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Forensic and Mental Health C83FMH. Lecture 2: Interventions for offending behaviour Dr Ellen Townsend. NB. You do not have all my slides on handouts: make notes!. Aims. To evaluate whether interventions designed to rehabilitate offenders are effective

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Forensic and Mental Health C83FMH

Lecture 2: Interventions for offending behaviour

Dr Ellen Townsend

NB. You do not have all my slides on handouts:

make notes!


Aims

  • To evaluate whether interventions designed to rehabilitate offenders are effective

  • To explore this question using an ‘evidence-based’ approach


Punishment or rehabilitation?

  • Should we try to rehabilitate young offenders or should we just punish them?

  • If rehabilitation

    • what should this involve

    • how should it be done

    • by whom and where?

  • Consider

    • Risk factors for offending?

    • Age?

    • Gender?

      Risk factors include -

  • Troubled home life

  • Peer-group pressure

  • Poor attainment at school

  • Drug and alcohol use or mental illness

  • Deprivation


What should we do about young offenders?

'Prison not working' for young offendersMatt Weaver

Monday May 8, 2006Guardian Unlimited

‘Government's young offender scheme fails’

Daily Mail

27th October 2005


Punishment and rehabilitation
Punishment and rehabilitation

  • The Youth Justice Board (YJB)

  • The YJB oversees the youth justice system in England and Wales.

  • Prevent offending and re-offending by children and young people < 18 


Youth justice facts in England and Wales

A child can be responsible for criminal behaviour in the England and Wales at age 10.

15 to 17 year-olds in prison - more than doubled in last ten years


What happens to them?

  • YOTS (Youth Offending Team) community orders e.g. Intensive Supervision and Surveillance Programme (ISSP) and intensive fostering.

  • Custody

    • LASCH (Local Authority Secure Children’s Home)

    • YOI

    • Secure Training Centres.


Interventions for offending behaviour
Interventions for offending behaviour

  • Family and parenting interventions

  • Multisystemic treatment

  • Cognitive behavioural interventions

  • Tackle re-offending and anti-social behaviour

  • Lack of randomized studies (eg. Farrington, 2003)

  • Effectiveness uncertain

  • Evidence-based approach required?


What is the best evidence
What is the best evidence?

  • Experimental study without randomisation? E.g. Case control

Expert opinion?

Observational study without control groups e.g. Cross-sectional study?

Experimental study with random allocation

e.g. RCT?


Evidence based practice
Evidence-based practice

  • Use of current best evidence in making decisions about practice (eg. healthcare)

  • Systematic reviews of evidence

  • Steps involved

  • Hierarchy of study designs (Highest quality first)

    • Experimental studies (RCT with concealed allocation).

    • Experimental study without randomisation

      • Observational study with control group

      • Cohort study

      • Case control

    • Observational study without control groups

      • Cross-sectional study

      • Before-and-after study

      • Case series

    • Expert opinion or consensus; Case reports

  • Study quality: design, conduct and analysis minimize bias.

Source: Khan et al (2003)


Bias eg. 1: Transcutaneous nerve stimulation

for post-operative pain relief


Bias eg. 2 : Methodological quality and estimates of

treatment effects in controlled trials

(Schulz et al 1995)

Trials were compared with those with adequately concealed treatment allocation



Evidence for offending and antisocial behaviour multisystemic therapy mst
Evidence for offending and antisocial behaviour: multisystemic therapy (MST)

  • One of few empirically supported interventions

  • Widely disseminated USA and Europe

  • Strong research base with multiple randomised controlled trials

  • MST:

    • Multifaceted, short term, community-based

    • Social and family systems theories and causes/correlates of antisocial behaviour

    • Manual-based

    • Time-limited

    • Professional mental health therapists deliver

    • Small caseloads

    • Intervention strategies integrated

    • USA


Main goals of mst
Main goals of MST multisystemic therapy (MST)

  • Reduce

    • criminal activity in young people

    • antisocial behavior such as drug abuse and sexual offending

  • Financial

    • decreasing rates of incarceration and out-of-home placements


Needs of young offenders and families
Needs of young offenders and families multisystemic therapy (MST)

  • Improve

    • parents discipline practices

    • family-community relations

    • school/vocational performance

  • Increase

    • family affection

    • association with pro-social peers

  • Decrease

    • association with deviant peers

  • Engage in positive recreational activities

  • Empower family to solve future difficulties


Nine mst treatment principles
Nine MST Treatment Principles multisystemic therapy (MST).

  • 1. Finding the Fit

  • 2. Positive & Strength Focused

  • 3. Increasing Responsibility

  • 4. Present-focused, action-oriented & well-defined

  • 5. Targeting Sequences


Nine MST Treatment Principles… multisystemic therapy (MST)

6. Developmentally Appropriate.

7. Continuous Effort.

8. Evaluation & Accountability.

9. Generalization.



Mst effectiveness 1 meta analysis
MST Effectiveness 1: meta-analysis multisystemic therapy (MST)

  • Curtis et al (2004) meta-analysis.

  • Henggeler (2004) comments on Curtis.

  • See reading list for references.


Mst effectiveness 2 systematic review
MST effectiveness 2: Systematic review multisystemic therapy (MST)

  • Littell, Popa & Forsythe (2005) systematic review*.

  • Littell (2005). Lessons from a systematic review of MST.

  • Henggeler (2006) response.

  • Littell (2006)

  • See reading list for references – Littell et al (2005) see*

* Cochrane Library: available via e-library gateway


Other interventions
Other interventions multisystemic therapy (MST)

  • Family and parenting (see Sukhodolsky and Ruchkin, 2006).

  • CBT (Felizer et al 2004).

    • Armelius and Andreassen (2007)

  • Find published effectiveness studies yourself.

*PDFs of papers in FMH practicals folder on Spsych


Quality assessment critical appraisal
Quality assessment/critical appraisal multisystemic therapy (MST)

  • See the Consolidated Standards of Reporting Trials (CONSORT) statement.

  • A checklist that authors of trials should use when writing up results.

  • Useful quality assessment/critiquing tool.

  • Reference: Moher et al (2001). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. The Lancet, 357, 1191-1194. Available via e-library gateway.


Summary
Summary multisystemic therapy (MST)

  • A number of types of intervention have been tested with young offenders

  • Experimental (randomized) evidence-base is lacking

  • Some interventions are promising (eg. MST) but results are equivocal.

  • Seek out effectiveness evidence for CBT and family interventions.


Video case studies
Video case studies multisystemic therapy (MST)

  • As you watch the video case studies make a note of the risk factors for

    • Offending

    • Mental health problems in offenders

  • Protective factors?

  • Implications for intervention?

  • Interventions tried?

  • Discussion at end


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