Connecting the Dots: What Is an Effective Program

In Chapter 10, the text addresses primary, secondary, and tertiary prevention programs. We are going to review the different level programs and explore their effectiveness. Prior to beginning work on this discussion, read Chapter 10 in your text. In addition,

Read Diverting Young Offenders From Prison Is ‘Smart Justice.’Links to an external site.
Read Dealing With Juvenile Offenders in the Criminal Justice System Links to an external site..
Read Nothing About Us Without Us! The Failure of the Modern Juvenile Justice System and a Call for Community-Based Justice Links to an external site..
Read Treatment Services in The Juvenile Justice System: Examining the Use and Funding of Services by Youth on Probation Links to an external site..
Watch It’s More Expensive to Do Nothing: Prison, Recidivism, and Remediation Links to an external site..

In this discussion, we will examine the different levels of programs and provide an example for each level. When introducing a program to the discussion, provide a brief description of the program, its intended purpose, and the target juvenile population. Discuss your perceptions of these programs’ effectiveness. How did you come to your conclusion on effectiveness?

When responding to one of your classmates, use one of the text’s questions below concerning prevention programs to focus your response and further the conversation. Select one bullet below and present the positives and the negatives for the issue addressed:

Does every juvenile who has been arrested need treatment? Should all juveniles arrested receive the same treatment services? Why or why not?
Should prevention programs be given to everyone, and if so, where? Should we consider ethnicity, race, education, socioeconomic standing?
Are the services worth the taxpayer costs? Consider both financial and social costs.
Should we mandate prevention for school-aged children, their parents, or for both? What if the parents refuse to participate?
What role does the state have in addressing pre-criminal status offenses or delinquent behavior? Should the state have the authority to force parents to participate? What sanctions should the state have to enforce compliance?

Note: this discussion format will differ from formats in prior courses. You must post in the discussion on at least three separate days by Day 7; your total word count for your posts should be a minimum of 600 words. There is no required word count for individual posts as long as your combined posts total at least 600 words. However, you must use at least one in-text citation to support your claims and properly cite any references

Learning Objectives
After studying this chapter, you should be able to accomplish the following objectives:

▪ Describe the philosophical shift that has occurred in reducing juvenile delinquency.

▪

Summarize the importance of prevention and treatment.

▪

Explain the principles of effective intervention.

▪

Explain how need factors contribute to risk for delinquent behavior.

▪

Describe each generation of risk and need assessment tools.

▪

Explain the significance of responsivity factors with regard to treatment.

▪

Summarize the philosophy behind cognitive behavioral programs.

▪

Analyze the model treatment programs and why they work.

▪

Explain the importance of relapse prevention techniques.

Prevention
and Treatment

Toby Talbot/Associated Press

Chapter Outline
10.1 Introduction

10.2 What Is Treatment and Prevention?

10.3 Evidence-Based Treatment: The Principles of Effective Intervention

10.4 Risk and Need Factors

10.5 Classification and Assessment

▪ First-Generation Assessment Tools

▪ Second-Generation Assessment Tools

▪ Third-Generation Assessment Tools

▪ Fourth-Generation Assessment Tools

10.6 Responsivity Factors

▪ Motivation to Change

▪ Approaches to Motivational Issues

10.7 Treatment Services

10.8 Examples of Effective Treatment Programs: Model Programs

▪ Functional Family Therapy

▪ The Incredible Years Series

▪ Big Brothers Big Sisters Community-Based Mentoring Program

▪ Promoting Alternative Thinking Strategies

▪ Life Skills Training

▪ Multisystemic Therapy

▪ Multidimensional Treatment Foster Care

▪ Nurse-Family Partnership

▪ Model Programs: Why They Work

10.9 Connecting the Dots: Relapse Prevention

In 1988, 7,000 youth were waived to adult court for criminal proceedings. In 1992, that num-
ber hit nearly 12,000 youth. The increase in waivers to adult court occurred in the context of
the decade-long movement to get tough on crime. This get-tough movement was characterized
by an increased use of punishment with the purpose of deterring crime. In real terms, these
punitive measures included an increased reliance on incarceration for juveniles, a policy shift
to allow younger juveniles to be transferred to adult court for a broader range of offenses, and
the increased use of tougher sanctions in the community such as boot camps.

The get-tough movement was politically popular for years. As discussed in Chapter 2, the
tough-on-crime agenda was popular among both political parties. For example, the Anti-Drug
Abuse Act, which led to mandatory minimum sentences for drug offenders, was passed while

Section 10.1Introduction

Ronald Reagan was president. But equally punitive “three strikes and you’re out” laws were
passed in many states during Bill Clinton’s administration.

Fast-forward to more recent times, and the stories sound more like this: “When Harry Coates
campaigned for the Oklahoma State Senate in 2002, he had one approach to crime: ‘Lock ’em
up and throw away the key.’ Now Coates is looking for that key” (Murphy, 2011). News stories
throughout the country are documenting the resulting effects of the get-tough movement on
state budgets. States are faced with enormous budget shortfalls that place criminal justice
expenditures in the crosshairs. Many states have repealed their mandatory sentencing policies
for drug use and revised their three-strikes policies. For the first time in many decades, states
are reducing prison populations and relying more on community-based alternatives for pun-
ishing offenders. Although economic conditions may be a primary catalyst for this shift, studies
also support treatment and prevention efforts as a cost-effective way to maintain public safety.

10.1 Introduction
Juvenile justice policy tends to change (sometimes dramatically) over time. Rehabilitation as
a guiding philosophy of the juvenile justice system fell out of favor by the late 1970s. At that
time, psychologist Robert Martinson (1974) examined whether youth who received treat-
ment services had lower recidivism rates. He found that receiving treatment did not lead to
significant reductions in crime. This finding led him to proclaim that “nothing works” when it
came to treatment. At the same time, the public was very concerned about the rise in juvenile
drug use and violent crime. Concerned as well, lawmakers began to suggest that the juvenile
justice system was too soft on crime and advocated for harsher punishments (Baird & Samu-
els, 1996).

Nearly 25 years later, the juvenile justice system is in the midst of another philosophical shift.
This time the shift is back toward rehabilitation. Why is the system moving back to what it
once abandoned? Just like before, there are a variety of reasons. As mentioned in the opening
story, the first reason is fiscal. In the 1980s and 1990s, states were willing to spend money to
crack down on crime and send a message to would-be offenders. However, as illustrated in
the accompanying Spotlight feature on criminal justice reforms taking place in Utah, many
states are rethinking some of the earlier get-tough strategies (Scott-Hayward, 2009).

Spotlight: Criminal Justice Reforms: Utah

According to the Pew Center on the States (2009), corrections ranks as the second highest
expenditure in the United States. With over 7 million adults under some form of correctional
supervision, 1 in every 15 state general fund dollars is now spent on corrections. Between
1982 and 2002, the budget for corrections increased 255%. As a result, many states are in a
financial crisis and can no longer afford to incarcerate people at the same rate.

Utah is one state that felt this crisis. In 2013, the state spent $269 million on corrections.
Moreover, many of those on parole were failing at a higher rate than 10 years ago. State poli-
cymakers decided that something had to be done to reduce costs and failure rates. In 2015,

(continued on next page)

Section 10.1Introduction

The shift back toward rehabilitation is also being driven by studies supporting its use. Since
Martinson’s “nothing works” statement, multiple studies have found that treatment services
can reduce criminal behavior among juvenile offenders by as much as 30–35% (Aos, Phipps,
Barnoski, & Lieb, 2000; Bonta & Andrews, 2007). In addition, Mark Lipsey (2009) examined
what types of programs worked better than others. He argued that structured, intensive ser-
vices focused on the youth’s problems were much more effective than other programs in
reducing recidivism. His research also found that services delivered in institutions (youth
prisons) tended to be less effective than those in the community. Finally, Lipsey noted that
there were in fact some programs that did not work. As a result, he and others began to argue
that Martinson’s claim of “nothing works” should have been that not all programs work. In
other words, some programs are more effective than others.

We can see evidence of this shift toward rehabilitation in state and federal policy. One note-
worthy example is in RECLAIM Ohio, a program designed to reduce the use of state juvenile
prison beds by encouraging counties to provide services to youth in their own communities.
For every youth who could have been sent to a juvenile institution but was instead kept in
the community, the state of Ohio would give money to the community. The state encouraged
counties to use the money to develop and pay for rehabilitation programs. The initiative has
been successful at reducing recidivism rates and is considered a more cost-effective option
than prison (Latessa, Turner, Moon, & Applegate, 1998).

Another example of a rehabilitation-based policy is the Second Chance Act of 2007 (passed in
2008). The act supports a variety of services for adults and juveniles who are reentering the
community, including aftercare programs that focus on areas such as employment and educa-
tion, as well as the Strengthening Relationships Between Young Fathers, Young Mothers, and
Their Children grant program, which provides family-based services and focuses on treat-
ment for the parent. For more information, see https://csgjusticecenter.org/nrrc/projects/
second-chance-act/.

Spotlight: Criminal Justice Reforms: Utah (continued)

the Utah Commission on Criminal and Juvenile Justice developed policy options that were
based on data-driven solutions to increase public safety while simultaneously reducing the
prison population. The legislation was aimed at reducing the incarceration of drug offend-
ers, increasing community-based alternatives, and improving and expanding reentry ser-
vices. According to the Utah governor, “[T]his package will enhance public safety and put the
brakes on the revolving prison door. H.B. 348 will establish better treatment resources and
alternatives for nonviolent offenders, ensuring our citizens get the best possible return on
their tax dollars” (Pew, 2015, para. 6).

Many states are favoring lower-cost, community-based options like drug treatment
and enhanced community supervision to reach better outcomes with both their
adult and juvenile populations. For more on reforms in Utah and other states, see
http://www.pewtrusts.org/en/about/events/2015/criminal-justice-reform-panel
and http://www.pewtrusts.org/en/research-and-analysis/articles/2017/04/
podcast-the-story-behind-the-drop-in-us-incarceration.

https://csgjusticecenter.org/nrrc/projects/second-chance-act/

http://www.pewtrusts.org/en/about/events/2015/criminal-justice-reform-panel

http://www.pewtrusts.org/en/research-and-analysis/articles/2017/04/podcast-the-story-behind-the-drop-in-us-incarceration

Section 10.2What Is Treatment and Prevention?

A third policy initiative that has gained popularity is the Justice Reinvestment Initiative (JRI).
Launched in 2006, the JRI is based on the premise that we can reinvest criminal justice dol-
lars into what has been shown to work in reducing recidivism. The Bureau of Justice Statistics
and the Pew Center on the States have provided resources and tools to states to guide them
through a four-step process to increase the effectiveness of their criminal justice systems. The
four-stage process includes (a) analyzing data to understand factors driving jail and prison
population growth; (b) developing and implementing policy options to generate savings and
increase public safety; (c) reinvesting in select, high-risk communities and measuring the
impact of policy changes and reinvestment resources; and (d) enhancing the accountability
of criminal justice system actors and policies.

Each of these policy initiatives uses evidence-based strategies to effectively treat and
prevent crime.

10.2 What Is Treatment and Prevention?
What exactly is treatment for juveniles? Treatment refers to a set of actions or services
designed to rehabilitate or change an individual. Treatment for juvenile offenders can include
a range of activities such as group therapy, individual sessions, school-based interventions,
and/or community mentoring programs. Treatment services can occur in homes, prisons, or
schools, or in various agencies in the community. Treatment services can also act as preven-
tion programs. Prevention programs are designed to avert a situation or prevent one from
worsening. For example, teaching juveniles the importance of avoiding drugs and alcohol is
intended to prevent youth from experimenting with them. However, prevention strategies
may also be implemented after a youth has committed a crime in an effort to reduce the
youth’s likelihood of committing another crime or a worse crime. For example, teaching youth
about the consequences of drug use could be beneficial to those who may have already exper-
imented with drugs. In this case, the program’s goal would be to stop the youth’s use from
escalating. In this context, prevention can be both proactive and reactive.

Prevention programs are often categorized into three levels based on who or what is being
targeted. For example, the first level attempts to prevent delinquency from occurring at all,
the second level attempts to intervene early in the youth’s involvement in delinquency, and
the third level attempts to stop the youth from escalating in his or her delinquent career. The
three prevention levels are labeled primary prevention, secondary prevention, and tertiary
prevention. Let’s take a look at them in more detail.

Primary prevention programs focus on the conditions that could lead to delinquent behavior
such as truancy, poor parenting, and prenatal exposure to toxins. These types of approaches
target at-risk juveniles and may include after-school programs to keep youth busy or a tru-
ancy reduction program to keep youth in school. Another example might include wellness
campaigns around prenatal care for mothers. The prenatal care would include educating new

Section 10.3Evidence-Based Treatment: The Principles of Effective Intervention

mothers on the dangers of smoking, drinking, or using drugs during pregnancy. These types
of programs act as barriers to protect against or prevent delinquency.

Secondary prevention programs shift the focus of services to the delinquent youth and
address the delinquent behavior at its earliest stages. By intervening early with youth, these
programs attempt to slow or stop their potential progression into crime. These types of pro-
grams may include diversion programs and mentoring programs such as Big Brothers Big
Sisters. A big brother or sister can help the youth get back on the right track by providing
support and encouragement to stay in school and avoid drugs and alcohol.

The third level, tertiary prevention, is focused on reducing recidivism among those who
are already in the juvenile justice system. In that sense, these programs are more reactive
approaches. The prevention efforts focus on limiting the problems and issues faced by the
youth. Treatment programs for anger management, addictions, family functioning, and
relapse prevention are examples of services designed for youth who have a high probability
of continuing their delinquent behavior.

As the preceding discussion illustrates, there are various treatment and prevention programs
for juveniles. One potential problem facing the juvenile justice system is figuring out which
program, policy, or strategy to choose. Not all programs are created equal, and it is difficult
to decide who needs what services and for how long. Researchers have found that some pro-
grams are more effective than others, but questions still remain. For example, does every
juvenile who has been arrested need treatment? Should all juveniles receive the same treat-
ment services? Should all juveniles participate in prevention programs, and if so, where? Are
the services worth the taxpayer costs? Should we mandate prevention for school-aged chil-
dren or for their parents?

10.3 Evidence-Based Treatment: The Principles of
Effective Intervention

When it comes to rehabilitation, no one-size-fits-all approach is likely to solve every problem
facing juveniles. The challenge to rehabilitate juvenile delinquents can be daunting if we con-
sider all the different problems they could be facing: poverty, failing schools, family conflict,
addictions to drugs or alcohol. We do know, however, that some approaches seem to work
better than others. As a result, for the past few decades, juvenile justice treatment reforms
have shifted to what is commonly referred to as a “what works” or “best practices” model.

Juvenile justice agencies and treatment programs are often required to show that they are
using strategies or programs that have been proven to be effective with juveniles. The reason
for this is twofold: (a) funding agencies need to make sure they are getting the most for their
money, and (b) studies have found that if programs follow certain principles or strategies
they are more likely to see reductions in recidivism (Manchak & Cullen, 2015). For example,
the Florida Department of Juvenile Justice has embarked on a “what works” initiative that is a
comprehensive program improvement project to increase the effectiveness of juvenile justice
services throughout the state. The department is attempting to incorporate only empirically
supported treatment models and techniques. In particular, the state requires thorough train-
ing and pilot testing of curricula and assessment instruments (Chapman, 2005).

Section 10.3Evidence-Based Treatment: The Principles of Effective Intervention

In an effort to identify strategies that were effective in reducing recidivism, researcher Paul
Gendreau (1996) developed the principles of effective intervention. These principles are
recommended strategies and practices that characterize effective programs. The principles
are based on his experiences working with offenders in prison and on research by others in
the field. On the surface, these principles are not groundbreaking. However, they were con-
sidered fairly radical for a field that was entrenched in the get-tough movement that focused
primarily on increased use of punishment. The following is a list of the core principles:

• Match treatment services to the offender’s risks and needs.
• Use treatment models that are behavioral and cognitive behavioral in nature.
• Develop a range of rewards and consequences for behavior.
• Provide relapse prevention strategies.

Gendreau also identified programs that
did not work. Many of the programs that
he identified as ineffective were deter-
rence-based programs commonly used
during the get-tough movement. Deter-
rence-based programs use severe punish-
ments with the goal of scaring youth from
coming back into the system. In other
words, the hope was that youth would
avoid crime in the future in order to avoid
a punitive sanction. Popular deterrence-
based programs used during this time
included chain gangs, boot camps, and
Scared Straight programs. Research found
that youth who went through these types
of programs still had high recidivism rates
(Wilson & Lipsey, 2000). Further, as seen
in the accompanying Spotlight feature,
boot camps had even greater problems, as
several youth died while participating. In general, it was argued that these strategies were not
effective because they did little to identify the causes of crime or to teach youth how to act
differently once released back into their communities.

Terry Barner/Associated Press
In this 2007 photo, supporters of Martin Lee
Anderson, foreground, listen at the trial of
eight former boot camp employees from the
Bay County, Florida, Sheriff’s Office. The former
guards and nurse were on trial for Anderson’s
death.

Spotlight: Boot Camps: What Went Wrong?

Martin Lee Anderson was a Florida teenager sentenced to the Bay County juvenile boot
camp for trespassing. He died on January 6, 2006, after guards repeatedly beat him while
restrained. Anthony Hayes, a 14-year-old from Arizona, was sent to a boot camp for a charge
of shoplifting. He died July 2001 after being required to spend several hours standing outside
in 112-degree heat. Gina Score, a 14-year-old South Dakota girl sent to a boot camp for shop-
lifting, died of heatstroke when she collapsed after a run and lay unattended for three hours.
In every case, staff members were charged in connection with the deaths. What is most-

(continued on next page)

Section 10.4Risk and Need Factors

10.4 Risk and Need Factors
Youth are considered “at risk” for delinquency if they are exposed to certain environments or
have certain personal traits. These high-risk environments can exist in youth’s communities,
schools, and families. These environments and traits are often referred to as criminogenic
needs. Criminogenic needs are known correlates of delinquency and include associating
with high-risk peers, experiencing family dysfunction, substance use, impulsivity, and poor
school achievement (Andrews & Bonta, 2010). The more criminogenic needs the person has,
the greater risk the person has for delinquency. The criminal justice system uses the word risk
to refer to the probability that someone will recidivate. A high-risk person has a high prob-
ability of delinquency in the future. Take the example of associating with delinquent peers.
This puts a youth at risk for delinquency because our close friends have a big impact on our
behavior in terms of the modeling they provide as well as peer pressure. Fortunately, once
these needs are identified, criminal justice practitioners can intervene to reduce them (e.g.,
creating opportunities for youth to associate with positive peers).

Let’s think about this using a medical example: When a doctor is visited by a patient who
is concerned about the potential for heart disease, the doctor will discuss risk factors for

Spotlight: Boot Camps: What Went Wrong? (continued)

striking is that in each case staff members were accused of either using excessive force or
failing to attend to the youth while they were in a medical crisis.

Developed for juvenile offenders in the early 1980s, the boot camp model was popular politi-
cally. Modeled after the military, boot camps for juvenile offenders were designed to use
rigorous, physically demanding activities to develop discipline and respect for authority.
Boot camps typically employed staff who would act as drill sergeants teaching the youth the
benefits of working hard, not quitting an activity, and showing deference to adults. The idea
was that the boot camp would break the youth down in an effort to change their destructive
and disrespectful behavior. The public and policymakers liked the idea of tough love, and by
1995 most states were operating boot camps.

Although some boot camps still exist, most were eventually closed. Many of the closures
came after the deaths and stories of abuse, which were widely publicized by the media. How-
ever, their closure was also due to the growing number of findings that, with a few excep-
tions, boot camps were not effective in reducing recidivism (Parent, 2003).

Various reasons have been offered as to why boot camps were unable to achieve their stated
goals. First, some argued that boot camps did not focus on the issues that brought the youth
to the camp. By relying only on coercive physical punishment, the camps failed to address
key issues facing youth within their families, schools, and communities. This is also one of
the reasons wilderness type programs (covered in Chapter 8) lacked effectiveness. Second, in
the traditional military model, participants are sent to military training after they complete
the boot camp. As part of their training they are given housing, meals, and support. Juvenile
boot camp participants were simply sent home to the same environment after they com-
pleted their boot camp training. Finally, some argued that teens felt boot camps were inher-
ently unfair and cruel and reported feeling defiance and anger toward guards. Ironically, this
hostility toward authority was exactly what the boot camp guards were trying to eradicate
(Robinson, 2001).

Section 10.5Classification and Assessment

the disease. Those risk factors include gender, age, family history, cholesterol level, weight,
whether the person smokes, physical activity, and so on. An older male with a history of heart
disease in his family, who has high cholesterol, gets limited physical activity, is overweight,
and smokes is at a higher risk for heart disease. Risk factors for delinquency work the same
way. The risk factors for delinquency were not picked at random. Research studies have estab-
lished that these factors are correlated with crime (Andrews & Bonta, 2010).

The more risks or problems individuals experience, the more likely they are to engage in crim-
inal behavior. Not everyone has the same number of risk factors. For some, school achieve-
ment may be the only problem area and otherwise they are doing well. In that circumstance,
a probation officer may conclude that the juvenile is at low risk for future criminal behavior.
In contrast, a youth who is having difficulty in school and/or with his or her parents, who is
addicted to drugs, and who chooses to associate with other delinquent peers is at a higher
risk of delinquency. Determining which factors are important for each person requires that
the probation officer conduct a risk assessment. The assessment of risk is typically based on
a classification tool.

10.5 Classification and Assessment
Classifying juveniles into groups is a common practice in the criminal justice system. Juve-
niles are grouped based on characteristics such as age, gender, suicide risk, addiction severity,
and so on. In general, an assessment is a
tool that evaluates how likely a youth
might be to engage in criminal behavior.
An assessment of a youth’s risk for crimi-
nal behavior may include an evaluation of
his or her needs (e.g., peers, personality,
and lifestyle factors). Assessing a youth’s
risk for future criminal behavior often
uses what is referred to as a risk and need
assessment tool.

Before we discuss some of the more pop-
ular risk and need assessment tools, it
is important to understand the history
behind assessment for juveniles. The his-
tory of assessment is often discussed
in the context of generations or phases
(Andrews, Bonta, & Wormith, 2006).

First-Generation
Assessment Tools
First-generation assessment tools are not actually tools but are unstructured “gut-level”
assessments of an individual’s risks and needs. An example of this type of assessment would
be a meeting that might happen between a probation officer and his or her client. The interac-
tion might sound something like this:

Bill Haber/Associated Press
Probation officers evaluate the personalities and
lifestyles of juveniles in hopes of assessing the
risks of criminal behavior.

Section 10.5Classification and Assessment

Probation Officer (P.O.): Why do you think you got into trouble this time?

Client: I keep hanging around with this buddy of mine, and we always just
seem to get into trouble.

P.O.: Don’t you think you should stop hanging around with this friend of yours?

Client: Yeah, I will see what I can do. I don’t know, though, we are pretty tight.

P.O.: Are you in school?

Client: I try to go when I can.

P.O.: You are going to have to go to school to do well on supervision.

Client: OK. I will see what I can do.

P.O.: OK. I will see you next time, and I expect to hear that you have been
attending school.

Based on this abbreviated interaction, the probation officer might assign a risk level to the
youth. The probation officer might conclude that the youth is at moderate risk for future
criminal behavior because the youth is associating with other delinquents and is truant from
school. But this “assessment” of risk will be based on the probation officer’s intuition or gut-
level reasoning about the youth’s probability for future criminal behavior. The assessment is
not guided by an actual paper-and-pencil assessment tool. The disadvantage of this approach
is that gut-level intuition or unguided clinical judgment tends to be inaccurate and provides
an incomplete picture of the important risk factors for delinquency (Grove, Zald, Lebow, Snitz,
& Nelson, 2000). First-generation assessments are often inaccurate due to bias. For example,
let’s assume for a moment that a probation officer believes that most juvenile delinquents
get into trouble because they have parents who do a poor job with discipline. When that
same probation officer interviews a youth, the probation officer would likely spend more
time questioning the youth about family interactions and discipline styles than other risk
factors (e.g., looking at the youth’s peers). It is natural for people to bring personal biases
into their interactions with others; however, these biases can lead some people to overlook
certain aspects of a youth’s life that might be important.

Second-Generation Assessment Tools
Second-generation assessment tools are structured questionnaires that guide the interview
process. The tools also assign a value to each risk factor. For example, a youth with a violent
prior record would receive more points than a youth with a nonviolent record. Second-gen-
eration assessments remove the bias by assigning points and providing an overall risk score.
The problem with second-generation tools is that they focus primarily on historical factors.
These historical factors are also referred to as static risk factors. A static risk factor is a cir-
cumstance in a youth’s life that cannot be changed because it happened in the past. For exam-
ple, if a youth has a long prior record, a history of substance abuse, and a history of violence,

Section 10.5Classification and Assessment

a second-generation tool would likely tell us that the youth is at high risk for future criminal
behavior. However, the risk factors are all static because they happened in the past. Relying
on historical factors misses some of the other problems the youth faces and does not provide
a clear path for treatment. These disadvantages led to the development of third-generation
assessment tools.

Third-Generation Assessment Tools
The third-generation assessment tools became popular in the late 1980s. Third-generation
assessment tools combine both static and dynamic factors to give a broader portrait of the
likelihood that a youth will commit a crime in the future. Dynamic risk factors, also referred
to as criminogenic needs (described earlier), are important risk factors in the individual’s life
that can be changed. An example of this type of tool is the Youth Assessment and Screening
Instrument (YASI). The YASI covers a number of dynamic and static risk factors such as crimi-
nal history, education, family relationships, peers, substance use, and antisocial attitudes. The
tool also provides an overall risk score from no risk to high risk. The third-generation tools
give the therapist an idea of what areas to work on in treatment but do not emphasize the
need to reassess youth as they progress through treatment.

Fourth-Generation Assessment Tools
Fourth-generation assessment tools are now considered a best practice in the field. Like their
predecessors, the fourth-generation tools build on the benefits of the third generation by tar-
geting both static and dynamic risk factors. In addition, the fourth-generation assessment
tools are designed to take the juvenile’s treatment plan from intake to case closure. Reassess-
ment is key to the process of treatment, because it helps determine whether a program had an
impact on an offender’s risk and it guides changes in the treatment or case plan. An example
of a fourth-generation tool is the Youthful Level of Service/Case Management Inventory (YLS/
CMI) (Hoge, Andrews, & Leschied, 2002). The YLS/CMI asks questions about eight areas in a
youth’s life including prior record, family, school, peers, substance abuse, leisure/recreation,
personality, and attitudes. The tool provides a risk score in each of the eight areas and an
overall risk score. The tool also has a section where the assessor can provide a reassessment
score. The developers encourage reassessment every 6–12 months depending on the amount
of time the youth spends under supervision.

Another recently developed fourth-generation assessment tool is called the Ohio Youth
Assessment System (OYAS). The OYAS was developed by Edward Latessa and associates at
the University of Cincinnati. The assessment contains five separate tools that can be used as
standalone tools or as a set, depending on the juvenile’s case plan. The instrument covers
all of the major risk factors including history; family and living arrangements; peers; educa-
tion and employment; prosocial skills; substance abuse; mental health and personality; and
values, beliefs, and attitudes. Each of the sections contains risk factors that are scored in a 0
(no problem) or 1 (evidence of a problem) format. The items are then summed to provide an
overall risk score. The summary results provide caseworkers with a graphic illustration of the
risk factors as well as the youth’s overall risk. The risk factor information should be used for
case planning and treatment assignment (Latessa, Lovins, & Ostrowski, 2009).

Section 10.6Responsivity Factors

10.6 Responsivity Factors
Even when appropriately assessed and placed in treatment, some youth seem to do bet-
ter than others. Sometimes other issues influence the success of treatment. These issues,
referred to as responsivity factors, are not risk factors for delinquency, but they are barriers
to treatment (Palmer, 1974). Responsivity factors are characteristics of the person or the
person’s environment that may act as obstacles to treatment and/or supervision. The barri-
ers can include personal or internal factors and environmental or external factors. Internal or
personal barriers can include factors such as motivation, personality, and intelligence. Intel-
ligence may act as a barrier to treatment if the topic presented in a treatment group is too
difficult to understand. For example, if a therapist is trying to teach a client how to be more
empathetic, the therapist might say, “Try to put yourself in someone else’s shoes, and think
about how he or she would feel.” A client with a lower IQ might have a difficult time with this
concept, because imagining what others might be thinking or feeling requires a fairly high
level of cognitive functioning.

Factors in the environment, or external factors, could impact treatment as well. External fac-
tors can include how well the therapist and client get along, whether the treatment happens
in an institution or in the home, and even something simple like transportation. Youth who
have difficulty finding transportation to the treatment agency may not do well simply because
they are unable to attend. All of these factors can be important and impact treatment, but one
responsivity factor that has received a considerable amount of attention is a client’s motiva-
tion to change.

Motivation to Change
It was once thought that if individuals were not motivated to change their behavior, then little
could be done to help. People would often talk about how addicts needed to hit “rock bottom”
before they were ready to engage in treatment. Although it is now understood that coerced or
involuntary treatment can work even if someone is not motivated at the outset (Anglin &
Hser, 1990), corrections professionals cannot ignore resistance; rather they need a plan in
place to diminish it over time.

We can think of motivation as existing
on a continuum with people who are not
motivated on one end and people who
are highly motivated on the other. In the
1980s, two researchers developed cat-
egories to capture the different levels of
motivation people progress through when
deciding whether to change their behavior.
They referred to these levels as the stages
of change (Prochaska & DiClemente,
1983). In the first stage, referred to as pre-
contemplation, individuals are not actively
seeking to change their behaviors. They
may be unaware that the behavior needs
to be changed or simply do not see their
“problem” as something to be addressed.

KatarzynaBialasiewicz/Getty Images
In the first stage of change, precontemplation,
individuals aren’t trying to change problem
behaviors.

Section 10.7Treatment Services

An example would be juveniles who do not see that their marijuana use is causing a problem
in their lives. The belief may exist even in the presence of evidence that the drug use is having
a negative impact on school, family relations, peers, and so forth.

In the second stage, contemplation, the youth may understand that the problem exists but
has yet to commit to change. In the marijuana use example, the youth may recognize that the
marijuana use is causing problems with school in terms of both attendance and performance,
but still wants to get high and is not committed to stopping. In the third stage, preparation,
the youth may begin taking steps that will lead to change but is not fully committed to imple-
menting the behavior. In this stage, individuals may decide that change is needed and begin
to think about other activities that would help keep them busy during the times that drug use
typically occurs (e.g., after school, on weekends).

In the fourth stage, action, the youth commits to change and begins to modify the behavior
in question. In this stage, the youth would stop the use of marijuana. The final stage, mainte-
nance, is when the youth develops clear steps to maintain the behavioral change. The mainte-
nance stage would include relapse prevention strategies such as avoiding high-risk situations
and friends that could trigger a lapse.

Approaches to Motivational Issues
Several tools and approaches are used to assess the issue of motivation to change. For exam-
ple, the Motivation to Change Inventory for Adolescents (Bauman, Merta, & Steiner, 2001)
measures motivation to engage in substance abuse treatment. As part of this process, the
scale examines issues such as social support, self-efficacy, and life skills.

Another popular approach to measuring and addressing motivational issues is called moti-
vational interviewing (Miller & Rollnick, 2004). Motivational interviewing is an interview-
based technique designed to reduce an individual’s resistance to engaging in treatment. The
therapist would work to have the youth understand why the behavior in question needs to
be changed. For example, if the youth does not want to stop using marijuana, the therapist
can discuss the reasoning behind the youth’s resistance and the impact drug use is having.
By helping the youth see the problems that marijuana use is creating, the theory is that the
person will see the benefits of changing the behavior. Techniques used in motivational inter-
viewing include being nonconfrontational, rolling with resistance, and supporting the client’s
self-efficacy. Proponents of this approach suggest that by working with rather than coercing
clients, the likelihood of increasing intentions to change is greater and longer lasting (Li, Zhu,
Tse, Tse, & Wong, 2018; Miller & Rollnick, 2004).

10.7 Treatment Services
Once an individual’s risk, need, and responsivity factors have been assessed, the next stage
is to begin treatment. As mentioned earlier, the principles of effective intervention outline
certain features of effective programs but stop short of recommending particular groups or
programs. That said, there are many existing programs and services that can be effective, par-
ticularly if they are implemented well and for a reasonable length of time. Some of the more
popular approaches are based on cognitive and social learning theories.

Section 10.7Treatment Services

Studies find that clients who exhibit antisocial logic and have poor problem-solving and cop-
ing skills are more likely to be involved in delinquency. Put another way, people who believe it
is acceptable to commit crime by justifying and minimizing their criminal behavior are more
likely to engage in that behavior (Cullen & Gendreau, 2000). Cognitive behavioral therapy
is a type of treatment approach focusing primarily on the way people think and subsequently
how they behave. Cognitive behavioral therapists try to teach clients that how they think
about situations tends to influence how they act in those situations. In other words, if a youth
believes that the police cannot be trusted, every interaction the youth has with the police will
be influenced by this belief. That belief itself often has a greater influence over the interaction
with the officer than the interaction itself. Two main types of therapy fall under the umbrella
of cognitive behavioral programming: cognitive restructuring and cognitive skill.

Cognitive restructuring therapy attempts to change antisocial cognitive beliefs or thoughts.
This therapy is based on the idea that people react as a result of how a situation is processed
cognitively. When those cognitions are distorted (also popularly referred to as thinking
errors), the reaction is often negative. For example, a juvenile delinquent may blame others
or minimize the role smoking marijuana played in a criminal act. The youth may feel that
marijuana should be legal and uses that belief to justify the drug use. The aim of cognitive
restructuring therapy is to teach people to recognize the situation, address how they perceive
that situation, and as a result change the outcome or the response.

Cognitive skills therapy, while similar, is intended to develop a set of skills individuals can
use when confronted with a problem or high-risk situation. For example, cognitive skills ther-
apy may involve increasing problem-solving or social skills, or teaching someone how to use
a coping skill such as self-talk. When people feel angry or frustrated, they may calm down
by telling themselves that everything will turn out fine. For example, Donald Meichenbaum
(1977) explored anger management techniques with juveniles and found that a commonly
used technique such as saying “Check yourself” worked to reduce anger responses. That is,
if a juvenile is feeling angry or is exhibiting angry behavior, the counselor would say, “Check
yourself,” and that would signal the youth to deal with those emotions differently. Programs
based on cognitive restructuring and cognitive skills have been found to be very effective in
reducing recidivism (Cullen & Gendreau, 2000).

Cognitive behavioral therapies can be run in a variety of settings and can be guided by a num-
ber of different curricula. Notable approaches include Albert Ellis’s rational emotive behavior
therapy (Ellis & MacLaren, 1998) and Stanton Samenow’s (1998) Commitment to Change.
The curricula allow clients to see the connection between attitudes and behavior and attempt
to teach clients how to manage their own emotions when they encounter difficult situations.
Thinking for a Change (T4C) is a popular cognitive behavioral curriculum that is discussed in
the accompanying Spotlight feature. T4C, developed by the National Institute of Corrections,
is used with both juveniles and adults.

Spotlight: Thinking for a Change (T4C)

Thinking for a Change (T4C) is a cognitive behavioral curriculum developed by Bush, Tay-
mans, and Glick (1997) for the National Institute of Corrections. The curriculum consists of

(continued on next page)

Section 10.8Examples of Effective Treatment Programs: Model Programs

In addition to these programs and curricula, other treatment and prevention programs have
been identified as effective. The programs are referred to as model programs and are cur-
rently considered best practices in the field. In the next section, we highlight several curricula
to illustrate the different types of programs available.

10.8 Examples of Effective Treatment Programs:
Model Programs

In the field of juvenile justice treatment, it can be difficult to determine which program to
choose. To make this task easier, the Center for the Study and Prevention of Violence at the
University of Colorado, Boulder, developed an information clearinghouse to identify violence
and drug prevention programs, policies, and practices in the field. Their Blueprints for Vio-
lence Prevention Initiative is designed to identify effective treatment programs and services
that could be replicated in communities across the nation. According to the center’s website,

The Blueprints mission is to identify truly outstanding violence and drug
prevention programs that meet a high scientific standard of effectiveness. In

Spotlight: Thinking for a Change (T4C) (continued)

22 lessons integrating both cognitive restructuring and cognitive skills exercises. The curric-
ulum has three components: cognitive self-change, social skills, and problem-solving skills.
Each section uses a variety of techniques to allow individuals to see how their thoughts influ-
ence feelings and behaviors. Group members are taught problem-solving skills that they can
use when confronted with high-risk situations. Each lesson is formatted in a similar way,
allowing for participants to learn a particular skill, practice the skill in front of others (role
play), and receive constructive feedback from the group.

In the cognitive self-change section, the curriculum offers a tool called a Thinking Report.
Thinking Reports have the youth identify the risky situation he or she experienced. An exam-
ple of a high-risk situation for a participant might be when the youth is asked by a group of
friends to use drugs after school, so he follows along and gets high. The counselor would
work with the youth to determine what thoughts the youth had prior to deciding to meet up
with his friends to get high (e.g., “I really want to go,” “I don’t want to get in trouble,” “getting
high would feel good”). The counselor then probes the youth to identify what feelings the
youth may have had in the situation (e.g., feeling anxious, excited, apprehensive). Finally, the
counselor probes the youth to think a little deeper about the attitudes or values he or she
has about the situation (e.g., “using drugs is normal for teens”). Going through this step-by-
step process, the youth can see how the thoughts, feelings, and attitudes about the situation
made it more likely that he or she would decide to use drugs. By working to develop this
awareness, the counselor can then help the youth consider thinking differently about the
situation in the future.

Each lesson is designed to occur within a two-hour format once a week; however, groups
can be held more than once per week. T4C has been implemented in hundreds of agencies
nationwide (Bush et al., 1997).

Section 10.8Examples of Effective Treatment Programs: Model Programs

doing so, Blueprints serves as a resource for governments, foundations, busi-
nesses, and other organizations trying to make informed judgments about
their investments in violence and drug prevention programs. (https://cspv
.colorado.edu/blueprints/index.html)

Center staff members categorized programs as either “model” programs, which indicates
they are effective with a variety of clients and agencies, or “promising” programs, which are
effective but need to be replicated elsewhere.

Another initiative similar to Blueprints, but not focused solely on violence and drug preven-
tion, is an initiative funded through the Office of Justice Programs. The Evidence Integration
Initiative is designed not only to inform agencies and policymakers on best practices in crim-
inal justice but also to assist them as they integrate the evidence into their current systems.
One part of this initiative is the development of a clearinghouse similar to the Blueprints
initiative that identifies programs as effective, promising, or having no effect. The clearing-
house lists various programs that show effectiveness in reducing recidivism in juveniles (see
[http://www.crimesolutions.gov).

As we might expect, a considerable amount of overlap exists between the two initiatives in
the programs they identify as effective. The following sections describe programs identified
as either model or effective by the respective agencies. Although there are undoubtedly other
effective programs and services, these programs have been reviewed extensively and hold the
most promise for reducing juvenile delinquency.

Functional Family Therapy
Functional Family Therapy (FFT) is a
family-based intervention that targets
youth ages 10–18 with wide-ranging
issues. The therapy can take place in vari-
ous settings including home, school, or
community agency offices (e.g., proba-
tion, parole, child welfare). The interven-
tion is relatively short, lasting on average
3–4 months. The program requires train-
ing for agency workers who wish to facil-
itate FFT.

Before the program begins, there is a pre-
treatment phase. At this point in the ther-
apy, the therapist works to establish referral sources and review assessments and potential
services that might already be in place. The program itself consists of five components:

• The engagement phase focuses on establishing a good rapport with the family and
any other agencies or sources providing services to the youth and family. Within this
context, the FFT therapist acts to develop a therapeutic alliance with the family in
order to gain trust and commitment.

• During the motivation phase, the FFT therapist works with the family and youth to
develop a positive outlook and goals (similar to motivational interviewing). The

Fstop123/Getty Images
Functional Family Therapy works with the entire
family to help troubled youth.

https://cspv.colorado.edu/blueprints/index.html

http://www.crimesolutions.gov

Section 10.8Examples of Effective Treatment Programs: Model Programs

therapist also works to move the functioning of the family from a negative cycle that
might include blaming and justification to one that is more optimistic and strength
focused.

• The relational assessment phase focuses on analyzing and working with assessment
information regarding the functioning of the family and its issues.

• The behavioral change phase is a crucial aspect of the therapy and one that focuses
on skill-building activities. This phase is designed to provide the platform for change
within the family.

• The final component, the generalization phase, includes developing and sustain-
ing existing linkages in the community and assisting the families with developing
relapse prevention plans.

The FFT organization has also developed a case management model to assist probation and
parole officers in their work with the youth’s families. Studies have found that these programs
reduce recidivism among youth and increase family communication.

Learn more at https://www.fftllc.com.

The Incredible Years Series
The Incredible Years Series program targets not only the family and youth but also the school
system. The program is designed for younger children, ages 2–10, who have shown to be at
risk or have a diagnosis of conduct disorder. The program consists of three series.

The first series, which is noted as the most important component, is called the Incredible
Years Training for Parent Series. The parent series consists of three core components:

• The BASIC program teaches parents skills such as relating to their children, playing
with their children, and effective approval and disapproval.

• The ADVANCE program teaches parents more advanced skills around support, anger
management, and communication.

• The SCHOOL program teaches parents how to encourage, support, and engage in the
youth’s education.

Studies suggest that parents who complete the series are more likely to use effective parent-
ing strategies, such as praise and limit setting, and they are more likely to report better inter-
actions with their children.

The second series, referred to as the Incredible Years Series for Teachers, focuses primarily on
building skills around classroom management. The focus of this series rests with the manage-
ment of difficult behaviors in the classroom through the use of redirection, rewards for posi-
tive behavior, and teaching problem solving. Studies suggest that teachers who complete the
program are more likely to use praise and have better interactions with youth and families.
Even more important, teachers who complete the program report reduced aggression among
youth in the class.

The third and final series, called the Incredible Years Training for Children, teaches youth age-
appropriate skills around self-management and self-control. The series also includes a pre-
vention curriculum that teachers can deliver to the entire class. Youth who completed this

https://www.fftllc.com

Section 10.8Examples of Effective Treatment Programs: Model Programs

program were found to be less likely to have problems at home and school and more likely to
use cognitive problem-solving strategies.

Read more at http://www.incredibleyears.com.

Big Brothers Big Sisters Community-Based Mentoring Program
Developed in 1904, Big Brothers Big Sisters is one of the country’s oldest delinquency pre-
vention programs. It provides mentoring services to youth ages 6–18 from at-risk single-par-
ent homes. These mentoring programs
are designed to allow youth to interact on
a regular basis with meaningful mentors,
typically volunteers who agree to engage
in activities with the youth at least twice a
month. A mentor can be someone in the
youth’s family or community. This is often
referred to as a natural mentor. If the
youth has no natural mentors in his or her
life, a mentor can be assigned. The youth
and the mentor are encouraged to engage
in fun outings or activities, such as picnics
at a park, attending movies, or going shop-
ping. The purpose is to have someone
there for the youth if he or she wants to
talk or needs advice, or just to engage in a
prosocial activity. The program offers ser-
vices in both rural and urban areas.

The Big Brothers Big Sisters program offers special programs to meet the needs of disadvan-
taged communities. Each of these programs attempts to match an adult of a similar back-
ground to the youth. Included are the following programs:

• African American mentoring
• Native American mentoring
• Hispanic mentoring
• Mentoring military children
• Amachi program (for children with an incarcerated parent)

The programs have been implemented in all 50 states and 12 countries. The Big Brothers Big
Sisters organization indicates that they currently have over 240,000 volunteers nationwide.

Studies suggest that this program is able to reduce drug use, interpersonal conflict, and tru-
ancy among youth who participate. Mentoring programs in general have become a popular
approach to treating youth in the community.

Learn more about this program at http://www.bbbs.org.

Graham Cullen/Associated Press
At-risk youth can enroll in a mentoring program
through Big Brothers Big Sisters.

http://www.incredibleyears.com

Home

Section 10.8Examples of Effective Treatment Programs: Model Programs

Promoting Alternative Thinking Strategies
The Promoting Alternative Thinking Strategies (PATHS) curriculum is a school-based inter-
vention designed for children ages 5–10. Although the program is designed to occur at school,
the curriculum also involves work that can be done at home between parent and child. The
program uses a social cognitive approach to improve problem solving and self-control.

The curriculum is designed to teach children how to use reflective listening, to recognize dif-
ferent emotions they may be feeling, to have empathy for others, and to teach problem-solv-
ing skills to reduce conflict. The underlying logic of this program is that children are unable
to regulate emotions well and often do not have the coping mechanisms necessary to manage
complex emotions like anger and frustration. Through various age-appropriate stories and
characters, the program teaches youth to recognize their emotions, to take a break and think
about the situation, and then ask for help by explaining the problem and how they are feeling.
Children are also taught to assist their peers with the same process. Ultimately, the program
aims to increase self-control, self-esteem, and self-confidence in children.

Studies suggest that the PATHS program is effective at teaching youth emotional regulation
strategies to deal with difficult emotions like anger and sadness. The program was also shown
to be effective when combined with the Big Brothers and Big Sisters program.

Learn more about the program at http://www.pathstraining.com/main/.

Life Skills Training
There are many life skills programs in existence that target a variety of behaviors. For exam-
ple, a life skills program in the community might work with youth to teach them basic hygiene
and appropriate dress for school. Other life skills programs might focus on employment and
teach youth about resume building or job interviewing. The Lifeskills Training program noted
by the Blueprints initiative is a substance abuse prevention program designed for youth in
grades K–12. The classroom-based program is broken down into three curricula: one for ele-
mentary schools, one for middle schools, and one for high schools. The program also includes
a transition program as an aftercare or maintenance-type program for high school students.
Each curriculum has a number of sessions designed to teach youth problem-solving skills to
avoid drug and alcohol use. For example, the elementary curriculum contains 24 sessions, the
middle school contains 30 sessions, and the high school program consists of 10 sessions. The
program includes three components:

• Drug resistance training: Youth are educated about drugs and taught skills for
dealing with peer pressure.

• Self-control skills training: Youth are taught to critically analyze situations, recog-
nize their consequences, and develop strategies for dealing with them effectively.

• General skills training: Youth are taught to develop general social skills including
communication, assertiveness, and anger management.

The program also offers booster sessions once youth complete the program. The booster ses-
sions provide additional, follow-up sessions to check in with youth and allow them to work

http://www.pathstraining.com/main

Section 10.8Examples of Effective Treatment Programs: Model Programs

through any problems they may be having at that time. Studies suggest that the program is
effective at reducing cigarette smoking, marijuana use, and alcohol use.

Learn more about the program at https://www.blueprintsprograms.org/factsheet/
lifeskills-training-lst.

Multisystemic Therapy
Developed in the mid-1970s, the Multisystemic Therapy (MST) program is an intensive
wraparound service-based approach that targets not only youth but also their entire system,
including family, school, and the community. The program is designed for youth who have had
chronic behavioral problems and typically have a long involvement with the criminal justice
system. The target age for the program is 12–17 years, and it includes both girls and boys.

The program tends to be more intensive than most interventions for youth. The therapist(s)
working with youth and their families are on call 7 days a week, 24 hours a day. Therapist
visits will include home visits, school meetings, and meetings with community agencies to
develop a supportive network for youth and their families. Providing services to youth in
these settings is seen as a better way to effect change than is simply providing services to
youth in an office only to send them back to the families and communities that may play a role
in their delinquent behavior.

Youth are encouraged to participate in prosocial activities, develop prosocial friendship net-
works, and improve their academic achievement. Therapists work with parents to increase
their problem-solving skills, develop effective communication styles with their sons and
daughters, and improve their parenting skills with the use of consistent reinforcement and
consequences. The therapist may meet weekly (even daily) with participants in the beginning
and then taper involvement as the family and youth stabilize.

A wealth of studies show the effectiveness of MST. In fact, the MST program has withstood
even more rigorous study designs (random assignments) than those found with research on
other treatment programs. These studies conclude that the program results in both short-
and long-term reductions in criminal behavior, including substance use and violence. More-
over, studies suggest MST positively impacts family functioning and the rate of out-of-home
placements.

Learn more at http://www.mstservices.com.

Multidimensional Treatment Foster Care
The Multidimensional Treatment Foster Care (MTFC) program, developed in the 1980s, is
designed to decrease problem behavior among youth who are in out-of-home placements.
Referrals for service often come from juvenile justice agencies, foster care, or mental health
agencies. Like Multisystemic Therapy, MTFC is multifaceted and targets youth and their fami-
lies, schools, and communities. Although the youth is in out-of-home placement at the time
of the referral, the program considers the biological family as an integral part of treatment.
As part of the program, youth are placed in a foster care setting for 6–9 months and live with
a trained MTFC family. The MTFC parents are trained to provide a consistent and support-
ive environment and maintain close contact with the youth’s treatment team. The primary

https://www.blueprintsprograms.org/factsheet/lifeskills-training-lst

http://www.mstservices.com

Section 10.8Examples of Effective Treatment Programs: Model Programs

therapy is behavioral in nature and focuses on appropriate and consistent reinforcement and
consequences for behavior. The program also focuses on skills training, academic support,
and positive attachments to adults and peers.

The program can serve children as young as preschool age to youth as old as 17. There are
three versions of the MTFC program:

• MTFC-P for preschool children ages 3–6: This program has been in existence
since 1996 and is designed as an alternative to residential placement. The program
attempts to promote secure attachments to adults in foster care with the eventual
goal of placement with the biological or adoptive family. The treatment is provided
through therapeutic play groups, and youth are seen as being delayed in maturation
rather than simply exhibiting behavioral problems.

• MTFC-C for elementary school children ages 7–11: This program targets youth
who are in out-of-home placements often for severe emotional or behavioral prob-
lems. The program targets the biological family from the beginning of treatment in
order to prepare the family for the youth’s eventual return.

• MTFC-A for adolescents ages 12–17: This program targets youth who have been
placed out of home due to significant antisocial behavior. Many of the youth may
have failed other programs and have multiple out-of-home placements. The youth
may be coming to the MTFC program via juvenile detention or group homes. The
purpose of this program is to prepare the youth to live in a family or independent
living situation.

Studies suggest this intervention has been effective in reducing criminal behavior, including
general delinquency, violence, and days spent in detention.

Learn more at https://www.blueprintsprograms.org/factsheet/
treatment-foster-care-oregon.

Nurse-Family Partnership
The Nurse-Family Partnership is a non-
profit organization designed to provide
prenatal and postnatal care to at-risk first-
time mothers. A nurse assigned to the
mother provides weekly or bimonthly ser-
vices in the mother’s home. The services
can continue until the child’s second
birthday. The focus of prenatal care often
includes wellness education, birth prepa-
ration, and education. The focus of post-
natal care includes caring for infants,
expectations for children, and appropriate
discipline techniques. The program also
provides emotional support for mothers
and encourages them to consider further-
ing their education and employment skills.

L. Mueller/Associated Press
The Nurse-Family Partnership supports at-risk
mothers through the birthing process before and
after the arrival of the baby.

https://www.blueprintsprograms.org/factsheet/treatment-foster-care-oregon

Section 10.9Connecting the Dots: Relapse Prevention

The Nurse-Family Partnership program has three goals:

• Improving pregnancy outcomes through preventive care. These prenatal services
include nutrition counseling and counseling regarding the effects of alcohol, tobacco,
and illicit drug use on the developing fetus.

• Working with mothers to ensure responsible care for the infant.
• Assisting mothers with financial needs, including helping them gain access to educa-

tion or employment opportunities.

Studies suggest that the program succeeds in reducing child maltreatment, increasing health
among infants, reducing arrest rates for mothers and children, and reduction in hospital
admissions for accidents and poisonings.

Learn more at https://www.nursefamilypartnership.org.

Model Programs: Why They Work
These model programs have several features in common that likely influence their
effectiveness.

• They target the criminogenic risk factors that have been shown to reduce criminal
behavior. Risk factors such as attitudes supportive of crime, associating with other
delinquent peers, low school achievement, and problems within families are core
problems for juvenile delinquents.

• Many of these programs also include the community as part of the treatment
approach. The community can include schools, social service agencies, neighbor-
hoods, and networks of support. A key to sustained change is the recognition that
treatment should focus not just on the individual but also on the social context in
which the youth lives.

• Many of these programs are age appropriate, providing services designed to be
responsive to the youth’s risk and needs as well as their developmental stage.

• Each of these programs has developed a comprehensive framework to assist with
implementation.

It is more likely that agencies will be effective at rehabilitating youth if they rely on these best
practices.

10.9 Connecting the Dots: Relapse Prevention
In the final stage of treatment, many programs introduce relapse prevention strategies,
which are designed to prevent or inhibit the likelihood of criminal behavior in the future.
It is not sufficient for staff to convince youth to stop using drugs only while they are in the
treatment program. Staff also need to convince youth to continue abstinence over the course
of their lives. Relapse prevention strategies teach youth ways to anticipate and cope with

Home

Section 10.9Connecting the Dots: Relapse Prevention

high-risk situations to avoid lapses. Without a comprehensive set of coping and problem-
solving skills, the belief is that juveniles are likely to relapse when placed back into the same
environment. Relapse prevention programs also attempt to increase the client’s sense of self-
efficacy, which refers to the individual’s ability to master a situation and feel confident in his
or her ability to handle challenging situations. The client is often taught that the power of
change comes from developing skills to handle adversity rather than simply relying on will-
power (Parks & Marlatt, 1999). In other words, if the troubled youth is confident that change
is possible and can be maintained, then a positive outcome (e.g., abstinence) is more likely.

Relapse can have a reciprocal effect on self-efficacy as well. Clients who do not relapse and
use their coping skills effectively are likely to increase their sense of self-efficacy or mastery
of a particularly problematic situation. Those who do not cope well are more likely to feel they
are unable to successfully navigate their environment. One strategy taught to clients is that a
minor lapse does not need to become a full relapse. In the case of drugs and alcohol, a minor
lapse in drug use can be stopped if clients are taught to accept that failures can happen but
that they need to be addressed quickly so that the client can get back into a pattern of sobriety
(Marlatt & Gordon, 1985). If a minor lapse is viewed as a failure, the client is more likely to fall
into a full-blown relapse that will make it more difficult to recover. Relapse prevention is a
common component of substance abuse programs but can also be found in most cognitive
behavioral programs and is relevant for all types of problem behaviors. The accompanying
feature provides a closer look at one such program.

Featured Program: TARGET
http://www.advancedtrauma.com/Services.html

Trauma Informed Care (TIC) has become a popular approach in juvenile justice. One cur-
riculum, referred to as TARGET (Trauma Affect Regulation: Guide for Education & Therapy),
was developed for adults with chronic mental health issues in 2000 and then adapted for
juveniles in 2004.

The TARGET curriculum is a manualized, strengths-based, present-focused approach that
focuses on teaching self-regulation skills to adolescent trauma survivors. Across 10 sessions,
TARGET teaches a simple sequence of seven skills, described by the mnemonic FREEDOM.1
The skills are designed to help youth to gain control of how they react to triggers in their
lives. Teaching skills for self-regulation is a direct way to address symptoms of posttraumatic
stress disorder (PTSD) and enable individuals to safely process stressful current experiences.
Self-regulation is needed to manage unwanted trauma memories, to regain a sense of well-
being, to build and sustain healthy relationships, and to feel in charge of oneself. TARGET can
be offered in individual or group sessions conducted by case managers, clinicians, rehabilita-
tion specialists, or teachers. The model is intended to be used to mobilize the adolescent’s
own resources and build on her or his internal strengths.

Prior studies report several key systemic benefits for program participants, including
improvements in depression, anxiety, and reports of hope and optimism (Ford & Hawke,
2012; Marrow, Knudsen, Olafson, & Bucher, 2012).
1Focus, Recognize triggers, Emotion self-check, Evaluate thoughts, Define goals, Options, and Make a contribution.

http://www.advancedtrauma.com/Services.html

Summary of Learning Objectives

Summary of Learning Objectives
Describe the philosophical shift that has occurred in reducing juvenile delinquency.

• A philosophical shift is taking place in juvenile corrections, shifting from get-tough
polices to an emphasis on treatment, prevention, and rehabilitation.

• The philosophical shift supporting a greater use of treatment and prevention pro-
grams is due to economic conditions as well as to studies supporting the effective-
ness of such programs.

• Programs are considered effective if they are supported by research studies that
document positive outcomes.

Summarize the importance of prevention and treatment.

• There are three types of prevention programs: primary, secondary, and tertiary.
• Prevention programs are important, as they can reduce the costs associated with

processing youth and have long-term benefits of keeping youth out of crime and
in school.

Explain the principles of effective intervention.

• The principles of effective intervention are recommended strategies and practices
that can increase the effectiveness of a treatment program.

• The principles of effective intervention include treating those who are at higher risk
of recidivism, in the community, and with proven strategies such as cognitive behav-
ioral techniques.

Explain how need factors contribute to risk for delinquent behavior.

• Certain need factors increase a youth’s risk of recidivism.
• Need factors related to recidivism include high-risk peers, a dysfunctional fam-

ily system, school difficulties, substance use, and attitudes supportive of criminal
behavior.

Describe each generation of risk and need assessment tools.

• Risk and need assessment tools measure the likelihood of recidivism among youth.
• The risk and need assessment tool identifies the factors in a youth’s life that can be

addressed through treatment services.

Explain the significance of responsivity factors with regard to treatment.

• Responsivity factors can impact the effectiveness of treatment.
• Responsivity factors include internal factors such as motivation and external factors

such as transportation.

Summarize the philosophy behind cognitive behavioral programs.

• Cognitive behavioral therapies are growing in popularity and recognize that how an
individual processes information influences his or her behavior.

Summary of Learning Objectives

• Cognitive behavioral programs teach youth how to identify the relationship between
thoughts, feelings, and behaviors.

• Cognitive restructuring attempts to change antisocial cognitive beliefs or thoughts.
• Cognitive skills therapy teaches clients how to cope with high-risk situations and

triggers.

Analyze the model treatment programs and why they work.

• The Blueprints for Violence Prevention Initiative and the Evidence Integration
Initiative are comprehensive efforts to identify effective programs operating in the
community.

• The model programs identified vary in terms of settings, intensity, and target popu-
lation and are shown to be effective by numerous research studies.

Explain the importance of relapse prevention techniques.

• Relapse prevention programs teach clients to anticipate problem situations and
effectively cope with them to avoid relapse.

Critical Thinking Questions
1. Would you recommend that every juvenile delinquent receive some type of treat-

ment program? If so, what would that/those program(s) be? If not, whom would you
exclude?

2. Should we consider giving risk and need assessments to the general population (e.g.,
in schools) to determine risk for delinquency before it happens? If so, what are the
potential pitfalls of this approach?

3. What are the potential problems with implementing cognitive restructuring and
cognitive skills programs for juveniles?

4. Imagine you are in charge of a probation agency. Would it be sufficient to adopt just
one of the model programs? Why or why not?

Key Terms
assessment A tool that evaluates how
likely a youth might be to engage in criminal
behavior.

Blueprints for Violence Prevention Initia-
tive An initiative designed to identify effec-
tive treatment programs and services that
could be replicated in communities across
the nation.

cognitive behavioral therapy A type of
treatment approach that focuses primarily
on the way people think and subsequently
how they behave.

cognitive restructuring therapy Therapy
that attempts to change antisocial cognitive
beliefs or thoughts.

cognitive skills therapy Therapy that
intends to develop a set of skills individuals
can use when confronted with problems or
high-risk situations.

criminogenic needs Also referred to as
dynamic risk factors; important risk factors
in the individual’s life that can be changed.

Summary of Learning Objectives

Evidence Integration Initiative An initia-
tive designed to inform agencies and policy-
makers on best practices in criminal justice
and to assist them as they integrate the
evidence into their current systems.

motivational interviewing An interview-
based technique designed to reduce an indi-
vidual’s resistance to engaging in treatment.

primary prevention Programs focusing on
the conditions that could lead to delinquent
behavior such as truancy, poor parenting,
and prenatal exposure to toxins.

principles of effective intervention Rec-
ommended strategies and practices that
characterize effective programs in reducing
recidivism.

relapse prevention Strategies designed to
prevent or inhibit the likelihood of criminal
behavior in the future.

responsivity factors Characteristics of the
person or the person’s environment that
may act as obstacles to treatment and/or
supervision.

secondary prevention Programs that shift
the focus of services to the delinquent youth
and address the delinquent behavior at its
earliest stages.

static risk factor A circumstance in a
youth’s life that cannot be changed because
it happened in the past.

tertiary prevention Programs focused on
reducing recidivism among those who are
already in the juvenile justice system.

treatment A set of actions or services
designed to rehabilitate or change an
individual.

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