Our Evidence Based Practice Services

Section I. Theoretical and Research Perspectives

This section describes the theoretical foundations and research evidence for development and implementation of adolescent-focused treatment programming. Included are discussions of risk and resiliency factors that mediate problem behaviors; mental health factors associated with deviant activity; bio/psycho/social underpinnings of substance abuse and crime; the action of AOD on the developing adolescent brain; factors that predict adolescent-limited and life-course-persistent patterns of criminal involvement; gender differences and treatment implications for juvenile justice clients; treatment enhancement through cultural mindfulness; perspectives on assessing risk and resiliency for screening; in-depth treatment planning; and outcome assessment.

1. Adolescent Development and Pathways to Problem Behavior

Deviant identity formation (i.e., antisocial actions based on acceptance of values, norms, and patterns of behavior alien to the framework of mainstream culture) is considered in light of current research on how adolescent brain development interacts with the teenager’s relationships with parents and peers and environmental circumstances. Eight theoretical models are used to examine causes of adolescent substance abuse and criminal conduct. Research evidence is presented for an array of risk and protective factors in the individual, family, and community infrastructure. Various subtypes of adolescent problem behaviors are analyzed according to specific risk factors. This section concludes with a discussion of the need for a strengths-based treatment model addressing delinquency, substance abuse, and co-occurring mental disorder.

2. Causes, Correlates, and Consequences of Teenage Substance Abuse

Information is presented on prevalence and severity of adolescent substance use and abuse, followed by discussion of imminent drug threats. Key factors in the etiology of adolescent-onset substance abuse are examined. These include social competence, life skills, deviant peer affiliations, and positive expectancies for substance use. Adolescent problem drinking is examined, including variables associated with teenage drinking and driving. The drug-crime relationship during adolescence is explored, as is the relationship between substance abuse and violence. The possible contribution from prescription drugs to teenage violence is also addressed. Ethnic identity is explored as a potential risk or protective factor for substance abuse during adolescence.

3. Mental Disorder within the Juvenile Justice Population

Most people experience adolescence without major emotional or behavioral disturbance. However, a large subpopulation of adolescents manifests symptoms of different mental disorders and become involved in delinquency, crime, and substance abuse. Diagnostic criteria and causal factors are examined for categories of mental disorder with the highest probability of intersecting with delinquency, crime, and substance abuse. Correlates and moderating factors are examined in profiles of attention deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, some personality disorders, and post-traumatic stress disorder. Information on diagnosis and psychosocial treatments is provided, as well as a summary of the arsenal of psychotherapeutic medications used in contemporary clinical practice. Issues of sequencing medication and cognitive-behavioral treatment are addressed.

4. Substance Abuse and the Adolescent Brain

Some very complex changes in brain “wiring” take place during adolescence, the most profound of which seem to occur in the frontal lobes. As a consequence of such changes, alcohol and other drugs affect adolescents and adults differently. An explanation of the neurochemical basis for brain functioning is followed by discussion of factors involved in adolescent brain development. Mechanisms of action are delineated for major categories of alcohol and other drug abuse, including use of alcohol, methamphetamine, cocaine, marijuana, opiates, Ecstasy, inhalants, hallucinogens, and tobacco. Each section concludes with a description of the possible long- and short-term effects of each type of substance abuse.

5. Juvenile Crime and Violence

General patterns of juvenile offending are investigated as well as the major correlates of juvenile crime. Two crime trajectories are identified—life-course-persistent and adolescence-limited. The etiology of each is explained, and implications for treatment and policy are explored. A developmental perspective on youth violence is presented, including studies about the trajectory of violent crime over the course of childhood and adolescence. A profile of serious criminality by juvenile offenders includes neurological, psychiatric, and sociocultural components. The phenomenon of juvenile homicide is explored, as well as recidivism among adolescent violent offenders. Finally, the situation of juveniles in the criminal justice system is investigated, concluding with a discussion of implications for treatment and policy.

6. Addressing Gang Culture in a Treatment Context

Given that more than 20,000 gangs consisting of approximately 1 million members exist in the United States, it is impossible to conceive that any serious effort to provide treatment programs for juvenile offenders does not include consideration of gang influence on the majority of adjudicated youth and in what ways it can be addressed in the context of treatment. Discussion of assessment of risk and protective factors around gang affiliation is provided, with the goal of targeting whole communities and enhancing the lives of their members. Relative to treatment, our primary focus is on attempts to change the attitudes, beliefs, and behaviors of gang-affected youth, targeting their strengths and abilities and helping them to perceive their environment (the accumulation of risk factors and developmental disruptions) in new and more optimistic ways. Several focused gang intervention strategies delivered within juvenile correctional facilities are discussed. We examine the potential benefits of interagency teams, typically comprised of outreach youth workers, police, probation officers, parole officers, and social service providers.

7. Female-Focused Treatment in the Juvenile Justice System

Issues of gender as they pertain to juvenile problem behavior are discussed. The major psychosocial factors associated with the development of problem behavior in adolescent girls are presented. This sets the stage for analysis of girls and status offenses; sexual abuse factors as they contribute to female substance abuse and crime; and the interrelationships among gender, gangs, and juvenile offending. The need for gender-specific programming is elaborated on. Gender norms are explored in terms of how they influence patterns of juvenile substance abuse, crime, and violence. Gender norms are also discussed in relationship to teen dating and the widespread phenomenon of date rape. Characteristics of sexually abusive adolescents are examined, followed by a discussion of implications for treatment and social policy.

8. Youth Culture and Diversity

Adolescent subgroups are viewed in terms of common beliefs, values, behaviors, and communication patterns. Effective treatment builds upon the developmental process of forming attitudes and behavioral patterns that foster a sense of belonging and purpose during adolescence. Beginning with an analysis of the adolescent quest for self-identity and social role definition, cultural similarities and differences are explored within four adolescent subgroups: violence based, music based, anti-authority, and thrill seeking. Due to the relative salience of peer influence compared to adult influence (in the short term), a treatment focus on commonalities of experience and purpose among group members can promote an “in-group” identity. Through a strength-based perspective, group members become aligned with positive attitudes about treatment and the common goal of achieving positive treatment outcomes. A continuum of cultural competence among counseling personnel is delineated with guidelines presented for how treatment providers can improve their counseling proficiencies by becoming mindful of their own cultural proclivities as well as the cultural orientations of each member of the treatment group. The three elements germane to cultural proficiency are understanding, respect, and support.

Section II. Foundational Treatment Models: Evidence-Based Approaches

This section explains the basic principles of cognitive-behavioral treatment, including the primary focal points of cognitive restructuring and social skills training. The integration of therapeutic and didactic approaches, as well as the synthesis of correctional and therapeutic strategies, results in improved relapse and recidivism prevention outcomes. Visual schemas, used throughout the program, are introduced to clarify how thinking and behavior are related to learning and change. A visual blueprint of the sequential model for relapse and recidivism prevention is provided. Section II shows how generic CBT principles are applied for juvenile justice clients and how these basic approaches are adapted for individual, family, and residential treatment applications.

1. Treatment Systems, Modalities, and Models of Care

An array of adolescent treatment approaches are discussed, each utilizing CBT as the primary intervention tool. We begin with a discussion of motivational enhancement, a set of principles that promote client engagement (i.e., treatment alliance), including willingness to discuss relevant treatment issues and developing a plan for continued therapeutic progress. Motivational enhancement strategies are generic across individual, family, and group modalities. Family treatment models are examined, with a common premise that improvement in the dynamics of the family will result in increased resiliency for all involved. In the domain of residential treatment, the therapeutic community (TC), a highly structured long-term treatment approach where the community itself acts as therapist and teacher, is discussed.

2. The Cognitive-Behavioral Model and Core Treatment Strategies for Adolescents

Behavioral and cognitive approaches have merged to form the primary psychotherapeutic model for treating criminal conduct, substance abuse, and mental disorder. The essential purpose of this training element is to elucidate cognitive-behavioral therapy specifically designed for adolescents. Attraction to a deviant subculture and initiation into substance abuse, promiscuous sexuality, gangs, and criminal conduct can be seen as attempts (albeit maladaptive ones) to survive, given cognitive appraisals derived from harsh and punishing life events. As alienation and social problem behaviors become repetitive, emerging juvenile justice clients increasingly fail to perceive positive cognitive and behavioral alternatives. Deviant identities become supported by fleeting feelings of empowerment. Nonjudgmental support and concern and accurate information, rather than blame and confrontation, can move an adolescent toward increased personal responsibility and self-efficacy. Counselors and treatment providers serve as role models who demonstrate positive coping skills for dealing with adversity and challenge throughout the life trajectory.

3. Community Reintegration: Reinforcing Change through Continuing Care

Approximately 100,000 youth are released annually from correctional placements. Considering developmental delays among young adult offenders and considering inmate releases through the age of 24, the number increases to 200,000 annually. Many of these youth consider reentry to be the most serious challenge in their lives. While several aftercare projects have been developed during the past few decades, reintegration of juvenile offenders remains problematic, and recidivism rates remain high. Juvenile facilities rarely have alumni programs, nor is it general practice to assign case managers upon release. Furthermore, community support agencies are not well coordinated. Many incarcerated youth face reentry with a lack of education, job training, job experience, family ties, pro-social friends, and housing, plus they bear the additional stigma of incarceration. They return to the same communities where they came from. This training component summarizes the recent literature on society’s attempt to meet the dire need for improving aftercare services for juveniles.

Section III. The Treatment Curriculum

Implementation and operational procedures for delivery of an adolescent focused, cognitive-behavioral, group treatment curriculum are provided. This section presents detailed guidelines for how to introduce cognitive-behavioral treatment in an atmosphere of safety, trust, and rapport within adolescent settings. The theoretical and research basis for sequential treatment phases are presented as clients move through Challenge to Change; Commitment to Change; and Ownership of Change. Hands-on counseling skills building exercises are the primary focus of this core training segment.

Expand Your Toolbox – Creative Strategies for Building Community and Engagement

In this portion of the workshop, we will explore creative strategies for preventing behavior problems and increasing engagement while addressing multiple learning styles. Utilizing game-like activities, facilitators can build community and trust within groups as well as reinforce positive social interactions. After this workshop, you will come away with a variety of simple and rewarding tools to positively impact your group’s ability to communicate, collaborate, and learn together.

Beyond shaping community within the group, hands-on learning tools support the curriculum and build engagement through interpersonal, visual, and kinesthetic pathways. We will model and rehearse several active strategies for introducing and exploring concepts covered in the curriculum. These alternative modes of presentation often successfully engage youth who exhibit various learning styles and offer an entry point towards deeper understanding for all.

In addition to exploring a variety of hands-on activities that can be implemented within the treatment curriculum, we will discuss behavior management ideas for groups and individual youth. When working in a group setting, behavior issues can impede progress and the social chemistry can change rapidly. To facilitate productive group sessions, it is imperative that a consistently safe and supportive environment is maintained. Expand your toolbox for preventing problem behavior and intervening when challenges arise.

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