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3 Assessment, Classification, and Treatment with Juvenile Delinquents

Jemel P. Aguilar and David W. Springer Between 1991 and 2003, the number of juveniles in residential corrections programs increased by 27 percent. In practical terms this means that over 96,000 juveniles are in residential correctional programs (Snyder & Sickmund, 2006). In addition to the large number of juveniles in residential programming, a recent research study (Teplin et al., 2002) showed that over 60 percent of young male offenders and 73 percent of young female offenders had a mental health diagnosis, such as major depression, generalized anxiety disorder, attention-deficit/hyperactivity disorder, conduct disorder, or obsessive-compulsive disorder. Hence, the juvenile justice system faces the task of serving a number of youth who have committed delinquent offenses and possibly contending with one or more mental health disorders. Following a number of critical reviews of evaluations, in particular Lipton, Martinson, and Wilks (1975), the accepted wisdom in the field related to juveniles became one of “nothing works.” Today, researchers are conducting complex statistical tests of the effectiveness of interventions with juvenile offenders. Lipsey and Wilson (1998), for example, conducted a meta-analysis of experimental or quasi-experimental studies of interventions with serious and violent juvenile delinquents. They reviewed 200 programs, 83 of which involved institutionalized juveniles and 117 involved noninstitutionalized juveniles. McBride et al. (1999, p. 58) summarize the findings of Lipsey and Wilson’s meta-analysis. Now researchers are confident that some interventions are effective in stemming juvenile delinquency (cf. Lipsey, Wilson, & Cothern, 2000). Among the programs in noninstitutional settings, those that demonstrate good evidence of effectiveness include behavioral therapies (family and contingency contracting), intensive case management (including system collaboration and continuing care), multisystemic therapy (MST), restitution programs (parole- and probation-based), and skills training. Program options that require more research to document their effectiveness include 12-step programs (AA, NA), adult mentoring (with behaviorally contingent reinforcement), after-school recreation programs, conflict resolution/violence prevention, intensive probation services (IPS), juvenile versions of Treatment Accountability for Safer Communities (TASC), peer mediation, and traditional inpatient/outpatient programs. Program options that do not show evidence of effectiveness include deterrence programs, vocational training or career counseling, and wilderness challenge programs. In institutional settings, evidence of effectiveness has been demonstrated for behavioral programs (cognitive mediation and stress inoculation training), longer-term community residential programs (therapeutic communities that employ cognitive-behavioral approaches), multiple services within residential communities (case management approach), and skills training (aggression replacement training and cognitive restructuring). More research is needed to determine the effectiveness of day treatment centers, as there were too few studies to review. Those programs that have been shown ineffective are juvenile boot camps, short-term residential facilities, and state training schools. MacKenzie, Gover, Armstrong, and Mitchell’s (2001) national evaluation of boot camps, for example, demonstrated that boot camps do not include the therapeutic elements that are effective in producing long-term behavioral changes in offending youth. MacKenzie, Gover, Armstrong and Mitchell (2001) compared 27 boot camp programs to 22 traditional corrections facilities to evaluate the impact of particular institutional environments on the outcomes of these facilities. They found that youth and staff reported many positive aspects of boot camps, such as providing a safe and structured environment, maintaining a high level of activity, and helping youth to be more prepared for their release back into the community. MacKenzie et al.’s research documents that many positive aspects of boot camps are apparent to both juvenile offenders and staff members. However, compared to traditional facilities, boot camp programs are not effective in reducing recidivism. Thus, practitioners unaware of boot camps’ ineffectiveness may recommend this type of intervention, assuming that it will result in long-term changes, when in fact boot camps will not. Accurate assessment and classification is a significant aspect of effective treatment of juvenile offenders (Shepard, Green, & Omobien, 2005). Thus, we argue that practitioners must accurately assess juvenile offenders’ biopsychosocial development, classify offenders according to their level of risk for future acts of delinquency, and employ empirically-based and effective intervention methods that target the multisystemic influences on juvenile offenders’ behavior. Practitioners new to the juvenile justice field and those already familiar with it need guidance regarding the best tools to assess, classify, and treat juvenile offenders. In this chapter we aim to (1) provide new and experienced practitioners with an overview of the biopsychosocial model of assessment; (2) discuss two classification tools—the Youth Level of Service Inventory and the Child and Adolescent Functional Assessment Scale—frequently used with juvenile offenders; and (3) discuss evidence-based treatment models that focus on youth, family, and/or the social environment. Beginning with a biopsychosocial model of assessment, we then discuss the two classification tools and how these provide a standardized categorization of the offender based on an understanding of his or her strengths and weaknesses. We also review several treatment options that have considerable empirical support. In all, we offer this chapter as a systematic guide for practitioners working with juvenile offenders and a means to update one’s knowledge of the leading practices within the field of juvenile justice. ASSESSMENT The biopsychosocial model of assessment examines the biological, psychological, and social processes that influence development and behavior. In this model, practitioners conduct systematic observations of a young offender’s medical history, personality, cognitive abilities, emotional development, family environment, and neighborhood (Austrian, 2002; Jordan & Franklin, 2003; Springer, 2002). The strength of a multisystemic assessment is that delinquency research and theories of human development agree that behavior is the result of complex interactional processes across intrapsychic, family, and community interactions (Aguilar, 2006). For example, youth offenders referred to treatment for delinquent behaviors are more apt to present as “involuntary clients” considering they are attending to fulfill a programmatic or court-related requirement (Rooney, 1992, 2002). Practitioners who engage with these youth may attribute difficult or resistant behaviors to the youth’s developmental stage or temperament, thus ignoring the involuntary nature of the practitioner-client relationship. However, we assert that addressing the involuntary nature of the relationship during the assessment phase can assist the practitioner in differentiating the behavior as developing from temperament or the context of the relationship (Corcoran & Springer, 2005; Rooney, 1992, 2002). Several sources of information can further assist the practitioner in constructing a comprehensive analysis of the youth’s circumstances and development over time. These are extensive interviews with a client and his or her family, interpretation of standardized instruments, reviews of documents related to juvenile justice or mental health system involvement, and knowledge of human behavior in the social environment (Jordan & Franklin, 2003). Most programs conduct an intake, which is an initial interview of the youth to determine the reasons for referral, psychosocial and family history, current medications, legal status, and areas of strength and vulnerability. Including measures of experiences or situations that place youth at risk for further delinquency can assist in defining problems and identifying areas of intervention. These measures can also aid in determining which factors are more amenable to change, compared to those more stable and longer-lasting factors (Bloom, Fisher, & Orme, 2006; Jordan & Franklin, 2003). For example, malleable risk factors include the number of delinquent peers, limited free-time activities, or the absence of pro-social mentors. In the classification section, we describe two standardized instruments used to measure a juvenile offender’s level of functioning and/or risk factors for future delinquency. Using these instruments along with the other assessment data, practitioners can also construct baseline measures of the multiple influences on a juvenile’s behavior. Bloom, Fischer, and Orme (2006) assert that establishing baselines prior to intervention is crucial to understanding the frequency, stability, and intensity of the presenting problems, as well as for practice evaluation. Jordan and Franklin (2003) also write that in an assessment process practitioners should construct a baseline understanding of the presenting problem to facilitate evaluation. Many scholars argue that practice evaluation is a significant underpinning of effective and ethical social work practice (Bloom, Fisher, & Orme, 2006; Jordan & Franklin, 2003). Evaluation is the process of determining the effectiveness of a given intervention by establishing a baseline, implementing an intervention, and then measuring changes in relevant variables or constructs (Barker, 1999; Bloom, Fischer, & Orme, 2006). In addition to determining the effectiveness of a given intervention, evaluation is a part of ethical and responsible practice (Bloom, Fisher, & Orme, 2006; Jordan & Franklin, 1995). CLASSIFICATION Using the findings or results of an assessment can inform classification of a juvenile offender. Classification, defined by Austin, Johnson, and Weitzer (2005), is “the process of determining at what level of custody an offender should be assigned” (p. 5). Other definitions of classification include references to diagnosis or the process by which a practitioner categorizes a person as exhibiting traits associated with a group (Bisman, 1999). To aid in the process of classification, researchers suggest the use of standardized instruments (Austin et al., 2005; Jordan & Franklin, 2003; Springer, 2002). We will discuss two such instruments, the Youth Level of Service Inventory and the Child and Adolescent Functional Assessment Scale. Youth Level of Service Inventory Hoge and Andrews (1994) developed the Youth Level of Service Inventory (YLSI) to assist professionals in the process of determining a young offender’s area of risk and needs. For this instrument, risks are defined as those situations or experiences that increase the likelihood of a negative outcome, such as delinquency or violence. Risks offer the practitioner insight into possible areas of intervention and services that the practitioner can provide to reduce some risks, while acknowledging that other, more stable risks may require long-term programming to facilitate change. The YLSI is based on a social-psychological approach to criminal behavior and as such suggests that youth identified with higher areas of risk and needs require more supervision and services than youth identified with lesser risks and needs (Hoge & Andrews, 1994). The YLSI measures eight areas of risk: prior and current offenses or dispositions, family circumstances and parenting, education and employment, peer relations, substance abuse, leisure and recreation, personality and behavior, and attitudes and orientation. Areas of strength are also recorded, however, strengths are not considered when calculating the level of risk. A total scale score of 8 indicates a low level of risk for recidivism, while 9–22 is medium risk, 23–34 is high, and 35–42 is very high (Hoge & Andrews, 1994). According to the developers (1994), juveniles with higher levels of risk are in need of more intensive supervision and services compared with those youth whose scores show lower levels of risk. The eight risk area scores and the total level of risk score can then guide practitioners in the formulation of measurable treatment objectives and goals. Child and Adolescent Functional Assessment Scale The Child and Adolescent Functional Assessment Scale (CAFAS; Hodges, 2000) is a standardized multidimensional assessment tool that is used to measure the extent to which the mental health/substance use disorders impair functioning of youths ages 7 to 17. It is completed by the clinician, and requires specialized training. A major benefit of the CAFAS in helping practitioners determine a youth’s overall level of functioning is that it covers eight areas: school/work, home, community, behavior toward others, moods/emotions, self-harmful behavior, substance use, and thinking. The adolescent’s level of functioning in each of these eight domains is scored as severe (score of 30), moderate (20), mild (10), or minimal (0). Additionally, an overall score can be computed. These scores can be graphically depicted on a one-page scoring sheet that provides a profile of the youth’s functioning. An appealing feature of recent versions is that the CAFAS now includes strength-based items. While these items are not used in the scoring, they are useful in treatment planning (Springer, McNeece, & Arnold, 2003). The psychometric properties of the CAFAS have been demonstrated in numerous studies (cf. Hodges & Cheong-Seok, 2000; Hodges & Wong, 1996). One study on the predictive validity of the CAFAS supported the notion that this scale is able to predict recidivism in juvenile delinquents (Hodges & Cheong-Seok, 2000). Higher scores on the CAFAS have been found to associate with previous psychiatric hospitalizations, serious psychiatric diagnoses, restrictive living arrangements, below-average school performance and attendance, and contact with law enforcement (Hodges, Doucette-Gates, & Oinghong, 1999). CASE #1: JUAN Patricia is a social worker for a metropolitan child guidance clinic. Patricia’s position requires her to conduct a biopsychosocial assessment on youth brought to the agency, to identify treatment goals, and to make recommendations to the treatment team regarding the services that should be provided. Patricia met with Juan, a 16-year-old Latino male who was brought to a child guidance clinic because he is chronically truant from school and is charged with violating the citywide curfew. Since moving to this new community, Juan has frequently been truant and/or skipped individual classes. Juan’s parents report that they suspect that he is getting involved with the “wrong crowd” and they are very concerned because they found marijuana in his room. Juan lives with his mother, father, two siblings, and maternal grandmother. Juan’s aunt, uncle, and cousins live in the house next door and they are frequently involved in supervising Juan when his parents are at work. All of Juan’s family members describe him as a “good kid,” quiet, who keeps to himself most of the time. Juan’s parents have noticed lately that Juan seems angry most of the time and, because of his temper, he has gotten into what his father describes as “minor scrapes” with neighborhood boys. Juan’s dad says that Juan is just getting used to living in this new neighborhood and is probably having trouble making friends but says, “Juan will grow out of it.” Juan’s grandmother says she is worried because they moved to this house a year ago and he is still having trouble. Upon interviewing Juan, Patricia discovers that he has very few friends in the neighborhood and in school. Patricia notices that Juan does not make overtures that indicate that things will change for him in the near future. Also during the interview Patricia finds that Juan has trouble sleeping at night and so he skips school because he is so tired in the mornings. Juan also admits his friends “hooked him up with some weed” and that smoking weed makes him feel relaxed. Juan says that he is thinking about dropping out of school because he thinks he “isn’t smart enough anyway,” but has not said anything to his parents because they would be disappointed. Initial Assessment Patricia’s initial impression of Juan is that he is a “good kid” but he is struggling with changes that occurred in his life. Patricia’s initial interview with Juan indicates that he is attempting to develop his own identity outside his home environment, understand the implications and value of his Mexican American identity, and acclimate to his new neighborhood and school. Patricia also notes some symptoms of a depressive disorder, but these symptoms may be indicative of Juan’s coping with his current situation. Juan’s family is very supportive of him and provides extensive supervision. Patricia is somewhat concerned that his family may not understand the extent of the problems that Juan is facing. Alternatively, Patricia recognizes that Juan’s family may not feel comfortable with providing their insights to a stranger whom they are required to meet with for a number of sessions. Juan scored in the low-risk range on the Youth Level of Service Inventory and the subscales did not strongly indicate particular risks that needed individual attention. Patricia enters the following diagnosis on the intake assessment: Axis I: 309.0 Adjustment disorder with depressed mood, chronic; 300.4 Dysthymic Disorder, early onset (Provisional) Axis II: v71.09 No diagnosis Axis III: None Axis IV: Fighting with peers, school truancy, marijuana use. Axis V: GAF = 60 Several recent meta-analyses suggest that the most effective approaches for treating juvenile offenders, such as Juan, are those with a cognitive-behavioral component combined with close supervision and advocacy. There is also evidence that more positive treatment effects are realized in community settings than in institutional settings (Deschenes & Greenwood, 1994). We now turn our attention to such treatment approaches. TREATMENT Juveniles in the corrections system can undergo a variety of treatment programs that differ in how they go about bringing long-term changes in the youthful offender’s behavior. Practitioners, such as Patricia, can become overwhelmed by the array of options available to treat youth offenders, but research can guide her decision-making process by outlining models that garnered favorable empirical support. In this section, we identify those empirically supported interventions used in juvenile corrections. To that end, we first describe the intervention, its goals, the populations the interventions are tested with, and its strengths and weaknesses. Multisystemic Therapy Multisystemic therapy (MST; Henggeler & Borduin, 1990; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998) is a family- and community-based treatment approach that is theoretically grounded in a social-ecological framework (Bronfenbrenner, 1979) and family systems (Haley, 1976; Minuchin, 1974), and as such, is a form of treatment that addresses the multiple influences for youth’s problematic behavior (Borduin et al., 1995; Henggeler et al., 1986). Essentially, MST intervenes in the “transactions” between adolescents and their “pertinent systems” such as family, school, or peer groups to alter how these interactions bring about antisocial or negative behaviors (Henggeler et al., 1986). Intervention modalities must address the various ways intrapsychic, family, and community systems operate on the developing youth because, as the developers of this treatment strategy assert, these interactions can produce delinquent and antisocial behaviors in a young person (Borduin et al., 1995). Individual factors such as a child’s cognitive strengths and weaknesses, physical appearance, coordination, attitudes, beliefs, and presence of disabilities should be considered in interventions; as well as presence of delinquent peers, family interaction patterns, sibling interactions, quality and resources of the youth’s neighborhood, and parental involvement in educational systems. MST can accommodate multiple theories of behavior change and/or intervention because it does not subscribe to any specific theoretical framework. Thus, MST clinicians can include cognitive skills, behavioral modification techniques, or psychoeducational treatment into an MST program. What is more, other professionals and teachers can reinforce treatment plans in their context by working with practitioners on learning to reinforce the skills and methods included in the intervention plan. MST, however, requires that practitioners have a reduced caseload and be available to clients 24 hours per day. This, along with the extensive training required to effectively implement this model, may be a barrier to successful implementation. Extensive evaluations of MST reveal that this intervention model produces significant changes in youths’ intrapsychic functioning, their interactions with parents, and educational outcomes (Henggeler et al., 1986). In one such evaluation, Henggeler et al. (1986) found that as parents increasingly became involved in their son’s or daughter’s education, the youth would perform better in school and demonstrate increased motivation for academic achievement. In that same study, the behavior problems decreased and overall interactions between the youth and his or her family improved. The authors remarked that youth were included in family decisions, intraparental communication improved, and parents reported that the child demonstrated fewer behavior and emotional problems (Henggeler et al., 1986). Based on the extensive research supporting MST as an intervention for juvenile offenders, the study authors argue that MST is a promising and effective treatment for juvenile offenders, benefiting the juvenile and also family interactions (Borduin et al., 1995; Henggeler et al., 1986). Through the Campbell and Cochrane Collaborations, Dr. Julia Littell, a social work professor at Bryn Mawr College in Pennsylvania, has conducted her own systematic review on the effectiveness of MST (Littell, 2005; Littell, Popa, & Forsythe, 2005). In her review, Dr. Littell includes both published and unpublished studies, as is standard practice for reviews conducted through the Campbell and Cochrane Collaborations. In total, Dr. Littell and her colleagues identified 35 unique studies and included 8 in their review. For example, Dr. Littell discovered an unpublished study that had been led by Dr. Alan Leschied, who conducted a trial of MST with 409 youth in Canada. Dr. Littell presented her findings at a recent meeting of the Campbell and Cochrane Collaborations, suggesting that MST may not be as effective as has been previously thought. The most recent development in this line of inquiry has appeared in the form of letters to the editor of Children and Youth Social Services, both from Dr. Scott Henggeler, the developer of MST, and his colleagues (Henggeler, Schoenwald, Borduin, & Swenson, 2006), and from Dr. Littell (2006). Cognitive-Behavioral Therapies The broad category of cognitive behavior therapies includes those therapeutic interventions designed to alter both a youth’s cognitions and behaviors related to their poor conduct or offending. Cognitive behavioral therapy is an umbrella category for contingency management, cognitive behavioral treatment, guided-group interaction/positive peer culture, and milieu therapy (Pearson, Lipton, Cleland, & Yee, 2002); however, two subcategories are evident. First, behavioral modification is the administration of positive reinforcement when an appropriate behavior is exhibited by a person. For example, when a youth offender completes a classroom exercise without engaging in disruptive behaviors, such as talking out of turn, then the instructor will provide the youth with a reward, such as a favored activity. Essentially, reinforcement is meant to draw youths toward appropriate behaviors by rewarding them (Pearson et al., 2002). The second subcategory is cognitive-behavioral treatments. Cognitive-behavior treatments are those interventions that target behavioral processes and lead to changes in one’s ways of thinking (Pearson, Lipton, Cleland, & Yee, 2002). Social skills training, problem-solving education, role modeling, cognitive behavior and rational emotive therapies are all forms of cognitive behavioral treatments. In an evaluation of the effects of cognitive skills programming on recidivism, Pearson and his colleagues (2002) found that social skills development and cognitive skills training can decrease the probability of recidivism. Pearson’s et al.’s evaluation confirms Izzo and Ross’s (1990) early studies of cognitive-behavioral interventions, thus lending even more support for this line of therapeutic intervention. Cognitive-behavioral interventions have significant strengths that facilitate applying this type of intervention to juvenile offenders (Pearson et al., 2002). For example, clinicians can encourage family and peer group members, mentors, school personnel, or a client’s coworkers to reinforce the youth’s behavioral changes. As a youth moves from a supportive treatment environment back into his or her social context, the assistance of community members in reinforcing behavioral changes can increase the likelihood of sustained change over time. Similar to MST, cognitive-behavioral treatments can be coupled with other forms of treatment to enhance the range of interventions offered to juvenile offenders. For example, practitioners can include cognitive-behavioral treatments with family therapies to bring about changes in a youth’s and family’s functioning or include psychoeducational components to aid the family in better understanding a youth’s behavioral problems while the youth undergoes treatment. Conversely, implementation can be a considerable weakness in creating a cognitive-behavioral program. Practitioners may have different understandings or professional training in cognitive-behavioral treatments. Consequently, when treatment facilities implement a cognitive-behavior treatment focused on building social skills and practitioners unwittingly design more behavior modification interventions in their work with clients, programmatic outcomes will be affected. Hence, staff members’ level of training in the methodology, a clear explication of the treatment method and sample exercises, and ongoing supervision of practitioners are all needed to create an effective and cogent cognitive behavioral program. Victim-Offender Mediation Victim-offender mediation is an intervention model that brings together victims and their offenders to discuss the impact of a crime, determine appropriate forms of restitution, and allow victims to be advocates in the justice process (Flash, 2003; Umbreit, 1993). Victim-offender mediation, as stated in the definition, includes all relevant parties directly involved in the crime and a trained mediator who facilitates the process. Victim-offender mediation begins when victims approach a mediator and request to meet with their offender. Offenders are then asked if they are willing to participate and if they agree, then individual sessions are set. These sessions provide the mediator with an opportunity to introduce the process of victim-offender mediation and help both parties reflect on what they would like to discuss in the mediation. After several individual sessions, the mediator establishes a meeting between the two parties and addresses any concerns that either party may have. At the meeting, the mediator restates the ground rules for the mediation and then “sits back” as the two parties have an opportunity to discuss the offense, ask and answer questions, and determine the restitution for the offense. At the end of this session, the mediator writes a contract that outlines the restitution and any stipulations that the parties mutually agree on, and then both parties sign it. Victim-offender mediation has significant strengths that make it a useful form of intervention with juvenile offenders. First, victims are directly involved in achieving a just outcome to the crime they have experienced (Flash, 2003; Umbreit, 1993). Adjudicatory processes typically involve many players, such as lawyers and judges, who take control of the process, leaving victims feeling revictimized by the justice system (Flash, 2003; Umbreit, 1993). Umbreit (1993) found that directly involving victims and offenders in the process creates a sense of ownership by both parties, focuses the criminal event as affecting human beings, and is empowering to victims and offenders. Next, victim-offender mediation is a low-cost alternative to adjudication (Flash, 2003). The structure of victim-offender mediation requires direct involvement by victims and offenders, instead of attorneys representing all parties and judges presiding over the judicial process. Mediation uses experienced and well-trained mediators who can be community volunteers or professionals to work with both parties throughout the process. Umbreit suggests that a small paid staff can manage a cadre of well-trained volunteers, thus reducing the need for an extensive staff member base. This simple process reduces the costs in time for district and defense attorneys, probation offenders, and other personnel typically associated with a juvenile adjudication process. Next, several victim-offender mediation researchers state that the focus is on “humanizing of the justice system.” In focusing “on problem-solving rather than vindictiveness, and an offender as seen as being against a person, not against the state, this view allows the victim to play a part in the proceedings, ask questions of the offender, and be empowered, rather than disempowered, by the justice process” (Flash, 2003, p. 512). Mediation practitioners are moving into using this intervention process with more severe and violent offenders with impressive results (Umbreit, Coates, & Vos, 2003). However, practitioners must gain a number of skills to effectively mediate between parties and understand the types of crimes (i.e., domestic violence) for which mediation is inappropriate. Victim-offender mediation is becoming increasingly popular as form of intervention for offenders and crime victims and, as research demonstrates, has a significant effect on both parties, aside from the provision of restitution. Wraparound Programming The eco-systemic natural wraparound model is similar to MST in that it focuses on the multiple systems influencing behavior. The wraparound model, however, uses the existing strengths and resources within a youth’s environment to bring about positive changes for the youth. The creators of this model comment that unlike other models, youth and their families are not required to change their beliefs or values to participate in wraparound programming. Instead, practitioners encourage families to maintain their beliefs and gather together many community supports that interact with the youth to determine the best ways to support a youth to adopt pro-social behaviors (Flash, 2003; Northey, Primer, & Christensen, 1997). Hence, families are thought to already have the resources they need to facilitate change in their social environment and value system (Flash, 2003; Northey et al., 1997). The theoretical foundation of this intervention model rests on systems theory and constructivism (Northey et al., 1997), sometimes referred to by proponents of this approach as a systems-of-care perspective. Systems theory is explained in the section on assessment, therefore we will not repeat those points in this section. Scholars of constructivism assert that the appearance of an objective reality is false and instead argue that reality is actually “constructed by people” (Blumer, 1968; Flash, 2003; Northey et al., 1997). In interactions with others or one’s context, people develop an understanding or definition of a situation or object. For example, through interactions with family members a child learns that “daddy is daddy.” A child also learns to define these objects through further interactions. Thus, daddy is defined in a way that is specific to the child and his or her family context, such as daddy is the man whom I live with and love (Blumer, 1968; Flash, 2003; Northey et al., 1997). The authors of this model use systems theory and constructivism to form a basis or premises for wraparound programming. According to the model, (1) youth’s behavior is derived from meanings, attachments, and potentialities; (2) successful wraparound programming reduces recidivism; (3) a youth’s self-perception or concept is an important element of wrap-around programming in that intrapsychic factors can inhibit wraparound programming; and (4) wrap-around programs must not only consider the interactions within systems but also interactions between different systems (Flash, 2003; Northey et al., 1997). The foundational elements guide the practitioner as he/she reviews assessment and classification reports and/or establishes treatment goals along with the client and his/her family. Natural eco-systemic wraparound models use social supports already present in a youth’s environment to provide a range of services. For example, supportive people and resources may advocate alongside a youth for services, assist family members with home-care difficulties, provide tutoring for a youth with academic difficulties, or be an additional supportive adult in the youth’s life. Using such natural resources reinforces the notion that family members can solve their problems using the resources already available to them. Moreover, family members can clearly attribute their successes to their own interventions (Flash, 2003; Northey et al., 1997). Eco-systemic natural wraparound programming has considerable benefits. First, the model encourages a strength-based perspective for the families of juvenile offenders instead of assuming that a juvenile offends because of inadequate parenting (Northey et al., 1997). Using social supports already present in one’s social environment also provides a family with support after the service is discontinued, which can help sustain changes created by the intervention. Moreover, the active involvement of family members in the treatment and evaluation process gives families ownership in their own treatment, while also permitting cultural factors to be included in treatment planning. For example, families are encouraged to develop plans for situations in which the family typically enters “crisis mode.” For some families, crises are the means to demonstrate one’s resilience or are what bring families closer together. In collaboration with therapists, however, family members plan for crises and work to avoid them in the future. Finally, eco-systemic natural wraparound models help family members recognize the considerable resources and strengths already that exist in their social environment. This model also respects a family’s values and norms while addressing unhelpful or problematic situations that lead to a young person engaging in delinquency. Multidimensional Treatment Foster Care Multidimensional treatment foster care (MTFC) is an effective model for treating juvenile offenders (Fisher & Chamberlain, 2000). Fisher and Chamberlain (2000) state, “MTFC capitalizes on more than 40 years of research and treatment activities that have supported the notion that families, and particularly parents who are skilled and supported, can have a powerful socializing role and positive influence on troubled youth” (p. 156). Chamberlain and other researchers argue that MTFC is effective with troubled youth because this model takes initiative in stemming behavior problems before they occur and maintaining a consistent environment that supports lasting changes (Fischer & Chamberlain, 2000). MTFC is based on the philosophy that for many youth who exhibit antisocial behavior, the most effective treatment is likely to take place in a community setting, in a family environment in which systematic control is exercised over the contingencies governing youth’s behavior. MTFC parents are the primary treatment agents for program children and adolescents; additionally, youths’ own biological/step/adoptive/relative families help shape their youngsters’ treatment plan and participate in family therapy and home visits throughout placement to prepare for reunification with their children/adolescents at the program’s end. To provide youth who have serious and chronic problems with delinquency with close supervision, fair and consistent limits, predictable consequences for rule breaking, a supportive relationship with at least one mentoring adult, and limited exposure and access to delinquent peers. Program staff members pay close attention to the individual youth’s progress/problems in the foster home and at school. Case managers typically carry a smaller caseload, MTFC parents are carefully recruited and a high level of preservice training as well as ongoing support and supervision are provided to them. MTFC parents are the eyes and ears of the program, maintain close communication with the case manager, and help identify target behaviors and formulate treatment plans. MTFC parents are strongly and repeatedly encouraged to call the case manager at any hour of the day or night if they are concerned or have a question about the child placed with them. Parents also participate with program staff in daily data collection on child problems/progress and program implementation via the parent daily report (PDR) calls and engage in weekly supervision/support meetings with their case manager and other MTFC parents. RECOMMENDATIONS FOR JUAN Based on the assessment and understanding of what treatment programs work best for young people, Patricia recommends that Juan and his family engage in the wraparound program in her. From her research, eco-systemic wraparound programs will use Juan’s family strengths and resources within their environment to support lasting behavior changes for Juan. Eco-systemic wraparound programs will also allow Juan’s family members to help direct his treatment in ways that are in line with his family’s values and norms. Eco-systemic wraparound programs will provide Juan’s family with the latitude to include additional members outside of the immediate family that interact with Juan in school or that could connect him with other youth in neighborhood programs. Finally, engaging Juan in wraparound programming will enable his allies to discuss and monitor the depressive symptoms identified through his interview. If a depressive disorder is developing and the wraparound community decides treatment is needed, then the wraparound community can refer Juan for services and Juan’s wraparound team can educate each other on depression and its treatment. Treatment Methods Table Treatment Type Focus of Treatment Benefits of Treatment Model Limitations of Treatment Model Multisystemic Therapy Individual, family, and community influences on behavior Produces changes in intrapsychic functioning and interactions with parents Requires reduced caseload and extensive training for practitioners Cognitive Behavioral Therapy Youth’s cognitions and behavior Ease of implementation Focuses on youth’s cognitions and behaviors Implementation can be impeded by different understandings of cognitive behavioral therapy Eco-systemic Natural wrap-around Models Individual, family, and community influences on behavior Targets the multiple influences on youth’s behaviors Uses family strengths and community volunteers Youth and family must have community supports willing to engage in the program Victim-Offender Mediation Impact of crime on victim and offender Reduces court costs Humanizes justice system Both parties must agree to participate Not appropriate for all types of crime Multidimensional Treatment Foster Care Youth’s problem behavior Forty years of empirical support Includes close contact between foster parents and social work staff Extensive training and supervision of foster parents Foster parents must have a clear understanding of the purpose of multidimensional treatment foster care Patricia decided against using other types of interventions because Juan’s situation did not warrant placement outside the home given that his family was willing to be involved in Juan’s treatment. Thus, Patricia was immediately able to rule out treatment modalities such as multidimensional foster care. Patricia also thought that cognitive-behavioral treatment would be beneficial for Juan. However, based on her assessment data, Patricia decided to leave this treatment decision up to the wraparound team because she thought his symptoms of depression were related to the family’s move to a new community. Patricia did not think that victim-offender mediation was necessary at this time because Juan was not at risk for adjudication for his fight with the neighborhood boys. As Patricia examined the assessment data she gathered and considered the empirically-based treatment options available in her area, she decided that a wraparound model best suited Juan and his family. CONCLUSION When working with youth who have committed crimes, social workers should be sensitive to the risk factors that have the greatest impact on recidivism. In a study recently conducted by Rivaux, Springer, Bohman, Wagner and Gil (2006), substance abuse predicted recidivism individually as did older age and being male. These findings highlight the need for a focus on prevention and early intervention services with delinquent behaviors, particularly for substance-abusing youth and for males. This study also found that greater levels of family problems predicted recidivism for Latino youth, while increased levels of psychological problems predicted recidivism for African American youth. Knowledge of these predictors could help social workers in assessments of risk and in targeting interventions in a culturally useful way. For example, such a finding might suggest a greater emphasis on family dynamics when working with Latino youth. The intersection of these various predictors of recidivism also highlights the need for prevention and intervention programs that are responsive to issues of both ethnicity and gender. McNeece, Bullington, Arnold, and Springer (2005) assert that treatment should be linked with a harm reduction approach. The harm reduction strategy promotes public health rather than the criminal justice perspective when determining what to do about drug users. Thus, all drug use, whether of “licit” or illicit substances, is seen as potentially problematic. Proponents of this approach assert that the distinctions made between legal and illegal substances are totally artificial and have led to a myopic focus solely on illicit chemicals (McNeece et al., 2005). We should make the receipt of federal funding contingent on the repeal of a number of state laws, including those that prohibit the free distribution of needles and syringes to intravenous drug users. Traditionally, therapeutic interventions with substance-abusing youth and violent juveniles have been driven more by practice wisdom than by scientifically based outcome studies (evidence-based practice). 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