Juvenile delinquents should be sentenced to bootcamp

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10

Prevention and Treatment

Toby Talbot/Associated Press

Learning Objectives

After studying this chapter, you should be able to accomplish the following objectives:

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In 1988, 7,000 youth were waived to adult court for criminal proceedings. In 1992, that number hit nearly 12,000 youth. The increase in waivers to adult court occurred in the context of the decade-long movement to get tough on crime. This get-tough movement was characterized by an increased use of punishment with the purpose of deterring crime. In real terms, these punitive measures included an increased reliance on incarceration for juveniles, a policy shift to allow younger juveniles to be transferred to adult court for a broader range of offenses, and the increased use of tougher sanctions in the community such as boot camps.

The get-tough movement was politically popular for years. As discussed in Chapter 2, the tough-on-crime agenda was popular among both political parties. For example, the Anti-Drug Abuse Act, which led to mandatory minimum sentences for drug offenders, was passed while Ronald Reagan was president. But equally punitive "three strikes and you're out" laws were passed in many states during Bill Clinton's administration.

Fast-forward to more recent times, and the stories sound more like this: "When Harry Coates campaigned for the Oklahoma State Senate in 2002, he had one approach to crime: 'Lock 'em up and throw away the key.' Now Coates is looking for that key" (Murphy, 2011). News stories throughout the country are documenting the resulting effects of the get-tough movement on state budgets. States are faced with enormous budget shortfalls that place criminal justice expenditures in the crosshairs. Many states have repealed their mandatory sentencing policies for drug use and revised their three-strikes policies. For the first time in many

Describe the philosophical shift that has occurred

in reducing juvenile delinquency.

Summarize the importance of prevention and

treatment.

Explain the principles of effective intervention.

Explain how need factors contribute to risk for

delinquent behavior.

Describe each generation of risk and need

assessment tools.

Explain the significance of responsivity factors

with regard to treatment.

Summarize the philosophy behind cognitive

behavioral programs.

Analyze the model treatment programs and why

they work.

Explain the importance of relapse prevention

techniques.

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decades, states are reducing prison populations and relying more on community-based alternatives for punishing offenders. Although economic conditions may be a primary catalyst for this shift, studies also support treatment and prevention efforts as a cost-effective way to maintain public safety.

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10.1 Introduction

Juvenile justice policy tends to change (sometimes dramatically) over time. Rehabilitation as a guiding philosophy of the juvenile justice system fell out of favor by the late 1970s. At that time, psychologist Robert Martinson (1974) examined whether youth who received treatment services had lower recidivism rates. He found that receiving treatment did not lead to significant reductions in crime. This finding led him to proclaim that "nothing works" when it came to treatment. At the same time, the public was very concerned about the rise in juvenile drug use and violent crime. Concerned as well, lawmakers began to suggest that the juvenile justice system was too soft on crime and advocated for harsher punishments (Baird & Samuels, 1996).

Nearly 25 years later, the juvenile justice system is in the midst of another philosophical shift. This time the shift is back toward rehabilitation. Why is the system moving back to what it once abandoned? Just like before, there are a variety of reasons. As mentioned in the opening story, the first reason is fiscal. In the 1980s and 1990s, states were willing to spend money to crack down on crime and send a message to would-be offenders. However, as illustrated in the accompanying Spotlight feature on criminal justice reforms taking place in Utah, many states are rethinking some of the earlier get-tough strategies (Scott-Hayward, 2009).

Spotlight: Criminal Justice Reforms: Utah

According to the Pew Center on the States (2009), corrections ranks as the second highest expenditure in the United States. With over 7 million adults under some form of correctional supervision, 1 in every 15 state general fund dollars is now spent on corrections. Between 1982 and 2002, the budget for corrections increased 255%. As a result, many states are in a financial crisis and can no longer afford to incarcerate people at the same rate.

Utah is one state that felt this crisis. In 2013, the state spent $269 million on corrections. Moreover, many of those on parole were failing at a higher rate than 10 years ago. State policymakers decided that something had to be done to reduce costs and failure rates. In 2015, the Utah Commission on Criminal and Juvenile Justice developed policy options that were based on data-driven solutions to increase public safety while simultaneously reducing the prison population. The legislation was aimed at reducing the incarceration of drug offenders, increasing community-based alternatives, and improving and expanding reentry services. According to the Utah governor, "[T]his package will enhance public safety and put the brakes on the revolving prison door. H.B. 348 will establish better treatment resources and alternatives for nonviolent offenders, ensuring our citizens get the best possible return on their tax dollars" (Pew, 2015, para. 6).

Many states are favoring lower-cost, community-based options like drug treatment and enhanced community supervision to reach better outcomes with both their adult and juvenile populations. For more on reforms in Utah and other states, see http://www.pewtrusts.org/en/about/events/2015/criminal-justice-reform-panel (https://www.pewtrusts.org/en/about/events/2015/criminal-justice-reform-panel) and http://www.pewtrusts.org/en/research-and-analysis/articles/2017/04/ podcast-the-story-behind- the-drop-in-us-incarceration (https://www.pewtrusts.org/en/research-and- analysis/articles/2017/04/podcast-the-story-behind-the-drop-in-us-incarceration) .

https://www.pewtrusts.org/en/about/events/2015/criminal-justice-reform-panel
https://www.pewtrusts.org/en/research-and-analysis/articles/2017/04/podcast-the-story-behind-the-drop-in-us-incarceration
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The shift back toward rehabilitation is also being driven by studies supporting its use. Since Martinson's "nothing works" statement, multiple studies have found that treatment services can reduce criminal behavior among juvenile offenders by as much as 30–35% (Aos, Phipps, Barnoski, & Lieb, 2000; Bonta & Andrews, 2007). In addition, Mark Lipsey (2009) examined what types of programs worked better than others. He argued that structured, intensive services focused on the youth's problems were much more effective than other programs in reducing recidivism. His research also found that services delivered in institutions (youth prisons) tended to be less effective than those in the community. Finally, Lipsey noted that there were in fact some programs that did not work. As a result, he and others began to argue that Martinson's claim of "nothing works" should have been that not all programs work. In other words, some programs are more effective than others.

We can see evidence of this shift toward rehabilitation in state and federal policy. One noteworthy example is in RECLAIM Ohio, a program designed to reduce the use of state juvenile prison beds by encouraging counties to provide services to youth in their own communities. For every youth who could have been sent to a juvenile institution but was instead kept in the community, the state of Ohio would give money to the community. The state encouraged counties to use the money to develop and pay for rehabilitation programs. The initiative has been successful at reducing recidivism rates and is considered a more cost-effective option than prison (Latessa, Turner, Moon, & Applegate, 1998).

Another example of a rehabilitation-based policy is the passage of the Second Chance Act in 2007. This federal initiative applies to both adults and juveniles and is designed to provide services to those reentering the community. Services include aftercare programs for inmates who completed an inpatient mental health and/or substance abuse program and family-based services that focus on comprehensive treatment for the entire family. The initiative also includes a mentoring program that pairs juveniles with a mentor while they are incarcerated. That mentor continues to work with the juvenile as he or she transitions back into the community and provides mentoring and support for several months after the juvenile's release. The reentry phase back into the community is often a difficult one for youth, and this initiative is designed to provide an added safety net. The Second Chance Act is part of a larger reentry treatment movement. For more information, see https://csgjusticecenter.org/nrrc/projects/second-chance-act/ (https://csgjusticecenter.org/nrrc/projects/second-chance-act/) .

A third policy initiative that has gained popularity is the Justice Reinvestment Initiative (JRI). Launched in 2006, the JRI is based on the premise that we can reinvest criminal justice dollars into what has been shown to work in reducing recidivism. The Bureau of Justice Statistics and the Pew Center on the States have provided resources and tools to states to guide them through a four-step process to increase the effectiveness of their criminal justice systems. The four-stage process includes (a) analyzing data to understand factors driving jail and prison population growth; (b) developing and implementing policy options to generate savings and increase public safety; (c) reinvesting in select, high-risk communities and measuring the impact of policy changes and reinvestment resources; and (d) enhancing the accountability of criminal justice system actors and policies.

Each of these policy initiatives uses evidence-based strategies to effectively treat and prevent crime.

https://csgjusticecenter.org/nrrc/projects/second-chance-act/
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10.2 What Is Treatment and Prevention?

What exactly is treatment for juveniles? Treatment refers to a set of actions or services designed to rehabilitate or change an individual. Treatment for juvenile offenders can include a range of activities such as group therapy, individual sessions, school-based interventions, and/or community mentoring programs. Treatment services can occur in homes, prisons, or schools, or in various agencies in the community. Treatment services can also act as prevention programs. Prevention programs are designed to avert a situation or prevent one from worsening. For example, teaching juveniles the importance of avoiding drugs and alcohol is intended to prevent youth from experimenting with them. However, prevention strategies may also be implemented after a youth has committed a crime in an effort to reduce the youth's likelihood of committing another crime or a worse crime. For example, teaching youth about the consequences of drug use could be beneficial to those who may have already experimented with drugs. In this case, the program's goal would be to stop the youth's use from escalating. In this context, prevention can be both proactive and reactive.

Prevention programs are often categorized into three levels based on who or what is being targeted. For example, the first level attempts to prevent delinquency from occurring at all, the second level attempts to intervene early in the youth's involvement in delinquency, and the third level attempts to stop the youth from escalating in his or her delinquent career. The three prevention levels are labeled primary prevention, secondary prevention, and tertiary prevention. Let's take a look at them in more detail.

Primary prevention programs focus on the conditions that could lead to delinquent behavior such as truancy, poor parenting, and prenatal exposure to toxins. These types of approaches target at-risk juveniles and may include after-school programs to keep youth busy or a truancy reduction program to keep youth in school. Another example might include wellness campaigns around prenatal care for mothers. The prenatal care would include educating new mothers on the dangers of smoking, drinking, or using drugs during pregnancy. These types of programs act as barriers to protect against or prevent delinquency.

Secondary prevention programs shift the focus of services to the delinquent youth and address the delinquent behavior at its earliest stages. By intervening early with youth, these programs attempt to slow or stop their potential progression into crime. These types of programs may include diversion programs and mentoring programs such as Big Brothers Big Sisters. A big brother or sister can help the youth get back on the right track by providing support and encouragement to stay in school and avoid drugs and alcohol.

The third level, tertiary prevention, is focused on reducing recidivism among those who are already in the juvenile justice system. In that sense, these programs are more reactive approaches. The prevention efforts focus on limiting the problems and issues faced by the youth. Treatment programs for anger management, addictions, family functioning, and relapse prevention are examples of services designed for youth who have a high probability of continuing their delinquent behavior.

As the preceding discussion illustrates, there are various treatment and prevention programs for juveniles. One potential problem facing the juvenile justice system is figuring out which program, policy, or strategy to choose. Not all programs are created equal, and it is difficult to decide who needs what services and for how long. Researchers have found that some programs are more effective than others, but questions still remain. For example, does every juvenile who has been arrested need treatment? Should all juveniles receive the same treatment services? Should all juveniles participate in prevention programs, and if so, where? Are the services worth the taxpayer costs? Should we mandate prevention for school-aged children or for their

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parents?

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Small Successes

Small successes achieved while incarcerated builds youth's confidence.

1. Why is it important to celebrate successes? 2. What kinds of interventions would you recommend

for girls who are pregnant while institutionalized?

10.3 Evidence-Based Treatment: The Principles of Effective Intervention

When it comes to rehabilitation, no one-size-fits-all approach is likely to solve every problem facing juveniles. The challenge to rehabilitate juvenile delinquents can be daunting if we consider all the different problems they could be facing: poverty, failing schools, family conflict, addictions to drugs or alcohol. We do know, however, that some approaches seem to work better than others. As a result, for the past few decades, juvenile justice treatment reforms have shifted to what is commonly referred to as a "what works" or "best practices" model.

Juvenile justice agencies and treatment programs are often required to show that they are using strategies or programs that have been proven to be effective with juveniles. The reason for this is twofold: (a) funding agencies need to make sure they are getting the most for their money, and (b) studies have found that if programs follow certain principles or strategies they are more likely to see reductions in recidivism (Manchak & Cullen, 2015). For example, the Florida Department of Juvenile Justice has embarked on a "what works" initiative that is a comprehensive program improvement project to increase the effectiveness of juvenile justice services throughout the state. The department is attempting to incorporate only empirically supported treatment models and techniques. In particular, the state requires thorough training and pilot testing of curricula and assessment instruments (Chapman, 2005).

In an effort to identify strategies that were effective in reducing recidivism, researcher Paul Gendreau (1996) developed the principles of effective intervention. These principles are recommended strategies and practices that characterize effective programs. The principles are based on his experiences working with offenders in prison and on research by others in the field. On the surface, these principles are not groundbreaking. However, they were considered fairly radical for a field that was entrenched in the get-tough movement that focused primarily on increased use of punishment. The following is a list of the core principles:

Match treatment services to the offender's risks and needs.

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In this 2007 photo, supporters of Martin Lee Anderson, foreground, listen at the trial of eight former boot camp employees from the Bay County, Florida, Sheriff's Office. The former guards and nurse were on trial for Anderson's death.

Terry Barner/Associated Press

Use treatment models that are behavioral and cognitive behavioral in nature. Develop a range of rewards and consequences for behavior. Provide relapse prevention strategies.

Gendreau also identified programs that did not work. Many of the programs that he identified as ineffective were deterrence-based programs commonly used during the get-tough movement. Deterrence-based programs use severe punishments with the goal of scaring youth from coming back into the system. In other words, the hope was that youth would avoid crime in the future in order to avoid a punitive sanction. Popular deterrence-based programs used during this time included chain gangs, boot camps, and Scared Straight programs. Research found that youth who went through these types of programs still had high recidivism rates (Wilson & Lipsey, 2000). Further, as seen in the accompanying Spotlight feature, boot camps had even greater problems, as several youth died while participating. In general, it was argued that these strategies were not effective because they did little to identify the causes of crime or to teach youth how to act differently once released back into their communities.

Spotlight: Boot Camps: What Went Wrong?

Martin Lee Anderson was a Florida teenager sentenced to the Bay County juvenile boot camp for trespassing. He died on January 6, 2006, after guards repeatedly beat him while restrained. Anthony Hayes, a 14-year-old from Arizona, was sent to a boot camp for a charge of shoplifting. He died July 2001 after being required to spend several hours standing outside in 112-degree heat. Gina Score, a 14-year-old South Dakota girl sent to a boot camp for shoplifting, died of heatstroke when she collapsed after a run and lay unattended for three hours. In every case, staff members were charged in connection with the deaths. What is most-striking is that in each case staff members were accused of either using excessive force or failing to attend to the youth while they were in a medical crisis.

Developed for juvenile offenders in the early 1980s, the boot camp model was popular politically. Modeled after the military, boot camps for juvenile offenders were designed to use rigorous, physically demanding activities to develop discipline and respect for authority. Boot camps typically employed staff who would act as drill sergeants teaching the youth the benefits of working hard, not quitting an activity, and showing deference to adults. The idea was that the boot camp would break the youth down in an effort to change their destructive and disrespectful behavior. The public and policymakers liked the idea of tough love, and by 1995 most states were operating boot camps.

Although some boot camps still exist, most were eventually closed. Many of the closures came after

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the deaths and stories of abuse, which were widely publicized by the media. However, their closure was also due to the growing number of findings that, with a few exceptions, boot camps were not effective in reducing recidivism (Parent, 2003).

Various reasons have been offered as to why boot camps were unable to achieve their stated goals. First, some argued that boot camps did not focus on the issues that brought the youth to the camp. By relying only on coercive physical punishment, the camps failed to address key issues facing youth within their families, schools, and communities. This is also one of the reasons wilderness type programs (covered in Chapter 8) lacked effectiveness. Second, in the traditional military model, participants are sent to military training after they complete the boot camp. As part of their training they are given housing, meals, and support. Juvenile boot camp participants were simply sent home to the same environment after they completed their boot camp training. Finally, some argued that teens felt boot camps were inherently unfair and cruel and reported feeling defiance and anger toward guards. Ironically, this hostility toward authority was exactly what the boot camp guards were trying to eradicate (Robinson, 2001).

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10.4 Risk and Need Factors

Youth are considered "at risk" for delinquency if they are exposed to certain environments or have certain personal traits. These high-risk environments can exist in youth's communities, schools, and families. These environments and traits are often referred to as criminogenic needs. Criminogenic needs are known correlates of delinquency and include associating with high-risk peers, experiencing family dysfunction, substance use, impulsivity, and poor school achievement (Andrews & Bonta, 2010). The more criminogenic needs the person has, the greater risk the person has for delinquency. The criminal justice system uses the word risk to refer to the probability that someone will recidivate. A high-risk person has a high probability of delinquency in the future. Take the example of associating with delinquent peers. This puts a youth at risk for delinquency because our close friends have a big impact on our behavior in terms of the modeling they provide as well as peer pressure. Fortunately, once these needs are identified, criminal justice practitioners can intervene to reduce them (e.g., creating opportunities for youth to associate with positive peers).

Let's think about this using a medical example: When a doctor is visited by a patient who is concerned about the potential for heart disease, the doctor will discuss risk factors for the disease. Those risk factors include gender, age, family history, cholesterol level, weight, whether the person smokes, physical activity, and so on. An older male with a history of heart disease in his family, who has high cholesterol, gets limited physical activity, is overweight, and smokes is at a higher risk for heart disease. Risk factors for delinquency work the same way. The risk factors for delinquency were not picked at random. Research studies have established that these factors are correlated with crime (Andrews & Bonta, 2010).

The more risks or problems individuals experience, the more likely they are to engage in criminal behavior. Not everyone has the same number of risk factors. For some, school achievement may be the only problem area and otherwise they are doing well. In that circumstance, a probation officer may conclude that the juvenile is at low risk for future criminal behavior. In contrast, a youth who is having difficulty in school and/or with his or her parents, who is addicted to drugs, and who chooses to associate with other delinquent peers is at a higher risk of delinquency. Determining which factors are important for each person requires that the probation officer conduct a risk assessment. The assessment of risk is typically based on a classification tool.

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Probation officers evaluate the personalities and lifestyles of juveniles in hopes of assessing the risks of criminal behavior.

Bill Haber/Associated Press

10.5 Classification and Assessment

Classifying juveniles into groups is a common practice in the criminal justice system. Juveniles are grouped based on characteristics such as age, gender, suicide risk, addiction severity, and so on. In general, an assessment is a tool that evaluates how likely a youth might be to engage in criminal behavior. An assessment of a youth's risk for criminal behavior may include an evaluation of his or her needs (e.g., peers, personality, and lifestyle factors). Assessing a youth's risk for future criminal behavior often uses what is referred to as a risk and need assessment tool.

Before we discuss some of the more popular risk and need assessment tools, it is important to understand the history behind assessment for juveniles. The history of assessment is often discussed in the context of generations or phases (Andrews, Bonta, & Wormith, 2006).

First-Generation Assessment Tools

First-generation assessment tools are not actually tools but are unstructured "gut-level" assessments of an individual's risks and needs. An example of this type of assessment would be a meeting that might happen between a probation officer and his or her client. The interaction might sound something like this:

Probation Officer (P.O.): Why do you think you got into trouble this time?

Client: I keep hanging around with this buddy of mine, and we always just seem to get into trouble.

P.O.: Don't you think you should stop hanging around with this friend of yours?

Client: Yeah, I will see what I can do. I don't know, though, we are pretty tight.

P.O.: Are you in school?

Client: I try to go when I can.

P.O.: You are going to have to go to school to do well on supervision.

Client: OK. I will see what I can do.

P.O.: OK. I will see you next time, and I expect to hear that you have been attending school.

Based on this abbreviated interaction, the probation officer might assign a risk level to the youth. The probation officer might conclude that the youth is at moderate risk for future criminal behavior because the youth is associating with other delinquents and is truant from school. But this "assessment" of risk will be based on the probation officer's intuition or gut-level reasoning about the youth's probability for future

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criminal behavior. The assessment is not guided by an actual paper-and-pencil assessment tool. The disadvantage of this approach is that gut-level intuition or unguided clinical judgment tends to be inaccurate and provides an incomplete picture of the important risk factors for delinquency (Grove, Zald, Lebow, Snitz, & Nelson, 2000). First-generation assessments are often inaccurate due to bias. For example, let's assume for a moment that a probation officer believes that most juvenile delinquents get into trouble because they have parents who do a poor job with discipline. When that same probation officer interviews a youth, the probation officer would likely spend more time questioning the youth about family interactions and discipline styles than other risk factors (e.g., looking at the youth's peers). It is natural for people to bring personal biases into their interactions with others; however, these biases can lead some people to overlook certain aspects of a youth's life that might be important.

Second-Generation Assessment Tools

Second-generation assessment tools are structured questionnaires that guide the interview process. The tools also assign a value to each risk factor. For example, a youth with a violent prior record would receive more points than a youth with a nonviolent record. Second-generation assessments remove the bias by assigning points and providing an overall risk score. The problem with second-generation tools is that they focus primarily on historical factors. These historical factors are also referred to as static risk factors. A static risk factor is a circumstance in a youth's life that cannot be changed because it happened in the past. For example, if a youth has a long prior record, a history of substance abuse, and a history of violence, a second-generation tool would likely tell us that the youth is at high risk for future criminal behavior. However, the risk factors are all static because they happened in the past. Relying on historical factors misses some of the other problems the youth faces and does not provide a clear path for treatment. These disadvantages led to the development of third-generation assessment tools.

Third-Generation Assessment Tools

The third-generation assessment tools became popular in the late 1980s. Third-generation assessment tools combine both static and dynamic factors to give a broader portrait of the likelihood that a youth will commit a crime in the future. Dynamic risk factors, also referred to as criminogenic needs (described earlier), are important risk factors in the individual's life that can be changed. An example of this type of tool is the Youth Assessment and Screening Instrument (YASI). The YASI covers a number of dynamic and static risk factors such as criminal history, education, family relationships, peers, substance use, and antisocial attitudes. The tool also provides an overall risk score from no risk to high risk. The third-generation tools give the therapist an idea of what areas to work on in treatment but do not emphasize the need to reassess youth as they progress through treatment.

Fourth-Generation Assessment Tools

Fourth-generation assessment tools are now considered a best practice in the field. Like their predecessors, the fourth-generation tools build on the benefits of the third generation by targeting both static and dynamic risk factors. In addition, the fourth-generation assessment tools are designed to take the juvenile's treatment plan from intake to case closure. Reassessment is key to the process of treatment, because it helps determine

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whether a program had an impact on an offender's risk and it guides changes in the treatment or case plan. An example of a fourth-generation tool is the Youthful Level of Service/Case Management Inventory (YLS/CMI) (Hoge, Andrews, & Leschied, 2002). The YLS/CMI asks questions about eight areas in a youth's life including prior record, family, school, peers, substance abuse, leisure/recreation, personality, and attitudes. The tool provides a risk score in each of the eight areas and an overall risk score. The tool also has a section where the assessor can provide a reassessment score. The developers encourage reassessment every 6–12 months depending on the amount of time the youth spends under supervision.

Another recently developed fourth-generation assessment tool is called the Ohio Youth Assessment System (OYAS). The OYAS was developed by Edward Latessa and associates at the University of Cincinnati. The assessment contains five separate tools that can be used as standalone tools or as a set, depending on the juvenile's case plan. The instrument covers all of the major risk factors including history; family and living arrangements; peers; education and employment; prosocial skills; substance abuse; mental health and personality; and values, beliefs, and attitudes. Each of the sections contains risk factors that are scored in a 0 (no problem) or 1 (evidence of a problem) format. The items are then summed to provide an overall risk score. The summary results provide caseworkers with a graphic illustration of the risk factors as well as the youth's overall risk. The risk factor information should be used for case planning and treatment assignment (Latessa, Lovins, & Ostrowski, 2009).

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Every Student Has a Story

Every student comes to the table with a different set of issues requiring a different set of solutions.

1. Why is it important to recognize that every student has a story?

2. Do you have any additional suggestions for how to handle resistance other than what was mentioned in the video?

10.6 Responsivity Factors

Even when appropriately assessed and placed in treatment, some youth seem to do better than others. Sometimes other issues influence the success of treatment. These issues, referred to as responsivity factors, are not risk factors for delinquency, but they are barriers to treatment (Palmer, 1974). Responsivity factors are characteristics of the person or the person's environment that may act as obstacles to treatment and/or supervision. The barriers can include personal or internal factors and environmental or external factors. Internal or personal barriers can include factors such as motivation, personality, and intelligence. Intelligence may act as a barrier to treatment if the topic presented in a treatment group is too difficult to understand. For example, if a therapist is trying to teach a client how to be more empathetic, the therapist might say, "Try to put yourself in someone else's shoes, and think about how he or she would feel." A client with a lower IQ might have a difficult time with this concept, because imagining what others might be thinking or feeling requires a fairly high level of cognitive functioning.

Factors in the environment, or external factors, could impact treatment as well. External factors can include how well the therapist and client get along, whether the treatment happens in an institution or in the home, and even something simple like transportation. Youth who have difficulty finding transportation to the treatment agency may not do well simply because they are unable to attend. All of these factors can be important and impact treatment, but one responsivity factor that has received a considerable amount of attention is a client's motivation to change.

Motivation to Change

It was once thought that if individuals were not motivated to change their behavior, then little could be done

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In the first stage of change, precontemplation, individuals aren't trying to change problem behaviors.

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to help. People would often talk about how addicts needed to hit "rock bottom" before they were ready to engage in treatment. Although it is now understood that coerced or involuntary treatment can work even if someone is not motivated at the outset (Anglin & Hser, 1990), corrections professionals cannot ignore resistance; rather they need a plan in place to diminish it over time.

We can think of motivation as existing on a continuum with people who are not motivated on one end and people who are highly motivated on the other. In the 1980s, two researchers developed categories to capture the different levels of motivation people progress through when deciding whether to change their behavior. They referred to these levels as the stages of change (Prochaska & DiClemente, 1983). In the first stage, referred to as precontemplation, individuals are not actively seeking to change their behaviors. They may be unaware that the behavior needs to be changed or simply do not see their "problem" as something to be addressed. An example would be juveniles who do not see that their marijuana use is causing a problem in their lives. The belief may exist even in the presence of evidence that the drug use is having a negative impact on school, family relations, peers, and so forth.

In the second stage, contemplation, the youth may understand that the problem exists but has yet to commit to change. In the marijuana use example, the youth may recognize that the marijuana use is causing problems with school in terms of both attendance and performance, but still wants to get high and is not committed to stopping. In the third stage, preparation, the youth may begin taking steps that will lead to change but is not fully committed to implementing the behavior. In this stage, individuals may decide that change is needed and begin to think about other activities that would help keep them busy during the times that drug use typically occurs (e.g., after school, on weekends).

In the fourth stage, action, the youth commits to change and begins to modify the behavior in question. In this stage, the youth would stop the use of marijuana. The final stage, maintenance, is when the youth develops clear steps to maintain the behavioral change. The maintenance stage would include relapse prevention strategies such as avoiding high-risk situations and friends that could trigger a lapse.

Approaches to Motivational Issues

Several tools and approaches are used to assess the issue of motivation to change. For example, the Motivation to Change Inventory for Adolescents (Bauman, Merta, & Steiner, 2001) measures motivation to engage in substance abuse treatment. As part of this process, the scale examines issues such as social support, self-efficacy, and life skills.

Another popular approach to measuring and addressing motivational issues is called motivational interviewing (Miller & Rollnick, 2004). Motivational interviewing is an interview-based technique designed to reduce an individual's resistance to engaging in treatment. The therapist would work to have the youth

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understand why the behavior in question needs to be changed. For example, if the youth does not want to stop using marijuana, the therapist can discuss the reasoning behind the youth's resistance and the impact drug use is having. By helping the youth see the problems that marijuana use is creating, the theory is that the person will see the benefits of changing the behavior. Techniques used in motivational interviewing include being nonconfrontational, rolling with resistance, and supporting the client's self-efficacy. Proponents of this approach suggest that by working with rather than coercing clients, the likelihood of increasing intentions to change is greater and longer lasting (Li, Zhu, Tse, Tse, & Wong, 2018; Miller & Rollnick, 2004).

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10.7 Treatment Services

Once an individual's risk, need, and responsivity factors have been assessed, the next stage is to begin treatment. As mentioned earlier, the principles of effective intervention outline certain features of effective programs but stop short of recommending particular groups or programs. That said, there are many existing programs and services that can be effective, particularly if they are implemented well and for a reasonable length of time. Some of the more popular approaches are based on cognitive and social learning theories.

Studies find that clients who exhibit antisocial logic and have poor problem-solving and coping skills are more likely to be involved in delinquency. Put another way, people who believe it is acceptable to commit crime by justifying and minimizing their criminal behavior are more likely to engage in that behavior (Cullen & Gendreau, 2000). Cognitive behavioral therapy is a type of treatment approach focusing primarily on the way people think and subsequently how they behave. Cognitive behavioral therapists try to teach clients that how they think about situations tends to influence how they act in those situations. In other words, if a youth believes that the police cannot be trusted, every interaction the youth has with the police will be influenced by this belief. That belief itself often has a greater influence over the interaction with the officer than the interaction itself. Two main types of therapy fall under the umbrella of cognitive behavioral programming: cognitive restructuring and cognitive skill.

Cognitive restructuring therapy attempts to change antisocial cognitive beliefs or thoughts. This therapy is based on the idea that people react as a result of how a situation is processed cognitively. When those cognitions are distorted (also popularly referred to as thinking errors), the reaction is often negative. For example, a juvenile delinquent may blame others or minimize the role smoking marijuana played in a criminal act. The youth may feel that marijuana should be legal and uses that belief to justify the drug use. The aim of cognitive restructuring therapy is to teach people to recognize the situation, address how they perceive that situation, and as a result change the outcome or the response.

Cognitive skills therapy, while similar, is intended to develop a set of skills individuals can use when confronted with a problem or high-risk situation. For example, cognitive skills therapy may involve increasing problem-solving or social skills, or teaching someone how to use a coping skill such as self-talk. When people feel angry or frustrated, they may calm down by telling themselves that everything will turn out fine. For example, Donald Meichenbaum (1977) explored anger management techniques with juveniles and found that a commonly used technique such as saying "Check yourself" worked to reduce anger responses. That is, if a juvenile is feeling angry or is exhibiting angry behavior, the counselor would say, "Check yourself," and that would signal the youth to deal with those emotions differently. Programs based on cognitive restructuring and cognitive skills have been found to be very effective in reducing recidivism (Cullen & Gendreau, 2000).

Cognitive behavioral therapies can be run in a variety of settings and can be guided by a number of different curricula. Notable approaches include Albert Ellis's rational emotive behavior therapy (Ellis & MacLaren, 1998) and Stanton Samenow's (1998) Commitment to Change. The curricula allow clients to see the connection between attitudes and behavior and attempt to teach clients how to manage their own emotions when they encounter difficult situations. Thinking for a Change (T4C) is a popular cognitive behavioral curriculum that is discussed in the accompanying Spotlight feature. T4C, developed by the National Institute of Corrections, is used with both juveniles and adults.