Cover Story

Research shows that delinquent youth fuel each others' bad behavior, yet most young people who commit crimes end up in group homes or juvenile detention centers with like peers.

Three psychologists--Scott Henggeler, PhD, of the Medical University of South Carolina, Patti Chamberlain, PhD, of Oregon Social Learning Center, and James Alexander, PhD, of the University of Utah--take a different tack on treating juvenile delinquency: Using a family and systems approach, they work directly in young offenders' homes and communities to improve their chances of living healthy, crime-free lives while at the same time helping them avoid deviant peers.

"The popular perception is, 'These kids are wreaking havoc; let's send them off so they're out of our hair,'" says Henggeler, creator of Multisystemic Therapy (MST), an intensive family-based program now used in 30 states and eight countries. "But it's pretty clear that the vast majority of kids who are locked up don't need to be if you can provide them with good community-based services."

The programs--MST, Alexander's Functional Family Therapy (FFT) and Chamberlain's Multidimensional Treatment Foster Care Treatment (MTFC)--aren't just feel-good projects: They've been shown in independent analyses to significantly cut crime and reduce costs. In a May 2001 review of 400 studies on crime-reduction programs, for example, psychologist Steve Aos, PhD, of the Washington State Institute for Public Policy, found that in a system that costs up to $64,000 per youth per year, MST saved $31,661, MTFC $21,836 and FFT $14,149 per child per year (a more recent analysis of FFT showed an even greater cost savings in that program). All three interventions also showed major reductions in re-arrests and out-of-home placements compared with conventional treatment (see chart).

Because they've shown cost savings, the programs are actually gaining momentum despite a political bent toward incarceration and punishment, the program psychologists add. They received a major boost in 1996, when the University of Colorado at Boulder's Center for the Study and Prevention of Violence (CSPV) chose them as part of its Blueprints for Violence Prevention, a program that identifies the nation's most effective violence-prevention programs. Soon after, the federal Office of Juvenile Justice and Delinquency Prevention (OJJDP) funded CSPV to sponsor replications of the programs throughout the country. As a result, the programs are being more widely disseminated, and there are plans for a pilot project that will combine the three approaches in a triage model for youth entering the system.

"We know that crime is linked to many other antisocial problems--relationship, educational, employment, mental health, drugs, and so on," comments David Farrington, PhD, professor of psychological criminology at the University of Cambridge and author of "Costs and Benefits of Preventing Crime" (Westview Press, 2001). "Effective programs like these can save money in a lot of different areas."

Unique attributes

Several features distinguish these programs from treatment as usual, their directors note.

Instead of providing individual or group therapy to the young person alone, the programs tailor cognitive, behavioral and family therapy techniques to the needs of teenagers and their families. Youngsters and families help create treatment plans, and parents are coached in parenting skills such as setting and enforcing limits and learning to better support their child with attention and praise.

"A lot of things can interfere with good parenting," Chamberlain explains, "so we help parents determine what's really important for their kid and figure out ways to follow through on that."

The programs also use the concept of risk and protective factors to help determine interventions. An example of a risk factor is parental substance abuse, which for obvious reasons increases the likelihood of poor parenting. To counter this, an FFT clinician, for example, might help the parents find a good substance abuse program or work with families to enhance youth outcomes even if the parents continue abusing substances, Alexander says.

Likewise, a protective factor is positive peer influences, which in turn can help youngsters learn better behavior. "We put a lot of energy into keeping kids out of deviant peer groups and getting them hooked up with prosocial peers in church, school and community groups," Henggeler says, an approach that squares with the research on deviant peers. "It's easier said than done," he adds with a smile. "Kids don't want to leave their friends."

The fact the programs are on-site makes them unique as well, comments psychologist Phillippe Cunningham, PhD, who supervises MST cases in South Carolina.

"We get to see directly what's going on," he notes. "We have the opportunity to reinforce healthy, more adaptive behaviors on the spot, because we get to see the contexts where people get stuck."

Finally, the programs emphasize quality control and outcomes, a focus that has been particularly fostered by Henggeler, whose MST program now includes separate research and dissemination arms. Indiana University psychologist Tom Sexton, PhD, has likewise developed a national dissemination protocol and quality-improvement system so FFT can be disseminated with validity and reliability. Researchers in all three programs regularly conduct evaluations and make changes as data dictate.

The programs differ in key regards as well. MTFC, for example, first places youngsters with foster families, who are coached in parenting and social-learning skills. At the same time, the youngster's family of origin learns the same techniques so they're ready when the youngster returns home. Henggeler's program is likewise intensive, but immediately begins to work with the child's family and in his community, providing around-the-clock assistance as needed. Alexander's approach is more short-term and proceeds through three distinct stages, from motivating families to teaching new skills to linking them with community supports. The programs last for different periods of time and cost more or less money as a result.

But they have more in common than not, program psychologists emphasize.

"We came up with the programs independently," says Henggeler, "but we all had access to the same knowledge base. If you look at the Blueprints project, you see that only three programs out of 600 were selected because they had positive outcomes related to juvenile offenders. That gives you a good idea of what works and what doesn't."

New directions

The programs are building on their successes in several ways. Later this year the Annie E. Casey Foundation plans to run a pilot project that will combine the three approaches in a single setting. The aim is to see if they can work complimentarily to provide effective treatment for young people entering the system.

In addition, program psychologists are expanding the types of clients they serve. Henggeler's team, for example, is studying ways to adapt MST to juvenile sex offenders, teens from abusive families and young people with serious mental health problems. Alexander, Sexton and FFT Dissemination Director Doug Kopp are applying FFT to increasingly diverse populations such as underage sex offenders in Anchorage, Alaska. Meanwhile, Chamberlain has focused her recent efforts on girls (see Girls us a different kind of weapon).

Alexander, the first of the three to develop the model, says the approaches give hope to youngsters and their families who face higher odds than most, including poverty and family dysfunction.

"We tend to act as though these things are a death sentence," Alexander says. "These programs offer ways for people to make it even though they have huge risk factors."

Tori DeAngelis is a writer in Syracuse, N.Y.