Evidence-Based Practices

[Please note: Reclaiming Futures and its partners are not endorsing or promoting the author's book. We are reprinting his column because it does a good job of showing how the principles of Motivational Interviewing (an evidence-based practice) can be used to help youth make positive changes. Though written for parents with teens using alcohol and drugs, it also applies to juvenile probation officers and other professionals who work with youth to help them change their behavior -- all sorts of behavior, not just alcohol and drug use. --Ed.]
Imagine you are in the Emergency Department (ED) with your 16-year-old daughter, who was brought in for her second episode of alcohol poisoning in six months. The doctor is about to discharge her because, medically, she’s fine, but you know she’s going to go right back to heavy drinking if you don’t do something. You and your husband feel you’ve tried everything to help your daughter, but you also believe that there has to be some way to take advantage of this dire emergency to motivate her to get into treatment and to stop drinking.
I’ve seen hundreds of families in this very situation and their dilemma is always the same: they all want to influence their child to get on a better path, but they don’t know that there is a quick, easy and scientifically-proven way of getting the job done. The approach I’m referring to is called “Instant Influence.” It’s based on Motivational Interviewing (which in its briefest form has been shown to reduce substance use among adolescents and young adults seen in the ED) and my 20 years of experience motivating some of the most resistant-to-change substance abusing children and adults in a wide variety of settings.
People tend to only listen to one person — themselves. And, as a result, they’re only influenced by one person … again — themselves. So, as frustrating as this may be for a parent who would like to sternly say, “You have to stop!” and to have that be enough, the real trick to motivating someone is to get them to convince themselves to make a change for their own good reasons.

The premier episode of the new season of the controversial reality show, “Beyond Scared Straight,” adheres to the themes that made it A&E’s most watched show: a small group of at-risk youth spend the day in prison where they are yelled at, intimidated and humiliated by sheriff’s deputies and inmates alike. The screaming and threats of prison rape are followed by emotional conversations with the inmates as they describe to the teens where they went wrong and how the teens can avoid the same fate.

The episode features Mecklenburg County, N.C.’s “Reality Program,” created by Sheriff Daniel “Chipp” Bailey.
“Our Reality Program stresses education, not intimidation,” Bailey is quoted as saying on the program’s website.
According to the website, the mission of the program is to “provide the community with a program which will help educate young people about the long-term effects of participating in criminal activity.”
After watching the show, non-violent communication and conflict management expert Dr. Heather Pincock was baffled.
“There is no coherent approach in the diversion program,” Pincock said. “Most of the episode they [the deputies] were there to intimidate the youth or break the youth down or humiliate them. Then they suddenly start saying. ‘We’re your friends, we’re here to help you.’ There are very mixed messages around their role. It doesn’t make any sense.”

• Selecting and Implementing Evidence-Based Practices
  Treatment funding is being increasingly tied to outcomes, a trend expected to continue as the integration of behavioral health with primary care moves forward in the context of healthcare reform. Learn more from the Addiction Technology Transfer Center of New England about achieving desired client outcomes in part 2 of a 3-part series.
• Poll: Drug Abuse Equals Childhood Obesity as Top Health Concern for Kids
  On Aug. 15th, the University of Michigan C.S. Mott Children’s Hospital released the results of its 5th annual national poll, in which Americans rated drug abuse and childhood obesity as the number one health concern for our nation’s youth. This is important news because it shows that drug abuse is now on the radar screens of people throughout the country and that Americans are very concerned about this issue. Community Anti-Drug Coalitions of America issues a statement in response. (Hat tip to Christa Myers.)

Much to our dismay, A&E Network will air a second season of "Beyond 'Scared Straight,'" its hit reality-TV show, beginning August 18, 2011. As you may know, the program exposes a group of teens who've committed offenses to a group of adult prison inmates who scream, yell, and talk tough, in an effort to convince the kids to "going straight." 
There's a lot of problems with this approach, but the chief one is this: it doesn't work. There's not a single piece of independent research that indicates it's effective, and quite a lot that shows it isn't -- in fact, an overview of nine studies shows that youth who participate are more likely to commit crimes than kids who don't.  That may make for great television, but it's not good for the kids or our communities. 
We've given a lot of coverage in the past to why "Scared Straight" is a bad idea, so I'll just link to it here:

• Beyond "Scared Straight" – Moving to Programs that Actually Work
• U.S. Department of Justice: Scared Straight is "Scary and Ineffective"
• Scared Straight: Don’t Believe the Hype (Facts from CJJ)
• Scared Straight -- or Just Scared? Judges Speak Out Against "Beyond 'Scared Straight'"
• "Scared Straight" Programs on Hold in Two States

Photo: anna gutermuth under a Creative Commons license.

Back in 1974, sociologist Robert Martinson reviewed the research and concluded that "nothing worked" when it came to rehabilitating offenders. Then, in the mid-1990s, when fears about rising juvenile crime rates were at their peak, John DiIulio of Princeton predicted an onslaught of teens in trouble with the law, whom he dubbed "super-predators," creating a toxic political environment for those who knew from experience that youth in the justice system were overwhelmingly capable of positive change and rehabilitation. 
Martinson and DiIulio were wrong. Most importantly, Martinson's research was flawed, and he admitted his errors in print. [For this history and much more, see "Juvenile Justice: Lessons for a New Era."]
But the myths remain -- and they get in the way of our ability to take advantage of new, evidence-based treatments that are exceptionally effective.
So argues Dr. Howard Liddle, of the Center for Treatment Research on Adolescent Drug Abuse (CTRADA) at the University of Miami, in the brief video below:

Here's four great resources for finding effective adolescent substance abuse treatment programs (emphasis on residential), plus one on how to train clinicians in evidence-based treatment:

1. How to Find the Best Drug Treatment for Teens: A Guide for Parents -- This guide from TIME magazine is excellent to pass on to parents struggling with their teens' drug and alcohol issues. Among other things, it includes a link to Time to Get Help, an excellent website developed and hosted by The Partnership at Drug-Free.org. (I'm glad TIME got the word about about this -- while Steve Pasierb, CEO of the Partnership, did a post for us about Time to Get Help way back in December, there's no denying that TIME gets a little more traffic than we do. And I was unaware of the next two resources before I read the TIME article.)
2. Questions for Parents to Ask Before Entering a Youth in a Residential Program - these questions were developed by the Federal Trade Commission and apply to all sorts of residential programs, not just alcohol and drug treatment programs.
    
3. Ten Important Questions to Ask Teen Substance Abuse Treatment Program. 
4. Questions for Youth to Ask When Entering a Treatment Program - Imagine a set of questions youth might ask themselves and others before agreeing to enter a residential program. Questions that could help them adjust to treatment faster.  Now, you don't have to imagine, thanks to the Building Bridges Initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA).  You can see similar tip sheets for parents and recommendations for treatment providers and adolescent substance abuse policy officials at the state level on how to use and disseminate them here. 
5. Strategies for Training Counselors in Evidence-Based Treatments - What's the most effective way to insure that your clinicians learn to implement evidence-based treatments?  Learn the answer(s) in this article, authored by Steve Martino of Yale University School of Medicine, which appeared in the December 2010 issue of Addiction Science and Clnical Practice. (Hat tip to Paul Savery.)

 
NOTE: This is an updated  version of a post that appeared in February 2011. 

Photo: hometownzero.

Looking for a credible source of information about what programs work for teens in the juvenile justice system, adults in the criminal justice system, or for crime victims?
Your search just got a little easier. Today, the Office of Justice Programs at the U.S. Department of Justice launched a new website, www.crimesolutions.gov,designed to be a "one-stop shop for programs that work in criminal justice, juvenile justice and crime victim services."
According to the OJP press release, the site "includes information on more than 150 justice-related programs and assigns "evidence ratings – effective, promising, or no effects — to indicate whether there is evidence from research that a program achieves its goals." And its searchable database includes programs for "corrections, courts, crime prevention, substance abuse, juveniles, law enforcement, technology and forensics, and victims."
The juvenile section of the site is divided into four categories:

• Child Protection/Health
• Children Exposed to Violence
• Delinquency Prevention
• Risk and Protective Factors

Looking for substance treatments for youth in the juvenile justice system? Check under "Child Protection/Health.
Besides dividing program results into "effective," "promising," and "no effect," you'll also see common -- and interesting -- questions, linked to answers.
My favorite was, "What is the national juvenile recidividism rate?" I've been in the field long enough now that it's been years since I've wondered (not seeing the forest for the trees). So I clicked on the answer and learned that there is no official national statistic for juvenile recidivism, because of the wide variability of juvenile justice systems from state to state.

[Testimony given April 2011 by John Roman, Ph.D., before the Council of the District of Columbia Committee on Human Services. Reprinted with permission from The Urban Institute. -Ed.]
Good morning. My name is John Roman and I am a senior fellow in the Justice Policy Center at the Urban Institute, where I have studied innovative crime and justice policies and programs for more than a decade. Thank you for the opportunity to testify today about integrating innovative practices to better serve juveniles involved with the justice system and to improve public safety.
Using Lessons from Recent Innovations to Create a Holistic Approach to Intervening with Juveniles
Over the last decade, across the United States, there has been tremendous interest in reforming juvenile and criminal justice systems to both improve their performance and to improve public safety by reducing crime and delinquency among adjudicated youth. What I would like to describe today is how those innovative practices—the Reclaiming Futures initiative, drugs courts and other alternatives to commitment, and Project HOPE—might be integrated to maximize their effectiveness and minimize costs.
In the first phase of Reclaiming Futures, begun in 2002, multidisciplinary teams in ten communities worked collaboratively to enhance the availability and quality of substance abuse interventions for youth involved with the juvenile justice system. All ten projects relied on judicial leadership, court/community collaborations, interorganizational performance management, enhanced treatment quality, and multiagency partnerships to improve their systems of care for youthful offenders with substance abuse problems.

• Filmed Proceedings from Child Welfare, Juvenile Justice to Be Offered for Research, Training
  The Institute for Juvenile Court and Corrections Research (IJCCR), a partnership of the Indiana University Research and Technology Corp. (IURTC) and Calamari Productions of Austin, Texas, plans to offer thousands of hours of film from juvenile court and child welfare proceedings to researchers -- and to train probation officers, child welfare case workers, lawyers, and judges.  The film will be made available on a subscription basis. (Calamari Productions also created the six-episode documentary, "Lockup," about youth in the juvenile justice system in Lake County, Indiana, which aired on MSNBC.)

  >>Check out sample footage of juvenile corrections, child welfare case work and more from the new institute.

• Without A Smoking Gun: Chicago Hammers Kids with Adult Court, Adult Time 
  In an attempt to get a handle on rising gun violence, Chicago cracked down on youth found possessing guns, and automatically transferring them to adult court.  But an investigation by a Chicago paper (and passed on via The Crime Report) of 90 cases from 2009 (or 57 percent of the cases) showed that about 25% of the youth were never shown to have a gun at all; and police recovered weapons less than half the time. Yet 87 percent of the teens --overwhelmingly black -- pled guilty and were sentenced to a combined total exceeding 4,606 years in prison. 

I doubt that there is an influence on the development of antisocial behavior among young people that is stronger than that of the family. (Steinberg, 2000)[i]
 
The most successful programs are those that emphasize family interactions, probably because they focus on providing skills to the adults who are in the best position to supervise and train the child. (Greenwood, 2009)[ii]
 
Thanks to many independent reviews, consensus documents, and meta-analyses of the evidence base on how to work effectively with juvenile offenders, there are numerous signs that the specialty has achieved a certain level of maturity.[iii]
 
A significant part of this new generation of work in the field pertains to the accumulated and rigorously derived findings about the role of families, family relationships, and parenting practices as key aspects of the creation and maintenance,[iv] as well as the reversal of antisocial and other problem behaviors.[v]
 
For some time, we’ve “known” that it can be beneficial to involve families more substantively and consistently in working with juvenile offenders, as evidenced in this quote: “In this era of an increased focus on public sector accountability, one of the important questions posed to policymakers and elected officials may be ‘Why are you waiting so long to support families?’ ” (Duchnowski, Hall, Kutash, & Friedman, 1998[vi]).