Interventions for Offending behaviour

Interventions for Offending Behaviour

• The financial cost of imprisoning so many offenders alone is enormous.
• At the present time there is no optimism that prison can contribute to crime reduction in some prisoners.
• Reducing recidivism is one way of reducing pressure on the public purse.
• Psychological treatment can be cost-effective to the extent that they demonstrably reduce the risk of re-offending.
• Studies of the effectiveness of treatment suggest that overall treatments reduced reoffending by about 10% but that some forms of treatment worked better than this.
• However researchers question whether the evidence on which this is based is adequate to draw such conclusions.
• With research make sure there is no bias, the difference is due to the intervention not other confounding variables

Punishment or rehabilitation

• Should we focus on trying to rehabilitate young offenders or should we just punish them?
• Think about adolescent limited offenders
• If we want to rehabilitate them: what should this involve, how should it be done, by whom and where
• Consider the risk factors for offending
• Risk factors include
• "Prison not working" for young offenders.
• "Government's young offender scheme"

EU vs. UK approach

• Incarceration
• EU: Children in conflict with the law. At very young age we are taking away key developmental experiences
• 70% of young offenders will re-offend and be re-arrested within two years.
• In terms of impact of future risk factors, the system does not seem to be hugely effective
• Young people end up with a label at very young age, and will be part of the criminal justice system at a very young age. What impact would that have on their possible employment and future? Limited involvement
• What could alternatives be?
• Anti-social behaviour Act (2003) enabled courts to try and include a fostering requirement as part of the Supervision Court. Intensive supervision program.
• Youth Justice Board (2005) commissioned agencies in three parts of England to pilot the evidence-based intervention Multi-Dimensional Treatment Foster Care (MTFC) model. Approach was first developed in the U.S.
• Intensive Fostering Program.
• Example of how a key risk factor e.g. poor parenting, poor home environment has been targeted to develop an intervention. Mapped onto development of an intervention to try and change behaviour.

Intensive Fostering Program

• One of the schemes is Staffordshire Intensive Fostering Programme
• Alternative to receiving a custodial sentence. Rather than young offenders institution a young person will receive a fostering placement, idea that it helps young people build on their skills and knowledge
• Live with experienced foster carers: encourage to talk about their issues. There is problems with this because young people often struggle to trust people. Young persons perspective this can be very empowering to be in an environment where adults listen.
• Ground Rules:
• Have to tell cares where they are
• Bag searches- drugs, anti-social behaviour e.g. stealing.
• Attend educational training program.
• Overall what we have seen with these kinds of programs is that rates of reoffending dropped from about 66% to about 33%
• Pilot Study Report (2010)
• Prior to convictions very few of all young people were engaged in education training or work.
• Lots of unstructured time, gaming or T.V.
• One year after sentence or release from custody, those members of the comparison group who were living in the community were much less likely to be engaged in education or training (30%) than the young people in the Intensive fostering group (70%)
• 40% of the comparison group, received treatment as usual, had begun another custodial sentence
• None of the IF group were in custody or homeless at this point.
• One aspect of fostering as an intervention that has not worked out very well. Importance of peer relations.
• One year after release the IF group remained as likely to be associated with pro-criminal peers as those in the comparison group. Big risk factor.
• Limitations of the fostering program is it doesn't seem to have that much of an impact of peer relations.
• Good for education bad for peer delinquency.

Study on Intensive Fostering

Other options for young people

• YOTS (Youth Offending Team) community orders e.g. intensive supervision and surveillance program
• LASCH (Local Authority Secure Children's Home)- risk of more abuse
• Young Offender Institution
• Secure Training Centres
• Mostly what the youth offending schemes want to achieve is to have young people on community orders, where they are managed in community.
• Incarceration is still being seen as a resort .

Interventions for young behaviour

• Procedural technique that is designed to interrupt or modify some kind of ongoing process e.g. offending behaviour
• Psychosocial intervention: try and improve symptoms and improve quality of life and improve behaviour and functioning
• Changing and intervening in order to affect change in some important domain.
• Family and Parenting interventions
• Multi-systemic treatment
• Cognitive behavioural interventions
• They all tackle re-offending and anti-social behaviour
• Important that we have a good quality of data that supports or does not support effectiveness of intervention
• The degree to which we think or know that the intervention has been effective is uncertain
• Adopt evidence based approach? Try and use where possible the best most unbiased evidence that we can
• Randomised studies are the only we to determine cause and effect
• Longitudinal study: direction of effects
• Causal impact: randomised control trials. We need to know what is effective. Cost effective.

Building Evidence-based practice

• What is the best design for evidence?
• The kind of study conducted is really dependent on the research question
• Effectiveness: randomised control trials.
• What outcome measures are we looking for?
• When talking about a study ask
• Experimental study without randomisation? Match people on certain characteristics. Conclusion on data gathered on similar people that are matched on characteristics.
• Expert opinion? MST effective or not.
• Experimental study with random allocation e.g. Ranomized Control trial. People that are struggling with addiction, randomise people to receive different types of interventions
• Observational studies? take a bunch of people with certain age. Cross-sectional study.
• Different types of studies that we could be using.
• Effectiveness = Randomised Control Trials. Only way to determine cause and effect.

Evidence-based practice

• Use of current best evidence in making decision about practice. Use evidence based framework to do that
• Systematic reviews of evidence: Gather together highest quality studies and synthesis them is the backbone of evidence based practice. Bring together evidence by asking very specific questions: e.g. are interventions for young offenders with mood disorders effective ? Determine whether or not overall these studies are effective. Part of this process might be meta-analysis (pull data together where it makes sense to do so)
• Hierarchy of study designs:
• 1. Systematic Reviews that bring together a number of RCT's in an area
• 2. Experimental study without randomisation, Observational study with control group, Cohort study, case control
• 3. Cross-sectional study, before-and-after study, case series
• 4. Expert opinion or consensus; Case Report
• Study quality: design, conduct and analysis minimise bias.

What is Bias?

• 1. Randomisation: generating random sequence
• 2. Allocation concealment
• 3. Blinding of participant: Need to know what or what they aren't receiving, psychosocial trials always suffer in terms of assessment of bias, need to now what intervention they are getting. Psychosocial always suffer in terms of assessment of bias in terms of drug trials.
• 4. Blinding of outcome assessment: May be pressure to receive positive results e.g. because of money
• 5. Incomplete outcome data (attrition bias- who has dropped out and why?
• 6. Selective reporting - only some parts of the study have been reported. Pre-registration of trial is important. Publish what outcome measures you are going to evaluate. Cant pick and choose.
• Exaggeration of odds ration from inadequate allocation concealment: That means the overestimation of impact intervention.
• Inadequate allocation = Larger by 41%
• Unclear Treatment allocation = Larger by 30%
• Trials not double blind = Larger by 17%

Multisystematic Therapy

• Intervention: making a change with targeting a young person transitioning out of the CJS
• Therapists are on call 24/7
• Parents receive parental training and regular engagement of the family
• One of the few empirically supported interventions: lack of randomised control evidence in this field.
• Widely disseminated USA and Europe
• Strong research base with multiple randomised controlled trials: you can do systematic review with this data. But this has been an animated discussion between experts.
• Multifaceted: tries to interconnect many risk factors
• Short-term, community based. You are involving systems
• Going into systems, not just taking individual on their own.
• Manual-based: you can train lots of people to do it
• Time limited: not as expensive
• Profesional mental health therapists deliver.
• Small caseloads.
• Intervention strategies integrated.
• Takes lots of different approaches- therapist then decides what is most effective for individual young person. Recognises risk factors associated with anti-social behaviour.
• TARGETS: Chronic, violent, or substance-abusing male and female juvenile offenders at risk or out-of-home placement
• Characterised by having multiple needs and problems and has multiple arrests
• Delinquency and drug use indicate that family, school and peer factors influence delinquent behavior

Main goals of MST

• Main goals of MST:
• Reduce criminal activity and anti-social behaviour
• Decrease rates of incarceration and out-of-home placement.
• Much cheaper that locking people up.
• Intense but cheaper
• Attends to needs of young offenders and their families: Improve parents discipline practice.
• Increase: Family affection, Association with pro-social peers (Intensive fostering failed to limit contact with anti-social peers)
• Decrease: Association with deviant peers
• Engage: In positive recreational activities
• Empower: Family to solve future difficulties, new skills to work on future difficulties. Future issues for families to deal with.

Henggeler et al. (1998) 9 MST principles

• 1. Finding the fit: individual differences element of that social complexity.
• 2. Focusing on positives and strengths: Protective factors, strengths, use factors that are already there, see how groups can come up with positive solutions, things that already exist e.g. sport talent, good relationships etc.
• 3. Increasing responsibilities: taking responsibility and not having mind-set of attributing to external factors
• 4. Present-focused, action-orientated & well-defined: what can we do here and now. All agree.
• 5. Targeting sequences: What happens if...confronted with situations that would normally result in offending. Diversion?
• 6. Developmentally Appropriate: Something that is suitable for a younger person might not be suitable for teenagers.
• 7. Continous Effort: Commitment over a long period of time, family members need to think: will this be a quick fix. Shorter and longer term follow up points
• 8. Evaluation and Accountability: Embedded into principle of evaluation of acts, don't label people and avoid blame. Taking responsibility where it is needed and moving forward is a key issue.
• 9. Generalisability: Family members have to be apart of the process: might be the drive to change
• Does it work?

Missouri Deliquency Project

• Bourdain et al.
• Early study looking at effectiveness of MST.
• Long term follow up. 5 year is very good.
• In terms of people not being arrested again: people that complete MST are the least likely to be re-arrested.
• Even people that drop out of MST do better in terms of being arrested again than people that were allocated individual therapy (control group)
• People who refuse to accept intervention did the worst of all..
• Supports the notion of effectiveness in regards to MST compared to other intervention programs

MST effectiveness 1: Meta-analysis

• Curtis et al. (2004)
• This is not a systematic review: Review with a meta-analysis.
• Aggregation of data.
• Literature search from 1986-2003
• 91 studies found
• Inclusion criteria: had to be MST, strictly incorporate 9 principles, random assignment to one or more control groups, clinical samples, pre-treatment and post-treatment assessment and statistics suitable for meta-analysis.
• The 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
• Treatment
• completion rates ranged from 76% to 100% for MST and
• from 56% to 100% for other treatment conditions
• Outcome measures: A multiagent, multimethod assessment approach was
• taken in six of seven studies, with a total of 23 different
• outcome measures being used
• Goals: Assessed across studies and included changes in (a) the rate, frequency, and seriousness of
• adolescent criminal activity; (b) days incarcerated; (c) days
• absent from school; (d) alcohol and marijuana use; and (e)
• days in mandated out-of-home placements
• Post treatment: range 12 months to 4 years.
• Results: Average effect of MST was cohens d 0.55. Medium.
• After treatment 70% of youths and their families were functioning better than those treated alternatively.
• MST
• had larger effects on measures of family relations than measures of: individual
• adjustment & peer relations
• Can’t
• tackle everything

Critique of Curtis: Henggeler (2004)

• Welcoming interest in this intervention-argued that efficacy studies showed more effect that effectiveness studies
• Need the evidence base to be applicable in the real world
• For example, factors rarely considered in efficacy research (e.g., funding structures, organizational climate, program maturity, site characteristics) are emerging as
• important determinants of treatment fidelity and, in turn, clinical outcomes for practice in
• real-world settings
• Need to see effectiveness translating into the field
• Current research is clearly demonstrating that evidence-based practices can be successfully transported, but much remains to be learned regarding the
• optimal parameters of such transport.
• Many variables can interfere with the capacity of an effective intervention to achieve desired outcomes in real-world
• clinical settings. Nevertheless, evidence from MST outcome
• and transportability research suggests that positive out-
• comes can be achieved in practice settings that are independent of treatment developers.
• A critical direction for future
• research is determining the conditions that optimise the
• effect sizes obtained by evidence-based treatments in such
• settings.

MST effectiveness 2: Systematic Review

• Littell et al. (2005)
• Systematic review
• 1985-2003: search and experts were contacted. Can include unpublished papers in a systematic review
• Included youth age 10-17 with social, emotional and /or behavioural problems.
• Randomised to licensed MST programs vs. usual services or alternative treatments
• Two reviewers independently reviewed 266 titles and abstracts; 95 full-text reports were retrieved, and 35 unique studies were identified.
• Two reviewers independently read all study reports for inclusion. Eight studies were eligible for inclusion. Two reviewers independently
• assessed study quality and extracted data from these studies.
• The most rigorous (intent-to-treat) analysis found no significant differences between MST and usual services in restrictive out-of-home
• placements and arrests or convictions. Pooled results that include studies with data of varying quality tend to favour MST, but these
• relative effects are not significantly different from zero. The study sample size is small and effects are not consistent across studies;
• hence, it is not clear whether MST has clinically significant advantages over other services.
• Post-Treatment data for program completes, no significant between-group differences on self-reported delinquency, peer relations, youth behaviour problems, youth psychiatric symptoms, parent psychiatric symptoms or family functioning.
• There is inconclusive evidence of the effectiveness of MST compared with other interventions with youth.There is no evidence that
• MST has harmful effects.
• - Difference to Curtis: still only analysed 8 trials.

Critique of Littell

• Henggeler (2006)
• Entire field is being discredited on terms on 11 studies used
• Empirically supported practices to improve outcomes for youths presenting serious antisocial behaviour could be eliminated? what are the alternatives.
• Young people going to prison by trying to scare-straight program which actually showed an increase in criminal behaviour.
• Criticised the peer review process which allowed flawed MST outcome studies to be published
• Suggested that the results of our clinical trials were not credible because there
• was substantial variability in the length of time that participants were followed up within
• each trial. More specifically, she implied that the length of follow-up for each participant
• within a given trial was arbitrary and may have been manipulated in a way that created
• better outcomes for one group relative to another. However, it should be noted that most
• clinical trials with long-term follow-ups have variability in the length of time that
• participants are followed up because all of the participants do not begin (or complete)
• treatment on the same dates

Cognitive Behavioural Therapy

• More promising rehabilitate treatments for criminal offenders
• Targets criminal thinking as a contributing factor to delinquent behaviour
• Has been adapted in a range of settings
• How does it work?
• Tackles distorted cognition e.g. misinterpretation of social cues, displacement of blame, deficient moral reasoning, schemas of dominance and entitlement
• Changes perception of situations as threats, demands of instant gratification, and confuse wants with needs.
• Tackles victims stance with offenders viewing themselves as unfairly blamed.
• Cognitive skills training: aims to teach such thinking skills as
• interpersonal problem-solving, long-term planning and perspective taking
• Anger management : Focuses on teaching offenders to monitor their
• Supplementary components : CBT programs differ in their emphasis. Some are geared mainly
• toward anger control and building conflict resolution skills. Others center on assuming personal
• responsibility for crimes

Effectiveness of CBT

• Lispsey et al. (2007)
• Positive CBT effects on the recidivism of offenders.
• Participants. The recipients of the intervention were criminal offenders, either juveniles or adults,
• treated while on probation, incarcerated/institutionalized, or during aftercare/parole. Offenders
• were drawn from a general offender population
• Outcome measures. The study reported criminal offending subsequent to treatment as an
• outcome variable
• Source. Both published and unpublished studies were eligible for inclusion, conducted in any
• country, and reported in any language.
• Review of the retrieved
• studies by one or more of the authors ultimately identified 58 studies meeting the criteria for
• inclusion in the present systematic review.
• Results: In relation to the mean recidivism
• rate for the control groups of about .40, this odds ratio indicates a recidivism reduction of 25% to
• a mean of .30.Most effective studies produced odds rations nearly twice as large as the mean, corresponding to recidivism rates of around .19 in the treatment groups, more than a 50% decrease from the .40 rate of the average control group.
• The mean odds ratio representing the average effect of intervention was 1.53,
• indicating that the odds of success (i.e., no recidivism in the post-intervention interval of
• approximately 12 months) for individuals in the treatment group were more than one and a half
• times as great as those for individuals in the control group

Lipsey et al. (2007) Critical Appraisal

• Attrition proportion: The proportion of the total initial sample (treatment plus control) for
• which recidivism outcome data were not available.
• Design problem: Indications of initial nonequivalence between groups on pretreatment
• variables or problems during or after the intervention that could have led to nonequivalence
• of the treatment and control group, rated by the coder on a 3-point scale (1=favors control
• group; 2=favors neither or insufficient evidence; 3=favors treatment group).
• With the key participant and general implementation characteristics controlled, no significant
• differences were found in the effectiveness of the different types or “brand names” of CBT. It
• thus appears to be the general CBT approach, and not any specific version, that is responsible
• for the overall positive effects on recidivism.

Summary

• Punishment is not working for young people in the UK. As a society are we ready to focus on rehabilitation.
• Alternatives to work with risk factors?
• Experimental (randomised) evidence-based design
• Somer interventions are promising, but results are equivocal. Look for systematic reviews
• What can we do about peer and peer relationships? School, home, community?
• CBT looks good for re-offending
• Seek out your own effectiveness for CBT and family interventions
• Think about quality and why it is important