Achievement Place: experiments in self-government with pre-delinquents

One of the goals of many treatment programs for pre-delinquent youths is the development of the skills involved in the democratic decision-making process. At Achievement Place, one aspect of the treatment program is a semi-self-government system whereby the seven pre-delinquent youths can democratically establish many of their own rules of behavior, monitor their peers' behavior to detect violations of their rules, and conduct a "trial" to determine a rule violator's guilt or innocence, and to determine the consequences for a youth who violates a rule. Two experiments were carried out to determine the role of some of the procedures in the boys' participation in the self-government system. Experiment I showed that more boys participated in the discussion of consequences for a rule violation when they had complete responsibility for setting the consequence during the trials than when the teaching-parents set the consequence for each rule violation before the trial. An analysis of the rule violations in this experiment indicated that the boys in Achievement Place reported more of the rule violations that resulted in trials than reported by the teaching-parents or school personnel. The boys reported rule violations that occurred in the community and school as well as at Achievement Place, including most of the serious rule violations that came to the attention of the teaching-parents. In Experiment II, the results indicated that more trials were called when the teaching-parents were responsible for calling trials on rule violations reported by the peers than when the boys were responsible for calling trials. When the youths earned points for calling trials the average number of trials per day increased, but more trivial rule violations were reported. These results suggest that aspects of the democratic decision-making process in a small group of pre-delinquents can be studied and variables that affect participation can be identified and evaluated.     

Achievement Place: development of the elected manager system

A series of experiments was carried out to compare several administrative systems at Achievement Place, a family style behavior modification program for pre-delinquent boys. One aspect of the motivation system at Achievement Place was the token economy in which the youths could earn or lose points that could be exchanged for privileges. Several arrangements for assigning routine tasks and for providing token consequences for task performance were compared for their effectiveness in accomplishing the tasks and for their preference by the boys. The independent variables studied included: (1) individually assigned tasks versus group assigned tasks; (2) consequences for individual performance versus consequences for group performance; (3) a peer managership that could be earned by the highest bidder versus a peer managership that could be determined democratically by the peers. The results suggested that among those systems studied the system that best met the criteria of effectiveness and preference involved a democratically elected peer manager who had the authority both to give and to take away points for his peers' performances.     

Client-level predictors of adherence to MST in community service settings

This study examined the association of youth and family characteristics with therapist fidelity to an evidence-based treatment provided in real world practice settings. Participants were 233 families that reported on the 66 therapists organized into 16 teams in nine organizations providing multisystemic therapy (MST). Therapist adherence ratings were lower for youths referred for both criminal offenses and substance abuse than for youths referred either for substance abuse or status offenses, and was negatively associated with pretreatment arrests and school suspensions. Adherence ratings were positively associated with educational disadvantage and caregiver-therapist ethnic match and marginally positively associated with economic disadvantage. The findings suggest directions for future research on the implementation of evidence-based treatments in community settings.     

A Comparison of Behavioral Parent Training Programs for Fathers of Children With Attention-Deficit/Hyperactivity Disorder

Few behavioral parent training (BPT) treatment studies for attention-deficit/hyperactivity disorder (ADHD) have included and measured outcomes with fathers. In this study, fathers were randomly assigned to attend a standard BPT program or the Coaching Our Acting-Out Children: Heightening Essential Skills (COACHES) program. The COACHES program included BPT plus sports skills training for the children and parent-child interactions in the context of a soccer game. Groups did not differ at baseline, and father ratings of treatment outcome indicated improvement at posttreatment for both groups on measures of child behavior. There was no significant difference between groups on ADHD-related measures of child outcome. However, at posttreatment, fathers who participated in the COACHES program rated children as more improved, and they were significantly more engaged in the treatment process (e.g., greater attendance and arrival on time at sessions, more homework completion, greater consumer satisfaction). The implications for these findings and father-related treatment efforts are discussed.     

The relationship between parent-youth interaction and delinquency in group homes

Interactions between the youths and group home parents in 10 group homes were directly observed during a 2-hour session in each home. These observations were compared to questionnaire measures of the youths' self-reported delinquency while in the group home, and their evaluation of the group home program. The results indicated that over the 10 homes there was a strong inverse correlation between mean self-reported delinquency and the average amount of time youths spent taking to (r _s =–.95)and in proximity to (r _s =–.81)their group home parents. Talking to group home parents also showed a positive correlation with the youths' evaluation of their group home program. Similar trends were found when the correlations were computed over individual youths, although the magnitudes were reduced. These data may have implications for our understanding of the relationship between parenting behaviors and delinquency, as well as for the improvement of group-home treatment programs.This research was supported by Grant MH20030 and by a postdoctoral research fellowship (Grant MH15200, awarded to the first author) from the National Institute of Mental Health (Center for Studies in Crime and Delinquency). These grants were made to the Bureau of Child Research and the Department of Human Development, University of Kansas. The authors wish to thank Susan Whitely for her statistical consultation, and Jay Atwater, Carol Cramer, and Lynette Forbes for their help in the data analysis. Appreciation is also extended to the many teaching-parents whose cooperation made the research possible.     

Reductions in criminality subsequent to group, individual, and family therapy in adolescent residential and day treatment settings.

The complete population of adolescents in a residential and day-treatment program over a 4-year period, 532 youths, served in two studies. Along with residential and day-treatment settings, predictive variables of interest were the number of hours spent in group, individual, and family therapy. A total of 227 adolescents qualified for Study 1 which found a reduction of rates of criminal charges from pre- to posttreatment. Study 1 also found that hours in group therapy explained the most variance in the reduction in rates of criminal charges, followed closely by hours in individual therapy. Hours in family therapy was not a significant predictor. A total of 430 adolescents qualified for Study 2, which found that residential treatment was associated with greater reductions in adult correctional commitments than day treatment. Implications stress the need for further research examining the relationships between therapeutic components of residential treatment and behavioral outcomes.     

The Treatment of Hard-Core Voluntary Drug Addict Patients

The complete population of adolescents in a residential and day-treatment program over a 4-year period, 532 youths, served in two studies. Along with residential and day-treatment settings, predictive variables of interest were the number of hours spent in group, individual, and family therapy. A total of 227 adolescents qualified for Study 1 which found a reduction of rates of criminal charges from pre- to posttreatment. Study 1 also found that hours in group therapy explained the most variance in the reduction in rates of criminal charges, followed closely by hours in individual therapy. Hours in family therapy was not a significant predictor. A total of 430 adolescents qualified for Study 2, which found that residential treatment was associated with greater reductions in adult correctional commitments than day treatment. Implications stress the need for further research examining the relationships between therapeutic components of residential treatment and behavioral outcomes.     

Women accused of sexual offenses

Few studies exist on female sexual offenders or women accused of sexual offenses. In some instances, conclusions from existing studies conflict. In an effort to better understand the phenomenon of sexual abuse by females, we gathered data on all women charged with a sexual offense referred to our facility (William S. Hall Psychiatric Institute in Columbia, South Carolina) for a criminal responsibility/competence to stand trial evaluation from 1987 to 1997. Alleged sexual offenses included criminal sexual conduct one, two, and three and performing a lewd act upon a minor. Fifteen women were referred. This study examines characteristics of the accused women and their victims. Patterns of the alleged offenses and outcome of forensic evaluation are also examined. We found women accused of committing sexual offenses to have a high likelihood of past sexual and physical victimization as well as ongoing physical victimization. Borderline intellectual function and mental retardation were common and women acted frequently with co-defendants. The victims knew the perpetrator in every instance.     

A Clinical Trial of In-Home CBT for Depressed Mothers in Home Visitation

Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3 months postpartum were randomized into IH-CBT and ongoing home visitation (n = 47) or standard home visitation (SHV; n = 46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs.     

Helping Police Officers to Cope with Stress: A Cognitive—Behavioral Approach

Police Academy trainees participated in a stress management program which focused on developing skills for coping with anxiety and anger. Stress management training took place in six 2-hour sessions and included instruction and practice in the self-monitoring of reactions to stressful situations, muscular relaxation, and the development of adaptive self-statements. Self-report measures of anxiety and anger were obtained before and after the stress management program. In addition, self and observer ratings of trainees' performance in stressful simulated police activities were utilized as posttreatment dependent measures. In comparison to a control group of trainees, the performance of the treatment group was rated, by academy personnel, as superior in several of the simulated police activities. The results of the present study suggest that stress management with law enforcement officers may be most effective when the program focuses on the specific situations which are likely to be encountered by trainees. Limitations of the present program are examined and suggestions for future efforts with law enforcement personnel are discussed.     

CREATING NEW REALITIES: PROGRAM DEVELOPMENT AND DISSEMINATION

Program development and dissemination in human services present challenges and opportunities for social scientists. Over the past 27 years the Teaching-Family Model of group home treatment has moved from prototype development to widespread dissemination across North America. Reviewing concepts in industry related to product development and dissemination, the application of these concepts to a human services delivery system, and program replication and dissemination data offer information about how innovative human services can be widely adapted and adopted.     

A Comparison of Computer-Assisted Psychotherapy and Cognitive-Behavioral Therapy in Groups

This study is the first independent, randomized controlled study in a clinical setting of a computer-assisted therapy program (Therapeutic Learning Program; TLP) developed to permit individualized therapy in a group setting. This software differs from other computer-assisted approaches in that targets for change are chosen by the patient rather than determined by the software. TLP was compared to a standard cognitive-behavioral treatment in 109 patients with 6-month follow-up. Although both treatments were associated with a significant reduction in symptoms of anxiety and depression at posttreatment and follow-up, no differences were found between treatments with respect to patient-rated satisfaction and effectiveness, clinician ratings of improvement, and scores on measures of anxiety and depression. At treatment midpoint patients tended to give more neutral ratings of satisfaction and treatment effectiveness of the TLP treatment, perhaps suspending judgment about this more novel treatment until its completion. It is concluded that at least one form of computer-assisted psychotherapy is as effective and acceptable to patients in a clinical setting as standard short-term cognitive-behavioral therapy conducted by experienced clinicians.     

The impact of mental health court: A Sacramento case study

Mental health courts (MHCs) use a collaborative justice approach to provide a therapeutic alternative to the traditional justice process for defendants with mental illnesses directly relevant to their alleged criminal offenses. MHCs have proliferated in recent years, in light of early research reports documenting their successes. The aim of this paper is to provide further evaluation of the effects of MHCs by evaluating the impact of the Sacramento County MHC in California. We analyzed quantitative data and conducted interviews with stakeholders and MHC participants to understand how the MHC influenced individual participants' recidivism rates, mental health, and quality of life. Results from the quantitative data analysis indicate that defendants had a lower rate of recidivism after the MHC program than before it. Moreover, graduates were less likely to be rearrested and rehospitalized than non‐graduates. Qualitative analyses revealed several core themes regarding participants' views on facilitators and barriers related to the MHC's success. These findings provide further insights into the effectiveness of MHCs.     

An outcome evaluation of Functional Family Therapy for court‐involved youth

This article presents results of a study on the effectiveness of Functional Family Therapy (FFT), a family intervention designed to prevent delinquency. The sample includes 155 court‐involved youth. This study employs two complementary outcomes: court‐obtained data on recidivism and the clinical data on clients’ psychosocial functioning, the Strengths and Needs Assessment (SNA). Adolescents in the treatment and in the comparison groups experienced statistically significant improvements on the majority of the SNA domains. Although youths in the treatment group improved more, the differences between the groups were not statistically significant. Multivariate analysis showed that youths in FFT had significantly lower odds of recidivism as measured by reconvictions for drug offenses, property offenses and technical violations. The results suggest that FFT was effective in reducing recidivism, however, such reductions cannot be attributed to improvements in the SNA scores.     

Attention Training as a Low-Intensity Treatment for Concerning Anxiety in Clinic-Referred Youth

Although youth anxiety treatment research has focused largely on severe and impairing anxiety levels, even milder anxiety levels, including levels that do not meet full criteria for a diagnosis, can be impairing and cause for concern. There is a need to develop and test viable treatments for these concerning anxiety levels to improve functioning and reduce distress. We present findings from a randomized controlled efficacy trial of attention bias modification treatment (ABMT) and attention control training (ACT) for youths with concerning anxiety levels. Fifty-three clinic-referred youths (29 boys, M age = 9.3 years, SD age = 2.6) were randomized to either ABMT or ACT. ABMT and ACT consisted of attention-training trials in a dot-probe task presenting angry and neutral faces; probes appeared in the location of neutral faces in 100% of ABMT trials and 50% of ACT trials. Independent evaluators provided youth anxiety severity ratings; youths and parents provided youth anxiety severity and global impairment ratings; and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and 2-month follow-up. In both arms, anxiety severity and global impairment were significantly reduced at posttreatment and follow-up. At follow-up, anxiety severity and global impairment were significantly lower in ACT compared with ABMT. Attention control, but not attention bias to threat, was significantly improved at follow-up in both arms. Changes in attention control and attention focusing were significantly associated with changes in anxiety severity. Findings support the viability of attention training as a low-intensity treatment for youths with concerning anxiety levels, including levels that do not meet full criteria for a diagnosis. Superior anxiety reduction effects in ACT highlight the critical need for mechanistic research on attention training in this population.     

A longitudinal evaluation of prevalent negative beliefs about residential placement for troubled adolescents

To investigate the validity of five prevalent negative beliefs about residential placement, we followed adolescents from a residential program and a comparison group at 3-month intervals for 4 to 8 years. This residential program in the Midwest uses the Teaching-Family Model in which six to eight adolescents live in a family-style environment. The interviews included five scales reflecting youths' views about important aspects of their lives in placement: (1) Delivery of Helpful Treatment, (2) Satisfaction with Supervising Adults, (3) Isolation from Family, (4) Isolation from Friends, and (5) Sense of Personal Control. Hierarchical linear modeling allowed us to estimate group differences while controlling for developmental trends, demographic factors, and prior differences between groups. The two groups were equivalent on all scales before the study. During the following placement, however, the treatment group's ratings were significantly more positive than the comparison group on four of the five scales and approached significance on the fifth. These findings suggest that negative beliefs about life in residential placement for adolescents may not apply to all programs.The authors acknowledge Gaylon Oswalt, Beth Chmelka, and Brian Noss for their assistance on this study and Richard Dangel, Thomas Dows, Robert Hawkins, Kathleen Lenerz, Kevin Moore, James Whittaker, and Montrose Wolf for helpful comments on this paper.     

Preliminary Evaluation of Sleepwise Program for Children With Sleep Disturbance and Developmental Delay

Sleep disturbances are very prevalent in children with developmental delay. Parental-assisted behavioral strategies have been used effectively in school-aged children; however, multimodal treatment for preschool-aged children is lacking. The current study is a preliminary investigation of the effectiveness of a parent group program called Sleepwise designed for young children with developmental delay and incorporating behavioral, communicative, and sensory strategies. Six parents attended three workshop sessions and implemented individualized treatment plans. Initial results revealed significant posttreatment reductions in child sleep disturbances and behavioral problems, with high treatment acceptability ratings by parents. Outcomes were generally maintained at 1-month follow-up.     

SOCIAL SKILLS TRAINING WITH CHILDREN: PROCEED WITH CAUTION

Three learning disabled children, selected on the basis of peer sociometric ratings and teacher referral, received social skills training. A group training procedure consisting of coaching, modeling, behavior rehearsal, and feedback was used to teach children the target behaviors of eye contact and appropriate verbal responses. A multiple baseline analysis across target behaviors was used to demonstrate treatment effectiveness on role-play scenes trained during treatment sessions. Duration of speech was measured as an untrained, corollary measure. The following measures were also obtained during baseline, posttreatment, and 1-mo follow-up for the experimental subjects and three control subjects: (a) performance on role-play scenes not trained during treatment sessions; (b) behavioral observations in a free play setting, and (c) sociometric ratings. In addition, the trained and untrained role-play scenes were administered by novel experimenters following treatment. The results indicated that socially unskilled, learning disabled children can be taught to respond appropriately to role-play situations. However, improved performance did not generalize to the natural school setting and treatment did not effect ratings of peer acceptance. The implications of these findings for future social skills training with children are discussed.     

ANALYSIS OF A SIMPLIFIED TREATMENT FOR STUTTERING IN CHILDREN

We investigated the effectiveness of a simplified program for the treatment of stuttering in children. The simplified treatment included awareness training, in which the subjects learned to detect every occurrence of stuttering; training a response incompatible with stuttering, which involved relaxation and regulation of air flow over the larynx when speaking; and social support, which involved parent-delivered prompts and praise of children's use of the techniques in everyday environments. Eight children were treated in their homes with the simplified treatment, in a multiple baseline across subjects design, and all reached the criterion level of less than 3% words stuttered. In addition, the reduction in stuttering generalized to the school setting and was maintained at posttreatment (10 to 13 months). The subjects' rates of speech remained stable throughout baseline and treatment. Pretreatment and posttreatment ratings by the parents showed that they found treatment to be both acceptable and credible. Finally, social validity measures revealed a noticeable improvement in the subjects' speech to parents and speech pathologists.     

Relation of scores on the Open Middle Test to self-control and academic achievement of inner-city fourth-grade children

The construct validity of the Open Middle Test, a measure of children's social problem-solving ability, was investigated by assessing its relationship to self-control (Self-control Rating Scale) and academic achievement (Wide-Range Achievement Test). Subjects were 113 minority fourth graders from two urban parochial schools. A significant correlation was obtained between Open Middle Test effectiveness scores of first responses and WRAT Reading scores. No other correlations were significant. However, mean differences were significant for Open Middle Test effectiveness ratings of first responses and chosen responses, suggesting possible deficits in the evaluation of self-generated problem solutions. Implications of the results for training programs and for the use of the Open Middle Test as an outcome measure are discussed.