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UNIVERSITY OF CINCINNATI Date:___________________
I, _________________________________________________________, hereby submit this work as part of the requirements for the degree of:
in:
It is entitled:
This work and its defense approved by:
Chair: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________
A COMMUNITY OF PEERS – PROMOTING BEHAVIOR CHANGE:
THE EFFECTIVENESS OF A THERAPEUTIC COMMUNITY FOR JUVENILE
MALE OFFENDERS IN REDUCING RECIDIVISM
A Dissertation Submitted to the:
Division of Research and Advance Studies Of the University of Cincinnati
In Partial Fulfillment of the Requirements for the Degree of
Doctorate of Philosophy (Ph.D.)
In the Division of Criminal Justice
Of the College of Education
April 2004
by
Jennifer A. Pealer, M.A.
B.A., East Tennessee State University, 1997 M.A., East Tennessee State University, 1999
Dissertation Committee: Edward J. Latessa, Ph.D. (Chair) Francis T. Cullen, Ph.D. John Paul Wright, Ph.D.
Melissa M. Moon, Ph.D.
ii
A COMMUNITY OF PEERS – PROMOTING BEHAVIOR CHANGE:
THE EFFECTIVENESS OF A THERAPEUTIC COMMUNITY FOR JUVENILE
MALE OFFENDERS IN REDUCING RECIDIVISM
One avenue that has received considerable attention for the substance abusing
adult population is a therapeutic community; however, research examining the
effectiveness of this popular treatment modality for juveniles is scarce. While some
studies have found a reduction in criminal behavior and substance abuse, others have
found null results concerning the effectiveness of therapeutic communities. Furthermore,
the literature on therapeutic communities has been criticized on the following points: 1)
studies fail to incorporate multiple outcome criteria to measure program success; 2)
follow-up time frames have been inadequate; 3) comparison groups often fa il to account
for important differences between groups that are likely to impact program outcome; and
4) insufficient attention that is given to the measure of program quality. Moreover,
research on the effectiveness of therapeutic communities for juvenile offenders is limited.
Accordingly, this research attempts to overcome the common shortcomings by: 1)
including multiple outcome criterion; 2) following the juveniles for a period up to 3 years
after program completion; 3) using a comparison group drawn from a sample of youth
that did not receive treatment but who are matched on risk and needs; and 4) using a
standardized instrument to measure program quality.1
The current study used a quasi-experimental design to estimate the impact of the
juvenile therapeutic community on recidivism (e.g., return to incarceration; both juvenile
and adult). The treatment group was a sample of 447 male youth who were sentenced to a
1 This dissertation is an expansion of the work of Pealer, Latessa, and Winesburg (2002a), which examined a therapeutic community for juveniles. Specifically, this dissertation will follow the juveniles for a period of three years whereas the previous study only followed the juveniles for a period of 18 months.
iii
residential treatment facility that operated as a therapeutic community from January 2000
to August 2001. The comparison group was derived from a sample of adjudicated youth
who were released from the Department of Youth Services in 1999. The comparison
group was matched based on risk and need levels (e.g., Youthful Level of Service/Case
Management Inventory). Due to the fact that there were different times to failure, a Cox
regression model was computed to determine if participation in a therapeutic community
significantly reduced the probability of a new incarceration. Results indicated that while
the treatment group was less likely to be incarcerated during this time period, the
difference between the groups was nonsignificant.
iv
ACKNOWLEDGEMENTS
There have been many people who have assisted me throughout my educational
career. I first need to thank my committee. Dr. Edward Latessa, you have given me many opportunities to see different institutions, programs, and even the countryside. I have learned much working with you throughout the years. Your guidance has helped to make the me person I am today. I look forward to many years of collaboration. Dr. Francis Cullen, you really do practice what you preach. You have given me much social support throughout my years at UC. You were always willing to give advice and counsel me as to my best options. You are a true role model and I appreciate all you have done for me. Dr. John Wright, again, you amaze me with your knowledge of the field and your ability to convey the knowledge in a way that anyone can understand. Thank you for always taking the time to answer any question. Dr. Melissa Moon, what can I say? You were the mechanism that started this whole thing – my mentor at ETSU. If it were not for your foresight I would never have dreamed of getting this degree. You saw something that I did not. I really appreciate you urging me to go for it and helping me along the way. You are a great friend.
I also need to thank individuals at the Department of Youth Services. Candy Peters and Andy Popel were instrumental in obtaining some initial data for the project. Also, Bruce Sowards contributed greatly by obtaining the latest outcome data on his own time. I really appreciate your contribution to this project.
Special thanks and acknowledgements go to case managers at Mohican Youth Center, and to Jeanette Britton for coordinating the data collection process, and to Elaine Surber for her leadership and ongoing support throughout this project.
I also need to thank John Schwartz, Chris Lowenkamp, Shelley Johnson-Listwan, and Debi Shaffer. John, you helped me navigate the red tape at UC and showed me how to get things done. I appreciate you being so helpful. The Center could not operate without you. Chris, you were always willing to answer any questions from a stat problem to raising kids. Thanks for the advice. Shelley, you helped to show me the ropes for working with Dr. Latessa. Debi, my travel buddy. We have had some really good times traveling all of Ohio, Indiana, Oklahoma, and other parts of the country. I will miss playing “good cop/bad cop” with you. We made an unlikely pair – you from Michigan and me from Tennessee – but man did we have fun.
A truly special thanks for one of my closest friends – Kristie Blevins. We started UC together, took proficiencies together, took comps together (well most of them), defended on the same day, and will graduate together. Having someone from East Tennessee here in Cincinnati made the North more tolerable. You have helped me tremendously. Many of the stories I tell my children about UC will begin with: “onetime Kristie and I …..”
v
Last but certainly not least, I need to thank my family for their love and support. My dad and mom, Jerry L. and Ruth Ann Sartain, you instilled the value of education from the start. I just took the concept to the extreme. Thanks for giving me financial support and emotional support. I knew I could not fail because I did not want dad coming up here. My brother, Jerry, we were always in competition to out do the other. Even though you are an architect I still have more degrees – so I win.
My husband, Jamie, I could not have done this without you. Five years ago you just picked up your life and moved away from family and friends just so I could go to school. I appreciate the faith you have in me. You were always willing to provide encouragement and advice when I needed it. Thanks for being there. Finally, thanks go to my new son, Jake, for sleeping so much in the beginning so Mommy could finish writing her dissertation.
vi
TABLE OF CONTENTS
Chapter 1: Statement of the Problem 1 Prevalence of Substance Abuse Among Juvenile Offenders
1
Development of Residential Substance Abuse Treatment 3 Criticisms of Drug Treatment Programs 4 Overcoming the Criticisms 6 Research Questions 8 Summary 8 Chapter 2: Literature Review 11 Introduction 11 The Mission of the Juvenile Justice System 11 The Development of the Juvenile Justice System 12 Criticisms of the Juvenile Justice System 14 Attacking Rehabilitation and the Juvenile Justice System 15 Social Context, Rehabilitation, and Treating Juvenile Offenders 15 Liberal Ideology 15 Conservative Ideology 18 Juvenile Justice: From Treatment to Punishment 20 Public Support for Juvenile Treatment 21 Support for General Rehabilitation 22 Support for Juvenile Rehabilitation 24 Therapeutic Communities as a Treatment Modality for Offenders 26 History of Therapeutic Communities 27 Developments in the United Kingdom 27 Development in the United States 29 Characteristics of Therapeutic Communities 32 View of Substance Abuse and the Individual 32 Treatment Modality of the Therapeutic Community 32 Structure of the Therapeutic Community 33 The Use of Work in the Therapeutic Community 35 The Use of Behavioral Reinforcements in the Therapeutic Community 38 The Types of Meetings and Groups in a Therapeutic Community 40 Therapeutic Communities and the Principles of Effective Interventions 42 Intensive and Behavioral Services 43 Targeting Criminogenic Needs of High-Risk Offenders 45 Reinforcement of Contingencies 47 Staff Characteristics 48 Relapse Prevention Strategies 48 Effectiveness of Therapeutic Communities 49 Reducing Recidivism 50 Treatment Versus Non-Treatment 50 Follow-Up Time Period 59 Completers Versus Non-Completers 60
vii
Transitional Therapeutic Communities 61 Meta-Analysis and Reviews of the Literature 62 Predictors of Recidivism 67 Demographic Characteristics 67 Severity or Risk Level 71 Psychological Factors 72 Participation/Completion of Treatment 73 Predictors of Successful Completion of Treatment 73 Summary of Effectiveness 74 Methodological Problems of Past Research 78 Summary 81 Chapter 3: Methods 83 Introduction 83 Research Questions 83 Research Design 84 Procedures for Collecting Data 85 Treatment Group 85 Mohican Youth Center 85 Sample Size, Time Period, and Selection of Youth 86 Type of Treatment 87 Job Assignments Within Mohican Youth Center 88 Behavior Management Within Mohican Youth Center 92 Groups Held at Mohican 93 Phases of Treatment 95 A Quantitative Assessment of the Principles of Effective Intervention 97 Comparison Group 104 Description of the Measures 104 Individual Characteristics Examined 104 Juvenile Demographics 105 Criminal History 105 Substance Abuse History 109 Risk Level 110 Psychological and Social Functioning 111 Cognitive Distortions 111 Termination Data 112 Outcome Variables Examined 112 Intermediate Outcomes 112 Long-term Outcomes 113 Statistical Tests 114 Limitations of the Study 116 Summary 117 Chapter 4: Results 119 Individual Characteristics 119 Social Demographic Characteristics 119
viii
Drug History 122 Substance Abuse Severity 122 Current Offense and Criminal History 126 Risk Level 128 Psychological and Social Functioning 134 Cognitive Distortions 134 Intermediate Outcomes 141 Changes In Psychological and Social Functioning 141 Changes in Cognitive Distortions 144 Successful Completion 148 Long-Term Outcomes 150 Rates of Incarceration 150 Model Predicting Incarceration for Both Groups 153 Model Predicting Incarceration for the Treatment Group Only 156 Chapter 5: Summary and Conclusions 161 Limitations 161 Summary of Findings 163 Background Characteristics 163 Impacting Intermediate Outcomes 166 Predictors of Successful Completion 169 Rates of Incarceration 170 Model Predicting Incarceration 171 Model Predicting Incarceration for the Treatment Group Only 175 Policy Implications and Recommendations 176 Suggestions for Future Research 179 References 182 Appendix A: Data Collection Instruments 193 Appendix B: Tables 198
ix
LIST OF TABLES
Table 1: Summary of Therapeutic Community Outcome Evaluation Findings 51 Table 2: Summary of Meta-Analyses and Reviews of the Literature 64 Table 3: Predictors of Success by a Therapeutic Community 68 Table 4: Variables and Measures Employed in the Study 106 Table 5: Background Characteristics 121 Table 6: Drug History 123 Table 7: Current Offense and Criminal History 127 Table 8: Youthful Level of Service/Case Management Inventory (YLS/CMI) Risk Categories
132
Table 9: Descriptive Statistics for Client Self Rating – Time 1 135 Table 10: Paired Sample t-tests on Client Self Rating Time 1 – Time 2 142 Table 11: Paired Sample t-tests on How I Think Questionnaire, Time 1 – Time 2 (Includes suspect cases)
145
Table 12: Paired Sample t-tests on How I Think Questionnaire, Time 1 – Time 2 (Does not include suspect cases)
147
Table 13: Termination Information 149 Table 14: Regression Coefficients Predicting Successful Completion 151 Table 15: Rates of Incarceration 154 Table 16: Regression Coefficients Predicting Incarceration 155 Table 17: Regression Coefficients Predicting Incarceration for the Treatment Group
159
x
LIST OF FIGURES
Figure 1: Structure Board For Mohican Youth Center 90 Figure 2: Mohican Youth Center CPAI Scores Compared to Average Scores 100 Figure 3: JASAE Scores 125 Figure 4: YLS/CMI Risk Categories by Group 130 Figure 5: Cognitive Distortion Scales for the Mohican Youth Center 137 Figure 6: Behavioral Referents for the Mohican Youth Center 139 Figure 7: Summary Score for How I Think the Mohican Youth Center 140 Figure 8: Significant Predictor and Probability for Successful Completion 152 Figure 9: Participation in Treatment by Incarceration 157 Figure 10: Age by Incarceration 160
1
CHAPTER 1 STATEMENT OF THE PROBLEM
PREVALENCE OF SUBSTANCE ABUSE AMONG JUVENILE OFFENDERS
Over the past 20 years, there has been a “war on drugs”, which has resulted in a
large number of drug abusing offenders being processed in the criminal justice system.
Indeed, beginning in 1984 and lasting for 13 years, the nation saw an increase in the
number of juvenile arrests ranging from a low of 6,765 arrests per 100,000 juveniles to
9405 arrests per 100,000 juveniles (Snyder, 2000). Since 1998, the number of juvenile
arrests has declined 27 percent with an arrest rate of 6889 in 2001 (Snyder, 2001).
However, even though the arrest rate has decreased, the juvenile justice system has seen
an increase in the number of juveniles that are processed throughout the years. For
example, the percentage of juveniles being formally processed through juvenile courts
has increased from 64 percent to 71 percent during the last 10 years (Stahl, 2003). Many
have speculated about the causes of the increase in juvenile processing within the
juvenile justice system.
One possible explanation is the link between substance abuse and criminal
behavior. Indeed, there is a strong correlation between substance abuse and criminal
behavior (see Andrews & Bonta, 1994; Beck, Kline, & Greenfield, 1988; Elliott &
Huizinga, 1984; Newcomb & Bentler, 1988). For example, Wanberg (1992) found that
correlations between substance abuse and delinquency ranged from .47 to .63 with a large
sample of juvenile offenders. Accordingly, even though the juvenile arrest rate is
declining the juvenile arrest rate for substance abuse has increased. Thus, the prevalence
of drug and alcohol use among juvenile offenders creates many challenges for the already
overburdened juvenile justice system. For example, drug testing conducted in twelve
2
cities during 1997 revealed that 42 to 66 percent of male youths tested positive for at least
one drug at the time of arrest (National Institute of Justice, 1998). Furthermore, the
Survey of Youth in Custody project found that 39 percent of youth under age 18 were
under the influence of drugs at the time of their offense with more than 57 percent
reported using drugs in the month prior to their arrest (Crowe, 1998).
Nationally, arrests for substance abuse among juveniles has increased 145 percent
from 1991 to 2000, whereas the same arrests for adults have increased only 42 percent
(Snyder, 2000). Indeed, drug abuse violations was the category with the highest arrest
rate in 1999 with the drug abuse violation rate being 649 arrests per 100,000 for persons
age 10 to 17 (Stahl, 2001). Thus, there is a glaring problem with America’s youthful
offenders and substance abuse.
Not only are juveniles being arrested for substance abuse, but they are also being
processed through the juvenile court system. In 1998, the juvenile courts processed
approximately 192,500 cases involving drug offenses (Stahl, 2001). These cases
accounted for 11 percent of all juvenile cases in 1998. When drug abuse cases went
before the court, 63 percent were formally processed with the youth being adjudicated
delinquent. Of the formally processed cases, 59 percent were given probation and 23
percent were given the most severe disposition – residential placement (Office of
Juvenile Justice and Delinquency Prevention, 1998).
Indeed, while the number of juvenile arrest rate has been declining, the number of
juveniles being formally processed in the court system has increased. Furthermore, the
number of juveniles being placed on detention has also risen 11 percent between 1990
and 1999 (Harms, 2003). Moreover, there was a 62 percent increase in the number of
3
detained cases concerning substance abuse during this time frame. Thus, the link between
substance abuse and juvenile delinquency has been well established. If this population is
left untreated, their chances of returning to criminal behavior and substance abuse ranges
from 50 percent to 80 percent (Andrews & Bonta, 1994; Lillyquist, 1980). Accordingly,
some type of treatment intervention is needed to break the drug-crime system.
DEVELOPMENT OF RESIDENTIAL SUBSTANCE ABUSE TREATMENT
One possible avenue for the treatment of substance abusing juvenile offenders is
residential treatment. While this type of treatment has been established for many years, it
has only been recently that many state and local agencies received federal monies to
implement residential substance abuse treatment programs. Recognizing the link
between continued drug use and recidivism, the federal government created the Violent
Crime Control and Law Enforcement Act of 1994. Subtitle U of the Act had significant
national implications for treating drug- involved offenders as it provided agencies with
money to treat drug offenders. Thus, the RSAT grants represent the first national
mandate to affirm the value of treatment for the criminal justice population (Harrison &
Martin, 2003). Accordingly, it is believed that residential substance abuse programs have
the potential to reduce criminal behavior and relapse among drug abusing offenders.
With the availability of federal funds, many states began to implement residential
substance abuse programs. As of 2003, all 52 states had implemented RSAT programs
and as of March 2001, there were more than 2,000 RSAT programs in place. A recent
evaluation conducted by the National Institute of Justice revealed that the majority of
operational programs were directed to adults with 30 percent targeting juvenile offenders
4
(Harrison & Martin, 2003). In addition, about 60 percent of the RSAT programs were
operating, or at least incorporating some elements of a therapeutic community.
While there is not a set model for a therapeutic community, there are some
commonalities. DeLeon (1986, 2000) describes this treatment modality as emerging out
of the self-help movement in which the offender is to make a global lifestyle change.
While substance abuse is a major target, the therapeutic community also seeks to increase
prosocial conduct such as obtaining employment, achievement in education, and
increasing prosocial attitudes and values (Pan, Scarpitti, Inciardi, & Lockwood, 1993).
The therapeutic community may be distinguished from other drug treatment programs in
two ways. First, the primary agent of change is the community of peers and staff who are
to act as role models (DeLeon, 1986). Thus, the offender experiences a 24-hour learning
environment. Second, therapeutic communities are very structured and offer a systematic
and holistic approach to changing the offender (DeLeon, 1986).
In corrections research, there has been much focus on this type of treatment
modality for drug offenders. Furthermore, a recent meta-analysis revealed that on
average, therapeutic communities reduced recidivism approximately 13 percent
compared to no or minimal treatment (Pearson & Lipton, 1999).
CRITICISMS OF DRUG TREATMENT PROGRAMS
While the number of therapeutic communities for correctional populations has
increased, the research on their effectiveness has been criticized on four points by
Inciardi, Martin, Butzin, Hooper, and Harrison (1997). First, studies have failed to
incorporate multiple outcome criteria to measure program success. Second, the follow-up
time frames have been inadequate. Third, the comparison group fails to account for
5
important differences between groups that are likely to impact program outcome. Lastly,
there has been a lack of multivariate designs, which leave us with little information
concerning the significant predictors of recidivism. In addition, research into therapeutic
communities and drug treatment in general has been plagued by the insufficient attention
given to the measure of program quality (Faupel, 1981; Moon & Latessa, 1994).
The research on RSAT programs has also revealed some difficulties (Harrison &
Martin, 2003). A national evaluation of 12 RSAT programs was conducted by the
National Institute of Justice. The findings revealed that many programs lack a structured
aftercare program. 2 Instead, many offenders return to the general population and then are
released into the community without any type of step-down program (Harrison & Martin,
2003). Furthermore, a survey of the RSAT programs revealed that programs were often
eclectic. Fifty-eight percent of the programs were mixed models (i.e., elements of a
therapeutic community combining cognitive-behavioral group work and 12-step
meetings), 24 percent were therapeutic communities, 13 percent were designed as
cognitive-behavioral approaches, and 5 percent were 12-step programs (Harrison &
Martin, 2003).
Another area of concern was that many programs reported problems delivering
the intended services to the participants (Harrison & Martin, 2003). For example, there
were fewer group and individual counseling sessions held than had originally be planned
in many programs. The evaluation found that this problem was mainly due to the lack of
experienced staff and significant staff turnover.
2 According to the RSAT grant, the mo nies could only be used for residential substance abuse treatment and did not fund aftercare programs (Harrison & Martin, 2003). Thus, many programs lacked an aftercare component.
6
The last problem area noted by the national evaluation was that many programs
did not use a standardized substance abuse assessment instrument that had been validated
(Harrison & Martin, 2003). The lack of assessment resulted in many inappropriate
offenders entering the program. A related concern was that many offenders entered the
program with too little or too much time left on their sentence (Harrison & Martin, 2003).
The issue of time is problematic because many offenders could not finish the program or
upon completion of the program were sent back to the general population, which may
serve to “undo” any treatment effect experienced.
One final area of concern is the lack of research on therapeutic communities for
juvenile offenders. One study found that participation in this type of treatment modality
resulted in a significant reduction in recidivism compared to offenders who did not
participate in treatment (Pealer, Latessa, Winesburg, 2002a). However, the follow-up
time period was only 18 months for this study. Accordingly, this dissertation will expand
on the previous study. Specifically, the dissertation will follow-up the juveniles for a
period of three years to determine if the treatment effect is robust across time.
OVERCOMING THE CRITICISMS
This dissertation will add to the literature on RSAT programs and therapeutic
communities in a number of ways. First, while much of the research examining the
effectiveness of therapeutic communities has been for adult male offenders, the literature
on the effectiveness of the treatment modality for juveniles is scarce. Accordingly, this
research will examine a RSAT program for juvenile offenders implemented at Mohican
Youth Center in Loundenville, Ohio. As did many other RSAT programs, the facility
chose to implement a therapeutic community as the treatment modality.
7
Second, as research has shown, programs tend to be more effective when they
have high program integrity (Antonwicz & Ross, 1994; Holsinger, 1999). For that reason,
this dissertation will attempt to address the issue of the black box of treatment by using a
standardized instrument to measure program quality (the Correctional Program
Assessment Inventory; CPAI). This technique will allow the researcher to determine if
the program was adhering to the principles of effective intervention and may help to
explain the presence or absence of a treatment effect.
Third, while many programs have examined the long-term outcomes of
therapeutic communities (e.g., recidivism), few have determined if participation in the
therapeutic community results in changes in intermediate outcomes. Therefore, this
dissertation will determine if participation in the program results in lower levels of
cognitive distortions and changes in psychological and social functioning.
Fourth, research has been mixed concerning the types of individuals who benefit
from participation in the therapeutic community. Furthermore, this research will be one
of the first to examine specific characteristics of the juveniles to determine if the
treatment provided by the therapeutic community is more effective for certain types of
juveniles.
Finally, to address the concerns from pervious research on therapeutic
communities, this dissertation attempts to overcome the common shortcomings by: 1)
including multiple outcome criteria (periods of new incarceration, time to incarceration,
and seriousness of new incarceration; 2) following the juveniles for a period up to three
years after program completion which allows the researcher to examine behavior from
adolescence into adulthood; 3) using a matched (i.e., risk and need) comparison group
8
drawn from a sample of youth that did not receive treatment; and 4) using multivariate
designs which will identify significant predictors of recidivism.
RESEARCH QUESTIONS
While the main goal of this dissertation is to determine if the therapeutic
community reduced the recidivism rates for juvenile male offenders, the following
specific research questions will be answered:
1. What are the characteristics of the treatment group and the comparison group? What if any differences exist between the treatment and comparison groups?
2. Did participation in treatment significantly impact the youth’s levels of
cognitive distortions and psychological and social functioning?
3. What factors predict successful completion of treatment?
4. What are the rates of new incarcerations for the treatment group and the comparison group? Are there significant differences in the rates of new incarcerations for the treatment group and the comparison group?
5. What factors predict a new incarceration?
6. Does the effectiveness of the treatment provided at Mohican Youth Center
differ among the different types of juveniles?
SUMMARY
This chapter has reviewed the prevalence of substance abuse among juvenile
offenders and problems that these arrests cause the juvenile justice system. Specifically,
while the number of juvenile arrests has decreased over the past 5 years, the number of
juveniles being formally processed through the court system has increased. Furthermore,
these juveniles are being processed for drug offenses and being placed on detention and
residential centers. In response to the link between substance abuse and criminal
behavior, states have received monies to implement residential substance abuse treatment
9
programs. With the money received from the federal government, the state of Ohio
implemented a therapeutic community for adolescent males. While much research has
been conducted on this type of treatment modality, little insight has been given on the
effectiveness of therapeutic communities for juveniles. As such, this dissertation will
present the results of a three-year follow-up to examine the effectiveness of therapeutic
communities for drug-involved adolescents.
Chapter Two will begin by examining the history of the juvenile justice system,
how it developed to treat juveniles, the attack of the juvenile justice system and
rehabilitation in general and the prevalence of public support for juvenile treatment
despite the attack on rehabilitation. The chapter will also explore the history of
therapeutic communities in corrections and how therapeutic communities have evolved
from traditional to modified communities that are found in many correctional programs
today. In addition, the chapter will explore the effectiveness of drug treatment especially
therapeutic communities and the methodological problems that plague many studies.
Finally, the chapter will explore the principles of effective interventions and how they
relate to residential substance abuse treatment.
Chapter Three of this dissertation will review the methods for this particular
study. In particular a quasi-experimental design was used whereby the comparison group
was matched to the treatment group based on an important predictor of recidivism–risk
level. Chapter Three will also review the sampling technique and procedures for
collecting the data for this study. In addition, the measures used to determine the
effectiveness of the therapeutic community will be explained along with the statistical
10
tests that were conducted. Finally, chapter three will conclude by addressing the
limitations of the study.
Chapter Four will present the results of the study. Specifically, the background
characteristics of the sample will be presented. The data that will be reported include:
demographic data, risk level, substance abuse level, the youth’s cognitive distortions, and
responsivity issues such as: anxiety levels, depression, self-esteem, self-efficacy,
decision-making abilities, and hostility levels. Information pertaining to the type of
termination (successful or unsuccessful completion) will be examined along with factors
predicting successful completion of treatment. Lastly, recidivism data such as:
percentage of juvenile offenders returning to a secure facility and factors predicting
return to a secure facility will be explored to address the issue of effectiveness of the
therapeutic community for juvenile offenders.
Chapter Five will present the discussion and limitations of the study. The chapter
will begin by reviewing the major findings and limitations of the dissertation. In
addition, explanations will be given concerning the major findings of the study.
Furthermore, policy implications will be suggested concerning the use of therapeutic
communities for juvenile offenders along with suggestions for future research.
11
CHAPTER 2 LITERATURE REVIEW
INTRODUCTION
Whereas chapter one provided insight into the epidemic of substance abuse and
delinquency for juveniles in the United States, this chapter will provide the context for
the project. The development of juvenile treatment and the juvenile justice system will
be explored to show how this country has always embraced the idea of rehabilitating
juveniles. Even though a “nothing works” mentality emerged and rehabilitation in
general was attacked in the later part of the 20th century, public support for rehabilitation,
especially for juveniles, has remained intact and is particularly strong. After the
discussion of public support is presented, the development of a specific form of
correctional intervention is explored – therapeutic communities. The research on this
type of treatment modality will be examined to determine if there are some
commonalities that can be found. In addition, evidence will be presented as to this
treatment modality’s effectiveness in reducing recidivism. While some research has
found therapeutic communities to be effective, there are some methodological issues of
this research that will be examined. This chapter will conclude by explaining how this
particular research was designed to overcome these past methodological problems to
examine the effectiveness of a therapeutic community for juvenile offenders.
THE MISSION OF THE JUVENILE JUSTICE SYSTEM
The modern treatment of juveniles had its rise in the industrial revolution
beginning in the late 19th century. The Progressive era was beginning to change America
in all areas: social, political, and economic. The changes were also beginning to take
hold in legal situations–especially for juvenile offenders. Prior to this time period,
12
juveniles were seen as miniature adults and were considered as property (Whitehead &
Lab, 1996). However, the Progressive era, driven by the Positivist school of criminology,
which based the causes of crime upon society rather than the individual, helped to foster a
different perception of the juvenile. Individuals during this time period postulated that
the environment in which the juvenile lived caused crime rather than the youth exercising
his or her own free-will. Furthermore, the status of the juveniles changed from that of
mini adults to individuals who were of less developed moral and cognitive capacities.
With the emergence of the Progressive era and the new view of crime and juveniles, the
social context was ripe for the development of a formal system for treating juvenile
offenders.
The Development of the Juvenile Justice System
Instead of locking up juvenile offenders, the progressive movement helped to
usher the development of a separate system for handling juvenile offenders (Platt, 1969).
With the Juvenile Court Act of 1899, the first juvenile court was established in Cook
County, Illinois (Lou, 1972). The progressives focus on “individualized treatment” was
evident in the juvenile court act of 1899 where its purpose was to “regulate the treatment
and control of dependent, neglected, and delinquent children” who were younger than 16
years of age (Lou, 1972, p.19). The central feature of the juvenile justice system was
treatment. Accordingly, in the juvenile justice system, delinquent behavior was not
viewed as a crime; rather it was behavior that needed to be treated (Empey & Stafford,
1991). According to the Progressives, a child was born innocent and he or she learned
criminal behavior from the environment in which he or she lived (Ryerson, 1978). In
other words, the early court continued the common law practice in which the child did
13
not possess the criminal mind. Because the child did not possess the criminal mind, then
he or she could not have been convicted of the crime (Kahn, 1953). Thus, the juvenile
court saw the defect in society and not in the child.
Since the child did not possess fully developed moral and cognitive capacities,
then he or she was not to be punished, but rather to be treated. Accordingly, it was argued
that juveniles were vulnerable and malleable by the environment in which they lived, and
therefore, they needed special adult guidance, education, and assistance so they could
become productive members of society. Thus, the early juvenile court operated under the
concept of “parens patriae” whereby the state would act as the parent (Mennel, 1973).
Under this doctrine, state officials were to serve as kindly parents who would focus on
the welfare of the child. Overall, the new system for juveniles was to be the
“superparent” for all those children who needed protection and treatment (Empey &
Stafford, 1991).
With state personnel operating under the “parens patriae” doctrine, dispositions
were tailored to the juvenile regardless of the offense. The treatment plans for juveniles
ranged from warnings to probation to training school placement and treatment lasted until
the juvenile was “cured” or turned twenty-one years old (Office of Juvenile Justice and
Delinquency Prevention, 1999). Furthermore, since the goal of the juvenile justice
system was rehabilitation through individualized treatment, the juvenile justice system
swept away all due process rights. It was argued since juvenile courts were not like adult
courts; juveniles did not need the same due process rights because the process may
interfere with the treatment of the child (Ryerson, 1978). In all, the progressive
reformers’ main concern was in reforming the juvenile at any possible cost.
14
The reformers saw a rapid development in the juvenile justice system. By 1925,
juvenile court legislation had been passed in all but two states and by 1932, there were
over 600 independent juvenile courts in the United States (Platt, 1969). The early
juvenile justice system has been said to be the proudest achievements of the Progressive
movement in which the courts and correctional personnel operated out of “truth, love,
and understanding” to provide a family type atmosphere where children could be treated
and rehabilitated (Mennel, 1973).
Criticisms of the Juvenile Justice System
While some saw the development of the juvenile justice system and the treatment
of juveniles as a labor love, there were some criticisms of the court. First, Platt (1969)
argues that the Progressives were led by the most class-conscious members of society
who wanted to form new social controls while protecting their privilege and power.
Rather than being a humanitarian involvement, the development of the juvenile justice
system was an attempt to intervene in the lives of lower class individuals in the name of
the state. The “child savers” developed a class of individuals who were labeled
delinquent because these individuals did not live up to the middle class goals and morals.
Platt (1969) argued that the philosophy was a defense against the “foreign” ideologies
and the child savers used force such as longer prison terms, long hours of labor, and
militaristic discipline to enforce their ideas. The child savers saw a way to control and
reform delinquent youths and thus allowed for a way to control the inferior lower social
class.
Second, still others believed that the juvenile justice could not live up to its
rhetoric. Rothman (1980) has argued that Progressives believed the early juvenile justice
15
system was almost like a panacea in which it could cure all delinquents. The concept of
informal and flexible policies would allow juveniles the benefit of being treated on a
case-by-case strategy. However, the reality of the implementation of these policies was
almost bewildering to the justice system. The reformers knew what the courts and
personnel should do, but they did not know exactly how to deliver the innovations.
Therefore, the reality of the early juvenile justice system was very different from the
rhetoric of the juvenile justice system and essentially the ideal principles of the reformers
did not fully develop.
ATTACKING REHABILITATION AND THE JUVENILE JUSTICE SYSTEM
Since the development of the juvenile court in 1899, the juvenile justice system
had remained virtually unchanged (Cullen & Gilbert, 1982). However, the turbulent times
of the 1960s forced both liberals and conservatives to reevaluate the original concepts of
the juvenile justice system. Although conservatives and liberals argued that the juvenile
justice system was in need of reform, their reasons for changing the system were quite
different. For both political camps, rehabilitation and treatment would no longer be
needed. Instead, it was argued that punishment and “just deserts” should be the guiding
principles of the juvenile justice system (Cullen & Gilbert, 1982).
Social Context, Rehabilitation, and Treating Juvenile Offenders
Liberal Ideology. The 1960s were turbulent times in America. During the Civil
Rights Movement, Americans witnessed the racial disparities that were prevalent in this
country. In some parts of the country, these peaceful marches would turn violent when
protesters would be assaulted by police trying to squash the march. The Civil Rights
16
Movement allowed citizens to see the government actively tolerating and in some times
perpetuating violence and inequality among groups (Cullen & Gilbert, 1982).
Along with the Civil Rights Movement, the Vietnam War was also a source of
social unrest among American citizens. Americans saw its country supporting a
dictatorial regime and in the process losing the claim of being the democratic defender
(Cullen & Gilbert, 1982). When protests over the War became too vocal, government
leaders would use any methods to control dissent over the war. Demonstrators against the
war would stage protests, but police would quickly squelch the protesters by using any
means necessary. Often the methods of control would result in violence against the
protesters. For example, during a protest at Kent State University, four students were
killed when National Guard opened fire into the rally. For the first time, America was
able to witness the destruction and violence the state inflicted upon its own citizens.
Eventually, liberals began to question the role of the state and its ability to protect
its citizens from harm (Cullen & Gilbert, 1982). The left wing saw the state misusing and
abusing its power against those who did not share its views. Therefore, liberals began to
doubt the willingness and capacity of the government to achieve a humane society that
treated everyone equal (Cullen & Gilbert, 1982). Eventually, this mistrust of the state led
liberals to call for safeguards for those who were being abused and victimized by the
state.
In the area of juvenile justice, liberals began to call for ways in which juveniles
could be protected from the abusive powers of the state. The original concept of the
juvenile justice system was to treat and rehabilitate the individual so that he or she would
become a productive member of society. The juvenile system would become a
17
“superparent” to those juveniles that needed help and treatment would be focused on that
child’s individual needs. However, the events of the 1960s showed liberals that the state
was abusing its role and, therefore, changes should be made to protect juveniles. The
liberals mistrust of the state helped foster the argument that due process was more
important than rehabilitation. Liberals argued that if government could not treat its
citizens well, then it should at least treat them fairly (Cullen & Gilbert, 1982). Therefore,
the juvenile courts turned away from the rehabilitation and treatment model and began to
allow juveniles some due process rights. The juvenile were given due process rights such
as: 1) right to a hearing; 2) right to counsel; 3) reasons from the judge if he or she is
bound over to adult court; 4) right to be notified of the charges; 5) right not to incriminate
himself or herself; and 6) the right to confront and cross examine witnesses. Today, the
only right not granted to juveniles is the right to a jury trial.
The liberals also believed that by allowing judges widespread discretion in
juvenile cases enabled disparities in the administration of justice. The left asserted that
individuals who were underprivileged were actively discriminated against. This
discrimination helped to repress certain populations. The liberals were concerned about
the discretion used by the judges in the informal juvenile courts and began to question the
purpose and processes of the juvenile justice system. Therefore, the liberals helped to
change the juvenile justice system by calling for due process rights, which would stop the
widespread discretion and the subsequent abuse of state power.
Even though liberals had wanted to protect juveniles by giving them the same due
process rights as adults and therefore, keeping the state from abusing its power, the
original goals and ideas of the juvenile justice system had been altered. The original
18
ideology of the juvenile court had been to rehabilitate the child and treat the child based
on his or her personal needs. This treatment was accomplished by allowing the courts to
have widespread discretion in administering treatment for juveniles. However, with the
Supreme Court granting juveniles certain due process rights, the juvenile court began to
lose some of its earlier goals (Feld, 1990). Instead of being an informal process with the
focus on individualized treatment, the process had become more formal and the primary
focus was on punishment instead of treatment (Feld, 1990). Even though the liberals had
a major victory with the Supreme Court in granting some due process rights to
individuals, beginning in the 1970s their agenda began to lose steam and the
conservatives began to dominate the political arena.
Conservative Ideology. Whereas the liberals saw the era of the 1960s as a period
of abuse of state power, the conservatives witnessed the 1960s as a period of threat to the
social order (Cullen & Gilbert, 1982). America was no longer a peaceful and tranquil
place for those on the political right. The political right saw the marches protesting
Vietnam as civil disobedience and disrespect for government. Conservatives also
believed that the country was in moral decay because abortions, premarital sex, living
together, divorce and teenage pregnancy were becoming more widespread and acceptable
(Cullen & Gilbert). This “mayhem” of the 1960s caused conservatives to be concerned
about establishing law and order. Conservatives argued that the social order was being
threatened by these events because society was too soft on crime. Thus, a “war on crime”
campaign ensued to combat the decaying morals of America and the soaring crime rates.
The right wing wanted to punish the “permissive society,” and “get back to the basics”
(Cullen & Gilbert). One of the main premises of the conservatives “war on crime” was
19
that there should be greater respect for authority and there should be firm discipline for
juveniles.
This war on crime campaign had its basis in the classical school of criminology
which viewed crime was a result of free-will. Conservatives asserted that juveniles chose
to exercise their free-will and commit crimes because the justice system was too lenient
with them. In other words, the criminal justice system was not doing its job. Instead of
being tough on the offender and focusing on the rights of the victim, the justice system
was more concerned with the offender. The right wing argued that the justice system
catered to the juvenile because it thought that he or she could be rehabilitated (Cullen &
Gilbert, 1982). It was claimed that the juvenile justice system had to be changed; it had to
become tougher on juvenile offenders. They saw the treatment element of the juvenile
court to be too lenient with the juvenile offenders and, therefore, the concept of
rehabilitation had to be changed.
Another important event that developed during this time that helped foster the
dissatisfaction with rehabilitation was the publication of Martinson’s article entitled,
“What Works? Questions and Answers About Prison Reform.” Martinson had evaluated
different treatment programs and found that: “with few and isolated exceptions, the
rehabilitative efforts that have been reported so far have had no appreciable effect on
recidivism.” (Martinson, 1974, p.25). This simple statement was soon interpreted as
“nothing works” by many individuals and the rehabilitative idea was dealt a devastating
blow (Cullen & Gilbert, 1982). Indeed, Martinson’s article, coupled with the soaring
crime rate, led many conservatives to feel that rehabilitation was simply not effective.
Offenders were not being rehabilitated but, instead, being allowed back on the streets to
20
commit more crimes. Conservatives argued that because rehabilitating offenders did not
work, it was time to start punishing the offenders and get tough on crime.
Therefore, the state needed another weapon in order to control crime. The
conservatives argued that the state needed to become tough with adult and juvenile
offenders. Instead of treating the juvenile, the state needed to punish the juvenile for his
or her crime. Therefore, conservatives opted for mandatory sentencing, juvenile transfers
to adult courts, and judicia l waivers as the new guidelines for the juvenile justice system.
It was argued that these interventions were the only way in which the crime rate would
drop and society would be safe from these offenders (Cullen & Gilbert, 1982).
Juvenile Justice: From Treatment to Punishment
When the juvenile justice system was first developed, the main emphasis was on
treating the juvenile so that he or she would become productive, well-adjusted members
of society (Empey & Stafford, 1991; and Kahn, 1953). Juveniles were not seen to be
culpable because they did not possess the criminal mind and, therefore, did not have the
criminal intent (Ryerson, 1978). This viewpoint dominated political ideology for 150
years. However, during the turbulent 1960s and 1970s, both liberal and conservatives
came to believe in due process and “just deserts.” The liberals pushed for due process
rights for juveniles in order to protect them from abusive powers of the state. The
conservatives, on the other hand, opted for “just deserts” because rehabilitation was
perceived to be ineffective and that the juvenile must be held accountable for his or her
actions. The “get tough” movement was gaining momentum and Americans no longer
viewed juveniles as innocent individuals who needed to be protected and treated. Instead,
21
the governing themes of justice would make the punishment fit the crime and determinate
sentencing would replace indeterminate sentencing.
These themes of justice have led the way for the justice system to become more
punitive in regards to juveniles. Over the past 20 years, there has been a call to treat
juveniles offenders like adults (Feld, 1997). States are becoming more punitive towards
juveniles by transferring them to adult courts so that they will receive sentences for adult
crimes. Recently, this punitive trend has increased to allow waivers to adult courts for
younger juveniles and for a broader range of offenses. Also, some states are considering
applying the “three strikes” law and the “once waived, always waived” law to juveniles
(Sorrentino, 1996). Given these alarming trends over the past two decades, it seems that
the correctional system in American is indeed becoming more punitive where juveniles
are concerned. However, despite the attack on rehabilitation and the “get tough”
movement for juveniles, there is still a substantial amount of public support for
rehabilitating juveniles.
PUBLIC SUPPORT FOR JUVENILE TREATMENT
While the juvenile justice system was founded on the concept of individualized
treatment and reforming the juvenile, these concepts were attacked on a number of
grounds and reasons. Recently, some have argued that the correctional system has
focused on “penal harm” instead of rehabilitation and treatment (Clear, 1994). Indeed,
this penal harm movement may be seen in the “get tough” philosophy of the later part of
20th century in which states moved to determinate sentencing and longer sentences for
adults to institutionalization of status offenders who violated court orders, and statutes for
transferring juveniles to adult courts (Moon, Applegate, & Latessa, 1997).
22
One potential reason for the “get tough” movement may be public opinion.
Oftentimes public policy is seen to be a mirror of public support. That is, policymakers
“get tough” with adult and juvenile offenders because the public is punitive and wants
these types of interventions. However, even with the public’s “get tough” mentality,
there is still substantial support for rehabilitation in general and the public’s support is
especially strong for juvenile rehabilitation.
Support for General Rehabilitation
Since Martinson’s “Nothing Works” article and the attack on rehabilitation, there
have been some that question whether the public supports rehabilitation for offenders.
Since the early 1980s, there has been a wealth of studies and public opinion polls to
measure the support for offender treatment. A review of the literature reveals some
conclusions that can be drawn concerning public support for rehabilitation (Cullen,
Fisher, & Applegate, 2000). First, the public does indeed hold punitive beliefs
concerning the handling of offenders. Indeed, research has shown that respondents favor
capital punishment for adult offenders (see Bohm 1991; Britt, 1998; Ellsworth & Ross,
1983; Grasmick, Cochran, Bursik & Kimpel, 1993; Sandys & McGarrell, 1994, 1995).
In addition, it appears that the public is supportive of harsh sentences such as the “three
strikes, you’re out” laws. For example, a Time/CNN poll found that 81 percent of adults
favored a life sentence for anyone convicted of a third serious crime (cited in Applegate,
Cullen, Turner, & Sundt, 1996).
Second, while the public may hold punitive attitudes towards offenders, their
attitudes appear to be mushy depending on how the questions are asked (Cullen et al.,
2000). Research has shown that broader questions, which tend to tap global attitudes,
23
reveal more punitive beliefs than specific questions about certain offenses, offenders, or
sentences (Applegate et al., 1996; Durham, Elrod, & Kinkade 1996; Sandys &
McGarrell, 1994, 1995). For example, when comparing global and specific attitudes
concerning support for three strikes laws; there were statistically significant differences.
Specifically, a large majority of respondents favored these laws when asked a global
question but when faced with a specific scenario that would result in the penalty only a
small minority supported life in prison (Applegate et al., 1996). Furthermore, while the
majority of respondents support capital punishment, the level of support declines when
they were faced with additional sentencing options such as life in prison without parole
and life in prison without parole plus paying restitution to the family (Bohm et al., 1990;
Bowers, 1993; Sandys & McGarrell, 1994).
Third, despite the attack on rehabilitation, the public continues to believe that
rehabilitation should be a focus of the correctional system. For example, as early as
1968, 70 percent of Americans believed that rehabilitation should be the main goal of
prisons (Harris, 1968). However, since that time the level of support for rehabilitation has
diminished. A study of Ohio residents found that 41.1 percent of the respondents
indicated that rehabilitation should be the main emphasis of prisons (Applegate, Cullen,
& Fisher, 1997). Furthermore, a recent national study found that 55 percent of U.S.
residents reported that “trying to rehabilitate the individual so that he might return to
society as a productive citizen” should be the main emphasis of prisons (Cullen, Pealer,
Fisher, Applegate, & Santana, 2002, p. 136).
While support for rehabilitation as the main goal of prison has declined, there is
some level of support for rehabilitation once the offender is placed into prison. For
24
example, a survey of Cincinnati residents found that 50.2 percent of the respondents
favored expanding rehabilitation programs in prisons (Sundt, Cullen, Applegate, &
Turner, 1998). In addition, 92 percent of the respondents in the national survey agreed “it
is a good idea to provide treatment for offenders who are in prison” (Cullen et al., 2002).
Accordingly, while the level of support for rehabilitation has decreased, the rehabilitative
idea continues to show tenacity.
Support for Juvenile Rehabilitation
While the decline in public support for rehabilitation may be due to the “penal
harm” movement (Sundt, et al., 1998), one should wonder if the same movement has
impacted support for juvenile rehabilitation. A review of the literature reveals that public
support for the rehabilitation of juveniles is strong (Applegate et al., 1997; Cullen et al.,
2000; Cullen et al., 2002; Moon, Sundt, Cullen, & Wright, 2000). Specifically, a sample
of Ohio residents was asked if they agreed with the following statement: “it is important
to try to rehabilitate juveniles who have committed crimes and are now in the correctional
system.” An overwhelming majority (96.1%) agreed with the statement with 35.9
percent strongly agreeing that the correctional system should focus on rehabilitating
juveniles (Applegate et al., 1997). In a national study of US residents, we see even
stronger support for juvenile rehabilitation. In particular, 98 percent of the respondents
agreed that it was important to rehabilitate juveniles who are in the correctional system
and, four out of five respondents selecting rehabilitation as the main emphasis of juvenile
prisons (Cullen et al., 2002).
Indeed, support for rehabilitating juveniles appears to be strong. Furthermore, the
public also supports a wide range of early intervention programs for juveniles even if
25
there was a tax increase due to the programs. For example, a sample of Tennessee
residents found that the lowest level of support for any program was 78.9 percent
(support for pre-school programs) with the highest level of support being 94.1 percent for
programs that require both first time offenders and their parents to participate in
rehabilitation programs so their problems would be dealt with (Cullen, Wright, Brown,
Moon, Blankenship, & Applegate, 1998). Respondents were also asked about using tax
dollars to support options for stopping crime. Seventy percent of the sample favored
spending their tax dollars on early intervention programs compared to only 20 percent of
the sample favoring spending tax dollars on incarceration.
Cullen et al., (2002) also examined support for early intervention programs in
their national sample of U.S. residents. In the national sample, 86 percent of the
respondents supported spending tax dollars on early intervent ion. In addition when asked
specifically about early intervention programs, the level of support ranged from a low of
89 percent for pre-school programs such as Head Start to a high of 96 percent for
programs for first time offenders and their parents. Thus, data from local and national
samples indicate that the level of support for juvenile rehabilitation is particularly strong.
Furthermore, the public supports juvenile rehabilitation to the point that they are willing
to spend their tax dollars on early intervention programs.
Not only is there a strong level of support for juvenile rehabilitation, but also the
level of support for juvenile rehabilitation appears to be stable. For example, a study of
Cincinnati residents in 1986 found that 94 percent of the respondents reported that
rehabilitation would be at least somewhat helpful for juveniles (Cullen, Skovron, Scott, &
Burton, 1990). Almost ten years later, the level of support remained high. For example,
26
a 1995 study of Cincinnati residents found that 91.6 percent of the respondents reported
that rehabilitation was at least somewhat helpful for juvenile offenders (Sundt et al.,
1998).
Accordingly, research has shown that despite the sustained level of attack on
rehabilitation, the public does support rehabilitation. Furthermore, the tenacity of the
rehabilitative idea is particularly strong for juvenile rehabilitation. As such, while there
may have been a movement to get tough on offenders, it appears that the public is still
compassionate enough to realize that rehabilitation is a viable alternative to punishment.
Therefore, one possible avenue for rehabilitating offenders is the use of therapeutic
communities.
THERAPEUTIC COMMUNITIES AS A TREATMENT MODALITY FOR OFFENDERS
The linkage between drug abuse and crime is well documented. For example,
seven out of every ten men and eight out of every ten women in the criminal justice
system have used drugs with some regularity before entering into the system (Lipton,
1998). The increase of substance abusers have lead to the war on drugs and the resulting
pressures for the criminal justice system to treat those with serious drug problems. It is
assumed that since criminal behavior and drug abuse is related, then interventions that
targeted drug abuse would reduce crime (Wexler, 1995). Thus, the 1994 Crime Bill, for
the first time, provided a substantial amount of money for treating offenders in state and
local agencies. From this Bill, the Residential Substance Abuse Treatment Grant
Program was created to establish programs to treat substance abuse among inmates. One
of the major treatment modalities that is used for treating substance abuse is therapeutic
communities.
27
History of Therapeutic Communities
Developments in the United Kingdom. While the term “therapeutic community”
was termed in 1945 by Thomas Main, the basis of the therapeutic community may be
traced to the early 1940s in Britain (Roberts, 1997). Specifically, the British therapeutic
communities have three main components. The first component has its beginning in
1942, in the Northfield Military Hospital, when Wilfred Bion, and later Thomas Main,
S.H. Foulkes, and Patrick de Mare began experimenting with the group process to treat
mental illness in WWII soldiers. The work by these individuals emphasized the
importance of group led discussions rather than therapist led discussions in treating
mental illness (Roberts, 1997). For example, the discussion of common experiences
helped to foster change in the individual and the other members of the group.
Furthermore, since the major emphasis was on the group process, any tensions that arose
among members were explored to maintain the cohesion of the group.
Also during this time, Maxwell Jones began work at Mill Hill Neurosis Unit in
London (Roberts, 1997).3 His contribution to the therapeutic community development
was in the form of the structure of the therapeutic community. Again working with
members of the British Armed Services, Jones began to see the soldiers’ attitudes toward
their symptoms change as a result of discussions among the group. The structure of the
“treatment” provided by Jones included community meetings, expression of feelings, a
highly structured environment, and open discussion of personal and group problems
(Brook & Whitehead, 1980). Specifically, there were three major themes that
characterized the work of Maxwell Jones. First, the structure allowed for
3 In 1959, Maxwell Jones left the Henderson Hospital and began work in the United States with the California Corrections Agency as a consultant (Roberts, 1997). In the U.S., he helped develop therapeutic community prison projects.
28
democratization and permissiveness in which behaviors were not only to be punished but
also tolerated and dealt with. Second, there was a sense of communalization where
members of the group were required to share their thoughts. The last major theme was
that of confrontation in which there was an expectation for the members to face their
problems and deal with the interpretations of problems and behaviors from other
members of the group (Brook & Whitehead, 1980).
The third component of the British therapeutic community was developed out of
the work of Thomas Main when he was employed at the Cassel Hospital in the United
Kingdom. Main’s contribution was the combination of the community with
psychoanalytic psychotherapy (Roberts, 1997). He addressed the issue of the whole
community, including staff, as being therapeutic. Specifically, he argued that the
community must establish and maintain a culture that allows for continuous questioning
to identify solutions to problems since each individual’s actions and responses have direct
consequences for the whole group. In addition, the importance of staff and patient
interactions was stressed, that resulted in therapeutic experiences necessary to facilitate
change (Hinshelwood, 1999).
Even though the components of the therapeutic community were developed
during the early 1940s, it was not until the 1960s that the components combined to treat
offenders. In 1962, a prison was specifically built to house a series of therapeutic
community wings. Grendon Underwood Prison, in Britain, incorporated the principles
used by Maxwell Jones, the use of group therapy developed by individuals at Northfield
Military Hospital, and the therapeutic relationships among the staff and offenders
described by Main at Cassel Hospital to rehabilitate offenders (Cullen, 1997).
29
Developments in the United States. Therapeutic communities began to develop
in the United States in the 1950s. Whereas the British communities were more
formalized and highly structured, and relied on group processing and psychoanalytic
psychotherapy, the American therapeutic communities were based on the self-help
movement. Charles Dederich applied the concepts of the therapeutic communities to
treating drug abuse in individuals. Dederich, a recovering alcoholic, became
disillusioned with Alcoholics Anonymous rigid focus on alcohol, and in 1958 developed
Synanon in California. The group initially began for alcoholics but eventually grew to
include drug addicts.
A split occurred among the group in which the addicts began community living
and Synanon was established (Brook & Whitehead, 1980).4 Synanon was an integrated
community of former addicts and offenders who participated in “brutal” confrontation
sessions, educational seminars, and discussions of self- image and work habits (Lipton,
1998). Members participated in groups called “games” in which they screamed loudly at
each other in a heated confrontation. It was said that these confrontations produced great
relief and were used to resolve conflicts and express emotions (Kooyman, 2001).
Concepts such as honesty and responsibility were stressed throughout the day. Indeed, a
sort of utopian society was developed in which members were required to renounce the
outside society and never return to the larger society.
While the description of Synanon may sound like an ideal society, others have
argued that the group became cult- like just short of brainwashing the members
(Abadinsky, 2001; Kooyman, 2001; Manning, 1989). Dederich believed that as a leader
he was a demigod and above confrontation unless he was confronted by his wife or his 4 The split of the addicts and the alcoholics occurred due to a dispute between the two groups.
30
brother. In addition, he ordered couples to change partners and be sterilized and
eventually implemented physical violence to handle juvenile delinquents. Furthermore,
any opposition to Synanon was meet with physical threats and death. 5
While the beginnings of therapeutic communities began in the 1950s, for the
purposes of corrections, the first therapeutic community for offenders opened in 1969 in a
federal penitentiary in Marion, Illinois. This program consisted of intense group
counseling and transactional analysis (Lipton, 1998). While this program did not operate
as most communities do today it did serve as a model for the federal government during
the 1970s. Indeed, many correctional therapeutic communities began operation in the
1970s and early 1980s due to the availability of funds from the Federal Law Enforcement
Assistance Administration funds; however, by the mid-1980s, the communities began to
close for a number of reasons. For example, monetary shortfalls, changes in executive
priorities, overcrowding, staff burnout, sabotage from custodial staff, and corruption
caused by weakened supervision and contraband caused many programs to fold (Lipton,
1998; Martin, Butzin, Saum, & Inciardi, 1999; Wexler, 1997). The exception of the
therapeutic community failures of the late 1970s and early 1980s was the New York
based therapeutic community Stay’N Out. As a matter of fact, this program served as a
model for many of the therapeutic communities that were developed during the late
1980s (Lipton, 1998).
The next surge of therapeutic communities was a result of monies available from
the Federal Anti-Drug Abuse Act of 1986. States used these monies to develop drug
abuse treatment programs for offenders in which treatment began in the institution and
5 Eventually, Dederich plead guilty to conspiracy of plotting to murder a lawyer who was representing ex-members of Synanon who maintained they were held against their will. He died in 1997 at the age of 83 (Abadinsky, 2001).
31
continued in the community upon release (Lipton, 1998). Indeed, even the Federal
Bureau of Prisons began to implement therapeutic communities with 34 programs that
served 30 percent of their drug abusing population being developed within 10 years6
(Lipton, 1998; Wexler, 1997). By 1997, the initiative started by the Act had resulted in
110 therapeutic communities in state and federal correctional institutions (Lipton, 1998).
In 1994, the Crime Bill also provided federal money for states to implement
residential substance abuse programs. The Residential Substance Abuse Grant Program
provided $270 million to states to operate treatment program for offenders with substance
abuse problems. While not required to establish therapeutic communities, the model
treatment program criteria are stipulated based on the findings of the effectiveness of the
successful therapeutic communities of the late 1980s. Furthermore, within two years of
the Act, 70 therapeutic communities have been developed or enhanced in more than 40
states (Lipton, 1998; Wexler, 1997). Indeed, the therapeutic community examined in this
dissertation was developed from monies obtained from the federal government as part of
the RSAT grant.
While therapeutic communities first began in Britain and focused on group
processing, psychoanalytic psychotherapy, and was highly structured, the foundation for
U.S. communities was the self-help movement. From this development, therapeutic
communities began to be used for offenders to treat substance abuse. From their first
appearance, they have been in and out of favor with corrections. Currently, with money
available from the federal government for the purpose of treating substance-abusing
offenders, many states are implementing therapeutic communities as the preferred
program. 6 The Federal Bureau of Prisons has since closed their therapeutic communities within the federal prisons.
32
Characteristics of Therapeutic Communities
While there is not one specific model defining therapeutic communities, there are
some similarities among this treatment intervention. Specifically, the characteristics of
the modality may be described along four dimensions – view of substance abuse and the
individual, treatment modality, structure, and activities.
View of Substance Abuse and the Individual. According to the therapeutic
community’s treatment perspective, drug abuse is seen as a personality disorder in which
the addict cannot postpone gratification, tolerate frustration, maintain stable relationships,
or assume responsibility for his actions (Wexler, 1995). The drug user has psychological,
social, and cognitive deficits such as: low self-esteem, problems with authority, poor
impulse control, feelings of guilt, and unrealistic expectations (Lipton, 1999). Thus,
drugs are not the problem; rather, the problem lies within the person and addiction is only
a symptom of the disorder. Since drug abuse is only a symptom of the personality
disorder, the primary goal of treatment is to change negative patterns of behavior and
thinking (DeLeon & Ziegenfuss, 1986; Nielson & Scarpitti, 1997). Thus, therapeutic
communities seek a holistic approach in which the aim is a global change in lifestyle:
abstinence from substance abuse, elimination of other antisocial activity, development of
employability skills, and enhancement of prosocial attitudes, values, and beliefs (DeLeon,
1999).
Treatment Modality of the Therapeutic Community. As previously
mentioned, the birth of therapeutic communities in the United States began out of the
self-help movement (Lipton, 1998; Wexler, 1997). The self-help movement is different
from traditional medical and social welfare approaches that foster a reliance on treatment
33
providers. Rather, self-help programs rely on self-responsibility and empowerment to
elicit commitment to one’s own healing. The self-help modality within therapeutic
communities promotes change by teaching members to take responsibility, gain control
over their situation, and improve competency (Wexler, 1997).
In addition to the self-help modality, therapeutic communities also adhere to a
structured social learning approach (Lipton, 1998). The social learning modality stresses
the importance of learning vicariously through observing others (Van Voorhis, 2000).
Unique to this treatment modality within the therapeutic community setting is the use of
the community to change the offender’s lifestyle. Specifically, the community consists of
offenders and staff who act as role models and guides in the recovery process.
Accordingly, the community is both the context for change and the method for
facilitating change (DeLeon, 1999). Some therapeutic communities use former addicts
and even ex-offenders who have been resocialized by the treatment modality as role
models whereas others use professionally trained staff (DeLeon, 1990; Lipton, 1998).
Structure of the Therapeutic Community. Therapeutic communities provide a
very structured environment in which the participants are isolated from the rest of society
or prison inmates (Springer, McNeece, & Arnold, 2003). There are strict rules and
regulations that offenders must follow to continue being a part of the community. In
addition, each day of the program is ordered and routine which serves to counter the
usually disorganized lives of the participants. It is theorized that the strict structure of
the days will assist the offender in developing time management skills, setting and
planning goals, and accountability (DeLeon, 1999).
34
In addition, to the rigid organization of the day, therapeutic communities have
distinct hierarchies among the offenders. The structure of the therapeutic community is
such that the program is largely self- regulated so that veteran participants are responsible
for guiding the behavior of newer residents (Springer et al., 2003). Hence, there is a
hierarchical structure in which leaders serve as important role models because they have
achieved success in the program (Broekaert, Kooyman, & Ottenberg, 1998). These
leaders are responsible for assisting new members in learning the concepts of the
therapeutic community, keeping an eye out for the other members, and praising and
correcting behaviors. Progression through the hierarchical structure is achieved by
demonstrating emotional growth and a commitment to the community.
Another important feature of the therapeutic community is the phase format of the
intervention. As DeLeon (1999) reports, the phases are developed to reflect incremental
learning, which helps to move the offender to the next stage of recovery. Many programs
have three phases of treatment. The first phase of treatment is the induction phase, which
is usually the first 30 days (DeLeon, 2000). During this time in the program, the
participants become assimilated into the community by learning the verbiage of the
community, the hierarchical structure, and the rules and regulations of the community.
The new member is usually assigned a senior member who will watch over and guide the
new participant, explain any questions, and counter comments pertaining to leaving the
community. In addition, any counseling sessions conducted during this time is usually of
a supportive nature in which the staff helps to reduce any anxieties surrounding the
individual (DeLeon, 2000).
35
The second phase of treatment is the primary treatment stage in which the focus is
on personal growth and psychological awareness through the use of the community,
educational and vocational services, and group meetings (DeLeon, 2000). It is during
this phase that the individual moves from being a passive observer to an active member
of the community eventually becoming a role model to others. Additiona lly, the member
is expected to “act as if” in which there is blind obedience to the community values and
rules of conduct until they become internalized (DeLeon, 2000). The phase two
participant is also expected to demonstrate knowledge of the therapeutic community,
accept that he has a problem and become committed to the recovery process, increase self
awareness and responsibility for his behaviors, and begin to hold others accountable for
their behaviors and attitudes (DeLeon, 2000).
Upon completion of phase two, participants enter the re-entry phase in which the
individual takes a more active role in the management of the community. He is adapt at
disclosing his thoughts to others, seeks helps when necessary, and works to strengthen
coping, decision-making, and problem-solving skills (DeLeon, 2000). This phase of
treatment works to get the participant ready for life outside the community.
The Use of Work in the Therapeutic Community. One of the core activities of
a therapeutic community is the use of work within the community. The purpose of work
is to replace the unstructured daily activities with regular routines (Brook & Whitehead,
1980). Since the therapeutic community is a separate environment, it is the responsibility
of the members to manage all aspects of the community (e.g., cleaning, meal preparation,
and maintenance). Thus, work is seen as a therapeutic intervention in that it helps to
promote responsibility and improve skills (DeLeon, 1999).
36
The primary purpose of work is not the by-product of the labor but rather the
personal change that takes place within the individual. It is believed that participation in
work will facilitate changes in behaviors, attitudes, and values of the participants
(DeLeon, 2000). For example, just as the structure within the therapeutic community is
hierarchical, job placement is also hierarchical. New members are usually assigned to
entry- level positions such as kitchen crewmember or clean-up crew. The tasks within
these jobs are menial and work is used to assess competency and willingness to complete
tasks. As members remain in the program and develop responsibility and competency,
they move to higher- level jobs such as maintenance and clerical work. These
assignments require greater self-management and higher levels of responsibility.
Placement in these jobs will result in acquiring stable work relations, greater
responsibility to self and others, and improvement in accountability (DeLeon, 2000). In
addition, these jobs have many of the same pressures as conventional work settings.
Aside from work within the facility, there is also job placement within the clinical
portion of the program. 7 For example, crew leaders are entry- level positions in which the
member has direct supervisory responsibility for other members on kitchen, clean up, and
other details. This position focuses on communication, self-management, accountability,
and motivating others (DeLeon, 2000). Crew leaders are usually supervised by
department heads. Individuals in this position report directly to the staff and must learn
to accept instruction and criticism from supervisors (DeLeon, 2000).
7 While placement into non-clinical jobs is based on position in the therapeutic community, placement into clinical jobs may be used as a therapeutic intervention. For example, if a participant needed to practice ‘being their brothers keeper’, he may be assigned an expediter job since they are responsible for monitoring and reporting on others’ behaviors.
37
The third type of clinical job is an expediter. These individuals are responsible
for monitoring and redirecting the other members (DeLeon, 2000). They must have
knowledge of the therapeutic community rules in order to detect and report any
violations. Individuals in this position have some degree of informal control over the
others as they are responsible for issuing verbal reprimands (e.g., pull-ups) and providing
information and suggestions to staff.
The highest-ranking position within the clinical setting is that of coordinator.
This individual has much informal authority, as he is usually the individual that is closest
to the staff.8 He has many responsibilities which include assisting in managing the daily
operations of the therapeutic community through facilitating house meetings, reviewing
daily schedules, and overseeing sanctions, privileges, and disciplinary actions (DeLeon,
2000). Thus, the coordinator must learn how to handle a position of authority and
develop decision-making skills.
The hierarchical structure within therapeutic communities is very strict (DeLeon,
2000). For example, while staff members are available in the program, participants are
expected to adhere to the chain of command. That is, individuals must take problems to
their crew leaders who then process the information to the department heads. The
department heads are then responsible for relaying the information to the expediter who
in turns transmits the request, problem, or suggestion to the staff. When an individual
“shoots a curve”, he is breaking the chain of command and usually goes directly to a staff
member with a request/suggestion. If this behavior is continued, then disciplinary action
is usually taken.
8 Since staff members in a therapeutic community are more hands-off than many other types of treatment interventions, the structure is developed so that all lines of communication to the staff flow through the coordinator.
38
The Use of Behavioral Reinforcements in the Therapeutic Community.
Aside from the community agent, the use of role models, and the hierarchical structure,
another avenue for changing behavior that is employed within therapeutic communities is
the use of reinforcements (DeLeon, 1990; Wexler, 1995). Specifically, push-ups, pull-
ups, learning experiences, and therapeutic reprimands/therapeutic haircuts are used
within the therapeutic community to bring attention to and change behavior. Push-ups
are a form of behavioral reinforcements in which participants receive positive feedback
(e.g., praise) for any signs of progress. The purpose of the push-up is to provide
encouragement to the recipients to continue the behavior/attitude (DeLeon, 2000).
Whereas push-ups are positive praise, pull-ups are awareness techniques that are
used within the community and may result in some type of sanction. There are two types
of pull-ups–verbal and written. Pull-ups are verbal statements of reminders issued by
peers at any time when there are lapses in awareness in behaviors and/or attitudes and the
recipient is assumed to know the appropriate behavior or attitude (DeLeon, 2000). When
a pull-up is issued, the recipient must listen to the pull-up without comment and then
express gratitude at receiving the reminder. When participants repeatedly perform an
undesired behavior/attitude, then written pull-ups (i.e., tickets) may be used to correct the
behavior. Whereas, verbal pull-ups do not result in a sanction, written pull-ups flow up
the chain of command to the staff and usually result in some type of sanction or learning
experience.
The most severe type of verbal corrective is the reprimand or “therapeutic
haircut.” Both staff and senior members may issue a therapeutic reprimand for repeated
negative behaviors. When offenders issue the haircut, staff members usually observe the
39
incident. The recipient must stand before the staff and other community participants
while staff either talk to and/or yell at the individual about his behaviors or attitudes for
approximately five minutes. During this time, the recipient is expected to maintain eye
contact and not speak while staff discuss the behavior, exp lain why it is unacceptable,
how it will lead to destructive outcomes, and positive alternative ways of behaving
(DeLeon, 2000). Thus, it is argued that reprimands are therapeutic in that it instructs the
individuals involved (both the recipient and the observers) on positive prosocial
behaviors and attitudes.
Aside from verbal warnings, members may also receive sanctions such as learning
experiences, wearing signs, speaking bans, loss of privileges, loss of phase status, and
ultimately discharge from the community. Learning experiences are administered for
minor rule violations and usually include some type of writing assignments, community
apologies, or physical activity (DeLeon, 2000). Usually the member must present the
learning experience to the entire community either during the morning meeting or the
evening meeting. Another type of sanction is the use of signs worn around the neck or
pinned to the shirt. It is argued that wearing signs helps to heighten the awareness of the
problem behavio rs/attiudes for both the resident and the other community members
(DeLeon, 2000). Speaking bans may also be employed within a therapeutic community.
Speaking bans may be directed to one individual or to the entire community. This type of
sanction is usually issued when there is negative communication concerning the use of
substance abuse, threats within the community, and cynical judgments about the program.
Loss of privileges and loss of phase levels are other sanctions that may be used to
change negative behavior. Loss of privileges is usually proportionate to the type of
40
infraction and is potent if the member feels the emotional reaction from losing the
privilege (DeLeon, 2000). For example, members may lose the ability to wear their own
clothes, to have more money or personal items, and to receive additional letters or make
more phone calls. Loss of phase levels are usually reserved for more severe infractions
(such as violating a major rule – horse playing, using profanity, or walking out of group)
and may reduce the member down one level or even to the lowest level depending on the
infraction. With the loss of levels, the member also loses the privileges associated with
the level. The loss of a level may be for a certain period of time or the member may be
required to re-complete the steps necessary to advance to the next level.
The ultimate sanction is termination from the program. When a member has
violated a cardinal rule (i.e., using physical violence, drugs, destruction of property, or
having contraband) or had repeated violations, then he may be unsuccessfully terminated
from the program. Early termination is usually reserved for behaviors that constitute a
threat to the safety of the community. In some cases, the member may be allowed to
return to the community after 30 days if he has shown some type of improvement in his
behavior (DeLeon, 2000).
The Types of Meetings and Groups in a Therapeutic Community. Each day
members participate in two different types of meetings – morning meetings and evening
meetings. While staff members are present for these meetings, the community members
facilitate the gatherings. The purpose of the morning meetings is to present the activities
for the day, motivate the members, present any assignments that were issued as sanctions,
and to get the day off to a good start. A morning meeting will typically include reciting
the philosophy of the program, reading a word of the day, the weather report, signing
41
songs, playing games, and skits. The reason for the activities in the morning meeting is
to show the participants that individuals can gather together in the morning to develop a
regular routine without the use of drugs (DeLeon, 2000). The evening meetings mirror
the morning meetings in that participants facilitate them with staff being present. They
are intended to end the day on a positive note and help the community to reflect on the
day (DeLeon, 2000). During the evening meetings, learning experiences may be issued
to the members and the writing assignments presented to the community.
Another type of meeting that is usually held in a therapeutic community is
seminars or didactic presentations that teach offenders various lifestyle skills that are
needed to keep offenders drug-free (Broekaert et al., 1998; DeLeon, 1990; DeLeon &
Ziengenfuss, 1986; Nielsen & Scarpitti, 1997). The members present the seminars in
order to build self-esteem. The topics of the seminars may vary but usually include the
following: telling your story, concepts of the therapeutic community, pros and cons of a
behavior/attitude, and topics about mainstream issues (DeLeon, 2000). The use of
seminars is a therapeutic tool, which attempts to train attention, listening, and speaking
skills to those who participate (DeLeon, 2000).
While morning and evening meetings and seminars are daily interventions, the
primary therapy used in therapeutic communities is encounter groups that are intense
confrontational sessions where immature behavior and criminal or antisocial values are
attacked (DeLeon, 1990; Lipton, 1998; Wexler, 1995). During an encounter group, two
individuals sit across from each other within a circle of the other members.9 The
9 While staff members are present, they do not participate in the encounter group unless there is a threat of violence. Staff members have no decision-making authority during these groups because it is argued that their authority would impede the spontaneity of the self-help process and hinder the members from resolving issues (DeLeon, 2000).
42
individual confronting the other member presents the behavior/attitude that is being
confronted. Once the behavior is brought to the attention of the individual, a verbal battle
is evoked in hopes that confronted individual will begin to change his attitude or
behavior. The argument is made concerning the negativity of the behavior/attitude by the
confronting member and may also include other members of the community who enter
the circle. Once the confrontation is complete, the encountered member is allowed to
defend himself and may even resist the encounter. Once the encounter is complete, a
period of closure is used to reaffirm the person and the process. It is argued that the
encounter environment provides motivation for individuals to change (DeLeon, 2000).
Recently, some communities have begun to provide services to facilitate
successful lifestyles outside of the therapeutic community (Wexler, 1995). In these
programs, offenders are given aftercare, which serves to strengthen the skills necessary to
continue living drug-free or crime-free lifestyles. Thus, therapeutic communities have
emerged from the self-help movement of the 1950s to include cognitive behavioral
interventions such as relapse prevention, aspects of social learning therapies such as
modeling, and radical behavioral aspects such as the use of reinforcements or rewards.
Therapeutic Communities and the Principles of Effective Interventions
Since Martinson’s “nothing works” days, research has discovered programs are
able to have a positive effect under certain circumstances. Specifically, Gendreau (1996)
has identified certain principles of effective intervention that if adhered to are more likely
to result in successful outcomes. The principles are as follows: 1) services should be
intensive and behavioral in nature; 2) behavioral programs should target criminogenic
needs of high-risk offenders; 3) the characteristics of the offenders, therapists, and
43
programs should be matched; 4) program contingencies and behavioral strategies should
be enforced in a firm but fair manner; 5) therapists should relate to offenders in
interpersonally sensitive and constructive manner and should be trained appropriately;
and 6) relapse prevention strategies should be provided (Gendreau, 1996, pp.120-125).
Indeed, many authors have found treatment effects for correctional programming
if they adhere to the principles of effective intervention (Andrews & Bonta, 1994;
Gendreau, Cullen, & Bonta, 1994; Lipsey, 1992; Lipsey & Wilson, 1998). Furthermore,
while some research has found that therapeutic communities are effective in reducing
recidivism, research has not examined this treatment modality in relation to the principles
of effective intervention. Thus, this section will explore important issues of therapeutic
communities as they relate to the “what works” body of evidence.
Intensive and Behavioral Services. Since offenders in therapeutic communities
are essentially in “treatment” 24 hours a day, the programs often meet the principle of
intensity. That is, the offenders are in programming for the majority of their time in the
program. They participate in groups and meetings for approximately 16 hours a day
(DeLeon, 2000). Furthermore, they are expected to be aware of their own and each
other’s attitudes/behaviors 24 hours a day. Another aspect of intensity is that programs
must be of sufficient length in order to allow for enough time for the offenders to change
their attitudes. Research has shown that effective programs average a length of six to
nine months (Gendreau, 1996). Accordingly, many correctional therapeutic communities
average a length of stay of about six months10 (Harrison & Martin, 2003).
10 Therapeutic communities that receive federal money from the RSAT grant must develop programs that are 6 months in length.
44
The problem with therapeutic communities lies in the behavioral portion of their
program. Many behavioral programs are based on the principles of operant conditioning
(Lester, Braswell, & Van Voorhis, 2000). Operant conditioning uses reinforcements to
change behavior. As previously discussed, members in the therapeutic community
provides verbal praise in the form of push-ups and members receive privileges as they
advance through the program (DeLeon, 2000). The problematic issue of reinforcements
within therapeutic communities is the types of punishers that are issued. The use of
therapeutic reprimands and learning experiences are not effective reinforcements. For
example, a therapeutic reprimand usually involves five minutes of yelling at the offender.
Learning experiences are issued to members for antisocial behaviors or attitudes and are
usually activities that result in some type of shaming. For instance, offenders are made to
wear signs, sing songs, or carry items such as toilet brushes throughout the day for
unwanted behavior. These techniques are seen as demeaning and shameful and thus are
not effective in shaping behavior (Spiegler & Guevremont, 1993).
Aside from using reinforcements, programs should be based on a behavioral
model. Gendreau (1996) describes three types of behavioral programs: token economies,
social learning, and cognitive-behavioral therapies. The foundation of therapeutic
communities in the United States is based on a self-help model. Indeed, a national
evaluation of the residential substance abuse treatment programs, many of which
implemented therapeutic communities, found that programs adhered to an eclectic model
of cognitive-behavioral and self-help, educational therapies (Harrison & Martin, 2003).
This type of model is not very effective in changing criminal behavior and substance
abuse (Andrews & Bonta, 1994; Kownacki & Shadish, 1999). However, many
45
therapeutic communities are combining a structured social learning approach with
cognitive behavioral techniques (Feld, 1984; Inciardi et al., 1997; Wexler, DeLeon,
Thomas, Kressel & Peters, 1999). Structured social learning programs stress the
importance of modeling in which offenders learn behaviors and attitudes through
watching and imitating others (Van Voorhis, 2000). Cognitive-behavioral programs
focus on changing antisocial attitudes through teaching skills such as problem-solving,
self-control, and self- instructional training (Gendreau, 1996). Thus, the therapeutic
communities that adhere to these approaches attempt to change attitudes and behaviors
through the use of role models and skill training.
Targeting Criminogenic Needs of High-Risk Offenders. Research has revealed
dynamic risk factors that predict recidivism among offenders. Specifically, programs that
target factors such as: antisocial attitudes, antisocial peer networks, antisocial personality,
familial factors, and education and vocational achievement are more likely to reduce
recidivism as these are some of the strongest predictors of criminal behavior (Andrews &
Bonta, 1994; Gendreau et al., 1994; Gendreau, Little, & Goggin, 1996; Simourd &
Andrews, 1994). While antisocial attitudes are targeted within the therapeutic
community, it appears that a major focus of many communities is making the member
employable (DeLeon, 2000). While vocational achievement is a criminogenic need, it is
not a strong of predictor as antisocial attitudes (Andrews & Bonta, 1994). Furthermore,
many therapeutic communities are not addressing the attitudes related to work but rather
are focusing on factors such as resume building, interviewing, and letter writing
(DeLeon, 2000).
46
Therapeutic communities also address non-criminogenic needs such as self-
esteem. As previously discussed, therapeutic communities postulate that individuals use
substances because of low self-esteem (Lipton, 1999). Therefore, in order to reduce
substance abuse, therapeutic communities seek to increase the self-esteem of the
offenders. Research has shown that self-esteem is not a predictor of recidivism and
therefore, should not be a target in correctional programming (Andrews & Bonta, 1994).
While low self-esteem is not a predictor of recidivism, an inflated self- image is a
predictor (Andrews & Bonta, 1994). Furthermore, many high-risk offenders suffer from
egocentrism in which case participation in therapeutic communities may serve to increase
recidivism. Thus, therapeutic communities may not be as effective in reducing
recidivism as programs that formally target antisocial attitudes.
Another problem of therapeutic communities is the lack of assessment
instruments that differentiate low and high-risk offenders. For example, Harrison and
Martin (2003) found that many programs did not use standardized assessment
instruments, which resulted in inappropriate offenders entering the program. As research
has shown, behavioral programs should target high-risk offenders. Targeting low risk
offenders tends to result in either no change in recidivism or an increase in recidivism
(Lowenkamp & Latessa, 2002). Thus, without a risk assessment instrument, many
therapeutic communities may not be targeting high-risk offenders.
Related to the lack of assessment instruments is the lack of screening or
exclusionary criteria for many programs. When programs do not have criteria in place to
prevent certain types of individuals from entering treatment, many inappropriate
offenders will receive treatment. These individuals may disrupt the treatment
47
intervention. For example, as research has shown allowing psychopaths to engage in
treatment interventions at best will result in no change and at worse will increase their
risk of recidivism (Hare, 1996, 1999). Furthermore, participation in a therapeutic
community has been found to actually increase a psychopath’s recidivism rates (Hare,
1999). It may that the structure of the therapeutic community allows the psychopath to
enhance their antisocial tendencies. For example, within a therapeutic community, the
participant’s self-esteem is increased; offenders have informal control over others; they
participate in confrontational encounter groups; and are allowed to issue learning
experiences for antisocial behavior. These experiences may serve to increase the
psychopaths’ antisocial disorders. Accordingly, without adequate screening/exclusionary
criteria and assessment instruments, therapeutic communities may be allowing
inappropriate offenders to enter treatment resulting in increased recidivism for certain
individuals.
Reinforcement of Contingencies. Staff members should reinforce behavioral
contingencies in a firm, fair, and consistent manner (Gendreau, 1996). However, within
therapeutic communities, there is an issue of offenders having authority over others
(DeLeon, 2000). Members are responsible for writing pull-ups. Senior members of the
community with staff approval usually determine the sanctions that are issued for the
pull-ups. Thus, the reinforcements may not be issued in a firm, fair, or consistent
manner. A related issue to the reinforcement of contingencies is the fact that staff should
be aware of the potential negative effects of reinforcing–especially when punishments
have to be issued (Gendreau, 1996). For example, punishments may have unintended
effects such as fear, avoidance, increased aggression, and breaking of social relations
48
(Spiegler & Guevremont, 1993). Within the therapeutic community, there is a concept
called “act as if”. This concept of “act as if” involves the offenders having blind
obedience to the rules and regulations (DeLeon, 2000). Given this concept, it does not
appear that staff may be attuned to or consistently monitor the potential negative effects
of punishment such as escalation of behavior, aggression, or avoidance. Thus,
therapeutic communities may not be adhering to the reinforcement of contingencies
principle.
Staff Characteristics. Programs tend to be more effective when they have staff
that are educated, have experience working with the offender population, and are
properly trained (Gendreau, 1996). An issue with therapeutic communities as it relates to
staff characteristics is the lack of training (Harrison & Martin, 2003). Many programs
will hire ex-addicts who themselves have been through a therapeutic community or ex-
offenders and not professionally trained substance abuse counselors (DeLeon, 2000).
These individuals may lack valuable education and are usually not properly trained in the
“what works” literature.
Relapse Prevention Strategies. Programs tend to be more effective when they
incorporate relapse prevention components (Gendreau, 1996; Lowenkamp, 2004).
Elements of a relapse prevention strategy should include components whereby the
offender is given ample opportunity to monitor and anticipate problem situations (i.e.,
identifying triggers and red flags), practice alternative prosocial behaviors in increasingly
difficult situations, and provide opportunities for booster sessions and/or aftercare
services (Van Voorhis & Hurst, 2000). While some therapeutic communities are
teaching offenders how to monitor problem situations and incorporating aftercare
49
services, many programs do not have ample opportunities for offenders to practice
alternative behaviors. Indeed, the offenders’ days are filled with didactic groups that may
be classified as “talking cures” and education based therapies. These strategies have been
shown to not be as effective as strategies that focus on skill building and rehearsal
(Gendreau, 1996).
While therapeutic communities adhere to some principles of effective
interventions (i.e., intensity, length of treatment, and use of praise and privileges,
identification of triggers), there is room for improvement. Specifically, therapeutic
communities rely on education-based programming and talking cures instead of
cognitive-behavioral therapies, fail to target appropriate criminogenic needs, may not be
targeting high risk offenders, hire ex-offenders and ex-substance abusers instead of
professionally trained staff, and use shaming techniques as sanctions. In addition, while
not a specific principle of effective intervention, it is problematic that offenders are
having informal authority over other offenders. For example, many job assignments
place offenders in a position of power over the other offenders (e.g., department heads,
expediters, and coordinators). Furthermore, members also have input into the type of
learning experience that is administered to the offender. Thus, with offenders having
some power over others, there is an opportunity for abusing the power.
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES
As research has shown, there is a continuing problem of drug abuse and
criminality. Without appropriate intervention, drug-abusing offenders (especially the
most severe offender-addicts) have a 90 percent chance of returning to drug use and
crime after release from an institution and most will be reincarcerated within three years
50
(Lipsey, 1995). Thus, there is a real need to establish ‘what works’ for drug abusing
offenders.
One promising avenue is placing offenders in therapeutic communities. A review
of the literature on the effectiveness of therapeutic communities in reducing recidivism
and drug use reveals four main issues that will be examined. First, research examining
the effectiveness of therapeutic communities compared to no treatment or minimal
treatment will be reviewed. A second issue concerning the research on therapeutic
communities has to do with the follow-up time period and the strength of the
effectiveness of the treatment. Next, research has also examined the effectiveness of the
treatment modality for individuals who actually complete treatment and individuals who
drop out of treatment. Last, studies have been conducted that examined outcomes for
transitional programs (i.e., in-prison therapeutic communities to work release programs
operated as therapeutic communities to supervised aftercare). Aside from these issues,
research will be presented that reviews the specific predictors of success. Specifically,
predictors of successful treatment outcome (i.e., recidivism) and predictors of successful
completion will be evaluated.
Reducing Recidivism
Treatment Versus Non-Treatment. There is mixed support for therapeutic
communities when comparing those who participate in treatment compared to offenders
who do not participate in treatment (see Table 1 for a review of studies). For example, in
one of the first outcome studies of a therapeutic community, Field (1984) examined the
Table 1: Summary of Therapeutic Community Outcome Evaluation Findings Year Authors Treatment Group Comparison
Group Measures Follow-up Findings
1984
Field Oregon’s Cornerstone Program
Individuals not receiving treatment
Reincarceration Three-year 29% of the TC graduates were reincarcerated compared to 37% of the untreated comparison group
1997
Inciardi, Martin, Butzin, Hooper, & Harrison
Males & females in a multistage TC in Delaware Prison with a step down to a community work release center operated as a TC
Those who were assigned to regular work-release
Arrest-free & Drug-free
Eighteen month
77% of offenders who participated in the in-prison TC and then the community TC/WR group were arrest free compared to 57% of community TC/WR group only; 43% of in-prison TC only; and 46% of the comparison group were arrest free 47% of in-prison TC+ community TC/WR group were drug free whereas 31% of community TC/WR group; 22% of in-prison TC only; and 16% of the comparison group
1999
Mart in, Butzin, Saum, & Inciardi
Males & females in a multistage TC in Delaware Prison with a step down to work release center and then aftercare in the community
Those who were assigned to regular work-release
Arrest-free & Drug-free
Three-year 43% of offenders who participated in in-prison TC+ community TC/WR group were arrest free compared to 37% of the TC/WR only group; 41% of the in-prison TC only; and 30% of the comparison group were arrest free at three years 23% of offenders who participated in in-prison TC+ community TC/WR group were drug free compared to 23% of the TC/WR; 22% of the in-prison TC only; and 6% of the comparison group were drug free 69% of the TC/WR+AC completers group were arrest free compared to 55% of the TC/WR completers were arrest free; 28% of the TC/WR dropouts were arrest free; and 29% of the comparison group were arrest free 35% of the TC/WR+AC completers were drug free compared to 27% of the TC/WR completers; 17% of the TC/WR dropouts; 5% of the comparison group were drug free
TC – therapeutic community; WR – work release, AC – aftercare
Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment
Group Comparison Group
Measures Follow-up Findings
2000
Farrell Females who participated in Delaware’s prison-based CREST TC in Delaware
Females participating in a work release program
Relapse with drugs & New arrest
18-month 39% of the treatment group had used drugs compared to 50% of the comparison group 39% of the treatment group & 39% of the comparison group had been arrested
2002
Butzin, Martin, & Inciardi
Participants in the Crest TC in Delaware
Compared the participants with the different levels of the treatment received
Relapse with drugs & New arrest
18 to 42-month
At one year follow-up, 39% of the TC/WR dropouts group, 42% of the TC/WR graduates, & 50% of the TC/WR + AC group were drug free. At 3- year follow-up, 19% of the TC/WR dropouts, 24% of the TC graduates, & 32% of the TC/WR + AC group were drug free. At one year follow-up, 68% of the TC/WR dropouts, 81% of the TC graduates, & 79% of the WR/TC + AC group were arrest free. At 3- year follow-up, 34% of the TC/WR dropouts group, 56% of the TC graduates, & 60% the TC/WR + AC group were arrest free.
Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment
Group Comparison Group
Measures Follow-up Findings
2004 Inciardi, Martin, Butzin
Individuals who participated in the CREST TC in Delaware
Individuals who were eligible for TC but received work release
New arrest & Drug usage
Up to 5 years Estimated probabilities of being drug free at 42 months were .29 for the TC+AC group; .20 for the TC completers only; .18 for the TC dropouts; and .05 for the “no treatment” group At the 60 month follow-up, the probabilities were .26 for the TC+AC group; .21 for the TC completers only; .17 for the TC dropouts; and .05 for the “no treatment” group The probabilities for remaining arrest-free at the 42 month follow-up were .53 for the TC+AC group; .47 for the TC completers only; .33 for the TC dropouts; and .27 for the “no treatment” group For the 60 month follow-up, the probabilities were .48 for the TC+AC group; .42 for the TC completers only; .28 for the TC dropouts; and .23 for the “no treatment” group
1999
Wexler, DeLeon, Thomas, Kressel, & Peters
California’s Amity Prison TC
None Reincarceration One year & Two-year
44.9% of TC dropouts; 40.2% of TC completers; 38.9% of TC completers but AC dropouts; and 8.2% of TC + AC group were reincarcerated at the one-year follow-up 60% of TC completers but AC dropouts were reincarcerated compared to 57.5% of the TC dropouts; 48.8% of the TC only group; and 14% of the TC + AC group at the two-year follow-up
Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment Group Comparison
Group Measures Follow-up Findings
1999
Wexler, Melnick, Lowe, & Peters
California’s Amity Prison TC
Individuals not receiving treatment
Reincarceration controlling for treatment readiness and motivation & Length of time to return to custody
Three-year 75% of the no treatment group were reincarcerated at the three-year period compared to 82% of the TC dropout group; 79% of the TC comp leters; and 7% of the TC + AC group The TC & AC group took 579 days to return to custody whereas the TC only group took 387 days to return; the TC dropouts took 306 days to return; and the non-treatment group took 295 days to return
1997 Knight, Simpson, Chatman, & Camacho
Kyle New Vision TC in TX (TC + AC + Probation.)
Individuals receiving no treatment
Arrest & Cocaine use
Six-month 3% of the treatment group were rearrested compared to 16% of the comparison group 35% of the treatment group used cocaine whereas 54% of the comparison group reported using during the follow-up period
1999 Hiller, Knight, & Simpson
293 parolees who participated in Kyle New Vision TC in TX (TC+AC with supervision)
Matched (drug use & criminal history) group of 103 parolees who received no treatment
Arrest
Three, six, nine-month, & one-year
2% of the TC+AC, 5% of the TC only & 4% of the comparison group were arrested at the 3-month period. 5% of the TC+AC, 13% of the TC only & 16% of the comparison group were arrested at the 6-month period. 12% of the TC+AC, 22% of the TC only & 24% of the comparison group were arrested at the 9-month period. 16% of the TC+AC, 29% of the TC only & 31% of the comparison group were arrested at the 12-month period.
Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment Group Comparison
Group Measures Follow-up Findings
1999 Knight, Simpson & Hiller
Nonviolent offenders who participated in the Kyle New Vision TC in TX (TC+AC with supervision)
Individuals receiving no treatment
Reincarceration
Three-year 64% of the TC completers but AC dropouts were reincarcerated 41% of the in-prison TC were reincarcerated 42% of the comparison group were reincarcerated 25% of the TC + AC completers were reincarcerated
1999 Siegel, Wang, Carlson, Falck, Rahman, & Fine
Inmates participating in Ohio’s in-prison TC
Inmates not participating in a TC
Arrest & Length of time to arrest
Unknown There were significant differences between the comparison group and the treatment group. Inmates with 6 months or more of TC treatment were significantly less likely to be arrested.
2002a Pealer, Latessa, & Winesburg
Juvenile males in a residential TC in Ohio
Juvenile males who participated in an eclectic program (12-step & CBT) & Juvenile males who were sentenced to the DYS who received no treatment
Incarceration in a youthful or adult facility & Length of time to incarceration
Up to 21 months
17.2% of the treatment group had been re-incarcerated compared to 37.5% of the eclectic group and 37% of the DYS no treatment group. The average length of time to incarceration was lowest for the treatment group at 193 days followed by the DYS group at 255 days and the eclectic group at 296 days.
Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment Group Comparison
Group Measures Follow-up Findings
2002
Winesburg, Latessa, & Pealer
Males inmates in a medium-security prison TC in Ohio
Inmates from the general population
Arrest & Incarceration
Up to 3 ½ years
There were no significant differences between the groups at the 2 year, 3 year, or 3year + time periods for arrest. However, for each time period, the treatment group had the lowest percentage of individuals being arrested. There were no significant differences between the groups at the 2 year, 3 year, or 3year + time periods for incarceration. The TC group had the lowest percentage for being incarcerated.
2002b Pealer, Latessa, & Winesburg
Males & females participating in a community-based correctional facility TC in Ohio
Individuals participating in the CBCF that used a holistic approach & probationers who participated in a 12-step program
Arrest & Incarceration
Up to 3 ½ years*
More individuals were arrested from the treatment group (35.8%) followed by the CBCF group (32.4%) and the 12-step group (26.3%) at the 1 year follow-up 7.1% of the treatment group were arrested within 1 to 2 years following release whereas 12.4% of the CBCF group and 13.5% of the 12-step comparison group were arrested. There were no individuals arrested from the treatment group at the 2 years or more follow-up; but 10.4% of the CBCF group and 9% of the 12-step group were arrested at this time. There were no significant differences between the groups for a new incarceration; however, a smaller percentage of the treatment group was incarcerated compared to the CBCF and 12-step groups at the one year and 2 year follow-up
* The same individuals were not tracked for each time period; thus, the reason for the finding that as length of time increases, the percentage of arrest and incarceration decreases.
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effects of Oregon’s Cornerstone Program, which is a 32-bed facility for correctional
inmates. Participation in the therapeutic community resulted in a significant decrease in
recidivism when compared to individuals not receiving treatment. Specifically, only 29
percent of the therapeutic community participants were reincarcerated at the three-year
follow-up compared to 37 percent of the individuals not receiving treatment (Field,
1984).
Research by Knight et al., (1997) also found a significant treatment effect for
individuals participating in a therapeutic community in Texas. At the six-month follow-
up period, only 3 percent of the treatment group had been arrested whereas 16 percent of
the comparison group (i.e., no treatment) had recidivated. Furthermore, the authors
examined cocaine usage at the follow-up time period and found that 35 percent of the
treatment group had used cocaine whereas 54 percent of the no treatment group had
reported using cocaine (Knight et al., 1997). Similar results were found in a review of
inmates who participated in Ohio’s therapeutic communities. Specifically, inmates who
received at least 180 days of treatment were less likely to be arrested compared to
inmates who did not receive treatment and inmates who received less than 180 days of
treatment (Siegal et al., 1999).
Whereas the above studies showed support for therapeutic communities, there
have been some studies that have shown no significant differences between the treatment
and the comparison groups. For example, other research conducted in Ohio revealed that
there were no statistically significant differences in medium security male inmates who
participated in a therapeutic community and a sample of inmates who did not participate
in treatment (Winesburg, Latessa, & Pealer, 2002). In addition, a community-based
58
therapeutic community did not produce significant reductions in recidivism (as measured
by arrest and incarceration) when compared to a sample that participated in an eclectic
residential drug treatment program and a sample of probationers who participated in a 12-
step program (Pealer, Latessa, & Winesburg, 2002b). Thus, while some studies have
found therapeutic communities to produce significant reductions in recidivism, others
have not seen this success. Furthermore, many studies have only included adult
offenders. Thus, the question remains is this treatment modality effective for juveniles.
Research pertaining to the effectiveness of therapeutic communities for specific
offender populations such as juveniles is scarce. In one of the first studies that examined
the effectiveness of a therapeutic community for juvenile offenders, Pealer, Latessa, and
Winesburg (2002a) found that juvenile males who participated in the therapeutic
community were significantly less likely to be incarcerated in either a juvenile facility or
an adult facility when compared to individuals who participated in an eclectic 12-step/
cognitive behavioral model and individuals who received no treatment. Specifically, 17
percent of the treatment group was reincarcerated at the follow-up time period whereas
37 percent of the eclectic group and 37 percent of the no treatment group were
reincarcerated (Pealer et al., 2002a).
Thus, these studies appear to show mix support for the therapeutic communities in
reducing recidivism. In some instances, the treatment resulted in a significant reduction
in arrest, incarceration, and even drug use (Field, 1984; Knight et al., 1997; Siegal et al.,
1999). However, other studies have found that therapeutic communities did not
significantly reduce recidivism especially when compared to other interventions (Pealer
et al., 2002b; Winesburg et al., 2002).
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Follow-Up Time Period. As previously mentioned, another issue that arose from
a review of the literature concerns the length of the follow-up time period in determining
effectiveness. Since the late 1980s and early 1990s, therapeutic communities have
emerged as a preferred method for treating substance-abusing offenders. Due to the
longevity of some communities, researchers have been able to examine the effects in
reducing recidivism over time. These studies have typically shown that the treatment
effect diminishes as more time elapses from release (Butzin, Martin, & Inciardi, 2002;
Inciardi et al., 1997; Martin et al., 1999; Wexler, DeLeon et al., 1999). For example, at
the 18-month follow-up, 77 percent of offenders who participated in a Delaware in-prison
therapeutic community and then were released to a therapeutic community work release
program were arrest free (Inciardi et al., 1997). However, at the 3-year time follow-up,
43 percent of the offenders who participated in the Delaware program were arrest free
(Martin et al., 1999). Similar results were found for offenders who participated in
California’s Amity prison therapeutic community, which also included aftercare (Wexler,
DeLeon et al., 1999). Eight percent of the treatment group had been reincarcerated at the
one-year follow up whereas the percentage almost doubled (14%) at the two-year follow-
up (Wexler, DeLeon et al., 1999). Thus, the effects of the therapeutic community
diminish as the length of time at risk increases.
Aside from examining arrest after release, research has also studied therapeutic
communities’ effectiveness at reducing drug abuse over a period of years. Again, 47
percent of offenders who participated in Delaware’s therapeutic community were drug
free at the 18-month follow-up whereas the percentage was reduced to 23 percent at the
3-year follow-up period (Inciardi et al., 1997; Martin et al., 1997). Other researchers
60
have also found that the percentage of offenders who were drug free was reduced as the
length of time from release increased. For example, Butzin et al., (2002) found that 50
percent of offenders who participated in an in-prison therapeutic community, then a
therapeutic community work release program, and lastly an aftercare program were drug
free at the one-year follow-up compared to only 32 percent of offenders who were drug
free at the three-year follow-up period. Thus, a two-year difference resulted in an 18
percent decrease in the number of offenders who were drug free.
Completers Versus Non-Completers. The third issue embedded in research on
therapeutic communities is the effectiveness of the treatment modality when the offender
does not complete the treatment. Indeed, therapeutic communities, as other treatment
interventions for substance abusing offenders, are characterized by high dropout rates
ranging from 44 percent to 89 percent (Condelli & Dustman, 1993; DeLeon & Schwartz,
1984, Knight et al., 1997). Fur thermore, research has shown that offenders who complete
treatment are less likely to recidivate compared to offenders who dropout of treatment
(Inciardi, Martin, & Butzin, 2004; Knight, Simpson, & Hiller, 1999; Martin et al., 1999;
Wexler, DeLeon et al., 1999). For example, offenders who participated in a therapeutic
community and work release program were more likely to be arrest free (55%) and drug
free (27%) compared to offenders who completed the therapeutic community but dropped
out of the work release program (28% were arrest free and 17% were drug free) (Martin
et al., 1999). Inciardi et al., (2004) also followed the Delaware offenders for a period of
five years. The estimated probability for remaining arrest free for offenders who
completed all steps of the program was .26 compared to .17 for offenders who dropped
out of the therapeutic community (Inciardi et al., 2004). Other research in Texas and
61
California have found that offenders who completed treatment were less likely to
recidivate compared to offenders who did not complete treatment (Knight et al., 1999;
Wexler, DeLeon et al., 1999). Thus, it appears that therapeutic communities are more
effective in reducing recidivism if the offender completes the treatment program.
Transitional Therapeutic Communities. The focus on therapeutic
communities has now turned to the effectiveness of a multistage treatment intervention,
which involves different levels of treatment. The primary stage of treatment takes place
in a therapeutic community in prison where inmates have an abundance of time to focus
on recovery (Inciardi et al., 2004). When they are released from prison, the offenders
enter the secondary stage of treatment, which involves transitional interventions – usually
work release in the community. The work release center is typically operated as a
therapeutic community in which offenders participate in therapeutic community
interventions while obtaining and maintaining employment in the outside community
(Inciardi et al., 2004). The tertiary stage of treatment (aftercare) is for offenders who
complete the work release setting. These offenders will be living on their own in the
community but be under criminal justice supervision (Inciardi et al., 2004). They attend
outpatient groups, meet with sponsors, and are supervised by criminal justice personnel.
Accordingly, there is a gradual step-down process from very intensive treatment in prison
to less intensive treatment in the community.
Research from these programs has shown some very promising results. First,
offenders who participated in Delaware’s program that included only in-prison treatment
and work release were more likely to be arrest free (77%) and drug free (47%) than
offenders who completed only the in-prison therapeutic community (43% were arrest free
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and 22% were drug free) (Inciardi et al., 1997). Furthermore, when offenders
participated in the tertiary phase of treatment (aftercare) the results are even more
dramatic. Sixty-nine percent of offenders who completed all three stages of treatment
were arrest free at three-years post-release compared to 55 percent of offenders who
completed the work release stage, and 28 percent of offenders who completed the in-
prison therapeutic community (Martin et al., 1999).
Results from a Texas therapeutic community in which offenders receive aftercare
followed by criminal justice supervision in the community were similar. Specifically,
only 16 percent of offenders who participated in the full gamut of services from in-prison
treatment to aftercare and supervision were arrested at the one-year follow-up compared
to 29 percent of offenders who participated in the in-prison therapeutic community
(Hiller, Knight, & Simpson, 1999a). These results hold true when the outcome is
reincarceration. Only 25 percent of the aftercare completers were reincarcerated at the
three-year follow-up; but 41 percent of the in-prison therapeutic community group was
reincarcerated during this time period (Knight et al., 1999). Accordingly, the results
reveal that offenders who participate in aftercare surpass treatment graduates who do not
receive continuing care in remaining arrest free, incarceration free, and drug free.
Meta-Analysis and Reviews of the Literature
For the above studies it appears that some therapeutic communities are effective
in reducing recidivism; however, these are studies of separate programs. A more
advanced statistical technique, called meta-analysis, has allowed researchers to determine
an overall effect of certain types of treatment interventions across similar programs. The
statistic that is derived from a meta-analysis is an effect size that measures the magnitude
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and/or direction of the relationship. Table 2 summarizes the studies. Many of the
studies included in the review do not include therapeutic communities. However, the
meta-analyses are presented for two reasons. First, the studies were included to show that
treatment is more effective than non-treatment. Second, they were included to show that
certain types of treatment were more effective in reducing recidivism. Accordingly,
while there has been few meta-analyses especially for therapeutic communities, some
characteristics of effective programming can be found in therapeutic communities (i.e.,
cognitive-behavioral techniques and social learning therapies).
Early meta-analyses have found weak support for juvenile programs (Gottschalk,
Davidson, Gensheimer, & Mayer, 1987; Whitehead & Lab, 1989). For example,
Gottschalk et al., (1987) found that while there was favorable outcomes for the treatment
group compared to the comparison group 60 percent of the time, the effect size was
statistically insignificant between the treatment and comparison groups. In addition,
Whitehead and Lab (1989) also reported weak support for interventions with juvenile
offenders.11 Specifically, institutional and residential programs were the least successful
in reducing recidivism.
Other meta-analyses have found support for treatment for both adult and juvenile
offenders. Garret (1985) revealed that the average effect size for the most effective
programs for adjudicated delinquents was .37. Specifically, cognitive-behavioral
programs, life skills training, and family therapy were the most supported types of
11 Whitehead and Lab (1989) used a measure of success as having a phi coefficient between .21 and .29. Andrews, Zinger, Hoge, Bonta, Gendreau, and Cullen (1990) have criticized this strict measure of success.
Table 2: Summary of Meta-Analyses and Reviews of the Literature Year Authors Criteria Population Number of
Studies Effect Size Findings
1985
Garrett
Institutional & Community Programs
Adjudicated delinquents
111
.37
Support for cognitive-behavioral programs, life skills, family therapy, individual therapy, and group therapy
1987 Gottschalk, Davidson, Gensheimer, & Mayer
Institutional & Community Programs
Juvenile offenders 90 Insignificant The effect size was insignificant between the treatment and comparison groups. The components that had positive outcomes were behavioral strategies, intensity, and program integrity
1989 Whitehead & Lab
Nonsystem & System Diversion, Community & Institutional
Juvenile offenders 50 .1215 There was weak support for juvenile programs. The most promising were system diversion and community programs. The least successful were institutional or residential programs.
1990 Andrews, Zinger, Hoge, Bonta, Gendreau, & Cullen
Sanctions, Appropriate & Inappropriate Services
Juvenile & adult offenders
80 .06 to .30
The effect size varied according to the type of treatment with an overall effect size being .15 for 124 studies. For inappropriate treatment the effect size was -.06 and for appropriate correctional services the effect size was .30.
1992 Lipsey Type of treatment & Specific methods
Juvenile offenders 443 .17 Multi-modal and behavioral therapies had the strongest impact on effect size. The effect size was in favor of those who received treatment. Programs that were structured had larges effect sizes. Duration affected the effect size with longer periods of treatment resulting in larger effect sizes. Treatment had more of an effect for higher-risk youth.
15 The phi coefficient was not reported by Whitehead and Lab (1989). The effect size was computed by Lipsey (1992) from the summary table appearing in Whitehead and Lab article.
Table 2: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Criteria Population Number of
Studies Effect Size Findings
1999
Dowden & Andrews
Providing some type of intervention
Juvenile offenders
229
.13
Programs that used sanctions only increased recidivism for juveniles whereas programs that delivered services had an average reduction in recidivism of 13%.
1999 Lipsey Type of treatment, Program elements & Specific methods
Serious juvenile offenders
200 .05 to .39 The most positive effects were for programs that focused on interpersonal skills, behavioral programs, and community residential programs. The expected recidivism rates were reduced when effective components were compounded.
1999 Pearson & Lipton
Type of treatment Incarcerated substance abusing offenders
30 .04 to .13 Effect size varied depending on the type of treatment involved. The effect size for boot camps was .05 with a methodological rating of poor. The effect size for therapeutic communities was .13 with a rating of good. The effect size for group counseling was .04 with a rating of fair.
1999 Taxman Treatment Intervention
Offenders Not specified
Literature review
Using criteria developed by the University of Maryland reports types of programs that doesn’t work, are promising, and works. Juvenile aftercare was shown as promising whereas vocational, educational, and in-prison therapeutic communities with aftercare were shown as working.
66
interventions for juvenile delinquents. Indeed, others have found similar results. For
example, Andrews, Zinger, Hoge, Bonta, Gendreau, and Cullen (1990) examined 80 studies
for adult and juvenile offenders. These authors found that the effect size varied according to
the type of program and the use of appropriate treatment with the average effect size being
.15. More specific, the mean effect size was -.06 for inappropriate correctional services such
as those programs that target low risk offenders; use non-directive or unstructured
programming; or scared straight programming. Accordingly, these types of programs
actually increased recidivism. Appropriate correctional interventions (i.e., cognitive-
behavioral programming, programs that target high-risk offenders, programs that address
responsivity, and structured programming targeting criminogenic needs) had an average
effect size of .30. In addition, other meta-analyses have found larger effect sizes for
programs that were structured, programs that were longer in duration, and programs for
higher-risk youth (Lipsey, 1992; Lipsey, 1999).
In a review that included therapeutic communities, Pearson and Lipton (1999)
conducted a meta-analysis of corrections-based drug treatment programs that also included
boot camps and group counseling. For both boot camps and group counseling, the overall
effect was small (.05 and .04 respectively) and the quality of the studies were lacking.
However, they reviewed seven studies on therapeutic communities and found that the overall
effect size was .13 meaning that there was a 13 percent difference in recidivism for those
who participated in the therapeutic community compared to individuals who did not
participate in a therapeutic community. Accordingly, they argue that there is a 56.7 percent
success rate for the experimental group (i.e., therapeutic community) versus 43.4 percent
success in the comparison group (Pearson & Lipton, 1999). Thus, while the effect size for
67
therapeutic communities is modest, there is, on average, a reduction in recidivism for
offenders who participate in this treatment modality.
Furthermore, Taxman (1999) reviewed studies to gain a general consensus among
scholars and practitioners concerning “what works” for offenders in substance abuse
treatment programs. Using criteria established by the University of Maryland, four
categories were used to determine the consensus: 1) programs that work; 2) programs that
don’t work; 3) programs that are promising; and 4) programs where there is insufficient
empirical evidence (categorized as don’t know). She found that the literature has typ ically
found that in-prison therapeutic communities that also provided aftercare were classified as
“working” meaning that they produce significant reductions in recidivism (Taxman, 1999).
Predictors of Recidivism
A review of the research pertaining to therapeutic communities revealed that some
programs are more successful than others. Thus, the questions becomes, aside from program
participation, what predicts success (measured as successful outcome and successful
completion of treatment) for a therapeutic community (Table 3).
Demographic Characteristics. Individual characteristics have been found to be
significant predictors of outcome for therapeutic communities. That is, certain individuals
are more likely to have positive outcomes compared to other individuals. For example, many
studies have found that age was a significant predictor of arrest and relapse (Butzin et al.,
2002; Martin et al., 1999; Messina, Nemes, Wish, & Wraight, 2001; Pealer et al., 2002b;
Wexler, DeLeon et al., 1999; Wexler, Falkin, Lipton, & Rosenblum, 1992; Winesburg et al.,
2002). Specifically, older individuals were less likely to be arrested and less likely to relapse
compared to younger individuals. For example, research conducted in an Ohio
Table 3: Predictors of Success by a Therapeutic Community Year Authors Treatment Group Measure Findings 1992 Wexler, Falkin, Lipton, &
Rosenblum. Participants in the Stay’N Out Prison TC in New York
Arrest Found that age, duration of time in aftercare, and participation in the program were significant predictors of time to arrest.
1999 Wexler, DeLeon, Thomas, Kressel, & Peters
Participants in California’s Amity Prison TC
Time to arrest Found that age and a classification of antisocial personality disorder were significant predictors of time to arrest.
1999 Wexler, Melnick, Lowe, & Peters
Participants in California’s Amity Prison TC
Time to reincarceration Found that readiness to change was a significant predictor of time to reincarceration at a three-year follow-up.
1999 Hiller, Knight, & Simpson Felony probationers who participated in a community based TC in TX
Dropout of a community based TC
Found that employment status, psychological factors, and risk level were related to dropping out of the program.
1999 Knight, Simpson, & Hiller Participants in a prison TC in Texas
Reincarceration Found that risk level was a significant predictor of reincarceration
1999 Martin, Butzin, Saum, & Inciardi
Males & females in a multistage TC in Delaware Prison: TC, Work release, Aftercare
Arrest-free & Drug-free Age, number of prior arrests were significant predictors of being arrest free at 3 years whereas previous drug use, participation in the TC only, and TC+WR, were significant predictors of drug-free status at 3 years.
2000 Farrell Females who participated in Delaware’s prison-based CREST TC in Delaware
Systems of support to predict recidivism and relapse
Women in the treatment group were significantly more likely to attend treatment & 12-step groups and the frequency of attendance was higher than the comparison group. Participation in treatment alone did not predict recidivism or relapse but having children was a significant predictor of both.
Table 3: Predictors of Success by a Therapeutic Community (continued) Year Authors Treatment Group Measure Findings 2001
Messina, Nemes, Wish, & Wraight
Randomly selected participants in a Washington DC TC
Completion of treatment & Arrest
Found that successful completion of treatment, participation in intensive services, age, gender, number of prior arrests were significant predictors of re -arrest. Age, heroin usage, and inpatient vocational/educational treatment were predictors of successful completion of treatment.
2002
Butzin, Martin, & Inciardi Participants in the Crest TC in Delaware
Relapse with drugs & arrest
At one year, age, prior drug use, CREST participation, and completion of aftercare were significant positive predictors of drug use. At 3 years, age, prior drug use, and CREST participation were significant predictors of drug use. At one year, age, number of times in prison, CREST participation and graduation were significant positive predictors of arrest. At 3 years, age and previous incarceration were significant positive predictors of arrest.
2002 Nielsen & Scarpitti Participants in the CREST
TC in Delaware Retention in the TC Of those who did not complete CREST, 16% left in the 1st
month, 36% left in th4e 2nd month, 47% left in the 3rd month, & by 7th month 91% of the non-completers had left the program. Educational level, type of offense, participation in a prison-based TC (KEY), personality factors and legal pressure predicted completion in the TC. Type of offense and psychological factors predicted the length of time in treatment.
Table 3: Predictors of Success by a Therapeutic Community (continued) Year Authors Treatment Group Measure Findings 2002 Winesburg, Latessa,
Pealer Medium-security male inmates who participated in a TC
Arrest & Incarceration Found that race, age, number of prior arrests were significant predictors of arrest. Martial status and time at risk were significant predictors of incarceration.
2002a Pealer, Latessa, Winesburg
Juvenile males in a residential TC in Ohio
Incarceration in a youthful or adult facility
Age, grade level, felony level, and JASAE score were significant predictors of incarceration.
2002b Pealer, Latessa, & Winesburg
Males & females participating in a community-based correctional facility TC in Ohio
Arrest & Incarceration Nonwhites, younger individuals, and those who had more prior arrests were significantly more likely to be arrested. Nonwhites and males were significantly more likely to be incarcerated.
71
medium-security in-prison therapeutic community found that individuals who were age 25
years had a 68 percent chance of being arrested compared to individuals who were 39 years
of age who had a 57 percent chance of being arrested (Winesburg et al., 2002). Thus, it
appears that the older the individual, the more likely he or she is to have a successful
outcome.
Aside from age, other individual characteristics that predict successful outcome
include: gender, marital status, and race (Hiller et al., 1999a; Messina et al., 2001; Nielson &
Scarpitti, 2002; Pealer et al., 2002b; Winesburg et al., 2002). Females who participated in a
therapeutic community in Delaware were more likely to be arrest free (Messina et al., 2001).
Nonwhites were more likely to be arrested and individuals who were single were more likely
to be re-incarcerated in an Ohio correctional facility (Winesburg et al., 2002). Accordingly,
it appears that participation in a therapeutic community may be more beneficial (as measured
by successful outcome of arrest or incarceration) for older offenders, female offenders,
married offenders, and Caucasian offenders.
Severity or Risk Level. Prior research has shown that risk level is related to
recidivism (Andrews, Bonta, & Hoge, 1990; Andrews, Zinger et al., 1990; Dowden &
Andrews, 1999; Lowenkamp & Latessa, 2002). Specifically, higher risk offenders are more
likely to recidivate compared to lower risk offenders. Accordingly, programs should target
higher risk offenders for more intensive treatment to increase their chances of having a more
successful outcome. For example, using the Salient Factor Score, Knight et al., (1999)
found that severity of crime and drug use was a significant predictor of reincarceration.
Forty-six percent of the higher severity offenders were reincarcerated compared to 30 percent
of the lower risk offenders. Furthermore, the strongest treatment effects were found within
72
the high-severity offenders. At a 3-year follow-up, only 26 percent of the high-severity
offenders who completed aftercare were reincarcerated compared to 66% of the high-severity
aftercare dropouts (Knight et al., 1999). Among the low-severity offenders, 22% of the
aftercare completers and 52% of the aftercare dropouts had been returned to prison. These
findings along with other research by Messina et al., (2001) and Hiller, Knight, and Simpson
(1999b) support the risk principle postulated by Gendreau, Cullen, and Bonta (1994) in
which programs should match services with risk level. Accordingly, due to the intensive
nature of therapeutic communities, this treatment modality may be beneficial only to higher
risk offenders.
Psychological Factors. The responsivity principle states that there are certain
individual characteristics, which cause offenders to respond differentially to treatment
(Andrews, Bonta, & Hoge, 1990). Accordingly, to increase the chances of successful
outcomes (such as reducing recidivism and relapse), programs should fine-tune the delivery
of services to allow offenders to be able to respond to the intervention (Cullen, 2002). Some
of the individual characteristics (i.e., psychological factors) that were related to successful
outcomes for therapeutic communities were motivation and antisocial personality (Wexler,
DeLeon et al., 1999; Wexler, Melnick et al., 1999). Specifically, offenders who scored
higher on a readiness to change scale had a significantly longer period of time to
reincarceration (Wexler, Melnick et al., 1999). However, offenders who had personality
disorders, as measured by the DSM-III-R, (American Psychiatric Association, 1987) had a
significantly shorter period of time to reincarceration than offenders who did not have
antisocial personalities (Wexler, DeLeon et al., 1999). Therefore, therapeutic communities
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should be aware of individual characteristics of offenders such as motivation and
psychological factors and provide programming to increase the responsiveness of offenders.
Participation/Completion of Treatment. One of the major predictors of recidivism
is participation in a treatment intervention. Indeed, both meta-analyses and individual studies
have found that recidivism was reduced if offenders participated in some type of treatment
intervention (Andrews, Zinger et al., 1990; Butzin et al., 2002; Dowden & Andrews, 1999;
Garret, 1985; Lipsey, 1992; Martin et al., 1999; Pealer et al., 2002a; Wexler et al., 1992).
For example, offenders who participated in the Stay’N Out therapeutic community between 9
and 12 months had significantly better parole outcomes and more elapsed time between
rearrest than offenders who were in the therapeutic community less than 9 months or more
than 12 months (Wexler et al., 1992). Furthermore, Martin et al., (1999) found that
participation in the therapeutic community and especially participation in the aftercare
component were significant predictors of being drug-free at a 3-year follow-up. In addition,
juveniles who participated in a therapeutic community had a 18 percent chance of being
incarcerated compared to a 33 percent chance of being incarcerated for offenders who did not
participate in treatment (Pealer et al., 2002a).
Predictors of Successful Completion of Treatment
As the above research has shown, participation and completion of treatment are
significant predictors of outcome for therapeutic communities. Thus, the question becomes
what predicts successful completion of a therapeutic community. When this question is
answered, programs can target the predictors, which should increase the chances of finding
success. Table 3 also reviewed the predictors of success for therapeutic communities.
Messina et al. (2001) examined the effects of specific services provided in therapeutic
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communities to determine if they predicted treatment outcomes. These authors ran two
models predicting treatment completion and found that those who participated in the
vocational/educational programs were more likely to complete the therapeutic community.
The second model predicted completion of treatment but combined all possible treatment
units. For this model, they found that for each additional unit of total services received, the
more likely the person was to successfully complete the community. Specifically, the data
showed that offenders who received a greater number of all inpatient services in the first 60
days were more likely to remain in treatment and ultimately complete the program (Messina
et al., 2001). Accordingly, it appears that therapeutic communities that provide intensive
services to offenders are more likely to have their population successfully complete
treatment.
An examination of a community-based therapeutic community found that educational
level, type of offense, and psychological factors were significant predictors of completion.
Specifically, offenders who had higher levels of educational attainment, offenders who were
incarcerated for a violent offense, and offenders who had higher levels of obsessive-
compulsive behaviors were more likely to complete the community therapeutic community
(Nielsen & Scarpitti, 2002).
Summary of Effectiveness
From the research presented above, there are several conclusions that may be reached
concerning the effectiveness of therapeutic communities. First, results from the meta-
analyses and reviews of the literature show that programs that provide some type of treatment
are effective in reducing recidivism for both adult and juvenile offenders (Andrews, Zinger et
al., 1990; Dowden & Andrews, 1999; Lipsey, 1992; Pearson & Lipton, 1999; Taxman,
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1999). Specifically, programs that provide treatment instead of only sanctions reduce
recidivism on average of 10 percent to 15 percent (Andrews, Zinger et al., 1990; Lipsey,
1992). However, programs that adhere to the principles of effective reduce recidivism by as
much as 30 percent to 40 percent (Andrews et al., 1990; Lipsey, 1999). As previously
discussed, therapeutic communities adhere to some of the principles of effective
interventions such as intensity, length of treatment, and use of praise and privileges and role
models. Based upon the meta-analyses and literature reviews, there should be some support
for therapeutic communities in reducing recidivism.
Second, while there is support for therapeutic communities in reducing recidivism the
support is mixed when comparing offenders who participate in a therapeutic community to
those who receive no treatment or very minimal treatment. Some studies have found that
therapeutic communities are successful in reducing recidivism (Field, 1984) and drug use
(Knight, Simpson et al., 1997) whereas others have not found a significant reduction in either
arrest or reincarceration (Pealer et al., 2002b; Winesburg et al., 2002). Furthermore, most of
the research examining therapeutic communities have pertained to adults. However, one
study that examined juveniles who participated in a therapeutic community found a
significant reduction in recidivism compared to offenders who received a rather eclectic
residential program and offenders who did not receive any treatment (Pealer et al., 2002a).
Third, while studies show that therapeutic communities may be successful in reducing
recidivism (measured as arrest, incarceration, and drug relapse), the success of the treatment
diminishes as the follow-up period increases. A 3-month follow-up period showed that only
a few offenders who participated in treatment had been arrested (2%) (Hiller et al., 1999a).
Yet, a 3-year follow-up period revealed that 25 percent of the offenders had been arrested
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(Knight et al., 1999). Thus, while studies have shown that therapeutic communities may be
effective in reducing recidivism, the effects tend to wear off as the offenders are out in the
community for longer periods of time.12 However, while the recidivism rates for the
treatment groups increased throughout the longer follow-up period, those who completed the
therapeutic community were still significantly less likely to recidivate compared to offenders
who did not participate in the treatment (Butzin et al., 2002; Hiller et al., 1999a; Inciardi et
al., 2004; Knight et al., 1999; Wexler, DeLeon et al., 1999).
Fourth, the studies have revealed that there is differential success depending on
whether the individual successfully completed the therapeutic community. For example,
dropouts were just as likely as offenders who did not participate in a therapeutic community
to be arrested (28% percent and 29% respectively) (Martin et al., 1999). In addition, the
offenders who dropped out of the program were significantly more likely to relapse with
drugs and be reincarcerated at the follow-up time period (Inciardi et al., 2002; Wexler,
DeLeon et al., 1999).
Fifth, as Gendreau (1996) has reported, programs tend to be more effective when
there is some type of aftercare program in place following the intensive phase of treatment.
Accordingly, there is evidence to support the fact that offenders who successfully completed
an in-prison therapeutic community should receive some type of aftercare (Hiller et al.,
1999a; Inciardi et al., 2004; Knight et al., 1999; Martin et al., 1999; Wexler, DeLeon et al.,
1999). For example, each of the above studies reported better success for offenders who
completed the therapeutic community, work release, and/or aftercare. That is, the recidivism
rates (measured as arrest, incarceration, and relapse) were significantly lower for individuals
who participated in a step-down program compared to offenders who completed the 12 This finding calls for a need for studies that follow offenders for a number of years post-release.
77
therapeutic community but dropped out of aftercare, offenders who did not complete the
therapeutic community, and offenders who did not receive any treatment. Accordingly,
failure to provide continuous treatment after the offender is released from the therapeutic
community may undermine the positive changes that have occurred during treatment.
Next, multivariate analyses have shown that there are certain predictors of outcome
for therapeutic communities. Specifically, demographic characteristics, severity/risk level,
psychological factors, and participation/completion of treatment were significant predictors
of arrest, incarceration, or relapse. For example, older offenders, females, and whites were
less likely to be arrested and/or reincarcerated (Butzin et al., 2002; Hiller et al., 1999a;
Martin et al., 1999; Messina et al., 2001; Nielson & Scarpitti, 2002; Pealer et al., 2002b;
Wexler et al., 1992; Wexler, DeLeon et al., 1999; Winesburg et al., 2002). In addition,
research has shown that offenders who were classified as “high-severity” were more likely to
be reincarcerated compared to offenders who were “low-severity” (Knight et al., 1999).
Last, in most of the research on therapeutic communities, participation and/or completion of
the program was a significant predictor of arrest and incarceration. Specifically, offenders
who participated in the treatment were less likely to be arrested or reincarcerated compared
to offenders who did not participate in a therapeutic community (Butzin et al., 2002; Martin
et al., 1999; Messina et al., 2001; Pealer et al., 2002a; Wexler et al., 1992).
Finally, as research has revealed, drug using delinquents are responsible for
disproportionately higher rates of offending, elevated levels of violent offenses, and a greater
risk for future offending (Catalano, Wells, Jenson, & Hawkins, 1989; Hawkins, Jenson,
Catalano, & Lishner, 1988). Accordingly, to reduce the probability of reoffending, some
type of treatment intervention instead of just punishing the juvenile is needed (Lipsey, 1999).
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While meta-analyses have shown that treatment interventions can be have a significant
reduction in recidivism for juveniles, little is known about the effectiveness of drug treatment
(especially therapeutic communities) for juveniles (Sealock, Gottfredson, & Gallagher,
1997). In one of the first studies of therapeutic communities for juvenile offenders, Pealer et
al. (2002a) did find tha t juvenile males who participated in a residential substance abuse
treatment program operated as a therapeutic community were significantly less likely to be
reincarcerated in either a juvenile facility or an adult facility. However, the follow-up time
period for that research was only 18-months. Therefore, this dissertation will expand that
research by using a longer follow-up period (up to three years) to determine if the treatment
effect remains. Furthermore, this dissertation will be one of the first works to study this
treatment modality for delinquents while striving to address methodological issues of past
research on therapeutic communities.
Methodological Problems of Past Research
While the number of therapeutic communities for correctional populations has
increased, the research on their effectiveness has been criticized on a number of
methodological areas (Inciardi et al., 1997). First, studies have failed to incorporate multiple
outcome criteria to measure program success. Many studies have only examined either arrest
or incarceration as the outcome of measure “success.” Indeed, most of the literature
reviewed here examined these two areas instead of using additional outcome measures. In
addition, many studies have failed to determine if therapeutic communities are successful in
addressing intermediate outcomes. Only one study addressed the issue of intermediate
outcomes. The research on the Cornerstone program in Oregon revealed that the program
had some positive effects on intermediate outcomes. For example, participation in treatment
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significantly reduced psychiatric symptoms, and increased self-esteem (Field, 1984).
Accordingly, it is important that research address both intermediate and long-term outcomes
to fully explore the issue of effectiveness. This dissertation will attempt to overcome these
past problems by determining if participation in a therapeutic community changed the
juveniles’ psychological and social factors such as depression, anxiety, self-efficacy, and
motivation and cognitive distortions such as minimizing, assuming the worst, and blaming
others. The long-term outcomes will address reincarceration to either a juvenile or adult
facility and the length of time to reincarceration.
Second, the follow-up time frames have been inadequate, potentially producing a
sample biased towards easier to find and less deviant respondents (Messina et al., 2001).
Some research on therapeutic communities has examined follow-up time frames as little as
six months post termination (Knight et al., 1997). This presents a problem especially when
the offender is still under supervision because the question becomes is he or she successful
because of the treatment intervention or because of the sustained supervision. This
dissertation will attempt to address the issue of follow-up by expanding on the work of Pealer
et al. (2002a) by tracking juveniles for a period up to three years after they have been
released from the therapeutic community. This time frame seems to be of an adequate length
to follow most of the sample into adulthood.
Related to the outcome measures and follow-up, many studies have relied primarily
on self-report measures of criminal activity, rather than objective measures (e.g., arrest and
incarceration records) (Messina et al., 2001). To overcome this problem, this study will use
data derived from the Offender Search Database from the Ohio Department of Rehabilitation
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and Corrections and data from the Department of Youth Services to determine if the juvenile
returned to a secure facility during the follow-up time period.
Third, the comparison group fails to account for important differences between
groups that are likely to impact program outcome (Inciardi et al., 1997). Many times in
correctional research, random assignment to treatment and comparison groups are not a
viable option. Indeed, only one study reported here used random assignment in groups
(Wexler, Melnick et al., 1999). Accordingly, it is necessary to compare different groups. As
such, many programs fail to control for the differences between the groups that could
potentially affect the outcome. For example, many studies will only control for gender, race,
and age when examining the outcome of therapeutic communities. This dissertation uses a
matched comparison group to obtained very similar groups. Specifically, the groups were
matched on risk level and gender (i.e., males only).13 In addition, if there are significant
differences between the groups on other factors, these factors will be controlled for when
predicting outcomes.
Lastly, there has been a lack of multivariate designs, which leave us with little
information concerning the significant predictors of recidivism. In addition, research into
therapeutic communities and drug treatment in general has been plagued by the insufficient
attention given to the measure of program quality (Faupel, 1981; Moon & Latessa, 1994).
This dissertation will use a standardized measure of program quality in an attempt to delve
into the “black box” of treatment and to obtain a better understanding of why therapeutic
communities are successful in reducing recidivism.
13 Risk level was chosen as a criterion for matching because research has shown that risk level is one of the best predictors of recidivism (Andrews, Bonta, & Hoge, 1990; and Lowenkamp & Latessa, 2002). The measure of risk was derived from the Youthful Level of Service/Case Management Inventory (Hoge & Andrews, 2003). The YLS/CMI is a standardized risk/need instrument that measures 42 different risk items across eight domains.
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SUMMARY
This chapter began by describing the mission of the juvenile justice system through
reviewing the history and development of the juvenile justice system. Specific attention was
given to the idea of “child saving” though rehabilitation and treatment. Next, the attack on
rehabilitation and the juvenile justice system was addressed by examining the social context
of the time and how it helped to shape the perceptions of the citizens of the United States.
While a movement to punish juveniles developed, a review of the literature reflects the fact
that the public still supports rehabilitation, specifically for juveniles. Next, the concept of
therapeutic communities and how they derived in the United States was presented along with
the research on their effectiveness in reducing recidivism. Furthermore, a review of the
literature revealed predictors of success to help determine why therapeutic communities
reduce recidivism. The last section of the chapter reviewed methodological problems that
existed with the previous research. To address these concerns from pervious research, this
dissertation attempts to overcome the common shortcomings by: 1) including multiple
outcome criteria; 2) following the juveniles for a period up to three years after program
completion; 3) using a matched (i.e., risk and need) comparison group drawn from a sample
of youth that did not receive treatment; 4) using multivariate designs which will identify
significant predictors of recidivism; and 5) using a standardized instrument to measure
program quality. Furthermore, this study is an expansion of the work by Pealer, et al.,
(2002a) that examined a therapeutic community for juvenile males by exploring a longer
follow-up time period and examining individual level predictors of recidivism.
Chapter Three will present the research design that was used to answer the research
questions, the procedures for collecting the data for the dissertation, describe the treatment
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and comparison groups and the statistical tests that were used to answer the research
questions. In addition, a description of the measures – both individual and outcome – used
will be discussed. The chapter will end by addressing the limitations of the dissertation.
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CHAPTER 3
METHODS
INTRODUCTION
The purpose of this study was to evaluate the effectiveness of a therapeutic
community for felony adjudicated adolescent males. While previous research has found that
therapeutic communities, on average, reduce recidivism by 13 percent (Pearson & Lipton,
1999), there has been a lack of research examining whether this treatment modality “works”
for juveniles.14 Thus, while there were multiple research questions that were addressed, the
main goal of this study used a quasi-experimental design to test whether participation in a
therapeutic community resulted in a significant reduction in recidivism as measured by a
period of new incarceration.
RESEARCH QUESTIONS
To fully evaluate the effectiveness of a treatment intervention, one must identify
certain research questions that the study will answer. For the current project, I have
identified a number of research questions: 1) What are the characteris tics of the treatment
group and the comparison group? What if any differences exist between the treatment and
comparison groups? 2) Did participation in treatment significantly impact the youth’s levels
of cognitive distortions and psychological and social functioning? 3) What factors predict
successful completion of treatment? 4) What are the rates of new incarcerations for the
treatment group and the comparison group? Are there significant differences in the rates of
14 In one of the few outcome evaluations published for therapeutic communities for juveniles, Pealer, et al., (2002a) found that participation in a therapeutic community significantly reduced recidivism. However, the follow-up time period for this study was only 18 months. Therefore, this dissertation will be an expansion of the above-cited work by examining the effectiveness of a therapeutic community for juveniles for a period of three years. In addition, individual level characteristics will be explored to determine if the treatment modality is more effective for certain types of juveniles.
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new incarcerations for the treatment group and the comparison group? 5) What factors
predict a new incarceration? and 6) Does the effectiveness of the treatment provided at
Mohican Youth Center differ among the different types of juveniles?
RESEARCH DESIGN
Because random assignment to the treatment group and the comparison group was not
possible, a quasi-experimental design was used to estimate the effectiveness of the
therapeutic community for adolescent males on future criminal involvement. To overcome
the potential for differences between the groups, which could possibly affect the outcome,
comparison group cases were matched by risk and need levels using a standardized risk
assessment and gender.
Risk level was chosen as a criterion for matching because research has shown that
risk level is one of the best predictors of recidivism (Andrews, Bonta, & Hoge, 1990; and
Lowenkamp & Latessa, 2002). The measure of risk was derived from the Youthful Level of
Service/Case Management Inventory (Hoge & Andrews, 2003). The YLS/CMI is a
theoretically and empirically based risk/need instrument that has been standardized. It
measures 42 different risk items across eight domains: prior criminal history, familial
circumstances, education/employment, peer relations, substance abuse, leisure/recreation,
personality and behaviors, and attitudes.15 Accordingly, while the sample was matched on
risk level, conceptually the matching was of the eight risk factor domains. For the remaining
individual characteristics, if there were significant differences between the groups based on
15 These eight domains include risk factors that research has identified as predicting recidivism. Furthermore, research has identified four major risk factors that are at least moderately correlated with recidivism: criminal history, attitudes, peers, and personality (Gendreau, Little, & Goggin, 1996). The YLS/CMI contains these “big four” risk factors.
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age, race, or severity of substance abuse, these differences were controlled in the final
analyses.
PROCEDURES FOR COLLECTING DATA
As part of the evaluation of the program, the University of Cincinnati created an
automated database to assist programs with data collection and provide a mechanism for
reporting results. Before the evaluation project began, the database was installed in the
treatment facility. Facility personnel collected and entered data into the database. The data
consisted of: demographics, offense and disposition, prior criminal history, drug use and
history, risk level, program phases and advancement, type of treatment, program violations,
drug screens, treatment outcome, psychological and social functioning assessments, and
cognitive distortions assessments. When the data were not in the database, case files were
reviewed to decrease the missing information.
In addition to the quantitative data for measuring program processes, the Correctional
Program Assessment Inventory (CPAI; Gendreau and Andrews, 1992) was used to measure
program integrity. Recidivism data (i.e., return to youthful facility) were collected by
Department of Youth Services personnel and sent to the researcher. Data pertaining to adult
incarceration were collected by the author using the Department of Rehabilitation and
Corrections Offender Search Database (www.drc.state.oh.us).
TREATMENT GROUP
Mohican Youth Center
To provide an adequate assessment of a program’s effectiveness, it is fundamental to
understand what the program entails. This section will provide a detailed outline of the
treatment program at Mohican Youth Center by describing the sample size and time period
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for the evaluation, how youth were selected to participate in the evaluation and the program,
the type of treatment provided at the Center, the phases of treatment, and the results of the
Correctional Program Assessment Inventory (CPAI; Gendreau & Andrews, 1992). The
information pertaining to the type of treatment was gathered from handbooks from the
facility, through external review, and through observations of the treatment at the facility (see
Shaffer & Johnson, 2001).
Sample Size, Time Period, and Selection of Youth. The treatment group consisted
of 447 adolescent males who had been adjudicated to the Department of Youth Services and
sentenced to the facility from January 2000 to August 2001. Since placing offenders who
have participated in treatment back into the general population can serve to “undo” any
treatment effect, the facility accepted felony adjudicated males who had six months left on
their sentences. While participation in the evaluation of the facility was voluntary,
participation in the treatment was mandatory in that the entire facility was a therapeutic
community. The purpose of Mohican Youth Center was to serve juvenile offenders who
have an extensive substance abuse problem. A serious and extensive substance abuse
problem was defined as a dependency on alcohol and/or drugs, which interfered with various
aspects of a juvenile’s life (i.e., family, education, peer relations, emotional, spiritual, or
legal). The substance abuse problem was determined by assessment and interviews.
Accordingly, the selection criteria that were used by Mohican Youth Center to determine
eligibility included the following: 1) males between the ages of 12 to 20 years old
adjudicated delinquent by a county juvenile judge and committed to the Ohio Department of
Youth Services; 2) having at least six months left in their commitment; 3) having a summary
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score of 21 or higher on the Juvenile Automated Substance Abuse Evaluation; and 4) all
felony levels including some viewed as a risk to abscond.
Type of Treatment. By the beginning of the evaluation period, Mohican Youth
Center had implemented a therapeutic community. At Mohican Youth Center there were
four “families” of 42 youth each. As previously stated, what distinguishes the therapeutic
community from other treatment approaches was the use of the community as the primary
agent to bring about social and psychological change. Within the therapeutic community
concept was the influence of peers on behavior. Thus, Mohican Youth Center incorporated
the positive peer culture in which youth were encouraged to help one another and in the
process help himself.
Until the youth became ingrained in the therapeutic community, senior members
acted as mentors who assisted the new members in becoming familiar with the concepts and
the rules and regulations of the therapeutic community. In addition, the members, but
especially new members, were required to “act as if” during their stay at Mohican. This
concept was based on the self-help movement in which individuals must conform to the
structure of the program until it becomes ingrained within the person (DeLeon, 2000). It was
theorized that before they arrived at Mohican, youth made poor choices and, if left to their
own devices, they would repeat their mistakes. While at Mohican, they were learning new
ways to think and behave. However, until these new patterns of thinking and behaving were
ingrained, they must first “go through the motions” or “act as if” until they were thinking and
behaving in an appropriate manner.
There were eight essential concepts of the community as method approach
incorporated at Mohican. The first concept was the use of youth roles in which each juvenile
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was expected to contribute/participate in all aspects of the daily therapeutic community.
Thus, youth were active participants in process of change. The use of peer feedback was the
second component. This concept relied on the community as an agent of change in which
youth were expected to provide each other with instruction and support similar to being “a
brother’s keeper.” The third concept was the use of role models in which the youth were
expected to be examples of change to others. The use of collective formats for individual
change was the fourth concept found at Mohican’s therapeutic community. This concept
relied on the activities such as groups, meetings, seminars, jobs functions, educational
training, and recreation to facilitate the change process.
The adherence to shared norms and values and the structure of the therapeutic
community were the next concepts of the environment at Mohican. Youth were expected to
obey the rules and regulations, which provided a safe environment to foster change within
the individual. In addition, the use of structure helped to give the youth some sense of
organization and stability, which resulted in accepting and respecting supervision and
becoming a responsible member of the community. Open communication between the
juveniles and the staff was another concept of the therapeutic community implemented at
Mohican. It was expected that the juveniles would share experiences with others to facilitate
the recovery process for himself and his peers. The last concept was the use of relationships.
In order to sustain the recovery process beyond the treatment facility, it was essential that
friendships form to develop a social network for change.
Job Assignments Within Mohican Youth Center. As with other therapeutic
communities, work at Mohican was viewed as both therapy and education. Youth performed
jobs in all areas of the community under supervision and safety provided staff. Job
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assignment was based on a hierarchy and advancement was determined by behavior, attitude,
and performance. Work at Mohican Youth Center was used to foster a sense of membership,
teach job skills, instill attitudes that promote competence, and shape behavior.
Figure 1 shows the structure board for Mohican Youth Center. The highest position
held by a juvenile was that of coordinator. The coordinator was the liaison between the
juveniles and the staff. He was responsible for providing a daily summary of the events and
concerns of the community to the staff. In addition, he made sure that all department heads
were performing their duties. The second highest position was the assistant coordinator. He
was responsible for coordinating and implementing all activities pertaining to the
community. This position also entailed monitoring the processing of pull-ups and encounter
slips.
The program department head and the service department head were responsible for
overseeing that the crewmembers completed their job duties. The program department head
was responsible for the orientation, ceremony, and core crews, whereas the service
department head was responsible for the recreation, cleaning, and expeditor crews. The
department heads reported to the assistant coordinator if crew leaders were not performing
their duties.
The next position on the job hierarchy was that of crew leader. Each crew leader had
general responsibilities that they must perform. For example, they were responsible for
assigning members to jobs within their crew, holding crew meetings, writing pull-ups for
poor job performance, and issuing push-ups for outstanding job performance. In addition,
there were specific duties related to their position. For example, the orientation crew leader
was responsible for coordinating orientation for all new members of the community. The
Figure 1: Structure Board For Mohican Youth Center
Coordinator
Assistant Coordinator
Program Department Head Service Department Head Orientation Ceremony Core Recreation Cleaning Expeditor Crew Leader Crew Leader Team Leader Crew Leader Crew Leader Crew Leader Orientation Ceremony Core Recreation Cleaning Expeditor Crew Crew Crew Crew Crew Crew
Unit Manager Service Department
Casework Supervisor Program Department
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ceremony crew leader was responsible for coordinating celebrations and special activities by
making a weekly plan for his crew. The core team leader was in charge of coordinating the
daily core team meeting in which pull-ups were reviewed with staff. The recreation crew
leader was responsible for coordinating and planning the beautification of the unit and
special activities. The cleaning crew leader must coordinate cleaning duties for each of his
members. The expeditor crew leader was in charge of making the community operate
efficiently and in a timely manner by scheduling and placing his team members in various
assignments.
The lowest job assignments were placement in the orientation, ceremony, core team,
recreation, cleaning, and expeditor crews. Individuals on the orientation crew were
responsib le for assisting new members in the community through distributing and reviewing
handbooks with the new members, introducing new members at the morning and evening
meetings, and providing recommendations for big brothers. The ceremony crew was
responsible for providing therapeutic activities for the community. They also planned and
hosted the morning meetings. The core team members reviewed written pull-ups and
assigned learning experiences for the pull-ups. They also planned and hosted the evening
meetings, which was usually conducted as a business meeting. The recreation crewmembers
planned special events for weekends and special occasions. When community members used
the gym, the recreation crew monitored the use of the equipment and saw that the area was
left clean. In addition, these individuals decorated the units with posters, community
language, and drawings. Cleaning crewmembers inspected the units on a daily basis and
corrected any deficiencies from the inspections. In addition, they completed all cleaning
assignments in restrooms, hallways, and bed area. They also were responsible for setting up
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each room for the groups and meetings. Individuals on the expeditor crew were responsible
for the smooth operation of the community activities. They announced the start and end of
all meetings, maintained sign- in sheets for all activities, and kept track of the pull-ups and the
completion of learning experiences associated with the pull-ups.
Behavior Management Within Mohican Youth Center. Programming at Mohican
Youth Center also incorporated the languages and techniques for behavior management for a
therapeutic community. For example, one behavior management technique took the form of
verbal and written pull-ups. Pull-ups were a primary form of confrontation in which the
juvenile was made aware of his behavior/attitudes. The pull-up was used as a helping tool
and the recipient was supposed to accept the pull-up appropriately. Verbal pull-ups were
statements about behaviors/attitudes that one member made to another. These were used as
reminders about an action or attitude and examples included: being late for an activity,
slouching in a chair, and not picking up after oneself. When a verbal pull-up was received,
the recipient responded by saying: “Thank you for bringing that to my attention. I’ll get right
on it.”
For more serious behaviors/attitudes (i.e., violating a major rule) or when the
behavior was repeated, a written pull-up was issued. Written pull-ups were documented
ways of making the entire community and staff aware of the behavior and in return allowing
for a learning experience to be assigned. A learning experience was given by the core team
and included both discipline (i.e., intended to eliminate the behavior) and replacing the
unwanted behavior with new more appropriate behaviors. Learning experiences included
public apologies, developing and presenting seminars, written essays, awareness experiences
(acting as the town crier in which the individual announces every activity), glue contracts
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whereby the individual was paired with another member, and spare parts. Spare parts took
the form of singing songs in front of the community and other image busting techniques such
as wearing signs.
In addition to the consequences for inappropriate behavior, Mohican also
incorporated rewards for prosocial behavior. Push-ups were positive affirmations that were
issued by the juveniles to one another for positive behaviors/attitudes. As with pull-ups,
push-ups may by either verbal or written. The written push-ups were presented at the
evening meeting in front of the entire community. In addition to the push-ups, juveniles
received privileges through the phase system. For example, juveniles in the orientation phase
received two ten-minute phone calls per week, two stamps per week, and state- issued
hygiene items only. When juveniles advance to phase one, they obtained three ten-minute
phone calls per week, two stamps, and five dollars to spend in the commissary. The
privileges associated with phase two included: three fifteen-minute phone calls, three stamps,
$7.50 to spend in the commissary, and eligibility for choir membership. The relapse
prevention phase (the last phase of treatment before discharge) included many different
privileges. For example, juveniles received four fifteen-minute phone calls, five stamps, ten
dollars commissary spending, special recreation and education activities, expanded number
of visitors, extra snacks, extra TV, game room, weight room time, playing Play Station,
pictures in bed area, and special bedspreads and polo shirts.
Groups Held at Mohican. Within a therapeutic community, the members hold a
greater role in conducting groups and confronting behavior. For example, each day began
with a morning meeting whose purpose was to begin the day on a positive note. The
juveniles conducted the morning meeting and its focus was on sharing information about the
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community, emphasizing social awareness regarding events in society, providing a positive
atmosphere through a thought for the day, and conducting some type of game or energizer to
motivate the youth. In addition to the morning meeting, youth also conducted evening
meetings. The purpose of these meetings was to provide an opportunity for accountability to
the community and to refocus on treatment. This meeting was conducted more like a
business meeting. It was also during this meeting that members make public any push-ups
and pull-ups that were received during the day. In addition, learning experiences were often
conducted during the evening meeting.
The backbone of the therapeutic community was the encounter group. It was a highly
structured, intensive, confrontational group designed to make the youth see how his behavior
affects the community and how his attitudes, thoughts, and value systems affect his behavior.
The encounter groups hold multiple purposes. First, they helped to establish accountability
to the community and to the individual. In addition, they allowed the members to ga in a
deeper level of honesty. They were used to break up the street images and defenses held by
the juveniles. The groups were also utilized to provide a forum to deal with conflict between
members. Lastly, they were mechanisms for expression of feelings and thoughts among the
individuals.
Other treatment groups held at Mohican Youth Center include: phase classes and life
skills/special interest classes. The phase groups targeted substance abuse and attitudes.16
This group typically had some type of manual for staff and the youth were required to
complete workbooks. The life skills groups were classes whereby staff with special
expertise may teach skills such as cooking, agricultural/farming, balancing a checkbook, or
16 In addition, some juveniles will receive anger management classes if there is a need.
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budgeting are taught. The goal of the life skills classes was learning topics that would assist
the juveniles for life outside of Mohican.
Other meetings or groups that were held included house meetings, caseload groups,
and educational classes. The purpose of the caseload groups was to: “allow time to share
feelings about both the past and present, to get help from peers and counselors and to
emotionally grow in a safe environment” (Resident Handbook, 2001, p. 44). House
meetings were designed as business meetings in which youth discuss any family business and
provide suggestions/input into the community. As mandated by the state, juveniles must
attend school during the day. As such, Mohican Youth Center has an accredited secondary
school on the grounds for grades seven through twelve. Juveniles who had not completed
high school must be enrolled in this school. The courses offer included: English, Math,
Science, Social Studies, Health, Physical Education, and Art. Juveniles who had completed
high school were placed in a graduated life experiences program whereby they could learn
job related skills and behaviors.
Phases of Treatment. While in the therapeutic community, youth also participated
in phase groups. There are four phases for youth to complete during their time in treatment.
The initial phase was the orientation phase, which is designed to last four weeks and was
used to familiarize the youth with the therapeutic community environment. For example,
youth learn the wording and concepts of the community, the philosophy, the privilege
system, and what was expected of them while at the facility. During the orientation phase,
youth must complete all orientation classes, write their life story and present it to the
community, recite the therapeutic community philosophy, and perform in their job
assignment.
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From the orientation phase, youth move into phase one, which lasts eight weeks.
This phase focuses on the beginning steps of changing attitudes. Specifically, youth begin to
identify antisocial attitudes or thinking errors and embark on overcoming these antisocial
attitudes. During phase one, youth must complete nine hours of public service, write and
present an essay entitled “Where I Am Today”, present two seminars, begin writing pull-ups
and participating in encounters, complete their step one workbook, and perform in their
assigned jobs. After successful completion of phase one, youth move to the second phase of
treatment.
Phase two was centered on personal recovery and lasts eight weeks. Youth in this
phase were introduced to the effects of chemical dependency and ways to abstain from
substance abuse, concentrate on family issues, evaluate their criminal values and self worth,
and learn how to express their feelings in a prosocial manner. Youth in phase two must
complete eight hours of community service, present four seminars with three lasting five
minutes and one lasting ten minutes, hold a position of assistant or crew leader, complete
recovery classes and their required assignments, write and present an essay entitled “Where I
Want to Go,” become a big brother, and complete steps 2 and 3 in their recovery workbook.
The last phase was phase three and this period focused on relapse prevention. In this
phase, which lasts for six weeks, youth were introduced to techniques to avoid relapse such
as how to avoid “easy money” and the “old life.” To successfully complete this phase, youth
must also finish a relapse prevention plan. The relapse prevention plan must be presented to
the community and the parole officer and include topics such as: “How I’m Going to Get
There,” talk about triggers, plans for new friends, and leisure activities that promote health,
sobriety, and right living (Resident Handbook, 2001). Youth in this phase are expected to act
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as senior members and as such they have more responsibility. For example, youth must
continue being a big brother, co-facilitate orientation classes, and write a promise letter. The
promise letter is written by departing members for the purpose of motivating those who are
left in the community.
A Quantitative Assessment of the Principles of Effective Intervention. Research
has shown that programs tend to have higher levels of program integrity and are more
effective when they adhere to the principles of effective intervention (Andrews, Bonta, &
Hoge, 1990; Gendreau & Goggin, 1996; Holsinger, 1999; Latessa & Holsinger, 1998).
Furthermore, many evaluations have failed to incorporate a standardized measure of program
integrity. Accordingly, this study used a standardized, objective, and quantifiable measure of
program integrity–the Correctional Program Assessment Inventory (CPAI) (Gendreau and
Andrews, 1992) The CPAI was used to measure how well the therapeutic community meets
known principles of effective correctional treatment. There are six primary sections of the
CPAI: 1) program implementation and the qualifications of the program director; 2) client
pre-service assessment; 3) characteristics of the program; 4) characteristics and practices of
the staff; 5) quality assurance and evaluation; and 6) miscellaneous items such as ethical
guidelines and levels of community support.
Each section of the CPAI consists of 6 to 26 items with a total of 77 items. Each of
these items is scored as “0” or “1.” For an item to be scored “1,” the program must
demonstrate that it has met the specified criteria. For each section, the score will be placed
into one of the following categories: “very satisfactory” (70% to 100%); “satisfactory” (69%
to 60%); “needs improvement” (59% to 50%); or “unsatisfactory” (less than 50%). The
overall total and score is summed across the six sections and the same scale is used in
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determining the overall assessment. Data for the CPAI were gathered through structured
interviews with program staff. Other sources of information include examination of program
documentation, review of case files, and observation of program activities.
There are several limitations to the CPAI that should be noted. First, the instrument
is based on an “ideal” type. The criteria have been developed from a large body of research
and knowledge that combines the best practices from the empirical literature on “what
works” in reducing offender recidivism. Second, as with any research process, objectivity
and reliability are always an issue. Although steps are taken to insure that the information
that is gathered is accurate and reliable, given the nature of the process, the assessor
invariably makes decisions about the information and data gathered. Third, the process is
time specific. That is, the assessment is based on the program at the time of the assessment.
Changes or modifications may be under development; however, only those activities and
processes that are present at the time of the review are scored. Fourth, the process does not
take into account all “system” issues that can affect program integrity. Finally, the process
does not address “why” a problem exists within a program.
Despite these limitations, research using the CPAI has shown it to be a significant
predictor of arrest and incarceration (Holsinger, 1999). Offenders who participate in
programs where there is low program integrity (as measured by the CPAI) are significantly
more likely to recidivate (e.g., be arrested and/or incarcerated). Furthermore, other
researchers have found support for the concepts that comprise the CPAI (Antonowicz &
Ross, 1994).
The CPAI (Gendreau & Andrews, 1992) was conducted on Mohican Youth Center on
May 31, 2001 by researchers from the University of Cincinnati (see Shaffer & Johnson,
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2001). Figure 2 shows the results of the Mohican assessment compared to the national
average of 320 CPAI assessments conducted by researchers from the University of
Cincinnati. The overall score for Mohican Youth Center was 52.1 percent, which fell into
the “needs improvement” category. Thus, while Mohican was meeting some principles of
effective interventions, there were areas in which improvement could be made.
The first section address how the program was implemented and assesses the program
director and the implementation process. The strengths for this section were the educational
level of the program director and his involvement with hiring and supervising treatment staff.
In addition, the program was developed out of a need for treatment programs for substance
abusing youth. In addition, the program was valued and supported by the criminal justice
community and the community at large. This section was scored as “satisfactory.”
The second section of the CPAI addresses the assessment process of Mohican. This
section received a score of 72.7 percent, which fell in the “very satisfactory” category. The
assessment process is stringent in that the program has certain selection and exclusionary
criteria in place to prevent inappropriate youth from entering the program. In addition, the
program received assessment information from the Department of Youth Services, which
included: the Youthful Level of Service/Case Management Inventory (YLS/CMI) and the
Juvenile Automated Substance Abuse Evaluation (JASAE). The only area that needed
improvement was that Mohican should be assessing responsivity factors such as personality,
IQ, and level of cognitive functioning.
The next section of the CPAI targets program characteristics or how well the program
delivers interventions. Mohican scored the lowest in this section with 24 percent, which fell
into the “unsatisfactory” category. The strengths for Mohican included: 1) the program was
Figure 2: Mohican Youth Center CPAI Scores Compared to Average Scores*
*The average scores are based on 320 CPAI results across a wide range of programs. Very Satisfactory=70% or higher; Satisfactory=60-69%; Needs Improvement=50-59%; Unsatisfactory=less than 50%.
Implem
entation
Assessm
ent
Treatm
ent
Staff
Evaluation
Other
Overall S
core
0
10
20
30
40
50
60
70
80
90
100
Mohican TC 64.3 72.7 24 54.5 75 83.3 52.1Average 72.5 48 41 58.5 35.5 83.1 53.4
Very Satisfactory
Satisfactory
Unsatisfactory
Needs Improvement
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targeting criminogenic needs such as attitudes and substance abuse; 2) the program was
intensive. The duration of the program lasted for six months, and youth were engaged in
treatment-related activities for the majority of their time at the program; 3) youth were
allowed to have input into the program through their participation in house meetings; and 4)
Mohican uses reinforcements to change behavior and not just for controlling the youth.
There were some problematic issues with the delivery of treatment at Mohican.
Treatment at Mohican may be improved if the program overcomes these concerns. First,
while the program utilized some cognitive-behavioral techniques, the majority of the groups
were education-based and processing. These techniques have not been shown to be as
effective in changing behavior. Second, while triggers were discussed throughout the
program, the groups lacked structure in which youth could progressively practice new skills
and behaviors in overcoming these triggers. Third, while the program received risk level and
need data from the Department of Youth Services, it was not using this information to the
fullest. For example, there was no differentiation in programming between low, moderate,
and high-risk youth. Furthermore, with the exception of anger management, all youth
received the same type of programming regardless of their needs.
The next area of concern was the use of reinforcements at the facility. Mohican used
a token economy in which youth either earn or lose points per day. Specifically, the point
system at Mohican was problematic because once youth earned the minimum number of
points, there was not a strong incentive to engage in prosocial behavior. In addition, the
application of the reinforcements was cause for concern. In order to effectively change
behavior, rewards should be used more often than punishments; however, Mohican staff
reported using more punishments than rewards. There was also a problem with the types of
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punishments that were utilized within Mohican Youth Center. For example, youth may
receive pull-ups in response to negative behavior. The core team and staff reviewed the pull-
ups and the core team issued learning experiences in response to the tickets. Examples of
learning experiences included: sign-wearing, image busters (i.e., singing a song), and writing
essays. Several of these were shaming techniques and the effectiveness of the learning
experiences was questionable.
Another problematic area was the follow-up after the administration of punishments.
Once punishments are administered, it is important that staff watch for any type of unwanted
negative effects of the punishments. However, within the therapeutic community, the
concept to “act as if” required the individual to accept the punishment without hesitation.
Therefore, staff did not routinely monitor the juveniles for unwanted emotions, escalation of
antisocial behavior, fear, or withdrawal.
The last area of concern for treatment delivery at Mohican focused on the release and
aftercare component for the juveniles. Release from a program should be based on the
acquisition of prosocial skills, behaviors, and attitudes and not be time-based. However, as
with many RSAT grants, the length of time at Mohican was six months. Thus, many youth
were released from the facility at end of their six months regardless of their phase placement.
In addition, once released from Mohican, the staff members were not able to follow-up with
the juveniles to determine if they were receiving any type of referrals that were made for the
community. Lastly, while it is important to have some type of step-down treatment from a
residential facility to the community, Mohican did not have a structured aftercare component
in place for the juveniles.
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The fourth section of the CPAI focuses on characteristics of the treatment staff and
examines such areas as: education, experience, clinical evaluation, training, and supervision.
Mohican treatment staff were well educated and reported that they were allowed to have
input into the program. In addition, they received clinical supervision on a regular basis.
However, there were some problems reported by the staff. First, the initial training for the
staff was lacking in both content and duration. In addition, staff members were not required
to participate in any type of on-going training throughout the year and many did not receive
any type of training within the last year from the evaluation. Anther concern was the lack of
clinical assessment for the staff members. While a performance evaluation was completed,
there was no assessment that measured the treatment staff’s clinical skills. The last
problematic area concerned the issue of support for the program. The lack of support was
due to members (mainly correctional officers) not being familiar with the therapeutic
community concepts and would be remedied with training on the concepts. Mohican scored
in the “needs improvement” category for this section with a total of 54.5 percent.
The fifth section of the CPAI assessment examines the quality assurance mechanisms
in place at the program. Mohican received a score of 75 percent in the section, which fell in
the “very satisfactory” category. The program had established quality control mechanisms
such as: case file reviews, client satisfaction surveys, and clinical supervision. Furthermore,
the Department of Youth Services collected recidivism data and staff received these data.
The last section of the CPAI is a miscellaneous section that examines issues such as
stability in funding and support. The funding for Mohican appeared to be stable as was the
level of community support. In addition, Mohican had an advisory board that guided the
program. The only area of concern was the stability of the program itself. For example, at
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the time of the evaluation, Mohican had experienced a great deal of staff turnover, which had
a negative impact on the program. The turnover affected the level of support among the staff
for the program. Accordingly, Mohican Youth Center achieved a score of 83.3 percent for
this section, which fell in the “very satisfactory” category.
COMPARISON GROUP
The comparison group for this dissertation was a group of males who were sentenced
to the Department of Youth Services from May 1997 to October 1999. The sample size was
447 adolescent males. The Department of Youth Services provided the University of
Cincinnati with a database of all juveniles who were sentenced to DYS from 1997 to 1999.
A random sample of 447 individuals was selected from the database to use as a comparison
group.17 The individuals from the comparison group were sentenced to institutions
throughout the state. Accordingly, this dissertation used a matched comparison group in
which individuals received minimal treatment.18
DESCRIPTION OF THE MEASURES
Individual Characteristics Examined The individual characteristics that were used in examining the effectiveness of the
therapeutic community included: demographic characteristics, criminal history and risk level,
substance abuse history and severity of substance abuse, psychological and social
functioning, cognitive distortions, and termination data. The standardized intake form19 was
17 Females, juveniles who had been sentenced to Mohican Youth Center, and juveniles who did not have a risk level score were removed from the database prior to the selection of the comparison group. 18 Risk level was chosen as a criterion for matching because research has shown that risk level is one of the best predictors of recidivism (Andrews, Bonta, & Hoge, 1990; and Lowenkamp & Latessa, 2002). The measure of risk was derived from the Youthful Level of Service/Case Management Inventory (Hoge & Andrews, 2003). The YLS/CMI is a standardized risk/need instrument that measures 42 different risk items across eight theoretically and empirically derived domains. Accordingly, every effort was made to obtain a comparison group that was equal to the treatment based on risk/need level. 19 See Appendix A for the standardized intake form used for this study.
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used to collect basic demographic information such as: age, race, number of dependents,
educational level, and employment status. In addition, the intake form collected information
on criminal history and substance abuse history. Table 4 reports the variables and measures
used in this study.
Juvenile Demographics. The juvenile’s age was assessed at intake into Mohican
Youth Center. This variable was defined as the number of years from birth to intake into
Mohican. The juvenile’s race was determined by staff members at the facility and included
responses such as: White, Black, Hispanic, Native American, Asian, and other; however,
due to the small number of individuals in certain categories, race was coded as White or
Non-white. Upon intake into Mohican, the youth were asked what was the highest grade he
had completed. Accordingly, educational level was defined as the highest completed grade
upon entrance into the program. In addition, data pertaining to the employment status of the
juveniles were collected. Juveniles were asked if they were unemployed, worked part-time,
or worked full-time prior to their arrest. This study defined employment status as
unemployed or employed.
Criminal History. The intake form also included questions related to the juvenile’s
criminal history. For example, staff determined the most serious charge (i.e., burglary, rape,
theft, or possession) that resulted in the juvenile’s placement in Mohican. For the purpose of
this study, most serious charge was defined as personal, property, drug offenses, or other. In
addition to type of charge, the level of offense was collected. This variable was measured as
misdemeanor, felony one, two, three, four, or five.
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Table 4: Variables and Measures Employed in the Study Measures Coding Juvenile Characteristics Age 12 – 20 years
Race 0 = white
1 = nonwhite
Years of education 1 – 12 grades
Employment status 0 = unemployed 1 = employed
Criminal History at Time of Arrest Type of charge 1 = personal
2= property 3 = drug 4 = other
Level of offense 0 = misdemeanor 1 = felony 5 2 = felony 4 3 = felony 3 4 = felony 2 5 = felony 1
Age at first arrest 7 – 18 years
Previous drug charge 0 = no 1 = yes
Substance Abuse History Drug of choice 1 = heroin
2 = crack or cocaine 3 = marijuana 4 = alcohol 5 = other
Age at first use 1 – 17 years
Family history 0 = no 1 = yes
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Table 4: Variables and Measures Employed in the Study (continued) Measures Coding Substance Abuse History JASAE score 0 – 76 Risk Level Y-LSI raw score 2 to 38
Y-LSI category 0 = low
1 = moderate 2 = high 3 = very high
Psychological & Social Functioning Anxiety 7 – 35
Depression 6 – 30
Self-esteem 6 – 30
Decision-making 9 – 45
Risk-taking 7 – 35
Hostility 8 – 40
Self-efficacy 7 – 35
Desire for help 7 – 35
Treatment readiness 8 – 40 Cognitive Distortions Self-centeredness 1 – 6
Blaming others 1 – 6
Minimizing 1 – 6
Assuming the worst 1 – 6
Oppositional defiance 1 – 6
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Table 4: Variables and Measures Employed in the Study (continued) Measures Coding Cognitive Distortions Physical aggression 1 – 6
Lying 1 – 6
Stealing 1 – 6
Overt 1 – 6
Covert 1 – 6
How I Think 1 – 6 Termination Type Type of termination 0 = unsuccessful
1 – successful
Length of time in program 13 – 429
Outcome Data New incarceration 0 = no
1 = yes
Time to incarceration 1 day to 514 days
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As previous research has shown, age of onset is a significant predictor of future
offending (Andrews & Bonta, 1994; Nagin & Farrington, 1992; and Stattin & Magnusson,
1989). Therefore, staff members at Mohican collected data on the age of first arrest. The
variable was defined as the number of years from birth to age of arrest. The last measure of
criminal history pertained to the previous drug charges. Individuals sentenced to Mohican
were asked if they were previously charged with a drug offense. When the individual’s files
were available, staff members were instructed to obtain this information from the case files.
Substance Abuse History. Five different types of data were collected pertaining to
the juveniles’ substance abuse histories. First, juveniles were asked about their drug of
choice. While many choices were offered, the responses were for the following categories:
heroin, crack, cocaine, marijuana, alcohol, amphetamines, LSD, PCP, and inhalants.
Related to drug of choice, data on the age of first usage (both alcohol and drug) was obtained
for the treatment group. This variable was defined as the number of years from birth to first
use. In addition, the juveniles were asked if they had participated in any type of substance
abuse treatment program previously. Another variable that related to substance abuse was
the whether the juvenile’s family members use drugs. Specifically, juveniles were asked if
any immediate family members have a substance abuse problem.
The last variable that measured substance abuse history examined the juvenile’s
severity of the current substance abuse problem. The juvenile’s level of substance abuse
severity was measured by the Juvenile Automated Substance Abuse Evaluation (JASAE)
(ADE Incorporated, 1987). The JASAE provided a summary score indicating the level of
substance abuse addiction and the level of treatment that was needed. The instrument was
coded so that the higher the score, the higher the substance abuse addiction. A score of 21 or
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above indicated that the youth had “a severe substance abuse problem along with ingrained
patterns and attitudes supporting the drug problem.” (ADE Incorporated, 1997, p. 6).
Additionally, youth who scored 21 and above were in need of for more intensive intervention
and possibly residential care. The JASAE was administered to all youth upon intake in the
Department of Youth Services Reception Center. The JASAE score was provided to the
Mohican Youth Center by the Reception Center and staff recorded the score on the intake
form.20
Risk Level. Research has shown that an individual’s risk level is an important
predictor of recidivism (Andrews & Bonta, 1994; Andrews, Bonta, Hoge, 1990; Gendreau,
Goggin, & Paparozzi, 1996; Jones, 1996). Higher-risk individuals are more likely to
recidivate unless they receive intensive treatment. Thus, it is important to include the
individual’s risk level in any type of outcome evaluation analysis. For this study, the
Youthful Level of Service/Case Management Inventory (Hoge & Andrews, 2003) was used
to measure the juveniles’ risk levels. The YLS/CMI is a standardized and objective risk
assessment instrument that examines risk and need factors such as: criminal history,
substance abuse involvement, family issues, educational and employment history, leisure
activities, antisocial personality, peer networks, and antisocial attitudes. The assessment was
conducted through semi-structured interviews with the juvenile and/or guardians. Additional
information was obtained through file reviews to substantiate the interview data.
The instrument is scored using objective scoring criteria and the higher the score, the
higher the risk level. Depending on their scores, youth are classified as “low”; “moderate”;
“high”; or “very high” for each of the subcomponents. A total score is also provided that
20 The JASAE scores were included in the database from the Department of Youth Services for the comparison group.
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indicates the overall level of risk of recidivism. The YLSI/CMI was administered to youth at
the Department of Youth Services’ Reception Center by Department staff. Mohican staff
members received the Y-LSI score from the Reception Center and recorded the information
in the automated database.
Psychological and Social Functioning. An individual’s psychological and social
functioning may affect one’s amenability to treatment. As such, the Client Self-Rating form
(Simpson & Knight, 1998) was used as a measure of youth’s level of psychological and
social functioning. This instrument measures factors such as: depression, anxiety, risk-
taking, hostility, self-esteem, self-efficacy, a desire for help, treatment readiness, and
decision-making ability. Individuals responded to the 65 statements using the following
response set: 1=strongly disagree, 2=disagree, 3=undecided, 4=agree, and 5=strongly agree.
In some instances the items had to be reversed coded so that higher scores indicate higher
levels of psychological and social functioning. Staff administered the Client Self-Rating to
youth at intake and termination from the therapeutic community. The alpha coefficients
along with the questions for the various scales are found in Appendix B.
Cognitive Distortions. Cognitive distortions are inaccurate ways of attending to or
conferring meaning upon experiences (Barriga, Gibbs, Potter, & Liau, 1999). Research has
indicated that cognitive distortions may contribute to antisocial or criminal behavior
(Yochelson & Samenow, 1976). Using the How I Think Questionnaire (Barriga et al., 1999),
youths’ cognitive distortions were assessed. This instrument measures four self-serving
cognitive distortions: self-centered (according such status to one’s own views that the
opinions of others are not considered), blaming others (misattributing blame to outside
sources), minimizing/mislabeling (believing that antisocial behavior is acceptable, admirable,
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or causes no real harm), and assuming the worst (assuming that improvement is impossible,
or considering a worst case scenario).
The How I Think Questionnaire also depicts four behavioral referents scales that are
manifested from the cognitive distortions: opposition/defiance, physical aggression, lying,
and stealing. From these subscales, three summary scores can be computed. The overt scale
is computed by averaging the opposition/defiance and physical aggression means. The covert
scale is computed by averaging the lying and stealing scales’ means. The overall How I Think
score is computed by averaging the means of all eight subscales.
This 63- item instrument was coded so that higher scores indicate higher levels of
cognitive distortions and behavioral referents. Youth were administered the How I Think
Questionnaire at intake and termination from the therapeutic community. The reliabilities
for the various scales are found in Appendix B.
Termination data. Data concerning the youth’s type of termination were gathered
from a discharge form21 that was completed by program staff when youth left the therapeutic
community. Specific data that were gathered included: type of termination and length of
time in the program. Type of termination was measured as successful, unsuccessful, or other.
Length of time in the program was measured as the number of days from intake into the
therapeutic community to discharge from the program.
Outcome Variables Examined
Intermediate Outcomes. Intermediate outcomes are the direct effects that are
attained through receiving the treatment. As such, we included two intermediate goals to
examine the effectiveness of the therapeutic community–changes in psychological and social
functioning and changes in cognitive distortions. 21 See Appendix A for a copy of the termination form.
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Psychological and social factors such as depression, anxiety, risk-taking, ant isocial
values, and hostility have been found to be positively related to substance abusing behaviors
and longevity and success in treatment while factors such as self-esteem, self-efficacy, and
decision-making ability have been found to be negatively associated with substance abusing
behaviors and longevity and success in treatment (Simpson & Knight, 1998). Therefore,
these areas are all potential targets for treatment. Theoretically, participation in the
therapeutic community should reduce individuals’ levels of anxiety, depression, risk-taking,
hostility, and antisocial values, and increase their self-esteem, self-efficacy, decision-making
ability, desire for help, and treatment readiness. To determine if participation in the
therapeutic community changed the youth’s level of psychological and social functioning, the
Client Self-Rating form (Simpson & Knight, 1998) was administered to the youth at intake
and termination from the program.
Aside from affecting the youth’s psychological and social functioning, participation
in a correctional treatment program should change an individual’s cognitive distortions. By
reducing the cognitive distortions, programs are more likely to reduce criminal behavior
(Barriga et al., 1999). To determine if participation in the therapeutic community reduced
the juveniles’ levels of cognitive distortions, the How I Think Questionnaire was
administered and intake and termination from the program by program staff.
Long-term Outcomes. This dissertation tracked the youth for a period up to 36
months after they were terminated from the therapeutic community or the Department of
Youth Services. There were two outcome measures for the current study: any new period of
incarceration and time to new incarceration. The first outcome measure examined recidivism
and was measured as any new period of incarceration (yes or no) in the Ohio Department of
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Youth Services or the Ohio Department of Rehabilitation and Corrections. Recidivism was
defined in this manner for two reasons. First, arrest data for the youth were unreliable and
thus were not used. For example, the Department of Youth Services formally tracks youth
for a period of only six months. This follow-up time frame is insufficient to adequately
assess the effectiveness of the treatment modality. Second, by using periods of new
incarceration, the study will have a more stringent test of the effectiveness of the therapeutic
community in reducing the recidivism of the youth.
An additional outcome measure was the time to incarceration. This item was
measured as the difference in days between termination from the facility and incarceration
into a facility.
Aside from examining the differences in recidivism between the treatment and
comparison groups, a within group difference for the treatment group was conducted.
Specifically, measures of cognitive functioning, psychological and social functioning, and
risk level will be examined to determine if the treatment intervention was more effective for
certain types of individuals.
STATISTICAL TESTS
This study examined multiple outcome measures for the therapeutic community
participants and comparison cases. In order to sufficiently address the research questions,
several statistical tests were performed. First, frequency distributions were conducted to
study the following variables for the treatment group:22 problems at school, employment
status, age at first arrest, prior drug charge, age at first alcohol and drug use, drug of choice,
psychological and social functioning, and cognitive distortions. Frequency distributions were
22 Data on the variables were collected using a standardized intake form and a service tracking form for juveniles who participated in the therapeutic community. Thus, these data were unavailable for the comparison group.
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computed to obtain a clear picture of the sample by reporting measures of central tendency
for each juvenile in the treatment group.
Chi-square and t-tests were conducted to examine the differences between treatment
and comparison groups. Chi-square analyses were used to test for differences between the
groups on the following variables: race, highest grade completed, enrollment in school,
previous suspensions, offense type, level of adjudications, and type of termination. Chi-
square tests were used because these data are categorical.
Independent samples t-tests were computed to test for significant differences between
the treatment and comparison groups on the following characteristics: age, severity of
substance abuse, risk level, length of stay in the facility, and time to new incarceration. The
independent samples t-test procedure compares means for two groups of cases. Specifically,
the analysis reports any statistically significant differences between the means of the groups.
To determine if participation in the therapeutic community changed the psychological
and social functioning and reduced the levels of cognitive distortions, paired sample t-tests
were computed. Paired sample t-tests compare the means of two variables for one group.
The statistical analysis computes the differences between values of the two variables for each
case and tests whether the average differs from 0. Observed differences between the groups
can then be attributed more readily to the variable of interest (i.e., participation in the
therapeutic community).
Another set of statistical tests that were conducted was logistic regression analyses.
Logistic regression measures the effects of multiple predictors on a dichotomous dependent
variable. The purpose of the logistic regression is two-fold. First, the analysis reveals
significant predictors of the outcome variable while holding all other variables constant.
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Second, logistic regression calculates beta coefficients, which can be converted into log-odds
probabilities. Accordingly, the logistic regression models identified the significant predictors
of successful completion of treatment.
Cox regression models were computed to determine whether participation in a
therapeutic community resulted in a decrease in the probability of obtaining a new
incarceration. Cox regression is like ordinary least squares regression (OLS) in that one may
predict a dependent variable as a function of a set of independent variables. However, Cox
regression differs in two ways. First, Cox regression allows for the computation of data that
contains censored data (e.g., juveniles that survived or who were not incarcerated during the
time period). Second, the statistical technique will provide an analysis of the cases in each
group to show at what point in time, if any, the two groups differ on the outcome.
LIMITATIONS OF THE STUDY
As with most studies examining the effectiveness of a drug treatment program on
recidivism, there are a number of limitations. First, the study could not randomly assign
individuals to the treatment group or the comparison group. Random assignment to groups
would have allowed the groups to be very similar and would have strengthened any findings
of a treatment effect. However, youth were adjudicated to the therapeutic community and the
Department of Youth Services by a judge and not the researcher. Even though the
comparison group was matched to the treatment group on certain characteristics, there may
still be significant differences on some background characteristics. These characteristics will
have to be controlled for when predicting outcome.
Missing data was also a concern for this study. A standardized intake form was used
to collect certain demographic data on the treatment group; however, these data were
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unavailable for the comparison group. For example, data concerning number of prior arrests,
prior commitments, age at first arrest, and substance abuse history were not available for the
comparison group. Therefore, this study will not be able to control for these factors. In
addition, information pertaining to intermediate outcomes will only be available for the
treatment group. The How I Think Questionnaire and the Client Self-Rating form was only
administered to youth in the treatment group. As such, this study cannot compare changes in
psychological and social functioning and cognitive distortions between the treatment group
and the comparison group.
Last, the length of follow-up may be problematic. While the length of follow-up for
the study is three years, the follow-up time period may not be sufficient to adequately assess
the long-term effects such as reincarceration rates of the therapeutic community.
SUMMARY
This chapter focused on the methods that were used to evaluate a therapeutic
community for juvenile offenders. A quasi-experimental design was used to determine if
participation in the treatment program resulted in a significant decrease in probability of
recidivism three years after termination from the program. Specifically, the study used a
matched group design to compare juvenile males who participated in a therapeutic
community to juvenile males who were adjudicated to the Department of Youth Services and
did not receive intensive treatment services. The individual characteristics that were used in
the analyses include: background characteristics, risk level, severity of substance abuse
problem, psychological and social functioning, cognitive distortions, and type of termination
and length of stay in the facility. This chapter also examined the measures for both the
intermediate outcomes (i.e., changes in psychological and social functioning and changes in
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cognitive distortions) and long-term outcomes (i.e., any new period of incarceration and
length of time to new incarceration). Statistical tests that were conducted were described
followed by limitations of the study. The results for each of the research questions will be
presented in Chapter Four.
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CHAPTER 4
RESULTS
The purpose of this research was to assess the effectiveness of a therapeutic
community for juvenile males in reducing recidivism up to three years post-release. While
there has been mixed support for this treatment modality in reducing recidivism, most of the
research has been directed toward adults (Field, 1994; Hiller et al., 1999a; Inciardi et al.,
1997; Martin et al., 1999). Accordingly, this dissertation expands and extends the work of
Pealer, et al., (2002a) in a number of ways. First, this dissertation tracked a sample of
juvenile offenders who participated in Mohican Youth Center (operated as a therapeutic
community) for a period up to three years to determine if participation in a therapeutic
community reduced the probability of a new period of incarceration. Second, Pealer et al.,
(2002a) failed to examine predictors of time to new incarceration to determine if certain
individual characteristics predict time at risk. Last, this research also examined individual
characteristics of the treatment group to determine if there was a differential treatment effect
for certain individuals.
Individual Characteristics
Social Demographic Characteristics. Social demographic data were collected in
order to describe the therapeutic community participants and comparison group and to
investigate whether differences in outcome were related to differences within the samples.
Examining social demographic characteristics allows for a determination of whether outcome
was influenced by any of these factors. This section profiles the groups based on
characteristics such as age, race, educational level and performance, employment, criminal
history, and substance abuse history.
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Aside from race, there were some significant differences between the groups;
however, the differences do not appear to be substantively significant (Table 5).
Approximately 52 percent of the treatment group was “white” and 50.8 percent of the
comparison group was “white.” There was a statistically significant difference between the
groups based on age. The average age for both groups was 16.61 for the treatment group and
15.89 for the comparison group.
When examining the education variables, there were some statistically significant
differences. For example, the majority of the juveniles in both groups had completed the 9th
grade (75.4% of the treatment versus 84.2% of the comparison group) with the average grade
of completion being 8.78 for the treatment group and 8.35 for the comparison group. While
an independent t-test revealed a significant difference for this variable, the difference would
not appear to be substantively different. Chi-square analysis revealed that a significant
difference in the percentage of youth who were enrolled in school prior to their commitment
to the Department of Youth Services. For example, 71.3 percent of the treatment group and
72.7 percent of the comparison group was enrolled in school prior to being sentenced. While
the majority of youth in both groups were enrolled in school, they also had some problems in
this area. For example, a large percentage of youth in both groups had been suspended at
least once in the educational career (89.4% of the treatment group and 72.7% of the
comparison group). Again, a significant difference arose between the two groups. More
youth in the comparison group had not received a previous suspension (27.3%) compared to
youth in the treatment group (10.6%).
When youth entered Mohican Youth Center, they were asked about their employment
status. A slight majority of youth (50.6%) was unemployed prior to their sentence to the
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Table 5: Background Characteristics Characteristics
Mohican (N= 447) N %
Comparison (N=447) N %
Race: White 231 51.7 227 50.8
Nonwhite 216 48.3 220 14.2 ?2 = .072; p = .789 Age at Intake: 13 or younger 5 1.1 19 4.3 14 20 4.5 49 11.2 15 53 11.9 74 16.9 16 113 25.3 132 30.1 17 152 34.0 148 33.7 18 87 19.5 15 3.4 19 & older 17 3.8 2 0.5 Mean 16.61 15.89 t = 8.601; p = .000 Highest Grade Completed: 7th grade or less 30 6.7 84 19.7 8th 161 36.0 165 38.7 9th 146 32.7 110 25.8 10th grade 86 19.2 48 11.3 11th grade 15 3.4 16 3.8 12th grade or higher 9 2.0 3 0.7 Mean 8.78 8.35 t = 5.269; p = .000 Enrolled in School Prior to Commitment Yes 318 71.3 309 72.7 No 128 28.7 107 27.3 ?2 = 10.506; p = .005 Previous Suspensions Yes 396 89.4 271 72.7 No 47 10.6 64 27.3 ?2 = 58.455; p = .000 Employment History Employed 221 49.4 NA Unemployed 226 50.6 NA N’s may not equal total due to missing data NA = data not available
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Department of Youth Services. However, this finding is not surprising given that the average
age of the sample was 16 years – barely the legal age of employment.
In review, the typical juvenile in the treatment and comparison groups were white;
age 16; had completed the 8th grade; was enrolled in school at the time of arrest; and had at
least one previous suspension.
Drug History. Table 6 reports the results of the treatment group’s drug history.23
The majority of the youth were ages 10 to 15 years when they first used alcohol with the
average age being 12.18 years. The sample was a little younger when they first used drugs
with the average age of first drug use being 11.98 years. A large number of the treatment
group rated marijuana (76.2%) as the drug of choice followed by alcohol (15.6%). A slight
majority of the treatment group reported a family history of substance abuse. Furthermore,
68.4 percent of the Mohican participants had received previous drug treatment. Thus, these
data suggest that the treatment group had a previous history of substance abuse and may be
need of some type of substance abuse treatment.
Substance Abuse Severity. Youth entering the Department of Youth Services were
assessed using the Juvenile Automated Substance Abuse Evaluation (JASAE) (ADE
Incorporated, 1997). The JASAE provides a summary score indicating the level of care
required. The summary score represents a range of problematic involvement with drugs and
alcohol, and the attitudes and life style patterns, which surround this involvement. As the
summary score increases, the need for more intensive intervention increases. A score of 21 or
above indicated the need for intensive treatment and possibly residential care because youth
23 Drug history data were collected as part of a larger study for the treatment group participants when they entered Mohican Youth Center. Therefore, these data were not available for the comparison group.
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Table 6: Drug History Variable
Mohican (N= 447) N %
Comparison (N=447) N %
Age at First Alcohol Use:* 9 and under 62 14.6 NA 10 to 12 143 33.7 NA 13 to 15 192 45.3 NA 16 and over 27 6.4 NA Mean 12.18 Age at First Drug Use: 9 and under 63 14.2 NA 10 to 12 177 40.0 NA 13 to 15 180 40.6 NA 16 and over 23 5.2 NA Mean 11.98 First Drug of Choice: Heroin 7 1.7 NA Crack or Cocaine 7 1.7 NA Marijuana 323 76.2 NA Alcohol 66 15.6 NA Other 21 5.0 NA Family History: Yes 231 52.0 NA No 213 48.0 NA Previous Substance Abuse Treatment:
Yes 305 68.4 NA No 141 31.6 NA JASAE Scores* Min. Max. Mean SD Min. Max. Mean SD 21.00 76.00 51.34 12.44 0.00 76.00 41.59 19.63 t = 8.874; p = .000 NA = Information not available * = Mean replacement used for 60 cases in the comparison group
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at this level “indicate a severe substance abuse problem along with ingrained patterns and
attitudes supporting this problem” (ADE Incorporated, 1997, p.6).
Table 6 reports the measures of central tendency for the JASAE for both groups.
Scores were available for 437 youth in the treatment group and 447 cases for the comparison
group.24 The average JASAE score for the treatment group was 51.34 whereas the mean
score for the comparison group was 41.59. The reason for the discrepancy was that Mohican
Youth Center was designated as a therapeutic community to treat juvenile males with a
substance abuse problem. As such, Mohican’s target population was youth with a JASAE
score of 21 or above whereas there was no distinction for youth in the DYS sample pool.25
The JASAE summary score may also be examined by ranges, which represent the
severity of substance abuse. Figure 3 reveals the JASAE scores for each group by category.
Approximately 8 percent of the comparison group scored in the 0 to 6 range meaning that the
individuals may be drinking or using drugs irresponsibly because of attitudes and life style
patterns which surround the involvement. Accordingly, participants in this category need a
substance abuse education program. The next level of involvement was for those who scored
in the 7 to 13 category. Approximately 7 percent of the comparison group scored in this
category, which indicates more than just occasional substance use. Accordingly, participants
in this category need a more intensive and comprehensive level of education.
A small percentage of the comparison group (1.6%) scored in the 14 to 20 range of
the JASAE summary score. Individuals in this category demonstrate an inability to change
24 Mean replacement was used for 60 cases in the comparison group. Analyses were computed with and without mean replacement. The results were very similar. Therefore, mean replacement will be used to minimize the number of missing cases. 25 The data were analyzed after removing those in the comparison group who had a JASAE score of 20 or below. Approximately 73 cases would have been removed from the comparison group. However, the removal of these cases resulted in a lower risk score for the comparison group. Therefore, instead of removing the cases from the sample, the JASAE variable will be controlled for in the final analysis.
Figure 3: JASAE Scores
Mean scores: Mohican (51.34); Comparison (41.59)
0 0 0
100
8.1 6.7
1.6
83.7
0 to 6 7 to 13 14 to 20 21 or above0
20
40
60
80
100
Percentage
Mohican Comparison
126
their use of alcohol and drugs and have an established pattern of substance abuse. Therefore,
the type of treatment needed for these individuals is a “structured intervention program
where they are accountable for meeting and maintaining behavior with prescribed
intervention goals and objectives” (ADE Incorporated, 1997; p. 6).
A clear majority of both groups scored in the last category of the JASAE summary
score (21+). All of the treatment participants scored in this category and 83.7 percent of the
comparison group scored in the most severe substance abuse category. As previously
indicated, scores in this category “reflect a severe substance abuse problem along with
ingrained patterns and attitudes supporting the problem” (ADE Incorporated, 1997, p. 6).
Accordingly, these individual need intensive treatment and may require residential treatment
to overcome the problem.
Current Offense and Criminal History. Data pertaining to the youth’s current
offense were obtained from Mohican Youth Center and the Department of Youth Services.
A chi-square test revealed no significant differences between the groups on crime type (Table
7). A large portion of both groups was placed in state custody for a property offense (53% of
the treatment group and 48.9% of the comparison group) followed by a personal offense
(29% of the treatment group versus 32.8% of the comparison group). Nine percent of the
therapeutic community participants and 11.2 percent of the comparison group were charged
with a drug offense.
Whereas there were no significant differences in the type of offense, there was a
statistically significant difference between the levels of adjudication for the two groups. For
example, a greater percentage of youth in the treatment group (18.8% versus 1.2%) were
charged with the highest- level felony (i.e., class one felony). In addition, a greater
127
Table 7: Current Offense and Criminal History Variable
Mohican (N= 447) N %
Comparison (447) N %
Crime Type: Personal 124 29.0 88 32.8
Property 227 53.0 131 48.9 Drug 40 9.3 30 11.2 Other 37 8.7 19 7.1 ?2 = 2.417; p = .491 Level of Adjudication: Felony 1 43 9.6 30 10.9 Felony 2 150 31.4 28 10.2 Felony 3 73 16.3 49 17.8 Felony 4 97 21.7 75 27.2 Felony 5 84 18.9 90 32.7 Misdemeanor 0 0.0 3 1.1 ?2 = 59.051; p = .000 Age at First Arrest: 9 or younger 35 8.2 NA 10 – 12 159 37.5 NA 13 – 15 194 45.8 NA 16 or older 36 8.5 NA Mean 12.67 N’s may not equal total due to missing data NA = data not available
128
percentage of youth in the comparison group (10.9%) was charged with a misdemeanor
crime compared to youth in the treatment group (no youth in the treatment group was
charged with a misdemeanor).
The last variable that examined criminal history was the age at first arrest for the
juveniles. These data were available for the treatment group only. Approximately 8 percent
of the treatment group was age 9 or younger when they were first arrested. Thirty-five
percent of the group was ages 10 to 12 years of age. Forty-five percent of the treatment
group was ages 13 to 15 years and 8.5 percent of the group was 16 to 18 years of age at the
first arrest.
Risk Level. Upon admission to the Department of Youth Services, a youth’s risk
level is assessed with the Youthful Level of Service/Case Management Inventory
(YLS/CMI). The YLS/CMI is an objective and quantifiable assessment instrument that
examines both static and dynamic risk factors that are associated with recidivism. These
factors include: criminal history, family circumstance, employment/education achievements,
peer relationships, substance abuse, leisure/recreation, personality characteristics, and
antisocial attitudes. The criminal history component examines items such as prior
convictions, prior probation period and detention, and current convictions. The family
circumstances component examines the supervision levels, discipline practices, and
relationships with parents. The factors comprising the education/employment component
include: disruptive behavior in the classroom and on school property, achievement, problems
with peers and teachers, and truancy. The presence of antisocial peers and the absence of
prosocial peers are examined in the peer relations subcomponent. The substance abuse
section of the YLS/CMI looks at screening items such as: occasional and chronic drug use,
129
chronic alcohol use, and whether the substance use interferes with life. Three items comprise
the leisure/recreation component – participation in activities, whether the youth could make
better use of his/her time, and the interests of the youth. The personality and behavior section
examines personality characteristics such as: an inflated self- image, aggressiveness, attention
span, and empathy. The last section of the YLS/CMI is attitudes and orientation. This
section examines the antisocial thinking, whether the individual is asking for help, if the
individual will attend treatment, and whether he/she defies authority.
Depending on their scores, youth are classified as “low,” “moderate,” or “high” risk
for each of the subcomponents. A total score is also provided that indicates the overall level
of risk of recidivism. Total YLS/CMI scores of 35-42 are considered “very high” for
recidivism; scores of 23-34 are considered “high risk” for recidivism; scores of 9-22 are
considered “moderate risk” of recidivism; and scores of 0-8 are considered “low risk” of
recidivism.
Figure 4 reports the total score categories for the groups. Data for the total score
were available for 447 youth in the treatment group and 447 youth in the comparison group.
The majority of youth in both groups were classified as “high risk” (63.5% of the treatment
group and 61.7% of the comparison group). Almost 33 percent of the treatment and
comparison groups were classified as “moderate risk.” Slightly more youth in the
comparison group (4.5%) were classified as “very high risk” compared to 2.8 percent of the
treatment group. Lastly, an equal number of youth in both groups (0.7%) were “low risk.” A
t-test was computed to compare the means of the YLS/CMI for the groups. 26 The treatment
26 Table B4 in Appendix B contains the Youth Level of Service/Case Management Inventory (Hoge & Andrews, 2003) subcomponent and total score means for both groups.
Figure 4: YLS/CMI Risk Categories by Group
Mean Scores: Mohican (24.72) Comparison (23.38)
0.7
32.9
63.5
2.80.7
33.1
61.7
4.5
Low (0-8) Moderate (9-22) High (23-34) Very high (35-42)
Risk Categories
0
20
40
60
80
100Percentage
Mohican Comparison
131
group had an overall mean of 24.72 whereas the comparison group had a mean YLSI
score of 23.38. The t-test revealed a statistically significant difference between these
scores (t = 3.463; p = .001).27 While the difference is statistically significant, along the
continuum of the YLS/CMI scale, the difference would not be substantial.
Aside from the total score, the eight sub-scores may also be classified as “low,”
“moderate,” or “high” risk. Table 8 indicates the differences between the groups based
on chi-square analyses of the YLS/CMI categories. There were five statistically
significant relationships: family circumstances and parenting, peer relations, substance
abuse, leisure/recreation, and attitudes and orientations. The treatment group had a
slightly higher percentage of youth being classified as “high risk” for family
circumstances and parenting (24.7% versus 18.1%). For the peer relations component,
which examines the presence of antisocial peers and the absence of prosocial peers, a
larger proportion of the comparison group (11.2%) were classified as “low risk”
compared to the treatment group (4.7%). A large majority of the treatment group
(90.1%) was classified as “high risk” in the substance abuse component compared to 73.2
percent of the comparison group. For the leisure/recreation component, 69.8 percent of
the comparison group was classified as “high risk” whereas 84.2 percent of the treatment
group was classified as “high risk.” The last significant relationship was for the
attitudes/orientations subcomponent. While the majority of youth in both groups were
classified as “moderate” risk, a larger percentage of youth in the comparison group were
classified as “low risk” (16.6% versus 9.9%).
27 The statistical difference may be the result of the sample size. A large sample size serves to decrease the standard deviation, which results in an increased t-value.
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Table 8: Youthful Level of Service/Case Management Inventory Risk Categories Component
Mohican (N= 447) N %
Comparison (N=447)
N % (Possible range of 0-5) Low (0) 18 4.2 27 6.0 Moderate (1-2) 86 20.2 95 21.3 High (3-5) ?2 = 1.718; p = .424
321 75.5
325 72.7
Family Circumstances and Parenting: (Possible range of 0-6) Low (0-2) 91 21.4 116 26.0 Moderate (3-4) 229 53.9 250 55.9 High (5-6) 105 24.7 81 18.1 ?2 = 6.486; p = .039 Education/Employment: (Possible range of 0-7) Low (0) 26 6.1 26 5.8 Moderate (1-3) 161 37.9 166 37.1 High (4-7) 238 56.0 255 57.0 ?2 = .108; p = .948 Peer Relations: (Possible range of 0-4) Low (0-1) 20 4.7 50 11.2 Moderate (2-3) 265 62.4 269 60.2 High (4) 140 32.9 128 28.6 ?2 = 12.878; p = .002 Substance Abuse: (Possible range of 0-5) Low (0) 12 2.8 55 12.3 Moderate (1-2) 30 7.1 65 14.5 High (3-5) 383 90.1 327 73.2 ?2 = 44.382; p = .000 Leisure/Recreation: (Possible range of 0-3) Low (0) 13 3.1 16 3.6 Moderate (1) 54 12.7 90 20.1 High (2-3) 358 84.2 312 69.8 ?2 = 40.940; p = .000
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Table 8: Youthful Level of Service/Case Management Inventory Risk Categories (continued) Component
Mohican (N= 447) N %
Comparison (N=447) N %
Personality and Behavior: (Possible range of 0-7) Low (0) 16 3.8 18 4.0 Moderate (1-4) 266 62.6 255 57.0 High (5-7) 143 33.6 174 38.9 ?2 = 2.828; p= .243 Attitudes/Orientations: (Possible range of 0-5) Low (0) 42 9.9 74 16.6 Moderate (1-3) 345 81.2 319 71.4 High (4-5) 38 8.9 54 12.1 ?2 = 12.081; p = .002 Total: (Possible range of 0-42) Low (0-8) 3 0.7 3 0.7 Moderate (9-22) 140 32.9 148 33.1 High (23-34) 270 63.5 276 61.7 Very high (35-42) 12 2.8 20 4.5 ?2 = 1.734; p =.629
134
Psychological and Social Functioning. Psychological and social factors such as
depression, anxiety, risk-taking, antisocial values, and hostility have been found to be
positively related to substance abusing behaviors and longevity and success in
treatment while factors such as self-esteem, self-efficacy, and decision-making ability
have been found to be negatively associated with substance abusing behaviors and
longevity and success in treatment (Simpson & Knight, 1998). Therefore, these areas are
all potential targets for treatment. Theoretically, therapy should reduce individuals’ levels
of anxiety, depression, risk-taking, hostility, and antisocial values, and increase their self-
esteem, self-efficacy, decision-making ability, desire for help, and treatment readiness.
The Client Self-Rating form (Simpson & Knight, 1998) was used as a measure of
the youth’s level of psychological and social functioning. 28 Upon entrance into Mohican
Youth Center, staff administered the form to the youth. Of the 447 participants,
psychological and social functioning data were available for 434 youth (97%). Because
the Client Self Rating form does not categorize the scores, the best way to review the data
is to examine the frequency distributions. Of the nine different scales, three were
negatively skewed meaning that the youths’ scores were clustered at the higher end of the
scale (Table 9). Accordingly, youth displayed a higher level of decision-making skills,
self-efficacy, and appeared ready for treatment (treatment readiness). Accordingly,
youth also displayed slightly lower levels of anxiety, depression, self-esteem, risk taking,
hostility, and a desire for help.
Cognitive Functioning. Cognitive distortions are inaccurate ways of attending
to or conferring meaning upon experiences (Barriga et al., 1999). Research has indicated
that cognitive distortions may contribute to antisocial or criminal behavior (Yochelson & 28 The scales were coded so that the higher the score, the greater the psychological and social functioning.
135
Table 9: Descriptive Statistics for Client Self Rating – Time 1 Mohican Youth Center (N = 434) Scale N Min. Max. Mean Median SD
Anxiety (range 7-35)
398 7.00 34.00 17.11 17.00 5.28
Depression (range 6-30)
403 6.00 35.00 12.87 12.00 4.07
Self-esteem (range 6-30)
399 11.00 30.00 22.60 23.00 3.96
Decision-making (range 9-45)
395 14.00 45.00 31.45 32.00 5.37
Risk-taking (range 7-35)
401 7.00 34.00 21.25 21.00 5.06
Hostility (range 8-40)
395 8.00 38.00 20.23 20.00 6.17
Self-efficacy (range 7-35)
397 11.00 35.00 26.38 27.00 4.23
Desire for Help (range 7-35)
402 8.00 34.00 23.53 24.00 5.30
Treatment Readiness (range 8-40)
396 8.00 40.00 26.59 27.00 5.52
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Samenow, 1976). Using the How I Think Questionnaire (Barriga et al., 1999),
youths’ cognitive distortions were assessed. Four self-serving cognitive distortions were
examined: self-centered (according such status to one’s own views that the opinions of
others are not considered), blaming others (misattributing blame to outside
sources), minimizing or mislabeling (believing that antisocial behavior is acceptable,
admirable, or causes no real harm), and assuming the worst (assuming that improvement
is impossible, or considering a worst case scenario). The How I Think Questionnaire also
depicts four behavioral referents scales that are manifested from the cognitive distortions:
opposition/defiance, physical aggression, lying, and stealing. From these subscales, three
summary scores can be computed: the overt, covert, and overall How I Think scales.
The How I Think Questionnaire was administered at intake and termination for
the treatment group only. Data from the How I Think Questionnaire were available for
394 youth (88.1%) in the treatment group. The questionnaire has an anomalous
responding scale that determines the truthfulness of the answers. Scores higher than 4.25
are considered invalid and should not be used in data analyses. Scores greater than 4.0
but less than or equal to 4.25 are considered “suspect” and interpreted with caution.
Thus, intake data were available for 299 cases of which 78 cases were considered
“suspect.”
One way to analyze the scales of the How I Think Questionnaire is to determine
which of the three ranges (non-clinical, borderline-clinical, clinical) the score falls into.29
The ranges on the eight subscales can be used to provide a fine-grained analysis of the
youth. As Figure 5 reveals, a large percentage of youth were classified in the clinical
range for the self-centeredness (49.3%), the blaming others (53.7%), and the minimizing 29 Table B5 and B6 in Appendix B reports the measures of central tendency for the How I Think scales.
Figure 5: Cognitive Distortion Scales for the Mohican Youth Center*
*Youth scoring 4.25 or lower on the Anomolous Response Scale. Youth were placed in the classifications based on which third of the scale their scores fell within. Higher scores indicate a problem in the cognitive distortion measured.
27.6
33.4
1
52.7
23.1
12.8
2
15.6
49.353.7
96.9
31.6
Self-centered Blaming others Minimizing Assuming the Worst0
20
40
60
80
100
Percentage
Non-clinical Borderline Clinical Clinical
138
(96.9%) scales. Thus, the majority of the youth believe that they were the most important
individuals regardless of others, that they were never to blame, and that their behavior
was not that bad. Accordingly, these youth can be described as having a strong
egocentric bias and a need for treatment that addresses their externalization and
minimizing the consequences of their actions. However, the majority of youth also were
classified as “non-clinical” for the assuming the worst scale (52.7%). Therefore, this
cognitive distortion was not problematic for a large percentage of youth.
Figure 6 shows the behavioral referent scales for the participants of Mohican
Youth Center. The majority of youth fell into the “clinical” range for the physical
aggression (69%) and stealing (90.6%) behavioral referents. Therefore, these youth were
more likely to participate in aggressive acts. An almost equal number of youth scored in
the “non-clinical” (41.4%) and “clinical” (39.1%) ranges for the oppositional defiance
scale. For the lying scale, 46.9% percent of the youth scored in the “clinical” range
whereas 32.8 percent scored in the “borderline-clinical” range of the scale.
Concerning the summary scores for the covert, overt and overall How I Think, the
majority of youth fell into the “clinical” range (Figure 7). For example, 76.8 percent of
the youth were classified as “clinical” for the covert scale and approximately 60 percent
of the youth were classified as “clinical” for the overt scale. Youth in the “borderline
clinical” and “clinical” ranges in the overt scale may exhibit antisocial behavior that
typically involves confrontation with the victims, whereas these ranges for the covert
scale indicate non-confrontational antisocial behavior (Barriga et al., 1999). In addition,
72.9 percent of the participants were in the “clinical” range for the How I Think scale.
Figure 6: Behavioral Referents for the Mohican Youth Center*
*Youth scoring 4.25 or lower on the Anomolous Response Scale. Youth were placed in the classifications based on which third of the scale their scores fell within. Higher scores indicate a problem in the behavioral referent measured.
41.4
15
20.3
1.3
19.516
32.8
8.1
39.1
69
46.9
90.6
Opposition Physical Aggression Lying Stealing0
20
40
60
80
100Percentage
Non-clinical Borderline-clinical Clinical
Figure 7: Summary Score for How I Think for the Mohican Youth Center
*Youth scoring 4.25 or lower on the Anomolous Response Scale Youth were placed in the classifications based on which third of the scale their scores fell within. Higher scores indicate a problem in the summary score measured.
6.6
22.1
10.9
16.6 1816.2
76.8
59.9
72.9
Covert Overt How I Think0
20
40
60
80
100Percentage
Non-clinical Borderline-clinical Clinical
141
According to Barriga et al. (1999), youth falling into the borderline-clinical and clinical
range for the How I Think scale may exhibit externalizing psychopathology.
Intermediate Outcomes
While research has focused on long-term outcomes for therapeutic communities,
few has focused on intermediate outcomes to determine if therapeutic communities are
effective in changing antisocial attitudes and addressing responsivity issues such as
anxiety, self-esteem, and depression. Accordingly, youth were re-assessed using the
Client Self Rating and the How I Think Questionnaire to determine if participation in a
therapeutic community significantly changed antisocial attitudes and responsivity factors.
Changes In Psychological and Social Functioning. The Client Self-Rating
form, designed to measure psychological and social factors such as depression, anxiety,
risk-taking, antisocial values, and hostility was administered at intake on 434 cases and
administered at termination on 213 cases.30 Of the 213 posttests that were available, the
number of useable pairs for analyses ranges from 171 cases to 177 cases. According to
Simpson and Knight (1998), treatment should reduce anxiety, depression, risk-taking, and
hostility and increase self-esteem, self-efficacy, decision-making, desire for help, and
treatment readiness. Paired sample t-tests between time 1 and time 2 scores on the Client
Self-Rating revealed no significant changes in the anxiety, risk-taking, self-efficacy,
desire for help, and treatment readiness scales (Table 10).
30 The data were derived as part of a larger study conducted on the Residential Substance Abuse Treatment programs. The site was responsible for collecting the assessment data. At Mohican, one staff member was assigned to administer the Client Self Rating and the How I Think Questionnaire at intake and termination. If the individual was not present when the youth was discharged from the facility, then the exit assessment was not conducted. Therefore, only 49 percent of the Client Self Rating pretests have posttests.
142
Table 10: Paired Sample t-tests on Client Self-Rating Time 1- Time 2* Scale No. of Pairs Time 1
Mean Time 2 Mean
t-value Sig.
Anxiety (range 7-35)
175 17.22 17.91 -1.734 .085
Depression (range 6-30)
177 13.05 12.32 2.055 .041
Self-esteem (range 6-30)
172 22.52 23.66 -3.444 .001
Decision-making (range 9-45)
171 31.72 32.84 -2.433 .016
Risk-taking (range 7-35)
174 21.35 21.82 -1.314 .191
Hostility (range 8-40)
172 20.27 21.49 -2.581 .011
Self-efficacy (range 7-35)
174 25.97 26.41 -1.254 .212
Desire for Help (range 7-35)
172 23.62 23.70 -.184 .855
Treatment Readiness (range 8-40)
173 26.52 26.28 .487 .627
* includes all time
143
The change in time 1 and time 2 scores on the depression, self-esteem, and
decision-making scales were statistically significant and in the hypothesized direction,
indicating that on average youths’ levels self-esteem (p = .001) and decision-making
abilities (p = .016) increased with participation in treatment whereas the level of
depression decreased (p = .041). In addition, the change in scores from time 1 to time 2
was statistically significant for the hostility scale (p = .011); however, the change was in
the wrong direction indicating that participation in the treatment program increased the
youths’ level of hostility. 31
To determine if the length of time in the program impacted the outcomes on the
posttests, regression models were computed to examine if the length of time between the
administrations of the instruments predicted the time 2 score while controlling for the
pretest score.32 The length of time between the pretests and posttests was a significant
positive predictor in two relationships (risk-taking and hostility) and a significant
negative predictor in one equation (treatment readiness) (see Table B8 in Appendix B).
As the number of days in the program increased, the score on the time 2 measure
increased for the risk-taking and hostility scores indicating that youth were more likely to
take chances and feel more hostile. For the treatment readiness scale, time was a
negative predictor indicating that as the number of days in the program increased, the
youths’ reported readiness for treatment diminished.
31 The findings from the paired sample t-tests may have been the result of a bias in the samp le in that prosocial youth were more likely to complete the posttest Client Self Rating Form. To examine if this was the case, independent samples t-tests were conducted to determine if there were differences between those who completed both the pre and posttests and those who completed only the pre-test. Table B7 in Appendix B reports the results. There were no significant differences between those who completed only the pretest and those who completed both the pretest and posttest. 32 The length of time between the scores should have been 180 days since Mohican Youth Center is a 6-month program. However, the length of time ranged from 13 days to 544 days with an average of 194.83 days between the administrations of the instrument.
144
Changes In Cognitive Distortions. Youths’ cognitive distortions such as self-
centered, blaming others, minimizing behavior, and assuming the worst were measured
by the How I Think Questionnaire. The instrument was administered to 394 youth at
intake and to 207 youth at termination. After removing the cases with the anomalous
response scale score of 4.25 or greater, the number of pairs for analyses was reduced to
150.
Participation in the therapeutic community should reduce the likelihood of
antisocial/criminal behavior by reducing risk factors such as the youth’s antisocial
attitudes. Therefore, theoretically, the levels of cognitive distortions should be lower at
the time 2 measure. While the posttest scores were lower, participation in treatment did
not result in a significant reduction in the cognitive distortions for the youth when the
“suspect” cases were included in the analyses (Table 11).33
To determine if length of time between scores affected the outcome, regression
analyses were computed (see Table B10 in Appendix B).34 It is theorized that time spent
in treatment would reduce youths’ cognitive distortions. However, length of time was a
significant positive predictor in four equations: minimizing, oppositional defiance, overt,
and How I Think scales. Accordingly, the longer the youth spent in treatment, the more
likely he was to report higher levels of minimizing and oppositional defiance attitudes,
33 The null findings may have been the result of who completed the instrument at intake and termination. Independent samples t-tests were conducted to determine if there were differences between those who completed both the pre and posttests and those who completed only the pre-test. Table B9 in Appendix B reports the results. There were no significant differences between those who completed only the pretest and those who completed both the pretest and posttest. Thus, the individuals who completed the posttest were no more prosocial or antisocial than those who completed only the pretest. 34 The length of time between the pretest How I Think Questionnaire and the posttest How I Think Questionnaire was 190.06 days with a range of 13 days to 341 days.
145
Table 11: Paired Sample t-tests on How I Think Questionnaire, Time 1- Time 2* Scale No. of Pairs Time 1
Mean Time 2 Mean
t-value Sig.
Cognitive Distortions Self-centered (range 0-6)
111 3.30 3.19 1.731 .086
Blaming Others (range 0-6)
114 3.23 3.22 .064 .949
Minimizing/Mislabeling (range 0-6)
111 4.19 4.19 .017 .986
Assuming the Worst (range 0-6)
109 2.83 2.71 1.546 .125
Behavioral Referents
Opposition-Defiance (range 0-6)
114 3.26 3.21 .568 .571
Physical Aggression (range 0-6)
113 3.41 3.35 1.217 .226
Lying (range 0-6)
104 3.51 3.44 1.209 .230
Stealing (range 0-6)
111 3.31 3.25 1.044 .299
Summary Scores Covert (range 1-6)
104 3.42 3.34 1.347 .181
Overt (range 1-6)
112 3.34 3.27 1.025 .308
How I Think (range 1-6)
101 3.39 3.31 1.369 .174
* Includes the scores that may be considered “suspect” because the AR scale is greater than 4.0 but less than 4.25.
146
display behaviors that may involve confrontation with victims, and exhibit externalizing
psychopathology.
The finding of no significant reduction in youths’ cognitive distortions was not
surprising considering that the above analysis included cases that may be considered
suspect, thus indicating that the youth may have been lying or randomly responding to
the questions. Therefore, an analysis was conducted on those cases that were not
considered suspect. When examining only the cases that were not considered suspect,
five significant relationships were found (Table 12). A statistically significant
relationship was found for one cognitive distortion: self-centeredness. Participation in
treatment reduced the youths’ self-centered thinking (p=.040). There was only one
behavioral referent scale that produced a statistically significant relationship. On
average, the youths’ lying was reduced by participating in the therapeutic community
(p=.005). All three summary scores produced a significant relationship and in the
expected direction. Youths’ overt behaviors such as oppositional defiance and physical
aggression were significant reduced (p= .043) whereas the covert behavior, which
typically includes non-confrontational antisocial behavior, was reduced (p = .014). In
addition, the overall How I Think score was reduced (p = .016) by participation in the
therapeutic community.
Regression analyses revealed that length of time between the administrations of
the How I Think Questionnaire was a significant predictor of the time 2 score (see Table
B11 in Appendix B). Theoretically, time spent in treatment would reduce the cognitive
distortions of the youths. However, while the amount of time between scores was a
positive predictor for all scales, the variable was a significant positive predictor in seven
147
Table 12: Paired Sample t-tests on How I Think Questionnaire, Time 1- Time 2* Scale No. of Pairs Time 1
Mean Time 2 Mean
t-value Sig.
Cognitive Distortions Self-centered (range 0-6)
66 3.53 3.34 2.091 .040
Blaming Others (range 0-6)
69 3.45 3.38 .713 .478
Minimizing/Mislabeling (range 0-6)
67 4.32 4.19 1.798 .077
Assuming the Worst (range 0-6)
66 3.06 2.88 1.663 .101
Behavioral Referents
Opposition-Defiance (range 0-6)
69 3.49 3.37 1.315 .193
Physical Aggression (range 0-6)
69 3.61 3.45 1.985 .051
Lying (range 0-6)
62 3.73 3.48 2.904 .005
Stealing (range 0-6)
66 3.51 3.39 1.552 .125
Summary Scores
Covert (range 1-6)
62 3.63 3.43 2.540 .014
Overt (range 1-6)
68 3.56 3.40 2.060 .043
How I Think (range 1-6)
60 3.60 3.42 2.471 .016
* Does not include the scores that may be considered “suspect” because the AR scale is greater than 4.0 but less than 4.25.
148
relationships: blaming others, minimizing, oppositional defiance, physical aggression,
stealing, overt, and How I Think scales. Thus, as the length of time increased between
the administrations of the instrument, the posttest score increased and the youth reported
higher levels of cognitive distortions.
Successful Completion. Table 13 shows the type of termination for the treatment
and comparison groups. The majority of youth in both groups were successfully
discharged from Mohican Youth Center (84.5%) or the Department of Youth Services
(66.6%). However, a chi-square analysis revealed that youth in the comparison group
(33.4%) was more likely to be unsuccessfully discharged compared to youth in the
treatment group (15.5%).35
The length of stay in Mohican or the Department of Youth Services was
computed from the placement and termination date. Even though Mohican Youth Center
is a 6-month program, the average length of stay was 192 days with placement lasting
from 13 days to 472 days. The average length of stay for the comparison group was
significantly longer with an average of 260 days with a range of 1 day to 1343 days (3.6
years).
To determine what factors predicted successful completion of the therapeutic
community, a logistic regression was computed. A logistic regression analysis reveals
any significant predictors of successful completion when all other variables are held
constant. Nine variables were included into the model to predict successful completion of
Mohican’s therapeutic community: age, race (1 = nonwhite), highest grade completed,
previous treatment (1 = yes), JASAE score, YLS/CMI score, How I Think score, Client 35 Unsuccessful discharge included those whom had a judicial release from Mohican or the Department of Youth Services, those who were released because of age, or those were transferred to another institution (treatment group only).
149
Table 13: Termination Information Variable
Mohican (N= 447) N %
Comparison (N=447) N %
Type of Termination
Successfully discharged 365 84.5 293 66.6 Unsuccessfully discharged 67 15.5 147 33.4 ?2 = 37.715; p = .000 Mohican (N= 447) Comparison (N=447) Min. Max. Mean SD Min. Max. Mean SD Length of stay: 13 472 192.35 59.36 1 1343 260.80 206.49 t= -6.539; p= .000
150
Self Rating score, and length of time in program. 36 There was only one significant
predictor of successful completion–length of time in the program (Table 14). The more
time the youth spent in Mohican, the more likely he was to successfully complete the
program.
In order to present the logit coefficients in a fashion that is easily understood,
each beta was converted into log-odds probabilities. Figure 8 reveals a linear relationship
between length of time in the program and successful completion. Youth who only spent
three months or less in Mohican had a 45 percent chance of successfully completing the
program whereas youth who spent six months in the program (Mohican is typically a 6-
month program) had an 87 percent chance of successfully completing.37 If the youth
spent 8 months in the program, he had a 96 percent chance of successfully completing the
therapeutic community.
Long-Term Outcomes
Rates of Incarceration. The long-term outcome for this study was a period of
new incarceration. 38 New incarceration was measured as period of incarceration in either
the Department of Youth Services or the Department of Rehabilitation and Correction.
Table 15 reports the rates of incarceration for each group. Forty-three percent of the
comparison group had a new period of incarceration whereas 36.7 percent of the
treatment group had a new period of incarceration. A chi-square analysis revealed that
36 The Client Self Rating score was computed by adding the anxiety, depression, self-esteem, decision-making, risk taking, hostility, self-efficacy, desire for help, and treatment readiness scales. The self-esteem, decision-making, self-efficacy, desire for help, and treatment readiness scales were reverse coded so that the higher the score the more problematic. 37 There were some youth who successfully completed the program in less than three months. 38 As previously mentioned, new incarceration was used as the outcome because the arrest data from the Department of Youth Services is unreliable. Furthermore, examining incarceration rates provides a more stringent test of the effectiveness of the therapeutic community in reducing recidivism.
151
Table 14: Regression Coefficients Predicting Successful Completion Factor Beta Significance Level Age -.019 .903 Race (1 = nonwhite) .308 .443 Highest Grade -.163 .283 Previous Treatment .108 .812 JASAE Score .001 .963 Y-LSI Score -.027 .478 How I Think Score .083 .829 Client Self Rating Score -.003 .712 Length on time in facility .690 .000 Constant .378 -2 Log Likelihood 197.572 Nagelkerke R2 .301
Figure 8: Significant Predictor and Probability for Successful Completion
Treatment Group
45
62
78
8793
96
Month = 3
Month = 4
Month = 5
Month = 6
Month = 7
Month = 8
0
20
40
60
80
100
153
this difference was not significant at the .05 level. However, when examining the time to
incarceration, a significant difference was found. Specifically, individuals who
participated in the therapeutic community were reincarcerated faster than individuals
from the comparison group (359 days versus 514 days).
Table 15 also examines whether the individual was incarcerated in a DYS facility
or a DRC facility. Again, a chi-square analysis revealed a non-significant difference
between the treatment and comparison groups. Twenty-one percent of the comparison
group was reincarcerated in a DYS facility whereas only 18.3 percent of the treatment
group was reincarcerated.
The last analysis examined the rates of incarceration in an adult facility. Again,
more individuals from the comparison group were incarcerated in an adult facility than
individuals from the treatment group; however, this difference was not significant (?2 =
3.012; p = .083).
Model Predicting Incarceration For Both Groups. To determine if
participation in treatment resulted in a significant decrease in the probability of
incarceration, a Cox regression model was computed. Six variables were entered
into the equation: age, race (1=nonwhite), JASAE score, type of completion
(1=successful completion), YLS/CMI category (1=high risk), and group (1=treatment).
There were three statistically significant relationships: age, race, and JASAE score (Table
16). First, younger juveniles, nonwhites, and juveniles who had more severe substance
abuse problems were significantly more likely to be incarcerated. Participation in the
therapeutic community should have resulted in a decrease in the probability of
154
Table 15: Rates of Incarceration Mohican Comparison N % N % Any Incarceration: Yes 164 36.7 192 43.0 No 283 63.3 255 57.0 ?2 = 3.659; p = .056 Time to Incarceration 359.24 days 514.84 days t = 5.107; p = .000 DYS Incarceration: Yes 82 18.3 94 21.0 No 365 81.7 353 79.0 ?2 = 1.019; p = .333 DRC Incarceration: Yes 94 21.0 116 26.0 No 353 79.0 331 74.0 ?2 = 3.012; p = .083
155
Table 16: Regression Coefficients Predicting Incarceration Factor Beta Significance Level Age -.263 .000 Race (1=nonwhite) .256 .019 JASAE .009 .011 Type of completion (1=successful) .183 .162 YLSI total (2=high) .195 .162 Group (1=treatment) -.084 .489 -2 Log Likelihood 4380.930 Chi-square 53.924 .000
156
incarceration. While the coefficient for the group variable was negative (indicating the
treatment group was less likely to be incarcerated), the relationship was not statistically
significant.
Results of the survival analysis by participation in treatment are shown in Figure
9. Figure 9 represents the independent effects of participation in treatment while
controlling for age, race, JASAE score, YLS/CMI score, and type of completion. For
ease of interpretation, the figure will be presented as failure curves instead of survival
curves. The failure curves are based on the probability of incarceration at each month,
given that the individual has survived up to that point, based on the proportion that failed
or were incarcerated. Throughout the period in question, the treatment group failed faster
than the comparison group; however, the difference is not statistically significant. For
example, during the first year at risk, the groups are very similar in their failure rates (.17
versus .15 at month 12).
During the second year (13 to 24 months), the failure rates of the groups are
becoming more distinct. For example, at year 24, the failure rate for the treatment group
was .38 for the treatment group and .33 for the comparison group. By the end of the
evaluation period, the probability of being incarcerated for the treatment group is .58
versus .52 for the comparison group.
Model Predicting Incarceration for the Treatment Group Only. A Cox
regression model was also computed to determine if there was a differential impact of
treatment for certain types of juveniles who participated in Mohican Youth Center. For
this model, seven factors were entered into the equation: age, race (1=nonwhite), JASAE
Figure 9: Participation in Treatment by Incarceration
&
&
&
&
&
#
#
#
#
#
0 months 10 months 20 months 30 months 40 months0
0.1
0.2
0.3
0.4
0.5
0.6Treatment Comparison# &
Treatment 0 0.15 0.31 0.45 0.58
Comparison 0 0.13 0.28 0.41 0.52
158
score, YLSI score (1=high risk), participation in previous treatment (1=yes), How I Think
Questionnaire score, and Client Self Rating score. There was only one statistically
significant relationship found–age (Table 17). Specifically, younger juveniles were more
likely to be incarcerated.
Figure 10 shows the failure probabilities by age for the treatment group. First, the
largest increase in the probability of failure occurs between the 10-month period and the
20-month period. The average increase in the probability of incarceration was .18 or an
18 percent increase in the chance of incarceration over the 10 months. The second
finding from this figure was that youth ages 13 and 14 were more likely to be
incarcerated throughout the evaluation period. For example, for juveniles age 14, the
probability of being incarcerated at the 10-month period was .21 whereas the probability
of failure at the 36-month period was .71. The last major finding was that juveniles age
16 and 17 and juveniles age 18 and 19 were very similar in their failure rates throughout
the length of the follow-up period. Thus, the largest difference in incarceration occurred
between youth ages 13 and 14 and youth ages 18 and 19.
159
Table 17: Regression Coefficients Predicting Incarceration for the Treatment Group Factor Beta Significance Level Age -.262 .001 Race (1 = nonwhite) .038 .849 Previous Treatment .067 .762 JASAE Score .002 .794 YLSI total (2=high) .397 .143 How I Think Score -.027 .898 Client Self Rating Score .004 .417 -2 Log Likelihood 1209.895 Chi-square 15.177 .034
Figure 10: Age By Incarceration
Treatment Group Only
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161
CHAPTER 5
SUMMARY AND CONCLUSIONS
As previously discussed, the relationship between criminal behavior/delinquency
and substance abuse is well documented (Andrews & Bonta, 1994; Elliott & Huizinga,
1984; Wanberg, 1992). Many states, having witnessed an increase in their incarceration
population, are seeking to combat the problem through substance abuse treatment
programs. One promising avenue for treating the substance-abusing offender is a
therapeutic community. While research for adult offenders has shown that therapeutic
communities may reduce recidivism by as much as 13 percent, the research on
therapeutic communities for juveniles is limited. The main focus of the current study
builds on the literature by examining a sample of juvenile males who participated in a
therapeutic community to determine if participation in treatment reduced the probability
of incarceration. The purpose of this chapter is to summarize the limitations and findings
and to provide policy implications and suggestions for future research.
Limitations
Although this study does build on the current literature for therapeutic
communities, there are some noteworthy limitations. First, the study could not randomly
assign individuals to the treatment group or the comparison group. Random assignment
to groups would have allowed the groups to be very similar and would have strengthened
any findings of a treatment effect. However, youth were adjudicated to the therapeutic
community and the Department of Youth Services by a judge and not the researcher.
Even though the comparison group was matched to the treatment group on certain
characteristics, there were some statistically significant differences between the groups.
162
Accordingly, these differences were controlled for in the final analyses predicting
outcomes.
Missing data for the comparison group was also a concern for this study. A
standardized intake form was used to collect certain demographic data on the treatment
group; however, these data were unavailable for the comparison group. For example, data
concerning number of prior arrests, prior commitments, age at first arrest, and substance
abuse history were not available for the comparison group. Therefore, this study was not
able to control for these factors. In addition, information pertaining to intermediate
outcomes were only available for the treatment group. As such, without a comparison
group, one may only speculate that the differences in the psychological and social
functioning and cognitive distortions were the result of participation in the therapeutic
community.
Another problematic issue concerning missing data was related to the posttest
measures of the Client Self Rating and the How I Think Questionnaire. Only 49 percent
of the cases had both pretest and posttest Client Self Rating assessments and 38 percent of
the cases had both the pretest and posttest How I Think Questionnaires. Due the number
of missing posttest cases, the pretest Client Self Rating and the How I Think
Questionnaire was used to predict outcome.
The length of follow-up may be problematic. While the length of follow-up for
the study was three years, the follow-up time period may not have been sufficient to
adequately assess the long-term effects such as incarceration rates of the therapeutic
community. Indeed, while the length of the follow-up time period is in sync with some
163
research, newer studies are following offenders who participate in a therapeutic
community for a period of five years (Inciardi et al., 2004 ).
Related to follow-up is the fact that no information was available concerning the
type of aftercare, if any, these juveniles received once they left Mohican Youth Center.
While some youth were placed on parole after termination, others were discharged
without any type of supervision. Furthermore, when the juvenile was placed on parole,
he was not guaranteed to receive any type of structured aftercare treatment. The lack of
an aftercare treatment component is important considering that much of the success of
therapeutic communities was derived from individuals who also received some type of
step-down treatment (Butzin et al., 2002; Hiller et al., 1999a; Inciardi et al., 2004; Knight
et al., 1999; Martin et al., 1999; Wexler, DeLeon et al., 1999; Wexler, Melnick et al.,
1999). Thus, without the follow-up information, the current study could not examine the
effects of the therapeutic community for those who received aftercare.
The last limitation for the current study is the fact that the sample contained only
males. Accordingly, the findings are limited to juvenile males and not females.
Summary of Findings
Background Characteristics. While the main focus of this dissertation was
whether participation in a therapeutic community reduced recidivism among juvenile
males, there were additional research questions that were addressed. To address the first
question, which was concerned with the characteristics of the two groups, several
analyses were conducted. The average juvenile in both groups was white, had completed
the 8th grade, was enrolled in school prior to his arrest, and had previous suspensions.
Except for race, there were significant differences between the groups on these
164
characteristics; however, the differences while statistically significant were not
substantively significant.
When examining the current offense and criminal history, there were no
significant differences in the type of current offense. For example, juveniles in both
groups were more likely to be arrested for a property crime or a personal crime.
However, there were significant differences between the offense levels for the current
crimes. Specifically, the comparison group was more likely to be arrested for a
misdemeanor whereas the treatment group was more likely to be arrested for a felony one
offense.
Data exploring the drug history was available for the treatment group only. The
typical juvenile was age 12 when he first used drugs or alcohol. Furthermore, the drug of
choice was marijuana and the majority of youth had been in previous treatment. When
examining the JASAE score for both groups, there were significant differences. The
treatment group had a more significant drug problem than the comparison group (51.34
versus 41.59); however, JASAE scores over 21 indicate a severe substance abuse
problem with a need for residential treatment. A large percentage of youth in both groups
had JASAE scores of 21 or above.
This study also incorporated a measure of risk of recidivism – the Youthful Level
of Service/Case Management Inventory (YLS/CMI). To obtain the comparison group,
when possible, the YLS/CMI total score was matched score by score; however, in some
instances this was not the case and selection of the comparison group had to be
accomplished by matching categories. Therefore, there was a statistically significant
difference between the two groups. Specifically, the treatment group’s total YLS/CMI
165
score was slightly higher than the comparison group (24.72 versus 23.38). While
statistically, the differences are significant, substantively the differences are not
significant. For example, both averages fall into the “high risk” category of the
YLS/CMI. Furthermore, on average, the difference is just indicative of a one point
difference across the eight different domains of the YLS/CMI.
The Client Self Rating form (Simpson & Knight, 1998) and the How I Think
Questionnaire (Barriga et al., 1999) were administered to individuals in the treatment
group. Accordingly, at intake, the typical juvenile had higher levels of self-efficacy,
decision-making skills, and appeared ready for treatment. Fur thermore, the average
juvenile had lower levels of anxiety, depression, self-esteem, risk taking behaviors,
hostility, and a desire for help. When examining the cognitive distortions, the typical
juvenile in Mohican had very high levels of the following cognitive distortions: self-
centeredness, blaming others, and minimizing. In addition, the typical youth was more
likely to engage in physical aggression and stealing as a result of these cognitive
distortions.
Based on these background characteristics, it appears that Mohican Youth Center
was targeting an appropriate population for the type of intensive treatment provided by
the institution. The data revealed that the majority of the therapeutic community
participants and the comparison group have substantial criminal histories and are at
“moderate” to “high risk” of recidivism according to the YLS/CMI. JASAE scores
revealed that all therapeutic community participants scored 21 or above on the JASAE
indicating a severe substance abuse problem and the need for residential treatment. In
166
addition, the individuals at Mohican had ingrained cognitive distortions that were likely
to result in antisocial and criminal behavior.
Impacting Intermediate Outcomes. The second research question examined the
treatment’s impact on the youth’s level of cognitive distortions and psychological and
social functioning. Paired sample t-tests were conducted on the pretest and posttest
measures of the Client Self Rating (Simpson & Knight, 1998) and the How I Think
Questionnaire (Barriga et al., 1999). There were no significant differences in the youth’s
levels of anxiety, risk-taking, self-efficacy, desire for help, and treatment readiness. One
reason for the null findings may be the result that the instrument has not been validated
on the juvenile offender population. Thus, the instrument may not be appropriate for the
juvenile offender population. Another possibility for the null findings may be due to the
fact that the instrument was not administered to all participants upon termination from
Mohican. Thus, the time 2 scores may be biased in the fact that not all participants were
reassessed.
The results from the Client Self Rating also indicated that participation in the
therapeutic community significantly decreased the youths’ levels of depression and
increased their self-esteem, decision-making abilities, and hostility levels. One possible
explanation for the positive increase in self-esteem and decision-making abilities may lie
within the structure of the therapeutic community. For example, it is the community of
peers (with limited staff interaction) that sets a therapeutic community apart from other
treatment modalities (DeLeon, 2000; Lipton, 1998). Specifically, the juveniles were
responsible for many aspects of the daily schedule. Members were responsible for
determining the content of the morning and evening meetings and the content of some
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groups. In addition, certain positions within the therapeutic community, such as
expediters and coordinators, have many decision-making opportunities. For example, the
expeditor is responsible for the redirection of other members through the use of pushups
and pull-ups. He is also responsible for bring behavior to the attention of the staff. The
coordinator is the highest-ranking position within the therapeutic community, and as
such, he has many responsibilities and decision-making opportunities. His
responsibilities include deciding about the content of the house meetings, developing
daily schedules, and overseeing sanc tions, privileges, and disciplinary actions (DeLeon,
2000). Thus, the job structure within the therapeutic community may have served to
increase the participants’ decision-making skills.
Along with the increase in decision-making skills, the youth also experienced an
increase in their self-esteem. The increase may be a function of the hierarchical structure
inherent within the therapeutic community. For example, new members are assigned to
the lowest jobs within the community. As they prove they can accomplish these tasks,
they are advanced to the next levels. Thus, with the advancement comes a sense of
accomplish which may serve to increase one’s self-esteem.
The last significant change in the Client Self Rating scales was the increase in the
hostility levels for the participants. Theoretically, participation in treatment should have
reduced the levels of hostility and as the length of time increased the time two score
should have decreased. However, the length of time between the pretest and posttest
revealed a significant positive relationship. As the length of time increased, the time two
score on the hostility scale increased. One possible explanation for the current finding
may be found in one aspect of the therapeutic community – encounter groups. These
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groups are sessions in which members confront each other on behavior and attitudes.
The very nature of the encounter group may serve to increase a delinquent’s hostility
levels. To be encountered, each juvenile must face each other within a circle of the other
members. The juvenile who is being encountered must remain silent until the encounter
is over. Then he is given an opportunity to defend himself. However, these encounter
groups may become very intense and juveniles may see the encounter as an attack against
him, which may serve to increase their hostility levels.
Another possible explanation for the increase in the hostility levels may be the
type of punishments or learning experiences that are issued. At Mohican Youth Center,
“image busters” are used to break down the “tough guy” image that some delinquents
hold. When an image buster is used, a juvenile may have to sing a song during the
morning meeting. Furthermore, some types of learning experiences, which are issued
after a written pull-up, may also serve to increase the youths’ hostility levels. For
example, youth were required to wear signs and perform skits as a punishment/learning
experience for antisocial behavior. These techniques are seen as shaming and degrading
to some members and thus may actually have a negative effect on behavior. In this case,
participation in these techniques may have served to increase the participants’ hostility
levels.
While the Client Self Rating form addressed psychological and social functioning,
the How I Think Questionnaire addressed cognitive distortions and behaviors that were
likely to form as a result of the cognitive distortions. Two models were computed. The
first model included the cases that were suspect meaning that the individuals may not be
truthful. For this model, there were no significant reductions in the cognitive distortions
169
or behavioral referent scales even though the time two score was lower. However, when
the suspect cases are removed, there are some significant differences between the pretest
and posttest measures. Specifically, participation in treatment resulted in a significant
decrease in the self-centeredness, lying, overt, and covert behaviors. Furthermore,
participation in the therapeutic community resulted in a significantly lower overall How I
Think score.
The possible explanation for these findings may also lie within the foundation of
the therapeutic community. For example, one mantra within the therapeutic community is
“I am my brother’s keeper” (DeLeon, 2000). Indeed, the community of peers will only be
effective if the members form a cohesive bond. In developing this bond, it is important
that the juvenile think of others and not just himself. Along with having mentors to assist
in the transformation from thinking only of himself to thinking of others, the juvenile
may be confronted if his self-centeredness persists. Furthermore, these encounter groups
are also used to confront juveniles who have a habit of lying. If the effectiveness of the
encounter groups is to be believed, it may be that these groups resulted in a decrease in
the self-centeredness and lying of the juveniles.
Predictors of Successful Completion. The third research question that was
addressed in the current study was “what factors predict successful completion of
treatment?” First, for the treatment group, a large percentage of juveniles successfully
completed the treatment (84.5%).39 The high rate of completion may be due to the fact
that once placed in treatment, most infractions were handled within the institution and did
not necessitate the removal of youth to other institutions.
39 Of the 16% that did not successful complete treatment, many were released early from the facility by a judge before they had completed the treatment goals.
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To determine which factors predicted completion of treatment, a logistic
regression model was computed in which nine variables were included in the analysis:
age, race, highest completed grade, previous treatment, JASAE score, YLSI score, the
How I Think score, Client Self Rating score, and length of time in treatment. From this
model, only one variable was statistically significant–length of time in the program. As
the length of time in the program increased, the juvenile was more likely to complete the
program. When the beta was converted to log-odds probabilities, youth who only spent
three months in treatment had a 45 percent chance whereas youth who spent 6 months in
treatment had an 87 percent chance of successfully completing treatment. This finding is
not surprising given that previous research has found length of time in a program to be a
predictor of success (Nielsen & Scarpitti, 2002; Wexler et al., 1992).
Furthermore, the null findings for the How I Think and the Client Self Rating is
not surprising given completion of treatment should not be confused with progress in
treatment. Results from the CPAI conducted on Mohican Youth Center indicated a
youth’s movement through the program was more dependent on the completion of their
sentence than it was on the acquisition of prosocial attitudes and behaviors. Furthermore,
as Pealer et al., (2002a) reported, of those who participated in the therapeutic community,
only 136 youth (30.4%) actually completed the last phase of treatment.
Rates of Incarceration. The outcome for this study was a new period of
incarceration. Specifically, three different rates of incarceration were examined. The
first model examined the rates of any new incarceration from termination to present.
While not significant, the treatment group was less likely to be incarcerated. The second
and third models, examined incarcerations into the Department of Youth Services and the
171
Department of Rehabilitation and Correction. Again, there were no statistically
significant differences between the groups, however; the treatment group was less likely
to be incarcerated in either facility.
A t-test indicated that there were significant differences between the lengths of
time to incarceration with the treatment group being incarcerated faster than the
comparison group. Thus, while the treatment group was less likely to be incarcerated,
when they were incarcerated, they failed faster than the comparison group.
Model Predicting Incarceration. The main focus of this dissertation was to
determine if participation in a therapeutic community resulted in a significant decrease in
the probability of being incarcerated when compared to individuals who did not receive
treatment. A Cox regression model was computed to determine if there was a treatment
effect while controlling for age, race, substance abuse level, risk level, and type of
completion. The coefficient for the group variable was negative indicating that on
average, individuals in the treatment group were less likely to be incarcerated compared
to individuals who did not receive treatment; however, the coefficient was not
statistically significant (p= .489). Thus, participation in a therapeutic community did not
result in a significant decrease in the probability of incarceration over the evaluation
period.
One possible explanation for the null findings for treatment may lie in the type of
treatment that was provided to the juveniles. Data from the CPAI that was conducted on
Mohican’s therapeutic community reveal that there was some room for improvement in
the quality of treatment. As previously mentioned, there are certain characteristics, if
which are adhered to, will likely result in promising outcomes (Gendreau, 1996). While
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the therapeutic community adhered to some of these principles of effective interventions,
the program was lacking in other areas.
The first problematic area is the type of treatment model in which the groups were
based upon. The overall model of the therapeutic community – a community of peers –
was based on a social learning approach (Lipton, 1998). The social learning modality
stresses the importance of learning vicariously through observing others (Van Voorhis,
2000). Specifically, the community consisted of offenders and staff who acted as role
models and guided in the recovery process. Research has shown that programs using the
social learning model were effective in reducing recidivism (Andrews, Zinger et al.,
1990; Lipsey, 1999). Accordingly, while the overall model was based on a social
learning approach, the groups within the program may serve to undermine the
effectiveness of the overall model. For example, the majority of the groups was
education-based and used processing (or talking cures) to change the attitudes and
behaviors of the youth. Research has shown that these techniques are not as effective in
reducing recidivism (Andrews, Zinger et al., 1990; Taxman, 1999). Furthermore, these
groups did not incorporate behavioral rehearsal techniques such as role-playing to
promote attitudinal and behavioral change.40 Rather, the groups used techniques such as
discussion and education in hopes to change the antisocial behaviors. Accordingly, this
process does not serve to increase the community’s cohesion; but rather to promote
individualized therapeutic work (Taxman & Bouffard, 2002). Therefore, the structure of
the groups may serve to undermine the therapeutic intention of the community of peers
approach.
40 Behavioral rehearsal techniques such as role-playing have been shown to be important components of a treatment program in promoting behavioral change (Andrews & Bonta, 1994; Gendreau, 1996).
173
Another reason for the lack of a treatment effect lies in risk factors that were
targeted. While the treatment targeted risk factors such as antisocial attitudes, substance
abuse, and education/employment, the main focus appeared to be on educational
attainment. As mandated by the Department of Youth Services, the majority of the day
was spent in traditional education classes. While poor educational skills is a predictor of
risk of recidivism, it is not as strong a predic tor as antisocial attitudes or antisocial peers
(Andrews & Bonta, 1994; Gendreau, Goggin, & Paparozzi, 1996; Simourd & Andrews,
1994). Thus, one possible explanation for the lack of a treatment effect may be the
insufficient attention given to the major risk factors.
A third treatment reason for the null finding may be the use of reinforcements at
Mohican Youth Center. To promote long-term behavioral change, programs should
provide appropriate reinforcements to the participants (Gendreau, 1996; Spiegler &
Guevremont, 1993). While the therapeutic community provides many opportunities for
positive reinforcement in the form of privileges and verbal praise, the problem lies with
the types of punishments that were issued. Specifically, the juveniles were required to
perform skits, sing songs, and wear signs as punishments. These techniques will not
encourage juveniles to change their behavior; but rather, may actually serve to increase
the antisocial tendencies of the juveniles (Spiegler & Guevremont, 1993. Therefore,
without appropriate punishments, the juveniles did not acquire prosocial behaviors and
attitudes, which would have resulted in a significant decrease in the probability of
incarceration.
The last area of concern for treatment delivery at Mohican focused on the release
and aftercare component for the juveniles. Release from a program should be based on
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the acquisition of prosocial skills, behaviors, and attitudes and not be time-based.
However, as with many RSAT grants, the length of time at Mohican was six months.
Thus, many youth were released from the facility at end of their six months regardless of
their phase placement. Therefore, many youth may have left the institution before
acquiring the necessary skills needed to refrain from criminal behavior.
Related to the departure of the youth is what happens to him once he left the
therapeutic community. Many studies on the effectiveness of therapeutic communities in
reducing recidivism have shown that aftercare is an important component in reducing
recidivism (Butzin et al., 2002; Hiller et al., 1999a; Inciardi et al., 2004; Knight et al.,
1999; Martin et al., 1999; Wexler, DeLeon et al., 1999; Wexler, Melnick et al., 1999).
Indeed, it is important that individuals completing a residentia l substance abuse program
receive some type of step-down treatment to make the transition to the community more
effective. However, Mohican’s therapeutic community did not have a structured aftercare
component in place for the juveniles. Rather, the individual parole officers of the
juveniles determined aftercare placement. Accordingly, some youth may have received
aftercare and others may not have received this important treatment component.
Therefore, without being able to control for what happened to the youth once he left the
institution, the study was unable to determine if aftercare participation resulted in a
reduction in recidivism.
The Cox regression model also revealed three significant predictors of
incarceration: age, race, and JASAE score. Younger individuals, nonwhites, and
juveniles who had a more severe substance abuse problem were more likely to be
incarcerated. The finding that juveniles with a more severe substance abuse problem
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were more likely to be incarcerated was not surprising given the link between substance
abuse and criminal behavior (Andrews & Bonta, 1994; Beck et al., 1988; Elliott &
Huizinga, 1984; Newcomb & Bentler, 1988). Furthermore, other studies have found that
age was a significant predictor of outcome with younger individuals being more likely to
be arrested (Wexler et al., 1992; Wexler, DeLeon et al., 1999). Accordingly, these
findings are consistent with previous research on the predictors of recidivism.
Model Predicting Incarceration for the Treatment Group Only. To
determine if there was a differential impact of treatment for certain type of juveniles,
survival analysis was computed. The results from the Cox regression model indicated
that only one variable was a statistically significant predictor of incarceration–age. As
previous research has found for adults, younger individuals were more likely to be
incarcerated than older individuals (Wexler et al., 1992; Wexler, DeLeon et al., 1999).
Specifically, juveniles who were age 13, 14, or 15 years old were more likely to be
incarcerated than juveniles who were older. One possible explanation for the finding of
age and incarceration could be that older individuals benefited more from the therapeutic
community than younger individuals. Specifically, the older juveniles were better able
to process the encounter groups, which were a major foundation of the therapeutic
community. For example, the older juveniles may have been able to internalize the
encounters and actually commit to changing their behaviors whereas the younger
juveniles were not mature enough to internalize the encounter process.
Another possible explanation for the finding may lie in the formal processing of
juveniles. The older juveniles, ages 18 or 19, may be seen as being too old for the
Department of Youth Services to re- incarcerate them whereas they were seen as being
176
too young for the Department of Rehabilitation and Corrections to incarcerate them for
adult crimes. Thus, the finding that older youth were less likely to be incarcerated may
be due to the bias in the processing of juveniles.
Policy Implications and Recommendations
Based on the findings from this dissertation, there are a few policy implications
and recommendations that may be suggested. Even though the analysis found that
participation in treatment did not significantly reduce the probability of being
incarcerated, the therapeutic community should continue to operate after the following
recommendations are implemented.41 First, the Department of Youth Services may want
to incorporate age restrictions for juveniles being placed in a therapeutic community.
The study found that younger juveniles who participated in the program were
significantly more likely to be incarcerated following termination. Accordingly, DYS
and Mohican may want to consider implementing exclusionary criteria for youth ages 15
and younger to prevent these juveniles from entering a therapeutic community as
participation in the therapeutic community made them worse.
Another policy recommendation would be to have the Department of Youth
Services require that Mohican Youth Center incorporate standardized assessments of
responsivity measures especially a measure of psychopathy. As Hare (1999) found,
psychopaths who participated in a therapeutic community were more likely to recidivate.
Given that the juveniles are responsible for operating the community, a psychopath has
the potential to severely disrupt the community, which will decrease the effectiveness of
the program in reducing recidivism for all juveniles. Therefore, Mohican should
41 Since the concept of the therapeutic community is based on a sound theoretical model (social learning) and previous studies have found therapeutic communities to be effective in reducing recidivism, Mohican Youth Center should continue to operate as a therapeutic community until further research is conducted.
177
implement an assessment instrument to measure psychopathy and develop exclusionary
criteria that would prevent psychopaths from entering the program.
The second recommendation would be to remove the encounter groups. While
DeLeon (2000) argues that the encounter groups provide an environment of motivation
for individuals to change, the groups are often times brutal sessions with much yelling.
While adults may be able to process the confrontations, it may be that the juveniles are
not mature enough to adequately conduct an encounter group. For example, youth may
see the sessions as a personal attack instead of a vehicle for promoting change.
Furthermore, some of the therapeutic techniques that are used within the encounter
groups (such as using similes, extremes, and opposites of the behavior being confronted)
may be too abstract and therefore, the juveniles may not have the cognitive ability to
comprehend the interventions. For these reasons, Mohican’s therapeutic community may
want to replace the encounter groups with interventions that are less confrontive and less
abstract.
A third policy recommendation for Mohican Youth Center would be to increase
the use of behavioral rehearsal techniques. With the amount of time that is spent at
Mohican, the staff have plenty of opportunity to assist the juveniles in identifying their
triggers for relapse and criminal behavior. The staff should take the next steps in
promoting change by providing many opportunities for youth to role-play alternative
prosocial responses to the triggers. By having the juveniles practice these situations, they
will be better equipped to handle potential high-risk situations once they are released
from the program, thereby reducing their chances of recidivism. Accordingly, Mohican
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should require that staff implement rehearsal opportunities throughout the treatment
groups.
The next policy recommendation for the therapeutic community concerns the use
of behavioral reinforcements. At the time of the evaluation, Mohican Youth Center used
some ineffective punishment techniques. For example, juveniles were required to
perform skits, sing songs, and wear signs as learning experiences when they received a
written pull-up. Research has shown that these techniques are not effective in promoting
behavioral change and may actually serve to increase antisocial tendencies (Spiegler &
Guevremont, 1993). Accordingly, Mohican should discontinue the use of these
techniques and focus more on removing levels and privileges of the juveniles.
Furthermore, in addition to using appropriate punishers, the therapeutic community
should implement a variety of rewards. Accordingly, instead of staff members and
community members trying to catch the juvenile being “bad,” they should try and catch
the juvenile being prosocial and reward him for his behavior/attitude. Using rewards is
important for two reasons. First, they inform the individual of what to expect from similar
behavior in the future. Second, the use of rewards increases the probability that the
behavior will be repeated in the future. Accordingly, the therapeutic community should
implement policy that explicitly spells out the types of punishments and rewards that will
be used for behavior.
The last policy recommendation for the therapeutic community at Mohican Youth
Center concerns the termination and aftercare components of the facility. First, Mohican
should develop completion criteria that require juveniles to show some type of behavioral
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and attitud inal change before they successfully complete treatment.42 For example,
Mohican may want to implement certain assessment instruments to gauge change. One
promising instrument is the In-Program Behavioral Assessment Instrument that can
measure behavioral in an institutional setting. The program may require that juveniles
either obtain a certain score on that instrument or show positive improvement on the
measures in order to successfully complete treatment.
Second, the facility should implement an aftercare component. Research has
shown that aftercare is an important component of therapeutic communities (Butzin et al.,
2002; Hiller et al., 1999a; Inciardi et al., 2004; Knight et al., 1999; Martin et al., 1999;
Wexler, DeLeon et al., 1999; Wexler, Melnick et al., 1999). At the time of the CPAI
assessment, Mohican did not have a structured aftercare component. Considering that
juveniles from all over the state attend Mohican, it may that the Department of Youth
Services has to develop a system to make sure that the juveniles receive high quality
aftercare services from programs in their hometown that address their needs.
Furthermore, the introduction of these aftercare services should begin while the youth is
finishing the services at Mohican so that there is a smooth continuance from residential
treatment to community treatment.
Suggestions for Future Research
While there have been many studies that have examined the effectiveness of
therapeutic communities in reducing recidivism for adults, few research has been
conducted on juvenile offenders and their success with therapeutic communities. The
42 The Department of Youth Services should also meet with judges to stress the importance of the acquisition of skills in order to successfully complete treatment. This process may result in fewer judges using Mohican as a “shock” value and removing the juveniles before he has successfully completed treatment.
180
findings from this dissertation show that participation in a therapeutic community did not
significantly reduce the probability of incarceration when compared to individuals who
did not receive treatment. However, due to the lack of adherence to some of the
principles of effective interventions, these finding should be viewed with caution when
deciding if the therapeutic community for juvenile males was effective. Specifically,
more research on the effectiveness of therapeutic communities, which adhere to the risk,
need, responsivity, and treatment principles for juveniles, is needed before one may
declare whether this treatment intervention “works” for juvenile offenders. Furthermore,
additional research should be pursued to determine what types of juveniles respond best
to the therapeutic community intervention. The sample for the current study was juvenile
males. It may be that therapeutic communities are more effective juvenile females.
Accordingly, research should be undertaken to determine if there is a differential impact
of effectiveness for certain types of juvenile offenders.
A second area for future study concerns the exploration of the “black box” of the
therapeutic community. Studies should be conducted which examine the treatment
components of a therapeutic community that either work or don’t work for juvenile
offenders. For example, the encounter groups are considered to be a staple of a
therapeutic community. However, research has yet to explore whether this specific
therapeutic intervention is effect in changing behavior. Furthermore, the hierarchical
structure found within the therapeutic community is assumed to increase self-esteem and
therefore assist in behavioral change. Again, this component has not been evaluated to
determine if the hierarchical structure actually promotes attitudinal and behavioral
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change. Therefore, studies should be developed which allow researchers to examine the
effectiveness of specific components of a therapeutic community.
In conclusion, this study may provide a framework for additional research into the
effectiveness of therapeutic communities for juvenile offenders. Hopefully, future
research will begin to explore therapeutic communities in relation with the principles of
effective intervention to determine which components actually support change in the
juveniles thereby increasing the knowledge base in the area of rehabilitation for juvenile
offenders.
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APPENDIX A
DATA COLLECTION INSTRUMENTS
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OHIO’S RESIDENTIAL SUBSTANCE ABUSE TREATMENT PROGRAMS Standardized Intake Form
1) ____________________________________ Name of individual completing form 2) _____ Program code 2= Mohican Youth Center 3=Monday Community Correctional Center 4=Noble Correctional Center IDENTIFYING INFORMATION 3) _________________________________________________ Case # 4) ________________________________________________________________ Name Last First Middle Initial
5) _____________________________________ SSN 6) _____/_____/_____ Date of birth OFFENDER CHARACTERISTICS 7) _____ Race: 1=White 2=Black 3=Hispanic 4= Native American 5=Asian 6=Other 8) _____ Sex: 1=male 2=female 9) _____ Marital status: 1=married 2=not married 10) _____ Number of dependents (under 18 years of age) 11) _____ Highest grade completed: 1-12=grades 1-12; 13=some college; 14=Bachelors or higher _____ If completed less than 12 grades, did the offender earn a GED? 1=yes; 2=no 12) _____ Employment status prior to arrest 1=employed fulltime (35 hours or more/week) 2=employed part-time (less than 35 hours/week) 3=unemployed CURRENT OFFENSE 13) _____________________ Most serious charge (enter name of charge – e.g., CCW, burglary)
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14) _____ Level of conviction offense: 1=F1 2=F2 3=F3 4=F4 5=F5 6=M1 7=M2 8=M3 9=M4 15) _____/_____/_____ Date screened for RSAT 16) _____/_____/_____ Date placed in RSAT program CRIMINAL HISTORY 17) _____/_____/_____ Date of first arrest _____ If exact date is unknown, please indicate age of first arrest 18) Number of prior arrests (adult and juvenile) _____ Felony _____ Misdemeanor 19) Number of prior convictions (adult and juvenile) _____ Felony _____ Misdemeanor 20) _____ Has the offender ever been arrested on a drug charge? 1=yes 2=no 21) _____ Number of prior sentences to a secure facility 22) _____ Number of prior sentences to community supervision 23) _____ Number of unsuccessful terminations from community supervision SUBSTANCE ABUSE HISTORY 24) _____ First drug of choice 1=heroin 7=LSD 2=non-crack cocaine 8=PCP 3=crack 9=inhalants 4=amphetamines 10=over the counter 5=barbiturates/tranquilizers 11=alcohol 6=marijuana 12=other: (specify) ____________________ 25) _____ Second drug of choice 26) _____ Age of first alcohol use 27) _____ Age of first drug use
28) _____ Do any immediate family members have a substance abuse problem?
1=yes 2=no
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29) _____ Has the offender received previous drug/alcohol treatment? 1=yes 2=no
If yes, indicate the number of times the offender has experienced each of the following types of treatment: _____ Detoxification _____ Methadone maintenance _____ Outpatient _____ Short-term inpatient (30 days or less) _____ Residential
30) _____ Has the offender been dual diagnosed with mental illness and substance
abuse? 1=yes 2=no
Please attach the following completed instruments OR a summary of results/scores: Noble – PII MonDay – LSI and ASUS
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OHIO’S RESIDENTIAL SUBSTANCE ABUSE TREATMENT PROGRAMS Standardized Termination Form
Please indicate the circumstances surrounding the client’s discharge from the program including the date of discharge, type of discharge, and plan for aftercare. 1) Client name: _______________________________________________________________________ 2) SSN: _____________________________________________________________________________ 3) Program code: _________ 2=Mohican 3=MonDay 4=Noble 4) Date of discharge: _____/_____/_____ 5) Type of discharge: _____ 1=successful completion (achieved treatment goals) 2=successful completion (completed time but not goals) 3=unsuccessful termination 4=voluntary withdrawal 5=escape/abscond 6=unable to participate due to reclassification, medical, out to court 7=other (specify): ______________________________________________________________ 6) Living arrangements upon discharge: _____ 1=with family/relatives 5=halfway house 2=with friends 6=foster care 3=by him/herself in apartment/house 7= other (specify): ___________________ 4=group home 7) Has continued drug/alcohol treatment been arranged for the client? ____ 1=yes 2=no 8) Criminal justice placement: _____ 1=probation supervision 4=prison 2=parole supervision 5=DYS institution 3=jail 6= other (specify): ___________________________ 9) To facilitate the collection of follow-up data, please provide the following information on the agency responsible for the offender’s supervision/custody upon discharge from RSAT. Agency (probation, parole, institution) ______________________________________________________ Probation/Parole officer’s name: ___________________________________________________________ Address: ______________________________________________________________________________ City, State, Zip: ________________________________________________________________________ Phone number: _________________________________________________________________________ 10) Please provide reassessment information by attaching the following items OR a summary of results/scores. MonDay – LSI reassessment Noble – PII reassessment
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APPENDIX B
TABLES
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Table B1: Items for the Client Self-Rating Scales Scale Information and Individual Items Anxiety – the following are summed together to achieve the anxiety scale score. The higher the score, the higher the individual’s level of anxiety. Participation in treatment should decrease the level of anxiety. You have trouble sitting still for long. You have trouble sleeping. You feel nervous. You have trouble concentrating or remembering things. You feel afraid of certain things, like crowds or going out alone. You feel tensed or keyed-up. You feel tightness or tension in your muscle. Depression – the following are summed together to achieve the depression scale. The higher the score, the higher the level of depression. Participation in treatment should decrease the level of depression. You feel sad or depressed. You have thoughts of committing suicide. You feel lonely. You feel interested in life. ( r) You feel extra tired or run down. You worry or brood a lot. Self-esteem – the following are summed together to achieve the self-esteem scale. The higher the score, the higher the level of self-esteem. Participation in treatment should increase the level of self-esteem. You have much to be proud of. In general, you are satisfied with yourself. You feel like a failure. (r ) You feel you are basically no good. ( r) You wish you had more respect for yourself. (r ) You feel you are unimportant to others. ( r) Decision-making – the following items are summed together to achieve the decision-making scale. The higher the score, the higher the level of decision-making. Participation in treatment should increase the level decision-making. You consider how your actions will affect others. You plan ahead. You think about the possible results of your actions. You have trouble making decisions. ( r) You think of several different ways to solve a problem. You analyze problems by looking at all the choices. You make decisions without thinking about consequences. ( r) You make good decisions. You think about what causes your current problems.
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Table B1: Items for the Client Self Rating Scales (continued) Scale Information and Individual Items Risk-taking – the following items are summed together to achieve the risk-taking scale. The higher the score, the higher the level of risk-taking. Participation in treatment should decrease the level of risk-taking behaviors. You like to take chances. You like the fast life. You like friends who are wild. You like to do things that are strange or exciting. You stay away from anything dangerous. ( r) You only do things that feel safe. ( r) You are always very careful. ( r) Hostility – the following are summed together to achieve the hostility scale. The higher the score, the higher the level of hostility. Participation in treatment should decrease the level of hostility. You feel mistreated by other people. You like others to feel afraid of you. You sometimes want to fight or hurt others. You have a hot temper. Your temper gets you into fights or other trouble. You get mad at other people easily. You have carried weapons, like knives or guns. You feel a lot of anger inside you. Self-efficacy – the following are summed together to achieve the self-efficacy scale. The higher the score, the higher the level of self-efficacy. Participation in treatment should increase the level of self-efficacy. You often feel helpless in dealing with the problems of life. ( r) There is really no way you can solve some of the problems you have. ( r) There is little you can do to change many of the important things in your life. ( r) Sometimes you feel that you are being pushed around in your life. ( r) You have little control over the things that happen to you. ( r) What happens to you in the future mostly depends on you. You can do just about anything you really set your mind to do. Desire for Help – the following items are summed together to achieve the desire for help scale. The higher the score, the higher the desire for help. Participation in treatment should increase the desire for help. You need help in dealing with your drug use. It is urgent that you find help immediately for your drug use. Your life has gone out of control. You are tired of the problems caused by drugs. You will give up your friends and hangouts to solve your drug problems. You want to get your life straightened out. You can quit using drugs without any help. ( r)
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Table B1: Items for the Client Self Rating Scales (continued) Scale Information and Individual Items Treatment Readiness – the following items are summed together to achieve the treatment readiness scale. The higher the score, the higher the level of treatment readiness. Participation in treatment should increase the level of treatment readiness. You want to be in a drug treatment program. This treatment program seems too demanding for you. ( r) You have too many outside responsibilities now to be in this treatment program. ( r) This treatment may be your last chance to solve your drug problems. This type of treatment program will not be very helpful to you. ( r) You are in this treatment program because someone else made you come. ( r) You plan to stay in this treatment program for a while. This treatment program can really help you.
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Table B2: Reliabilities for the Client Self Rating for the Treatment Group Scale N Pre-test N Post-test Anxiety 401 .7562 198 .7887 Depression 406 .7204 202 .7170 Self-esteem 402 .7028 198 .6692 Decision Making 398 .7431 198 .7204 Risk Taking 404 .7482 197 .7615 Hostility 398 .8062 197 .7391 Self-efficacy 400 .5987 197 .6349 Desire for Help 407 .7157 195 .6838 Treatment Readiness 399 .7003 200 .6545
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Table B3: Reliabilities for How I Think for the Treatment Group Scale N Pre-test N Post-test Anomalous response 396 .6730 209 .5971 Self-centered 388 .6893 205 .5803 Blaming others 397 .7634 209 .7320 Minimizing 393 .6087 207 .5936 Assuming the worst 393 .8327 207 .8071 Oppositional defiance 397 .7594 211 .6901 Physical aggression 394 .7266 208 .6347 Lying 390 .5784 205 .4677 Stealing 397 .7022 205 .6625 Overt 391 .8595 207 .8066 Covert 385 .7981 203 .7572 How I Think 377 .9114 201 .8835 How I Think (all) 377 .9563 201 .9425
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Table B4: Youthful Level of Service/Case Management Inventory YLS/CMI Scale Mohican (N= 425) Comparison (N=447) Min. Max. Mean SD Min. Max. Mean SD Prior & Current Offenses, Adjudications (range 0-5)
0.00 5.00 3.16 1.18 0.00 5.00 3.00 1.26
t =1.905; p = .057
Family Circumstances & Parenting (range 0-6)
0.00 6.00 3.52 1.35 0.00 6.00 3.29 1.39
t =2.437; p = .015
Employment/Education (range 0-7) t = -.478; p = .633
0.00 7.00 3.67 1.85 0.00 7.00 3.73 1.77
Peer Relations (range 0-4) t =3.885; p = .000
0.00 4.00 2.91 0.92 0.00 4.00 2.65 1.04
Substance Abuse (range 0-5) t =6.910; p = .000
0.00 5.00 3.99 1.22 0.00 5.00 3.30 1.68
Leisure/Recreation (range 0-3) t =1.238; p = .216
0.00 3.00 1.94 0.61 0.00 3.00 1.88 0.70
Personality & Behavior (range 0-7) t = -1.757; p = .079
0.00 7.00 3.58 1.66 0.00 7.00 3.78 1.80
Attitudes & Orientations (range 0-5) t =3.009; p = .003
0.00 5.00 2.00 1.12 0.00 5.00 1.74 1.34
Total (range 0-42)
5.00 37.00 24.72 5.39 2.00 38.00 23.38 6.15
t=3.463; p = .001
205
Table B5: Descriptive Statistics for How I Think Questionnaire – Time 1* Scale N Minimum Maximum Mean SD Cognitive Distortions
Anomalous Responding (range 1-6)
299 1.00 4.25 3.67 .53
Self-centered (range 1-6)
294 1.67 6.00 3.24 .61
Blaming Others (range 1-6)
296 1.00 6.00 3.16 .63
Minimizing/Mislabeling (range 1-6)
294 2.56 6.00 4.13 .58
Assuming the Worst (range 1-6)
294 1.27 6.00 2.76 .67
Behavioral Referents
Opposition-Defiance (range 1-6)
297 1.40 6.00 3.18 .68
Physical Aggression (range 1-6)
294 2.00 6.00 3.34 .59
Lying (range 1-6)
290 .25 6.00 3.44 .57
Stealing (range 1-6)
297 1.91 6.00 3.23 .56
Summary Scores Covert (range 1-6)
289 1.40 6.00 3.33 .50
Overt (range 1-6)
294 1.80 6.00 3.27 .59
How I Think (range 1-6)
284 1.91 6.00 3.31 .52
* Includes the scores that may be considered “suspect” because the AR scale is greater than 4.0 but less than 4.25.
206
Table B6: Descriptive Statistics for How I Think Questionnaire – Time 1* Scale N Minimum Maximum Mean SD Cognitive Distortions
Anomalous Responding (range 1-6)
221 1.00 4.00 3.49 .51
Self-centered (range 1-6)
217 2.22 6.00 3.38 .61
Blaming Others (range 1-6)
219 2.00 6.00 3.32 .61
Minimizing/Mislabeling (range 1-6)
217 2.56 6.00 4.21 .58
Assuming the Worst (range 1-6)
218 1.45 6.00 2.92 .67
Behavioral Referents
Opposition-Defiance (range 1-6)
220 2.10 6.00 3.34 .68
Physical Aggression (range 1-6)
218 2.20 6.00 3.49 .57
Lying (range 1-6)
214 2.13 6.00 3.55 .54
Stealing (range 1-6)
219 1.91 6.00 3.36 .56
Summary Scores
Covert (range 1-6)
213 2.29 6.00 3.45 .49
Overt (range 1-6)
218 2.30 6.00 3.42 .58
How I Think (range 1-6)
210 2.44 6.00 3.45 .51
* Does not include the scores that may be considered “suspect” because the AR scale is greater than 4.0 but less than 4.25.
207
Table B7: Independent Samples t-tests for the Client Self Rating Scale N for
Time 1 Time 1 Mean
N for Time 2
Time 2 Mean
t-value Sig.
Anxiety (range 7-35)
211 17.06 187 17.15 -.176 .860
Depression (range 6-30)
215 12.72 188 13.04 -.791 .430
Self-esteem (range 6-30)
212 22.69 187 22.49 .520 .604
Decision-making (range 9-45)
211 31.40 184 31.51 -.198 .843
Risk-taking (range 7-35)
211 21.15 190 21.36 -.407 .684
Hostility (range 8-40)
210 20.19 185 20.26 -.119 .905
Self-efficacy (range 7-35)
208 26.69 189 26.04 1.534 .126
Desire for Help (range 7-35)
214 23.35 188 23.73 -.724 .469
Treatment Readiness (range 8-40)
211 26.62 185 26.57 .087 .931
Time 1 = pretest only Time 2 = both pre and posttests
Table B8: The Effects of Time on Psychological and Social Functioning, With Controls for Pre -test Scores
Anxiety Depression Self Esteem
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time .012 .007 .118 .003 .005 .043 .000 .005 .010 Pre-test score .542 .067 .519* .243 .059 .299* .345 .068 .363* Constant 6.240 1.719* --- 8.604 1.225* --- 15.762 1.769* --- F-value 34.992 8.734 12.913 R2 .29 .09 .13
Decision-making Risk-taking Hostility
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time .005 .007 .050 .015 .006 .160* .021 .007 .203* Pre-test score .343 .072 .345* .546 .061 .552* .389 .060 .437* Constant 21.035 2.657* --- 7.325 1.660* --- 9.558 1.756* --- F-value 11.690 45.489 27.899 R2 .12 .35 .25 * p = .05
Table B8: The Effects of Time on Psychological and Social Functioning, With Controls for Pre -test Scores (continued)
Self-efficacy Desire for Help Treatment Readiness
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time -.001 .005 -.018 -.005 .006 -.054 -.014 .007 -.146* Pre-test score .368 .070 .371* .426 .062 .468* .282 .064 .318* Constant 17.138 2.181* --- 14.567 1.968* --- 21.542 2.244* --- F-value 13.804 24.565 12.398 R2 .14 .23 .13 * p = .05
Table B9: Independent Samples t-tests for the How I Think Questionnaire Scale N for
Time 1 Time 1 Mean
N for Time 2
Time 2 Mean
t-value Sig.
Cognitive Distortions
Self-centered (range 1-6)
154 3.25 113 3.30 -.772 .441
Blaming Others (range 1-6)
154 3.17 115 3.23 -.814 .416
Minimizing/Mislabeling (range 1-6)
155 4.14 113 4.18 -.683 .495
Assuming the Worst (range 1-6)
155 2.76 112 2.85 -1.094 .275
Behavioral Referents
Opposition-Defiance (range 1-6)
115 3.19 115 3.25 -.810 .419
Physical Aggression (range 1-6)
154 3.34 113 3.41 -.942 .347
Lying (range 1-6)
054 3.45 109 3.51 -.881 .379
Stealing (range 1-6)
156 3.23 115 3.30 -.924 .356
Summary Scores
Covert (range 1-6)
154 3.34 109 3.40 -1.013 .312
Overt (range 1-6)
154 3.27 113 3.33 -.918 .360
How I Think (range 1-6)
152 3.32 106 3.39 -1.134 .258
Time 1 = pretest only Time 2 = both pre and posttests
Table B10: The Effects of Time on How I Think Scales, With Controls for Pre -test Scores (includes suspect cases)
Self-Centered Blaming Others Minimizing/ Mislabeling
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time .001 .001 .124 .002 .001 .132 .003 .001 .193* Pre-test score .272 .073 .336* .285 .072 .351* .491 .091 .450* Constant 2.007 .300* --- 1.974 .296* --- 1.616 .407* --- F-value 8.685 10.379 5.765 R2 .14 .16 .27
Assuming the Worst
Oppositional Defiance
Physical Aggression
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time .002 .001 .124 .003 .001 .231* .002 .001 .169 Pre-test score .181 .077 .221* .247 .075 .290* .310 .076 .357* Constant 1.878 .334* --- 1.795 .330* --- 1.882 .311* --- F-value 3.573 9.547 11.468 R2 .06 .15 .17 * p = .05
Table B10: The Effects of Time on How I Think Scales, With Controls for Pre -test Scores (includes suspect cases)
Lying Stealing Overt
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time .012 .001 .121 .001 .001 .079 .003 .001 .223* Pre-test score .235 .066 .335* .339 .074 .405* .282 .070 .351* Constant 2.376 .275* --- 1.951 .292* --- 1.841 .288* --- F-value 8.095 11.874 12.786 R2 .14 .17 .18
Covert How I Think
Independent Variables
b
SE
Beta
b
SE
Beta
Time .001 .001 .111 .002 .001 .191* Pre-test score .289 .069 .385* .298 .070 .386* Constant 2.148 .269* --- 1.936 .276* --- F-value 10.684 12.743 R2 .16 .19 * p = .05
Table B11: The Effects of Time on How I Think Scales, With Controls for Pre-test Scores (does not include suspect cases)
Self-Centered Blaming Others Minimizing/ Mislabeling
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time .003 .002 .186 .004 .002 .262* .005 .002 .302* Pre-test score .257 .103 .300* .225 .097 .271* .521 .107 .486* Constant 1.942 .421* --- 1.885 .389* --- 1.048 .491* --- F-value 5.733 7.634 20.929 R2 .13 .19 .38
Assuming the Worst
Oppositional Defiance
Physical Aggression
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time .003 .002 .170 .005 .002 .296* .003 .002 .238* Pre-test score .158 .105 .186 .253 .096 .296* .248 .101 .288* Constant 1.900 .442* --- 1.618 .417* --- 1.943 .398* --- F-value 2.576 9.034 7.366 R2 .05 .19 .16 * p = .05
Table B11: The Effects of Time on How I Think Scales, With Controls for Pre -test Scores (does not include suspect cases)
Lying Stealing Overt
Independent Variables
b
SE
Beta
b
SE
Beta
b
SE
Beta
Time .023 .001 .194 .003 .002 .240* .004 .001 .296* Pre-test score .223 .100 .284* .277 .099 .326* .271 .089 .339* Constant 2.212 .392* --- 1.818 .396* --- 1.725 .354* --- F-value 5.404 8.043 11.484 R2 .13 .18 .24
Covert How I Think
Independent Variables
b
SE
Beta
b
SE
Beta
Time .003 .001 .224 .003 .001 .290* Pre-test score .278 .100 .340* .287 .096 .357* Constant 1.935 .378* --- 1.758 .362* --- F-value 8.082 10.946 R2 .19 .25 * p = .05
Recommended