By Robert E. Morris, MD
Posted on June 13, 2008 – After several decades of bad news about the juvenile justice system, statistics began to show a few positive trends in the late 1990s, but many challenges still remain.
Youth murders and sexual assaults from 1975 to 2005 declined 55% and 81% respectively. Despite an overall decrease in crimes, young men in adult correctional facilities increased twofold from 1990 to 2005. Now all states can transfer teenagers to adult court where they face adult sentences, including life without parole, such that in 2000 an estimated 2,225 youth received sentences of life without parole. Often youth in adult prisons are in isolation and lack appropriate education, exercise and diets. The staff used to dealing with adult inmates may be ill equipped to manage youngsters whose developmental stage and behavior differs from adults.
Recent research in neurodevelopmental science utilizing functional magnetic resonance imaging demonstrates that adolescents’ decision-making behavior is influenced by the limbic system and amygdale (the impulsive/aggression areas of the brain). By the mid-third decade, these processes migrate to the prefrontal cortex where executive decision processes occur. As the brain develops during the adolescent period, it is plastic and subject to experiential influences including psychological trauma. Despite this strong evidence that adolescents are subject to immature decision making, new laws hold teens accountable for crimes as though they were functioning as adults.
During the same time frame, legislatures have moved to criminalize teenage sexual behavior with the premise that teen females require extra protection because they are immature and incapable of making an informed decision to engage in sexual activity. This interesting dichotomy results in treating boy’s behavior as adult while treating girls as young children. Neither approach is consistent with our understanding of adolescent behavior and developmental stages.
Despite the reductions in juvenile crime, gang involvement and offending remains a significant challenge. Gangs are found in all areas of the country—rural, suburban and urban. However, most research involves urban gangs, therefore giving the impression that it is only a city problem. The causes are similar to delinquent behavior, with most gang members engaging in delinquency before joining the gang and escalating their criminal behavior after entering a gang. Programs with a single focus such as police suppression of gangs have little long-term effect on gang violence.
Since traditional services have proved ineffective in reaching gang members, a comprehensive community-wide approach may help to decrease gang activity. This includes mobilizing existing organizations, while modifying the agencies to better address gang problems. The use of outreach workers, while increasing access to schools and economic and social opportunities, can help.
At the local health care level, practitioners who encounter injured youths in emergency departments and clinics can ask about the etiology of the injury, gang affiliation, and whether the teen thought the injury would hurt. Using motivational interviewing techniques, the health care provider can explore the youth’s interest in moving away from the gang. To successfully leave a gang, the person must believe they can leave. A beginning step involves spending less time with the gang by developing excuses for the lack of time to participate. Methods of copping out at times of high-risk activity can be developed, such as having a parent call and demand the youth return home. A pretend call can have the same effect.
Once a youth becomes involved with the juvenile justice system, the theoretical aim involves providing rehabilitation so that the youth can leave the system and become a contributing member of the community. Rehabilitation theory addresses the six major risk factors for recidivism, also known as criminogenic needs. These are, in order of importance:
1. A history of antisocial behavior/low self-control.
2. Personal attitudes, values and beliefs supportive of crime.
3. Pro-criminal associates and isolation from anticriminal others.
4. Current dysfunctional family features.
5. Callous personality factors.
6. Substance abuse.
The principles of effective interventions involve:
1. Risk: Identify those who need treatment. (Avoid involving low-risk kids, as intense services to low-risk youth tend to make them worse.)
2. Need: Target the criminogenic needs listed above and ignore personal problems such as self-esteem.
3. Responsivity: Use styles and modes that match the learning styles of the offenders. Include behavioral and social learning processes, e.g., cognitive behavior therapy.
4. Professional Discretion/Override: Adhere to ethical guidelines and professional conduct, and allow professional override in certain circumstances.
5. Program Integrity: Professional training, staff supervision, evaluation of outcomes and fidelity to the model that has been shown to be effective.
Writing in Pediatrics (March 2002), Anthony J. Petrosino advocates for an increase in good evaluations of rehabilitation programs with rigorous design, even if that means few studies. There is evidence regarding some rehabilitation programs already available that should be evaluated to help guide new approaches to improving outcomes. In addition, it is important for researchers to know how research is used by policy makers in our legislative and administrative governmental branches. Petrosino suggests building bridges to policy makers. It is especially important for legislators to avoid decision making by murder, in which ill-considered laws are passed in response to a perceived crime.
Ideally, juvenile delinquency should be prevented. Many programs have been proposed and tried, but only 8% have had repeated design and evaluation showing them to be effective. Rather, 90% of prevention programs have no evidence-based support, and 2% after evaluation were found to be useless.
Who should conduct prevention programs? The justice system’s mission is control, risk assessment and monitoring plus punishment. Involvement with the justice system (e.g., police, courts) imposes a heavy stigma. On the other hand, health and human service organizations and education departments assist youth with their needs utilizing principles of human development. Service providers tend to be mental health professionals, teachers and nurses with special training. Thus, it is most appropriate for the juvenile justice system to focus only on tertiary programs for youth already in the system.
In general, programs that begin early in a youth’s life are most effective in preventing delinquency. David Olds’ studies that provided prenatal and infancy home visits to low income unmarried mothers by trained nurses resulted in significantly few arrests, convictions and alcohol use by their teen children when followed years later. The use of lay visitors, although less expensive, does not result in similar effects. This demonstrates that only fidelity to the effective model results in the desired outcome.
Arthur Reynolds’ 15-year follow-up of an intervention providing a half day of school, beginning at age 3 or 4 and continuing to age 9, amongst low income children born in 1990 showed a higher rate of high school completion, low juvenile arrests and lower arrests for violent crimes. The results were impressive, but less impressive than Dr. Olds’ work, possibly because the intervention did not begin until later in the children’s lives.
The emphasis recently moved from punitive treatment of offenders to a more rehabilitative model. However, this is still occurring haphazardly across the country. A nationally-coordinated program that is adequately funded to compare matched programs in various juvenile corrections settings could allow us to slowly improve delinquency programs. After comparison of 2 or 3 programs, the program with the best outcome could be modified further and compared to the original program to determine if the newer program is more effective. After a number of these comparisons, significant improvement in juvenile delinquency rehabilitation will emerge.
Dr. Morris is an SCP member and Professor of Pediatrics, Department of Pediatrics. University of California at Los Angeles. Readers may contact Dr. Morris at rmorris@ucla.edu.
