Multisystemic TherapyBy Steve
Interventions for First-Time Juvenile Offenders in Central and Northwestern Oklahoma
Erin Andrews and Steve Weber
University of Oklahoma
Juvenile delinquency in Oklahoma is a problem that negatively affects the offenders, their victims, and society as a whole. Besides the emotional and family aspects, the monetary costs for dealing with juvenile delinquency are staggering. The use of effective EBP therapeutic interventions could reduce the number of repeat juvenile offenders in Oklahoma. Although much attention is placed upon providing interventions to first-time juvenile offenders, there are questions as to whether Oklahoma is using the best available interventions. Multisystemic Therapy (MST) is an evidence-based program (EBP) utilizing multiple therapeutic methods collectively addressing change at all three sociological levels (i.e. micro, mezzo, and macro) to reduce delinquent behavior in juveniles. Analysis of the agencies in central and northern Oklahoma providing services to first-time juvenile offenders resulted in a discovery that none of the agencies are delivering an EBP backed by empirical evidence of there effectiveness with juvenile offenders. Lastly, a comparison of the commonly used services in Oklahoma to MST results in a recommendation for the utilization of MST in Oklahoma.
Key Words: Juvenile delinquency, first-time juvenile offenders, Evidence-based program (EBP), Multisystemic Therapy (MST)
According to the Oklahoma Office of Juvenile Affairs’ (OJA) website (OJA, 2012.), the annual expenditures for fiscal year 2012 were $105,770,346. During that same time period, the Office of Juvenile Affairs reported contact with 11,494 Oklahoma youth. Of those youth, 3,707 had their cases dismissed or otherwise referred out of the juvenile system without having services provided. That leaves 7,787 youth who remained in the system receiving services in some manner. This equates to an annual expenditure by the Office of Juvenile Affairs of $13,582 per youth for the 2012 fiscal year. It seems fair to question whether or not those funds are, in fact, being used in the most appropriate manner to address the problem of juvenile delinquency in Oklahoma.
The question of whether or not funds are being used effectively becomes even more important when one considers that of the 7,787 youth in the system, 4,394 are repeat offenders. Unfortunately, statistics may indicate that Oklahoma is not performing well in addressing the problem of juvenile delinquency. According to the Justice Policy Institute (2009), with respect to success rates among U.S. states for reducing juvenile crime rates, Oklahoma ranks in the bottom ten states. In other words, forty states do a better job of reducing their rates of juvenile crime than does Oklahoma. Considering that in 2012, 56% of the youth placed into the Oklahoma juvenile system were repeat offenders, reducing the recidivism rate would strongly and positively impact the overall problem of juvenile delinquency in Oklahoma. Is Oklahoma using the most effective evidence based interventions to address the issue of juvenile recidivism?
Literature Review of MST
Multisystemic Therapy (MST) is a therapeutic intervention often used with juvenile offenders to address delinquent behavior and reduce ones rate of recidivism. Several empirical research studies have provided evidence for the effectiveness of MST in regards to the reduction of delinquency, also known as antisocial behavior, in children and adolescents (Borduin, Mann, Cone, Henggeler, Fucci, Blaske, and Williams, 1995; Curtis, Ronan, & Borduin, 2004; Ogden & Halliday-Boykins, 2004; Schaeffer & Borduin, 2005; Sawyer & Borduin, 2011). Through this empirical support MST has been deemed an evidence-based practice (EBP). In other words, it is “best-practice” or strongly recommended when addressing juvenile delinquency therapist, agencies, and state juvenile justice departments utilize MST. Henggeler, Schoenwald, and Pickrel (1995) states:
MST is consistent with social-ecological models of behavior (e.g., Bronfenbrenner, 1979) in which the child and family’s school, work, peer, community, and cultural institutions are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. (710)
Additionally, MST was developed based upon empirical research that discerned a strong correlation between youth criminal and violent behaviors with poor interpersonal family relations, deviant peer association and school performance (Schaeffer & Borduin, 2005). Subsequently, these are the areas targeted for change in this multi-leveled approach to intervention.
Upholding the person-in-environment ethos of the social-ecological model the creators of MST require the intervention take place in the environment one is experiencing the most difficulty. Therefore, services could take place in the individuals’ home, school or neighborhood. Initially, the assigned therapist conducts an assessment of the individual and family to determine the service site and ensure the specific needs of the client and family as a whole are the foci of the intervention (Sawyer & Borduin, 2011). Allowing for flexibility in the intervention model and using a person-centered approach has been seen as one of the reasons why MST is consistently effective (Ogden & Halliday-Boykins, 2004). Moreover, this approach is congruent with the social work ethical standard of the client’s right to self-determination (NASW, 2008). The inclusion of family therapy in MST aims to establish a working parent – child relationship and provide the parent/caregiver(s) with the skills and resources necessary to mange the youth’s problem behaviors. At the macro level, MST can create two changes that benefit society as a whole. First, the reduction of criminal and violent activity is beneficial to all. Second, Klietz, Borduin, and Schaeffer (2010) found:
The reductions in criminality in the MST versus IT conditions were associated with substantial reductions in expenses to taxpayers and intangible losses to crime victims, with cumulative benefits ranging from $75,110 to $199,374 per MST participant. Stated differently, it was estimated that every dollar spent on MST provides $9.51 to $23.59 in savings to taxpayers and crime victims in the years ahead. (657)
Overall, MST strives to create change at all the sociological levels micro, mezzo and macro.
Borduin et al. (1995) conducted the first clinical trial looking at the long-term effectiveness of MST in relation to the reduction of criminal and violent activity in MST participants compared to IT (i.e. individual therapy) participants. The initial study was conducted four years after services were provided; subsequently, there have been two more follow up studies with the same participants around 13.7 and 21.9 years after services were initially provided (Schaeffer & Borduin, 2005; Sawyer & Borduin, 2011). Bourduin et al. (1995) found that within the four gap only 21.6% of the MST participants had been arrested compared to 71.4% of the IT participants. Schaeffer & Borduin (2005) found as adults the arrest percentage had increased to 50 %; however, these participants were also sentenced to fewer days in jail and awarded shorter probation. Lastly, Sawyer and Borduin (2011) were the first ones to look at suits related to family instability and found MST participants were half as likely to be involved in a divorce, paternity, or child support suit compared to the IT participant. Collectively, all three studies provide the evidence for the lasting affects of MST on criminal and violent behaviors in addition to quality of life for children and adolescent offenders years after service.
In a meta-analysis of numerous outcome-based (i.e. effectiveness) studies Curtis, Ronan, and Borduin (2004) found collectively the MST participants were 70% less likely to reoffend in the years following treatment compared to participants receiving common services. Moreover, Ogden and Halliday-Boykins (2004) found MST to be effective for adolescents with serious behavior problems in Norway. Thus, providing empirical evidence to the reliability of MST across cultures. Research has shown fidelity to the MST program is vital to its effectiveness and to counter act infidelity the MST adherence measure was created in addition to the requirement of weekly feedback from the family in regards to the therapist fidelity (Curtis, Ronan, & Borduin, 2004). Notably, a majority of the MST effectiveness studies were conducted with serious and violent juvenile offenders; however, since MST is able to reduce recidivism rates for juveniles with high arrest recorders it can be deduced MST’s effectiveness would be similar, if not more effective for first-time offenders.
Description of Local Services
Although the cost of addressing juvenile justice in Oklahoma is significant, that cost pales in comparison to the lifetime costs associated with juvenile delinquency. Many repeat juvenile offenders will continue offending into adulthood. The economic impact can be staggering. The total monetary cost to society of just a single lifetime of crime can reach $1.5 million (Sawyer & Borduin, 2011). The issue of course is not just about the enormous financial costs to society. One also has to consider the lost hope, dreams, and lives of many of the offenders and their possible victims.
Most first-time offenders entering the juvenile justice system in Oklahoma are referred to a third party for counseling services. Almost all referrals in Oklahoma and Cleveland counties go to Youth Services of Oklahoma County located in Oklahoma City, Mid-Del Youth and Family Center located in Del City, and Crossroads Youth and Family Services of Norman. Each of these centers is contracted with the Oklahoma Office of Juvenile Affairs to provide counseling services for juvenile offenders in the respective counties and areas. Additionally, the centers also receive juvenile offender referrals from municipal courts in the area.
The Mid-Del and Crossroads centers both utilize the same curriculum for their first-offender counseling programs. Notably, the Oklahoma Association of Youth Services developed the “First Time Offender Program” curriculum utilized by both agencies (First Time Offender Program, n.d.). The program for first-time offenders involves a total of fourteen hours of group counseling administered across eight evening sessions. The offender and at least one of their parents or guardians attend the sessions. The eight sessions are divided into these topics: Introduction to the juvenile justice system, communication, emotional regulation, smart choices, values, substance use, family systems and graduation. The entire curriculum is available for public download and was reviewed by the authors of this paper.
Although the developers of the curriculum state that parts have been designed around various evidenced based methods, the program itself has no research supporting its effectiveness. Upon review, one can see the intervention is focused upon the offenders’ personal emotions and values, coping skills, life skills, etc. One might assume the family systems unit would target family dynamics and issues between the youth and parents. However, the unit’s major emphasis is focused upon impulse control in the family setting. Virtually none of the curriculum addressed the juveniles’ environment and very little infuses is placed on interpersonal relationships with ones parent(s). Furthermore, although licensed therapists presented or oversaw the presentation of the program, one-on-one counseling is not included. With this intervention model, the empirically proven need for including environmentally based assessments in a successful intervention for first-time offenders is not included as part of the program (Henggeler, Schoenwald, & Pickrel,1995). If no change is brought to the offenders’ environment the likelihood one is driven back into old behaviors is high.
Youth Services of Oklahoma County offer a different program for first-time offenders referred by the Office of Juvenile Affairs (“Programs,” n.d.). The program is quite similar to the program at the Mid-Del and Crossroads centers. The Oklahoma County Youth Services is a sixteen-hour program instead of fourteen but is also held in the evenings at the center for the offender and their parents. Improving communication skills, making healthy choices, and basic life skills are the primary focus of the intervention. Additionally, the program was modified to incorporate the Prevention and Relationship Enhancement Program (PREP). Although PREP has been the focus of many empirical studies and shown to be highly successful as an intervention, no quantitative or qualitative research could be found supporting its use as a therapeutic intervention involving juvenile delinquency.
Although the majority of juvenile offenses occur in the urban areas of Oklahoma, what are the types of interventions available for rural offenders? One of the authors of this paper has experience in four northwest Oklahoma counties with the Office of Juvenile Affairs and the agency used for counseling services. On-site group counseling is a method urban centers use to provide services to large numbers of first-time offenders. However, rural settings present a unique problem for meeting the needs of youth in the juvenile system. For example, the Blaine county Office of Juvenile Affairs contracts with Youth and Family Services of El Reno to provide counseling to first-time offenders. Consequently, traveling to El Reno from most locations in Blaine County requires a one-way travel time of over one hour and for some towns it is over ninety minutes. Requiring youth in Blaine County to attend counseling at the El Reno facility is simply not practical.
The alternative offered for Blaine county youth, and other youth in the surrounding counties serviced by the El Reno center, is one-on-one counseling services in ones’ own town. However, due to costs and logistics, it is not possible to provide licensed therapists for the one-on-one counseling with the youthful offenders. Instead, a licensed therapist at the center oversees a group of Behavioral Health Rehabilitation Specialists (BHRS) who travel to the area towns and provide counseling services to the juvenile offenders. Although some changes are coming in 2014, in order to practice as a BHRS in Oklahoma, the only requirements are a Bachelor’s degree in any area and the passing of a simple, online test, which can be taken as many times as needed to pass. The non-profit agencies are able to call their BHRS’s “counselors” and the service they provide “counseling” because of a loophole in the Oklahoma Department of Mental Health regulations. The loophole allows for the designation of “counselor” to a BHRS if the agency’s own job description and requirements have a BHRS specified in that manner. In other words, if the wording “field counselors for Youth and Family Services must have BHRS certification” is found in the agency’s job description for the “counselor” position, the agency may rightfully call those employees counselors.
Critique of Services
Comparatively, MST has stronger empirical support and theoretical backing than the current services in central and northwestern Oklahoma in regards to addressing delinquent behavior in juveniles. On average the duration of MST is “40 hours over 15 weeks for up to 24 weeks” (Curtis, Ronan, & Borduin, 2004). Thus, participants of MST are provided with 26-24 more hours and 7 to 16 more weeks of services compared to the current services. The increased hours may be because both individual and family therapy are a part of MST unlike the current services that only focus on psychoeducation groups. Pyschoeducation can provide some very good information and skills; however, there is a lot of information to be disseminated in a short leaving very little time for the group members to absorb the information and practice the new skills. More importantly, the curriculum does not directly address each families needs but instead provides an overview of a board range of topics. Alternatively, MST is flexible and aims to provide the client and family therapy, psychoeducation on parenting and resources that will help them meet their needs (Curtis, Ronan, & Borduin, 2004). Thus the individuals and families have a longer period of time to develop new skills and allow change to occur.
Additionally, MST therapist are graduate level counselors or above that go through a rigorous training program and are provide with weekly supervisory sessions by another trained MST therapist throughout the service delivery (Henggeler, Schoenwald & Pickrel, 1995). Comparably, in rural northwestern Oklahoma youth are receiving services from BHRS’s who are not properly trained therapist. Location and time of services can hinder or benefit the probability of change for clientele. Current services require clients to meet at a specific time (i.e. nights) and place (i.e. office or conference room setting), which can present several problems for clients that do not have reliable transportation or work at night. Respectively, MST brings services to the family’s home or the youth’s school and delivered at the most convenient time for the family, not the agency (Sawyer & Borduin, 2011). Accessibility of services is extremely important and MST provides the most accessibility compared to the current services.
The A, B, C, D, F grading scale will be applied to each of the agency’s service in regards to it being a proper intervention to address juvenile delinquency. Since the Mid-Del Crossroads centers utilize similar intervention curriculum collectively the service is awarded a D. The main reason for this grade is in regards to the use of psychoeducaiton without individual and family therapy in addition to the lack of focus on each family’s individual needs. Additionally, the services are only delivered at night, in a clinical setting, and last for a short amount of time. More importantly, no research was found in regards to the reduction of delinquent behavior in juveniles. Youth Services of Oklahoma County utilizing the evidence-based program, PREP, allows it be award with a B. PREP is an respectable EBP and has strong support for its effectiveness in regards to improving relationships; however, there is no empirical research providing evidence to its effectiveness with the reduction of delinquent or antisocial behavior in juveniles. Services in northwestern Oklahoma are awarded a C because they provide both group and individual therapy to juvenile offenders. However, the fact that families may have to drive over an hour one-way to receive services is ridiculous. Moreover, the services are once again focused on the individual and not the individual and family as a whole. For the grades these services have been awarded it is not surprising that Oklahoma is ranked in the bottom ten nationally in reducing juvenile crime rates.
Change needs to happen in how Oklahoma is addressing juvenile delinquency or the juvenile crime rates will continue to increase. Since the Oklahoma Office of Juvenile Affairs dictates what services are provided in Oklahoma one needs to direct a majority of advocacy efforts at the office. Most importantly, improvements need to be made in regards to focus on the individual and family at the same time because delinquent behavior is not a one-dimensional problem. If it is unrealistic to provide each individual and their family direct services and attention then a shift toward individual therapy in conjunction with psychoeducation group with parent/caregiver(s) in attendance is strongly recommend. Additionally, agencies should look into their ability to deliver home-based services in regards to individual and family therapy over their current clinical setting. Lastly, the Oklahoma Office of Juvenile Affairs needs to be advocating for the use of EBP interventions and not be endorsing intervention without empirical support because that is unethical. Thus, it is recommended the Oklahoma Office of Juvenile Affairs look in to MST and it implementation statewide to address juvenile delinquency in Oklahoma.