Opportunities and Challenges of EvidenceBased Interventions for Juveniles

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Opportunities and Challenges of Evidence-Based
Interventions for Juveniles

• Peter Greenwood
• Lilas Rajaee-Moore
• Moderator Dr. Robert Kinscherff

Smart Responses in Tough Times Achieving Better
Outcomes for People with Mental Illnesses
Involved in the Criminal Justice System July
15-17, 2009
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Evidence-Based Delinquency Prevention

• Reducing crime, costs recidivism rates
• Peter Greenwood
• Peter.greenwood_at_sbcglobal.net
• www.aaebp.org

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The Malibu Creek Institute
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Evidence-Based Practice

• Uses scientific principles to
• assess the available data
• regarding program effectiveness,
• and
• develop principles for best practice
• in any particular field

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Evidence-Based Programs

• Have proven their effectiveness
• Cover full range of child development
• Can pay for themselves, many times over,
  primarily in reduced corrections costs

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An Important Qualification

• They only work when implemented with a high
  degree of fidelity
• All require substantial training, ongoing quality
  assurance monitoring.

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How does a program get to be considered proven
or promising

• Evaluation (of sufficient rigor)
• Lasting effects on targeted outcomes
• Replication of effects in other sites

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How proven strategies are identified
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What Works

• Functional Family Therapy (FFT)
• Multi-systemic Therapy (MST)
• Treatment Foster Care (TFC)
• Nurse-Family Partnerships (NFP)
• Aggression Replacement Training (ART)
• Life Skills Training (LST)
• Quality Assurance (QA)

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What Doesnt Work

• Punishment
• Waiver to Adult Court
• D.A.R.E
• Scared Straight
• Standard probation supervision
• Intensive supervision

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Are all copies of proven programs equally
effective?

• Inappropriate
• Setting
• Kids
• Staff
• Inadequate
• Funding
• Training
• TA
• QA

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Obstacles to be overcome

• Politicians like to be tough and punishment
  sounds tough treatment soft
• Most funding streams are already earmarked or
  otherwise claimed by some existing program
• Prevention costs are local, savings accrue to
  state
• Implementation sounds easy is really hard

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Some who are well on their way

• State of Washington
• Florida Dept of Juv Justice
• Arizona Administrative Office of the Courts
• PA Juvenile Court Judges
• PA Department of Children Families
• State of Maryland Childrens Cabinet
• Orange County (CA) Probation Department
• CA Governors Office of Youth Gang Violence
• US Dept of Justice

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Evidence-Based Public Policy Options To Reduce
Future Prison Construction, Criminal Justice
Costs, and Crime Rates Washington Senate Ways
Means Committee January 24, 2007
Steve Aos Associate Director Washington State
Institute for Public Policy Phone (360)
586-2740 E-mail saos_at_wsipp.wa.gov Institute
Publications www.wsipp.wa.gov
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Fighting Crime Pinching Pennies Picking em,
Passing em, and Doing em Evidence-Based
Progress Report from Washington State on
Improving Public Outcomes Turning the Page
Conference Marina Del Rey, California April 16,
2009
Steve Aos Assistant Director Washington State
Institute for Public Policy Phone (360)
586-2740 E-mail saos_at_wsipp.wa.gov Institute
Publications www.wsipp.wa.gov
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• Washington Legislature has directed WSIPP to
  examine evidence-based options affecting several
  outcomes
• Crime (1994, 1999, 2003, 2005),
• Education, Early Ed. (2003, 2006, 2007),
• Child Abuse Neglect (2003, 2007),
• Substance Abuse (2003, 2005),
• Mental Health (2005)
• Developmental Disabilities (2008)

• Washingtons Evolving Recipe
• What to Fund or Cut? 4 Tests
• Evidence (for outcomes)?
• Economics?
• Repeat with Fidelity?
• Politics?
• Analytical Framework
• Non-Partisan Institute
• ROI (Consumer Reports)
• Meta-analysis when possible
• Internally-consistent model
• Portfolio level (big picture)
• 5 Implementation Topics
• Formal Assessment Tools
• Quality/Fidelity Systems
• State EB List Local Selection
• RD Percent, with Evaluation
• Outcome Tracking System

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Adult Prison Incarceration Rates


1930 to 2005
Incarceration Rate
12
11
10

9

8
7
6
5
4
3
2

1
0
1930

1940

1950

1960

1970

1980

1990

2000

2010

2020
The incarceration rate is defined as the number
of inmates in state prisons per 1,000 18- to
49-year-olds in Washington or the United States.
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Two Big Picture Outcome Measures Relevant to WA
Policymakers Crime Rates and Taxpayer Costs 1980
to 2007
In 1980, taxpayers spent 557 per household on
the criminal justice system. Today they
spend 1,223, a 120 increase.
In 2007, crime rates were 39 lower than they
were in 1980.
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Results for Three Example Portfolios of
Evidence-Based Options
30,000
CFC prison forecast and WSIPP extension
28,000
Forecast with Current Level Portfolio
Forecast with Moderate Implementation Portfolio
Forecast with Aggressive Implementation Portfolio
26,000
24,000
22,000
20,000
18,000
Existing Prison Supply
Existing Prison Supply
Rented Jail Beds
Rented Jail Beds
16,000
Current Level
Aggressive
Moderate
Taxpayer Summary Statistics
Annual cost of portfolio
41 million
63 million
85 million
Long-run benefits minus costs
1.1 billion
1.7 billion
2.4 billion
Benefit-to-cost ratio
2.45
2.55
2.60
Return on investment
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27
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6 of 7
Crime Rate in 2020 (2005 rate 52)
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Our Main Finding
If Washington decides to modify and expand its
current portfolio of evidence-based options,
including, adult corrections programs juvenile
corrections programs, and prevention programs,
then significant levels of prison construction
can be avoided, taxpayers can save money, and
crime rates can be reduced.
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Evidence-Based Programs, Crime Outcomes
Expected Change In Crime ( of EB Studies)
Benefits minus Costs (per-person, life cycle)
Selected Results
Adult Offenders
Cog-Behavioral Treatment -6.3 (25) 10,299
Education Prms., Prison -7.0 (17) 10,669
Drug Tx in Prison (TC or out-patient) -5.7
(20) 7,835
Adult Drug Courts -8.0 (57) 4,767
ISP surveillance -0.0 (23) -3,747
ISP treatment -17.1 (11) 11,563
Juvenile Offenders
Functional Family Thpy. -15.9 (7) 31,821
Family Int. Transitions -13.0 (1) 40,545
Aggression Repl. Trng. -7.3 (4) 14,660
Restorative Justice (low risk) -8.7 (21) 7,067
Prevention
Pre-School (low income) -14.2 (8) 12,196
Nurse Family Partnership -36.3 (2) 27,105
Electronic Monitoring -0.0 (9) 870
Some Things Work, Some DontBe a Smart Investor!
Why Focus on Juveniles? 73 of Adults in
Washingtons Prisons have been in Washingtons
Juvenile Justice System
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Thank You!
Mount Rainier
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CA Prevention Program Rating Scale

• Preferred Proven cost effective
• Proven BP model or meta-analysis
• Promising BP promising
• Unproven Not enough evidence
• Proven Proof to promising standard
• ineffective that program has no positive
• effects.

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CPPRS
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CPPRS
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For further information

• Association for the Advancement of Evidence-Based
  Practice (www.aaebp.org)
• Blueprints for Violence Prevention
• WSIPP at (www.wsipp.org)
• Changing Lives Delinquency Prevention as Crime
  Control Policy
• by Peter Greenwood, University of Chicago Press
  (2006)
• Prevention and Intervention Programs for Juvenile
  Offenders The Benefits of Evidence-Based
  Practice
• by Peter Greenwood, published in The Future of
  Children vol 18, no. 2 Fall 2008

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Organizational Change and Implementation of
Evidence-Based PracticesRobert Kinscherff, PhD.
Esq.Senior AssociateNational Center for Mental
Health and Juvenile Justice
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Stages of Change

• Precontemplation
• Not considering change, see no problem/opportunity
  
• Contemplation
• Considering change but often ambivalent
• Preparation
• Preparation for change but not actively changing
  yet
• Action
• Maintenance

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Like Human Beings, Organizations Experience and
Transition Through Stages of Change

• Pre-contemplation
• Not considering change, see no problem/opportunity
  
• Contemplation
• Considering change but often ambivalent
• Preparation
• Preparation for change but not yet actively
  changing

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Stages of Change

• Action
• In process of actively changing
• Maintenance
• Change has occurred and focus is on work to
  maintain the achievements of change and the
  changes in thinking and action associated with
  change

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Potential Barriers to Change

• System Structures
• Barriers associated with inadequate or
  unauthorized resources, system fragmentation or
  conflict, communication problems

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Potential Barriers to Change

• Policy Makers
• Decisions by policy-makers that fail to support
  changes that may challenge established
  orthodoxies of policy, procedures and practices
  (including dissemination of evidence-based
  practices)

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Potential Barriers to Change

• Research Community
• Difficulties for practitioner community in
  accessing, appreciating, and applying research
  findings to clinical practice
• Detachment of intervention researchers from the
  real world of persons receiving clinical
  services and the constraints experienced by
  clinical practitioners

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Potential Barriers to Change

• Agency Leadership
• Lack of support for changes that may challenge
  current policies, practices and procedures
• Concerns about lack of support from sources of
  fiscal support
• Concerns about costs associated with change
• Degree of personal and career investment in
  status quo

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Assessing Agency Change Readiness

• Research in Human Services organizations
  correlates positive and active leadership with
• More positive organizational climate
• Positive strength of clinician and client
  alliance
• Higher client satisfaction with services
• Higher levels of organizational commitment

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Leadership Styles and Change Readiness

• Transformational Leadership Style
• Charismatic and visionary
• High capacity to motive, inspire
• Most effective in close interpersonal interaction
• Supports motivation, not necessarily meeting
  specific goals
• Transactional Leadership Style
• Works through rewarding specific actions
• Pragmatically focuses on goals, objectives
• Timely recognition of specific goal achievement
• Supports goal achievement, not necessarily
  innovation

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Leadership Styles and Adopting Evidence-Based MH
Practices (G Aarons, 2006)

• Transformational Leadership Style
• Supports adoption of EBP in clinical settings
• Engenders attitudes of openness to change
• But linked to lower appreciation by subordinates
  of actual divergence between current practice and
  EBP approaches
• Transactional Leadership Style
• Also supports adoption of EBP in clinical
  settings
• Relies on specific reinforcement of change in
  subordinates
• But requires awareness of, attention to actual
  practices

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Potential Barriers to Change

• Agency Staff
• Resistance arising from factors including lack
  of understanding of the changes or the need for
  change lack of specific motivations or
  incentives for change concern about potential
  shifts in status, role or payment fear of
  failure
• Note Role of Official and Indigenous
  Opinion Leaders Among Staff

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Common Themes of Staff Concern (Nelson, et al,
2006)

• Characteristics of EBP approaches
• EPB interventions too long in duration to
  implement in community practice
• EPB requires specialized competence in the
  modality used
• Skepticism that EPB approaches can be applied to
  their clinical populations
• Preferences for the familiar (even if not backed
  by research) and anecdotal confidence in
  familiar interventions due to natural course of
  disorders

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Common Themes of Staff Concern (Nelson, et al,
2006)

• Characteristics of Practitioners and Settings
• EPB too difficult to learn when have heavy
  caseloads
• Lack access to training and supervision to learn
  an EBP approach, reliance upon workshop
  trainings without implementation follow-up
• Perceptions of funding obstacles if attempted to
  implement EBP in clinical care

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Common Themes of Staff Concern (Nelson, et al,
2006)

• Characteristics of Clients
• EPB not validated for clients with multiple
  challenges and stressors
• Client resistance to EBPs, esp. when perceived as
  being driven by manuals
• Client resistance to tasks required by EBP
  approaches
• Inconsistency of client attendance for treatment,
  therefore hard to do sequenced treatments

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Potential Barriers to Change

• Agency Clients
• Concerns arising from re-definition of targets
  for intervention (My family is not the problem,
  this kid is the problem), re-definition of what
  may be required for success (I dont need to
  change, my kid does), or greater flexibility
  around the boundaries or privacy of treatment

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Common Themes and Staff Concerns (Nelson et al,
2006)

• Staff More Accepting of EBP If
• EPB viewed as flexible, capable of adapting to
  client characteristics, urgent needs
• EBP is easier to learn and implement
• EPB allows for attention to treatment alliance
• Access to training, supervision, consultation
• Builds on clinical skills rather than seeming to
  marginalize them

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Addressing Resistance to Change

• Acknowledge that change is stressful
• Articulate clearly the need for change and the
  vision for the change
• Be alert for resistance in many forms at all
  levels of the organization
• Appreciate that persons and organizations change
  at different paces

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Addressing Resistance to Change

• Directly and patiently address resistance
• Discuss pros and cons of change openly
• Ally with key opinion leaders
• Provide clear incentives and rewards for change
• Involve as many persons as possible from the
  start of the process of considering changes

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Addressing Resistance to Change

• Creatively create and rely upon communication and
  coalition with other organizations or systems
  whose cooperation is essential for change
• Keep goals realistic and sensitive to timing of
  change processes
• Show that feedback does shape the process
• Do not wait until there is complete buy-in by all
  parties, and celebrate early and key change
  victories

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Assessing Agency Change Readiness

• Size, organizational structure of agency
• Mission of the agency
• Kinds of services provided to clients
• Staff composition and structure
• Educational and experience level of staff
• Cultural make-up of the staff
• Characteristics of client population

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Assessing Agency Change Readiness

• What is motivating the sense the change is
  needed? At what stage of change is the agency?
• What are key organizational resources or supports
  that can facilitate the changes desired?
• What are key barriers that can undermine change?
• What would this change mean at all levels of the
  agency, collateral systems, and the clients?

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Assessing Agency Change Readiness

• What incentives exist or can be put into place to
  support the desired change?
• What concerns from persons at all points in the
  organization will need to be addressed?
• What would adoption of change mean for the
  agency? Staff? Clients? Collateral systems?
• What is already occurring that might lay the
  foundation for the desired change?

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Evidence-Based Practices on the Ground A
Grantee PerspectiveLilas Rajaee-MooreProject
Director SOAR ProjectDenver, Colorado (2008
JMHCP Grantee)
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Thank you

• For further information conference
  presentations
• please visit
• www.consensusproject.org

This material was developed by presenters for the
July 2009 event Smart Responses in Tough Times
Achieving Better Outcomes for People with Mental
Illnesses Involved in the Criminal Justice
System. Presentations are not externally
reviewed for form or content and as such, the
statements within reflect the views of the
authors and should not be considered the official
position of the Bureau of Justice Assistance,
Justice Center, the members of the Council of
State Governments, or funding agencies supporting
the work.