Managing High Risk Young Persons in

Social Welfare Institutions

MultifunCMultifunctional Treatment in Residential and Community

SettingsDevelopmental Project in

Norway and Sweden

1.1. Review of the research on residential Review of the research on residential treatment of antisocial behaviour in juveniles treatment of antisocial behaviour in juveniles (2001-2002). (2001-2002).

2.2. Development of a residential treatment Development of a residential treatment program based on the research (2003-2004).program based on the research (2003-2004).

3.3. Implementing the treatment program – Implementing the treatment program – MultifunC - in Norway (six units) and in - in Norway (six units) and in Sweden (three units) (2005-2007).Sweden (three units) (2005-2007).

4.4. Evaluation of the program (2008-10?)Evaluation of the program (2008-10?)

1.1. Review of the research on residential Review of the research on residential treatment of antisocial behaviour in juveniles treatment of antisocial behaviour in juveniles (2001-2002). (2001-2002).

2.2. Development of a residential treatment Development of a residential treatment program based on the research (2003-2004).program based on the research (2003-2004).

3.3. Implementing the treatment program – Implementing the treatment program – MultifunC - in Norway (six units) and in - in Norway (six units) and in Sweden (three units) (2005-2007).Sweden (three units) (2005-2007).

4.4. Evaluation of the program (2008-10?)Evaluation of the program (2008-10?)

MultifunC is based on research on predictors of MultifunC is based on research on predictors of antisocial behaviour (risk factors), on the antisocial behaviour (risk factors), on the ”Principles of Effective Intervention” – Risk, Need and Responsivity and and ”The Psychology of Criminal Conduct” which is a which is a teorethical explanation for criminal behaviour, teorethical explanation for criminal behaviour, and the change of this (Andrews, Gendreau, and the change of this (Andrews, Gendreau, Cullen and Bonta, 1990, 2006).Cullen and Bonta, 1990, 2006).

The principles are supported by several meta-The principles are supported by several meta-analysis (analysis (Andrews og Dowden, 2000; Lipsey og Wilson, 1998; Tong og Farrington, 2006; Lowenkamp and Latessa, 2006; Lipsey, 2007, and other).

MultifunC is based on research on predictors of MultifunC is based on research on predictors of antisocial behaviour (risk factors), on the antisocial behaviour (risk factors), on the ”Principles of Effective Intervention” – Risk, Need and Responsivity and and ”The Psychology of Criminal Conduct” which is a which is a teorethical explanation for criminal behaviour, teorethical explanation for criminal behaviour, and the change of this (Andrews, Gendreau, and the change of this (Andrews, Gendreau, Cullen and Bonta, 1990, 2006).Cullen and Bonta, 1990, 2006).

The principles are supported by several meta-The principles are supported by several meta-analysis (analysis (Andrews og Dowden, 2000; Lipsey og Wilson, 1998; Tong og Farrington, 2006; Lowenkamp and Latessa, 2006; Lipsey, 2007, and other).

Risk Principle: Intensivity of intervention should match individual risk level. Target high-risk offenders

Risk Principle: Intensivity of intervention should match individual risk level. Target high-risk offenders

Need Principle: Targets of interventions should be known dynamic risk factors (criminogenic needs).

Need Principle: Targets of interventions should be known dynamic risk factors (criminogenic needs).

Responsivity Principle: The intervention should bematched to the individual learning style. Use methods based oncognitive behaviour and social learning theory

Responsivity Principle: The intervention should bematched to the individual learning style. Use methods based oncognitive behaviour and social learning theory

History of antisocial behaviour

Antisocial personality pattern

Antisocial cognition

The

“Big

Fou

r”

Ri

sk F

acto

rs

Antisocial associates

Family and/or marital

School and/or work

Leisure and/or recreation

The

“Cen

tral E

ight

” Risk

Fac

tors

Substance abuse

Major Risk Factors

Effects for low risk Effects for high risk

Matched with the same risk level in interventions outside institutions

Factor Risk Dynamic Need

History of Antisocial Early & continued Build noncriminal Behavior involvement in a number alternative behaviors

antisocial acts in risky situations

Antisocial personality Adventurous, pleasure Build problem-solving, self-seeking, weak self management,

anger mgt &control, restlessly coping skillsaggressive

Antisocial cognition Attitudes, values, beliefs Reduce antisocial cognition,

& rationalizations recognize risky thinking &

supportive of crime, feelings, build up alternative

cognitive emotional states less risky thinking & feelings

of anger, resentment, & Adopt a reform and/or

defiance anticriminal identity

Antisocial associates Close association with Reduce association w/ criminals & relative criminals, enhance isolation association w/

prosocial peoplefrom prosocial people

Adopted from Andrews, D.A. et al, (2006). The Recent Past and Near Future of Risk and/or Need Assessment. Crime and Delinquency, 52 (1).

Factor Risk Dynamic Need

Family and/or marital Key elements are Reduce conflict, build caring, better positive relationships,

monitoring and/or communication, enhance supervision monitoring & supervision

School and/or work Low levels of performance Enhance performance,

& satisfaction rewards, & satisfaction

Leisure and/or recreation Low levels of involvement Enhancement involvement

& satisfaction in anti- & satisfaction in prosocialcriminal leisure activities activities

Substance Abuse Abuse of alcohol and/or Reduce SA, reduce the drugs personal & interpersonal

supports for SA behavior,enhance alternatives to SA

Adopted from Andrews, D.A. et al, (2006). The Recent Past and Near Future of Risk and/or Need Assessment. Crime and Delinquency, 52 (1).

The most effective interventions are behavioral

1. Focus on current factors that influence behavior2. Action oriented3. Offender behaviors are appropriately reinforced

The most effective behavioral models are

1. Social learning—practice new skills and behaviors

2. Cognitive behavioral approaches that target criminogenic needs

Slide 9

Structure and support (Gold and Osgood, Structure and support (Gold and Osgood, 1992; Brown et al, 1998), control and 1992; Brown et al, 1998), control and autonomy (Sinclair and Gibbs, 1998), peer autonomy (Sinclair and Gibbs, 1998), peer culture (Dodge, Dishion and Lansford, 2006), culture (Dodge, Dishion and Lansford, 2006), re-integration and aftercare, (re-integration and aftercare, (Altschüler, 2005; Liddle , 2002), fidelity..............………………fidelity..............………………

Liddle, 2002: Residential treatment needs to be understood as part of a continuum of services. The quality of the post-treatment environment--particularly relationships with family and non-criminal friends and involvement in school and pro-social activities--are critical predictors of recovery.

In addition to the work of the reaserchers from Carleton University,In addition to the work of the reaserchers from Carleton University,MultifunC is based on research on several other topics thatMultifunC is based on research on several other topics that

are important in residential treatment;are important in residential treatment;

In addition to the work of the reaserchers from Carleton University,In addition to the work of the reaserchers from Carleton University,MultifunC is based on research on several other topics thatMultifunC is based on research on several other topics that

are important in residential treatment;are important in residential treatment;

Influence of antisocial peers and antisocial peer cultures are important risk factors.

In residential settings an unintended consequence might be that the group might contribute to the development and maintenance of antisocial behaviour, and then to iatrogenic effects of the treatment (Dodge, Dishion and Lansford, 2006).

The risk of negative influence from antisocial peers implies that the period of time used in residential setting should be as short as possibly, and should be linked to community services.

Target high risk juveniles:

► Adress both individual and contextual factors (criminogenic needs) including cognition, attitudes, education, peer associations, and family issues

► Are able to manage serious negatively behaviour (violence)

► Enhance intrinsic motivation through use of constructive communication, such as motivational interviewing

► Balance between control and autonomy ► Balance between structur and support► Systematic and structured training in social skills► Use cognitive behavioural techniques► Training in school or work► Are linked to community and help establish prosocial

contacts► Includes aftercare as an integrated part of the

intervention► Measures performance and use this information for

continuous improvement (quality assurance)

Small units (8 juveniles in each unit)

Open institutions (non-secure). This does not mean that they are free to go………..

Located close to community services (school, leisure/recreation activities and communication /transport)

Makes it possibly to establish prosocial contacts, to be in

local schools, training in new skills in natural settings, and to maintain contact with family.

Juveniles with serious behaviour problems Juveniles with serious behaviour problems (crime, substance abuse, violence, etc.).(crime, substance abuse, violence, etc.).

High risk for future criminal behaviour High risk for future criminal behaviour (high total sum of risk factors – static and (high total sum of risk factors – static and dynamic)dynamic)

Before placement the behaviour is assessed Before placement the behaviour is assessed with Achenbach’s check lists (CBCL),with Achenbach’s check lists (CBCL), and the and the Risk level is Risk level is assessed with the risk inventory assessed with the risk inventory Youth Level of Service/Case Management Youth Level of Service/Case Management Inventory (YLS/CMI)Inventory (YLS/CMI)

Juveniles with serious behaviour problems Juveniles with serious behaviour problems (crime, substance abuse, violence, etc.).(crime, substance abuse, violence, etc.).

High risk for future criminal behaviour High risk for future criminal behaviour (high total sum of risk factors – static and (high total sum of risk factors – static and dynamic)dynamic)

Before placement the behaviour is assessed Before placement the behaviour is assessed with Achenbach’s check lists (CBCL),with Achenbach’s check lists (CBCL), and the and the Risk level is Risk level is assessed with the risk inventory assessed with the risk inventory Youth Level of Service/Case Management Youth Level of Service/Case Management Inventory (YLS/CMI)Inventory (YLS/CMI)

Static riskfactors

Static riskfactors

Dynamic riskfactors

Dynamic riskfactors

Responcivity / personality-factors

Responcivity / personality-factors

Target groupTarget group

Treatment-targets and -plans

Treatment-targets and -plans

Treatment methods and targets

Treatment methods and targets

Behaviour and Risk-assessment

Behaviour and Risk-assessment

Treatment

Targets

Treatment

Targets

•Behaviour

•Skills

•Attitudes

•Behaviour

•Skills

•Attitudes

Family

•Parental skills

•Communication

•Decrease antisocial

•Increase prosocial

•Decrease antisocial

•Increase prosocial

•Attendance

•Skills

•Behaviour

•Attendance

•Skills

•Behaviour

Peers

SchoolJuvenile

Residential / institution

Transition Reintegration / aftercareTreatment

JuvenileJuvenile

SchoolSchool

PeersPeers

FamilyFamily

Community

Focus of

treatment

Inntake

Motivation Motivation Prepare Family

Assesment Focused Treatment re-entry support

Structure Treatment climate

Motivation Motivation Prepare Family

Assesment Focused Treatment re-entry support

Structure Treatment climate

Duration of residential stay: Duration of aftercare:

about 6 months (not fixed) about 4-5 months (not fixed)

For each juvenile there will be Treatment teams across all teams including one or several staff from each team.

LeaderLeader

Assessment

and

Planning team

Assessment

and

Planning team

Mileau therapy

-team

Mileau therapy

-team

Educational/

Pedagogical

team

Educational/

Pedagogical

team

Family- and

follow up team

Family- and

follow up team

The treatment mileau:Control where this is neccesary, but no unneccessary control Involvement of the juveniles wherever this is possiblyStructure, but not unneccessary structurePrinciples from ”Core correctional practice” - staff behaviour

Interventions with focus on individual juveniles:Motivating for change (based on Motivational Interviewing)Behavioural analysis and/or MST’s fit-cirkelContingency Management Systems/Tocen economy and

Behavioural contractsAggression Replacement Training (ART)Weekly treatment goals and evaluation of progress

(intesivity)

The treatment mileau:Control where this is neccesary, but no unneccessary control Involvement of the juveniles wherever this is possiblyStructure, but not unneccessary structurePrinciples from ”Core correctional practice” - staff behaviour

Interventions with focus on individual juveniles:Motivating for change (based on Motivational Interviewing)Behavioural analysis and/or MST’s fit-cirkelContingency Management Systems/Tocen economy and

Behavioural contractsAggression Replacement Training (ART)Weekly treatment goals and evaluation of progress

(intesivity)

Tocen economy and Motivational Interviewing motivates for change. The basis for actual change is new skills which makes changes possibly.

Aggression Replacement Training (ART) consists of a multimodal intervention design that combines: Training in control of aggression

(ACT), Training of social skills, andLearning of moral thinking

(Goldstein og Glick, 1994).

Promote prosocial influence (contact with prosocial peers outside the institution – school and leisure)

Moderate antisocial influence (decrease contact with antisocial juveniles outside the institution and antisocial communication among juveniles within the institution)

Increase participation in school and performance in school situation (support to the juveniles and the school).

Increase parental function and family processes (training of parents in the institution and during the juveniles home-visits).

FocusFocusIncreasing family Increasing family

affection/communication affection/communication

Increasing monitoring/supervision skillsIncreasing monitoring/supervision skills

Methods:Methods:Principles from Parental Management Principles from Parental Management

Training (PMT) during the residential Training (PMT) during the residential staystay

Principles from Multisystemic Therapy Principles from Multisystemic Therapy (MST) during leaves and aftercare(MST) during leaves and aftercare

FocusFocusIncreasing family Increasing family

affection/communication affection/communication

Increasing monitoring/supervision skillsIncreasing monitoring/supervision skills

Methods:Methods:Principles from Parental Management Principles from Parental Management

Training (PMT) during the residential Training (PMT) during the residential staystay

Principles from Multisystemic Therapy Principles from Multisystemic Therapy (MST) during leaves and aftercare(MST) during leaves and aftercare

School orwork

School orwork

YouthYouth

Family

team

Family

team

PeersPeers

ParentsParents

Written Manuals for each topic (assessment, treatment, aftercare and so on) is included in the treatment model

Weekly phone-consultations with checklists and discussions with each institution

Regularly visits at all the institutions

Regularly Boosters on spesific topics

Future: Regularly interviews with juveniles and parents

Design for Study of effects Design for Study of effects

Bergen Youth Centre

Stjørdal Youth Centre

Tromsø Youth Centre

Sandefjord Youth Centre Ås Youth Centre

OsloMargrete Lund

Brättegården

The nine

existing

MultifunC-

institutions

Råby Youth Centre

Assess target population based on risk faktors predictive of recidivism and select more serious offenders

Adress criminogenic risk faktors open to change within target population

Develop theoretical basis for intervention and expected outcomes

Design interventions shown to be effective (cognitive behaviour)

Implement with quality and fidelity to the program design

Agency Mission Agency Leadership Agency Funding Community Support Connections across

Services

Support and Resources surrounding the Intervention

Ashley (2005), King County Departement of Community and Human Services

We have some guidelines from research, but there is no ”Magic

Bullet” (Lipsey, 2007)

TheEnd

We have some guidelines from research, but there is no ”Magic

Bullet” (Lipsey, 2007)

TheEnd

Tore.Andreassen@hibo.no

1. Exploration and adoptation

2. Program installation

3. Initial implementation

4. Full operation

5. Innovation

6. Sustainability