2001). Integrating evidence-based substance abuse treatment into juvenile drug courts: Implications for outcomes. National Drug Court Institute Review, 3, 89-115.
222. Henggeler, S.W., Lee, T., & Burns, J.A. (2002). What happens after the innovation is identified? Clinical Psychology: Science and Practice, 9, 191-194.
245. Schoenwald, S.K., & Henggeler, S.W. (2003). Current strategies for moving evidence-based interventions into clinical practice: Introductory comments. Cognitive and Behavioral Practice, 10, 275-277.
249. Henggeler, S.W. (2003). Advantages and disadvantages of multisystemic therapy and other evidence-based practices for treating juvenile offender. Journal of Forensic Psychology Practice, 3, 53-59.
257. Schoenwald, S.K., Henggeler, S.W. (2004). A public health perspective on the transport of evidence-based practices. Clinical Psychology: Science and Practice, V11 N4, 360-363.
266. Weisz, J.R., Weersing, V.R., Henggeler, S.W., (2005). Jousting with straw men: Comment on Westen, Novonty, and Thompson-Brenner (2004). Psychological Bulletin, 131, 418-426.
273. Letourneau, E.J., Miner, M.H. (2005). Juvenile sex offenders: A case against legal and clinical status quo. Sexual Abuse: A Journal of Research and Treatment, 17 (3), 293-312.
277. Letourneau, E.J. (2005). Legal consequences of juvenile sex offending in the United States. In H.E. Barbaree, & W.L. Marshall (eds.). The Juvenile Sex Offender, 2nd Edition. (pp. 275-290). Guilford Press: New York, NY.
285. Henggeler, S.W., Schoenwald, S.K., Swenson, C.C., Borduin, C.M. (2006). Methodological critique and meta-analysis as Trojan horse. Children and Youth Services Review, 28, 447-457.
293. Sheidow, A. J., Schoenwald, S. K., Wagner, H. R., Allred, C. A., & Burns, B. J. (in press). Predictors of workforce turnover in a transported treatment program. Administration and Policy in Mental Health and Mental Health Services Research.
301. Saldana, L., Chapman, J.E., Henggeler, S.W., Rowland, M.D. (2007). The organizational readiness for change scale in adolescent programs: Criterion validity. Journal of Substance Abuse Treatment, 33, 159-169.
339. McCollister, K.E., French, M.T., Sheidow, A.J., Henggeler, S.W., & Halliday-Boykins, C.A. (2009). Estimating the differential costs of criminal activity for juvenile drug court participants: Challenges and recommendations. The Journal of Behavioral Health Services & Research, 36(1), 111–126.
340. Capella, E., Frazier, S.L., Atkins, M.S., Schoenwald, S.K., & Glisson, C. (2008). An ecological model of school-based mental health services: Enhancing schools' capacity to support children in poverty. Administration and Policy in Mental Health and Mental Health Services Research, 76(4), 556-567.
348. Ogden, T., & Hagen, K.A. (2009). What works for whom? Gender differences in intake characteristics and treatment outcomes following multisystemic therapy. Journal of Adolescence, 1-11.
377. Letourneau, E. J., Levenson, J. S., Bandyopadhyay, D., Sinha, D., Armstrong, K. S. (2009). Effects of South Carolina’s sex offender registration and notification policy on adult recidivism. [Electronic version], Criminal Justice Policy, December 16, 2009. doi:10.1177/0887403409353148
379. Levenson, J. S., Letourneau, E. J., Armstrong, K. S., Zgoba, K. (2010). Failure to register as a sex offender: Is it associated with recidivism? Justice Quarterly, 27(3), 305-331. doi: 10.1080/07418820902972399
387. Henggeler, S. W., Schoenwald, S. K. (2011). Evidence-based interventions for juvenile offenders and juvenile justice policies that support them. Society for Research in Child Development: Social Policy Report, 25, 1-20.
392. Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., Southam-Gerow, M. A. (2011). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 32-43.
393. Schoenwald, S. K. (2011). It’s a bird, it’s a plane, it’s . . . fidelity measurement in the real world. Clinical Psychology: Science and Practice, 18, 142-147.
411. Sheidow, A. J., McCart, M. R., Zajac, K., Davis, M. (2012). Prevalence and impact of substance use among emerging adults with serious mental health conditions. Psychiatric Rehabilitation Journal, 35, (3), 235-43.
Summarized and synthesized are recommended systems-level and clinical-level changes advocated within the task force report and by others concerned about the poor condition of mental health services for children. Systems-level changes include recommendations to reduce use of restrictive services, increase the availability of home and community-based services, increase services integration and provider accountability, reform mechanisms for financing services, and train providers in the delivery of more cost-effective services. Clinical-level changes (a) include recommendations to provide more flexible, individualized, and comprehensive services, and (b) emphasize approaches that empower families. Such recommendations are consistent with Stroul and Friedman’s (1986) blueprint for the reform of mental health services for children and the central thrusts of President Clinton'’ Health Security Plan (White House Domestic Policy Council, 1993).
The apparent increase in the violence of juvenile crime and the media’s sensationalistic portrayals of juvenile violence have fueled public outrage and spawned numerous political strategies to “get tough”. Among the most popular of these is for shapers of policy to vocally advocate the development and proliferation of boot camps. As this editorial is being written, governors and legislators in several states are advocating the use of boot camps for juvenile offenders, and the Crime Bill currently being debated in Congress, and supported by President Clinton, contains a provision for boot camps for juvenile offenders. While the boot camp solution may be politically expedient (in that is assuages public anger and fear and casts the impression that lawmakers are taking action) there is little reason to believe or suggest that such camps are effective in treating chronic, serious, or violent juvenile offenders.Two types of evidence bear upon the question of whether boot camps are effective. The first type consists of findings from studies of boot camps themselves. Most of the studies are quasi-experimental, at best, and many reports are based entirely upon anecdotal evidence (Office of Technology Assessment, 1991). The second type consists of findings on the correlates and causes of juvenile delinquency.
Service system reforms of the past decade have yielded innovations in type, accessibility, and cost of services provided for some children and families with serious problems, but few of the treatments delivered have been empirically evaluated. Rigorous test of well-conceived treatments are needed to provide a solid foundation for continued reform. Multisystemic therapy has demonstrated efficacy in treating serious clinical problems in adolescents and their multineed famililes and is an example of the successful blending of rigorous treatment outcome research and service system innovation.
Examined the evidence regarding efficacy, necessity, and outcomes of psychiatric hospitalization for children and adolescents and described recently developed alternatives that are likely to be more ethical and clinically and cost effective.
The purpose of this application is to expand and extend the implementation of an evidence-based treatment of adolescent substance abuse and co-occurring psychosocial problems that is currently integrated into a juvenile drug court in Charleston, South Carolina. The particular evidence-based treatments (i.e., multisystemic therapy [MST] enhanced with contingency management [CM]) have been cited by the National Institute on Drug Abuse (NIDA, 1999), the Center for Substance Abuse Prevention (2001), and leading reviewers (McBride, VanderWaal, Terry, & VanBuren, 1999; Stanton & Shadish, 1997) as effective or highly promising treatments of adolescent substance abuse. As presented in the application, the effectiveness of MST/CM is further supported by the emerging findings from a NIDA and NIAAA funded randomized clinical trial that is currently being conducted in the Charleston Juvenile Drug Court. Substance abusing juvenile offenders in drug court treated with this evidence-based approach (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) are achieving significantly better drug use, criminal activity, and placement outcomes than drug court counterparts treated with traditional group-based substance abuse interventions.
The present application, therefore, aims to include an additional MST/CM team of three clinicians to provide treatment to substance abusing juvenile offenders currently excluded from the current drug court research project and to maintain such services as the clinical portion of the randomized trial ends in September 2003. Importantly, the favorable outcomes achieved for MST/CM participants in this research study can be used as benchmarks for evaluating the effectiveness of the new MST/CM team proposed in this application. These data provide an extraordinary opportunity to make comparisons that are typically not possible in the evaluation of community-based services. In addition, substantive efforts are underway to support the long-term sustainability of the treatment services provided in the Charleston Juvenile Drug Court.
The absence of significant clinical outcomes from the Fort Bragg Project is not surprising to many treatment outcome researchers. Indeed, a review of the child psychotherapy literature reveals that few treatment approaches have established effectiveness in community settings with youth presenting serious clinical problems. For example, positive child psychotherapy literature reveals that few treatment approaches have established effectiveness in community settings with youth presenting serious clinical problems. For example, positive child psychotherapy effects demonstrated in studies conducted in university settings have rarely been observed in studies conducted in community settings (Weisz & Weiss, 1993; Weisz, Weiss, & Doneberg, 1992). Similarly, with rare exception, treatments of serious antisocial behavior (Henggeler, 1989; Mulverym Arthur, & Reppucci, 1990) and adolescent substance abuse (Henggeler, in press) have not demonstrated long-term effects in randomized clinical trials. Moreover, little empirical support exists for the effectiveness of innovative services such as family preservation (e.g., Rzepnicki, Schuerman, Littell, Chak, & Lopez, 1994) and case management (Burns, Gwaltney, & Bishop, 1995). Thus, if existing treatment models are not clinically effective, why should just the provision of more treatment options to youth in a more coordinated and integrated fashion, as accomplished in the Fort Bragg Project, lead to more positive clinical outcomes?
(from the jacket) This book makes recommendations for developing and disseminating innovative mental health services. The book is geared toward clinicians, administrators, and policy makers struggling to develop both clinically effective and cost-effective mental health and substance abuse services. It focuses on services for individuals who use the highest proportion of mental health resources and for whom traditional services have not been effective. These target populations include youth with serious behavioral and emotional disturbances and adults with severe and persistent mental illnesses. The transition from centralized to community-based care is discussed, and normalizing a patient's daily routine as an important factor in the success of state-of-the-art community support programs is emphasized.
This article purposes, within the context of discouraging findings from child psychotherapy literatures, 2 theory- and empirically based explanations for the emergent success of multisystemic therapy (MST) when implemented in community settings as well as for MST’s favorable long-term effects on serious antisocial behavior in adolescents. First, MST may have demonstrated success in community settings because it explicitly bridges the gap between university-based psychotherapy studies and their community-based counterparts (J.R. Weisz & B. Weiss, 1993). Second, although MST is based on a social-ecological model of behavior, its favorable cross-setting and temporal outcomes may exemplify the successful use of several active behavioral generalization strategies.
(from the chapter) This chapter presents a new strategy for dealing with emotional disturbances in children: the ecological method. The ecological viewpoint challenges the traditional, individualistic, "inner treatment" philosophy in mental health and advocates helping the child with emotional disturbance by making changes in the outer, or ecological, factors that influence behavior. The key in the ecological viewpoint becomes identifying and enabling critical environmental trajectories in the child's life. Child clinicians who learn ecological techniques will find that these techniques are flexible enough to let them master new areas of diagnosis and treatment. The techniques will reveal why a child's environment--whether at home, at school, in the town swimming pool, or anywhere else--is a critical factor in effective community mental health treatment.
Objective: Clinical services for psychiatrically impaired populations have only recently been studied with significantly valid designs to explore innovations in structure, accessibility, and financing. Health systems reform in the United States has provided the impetus for better defining clinically effective and cost-sensitive models for mental health services. This article reviews assertive community treatment, used for adults with severe mental illnesses, and multisystemic therapy, used for adolescents with serious emotional disturbances, as examples of service system innovations that have been studied with controlled clinical trial designs and have demonstrated efficacy in treating difficult and costly clinical populations. Method: The authors reviewed the published controlled clinical trials of assertive community treatment and multisystemic therapy, focusing on the clinical and administrative elements that distinguish them from traditional service systems. Results: A qualitative assessment of these two approaches suggests that they share common elements, with important implications for mental health policy. Specifically, the use of an ecological model of behavior applied to mental health patients is critical to both systems. In addition, therapeutic principles emphasizing pragmatic (outcome-oriented) treatment approaches, home-based interventions, and individualized goals are key elements of their success. Most important, both systems embody a therapeutic philosophy demanding therapist accountability, in which personnel are rewarded for clinical outcomes and therapeutic innovation rather than for following a prescribed plan. Conclusions: As empirically tested approaches, assertive community treatment and multisystemic therapy provide a specific foundation for continued reform and serve to illustrate critical elements in designing new community treatment initiatives for behavioral as well as medical conditions.
(from the chapter) The primary aims of this chapter are to familiarize psychologists with the family-preservation services literature and to illuminate the important role that psychologists and child and adolescent psychotherapy researchers can play in the development, evaluation, and dissemination of effective family-preservation services for youth with serious clinical problems. Family preservation is described as a model of service delivery through which a variety of counseling and concrete service interventions are implemented in the home and communities of at risk families. The basic assumption underlying most programs is that children and adolescents are better off being raised in their natural families than in surrogate families or institutions. First, the philosophical and programmatic features that distinguish family preservation services from traditional (e.g., inpatient, residential, traditional outpatient) models of mental health service delivery are described, as are the most prevalent "practice models" of family preservation services. Next, research on the effectiveness of family-preservation programs with child welfare, juvenile justice, and "mixed" populations is reviewed, and the implications of these findings for the development of effective family-preservation services for child mental health populations are discussed. Emerging practice models designed specifically for youth with serious clinical problems are described. One of these models, multisystemic therapy (MST), has been empirically validated in several clinical trials and provides a good example of the type of theory- and research-driven approaches that may advance the family-preservation field.
Reviewed empirical research on the short- and long-term effects of four major types of child maltreatment (physical abuse, sexual abuse, psychological abuse, and neglect). Outcome research for a variety of treatments for child victims of abuse and for adults abused as children suggests that treatment is effective; however, comprehensive and carefully designed studies have not been done. Likewise, outcome research for treatment efforts with parents and caregivers who engage in child maltreatment is limited, but evidence supports treatment efficacy. Thirteen recommendations are offered pertaining to improvement of conceptualization, treatment, and research in the area of child maltreatment.
On the basis of research by D. Gorman-Smith, P.H. Tolan, A. Zelli, and L.R. Huesmann (1996) and many others, a reasonable consensus has been achieved regarding the concurrent correlates of criminal behavior in adolescents. Moreover, it is known that when these correlates are addressed through a well-specified, ecological treatment model that emphasizes the delivery of flexible, individualized, and comprehensive empirically based services to youths and their families, rates of serious juvenile offending are decreased. Yet, prevailing mental health and juvenile justice services rarely attend to the known determinants of serious antisocial behavior and, in fact provide interventions that are expensive and likely exacerbate the problem. The challenge is both to develop and validate ecologically based treatment models to advocate for the myriad needs of serious juvenile offenders and their families.
The development and validation of family-based alternatives to out-of-home placements for children is an important goal in the mental health services field. The rigorous evaluation of such alternatives, however, can be difficult to accomplish. The purpose of this article is to describe initial barriers experienced during the pilot study of a randomized trial, funded by the National Institute of Mental Health, conducted in a field setting, and strategies that were used to overcome these barriers. The randomized trial is examining home-based multisystemic therapy as an alternative to the psychiatric hospitalization of youths presenting psychiatric emergencies. The pilot study illuminated the interface of treatment and services research issues, prompting significant changes in the project’s clinical procedures, organization, and supervisory processes, as well as in the project’s interface with exiting community resources for serving youths with serious emotional disturbances.
Current treatment models for adolescent sexual offenders are individually oriented and have limited empirical support. These models may not be effective in reducing recidivism because they do not address the multiple factors (i.e., individual, family, peer, school) related to sexual offending. Multisystemic therapy (MST), an ecologically based treatment model that addresses multiple determinants of behavior, has proven effective with chronic, violent nonsexual offenders in several randomized trials. Preliminary research also indicates promise for MST with sexual offenders. This article: (a) presents empirical support for use of an ecological approach with adolescent sexual offenders based on a multidetermined etiology, (b) provides a theoretical and clinical description of MST, and (c) describes a recent adaptation of MST that maintains the ecological emphasis of MST and integrates important conceptualizations from the literature on adolescent sexual offending.
This article presents the key elements and documented outcomes of multisystemic therapy (MST), which to date, is the only treatment for serious delinquent behavior that has demonstrated both short- and long-term outcomes with violent and chronic juvenile offenders and their families from various cultural and ethnic backgrounds.
The authors identify and define key aspects of the progression from research on the efficacy of a new intervention to its dissemination. They highlight the role of transportability questions that arise in that progression and illustrate key conceptual and design features that differentiate efficacy, effectiveness, and dissemination research. An ongoing study of the transportability of multisystemic therapy is used to illustrate independent and interdependent aspects of effectiveness, transportability, and dissemination studies. Variables relevant to the progression from treatment efficacy to dissemination include features of the intervention itself as well as variables pertaining to the practitioner, client, model of service delivery, organization, and service system. The authors provide examples of how some of these variables are relevant to the transportability of different tytpes of interventions. They also discuss sample research questions, study design, and challenges to be anticipated in the arena of transportability research.
This article describes the importance of integrating evidence-based substance abuse treatments into juvenile drug courts. Guidelines from the National Institute on Drug Abuse (NIDA) are offered as a template to enable drug courts to select substance abuse treatments based on available evidence of effectiveness. Multisystemic therapy (MST) is presented as an example of an evidence-based model of treatment that meets NIDA guidelines and has been integrated into several juvenile drug courts. Substance abuse outcomes from published MST trials are summarized, and a current study that examines the relative effectiveness of drug court with MST versus drug court with traditional substance abuse treatment is described.
Although the identification of efficacious and effective mental health treatments represents a potentially important synthesis of research literatures, such identification is but a first step in the transport of evidence-based treatments to field settings. Based on multidisciplinary research on the diffusion of innovation articulated by Rogers, this commentary briefly describes characteristics of the innovation and of the social system that may influence the adoption of mental health innovations.
Key words: evidence-based practices, dissemination of innovation, evidence-based treatments, program improvement, mental health innovations.
This special section presents four evidence-based practices that are currently being transported to community-based settings: Nurse-Family Partnership for infant health and development, Assertive Community Treatment for adults with serious and persistent mental illness. Oregon Therapeutic Foster Care for chronic juvenile offenders, and Parenting Wisely for caregivers of children with disruptive behavior: Although each model addresses a very different clinical population, their similarities in development, emphasis on fidelity and quality assurance, and use of dedicated organizations to support effective transport are noteworthy. Admirably, the intervention developers are taking the same care in crafting strategies to transport their models as they took in validating these clinical innovations. Such care is critical to increasing the probability that the intervention models will be transported to community settings with the fidelity needed to achieve intended outcomes.
266. Jousting with straw men: Comment on Westen, Novotny, and Thompson-Brenner (2004)
Empirically supported treatments (ESTs) do not cure every patient and the randomized trial is not a flawless methodology. Upon these often-noted and widely accepted points, D. Westen. C. M. Novotny. and H. Thompson-Brenner (2004a) built a critique of ESTs and EST research. However, important work developing effective clinically relevant treatments for serious problems was omitted from the Westen el al.(2004a) review. Little documentation was offered for the purported "assumptions" of EST methodology that Westen et al. (2004a) criticized; and different review standards were applied to studies supporting versus those disagreeing with Westen et al.'s (2004a) views. Finally, the correlational research designs proposed as a remedy by Westen cc al. (2004a) have far more serious weaknesses than randomized trials, thoughtfully applied to real-world clinical care.
Keywords: empirically supported treatments, psychotherapy. clinical practice, randomized controlled trials
The past two decades have seen a movement toward harsher legal sanctions and lengthy restrictive treatment programs for sex offenders. This has not only been the case for adults, but also for juveniles who commit sex offenses. The increased length and severity of legal and clinical interventions for juvenile sex offenders appear to have resulted from three false assumptions: (1) there is an epidemic of juvenile offending, including juvenile sex offending; (2) juvenile sex offenders have more in common with adult sex offenders than with other juvenile delinquents; and (3) in the absence of sex offender-specific treatment, juvenile sex offenders are at exceptionally high risk of reoffending. The available data do not support any of the above assumptions; however, these assumptions continue to influence the treatment and legal interventions applied to juvenile sex offenders and contributed to the application of adult interventions to juvenile sex offending. In so doing, these legal and clinical interventions fail to consider the unique developmental factors that characterize adolescence, and thus may be ineffective or worse. Fortunately, a paradigm shift that acknowledges these developmental factors appears to be emerging in clinical areas of intervention, although this trend does not appear as prevalent in legal sanctions.
Key words: juvenile sex offenders; treatment; registration; community notification
This chapter reviews the application of special legislation designed for high-risk adult sex offenders to juvenile sex offenders and whether such applications are likely to have intended effects (e.g., reducing sexual recidivism) and/or unintended effects (e.g., reducing detection of juvenile sex offenders). Recent changes in legal procedures have resulted in significantly altered consequences to juvenile sex offenders. Specifically, many juvenile sex offenders are now requited to register personal information on publicly available sex-offender registries. These registries are maintained by local or state law enforcement agencies and list offenders who have committed specific sexual crimes. Likewise, many juvenile offenders are also subjected to community notification procedures, in which persons external to law enforcement are informed about the specific sexual crimes of some youths. Per federal guidelines, registration and notification polices exclude juvenile offenders except for those youths prosecuted as adults. However, several states have extended registration and notification requirements to juvenile sex offenders.
In this article, we respond to a recent paper published in Children and Youth Services Review, in which Dr. Julia Littell concluded that multisystemic (MST), a family-and evidence-based treatment of serious juvenile offenders, does not reduce rates or rearrest or incarceration and does not improve family relations. Dr. Littell’s conclusion is contrasted with those of highly respected reviewers and federal entities that are entirely independent of MST developers and researchers. Moreover, we describe how Dr. Littell’s conceptual and methodological analyses have misinterpreted and misrepresented MST research studies and reflect poor appreciation for the conduct of community-based research with challenging clinical populations; the distinctions between efficacy, effectiveness, and transportability research: the nuances of conducting meta-analyses; the importance of treatment fidelity to internal validity; and the fact that not all outcome studies are asking the same conceptual questions. Finally, the implications of Dr. Littell’s contentions are noted.
This study examined relations between workforce turnover and select clinician (demographic and professional characteristics and perceptions of treatment model features and job requirements) organizational (perceptions of organizational climate and structure) and program level (salary, case mix) variables in a sample of 453 clinicians across 45 organizations participating in a transportability study of an empirically supported adolescent treatment (i.e., MST). At 20% annually, turnover was lower than in the national mental health workforce (i.e., 50-60%). Clinician demographic, professional background, and perceptions of the treatment model and demands did not predict turnover. Perceptions of an emotionally demanding organizational climate, program salary level, and program case mix of youth did predict turnover.
Key words: transported treatment, dissemination, evidence-based treatment, empirically supported treatment, workforce turnover
This study examined the convergent validity and concurrent validity of the Organizational Readiness for Change (ORC; Lehman WEK, Greener JM, Simpson DD, 2002. Assessing organizational readiness for change. Journal of Substance Abuse Treatment. 22 197-210) scale among practitioners who treat adolescents. Within the context of a larger study, we administered the ORC scale and measures of practitioner attitudes toward evidence-based practices as well as treatment manuals to a heterogeneous sample of 543 community-based therapists in the state mental health and substance abuse treatment sectors. Using a contextual random-effects regression model, the association between ORC scale domains and measures of practitioner characteristics and attitudes were examined at both therapist and agency levels. The results support the convergent validity and concurrent validity of several domains. Namely, the domains focusing on motivational readiness and training needs were associated with higher appeal and openness to innovations. Those on program resources and climate were less related, however. Our discussion focuses on the utility of the ORC scale in helping evaluate the needs of programs considering the adoption of evidence-based practices.
Juvenile drug court (JDC) programs have expanded rapidly over the past 20 years and are an increasingly popular option for rehabilitating juvenile offenders with substance use problems. Given the hgih cost of crime to society, an important economic question is whether and to what extent JDC programs reduce criminal activity among juvenile offenders. To address this question, the present study added an economic cost analysis to an ongoing randomized trial of JDC conducted in Charleston, South Carolina. Four treatment conditions were included in the parent study: Family court with usual community-based treatment (FC, the comparison group), Drug Court with usual community-based treatment (DC), DC with Multisystemic Therapy (DC/MST), and DC/MST enhanced with Contingency Management (DC/MST/CM). The economic study estimated the cost of criminal activity for nine specific crimes at baseline (pretreatment) and 4 and 12 months thereafter. A number of methodological challenges were encountered, suggesting that it may be more difficult to economically quantify frequency and type of criminal activity for adolescents than for adults. The present paper addresses methodological approaches and challenges, and proposes guidelines for future economic evaluations of adolescents substance abuse and crime prevention programs.
School based mental health services for children in poverty can apitalize on schools' inherent capacity to support development and bridge home and neighborhood ecologies. We propose an ecological model informed by public health and organizational theories to refocus school based services in poor communities on the core function of schools to promote learning. We describe how coalescing mental health resources around school goals includes a focus on universal programming, mobilizing indigenous school and community resources, and supporting core teaching technologies. We suggest an iterative research-practice approach to program adaptation and implementation as a means toward advancing science and developing healthy children.