FORUM on Corrections Research

A community-based alternative for high-risk young offenders

by Alan W. Leschied ¹
Associate Professor, Faculty of Education, University of Western Ontario

and Alison Cunningham ²
Research Coordinator, London Family Court Clinic

The clinical trials of multisystemic therapy (MST) are a collaborative effort of children’s services in Ottawa, Simcoe County, Mississauga and London. Funding for services, training and consultation is provided by the Ontario Ministry of Community and Social Services. The evaluation component is funded through the National Crime Prevention Centre. The ongoing training and consultation of Multisystemic Therapy Services Inc. and the Family Services Research Center of the Medical University of South Carolina are gratefully acknowledged.³ The authors also acknowledge Wendy Lewis, Department of Psychology, University of Western Ontario, who assisted with the database searches.

Evidence-based support for effective service

Prison admissions for both adults and young offenders have risen steadily for two decades. Yet, in the United States, the near-exponential rise in prison costs has not been matched with increases in community safety.⁴ In Canada, we may look smugly at the havoc wrought by fear-driven penal policy, but the rate at which adjudicated young offenders are sentenced to custody in Canada, 33% of cases in 1996–97,⁵ is among the highest rate of youth incarceration in western industrialized countries.⁶

Compelling evidence from numerous sources suggests that human service programs, supported through court-based sanctions, contribute more to reductions in antisocial behaviour than sanctions alone.⁷ This conclusion applies equally for adults and young offenders.⁸ The paradox, therefore, is that reliance on imprisonment as a response to criminal behaviour is not only costly, but also likely ineffective in meeting the goal of societal protection.

The growth of knowledge in young offender assessment

A PsychInfo database search was conducted for assessment, outcome evaluation, development of community-based alternatives, and prevention and early intervention. The growth in the number of articles in reputable journals has been overwhelming. Figure 1 illustrates the growing attention to the assessment of risk and needs with young offenders and the prediction of their recidivism. A general review of the direction that literature has taken suggests two trends:

• a move away from general personality theory and broad-based measures of antisocial behaviour; and
• more emphasis on risk measurement and measures of specific indices of criminogenic potential.

Figure 1

We have also seen an enormous rise in the number of published program evaluations in youth corrections (see Figure 2), probably driven by the need to understand what works and for whom. Two major observations can be made for these studies:

• negative findings are generally reported for boot camps, shock incarceration and sanction-based programs without clearly identified human-service components; and
• positive findings support programs that clearly identify service components tied to known causes of crime.

This has been accompanied by a recognition that monitoring program integrity is an important aspect of service delivery.

Figure 2

Figure 3

Another observation from the literature is that alternatives to custody are needed. This may surprise those who believe that high rates of custody admissions reflect the absence of demonstrably effective alternatives. Figure 3 shows that three times the number of articles about alternatives to custody appeared in refereed journals over the past decade compared with the period 1960 to 1976. Research suggests that programs with the best outcomes, as measured in lower reoffending rates, are associated with community-based programs as opposed to residential programs.⁹

Perhaps nowhere has the increase in knowledge been as apparent as in the area of prevention and early intervention. From 1960 to 1976, a total of eight articles on this topic appeared in refereed journals. But from 1987 to 1997, more than 300 published accounts focused on providing program support for at-risk youth and their families either before or early in their criminogenic histories (see Figure 4). The major trends in this area suggest the following:

• programs tied to known causes of antisocial behaviour are associated with better outcomes; and
• programs that emphasize an integrated community response to the multi-determined nature of high-risk children and families show better outcomes than programs that are discretely offered, targeting one-dimensional causes of high-risk children.

With this rapid increase in literature on programs for at-risk youth, terms such as validated, empirically supported and evidence-based are now commonly used to describe the yardsticks by which interventions are described and prescribed.¹⁰

Lastly, funders are demanding that programs be both effective and cost-effective. Any assessment of effectiveness must address the cost of the program vis-à-vis the impact on community safety.

Figure 4

The data from a Washington survey, found in Table 1, examines effectiveness in the context of costs of service. These data suggest that the politically driven boot camps, for example, do not measure up to services that emphasize human service-driven components such as Big Brothers and Big Sisters and MST.

Table 1

Cost-Benefit View of Selected Youth Justice Programs
Program	Change in criminal	Years before program offences cost repaid
Juvenile boot camp	Average increase of 16%	Never
Multisystemic therapy	Average decrease of 44%	2 Years
Perry Preschool Project	Average decrease of 48%	Never
Big Brothers/Big Sisters	Average decrease of 20%	3 Years
Source: Compiled from data in Washington State Institute for Public Policy, Watching the Bottom Line: Cost-Efficient Interventions for Reducing Crime in Washington (Olympia, WA: Washington State Institute for Public Policy, 1998).

What is multisystemic therapy?

MST was developed over a 15-year period by Scott Henggeler and his colleagues at the Family Services Research Center at the Medical University of South Carolina in Charleston. MST is an empirically derived approach to the community-based treatment of high-risk young offenders. As an intervention, it reflects the components of assessment and service that have strong research support. It is considered systemic, working with the youth’s family, friends and school. It is intensive, short-term, strength-based and solution-focused. The skills of a successful MST therapist include an ability to quickly engage with the family, to develop workable short-term goals that require daily effort, and to select goals that are related to the youth’s antisocial behaviour. The therapist is available 24 hours a day, seven days a week and is responsible for creating the conditions for change with the family.

Many randomized and quasi-experimental studies document the effectiveness of MST in reducing offending and service utilization.¹¹ MST is specifically designed for use with high-risk youth, as defined by the degree of their penetration into the juvenile justice system or by the seriousness of their offences.

MST for Young Offender Services in Canada

The federal Department of Justice has outlined a series of proposed revisions to Canadian youth justice.¹² Among these proposals is a call for redressing the high use of custody through the development of community-based alternatives. It would appear that, both politically and substantively, direction is being sought for cost-effective services with a proven track record in lowering the risk potential of higher-risk youth. The recent literature in this area suggests that MST would measure up to the above outlined standards for many reasons:

1. There is a research base to support MST as an effective intervention for reoffending and serious offending youth, who consume a disproportionate amount of the corrections dollar.
2. Components of MST service reflect a theoretical orientation that is consistent with risk-based classification and service planning. That is, MST ties intervention to known causes of youth crime. These causes are systemically linked to risk and concentrate on the influences of family, peers and school.
3. The delivery of service is community-based and focused on both individual and systemic strengths.
4. The training protocol is well articulated, ensuring the development of MST teams who offer service faithful to the model through adherence to the principles of MST. The training is intensive and challenging, requiring clinicians to participate in a one-week training session, quarterly “booster” training sessions and weekly, case-specific telephone consultations with the MST consultant in South Carolina.

Strong commitment to evaluation

With the support of the Department of Justice through the National Crime Prevention Centre, the implementation of MST in Canada is being evaluated to answer the question “Does it work and for whom?”¹³ Features of the study include the following:

• initial screening of referred cases to ensure inclusion of only high-risk cases as measured by the Risk/Needs Assessment;¹⁴
• random assignment to MST or usual services, the latter group to be a control group;
• process measures of change in family functioning, social skills, cognitive orientation toward antisocial behaviour and a set of factors related to general well-being

as measured by the Standardized Client Information System of the Ontario Association of Children’s Mental Health Centres;

• measurement of treatment integrity and adherence to the MST model;
• follow-up of up to three years after discharge from the program to measure two key outcomes: offending and service utilization; and
• assessment of the cost-effectiveness of MST relative to usual services.

Site selection took place in the summer of 1996. Sites were selected on the basis of interest and commitment to developing the model, but mindful of the need to have diversity in the sample. Implementation began with training in April 1997. Currently, all four trial sites are fully operational and fully adhere to the evaluation.

Conclusion

The implementation of the MST clinical trials in Ontario represents, we believe, a model of policy and program cooperation that is almost as multi-faceted as the treatment intervention itself. Cooperation among two levels of government and multiple agencies in several communities to implement and empirically evaluate an intervention is a rarity in youth justice in this country. In the spring of 1999, the first data describing the impact of service on youths seen in the first year will be available. Training and consultation in MST has already shown itself to be possible with the consultative support of MST Services Inc. and the clearly written manuals now available. Integrity of implementation, in the context of that training, will be a primary focus in the data.

---

1. 1137 Western Ontario, London, Ontario N6G 1G7.

2. 200–254 Pall Mall St., London, Ontario N6A 5P6.

3. Interim results of the clinical trial are posted as they become available on the Web site of the London Family Court Clinic

4. M. Mauer, Adjudication and Sentencing Obstacles and Opportunities. Paper presented at the Beyond Prisons Conference (Kingston, ON: March 1998).

5. Canadian Centre for Justice Statistics, Youth Court Statistics 1996-97 (Ottawa: Minister of Industry, Science and Technology, 1998).

6. Remarks by the Honourable Anne McClellan, “Young Offender Reforms in Canada.” London, Ontario, November 5, 1998.

7. D. A. Andrews and J. Bonta, The Psychology of Criminal Conduct. (Cincinnati, OH: Andersen Publishing, 1998); see also P. Gendreau and C. Goggin, “Correctional Treatment: Accomplishments and Realities.” Correctional Counselling, 3r d ed., P. Van Voorhis, M. Braswell and D. Lester, Eds. (Cincinnati, OH: Andersen Publishing, 1997): 271–280; F. Lösel, “Working With Young Offenders: The Impact of Meta-Analysis.” Clinical Approaches to Working With Young Offenders, C. R. Hollin and K. Howells, Eds. (Chichester, UK: John Wiley and Sons, 1996): 57–82.

8. D. A. Andrews, A. W. Leschied and R. D. Hoge, Review of the Profile, Classification and Treatment Literature with Young Offenders: A Social Psychological Approach (Toronto, ON: Ministry of Community and Social Services, 1992).

9. D. A. Andrews, The Importance of the Appropriate Management of Risk and Reintegration Potential. Paper presented at the Beyond Prisons Conference (Kingston, ON: March 1998).

10. A. E. Kazdin and J. R. Weisz, “Identifying and Developing Empirically Supported Child and Adolescent Treatments,” Journal of Consulting and Clinical Psychology, 66, 1, (1998): 19–36.

11. For a review of previous research, see S. W. Henggeler, S. K. Schoenwald, C. M. Bourduin, M. D. Rowland and P. B. Cunningham, Multisystematic Treatment of Antisocial Behaviour in Children and Adolescents (New York, NY: The Guilford Press, 1998).

12. Department of Justice, A Strategy for the Renewal of Youth Justice (Ottawa, ON: Department of Justice, 1998).

13. L. W. Sherman, Preventing Crime: What Works, What Doesn’t, What’s Promising (Washington, DC: Office of Justice Programs, U.S. Department of Justice, 1997).

14. Andrews, Leschied and Hoge, Review of the Profile Classification and Treatment Literature with Young Offenders: A Social Psychological Approach.