Offending Behaviour Programmes

Transcription

1 Offending Behaviour Programmes Source document Author: Per-Olof Wikström and Kyle Treiber YJB

2 Contents Background 4 Introduction 5 Addressing the causes of young people's crime: some important basics about causation and prevention 7 Treating the problems of prediction and causation as separate problems 7 Treating how best to establish causes, and how best to manipulate these causes, as two separate problems 8 Key points 1: Important basics about causation and prevention 10 The causes of young people's involvement in crime 11 Key points 2: The causes of young people s crime involvement 13 The problem of demonstrating the effects of an intervention programme 15 How do we establish that an intervention has had a desired effect?15 How do we determine if an intervention has been effective? 17 How do we best summarise the findings from many evaluations? 18 Key points 3: Demonstrating the effects of an intervention programme 20 The problem of effective implementation and delivery 21 Key points 4: Effective implementation and delivery 24 Offender-oriented programmes 25 Key points 5: Offender-oriented programmes 27 Cognitive behavioural therapy 28 Theory and main programme content 28 Evidence 30 Key points 6: Cognitive behavioural therapy (CBT) 33 Multi-systemic therapy 34 Theory and main programme content 34 Evidence 36 Key points 7: Multi-systemic therapy (MST) 38 Guidance for youth justice management and practice 39 Are CBT and MST programmes effective in routine practice? 39 What general factors are important for determining if CBT and MST therapies will work well (or fail) when applied in routine practice? 40 Are there particular groups of young people who offend ~ for whom CBT and MST programmes are more (or less) effective (or promising)? 40 General recommendations 41 2

3 Key points 8: Guidance for youth justice management and practice 42 Assessment 43 Individual needs 46 Communication 49 Service delivery 50 Transitions 51 Training 52 Management 53 Service development 55 Monitoring and evaluation 56 Conclusion 58 Appendix A: Methodology of the systematic review 59 Appendix B: Beyond the Maryland Scientific Scale 61 References 63 3

4 Background This review was commissioned to serve as a background source document to accompany guidance produced by the Youth Justice Board for England and Wales (YJB), identifying key elements of effective practice in interventions in the youth justice context. It has not been written primarily for an academic or research audience, but for managers and practitioners working in the youth justice field who are directly involved in providing, or brokering access to, services for young people who offend and their families. The review offers an accessible guide to the current state of the evidence base on effective interventions and services, helping youth justice practitioners and managers to be aware of and deliver more rigorously evidence-based services. The review document is divided into sections structured around a number of key themes or headings relevant to practice in youth justice services. The source document is structured to mirror the Key Elements of Effective Practice to facilitate cross-referencing between the two documents, and to ensure it is a useful document for the intended audience who may wish to explore the areas covered in the Key Elements of Effective Practice summary in more depth. These nine common sections therefore reflect what are considered to be core areas of consideration for practice and management within youth justice. The following Key Elements of Effective Practice titles and corresponding source documents are available from the YJB website ( Accommodation Assessment, Planning Interventions and Supervision Education, Training and Employment Engaging Young People who Offend Mental Health Offending Behaviour Programmes Parenting Restorative Justice Substance Misuse Young People who Sexually Abuse. 4

5 Introduction The ultimate aim for the youth justice system is to prevent offending and reoffending by children and young people. Achieving this goal requires the use of effective and properly implemented and delivered prevention and intervention programmes, of which offending behaviour programmes are one chief example. The main purpose of this source document is to present a systematic review of research from the past five years regarding the effectiveness of cognitive behavioural and multisystemic offender-oriented crime prevention programmes for young people. The review was limited to these types of interventions to avoid overlap with other reviews in the series, and because previous reviews have shown that cognitive-behavioural and multisystemic interventions tend to be the most promising for young people who offend (Izzo and Ross, 1990; Latimer et al, 2003; Lipsey, 1995; Lösel, 2001; MacKenzie, 2006). We systematically reviewed the literature related to these types of interventions, published or unpublished, which became available between 2001 and 2006, in order to undertake the most complete and up-to-date examination of the evidence base possible. The review identified more than 500 articles, including 300 evaluations of cognitive behavioural and multi-systemic interventions (see Appendix B for a description of the methodology employed). For the purpose of this review, we define a young person who offends as someone aged between10 to 17 years old. The main objectives of this document are to review: evidence on whether these kinds of programmes and interventions have proven effective or promising existing knowledge about the extent to which these programmes effectiveness varies for different kinds of young people when introduced in different kinds of social circumstances our knowledge about any (other) factors that have proven important for the most effective implementation and delivery of these programmes and interventions, and any factors that may contribute to their failure. In the document we will also provide an initial overview of some key assumptions and problems regarding: the assessment of the effects of prevention programmes and interventions based on reviews of conducted evaluation research the use of such knowledge to inform policy and develop practice. This will illustrate the limitations and problems youth justice managers and practitioners must take into account in order to apply this knowledge to best effect when developing policy and practice. To ensure the best possible crime prevention and reduction outcomes for young people who offend, the fundamental (and equally important) main tasks for youth justice managers and practitioners are: 5

6 to make sure they only use programmes and interventions that have proven effective or promising 1 to ensure that such programmes and interventions are fully implemented, delivered and sustained as intended. Achieving this requires that youth justice managers and practitioners have adequate user competence, that is (i) adequate knowledge about different kinds of programmes and interventions effectiveness or promise (managers); (ii) adequate skills and training to effectively implement, deliver and sustain such programmes and interventions as intended (managers and staff). User competence also involves adequate knowledge about (iii) various programmes and interventions cost-effectiveness, which enables informed judgements about whether a programme is cost-effective, or which is the most cost-effective among competing programmes and interventions, which target the same causal factors or processes (managers). To build and ensure user competence among youth justice managers and practitioners, and to effectively implement and deliver promising prevention programmes or interventions for young people who offend, requires adequate human and financial resources (e.g. for recruitment, training, supervision and continued assessment of outcomes). Without adequate resources and user competence, no prevention programme or intervention is likely to succeed. 1 With the obvious exception of those cases in which they are involved in demonstration projects to test new programmes or interventions. 6

7 Addressing the causes of young people's crime: some important basics about causation and prevention Human behaviour (like acts of crime and disorder) is an outcome of the interaction between an individual s characteristics and experiences and the features of the environments in which he/she operates (Bronfenbrenner, 1979; Magnusson and Statin, 1998; Wikström, 2006). To change a young person s behaviour one can, in principle, either change the individual or change the environments in which he/she operates (or both). For some young people, individual characteristics and experiences may be the most important factor influencing their problematic behaviour; for others, it may be the environment in which they operate (Wikström and Butterworth, 2006). Therefore, to design an effective prevention programme or intervention, one needs to know what key individual and/or environmental factors to target, both generally and for specific groups of young people who offend, or in particular kinds of social contexts. This requires: an understanding of what causes (directly and indirectly) young people s offending knowledge about how we can manipulate these causes (or their causes) to reduce or eliminate the behaviour in question. Direct causes move a young person to engage in an act of crime. Indirect causes affect the causes that move a young person to engage in an act of crime. For example, if a young person s moral judgements and habits are factors that contribute to his/her engagement in an act of crime, they are examples of direct causes, while those factors that help mould that young person s moral values and habits (such as his/her moral education and experience of certain moral contexts) are examples of indirect causes. Indirect causes may be thought of as the causes of the causes (see Wikström, 2007a for further discussion). Treating the problems of prediction and causation as separate problems Anyone who implements a programme or intervention with the aim of preventing a specific behaviour assumes, or should assume, that the programme or intervention addresses (at least) some of the factors that (directly or indirectly) cause the behaviour in question. Without causation there can be no prevention (Wikström, 2007a). To prevent something is to make something not happen that would otherwise have happened (the idea of preventing a young person s offending is the idea that the young person would have committed crimes, or more crimes, if the intervention hadn t taken place). Prevention programmes or interventions are based on causal hypotheses (regardless of whether or not these are made explicit). Effective prevention occurs as a result of an intervention that: removes or suppresses a (direct or indirect) cause successfully interferes with, or alters, a causal process (i.e. the process that links the cause and the effect and produces the effect). 7

8 In the latter case, prevention of offending and reoffending is about counteracting the influence of a cause (or causes) in operation; an example would be interventions, which aim to counteract the criminogenic influences of an individual s cognitive deficiencies. Successful prevention thus implies that the prevention programme or intervention has effectively removed or suppressed a cause or interfered with or altered a causal process. A test of a prevention programme or intervention may therefore, in principle, be viewed not only as a test of whether or not the particular programme or intervention works, but also a test of the correctness of the underlying causal hypothesis. In this context it is important to highlight that what predicts is not necessarily what causes. The fact that we can use of range of variables (such as those collected by assessment and prediction tools like Asset 2 ) to predict a young person s crime involvement, or future risk of crime involvement, does not mean that the factors that predict are also the factors that cause a young person s criminality. This problem is particularly common in some applications of the popular risk factor approach and the related strategy of risk-focused prevention. When a prevention strategy focuses on reducing as many risk factors as possible (risk-focused prevention) without properly addressing the extent to which the identified risk factors (stable predictors) are causes or mere correlates, there is a danger the prevention efforts will deal largely with factors that are markers or symptoms rather than causes, and waste valuable time and resources on their implementation and testing (Wikström, 2007a). It is therefore essential to take the problem of causation seriously when aiming to create effective prevention for young people s involvement in crime. Treating how best to establish causes, and how best to manipulate these causes, as two separate problems Even if we have knowledge about the key causes of young people s involvement in crime, this does not necessarily imply that we know how to successfully manipulate them in order to change a young person s behaviour. Establishing that a factor causes (or contributes to) the occurrence of an undesired behaviour is not the same as establishing how we can effectively intervene to affect the particular cause. If an intervention fails to work, this may be due to the fact that: we did not target a cause (or causal process) our intervention was not designed (or implemented, delivered and sustained) in a way that effectively influenced the cause (or causal process). One implication of this is that even if we try one method of manipulating a putative cause (or causal process) and it fails, it does not necessarily mean that the targeted cause (or causal process) is unimportant. We might still be right about the significance of a cause, but mistaken about the potential of our particular intervention to affect the cause (or causal process). There may, for example, be other ways (perhaps by modifying our original approach) to influence the particular cause (or causal process). This is 2 It should be noted that in the case of Asset information on risk factors is based on assessments by practitioners concerning the extent to which they think the problems they have identified are associated with a risk of reoffending (Baker, 2004:74, authors emphasis). Practitioners draw these conclusions using data collected about and from young people who offend, which is thought to relate to their offending. 8

9 important to bear in mind because there is always a danger that we may wrongly conclude, on the basis of a failed intervention, that the targeted cause (or causal process) was not important. Moreover, some causal processes may be irreversible (or difficult to reverse) so that when an effect has appeared, it cannot be reversed (or only reversed with great difficulty) by manipulating what caused it to appear in the first place so-called, asymmetric causation (Wikström, 2007b). It seems likely that many developmental processes relevant to the characteristics or experiences that influence a young person s current crime involvement may have the characteristic of asymmetric causation. For example, certain childhood experiences (e.g. malnutrition or receiving repeated severe blows to the head from a parent), may have influenced the emergence of cognitive deficiencies that affect a young person s current propensity to commit crime. In such cases, effective intervention for these individuals may be a question of finding methods that can improve (already existing) cognitive deficiencies or limit the behavioural consequences of their expression rather than target the parent s mistreatment of the child, which caused the deficiency in the first place (because the damage has already occurred and cannot be reversed by targeting its cause 3 ). An important implication of this is that for some young people (in the age range), the individual characteristics contributing to their current problematic behaviour may have emerged before the age of 10, and crucially, these characteristics cannot always be reversed by addressing what caused them in the first place. For example, it may not always be possible to compensate for the effects of poor parental handling in childhood by aiming to improve parent behaviour later in the young person s life. A comprehensive strategy to address young people s crime involvement therefore needs: in the longer-term: to focus on preventing the emergence of frequent and serious crimes by young people by developing early prevention programmes and interventions that target the childhood development of characteristics and experiences that later in life influence their propensity to engage in crime and disorderly conduct in the short-term: to address the environmental and individual factors that cause young people to engage in acts of crime and disorder and influence their risk of continued prolonged offending. In this source document we will only discuss the problem of eliminating or reducing offending (or the risk of continued prolonged offending) among young people who offend, but we feel it is important to stress the significance of early prevention since it may often (in the longer-term) be the most effective way to eliminate or reduce frequent and serious offending among young people (by preventing it from occurring in the first place). We have already stated that human actions result from the interaction between individuals characteristics and the features of the environments in which they operate. This introduces a particular problem for assessing the effect of interventions that specifically target individual characteristics and experiences or environmental features, 3 This is of course not to say that in these cases one should not address parental mistreatment of their children, only that one should do so for different reasons. 9

10 but not the interaction between the two. For example, certain individually-oriented interventions may differ in their effectiveness for different individuals because those individuals operate in different environments, or certain environmentally-oriented interventions may differ in their effectiveness for different individuals because of those individuals unique characteristics and experiences. Creating effective intervention programmes for young people s offending requires identifying the types of interventions that work best for certain types of young people, and in what types of social circumstances. It should be evident from the discussion so far that creating the most effective crime prevention for young people requires not only testing the effectiveness of existing programmes and interventions but, crucially, making sure we have developed programmes and interventions that actually target the main causes (or the causes of the causes) of young people s crime. Because resources are limited, it is essential that the prevention programmes or interventions selected for implementation or testing have a strong theoretical rationale and empirical grounding. Otherwise: we risk spending time and resources trying out and evaluating measures that are unlikely to produce the desired effects (or which may only produce marginal effects or even worsen the situation) we may fail to develop and test programmes and interventions that have the potential to more effectively produce the desired effects. The best way to avoid this problem is to make sure that the programmes and interventions that are (i) in use or (ii) selected for implementation and testing (whether newly developed or existing) are only those based on the best available theory and empirical research regarding the problem of crime causation (and therefore have the greatest potential to be effective). Prevention programmes and interventions based on sound theory (which are properly implemented) more often prove effective or promising than those which are not. Izzo and Ross (1990:138) report from a meta-analysis of young offender programmes that programs that were based on a theoretical principle were an average of five times more effective than those who had no particular theoretical basis. When conducting a review of existing evaluations of interventions and programmes that meet a minimum scientific standard, it is important to bear in mind that the outcome of the review regarding the effectiveness of interventions and programmes is limited to those that have been properly evaluated. Some potentially effective programmes (or suggested improvements of existing programmes to make them potentially effective) may not yet have been properly evaluated. Key points 1: Important basics about causation and prevention Factors that predict offending do not necessarily cause offending. Successful interventions address the causes of crime. Identifying the causes of crime requires strong theoretical and empirical research. Research indicates that interventions that are based on strong theoretical and empirical evidence are the most effective. 10

11 The causes of young people's involvement in crime We have already highlighted that not all of the factors normally listed as risk factors (predictors) are causes of young people s involvement in crime, and that most of them may only be symptoms or markers. This is a problem that has been clearly and repeatedly acknowledged by one of the leading developmental criminologists (David Farrington), and needs to be taken seriously to avoid spending time and resources on programmes and interventions with little prospect of being effective. there is no shortage of factors that are significantly correlated with offending and antisocial behavior; indeed, literally thousands of variables differentiate significantly between official offenders and nonoffenders or correlate significantly with self-reported offending. (Farrington, 1992:256) a major problem with the risk factor paradigm is to determine which risks factors are causes and which are merely markers or correlated with causes. (Farrington, 2000:7) little is known about the causal processes that intervene between risk factors and offending. (Farrington, 2003a:207) Thus, in order to better guide practice, we need to assess (to the best of our current knowledge) which among the identified risk factors (stable correlates) are likely to be causes, and which are likely to be mere symptoms and markers. It is commonplace in the offender-oriented prevention literature to talk about risk factors as criminogenic needs (but this difference in vocabulary does not change the point being made here). We have further highlighted the importance of distinguishing between causes and the causes of the causes. When we understand the direct causes of young people s crime involvement (i.e. what moves them to engage in acts of crime), we will be in a good position to develop and refine programmes and interventions that target these causes, and the causes of those causes, and concentrate our efforts in areas in which interventions have the most potential to be effective. We suggest that the current knowledge base indicates that key individual factors, which directly influence young people s propensity to engage in crime, are their moral values (their conception of what it is right or wrong to do in given situations), and their ability to exercise self-control (to inhibit and redirect their actions). Researchers refer to these constructs by various names (e.g. pro-social values, norms, attitudes and beliefs or impulsivity, self-regulation and risk-taking, respectively) but they are widely accepted, and empirically supported, as primary individual causes of delinquent, anti-social and criminal behaviour. Moffitt, for example, has suggested, and gathered evidence to support the argument, that persistent offending that begins in early childhood arises from neurological deficits, which manifest as hyperactivity, impulsivity and low selfcontrol (Moffitt, 1993; 1997; 2003). Gottfredson and Hirschi s renowned general theory of crime posits low self-control as the key causal factor, individual or otherwise, that leads to offending, and a meta-analysis by Pratt and Cullen has shown this variable to be one of the strongest known correlates of crime (Gottfredson and Hirschi, 1990; Pratt 11

12 and Cullen, 2000:952). Farrington has likewise stated that hyperactivity and impulsivity are among the most important personality or individual-difference factors that predict later delinquency (Farrington, 1996:8). Farrington (1992:275) collated key risk factors for offending into six categories, three of which relate to moral values ( internalized norms and attitudes favoring antisocial behaviour ; weak conscience, low guilt or remorse, low internal inhibitions against antisocial behavior ; and low empathy, emotionally cold, callous, egocentric, selfish ), and two of which relate to self-control ( impulsivity, hyperactivity, sensations seeking, risk taking, poor ability to defer gratification ; and poor ability to manipulate abstract concepts ), indicating that these two concepts are key predictors of offending (see Wikström and Sampson, 2003). In 2006, Wikström and Butterworth published evidence from a large UK cross-sectional study showing that self-control and morality were key individual factors implicated in adolescent offending. Acts of crime are moral behaviours because they are are based upon what it is right or wrong to do in a given setting. Specifically, acts of crime are acts that break moral rules, individuals attitudes and beliefs about those rules, and their ability to control their actions in accordance with those rules, naturally play a key role in explaining why some individuals break moral rules. 4 The most important environmental factor that concurrently (directly) and developmentally (indirectly) influences young people s engagement in acts of crime (whether or not they choose to break moral rules) is the moral context in which they operate (i.e. the characteristics of the settings they encounter that determine the rules about what is right or wrong to do in those settings, and the degree to which those rules are sanctioned) (Wikström, 2004; 2005; 2006; Wikström and Treiber, 2007). The fact that offending varies by moral context has been long established by the ecological tradition in criminological research, using concepts such as social disorder, disorganisation and (poor) collective efficacy, to denote the varying expression of norms and their formal and informal enforcement in different contexts. Studies relating to these topics show clear evidence that differences in moral contexts may play an important role in offending (see Sampson and Raudenbush, 1999; Skogan, 1992 regarding social disorder and disorganisation; Sampson et al, 1997; Sampson, 2004; Wilson et al, 1997 on collective efficacy). The involvement of a young person in crime may be regarded as the outcome of the interaction of his/her morality and ability to exercise self-control on the one hand, and his/her exposure to criminogenic moral contextson the other. 5 A young person s morality is important because it influences the extent to which he/she might consider breaking the moral rules of a setting and committing an act of crime. A young person s ability to exercise self-control is also important because it influences the extent to which he/she can refrain from acting upon temptations and provocations in a setting to commit an act of crime. The moral contexts in which a young person develops are important 4 For a review of research evidence regarding the role of self-control in crime involvement, see, for example, Pratt and Cullen, For a review of research evidence regarding the role of morality in crime involvement, see, for example, Stams et al, This is not to deny the importance of broader social factors like inequality and segregation. However, we argue that the role of these factors in crime causation is best analysed in terms of, for example, how they contribute to the emergence of different kinds of moral contexts, and how they affect young people s differential exposure to different moral contexts. 12

13 because they help to mould the development of moral values and self-control. The moral contexts to which a young person is contemporaneously exposed are also important because it is in these environments that he/she reacts to the temptations and provocations that interact with his/her morality and ability to exercise self-control to determine what action will follow (see Wikström, 2006 for further discussion on the role of moral contexts in crime causation). A criminogenic moral context is one that promotes young people s involvement in crime through the lack of effective communication and enforcement of moral rules consistent with the law. These are typically settings in which young people socialise, unsupervised, in environments that lack collective efficacy (environments characterised by weak social cohesion and poor informal social control) (see, for example, Osgood et al, 1996; Wikström & Butterworth, 2006). If we are correct in our assessment of the knowledge base (i.e. our current analytical and empirical knowledge about crime causation), this means that programmes and interventions, which aim to eliminate or reduce young people s offending, should target those factors that influence: the development and sustainability of morality (and supporting moral emotions), with the goal of promoting moral values (and associated moral emotions) consistent with, and supporting, abidance of moral rules defined by the law the ability to exercise self-control, with the goal of strengthening the capability to exercise self-control (also including interventions that aim to reduce excessive alcohol and drug consumption, which can momentary affect the ability to exercise self-control) the emergence and sustainability of criminogenic moral contexts, with the goal of reducing the prevalence of criminogenic moral contexts young people s exposure to criminogenic moral contexts, with the goal of minimising their exposure to criminogenic moral contexts. Recent findings from the Peterborough Youth Study (Wikström and Butterworth, 2006) show that young people s pro-social values, generalised ability to exercise self-control, and exposure to criminogenic moral contexts are all important factors that predict young people s involvement in crime. Young people who lack stronger pro-social values have a poorer generalised ability to exercise self-control, often take part in criminogenic moral contexts and tend to be frequently involved in crime. It is also interesting to note that of the existing offender-oriented programmes and interventions, those that target factors affecting people s morality (particularly those reinforcing pro-social values) and ability to exercise self-control (those strengthening cognitive capabilities) generally show the greatest promise (see the Offender-oriented programmes chapter). Key points 2: The causes of young people s crime involvement Most risk factors are not causes of crime and therefore interventions based on the risk factor approach may not be the most successful. Current evidence suggests that moral values (pro-social values, norms, attitudes, beliefs, etc.) and self-control (impulsivity, self-regulation, risk-taking, etc.) are the key individual factors that influence offending. 13

14 Offending is the outcome of an interaction between an individual s moral values, ability to exhibit self-control and his/her exposure to criminogenic moral contexts. Offender-oriented intervention programmes should target the ability to exercise self-control and factors that influence: development and sustainment of moral values emergence and sustainment of criminogenic moral contexts young people s exposure to such contexts. 14

15 The problem of demonstrating the effects of an intervention programme A central task for youth justice managers and practitioners is to ensure the selection of offender-oriented programmes and interventions that have proven effective or promising. The central questions for any assessment of what works have been well formulated by Bloom (2006): What social programs, policies, and interventions work? For whom do they work, and under what conditions? And why do they work or fall short? (Bloom, 2006:ix) How do we establish that an intervention has had a desired effect? The fundamental principle of establishing causal effects is to manipulate the putative cause (or causal process) and observe what happens. If the outcome changes in predicted ways as a result of our manipulation (intervention), we have some evidence of a causal dependency between the putative cause and the effect (and therefore some evidence that our intervention can prevent or contribute to the prevention of the undesired effect). However, successful manipulation alone is not enough to make sure that the outcome can be attributed to the manipulation. We also need to establish that without the manipulation, the observed change would not have happened (the counterfactual question). This is why experimental designs are generally preferred. Experimental designs, in which one compares young people exposed to an intervention with those not exposed to the intervention, and compares the outcomes (e.g. crime frequency), is the basic way to establish whether or not an intervention has an effect. For example, if we believe that a particular intervention will reduce young people s future involvement in crime and we compare young people who took part in the intervention with those who did not, only to find that both groups reduce their involvement in crime, we do not have much evidence that our intervention was effective. On the other hand, if those who received the treatment show reduced involvement in crime, but the controls do not, we have some evidence that our intervention may have been the cause. However, since there may be individual differences in how young people respond to a particular intervention (e.g. depending on their individual characteristics and experiences and/or the environments in which they operate), it is generally also necessary to randomly select (for sufficiently large samples) which young people are exposed to the intervention, and which are not, to ensure that what is measured is only the effect of the intervention (and is not confounded by any significant differences between the compared groups in any individual or environmental factors that influence the effectiveness of the intervention). In a prolonged intervention in particular, there is also a risk that the outcome may be influenced by other selectively operating causal factors than the intervention. Again, comparing randomised groups takes care of this problem because one can assume that these factors equally affect both groups (due to the randomisation). These are the main reasons why randomised experiments are generally regarded as the gold standard of evaluation. 15

16 However, many current (in fact, most) evaluations do not constitute randomised experiments, and by including other types of evaluations we introduce more uncertainties into our assessment of a particular intervention s effectiveness. The crucial question for any review of evaluations is what should be the minimum scientific criterion for their inclusion? Farrington argues (in our opinion correctly) that: it is not for a reviewer to attempt to review all evaluation studies on a particular topic, however poor their methodology, but rather to include only the best studies. The question is; what scientific threshold should we use for inclusion? (Farrington, 2003b:50) If we stick with evaluations that meet the gold standard, we can be reasonably sure (if we also verify that the programmes or interventions have been properly implemented with an adequate dosage, which may not always be the case) that our evidence has a solid foundation. The less stringent we are in selecting our criteria for inclusion, the higher the risk that our evidence is based on misleading findings and, subsequently, the higher the risk that our guidance to practice may be flawed. In an ideal world, we would base our conclusions about the effectiveness of a particular programme or intervention only on randomised experiments but since in many cases there is a shortage of randomised experiments, we must compromise between the quantity and quality of available information. Methodological quality scales have been developed to help address this problem. One example is the Scientific Methods Scale (sometimes also referred to as the Maryland Scale), which includes five levels (Sherman et al, 2002:16 17): Level 1: Correlation between an intervention and an outcome at one point in time. Level 2: A before-and-after intervention measure of the outcome. Level 3: Comparison of a before-and-after intervention measure for one group and a before-and-after measure without any intervention for another (control) group. Level 4: A before-and-after measure in multiple experimental and control units, controlling for other variables that influences crime. Level 5: Randomised experiments. The Maryland Scale does not include a common type of evaluation often used to guide practice and that is evaluations based on the opinion of those who conduct an intervention as to whether or not it is effective (testimonials). While it is easy to agree that evaluations based on opinion or Level 1 designs should not be considered as any evidence of the effectiveness of an intervention, and that Level 5 evaluations are the gold standard, in our opinion, the assessment of the relative scientific value of evaluations at Levels 2 to 4 is not as straightforward as the Maryland Scale implies. Sherman et al (2002:17) regard Level 3 as the minimum design that is adequate for drawing conclusions about what works, but acknowledge that this design does not solve the problem of selection effects because experiment and control groups are not randomised. The reason why Level 3 is considered a threshold is never made fully clear (but we assume it is because it includes controls). 16

17 Despite its problems, the Maryland Scale provides a useful, if approximate, guide to effective evaluation methodologies. However, see Appendix A for a more robust scale that takes intervention as well as evaluation design into consideration in valuing outcomes. How do we determine if an intervention has been effective? A common way to determine if an intervention has been successful is to calculate the statistical significance to see whether the differences obtained are greater than what would have been expected by chance. Although a statistically significant difference could be regarded as a minimum requirement for considering an intervention as potentially effective, it is not a strong independent criterion because statistical significance does not necessarily imply any greater effect (in large samples, even the weakest associations are significant). To determine if a significant difference is also an important difference, one can calculate the effect size (ES) 6. In principle, the effect size (which can be measured in different ways, such as Cohen s d 7 or the correlation coefficient) is a measure of how much of the variation in the outcome can be explained by the intervention (e.g. the percentage reduction in crimes by young people as a result of the intervention). There are no simple rules regarding what constitutes a large, medium or small effect size that can be used as a straightforward criterion for the selection of programmes or interventions. Sometimes rules of thumb are given in the literature, for example, referring to Cohen (1988), Butler et al (2006:18) states that, effect sizes have been categorised along a continuum of no effect (ES < 0.2), low (0.2 ES < 0.5), medium (0.5 ES < 0.8) and high (ES 0.8). This translates approximately to a change of less than 15% constituting little to no effect, a change of less than 35% constituting a small to medium effect, and a change of more than 35% constituting a large effect (Cohen, 1988). However, the minimum effect size for considering an intervention worthwhile largely depends on what one regards as a useful effect, for example: in terms of the intervention s cost-effectiveness (e.g. one may be happier to accept smaller effects from an inexpensive, rather than an expensive, intervention) in terms of the seriousness of the outcome targeted by the intervention (e.g. even a small effect on a serious outcome, such as homicide, may be regarded as reason enough to motivate an intervention, while a small effect on a more trivial outcome, such as littering, may not). Since the effect sizes obtained in meta-analyses of offender-oriented programmes are generally small 8 the question of whether these programmes are worthwhile has been raised. A common argument in defence of keeping programmes with small effect sizes 6 Please note that in studies with small samples the effect size may be relatively large without reaching statistical significance (which tends to occur particularly in some demonstration projects). 7 Cohen s d compares the mean difference in outcome between experimental and control groups, taking into consideration their standard deviations (i.e. the mean change divided by the average standard deviation of the groups). 8 See, for example, Cunningham, 2002; Curtis et al, 2004; Farrington and Welsh, 2002; Landenberger and Lipsey, 2005; Lipsey et al, 2001; Littell et al, 2005; MacKenzie, 2006; Pearson et al, 2002; and Wilson et al, See also the Offender-oriented programmes, Cognitive behavioural therapy and Multisystemic therapy chapters. 17

18 is that small program effects should not be underrated in policy making and practice because they are similar to those found for recognised methods of medical treatment and that they may pay off from monetary perspectives as well (Lösel and Beelman, 2003:98). What is clear, however, is that offender-oriented programmes or interventions alone are far from enough of what is needed to achieve large reductions in offending by young people. How do we best summarise the findings from many evaluations? A central problem in assessing the effect of a particular type of programme or intervention is how to summarise the findings from a number of different evaluations (with different designs, samples, etc). One way is to average the outcomes (mean effect sizes) from all evaluations that meet a minimum scientific standard (e.g. based on a certain level of a Scientific Methods Scale) and regard this as a summary measure of the evidence of the effectiveness of a particular programme or intervention. Such types of studies are generally called meta-analysis and have become an increasingly popular method to assess programme or intervention effectiveness (for an overview of the technique of meta-analysis see, for example, Durlak and Lipsey, 1991 or Wilson, 2001). This practice may not be so much of a problem if the criteria for inclusion are narrow (e.g. if only Level 5 gold standard evaluations are included in the meta-analysis) but become more problematic when the criteria for inclusion are much wider (e.g. if it is based on a mix of Level 3 to 5 evaluations according to the Maryland Scale). Averaging the effects of well and less well-designed evaluations is obviously not fully satisfactory, and this method risks producing misleading findings. For example, in cases where the findings from well and less well-designed evaluations show different outcomes, it may be advisable to only count the findings from the more rigorous ones rather than average all effect sizes. On a more general note, as pointed out by Wilson (2001:78), the mean effect size is meaningful only if the effects are consistent across studies, and therefore cases in which the mean effect size is based on summing highlyconflicting findings (e.g. evaluations showing a mix of positive and negative effects), the measure is at best uninformative (and at worst misleading). In principle, one can make a sound argument that, for example, one well-designed evaluation (e.g. a randomised experiment 9 ) may outweigh the evidence from 10 weakly designed evaluations (e.g. 10 before-and-after measure studies). However, even a well-designed evaluation does not always guarantee unbiased findings. While a well-designed evaluation is of crucial importance for our ability to determine a programme or intervention s effectiveness, it is not always enough to accomplish the task because there may be (in fact, often are) problems of attrition and implementation/delivery that may distort the findings. For example, it is not uncommon: that some people may refuse to participate in a programme or intervention, and that others may not fully participate or drop out that those delivering the intervention may lack adequate skills and training or motivation to fully carry out the intervention as intended. Dumas et al point out that: 9 Given the programme in question is properly implemented and delivered. 18

19 traditional outcome research has paid considerable attention to other key methodological issues (e.g. experimental design, reliability of measurements and statistical power), but has more often assumed, rather than demonstrated, that participants received the intervention(s) they were supposed to receive as designed. (Dumas et al, 2001:39) Even a gold standard randomised experiment may, in the worst case, be rendered more or less useless by problems of attrition or implementation/delivery failures. It is therefore essential to consider not only the quality of the design of an evaluation, but also aim (as far as possible) to assess how well the studied intervention was implemented and delivered. 10 It is customary to differentiate between a programme or intervention s (i) overall effect and (ii) effect on those who fully took part (e.g. Bloom, 2006). The overall effect is generally referred to as the effect of the intention-to-treat (ITT) and the effect on those who fully took part as the effect of treatment-on-the-treated (TOT). As may be expected, it is generally reported that the effect sizes are higher when calculated restricted to those who actually took part in the programme, for example, when excluding non-shows and drop-outs (e.g. Landenberger and Lipsey, 2005:462). Measures of outcomes of ITT and TOT address two different, but equally, crucial questions; in the case of ITT, What is the effect of offering a programme or intervention?, and in the case of TOT, What is the effect of actually taking part in the intervention?. If there is a big difference in effect when measuring ITT and TOT, it may indicate problems of engaging subjects or keeping them in the programme, and hence points to room for improved effectiveness by targeting subjects treatment motivation. It is important to note that any evaluation that does not take into account implementation and delivery is an evaluation of the effects of ITT rather than the effects of TOT. The effect of ITT includes the effect of the intervention on those who 10 One way to address implementation and delivery when assessing a programme or intervention s effect is to use instrumental variables (see, for example, Bloom, 2006:75 114; Angrist, 2006). In principle, instrumental variables are variables that measure important aspects of a programme or intervention other than the outcome. One key purpose of instrumental variables is to assess whether differences in outcomes between evaluations can be systematically linked to such things as differences in attrition, implementation rigour, dosage or type of outcome measure (e.g. differences in length of outcome observation period). Instrumental variables can also help to provide information about the crucial question of whether a particular intervention is differently effective for different young people or when applied in different social circumstances. Instrumental variables, which have proven influential, are often referred to as moderators (i.e. factors that interact with the intervention in producing the outcome). Taking moderators into account may help improve interventions and their implementation and delivery (for example, by indicating how to modify or target the intervention so it better addresses the needs of different groups of young people who offend). Instrumental variable approaches may also be particularly valuable in the evaluation of prevention programmes that consist of a range of interventions, where it can be very difficult to determine which components of a programme are effective (or ineffective, or even counterproductive) because they can be used to assess the contribution of the programmes various parts (interventions) to the outcome. It should be highlighted that it is often easier to select important instrumental variables for analysis if the programme or intervention is based on strong theory. 19

20 participated fully in the intervention; therefore the effect of TOT provides an index of how effective the programme can be when participants are effectively engaged in the intervention and it is implemented and delivered as intended. This can illustrate, and highlight, the importance of effective implementation and delivery to effective practice, particularly under routine practice conditions. A meta-analysis of randomised experiments combined with an instrumental variable analysis is probably the best method available to properly assess the overall effectiveness of a programme or intervention. However, because such studies are rare, it is important to keep in mind that the evidence base is never better than the quality of the evidence upon which it is based. Key points 3: Demonstrating the effects of an intervention programme The evidence base is never better than the quality of the evidence upon which it is based. Few interventions are evaluated using the best methods available, which means their conclusions may be based on misleading findings. Intervention effectiveness is measured at a group level. The outcomes for individual cases may therefore vary strongly. 20

21 The problem of effective implementation and delivery Proper implementation and delivery is not only a concern when evaluating a programme or intervention s (potential) effectiveness, but also a key problem in the creation of effective practice. Even if a programme or intervention is in principle effective, if it is not properly implemented and delivered, there is no reason to expect it to have any greater effect. For example, meta-analytic research consistently shows that poorlyimplemented and delivered cognitive behavioural programmes are associated with smaller (or no) effects than better implemented and delivered programmes and interventions (e.g. Lipsey and Landenberger, 2006). A particularly interesting finding in this context is the research that indicates that programmes and interventions tend to be more effective when researchers/evaluators are actively involved in their set up and implementation (see, e.g. Landenberger & Lipsey, 2005; Lipsey, 1995; Lipsey & Landenberger, 2006; Leschied et al., 2001; Lösel, 2001; MacKenzie, 2006; van de Weil et al, 2002). A main suggested reason for this is that many of those working in day-to-day practice may not always have the relevant skills and training or motivation to fully carry out the programme or intervention as intended. 11 Gendreau et al (2006: ) report, for example, that among the factors that contribute to whether a programme works are that the staff are trained and hired based on their knowledge of effective relationship and therapeutic skills, and evaluators are involved in the programme, but comment that few practitioners and managers in correction have the requisite management skills and clinical training to establish and conduct treatment programs of therapeutic integrity (p.437). Latimer et al (2003:9) reports, in a meta-analysis of 195 youth offending programmes (of all kinds) targeting under-18s, that poor programme integrity was the rule rather than the exception; only 11 programmes indicated the existence of a program manual, provided staff training and supervision, and monitored program compliance 12. The key problem appears to be the difficulty of transforming programmes or interventions which have proven effective or promising when researcher/evaluator-led into effective everyday practice in the criminal justice area. This may be referred to as the problem of mainstreaming effective or promising demonstration programmes or interventions. The extent to which this problem can be effectively addressed has huge implications for the possibility of creating more effective routine practice among criminal justice organisations working towards the goal of preventing the further criminal involvement of children and young people who offend. It is therefore important to consider what is known about the factors that contribute to successful programmes and interventions. 11 This may sometimes also have to do with the fact that in some demonstration projects, the initial recruitment to take part (before randomisation) may be selective (only those who agree to take part in the treatment are randomised), and therefore there is a risk that demonstration projects include more subjects favourable to treatment than would apply in a study of routine practice. 12 They report that of these programmes, 15% had a programme manual, 15% monitored programme compliance, 22% offered staff supervision, and 46% provided staff training (p.10), but only 6% (11 out of 195) offered all of these components of programme integrity. 21

22 Gendreau et al (2006) suggest seven principles of effective correctional intervention: 1. that the organisational culture is receptive to implementing new ideas and has a code of ethics (p.425) 2. that implementation of the program is based upon individual level survey data on the need for service and a thorough review of the relevant treatment literature (p.425) 3. that the director of the program has an advanced degree in a helping profession with several years experience working in offender treatment programs (p.427) 4. that offenders are assessed on a risk instrument that has adequate predictive validities and contains a wide range of criminogenic needs (p.427), where criminogenic needs refer to an offender s way of thinking and behaving that supports offending behaviour (p.426). 5. that the programmes employ treatment methods which target behaviour (because they are proven to be the most effective types of offender-oriented programmes) as well as the criminogenic needs of higher risk offenders (p.427) which, according to Gendreau et al (2006:428), involves the following key targets (depending on the particular subject s identified needs): a. change attitudes and feelings supportive of law violations and anti-criminal role models b. reduce anti-social peer associations c. reduce problems associated with alcohol/drug abuse d. replace the skills of lying, stealing, and aggression with pro-social alternatives. They also add the following targets as important only when they are linked to any of the above (i.e. linked to a, b, c or d): e. increase self-control, self-management and problem-solving skills f. enhance constructive use of leisure time g. improve skills in interpersonal conflict resolution h. promote more positive attitudes/increase performance regarding schoolwork and the workplace i. resolve emotional problems associated with intra- or extra-familial child abuse j. promote family affection/communication/monitoring/problem solving k. resolve deviant sexual arousal l. alleviate the personal and circumstantial barriers to service (client motivation, background stressors). These criminogenic needs (particularly points a e) are highly consistent with the direct individual causes of young people s involvement in crime, namely morality and self-control, which were discussed earlier in The causes of young people s involvement in crime chapter. 6. that program therapists engage in the following therapeutic practices (p.427): a. anti-criminal modelling 22

23 b. effective reinforcement and disapproval c. problem-solving techniques d. structured learning procedures for skill-building e. effective use of authority f. cognitive self-change g. relationship practices h. motivational interviewing 7. that the agency establishes a system whereby offenders are referred to other community agencies that can provide high quality services (p.427). In their meta- and other analyses of the evidence for their suggested seven principles of effective correctional intervention, Gendreau et al (2006:436) report the strongest empirical support for principles 4 and 5 (which mainly concerns the importance of need assessment and particular programme content), appreciable potential but less empirical support (p.437) for principles 2, 3 and 6 (which mainly concern the importance of proper implementation, management/staffing and particular practices), but no empirical support for principles 1 and 7 (which concern organisational culture and inter-agency co-operation) (p.437), the latter mainly due to a lack of proper research into their importance. Gendreau et al (2006) are not alone in trying to establish principles for the development of effective practice. Other prominent examples include Andrews (1995), Lösel (1995), McGuire (1995) and Nation et al (2003). By and large, the content of the principles are much the same, so there appears to be some general agreement on the core features of effective practice. In this context it is, in our opinion, particularly important to bear in mind that it is what we do rather than how we organise and manage what we do that is of fundamental importance, especially when politicians and policy-makers responsible for devising and implementing crime prevention often appear obsessed with issues of programme organisation and management rather than content. Only when we do the right things (i.e. get the content right) do questions about how to most effectively organise and manage implementation and delivery become important. In fact, the well-organised and well-managed delivery of ineffective (or even counterproductive) intervention programmes may cause more problems than they solve (possibly making the situation worse). Having dealt with the problems of how to establish whether programmes and interventions are effective (and the general problems of effectively transforming such knowledge into routine practice), we now turn to the task of assessing the evidence for the effectiveness offender-oriented prevention programmes and interventions for young people, with a particular focus on cognitive behavioural and multi-systemic therapies. 23

24 Key points 4: Effective implementation and delivery Implementation and delivery may significantly impact an intervention s outcomes; even effective interventions may prove ineffective if poorly implemented. Interventions are often less effective when implemented in routine practice compared to research conditions. If implementation and delivery in routine practice can match that of demonstration projects, intervention outcomes may be significantly improved. However, the selection of intervention programmes is fundamentally more important to the outcome than their organisation and management; a well-managed but ineffective intervention will still be ineffective, while a poorly-managed but effective intervention may still be effective. 24

25 Offender-oriented programmes Overall, evaluations of offender-oriented programmes demonstrate a rather small effect on reoffending by young people. On the basis of his classic meta-analysis of offenderoriented intervention programmes for young people, Lipsey (1995) reports that for all types of programmes, the average recidivism for treated young people was 45% compared to 50% for controls. This amounts to a 10% reduction in recidivism. Whether or not this should be considered a useful effect size can be discussed, but Lipsey argues that: a net 10% average reduction cannot be called trivial it is, for example, within the range of effects viewed as significant in medical treatment and other such domains. (Lipsey, 1995:67) However, there are many different kinds of offender-oriented intervention programmes and some are more effective than others (some tend to be ineffective and others appear even counterproductive; see Lösel, 2001; Mackenzie, 2006 and Redondo et al, 1997). Moreover, the effectiveness of a particular programme depends on the rigour and quality of its implementation and delivery (and some programmes are poorly implemented and delivered). One can expect (and indeed tends to find) stronger effects for certain kinds of offender-oriented programmes, particularly when they are well implemented and delivered. The trick to creating the most effective practice is thus to select the most promising programmes and make sure they are effectively implemented and delivered as intended. As shown below, there seems to be quite a high consensus among evaluators that offender-oriented programmes that target (or include key components addressing) offenders ways of thinking and the moral content of their thinking are particularly promising (such programmes are generally referred to as cognitive behavioural programmes). They also seem to agree that multi-modal programmes tend to do better than others, particularly programmes that combine a cognitive behavioural approach with interventions aimed at influencing criminogenic features of the offender s immediate environment (e.g. criminogenic features relating to family, peer or school environments). These types of programmes are often referred to as systemic programmes. Lösel (2001) summarises the offender-oriented intervention research (on youths and adults) by saying that: nearly all research syntheses showed relatively consistent differences between modes of treatment: theoretically and empirically driven wellfounded, multimodal, cognitive-behavioral and skill-oriented programs that address the offenders risk, needs, and responsivity had substantially larger effects than the overall mean. He goes on to say that, in contrast, traditional psychodynamic and non-directive therapy and counselling, lowstructured milieu therapy and therapeutic communities, merely formal variations in punishment had relatively weak or no effects. (Lösel 2001:68) 25

26 MacKenzie (2006:333) concludes on the basis of her systematic reviews of different kinds of offender-oriented programmes (adult and youth) that the effective programs are skill-oriented, based on cognitive-behavior/behavior models, and treat deficits simultaneously (i.e. are multimodal). Most studies included in the above-mentioned meta-analyses are North American. In a meta-analysis of what works in correctional rehabilitation restricted to European studies, the authors conclude that also in Europe the cognitive and behavioural treatment modalities are the most effective in the treatment of offenders (Redondo et al, 1997:514). Meta-analyses that have focused specifically on offender-oriented programmes applied to young people, by and large, report similar findings: effective programs differ significantly from ineffective programs in terms of their inclusion of techniques that can foster the development of the offender s thinking and reasoning skills, social perceptions, and problem-solving / / Most programs that included a cognitive component worked; most that did not, failed. (Izzo and Ross, 1990:139) at the high end/ / are treatments that have a more concrete, behavioural/or skills-oriented character. At the lower end of the continuum are treatments that are more oriented to psychological processes, e.g. the several forms of counselling. (Lipsey, 1995:74) In general, positive programs that target anger management, academic skills, anti-social attitudes, cognitive skills and social skills demonstrate improvements in recidivism compared to programs that do not target these needs. On the other hand, programs that target the psychological well-being of youth, leisure/recreation and substance abuse demonstrate diminished effects (i.e. increases in recidivism compared to programs that do not target these specific needs). (Latimer et al, 2003:13) Addressing the effectiveness of selected offender-oriented programmes for young people, by comparing multi-systemic therapy (MST), residential programmes (e.g. wilderness programmes) and community supervision (e.g. probationary and intensive supervision programmes), MacKenzie found that only MST was found to be effective in reducing recidivism (2006:185). Even though cognitive behavioural and systemic therapies tend to be the most promising kinds of offender-oriented programmes, there is great heterogeneity in the outcome of reviewed studies. Therefore one needs to consider carefully what elements of content or factors of application distinguish more successful programmes from less successful programmes. This is of crucial importance for effective practice because effective practice depends not only on selecting types of programmes that have proven effective, but also, within a group of programmes, on the ones that most effectively suit current purposes. Moreover, any knowledge of what other factors (than particular content) makes a programme more or less effective, in general, or for specific offender groups, is central knowledge for achieving best practice. 26

27 The kinds of intervention programmes we focus on in this source document (i.e. cognitive behavioural and multi-systemic therapies) aim to influence (change) already existing individual characteristics that are important for young people s criminal propensity (cognitive behavioural therapies), as well as some kinds of proximate environmental factors, which affect young people s exposure to criminogenic moral contexts (multi-systemic therapies). An example of a criminogenic moral context is an area with weak formal and informal social controls where young people socialise unsupervised. What these programmes do not target is (i) the broader social factors that cause the emergence and sustainability of criminogenic environments and young people s differential exposure to such environments, and (ii) the social and developmental factors that are responsible for the (early) development of the individual characteristics and experiences that influence later-life propensities to engage in acts of crime (although systemic therapies targeting children may address some of these). It is important to point this out because it helps us to have realistic expectations of what offender-oriented intervention programmes can achieve in terms of crime reduction by highlighting the fact that offender-oriented intervention programmes only target some (and not necessarily the most important) of the many factors that need to be addressed by a comprehensive strategy to substantially reduce offending by children and young people. Key points 5: Offender-oriented programmes On average, offender-oriented intervention programmes for young people who offend reduce recidivism by 10%. Promising offender-oriented programmes are those which address offenders ways of thinking and the moral content of their thinking (e.g. cognitive behavioural therapy [CBT] interventions) and multi-modal programmes, which combine a CBT approach with interventions influencing the criminogenic features of an offender s immediate environment (MST interventions). Programmes should be selected for implementation not only because research evidence supports their effectiveness, but also because they are the most appropriate for the current purposes. 27

28 Cognitive behavioural therapy We have already stated that there are two fundamental ways to change a young person s behaviour; by changing the individual or by changing the environment in which he/she operates (or both). We have also highlighted that the most important cause of the criminality of some young people who offend is their individual characteristics, while for others it is their environments. CBT is based on the idea that if you can change the individual, you can also change his/her behaviour. More specifically, if you can change the way an individual perceives and thinks about the social settings he/she encounters and his/her actions, you can change his/her behaviour. This prevention model implies that cognition is important for behaviour and that short-term interventions can change young people s cognition in a way that significantly impacts their offending behaviour. Theory and main programme content CBT is a relatively new intervention type which has arisen from advances in our understanding about the role of internal cognition in the expression of external behaviours. Cognitive science and neuropsychology have progressed rapidly in the past three decades, bringing a new awareness of how the ways in which individuals think and feel influences how they respond to the settings in which they take part. This has revolutionised thinking in the field of criminology and the study of crime causation, as it extends the causal chain from environmental influences to internal influences via attention and perception (Dobson and Khatri, 2000; Leschied, 2002). These are important elements in behaviour and crime causation (Wikström, 2006), and suggest that successfully influencing these elements can have a significant and lasting impact on how individuals choose to act. One of the strengths of CBT is its firm foundation in an empirically-supported causal model of delinquency. CBT is constructed around the notion that cognition affects behaviour, and that individuals have the capacity to monitor and adapt their ways of thinking, which can change how they perceive the settings they take part in, thereby changing how they respond to those settings in other words, their behaviour (including their offending behaviour) (Hollin, 1990). Criminologists extend this theory to suggest that offenders may think and feel differently than non-offenders, and this difference in cognition may be causally linked to their offending behaviour. Although there are many different types of cognitive behavioural interventions, these interventions generally aim to correct deficient, dysfunctional or distorted cognition, which may bolster offending behaviour by teaching new cognitive skills, such as selfmonitoring, self-awareness, interpersonal perception, knowledge and consideration of behavioural alternatives, moral reasoning and effective decision-making, which increase awareness of the link between thought processes and maladaptive behaviours, and strengthen an individual s ability to actively alter those processes in a positive direction (Landenberger and Lipsey, 2005; Meichenbaum, 1995; Wilson et al, 2005). Cognitive behavioural interventions can affect many different areas of cognition and behaviour, as they may target, for example, emotional characteristics of behaviour, decision-making processes or the application of cognitive activity to behaviour (Coyle, 28

29 2005). Some of the areas commonly addressed in cognitive behavioural therapy are the following: anger management Anger management interventions may be considered a subset of general coping skills. These interventions address an individual s ability to respond effectively to stressful situations by teaching techniques for recognising elements which elicit maladaptive emotional and behavioural responses, as well as techniques that reduce the expression of these responses and help the individual to exhibit self-control. behaviour modification Behaviour modification interventions arise from social learning theories, and use reward and punishment contingencies to reinforce or reduce particular behaviours. Behaviour contracts fall under this category of cognitive behavioural intervention. cognitive restructuring Cognitive restructuring interventions address cognitive distortions that lead to errors in perception, and therefore response, to different settings. These interventions target individuals ability to recognise and modify cognitive distortions or dysfunctional thought processes that lead to maladaptive behaviours. cognitive skills training: Cognitive skills-training interventions focus on enhancing individuals general reasoning and decision-making skills in order to reduce impulsivity, increase the consideration of alternative solutions, and influence individuals action choices. moral reasoning: Moral reasoning interventions are designed to improve individuals ability to reason about what it is right or wrong to do in different situations and to enhance their awareness of the moral implications of their actions. relapse prevention Relapse prevention programmes stress awareness of the settings and situations associated with an individual s offending behaviour, and target that individual s interaction and engagement with those settings and situations to reduce the opportunity for relapse. social skills training Social skills training interventions address interpersonal issues such as an individual s ability to interpret and respond to the behaviour of others. These interventions address how individuals perceive interpersonal social cues, such as how others think and feel. They teach interpersonal problem-solving skills and address how individuals deal with interpersonal conflict and peer pressure by promoting pro-social coping behaviours and communication skills. victim impact Victim impact interventions stress awareness and consideration of the impact of maladaptive behaviours on others. Consequently, this genre of cognitive behavioural interventions overlaps with mediational and restorative justice interventions. 29

30 Within the correctional setting, CBTs are usually delivered in groups of eight to 12 offenders. The most common cognitive behavioural interventions applied in the correctional setting are Moral Reconation Therapy (MRT), a moral reasoning intervention, which targets moral development and can be delivered in groups of 10 to 15 participants, and Reasoning and Rehabilitation (R&R), a cognitive skills-training intervention, which can be delivered in groups of six to eight participants (Wilson et al., 2005). Other popular therapies include Aggression Replacement Training (ART), which incorporates anger management and moral reasoning elements, and other cognitive skills training interventions, which target awareness of thinking patterns, the perceived legitimacy of offending behaviour and problem-solving skills to promote consideration of alternatives (Kurtz, 2002). Evidence Recent meta-analyses of CBT all agree that this type of offender-oriented intervention is effective, although the overall effect tends to be small and reported levels of effectiveness vary significantly between studies. The average reported reduction in recidivism is in the range of 20 30%, an effect size of less than 0.5, which falls in the small to medium range (e.g. Lipsey et al, 2001; Pearson et al, 2002; Landenberger and Lipsey, 2005; Wilson et al, 2005; MacKenzie, 2006). 13 Lipsey et al. (2001) report that CBT interventions tend to be most effective for young people who offend. However, they warn that there were no routine practice interventions with young people who had offended included in their meta-analysis, and that all interventions with young people referred to demonstration projects (demonstration projects tend to be more effective than routine practice see further below). In a later meta-analysis, Landenberger and Lipsey (2005:451, our emphasis) conclude that CBT was as effective for juveniles as adults, other things equal, and thus should be used in both juvenile justice and criminal justice settings. In an even more recent systematic review, Lipsey et al. (2007) found further support that CBT is effective for young and adult offenders. However, some research findings suggest that for the youngest people who offend in the age group, other types of therapies may be more effective. McCart et al (2006) compared the effectiveness of Behavioural Parent-Training 14 (BPT) with CBT for young people in a meta-analysis, and found that for the youngest of the young people (between the ages of 6 12 years), BPT was most effective, while for the older of the young people (between the ages of years), CBT was most effective. They suggest that these differences may be related to the fact that in the 6 12 year age range, BPT interventions may be more effective because youth at this developmental level are more dependent on their parents and look to them for guidance and support, and that with age, as youth enter more advanced levels of cognitive development, they receive increased benefits from /CBT/ intervention (p. 38). 13 While this would be considered a low effect size in most empirical research (see discussion in the chapter The problem of demonstrating the effects of an intervention programme ), the beneficial outcomes of even this small effect on criminal recidivism could be significant. 14 Behavioural Parent-Training refers to training parents to use effective behavioural management strategies. 30

31 Of crucial importance to practice is the finding that the effect sizes for CBT are much larger in demonstration projects (Research and Development projects) than in routine practice. Lipsey and Landenberger (2006:68) report that the average recidivism reduction shown in studies of the application of CBT in practice projects was 11%, compared with 49% in R&D projects. A crucial question for practice is thus how to translate the more effective demonstration projects into routine practice. The answer appears to partly lie in improving the effectiveness of implementation and delivery. Landenberger and Lipsey (2005) report that: what characterizes effective CBT programmes is high quality implementation as represented by low proportions of treatment dropouts, close monitoring of the quality and fidelity of the treatment implementation, and adequate CBT training for the providers. These characteristics are more closely associated with research and demonstration projects than with those implemented in routine practice. (Landenberger and Lipsey, 2005:471) Another important aspect is that of engagement and treatment motivation, since in many demonstration projects only those who agree to take part in the treatment are included in the study and allocated (or randomised) to control and experiment groups. To achieve the same effect sizes as in the best demonstration projects, routine practice may have to come up with methods to effectively engage and motivate those who may be inclined to refuse or not fully take part in the treatment. A recent review by Lipsey et al (2007) concludes the different brands of CBT are not significantly more or less effective than the average of such interventions. This supported the findings of an earlier review (Lipsey and Landenberger, 2006:69), which also failed to find a significant difference between different brands 15 in overall effect size, although the number of studies evaluating each brand was too small to draw definitive conclusions. In contrast, MacKenzie (2006:129) reports that evaluations suggest MRT is more effective than R&R, and Landenberger and Lipsey s (2005) review found that programmes that included elements of cognitive restructuring, anger control and greater individual attention yielded higher effect sizes (pp ), while programmes that addressed victim impact and behaviour modification yielded smaller effect sizes (p.470). It appears reasonable that there would be some differences between CBT brands in their effectiveness given that they target different areas of cognition and behaviour (see above). However, the inconsistency of these findings makes it impossible to justify any ranking of different CBT brands in terms of their general effectiveness. There is little knowledge about the kind of young people who offend for which CBT (or different kinds of CBT) may be an effective form of intervention. In general, it seems plausible that the therapy should be most effective for people whose offending is driven (or influenced) by deficient, dysfunctional or distorted cognition rather than by strong environmental inducements. For example, Tong and Farrington (2006:5), in an analysis of R&R Therapy, highlight that the therapy: is not suitable for offenders with an IQ below 70 as they may have inadequate verbal skills to understand the content; for cognitively skilled 15 Examples of compared main brands are Aggression Replacement Therapy, Reasoning and Rehabilitation and Moral Reconation Therapy. 31

32 offenders because their antisocial behaviour is not caused by cognitive deficits; or for offenders with psychiatric problems. Because different CBT brands vary in their emphasis on cognitive, emotional and moral components, it may be advisable to try to match particular kinds of cognitive therapies to the particular kinds of needs of young people who offend (of those deemed suitable for CBT). For example, for some young people who offend, morality may play a larger role in their offending, while for others offending stems more from an inability to exercise self-control when confronted with temptations or provocations. However, it should be stressed that our knowledge about how to best match different CBT approaches to the particular needs of different young people who have offended is limited. Evaluations of CBT regularly show that the effects tend to be stronger for more frequent offenders: the effects of CBT were greater for offenders with higher risk of recidivism than those with lower risk (Landenberger and Lipsey, 2005:451; Lipsey et al, 2007; Polaschek and Collie, 2004). One reason for this may be that cognitive behavioural problems are often the driving force behind frequent offenders criminality (with frequent offending serving as a marker of cognitive problems). This assumption is consistent with the repeated finding in criminological research that serious and frequent offenders tend to be characterised by moral values, which promote offending, and deficiencies in the ability to exercise self-control (see, for example, Wikström and Butterworth, 2006). Another reason may be that it is easier to achieve larger effects of crime reduction among frequent offenders. The general implication of this is that CBT may generally be more cost-effective for more serious and frequent offenders. However, Lösel (2007) has warned that these therapies may be unsuitable for some types of highrisk offenders (e.g. psychopathic offenders), and suggested that the effects may follow a U-shaped curve, being less effective at reducing offending for very low and very highrisk offenders. The answer to the question of whether CBT is more effective when administrated in institutional or community settings appears inconclusive. Some research reports that interventions in community settings tend to be more effective. However, several more recent reviews report no significant differences between interventions in community versus institutional settings. A recent meta-analysis by Landerberger and Lipsey (2005:471) states that the treatment setting was not related to treatment effects, a finding supported by Lipsey et al s 2007 systematic review. The dosage of a CBT intervention (i.e. its duration and intensity) is also inconsistently related to its effect on recidivism. Lipsey (1995) found that interventions with a higher dosage tended to be more effective, while some other meta-analysis report the reverse (Latimer et al., 2003). Lipsey et al. (2007:17) report that the number of sessions and hours per week are related to the effect size, but, apparently, the duration of treatment is not. This implies that the intensity of treatment, but not the duration, affects an intervention s outcomes. However, these findings require further clarification before robust conclusions can be drawn about the ideal intensity and duration of CBT interventions. Finally, it should be noted that most evaluations of CBT included in the conducted meta-analyses are not of the gold standard (randomised experiments) 16. Many suffer 16 As a rule, cited meta-analyses required at least matched control groups as a minimum inclusion criteria (although it should be stressed that the required matching criteria was not of the strength represented by 32

33 from problems of attrition, implementation and delivery (see The problem of demonstrating the effects of an intervention programme chapter), and most measure short-term effects. Key points 6: Cognitive behavioural therapy (CBT) CBT aims to correct deficient, dysfunctional or distorted cognition, which may lead to offending by increasing an offender s awareness of the link between his/her thought processes and his/her offending, and strengthening his/her ability to alter those processes in a positive direction. The average reported reduction in recidivism for CBT interventions is currently in the range of 20 30%. CBT is most effective for 13 to 18-year-olds; for younger children, behavioural interventions which target parents may be more effective. The effects of CBT tend to be larger for more frequent offenders. Effect sizes for CBT are much larger in demonstration projects than in routine practice. No brands of CBT stand out as more effective than other CBT interventions, although there is some evidence that those that address cognitive distortions, anger control, and involve greater individual attention, are most effective, while those that address victim impact and behaviour modification are least effective. CBT interventions should be matched to young people who offend based on their specific needs. the method of propensity score matching discussed above in The problem of demonstrating the effects of an intervention programme chapter). 33

34 Multi-systemic therapy While CBT focuses on changing offenders ways of dealing with their environment by changing their perceptions and the thinking patterns that are relevant to their offending, in addition, multi-systemic therapy (MST) stresses the need for changes in an offender s immediate social environments (the family, peer and school environments 17 ) to help reduce or prevent their problematic behaviour and offending (see further below). This approach makes much sense since offenders do not act in a social vacuum, and their criminality is an outcome of their interaction with the social environment. It may, for example, be easier to change an offender s moral values and habits that support lawbreaking by also changing those aspects of his/her environment (e.g. family or peer influences) that may support such values and habits. Moreover, for those offenders for whom the social environment is the main cause of their offending, a systemic approach has, in principle, a greater potential to effectively address their needs than a pure CBT approach (which focuses solely on changing individual characteristics). Including the offender s immediate social environment as a target of the intervention broadens the scope and complexity of MST programmes compared to CBT programmes. Effective MST programmes do not only require achieving treatment motivation from the offender, but also require effective co-operation from significant others, such as members of the offender s family (and, to a lesser extent, teachers and peers). Consequently, implementation and delivery is likely to be much more difficult and demanding for an MST programme than for a CBT programme. This implies that MST programmes may be much more difficult to introduce into mainstream practice than CBT programmes (which already pose many challenges to effective implementation and delivery). MST programmes are also generally much more expensive than CBT programmes. The crucial question for practice is how difficult is it to effectively implement and deliver MST programmes as part of routine practice? Unfortunately, we have limited knowledge about this since most meta-analyses of MST programmes are based on demonstration projects. Theory and main programme content MST was specifically developed to treat youths with serious behaviour problems and offending, and is aimed at the age range. It is an intensive, individualised intervention programme, which targets the social systems in which a young person who offends operates. MST views offending behaviour as a consequence of the interplay between individuals and the external, social systems in which they take part. Its primary goal is to promote multi-faceted change in individual, familial, peer, school and neighbourhood variables which influence offending (Borduin et al, 2003). MST draws upon two theoretical traditions. The first is Bronfenbrenner s human ecology theory, which links individuals behaviour to their interactions with their settings and emphasises the importance of understanding behavior within the context in which it occurs (ecological validity) (Bronfenbrenner, 1979). MST has considerable ecological validity as it targets behavioural change by providing support, skills training and 17 Although, the main focus is on the family environment (see, for example, Henggeler and Borduin, 1990). 34

35 behavioural therapy within a participant s natural settings (home, school, neighbourhood, etc.) rather than a clinical, residential or correctional setting. MST also draws upon family systems theory by approaching the family as its own unique social system and considering the function of offending behaviour within that system to understand how the family environment supports or perpetuates offending. Both human ecological theory and family systems theory suggest offending behaviour has multiple determinants, which arise within the various systems in which the offender takes part; MST, consequently, targets multiple systems in the offender s social network, delivering interventions within those settings, with the added advantage of reducing barriers to service access (Borduin et al, 2003; Henggeler et al, 1998). In an MST intervention, a therapist works in collaboration with family members to identify problem behaviours, their potential sources, and agreeable methods for addressing them. MST is a short but intensive intervention, generally requiring approximately 60 hours of contact between clients and therapists over a three to sixmonth period, although the intensity of delivery and timing of therapist-client contact is determined according to the client s unique needs (Borduin and Schaeffer, 2001; Henggeler and Sheidow, 2003; Henggeler et al, 1998). Interventions seek to empower clients to sustain the changes made during the duration of the intervention through breaking old, and establishing new, patterns of behaviour. The primary goals of MST are to: 1. remove impediments to effective parenting, such as parental substance abuse, psychopathology, stress, marital conflict, etc. 2. enhance parents knowledge about family circumstances and improve communication between family members 3. improve parents disciplinary practices 4. improve affective relations between family members 5. decrease the association of young people who offend with deviant peers (for example, by supporting parents in actively discouraging such associations through stringent sanctioning) 6. increase the association of young people who offend with pro-social peers (for example, by encouraging parents to actively support involvement in pro-social groups by providing transportation or increasing privileges) 7. engage youths in pro-social recreational activities 8. improve academic and/or vocational performance by increasing parental monitoring and involvement, establishing supportive communication between parents and teachers and increasing engagement in academic work 9. modify social perceptual problem-solving skills, attitudes and beliefs, and motivation 10. develop a support network, which includes extended family, neighbours and/or friends who can support and help sustain changes achieved during the intervention (Borduin and Schaeffer, 2001; Huey and Henggeler, 2001). Alongside the strengths of MST described above (i.e. its individualised and comprehensive approach, its ecological validity and its accessibility), MST is also constrained by strict guidelines that describe how treatments may be designed to most 35

36 benefit clients, and how treatment progress and success can be measured and evaluated (Henggeler and Sheidow, 2003; Leschied, 2002; Randall and Cunningham, 2003). This ensures the efficacy and quality of the MST intervention. These guidelines are: 1. Assessment within MST exists to clarify the relationship between systemic contexts and problem behaviours. 2. MST should emphasise positive elements and systemic strengths, and utilise them to further change. 3. Interventions should promote responsible, and decrease irresponsible, behaviour in the client family. 4. Interventions should focus on immediate issues and actively target clearly-defined problem areas. 5. Interventions should target sequences of behaviour spanning multiple systems, which perpetuate problem behaviour. 6. Interventions should be developmentally appropriate. 7. Interventions should require active participation (daily or weekly) by client family members. 8. Interventions should be evaluated throughout their duration, and providers held accountable for intervention outcomes. 9. Interventions should promote generalisation of treatment and sustained change by empowering clients to maintain their achievements (Borduin et al, 2003; Huey and Henggeler, 2001). Evidence Multi-systemic therapy has been listed as a model programme (for example, by the Centre for the Study and Prevention of Violence), and many recent reviews have concluded that it is an effective or very promising method for dealing with serious young offenders (e.g. Farrington and Welsh, 2002; Curtis et al, 2004; MacKenzie, 2006). Evidence of the effectiveness of MST is strengthened by the fact that evaluations included in meta-analyses consist of randomised experiments, but is weakened by the fact that they are typically conducted on rather small samples, which lowers their statistical power. However, these evaluations are often demonstration projects that, as we know from earlier discussion, are associated with stronger effects, which may counterbalance the effect of small sample sizes (Lipsey, 2003; see also The problems of demonstrating the effects of an intervention programme ). A small sample size means small effects may not obtain statistical significance and, as we know from the previous discussion, CBT and offender-oriented programmes more generally, rarely display strong effects. Also, most meta-analysed evaluations of MST involve comparisons between MST and alternative treatments or usual services, so the findings describe whether MST is better than other treatments or usual services, rather than no treatment at all. This, coupled with the fact that most MST evaluations involve small-scale demonstration projects, means there is little evidence of how effective MST is in largescale routine practice. In a meta-analysis of seven MST programmes evaluated through randomised experiments, Curtis et al (2004:416) report a moderate effect size (d = 0.55) for the 36

37 number of arrests for all kinds of crime. Interestingly, the authors also report that projects in which therapists were more closely supervised by the MST developers yielded much higher effect sizes (d = 0.81) compared to other projects (d = 0.26). This finding highlights a possible problem for practice because stronger effects may require high-quality supervision, which may be difficult to achieve in routine practice (such as can be provided by the developers of a programme). The fact that MST programmes tend to be more effective when the developers are involved has been noted by others. Farrington and Welsh (2002: ) observe in a meta-analysis of six randomised trials of MST that four had desirable effects on criminality, although only two had effects that were statistically significant. 18 What characterised the two trials with less impressive effects was that clinical supervision was not provided by the developers of MST. One of these studies was an evaluation of a Canadian programme, which was also the only larger-scale programme included, and the only programme conducted outside the US. The Canadian programme is particularly interesting because it is a high-quality evaluation of MST programmes which resemble routine practice (see, e.g. Cunningham, 2002). In another recent meta-analysis of seven randomised experimental evaluations of MST programmes, MacKenzie (2006:176) reports that the recidivism rates were lower for the experiment groups in all of the evaluations, [and] in four evaluations the difference was significant. She concludes that the large number of randomised trials combined with results showing lower recidivism rates provided strong evidence that MST is effective in reducing recidivism. However, she also introduces a cautionary note by referring to some methodological criticism of the MST evaluations by Littell et al, (2005), which question whether the MST programme s effectiveness is really proven. While the three meta-analyses of MST discussed so far appear to agree that MST is a potentially effective programme for young serious offenders (if properly implemented and delivered), Littell et al (2005) present a more negative evaluation of the overall effects of MST programmes. 19 Their meta-analysis includes eight randomised experiment evaluations of MST (six in the US, one in Canada and one in Norway). Littell et al conclude that: the overall direction of effects usually favors MST and, given the low statistical power of the analysis, it is possible that MST has some effects that cannot be detected in this small set of heterogeneous studies. However, we cannot rule out the possibility that MST is no more effective than other services. (Littell et al, 2005:11) They go on to say that the evidence about the effectiveness of MST is inconclusive. The Littell et al (2005) study has led to an intense debate between the developers of MST (Henggeler et al, 2006) and Littell (2006) concerning the quality and interpretation of the evidence for MST. The basic position taken by Henggeler et al appears to be that MST proves effective in trials in which it has been properly implemented and delivered 18 Farrington & Welsh (2002:143) comment that the large mean effect size for MST was largely driven by these two evaluations. 19 It is worthwhile to note that the different discussed meta-analyses of MST are largely based on the same primary evaluations (with some difference in the range of included evaluations). 37

38 (and for those who complete the trial), while Littell s position appears to be that this has not yet been convincingly demonstrated. However, there seems to be little question that it is difficult to implement and deliver programmes like MST on a large scale through routine practice to the same effect that has been suggested by the outcomes of some demonstration project (which is not to say it is impossible). Henggeler et al (2002) acknowledge that there is a problem transferring (or, as they say, transporting) demonstration projects to routine practice and argue that this is due, in part, to the fact that while: university-based efficacy studies typically attend intensely to treatment fidelity through the use of treatment manuals and close clinical supervision, therapist skill development in community settings often follows the train and hope approach (e.g. one to two day workshops, with minimal follow through), and clinical supervision typically focuses on administrative requirements and providing practitioners with social support. Littell also raises the important consideration that: (Henggeler et al, 2002:155) there may be real limitations to what can be accomplished with short-term interventions aimed at children and families, even when we engage them on their own terms in their own milieus. (Littell et al, 2006:470) It is possible that MST (and CBT) programmes need the support of a long-term comprehensive social and developmental prevention strategy targeting not only the young person who offends and his/her immediate environment, but also the broader environment in which young people who offend operate to reach their full potential. There are, for example, limits to how much even the most effectively implemented and delivered MST programme can influence relevant aspects of the wider social environment in which a young person who offends takes part (e.g. high levels of disadvantage and poor collective efficacy), and criminogenic factors arising from individual characteristics that have emerged during the offender s early development (e.g. reversing or counteracting serious early developmental cognitive deficiencies). Key points 7: Multi-systemic therapy (MST) MST interventions promote multi-faceted change in individual, family, peer, school and neighbourhood variables, which influence offending. MST interventions require treatment motivation and co-operation from significant others, such as family members and potentially other influential adults and peers, and may therefore prove more difficult to implement and deliver than CBT interventions. There is little evidence of how effective MST interventions are in large-scale routine practice, although therapies may be more successful if therapists are closely supervised. 38

39 Guidance for youth justice management and practice The overall conclusion from this review is that some offender-oriented crime prevention or intervention programmes for young people have the potential to be moderately effective, and CBT and MST are both examples of such programmes when they are carried out under ideal conditions. However, conditions are often not ideal when these programmes are applied in routine practice. The crucial question for practice is to what extent it is possible for, and what is required by, routine practice to achieve the highest standard of implementation and delivery necessary to reach the full potential of CBT and MST programmes, bearing in mind that there are limits to the effectiveness one can expect from such programmes in isolation. In this chapter we will attempt to summarise key evidence regarding the effectiveness and promise of CBT and MST programmes, and identify the key problems relating to their implementation and delivery in routine practice. Assessing evidence of the effectiveness of implementation and delivery of offender-oriented therapies for young people is a complicated task. The evidence base varies in quality (see The problem of demonstrating the effects of an intervention programme and The problem of effective implementation and delivery ) and, in some instances, competent researchers differ in opinion regarding the demonstrated effectiveness and promise of particular programmes, and the implications of this for routine practice. When assessing the potential value and contribution of CBT and MST therapies, three central questions for youth justice management and practice are: 1. To what extent are they likely to prove effective (or promising) when applied in routine practice? 2. What general factors are important in determining whether CBT and MST therapies will work well (or fail) when applied in routine practice? 3. Are there particular groups of young people who offend for whom CBT and MST are more (or less) effective (or promising)? The extent of our knowledge on these points is varied and in some instances limited. There is a real need for large-scale routine practice randomised experiments in the UK to further advance our knowledge on these points. Are CBT and MST programmes effective in routine practice? Based on the current evidence regarding the effects of MST and CBT interventions on reoffending by young people, one cannot expect even successfully implemented and delivered interventions to have a dramatic overall effect on young people s involvement in crime. Even under ideal conditions of implementation and delivery, no more than a moderate effect is to be expected. In normal routine practice, only small effects are to be expected. However, many researchers have argued that even small effects are not practically unimportant (and may be cost-effective). CBT and MST programmes generally show more potential for reducing children and young people s offending than other common interventions orientated towards young people who offend. The evidence by and large favours the promise of cognitive behavioural and multi-systemic therapies (although the evidence for the effectiveness of 39

40 MST in routine practice is inconclusive). Many other forms of offender-oriented interventions are less promising and some may even be counterproductive (there is, to our knowledge, no evidence to suggest that competently-implemented and delivered CBT or MST therapies risk harming or worsening a situation for those young people who offend who take part, although one has to be aware of the risk of deviancy training when bringing together groups of young people who are actively offending). Because CBT and MST programmes in demonstration projects tend to display stronger effects than in routine practice, a crucial question is whether, and if so by what means, routine practice can achieve the level of effects that are sometimes obtained in demonstration projects. What general factors are important for determining if CBT and MST therapies will work well (or fail) when applied in routine practice? There appear to be two broad factors of crucial importance to the effectiveness of CBT and MST programmes: 1. programmes are implemented and delivered by well-qualified, well-trained and properly clinically supervised therapists 2. therapists succeed in achieving high levels of engagement and treatment motivation among young people who offend. Demonstration programmes are generally conducted by well-qualified, well-trained and properly clinically supervised therapists, and more often recruit participants that have higher levels of treatment motivation (because they and/or their parents have to agree to take part in the trial). If routine practice can match these levels of training, supervision and treatment motivation, it is plausible this could improve the effectiveness of mainstream CBT and MST therapies. 20 This requires the availability of well-qualified therapists who can be recruited to work with young people who offend and adequate resources for their necessary specialist programme training and clinical supervision (and the availability of adequately qualified teachers and supervisors to provide the necessary training and supervision). 21 Moreover, it requires effective measures to engage and motivate (unwilling) young people who have offended for treatment. Are there particular groups of young people who offend for whom CBT and MST programmes are more (or less) effective (or promising)? The evidence about the types of programmes and interventions that work best for certain types of young people who offend is limited. It is generally found that the effects are stronger when the programmes or interventions are applied to more prolific young people who offend, i.e. those with a high risk of reoffending. 20 However, what is really needed to verify this assumption is randomised experiments in routine practice where the conditions of the implementation and delivery of the therapy and the treatment motivation approaches that which characterises the most successful demonstration projects. 21 It should be pointed out that such changes may substantially increase the costs of running the programmes, and therefore requires significantly stronger outcome effects in order not to negatively affect the cost-effectiveness of the programmes. 40

41 Knowledge about whether CBT and MST programmes need to be tailored to suit the needs of young people who offend of different genders or ethnicity is limited. However, in a recent meta-analysis, Wilson et al (2003:3) draw the overall conclusion that the use of mainstream service programs for ethnic minority juvenile delinquents without cultural tailoring is supported. It has been convincingly argued that CBT programmes should target those young people who offend for whom cognitive deficiencies are a driving force of (or strongly contribute to) their crime involvement. However, it has also been convincingly argued that CBT programmes may not be applicable to those with very poor cognitive skills (low IQ) and are less effective for children and young people who offend below the age of 12 (for whom parenting programmes may prove more effective). It has also been questioned whether these therapies in their current form can make a difference for the most severely cognitively-deficient young people (e.g. psychotic offenders). MST programmes are specifically developed to target young people presenting the most serious anti-social or offending behaviour. There is limited evidence about whether MST programmes differ in effectiveness for different types of young people who offend in different types of immediate social situations. It is reasonable to expect that MST programmes may be more effective when applied to situations in which family dynamics and dysfunction contribute significantly to the young person s offending (since addressing family dynamics and dysfunction is a key part of the programme). In general, one can argue that there is a crucial knowledge gap regarding the types of young people who offend and the types of social circumstances for which CBT and MST programmes are the most effective. Moreover, one can argue that another important knowledge gap concerns how CBT and MST programmes work in combination with other kinds of interventions. CBT and MST programmes do not take place in a social vacuum, and therefore their success and failure may depend on broader social and developmental factors outside the control of the therapist. This highlights the fact that the success of offender-oriented therapies for young people may depend on whether they are part of a comprehensive and integrated prevention strategy that not only addresses problems concerning the individual and his/her immediate environment, but also the broader social processes relevant to the success or failure of particular offender-oriented therapies for young people. General recommendations We have already stated that the most important aspect of any prevention programme ultimately is what we do rather than how we organise and manage what we do. It is worth recalling that well-organised and well-managed implementation and delivery of ineffective (or counterproductive) programmes and interventions could even make the situation worse. The evidence indicates that the following three measures are therefore critical to effective youth justice management and practice: 1. Those who (strategically and in day-to-day practice) manage crime prevention activities for children and young people who offend should make sure (as far as possible) that the programmes and interventions they already routinely administer, or any new programmes and interventions selected for routine implementation and delivery, are only those that have proven effective or promising. 41

42 2. There should be well-developed procedures in place to ensure that those who deliver the programmes or interventions have adequate and relevant skills, training and supervision. 3. Programmes and interventions should be consistently monitored, and their outcomes continuously assessed, to ensure they are effectively implemented and delivered as intended. While the first measure stresses the importance of what we do (the selection of appropriate programmes) over how we organise and manage what we do, the latter measures acknowledge that once (but only once) we know what to do (i.e. what programme to implement), it is of the utmost importance that our implementation and delivery is effectively organised and managed. That is particularly true in combating the commonly-identified problem of mainstreaming, when programmes and interventions which have proven effective or promising in researcher/evaluator-implemented and delivered demonstration projects prove less effective (or fail) when mainstreamed. Key points 8: Guidance for youth justice management and practice CBT and MST programmes generally show more potential than other common offender-oriented interventions for reducing offending by young people. When carried out under ideal conditions, MST and CBT interventions may be moderately effective in preventing youth offending. Under current routine practice conditions, only small effects can be expected from MST and CBT interventions, although outcomes may be enhanced by improving implementation and delivery methods. There appear to be two broad factors which determine the effectiveness of CBT and MST programmes: that they are implemented and delivered by well-qualified, well-trained and properly supervised therapists that they achieve high levels of engagement and treatment motivation among young people who offend. The challenge to practitioners is to ensure these two factors in routine practice. CBT and MST programmes are most effective for high-frequency offenders and do not require adaptation for gender or ethnicity: CBT programmes should target offenders for whom cognitive deficiencies strongly contribute to their crime involvement, although they may not be applicable for those with very poor cognitive skills, and are less effective for children below the age of 13. MST programmes may be the most effective for young people who offend whose family and peer dynamics and dysfunction contribute significantly to their crime involvement, although evidence of their effectiveness is limited. In general, there is a crucial knowledge gap regarding the kinds of young people who offend and the kinds of social circumstances for which CBT and MST programmes are most effective. 42

43 Assessment When deciding whether to implement an MST or CBT programme, practitioners need to answer several questions: 1. Is this kind of intervention appropriate for the target population? 2. Is there evidence supporting the effectiveness (and cost-effectiveness) of the intervention in routine practice? 3. What resources are required to implement the intervention? 4. What kind of outcomes should one expect? The extent to which we can answer these questions is limited by the knowledge currently available concerning the mainstream implementation of CBT and MST interventions. There remains a pressing need for more large-scale randomised experiments to investigate the effects of intervention implementation in routine practice, which can then advance our knowledge and help us answer these important questions more definitively. What we do know: Is this kind of intervention appropriate for children and young people who offend? CBT has been shown to be as effective for young people who offend as for adult offenders (Landenberger and Lipsey, 2005; Lipsey et al, 2007) and a review by Lipsey et al (2001) reports that, at least in demonstration projects, CBT may be even more effective for young people who offend. This highlights yet again the difference that effective implementation can have on treatment outcomes. While CBT has been shown to be particularly effective with adolescents who offend, for very young people who offend (between the ages of 6 12 years), Behavioural Parent Training may be more effective than CBT (McCart et al, 2006). MST was specifically developed to target the offending behaviours of young people between the ages of 10 and 17 years, especially that of serious offenders. Thus its effectiveness is specifically associated with the treatment of serious offences by young people. Is there evidence supporting the effectiveness (and cost-effectiveness) of the intervention in routine practice? As the paper above has described, evidence does support the effectiveness of CBT and MST programmes in routine practice, although effect sizes are generally much lower for evaluations taking place under more routine conditions than for those taking place as part of demonstration projects (see below on effect sizes). Consequently, even though CBT and MST programmes generally show more promise than other common young offender-oriented interventions, evaluations and reviews show that their outcomes can vary significantly (although, to our knowledge, while other interventions may even prove counterproductive, there is no evidence suggesting that competently implemented and delivered CBT or MST 43

44 therapies risk harming or worsening a situation for young people who offend. However, see the subsequent chapter on service delivery about the potential problem of group contagion effects). Because CBT and MST programmes tend to display stronger effects when implemented in demonstration projects compared to routine practice, a crucial question is whether, and if so by what means, routine practice can achieve the same level of effectiveness obtained in demonstration projects. Practitioners need to carefully consider the content and implementation factors, as well as other external factors, which differentiate successful from less successful programmes, to ensure not only that the effectiveness of the chosen programme has been empirically supported, but also that the chosen programme is suited to the current target population (see the following chapter on individual needs). What resources are required to implement the intervention? There appear to be two broad factors critical to the effectiveness of CBT and MST programmes: that they are implemented and delivered by well-qualified, well-trained and properly clinically supervised therapists that therapists achieve high levels of engagement and treatment motivation among young people who are taking part in the intervention. We have emphasised throughout this source document the importance of employing qualified, well-trained staff with the knowledge and skills necessary to implement the chosen intervention. This requires not only recruiting well-qualified therapists to work with young people who offend, but also providing adequate resources to equip them with specialist programme training and clinical supervision (as well as the availability of adequately-qualified teachers and supervisors to provide the necessary training and supervision). 22 It is also critical that resources are available to continuously monitor and assess the interventions progress, and to ascertain whether or not it is having its intended effect upon the participants. Practitioners will also require resources to track and monitor participants progress throughout, and subsequent to the intervention, to assess user engagement, individual outcomes and changing or unique individual needs. Demonstration programmes are generally conducted by well-qualified, welltrained and properly clinically supervised therapists, and more often recruit participants that have higher levels of treatment motivation (because they and/or their parents have to agree to take part in the trial). If routine practice can match these levels of training, supervision and treatment motivation, it is plausible this could improve the effectiveness of mainstream CBT and MST therapies It should be pointed out that such changes may substantially increase the costs of running the programmes and therefore requires significantly stronger outcome effects not to negatively affect the cost-effectiveness of the programmes. 23 However, what is really needed to verify this assumption is randomised experiments in routine practice, where the conditions of the implementation and delivery of the therapy and the treatment motivation approaches that which characterises the most successful demonstration projects. 44

45 What kind of outcomes should one expect? Evidence suggests that even when successfully implemented and delivered, MST and CBT interventions cannot be expected to have dramatic overall effects on the involvement of young people in crime. Even when these interventions are implemented and delivered under ideal conditions, no more than a moderate effect, at best, is to be expected. Consequently, when these interventions are implemented and delivered under the typical conditions of routine practice, only small effects, at best, can be expected. However, many researchers have argued that even small effects are not inconsequential (and may be cost-effective) when taking into account the seriousness of the targeted outcome. The average effect size for all intervention programmes for young people who offend is around a 10% reduction in recidivism (Lipsey, 1995). Comparably, CBT programmes report an average 20 30% reduction in recidivism (e.g. Lipsey, et al, 2001; Pearson et al, 2002; Landenberger and Lipsey, 2005; Wilson et al, 2005; MacKenzie, 2006). However, as we have seen, the effect size varies dramatically between routine practice (11% reduction) and demonstration projects (49% reduction) (Lipsey and Landenberger, 2006). This provides further support for the importance of effective implementation and the careful translation of implementation and delivery methods from research into general practice. MST programmes also report moderate to large effect sizes. A meta-analysis by Curtis et al (2004) provides further evidence of the importance of implementation practices; carefully supervised projects reported much higher effect sizes than projects which were not closely supervised (see the start of this chapter). The issue is further highlighted by the ongoing debate between Littell et al and Henggeler et al, which suggests that MST interventions may be ineffective if they are not implemented according to very strict guidelines. When considering the effectiveness of these programmes, it is important to remember that they do not target the broader social factors that cause and sustain the emergence of criminogenic environments, and affect young people s exposure to those environments, or the social and developmental factors responsible for individuals characters and experiences that influence their propensity to engage in acts of crime. While it is impossible to address these processes in retrospect, their influence will continue to counter the effects of any interventions, no matter how substantial they are. 45

46 Individual needs Once practitioners have determined that a CBT or MST intervention is appropriate for addressing the needs of the target population, practitioners need to assess whether considerations such as gender, ethnicity or the age of participants may affect the outcomes of the intervention. Understanding the role such individual characteristics may play in intervention outcomes requires an understanding of their general role in crime causation. Randomised experimental implementation of an intervention can help ensure the intervention is effective for individuals with a wide range of individual characteristics. Similarly, individuals may refer not only to the specific characteristics of an individual, but also to the characteristics of the environment in which an individual takes part. Therefore, it is also important that practitioners consider the types of environments their intervention groups take part in, and how the characteristics of those environments are linked to offending behaviour. As we have described above, some research suggests that the two most important individual differences that directly influence young people s propensity to engage in crime are self-control and morality, while the most important environmental factor is the moral context of the social settings in which young people operate. A young person s involvement in crime may be seen as the outcome of the interaction of his/her morality and ability to exercise self-control and his/her exposure to criminogenic moral contexts. Supporting this supposition, programmes that target factors affecting individuals morality and self-control show the greatest promise for reducing offending by children and young people. CBT and MST target how offenders think and the moral content of their thoughts. CBT specifically aims to influence existing individual characteristics that elevate a young person s propensity to engage in crime, including moral reasoning and self-control. MST also aims to influence individual characteristics while simultaneously targeting some environmental factors that affect a young person s exposure to criminogenic moral contexts. Evidence concerning the types of programmes and interventions that are most effective for the different types of young people who offend is limited, although studies show that CBT programmes may be more effective for young people who offend more frequently (Landenberger and Lipsey, 2005:451; Lipsey et al, 2007; Polaschek and Collie, 2004). CBT will arguably be most effective for young people who offend whose offending is driven by deficient, dysfunctional or distorted cognition. However, individuals with especially severe cognitive deficits (e.g. low IQ) may not be able to effectively engage with these interventions. There are many different ways in which children and young people express severe cognitive deficits, and it will be important for practitioners to be familiar with the specific difficulties of the children and young people with whom they work, so that they may take these deficits into consideration when choosing or developing intervention programmes for those participants. It has also been questioned whether these therapies in their current form can make a difference for the most severely cognitively-deficient young people (e.g. psychotic offenders). Again these issues need to be considered on a case-to-case basis. It has been suggested that different brands of CBT could be matched to different types of young people who offend, though knowledge about matching brands of CBT and 46

47 specific groups of young people is limited. Some evidence suggests moral reconation therapy may be more effective than R&R. Other research indicates that elements of cognitive restructuring, anger control and personal attention, in addition to group therapy, may lead to stronger effects, while victim impact and behaviour modification elements have been associated with smaller effects. Because these findings are not definitive, it is important that practitioners consider the specific needs of their target population when choosing or developing a CBT intervention programme. MST may be more effective for young people whose offending is driven by the external social environment. MST programmes have been specifically developed to target the most serious types of young people who offend (Borduin et al, 2003). However, evidence concerning whether MST programmes differ in effectiveness for different types of young people in different types of immediate social situations is limited. It is reasonable to expect they may be more effective when applied to situations in which family dynamics and dysfunction contribute significantly to the young person s offending (since addressing family dynamics and dysfunction is a key part of the programme). Knowledge about whether CBT and MST programmes need to be tailored to suit the different gender or ethnicity needs of young people who offend is limited. However, in a recent meta-analysis, Wilson et al, (2003:3) draw the overall conclusion that the use of mainstream service programs for ethnic minority juvenile delinquents without cultural tailoring is supported. In general, one can argue that there is a crucial knowledge gap regarding the types of young people who offend and the types of social circumstances for which CBT and MST programmes are the most effective. Moreover, one can argue that another important knowledge gap concerns how CBT and MST programmes work in combination with other types of intervention. CBT and MST programmes do not take place in a social vacuum, and therefore their success and failure may depend on broader social and developmental factors outside the control of the therapist. This highlights that the success of offender-oriented therapies for young people may depend on whether they are part of a comprehensive and integrated intervention strategy that not only addresses problems concerning the individual and his/her immediate environment, but also the broader social processes relevant to the success or failure of particular offenderoriented therapies (such as social capital) for young people. To effectively apply our limited knowledge of what types of interventions are effective for certain types of individuals, and in which types of settings, it is important for practitioners to possess the knowledge and skills: to assess the needs of young people who offend: this requires adequate access to, and training in the use of, assessment tools that (i) predict future risk of offending and (ii) the major causal factors contributing to offending. It is important to distinguish assessment tools that predict future risk of offending from those that define criminogenic needs (i.e. key causes contributing to criminality by young people who offend) Asset is a tool used by YOTs to predict the likelihood of a young offender being reconvicted (Baker at al., 2003b) and to help practitioners to identify areas for intervention in order to reduce the risk of further offending (Baker et al., 2003a:10; see page 20 of the source document Assessment, Planning Interventions and Supervision [YJB, 2008] for more information). 47

48 to match particular programmes and services to the needs of young people who offend: this requires access to, and knowledge of, different programmes and other services, as well as knowledge about how to best match particular programmes and services to the specific criminogenic needs of young people who offend. This also involves assessing whether other services may be needed as part of an intervention (such as substance abuse interventions). 48

49 Communication Ensuring that programmes are delivered effectively to the target population requires effective communication of the programme into practice. This means ensuring participants receive the implementation as it is intended from start to finish and considering issues of engagement and attrition. Instrumental variables that could influence the effects of the intervention should be taken into consideration, as should the difference between the effect of the intention-totreat (ITT) and the effect of treatment-on-the-treated (TOT). Individuals receiving different dosages of the treatment or who respond to unintended aspects of the treatment will present different outcomes than those who receive the treatment as intended from start to finish. Practitioners can increase engagement with, and commitment to, the interventions using techniques such as motivational interviewing. Practitioners can also increase user engagement and reduce attrition by increasing involvement with participants family members or other influential social contacts. This is especially critical in MST and can supplement tracking efforts, participant monitoring and assessment of treatment outcomes. Therapists also need to be adequately motivated to complete the intervention, even under difficult circumstances. Under such circumstances, support by management staff and collaboration with other social support agents may be particularly critical. Factors of tracking and attrition will be more significant in community versus custodial settings, and therefore community-based interventions will need to devote more planning and resources to ensure stable contact with participants and encourage commitment to the intervention. Effective communication of a programme into practice can lead to significantly larger effect sizes, especially for participants who complete an entire course of MST or CBT treatment. 49

50 Service delivery Clear guidelines should be developed and disseminated for any intervention programme that has been determined to be effective or promising. The guidelines should detail the implementation and delivery conditions under which the intervention proved most effective or promising so that they can be followed during subsequent implementation of the programme. Resources need to be allocated to ensure these guidelines are being followed, and that the intervention remains on track. These guidelines should take into consideration issues involved in implementing the intervention in group as well as individual settings, and they should identify which setting is most appropriate for the particular intervention (although most CBT interventions are delivered in group settings, MST interventions may require a more individual, or family-oriented, design see below). They should also stipulate any additional considerations about the population for which the intervention is appropriate, and what practitioners should expect from participants at different stages of the intervention. These factors should be continuously monitored and addressed immediately whenever an issue arises. Generally, CBT interventions are delivered in groups of eight to 12 young people. MST is a more individualised intervention that involves greater one-to-one contact with the young people who have offended and their families 25. One concern with group-based therapies is contagion (or iatrogenic) effects, one form of which is deviancy training. Deviancy training occurs when contact with delinquent peers in the group setting has an escalating influence on an individual s delinquent behaviour. Any group-based interventions should take into consideration the potential for such effects. Research into these effects remains inconsistent. Some studies report the presence of such effects (see, for example, Cho et al, 2005 and Poulin et al, 2001), while others report no such effects (see Mager, 2004). An extensive review and meta-analysis by Weiss et al (2005) concludes there is little evidence for the presence of these effects in group therapy. Rhule (2005), however, suggests there is enough evidence in favour of these effects that programme designers should take caution when developing and implementing interventions. Rhule also emphasises the importance of effective implementation in minimising these effects. Ensuring group sessions are consistently structured, and children and young people remain engaged in the intervention, may reduce participants opportunities to interact in ways detrimental to their behaviour. 25 As described, MST interventions target the various systems in which a child or young person is embedded, which may influence his/her offending. These systems include the family and peer networks. Therefore, it may be inappropriate to carry out MST in group settings where peers are present or details about the child or young person s family structure are being addressed. It is also important that the child or young person s family is involved in the intervention programme; therefore MST is more effective in an individual or family, rather than a group, setting. It is important for practitioners to recognise that such reasoning underlies the structure of MST interventions so that they implement the intervention effectively and as intended. 50

51 Transitions Custodial versus community implementation MST interventions are implemented in community settings. CBT interventions have proven effective when implemented in both community and custodial settings. However, the guidelines for specific interventions should detail any special considerations that need to be addressed when implementing an intervention in either of these settings. Generally these will involve differences in techniques for tracking participants in non-custodial settings and monitoring their outcomes, as well as different techniques for reducing attrition and ensuring engagement with the intervention. These involve increasing commitment to the intervention, offering rewards for taking part in the intervention, facilitating ease of access to the intervention and increasing communication about, and participants familiarity with, the intervention to maintain their focus on and comfort with the intervention. A recent review reports that treatment setting did not affect treatment outcomes for CBT interventions (Landenberger and Lipsey, 2005). 51

52 Training Ensuring skills and knowledge Because CBT and MST interventions are carefully structured, theoretically grounded on an in-depth understanding of cognition, behaviour and social systems, and require intense involvement of therapists with participants and participants families, it is important that staff delivering these interventions are educated and well-trained in the specific knowledge and skills necessary to implement these interventions. It is also critical that the staff overseeing the implementation of these interventions, and the recruitment of staff to deliver these interventions, have a clear understanding of what is required by, and expected from, the intervention. Research indicates one of the key problems in effectively mainstreaming offenderoriented programmes, such as CBT and MST, is a common lack of sufficient knowledge, skills and training among practitioners (and local managers) to effectively implement and deliver these programmes as intended. 26 There is a great need to develop and promote continuous advanced education and training programmes for strategic partnerships and local managers to ensure the best quality of management for the local selection, implementation and delivery of programmes and interventions for young people who offend. This education should be clearly focused on increasing user competence in the selection, implementation and delivery of programmes and interventions for young.people who offend. Preferably this education should be delivered by high-ranking academic experts in the field of evaluative research, youth crime prevention and crime causation, and should be based on firm empirical evidence. Strategic partnerships in youth justice are well situated to help address this deficiency (perhaps by collaborating with a qualified university department to create targeted and thorough basic and further education for those who work locally as youth justice managers, or for youth justice practitioners who directly deliver offender-oriented treatments for young people). 26 Although it has not been a task for this review to assess whether those working in youth justice generally have adequate skills and training to effectively conduct CBT and MST therapies, it seems reasonable to expect that the general situation in the UK is not very different to what has been found to be the case in studies conducted primarily in the US and Canada. 52

53 Management Based on the evidence regarding what characterises effective practice, those who (strategically and in day-to-day practice) manage crime intervention activities for young people who offend should make sure that: (as far as possible) the programmes and interventions they already routinely administer, or any new programmes and interventions selected for routine implementation and delivery, are only those that have proven effective or promising. Having made sure that the programmes and interventions in routine operation are only those which have demonstrated effectiveness or promise, they should make sure that: there are well-developed procedures in place to ensure that those who deliver the programmes or interventions have adequate and relevant skills, training and supervision programmes and interventions are consistently monitored, and their outcomes continuously assessed, to ensure effective implementation and delivery as intended. What those who work with children and young people who offend do (e.g. what programmes they implement) is more important than how they organise and manage what they do. Only when practitioners know what to do can implementation and delivery be effectively organised and managed. This is particularly important to avoid the pitfalls of mainstreaming, in which programmes and interventions that have proven effective or promising when implemented and delivered in researcher/evaluator-led demonstration projects prove less effective (or ineffective) when mainstreamed. Effective management of the implementation and delivery of a CBT or MST intervention involves effective recruitment and supervision of staff and continuous monitoring and assessment of implementation and delivery techniques and intervention outcomes. Evidence shows that the most effective programmes employ qualified staff, ensure appropriate implementation and delivery, and continuously monitor and assess intervention outcomes. The duties of a programme manager should then be: to ensure the recruitment of adequately-skilled staff with relevant training and experience to work with offender-oriented treatments to ensure that staff are offered, and take part in, specialist training for the kinds of programmes they are expected to deliver (and to ensure that staff understand the theoretical rationale and empirical grounding behind those programmes) to ensure that staff receive adequate supervision to ensure that staff have access to, and adequate training, in necessary standardised assessment tools to ensure there are well-developed procedures to enhance engagement and treatment motivation of children and young people who offend 53

54 to ensure there are well-developed channels of communication between a youth justice agency s own staff and the staff of other relevant agencies and organisations involved with children and young people who offend to ensure there are well-developed procedures to track children and young people who offend who take part in intervention programmes in non-custodial settings to ensure there are adequate procedures in place to monitor the outcomes of programmes for children and young people who offend, in the short and longerterm. 54

55 Service development A central task for youth justice managers and practitioners is to ensure the selection of offender-oriented programmes, and interventions that have proven effective or promising. However, the local youth justice organisation and management structure is complex, and this may make it difficult to ensure the selection and successful implementation and delivery of the most effective or promising programmes. Local youth justice practitioners generally do not have the expertise, or access to the expertise (and time and resources), to continually assess the current evidence regarding different young offender-oriented programmes and their implementation and delivery, or to test experimentally the effectiveness of new interventions techniques. This is a problem that we will not address directly in this source document. However, strategic partnerships may be able to collaborate to ensure that new and promising programmes are rigorously tested, and that the programmes and interventions that filter down into practice fulfil the requirements of having been appropriate evaluated and found to be acceptably promising, relieving practitioners of the responsibility of considering evaluation research themselves. 55

56 Monitoring and evaluation In order to monitor and evaluate the effectiveness of interventions for a target population, it is important to integrate various levels of knowledge about youth offending and the offending of the specific target population. Integration of different levels of knowledge will allow general knowledge to inform specific practice and enhance communication between experts regarding various aspects of offending by children and young people, from academic research to public practice from the national to the local level. The need for this level of knowledge integration should also foster communication between various agencies working with children and young people who offend so that practitioners do not work in isolation, and know who they can contact for specific information. Evidence suggests that the most effective intervention programmes for children and young people s involvement in crime require a consistent approach across all levels of youth justice based on recognising the importance of the overarching recommendations for ensuring and evaluating effective practice, which have formed the core of this document: 1. Only programmes or interventions that have proven effective or promising should be implemented to address youth crime. 2. Those who implement these programmes and interventions must have adequate training and supervision. 3. Programmes and interventions and their outcomes need to be continuously monitored and assessed to ensure they are implemented and delivered effectively. Intervention programmes such as CBT and MST need to be monitored and evaluated as part of a comprehensive and integrated strategy to deal with at-risk children and young people. Different levels of knowledge should be integrated to help ensure the most effective evidence-based interventions for specific local youth justice units. For example, communication between local youth justice partnerships and a centralised accreditation panel (see below) can facilitate integration of knowledge about crime causation and effective evidence-based practice with knowledge about the characteristics of the local population and social environment. This can help to identify the most cost-effective areas to target and identify the intervention programmes that show the most promise for addressing those specific areas. This requires, however, that the local partnership has access to adequate knowledge, analytical skills and data concerning local offenders and the settings in which they take part, and adequate knowledge and analytical skills to integrate this information with information received from other agencies. To facilitate this level of communication between agencies and to ensure its effectiveness, it is important to ensure that: there is efficient communication and collaboration between youth justice and other agencies and organisations who may possess important information about children and young people who offend there are procedures in place to ensure the recruitment of adequately-skilled local youth justice managers 56

57 there are procedures in place to monitor the progress and outcomes of local youth justice prevention activities there are procedures in place to monitor those working in local youth justice (including local youth justice managers) to ensure they receive adequate training and supervision for the types of programmes they deliver (as well as the theory behind these programmes). 57

58 Conclusion The above guidance to youth justice managers and practitioners is firmly grounded on three critical facets of effective intervention. These are: 1. Programmes and interventions that have proven promising or effective through appropriate evaluation procedures (e.g. randomised experimentation and correct interpretation of outcomes) have the greatest potential to provide effective intervention when applied to routine practices (other interventions risk wasting time and resources). 2. Effective implementation and delivery of interventions and programmes requires an understanding of the theoretical basis of the intervention (e.g. what it intends to effect, and how). 3. Effective implementation and delivery is critical to the success of an intervention, and should be carefully structured and continuously monitored and supervised by qualified practitioners to ensure that the programme is doing what it is meant to do. These principles should be at the core of the selection and implementation of any intervention, and will help to provide the best opportunity to derive appreciable results from promising interventions. 58

59 Appendix A: Methodology of the systematic review To collect the 500+ articles that informed this source document, we undertook an extensive search of available literature written and/or published after 2001 by searching a plethora of relevant databases and contacting major figures, institutions and agencies involved in research on young people who offend. The review was initially intended to encompass all offender-oriented interventions for young people undertaken subsequent to the last edition of this document (YJB, 2003); therefore the initial sweep of databases, relevant literature and other data sources was not limited to literature on cognitive behavioural or multi-systemic interventions. Consequently, the large databases (Cambridge Scientific Abstracts (CSA) (covering Applied Social Sciences Index and Abstracts (ASSIA), Criminal Justice Abstracts (CJA), CSA Social Services, CSA Sociological Abstracts and National Criminal Justice Reference Service Abstracts (NCJRSA)); International Bibliography of Social Sciences (IBSS); PsycInfo; PubMed; ScienceDirect (covering MedLine); and SpringerLink) were searched using the following tree, such that all combinations of search terms were employed. youth juvenile young person adolescent child AND offending offender reoffending re-offender custody justice crime delinquent delinquency antisocial conduct disorder AND assessment clinical trial experiment evaluation intervention manipulation non-experimental prevention program programme therapy trial The only search limitations were that references referred to interventions performed with young people who offend or young people at risk of offending between the ages of 10 and 17, published since 2001 (allowing for some overlap with the 2003 document). This derived a total of 37,521 hits, of which 1,929 references were relevant to the systematic review (the breakdown of hits and relevant articles found among the major databases is presented in Table 1 below). Smaller data sources and reference providers (Academy of Experimental Criminology (AEC); Cambridge Journals Online (CJO); Campbell Collaboration (covering C2-Prot, C2-Ripe and C2-Spectr); Centre for Disease Control National Centre for Injury Prevention and Control (CDC-NCIPC); Centre for the Study and Prevention of Violence (covering VioLit and VioPro); Crime and Justice Coordinating Group (CCJG); Cochrance Library; Database of Abstracts and Reviews of Effects (DARE); Economic and Social Research Council (ESRC); European Union (EU); Home Office; NACRO; National Academy of Sciences; National Youth Violence Prevention Resource Centre; PolicyHub; PolicyLibrary (covering Crime Prevention and Legal Policy); RAND Corporation; Society for Prevention Research; Surgeon General; SwetsWise; United Nations Office of Drugs and Crime (UNODC); and the Youth Justice Board (YJB)) were searched manually for relevant references. A total of 1,566 59

60 unique articles were derived from major and minor reference providers, referring to all interventions with young people who offend or are at risk of offending. Of these, 539 were found to be relevant to cognitive, emotional, behavioural or social skills training interventions or systemic (including multi-systemic) therapy. Fourty-one represent systematic reviews (24 specifically pertaining to cognitive behavioural interventions, nine to systemic interventions), 198 represent general reviews (51 specifically pertaining to cognitive behavioural interventions, 39 to systemic interventions) and 300 report intervention findings (195 pertain to cognitive behavioural interventions, 105 to systemic interventions). These 539 references were then gathered for application to the final analysis. Table 1: Hits and relevant references (major databases only) Database Total hits Relevant articles Cambridge Scientific Abstracts (CSA) 10, International Bibliography of Social Sciences (IBSS) PsycInfo 3, PubMed 2, ScienceDirect 18, SpringerLink 1, TOTAL 37,521 1,939 60

61 Appendix B: Beyond the Maryland Scientific Scale Advances in evidence-based research indicate that the Maryland Scale may be improved upon via the collapse of several of its levels, with qualifications, and the introduction of a theoretical dimension, which can bolster the applicability of weaker methodologies. In our view, it is not obvious that using non-randomised experiment and control groups as a basis for establishing an effect is always better than just having a straightforward before-and-after intervention measure (which in itself is not very strong evidence). Bloom (2006:25) stresses that large biases can arise from using non-experimental comparison groups. Therefore, we do not believe that the scientific rigour of Levels 2 and 3 is necessarily very different as they are defined in the Maryland Scale. In fact, we believe that one can make a sound argument that it is better to differentiate before-and-after intervention studies according to whether they test an intervention based on (empirically grounded) strong theory, rather than whether or not they include non-experimental comparison groups. To take a somewhat extreme example, it is probably not necessary when testing the effectiveness of a protection vest (intervention) in preventing fatalities from gun shots that one need demonstrate that if people are shot in the chest by a gun without wearing a protection vest (control group), they are likely to be seriously injured or die. It is probably sufficient to show that wearing the protection vest (experiment group) actually can stop the bullet from a gun and prevent people from getting seriously injured or dying. However, it is rare that we have that strong a theory in the area of crime causation (i.e. that we know for certain that a cause will always produce a particular effect if we do not intervene). When we talk about strong theory, we mean a theory based on: well-established empirical associations the identification of a plausible process (mechanism) that links the cause to the effect a demonstration that the intervention in question is likely either to remove and suppress the cause or interfere or alter the causal process. One may even question if Level 4 as defined in the Maryland Scale is very different in scientific rigour from Levels 2 and 3. One criterion for a Level 4 inclusion is that there are multiple experiment and control units, but one may argue that the number of units does not in itself solve the problem of having non-randomised experiment and control groups. Another important criterion at Level 4 is that we know all other causes of crime that may influence differences in outcome between the control and experimental groups so that we can statistically control for their influence, which seems to be a highly unrealistic assumption (because it would not only require that we have correctly identified all important causes but also that we are able to measure, and have access to measures of, all these other causes for our statistical analyses). An alternative, and in our opinion better, way to clearly define Level 4 evaluations is to focus the criteria of inclusion on whether or not those subjected to the interventions and their controls have been properly matched. For example, efforts have been made to develop statistical approaches that help to approximate the scientific experiment more 61

62 closely, such as propensity score matching (see, for example, Winship and Morgan, 1999). Somewhat simplified, the basic idea behind propensity score matching is to create a single measure (propensity score) that summarises the subjects on as many (pretreatment) characteristics as possible (according to the maxim the more the better ), and then match according to their propensity score, case-by-case, as closely as possible subjects who did receive the treatment 27 with subjects who did not. On this basis, groups of subjects with similar propensity scores can be created, each group including those who have, and have not, received a treatment. 28 The difference in the outcome between those with similar propensity scores who received a treatment and those who did not can then be compared, taking into consideration ( controlling for ) the factors that may have been responsible for them being allocated to treatment or not (i.e. approximating randomisation). However, to be effective this method requires a large enough sample and that all important confounding factors have been included when calculating the propensity score. As Rubin (1997:763) points out, it always must be remembered that propensity scores only adjust for the observed covariates that went into their estimation. Allowing for the importance of strong theory, we suggest that the following ranking of scientific methods in evaluation: Table 2: Ranking of scientific methods in evaluation Strong theory Design No Yes Testimonials Before and after measures - * + Experimental design - * + Randomised/matched comparison groups ** ** -- No evidence; - weak evidence; * some evidence; ** strong evidence What the table suggests is that, ideally, testimonials should never be considered evidence, regardless of whether or not a programme/intervention is based on strong theory. Findings based on before-and-after designs (with or without non-randomised comparisons groups) should be considered evidence only if the intervention is based on strong theory. Findings based on randomised and properly matched comparison groups should be considered strong evidence (even when there is no strong theory). In other words, we claim that testimonials should never be considered evidence, and that the role of strong theory is particularly important when considering whether weaker designs (i.e. before-and-after measures without randomised comparison groups) should be counted as evidence or not. 27 A treatment can be anything the investigator assumes has a causal influence on the effect considered. For example, one might compare future crime involvement to whether or not a person received a prison sentence for a current crime. 28 The method requires that there are enough subjects in each propensity score group who have and have not received treatment to make valid comparisons of the treatment effect. If this is not the case, the method is not feasible. 62

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