Chapter 5

Ineffective Secondary Prevention Approaches

Whereas the research presented above demonstrates that a large number of approaches and programs can have significant, positive effects on youth violence and violence-related risk factors, several popular prevention approaches used in high-risk populations have been shown to be ineffective. These include gun buyback programs, firearm training, and mandatory gun ownership.

Two community-based strategies for preventing youth violence, redirecting youth behavior and shifting peer group norms, have also shown a lack of effect in reducing youth violence. In fact, because both approaches tend to group high-risk youths together, they can actually increase the cohesiveness of delinquent peer groups and facilitate deviancy training (Dishion et al., 1994, 1995; Elliott & Menard, 1996; Patterson & Yoerger, 1997). Programs that aim to redirect high-risk youth toward conventional activities involve recreational, enrichment, and leisure activities, including the popular Midnight Basketball program. In general, programs that focus on shifting peer group norms have attempted to turn youth gangs into benign clubs. Instead, these programs have had no effect or have actually increased gang-related delinquent behavior.

Tertiary Prevention: Violent or Seriously Delinquent Youths

Each of the programs and strategies highlighted in this section is implemented on an indicated scale, that is, for young people who have already demonstrated violent or seriously delinquent behavior. The best information on general strategies that are effective or ineffective in reducing the risk of further violence among these youths comes from meta-analyses. The most rigorous and most frequently cited meta-analyses of violence prevention programs are those conducted by Lipsey and colleagues and by Andrews and colleagues (Lipsey, 1992a, 1992b; Lipsey & Wilson, 1998; Andrews, 1994; Andrews et al., 1990). This section draws largely on these analyses, which include interventions targeting youths involved in any delinquent behavior and those involved in serious delinquent behavior. To enhance readability, the meta-analyses are cited here rather than throughout the text. Effect sizes are a standardized mean difference, corrected for small sample size and method effects. This measure reflects the average difference (expressed in standard deviation units) between the program group and comparison groups in regard to violence, substance abuse, and risk factors.

Two major conclusions come from Lipsey’s research. The first is that effective treatment can divert a significant proportion of delinquent and violent youths from future violence and crime. This finding contradicts the conclusions of scientists two decades ago who declared that nothing had been shown to prevent youth violence. The second major conclusion is that there is enormous variability in the effectiveness of different types of programs for seriously delinquent youth. The most effective programs, on average, reduce the rate of subsequent offending by nearly half (46 percent), compared to controls, whereas the least effective programs actually increase the rate of subsequent offending by 18 percent, compared to controls. So, while some kinds of interventions substantially reduce youth violence and delinquency, others appear to be harmful (iatrogenic), actually increasing involvement in these behaviors.

Behavioral and Skill Development Interventions

Studies of male serious offenders demonstrate that treatment which includes a social perspective-taking/role-taking component can improve role-taking skills and reduce serious delinquent behavior for at least 18 months after treatment (Chandler, 1993). This finding is consistent with results from the Lipsey (Table 5–1) and Andrews studies, which indicate that multimodal, behavioral, and skills-oriented interventions are more effective than counseling and other less-structured approaches (see also Gendreau & Ross, 1987). In fact, in most youth populations—universal, selected, or indicated—behavioral and skills-oriented strategies are among the most effective violence prevention approaches.

Family Clinical Interventions

Although Lipsey reports only a small average effect size for reducing recidivism with family therapy (Table 5–1), the review literature indicates that specific strategies can be quite effective at preventing violence in delinquent youths and preventing further violence in already violent youths. One such approach is marital and family therapy by clinical staff. While marital and family therapy can include several different strategies, a common thread is the focus on changing maladaptive or dysfunctional patterns of family interaction and communication, including negative parenting behaviors—all risk factors for youth violence. Marital and family therapy shows consistent, positive effects on family functioning, child behavior, family interactions, and delinquency (Tremblay & Craig, 1995). Long-term studies have demonstrated positive effects of family therapy by clinical staff lasting up to 9 years.

Three Model tertiary youth violence prevention programs that use the family therapy approach are Functional Family Therapy, Multisystemic Therapy, and Multidimensional Treatment Foster Care. They are described below.

Functional Family Therapy (FFT) is actually a secondary and tertiary prevention program, since it targets youths 11 to 18 years old at risk of or already demonstrating delinquency, violence, substance use, conduct disorder, oppositional defiant disorder, or disruptive behavior disorder. FFT is a multistep, phasic intervention that includes 8 to 30 hours of direct services for youths and their families, depending upon individual needs. The phases of the intervention include engagement (to reduce the risk of early dropout), motivation (to change maladaptive beliefs and behaviors), assessment (to clarify interpersonal behavior and relationships), behavior change (including skills training for youths and parents), and generalization (in which individualized casework is used to ensure that new skills are applied to functional family needs).

Table 5-1. Average effect sizes

These services are delivered in multiple settings by a wide range of interventionists, including supervised paraprofessionals, trained probation officers, mental health technicians, and mental health professionals with appropriate advanced degrees. The benefits of FFT include the effective treatment of conduct disorder, oppositional defiant disorder, disruptive behavior disorder, and alcohol and other drug abuse disorders; reductions in the need for more restrictive, costly services and other social services; reductions in the incidence of the original problem being addressed; and reductions in the proportion of youths who eventually enter the adult criminal justice system. In two trials, recidivism was found to be lower among participants than controls. Evidence of a diffusion effect was also found, with fewer siblings of participants acquiring a court record in the 2 to 3 years following treatment.

Multisystemic Therapy (MST) is an intensive family- and community-based treatment that addresses multiple determinants of antisocial behavior. This approach is implemented within a network of interconnected systems that includes one or more of the following contexts: individual, family, peer, school, and neighborhood. MST targets families with children in the juvenile justice system who are violent, substance-abusing, or chronic offenders and at high risk of out-of-home placement. Four types of services are delivered through a home-based model: strategic family therapy, structural family therapy, behavioral parent training, and cognitive-behavioral therapy. While the intensity of services ultimately depends on individual youth and family needs, the average MST family receives 60 hours of direct services delivered over a period of 4 months. Program outcomes in serious delinquents include reductions in long-term rates of rearrest, reductions in out-of-home placements, improvements in family functioning, and reductions in mental health problems among treated youths, compared to controls.

Multidimensional Treatment Foster Care is a multisystemic (multicontextual) clinical intervention that targets teenagers with histories of chronic and severe criminal behavior as an alternative to incarceration, group or residential treatment, or hospitalization. Meta-analyses conducted by Lipsey and others demonstrate that community-based treatment is more successful than residential treatment for this population of youths. Multidimensional Treatment Foster Care implementers recruit, train, and supervise foster families to offer youths treatment and intensive supervision at home, in school, and in the community. The program also provides parent training and other services to the biological families of treated youths, helping to improve family relationships and reduce delinquency when youths return to their homes. Youths who participate in this program also receive behavior management and skill-focused therapy and a community liaison who coordinates contacts among case managers and others involved with the youths. Evaluations indicate that Multidimensional Treatment Foster Care can reduce the number of days of incarceration, overall arrest rates, drug use, and program dropout rates in treated youths versus controls during the first 12 months after completing treatment; it can also speed the placement of youths in less restrictive, community settings.

Justice System Services

Justice system approaches to preventing youth violence can be effective when they focus on providing services rather than instituting greater penalties. One promising justice system approach is wraparound services, in which comprehensive services are tailored to individual youths, as opposed to trying to fit youths into predetermined or inflexible programs. Evaluations of Wraparound Milwaukee have shown reductions in recidivism and arrests during the year following participation.

One juvenile justice system approach to preventing youth violence meets the standards described above for a Promising program: Intensive Protective Supervision Project. This intervention removes delinquent youths (status offenders) under the age of 16 from criminal justice institutions and provides them with proactive and extensive community supervision. This program has been shown to have greater deterrent effects on referrals to juvenile court than standard protective supervision does.