Evidence-Based Practices

The Addiction Technology Transfer Center (ATTC) Network hosts regular "iTrainings" in the field of addictions treatment and recovery services. Here's one you won't want to miss. "Motivational Interviewing" is a therapeutic technique that uses research on how people make behavior changes to help counselors be significantly more effective with resistant clients -- even those struggling with alcohol and drug use.
 
Adapted from the announcement:
 
Motivational Interviewing: An Introduction to an Evidence-Based Program and Implementation Process
April 21, 2011
11 am - 12:30 pm PST / 2pm - 3:30 pm EST
Hosted by: Northeast ATTC
 
This webinar will provide attendees with a brief introduction to Motivational Interviewing, its core concepts and treatment approach. In addition, strategies to insure the successful implementation of this evidence-based chemical dependency treatment model will be discussed. A question and answer period will accompany this presentation to allow participants an opportunity to gain further clarification regarding the model and a program implementation process.
 
>>Register here.

Seems like youth violence -- and ways to address it -- is all over the news right now.

1. Research: Children Exposed to or Victims of Violence More Likely to Become Violent.
2. Evidence-Based Practices for Children Exposed to Violence: A Selection from Federal Databases.
   This publication from the U.S. Departments of Justice and Health and Human Services "summarizes findings from federal reviews of research studies and program evaluations to help communities improve outcomes for children exposed to violence. It cites evidence-based practices that practitioners and policymakers can use to implement prevention services and activities for these children." (H/t to www.findyouthinfo.gov.)

Recently, I posted a question from a juvenile justice professional about what the research said about possible harm done to youth who visit their family members in juvenile detention or prison. We got an answer to that one, but it raised a new question from someone else:

What about children who are removed by either family or the state from parents who are addicted to drugs and have previously exposed the child to unsafe situations as well as neglect? 
Is it beneficial or harmful to the child for the absent parent who is addicted to substances to allow visitation, knowing that the parent will be intoxicated at the time of visitation?  And does age make a difference?  Is it different for a 5 year old vs a 12 year old? 
Any info would be appreciated.

What do you think? Anyone know what the research says about this?  Please share, and I'll post what I learn -- leave a comment, drop me an email, or start a discussion in our LinkedIn group, "Juvenile Justice Reform and Adolescent Substance Abuse Treatment." 

Multidimensional Family Therapy (MDFT) is an evidence-based practice for working with adolescents struggling with substance abuse – the manual can be downloaded from SAMHSA for free. (SAMHSA is the Substance Abuse and Mental Health Services Administration.) One of five treatment protocols developed and tested in the past decade by SAMHSA, it has been shown to be clinically and cost-effective.
As it happens, the creator of MDFT, Dr. Howard A. Liddle, Ed.D., will be doing a webinar for us on family engagement on April 30, 2011, at 11 am PST / 12 pm CST / 2 pm EST. You can learn more and register for it on our webinars page.
Dr. Liddle told me recently that there was an MDFT program operating in Portland, Oregon, where I live, so I set up an interview with Deena Corso, who is a clinical supervisor in the Juvenile Treatment Services unit at the Department of Community Justice (DCJ) in Multnomah County, Oregon. (Deena and I were co-workers when I was employed there between 2000 and 2007.)
 

Benjamin: What are the top reasons to implement MDFT?
Deena: We picked MDFT as our treatment model because it's an evidence-based practice, effective at reducing substance abuse and delinquent behavior for populations that looked like ours. We’d had a Multi-Systemic Therapy [MST] program for many years with good outcomes, but budget cuts forced us to look for an alternative, and once we looked at the research, we decided on MDFT. 

 
When I was at the Joint Meeting on Adolescent Treatment Effectiveness (JMATE) in 2010, I interviewed Dr. Mark Lipsey about a new tool he and several other colleagues developed to improve the implementation of evidence-based juvenile justice programs. Dubbed the Standardized Program Evaluation Protocol (SPEP), the tool uses a massive meta-analysis of nearly 700 evaluations to help local jurisdictions identify what they're already doing that's working, and to improve on what they've got. 
I asked Dr. Lipsey the following questions:

1. Why did you do the meta analysis and develop this tool to improve effective programming in juvenile justice? (:20)
2. How is the new tool different from simply implementing evidence-based programming? (2:35)
3. How do I get my hands on it? Can I just download it? (6:36)
4. How do I access the assistance I need to implement the SPEP? (8:57)

Prisons in Maryland and California have put their "Scared Straight" programs on hold in the wake of warnings from the U.S. Department of Justice (DOJ) that federal funding could be cut for states using the discredited intervention.
Two DOJ officials, including Jeff Slowikowski, the Acting Director of the Office of Juvenile Justice and Delinquency Prevention (OJJDP), wrote in an editorial published last week that the "Scared Straight" program was "scary -- and inffective," and that it "could run counter to the law."
They cited studies showing that  "Scared Straight" youth are more likely to commit new crimes.

"Traumatizing at-risk kids is not the way to lead them away from crime and drugs,"write Laurie O. Robinson and Jeff Slowikowski of the U.S. Department of Justice in a January 31st editorial published in The Baltimore Sun responding to A&E television network's reality show, "Beyond 'Scared Straight.'" (Hat tip to the Justice Policy Institute on Facebook.)
Robinson is assistant attorney general for the federal Office of Justice Programs (OJP), and Slowikowski is acting administrator of the federal Office of Juvenile Justice and Delinquency Prevention (OJJDP).
They point to the research showing that "scared straight" programs actually make youth more likely to commit new crimes, not less. They go on:
"The fact that these types of programs are still being touted as effective, despite stark evidence to the contrary, is troubling. In the decades following the original scared straight program, states across the country developed similar models in the hopes that this get-tough approach would make an impact on their impressionable youth. As it turns out, the impact was not the one they had hoped for.
"Fortunately, in recent years, policymakers and criminal and juvenile justice practitioners have begun to recognize that answers about what works are best found in sound research, not in storytelling. Evidence from science provides the field with the best tool for sound decision-making. This 'smart on crime' approach saves taxpayer money and maximizes limited government resources — especially critical at a time of budget cuts."
We applaud them and the rest of the leadership at the Department of Justice for adding their voices of opposition to scared-straight programming for youth in the justice system. Their voices now join the Coalition for Juvenile Justice, the National Council of Juvenile and Famliy Court Judges (NCJFCJ), the Campaign for Youth Justice, and of course Reclaiming Futures -- we're glad to see so many arrayed publicly against an intervention that wastes money and lives.

Update August 2011: in spite of overwhelming research evidence and opposition from juvenile judges, federal officials, and juvenile justice experts,  A&E Television is airing a new series of episodes of Beyond 'Scared Straight.'
 
 

The National Council of Juvenile and Family Court Judges (NCJFCJ) is calling on A&E television network to stop misrepresenting the facts about  the effectiveness of "Scared Straight" interventions with young people involved in the justice system. "Scared Straight" exposes youth in the juvenile justice system (from runaways to violent offenders) to adult prisoners, who intimidate, harrass, and humiliate the teens in an effort to scare them into "going straight." The intervention is now the subject of a reality show , "Beyond 'Scared Straight,'" on the A&E network.
In a statement published January 27, 2011, NCJFCJ wrote:
Although advertisements for the show claim Scared Straight! is "an effective juvenile prevention/intervention program," social science research clearly demonstrates the opposite. In fact, research strongly suggests Scared Straight! and similar programs have a harmful impact on youth and are associated with increased risk for continued delinquent/criminal behaviors. Further, it is clear these types of interventions as portrayed are neither developmentally appropriate nor trauma-informed.
 
The judges want "A&E to provide a meaningful opportunity to present the facts around Scared Straight! and similar programs." They have joined Reclaiming Futures, the Coalition for Juvenile Justice, the Campaign for Youth Justice, and many other juvenile justice advocates in their opposition to the program.
NCJFCJ's research arm, the National Center for Juvenile Justice (NCJJ), has also released a position statement, "Scared Straight or just Scared? The False Promise and Potential Danger of Scared Straight Programs for Youth." NCJJ takes the reality show to task because it "falsely claims that “Scared Straight” will result in better outcomes and less delinquency among youth participants" when research shows the opposite.

[The following position statement was released by the Coalition for Juvenile Justice (CJJ) in response to the A&E television network's decision to air "Beyond 'Scared Straight,'" a reality TV show about teens being yelled at and shamed by adult prison inmates in an attempt to scare them "straight." Be sure to check out CJJ's fact sheet, Scared Straight: Don't Believe the Hype, and Laura Nissen's editorial, "Beyond 'Scared Straight' – Moving to Programs that Actually Work." --Ed.]
 
Washington, D.C. – The Coalition for Juvenile Justice (CJJ), a national association of Governor-appointed state advisory groups on juvenile justice and allies, questions the value of the A&E series, “Beyond Scared Straight,” scheduled to begin airing on Thursday, January 13, 2011. The planned series highlights an intervention that purports to turn children and youth away from delinquent and criminal behavior. In fact, such approaches, explains CJJ, are shown to have the opposite of the desired effect and to increase delinquency.
 
“Started years ago with good intentions, ‘Scared Straight’ approaches have now been well-evaluated and shown to have a damaging rather than positive impact,” according to David Schmidt, CJJ National Chair and President of New Mexico Council on Crime and Delinquency. “Research makes it clear that youth exposed to adult inmates, particularly in prison or jail settings, are at heightened risk of emotional harm and anxiety and receive harmful messages that lead to increased potential for them to commit delinquent offenses.[1] Intentionally exposing youth to these risks, even for a short period of time in a controlled environment, is profoundly counterproductive.” 

In the last couple of decades, we've seen an explosion of research that tells us what works in adolescent substance abuse treatment and in helping kids caught in the juvenile justice system turn their lives around. As a result, foundations and lawmakers have raised their expectations: quite rightly, they want to fund "what works."
Which is why it's maddening to see "Scared Straight" held up as a model for juvenile justice on national television in "Beyond 'Scared Straight,'" a multi-episode series on A&E that premieres on Thursday, January 13, 2011.
 
The original "Scared Straight" program, in which a group of adult prison inmates attempted to terrify a group of teen offenders into "going straight," was the focus of a television special in 1978. Since then, the authors of "'Scared Straight' and other juvenile awareness programs for preventing juvenile delinquency (Review)," a 2002 meta-analysis of relevant research on nine such programs, found that "not only does it fail to deter crime, but it actually leads to more offending behavior."
 
That's right: "Scared Straight" increases the chance that youth will reoffend, compared to doing nothing. This is retro-programming that went out with other ill-advised approaches years ago. We need to move forward on this issue – not backwards.