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Forensic and Mental Health C83FMH
Lecture 2: Interventions for offending behaviour
Dr Ellen Townsend
NB. You do not have all my slides on handouts: make notes!
Aims
To evaluate whether interventions designed to rehabilitate offenders are effective
To explore this question using an ‘evidence-based’ approach
Punishment or rehabilitation?
Should we try to rehabilitate young offenders or should we just punish them?
If rehabilitation – what should this involve– how should it be done– by whom and where?
Consider– Risk factors for
offending?– Age?– Gender?
Risk factors include - Troubled home life
Peer-group pressure
Poor attainment at school
Drug and alcohol use or mental illness
Deprivation
What should we do about young offenders?
'Prison not working' for young offenders
Matt Weaver
Monday May 8, 2006Guardian Unlimited
‘Government's young offender scheme fails’
Daily Mail
27th October 2005
Punishment and rehabilitation
The Youth Justice Board (YJB)
The YJB oversees the youth justice system in England and Wales.
Prevent offending and re-offending by children and young people < 18
Youth justice facts in England and Wales
A child can be responsible for criminal behaviour in the England and Wales at age 10.
15 to 17 year-olds in prison - more than doubled in last ten years
What happens to them?
YOTS (Youth Offending Team) community orders e.g. Intensive Supervision and Surveillance Programme (ISSP) and intensive fostering.
Custody – LASCH (Local Authority Secure Children’s
Home)– YOI– Secure Training Centres.
Interventions for offending behaviour
Family and parenting interventions
Multisystemic treatment
Cognitive behavioural interventions
Tackle re-offending and anti-social behaviour
Lack of randomized studies (eg. Farrington, 2003)
Effectiveness uncertain
Evidence-based approach required?
What is the best evidence?
Observational study without control groups e.g. Cross-sectional study?
Expert opinion? Experimental study without randomisation? E.g. Case control
Experimental study with random allocatione.g. RCT?
Evidence-based practice
Use of current best evidence in making decisions about practice (eg. healthcare)Systematic reviews of evidence Steps involvedHierarchy of study designs (Highest quality first)1. Experimental studies (RCT with concealed allocation).2. Experimental study without randomisation
Observational study with control groupCohort studyCase control
3. Observational study without control groupsCross-sectional studyBefore-and-after studyCase series
4. Expert opinion or consensus; Case reports
Study quality: design, conduct and analysis minimize bias.
Source: Khan et al (2003)
Methodological issue Exaggeration of odds ratio (%)
Inadequate allocation (e.g. alternation)
Larger by 41%
Unclear treatment allocation Larger by 30%
Trials not double blind Larger by 17%
Bias eg. 2 : Methodological quality and estimates of treatment effects in controlled trials
(Schulz et al 1995)
Trials were compared with those with adequately concealed treatment allocation
Evidence for offending and antisocial behaviour: multisystemic therapy (MST)
One of few empirically supported interventionsWidely disseminated USA and EuropeStrong research base with multiple randomised controlled trialsMST:– Multifaceted, short term, community-based – Social and family systems theories and
causes/correlates of antisocial behaviour– Manual-based– Time-limited – Professional mental health therapists deliver – Small caseloads – Intervention strategies integrated – USA
Main goals of MST
Reduce– criminal activity in young people– antisocial behavior such as drug abuse and
sexual offending
Financial– decreasing rates of incarceration and out-of-
home placements
Needs of young offenders and families
Improve – parents discipline practices– family-community relations– school/vocational performance
Increase– family affection– association with pro-social peers
Decrease – association with deviant peers
Engage in positive recreational activities
Empower family to solve future difficulties
Nine MST Treatment Principles.
1. Finding the Fit
2. Positive & Strength Focused
3. Increasing Responsibility
4. Present-focused, action-oriented & well-defined
5. Targeting Sequences
Nine MST Treatment Principles…
6. Developmentally Appropriate.
7. Continuous Effort.
8. Evaluation & Accountability.
9. Generalization.
Missouri Delinquency Project (Bourdain et al)
MSTCompleters
MSTDropouts
IT Completers
IT Dropouts
Refusers0%
20%
40%
60%
80%
100%
120%
0 0.6 1.1 1.7 2.2 2.8 3.3 3.9 4.4 5
Years Past Treatment Termination
Perc
en
t o
f O
ffen
ders
No
t R
e-A
rreste
d
MST Effectiveness 1: meta-analysis
Curtis et al (2004) meta-analysis.
Henggeler (2004) comments on Curtis.
See reading list for references.
MST effectiveness 2: Systematic reviewLittell, Popa & Forsythe (2005) systematic review*.
Littell (2005). Lessons from a systematic review of MST.
Henggeler (2006) response.
Littell (2006)
See reading list for references – Littell et al (2005) see* * Cochrane Library: available via e-library gateway
Other interventions
Family and parenting (see Sukhodolsky and Ruchkin, 2006).
CBT (Felizer et al 2004). – Armelius and Andreassen (2007)
Find published effectiveness studies yourself.
*PDFs of papers in FMH practicals folder on Spsych
Quality assessment/critical appraisal
See the Consolidated Standards of Reporting Trials (CONSORT) statement.
A checklist that authors of trials should use when writing up results.
Useful quality assessment/critiquing tool.
Reference: Moher et al (2001). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. The Lancet, 357, 1191-1194. Available via e-library gateway.
Summary
A number of types of intervention have been tested with young offenders
Experimental (randomized) evidence-base is lacking
Some interventions are promising (eg. MST) but results are equivocal.
Seek out effectiveness evidence for CBT and family interventions.