Managing High Risk Young Persons in Social Welfare Institutions

MultifunC

Multifunctional Treatment in Residential and Community Settings

Developmental Project in Norway and Sweden

1.

Review of the research on residential treatment of antisocial behaviour in juveniles (2001-2002). 2.

Development of a residential treatment program based on the research (2003-2004).

3.

Implementing the treatment program – MultifunC - in Norway (six units) and in Sweden (three units) (2005-2007).

4.

Evaluation of the program (2008-10?)

 MultifunC is based on research on predictors of antisocial behaviour (risk factors), on the

Responsivity

and

”Principles of Effective Intervention” – Risk, Need and ”The Psychology of Criminal Conduct”

which is a teorethical explanation for criminal behaviour, and the change of this (Andrews, Gendreau, Cullen and Bonta, 1990, 2006).

 The principles are supported by several meta-analysis (Andrews og Dowden, 2000; Lipsey og Wilson, 1998; Tong og Farrington, 2006; Lowenkamp and Latessa, 2006; Lipsey, 2007, and other).

Risk Principle:

Intensivity of intervention should match individual risk level. Target high-risk offenders

Need Principle:

Targets of interventions should be known dynamic risk factors (criminogenic needs).

Responsivity Principle:

The intervention should be matched to the individual learning style. Use methods based on cognitive behaviour and social learning theory

Major Risk Factors

History of antisocial behaviour Antisocial personality pattern Antisocial cognition Antisocial associates Family and/or marital School and/or work Leisure and/or recreation Substance abuse

Effects for low risk Effects for high risk

Matched with the same risk level in interventions outside institutions

Factor

History of Antisocial Behavior Antisocial personality Antisocial cognition Antisocial associates

Risk

Early & continued involvement in a number antisocial acts Adventurous, pleasure seeking, weak self control, restlessly aggressive Attitudes, values, beliefs & rationalizations supportive of crime, cognitive emotional states of anger, resentment, & defiance Close association with criminals & relative isolation from prosocial people

Dynamic Need

Build noncriminal alternative behaviors in risky situations Build problem-solving, self management, anger mgt & coping skills Reduce antisocial cognition, recognize risky thinking & feelings, build up alternative less risky thinking & feelings Adopt a reform and/or anticriminal identity Reduce association w/ criminals, enhance association w/ prosocial people Adopted from Andrews, D.A. et al, (2006). The Recent Past and Near Future of Risk and/or Need Assessment. Crime and Delinquency, 52 (1).

Factor

Family and/or marital School and/or work Leisure and/or recreation Substance Abuse

Risk

Key elements are caring, better monitoring and/or supervision Low levels of performance & satisfaction Low levels of involvement & satisfaction in anti criminal leisure activities Abuse of alcohol and/or drugs

Dynamic Need

Reduce conflict, build positive relationships, communication, enhance monitoring & supervision Enhance performance, rewards, & satisfaction Enhancement involvement & satisfaction in prosocial activities Reduce SA, reduce the personal & interpersonal supports for SA behavior, enhance alternatives to SA Adopted from Andrews, D.A. et al, (2006). The Recent Past and Near Future of Risk and/or Need Assessment. Crime and Delinquency, 52 (1).

The most effective interventions are behavioral 1.

2.

Focus on current factors that influence behavior Action oriented 3.

Offender behaviors are appropriately reinforced The most effective behavioral models are 1.

2.

Social learning—practice new skills and behaviors Cognitive behavioral approaches that target criminogenic needs Slide 9

In addition to the work of the reaserchers from Carleton University, MultifunC is based on research on several other topics that are important in residential treatment; 

Structure and support (Gold and Osgood, 1992; Brown et al, 1998), control and autonomy (Sinclair and Gibbs, 1998), peer culture (Dodge, Dishion and Lansford, 2006), re-integration and aftercare, (Altschüler, 2005; Liddle , 2002), fidelity..............………………

 Liddle, 2002: Residential treatment needs to be understood as part of a continuum of services. The quality of the post treatment environment--particularly relationships with family and non-criminal friends and involvement in school and pro-social activities--are critical predictors of recovery.

 Influence of antisocial peers and antisocial peer cultures are important risk factors.

 In residential settings an unintended consequence might be that the group might contribute to the development and maintenance of antisocial behaviour, and then to iatrogenic effects of the treatment (Dodge, Dishion and Lansford, 2006).

 T he risk of negative influence from antisocial peers implies that the period of time used in residential setting should be as short as possibly, and should be linked to community services.

Target high risk juveniles: ► ► ► ► ► ► ► ► ► ► ► Adress both individual and contextual factors (criminogenic needs) including cognition, attitudes, education, peer associations, and family issues Are able to manage serious negatively behaviour (violence) Enhance intrinsic motivation through use of constructive communication, such as motivational interviewing Balance between control and autonomy Balance between structur and support Systematic and structured training in social skills Use cognitive behavioural techniques Training in school or work Are linked to community and help establish prosocial contacts Includes aftercare as an integrated part of the intervention Measures performance and use this information for continuous improvement (quality assurance)

 Small units (8 juveniles in each unit)  Open institutions (non-secure). This does not mean that they are free to go………..

 Located close to community services (school, leisure/recreation activities and communication /transport) Makes it possibly to establish prosocial contacts, to be in local schools, training in new skills in natural settings, and to maintain contact with family.

 Juveniles with serious behaviour problems (crime, substance abuse, violence, etc.).

 High risk for future criminal behaviour (high total sum of risk factors – static and dynamic)  Before placement the behaviour is assessed with Achenbach’s check lists (CBCL), and the Risk level is assessed with the risk inventory Youth Level of

Service/Case Management Inventory (YLS/CMI)

Behaviour and Risk assessment Static riskfactors Dynamic riskfactors Responcivity / personality factors Target group Treatment targets and -plans Treatment methods and targets

Family

•Parental skills •Communication

Juvenile

•Behaviour •Skills •Attitudes

Peers

•Decrease antisocial •Increase prosocial

Treatment Targets School

•Attendance •Skills •Behaviour

Residential / institution

Inntake Treatment Transition Motivation Motivation Assesment Focused Treatment Structure Treatment climate Prepare re-entry Duration of residential stay: about 6 months (not fixed) Juvenile

Focus of treatment

School Peers Family

Community

Reintegration / aftercare Family support Duration of aftercare: about 4-5 months (not fixed)

Leader Assessment and Planning team Mileau therapy -team Educational/ Pedagogical team Family- and follow up team For each juvenile there will be Treatment teams across all teams including one or several staff from each team.



The treatment mileau:

 Control where this is neccesary, but no unneccessary control  Involvement of the juveniles wherever this is possibly  Structure, but not unneccessary structure   Principles from ”Core correctional practice” - staff behaviour

Interventions with focus on individual juveniles:

 Motivating for change (based on Motivational Interviewing)  Behavioural analysis and/or MST’s fit-cirkel  Contingency Management Systems/Tocen economy and Behavioural contracts  Aggression Replacement Training (ART)  Weekly treatment goals and evaluation of progress (intesivity)

 Tocen economy and Motivational Interviewing motivates for change. The basis for actual change is new skills which makes changes possibly.

 Aggression Replacement Training (ART) consists of a multimodal intervention design that combines: 

Training in control of aggression (ACT),



Training of social skills, and



Learning of moral thinking

(Goldstein og Glick, 1994).

 Promote prosocial influence (contact with prosocial peers outside the institution – school and leisure)   Moderate antisocial influence (decrease contact with antisocial juveniles outside the institution and antisocial communication among juveniles within the institution) Increase participation in school and performance in school situation (support to the juveniles and the school).  Increase parental function and family processes (training of parents in the institution and during the juveniles home visits).

Focus

 Increasing family affection/communication  Increasing monitoring/supervision skills

Methods:

 Principles from Parental Management Training (PMT) during the residential stay  Principles from Multisystemic Therapy (MST) during leaves and aftercare

Family team Parents Youth School or work Peers

 Written Manuals for each topic (assessment, treatment, aftercare and so on) is included in the treatment model  Weekly phone-consultations with checklists and discussions with each institution  Regularly visits at all the institutions  Regularly Boosters on spesific topics  Future: Regularly interviews with juveniles and parents

Design for Study of effects

The nine existing MultifunC institutions Stjørdal Youth Centre Bergen Youth Centre Sandefjord Youth Centre Tromsø Youth Centre Oslo Margrete Lund Ås Youth Centre Brättegården

Råby Youth Centre

Assess target population based on risk faktors predictive of recidivism and select more serious offenders Adress criminogenic risk faktors open to change within target population Develop theoretical basis for intervention and expected outcomes Design interventions shown to be effective (cognitive behaviour) Implement with quality and fidelity to the program design Support and Resources surrounding the Intervention Agency Mission Agency Leadership Community Support Agency Funding Connections across Services Ashley (2005), King County Departement of Community and Human Services

We have some guidelines from research, but there is no ”Magic Bullet” (Lipsey, 2007)

The End

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1.

Exploration and adoptation 2.

Program installation

3. Initial implementation 4. Full operation

5.

Innovation 6.

Sustainability