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

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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

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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

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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

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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.

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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

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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.

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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

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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.

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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.

132

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

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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

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0 months 10 months 20 months 30 months 40 months0

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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

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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

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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).

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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

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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.

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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.

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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