UNIVERSITY OF CINCINNATI

Date:______

I, ______, hereby submit this work as part of the requirements for the degree of: in:

It is entitled:

This work and its defense approved by:

Chair: ______

A COMMUNITY OF PEERS – PROMOTING BEHAVIOR CHANGE:

THE EFFECTIVENESS OF A THERAPEUTIC COMMUNITY FOR JUVENILE

MALE OFFENDERS IN REDUCING RECIDIVISM

A Dissertation Submitted to the:

Division of Research and Advance Studies Of the University of Cincinnati

In Partial Fulfillment of the Requirements for the Degree of

Doctorate of Philosophy (Ph.D.)

In the Division of Criminal Justice Of the College of Education

April 2004

by

Jennifer A. Pealer, M.A.

B.A., East Tennessee State University, 1997 M.A., East Tennessee State University, 1999

Dissertation Committee: Edward J. Latessa, Ph.D. (Chair) Francis T. Cullen, Ph.D. John Paul Wright, Ph.D. Melissa M. Moon, Ph.D.

A COMMUNITY OF PEERS – PROMOTING BEHAVIOR CHANGE: THE EFFECTIVENESS OF A THERAPEUTIC COMMUNITY FOR JUVENILE MALE OFFENDERS IN REDUCING RECIDIVISM

One avenue that has received considerable attention for the substance abusing adult population is a therapeutic community; however, research examining the effectiveness of this popular treatment modality for juveniles is scarce. While some studies have found a reduction in criminal behavior and substance abuse, others have found null results concerning the effectiveness of therapeutic communities. Furthermore, the literature on therapeutic communities has been criticized on the following points: 1) studies fail to incorporate multiple outcome criteria to measure program success; 2) follow-up time frames have been inadequate; 3) comparison groups often fail to account for important differences between groups that are likely to impact program outcome; and

4) insufficient attention that is given to the measure of program quality. Moreover, research on the effectiveness of therapeutic communities for juvenile offenders is limited.

Accordingly, this research attempts to overcome the common shortcomings by: 1) including multiple outcome criterion; 2) following the juveniles for a period up to 3 years after program completion; 3) using a comparison group drawn from a sample of youth that did not receive treatment but who are matched on risk and needs; and 4) using a standardized instrument to measure program quality.1

The current study used a quasi-experimental design to estimate the impact of the juvenile therapeutic community on recidivism (e.g., return to incarceration; both juvenile and adult). The treatment group was a sample of 447 male youth who were sentenced to a

1 This dissertation is an expansion of the work of Pealer, Latessa, and Winesburg (2002a), which examined a therapeutic community for juveniles. Specifically, this dissertation will follow the juveniles for a period of three years whereas the previous study only followed the juveniles for a period of 18 months.

ii residential treatment facility that operated as a therapeutic community from January 2000 to August 2001. The comparison group was derived from a sample of adjudicated youth who were released from the Department of Youth Services in 1999. The comparison group was matched based on risk and need levels (e.g., Youthful Level of Service/Case

Management Inventory). Due to the fact that there were different times to failure, a Cox regression model was computed to determine if participation in a therapeutic community significantly reduced the probability of a new incarceration. Results indicated that while the treatment group was less likely to be incarcerated during this time period, the difference between the groups was nonsignificant.

iii ACKNOWLEDGEMENTS

There have been many people who have assisted me throughout my educational career. I first need to thank my committee. Dr. Edward Latessa, you have given me many opportunities to see different institutions, programs, and even the countryside. I have learned much working with you throughout the years. Your guidance has helped to make the me person I am today. I look forward to many years of collaboration. Dr. Francis Cullen, you really do practice what you preach. You have given me much social support throughout my years at UC. You were always willing to give advice and counsel me as to my best options. You are a true role model and I appreciate all you have done for me. Dr. John Wright, again, you amaze me with your knowledge of the field and your ability to convey the knowledge in a way that anyone can understand. Thank you for always taking the time to answer any question. Dr. Melissa Moon, what can I say? You were the mechanism that started this whole thing – my mentor at ETSU. If it were not for your foresight I would never have dreamed of getting this degree. You saw something that I did not. I really appreciate you urging me to go for it and helping me along the way. You are a great friend.

I also need to thank individuals at the Department of Youth Services. Candy Peters and Andy Popel were instrumental in obtaining some initial data for the project. Also, Bruce Sowards contributed greatly by obtaining the latest outcome data on his own time. I really appreciate your contribution to this project.

Special thanks and acknowledgements go to case managers at Mohican Youth Center, and to Jeanette Britton for coordinating the data collection process, and to Elaine Surber for her leadership and ongoing support throughout this project.

I also need to thank John Schwartz, Chris Lowenkamp, Shelley Johnson-Listwan, and Debi Shaffer. John, you helped me navigate the red tape at UC and showed me how to get things done. I appreciate you being so helpful. The Center could not operate without you. Chris, you were always willing to answer any questions from a stat problem to raising kids. Thanks for the advice. Shelley, you helped to show me the ropes for working with Dr. Latessa. Debi, my travel buddy. We have had some really good times traveling all of Ohio, Indiana, Oklahoma, and other parts of the country. I will miss playing “good cop/bad cop” with you. We made an unlikely pair – you from Michigan and me from Tennessee – but man did we have fun.

A truly special thanks for one of my closest friends – Kristie Blevins. We started UC together, took proficiencies together, took comps together (well most of them), defended on the same day, and will graduate together. Having someone from East Tennessee here in Cincinnati made the North more tolerable. You have helped me tremendously. Many of the stories I tell my children about UC will begin with: “onetime Kristie and I …..”

iv Last but certainly not least, I need to thank my family for their love and support. My dad and mom, Jerry L. and Ruth Ann Sartain, you instilled the value of education from the start. I just took the concept to the extreme. Thanks for giving me financial support and emotional support. I knew I could not fail because I did not want dad coming up here. My brother, Jerry, we were always in competition to out do the other. Even though you are an architect I still have more degrees – so I win.

My husband, Jamie, I could not have done this without you. Five years ago you just picked up your life and moved away from family and friends just so I could go to school. I appreciate the faith you have in me. You were always willing to provide encouragement and advice when I needed it. Thanks for being there. Finally, thanks go to my new son, Jake, for sleeping so much in the beginning so Mommy could finish writing her dissertation.

v TABLE OF CONTENTS

Chapter 1: Statement of the Problem 1 Prevalence of Substance Abuse Among Juvenile 1 Offenders Development of Residential Substance Abuse Treatment 3 Criticisms of Drug Treatment Programs 4 Overcoming the Criticisms 6 Research Questions 8 Summary 8

Chapter 2: Literature Review 11 Introduction 11 The Mission of the Juvenile Justice System 11 The Development of the Juvenile Justice System 12 Criticisms of the Juvenile Justice System 14 Attacking Rehabilitation and the Juvenile Justice System 15 Social Context, Rehabilitation, and Treating Juvenile Offenders 15 Liberal Ideology 15 Conservative Ideology 18 Juvenile Justice: From Treatment to Punishment 20 Public Support for Juvenile Treatment 21 Support for General Rehabilitation 22 Support for Juvenile Rehabilitation 24 Therapeutic Communities as a Treatment Modality for Offenders 26 History of Therapeutic Communities 27 Developments in the United Kingdom 27 Development in the United States 29 Characteristics of Therapeutic Communities 32 View of Substance Abuse and the Individual 32 Treatment Modality of the Therapeutic Community 32 Structure of the Therapeutic Community 33 The Use of Work in the Therapeutic Community 35 The Use of Behavioral Reinforcements in the Therapeutic Community 38 The Types of Meetings and Groups in a Therapeutic Community 40 Therapeutic Communities and the Principles of Effective Interventions 42 Intensive and Behavioral Services 43 Targeting Criminogenic Needs of High-Risk Offenders 45 Reinforcement of Contingencies 47 Staff Characteristics 48 Relapse Prevention Strategies 48 Effectiveness of Therapeutic Communities 49 Reducing Recidivism 50 Treatment Versus Non-Treatment 50 Follow-Up Time Period 59 Completers Versus Non-Completers 60

vi Transitional Therapeutic Communities 61 Meta-Analysis and Reviews of the Literature 62 Predictors of Recidivism 67 Demographic Characteristics 67 Severity or Risk Level 71 Psychological Factors 72 Participation/Completion of Treatment 73 Predictors of Successful Completion of Treatment 73 Summary of Effectiveness 74 Methodological Problems of Past Research 78 Summary 81

Chapter 3: Methods 83 Introduction 83 Research Questions 83 Research Design 84 Procedures for Collecting Data 85 Treatment Group 85 Mohican Youth Center 85 Sample Size, Time Period, and Selection of Youth 86 Type of Treatment 87 Job Assignments Within Mohican Youth Center 88 Behavior Management Within Mohican Youth Center 92 Groups Held at Mohican 93 Phases of Treatment 95 A Quantitative Assessment of the Principles of Effective Intervention 97 Comparison Group 104 Description of the Measures 104 Individual Characteristics Examined 104 Juvenile Demographics 105 Criminal History 105 Substance Abuse History 109 Risk Level 110 Psychological and Social Functioning 111 Cognitive Distortions 111 Termination Data 112 Outcome Variables Examined 112 Intermediate Outcomes 112 Long-term Outcomes 113 Statistical Tests 114 Limitations of the Study 116 Summary 117

Chapter 4: Results 119 Individual Characteristics 119 Social Demographic Characteristics 119

vii Drug History 122 Substance Abuse Severity 122 Current Offense and Criminal History 126 Risk Level 128 Psychological and Social Functioning 134 Cognitive Distortions 134 Intermediate Outcomes 141 Changes In Psychological and Social Functioning 141 Changes in Cognitive Distortions 144 Successful Completion 148 Long-Term Outcomes 150 Rates of Incarceration 150 Model Predicting Incarceration for Both Groups 153 Model Predicting Incarceration for the Treatment Group Only 156

Chapter 5: Summary and Conclusions 161 Limitations 161 Summary of Findings 163 Background Characteristics 163 Impacting Intermediate Outcomes 166 Predictors of Successful Completion 169 Rates of Incarceration 170 Model Predicting Incarceration 171 Model Predicting Incarceration for the Treatment Group Only 175 Policy Implications and Recommendations 176 Suggestions for Future Research 179

References 182

Appendix A: Data Collection Instruments 193

Appendix B: Tables 198

viii LIST OF TABLES

Table 1: Summary of Therapeutic Community Outcome Evaluation Findings 51 Table 2: Summary of Meta-Analyses and Reviews of the Literature 64 Table 3: Predictors of Success by a Therapeutic Community 68 Table 4: Variables and Measures Employed in the Study 106 Table 5: Background Characteristics 121 Table 6: Drug History 123 Table 7: Current Offense and Criminal History 127 Table 8: Youthful Level of Service/Case Management Inventory (YLS/CMI) Risk Categories 132 Table 9: Descriptive Statistics for Client Self Rating – Time 1 135 Table 10: Paired Sample t-tests on Client Self Rating Time 1 – Time 2 142 Table 11: Paired Sample t-tests on How I Think Questionnaire, Time 1 – Time 2 (Includes suspect cases) 145 Table 12: Paired Sample t-tests on How I Think Questionnaire, Time 1 – Time 2 (Does not include suspect cases) 147 Table 13: Termination Information 149 Table 14: Regression Coefficients Predicting Successful Completion 151 Table 15: Rates of Incarceration 154 Table 16: Regression Coefficients Predicting Incarceration 155 Table 17: Regression Coefficients Predicting Incarceration for the Treatment Group 159

ix LIST OF FIGURES

Figure 1: Structure Board For Mohican Youth Center 90 Figure 2: Mohican Youth Center CPAI Scores Compared to Average Scores 100 Figure 3: JASAE Scores 125 Figure 4: YLS/CMI Risk Categories by Group 130 Figure 5: Cognitive Distortion Scales for the Mohican Youth Center 137 Figure 6: Behavioral Referents for the Mohican Youth Center 139 Figure 7: Summary Score for How I Think the Mohican Youth Center 140 Figure 8: Significant Predictor and Probability for Successful Completion 152 Figure 9: Participation in Treatment by Incarceration 157 Figure 10: Age by Incarceration 160

x CHAPTER 1 STATEMENT OF THE PROBLEM

PREVALENCE OF SUBSTANCE ABUSE AMONG JUVENILE OFFENDERS

Over the past 20 years, there has been a “war on drugs”, which has resulted in a large number of drug abusing offenders being processed in the criminal justice system.

Indeed, beginning in 1984 and lasting for 13 years, the nation saw an increase in the number of juvenile arrests ranging from a low of 6,765 arrests per 100,000 juveniles to

9405 arrests per 100,000 juveniles (Snyder, 2000). Since 1998, the number of juvenile arrests has declined 27 percent with an arrest rate of 6889 in 2001 (Snyder, 2001).

However, even though the arrest rate has decreased, the juvenile justice system has seen an increase in the number of juveniles that are processed throughout the years. For example, the percentage of juveniles being formally processed through juvenile courts has increased from 64 percent to 71 percent during the last 10 years (Stahl, 2003). Many have speculated about the causes of the increase in juvenile processing within the juvenile justice system.

One possible explanation is the link between substance abuse and criminal behavior. Indeed, there is a strong correlation between substance abuse and criminal behavior (see Andrews & Bonta, 1994; Beck, Kline, & Greenfield, 1988; Elliott &

Huizinga, 1984; Newcomb & Bentler, 1988). For example, Wanberg (1992) found that correlations between substance abuse and delinquency ranged from .47 to .63 with a large sample of juvenile offenders. Accordingly, even though the juvenile arrest rate is declining the juvenile arrest rate for substance abuse has increased. Thus, the prevalence of drug and alcohol use among juvenile offenders creates many challenges for the already overburdened juvenile justice system. For example, drug testing conducted in twelve

1 cities during 1997 revealed that 42 to 66 percent of male youths tested positive for at least one drug at the time of arrest (National Institute of Justice, 1998). Furthermore, the

Survey of Youth in Custody project found that 39 percent of youth under age 18 were under the influence of drugs at the time of their offense with more than 57 percent reported using drugs in the month prior to their arrest (Crowe, 1998).

Nationally, arrests for substance abuse among juveniles has increased 145 percent from 1991 to 2000, whereas the same arrests for adults have increased only 42 percent

(Snyder, 2000). Indeed, drug abuse violations was the category with the highest arrest rate in 1999 with the drug abuse violation rate being 649 arrests per 100,000 for persons age 10 to 17 (Stahl, 2001). Thus, there is a glaring problem with America’s youthful offenders and substance abuse.

Not only are juveniles being arrested for substance abuse, but they are also being processed through the juvenile court system. In 1998, the juvenile courts processed approximately 192,500 cases involving drug offenses (Stahl, 2001). These cases accounted for 11 percent of all juvenile cases in 1998. When drug abuse cases went before the court, 63 percent were formally processed with the youth being adjudicated delinquent. Of the formally processed cases, 59 percent were given probation and 23 percent were given the most severe disposition – residential placement (Office of

Juvenile Justice and Delinquency Prevention, 1998).

Indeed, while the number of juvenile arrest rate has been declining, the number of juveniles being formally processed in the court system has increased. Furthermore, the number of juveniles being placed on detention has also risen 11 percent between 1990 and 1999 (Harms, 2003). Moreover, there was a 62 percent increase in the number of

2 detained cases concerning substance abuse during this time frame. Thus, the link between substance abuse and juvenile delinquency has been well established. If this population is left untreated, their chances of returning to criminal behavior and substance abuse ranges from 50 percent to 80 percent (Andrews & Bonta, 1994; Lillyquist, 1980). Accordingly, some type of treatment intervention is needed to break the drug-crime system.

DEVELOPMENT OF RESIDENTIAL SUBSTANCE ABUSE TREATMENT

One possible avenue for the treatment of substance abusing juvenile offenders is residential treatment. While this type of treatment has been established for many years, it has only been recently that many state and local agencies received federal monies to implement residential substance abuse treatment programs. Recognizing the link between continued drug use and recidivism, the federal government created the Violent

Crime Control and Law Enforcement Act of 1994. Subtitle U of the Act had significant national implications for treating drug-involved offenders as it provided agencies with money to treat drug offenders. Thus, the RSAT grants represent the first national mandate to affirm the value of treatment for the criminal justice population (Harrison &

Martin, 2003). Accordingly, it is believed that residential substance abuse programs have the potential to reduce criminal behavior and relapse among drug abusing offenders.

With the availability of federal funds, many states began to implement residential substance abuse programs. As of 2003, all 52 states had implemented RSAT programs and as of March 2001, there were more than 2,000 RSAT programs in place. A recent evaluation conducted by the National Institute of Justice revealed that the majority of operational programs were directed to adults with 30 percent targeting juvenile offenders

3 (Harrison & Martin, 2003). In addition, about 60 percent of the RSAT programs were operating, or at least incorporating some elements of a therapeutic community.

While there is not a set model for a therapeutic community, there are some commonalities. DeLeon (1986, 2000) describes this treatment modality as emerging out of the self-help movement in which the offender is to make a global lifestyle change.

While substance abuse is a major target, the therapeutic community also seeks to increase prosocial conduct such as obtaining employment, achievement in education, and increasing prosocial attitudes and values (Pan, Scarpitti, Inciardi, & Lockwood, 1993).

The therapeutic community may be distinguished from other drug treatment programs in two ways. First, the primary agent of change is the community of peers and staff who are to act as role models (DeLeon, 1986). Thus, the offender experiences a 24-hour learning environment. Second, therapeutic communities are very structured and offer a systematic and holistic approach to changing the offender (DeLeon, 1986).

In corrections research, there has been much focus on this type of treatment modality for drug offenders. Furthermore, a recent meta-analysis revealed that on average, therapeutic communities reduced recidivism approximately 13 percent compared to no or minimal treatment (Pearson & Lipton, 1999).

CRITICISMS OF DRUG TREATMENT PROGRAMS

While the number of therapeutic communities for correctional populations has increased, the research on their effectiveness has been criticized on four points by

Inciardi, Martin, Butzin, Hooper, and Harrison (1997). First, studies have failed to incorporate multiple outcome criteria to measure program success. Second, the follow-up time frames have been inadequate. Third, the comparison group fails to account for

4 important differences between groups that are likely to impact program outcome. Lastly, there has been a lack of multivariate designs, which leave us with little information concerning the significant predictors of recidivism. In addition, research into therapeutic communities and drug treatment in general has been plagued by the insufficient attention given to the measure of program quality (Faupel, 1981; Moon & Latessa, 1994).

The research on RSAT programs has also revealed some difficulties (Harrison &

Martin, 2003). A national evaluation of 12 RSAT programs was conducted by the

National Institute of Justice. The findings revealed that many programs lack a structured aftercare program. 2 Instead, many offenders return to the general population and then are released into the community without any type of step-down program (Harrison & Martin,

2003). Furthermore, a survey of the RSAT programs revealed that programs were often eclectic. Fifty-eight percent of the programs were mixed models (i.e., elements of a therapeutic community combining cognitive-behavioral group work and 12-step meetings), 24 percent were therapeutic communities, 13 percent were designed as cognitive-behavioral approaches, and 5 percent were 12-step programs (Harrison &

Martin, 2003).

Another area of concern was that many programs reported problems delivering the intended services to the participants (Harrison & Martin, 2003). For example, there were fewer group and individual counseling sessions held than had originally be planned in many programs. The evaluation found that this problem was mainly due to the lack of experienced staff and significant staff turnover.

2 According to the RSAT grant, the mo nies could only be used for residential substance abuse treatment and did not fund aftercare programs (Harrison & Martin, 2003). Thus, many programs lacked an aftercare component.

5 The last problem area noted by the national evaluation was that many programs did not use a standardized substance abuse assessment instrument that had been validated

(Harrison & Martin, 2003). The lack of assessment resulted in many inappropriate offenders entering the program. A related concern was that many offenders entered the program with too little or too much time left on their sentence (Harrison & Martin, 2003).

The issue of time is problematic because many offenders could not finish the program or upon completion of the program were sent back to the general population, which may serve to “undo” any treatment effect experienced.

One final area of concern is the lack of research on therapeutic communities for juvenile offenders. One study found that participation in this type of treatment modality resulted in a significant reduction in recidivism compared to offenders who did not participate in treatment (Pealer, Latessa, Winesburg, 2002a). However, the follow-up time period was only 18 months for this study. Accordingly, this dissertation will expand on the previous study. Specifically, the dissertation will follow-up the juveniles for a period of three years to determine if the treatment effect is robust across time.

OVERCOMING THE CRITICISMS

This dissertation will add to the literature on RSAT programs and therapeutic communities in a number of ways. First, while much of the research examining the effectiveness of therapeutic communities has been for adult male offenders, the literature on the effectiveness of the treatment modality for juveniles is scarce. Accordingly, this research will examine a RSAT program for juvenile offenders implemented at Mohican

Youth Center in Loundenville, Ohio. As did many other RSAT programs, the facility chose to implement a therapeutic community as the treatment modality.

6 Second, as research has shown, programs tend to be more effective when they have high program integrity (Antonwicz & Ross, 1994; Holsinger, 1999). For that reason, this dissertation will attempt to address the issue of the black box of treatment by using a standardized instrument to measure program quality (the Correctional Program

Assessment Inventory; CPAI). This technique will allow the researcher to determine if the program was adhering to the principles of effective intervention and may help to explain the presence or absence of a treatment effect.

Third, while many programs have examined the long-term outcomes of therapeutic communities (e.g., recidivism), few have determined if participation in the therapeutic community results in changes in intermediate outcomes. Therefore, this dissertation will determine if participation in the program results in lower levels of cognitive distortions and changes in psychological and social functioning.

Fourth, research has been mixed concerning the types of individuals who benefit from participation in the therapeutic community. Furthermore, this research will be one of the first to examine specific characteristics of the juveniles to determine if the treatment provided by the therapeutic community is more effective for certain types of juveniles.

Finally, to address the concerns from pervious research on therapeutic communities, this dissertation attempts to overcome the common shortcomings by: 1) including multiple outcome criteria (periods of new incarceration, time to incarceration, and seriousness of new incarceration; 2) following the juveniles for a period up to three years after program completion which allows the researcher to examine behavior from adolescence into adulthood; 3) using a matched (i.e., risk and need) comparison group

7 drawn from a sample of youth that did not receive treatment; and 4) using multivariate designs which will identify significant predictors of recidivism.

RESEARCH QUESTIONS

While the main goal of this dissertation is to determine if the therapeutic community reduced the recidivism rates for juvenile male offenders, the following specific research questions will be answered:

1. What are the characteristics of the treatment group and the comparison group? What if any differences exist between the treatment and comparison groups?

2. Did participation in treatment significantly impact the youth’s levels of cognitive distortions and psychological and social functioning?

3. What factors predict successful completion of treatment?

4. What are the rates of new incarcerations for the treatment group and the comparison group? Are there significant differences in the rates of new incarcerations for the treatment group and the comparison group?

5. What factors predict a new incarceration?

6. Does the effectiveness of the treatment provided at Mohican Youth Center differ among the different types of juveniles?

SUMMARY

This chapter has reviewed the prevalence of substance abuse among juvenile offenders and problems that these arrests cause the juvenile justice system. Specifically, while the number of juvenile arrests has decreased over the past 5 years, the number of juveniles being formally processed through the court system has increased. Furthermore, these juveniles are being processed for drug offenses and being placed on detention and residential centers. In response to the link between substance abuse and criminal behavior, states have received monies to implement residential substance abuse treatment

8 programs. With the money received from the federal government, the state of Ohio implemented a therapeutic community for adolescent males. While much research has been conducted on this type of treatment modality, little insight has been given on the effectiveness of therapeutic communities for juveniles. As such, this dissertation will present the results of a three-year follow-up to examine the effectiveness of therapeutic communities for drug-involved adolescents.

Chapter Two will begin by examining the history of the juvenile justice system, how it developed to treat juveniles, the attack of the juvenile justice system and rehabilitation in general and the prevalence of public support for juvenile treatment despite the attack on rehabilitation. The chapter will also explore the history of therapeutic communities in corrections and how therapeutic communities have evolved from traditional to modified communities that are found in many correctional programs today. In addition, the chapter will explore the effectiveness of drug treatment especially therapeutic communities and the methodological problems that plague many studies.

Finally, the chapter will explore the principles of effective interventions and how they relate to residential substance abuse treatment.

Chapter Three of this dissertation will review the methods for this particular study. In particular a quasi-experimental design was used whereby the comparison group was matched to the treatment group based on an important predictor of recidivism–risk level. Chapter Three will also review the sampling technique and procedures for collecting the data for this study. In addition, the measures used to determine the effectiveness of the therapeutic community will be explained along with the statistical

9 tests that were conducted. Finally, chapter three will conclude by addressing the limitations of the study.

Chapter Four will present the results of the study. Specifically, the background characteristics of the sample will be presented. The data that will be reported include: demographic data, risk level, substance abuse level, the youth’s cognitive distortions, and responsivity issues such as: anxiety levels, depression, self-esteem, self-efficacy, decision-making abilities, and hostility levels. Information pertaining to the type of termination (successful or unsuccessful completion) will be examined along with factors predicting successful completion of treatment. Lastly, recidivism data such as: percentage of juvenile offenders returning to a secure facility and factors predicting return to a secure facility will be explored to address the issue of effectiveness of the therapeutic community for juvenile offenders.

Chapter Five will present the discussion and limitations of the study. The chapter will begin by reviewing the major findings and limitations of the dissertation. In addition, explanations will be given concerning the major findings of the study.

Furthermore, policy implications will be suggested concerning the use of therapeutic communities for juvenile offenders along with suggestions for future research.

10 CHAPTER 2 LITERATURE REVIEW

INTRODUCTION

Whereas chapter one provided insight into the epidemic of substance abuse and delinquency for juveniles in the United States, this chapter will provide the context for the project. The development of juvenile treatment and the juvenile justice system will be explored to show how this country has always embraced the idea of rehabilitating juveniles. Even though a “nothing works” mentality emerged and rehabilitation in general was attacked in the later part of the 20th century, public support for rehabilitation, especially for juveniles, has remained intact and is particularly strong. After the discussion of public support is presented, the development of a specific form of correctional intervention is explored – therapeutic communities. The research on this type of treatment modality will be examined to determine if there are some commonalities that can be found. In addition, evidence will be presented as to this treatment modality’s effectiveness in reducing recidivism. While some research has found therapeutic communities to be effective, there are some methodological issues of this research that will be examined. This chapter will conclude by explaining how this particular research was designed to overcome these past methodological problems to examine the effectiveness of a therapeutic community for juvenile offenders.

THE MISSION OF THE JUVENILE JUSTICE SYSTEM

The modern treatment of juveniles had its rise in the industrial revolution beginning in the late 19th century. The Progressive era was beginning to change America in all areas: social, political, and economic. The changes were also beginning to take hold in legal situations–especially for juvenile offenders. Prior to this time period,

11 juveniles were seen as miniature adults and were considered as property (Whitehead &

Lab, 1996). However, the Progressive era, driven by the Positivist school of criminology, which based the causes of crime upon society rather than the individual, helped to foster a different perception of the juvenile. Individuals during this time period postulated that the environment in which the juvenile lived caused crime rather than the youth exercising his or her own free-will. Furthermore, the status of the juveniles changed from that of mini adults to individuals who were of less developed moral and cognitive capacities.

With the emergence of the Progressive era and the new view of crime and juveniles, the social context was ripe for the development of a formal system for treating juvenile offenders.

The Development of the Juvenile Justice System

Instead of locking up juvenile offenders, the progressive movement helped to usher the development of a separate system for handling juvenile offenders (Platt, 1969).

With the Juvenile Court Act of 1899, the first juvenile court was established in Cook

County, Illinois (Lou, 1972). The progressives focus on “individualized treatment” was evident in the juvenile court act of 1899 where its purpose was to “regulate the treatment and control of dependent, neglected, and delinquent children” who were younger than 16 years of age (Lou, 1972, p.19). The central feature of the juvenile justice system was treatment. Accordingly, in the juvenile justice system, delinquent behavior was not viewed as a crime; rather it was behavior that needed to be treated (Empey & Stafford,

1991). According to the Progressives, a child was born innocent and he or she learned criminal behavior from the environment in which he or she lived (Ryerson, 1978). In other words, the early court continued the common law practice in which the child did

12 not possess the criminal mind. Because the child did not possess the criminal mind, then he or she could not have been convicted of the crime (Kahn, 1953). Thus, the juvenile court saw the defect in society and not in the child.

Since the child did not possess fully developed moral and cognitive capacities, then he or she was not to be punished, but rather to be treated. Accordingly, it was argued that juveniles were vulnerable and malleable by the environment in which they lived, and therefore, they needed special adult guidance, education, and assistance so they could become productive members of society. Thus, the early juvenile court operated under the concept of “parens patriae” whereby the state would act as the parent (Mennel, 1973).

Under this doctrine, state officials were to serve as kindly parents who would focus on the welfare of the child. Overall, the new system for juveniles was to be the

“superparent” for all those children who needed protection and treatment (Empey &

Stafford, 1991).

With state personnel operating under the “parens patriae” doctrine, dispositions were tailored to the juvenile regardless of the offense. The treatment plans for juveniles ranged from warnings to probation to training school placement and treatment lasted until the juvenile was “cured” or turned twenty-one years old (Office of Juvenile Justice and

Delinquency Prevention, 1999). Furthermore, since the goal of the juvenile justice system was rehabilitation through individualized treatment, the juvenile justice system swept away all due process rights. It was argued since juvenile courts were not like adult courts; juveniles did not need the same due process rights because the process may interfere with the treatment of the child (Ryerson, 1978). In all, the progressive reformers’ main concern was in reforming the juvenile at any possible cost.

13 The reformers saw a rapid development in the juvenile justice system. By 1925, juvenile court legislation had been passed in all but two states and by 1932, there were over 600 independent juvenile courts in the United States (Platt, 1969). The early juvenile justice system has been said to be the proudest achievements of the Progressive movement in which the courts and correctional personnel operated out of “truth, love, and understanding” to provide a family type atmosphere where children could be treated and rehabilitated (Mennel, 1973).

Criticisms of the Juvenile Justice System

While some saw the development of the juvenile justice system and the treatment of juveniles as a labor love, there were some criticisms of the court. First, Platt (1969) argues that the Progressives were led by the most class-conscious members of society who wanted to form new social controls while protecting their privilege and power.

Rather than being a humanitarian involvement, the development of the juvenile justice system was an attempt to intervene in the lives of lower class individuals in the name of the state. The “child savers” developed a class of individuals who were labeled delinquent because these individuals did not live up to the middle class goals and morals.

Platt (1969) argued that the philosophy was a defense against the “foreign” ideologies and the child savers used force such as longer prison terms, long hours of labor, and militaristic discipline to enforce their ideas. The child savers saw a way to control and reform delinquent youths and thus allowed for a way to control the inferior lower social class.

Second, still others believed that the juvenile justice could not live up to its rhetoric. Rothman (1980) has argued that Progressives believed the early juvenile justice

14 system was almost like a panacea in which it could cure all delinquents. The concept of informal and flexible policies would allow juveniles the benefit of being treated on a case-by-case strategy. However, the reality of the implementation of these policies was almost bewildering to the justice system. The reformers knew what the courts and personnel should do, but they did not know exactly how to deliver the innovations.

Therefore, the reality of the early juvenile justice system was very different from the rhetoric of the juvenile justice system and essentially the ideal principles of the reformers did not fully develop.

ATTACKING REHABILITATION AND THE JUVENILE JUSTICE SYSTEM

Since the development of the juvenile court in 1899, the juvenile justice system had remained virtually unchanged (Cullen & Gilbert, 1982). However, the turbulent times of the 1960s forced both liberals and conservatives to reevaluate the original concepts of the juvenile justice system. Although conservatives and liberals argued that the juvenile justice system was in need of reform, their reasons for changing the system were quite different. For both political camps, rehabilitation and treatment would no longer be needed. Instead, it was argued that punishment and “just deserts” should be the guiding principles of the juvenile justice system (Cullen & Gilbert, 1982).

Social Context, Rehabilitation, and Treating Juvenile Offenders

Liberal Ideology. The 1960s were turbulent times in America. During the Civil

Rights Movement, Americans witnessed the racial disparities that were prevalent in this country. In some parts of the country, these peaceful marches would turn violent when protesters would be assaulted by police trying to squash the march. The Civil Rights

15 Movement allowed citizens to see the government actively tolerating and in some times perpetuating violence and inequality among groups (Cullen & Gilbert, 1982).

Along with the Civil Rights Movement, the Vietnam War was also a source of social unrest among American citizens. Americans saw its country supporting a dictatorial regime and in the process losing the claim of being the democratic defender

(Cullen & Gilbert, 1982). When protests over the War became too vocal, government leaders would use any methods to control dissent over the war. Demonstrators against the war would stage protests, but police would quickly squelch the protesters by using any means necessary. Often the methods of control would result in violence against the protesters. For example, during a protest at Kent State University, four students were killed when National Guard opened fire into the rally. For the first time, America was able to witness the destruction and violence the state inflicted upon its own citizens.

Eventually, liberals began to question the role of the state and its ability to protect its citizens from harm (Cullen & Gilbert, 1982). The left wing saw the state misusing and abusing its power against those who did not share its views. Therefore, liberals began to doubt the willingness and capacity of the government to achieve a humane society that treated everyone equal (Cullen & Gilbert, 1982). Eventually, this mistrust of the state led liberals to call for safeguards for those who were being abused and victimized by the state.

In the area of juvenile justice, liberals began to call for ways in which juveniles could be protected from the abusive powers of the state. The original concept of the juvenile justice system was to treat and rehabilitate the individual so that he or she would become a productive member of society. The juvenile system would become a

16 “superparent” to those juveniles that needed help and treatment would be focused on that child’s individual needs. However, the events of the 1960s showed liberals that the state was abusing its role and, therefore, changes should be made to protect juveniles. The liberals mistrust of the state helped foster the argument that due process was more important than rehabilitation. Liberals argued that if government could not treat its citizens well, then it should at least treat them fairly (Cullen & Gilbert, 1982). Therefore, the juvenile courts turned away from the rehabilitation and treatment model and began to allow juveniles some due process rights. The juvenile were given due process rights such as: 1) right to a hearing; 2) right to counsel; 3) reasons from the judge if he or she is bound over to adult court; 4) right to be notified of the charges; 5) right not to incriminate himself or herself; and 6) the right to confront and cross examine witnesses. Today, the only right not granted to juveniles is the right to a jury trial.

The liberals also believed that by allowing judges widespread discretion in juvenile cases enabled disparities in the administration of justice. The left asserted that individuals who were underprivileged were actively discriminated against. This discrimination helped to repress certain populations. The liberals were concerned about the discretion used by the judges in the informal juvenile courts and began to question the purpose and processes of the juvenile justice system. Therefore, the liberals helped to change the juvenile justice system by calling for due process rights, which would stop the widespread discretion and the subsequent abuse of state power.

Even though liberals had wanted to protect juveniles by giving them the same due process rights as adults and therefore, keeping the state from abusing its power, the original goals and ideas of the juvenile justice system had been altered. The original

17 ideology of the juvenile court had been to rehabilitate the child and treat the child based on his or her personal needs. This treatment was accomplished by allowing the courts to have widespread discretion in administering treatment for juveniles. However, with the

Supreme Court granting juveniles certain due process rights, the juvenile court began to lose some of its earlier goals (Feld, 1990). Instead of being an informal process with the focus on individualized treatment, the process had become more formal and the primary focus was on punishment instead of treatment (Feld, 1990). Even though the liberals had a major victory with the Supreme Court in granting some due process rights to individuals, beginning in the 1970s their agenda began to lose steam and the conservatives began to dominate the political arena.

Conservative Ideology. Whereas the liberals saw the era of the 1960s as a period of abuse of state power, the conservatives witnessed the 1960s as a period of threat to the social order (Cullen & Gilbert, 1982). America was no longer a peaceful and tranquil place for those on the political right. The political right saw the marches protesting

Vietnam as civil disobedience and disrespect for government. Conservatives also believed that the country was in moral decay because abortions, premarital sex, living together, divorce and teenage pregnancy were becoming more widespread and acceptable

(Cullen & Gilbert). This “mayhem” of the 1960s caused conservatives to be concerned about establishing law and order. Conservatives argued that the social order was being threatened by these events because society was too soft on crime. Thus, a “war on crime” campaign ensued to combat the decaying morals of America and the soaring crime rates.

The right wing wanted to punish the “permissive society,” and “get back to the basics”

(Cullen & Gilbert). One of the main premises of the conservatives “war on crime” was

18 that there should be greater respect for authority and there should be firm discipline for juveniles.

This war on crime campaign had its basis in the classical school of criminology which viewed crime was a result of free-will. Conservatives asserted that juveniles chose to exercise their free-will and commit crimes because the justice system was too lenient with them. In other words, the criminal justice system was not doing its job. Instead of being tough on the offender and focusing on the rights of the victim, the justice system was more concerned with the offender. The right wing argued that the justice system catered to the juvenile because it thought that he or she could be rehabilitated (Cullen &

Gilbert, 1982). It was claimed that the juvenile justice system had to be changed; it had to become tougher on juvenile offenders. They saw the treatment element of the juvenile court to be too lenient with the juvenile offenders and, therefore, the concept of rehabilitation had to be changed.

Another important event that developed during this time that helped foster the dissatisfaction with rehabilitation was the publication of Martinson’s article entitled,

“What Works? Questions and Answers About Prison Reform.” Martinson had evaluated different treatment programs and found that: “with few and isolated exceptions, the rehabilitative efforts that have been reported so far have had no appreciable effect on recidivism.” (Martinson, 1974, p.25). This simple statement was soon interpreted as

“nothing works” by many individuals and the rehabilitative idea was dealt a devastating blow (Cullen & Gilbert, 1982). Indeed, Martinson’s article, coupled with the soaring crime rate, led many conservatives to feel that rehabilitation was simply not effective.

Offenders were not being rehabilitated but, instead, being allowed back on the streets to

19 commit more crimes. Conservatives argued that because rehabilitating offenders did not work, it was time to start punishing the offenders and get tough on crime.

Therefore, the state needed another weapon in order to control crime. The conservatives argued that the state needed to become tough with adult and juvenile offenders. Instead of treating the juvenile, the state needed to punish the juvenile for his or her crime. Therefore, conservatives opted for mandatory sentencing, juvenile transfers to adult courts, and judicial waivers as the new guidelines for the juvenile justice system.

It was argued that these interventions were the only way in which the crime rate would drop and society would be safe from these offenders (Cullen & Gilbert, 1982).

Juvenile Justice: From Treatment to Punishment

When the juvenile justice system was first developed, the main emphasis was on treating the juvenile so that he or she would become productive, well-adjusted members of society (Empey & Stafford, 1991; and Kahn, 1953). Juveniles were not seen to be culpable because they did not possess the criminal mind and, therefore, did not have the criminal intent (Ryerson, 1978). This viewpoint dominated political ideology for 150 years. However, during the turbulent 1960s and 1970s, both liberal and conservatives came to believe in due process and “just deserts.” The liberals pushed for due process rights for juveniles in order to protect them from abusive powers of the state. The conservatives, on the other hand, opted for “just deserts” because rehabilitation was perceived to be ineffective and that the juvenile must be held accountable for his or her actions. The “get tough” movement was gaining momentum and Americans no longer viewed juveniles as innocent individuals who needed to be protected and treated. Instead,

20 the governing themes of justice would make the punishment fit the crime and determinate sentencing would replace indeterminate sentencing.

These themes of justice have led the way for the justice system to become more punitive in regards to juveniles. Over the past 20 years, there has been a call to treat juveniles offenders like adults (Feld, 1997). States are becoming more punitive towards juveniles by transferring them to adult courts so that they will receive sentences for adult crimes. Recently, this punitive trend has increased to allow waivers to adult courts for younger juveniles and for a broader range of offenses. Also, some states are considering applying the “three strikes” law and the “once waived, always waived” law to juveniles

(Sorrentino, 1996). Given these alarming trends over the past two decades, it seems that the correctional system in American is indeed becoming more punitive where juveniles are concerned. However, despite the attack on rehabilitation and the “get tough” movement for juveniles, there is still a substantial amount of public support for rehabilitating juveniles.

PUBLIC SUPPORT FOR JUVENILE TREATMENT

While the juvenile justice system was founded on the concept of individualized treatment and reforming the juvenile, these concepts were attacked on a number of grounds and reasons. Recently, some have argued that the correctional system has focused on “penal harm” instead of rehabilitation and treatment (Clear, 1994). Indeed, this penal harm movement may be seen in the “get tough” philosophy of the later part of

20th century in which states moved to determinate sentencing and longer sentences for adults to institutionalization of status offenders who violated court orders, and statutes for transferring juveniles to adult courts (Moon, Applegate, & Latessa, 1997).

21 One potential reason for the “get tough” movement may be public opinion.

Oftentimes public policy is seen to be a mirror of public support. That is, policymakers

“get tough” with adult and juvenile offenders because the public is punitive and wants these types of interventions. However, even with the public’s “get tough” mentality, there is still substantial support for rehabilitation in general and the public’s support is especially strong for juvenile rehabilitation.

Support for General Rehabilitation

Since Martinson’s “Nothing Works” article and the attack on rehabilitation, there have been some that question whether the public supports rehabilitation for offenders.

Since the early 1980s, there has been a wealth of studies and public opinion polls to measure the support for offender treatment. A review of the literature reveals some conclusions that can be drawn concerning public support for rehabilitation (Cullen,

Fisher, & Applegate, 2000). First, the public does indeed hold punitive beliefs concerning the handling of offenders. Indeed, research has shown that respondents favor capital punishment for adult offenders (see Bohm 1991; Britt, 1998; Ellsworth & Ross,

1983; Grasmick, Cochran, Bursik & Kimpel, 1993; Sandys & McGarrell, 1994, 1995).

In addition, it appears that the public is supportive of harsh sentences such as the “three strikes, you’re out” laws. For example, a Time/CNN poll found that 81 percent of adults favored a life sentence for anyone convicted of a third serious crime (cited in Applegate,

Cullen, Turner, & Sundt, 1996).

Second, while the public may hold punitive attitudes towards offenders, their attitudes appear to be mushy depending on how the questions are asked (Cullen et al.,

2000). Research has shown that broader questions, which tend to tap global attitudes,

22 reveal more punitive beliefs than specific questions about certain offenses, offenders, or sentences (Applegate et al., 1996; Durham, Elrod, & Kinkade 1996; Sandys &

McGarrell, 1994, 1995). For example, when comparing global and specific attitudes concerning support for three strikes laws; there were statistically significant differences.

Specifically, a large majority of respondents favored these laws when asked a global question but when faced with a specific scenario that would result in the penalty only a small minority supported life in prison (Applegate et al., 1996). Furthermore, while the majority of respondents support capital punishment, the level of support declines when they were faced with additional sentencing options such as life in prison without parole and life in prison without parole plus paying restitution to the family (Bohm et al., 1990;

Bowers, 1993; Sandys & McGarrell, 1994).

Third, despite the attack on rehabilitation, the public continues to believe that rehabilitation should be a focus of the correctional system. For example, as early as

1968, 70 percent of Americans believed that rehabilitation should be the main goal of prisons (Harris, 1968). However, since that time the level of support for rehabilitation has diminished. A study of Ohio residents found that 41.1 percent of the respondents indicated that rehabilitation should be the main emphasis of prisons (Applegate, Cullen,

& Fisher, 1997). Furthermore, a recent national study found that 55 percent of U.S. residents reported that “trying to rehabilitate the individual so that he might return to society as a productive citizen” should be the main emphasis of prisons (Cullen, Pealer,

Fisher, Applegate, & Santana, 2002, p. 136).

While support for rehabilitation as the main goal of prison has declined, there is some level of support for rehabilitation once the offender is placed into prison. For

23 example, a survey of Cincinnati residents found that 50.2 percent of the respondents favored expanding rehabilitation programs in prisons (Sundt, Cullen, Applegate, &

Turner, 1998). In addition, 92 percent of the respondents in the national survey agreed “it is a good idea to provide treatment for offenders who are in prison” (Cullen et al., 2002).

Accordingly, while the level of support for rehabilitation has decreased, the rehabilitative idea continues to show tenacity.

Support for Juvenile Rehabilitation

While the decline in public support for rehabilitation may be due to the “penal harm” movement (Sundt, et al., 1998), one should wonder if the same movement has impacted support for juvenile rehabilitation. A review of the literature reveals that public support for the rehabilitation of juveniles is strong (Applegate et al., 1997; Cullen et al.,

2000; Cullen et al., 2002; Moon, Sundt, Cullen, & Wright, 2000). Specifically, a sample of Ohio residents was asked if they agreed with the following statement: “it is important to try to rehabilitate juveniles who have committed crimes and are now in the correctional system.” An overwhelming majority (96.1%) agreed with the statement with 35.9 percent strongly agreeing that the correctional system should focus on rehabilitating juveniles (Applegate et al., 1997). In a national study of US residents, we see even stronger support for juvenile rehabilitation. In particular, 98 percent of the respondents agreed that it was important to rehabilitate juveniles who are in the correctional system and, four out of five respondents selecting rehabilitation as the main emphasis of juvenile prisons (Cullen et al., 2002).

Indeed, support for rehabilitating juveniles appears to be strong. Furthermore, the public also supports a wide range of early intervention programs for juveniles even if

24 there was a tax increase due to the programs. For example, a sample of Tennessee residents found that the lowest level of support for any program was 78.9 percent

(support for pre-school programs) with the highest level of support being 94.1 percent for programs that require both first time offenders and their parents to participate in rehabilitation programs so their problems would be dealt with (Cullen, Wright, Brown,

Moon, Blankenship, & Applegate, 1998). Respondents were also asked about using tax dollars to support options for stopping crime. Seventy percent of the sample favored spending their tax dollars on early intervention programs compared to only 20 percent of the sample favoring spending tax dollars on incarceration.

Cullen et al., (2002) also examined support for early intervention programs in their national sample of U.S. residents. In the national sample, 86 percent of the respondents supported spending tax dollars on early intervention. In addition when asked specifically about early intervention programs, the level of support ranged from a low of

89 percent for pre-school programs such as Head Start to a high of 96 percent for programs for first time offenders and their parents. Thus, data from local and national samples indicate that the level of support for juvenile rehabilitation is particularly strong.

Furthermore, the public supports juvenile rehabilitation to the point that they are willing to spend their tax dollars on early intervention programs.

Not only is there a strong level of support for juvenile rehabilitation, but also the level of support for juvenile rehabilitation appears to be stable. For example, a study of

Cincinnati residents in 1986 found that 94 percent of the respondents reported that rehabilitation would be at least somewhat helpful for juveniles (Cullen, Skovron, Scott, &

Burton, 1990). Almost ten years later, the level of support remained high. For example,

25 a 1995 study of Cincinnati residents found that 91.6 percent of the respondents reported that rehabilitation was at least somewhat helpful for juvenile offenders (Sundt et al.,

1998).

Accordingly, research has shown that despite the sustained level of attack on rehabilitation, the public does support rehabilitation. Furthermore, the tenacity of the rehabilitative idea is particularly strong for juvenile rehabilitation. As such, while there may have been a movement to get tough on offenders, it appears that the public is still compassionate enough to realize that rehabilitation is a viable alternative to punishment.

Therefore, one possible avenue for rehabilitating offenders is the use of therapeutic communities.

THERAPEUTIC COMMUNITIES AS A TREATMENT MODALITY FOR OFFENDERS

The linkage between drug abuse and crime is well documented. For example, seven out of every ten men and eight out of every ten women in the criminal justice system have used drugs with some regularity before entering into the system (Lipton,

1998). The increase of substance abusers have lead to the war on drugs and the resulting pressures for the criminal justice system to treat those with serious drug problems. It is assumed that since criminal behavior and drug abuse is related, then interventions that targeted drug abuse would reduce crime (Wexler, 1995). Thus, the 1994 Crime Bill, for the first time, provided a substantial amount of money for treating offenders in state and local agencies. From this Bill, the Residential Substance Abuse Treatment Grant

Program was created to establish programs to treat substance abuse among inmates. One of the major treatment modalities that is used for treating substance abuse is therapeutic communities.

26 History of Therapeutic Communities

Developments in the United Kingdom. While the term “therapeutic community” was termed in 1945 by Thomas Main, the basis of the therapeutic community may be traced to the early 1940s in Britain (Roberts, 1997). Specifically, the British therapeutic communities have three main components. The first component has its beginning in

1942, in the Northfield Military Hospital, when Wilfred Bion, and later Thomas Main,

S.H. Foulkes, and Patrick de Mare began experimenting with the group process to treat mental illness in WWII soldiers. The work by these individuals emphasized the importance of group led discussions rather than therapist led discussions in treating mental illness (Roberts, 1997). For example, the discussion of common experiences helped to foster change in the individual and the other members of the group.

Furthermore, since the major emphasis was on the group process, any tensions that arose among members were explored to maintain the cohesion of the group.

Also during this time, Maxwell Jones began work at Mill Hill Neurosis Unit in

London (Roberts, 1997).3 His contribution to the therapeutic community development was in the form of the structure of the therapeutic community. Again working with members of the British Armed Services, Jones began to see the soldiers’ attitudes toward their symptoms change as a result of discussions among the group. The structure of the

“treatment” provided by Jones included community meetings, expression of feelings, a highly structured environment, and open discussion of personal and group problems

(Brook & Whitehead, 1980). Specifically, there were three major themes that characterized the work of Maxwell Jones. First, the structure allowed for

3 In 1959, Maxwell Jones left the Henderson Hospital and began work in the United States with the California Corrections Agency as a consultant (Roberts, 1997). In the U.S., he helped develop therapeutic community prison projects.

27 democratization and permissiveness in which behaviors were not only to be punished but also tolerated and dealt with. Second, there was a sense of communalization where members of the group were required to share their thoughts. The last major theme was that of confrontation in which there was an expectation for the members to face their problems and deal with the interpretations of problems and behaviors from other members of the group (Brook & Whitehead, 1980).

The third component of the British therapeutic community was developed out of the work of Thomas Main when he was employed at the Cassel Hospital in the United

Kingdom. Main’s contribution was the combination of the community with psychoanalytic psychotherapy (Roberts, 1997). He addressed the issue of the whole community, including staff, as being therapeutic. Specifically, he argued that the community must establish and maintain a culture that allows for continuous questioning to identify solutions to problems since each individual’s actions and responses have direct consequences for the whole group. In addition, the importance of staff and patient interactions was stressed, that resulted in therapeutic experiences necessary to facilitate change (Hinshelwood, 1999).

Even though the components of the therapeutic community were developed during the early 1940s, it was not until the 1960s that the components combined to treat offenders. In 1962, a prison was specifically built to house a series of therapeutic community wings. Grendon Underwood Prison, in Britain, incorporated the principles used by Maxwell Jones, the use of group therapy developed by individuals at Northfield

Military Hospital, and the therapeutic relationships among the staff and offenders described by Main at Cassel Hospital to rehabilitate offenders (Cullen, 1997).

28 Developments in the United States. Therapeutic communities began to develop in the United States in the 1950s. Whereas the British communities were more formalized and highly structured, and relied on group processing and psychoanalytic psychotherapy, the American therapeutic communities were based on the self-help movement. Charles Dederich applied the concepts of the therapeutic communities to treating drug abuse in individuals. Dederich, a recovering alcoholic, became disillusioned with Alcoholics Anonymous rigid focus on alcohol, and in 1958 developed

Synanon in California. The group initially began for alcoholics but eventually grew to include drug addicts.

A split occurred among the group in which the addicts began community living and Synanon was established (Brook & Whitehead, 1980).4 Synanon was an integrated community of former addicts and offenders who participated in “brutal” confrontation sessions, educational seminars, and discussions of self-image and work habits (Lipton,

1998). Members participated in groups called “games” in which they screamed loudly at each other in a heated confrontation. It was said that these confrontations produced great relief and were used to resolve conflicts and express emotions (Kooyman, 2001).

Concepts such as honesty and responsibility were stressed throughout the day. Indeed, a sort of utopian society was developed in which members were required to renounce the outside society and never return to the larger society.

While the description of Synanon may sound like an ideal society, others have argued that the group became cult-like just short of brainwashing the members

(Abadinsky, 2001; Kooyman, 2001; Manning, 1989). Dederich believed that as a leader he was a demigod and above confrontation unless he was confronted by his wife or his

4 The split of the addicts and the alcoholics occurred due to a dispute between the two groups.

29 brother. In addition, he ordered couples to change partners and be sterilized and eventually implemented physical violence to handle juvenile delinquents. Furthermore, any opposition to Synanon was meet with physical threats and death. 5

While the beginnings of therapeutic communities began in the 1950s, for the purposes of corrections, the first therapeutic community for offenders opened in 1969 in a federal penitentiary in Marion, Illinois. This program consisted of intense group counseling and transactional analysis (Lipton, 1998). While this program did not operate as most communities do today it did serve as a model for the federal government during the 1970s. Indeed, many correctional therapeutic communities began operation in the

1970s and early 1980s due to the availability of funds from the Federal Law Enforcement

Assistance Administration funds; however, by the mid-1980s, the communities began to close for a number of reasons. For example, monetary shortfalls, changes in executive priorities, overcrowding, staff burnout, sabotage from custodial staff, and corruption caused by weakened supervision and contraband caused many programs to fold (Lipton,

1998; Martin, Butzin, Saum, & Inciardi, 1999; Wexler, 1997). The exception of the therapeutic community failures of the late 1970s and early 1980s was the New York based therapeutic community Stay’N Out. As a matter of fact, this program served as a model for many of the therapeutic communities that were developed during the late

1980s (Lipton, 1998).

The next surge of therapeutic communities was a result of monies available from the Federal Anti-Drug Abuse Act of 1986. States used these monies to develop drug abuse treatment programs for offenders in which treatment began in the institution and

5 Eventually, Dederich plead guilty to conspiracy of plotting to murder a lawyer who was representing ex- members of Synanon who maintained they were held against their will. He died in 1997 at the age of 83 (Abadinsky, 2001).

30 continued in the community upon release (Lipton, 1998). Indeed, even the Federal

Bureau of Prisons began to implement therapeutic communities with 34 programs that served 30 percent of their drug abusing population being developed within 10 years6

(Lipton, 1998; Wexler, 1997). By 1997, the initiative started by the Act had resulted in

110 therapeutic communities in state and federal correctional institutions (Lipton, 1998).

In 1994, the Crime Bill also provided federal money for states to implement residential substance abuse programs. The Residential Substance Abuse Grant Program provided $270 million to states to operate treatment program for offenders with substance abuse problems. While not required to establish therapeutic communities, the model treatment program criteria are stipulated based on the findings of the effectiveness of the successful therapeutic communities of the late 1980s. Furthermore, within two years of the Act, 70 therapeutic communities have been developed or enhanced in more than 40 states (Lipton, 1998; Wexler, 1997). Indeed, the therapeutic community examined in this dissertation was developed from monies obtained from the federal government as part of the RSAT grant.

While therapeutic communities first began in Britain and focused on group processing, psychoanalytic psychotherapy, and was highly structured, the foundation for

U.S. communities was the self-help movement. From this development, therapeutic communities began to be used for offenders to treat substance abuse. From their first appearance, they have been in and out of favor with corrections. Currently, with money available from the federal government for the purpose of treating substance-abusing offenders, many states are implementing therapeutic communities as the preferred program.

6 The Federal Bureau of Prisons has since closed their therapeutic communities within the federal prisons.

31 Characteristics of Therapeutic Communities

While there is not one specific model defining therapeutic communities, there are some similarities among this treatment intervention. Specifically, the characteristics of the modality may be described along four dimensions – view of substance abuse and the individual, treatment modality, structure, and activities.

View of Substance Abuse and the Individual. According to the therapeutic community’s treatment perspective, drug abuse is seen as a personality disorder in which the addict cannot postpone gratification, tolerate frustration, maintain stable relationships, or assume responsibility for his actions (Wexler, 1995). The drug user has psychological, social, and cognitive deficits such as: low self-esteem, problems with authority, poor impulse control, feelings of guilt, and unrealistic expectations (Lipton, 1999). Thus, drugs are not the problem; rather, the problem lies within the person and addiction is only a symptom of the disorder. Since drug abuse si only a symptom of the personality disorder, the primary goal of treatment is to change negative patterns of behavior and thinking (DeLeon & Ziegenfuss, 1986; Nielson & Scarpitti, 1997). Thus, therapeutic communities seek a holistic approach in which the aim is a global change in lifestyle: abstinence from substance abuse, elimination of other antisocial activity, development of employability skills, and enhancement of prosocial attitudes, values, and beliefs (DeLeon,

1999).

Treatment Modality of the Therapeutic Community. As previously mentioned, the birth of therapeutic communities in the United States began out of the self-help movement (Lipton, 1998; Wexler, 1997). The self-help movement is different from traditional medical and social welfare approaches that foster a reliance on treatment

32 providers. Rather, self-help programs rely on self-responsibility and empowerment to elicit commitment to one’s own healing. The self-help modality within therapeutic communities promotes change by teaching members to take responsibility, gain control over their situation, and improve competency (Wexler, 1997).

In addition to the self-help modality, therapeutic communities also adhere to a structured social learning approach (Lipton, 1998). The social learning modality stresses the importance of learning vicariously through observing others (Van Voorhis, 2000).

Unique to this treatment modality within the therapeutic community setting is the use of the community to change the offender’s lifestyle. Specifically, the community consists of offenders and staff who act as role models and guides in the recovery process.

Accordingly, the community is both the context for change and the method for facilitating change (DeLeon, 1999). Some therapeutic communities use former addicts and even ex-offenders who have been resocialized by the treatment modality as role models whereas others use professionally trained staff (DeLeon, 1990; Lipton, 1998).

Structure of the Therapeutic Community. Therapeutic communities provide a very structured environment in which the participants are isolated from the rest of society or prison inmates (Springer, McNeece, & Arnold, 2003). There are strict rules and regulations that offenders must follow to continue being a part of the community. In addition, each day of the program is ordered and routine which serves to counter the usually disorganized lives of the participants. It is theorized that the strict structure of the days will assist the offender in developing time management skills, setting and planning goals, and accountability (DeLeon, 1999).

33 In addition, to the rigid organization of the day, therapeutic communities have distinct hierarchies among the offenders. The structure of the therapeutic community is such that the program is largely self-regulated so that veteran participants are responsible for guiding the behavior of newer residents (Springer et al., 2003). Hence, there is a hierarchical structure in which leaders serve as important role models because they have achieved success in the program (Broekaert, Kooyman, & Ottenberg, 1998). These leaders are responsible for assisting new members in learning the concepts of the therapeutic community, keeping an eye out for the other members, and praising and correcting behaviors. Progression through the hierarchical structure is achieved by demonstrating emotional growth and a commitment to the community.

Another important feature of the therapeutic community is the phase format of the intervention. As DeLeon (1999) reports, the phases are developed to reflect incremental learning, which helps to move the offender to the next stage of recovery. Many programs have three phases of treatment. The first phase of treatment is the induction phase, which is usually the first 30 days (DeLeon, 2000). During this time in the program, the participants become assimilated into the community by learning the verbiage of the community, the hierarchical structure, and the rules and regulations of the community.

The new member is usually assigned a senior member who will watch over and guide the new participant, explain any questions, and counter comments pertaining to leaving the community. In addition, any counseling sessions conducted during this time is usually of a supportive nature in which the staff helps to reduce any anxieties surrounding the individual (DeLeon, 2000).

34 The second phase of treatment is the primary treatment stage in which the focus is on personal growth and psychological awareness through the use of the community, educational and vocational services, and group meetings (DeLeon, 2000). It is during this phase that the individual moves from being a passive observer to an active member of the community eventually becoming a role model to others. Additionally, the member is expected to “act as if” in which there is blind obedience to the community values and rules of conduct until they become internalized (DeLeon, 2000). The phase two participant is also expected to demonstrate knowledge of the therapeutic community, accept that he has a problem and become committed to the recovery process, increase self awareness and responsibility for his behaviors, and begin to hold others accountable for their behaviors and attitudes (DeLeon, 2000).

Upon completion of phase two, participants enter the re-entry phase in which the individual takes a more active role in the management of the community. He is adapt at disclosing his thoughts to others, seeks helps when necessary, and works to strengthen coping, decision-making, and problem-solving skills (DeLeon, 2000). This phase of treatment works to get the participant ready for life outside the community.

The Use of Work in the Therapeutic Community. One of the core activities of a therapeutic community is the use of work within the community. The purpose of work is to replace the unstructured daily activities with regular routines (Brook & Whitehead,

1980). Since the therapeutic community is a separate environment, it is the responsibility of the members to manage all aspects of the community (e.g., cleaning, meal preparation, and maintenance). Thus, work is seen as a therapeutic intervention in that it helps to promote responsibility and improve skills (DeLeon, 1999).

35 The primary purpose of work is not the by-product of the labor but rather the personal change that takes place within the individual. It is believed that participation in work will facilitate changes in behaviors, attitudes, and values of the participants

(DeLeon, 2000). For example, just as the structure within the therapeutic community is hierarchical, job placement is also hierarchical. New members are usually assigned to entry-level positions such as kitchen crewmember or clean-up crew. The tasks within these jobs are menial and work is used to assess competency and willingness to complete tasks. As members remain in the program and develop responsibility and competency, they move to higher-level jobs such as maintenance and clerical work. These assignments require greater self-management and higher levels of responsibility.

Placement in these jobs will result in acquiring stable work relations, greater responsibility to self and others, and improvement in accountability (DeLeon, 2000). In addition, these jobs have many of the same pressures as conventional work settings.

Aside from work within the facility, there is also job placement within the clinical portion of the program. 7 For example, crew leaders are entry-level positions in which the member has direct supervisory responsibility for other members on kitchen, clean up, and other details. This position focuses on communication, self-management, accountability, and motivating others (DeLeon, 2000). Crew leaders are usually supervised by department heads. Individuals in this position report directly to the staff and must learn to accept instruction and criticism from supervisors (DeLeon, 2000).

7 While placement into non-clinical jobs is based on position in the therapeutic community, placement into clinical jobs may be used as a therapeutic intervention. For example, if a participant needed to practice ‘being their brothers keeper’, he may be assigned an expediter job since they are responsible for monitoring and reporting on others’ behaviors.

36 The third type of clinical job is an expediter. These individuals are responsible for monitoring and redirecting the other members (DeLeon, 2000). They must have knowledge of the therapeutic community rules in order to detect and report any violations. Individuals in this position have some degree of informal control over the others as they are responsible for issuing verbal reprimands (e.g., pull-ups) and providing information and suggestions to staff.

The highest-ranking position within the clinical setting is that of coordinator.

This individual has much informal authority, as he is usually the individual that is closest to the staff.8 He has many responsibilities which include assisting in managing the daily operations of the therapeutic community through facilitating house meetings, reviewing daily schedules, and overseeing sanctions, privileges, and disciplinary actions (DeLeon,

2000). Thus, the coordinator must learn how to handle a position of authority and develop decision-making skills.

The hierarchical structure within therapeutic communities is very strict (DeLeon,

2000). For example, while staff members are available in the program, participants are expected to adhere to the chain of command. That is, individuals must take problems to their crew leaders who then process the information to the department heads. The department heads are then responsible for relaying the information to the expediter who in turns transmits the request, problem, or suggestion to the staff. When an individual

“shoots a curve”, he is breaking the chain of command and usually goes directly to a staff member with a request/suggestion. If this behavior is continued, then disciplinary action is usually taken.

8 Since staff members in a therapeutic community are more hands-off than many other types of treatment interventions, the structure is developed so that all lines of communication to the staff flow through the coordinator.

37 The Use of Behavioral Reinforcements in the Therapeutic Community.

Aside from the community agent, the use of role models, and the hierarchical structure, another avenue for changing behavior that is employed within therapeutic communities is the use of reinforcements (DeLeon, 1990; Wexler, 1995). Specifically, push-ups, pull- ups, learning experiences, and therapeutic reprimands/therapeutic haircuts are used within the therapeutic community to bring attention to and change behavior. Push-ups are a form of behavioral reinforcements in which participants receive positive feedback

(e.g., praise) for any signs of progress. The purpose of the push-up is to provide encouragement to the recipients to continue the behavior/attitude (DeLeon, 2000).

Whereas push-ups are positive praise, pull-ups are awareness techniques that are used within the community and may result in some type of sanction. There are two types of pull-ups–verbal and written. Pull-ups are verbal statements of reminders issued by peers at any time when there are lapses in awareness in behaviors and/or attitudes and the recipient is assumed to know the appropriate behavior or attitude (DeLeon, 2000). When a pull-up is issued, the recipient must listen to the pull-up without comment and then express gratitude at receiving the reminder. When participants repeatedly perform an undesired behavior/attitude, then written pull-ups (i.e., tickets) may be used to correct the behavior. Whereas, verbal pull-ups do not result in a sanction, written pull-ups flow up the chain of command to the staff and usually result in some type of sanction or learning experience.

The most severe type of verbal corrective is the reprimand or “therapeutic haircut.” Both staff and senior members may issue a therapeutic reprimand for repeated negative behaviors. When offenders issue the haircut, staff members usually observe the

38 incident. The recipient must stand before the staff and other community participants while staff either talk to and/or yell at the individual about his behaviors or attitudes for approximately five minutes. During this time, the recipient is expected to maintain eye contact and not speak while staff discuss the behavior, explain why it is unacceptable, how it will lead to destructive outcomes, and positive alternative ways of behaving

(DeLeon, 2000). Thus, it is argued that reprimands are therapeutic in that it instructs the individuals involved (both the recipient and the observers) on positive prosocial behaviors and attitudes.

Aside from verbal warnings, members may also receive sanctions such as learning experiences, wearing signs, speaking bans, loss of privileges, loss of phase status, and ultimately discharge from the community. Learning experiences are administered for minor rule violations and usually include some type of writing assignments, community apologies, or physical activity (DeLeon, 2000). Usually the member must present the learning experience to the entire community either during the morning meeting or the evening meeting. Another type of sanction is the use of signs worn around the neck or pinned to the shirt. It is argued that wearing signs helps to heighten the awareness of the problem behaviors/attiudes for both the resident and the other community members

(DeLeon, 2000). Speaking bans may also be employed within a therapeutic community.

Speaking bans may be directed to one individual or to the entire community. This type of sanction is usually issued when there is negative communication concerning the use of substance abuse, threats within the community, and cynical judgments about the program.

Loss of privileges and loss of phase levels are other sanctions that may be used to change negative behavior. Loss of privileges is usually proportionate to the type of

39 infraction and is potent if the member feels the emotional reaction from losing the privilege (DeLeon, 2000). For example, members may lose the ability to wear their own clothes, to have more money or personal items, and to receive additional letters or make more phone calls. Loss of phase levels are usually reserved for more severe infractions

(such as violating a major rule – horse playing, using profanity, or walking out of group) and may reduce the member down one level or even to the lowest level depending on the infraction. With the loss of levels, the member also loses the privileges associated with the level. The loss of a level may be for a certain period of time or the member may be required to re-complete the steps necessary to advance to the next level.

The ultimate sanction is termination from the program. When a member has violated a cardinal rule (i.e., using physical violence, drugs, destruction of property, or having contraband) or had repeated violations, then he may be unsuccessfully terminated from the program. Early termination is usually reserved for behaviors that constitute a threat to the safety of the community. In some cases, the member may be allowed to return to the community after 30 days if he has shown some type of improvement in his behavior (DeLeon, 2000).

The Types of Meetings and Groups in a Therapeutic Community. Each day members participate in two different types of meetings – morning meetings and evening meetings. While staff members are present for these meetings, the community members facilitate the gatherings. The purpose of the morning meetings is to present the activities for the day, motivate the members, present any assignments that were issued as sanctions, and to get the day off to a good start. A morning meeting will typically include reciting the philosophy of the program, reading a word of the day, the weather report, signing

40 songs, playing games, and skits. The reason for the activities in the morning meeting is to show the participants that individuals can gather together in the morning to develop a regular routine without the use of drugs (DeLeon, 2000). The evening meetings mirror the morning meetings in that participants facilitate them with staff being present. They are intended to end the day on a positive note and help the community to reflect on the day (DeLeon, 2000). During the evening meetings, learning experiences may be issued to the members and the writing assignments presented to the community.

Another type of meeting that is usually held in a therapeutic community is seminars or didactic presentations that teach offenders various lifestyle skills that are needed to keep offenders drug-free (Broekaert et al., 1998; DeLeon, 1990; DeLeon &

Ziengenfuss, 1986; Nielsen & Scarpitti, 1997). The members present the seminars in order to build self-esteem. The topics of the seminars may vary but usually include the following: telling your story, concepts of the therapeutic community, pros and cons of a behavior/attitude, and topics about mainstream issues (DeLeon, 2000). The use of seminars is a therapeutic tool, which attempts to train attention, listening, and speaking skills to those who participate (DeLeon, 2000).

While morning and evening meetings and seminars are daily interventions, the primary therapy used in therapeutic communities is encounter groups that are intense confrontational sessions where immature behavior and criminal or antisocial values are attacked (DeLeon, 1990; Lipton, 1998; Wexler, 1995). During an encounter group, two individuals sit across from each other within a circle of the other members.9 The

9 While staff members are present, they do not participate in the encounter group unless there is a threat of violence. Staff members have no decision-making authority during these groups because it is argued that their authority would impede the spontaneity of the self-help process and hinder the members from resolving issues (DeLeon, 2000).

41 individual confronting the other member presents the behavior/attitude that is being confronted. Once the behavior is brought to the attention of the individual, a verbal battle is evoked in hopes that confronted individual will begin to change his attitude or behavior. The argument is made concerning the negativity of the behavior/attitude by the confronting member and may also include other members of the community who enter the circle. Once the confrontation is complete, the encountered member is allowed to defend himself and may even resist the encounter. Once the encounter is complete, a period of closure is used to reaffirm the person and the process. It is argued that the encounter environment provides motivation for individuals to change (DeLeon, 2000).

Recently, some communities have begun to provide services to facilitate successful lifestyles outside of the therapeutic community (Wexler, 1995). In these programs, offenders are given aftercare, which serves to strengthen the skills necessary to continue living drug-free or crime-free lifestyles. Thus, therapeutic communities have emerged from the self-help movement of the 1950s to include cognitive behavioral interventions such as relapse prevention, aspects of social learning therapies such as modeling, and radical behavioral aspects such as the use of reinforcements or rewards.

Therapeutic Communities and the Principles of Effective Interventions

Since Martinson’s “nothing works” days, research has discovered programs are able to have a positive effect under certain circumstances. Specifically, Gendreau (1996) has identified certain principles of effective intervention that if adhered to are more likely to result in successful outcomes. The principles are as follows: 1) services should be intensive and behavioral in nature; 2) behavioral programs should target criminogenic needs of high-risk offenders; 3) the characteristics of the offenders, therapists, and

42 programs should be matched; 4) program contingencies and behavioral strategies should be enforced in a firm but fair manner; 5) therapists should relate to offenders in interpersonally sensitive and constructive manner and should be trained appropriately; and 6) relapse prevention strategies should be provided (Gendreau, 1996, pp.120-125).

Indeed, many authors have found treatment effects for correctional programming if they adhere to the principles of effective intervention (Andrews & Bonta, 1994;

Gendreau, Cullen, & Bonta, 1994; Lipsey, 1992; Lipsey & Wilson, 1998). Furthermore, while some research has found that therapeutic communities are effective in reducing recidivism, research has not examined this treatment modality in relation to the principles of effective intervention. Thus, this section will explore important issues of therapeutic communities as they relate to the “what works” body of evidence.

Intensive and Behavioral Services. Since offenders in therapeutic communities are essentially in “treatment” 24 hours a day, the programs often meet the principle of intensity. That is, the offenders are in programming for the majority of their time in the program. They participate in groups and meetings for approximately 16 hours a day

(DeLeon, 2000). Furthermore, they are expected to be aware of their own and each other’s attitudes/behaviors 24 hours a day. Another aspect of intensity is that programs must be of sufficient length in order to allow for enough time for the offenders to change their attitudes. Research has shown that effective programs average a length of six to nine months (Gendreau, 1996). Accordingly, many correctional therapeutic communities average a length of stay of about six months10 (Harrison & Martin, 2003).

10 Therapeutic communities that receive federal money from the RSAT grant must develop programs that are 6 months in length.

43 The problem with therapeutic communities lies in the behavioral portion of their program. Many behavioral programs are based on the principles of operant conditioning

(Lester, Braswell, & Van Voorhis, 2000). Operant conditioning uses reinforcements to change behavior. As previously discussed, members in the therapeutic community provides verbal praise in the form of push-ups and members receive privileges as they advance through the program (DeLeon, 2000). The problematic issue of reinforcements within therapeutic communities is the types of punishers that are issued. The use of therapeutic reprimands and learning experiences are not effective reinforcements. For example, a therapeutic reprimand usually involves five minutes of yelling at the offender.

Learning experiences are issued to members for antisocial behaviors or attitudes and are usually activities that result in some type of shaming. For instance, offenders are made to wear signs, sing songs, or carry items such as toilet brushes throughout the day for unwanted behavior. These techniques are seen as demeaning and shameful and thus are not effective in shaping behavior (Spiegler & Guevremont, 1993).

Aside from using reinforcements, programs should be based on a behavioral model. Gendreau (1996) describes three types of behavioral programs: token economies, social learning, and cognitive-behavioral therapies. The foundation of therapeutic communities in the United States is based on a self-help model. Indeed, a national evaluation of the residential substance abuse treatment programs, many of which implemented therapeutic communities, found that programs adhered to an eclectic model of cognitive-behavioral and self-help, educational therapies (Harrison & Martin, 2003).

This type of model is not very effective in changing criminal behavior and substance abuse (Andrews & Bonta, 1994; Kownacki & Shadish, 1999). However, many

44 therapeutic communities are combining a structured social learning approach with cognitive behavioral techniques (Feld, 1984; Inciardi et al., 1997; Wexler, DeLeon,

Thomas, Kressel & Peters, 1999). Structured social learning programs stress the importance of modeling in which offenders learn behaviors and attitudes through watching and imitating others (Van Voorhis, 2000). Cognitive-behavioral programs focus on changing antisocial attitudes through teaching skills such as problem-solving, self-control, and self-instructional training (Gendreau, 1996). Thus, the therapeutic communities that adhere to these approaches attempt to change attitudes and behaviors through the use of role models and skill training.

Targeting Criminogenic Needs of High-Risk Offenders. Research has revealed dynamic risk factors that predict recidivism among offenders. Specifically, programs that target factors such as: antisocial attitudes, antisocial peer networks, antisocial personality, familial factors, and education and vocational achievement are more likely to reduce recidivism as these are some of the strongest predictors of criminal behavior (Andrews &

Bonta, 1994; Gendreau et al., 1994; Gendreau, Little, & Goggin, 1996; Simourd &

Andrews, 1994). While antisocial attitudes are targeted within the therapeutic community, it appears that a major focus of many communities is making the member employable (DeLeon, 2000). While vocational achievement is a criminogenic need, it is not a strong of predictor as antisocial attitudes (Andrews & Bonta, 1994). Furthermore, many therapeutic communities are not addressing the attitudes related to work but rather are focusing on factors such as resume building, interviewing, and letter writing

(DeLeon, 2000).

45 Therapeutic communities also address non-criminogenic needs such as self- esteem. As previously discussed, therapeutic communities postulate that individuals use substances because of low self-esteem (Lipton, 1999). Therefore, in order to reduce substance abuse, therapeutic communities seek to increase the self-esteem of the offenders. Research has shown that self-esteem is not a predictor of recidivism and therefore, should not be a target in correctional programming (Andrews & Bonta, 1994).

While low self-esteem is not a predictor of recidivism, an inflated self-image is a predictor (Andrews & Bonta, 1994). Furthermore, many high-risk offenders suffer from egocentrism in which case participation in therapeutic communities may serve to increase recidivism. Thus, therapeutic communities may not be as effective in reducing recidivism as programs that formally target antisocial attitudes.

Another problem of therapeutic communities is the lack of assessment instruments that differentiate low and high-risk offenders. For example, Harrison and

Martin (2003) found that many programs did not use standardized assessment instruments, which resulted in inappropriate offenders entering the program. As research has shown, behavioral programs should target high-risk offenders. Targeting low risk offenders tends to result in either no change in recidivism or an increase in recidivism

(Lowenkamp & Latessa, 2002). Thus, without a risk assessment instrument, many therapeutic communities may not be targeting high-risk offenders.

Related to the lack of assessment instruments is the lack of screening or exclusionary criteria for many programs. When programs do not have criteria in place to prevent certain types of individuals from entering treatment, many inappropriate offenders will receive treatment. These individuals may disrupt the treatment

46 intervention. For example, as research has shown allowing psychopaths to engage in treatment interventions at best will result in no change and at worse will increase their risk of recidivism (Hare, 1996, 1999). Furthermore, participation in a therapeutic community has been found to actually increase a psychopath’s recidivism rates (Hare,

1999). It may that the structure of the therapeutic community allows the psychopath to enhance their antisocial tendencies. For example, within a therapeutic community, the participant’s self-esteem is increased; offenders have informal control over others; they participate in confrontational encounter groups; and are allowed to issue learning experiences for antisocial behavior. These experiences may serve to increase the psychopaths’ antisocial disorders. Accordingly, without adequate screening/exclusionary criteria and assessment instruments, therapeutic communities may be allowing inappropriate offenders to enter treatment resulting in increased recidivism for certain individuals.

Reinforcement of Contingencies. Staff members should reinforce behavioral contingencies in a firm, fair, and consistent manner (Gendreau, 1996). However, within therapeutic communities, there is an issue of offenders having authority over others

(DeLeon, 2000). Members are responsible for writing pull-ups. Senior members of the community with staff approval usually determine the sanctions that are issued for the pull-ups. Thus, the reinforcements may not be issued in a firm, fair, or consistent manner. A related issue to the reinforcement of contingencies is the fact that staff should be aware of the potential negative effects of reinforcing–especially when punishments have to be issued (Gendreau, 1996). For example, punishments may have unintended effects such as fear, avoidance, increased aggression, and breaking of social relations

47 (Spiegler & Guevremont, 1993). Within the therapeutic community, there is a concept called “act as if”. This concept of “act as if” involves the offenders having blind obedience to the rules and regulations (DeLeon, 2000). Given this concept, it does not appear that staff may be attuned to or consistently monitor the potential negative effects of punishment such as escalation of behavior, aggression, or avoidance. Thus, therapeutic communities may not be adhering to the reinforcement of contingencies principle.

Staff Characteristics. Programs tend to be more effective when they have staff that are educated, have experience working with the offender population, and are properly trained (Gendreau, 1996). An issue with therapeutic communities as it relates to staff characteristics is the lack of training (Harrison & Martin, 2003). Many programs will hire ex-addicts who themselves have been through a therapeutic community or ex- offenders and not professionally trained substance abuse counselors (DeLeon, 2000).

These individuals may lack valuable education and are usually not properly trained in the

“what works” literature.

Relapse Prevention Strategies. Programs tend to be more effective when they incorporate relapse prevention components (Gendreau, 1996; Lowenkamp, 2004).

Elements of a relapse prevention strategy should include components whereby the offender is given ample opportunity to monitor and anticipate problem situations (i.e., identifying triggers and red flags), practice alternative prosocial behaviors in increasingly difficult situations, and provide opportunities for booster sessions and/or aftercare services (Van Voorhis & Hurst, 2000). While some therapeutic communities are teaching offenders how to monitor problem situations and incorporating aftercare

48 services, many programs do not have ample opportunities for offenders to practice alternative behaviors. Indeed, the offenders’ days are filled with didactic groups that may be classified as “talking cures” and education based therapies. These strategies have been shown to not be as effective as strategies that focus on skill building and rehearsal

(Gendreau, 1996).

While therapeutic communities adhere to some principles of effective interventions (i.e., intensity, length of treatment, and use of praise and privileges, identification of triggers), there is room for improvement. Specifically, therapeutic communities rely on education-based programming and talking cures instead of cognitive-behavioral therapies, fail to target appropriate criminogenic needs, may not be targeting high risk offenders, hire ex-offenders and ex-substance abusers instead of professionally trained staff, and use shaming techniques as sanctions. In addition, while not a specific principle of effective intervention, it is problematic that offenders are having informal authority over other offenders. For example, many job assignments place offenders in a position of power over the other offenders (e.g., department heads, expediters, and coordinators). Furthermore, members also have input into the type of learning experience that is administered to the offender. Thus, with offenders having some power over others, there is an opportunity for abusing the power.

EFFECTIVENESS OF THERAPEUTIC COMMUNITIES

As research has shown, there is a continuing problem of drug abuse and criminality. Without appropriate intervention, drug-abusing offenders (especially the most severe offender-addicts) have a 90 percent chance of returning to drug use and crime after release from an institution and most will be reincarcerated within three years

49 (Lipsey, 1995). Thus, there is a real need to establish ‘what works’ for drug abusing offenders.

One promising avenue is placing offenders in therapeutic communities. A review of the literature on the effectiveness of therapeutic communities in reducing recidivism and drug use reveals four main issues that will be examined. First, research examining the effectiveness of therapeutic communities compared to no treatment or minimal treatment will be reviewed. A second issue concerning the research on therapeutic communities has to do with the follow-up time period and the strength of the effectiveness of the treatment. Next, research has also examined the effectiveness of the treatment modality for individuals who actually complete treatment and individuals who drop out of treatment. Last, studies have been conducted that examined outcomes for transitional programs (i.e., in-prison therapeutic communities to work release programs operated as therapeutic communities to supervised aftercare). Aside from these issues, research will be presented that reviews the specific predictors of success. Specifically, predictors of successful treatment outcome (i.e., recidivism) and predictors of successful completion will be evaluated.

Reducing Recidivism

Treatment Versus Non-Treatment. There is mixed support for therapeutic communities when comparing those who participate in treatment compared to offenders who do not participate in treatment (see Table 1 for a review of studies). For example, in one of the first outcome studies of a therapeutic community, Field (1984) examined the

50 Table 1: Summary of Therapeutic Community Outcome Evaluation Findings Year Authors Treatment Group Comparison Measures Follow-up Findings Group 1984 Field Oregon’s Individuals not Reincarceration Three-year 29% of the TC graduates were reincarcerated compared Cornerstone receiving to 37% of the untreated comparison group Program treatment

1997 Inciardi, Martin, Males & females Those who were Arrest-free & Drug- Eighteen 77% of offenders who participated in the in-prison TC Butzin, Hooper, in a multistage TC assigned to regular free month and then the community TC/WR group were arrest free & Harrison in Delaware work-release compared to 57% of community TC/WR group only; Prison with a step 43% of in-prison TC only; and 46% of the comparison down to a group were arrest free community work release center 47% of in-prison TC+ community TC/WR group were operated as a TC drug free whereas 31% of community TC/WR group; 22% of in-prison TC only; and 16% of the comparison group

1999 Mart in, Butzin, Males & females Those who were Arrest-free & Drug- Three-year 43% of offenders who participated in in-prison TC+ Saum, & Inciardi in a multistage TC assigned to regular free community TC/WR group were arrest free compared to in Delaware work-release 37% of the TC/WR only group; 41% of the in-prison TC Prison with a step only; and 30% of the comparison group were arrest free down to work at three years release center and then aftercare in 23% of offenders who participated in in-prison TC+ the community community TC/WR group were drug free compared to 23% of the TC/WR; 22% of the in-prison TC only; and 6% of the comparison group were drug free

69% of the TC/WR+AC completers group were arrest free compared to 55% of the TC/WR completers were arrest free; 28% of the TC/WR dropouts were arrest free; and 29% of the comparison group were arrest free

35% of the TC/WR+AC completers were drug free compared to 27% of the TC/WR completers; 17% of the TC/WR dropouts; 5% of the comparison group were drug free TC – therapeutic community; WR – work release, AC – aftercare

Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment Comparison Measures Follow-up Findings Group Group 2000 Farrell Females who Females Relapse with 18-month 39% of the treatment group had used drugs participated in participating in drugs & New compared to 50% of the comparison group Delaware’s a work release arrest prison-based program 39% of the treatment group & 39% of the CREST TC in comparison group had been arrested Delaware

2002 Butzin, Martin, Participants in Compared the Relapse with 18 to 42- At one year follow-up, 39% of the TC/WR & Inciardi the Crest TC in participants with drugs & New month dropouts group, 42% of the TC/WR graduates, & Delaware the different arrest 50% of the TC/WR + AC group were drug free. levels of the treatment At 3- year follow-up, 19% of the TC/WR dropouts, received 24% of the TC graduates, & 32% of the TC/WR + AC group were drug free.

At one year follow-up, 68% of the TC/WR dropouts, 81% of the TC graduates, & 79% of the WR/TC + AC group were arrest free.

At 3- year follow-up, 34% of the TC/WR dropouts group, 56% of the TC graduates, & 60% the TC/WR + AC group were arrest free.

Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment Comparison Measures Follow-up Findings Group Group 2004 Inciardi, Martin, Individuals who Individuals who New arrest & Up to 5 years Estimated probabilities of being drug free at 42 Butzin participated in were eligible for Drug usage months were .29 for the TC+AC group; .20 for the the CREST TC TC but received TC completers only; .18 for the TC dropouts; and in Delaware work release .05 for the “no treatment” group

At the 60 month follow-up, the probabilities were .26 for the TC+AC group; .21 for the TC completers only; .17 for the TC dropouts; and .05 for the “no treatment” group

The probabilities for remaining arrest-free at the 42 month follow-up were .53 for the TC+AC group; .47 for the TC completers only; .33 for the TC dropouts; and .27 for the “no treatment” group

For the 60 month follow-up, the probabilities were .48 for the TC+AC group; .42 for the TC completers only; .28 for the TC dropouts; and .23 for the “no treatment” group

1999 Wexler, California’s None Reincarceration One year & 44.9% of TC dropouts; 40.2% of TC completers; DeLeon, Amity Prison Two-year 38.9% of TC completers but AC dropouts; and Thomas, TC 8.2% of TC + AC group were reincarcerated at the Kressel, & one-year follow-up Peters 60% of TC completers but AC dropouts were reincarcerated compared to 57.5% of the TC dropouts; 48.8% of the TC only group; and 14% of the TC + AC group at the two-year follow-up

Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment Group Comparison Measures Follow-up Findings Group 1999 Wexler, California’s Individuals not Reincarceration Three-year 75% of the no treatment group were reincarcerated Melnick, Lowe, Amity Prison TC receiving controlling for at the three-year period compared to 82% of the & Peters treatment treatment TC dropout group; 79% of the TC comp leters; and readiness and 7% of the TC + AC group motivation & Length of time to The TC & AC group took 579 days to return to return to custody custody whereas the TC only group took 387 days to return; the TC dropouts took 306 days to return; and the non-treatment group took 295 days to return

1997 Knight, Kyle New Vision Individuals Arrest & Six-month 3% of the treatment group were rearrested Simpson, TC in TX receiving no Cocaine use compared to 16% of the comparison group Chatman, & (TC + AC + treatment Camacho Probation.) 35% of the treatment group used cocaine whereas 54% of the comparison group reported using during the follow-up period

1999 Hiller, Knight, 293 parolees who Matched (drug Arrest Three, six, 2% of the TC+AC, 5% of the TC only & 4% of the & Simpson participated in use & criminal nine-month, comparison group were arrested at the 3-month Kyle New Vision history) group of & one-year period. TC in TX 103 parolees (TC+AC with who received no 5% of the TC+AC, 13% of the TC only & 16% of supervision) treatment the comparison group were arrested at the 6-month period.

12% of the TC+AC, 22% of the TC only & 24% of the comparison group were arrested at the 9-month period.

16% of the TC+AC, 29% of the TC only & 31% of the comparison group were arrested at the 12- month period.

Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment Group Comparison Measures Follow-up Findings Group 1999 Knight, Nonviolent Individuals Reincarceration Three-year 64% of the TC completers but AC dropouts were Simpson & offenders who receiving no reincarcerated Hiller participated in the treatment 41% of the in-prison TC were reincarcerated Kyle New Vision 42% of the comparison group were reincarcerated TC in TX 25% of the TC + AC completers were (TC+AC with reincarcerated supervision)

1999 Siegel, Wang, Inmates Inmates not Arrest & Length Unknown There were significant differences between the Carlson, Falck, participating in participating in a of time to arrest comparison group and the treatment group. Rahman, & Ohio’s in-prison TC Fine TC Inmates with 6 months or more of TC treatment were significantly less likely to be arrested.

2002a Pealer, Latessa, Juvenile males in Juvenile males Incarceration in a Up to 21 17.2% of the treatment group had been re- & Winesburg a residential TC who participated youthful or adult months incarcerated compared to 37.5% of the eclectic in Ohio in an eclectic facility & Length group and 37% of the DYS no treatment group. program (12- of time to step & CBT) & incarceration The average length of time to incarceration was Juvenile males lowest for the treatment group at 193 days who were followed by the DYS group at 255 days and the sentenced to the eclectic group at 296 days. DYS who received no treatment

Table 1: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Treatment Group Comparison Measures Follow-up Findings Group 2002 Winesburg, Males inmates in Inmates from the Arrest & Up to 3 ½ There were no significant differences between the Latessa, & a medium- general Incarceration years groups at the 2 year, 3 year, or 3year + time Pealer security prison population periods for arrest. However, for each time period, TC in Ohio the treatment group had the lowest percentage of individuals being arrested.

There were no significant differences between the groups at the 2 year, 3 year, or 3year + time periods for incarceration. The TC group had the lowest percentage for being incarcerated.

2002b Pealer, Latessa, Males & females Individuals Arrest & Up to 3 ½ More individuals were arrested from the treatment & Winesburg participating in a participating in Incarceration years* group (35.8%) followed by the CBCF group community-based the CBCF that (32.4%) and the 12-step group (26.3%) at the 1 correctional used a holistic year follow-up facility TC in approach & Ohio probationers 7.1% of the treatment group were arrested within 1 who participated to 2 years following release whereas 12.4% of the in a 12-step CBCF group and 13.5% of the 12-step comparison program group were arrested.

There were no individuals arrested from the treatment group at the 2 years or more follow-up; but 10.4% of the CBCF group and 9% of the 12- step group were arrested at this time.

There were no significant differences between the groups for a new incarceration; however, a smaller percentage of the treatment group was incarcerated compared to the CBCF and 12-step groups at the one year and 2 year follow-up

* The same individuals were not tracked for each time period; thus, the reason for the finding that as length of time increases, the percentage of arrest and incarceration decreases.

effects of Oregon’s Cornerstone Program, which is a 32-bed facility for correctional inmates. Participation in the therapeutic community resulted in a significant decrease in recidivism when compared to individuals not receiving treatment. Specifically, only 29 percent of the therapeutic community participants were reincarcerated at the three-year follow-up compared to 37 percent of the individuals not receiving treatment (Field,

1984).

Research by Knight et al., (1997) also found a significant treatment effect for individuals participating in a therapeutic community in Texas. At the six-month follow- up period, only 3 percent of the treatment group had been arrested whereas 16 percent of the comparison group (i.e., no treatment) had recidivated. Furthermore, the authors examined cocaine usage at the follow-up time period and found that 35 percent of the treatment group had used cocaine whereas 54 percent of the no treatment group had reported using cocaine (Knight et al., 1997). Similar results were found in a review of inmates who participated in Ohio’s therapeutic communities. Specifically, inmates who received at least 180 days of treatment were less likely to be arrested compared to inmates who did not receive treatment and inmates who received less than 180 days of treatment (Siegal et al., 1999).

Whereas the above studies showed support for therapeutic communities, there have been some studies that have shown no significant differences between the treatment and the comparison groups. For example, other research conducted in Ohio revealed that there were no statistically significant differences in medium security male inmates who participated in a therapeutic community and a sample of inmates who did not participate in treatment (Winesburg, Latessa, & Pealer, 2002). In addition, a community-based

57 therapeutic community did not produce significant reductions in recidivism (as measured by arrest and incarceration) when compared to a sample that participated in an eclectic residential drug treatment program and a sample of probationers who participated in a 12- step program (Pealer, Latessa, & Winesburg, 2002b). Thus, while some studies have found therapeutic communities to produce significant reductions in recidivism, others have not seen this success. Furthermore, many studies have only included adult offenders. Thus, the question remains is this treatment modality effective for juveniles.

Research pertaining to the effectiveness of therapeutic communities for specific offender populations such as juveniles is scarce. In one of the first studies that examined the effectiveness of a therapeutic community for juvenile offenders, Pealer, Latessa, and

Winesburg (2002a) found that juvenile males who participated in the therapeutic community were significantly less likely to be incarcerated in either a juvenile facility or an adult facility when compared to individuals who participated in an eclectic 12-step/ cognitive behavioral model and individuals who received no treatment. Specifically, 17 percent of the treatment group was reincarcerated at the follow-up time period whereas

37 percent of the eclectic group and 37 percent of the no treatment group were reincarcerated (Pealer et al., 2002a).

Thus, these studies appear to show mix support for the therapeutic communities in reducing recidivism. In some instances, the treatment resulted in a significant reduction in arrest, incarceration, and even drug use (Field, 1984; Knight et al., 1997; Siegal et al.,

1999). However, other studies have found that therapeutic communities did not significantly reduce recidivism especially when compared to other interventions (Pealer et al., 2002b; Winesburg et al., 2002).

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Follow-Up Time Period. As previously mentioned, another issue that arose from a review of the literature concerns the length of the follow-up time period in determining effectiveness. Since the late 1980s and early 1990s, therapeutic communities have emerged as a preferred method for treating substance-abusing offenders. Due to the longevity of some communities, researchers have been able to examine the effects in reducing recidivism over time. These studies have typically shown that the treatment effect diminishes as more time elapses from release (Butzin, Martin, & Inciardi, 2002;

Inciardi et al., 1997; Martin et al., 1999; Wexler, DeLeon et al., 1999). For example, at the 18-month follow-up, 77 percent of offenders who participated in a Delaware in-prison therapeutic community and then were released to a therapeutic community work release program were arrest free (Inciardi et al., 1997). However, at the 3-year time follow-up,

43 percent of the offenders who participated in the Delaware program were arrest free

(Martin et al., 1999). Similar results were found for offenders who participated in

California’s Amity prison therapeutic community, which also included aftercare (Wexler,

DeLeon et al., 1999). Eight percent of the treatment group had been reincarcerated at the one-year follow up whereas the percentage almost doubled (14%) at the two-year follow- up (Wexler, DeLeon et al., 1999). Thus, the effects of the therapeutic community diminish as the length of time at risk increases.

Aside from examining arrest after release, research has also studied therapeutic communities’ effectiveness at reducing drug abuse over a period of years. Again, 47 percent of offenders who participated in Delaware’s therapeutic community were drug free at the 18-month follow-up whereas the percentage was reduced to 23 percent at the

3-year follow-up period (Inciardi et al., 1997; Martin et al., 1997). Other researchers

59 have also found that the percentage of offenders who were drug free was reduced as the length of time from release increased. For example, Butzin et al., (2002) found that 50 percent of offenders who participated in an in-prison therapeutic community, then a therapeutic community work release program, and lastly an aftercare program were drug free at the one-year follow-up compared to only 32 percent of offenders who were drug free at the three-year follow-up period. Thus, a two-year difference resulted in an 18 percent decrease in the number of offenders who were drug free.

Completers Versus Non-Completers. The third issue embedded in research on therapeutic communities is the effectiveness of the treatment modality when the offender does not complete the treatment. Indeed, therapeutic communities, as other treatment interventions for substance abusing offenders, are characterized by high dropout rates ranging from 44 percent to 89 percent (Condelli & Dustman, 1993; DeLeon & Schwartz,

1984, Knight et al., 1997). Furthermore, research has shown that offenders who complete treatment are less likely to recidivate compared to offenders who dropout of treatment

(Inciardi, Martin, & Butzin, 2004; Knight, Simpson, & Hiller, 1999; Martin et al., 1999;

Wexler, DeLeon et al., 1999). For example, offenders who participated in a therapeutic community and work release program were more likely to be arrest free (55%) and drug free (27%) compared to offenders who completed the therapeutic community but dropped out of the work release program (28% were arrest free and 17% were drug free) (Martin et al., 1999). Inciardi et al., (2004) also followed the Delaware offenders for a period of five years. The estimated probability for remaining arrest free for offenders who completed all steps of the program was .26 compared to .17 for offenders who dropped out of the therapeutic community (Inciardi et al., 2004). Other research in Texas and

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California have found that offenders who completed treatment were less likely to recidivate compared to offenders who did not complete treatment (Knight et al., 1999;

Wexler, DeLeon et al., 1999). Thus, it appears that therapeutic communities are more effective in reducing recidivism if the offender completes the treatment program.

Transitional Therapeutic Communities. The focus on therapeutic communities has now turned to the effectiveness of a multistage treatment intervention, which involves different levels of treatment. The primary stage of treatment takes place in a therapeutic community in prison where inmates have an abundance of time to focus on recovery (Inciardi et al., 2004). When they are released from prison, the offenders enter the secondary stage of treatment, which involves transitional interventions – usually work release in the community. The work release center is typically operated as a therapeutic community in which offenders participate in therapeutic community interventions while obtaining and maintaining employment in the outside community

(Inciardi et al., 2004). The tertiary stage of treatment (aftercare) is for offenders who complete the work release setting. These offenders will be living on their own in the community but be under criminal justice supervision (Inciardi et al., 2004). They attend outpatient groups, meet with sponsors, and are supervised by criminal justice personnel.

Accordingly, there is a gradual step-down process from very intensive treatment in prison to less intensive treatment in the community.

Research from these programs has shown some very promising results. First, offenders who participated in Delaware’s program that included only in-prison treatment and work release were more likely to be arrest free (77%) and drug free (47%) than offenders who completed only the in-prison therapeutic community (43% were arrest free

61 and 22% were drug free) (Inciardi et al., 1997). Furthermore, when offenders participated in the tertiary phase of treatment (aftercare) the results are even more dramatic. Sixty-nine percent of offenders who completed all three stages of treatment were arrest free at three-years post-release compared to 55 percent of offenders who completed the work release stage, and 28 percent of offenders who completed the in- prison therapeutic community (Martin et al., 1999).

Results from a Texas therapeutic community in which offenders receive aftercare followed by criminal justice supervision in the community were similar. Specifically, only 16 percent of offenders who participated in the full gamut of services from in-prison treatment to aftercare and supervision were arrested at the one-year follow-up compared to 29 percent of offenders who participated in the in-prison therapeutic community

(Hiller, Knight, & Simpson, 1999a). These results hold true when the outcome is reincarceration. Only 25 percent of the aftercare completers were reincarcerated at the three-year follow-up; but 41 percent of the in-prison therapeutic community group was reincarcerated during this time period (Knight et al., 1999). Accordingly, the results reveal that offenders who participate in aftercare surpass treatment graduates who do not receive continuing care in remaining arrest free, incarceration free, and drug free.

Meta-Analysis and Reviews of the Literature

For the above studies it appears that some therapeutic communities are effective in reducing recidivism; however, these are studies of separate programs. A more advanced statistical technique, called meta-analysis, has allowed researchers to determine an overall effect of certain types of treatment interventions across similar programs. The statistic that is derived from a meta-analysis is an effect size that measures the magnitude

62 and/or direction of the relationship. Table 2 summarizes the studies. Many of the studies included in the review do not include therapeutic communities. However, the meta-analyses are presented for two reasons. First, the studies were included to show that treatment is more effective than non-treatment. Second, they were included to show that certain types of treatment were more effective in reducing recidivism. Accordingly, while there has been few meta-analyses especially for therapeutic communities, some characteristics of effective programming can be found in therapeutic communities (i.e., cognitive-behavioral techniques and social learning therapies).

Early meta-analyses have found weak support for juvenile programs (Gottschalk,

Davidson, Gensheimer, & Mayer, 1987; Whitehead & Lab, 1989). For example,

Gottschalk et al., (1987) found that while there was favorable outcomes for the treatment group compared to the comparison group 60 percent of the time, the effect size was statistically insignificant between the treatment and comparison groups. In addition,

Whitehead and Lab (1989) also reported weak support for interventions with juvenile offenders.11 Specifically, institutional and residential programs were the least successful in reducing recidivism.

Other meta-analyses have found support for treatment for both adult and juvenile offenders. Garret (1985) revealed that the average effect size for the most effective programs for adjudicated delinquents was .37. Specifically, cognitive-behavioral programs, life skills training, and family therapy were the most supported types of

11 Whitehead and Lab (1989) used a measure of success as having a phi coefficient between .21 and .29. Andrews, Zinger, Hoge, Bonta, Gendreau, and Cullen (1990) have criticized this strict measure of success.

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Table 2: Summary of Meta-Analyses and Reviews of the Literature Year Authors Criteria Population Number of Effect Size Findings Studies

1985 Garrett Institutional & Adjudicated 111 .37 Support for cognitive-behavioral programs, life skills, Community delinquents family therapy, individual therapy, and group therapy Programs

1987 Gottschalk, Institutional & Juvenile offenders 90 Insignificant The effect size was insignificant between the treatment Davidson, Community and comparison groups. The components that had Gensheimer, Programs positive outcomes were behavioral strategies, intensity, & Mayer and program integrity

1989 Whitehead & Nonsystem & Juvenile offenders 50 .1215 There was weak support for juvenile programs. The Lab System Diversion, most promising were system diversion and community Community & programs. The least successful were institutional or Institutional residential programs.

1990 Andrews, Sanctions, Juvenile & adult 80 .06 to .30 The effect size varied according to the type of treatment Zinger, Appropriate & offenders with an overall effect size being .15 for 124 studies. Hoge, Bonta, Inappropriate For inappropriate treatment the effect size was -.06 and Gendreau, & Services for appropriate correctional services the effect size was Cullen .30.

1992 Lipsey Type of treatment Juvenile offenders 443 .17 Multi-modal and behavioral therapies had the strongest & Specific impact on effect size. The effect size was in favor of methods those who received treatment. Programs that were structured had larges effect sizes. Duration affected the effect size with longer periods of treatment resulting in larger effect sizes. Treatment had more of an effect for higher-risk youth.

15 The phi coefficient was not reported by Whitehead and Lab (1989). The effect size was computed by Lipsey (1992) from the summary table appearing in Whitehead and Lab article.

Table 2: Summary of Therapeutic Community Outcome Evaluation Findings (continued) Year Authors Criteria Population Number of Effect Size Findings Studies

1999 Dowden & Providing some Juvenile offenders 229 .13 Programs that used sanctions only increased recidivism Andrews type of for juveniles whereas programs that delivered services intervention had an average reduction in recidivism of 13%.

1999 Lipsey Type of treatment, Serious juvenile 200 .05 to .39 The most positive effects were for programs that Program elements offenders focused on interpersonal skills, behavioral programs, & Specific and community residential programs. The expected methods recidivism rates were reduced when effective components were compounded.

1999 Pearson & Type of treatment Incarcerated 30 .04 to .13 Effect size varied depending on the type of treatment Lipton substance abusing involved. The effect size for boot camps was .05 with a offenders methodological rating of poor. The effect size for therapeutic communities was .13 with a rating of good. The effect size for group counseling was .04 with a rating of fair.

1999 Taxman Treatment Offenders Not Literature Using criteria developed by the University of Maryland Intervention specified review reports types of programs that doesn’t work, are promising, and works. Juvenile aftercare was shown as promising whereas vocational, educational, and in- prison therapeutic communities with aftercare were shown as working.

interventions for juvenile delinquents. Indeed, others have found similar results. For example, Andrews, Zinger, Hoge, Bonta, Gendreau, and Cullen (1990) examined 80 studies for adult and juvenile offenders. These authors found that the effect size varied according to the type of program and the use of appropriate treatment with the average effect size being

.15. More specific, the mean effect size was -.06 for inappropriate correctional services such as those programs that target low risk offenders; use non-directive or unstructured programming; or scared straight programming. Accordingly, these types of programs actually increased recidivism. Appropriate correctional interventions (i.e., cognitive- behavioral programming, programs that target high-risk offenders, programs that address responsivity, and structured programming targeting criminogenic needs) had an average effect size of .30. In addition, other meta-analyses have found larger effect sizes for programs that were structured, programs that were longer in duration, and programs for higher-risk youth (Lipsey, 1992; Lipsey, 1999).

In a review that included therapeutic communities, Pearson and Lipton (1999) conducted a meta-analysis of corrections-based drug treatment programs that also included boot camps and group counseling. For both boot camps and group counseling, the overall effect was small (.05 and .04 respectively) and the quality of the studies were lacking.

However, they reviewed seven studies on therapeutic communities and found that the overall effect size was .13 meaning that there was a 13 percent difference in recidivism for those who participated in the therapeutic community compared to individuals who did not participate in a therapeutic community. Accordingly, they argue that there is a 56.7 percent success rate for the experimental group (i.e., therapeutic community) versus 43.4 percent success in the comparison group (Pearson & Lipton, 1999). Thus, while the effect size for

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therapeutic communities is modest, there is, on average, a reduction in recidivism for offenders who participate in this treatment modality.

Furthermore, Taxman (1999) reviewed studies to gain a general consensus among scholars and practitioners concerning “what works” for offenders in substance abuse treatment programs. Using criteria established by the University of Maryland, four categories were used to determine the consensus: 1) programs that work; 2) programs that don’t work; 3) programs that are promising; and 4) programs where there is insufficient empirical evidence (categorized as don’t know). She found that the literature has typically found that in-prison therapeutic communities that also provided aftercare were classified as

“working” meaning that they produce significant reductions in recidivism (Taxman, 1999).

Predictors of Recidivism

A review of the research pertaining to therapeutic communities revealed that some programs are more successful than others. Thus, the questions becomes, aside from program participation, what predicts success (measured as successful outcome and successful completion of treatment) for a therapeutic community (Table 3).

Demographic Characteristics. Individual characteristics have been found to be significant predictors of outcome for therapeutic communities. That is, certain individuals are more likely to have positive outcomes compared to other individuals. For example, many studies have found that age was a significant predictor of arrest and relapse (Butzin et al.,

2002; Martin et al., 1999; Messina, Nemes, Wish, & Wraight, 2001; Pealer et al., 2002b;

Wexler, DeLeon et al., 1999; Wexler, Falkin, Lipton, & Rosenblum, 1992; Winesburg et al.,

2002). Specifically, older individuals were less likely to be arrested and less likely to relapse compared to younger individuals. For example, research conducted in an Ohio

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Table 3: Predictors of Success by a Therapeutic Community Year Authors Treatment Group Measure Findings 1992 Wexler, Falkin, Lipton, & Participants in the Stay’N Arrest Found that age, duration of time in aftercare, and participation in Rosenblum. Out Prison TC in New the program were significant predictors of time to arrest. York 1999 Wexler, DeLeon, Thomas, Participants in California’s Time to arrest Found that age and a classification of antisocial personality Kressel, & Peters Amity Prison TC disorder were significant predictors of time to arrest.

1999 Wexler, Melnick, Lowe, Participants in California’s Time to reincarceration Found that readiness to change was a significant predictor of time & Peters Amity Prison TC to reincarceration at a three-year follow-up.

1999 Hiller, Knight, & Simpson Felony probationers who Dropout of a Found that employment status, psychological factors, and risk participated in a community based TC level were related to dropping out of the program. community based TC in TX

1999 Knight, Simpson, & Hiller Participants in a prison TC Reincarceration Found that risk level was a significant predictor of in Texas reincarceration

1999 Martin, Butzin, Saum, & Males & females in a Arrest-free & Drug-free Age, number of prior arrests were significant predictors of being Inciardi multistage TC in Delaware arrest free at 3 years whereas previous drug use, participation in Prison: TC, Work release, the TC only, and TC+WR, were significant predictors of drug- Aftercare free status at 3 years.

2000 Farrell Females who participated Systems of support to Women in the treatment group were significantly more likely to in Delaware’s prison-based predict recidivism and attend treatment & 12-step groups and the frequency of CREST TC in Delaware relapse attendance was higher than the comparison group.

Participation in treatment alone did not predict recidivism or relapse but having children was a significant predictor of both.

Table 3: Predictors of Success by a Therapeutic Community (continued) Year Authors Treatment Group Measure Findings 2001 Messina, Nemes, Wish, Randomly selected Completion of Found that successful completion of treatment, participation in & Wraight participants in a treatment & Arrest intensive services, age, gender, number of prior arrests were Washington DC TC significant predictors of re -arrest.

Age, heroin usage, and inpatient vocational/educational treatment were predictors of successful completion of treatment.

2002 Butzin, Martin, & Inciardi Participants in the Crest Relapse with drugs & At one year, age, prior drug use, CREST participation, and TC in Delaware arrest completion of aftercare were significant positive predictors of drug use.

At 3 years, age, prior drug use, and CREST participation were significant predictors of drug use.

At one year, age, number of times in prison, CREST participation and graduation were significant positive predictors of arrest.

At 3 years, age and previous incarceration were significant positive predictors of arrest.

2002 Nielsen & Scarpitti Participants in the CREST Retention in the TC Of those who did not complete CREST, 16% left in the 1st TC in Delaware month, 36% left in th4e 2nd month, 47% left in the 3rd month, & by 7th month 91% of the non-completers had left the program.

Educational level, type of offense, participation in a prison- based TC (KEY), personality factors and legal pressure predicted completion in the TC. Type of offense and psychological factors predicted the length of time in treatment.

Table 3: Predictors of Success by a Therapeutic Community (continued) Year Authors Treatment Group Measure Findings 2002 Winesburg, Latessa, Medium-security male Arrest & Incarceration Found that race, age, number of prior arrests were significant Pealer inmates who participated predictors of arrest. in a TC Martial status and time at risk were significant predictors of incarceration.

2002a Pealer, Latessa, Juvenile males in a Incarceration in a Age, grade level, felony level, and JASAE score were significant Winesburg residential TC in Ohio youthful or adult predictors of incarceration. facility

2002b Pealer, Latessa, & Males & females Arrest & Incarceration Nonwhites, younger individuals, and those who had more prior Winesburg participating in a arrests were significantly more likely to be arrested. community-based correctional facility TC in Nonwhites and males were significantly more likely to be Ohio incarcerated.

medium-security in-prison therapeutic community found that individuals who were age 25 years had a 68 percent chance of being arrested compared to individuals who were 39 years of age who had a 57 percent chance of being arrested (Winesburg et al., 2002). Thus, it appears that the older the individual, the more likely he or she is to have a successful outcome.

Aside from age, other individual characteristics that predict successful outcome include: gender, marital status, and race (Hiller et al., 1999a; Messina et al., 2001; Nielson &

Scarpitti, 2002; Pealer et al., 2002b; Winesburg et al., 2002). Females who participated in a therapeutic community in Delaware were more likely to be arrest free (Messina et al., 2001).

Nonwhites were more likely to be arrested and individuals who were single were more likely to be re-incarcerated in an Ohio correctional facility (Winesburg et al., 2002). Accordingly, it appears that participation in a therapeutic community may be more beneficial (as measured by successful outcome of arrest or incarceration) for older offenders, female offenders, married offenders, and Caucasian offenders.

Severity or Risk Level. Prior research has shown that risk level is related to recidivism (Andrews, Bonta, & Hoge, 1990; Andrews, Zinger et al., 1990; Dowden &

Andrews, 1999; Lowenkamp & Latessa, 2002). Specifically, higher risk offenders are more likely to recidivate compared to lower risk offenders. Accordingly, programs should target higher risk offenders for more intensive treatment to increase their chances of having a more successful outcome. For example, using the Salient Factor Score, Knight et al., (1999) found that severity of crime and drug use was a significant predictor of reincarceration.

Forty-six percent of the higher severity offenders were reincarcerated compared to 30 percent of the lower risk offenders. Furthermore, the strongest treatment effects were found within

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the high-severity offenders. At a 3-year follow-up, only 26 percent of the high-severity offenders who completed aftercare were reincarcerated compared to 66% of the high-severity aftercare dropouts (Knight et al., 1999). Among the low-severity offenders, 22% of the aftercare completers and 52% of the aftercare dropouts had been returned to prison. These findings along with other research by Messina et al., (2001) and Hiller, Knight, and Simpson

(1999b) support the risk principle postulated by Gendreau, Cullen, and Bonta (1994) in which programs should match services with risk level. Accordingly, due to the intensive nature of therapeutic communities, this treatment modality may be beneficial only to higher risk offenders.

Psychological Factors. The responsivity principle states that there are certain individual characteristics, which cause offenders to respond differentially to treatment

(Andrews, Bonta, & Hoge, 1990). Accordingly, to increase the chances of successful outcomes (such as reducing recidivism and relapse), programs should fine-tune the delivery of services to allow offenders to be able to respond to the intervention (Cullen, 2002). Some of the individual characteristics (i.e., psychological factors) that were related to successful outcomes for therapeutic communities were motivation and antisocial personality (Wexler,

DeLeon et al., 1999; Wexler, Melnick et al., 1999). Specifically, offenders who scored higher on a readiness to change scale had a significantly longer period of time to reincarceration (Wexler, Melnick et al., 1999). However, offenders who had personality disorders, as measured by the DSM-III-R, (American Psychiatric Association, 1987) had a significantly shorter period of time to reincarceration than offenders who did not have antisocial personalities (Wexler, DeLeon et al., 1999). Therefore, therapeutic communities

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should be aware of individual characteristics of offenders such as motivation and psychological factors and provide programming to increase the responsiveness of offenders.

Participation/Completion of Treatment. One of the major predictors of recidivism is participation in a treatment intervention. Indeed, both meta-analyses and individual studies have found that recidivism was reduced if offenders participated in some type of treatment intervention (Andrews, Zinger et al., 1990; Butzin et al., 2002; Dowden & Andrews, 1999;

Garret, 1985; Lipsey, 1992; Martin et al., 1999; Pealer et al., 2002a; Wexler et al., 1992).

For example, offenders who participated in the Stay’N Out therapeutic community between 9 and 12 months had significantly better parole outcomes and more elapsed time between rearrest than offenders who were in the therapeutic community less than 9 months or more than 12 months (Wexler et al., 1992). Furthermore, Martin et al., (1999) found that participation in the therapeutic community and especially participation in the aftercare component were significant predictors of being drug-free at a 3-year follow-up. In addition, juveniles who participated in a therapeutic community had a 18 percent chance of being incarcerated compared to a 33 percent chance of being incarcerated for offenders who did not participate in treatment (Pealer et al., 2002a).

Predictors of Successful Completion of Treatment

As the above research has shown, participation and completion of treatment are significant predictors of outcome for therapeutic communities. Thus, the question becomes what predicts successful completion of a therapeutic community. When this question is answered, programs can target the predictors, which should increase the chances of finding success. Table 3 also reviewed the predictors of success for therapeutic communities.

Messina et al. (2001) examined the effects of specific services provided in therapeutic

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communities to determine if they predicted treatment outcomes. These authors ran two models predicting treatment completion and found that those who participated in the vocational/educational programs were more likely to complete the therapeutic community.

The second model predicted completion of treatment but combined all possible treatment units. For this model, they found that for each additional unit of total services received, the more likely the person was to successfully complete the community. Specifically, the data showed that offenders who received a greater number of all inpatient services in the first 60 days were more likely to remain in treatment and ultimately complete the program (Messina et al., 2001). Accordingly, it appears that therapeutic communities that provide intensive services to offenders are more likely to have their population successfully complete treatment.

An examination of a community-based therapeutic community found that educational level, type of offense, and psychological factors were significant predictors of completion.

Specifically, offenders who had higher levels of educational attainment, offenders who were incarcerated for a violent offense, and offenders who had higher levels of obsessive- compulsive behaviors were more likely to complete the community therapeutic community

(Nielsen & Scarpitti, 2002).

Summary of Effectiveness

From the research presented above, there are several conclusions that may be reached concerning the effectiveness of therapeutic communities. First, results from the meta- analyses and reviews of the literature show that programs that provide some type of treatment are effective in reducing recidivism for both adult and juvenile offenders (Andrews, Zinger et al., 1990; Dowden & Andrews, 1999; Lipsey, 1992; Pearson & Lipton, 1999; Taxman,

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1999). Specifically, programs that provide treatment instead of only sanctions reduce recidivism on average of 10 percent to 15 percent (Andrews, Zinger et al., 1990; Lipsey,

1992). However, programs that adhere to the principles of effective reduce recidivism by as much as 30 percent to 40 percent (Andrews et al., 1990; Lipsey, 1999). As previously discussed, therapeutic communities adhere to some of the principles of effective interventions such as intensity, length of treatment, and use of praise and privileges and role models. Based upon the meta-analyses and literature reviews, there should be some support for therapeutic communities in reducing recidivism.

Second, while there is support for therapeutic communities in reducing recidivism the support is mixed when comparing offenders who participate in a therapeutic community to those who receive no treatment or very minimal treatment. Some studies have found that therapeutic communities are successful in reducing recidivism (Field, 1984) and drug use

(Knight, Simpson et al., 1997) whereas others have not found a significant reduction in either arrest or reincarceration (Pealer et al., 2002b; Winesburg et al., 2002). Furthermore, most of the research examining therapeutic communities have pertained to adults. However, one study that examined juveniles who participated in a therapeutic community found a significant reduction in recidivism compared to offenders who received a rather eclectic residential program and offenders who did not receive any treatment (Pealer et al., 2002a).

Third, while studies show that therapeutic communities may be successful in reducing recidivism (measured as arrest, incarceration, and drug relapse), the success of the treatment diminishes as the follow-up period increases. A 3-month follow-up period showed that only a few offenders who participated in treatment had been arrested (2%) (Hiller et al., 1999a).

Yet, a 3-year follow-up period revealed that 25 percent of the offenders had been arrested

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(Knight et al., 1999). Thus, while studies have shown that therapeutic communities may be effective in reducing recidivism, the effects tend to wear off as the offenders are out in the community for longer periods of time.12 However, while the recidivism rates for the treatment groups increased throughout the longer follow-up period, those who completed the therapeutic community were still significantly less likely to recidivate compared to offenders who did not participate in the treatment (Butzin et al., 2002; Hiller et al., 1999a; Inciardi et al., 2004; Knight et al., 1999; Wexler, DeLeon et al., 1999).

Fourth, the studies have revealed that there is differential success depending on whether the individual successfully completed the therapeutic community. For example, dropouts were just as likely as offenders who did not participate in a therapeutic community to be arrested (28% percent and 29% respectively) (Martin et al., 1999). In addition, the offenders who dropped out of the program were significantly more likely to relapse with drugs and be reincarcerated at the follow-up time period (Inciardi et al., 2002; Wexler,

DeLeon et al., 1999).

Fifth, as Gendreau (1996) has reported, programs tend to be more effective when there is some type of aftercare program in place following the intensive phase of treatment.

Accordingly, there is evidence to support the fact that offenders who successfully completed an in-prison therapeutic community should receive some type of aftercare (Hiller et al.,

1999a; Inciardi et al., 2004; Knight et al., 1999; Martin et al., 1999; Wexler, DeLeon et al.,

1999). For example, each of the above studies reported better success for offenders who completed the therapeutic community, work release, and/or aftercare. That is, the recidivism rates (measured as arrest, incarceration, and relapse) were significantly lower for individuals who participated in a step-down program compared to offenders who completed the

12 This finding calls for a need for studies that follow offenders for a number of years post-release.

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therapeutic community but dropped out of aftercare, offenders who did not complete the therapeutic community, and offenders who did not receive any treatment. Accordingly, failure to provide continuous treatment after the offender is released from the therapeutic community may undermine the positive changes that have occurred during treatment.

Next, multivariate analyses have shown that there are certain predictors of outcome for therapeutic communities. Specifically, demographic characteristics, severity/risk level, psychological factors, and participation/completion of treatment were significant predictors of arrest, incarceration, or relapse. For example, older offenders, females, and whites were less likely to be arrested and/or reincarcerated (Butzin et al., 2002; Hiller et al., 1999a;

Martin et al., 1999; Messina et al., 2001; Nielson & Scarpitti, 2002; Pealer et al., 2002b;

Wexler et al., 1992; Wexler, DeLeon et al., 1999; Winesburg et al., 2002). In addition, research has shown that offenders who were classified as “high-severity” were more likely to be reincarcerated compared to offenders who were “low-severity” (Knight et al., 1999).

Last, in most of the research on therapeutic communities, participation and/or completion of the program was a significant predictor of arrest and incarceration. Specifically, offenders who participated in the treatment were less likely to be arrested or reincarcerated compared to offenders who did not participate in a therapeutic community (Butzin et al., 2002; Martin et al., 1999; Messina et al., 2001; Pealer et al., 2002a; Wexler et al., 1992).

Finally, as research has revealed, drug using delinquents are responsible for disproportionately higher rates of offending, elevated levels of violent offenses, and a greater risk for future offending (Catalano, Wells, Jenson, & Hawkins, 1989; Hawkins, Jenson,

Catalano, & Lishner, 1988). Accordingly, to reduce the probability of reoffending, some type of treatment intervention instead of just punishing the juvenile is needed (Lipsey, 1999).

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While meta-analyses have shown that treatment interventions can be have a significant reduction in recidivism for juveniles, little is known about the effectiveness of drug treatment

(especially therapeutic communities) for juveniles (Sealock, Gottfredson, & Gallagher,

1997). In one of the first studies of therapeutic communities for juvenile offenders, Pealer et al. (2002a) did find that juvenile males who participated in a residential substance abuse treatment program operated as a therapeutic community were significantly less likely to be reincarcerated in either a juvenile facility or an adult facility. However, the follow-up time period for that research was only 18-months. Therefore, this dissertation will expand that research by using a longer follow-up period (up to three years) to determine if the treatment effect remains. Furthermore, this dissertation will be one of the first works to study this treatment modality for delinquents while striving to address methodological issues of past research on therapeutic communities.

Methodological Problems of Past Research

While the number of therapeutic communities for correctional populations has increased, the research on their effectiveness has been criticized on a number of methodological areas (Inciardi et al., 1997). First, studies have failed to incorporate multiple outcome criteria to measure program success. Many studies have only examined either arrest or incarceration as the outcome of measure “success.” Indeed, most of the literature reviewed here examined these two areas instead of using additional outcome measures. In addition, many studies have failed to determine if therapeutic communities are successful in addressing intermediate outcomes. Only one study addressed the issue of intermediate outcomes. The research on the Cornerstone program in Oregon revealed that the program had some positive effects on intermediate outcomes. For example, participation in treatment

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significantly reduced psychiatric symptoms, and increased self-esteem (Field, 1984).

Accordingly, it is important that research address both intermediate and long-term outcomes to fully explore the issue of effectiveness. This dissertation will attempt to overcome these past problems by determining if participation in a therapeutic community changed the juveniles’ psychological and social factors such as depression, anxiety, self-efficacy, and motivation and cognitive distortions such as minimizing, assuming the worst, and blaming others. The long-term outcomes will address reincarceration to either a juvenile or adult facility and the length of time to reincarceration.

Second, the follow-up time frames have been inadequate, potentially producing a sample biased towards easier to find and less deviant respondents (Messina et al., 2001).

Some research on therapeutic communities has examined follow-up time frames as little as six months post termination (Knight et al., 1997). This presents a problem especially when the offender is still under supervision because the question becomes is he or she successful because of the treatment intervention or because of the sustained supervision. This dissertation will attempt to address the issue of follow-up by expanding on the work of Pealer et al. (2002a) by tracking juveniles for a period up to three years after they have been released from the therapeutic community. This time frame seems to be of an adequate length to follow most of the sample into adulthood.

Related to the outcome measures and follow-up, many studies have relied primarily on self-report measures of criminal activity, rather than objective measures (e.g., arrest and incarceration records) (Messina et al., 2001). To overcome this problem, this study will use data derived from the Offender Search Database from the Ohio Department of Rehabilitation

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and Corrections and data from the Department of Youth Services to determine if the juvenile returned to a secure facility during the follow-up time period.

Third, the comparison group fails to account for important differences between groups that are likely to impact program outcome (Inciardi et al., 1997). Many times in correctional research, random assignment to treatment and comparison groups are not a viable option. Indeed, only one study reported here used random assignment in groups

(Wexler, Melnick et al., 1999). Accordingly, it is necessary to compare different groups. As such, many programs fail to control for the differences between the groups that could potentially affect the outcome. For example, many studies will only control for gender, race, and age when examining the outcome of therapeutic communities. This dissertation uses a matched comparison group to obtained very similar groups. Specifically, the groups were matched on risk level and gender (i.e., males only).13 In addition, if there are significant differences between the groups on other factors, these factors will be controlled for when predicting outcomes.

Lastly, there has been a lack of multivariate designs, which leave us with little information concerning the significant predictors of recidivism. In addition, research into therapeutic communities and drug treatment in general has been plagued by the insufficient attention given to the measure of program quality (Faupel, 1981; Moon & Latessa, 1994).

This dissertation will use a standardized measure of program quality in an attempt to delve into the “black box” of treatment and to obtain a better understanding of why therapeutic communities are successful in reducing recidivism.

13 Risk level was chosen as a criterion for matching because research has shown that risk level is one of the best predictors of recidivism (Andrews, Bonta, & Hoge, 1990; and Lowenkamp & Latessa, 2002). The measure of risk was derived from the Youthful Level of Service/Case Management Inventory (Hoge & Andrews, 2003). The YLS/CMI is a standardized risk/need instrument that measures 42 different risk items across eight domains.

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SUMMARY

This chapter began by describing the mission of the juvenile justice system through reviewing the history and development of the juvenile justice system. Specific attention was given to the idea of “child saving” though rehabilitation and treatment. Next, the attack on rehabilitation and the juvenile justice system was addressed by examining the social context of the time and how it helped to shape the perceptions of the citizens of the United States.

While a movement to punish juveniles developed, a review of the literature reflects the fact that the public still supports rehabilitation, specifically for juveniles. Next, the concept of therapeutic communities and how they derived in the United States was presented along with the research on their effectiveness in reducing recidivism. Furthermore, a review of the literature revealed predictors of success to help determine why therapeutic communities reduce recidivism. The last section of the chapter reviewed methodological problems that existed with the previous research. To address these concerns from pervious research, this dissertation attempts to overcome the common shortcomings by: 1) including multiple outcome criteria; 2) following the juveniles for a period up to three years after program completion; 3) using a matched (i.e., risk and need) comparison group drawn from a sample of youth that did not receive treatment; 4) using multivariate designs which will identify significant predictors of recidivism; and 5) using a standardized instrument to measure program quality. Furthermore, this study is an expansion of the work by Pealer, et al.,

(2002a) that examined a therapeutic community for juvenile males by exploring a longer follow-up time period and examining individual level predictors of recidivism.

Chapter Three will present the research design that was used to answer the research questions, the procedures for collecting the data for the dissertation, describe the treatment

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and comparison groups and the statistical tests that were used to answer the research questions. In addition, a description of the measures – both individual and outcome – used will be discussed. The chapter will end by addressing the limitations of the dissertation.

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CHAPTER 3

METHODS

INTRODUCTION

The purpose of this study was to evaluate the effectiveness of a therapeutic community for felony adjudicated adolescent males. While previous research has found that therapeutic communities, on average, reduce recidivism by 13 percent (Pearson & Lipton,

1999), there has been a lack of research examining whether this treatment modality “works” for juveniles.14 Thus, while there were multiple research questions that were addressed, the main goal of this study used a quasi-experimental design to test whether participation in a therapeutic community resulted in a significant reduction in recidivism as measured by a period of new incarceration.

RESEARCH QUESTIONS

To fully evaluate the effectiveness of a treatment intervention, one must identify certain research questions that the study will answer. For the current project, I have identified a number of research questions: 1) What are the characteristics of the treatment group and the comparison group? What if any differences exist between the treatment and comparison groups? 2) Did participation in treatment significantly impact the youth’s levels of cognitive distortions and psychological and social functioning? 3) What factors predict successful completion of treatment? 4) What are the rates of new incarcerations for the treatment group and the comparison group? Are there significant differences in the rates of

14 In one of the few outcome evaluations published for therapeutic communities for juveniles, Pealer, et al., (2002a) found that participation in a therapeutic community significantly reduced recidivism. However, the follow-up time period for this study was only 18 months. Therefore, this dissertation will be an expansion of the above-cited work by examining the effectiveness of a therapeutic community for juveniles for a period of three years. In addition, individual level characteristics will be explored to determine if the treatment modality is more effective for certain types of juveniles.

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new incarcerations for the treatment group and the comparison group? 5) What factors predict a new incarceration? and 6) Does the effectiveness of the treatment provided at

Mohican Youth Center differ among the different types of juveniles?

RESEARCH DESIGN

Because random assignment to the treatment group and the comparison group was not possible, a quasi-experimental design was used to estimate the effectiveness of the therapeutic community for adolescent males on future criminal involvement. To overcome the potential for differences between the groups, which could possibly affect the outcome, comparison group cases were matched by risk and need levels using a standardized risk assessment and gender.

Risk level was chosen as a criterion for matching because research has shown that risk level is one of the best predictors of recidivism (Andrews, Bonta, & Hoge, 1990; and

Lowenkamp & Latessa, 2002). The measure of risk was derived from the Youthful Level of

Service/Case Management Inventory (Hoge & Andrews, 2003). The YLS/CMI is a theoretically and empirically based risk/need instrument that has been standardized. It measures 42 different risk items across eight domains: prior criminal history, familial circumstances, education/employment, peer relations, substance abuse, leisure/recreation, personality and behaviors, and attitudes.15 Accordingly, while the sample was matched on risk level, conceptually the matching was of the eight risk factor domains. For the remaining individual characteristics, if there were significant differences between the groups based on

15 These eight domains include risk factors that research has identified as predicting recidivism. Furthermore, research has identified four major risk factors that are at least moderately correlated with recidivism: criminal history, attitudes, peers, and personality (Gendreau, Little, & Goggin, 1996). The YLS/CMI contains these “big four” risk factors.

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age, race, or severity of substance abuse, these differences were controlled in the final analyses.

PROCEDURES FOR COLLECTING DATA

As part of the evaluation of the program, the University of Cincinnati created an automated database to assist programs with data collection and provide a mechanism for reporting results. Before the evaluation project began, the database was installed in the treatment facility. Facility personnel collected and entered data into the database. The data consisted of: demographics, offense and disposition, prior criminal history, drug use and history, risk level, program phases and advancement, type of treatment, program violations, drug screens, treatment outcome, psychological and social functioning assessments, and cognitive distortions assessments. When the data were not in the database, case files were reviewed to decrease the missing information.

In addition to the quantitative data for measuring program processes, the Correctional

Program Assessment Inventory (CPAI; Gendreau and Andrews, 1992) was used to measure program integrity. Recidivism data (i.e., return to youthful facility) were collected by

Department of Youth Services personnel and sent to the researcher. Data pertaining to adult incarceration were collected by the author using the Department of Rehabilitation and

Corrections Offender Search Database (www.drc.state.oh.us).

TREATMENT GROUP

Mohican Youth Center

To provide an adequate assessment of a program’s effectiveness, it is fundamental to understand what the program entails. This section will provide a detailed outline of the treatment program at Mohican Youth Center by describing the sample size and time period

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for the evaluation, how youth were selected to participate in the evaluation and the program, the type of treatment provided at the Center, the phases of treatment, and the results of the

Correctional Program Assessment Inventory (CPAI; Gendreau & Andrews, 1992). The information pertaining to the type of treatment was gathered from handbooks from the facility, through external review, and through observations of the treatment at the facility (see

Shaffer & Johnson, 2001).

Sample Size, Time Period, and Selection of Youth. The treatment group consisted of 447 adolescent males who had been adjudicated to the Department of Youth Services and sentenced to the facility from January 2000 to August 2001. Since placing offenders who have participated in treatment back into the general population can serve to “undo” any treatment effect, the facility accepted felony adjudicated males who had six months left on their sentences. While participation in the evaluation of the facility was voluntary, participation in the treatment was mandatory in that the entire facility was a therapeutic community. The purpose of Mohican Youth Center was to serve juvenile offenders who have an extensive substance abuse problem. A serious and extensive substance abuse problem was defined as a dependency on alcohol and/or drugs, which interfered with various aspects of a juvenile’s life (i.e., family, education, peer relations, emotional, spiritual, or legal). The substance abuse problem was determined by assessment and interviews.

Accordingly, the selection criteria that were used by Mohican Youth Center to determine eligibility included the following: 1) males between the ages of 12 to 20 years old adjudicated delinquent by a county juvenile judge and committed to the Ohio Department of

Youth Services; 2) having at least six months left in their commitment; 3) having a summary

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score of 21 or higher on the Juvenile Automated Substance Abuse Evaluation; and 4) all felony levels including some viewed as a risk to abscond.

Type of Treatment. By the beginning of the evaluation period, Mohican Youth

Center had implemented a therapeutic community. At Mohican Youth Center there were four “families” of 42 youth each. As previously stated, what distinguishes the therapeutic community from other treatment approaches was the use of the community as the primary agent to bring about social and psychological change. Within the therapeutic community concept was the influence of peers on behavior. Thus, Mohican Youth Center incorporated the positive peer culture in which youth were encouraged to help one another and in the process help himself.

Until the youth became ingrained in the therapeutic community, senior members acted as mentors who assisted the new members in becoming familiar with the concepts and the rules and regulations of the therapeutic community. In addition, the members, but especially new members, were required to “act as if” during their stay at Mohican. This concept was based on the self-help movement in which individuals must conform to the structure of the program until it becomes ingrained within the person (DeLeon, 2000). It was theorized that before they arrived at Mohican, youth made poor choices and, if left to their own devices, they would repeat their mistakes. While at Mohican, they were learning new ways to think and behave. However, until these new patterns of thinking and behaving were ingrained, they must first “go through the motions” or “act as if” until they were thinking and behaving in an appropriate manner.

There were eight essential concepts of the community as method approach incorporated at Mohican. The first concept was the use of youth roles in which each juvenile

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was expected to contribute/participate in all aspects of the daily therapeutic community.

Thus, youth were active participants in process of change. The use of peer feedback was the second component. This concept relied on the community as an agent of change in which youth were expected to provide each other with instruction and support similar to being “a brother’s keeper.” The third concept was the use of role models in which the youth were expected to be examples of change to others. The use of collective formats for individual change was the fourth concept found at Mohican’s therapeutic community. This concept relied on the activities such as groups, meetings, seminars, jobs functions, educational training, and recreation to facilitate the change process.

The adherence to shared norms and values and the structure of the therapeutic community were the next concepts of the environment at Mohican. Youth were expected to obey the rules and regulations, which provided a safe environment to foster change within the individual. In addition, the use of structure helped to give the youth some sense of organization and stability, which resulted in accepting and respecting supervision and becoming a responsible member of the community. Open communication between the juveniles and the staff was another concept of the therapeutic community implemented at

Mohican. It was expected that the juveniles would share experiences with others to facilitate the recovery process for himself and his peers. The last concept was the use of relationships.

In order to sustain the recovery process beyond the treatment facility, it was essential that friendships form to develop a social network for change.

Job Assignments Within Mohican Youth Center. As with other therapeutic communities, work at Mohican was viewed as both therapy and education. Youth performed jobs in all areas of the community under supervision and safety provided staff. Job

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assignment was based on a hierarchy and advancement was determined by behavior, attitude, and performance. Work at Mohican Youth Center was used to foster a sense of membership, teach job skills, instill attitudes that promote competence, and shape behavior.

Figure 1 shows the structure board for Mohican Youth Center. The highest position held by a juvenile was that of coordinator. The coordinator was the liaison between the juveniles and the staff. He was responsible for providing a daily summary of the events and concerns of the community to the staff. In addition, he made sure that all department heads were performing their duties. The second highest position was the assistant coordinator. He was responsible for coordinating and implementing all activities pertaining to the community. This position also entailed monitoring the processing of pull-ups and encounter slips.

The program department head and the service department head were responsible for overseeing that the crewmembers completed their job duties. The program department head was responsible for the orientation, ceremony, and core crews, whereas the service department head was responsible for the recreation, cleaning, and expeditor crews. The department heads reported to the assistant coordinator if crew leaders were not performing their duties.

The next position on the job hierarchy was that of crew leader. Each crew leader had general responsibilities that they must perform. For example, they were responsible for assigning members to jobs within their crew, holding crew meetings, writing pull-ups for poor job performance, and issuing push-ups for outstanding job performance. In addition, there were specific duties related to their position. For example, the orientation crew leader was responsible for coordinating orientation for all new members of the community. The

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Figure 1: Structure Board For Mohican Youth Center

Casework Supervisor Coordinator Unit Manager Program Department Service Department

Assistant Coordinator

Program Department Head Service Department Head

Orientation Ceremony Core Recreation Cleaning Expeditor Crew Leader Crew Leader Team Leader Crew Leader Crew Leader Crew Leader

Orientation Ceremony Core Recreation Cleaning Expeditor Crew Crew Crew Crew Crew Crew

ceremony crew leader was responsible for coordinating celebrations and special activities by making a weekly plan for his crew. The core team leader was in charge of coordinating the daily core team meeting in which pull-ups were reviewed with staff. The recreation crew leader was responsible for coordinating and planning the beautification of the unit and special activities. The cleaning crew leader must coordinate cleaning duties for each of his members. The expeditor crew leader was in charge of making the community operate efficiently and in a timely manner by scheduling and placing his team members in various assignments.

The lowest job assignments were placement in the orientation, ceremony, core team, recreation, cleaning, and expeditor crews. Individuals on the orientation crew were responsible for assisting new members in the community through distributing and reviewing handbooks with the new members, introducing new members at the morning and evening meetings, and providing recommendations for big brothers. The ceremony crew was responsible for providing therapeutic activities for the community. They also planned and hosted the morning meetings. The core team members reviewed written pull-ups and assigned learning experiences for the pull-ups. They also planned and hosted the evening meetings, which was usually conducted as a business meeting. The recreation crewmembers planned special events for weekends and special occasions. When community members used the gym, the recreation crew monitored the use of the equipment and saw that the area was left clean. In addition, these individuals decorated the units with posters, community language, and drawings. Cleaning crewmembers inspected the units on a daily basis and corrected any deficiencies from the inspections. In addition, they completed all cleaning assignments in restrooms, hallways, and bed area. They also were responsible for setting up

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each room for the groups and meetings. Individuals on the expeditor crew were responsible for the smooth operation of the community activities. They announced the start and end of all meetings, maintained sign-in sheets for all activities, and kept track of the pull-ups and the completion of learning experiences associated with the pull-ups.

Behavior Management Within Mohican Youth Center. Programming at Mohican

Youth Center also incorporated the languages and techniques for behavior management for a therapeutic community. For example, one behavior management technique took the form of verbal and written pull-ups. Pull-ups were a primary form of confrontation in which the juvenile was made aware of his behavior/attitudes. The pull-up was used as a helping tool and the recipient was supposed to accept the pull-up appropriately. Verbal pull-ups were statements about behaviors/attitudes that one member made to another. These were used as reminders about an action or attitude and examples included: being late for an activity, slouching in a chair, and not picking up after oneself. When a verbal pull-up was received, the recipient responded by saying: “Thank you for bringing that to my attention. I’ll get right on it.”

For more serious behaviors/attitudes (i.e., violating a major rule) or when the behavior was repeated, a written pull-up was issued. Written pull-ups were documented ways of making the entire community and staff aware of the behavior and in return allowing for a learning experience to be assigned. A learning experience was given by the core team and included both discipline (i.e., intended to eliminate the behavior) and replacing the unwanted behavior with new more appropriate behaviors. Learning experiences included public apologies, developing and presenting seminars, written essays, awareness experiences

(acting as the town crier in which the individual announces every activity), glue contracts

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whereby the individual was paired with another member, and spare parts. Spare parts took the form of singing songs in front of the community and other image busting techniques such as wearing signs.

In addition to the consequences for inappropriate behavior, Mohican also incorporated rewards for prosocial behavior. Push-ups were positive affirmations that were issued by the juveniles to one another for positive behaviors/attitudes. As with pull-ups, push-ups may by either verbal or written. The written push-ups were presented at the evening meeting in front of the entire community. In addition to the push-ups, juveniles received privileges through the phase system. For example, juveniles in the orientation phase received two ten-minute phone calls per week, two stamps per week, and state-issued hygiene items only. When juveniles advance to phase one, they obtained three ten-minute phone calls per week, two stamps, and five dollars to spend in the commissary. The privileges associated with phase two included: three fifteen-minute phone calls, three stamps,

$7.50 to spend in the commissary, and eligibility for choir membership. The relapse prevention phase (the last phase of treatment before discharge) included many different privileges. For example, juveniles received four fifteen-minute phone calls, five stamps, ten dollars commissary spending, special recreation and education activities, expanded number of visitors, extra snacks, extra TV, game room, weight room time, playing Play Station, pictures in bed area, and special bedspreads and polo shirts.

Groups Held at Mohican. Within a therapeutic community, the members hold a greater role in conducting groups and confronting behavior. For example, each day began with a morning meeting whose purpose was to begin the day on a positive note. The juveniles conducted the morning meeting and its focus was on sharing information about the

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community, emphasizing social awareness regarding events in society, providing a positive atmosphere through a thought for the day, and conducting some type of game or energizer to motivate the youth. In addition to the morning meeting, youth also conducted evening meetings. The purpose of these meetings was to provide an opportunity for accountability to the community and to refocus on treatment. This meeting was conducted more like a business meeting. It was also during this meeting that members make public any push-ups and pull-ups that were received during the day. In addition, learning experiences were often conducted during the evening meeting.

The backbone of the therapeutic community was the encounter group. It was a highly structured, intensive, confrontational group designed to make the youth see how his behavior affects the community and how his attitudes, thoughts, and value systems affect his behavior.

The encounter groups hold multiple purposes. First, they helped to establish accountability to the community and to the individual. In addition, they allowed the members to gain a deeper level of honesty. They were used to break up the street images and defenses held by the juveniles. The groups were also utilized to provide a forum to deal with conflict between members. Lastly, they were mechanisms for expression of feelings and thoughts among the individuals.

Other treatment groups held at Mohican Youth Center include: phase classes and life skills/special interest classes. The phase groups targeted substance abuse and attitudes.16

This group typically had some type of manual for staff and the youth were required to complete workbooks. The life skills groups were classes whereby staff with special expertise may teach skills such as cooking, agricultural/farming, balancing a checkbook, or

16 In addition, some juveniles will receive anger management classes if there is a need.

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budgeting are taught. The goal of the life skills classes was learning topics that would assist the juveniles for life outside of Mohican.

Other meetings or groups that were held included house meetings, caseload groups, and educational classes. The purpose of the caseload groups was to: “allow time to share feelings about both the past and present, to get help from peers and counselors and to emotionally grow in a safe environment” (Resident Handbook, 2001, p. 44). House meetings were designed as business meetings in which youth discuss any family business and provide suggestions/input into the community. As mandated by the state, juveniles must attend school during the day. As such, Mohican Youth Center has an accredited secondary school on the grounds for grades seven through twelve. Juveniles who had not completed high school must be enrolled in this school. The courses offer included: English, Math,

Science, Social Studies, Health, Physical Education, and Art. Juveniles who had completed high school were placed in a graduated life experiences program whereby they could learn job related skills and behaviors.

Phases of Treatment. While in the therapeutic community, youth also participated in phase groups. There are four phases for youth to complete during their time in treatment.

The initial phase was the orientation phase, which is designed to last four weeks and was used to familiarize the youth with the therapeutic community environment. For example, youth learn the wording and concepts of the community, the philosophy, the privilege system, and what was expected of them while at the facility. During the orientation phase, youth must complete all orientation classes, write their life story and present it to the community, recite the therapeutic community philosophy, and perform in their job assignment.

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From the orientation phase, youth move into phase one, which lasts eight weeks.

This phase focuses on the beginning steps of changing attitudes. Specifically, youth begin to identify antisocial attitudes or thinking errors and embark on overcoming these antisocial attitudes. During phase one, youth must complete nine hours of public service, write and present an essay entitled “Where I Am Today”, present two seminars, begin writing pull-ups and participating in encounters, complete their step one workbook, and perform in their assigned jobs. After successful completion of phase one, youth move to the second phase of treatment.

Phase two was centered on personal recovery and lasts eight weeks. Youth in this phase were introduced to the effects of chemical dependency and ways to abstain from substance abuse, concentrate on family issues, evaluate their criminal values and self worth, and learn how to express their feelings in a prosocial manner. Youth in phase two must complete eight hours of community service, present four seminars with three lasting five minutes and one lasting ten minutes, hold a position of assistant or crew leader, complete recovery classes and their required assignments, write and present an essay entitled “Where I

Want to Go,” become a big brother, and complete steps 2 and 3 in their recovery workbook.

The last phase was phase three and this period focused on relapse prevention. In this phase, which lasts for six weeks, youth were introduced to techniques to avoid relapse such as how to avoid “easy money” and the “old life.” To successfully complete this phase, youth must also finish a relapse prevention plan. The relapse prevention plan must be presented to the community and the parole officer and include topics such as: “How I’m Going to Get

There,” talk about triggers, plans for new friends, and leisure activities that promote health, sobriety, and right living (Resident Handbook, 2001). Youth in this phase are expected to act

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as senior members and as such they have more responsibility. For example, youth must continue being a big brother, co-facilitate orientation classes, and write a promise letter. The promise letter is written by departing members for the purpose of motivating those who are left in the community.

A Quantitative Assessment of the Principles of Effective Intervention. Research has shown that programs tend to have higher levels of program integrity and are more effective when they adhere to the principles of effective intervention (Andrews, Bonta, &

Hoge, 1990; Gendreau & Goggin, 1996; Holsinger, 1999; Latessa & Holsinger, 1998).

Furthermore, many evaluations have failed to incorporate a standardized measure of program integrity. Accordingly, this study used a standardized, objective, and quantifiable measure of program integrity–the Correctional Program Assessment Inventory (CPAI) (Gendreau and

Andrews, 1992) The CPAI was used to measure how well the therapeutic community meets known principles of effective correctional treatment. There are six primary sections of the

CPAI: 1) program implementation and the qualifications of the program director; 2) client pre-service assessment; 3) characteristics of the program; 4) characteristics and practices of the staff; 5) quality assurance and evaluation; and 6) miscellaneous items such as ethical guidelines and levels of community support.

Each section of the CPAI consists of 6 to 26 items with a total of 77 items. Each of these items is scored as “0” or “1.” For an item to be scored “1,” the program must demonstrate that it has met the specified criteria. For each section, the score will be placed into one of the following categories: “very satisfactory” (70% to 100%); “satisfactory” (69% to 60%); “needs improvement” (59% to 50%); or “unsatisfactory” (less than 50%). The overall total and score is summed across the six sections and the same scale is used in

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determining the overall assessment. Data for the CPAI were gathered through structured interviews with program staff. Other sources of information include examination of program documentation, review of case files, and observation of program activities.

There are several limitations to the CPAI that should be noted. First, the instrument is based on an “ideal” type. The criteria have been developed from a large body of research and knowledge that combines the best practices from the empirical literature on “what works” in reducing offender recidivism. Second, as with any research process, objectivity and reliability are always an issue. Although steps are taken to insure that the information that is gathered is accurate and reliable, given the nature of the process, the assessor invariably makes decisions about the information and data gathered. Third, the process is time specific. That is, the assessment is based on the program at the time of the assessment.

Changes or modifications may be under development; however, only those activities and processes that are present at the time of the review are scored. Fourth, the process does not take into account all “system” issues that can affect program integrity. Finally, the process does not address “why” a problem exists within a program.

Despite these limitations, research using the CPAI has shown it to be a significant predictor of arrest and incarceration (Holsinger, 1999). Offenders who participate in programs where there is low program integrity (as measured by the CPAI) are significantly more likely to recidivate (e.g., be arrested and/or incarcerated). Furthermore, other researchers have found support for the concepts that comprise the CPAI (Antonowicz &

Ross, 1994).

The CPAI (Gendreau & Andrews, 1992) was conducted on Mohican Youth Center on

May 31, 2001 by researchers from the University of Cincinnati (see Shaffer & Johnson,

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2001). Figure 2 shows the results of the Mohican assessment compared to the national average of 320 CPAI assessments conducted by researchers from the University of

Cincinnati. The overall score for Mohican Youth Center was 52.1 percent, which fell into the “needs improvement” category. Thus, while Mohican was meeting some principles of effective interventions, there were areas in which improvement could be made.

The first section address how the program was implemented and assesses the program director and the implementation process. The strengths for this section were the educational level of the program director and his involvement with hiring and supervising treatment staff.

In addition, the program was developed out of a need for treatment programs for substance abusing youth. In addition, the program was valued and supported by the criminal justice community and the community at large. This section was scored as “satisfactory.”

The second section of the CPAI addresses the assessment process of Mohican. This section received a score of 72.7 percent, which fell in the “very satisfactory” category. The assessment process is stringent in that the program has certain selection and exclusionary criteria in place to prevent inappropriate youth from entering the program. In addition, the program received assessment information from the Department of Youth Services, which included: the Youthful Level of Service/Case Management Inventory (YLS/CMI) and the

Juvenile Automated Substance Abuse Evaluation (JASAE). The only area that needed improvement was that Mohican should be assessing responsivity factors such as personality,

IQ, and level of cognitive functioning.

The next section of the CPAI targets program characteristics or how well the program delivers interventions. Mohican scored the lowest in this section with 24 percent, which fell into the “unsatisfactory” category. The strengths for Mohican included: 1) the program was

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Figure 2: Mohican Youth Center CPAI Scores Compared to Average Scores* 100

90 Very 80 Satisfactory

70 Satisfactory 60 Needs 50 Improvement

40 30 Unsatisfactory

20 10

0 Implementation Assessment Treatment Staff Evaluation Other Overall Score

Mohican TC 64.3 72.7 24 54.5 75 83.3 52.1 Average 72.5 48 41 58.5 35.5 83.1 53.4

*The average scores are based on 320 CPAI results across a wide range of programs. Very Satisfactory=70% or higher; Satisfactory=60-69%; Needs Improvement=50-59%; Unsatisfactory=less than 50%.

targeting criminogenic needs such as attitudes and substance abuse; 2) the program was intensive. The duration of the program lasted for six months, and youth were engaged in treatment-related activities for the majority of their time at the program; 3) youth were allowed to have input into the program through their participation in house meetings; and 4)

Mohican uses reinforcements to change behavior and not just for controlling the youth.

There were some problematic issues with the delivery of treatment at Mohican.

Treatment at Mohican may be improved if the program overcomes these concerns. First, while the program utilized some cognitive-behavioral techniques, the majority of the groups were education-based and processing. These techniques have not been shown to be as effective in changing behavior. Second, while triggers were discussed throughout the program, the groups lacked structure in which youth could progressively practice new skills and behaviors in overcoming these triggers. Third, while the program received risk level and need data from the Department of Youth Services, it was not using this information to the fullest. For example, there was no differentiation in programming between low, moderate, and high-risk youth. Furthermore, with the exception of anger management, all youth received the same type of programming regardless of their needs.

The next area of concern was the use of reinforcements at the facility. Mohican used a token economy in which youth either earn or lose points per day. Specifically, the point system at Mohican was problematic because once youth earned the minimum number of points, there was not a strong incentive to engage in prosocial behavior. In addition, the application of the reinforcements was cause for concern. In order to effectively change behavior, rewards should be used more often than punishments; however, Mohican staff reported using more punishments than rewards. There was also a problem with the types of

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punishments that were utilized within Mohican Youth Center. For example, youth may receive pull-ups in response to negative behavior. The core team and staff reviewed the pull- ups and the core team issued learning experiences in response to the tickets. Examples of learning experiences included: sign-wearing, image busters (i.e., singing a song), and writing essays. Several of these were shaming techniques and the effectiveness of the learning experiences was questionable.

Another problematic area was the follow-up after the administration of punishments.

Once punishments are administered, it is important that staff watch for any type of unwanted negative effects of the punishments. However, within the therapeutic community, the concept to “act as if” required the individual to accept the punishment without hesitation.

Therefore, staff did not routinely monitor the juveniles for unwanted emotions, escalation of antisocial behavior, fear, or withdrawal.

The last area of concern for treatment delivery at Mohican focused on the release and aftercare component for the juveniles. Release from a program should be based on the acquisition of prosocial skills, behaviors, and attitudes and not be time-based. However, as with many RSAT grants, the length of time at Mohican was six months. Thus, many youth were released from the facility at end of their six months regardless of their phase placement.

In addition, once released from Mohican, the staff members were not able to follow-up with the juveniles to determine if they were receiving any type of referrals that were made for the community. Lastly, while it is important to have some type of step-down treatment from a residential facility to the community, Mohican did not have a structured aftercare component in place for the juveniles.

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The fourth section of the CPAI focuses on characteristics of the treatment staff and examines such areas as: education, experience, clinical evaluation, training, and supervision.

Mohican treatment staff were well educated and reported that they were allowed to have input into the program. In addition, they received clinical supervision on a regular basis.

However, there were some problems reported by the staff. First, the initial training for the staff was lacking in both content and duration. In addition, staff members were not required to participate in any type of on-going training throughout the year and many did not receive any type of training within the last year from the evaluation. Anther concern was the lack of clinical assessment for the staff members. While a performance evaluation was completed, there was no assessment that measured the treatment staff’s clinical skills. The last problematic area concerned the issue of support for the program. The lack of support was due to members (mainly correctional officers) not being familiar with the therapeutic community concepts and would be remedied with training on the concepts. Mohican scored in the “needs improvement” category for this section with a total of 54.5 percent.

The fifth section of the CPAI assessment examines the quality assurance mechanisms in place at the program. Mohican received a score of 75 percent in the section, which fell in the “very satisfactory” category. The program had established quality control mechanisms such as: case file reviews, client satisfaction surveys, and clinical supervision. Furthermore, the Department of Youth Services collected recidivism data and staff received these data.

The last section of the CPAI is a miscellaneous section that examines issues such as stability in funding and support. The funding for Mohican appeared to be stable as was the level of community support. In addition, Mohican had an advisory board that guided the program. The only area of concern was the stability of the program itself. For example, at

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the time of the evaluation, Mohican had experienced a great deal of staff turnover, which had a negative impact on the program. The turnover affected the level of support among the staff for the program. Accordingly, Mohican Youth Center achieved a score of 83.3 percent for this section, which fell in the “very satisfactory” category.

COMPARISON GROUP

The comparison group for this dissertation was a group of males who were sentenced to the Department of Youth Services from May 1997 to October 1999. The sample size was

447 adolescent males. The Department of Youth Services provided the University of

Cincinnati with a database of all juveniles who were sentenced to DYS from 1997 to 1999.

A random sample of 447 individuals was selected from the database to use as a comparison group.17 The individuals from the comparison group were sentenced to institutions throughout the state. Accordingly, this dissertation used a matched comparison group in which individuals received minimal treatment.18

DESCRIPTION OF THE MEASURES

Individual Characteristics Examined

The individual characteristics that were used in examining the effectiveness of the therapeutic community included: demographic characteristics, criminal history and risk level, substance abuse history and severity of substance abuse, psychological and social functioning, cognitive distortions, and termination data. The standardized intake form19 was

17 Females, juveniles who had been sentenced to Mohican Youth Center, and juveniles who did not have a risk level score were removed from the database prior to the selection of the comparison group. 18 Ris k level was chosen as a criterion for matching because research has shown that risk level is one of the best predictors of recidivism (Andrews, Bonta, & Hoge, 1990; and Lowenkamp & Latessa, 2002). The measure of risk was derived from the Youthful Level of Service/Case Management Inventory (Hoge & Andrews, 2003). The YLS/CMI is a standardized risk/need instrument that measures 42 different risk items across eight theoretically and empirically derived domains. Accordingly, every effort was made to obtain a comparison group that was equal to the treatment based on risk/need level. 19 See Appendix A for the standardized intake form used for this study.

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used to collect basic demographic information such as: age, race, number of dependents, educational level, and employment status. In addition, the intake form collected information on criminal history and substance abuse history. Table 4 reports the variables and measures used in this study.

Juvenile Demographics. The juvenile’s age was assessed at intake into Mohican

Youth Center. This variable was defined as the number of years from birth to intake into

Mohican. The juvenile’s race was determined by staff members at the facility and included responses such as: White, Black, Hispanic, Native American, Asian, and other; however, due to the small number of individuals in certain categories, race was coded as White or

Non-white. Upon intake into Mohican, the youth were asked what was the highest grade he had completed. Accordingly, educational level was defined as the highest completed grade upon entrance into the program. In addition, data pertaining to the employment status of the juveniles were collected. Juveniles were asked if they were unemployed, worked part-time, or worked full-time prior to their arrest. This study defined employment status as unemployed or employed.

Criminal History. The intake form also included questions related to the juvenile’s criminal history. For example, staff determined the most serious charge (i.e., burglary, rape, theft, or possession) that resulted in the juvenile’s placement in Mohican. For the purpose of this study, most serious charge was defined as personal, property, drug offenses, or other. In addition to type of charge, the level of offense was collected. This variable was measured as misdemeanor, felony one, two, three, four, or five.

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Table 4: Variables and Measures Employed in the Study Measures Coding

Juvenile Characteristics Age 12 – 20 years

Race 0 = white 1 = nonwhite

Years of education 1 – 12 grades

Employment status 0 = unemployed 1 = employed

Criminal History at Time of Arrest Type of charge 1 = personal 2= property 3 = drug 4 = other

Level of offense 0 = misdemeanor 1 = felony 5 2 = felony 4 3 = felony 3 4 = felony 2 5 = felony 1

Age at first arrest 7 – 18 years

Previous drug charge 0 = no 1 = yes

Substance Abuse History Drug of choice 1 = heroin 2 = crack or cocaine 3 = marijuana 4 = alcohol 5 = other

Age at first use 1 – 17 years

Family history 0 = no 1 = yes

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Table 4: Variables and Measures Employed in the Study (continued) Measures Coding

Substance Abuse History JASAE score 0 – 76

Risk Level Y-LSI raw score 2 to 38

Y-LSI category 0 = low 1 = moderate 2 = high 3 = very high

Psychological & Social Functioning Anxiety 7 – 35

Depression 6 – 30

Self-esteem 6 – 30

Decision-making 9 – 45

Risk-taking 7 – 35

Hostility 8 – 40

Self-efficacy 7 – 35

Desire for help 7 – 35

Treatment readiness 8 – 40

Cognitive Distortions Self-centeredness 1 – 6

Blaming others 1 – 6

Minimizing 1 – 6

Assuming the worst 1 – 6

Oppositional defiance 1 – 6

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Table 4: Variables and Measures Employed in the Study (continued) Measures Coding

Cognitive Distortions Physical aggression 1 – 6

Lying 1 – 6

Stealing 1 – 6

Overt 1 – 6

Covert 1 – 6

How I Think 1 – 6

Termination Type Type of termination 0 = unsuccessful 1 – successful

Length of time in program 13 – 429

Outcome Data New incarceration 0 = no 1 = yes

Time to incarceration 1 day to 514 days

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As previous research has shown, age of onset is a significant predictor of future offending (Andrews & Bonta, 1994; Nagin & Farrington, 1992; and Stattin & Magnusson,

1989). Therefore, staff members at Mohican collected data on the age of first arrest. The variable was defined as the number of years from birth to age of arrest. The last measure of criminal history pertained to the previous drug charges. Individuals sentenced to Mohican were asked if they were previously charged with a drug offense. When the individual’s files were available, staff members were instructed to obtain this information from the case files.

Substance Abuse History. Five different types of data were collected pertaining to the juveniles’ substance abuse histories. First, juveniles were asked about their drug of choice. While many choices were offered, the responses were for the following categories: heroin, crack, cocaine, marijuana, alcohol, amphetamines, LSD, PCP, and inhalants.

Related to drug of choice, data on the age of first usage (both alcohol and drug) was obtained for the treatment group. This variable was defined as the number of years from birth to first use. In addition, the juveniles were asked if they had participated in any type of substance abuse treatment program previously. Another variable that related to substance abuse was the whether the juvenile’s family members use drugs. Specifically, juveniles were asked if any immediate family members have a substance abuse problem.

The last variable that measured substance abuse history examined the juvenile’s severity of the current substance abuse problem. The juvenile’s level of substance abuse severity was measured by the Juvenile Automated Substance Abuse Evaluation (JASAE)

(ADE Incorporated, 1987). The JASAE provided a summary score indicating the level of substance abuse addiction and the level of treatment that was needed. The instrument was coded so that the higher the score, the higher the substance abuse addiction. A score of 21 or

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above indicated that the youth had “a severe substance abuse problem along with ingrained patterns and attitudes supporting the drug problem.” (ADE Incorporated, 1997, p. 6).

Additionally, youth who scored 21 and above were in need of for more intensive intervention and possibly residential care. The JASAE was administered to all youth upon intake in the

Department of Youth Services Reception Center. The JASAE score was provided to the

Mohican Youth Center by the Reception Center and staff recorded the score on the intake form. 20

Risk Level. Research has shown that an individual’s risk level is an important predictor of recidivism (Andrews & Bonta, 1994; Andrews, Bonta, Hoge, 1990; Gendreau,

Goggin, & Paparozzi, 1996; Jones, 1996). Higher-risk individuals are more likely to recidivate unless they receive intensive treatment. Thus, it is important to include the individual’s risk level in any type of outcome evaluation analysis. For this study, the

Youthful Level of Service/Case Management Inventory (Hoge & Andrews, 2003) was used to measure the juveniles’ risk levels. The YLS/CMI is a standardized and objective risk assessment instrument that examines risk and need factors such as: criminal history, substance abuse involvement, family issues, educational and employment history, leisure activities, antisocial personality, peer networks, and antisocial attitudes. The assessment was conducted through semi-structured interviews with the juvenile and/or guardians. Additional information was obtained through file reviews to substantiate the interview data.

The instrument is scored using objective scoring criteria and the higher the score, the higher the risk level. Depending on their scores, youth are classified as “low”; “moderate”;

“high”; or “very high” for each of the subcomponents. A total score is also provided that

20 The JASAE scores were included in the database from the Department of Youth Services for the comparison group.

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indicates the overall level of risk of recidivism. The YLSI/CMI was administered to youth at the Department of Youth Services’ Reception Center by Department staff. Mohican staff members received the Y-LSI score from the Reception Center and recorded the information in the automated database.

Psychological and Social Functioning. An individual’s psychological and social functioning may affect one’s amenability to treatment. As such, the Client Self-Rating form

(Simpson & Knight, 1998) was used as a measure of youth’s level of psychological and social functioning. This instrument measures factors such as: depression, anxiety, risk- taking, hostility, self-esteem, self-efficacy, a desire for help, treatment readiness, and decision-making ability. Individuals responded to the 65 statements using the following response set: 1=strongly disagree, 2=disagree, 3=undecided, 4=agree, and 5=strongly agree.

In some instances the items had to be reversed coded so that higher scores indicate higher levels of psychological and social functioning. Staff administered the Client Self-Rating to youth at intake and termination from the therapeutic community. The alpha coefficients along with the questions for the various scales are found in Appendix B.

Cognitive Distortions. Cognitive distortions are inaccurate ways of attending to or conferring meaning upon experiences (Barriga, Gibbs, Potter, & Liau, 1999). Research has indicated that cognitive distortions may contribute to antisocial or criminal behavior

(Yochelson & Samenow, 1976). Using the How I Think Questionnaire (Barriga et al., 1999), youths’ cognitive distortions were assessed. This instrument measures four self-serving cognitive distortions: self-centered (according such status to one’s own views that the opinions of others are not considered), blaming others (misattributing blame to outside sources), minimizing/mislabeling (believing that antisocial behavior is acceptable, admirable,

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or causes no real harm), and assuming the worst (assuming that improvement is impossible, or considering a worst case scenario).

The How I Think Questionnaire also depicts four behavioral referents scales that are manifested from the cognitive distortions: opposition/defiance, physical aggression, lying, and stealing. From these subscales, three summary scores can be computed. The overt scale is computed by averaging the opposition/defiance and physical aggression means. The covert scale is computed by averaging the lying and stealing scales’ means. The overall How I Think score is computed by averaging the means of all eight subscales.

This 63-item instrument was coded so that higher scores indicate higher levels of cognitive distortions and behavioral referents. Youth were administered the How I Think

Questionnaire at intake and termination from the therapeutic community. The reliabilities for the various scales are found in Appendix B.

Termination data. Data concerning the youth’s type of termination were gathered from a discharge form21 that was completed by program staff when youth left the therapeutic community. Specific data that were gathered included: type of termination and length of time in the program. Type of termination was measured as successful, unsuccessful, or other.

Length of time in the program was measured as the number of days from intake into the therapeutic community to discharge from the program.

Outcome Variables Examined

Intermediate Outcomes. Intermediate outcomes are the direct effects that are attained through receiving the treatment. As such, we included two intermediate goals to examine the effectiveness of the therapeutic community–changes in psychological and social functioning and changes in cognitive distortions.

21 See Appendix A for a copy of the termination form.

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Psychological and social factors such as depression, anxiety, risk-taking, antisocial values, and hostility have been found to be positively related to substance abusing behaviors and longevity and success in treatment while factors such as self-esteem, self-efficacy, and decision-making ability have been found to be negatively associated with substance abusing behaviors and longevity and success in treatment (Simpson & Knight, 1998). Therefore, these areas are all potential targets for treatment. Theoretically, participation in the therapeutic community should reduce individuals’ levels of anxiety, depression, risk-taking, hostility, and antisocial values, and increase their self-esteem, self-efficacy, decision-making ability, desire for help, and treatment readiness. To determine if participation in the therapeutic community changed the youth’s level of psychological and social functioning, the

Client Self-Rating form (Simpson & Knight, 1998) was administered to the youth at intake and termination from the program.

Aside from affecting the youth’s psychological and social functioning, participation in a correctional treatment program should change an individual’s cognitive distortions. By reducing the cognitive distortions, programs are more likely to reduce criminal behavior

(Barriga et al., 1999). To determine if participation in the therapeutic community reduced the juveniles’ levels of cognitive distortions, the How I Think Questionnaire was administered and intake and termination from the program by program staff.

Long-term Outcomes. This dissertation tracked the youth for a period up to 36 months after they were terminated from the therapeutic community or the Department of

Youth Services. There were two outcome measures for the current study: any new period of incarceration and time to new incarceration. The first outcome measure examined recidivism and was measured as any new period of incarceration (yes or no) in the Ohio Department of

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Youth Services or the Ohio Department of Rehabilitation and Corrections. Recidivism was defined in this manner for two reasons. First, arrest data for the youth were unreliable and thus were not used. For example, the Department of Youth Services formally tracks youth for a period of only six months. This follow-up time frame is insufficient to adequately assess the effectiveness of the treatment modality. Second, by using periods of new incarceration, the study will have a more stringent test of the effectiveness of the therapeutic community in reducing the recidivism of the youth.

An additional outcome measure was the time to incarceration. This item was measured as the difference in days between termination from the facility and incarceration into a facility.

Aside from examining the differences in recidivism between the treatment and comparison groups, a within group difference for the treatment group was conducted.

Specifically, measures of cognitive functioning, psychological and social functioning, and risk level will be examined to determine if the treatment intervention was more effective for certain types of individuals.

STATISTICAL TESTS

This study examined multiple outcome measures for the therapeutic community participants and comparison cases. In order to sufficiently address the research questions, several statistical tests were performed. First, frequency distributions were conducted to study the following variables for the treatment group:22 problems at school, employment status, age at first arrest, prior drug charge, age at first alcohol and drug use, drug of choice, psychological and social functioning, and cognitive distortions. Frequency distributions were

22 Data on the variables were collected using a standardized intake form and a service tracking form for juveniles who participated in the therapeutic community. Thus, these data were unavailable for the comparison group.

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computed to obtain a clear picture of the sample by reporting measures of central tendency for each juvenile in the treatment group.

Chi-square and t-tests were conducted to examine the differences between treatment and comparison groups. Chi-square analyses were used to test for differences between the groups on the following variables: race, highest grade completed, enrollment in school, previous suspensions, offense type, level of adjudications, and type of termination. Chi- square tests were used because these data are categorical.

Independent samples t-tests were computed to test for significant differences between the treatment and comparison groups on the following characteristics: age, severity of substance abuse, risk level, length of stay in the facility, and time to new incarceration. The independent samples t-test procedure compares means for two groups of cases. Specifically, the analysis reports any statistically significant differences between the means of the groups.

To determine if participation in the therapeutic community changed the psychological and social functioning and reduced the levels of cognitive distortions, paired sample t-tests were computed. Paired sample t-tests compare the means of two variables for one group.

The statistical analysis computes the differences between values of the two variables for each case and tests whether the average differs from 0. Observed differences between the groups can then be attributed more readily to the variable of interest (i.e., participation in the therapeutic community).

Another set of statistical tests that were conducted was logistic regression analyses.

Logistic regression measures the effects of multiple predictors on a dichotomous dependent variable. The purpose of the logistic regression is two-fold. First, the analysis reveals significant predictors of the outcome variable while holding all other variables constant.

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Second, logistic regression calculates beta coefficients, which can be converted into log-odds probabilities. Accordingly, the logistic regression models identified the significant predictors of successful completion of treatment.

Cox regression models were computed to determine whether participation in a therapeutic community resulted in a decrease in the probability of obtaining a new incarceration. Cox regression is like ordinary least squares regression (OLS) in that one may predict a dependent variable as a function of a set of independent variables. However, Cox regression differs in two ways. First, Cox regression allows for the computation of data that contains censored data (e.g., juveniles that survived or who were not incarcerated during the time period). Second, the statistical technique will provide an analysis of the cases in each group to show at what point in time, if any, the two groups differ on the outcome.

LIMITATIONS OF THE STUDY

As with most studies examining the effectiveness of a drug treatment program on recidivism, there are a number of limitations. First, the study could not randomly assign individuals to the treatment group or the comparison group. Random assignment to groups would have allowed the groups to be very similar and would have strengthened any findings of a treatment effect. However, youth were adjudicated to the therapeutic community and the

Department of Youth Services by a judge and not the researcher. Even though the comparison group was matched to the treatment group on certain characteristics, there may still be significant differences on some background characteristics. These characteristics will have to be controlled for when predicting outcome.

Missing data was also a concern for this study. A standardized intake form was used to collect certain demographic data on the treatment group; however, these data were

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unavailable for the comparison group. For example, data concerning number of prior arrests, prior commitments, age at first arrest, and substance abuse history were not available for the comparison group. Therefore, this study will not be able to control for these factors. In addition, information pertaining to intermediate outcomes will only be available for the treatment group. The How I Think Questionnaire and the Client Self-Rating form was only administered to youth in the treatment group. As such, this study cannot compare changes in psychological and social functioning and cognitive distortions between the treatment group and the comparison group.

Last, the length of follow-up may be problematic. While the length of follow-up for the study is three years, the follow-up time period may not be sufficient to adequately assess the long-term effects such as reincarceration rates of the therapeutic community.

SUMMARY

This chapter focused on the methods that were used to evaluate a therapeutic community for juvenile offenders. A quasi-experimental design was used to determine if participation in the treatment program resulted in a significant decrease in probability of recidivism three years after termination from the program. Specifically, the study used a matched group design to compare juvenile males who participated in a therapeutic community to juvenile males who were adjudicated to the Department of Youth Services and did not receive intensive treatment services. The individual characteristics that were used in the analyses include: background characteristics, risk level, severity of substance abuse problem, psychological and social functioning, cognitive distortions, and type of termination and length of stay in the facility. This chapter also examined the measures for both the intermediate outcomes (i.e., changes in psychological and social functioning and changes in

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cognitive distortions) and long-term outcomes (i.e., any new period of incarceration and length of time to new incarceration). Statistical tests that were conducted were described followed by limitations of the study. The results for each of the research questions will be presented in Chapter Four.

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CHAPTER 4

RESULTS

The purpose of this research was to assess the effectiveness of a therapeutic community for juvenile males in reducing recidivism up to three years post-release. While there has been mixed support for this treatment modality in reducing recidivism, most of the research has been directed toward adults (Field, 1994; Hiller et al., 1999a; Inciardi et al.,

1997; Martin et al., 1999). Accordingly, this dissertation expands and extends the work of

Pealer, et al., (2002a) in a number of ways. First, this dissertation tracked a sample of juvenile offenders who participated in Mohican Youth Center (operated as a therapeutic community) for a period up to three years to determine if participation in a therapeutic community reduced the probability of a new period of incarceration. Second, Pealer et al.,

(2002a) failed to examine predictors of time to new incarceration to determine if certain individual characteristics predict time at risk. Last, this research also examined individual characteristics of the treatment group to determine if there was a differential treatment effect for certain individuals.

Individual Characteristics

Social Demographic Characteristics. Social demographic data were collected in order to describe the therapeutic community participants and comparison group and to investigate whether differences in outcome were related to differences within the samples.

Examining social demographic characteristics allows for a determination of whether outcome was influenced by any of these factors. This section profiles the groups based on characteristics such as age, race, educational level and performance, employment, criminal history, and substance abuse history.

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Aside from race, there were some significant differences between the groups; however, the differences do not appear to be substantively significant (Table 5).

Approximately 52 percent of the treatment group was “white” and 50.8 percent of the comparison group was “white.” There was a statistically significant difference between the groups based on age. The average age for both groups was 16.61 for the treatment group and

15.89 for the comparison group.

When examining the education variables, there were some statistically significant differences. For example, the majority of the juveniles in both groups had completed the 9th grade (75.4% of the treatment versus 84.2% of the comparison group) with the average grade of completion being 8.78 for the treatment group and 8.35 for the comparison group. While an independent t-test revealed a significant difference for this variable, the difference would not appear to be substantively different. Chi-square analysis revealed that a significant difference in the percentage of youth who were enrolled in school prior to their commitment to the Department of Youth Services. For example, 71.3 percent of the treatment group and

72.7 percent of the comparison group was enrolled in school prior to being sentenced. While the majority of youth in both groups were enrolled in school, they also had some problems in this area. For example, a large percentage of youth in both groups had been suspended at least once in the educational career (89.4% of the treatment group and 72.7% of the comparison group). Again, a significant difference arose between the two groups. More youth in the comparison group had not received a previous suspension (27.3%) compared to youth in the treatment group (10.6%).

When youth entered Mohican Youth Center, they were asked about their employment status. A slight majority of youth (50.6%) was unemployed prior to their sentence to the

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Table 5: Background Characteristics Characteristics Mohican (N= 447) Comparison (N=447) N % N % Race: White 231 51.7 227 50.8 Nonwhite 216 48.3 220 14.2 ?2 = .072; p = .789

Age at Intake: 13 or younger 5 1.1 19 4.3 14 20 4.5 49 11.2 15 53 11.9 74 16.9 16 113 25.3 132 30.1 17 152 34.0 148 33.7 18 87 19.5 15 3.4 19 & older 17 3.8 2 0.5

Mean 16.61 15.89 t = 8.601; p = .000

Highest Grade Completed: 7th grade or less 30 6.7 84 19.7 8th 161 36.0 165 38.7 9th 146 32.7 110 25.8 10th grade 86 19.2 48 11.3 11th grade 15 3.4 16 3.8 12th grade or higher 9 2.0 3 0.7

Mean 8.78 8.35 t = 5.269; p = .000

Enrolled in School Prior to Commitment Yes 318 71.3 309 72.7 No 128 28.7 107 27.3 ?2 = 10.506; p = .005

Previous Suspensions Yes 396 89.4 271 72.7 No 47 10.6 64 27.3 ?2 = 58.455; p = .000

Employment History Employed 221 49.4 NA Unemployed 226 50.6 NA

N’s may not equal total due to missing data NA = data not available

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Department of Youth Services. However, this finding is not surprising given that the average age of the sample was 16 years – barely the legal age of employment.

In review, the typical juvenile in the treatment and comparison groups were white; age 16; had completed the 8th grade; was enrolled in school at the time of arrest; and had at least one previous suspension.

Drug History. Table 6 reports the results of the treatment group’s drug history. 23

The majority of the youth were ages 10 to 15 years when they first used alcohol with the average age being 12.18 years. The sample was a little younger when they first used drugs with the average age of first drug use being 11.98 years. A large number of the treatment group rated marijuana (76.2%) as the drug of choice followed by alcohol (15.6%). A slight majority of the treatment group reported a family history of substance abuse. Furthermore,

68.4 percent of the Mohican participants had received previous drug treatment. Thus, these data suggest that the treatment group had a previous history of substance abuse and may be need of some type of substance abuse treatment.

Substance Abuse Severity. Youth entering the Department of Youth Services were assessed using the Juvenile Automated Substance Abuse Evaluation (JASAE) (ADE

Incorporated, 1997). The JASAE provides a summary score indicating the level of care required. The summary score represents a range of problematic involvement with drugs and alcohol, and the attitudes and life style patterns, which surround this involvement. As the summary score increases, the need for more intensive intervention increases. A score of 21 or above indicated the need for intensive treatment and possibly residential care because youth

23 Drug history data were collected as part of a larger study for the treatment group participants when they entered Mohican Youth Center. Therefore, these data were not available for the comparison group.

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Table 6: Drug History Variable Mohican (N= 447) Comparison (N=447) N % N % Age at First Alcohol Use:* 9 and under 62 14.6 NA 10 to 12 143 33.7 NA 13 to 15 192 45.3 NA 16 and over 27 6.4 NA

Mean 12.18

Age at First Drug Use: 9 and under 63 14.2 NA 10 to 12 177 40.0 NA 13 to 15 180 40.6 NA 16 and over 23 5.2 NA

Mean 11.98

First Drug of Choice: Heroin 7 1.7 NA Crack or Cocaine 7 1.7 NA Marijuana 323 76.2 NA Alcohol 66 15.6 NA Other 21 5.0 NA

Family History: Yes 231 52.0 NA No 213 48.0 NA

Previous Substance Abuse Treatment: Yes 305 68.4 NA No 141 31.6 NA

JASAE Scores* Min. Max. Mean SD Min. Max. Mean SD 21.00 76.00 51.34 12.44 0.00 76.00 41.59 19.63 t = 8.874; p = .000

NA = Information not available * = Mean replacement used for 60 cases in the comparison group

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at this level “indicate a severe substance abuse problem along with ingrained patterns and attitudes supporting this problem” (ADE Incorporated, 1997, p.6).

Table 6 reports the measures of central tendency for the JASAE for both groups.

Scores were available for 437 youth in the treatment group and 447 cases for the comparison group.24 The average JASAE score for the treatment group was 51.34 whereas the mean score for the comparison group was 41.59. The reason for the discrepancy was that Mohican

Youth Center was designated as a therapeutic community to treat juvenile males with a substance abuse problem. As such, Mohican’s target population was youth with a JASAE score of 21 or above whereas there was no distinction for youth in the DYS sample pool.25

The JASAE summary score may also be examined by ranges, which represent the severity of substance abuse. Figure 3 reveals the JASAE scores for each group by category.

Approximately 8 percent of the comparison group scored in the 0 to 6 range meaning that the individuals may be drinking or using drugs irresponsibly because of attitudes and life style patterns which surround the involvement. Accordingly, participants in this category need a substance abuse education program. The next level of involvement was for those who scored in the 7 to 13 category. Approximately 7 percent of the comparison group scored in this category, which indicates more than just occasional substance use. Accordingly, participants in this category need a more intensive and comprehensive level of education.

A small percentage of the comparison group (1.6%) scored in the 14 to 20 range of the JASAE summary score. Individuals in this category demonstrate an inability to change

24 Mean replacement was used for 60 cases in the comparison group. Analyses were computed with and without mean replacement. The results were very similar. Therefore, mean replacement will be used to minimize the number of missing cases. 25 The data were analyzed after removing those in the comparison group who had a JASAE score of 20 or below. Approximately 73 cases would have been removed from the comparison group. However, the removal of these cases resulted in a lower risk score for the comparison group. Therefore, instead of removing the cases from the sample, the JASAE variable will be controlled for in the final analysis.

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Figure 3: JASAE Scores

Percentage 100 100 Mohican Comparison

83.7 80

60

40

20

8.1 6.7 1.6 0 0 0 0 0 to 6 7 to 13 14 to 20 21 or above

Mean scores: Mohican (51.34); Comparison (41.59)

their use of alcohol and drugs and have an established pattern of substance abuse. Therefore, the type of treatment needed for these individuals is a “structured intervention program where they are accountable for meeting and maintaining behavior with prescribed intervention goals and objectives” (ADE Incorporated, 1997; p. 6).

A clear majority of both groups scored in the last category of the JASAE summary score (21+). All of the treatment participants scored in this category and 83.7 percent of the comparison group scored in the most severe substance abuse category. As previously indicated, scores in this category “reflect a severe substance abuse problem along with ingrained patterns and attitudes supporting the problem” (ADE Incorporated, 1997, p. 6).

Accordingly, these individual need intensive treatment and may require residential treatment to overcome the problem.

Current Offense and Criminal History. Data pertaining to the youth’s current offense were obtained from Mohican Youth Center and the Department of Youth Services.

A chi-square test revealed no significant differences between the groups on crime type (Table

7). A large portion of both groups was placed in state custody for a property offense (53% of the treatment group and 48.9% of the comparison group) followed by a personal offense

(29% of the treatment group versus 32.8% of the comparison group). Nine percent of the therapeutic community participants and 11.2 percent of the comparison group were charged with a drug offense.

Whereas there were no significant differences in the type of offense, there was a statistically significant difference between the levels of adjudication for the two groups. For example, a greater percentage of youth in the treatment group (18.8% versus 1.2%) were charged with the highest-level felony (i.e., class one felony). In addition, a greater

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Table 7: Current Offense and Criminal History Variable Mohican (N= 447) Comparison (447) N % N % Crime Type: Personal 124 29.0 88 32.8 Property 227 53.0 131 48.9 Drug 40 9.3 30 11.2 Other 37 8.7 19 7.1 ?2 = 2.417; p = .491

Level of Adjudication: Felony 1 43 9.6 30 10.9 Felony 2 150 31.4 28 10.2 Felony 3 73 16.3 49 17.8 Felony 4 97 21.7 75 27.2 Felony 5 84 18.9 90 32.7 Misdemeanor 0 0.0 3 1.1 ?2 = 59.051; p = .000

Age at First Arrest: 9 or younger 35 8.2 NA 10 – 12 159 37.5 NA 13 – 15 194 45.8 NA 16 or older 36 8.5 NA

Mean 12.67

N’s may not equal total due to missing data NA = data not available

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percentage of youth in the comparison group (10.9%) was charged with a misdemeanor crime compared to youth in the treatment group (no youth in the treatment group was charged with a misdemeanor).

The last variable that examined criminal history was the age at first arrest for the juveniles. These data were available for the treatment group only. Approximately 8 percent of the treatment group was age 9 or younger when they were first arrested. Thirty-five percent of the group was ages 10 to 12 years of age. Forty-five percent of the treatment group was ages 13 to 15 years and 8.5 percent of the group was 16 to 18 years of age at the first arrest.

Risk Level. Upon admission to the Department of Youth Services, a youth’s risk level is assessed with the Youthful Level of Service/Case Management Inventory

(YLS/CMI). The YLS/CMI is an objective and quantifiable assessment instrument that examines both static and dynamic risk factors that are associated with recidivism. These factors include: criminal history, family circumstance, employment/education achievements, peer relationships, substance abuse, leisure/recreation, personality characteristics, and antisocial attitudes. The criminal history component examines items such as prior convictions, prior probation period and detention, and current convictions. The family circumstances component examines the supervision levels, discipline practices, and relationships with parents. The factors comprising the education/employment component include: disruptive behavior in the classroom and on school property, achievement, problems with peers and teachers, and truancy. The presence of antisocial peers and the absence of prosocial peers are examined in the peer relations subcomponent. The substance abuse section of the YLS/CMI looks at screening items such as: occasional and chronic drug use,

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chronic alcohol use, and whether the substance use interferes with life. Three items comprise the leisure/recreation component – participation in activities, whether the youth could make better use of his/her time, and the interests of the youth. The personality and behavior section examines personality characteristics such as: an inflated self-image, aggressiveness, attention span, and empathy. The last section of the YLS/CMI is attitudes and orientation. This section examines the antisocial thinking, whether the individual is asking for help, if the individual will attend treatment, and whether he/she defies authority.

Depending on their scores, youth are classified as “low,” “moderate,” or “high” risk for each of the subcomponents. A total score is also provided that indicates the overall level of risk of recidivism. Total YLS/CMI scores of 35-42 are considered “very high” for recidivism; scores of 23-34 are considered “high risk” for recidivism; scores of 9-22 are considered “moderate risk” of recidivism; and scores of 0-8 are considered “low risk” of recidivism.

Figure 4 reports the total score categories for the groups. Data for the total score were available for 447 youth in the treatment group and 447 youth in the comparison group.

The majority of youth in both groups were classified as “high risk” (63.5% of the treatment group and 61.7% of the comparison group). Almost 33 percent of the treatment and comparison groups were classified as “moderate risk.” Slightly more youth in the comparison group (4.5%) were classified as “very high risk” compared to 2.8 percent of the treatment group. Lastly, an equal number of youth in both groups (0.7%) were “low risk.” A t-test was computed to compare the means of the YLS/CMI for the groups. 26 The treatment

26 Table B4 in Appendix B contains the Youth Level of Service/Case Management Inventory (Hoge & Andrews, 2003) subcomponent and total score means for both groups. 129

Figure 4: YLS/CMI Risk Categories by Group

Percentage 100

Mohican Comparison

80

63.5 61.7 60

40 32.9 33.1

20

2.8 4.5 0.7 0.7 0 Low (0-8) Moderate (9-22) High (23-34) Very high (35-42) Risk Categories

Mean Scores: Mohican (24.72) Comparison (23.38)

group had an overall mean of 24.72 whereas the comparison group had a mean YLSI score of 23.38. The t-test revealed a statistically significant difference between these scores (t = 3.463; p = .001).27 While the difference is statistically significant, along the continuum of the YLS/CMI scale, the difference would not be substantial.

Aside from the total score, the eight sub-scores may also be classified as “low,”

“moderate,” or “high” risk. Table 8 indicates the differences between the groups based on chi-square analyses of the YLS/CMI categories. There were five statistically significant relationships: family circumstances and parenting, peer relations, substance abuse, leisure/recreation, and attitudes and orientations. The treatment group had a slightly higher percentage of youth being classified as “high risk” for family circumstances and parenting (24.7% versus 18.1%). For the peer relations component, which examines the presence of antisocial peers and the absence of prosocial peers, a larger proportion of the comparison group (11.2%) were classified as “low risk” compared to the treatment group (4.7%). A large majority of the treatment group

(90.1%) was classified as “high risk” in the substance abuse component compared to 73.2 percent of the comparison group. For the leisure/recreation component, 69.8 percent of the comparison group was classified as “high risk” whereas 84.2 percent of the treatment group was classified as “high risk.” The last significant relationship was for the attitudes/orientations subcomponent. While the majority of youth in both groups were classified as “moderate” risk, a larger percentage of youth in the comparison group were classified as “low risk” (16.6% versus 9.9%).

27 The statistical difference may be the result of the sample size. A large sample size serves to decrease the standard deviation, which results in an increased t-value. 131

Table 8: Youthful Level of Service/Case Management Inventory Risk Categories Component Mohican (N= 447) Comparison N % (N=447) N % (Possible range of 0-5) Low (0) 18 4.2 27 6.0 Moderate (1-2) 86 20.2 95 21.3 High (3-5) 321 75.5 325 72.7 ?2 = 1.718; p = .424

Family Circumstances and Parenting: (Possible range of 0-6) Low (0-2) 91 21.4 116 26.0 Moderate (3-4) 229 53.9 250 55.9 High (5-6) 105 24.7 81 18.1 ?2 = 6.486; p = .039

Education/Employment: (Possible range of 0-7) Low (0) 26 6.1 26 5.8 Moderate (1-3) 161 37.9 166 37.1 High (4-7) 238 56.0 255 57.0 ?2 = .108; p = .948

Peer Relations: (Possible range of 0-4) Low (0-1) 20 4.7 50 11.2 Moderate (2-3) 265 62.4 269 60.2 High (4) 140 32.9 128 28.6 ?2 = 12.878; p = .002

Substance Abuse: (Possible range of 0-5) Low (0) 12 2.8 55 12.3 Moderate (1-2) 30 7.1 65 14.5 High (3-5) 383 90.1 327 73.2 ?2 = 44.382; p = .000

Leisure/Recreation: (Possible range of 0-3) Low (0) 13 3.1 16 3.6 Moderate (1) 54 12.7 90 20.1 High (2-3) 358 84.2 312 69.8 ?2 = 40.940; p = .000

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Table 8: Youthful Level of Service/Case Management Inventory Risk Categories (continued) Component Mohican (N= 447) Comparison (N=447) N % N %

Personality and Behavior: (Possible range of 0-7) Low (0) 16 3.8 18 4.0 Moderate (1-4) 266 62.6 255 57.0 High (5-7) 143 33.6 174 38.9 ?2 = 2.828; p= .243

Attitudes/Orientations: (Possible range of 0-5) Low (0) 42 9.9 74 16.6 Moderate (1-3) 345 81.2 319 71.4 High (4-5) 38 8.9 54 12.1 ?2 = 12.081; p = .002

Total: (Possible range of 0-42) Low (0-8) 3 0.7 3 0.7 Moderate (9-22) 140 32.9 148 33.1 High (23-34) 270 63.5 276 61.7 Very high (35-42) 12 2.8 20 4.5 ?2 = 1.734; p =.629

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Psychological and Social Functioning. Psychological and social factors such as depression, anxiety, risk-taking, antisocial values, and hostility have been found to be positively related to substance abusing behaviors and longevity and success in treatment while factors such as self-esteem, self-efficacy, and decision-making ability have been found to be negatively associated with substance abusing behaviors and longevity and success in treatment (Simpson & Knight, 1998). Therefore, these areas are all potential targets for treatment. Theoretically, therapy should reduce individuals’ levels of anxiety, depression, risk-taking, hostility, and antisocial values, and increase their self- esteem, self-efficacy, decision-making ability, desire for help, and treatment readiness.

The Client Self-Rating form (Simpson & Knight, 1998) was used as a measure of the youth’s level of psychological and social functioning. 28 Upon entrance into Mohican

Youth Center, staff administered the form to the youth. Of the 447 participants, psychological and social functioning data were available for 434 youth (97%). Because the Client Self Rating form does not categorize the scores, the best way to review the data is to examine the frequency distributions. Of the nine different scales, three were negatively skewed meaning that the youths’ scores were clustered at the higher end of the scale (Table 9). Accordingly, youth displayed a higher level of decision-making skills, self-efficacy, and appeared ready for treatment (treatment readiness). Accordingly, youth also displayed slightly lower levels of anxiety, depression, self-esteem, risk taking, hostility, and a desire for help.

Cognitive Functioning. Cognitive distortions are inaccurate ways of attending to or conferring meaning upon experiences (Barriga et al., 1999). Research has indicated that cognitive distortions may contribute to antisocial or criminal behavior (Yochelson &

28 The scales were coded so that the higher the score, the greater the psychological and social functioning. 134

Table 9: Descriptive Statistics for Client Self Rating – Time 1 Mohican Youth Center (N = 434) Scale N Min. Max. Mean Median SD

Anxiety 398 7.00 34.00 17.11 17.00 5.28 (range 7-35)

Depression 403 6.00 35.00 12.87 12.00 4.07 (range 6-30)

Self-esteem 399 11.00 30.00 22.60 23.00 3.96 (range 6-30)

Decision-making 395 14.00 45.00 31.45 32.00 5.37 (range 9-45)

Risk-taking 401 7.00 34.00 21.25 21.00 5.06 (range 7-35)

Hostility 395 8.00 38.00 20.23 20.00 6.17 (range 8-40)

Self-efficacy 397 11.00 35.00 26.38 27.00 4.23 (range 7-35)

Desire for Help 402 8.00 34.00 23.53 24.00 5.30 (range 7-35)

Treatment Readiness 396 8.00 40.00 26.59 27.00 5.52 (range 8-40)

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Samenow, 1976). Using the How I Think Questionnaire (Barriga et al., 1999), youths’ cognitive distortions were assessed. Four self-serving cognitive distortions were examined: self-centered (according such status to one’s own views that the opinions of others are not considered), blaming others (misattributing blame to outside sources), minimizing or mislabeling (believing that antisocial behavior is acceptable, admirable, or causes no real harm), and assuming the worst (assuming that improvement is impossible, or considering a worst case scenario). The How I Think Questionnaire also depicts four behavioral referents scales that are manifested from the cognitive distortions: opposition/defiance, physical aggression, lying, and stealing. From these subscales, three summary scores can be computed: the overt, covert, and overall How I Think scales.

The How I Think Questionnaire was administered at intake and termination for the treatment group only. Data from the How I Think Questionnaire were available for

394 youth (88.1%) in the treatment group. The questionnaire has an anomalous responding scale that determines the truthfulness of the answers. Scores higher than 4.25 are considered invalid and should not be used in data analyses. Scores greater than 4.0 but less than or equal to 4.25 are considered “suspect” and interpreted with caution.

Thus, intake data were available for 299 cases of which 78 cases were considered

“suspect.”

One way to analyze the scales of the How I Think Questionnaire is to determine which of the three ranges (non-clinical, borderline-clinical, clinical) the score falls into.29

The ranges on the eight subscales can be used to provide a fine-grained analysis of the youth. As Figure 5 reveals, a large percentage of youth were classified in the clinical range for the self-centeredness (49.3%), the blaming others (53.7%), and the minimizing

29 Table B5 and B6 in Appendix B reports the measures of central tendency for the How I Think scales. 136

Figure 5: Cognitive Distortion Scales for the Mohican Youth Center*

Percentage

100 96.9 Non-clinical Borderline Clinical Clinical

80

60 53.7 52.7 49.3

40 33.4 31.6 27.6 23.1

20 15.6 12.8

1 2 0 Self-centered Blaming others Minimizing Assuming the Worst

*Youth scoring 4.25 or lower on the Anomolous Response Scale. Youth were placed in the classifications based on which third of the scale their scores fell within. Higher scores indicate a problem in the cognitive distortion measured.

(96.9%) scales. Thus, the majority of the youth believe that they were the most important individuals regardless of others, that they were never to blame, and that their behavior was not that bad. Accordingly, these youth can be described as having a strong egocentric bias and a need for treatment that addresses their externalization and minimizing the consequences of their actions. However, the majority of youth also were classified as “non-clinical” for the assuming the worst scale (52.7%). Therefore, this cognitive distortion was not problematic for a large percentage of youth.

Figure 6 shows the behavioral referent scales for the participants of Mohican

Youth Center. The majority of youth fell into the “clinical” range for the physical aggression (69%) and stealing (90.6%) behavioral referents. Therefore, these youth were more likely to participate in aggressive acts. An almost equal number of youth scored in the “non-clinical” (41.4%) and “clinical” (39.1%) ranges for the oppositional defiance scale. For the lying scale, 46.9% percent of the youth scored in the “clinical” range whereas 32.8 percent scored in the “borderline-clinical” range of the scale.

Concerning the summary scores for the covert, overt and overall How I Think, the majority of youth fell into the “clinical” range (Figure 7). For example, 76.8 percent of the youth were classified as “clinical” for the covert scale and approximately 60 percent of the youth were classified as “clinical” for the overt scale. Youth in the “borderline clinical” and “clinical” ranges in the overt scale may exhibit antisocial behavior that typically involves confrontation with the victims, whereas these ranges for the covert scale indicate non-confrontational antisocial behavior (Barriga et al., 1999). In addition,

72.9 percent of the participants were in the “clinical” range for the How I Think scale.

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Figure 6: Behavioral Referents for the Mohican Youth Center*

Percentage 100 90.6 Non-clinical Borderline-clinical Clinical

80

69

60

46.9 41.4 39.1 40 32.8

19.5 20.3 20 15 16

8.1

1.3 0 Opposition Physical Aggression Lying Stealing

*Youth scoring 4.25 or lower on the Anomolous Response Scale. Youth were placed in the classifications based on which third of the scale their scores fell within. Higher scores indicate a problem in the behavioral referent measured.

Figure 7: Summary Score for How I Think for the Mohican Youth Center

Percentage 100 Non-clinical Borderline-clinical Clinical

80 76.8 72.9

59.9 60

40

22.1 18 20 16.6 16.2 10.9 6.6

0 Covert Overt How I Think

*Youth scoring 4.25 or lower on the Anomolous Response Scale Youth were placed in the classifications based on which third of the scale their scores fell within. Higher scores indicate a problem in the summary score measured.

According to Barriga et al. (1999), youth falling into the borderline-clinical and clinical range for the How I Think scale may exhibit externalizing psychopathology.

Intermediate Outcomes

While research has focused on long-term outcomes for therapeutic communities, few has focused on intermediate outcomes to determine if therapeutic communities are effective in changing antisocial attitudes and addressing responsivity issues such as anxiety, self-esteem, and depression. Accordingly, youth were re-assessed using the

Client Self Rating and the How I Think Questionnaire to determine if participation in a therapeutic community significantly changed antisocial attitudes and responsivity factors.

Changes In Psychological and Social Functioning. The Client Self-Rating form, designed to measure psychological and social factors such as depression, anxiety, risk-taking, antisocial values, and hostility was administered at intake on 434 cases and administered at termination on 213 cases.30 Of the 213 posttests that were available, the number of useable pairs for analyses ranges from 171 cases to 177 cases. According to

Simpson and Knight (1998), treatment should reduce anxiety, depression, risk-taking, and hostility and increase self-esteem, self-efficacy, decision-making, desire for help, and treatment readiness. Paired sample t-tests between time 1 and time 2 scores on the Client

Self-Rating revealed no significant changes in the anxiety, risk-taking, self-efficacy, desire for help, and treatment readiness scales (Table 10).

30 The data were derived as part of a larger study conducted on the Residential Substance Abuse Treatment programs. The site was responsible for collecting the assessment data. At Mohican, one staff member was assigned to administer the Client Self Rating and the How I Think Questionnaire at intake and termination. If the individual was not present when the youth was discharged from the facility, then the exit assessment was not conducted. Therefore, only 49 percent of the Client Self Rating pretests have posttests.

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Table 10: Paired Sample t-tests on Client Self-Rating Time 1- Time 2* Scale No. of Pairs Time 1 Time 2 t-value Sig. Mean Mean

Anxiety 175 17.22 17.91 -1.734 .085 (range 7-35)

Depression 177 13.05 12.32 2.055 .041 (range 6-30)

Self-esteem 172 22.52 23.66 -3.444 .001 (range 6-30)

Decision-making 171 31.72 32.84 -2.433 .016 (range 9-45)

Risk-taking 174 21.35 21.82 -1.314 .191 (range 7-35)

Hostility 172 20.27 21.49 -2.581 .011 (range 8-40)

Self-efficacy 174 25.97 26.41 -1.254 .212 (range 7-35)

Desire for Help 172 23.62 23.70 -.184 .855 (range 7-35)

Treatment Readiness 173 26.52 26.28 .487 .627 (range 8-40)

* includes all time

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The change in time 1 and time 2 scores on the depression, self-esteem, and decision-making scales were statistically significant and in the hypothesized direction, indicating that on average youths’ levels self-esteem (p = .001) and decision-making abilities (p = .016) increased with participation in treatment whereas the level of depression decreased (p = .041). In addition, the change in scores from time 1 to time 2 was statistically significant for the hostility scale (p = .011); however, the change was in the wrong direction indicating that participation in the treatment program increased the youths’ level of hostility. 31

To determine if the length of time in the program impacted the outcomes on the posttests, regression models were computed to examine if the length of time between the administrations of the instruments predicted the time 2 score while controlling for the pretest score.32 The length of time between the pretests and posttests was a significant positive predictor in two relationships (risk-taking and hostility) and a significant negative predictor in one equation (treatment readiness) (see Table B8 in Appendix B).

As the number of days in the program increased, the score on the time 2 measure increased for the risk-taking and hostility scores indicating that youth were more likely to take chances and feel more hostile. For the treatment readiness scale, time was a negative predictor indicating that as the number of days in the program increased, the youths’ reported readiness for treatment diminished.

31 The findings from the paired sample t-tests may have been the result of a bias in the samp le in that prosocial youth were more likely to complete the posttest Client Self Rating Form. To examine if this was the case, independent samples t-tests were conducted to determine if there were differences between those who completed both the pre and posttests and those who completed only the pre-test. Table B7 in Appendix B reports the results. There were no significant differences between those who completed only the pretest and those who completed both the pretest and posttest. 32 The length of time between the scores should have been 180 days since Mohican Youth Center is a 6- month program. However, the length of time ranged from 13 days to 544 days with an average of 194.83 days between the administrations of the instrument. 143

Changes In Cognitive Distortions. Youths’ cognitive distortions such as self- centered, blaming others, minimizing behavior, and assuming the worst were measured by the How I Think Questionnaire. The instrument was administered to 394 youth at intake and to 207 youth at termination. After removing the cases with the anomalous response scale score of 4.25 or greater, the number of pairs for analyses was reduced to

150.

Participation in the therapeutic community should reduce the likelihood of antisocial/criminal behavior by reducing risk factors such as the youth’s antisocial attitudes. Therefore, theoretically, the levels of cognitive distortions should be lower at the time 2 measure. While the posttest scores were lower, participation in treatment did not result in a significant reduction in the cognitive distortions for the youth when the

“suspect” cases were included in the analyses (Table 11).33

To determine if length of time between scores affected the outcome, regression analyses were computed (see Table B10 in Appendix B).34 It is theorized that time spent in treatment would reduce youths’ cognitive distortions. However, length of time was a significant positive predictor in four equations: minimizing, oppositional defiance, overt, and How I Think scales. Accordingly, the longer the youth spent in treatment, the more likely he was to report higher levels of minimizing and oppositional defiance attitudes,

33 The null findings may have been the result of who completed the instrument at intake and termination. Independent samples t-tests were conducted to determine if there were differences between those who completed both the pre and posttests and those who completed only the pre-test. Table B9 in Appendix B reports the results. There were no significant differences between those who completed only the pretest and those who completed both the pretest and posttest. Thus, the individuals who completed the posttest were no more prosocial or antisocial than those who completed only the pretest. 34 The length of time between the pretest How I Think Questionnaire and the posttest How I Think Questionnaire was 190.06 days with a range of 13 days to 341 days. 144

Table 11: Paired Sample t-tests on How I Think Questionnaire, Time 1- Time 2* Scale No. of Pairs Time 1 Time 2 t-value Sig. Mean Mean Cognitive Distortions

Self-centered 111 3.30 3.19 1.731 .086 (range 0-6)

Blaming Others 114 3.23 3.22 .064 .949 (range 0-6)

Minimizing/Mislabeling 111 4.19 4.19 .017 .986 (range 0-6)

Assuming the Worst 109 2.83 2.71 1.546 .125 (range 0-6)

Behavioral Referents

Opposition-Defiance 114 3.26 3.21 .568 .571 (range 0-6)

Physical Aggression 113 3.41 3.35 1.217 .226 (range 0-6)

Lying 104 3.51 3.44 1.209 .230 (range 0-6)

Stealing 111 3.31 3.25 1.044 .299 (range 0-6)

Summary Scores

Covert 104 3.42 3.34 1.347 .181 (range 1-6)

Overt 112 3.34 3.27 1.025 .308 (range 1-6)

How I Think 101 3.39 3.31 1.369 .174 (range 1-6)

* Includes the scores that may be considered “suspect” because the AR scale is greater than 4.0 but less than 4.25.

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display behaviors that may involve confrontation with victims, and exhibit externalizing psychopathology.

The finding of no significant reduction in youths’ cognitive distortions was not surprising considering that the above analysis included cases that may be considered suspect, thus indicating that the youth may have been lying or randomly responding to the questions. Therefore, an analysis was conducted on those cases that were not considered suspect. When examining only the cases that were not considered suspect, five significant relationships were found (Table 12). A statistically significant relationship was found for one cognitive distortion: self-centeredness. Participation in treatment reduced the youths’ self-centered thinking (p=.040). There was only one behavioral referent scale that produced a statistically significant relationship. On average, the youths’ lying was reduced by participating in the therapeutic community

(p=.005). All three summary scores produced a significant relationship and in the expected direction. Youths’ overt behaviors such as oppositional defiance and physical aggression were significant reduced (p= .043) whereas the covert behavior, which typically includes non-confrontational antisocial behavior, was reduced (p = .014). In addition, the overall How I Think score was reduced (p = .016) by participation in the therapeutic community.

Regression analyses revealed that length of time between the administrations of the How I Think Questionnaire was a significant predictor of the time 2 score (see Table

B11 in Appendix B). Theoretically, time spent in treatment would reduce the cognitive distortions of the youths. However, while the amount of time between scores was a positive predictor for all scales, the variable was a significant positive predictor in seven

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Table 12: Paired Sample t-tests on How I Think Questionnaire, Time 1- Time 2* Scale No. of Pairs Time 1 Time 2 t-value Sig. Mean Mean Cognitive Distortions

Self-centered 66 3.53 3.34 2.091 .040 (range 0-6)

Blaming Others 69 3.45 3.38 .713 .478 (range 0-6)

Minimizing/Mislabeling 67 4.32 4.19 1.798 .077 (range 0-6)

Assuming the Worst 66 3.06 2.88 1.663 .101 (range 0-6)

Behavioral Referents

Opposition-Defiance 69 3.49 3.37 1.315 .193 (range 0-6)

Physical Aggression 69 3.61 3.45 1.985 .051 (range 0-6)

Lying 62 3.73 3.48 2.904 .005 (range 0-6)

Stealing 66 3.51 3.39 1.552 .125 (range 0-6)

Summary Scores

Covert 62 3.63 3.43 2.540 .014 (range 1-6)

Overt 68 3.56 3.40 2.060 .043 (range 1-6)

How I Think 60 3.60 3.42 2.471 .016 (range 1-6) * Does not include the scores that may be considered “suspect” because the AR scale is greater than 4.0 but less than 4.25.

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relationships: blaming others, minimizing, oppositional defiance, physical aggression, stealing, overt, and How I Think scales. Thus, as the length of time increased between the administrations of the instrument, the posttest score increased and the youth reported higher levels of cognitive distortions.

Successful Completion. Table 13 shows the type of termination for the treatment and comparison groups. The majority of youth in both groups were successfully discharged from Mohican Youth Center (84.5%) or the Department of Youth Services

(66.6%). However, a chi-square analysis revealed that youth in the comparison group

(33.4%) was more likely to be unsuccessfully discharged compared to youth in the treatment group (15.5%).35

The length of stay in Mohican or the Department of Youth Services was computed from the placement and termination date. Even though Mohican Youth Center is a 6-month program, the average length of stay was 192 days with placement lasting from 13 days to 472 days. The average length of stay for the comparison group was significantly longer with an average of 260 days with a range of 1 day to 1343 days (3.6 years).

To determine what factors predicted successful completion of the therapeutic community, a logistic regression was computed. A logistic regression analysis reveals any significant predictors of successful completion when all other variables are held constant. Nine variables were included into the model to predict successful completion of

Mohican’s therapeutic community: age, race (1 = nonwhite), highest grade completed, previous treatment (1 = yes), JASAE score, YLS/CMI score, How I Think score, Client

35 Unsuccessful discharge included those whom had a judicial release from Mohican or the Department of Youth Services, those who were released because of age, or those were transferred to another institution (treatment group only). 148

Table 13: Termination Information Variable Mohican (N= 447) Comparison (N=447) N % N %

Type of Termination Successfully discharged 365 84.5 293 66.6 Unsuccessfully discharged 67 15.5 147 33.4 ?2 = 37.715; p = .000

Mohican (N= 447) Comparison (N=447)

Min. Max. Mean SD Min. Max. Mean SD

Length of stay: 13 472 192.35 59.36 1 1343 260.80 206.49 t= -6.539; p= .000

149

Self Rating score, and length of time in program. 36 There was only one significant predictor of successful completion–length of time in the program (Table 14). The more time the youth spent in Mohican, the more likely he was to successfully complete the program.

In order to present the logit coefficients in a fashion that is easily understood, each beta was converted into log-odds probabilities. Figure 8 reveals a linear relationship between length of time in the program and successful completion. Youth who only spent three months or less in Mohican had a 45 percent chance of successfully completing the program whereas youth who spent six months in the program (Mohican is typically a 6- month program) had an 87 percent chance of successfully completing.37 If the youth spent 8 months in the program, he had a 96 percent chance of successfully completing the therapeutic community.

Long-Term Outcomes

Rates of Incarceration. The long-term outcome for this study was a period of new incarceration. 38 New incarceration was measured as period of incarceration in either the Department of Youth Services or the Department of Rehabilitation and Correction.

Table 15 reports the rates of incarceration for each group. Forty-three percent of the comparison group had a new period of incarceration whereas 36.7 percent of the treatment group had a new period of incarceration. A chi-square analysis revealed that

36 The Client Self Rating score was computed by adding the anxiety, depression, self-esteem, decision- making, risk taking, hostility, self-efficacy, desire for help, and treatment readiness scales. The self- esteem, decision-making, self-efficacy, desire for help, and treatment readiness scales were reverse coded so that the higher the score the more problematic. 37 There were some youth who successfully completed the program in less than three months. 38 As previously mentioned, new incarceration was used as the outcome because the arrest data from the Department of Youth Services is unreliable. Furthermore, examining incarceration rates provides a more stringent test of the effectiveness of the therapeutic community in reducing recidivism. 150

Table 14: Regression Coefficients Predicting Successful Completion Factor Beta Significance Level

Age -.019 .903 Race (1 = nonwhite) .308 .443 Highest Grade -.163 .283 Previous Treatment .108 .812 JASAE Score .001 .963 Y-LSI Score -.027 .478 How I Think Score .083 .829 Client Self Rating Score -.003 .712 Length on time in facility .690 .000

Constant .378

-2 Log Likelihood 197.572 Nagelkerke R2 .301

151

Figure 8: Significant Predictor and Probability for Successful Completion

Treatment Group

100 96 93 87 80 78

62 60

45 40

20

0 Month = 3 Month = 4 Month = 5 Month = 6 Month = 7 Month = 8

this difference was not significant at the .05 level. However, when examining the time to incarceration, a significant difference was found. Specifically, individuals who participated in the therapeutic community were reincarcerated faster than individuals from the comparison group (359 days versus 514 days).

Table 15 also examines whether the individual was incarcerated in a DYS facility or a DRC facility. Again, a chi-square analysis revealed a non-significant difference between the treatment and comparison groups. Twenty-one percent of the comparison group was reincarcerated in a DYS facility whereas only 18.3 percent of the treatment group was reincarcerated.

The last analysis examined the rates of incarceration in an adult facility. Again, more individuals from the comparison group were incarcerated in an adult facility than individuals from the treatment group; however, this difference was not significant (?2 =

3.012; p = .083).

Model Predicting Incarceration For Both Groups. To determine if participation in treatment resulted in a significant decrease in the probability of incarceration, a Cox regression model was computed. Six variables were entered into the equation: age, race (1=nonwhite), JASAE score, type of completion

(1=successful completion), YLS/CMI category (1=high risk), and group (1=treatment).

There were three statistically significant relationships: age, race, and JASAE score (Table

16). First, younger juveniles, nonwhites, and juveniles who had more severe substance abuse problems were significantly more likely to be incarcerated. Participation in the therapeutic community should have resulted in a decrease in the probability of

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Table 15: Rates of Incarceration Mohican Comparison N % N % Any Incarceration: Yes 164 36.7 192 43.0 No 283 63.3 255 57.0 ?2 = 3.659; p = .056

Time to Incarceration 359.24 days 514.84 days t = 5.107; p = .000

DYS Incarceration: Yes 82 18.3 94 21.0 No 365 81.7 353 79.0 ?2 = 1.019; p = .333

DRC Incarceration: Yes 94 21.0 116 26.0 No 353 79.0 331 74.0 ?2 = 3.012; p = .083

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Table 16: Regression Coefficients Predicting Incarceration Factor Beta Significance Level

Age -.263 .000 Race (1=nonwhite) .256 .019 JASAE .009 .011 Type of completion (1=successful) .183 .162 YLSI total (2=high) .195 .162 Group (1=treatment) -.084 .489

-2 Log Likelihood 4380.930 Chi-square 53.924 .000

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incarceration. While the coefficient for the group variable was negative (indicating the treatment group was less likely to be incarcerated), the relationship was not statistically significant.

Results of the survival analysis by participation in treatment are shown in Figure

9. Figure 9 represents the independent effects of participation in treatment while controlling for age, race, JASAE score, YLS/CMI score, and type of completion. For ease of interpretation, the figure will be presented as failure curves instead of survival curves. The failure curves are based on the probability of incarceration at each month, given that the individual has survived up to that point, based on the proportion that failed or were incarcerated. Throughout the period in question, the treatment group failed faster than the comparison group; however, the difference is not statistically significant. For example, during the first year at risk, the groups are very similar in their failure rates (.17 versus .15 at month 12).

During the second year (13 to 24 months), the failure rates of the groups are becoming more distinct. For example, at year 24, the failure rate for the treatment group was .38 for the treatment group and .33 for the comparison group. By the end of the evaluation period, the probability of being incarcerated for the treatment group is .58 versus .52 for the comparison group.

Model Predicting Incarceration for the Treatment Group Only. A Cox regression model was also computed to determine if there was a differential impact of treatment for certain types of juveniles who participated in Mohican Youth Center. For this model, seven factors were entered into the equation: age, race (1=nonwhite), JASAE

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Figure 9: Participation in Treatment by Incarceration

0.6 #Treatment &Comparison # & 0.5 # 0.4 &

0.3 # &

0.2 # & 0.1

0 &# 0 months 10 months 20 months 30 months 40 months Treatment 0 0.15 0.31 0.45 0.58 Comparison 0 0.13 0.28 0.41 0.52

score, YLSI score (1=high risk), participation in previous treatment (1=yes), How I Think

Questionnaire score, and Client Self Rating score. There was only one statistically significant relationship found–age (Table 17). Specifically, younger juveniles were more likely to be incarcerated.

Figure 10 shows the failure probabilities by age for the treatment group. First, the largest increase in the probability of failure occurs between the 10-month period and the

20-month period. The average increase in the probability of incarceration was .18 or an

18 percent increase in the chance of incarceration over the 10 months. The second finding from this figure was that youth ages 13 and 14 were more likely to be incarcerated throughout the evaluation period. For example, for juveniles age 14, the probability of being incarcerated at the 10-month period was .21 whereas the probability of failure at the 36-month period was .71. The last major finding was that juveniles age

16 and 17 and juveniles age 18 and 19 were very similar in their failure rates throughout the length of the follow-up period. Thus, the largest difference in incarceration occurred between youth ages 13 and 14 and youth ages 18 and 19.

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Table 17: Regression Coefficients Predicting Incarceration for the Treatment Group Factor Beta Significance Level

Age -.262 .001 Race (1 = nonwhite) .038 .849 Previous Treatment .067 .762 JASAE Score .002 .794 YLSI total (2=high) .397 .143 How I Think Score -.027 .898 Client Self Rating Score .004 .417

-2 Log Likelihood 1209.895 Chi-square 15.177 .034

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Figure 10: Age By Incarceration

Treatment Group Only

0.8 "13 $14 &15 ' 16 +17 -18 )19 20 $ $ " 0.6 " $ " & &

0.4 &

+' +' - +' )- ) 0.2 "$ & -) )+ -' 0 -+$")'& 0 months 10 months 20 months 30 months 36 months 13 0 0.19 0.52 0.61 0.63 14 0 0.21 0.55 0.68 0.71 15 0 0.17 0.41 0.51 0.51 16 0 0.08 0.22 0.29 0.31 17 0 0.09 0.22 0.29 0.31 18 0 0.07 0.18 0.23 0.24 19 0 0.09 0.17 0.22 0.23 20 0 0.18 0.31 0.36 0.37

CHAPTER 5

SUMMARY AND CONCLUSIONS

As previously discussed, the relationship between criminal behavior/delinquency and substance abuse is well documented (Andrews & Bonta, 1994; Elliott & Huizinga,

1984; Wanberg, 1992). Many states, having witnessed an increase in their incarceration population, are seeking to combat the problem through substance abuse treatment programs. One promising avenue for treating the substance-abusing offender is a therapeutic community. While research for adult offenders has shown that therapeutic communities may reduce recidivism by as much as 13 percent, the research on therapeutic communities for juveniles is limited. The main focus of the current study builds on the literature by examining a sample of juvenile males who participated in a therapeutic community to determine if participation in treatment reduced the probability of incarceration. The purpose of this chapter is to summarize the limitations and findings and to provide policy implications and suggestions for future research.

Limitations

Although this study does build on the current literature for therapeutic communities, there are some noteworthy limitations. First, the study could not randomly assign individuals to the treatment group or the comparison group. Random assignment to groups would have allowed the groups to be very similar and would have strengthened any findings of a treatment effect. However, youth were adjudicated to the therapeutic community and the Department of Youth Services by a judge and not the researcher.

Even though the comparison group was matched to the treatment group on certain characteristics, there were some statistically significant differences between the groups.

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Accordingly, these differences were controlled for in the final analyses predicting outcomes.

Missing data for the comparison group was also a concern for this study. A standardized intake form was used to collect certain demographic data on the treatment group; however, these data were unavailable for the comparison group. For example, data concerning number of prior arrests, prior commitments, age at first arrest, and substance abuse history were not available for the comparison group. Therefore, this study was not able to control for these factors. In addition, information pertaining to intermediate outcomes were only available for the treatment group. As such, without a comparison group, one may only speculate that the differences in the psychological and social functioning and cognitive distortions were the result of participation in the therapeutic community.

Another problematic issue concerning missing data was related to the posttest measures of the Client Self Rating and the How I Think Questionnaire. Only 49 percent of the cases had both pretest and posttest Client Self Rating assessments and 38 percent of the cases had both the pretest and posttest How I Think Questionnaires. Due the number of missing posttest cases, the pretest Client Self Rating and the How I Think

Questionnaire was used to predict outcome.

The length of follow-up may be problematic. While the length of follow-up for the study was three years, the follow-up time period may not have been sufficient to adequately assess the long-term effects such as incarceration rates of the therapeutic community. Indeed, while the length of the follow-up time period is in sync with some

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research, newer studies are following offenders who participate in a therapeutic community for a period of five years (Inciardi et al., 2004 ).

Related to follow-up is the fact that no information was available concerning the type of aftercare, if any, these juveniles received once they left Mohican Youth Center.

While some youth were placed on parole after termination, others were discharged without any type of supervision. Furthermore, when the juvenile was placed on parole, he was not guaranteed to receive any type of structured aftercare treatment. The lack of an aftercare treatment component is important considering that much of the success of therapeutic communities was derived from individuals who also received some type of step-down treatment (Butzin et al., 2002; Hiller et al., 1999a; Inciardi et al., 2004; Knight et al., 1999; Martin et al., 1999; Wexler, DeLeon et al., 1999; Wexler, Melnick et al.,

1999). Thus, without the follow-up information, the current study could not examine the effects of the therapeutic community for those who received aftercare.

The last limitation for the current study is the fact that the sample contained only males. Accordingly, the findings are limited to juvenile males and not females.

Summary of Findings

Background Characteristics. While the main focus of this dissertation was whether participation in a therapeutic community reduced recidivism among juvenile males, there were additional research questions that were addressed. To address the first question, which was concerned with the characteristics of the two groups, several analyses were conducted. The average juvenile in both groups was white, had completed the 8th grade, was enrolled in school prior to his arrest, and had previous suspensions.

Except for race, there were significant differences between the groups on these

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characteristics; however, the differences while statistically significant were not substantively significant.

When examining the current offense and criminal history, there were no significant differences in the type of current offense. For example, juveniles in both groups were more likely to be arrested for a property crime or a personal crime.

However, there were significant differences between the offense levels for the current crimes. Specifically, the comparison group was more likely to be arrested for a misdemeanor whereas the treatment group was more likely to be arrested for a felony one offense.

Data exploring the drug history was available for the treatment group only. The typical juvenile was age 12 when he first used drugs or alcohol. Furthermore, the drug of choice was marijuana and the majority of youth had been in previous treatment. When examining the JASAE score for both groups, there were significant differences. The treatment group had a more significant drug problem than the comparison group (51.34 versus 41.59); however, JASAE scores over 21 indicate a severe substance abuse problem with a need for residential treatment. A large percentage of youth in both groups had JASAE scores of 21 or above.

This study also incorporated a measure of risk of recidivism – the Youthful Level of Service/Case Management Inventory (YLS/CMI). To obtain the comparison group, when possible, the YLS/CMI total score was matched score by score; however, in some instances this was not the case and selection of the comparison group had to be accomplished by matching categories. Therefore, there was a statistically significant difference between the two groups. Specifically, the treatment group’s total YLS/CMI

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score was slightly higher than the comparison group (24.72 versus 23.38). While statistically, the differences are significant, substantively the differences are not significant. For example, both averages fall into the “high risk” category of the

YLS/CMI. Furthermore, on average, the difference is just indicative of a one point difference across the eight different domains of the YLS/CMI.

The Client Self Rating form (Simpson & Knight, 1998) and the How I Think

Questionnaire (Barriga et al., 1999) were administered to individuals in the treatment group. Accordingly, at intake, the typical juvenile had higher levels of self-efficacy, decision-making skills, and appeared ready for treatment. Furthermore, the average juvenile had lower levels of anxiety, depression, self-esteem, risk taking behaviors, hostility, and a desire for help. When examining the cognitive distortions, the typical juvenile in Mohican had very high levels of the following cognitive distortions: self- centeredness, blaming others, and minimizing. In addition, the typical youth was more likely to engage in physical aggression and stealing as a result of these cognitive distortions.

Based on these background characteristics, it appears that Mohican Youth Center was targeting an appropriate population for the type of intensive treatment provided by the institution. The data revealed that the majority of the therapeutic community participants and the comparison group have substantial criminal histories and are at

“moderate” to “high risk” of recidivism according to the YLS/CMI. JASAE scores revealed that all therapeutic community participants scored 21 or above on the JASAE indicating a severe substance abuse problem and the need for residential treatment. In

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addition, the individuals at Mohican had ingrained cognitive distortions that were likely to result in antisocial and criminal behavior.

Impacting Intermediate Outcomes. The second research question examined the treatment’s impact on the youth’s level of cognitive distortions and psychological and social functioning. Paired sample t-tests were conducted on the pretest and posttest measures of the Client Self Rating (Simpson & Knight, 1998) and the How I Think

Questionnaire (Barriga et al., 1999). There were no significant differences in the youth’s levels of anxiety, risk-taking, self-efficacy, desire for help, and treatment readiness. One reason for the null findings may be the result that the instrument has not been validated on the juvenile offender population. Thus, the instrument may not be appropriate for the juvenile offender population. Another possibility for the null findings may be due to the fact that the instrument was not administered to all participants upon termination from

Mohican. Thus, the time 2 scores may be biased in the fact that not all participants were reassessed.

The results from the Client Self Rating also indicated that participation in the therapeutic community significantly decreased the youths’ levels of depression and increased their self-esteem, decision-making abilities, and hostility levels. One possible explanation for the positive increase in self-esteem and decision-making abilities may lie within the structure of the therapeutic community. For example, it is the community of peers (with limited staff interaction) that sets a therapeutic community apart from other treatment modalities (DeLeon, 2000; Lipton, 1998). Specifically, the juveniles were responsible for many aspects of the daily schedule. Members were responsible for determining the content of the morning and evening meetings and the content of some

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groups. In addition, certain positions within the therapeutic community, such as expediters and coordinators, have many decision-making opportunities. For example, the expeditor is responsible for the redirection of other members through the use of pushups and pull-ups. He is also responsible for bring behavior to the attention of the staff. The coordinator is the highest-ranking position within the therapeutic community, and as such, he has many responsibilities and decision-making opportunities. His responsibilities include deciding about the content of the house meetings, developing daily schedules, and overseeing sanctions, privileges, and disciplinary actions (DeLeon,

2000). Thus, the job structure within the therapeutic community may have served to increase the participants’ decision-making skills.

Along with the increase in decision-making skills, the youth also experienced an increase in their self-esteem. The increase may be a function of the hierarchical structure inherent within the therapeutic community. For example, new members are assigned to the lowest jobs within the community. As they prove they can accomplish these tasks, they are advanced to the next levels. Thus, with the advancement comes a sense of accomplish which may serve to increase one’s self-esteem.

The last significant change in the Client Self Rating scales was the increase in the hostility levels for the participants. Theoretically, participation in treatment should have reduced the levels of hostility and as the length of time increased the time two score should have decreased. However, the length of time between the pretest and posttest revealed a significant positive relationship. As the length of time increased, the time two score on the hostility scale increased. One possible explanation for the current finding may be found in one aspect of the therapeutic community – encounter groups. These

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groups are sessions in which members confront each other on behavior and attitudes.

The very nature of the encounter group may serve to increase a delinquent’s hostility levels. To be encountered, each juvenile must face each other within a circle of the other members. The juvenile who is being encountered must remain silent until the encounter is over. Then he is given an opportunity to defend himself. However, these encounter groups may become very intense and juveniles may see the encounter as an attack against him, which may serve to increase their hostility levels.

Another possible explanation for the increase in the hostility levels may be the type of punishments or learning experiences that are issued. At Mohican Youth Center,

“image busters” are used to break down the “tough guy” image that some delinquents hold. When an image buster is used, a juvenile may have to sing a song during the morning meeting. Furthermore, some types of learning experiences, which are issued after a written pull-up, may also serve to increase the youths’ hostility levels. For example, youth were required to wear signs and perform skits as a punishment/learning experience for antisocial behavior. These techniques are seen as shaming and degrading to some members and thus may actually have a negative effect on behavior. In this case, participation in these techniques may have served to increase the participants’ hostility levels.

While the Client Self Rating form addressed psychological and social functioning, the How I Think Questionnaire addressed cognitive distortions and behaviors that were likely to form as a result of the cognitive distortions. Two models were computed. The first model included the cases that were suspect meaning that the individuals may not be truthful. For this model, there were no significant reductions in the cognitive distortions

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or behavioral referent scales even though the time two score was lower. However, when the suspect cases are removed, there are some significant differences between the pretest and posttest measures. Specifically, participation in treatment resulted in a significant decrease in the self-centeredness, lying, overt, and covert behaviors. Furthermore, participation in the therapeutic community resulted in a significantly lower overall How I

Think score.

The possible explanation for these findings may also lie within the foundation of the therapeutic community. For example, one mantra within the therapeutic community is

“I am my brother’s keeper” (DeLeon, 2000). Indeed, the community of peers will only be effective if the members form a cohesive bond. In developing this bond, it is important that the juvenile think of others and not just himself. Along with having mentors to assist in the transformation from thinking only of himself to thinking of others, the juvenile may be confronted if his self-centeredness persists. Furthermore, these encounter groups are also used to confront juveniles who have a habit of lying. If the effectiveness of the encounter groups is to be believed, it may be that these groups resulted in a decrease in the self-centeredness and lying of the juveniles.

Predictors of Successful Completion. The third research question that was addressed in the current study was “what factors predict successful completion of treatment?” First, for the treatment group, a large percentage of juveniles successfully completed the treatment (84.5%).39 The high rate of completion may be due to the fact that once placed in treatment, most infractions were handled within the institution and did not necessitate the removal of youth to other institutions.

39 Of the 16% that did not successful complete treatment, many were released early from the facility by a judge before they had completed the treatment goals.

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To determine which factors predicted completion of treatment, a logistic regression model was computed in which nine variables were included in the analysis: age, race, highest completed grade, previous treatment, JASAE score, YLSI score, the

How I Think score, Client Self Rating score, and length of time in treatment. From this model, only one variable was statistically significant–length of time in the program. As the length of time in the program increased, the juvenile was more likely to complete the program. When the beta was converted to log-odds probabilities, youth who only spent three months in treatment had a 45 percent chance whereas youth who spent 6 months in treatment had an 87 percent chance of successfully completing treatment. This finding is not surprising given that previous research has found length of time in a program to be a predictor of success (Nielsen & Scarpitti, 2002; Wexler et al., 1992).

Furthermore, the null findings for the How I Think and the Client Self Rating is not surprising given completion of treatment should not be confused with progress in treatment. Results from the CPAI conducted on Mohican Youth Center indicated a youth’s movement through the program was more dependent on the completion of their sentence than it was on the acquisition of prosocial attitudes and behaviors. Furthermore, as Pealer et al., (2002a) reported, of those who participated in the therapeutic community, only 136 youth (30.4%) actually completed the last phase of treatment.

Rates of Incarceration. The outcome for this study was a new period of incarceration. Specifically, three different rates of incarceration were examined. The first model examined the rates of any new incarceration from termination to present.

While not significant, the treatment group was less likely to be incarcerated. The second and third models, examined incarcerations into the Department of Youth Services and the

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Department of Rehabilitation and Correction. Again, there were no statistically significant differences between the groups, however; the treatment group was less likely to be incarcerated in either facility.

A t-test indicated that there were significant differences between the lengths of time to incarceration with the treatment group being incarcerated faster than the comparison group. Thus, while the treatment group was less likely to be incarcerated, when they were incarcerated, they failed faster than the comparison group.

Model Predicting Incarceration. The main focus of this dissertation was to determine if participation in a therapeutic community resulted in a significant decrease in the probability of being incarcerated when compared to individuals who did not receive treatment. A Cox regression model was computed to determine if there was a treatment effect while controlling for age, race, substance abuse level, risk level, and type of completion. The coefficient for the group variable was negative indicating that on average, individuals in the treatment group were less likely to be incarcerated compared to individuals who did not receive treatment; however, the coefficient was not statistically significant (p= .489). Thus, participation in a therapeutic community did not result in a significant decrease in the probability of incarceration over the evaluation period.

One possible explanation for the null findings for treatment may lie in the type of treatment that was provided to the juveniles. Data from the CPAI that was conducted on

Mohican’s therapeutic community reveal that there was some room for improvement in the quality of treatment. As previously mentioned, there are certain characteristics, if which are adhered to, will likely result in promising outcomes (Gendreau, 1996). While

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the therapeutic community adhered to some of these principles of effective interventions, the program was lacking in other areas.

The first problematic area is the type of treatment model in which the groups were based upon. The overall model of the therapeutic community – a community of peers – was based on a social learning approach (Lipton, 1998). The social learning modality stresses the importance of learning vicariously through observing others (Van Voorhis,

2000). Specifically, the community consisted of offenders and staff who acted as role models and guided in the recovery process. Research has shown that programs using the social learning model were effective in reducing recidivism (Andrews, Zinger et al.,

1990; Lipsey, 1999). Accordingly, while the overall model was based on a social learning approach, the groups within the program may serve to undermine the effectiveness of the overall model. For example, the majority of the groups was education-based and used processing (or talking cures) to change the attitudes and behaviors of the youth. Research has shown that these techniques are not as effective in reducing recidivism (Andrews, Zinger et al., 1990; Taxman, 1999). Furthermore, these groups did not incorporate behavioral rehearsal techniques such as role-playing to promote attitudinal and behavioral change.40 Rather, the groups used techniques such as discussion and education in hopes to change the antisocial behaviors. Accordingly, this process does not serve to increase the community’s cohesion; but rather to promote individualized therapeutic work (Taxman & Bouffard, 2002). Therefore, the structure of the groups may serve to undermine the therapeutic intention of the community of peers approach.

40 Behavioral rehearsal techniques such as role-playing have been shown to be important components of a treatment program in promoting behavioral change (Andrews & Bonta, 1994; Gendreau, 1996).

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Another reason for the lack of a treatment effect lies in risk factors that were targeted. While the treatment targeted risk factors such as antisocial attitudes, substance abuse, and education/employment, the main focus appeared to be on educational attainment. As mandated by the Department of Youth Services, the majority of the day was spent in traditional education classes. While poor educational skills is a predictor of risk of recidivism, it is not as strong a predictor as antisocial attitudes or antisocial peers

(Andrews & Bonta, 1994; Gendreau, Goggin, & Paparozzi, 1996; Simourd & Andrews,

1994). Thus, one possible explanation for the lack of a treatment effect may be the insufficient attention given to the major risk factors.

A third treatment reason for the null finding may be the use of reinforcements at

Mohican Youth Center. To promote long-term behavioral change, programs should provide appropriate reinforcements to the participants (Gendreau, 1996; Spiegler &

Guevremont, 1993). While the therapeutic community provides many opportunities for positive reinforcement in the form of privileges and verbal praise, the problem lies with the types of punishments that were issued. Specifically, the juveniles were required to perform skits, sing songs, and wear signs as punishments. These techniques will not encourage juveniles to change their behavior; but rather, may actually serve to increase the antisocial tendencies of the juveniles (Spiegler & Guevremont, 1993. Therefore, without appropriate punishments, the juveniles did not acquire prosocial behaviors and attitudes, which would have resulted in a significant decrease in the probability of incarceration.

The last area of concern for treatment delivery at Mohican focused on the release and aftercare component for the juveniles. Release from a program should be based on

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the acquisition of prosocial skills, behaviors, and attitudes and not be time-based.

However, as with many RSAT grants, the length of time at Mohican was six months.

Thus, many youth were released from the facility at end of their six months regardless of their phase placement. Therefore, many youth may have left the institution before acquiring the necessary skills needed to refrain from criminal behavior.

Related to the departure of the youth is what happens to him once he left the therapeutic community. Many studies on the effectiveness of therapeutic communities in reducing recidivism have shown that aftercare is an important component in reducing recidivism (Butzin et al., 2002; Hiller et al., 1999a; Inciardi et al., 2004; Knight et al.,

1999; Martin et al., 1999; Wexler, DeLeon et al., 1999; Wexler, Melnick et al., 1999).

Indeed, it is important that individuals completing a residential substance abuse program receive some type of step-down treatment to make the transition to the community more effective. However, Mohican’s therapeutic community did not have a structured aftercare component in place for the juveniles. Rather, the individual parole officers of the juveniles determined aftercare placement. Accordingly, some youth may have received aftercare and others may not have received this important treatment component.

Therefore, without being able to control for what happened to the youth once he left the institution, the study was unable to determine if aftercare participation resulted in a reduction in recidivism.

The Cox regression model also revealed three significant predictors of incarceration: age, race, and JASAE score. Younger individuals, nonwhites, and juveniles who had a more severe substance abuse problem were more likely to be incarcerated. The finding that juveniles with a more severe substance abuse problem

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were more likely to be incarcerated was not surprising given the link between substance abuse and criminal behavior (Andrews & Bonta, 1994; Beck et al., 1988; Elliott &

Huizinga, 1984; Newcomb & Bentler, 1988). Furthermore, other studies have found that age was a significant predictor of outcome with younger individuals being more likely to be arrested (Wexler et al., 1992; Wexler, DeLeon et al., 1999). Accordingly, these findings are consistent with previous research on the predictors of recidivism.

Model Predicting Incarceration for the Treatment Group Only. To determine if there was a differential impact of treatment for certain type of juveniles, survival analysis was computed. The results from the Cox regression model indicated that only one variable was a statistically significant predictor of incarceration–age. As previous research has found for adults, younger individuals were more likely to be incarcerated than older individuals (Wexler et al., 1992; Wexler, DeLeon et al., 1999).

Specifically, juveniles who were age 13, 14, or 15 years old were more likely to be incarcerated than juveniles who were older. One possible explanation for the finding of age and incarceration could be that older individuals benefited more from the therapeutic community than younger individuals. Specifically, the older juveniles were better able to process the encounter groups, which were a major foundation of the therapeutic community. For example, the older juveniles may have been able to internalize the encounters and actually commit to changing their behaviors whereas the younger juveniles were not mature enough to internalize the encounter process.

Another possible explanation for the finding may lie in the formal processing of juveniles. The older juveniles, ages 18 or 19, may be seen as being too old for the

Department of Youth Services to re-incarcerate them whereas they were seen as being

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too young for the Department of Rehabilitation and Corrections to incarcerate them for adult crimes. Thus, the finding that older youth were less likely to be incarcerated may be due to the bias in the processing of juveniles.

Policy Implications and Recommendations

Based on the findings from this dissertation, there are a few policy implications and recommendations that may be suggested. Even though the analysis found that participation in treatment did not significantly reduce the probability of being incarcerated, the therapeutic community should continue to operate after the following recommendations are implemented.41 First, the Department of Youth Services may want to incorporate age restrictions for juveniles being placed in a therapeutic community.

The study found that younger juveniles who participated in the program were significantly more likely to be incarcerated following termination. Accordingly, DYS and Mohican may want to consider implementing exclusionary criteria for youth ages 15 and younger to prevent these juveniles from entering a therapeutic community as participation in the therapeutic community made them worse.

Another policy recommendation would be to have the Department of Youth

Services require that Mohican Youth Center incorporate standardized assessments of responsivity measures especially a measure of psychopathy. As Hare (1999) found, psychopaths who participated in a therapeutic community were more likely to recidivate.

Given that the juveniles are responsible for operating the community, a psychopath has the potential to severely disrupt the community, which will decrease the effectiveness of the program in reducing recidivism for all juveniles. Therefore, Mohican should

41 Since the concept of the therapeutic community is based on a sound theoretical model (social learning) and previous studies have found therapeutic communities to be effective in reducing recidivism, Mohican Youth Center should continue to operate as a therapeutic community until further research is conducted.

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implement an assessment instrument to measure psychopathy and develop exclusionary criteria that would prevent psychopaths from entering the program.

The second recommendation would be to remove the encounter groups. While

DeLeon (2000) argues that the encounter groups provide an environment of motivation for individuals to change, the groups are often times brutal sessions with much yelling.

While adults may be able to process the confrontations, it may be that the juveniles are not mature enough to adequately conduct an encounter group. For example, youth may see the sessions as a personal attack instead of a vehicle for promoting change.

Furthermore, some of the therapeutic techniques that are used within the encounter groups (such as using similes, extremes, and opposites of the behavior being confronted) may be too abstract and therefore, the juveniles may not have the cognitive ability to comprehend the interventions. For these reasons, Mohican’s therapeutic community may want to replace the encounter groups with interventions that are less confrontive and less abstract.

A third policy recommendation for Mohican Youth Center would be to increase the use of behavioral rehearsal techniques. With the amount of time that is spent at

Mohican, the staff have plenty of opportunity to assist the juveniles in identifying their triggers for relapse and criminal behavior. The staff should take the next steps in promoting change by providing many opportunities for youth to role-play alternative prosocial responses to the triggers. By having the juveniles practice these situations, they will be better equipped to handle potential high-risk situations once they are released from the program, thereby reducing their chances of recidivism. Accordingly, Mohican

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should require that staff implement rehearsal opportunities throughout the treatment groups.

The next policy recommendation for the therapeutic community concerns the use of behavioral reinforcements. At the time of the evaluation, Mohican Youth Center used some ineffective punishment techniques. For example, juveniles were required to perform skits, sing songs, and wear signs as learning experiences when they received a written pull-up. Research has shown that these techniques are not effective in promoting behavioral change and may actually serve to increase antisocial tendencies (Spiegler &

Guevremont, 1993). Accordingly, Mohican should discontinue the use of these techniques and focus more on removing levels and privileges of the juveniles.

Furthermore, in addition to using appropriate punishers, the therapeutic community should implement a variety of rewards. Accordingly, instead of staff members and community members trying to catch the juvenile being “bad,” they should try and catch the juvenile being prosocial and reward him for his behavior/attitude. Using rewards is important for two reasons. First, they inform the individual of what to expect from similar behavior in the future. Second, the use of rewards increases the probability that the behavior will be repeated in the future. Accordingly, the therapeutic community should implement policy that explicitly spells out the types of punishments and rewards that will be used for behavior.

The last policy recommendation for the therapeutic community at Mohican Youth

Center concerns the termination and aftercare components of the facility. First, Mohican should develop completion criteria that require juveniles to show some type of behavioral

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and attitudinal change before they successfully complete treatment.42 For example,

Mohican may want to implement certain assessment instruments to gauge change. One promising instrument is the In-Program Behavioral Assessment Instrument that can measure behavioral in an institutional setting. The program may require that juveniles either obtain a certain score on that instrument or show positive improvement on the measures in order to successfully complete treatment.

Second, the facility should implement an aftercare component. Research has shown that aftercare is an important component of therapeutic communities (Butzin et al.,

2002; Hiller et al., 1999a; Inciardi et al., 2004; Knight et al., 1999; Martin et al., 1999;

Wexler, DeLeon et al., 1999; Wexler, Melnick et al., 1999). At the time of the CPAI assessment, Mohican did not have a structured aftercare component. Considering that juveniles from all over the state attend Mohican, it may that the Department of Youth

Services has to develop a system to make sure that the juveniles receive high quality aftercare services from programs in their hometown that address their needs.

Furthermore, the introduction of these aftercare services should begin while the youth is finishing the services at Mohican so that there is a smooth continuance from residential treatment to community treatment.

Suggestions for Future Research

While there have been many studies that have examined the effectiveness of therapeutic communities in reducing recidivism for adults, few research has been conducted on juvenile offenders and their success with therapeutic communities. The

42 The Department of Youth Services should also meet with judges to stress the importance of the acquisition of skills in order to successfully complete treatment. This process may result in fewer judges using Mohican as a “shock” value and removing the juveniles before he has successfully completed treatment.

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findings from this dissertation show that participation in a therapeutic community did not significantly reduce the probability of incarceration when compared to individuals who did not receive treatment. However, due to the lack of adherence to some of the principles of effective interventions, these finding should be viewed with caution when deciding if the therapeutic community for juvenile males was effective. Specifically, more research on the effectiveness of therapeutic communities, which adhere to the risk, need, responsivity, and treatment principles for juveniles, is needed before one may declare whether this treatment intervention “works” for juvenile offenders. Furthermore, additional research should be pursued to determine what types of juveniles respond best to the therapeutic community intervention. The sample for the current study was juvenile males. It may be that therapeutic communities are more effective juvenile females.

Accordingly, research should be undertaken to determine if there is a differential impact of effectiveness for certain types of juvenile offenders.

A second area for future study concerns the exploration of the “black box” of the therapeutic community. Studies should be conducted which examine the treatment components of a therapeutic community that either work or don’t work for juvenile offenders. For example, the encounter groups are considered to be a staple of a therapeutic community. However, research has yet to explore whether this specific therapeutic intervention is effect in changing behavior. Furthermore, the hierarchical structure found within the therapeutic community is assumed to increase self-esteem and therefore assist in behavioral change. Again, this component has not been evaluated to determine if the hierarchical structure actually promotes attitudinal and behavioral

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change. Therefore, studies should be developed which allow researchers to examine the effectiveness of specific components of a therapeutic community.

In conclusion, this study may provide a framework for additional research into the effectiveness of therapeutic communities for juvenile offenders. Hopefully, future research will begin to explore therapeutic communities in relation with the principles of effective intervention to determine which components actually support change in the juveniles thereby increasing the knowledge base in the area of rehabilitation for juvenile offenders.

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REFERENCES

Abadinsky, H. (2001). Drug abuse treatment. In H. Abadinsky (Ed.), Drugs: An Introduction (4th), (pp. 189-227) Belmont, CA: Wadsworth Thomas Learning.

ADE Incorporated. (1997). Juvenile Automated Substance Abuse Evaluation Reference Guide. Clarkston, MI: Author.

American Psychiatric Association (1987). Diagnostic & Statistical Manual of Mental Disorders. (3rd ed. Revised) Washington, DC: Author.

Andrews, D.A. & J. Bonta (1994). The Psychology of Criminal Conduct. Cincinnati, OH: Anderson.

Andrews, D.A., J. Bonta, & R.D. Hoge (1990). Classification for effective rehabilitation: rediscovering psychology. Criminal Justice and Behavior, 17:19-52.

Andrews, D.A., I. Zinger, R.D. Hoge, J. Bonta, P. Gendreau, & F.T. Cullen (1990). Does correctional treatment work? A clinically relevant and psychologically informed meta- analysis. Criminology, 8: 369-404.

Antonwicz, D.H. & R.R. Ross (1994). Essential components of successful rehabilitation programs for offenders. International Journal of Offender Therapy and Comparative Criminology, 38(2): 97-104.

Applegate, B.K., F.T., Cullen, & B.S. Fisher (1997). Public support for correctional treatment: The continuing appeal of the rehabilitative ideal. The Prison Journal, 77(3): 237-258.

Applegate, B.K., F.T. Cullen, M.G. Turner, & J.L. Sundt (1996). Assessing public support for three-strikes-and-you’re-out laws: Global versus specific attitudes. Crime and Delinquency, 42:517-34.

Barriga, A. Q., Gibbs, J. C., Potter, G., & Liau, A. K. (1999) How I Think Questionnaire.

Beck, A.J., S.A. Kline, & L.A. Greenfield (1988). Survey of youth in custody, 1987. Bureau of Justice Statistics Special Report. Washington DC: U.S. Department of Justice.

Bohm, R. M. (1991). American death penalty opinion, 1936-1986: A critical examination of the Gallup polls. In R. M. Bohm (Ed.), The Death Penalty in America: Current Research, (pp. 113-145). Cincinnati, OH: Anderson.

Bohm, R. M., T.J. Flanagan & P.W. Harris (1990). Current death penalty opinion in New York State. Albany Law Review, 54, 819-843.

182

Bowers, W. (1993). Capital punishment and contemporary values: People’s misgivings and the court’s misperceptions. Law & Society Review, 27, 157-175.

Britt, C. L. (1998). Race, religion, and support for the death penalty: A research note. Justice Quarterly, 15, 175-191.

Broekaert, E., M. Kooyman, & D.J. Ottenberg (1998). The “new” drug-free therapeutic community: Challenging encounter of classic and open therapeutic communities. Journal of Substance Abuse Treatment, 15(6): 595-597.

Brook, R.C. & P.C. Whitehead (1980). Drug Free Therapeutic Community: An Evaluation. (pp. 19-49) New York: Human Sciences Press.

Butzin, C.A., S.S. Martin, & J.A. Inciardi (2002). Evaluating component effects of prison-based treatment continuum. Journal of Substance Abuse Treatment, 22:63-69.

Catalano, R.F., E.A. Wells, J.M. Jenson, & J.D. Hawkins (1989). Aftercare services for drug-using institutionalized delinquents. Social Service Review 63: 553-77.

Clear, T.R. (1994). Harm in American Penology: Offenders, Victims, and Their Communities. Albany: State University of New York Press.

Condelli, W.S., & G.H. Dunteman (1996). Issues to consider when predicting retention in therapeutic communities. Journal of Psychoactive Drugs, 25: 239-244.

Crowe, A.H. (1998). Drug Identification and Testing in the Juvenile Justice System. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.

Cullen, E. (1997). Can a prison be a therapeutic community? The Grendon template. In E. Cullen, L. Jones, & R. Woodward (eds.) Therapeutic Communities for Offenders. (pp. 3–22). New York: John Wiley & Sons, Ltd.

Cullen, F.T. (2002). Rehabilitation and treatment programs. In J.Q. Wilson & J. Petersilia (eds.), Crime and Public Policy, 2nd Ed. (pp. 253-289). San Francisco, CA: ICS Press.

Cullen, F.T., & K. E. Gilbert (1982). Reaffirming Rehabilitation. Cincinnati, OH: Anderson.

Cullen, F.T., B.S. Fisher, & B.K. Applegate (2000). Public opinion about punishment and corrections. In M. Tonry (ed.) Crime and Justice: A Review of Research, vol. 27. Chicago: University of Chicago Press.

Cullen, F.T., J.A. Pealer, B.S. Fisher, B.K. Applegate, & S.A. Santana (2002). Public support for correctional rehabilitation in America: Change or consistency? In J.V. Roberts and M. Hough (eds.) Changing Attitudes to Punishment: Public Opinion, Crime, and Justice. (pp. 128-147). Cullompton, UK: Willan Publishing.

183

Cullen, F.T., S.E. Skovron, J.E. Scott, and V.S. Burton, Jr. (1990). Public support for correctional treatment: The tenacity of rehabilitative ideology. Criminal Justice and Behavior, 17: 6-18.

Cullen, F.T., J.P. Wright, S. Brown, M.M. Moon, M.B. Blankenship, & B.K. Applegate (1998). Public support for early intervention programs: Implications for a progressive policy agenda. Crime and Delinquency, 44: 187-204.

DeLeon, G. (1986). The therapeutic community for substance abuse: Perspective and approach. In G. DeLeon & J.T. Ziegenfuss (eds.) Therapeutic Communities For Addictions: Readings in Theory, Research, and Practice. Springfield, IL: Charles C. Thomas Publishing.

DeLeon, G. (1990). Effectiveness of therapeutic communities. In J.J. Platt, C.D. Kaplin, & P.J. McKim (eds.) The Effectiveness of Drug Abuse Treatment: Dutch and American Perspectives. (pp. 113-126). Malabar, FL: Robert E. Krieger Publishing.

DeLeon, G. (1999). Therapeutic communities. In P.J. Ott, R.E. Tarter, & R.T. Ammerman (eds.) Sourcebook on Substance Abuse: Etiology, Epidemiology, Assessment, and Treatment. (pp. 321-336). Boston, MA: Allyn & Bacon.

DeLeon, G. (2000). The Therapeutic Community: Theory, Model, and Methods. New York: Springer.

DeLeon, G. & S. Schwartz (1984). The therapeutic community: What are the retention rates? American Journal of Drug and Alcohol Abuse, 10: 267-284.

DeLeon, G. & J.T. Ziegenfuss (1986). Therapeutic Communities for Addictions: Readings in Theory, Research, and Practice. Springfield: Charles C. Thomas.

Dowden, C. & D.A. Andrews (1999). What works in young offender treatment: A meta- analysis. Forum on Corrections Research, 11: 21-24.

Durham, A. M., Elrod, H. P., & P.T. Kinkade (1996). Public support for the death penalty: Beyond Gallup. Justice Quarterly, 13: 706-735.

Elliott, D.S. & D. Huizinga (1984). The Relationship Between Delinquent Behavior and ADM Problems. Boulder, CO: Behavioral Research Institute.

Ellsworth, P. C., & L. Ross (1983). Public opinion and capital punishment: A close examination of the views of abolitionists and retentionists. Crime & Delinquency, 29: 116-169.

Empey, L. T., & M.C. Stafford (1991). American Delinquency. (3rd ed.). (pp.16-69). California: Wadsworth.

184

Farrell, A. (2000). Women, crime, and drugs: Testing the effects of therapeutic communities. Women & Criminal Justice, 11: 21-48.

Faupel, C. E. (1981). Drug treatment and criminality: Methodological and theoretical considerations. In J. A. Inciardi (Ed.), The Drugs Crime Connection (pp. 183-206). Beverly Hills: Sage.

Field, G. (1984). The Cornerstone program: A client outcome study. Federal Probation, 48: 50-55.

Feld, B. C. (1990). The punitive juvenile court and the quality of procedural justice: Disjunctions between rhetoric and reality. Crime & Delinquency, 36: 443-466.

Feld, B.C. (1997). Abolish the juvenile court: Youthfulness, criminal responsibility, and sentencing policy. The Journal of Criminal Law and Criminology, 88: 134-145.

Flanagan, T. J. (1996). Public opinion on crime and justice: History, development, and trends. In T. J. Flanagan & D. R. Longmire (eds.), Americans View Crime and Justice: A National Public Opinion Survey (pp.1-15). Newbury Park, CA: Sage.

Garrett, C.J. (1985). Effects of residential treatment on adjudicated delinquents: A meta- analysis. Journal of Research in Crime & Delinquency, 22: 287-308.

Gendreau, P. & D.A. Andrews (1992). Correctional Program Assessment Inventory (CPAI). Saint John, NB: University of New Brunswick.

Gendreau, P. (1996) “The principles of effective intervention with offenders.” In A.T. Harland (ed.) Choosing Correctional Options That Work: Defining the Demand and Evaluating the Supply. (pp. 117-130). Thousand Oaks, CA: Sage.

Gendreau, P., F.T Cullen, & J. Bonta (1994). Intensive rehabilitation supervision: The next generation in community corrections? Federal Probation, 58:72-78.

Gendreau, P., C. Goggin, & M. Paparozzi (1996). Principles of effective assessment for community corrections. Federal Probation, 60: 18-24.

Gendreau, P. & C. Goggin (1996). Correctional treatment: Accomplishments and realities. In P. Van Voorhis, M. Braswell, M., & D. Lester (eds.) Correctional Counseling and Rehabilitation, 3rd Ed., Cincinnati: Anderson, pp. 271-280.

Gendreau, P., T. Little, & C. Goggin (1996). A meta-analysis of the predictors of adult offender recidivism: What works?” Criminology, 34: 575- 607.

185

Gottschalk, R., W.S. Davidson, J.P. Mayer, & L.K. Gensheimer (1987). Behavioral approaches with juvenile offenders: A meta-analysis of long-term treatment efficacy. In E.K. Morris & C.J. Braukmann, (eds.). Behavioral Approaches to Crime and Delinquency. (pp. 399-422). New York: Plenum.

Grasmick, H. G., Cochran, J. K., Bursik, R. J., & M. Kimpel. (1993). Religion, punitive justice, and support for the death penalty. Justice Quarterly, 10: 289-313.

Hare, R.D. (1999). Psychopathy as a risk factor for violence. Psychiatric Quarterly, 70: 181-197.

Hare, R.D. (1996). Psychopathy: A clinical construct whose time has come. Criminal Justice and Behavior, 23: 25-54.

Harms, P. (2003). Detention in Delinquency Cases, 1990-1999. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.

Harris, L. (1968). Changing public attitudes toward crime and corrections. Federal Probation 32: 9-16.

Harrison, L.D. & S.S. Martin (2003). Residential Substance Abuse Treatment for State Prisoners: Implementation Lessons Learned. Washington, DC: Office of Justice Programs.

Hawkins, J.D., J.M. Jenson, R.F. Catalano, & D.M. Lishner (1988). Delinquency and drug abuse: Implications for social services.” Social Service Review 62: 258-84.

Hiller, M.L., K. Knight, & D.D. Simpson (1999a). Prison-based substance abuse treatment, residential aftercare and recidivism: Research report. Addiction, 94: 833-842.

Hiller, M.L., K. Knight, & D.D. Simpson (1999b). Risk factors that predict dropout from corrections-based treatment for drug abuse. The Prison Journal, 79: 411-430.

Hinshelwood, R.D. (1999). Psychoanalytic origins and today’s work: The Cassel heritage. In P. Campling & R. Haigh (eds.) Therapeutic Communities: Past, Present, and Future. (pp. 39-49). Philadelphia, PA: Jessica Kingsley Publishers.

Hoge, R. & D.A. Andrews (2003). Youthful Level of Service/Case Management Inventory-Revised. Tonawanda, NY: Multi-Health Systems.

Holsinger, A. (1999). Opening the ‘Black Box’: Assessing the Relationship Between Program Integrity and Recidivism. [Unpublished Dissertation] Ann Arbor, MI: UMI.

186

Inciardi, J.A., S.S. Martin, & C.A. Butzin (2004). Five-year outcomes for therapeutic community treatment of drug involved offenders after release from prison. Crime & Delinquency, 50: 88-107.

Inciardi, J.A., S.S. Martin, C.A. Butzin, R.M. Hooper, & L.D. Harrison (1997). An effective model of prison-based treatment for drug-involved offenders. Journal of Drug Issues 27: 261-278.

Jones, P. (1996). Risk Prediction in Criminal Justice. In A.T. Harland (Ed.) Choosing Correctional Options That Work: Defining the Demand and Evaluating the Supply. Thousand Oaks, CA: SAGE Publication.

Kahn, A. J. (1953). A Court for the Children: A Study of the New York City Children’s Court. (pp. 16-30). New York: Columbia University Press.

Kooyman, M. (2001). The history of therapeutic communities: A view from Europe. In B. Rawlings & R. Yates (Eds.) Therapeutic Communities for Treatment of Drug Users, (pp. 59-78). Philadelphia, PA: Jessica Kingsley Publishers.

Kownacki, R.J. & W. R. Shadish (1999). Does Alcoholics Anonymous work? The results from a meta-analysis of controlled experiments. Substance Use & Misuse, 34: 1897-1916.

Knight, K., D. Simpson, L.R. Chatham, & L.M. Camacho. (1997). An assessment of prison-based drug treatment: Texas’ in-prison therapeutic community program. Journal of Offender Rehabilitation, 24: 75-100.

Knight, K., D. Simpson, & M.L. Hiller (1999). Three-year reincarceration outcomes for in-prison therapeutic community treatment. The Prison Journal 79: 337-351.

Latessa, E. J. & A. Holsinger (1998). The importance of evaluating correctional programs: Assessing outcome and quality. Corrections Management Quarterly, 2: 22-29.

Lester, D., M. Braswell, & P. Van Voorhis (2000). Radical Behavioral Interventions. In P. Van Voorhis, M. Braswell, M., & D. Lester (Eds.) Correctional Counseling and Rehabilitation, 4th Edition, Cincinnati: Anderson, pp. 129-148.

Lillyquist, M.J. (1980). Understanding and Changing Criminal Behavior. Englewood Cliffs, NJ: Prentice-Hall.

Lipsey, M.W. (1995). The Effectiveness of Treatment for Drug Abusers Under Criminal Justice Supervision. Washington, DC: US Department of Justice.

Lipsey, M.W. (1999). Can intervention rehabilitate serious delinquents? Annals, 564: 142-166.

187

Lipsey, M.W. (1992). Juvenile delinquency treatment: A meta-analytic inquiry into the variability of effects. In T.D Cook, H. Cooper, D.S. Corday, H. Hartmann, L.V. Hedges, R.J. Light, T.A. Lewis, & F. Mosteller (eds.) Meta-Analysis for Explanation: A Casebook, (pp. 83-127), New York: Russell Sage.

Lipsey, M.W. & D.B. Wilson (1998). Effective intervention for serious juvenile offenders: A synthesis of research. In R. Loeber & D.P. Farrington (eds.) Serious and Violent Juvenile Offenders: Risk Factors and Successful Interventions (pp. 313-366). Thousand Oaks: Sage Publications.

Lipton, D.S. (1998). Therapeutic communities: History, effectiveness, and prospects. Corrections Today, 60: 106-110.

Lou, H. H. (1972). Juvenile Courts in the United States. (pp. 13-31), New York: Arno Press.

Lowenkamp, C.T (2004). Correctional Program Integrity and Treatment Effectiveness: A Multi-site, Program-Level Analysis. [Unpublished Dissertation] Ann Arbor, MI: UMI.

Lowenkamp, C.T & E.J. Latessa (2002). Evaluation of Ohio’s Community Based Correctional Facilities and Halfway House Programs. [Unpublished report].

Manning, N. (1989). The Therapeutic Community Movement: Charisma and Routinization. New York: Routledge.

Martin, S.S., C.A. Butzin, C.A. Saum, & J.A. Inciardi (1999). Three-year outcomes of therapeutic community treatment for drug-involved offenders in Delaware: From prison to work release to aftercare. The Prison Journal, 79: 294-320.

Martinson, R. (1974). What works? Questions and answers about prison reform. Public Interest, Spring, 22-54.

Mennel, R. M. (1973). Thorns & Thistles: Juvenile Delinquents in the United States 1825-1940. (pp. 124-157). Hanover, NJ: The University Press of New England.

Messina, N., S. Nemes, E. Wish, & B. Wraight (2001). Opening the black box: The impact of inpatient treatment services on client outcomes. Journal of Substance Abuse Treatment, 20: 177-183.

Moon, M.M., B.K. Applegate, & E.J. Latessa (1997). RECLAIM Ohio: A politically viable alternative to treating youthful felony offenders. Crime and Delinquency, 43: 438- 456.

Moon, M.M. & E.J. Latessa (1994). Drug treatment in adult probation: An evaluation of an outpatient and acupuncture program. Evaluation & Program Planning, 17: 217-226.

188

Moon, M.M., J.L. Sundt, F.T. Cullen, & J.P. Wright (2000). Is child saving dead? Public support for juvenile rehabilitation. Crime and Delinquency, 46: 38-60.

Nagin, D.S. & D.P. Farrington (1992). The stability of criminal potential from childhood to adulthood. Criminology 30: 235-260.

National Institute of Justice. (1998). 1997 Drug Use Forecasting Annual Report on Adult and Juvenile Arrestees. Washington, DC: Author, U.S. Department of Justice.

Newcomb, M.D. & P.M. Bentler (1988). Consequences of Adolescent Drug Use. Newbury Park, CA: SAGE.

Nielson, A.L., & F.R. Scarpitti (1997). Changing the behavior of substance abusers: Factors influencing the effectiveness of therapeutic communities. Journal of Drug Issues 27: 279-298.

Nielson, A.L., & F.R. Scarpitti (2002). Predicting retention in a therapeutic community for incarcerated substance abusers. Journal of Offender Rehabilitation, 34: 47-65.

Office of Juvenile Justice and Delinquency Prevention (1998). Juvenile Court Statistics. Washington, DC: Author, U.S. Department of Justice.

Office of Juvenile Justice and Delinquency Prevention. (1999). Juvenile Justice: A Century of Change. Washington, D.C.: U.S. Department of Justice.

Office of National Drug Control Policy (2001). Drug Treatment in the Criminal Justice System. Washington, DC: Author, Drug Policy Information Clearinghouse.

Pan, J., F.R. Scarpitti, J.A. Inciardi, & D. Lockwood (1993). Some considerations on therapeutic communities in corrections. In J.A. Inciardi (ed.), Drug Treatment and Criminal Justice. Newbury Park, CA: SAGE.

Pealer, J.A., E.J. Latessa, & M. Winesburg (2002a). Final Report: Mohican Youth Center RSAT Outcome. [Unpublished Report].

Pealer, J.A., E.J. Latessa, & M. Winesburg (2002b). Final Report: MonDay Community Correctional Institution RSAT Outcome. [Unpublished Report].

Pearson, F.S. & D.S. Lipton (1999). A meta-analytic review of the effectiveness of corrections-based treatments for drug abuse. The Prison Journal, 79: 384-410.

Platt, A. M. (1969). The Child Savers: The Invention of Delinquency. (2nd ed.), Chicago, IL: The University of Chicago Press.

Resident Handbook (2001). Mohican Therapeutic Community Resident Handbook.

189

Roberts, J. (1997). History of the therapeutic community. In E. Cullen, L. Jones, & R. Woodward (eds.) Therapeutic Communities for Offenders. (pp. 3 – 22). New York: John Wiley & Sons, Ltd.

Rothman, D. J. (1980). Conscience and Convenience: The Asylum and Its Alternatives in Progressive America. Boston, MA: Little, Brown, and Company. Ryerson, E. (1978). The Best Laid Plans: America’s Juvenile Court Experiment. New York, NY: Hill & Wang.

Sandhu, T.S. (1981). The effectiveness of community-based correctional programs. In S. Sandhu (ed.) Community Corrections: New Horizons. (pp. 296-351). Springfield: Banner House.

Sandys, M., & E.F. McGarrell (1994). Attitudes toward capital punishment among Indiana legislators: Diminished support in light of alternative sentencing options. Justice Quarterly, 11: 651-677.

Sandys, M., & E.F. McGarrell (1995). Attitudes toward capital punishment: Preference for the penalty or mere acceptance. Journal of Research in Crime and Delinquency, 32: 191-213.

Sealock, M.D., D.C. Gottfredson, & C.A. Gallagher (1997). Drug treatment for juvenile offenders: Some good and bad news. Journal of Research in Crime and Delinquency, 34: 210-236.

Shaffer, D.K. & S. Johnson (2001). Correctional Program Assessment Inventory Report Conducted on Mohican Youth Center. [Unpublished Report].

Siegel, H.A., J. Wang, R. G. Carlson, R. S. Falck, A.M. Rahman, & R. L. Fine (1999). Ohio’s prison-based therapeutic community treatment programs for substance abusers: Preliminary analysis of re-arrest data. Journal of Offender Rehabilitation, 28: 33-48.

Simourd, L. & D. Andrews (1994). Correlates of delinquency: A look at gender differences. Forum on Corrections Research, 6: 26-31.

Simpson, D.D., & K. Knight (1998). TCU Data Collection Forms for Correctional Residential Treatment. Fort Worth: Texas Christian University, Institute of Behavioral Research [On-line]. Available: www.ibr.tcu.edu

Snyder, H. (2000). Juvenile Arrests 1999. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.

Snyder, H. (2001). Juvenile Arrests 2001 [Forthcoming]. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.

190

Sorrentino, J. (1996, June 11). A felony’s a felony, whether you’re a kid or adult. USA Today. Retrieved June, 1999 from the World Wide Web: www.ncpa.org/hotlines/juvcrm/sol3a.html#3b

Spiegler, M., & D. Guevremont. (1993). Contemporary Behavior Therapy. Pacific Grove: Brooks Cole.

Springer, D.W., C.A. McNeece, & E.M. Arnold (2003). Substance Abuse Treatment for Criminal Offenders: An Evidence-Based Guide for Practitioners. Washington, DC: American Psychological Association.

Stahl, A.L. (2003). Delinquency Cases in Juvenile Courts, 1999. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.

Stattin, H. & D. Magnusson (1989). The role of early aggressive behavior in frequency, seriousness, and types of later crime. Journal of Consulting and Clinical Psychology, 57: 710-718.

Sundt, J.L., F.T. Cullen, B.K. Applegate, & M.G. Turner (1998). The tenacity of the rehabilitative ideal revisited: Have attitudes toward offender treatment changed? Criminal Justice and Behavior, 25: 426-442.

Taxman, F.S. (1999). Unraveling what works for offenders in substance abuse treatment services. National Drug Court Institute Review, 2: 91-132.

Taxman, F.S. & J.A. Bouffard (2002). Assessing therapeutic integrity in modified therapeutic communities for drug-involved offenders. The Prison Journal, 82:189-212.

Van Voorhis, P. (2000). Social learning models. In P. Van Voorhis, M. Braswell, M., & D. Lester (eds.) Correctional Counseling and Rehabilitation, 4th Edition, Cincinnati: Anderson, pp. 149-166.

Van Voorhis, P. & G. Hurst (2000). Treating substance abuse in offender populations. In P. Van Voorhis, M. Braswell, M., & D. Lester (eds.) Correctional Counseling and Rehabilitation, 4th Edition, Cincinnati: Anderson, pp. 265-288.

Wanberg, K.W. (1992). A User’s Guide for the Adolescent Self-Assessment Profile. Arvada, CO: Center for Addictions Research and Evaluation.

Wexler, H.K. (1995). The success of therapeutic communities of substance abusers in American prisons. Journal of Psychoactive Drugs 27: 57-66.

Wexler, H.K. (1997). Therapeutic communities in American prisons. In E. Cullen, L. Jones, & R. Woodward (eds.) Therapeutic Communities for Offenders. New York: John Wiley & Sons. (pp. 161-179).

191

Wexler, H.K., D. DeLeon, G. Thomas, D. Kressel, & J. Peters (1999). The Amity prison TC evaluation: Reincarceration outcomes. Criminal Justice and Behavior 26: 147-167.

Wexler, H.K., G.P. Falkin, D.S. Lipton, & A.B. Rosenblum (1992). Outcome evaluation of a prison therapeutic community for substance abuse treatment. In C.G. Leukefeld & F.M. Tims (Eds) Drug Abuse Treatment in Prison and Jails. National Institute on Drug Abuse Research Monograph Series. Rockville, MD: U.S. Department of Health and Human Services.

Wexler, H.K., G. Melnick, L. Lowe, & J. Peters (1999). Three-tear reincarceration outcomes for Amity in-prison therapeutic community and aftercare in California. The Prison Journal, 79: 321-336.

Whitehead, J.T. & S.P. Lab (1989). A meta-analysis of juvenile correctional treatment. Journal of Research in Crime and Delinquency, 26: 276-295.

Whitehead, J.T. & S.P. Lab (1996). The history of juvenile justice. In J.T. Whitehead & S.P. Lab (eds.) Juvenile Justice: An Introduction. Cincinnati, OH: Anderson. (pp. 37-54).

Winesburg, M., E.J. Latessa, & J.A. Pealer (2002). Final Report: Noble Choices RSAT Outcome. [Unpublished Report].

Yochelson, S. & S.E. Samenow (1976). The Criminal Personality: A Profile for Change. New York, NY: Jason Aronson.

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APPENDIX A

DATA COLLECTION INSTRUMENTS

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OHIO’S RESIDENTIAL SUBSTANCE ABUSE TREATMENT PROGRAMS Standardized Intake Form

1) ______Name of individual completing form

2) _____ Program code 2= Mohican Youth Center 3=Monday Community Correctional Center 4=Noble Correctional Center

IDENTIFYING INFORMATION

3) ______Case #

4) ______Name Last First Middle Initial

5) ______SSN

6) _____/_____/_____ Date of birth

OFFENDER CHARACTERISTICS

7) _____ Race: 1=White 2=Black 3=Hispanic 4= Native American 5=Asian 6=Other

8) _____ Sex: 1=male 2=female

9) _____ Marital status: 1=married 2=not married

10) _____ Number of dependents (under 18 years of age)

11) _____ Highest grade completed: 1-12=grades 1-12; 13=some college; 14=Bachelors or higher

_____ If completed less than 12 grades, did the offender earn a GED? 1=yes; 2=no

12) _____ Employment status prior to arrest

1=employed fulltime (35 hours or more/week) 2=employed part-time (less than 35 hours/week) 3=unemployed

CURRENT OFFENSE

13) ______Most serious charge (enter name of charge – e.g., CCW, burglary)

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14) _____ Level of conviction offense: 1=F1 2=F2 3=F3 4=F4 5=F5 6=M1 7=M2 8=M3 9=M4

15) _____/_____/_____ Date screened for RSAT

16) _____/_____/_____ Date placed in RSAT program

CRIMINAL HISTORY

17) _____/_____/_____ Date of first arrest

_____ If exact date is unknown, please indicate age of first arrest

18) Number of prior arrests (adult and juvenile) _____ Felony _____ Misdemeanor

19) Number of prior convictions (adult and juvenile) _____ Felony _____ Misdemeanor

20) _____ Has the offender ever been arrested on a drug charge? 1=yes 2=no

21) _____ Number of prior sentences to a secure facility

22) _____ Number of prior sentences to community supervision

23) _____ Number of unsuccessful terminations from community supervision

SUBSTANCE ABUSE HISTORY

24) _____ First drug of choice

1=heroin 7=LSD 2=non-crack cocaine 8=PCP 3=crack 9=inhalants 4=amphetamines 10=over the counter 5=barbiturates/tranquilizers 11=alcohol 6=marijuana 12=other: (specify) ______

25) _____ Second drug of choice

26) _____ Age of first alcohol use

27) _____ Age of first drug use

28) _____ Do any immediate family members have a substance abuse problem? 1=yes 2=no

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29) _____ Has the offender received previous drug/alcohol treatment? 1=yes 2=no

If yes, indicate the number of times the offender has experienced each of the following types of treatment:

_____ Detoxification _____ Methadone maintenance _____ Outpatient _____ Short-term inpatient (30 days or less) _____ Residential

30) _____ Has the offender been dual diagnosed with mental illness and substance abuse? 1=yes 2=no

Please attach the following completed instruments OR a summary of results/scores:

Noble – PII

MonDay – LSI and ASUS

196

OHIO’S RESIDENTIAL SUBSTANCE ABUSE TREATMENT PROGRAMS Standardized Termination Form

Please indicate the circumstances surrounding the client’s discharge from the program including the date of discharge, type of discharge, and plan for aftercare.

1) Client name: ______

2) SSN: ______

3) Program code: ______2=Mohican 3=MonDay 4=Noble

4) Date of discharge: _____/_____/_____

5) Type of discharge: _____ 1=successful completion (achieved treatment goals) 2=successful completion (completed time but not goals) 3=unsuccessful termination 4=voluntary withdrawal 5=escape/abscond 6=unable to participate due to reclassification, medical, out to court 7=other (specify): ______

6) Living arrangements upon discharge: _____ 1=with family/relatives 5=halfway house 2=with friends 6=foster care 3=by him/herself in apartment/house 7= other (specify): ______4=group home

7) Has continued drug/alcohol treatment been arranged for the client? ____ 1=yes 2=no

8) Criminal justice placement: _____ 1=probation supervision 4=prison 2=parole supervision 5=DYS institution 3=jail 6= other (specify): ______

9) To facilitate the collection of follow-up data, please provide the following information on the agency responsible for the offender’s supervision/custody upon discharge from RSAT.

Agency (probation, parole, institution) ______

Probation/Parole officer’s name: ______

Address: ______

City, State, Zip: ______

Phone number: ______

10) Please provide reassessment information by attaching the following items OR a summary of results/scores.

MonDay – LSI reassessment Noble – PII reassessment

197

APPENDIX B

TABLES

198

Table B1: Items for the Client Self-Rating Scales Scale Information and Individual Items Anxiety – the following are summed together to achieve the anxiety scale score. The higher the score, the higher the individual’s level of anxiety. Participation in treatment should decrease the level of anxiety. You have trouble sitting still for long. You have trouble sleeping. You feel nervous. You have trouble concentrating or remembering things. You feel afraid of certain things, like crowds or going out alone. You feel tensed or keyed-up. You feel tightness or tension in your muscle.

Depression – the following are summed together to achieve the depression scale. The higher the score, the higher the level of depression. Participation in treatment should decrease the level of depression. You feel sad or depressed. You have thoughts of committing suicide. You feel lonely. You feel interested in life. ( r) You feel extra tired or run down. You worry or brood a lot.

Self-esteem – the following are summed together to achieve the self-esteem scale. The higher the score, the higher the level of self-esteem. Participation in treatment should increase the level of self-esteem. You have much to be proud of. In general, you are satisfied with yourself. You feel like a failure. (r ) You feel you are basically no good. ( r) You wish you had more respect for yourself. (r ) You feel you are unimportant to others. ( r)

Decision-making – the following items are summed together to achieve the decision- making scale. The higher the score, the higher the level of decision-making. Participation in treatment should increase the level decision-making. You consider how your actions will affect others. You plan ahead. You think about the possible results of your actions. You have trouble making decisions. ( r) You think of several different ways to solve a problem. You analyze problems by looking at all the choices. You make decisions without thinking about consequences. ( r) You make good decisions. You think about what causes your current problems.

199

Table B1: Items for the Client Self Rating Scales (continued) Scale Information and Individual Items Risk-taking – the following items are summed together to achieve the risk-taking scale. The higher the score, the higher the level of risk-taking. Participation in treatment should decrease the level of risk-taking behaviors. You like to take chances. You like the fast life. You like friends who are wild. You like to do things that are strange or exciting. You stay away from anything dangerous. ( r) You only do things that feel safe. ( r) You are always very careful. ( r)

Hostility – the following are summed together to achieve the hostility scale. The higher the score, the higher the level of hostility. Participation in treatment should decrease the level of hostility. You feel mistreated by other people. You like others to feel afraid of you. You sometimes want to fight or hurt others. You have a hot temper. Your temper gets you into fights or other trouble. You get mad at other people easily. You have carried weapons, like knives or guns. You feel a lot of anger inside you.

Self-efficacy – the following are summed together to achieve the self-efficacy scale. The higher the score, the higher the level of self-efficacy. Participation in treatment should increase the level of self-efficacy. You often feel helpless in dealing with the problems of life. ( r) There is really no way you can solve some of the problems you have. ( r) There is little you can do to change many of the important things in your life. ( r) Sometimes you feel that you are being pushed around in your life. ( r) You have little control over the things that happen to you. ( r) What happens to you in the future mostly depends on you. You can do just about anything you really set your mind to do.

Desire for Help – the following items are summed together to achieve the desire for help scale. The higher the score, the higher the desire for help. Participation in treatment should increase the desire for help. You need help in dealing with your drug use. It is urgent that you find help immediately for your drug use. Your life has gone out of control. You are tired of the problems caused by drugs. You will give up your friends and hangouts to solve your drug problems. You want to get your life straightened out. You can quit using drugs without any help. ( r)

200

Table B1: Items for the Client Self Rating Scales (continued) Scale Information and Individual Items Treatment Readiness – the following items are summed together to achieve the treatment readiness scale. The higher the score, the higher the level of treatment readiness. Participation in treatment should increase the level of treatment readiness. You want to be in a drug treatment program. This treatment program seems too demanding for you. ( r) You have too many outside responsibilities now to be in this treatment program. ( r) This treatment may be your last chance to solve your drug problems. This type of treatment program will not be very helpful to you. ( r) You are in this treatment program because someone else made you come. ( r) You plan to stay in this treatment program for a while. This treatment program can really help you.

201

Table B2: Reliabilities for the Client Self Rating for the Treatment Group Scale N Pre-test N Post-test

Anxiety 401 .7562 198 .7887

Depression 406 .7204 202 .7170

Self-esteem 402 .7028 198 .6692

Decision Making 398 .7431 198 .7204

Risk Taking 404 .7482 197 .7615

Hostility 398 .8062 197 .7391

Self-efficacy 400 .5987 197 .6349

Desire for Help 407 .7157 195 .6838

Treatment Readiness 399 .7003 200 .6545

202

Table B3: Reliabilities for How I Think for the Treatment Group Scale N Pre-test N Post-test

Anomalous response 396 .6730 209 .5971

Self-centered 388 .6893 205 .5803

Blaming others 397 .7634 209 .7320

Minimizing 393 .6087 207 .5936

Assuming the worst 393 .8327 207 .8071

Oppositional defiance 397 .7594 211 .6901

Physical aggression 394 .7266 208 .6347

Lying 390 .5784 205 .4677

Stealing 397 .7022 205 .6625

Overt 391 .8595 207 .8066

Covert 385 .7981 203 .7572

How I Think 377 .9114 201 .8835

How I Think (all) 377 .9563 201 .9425

203

Table B4: Youthful Level of Service/Case Management Inventory YLS/CMI Scale Mohican (N= 425) Comparison (N=447) Min. Max. Mean SD Min. Max. Mean SD Prior & Current Offenses, 0.00 5.00 3.16 1.18 0.00 5.00 3.00 1.26 Adjudications (range 0-5) t =1.905; p = .057

Family Circumstances & 0.00 6.00 3.52 1.35 0.00 6.00 3.29 1.39 Parenting (range 0-6) t =2.437; p = .015

Employment/Education 0.00 7.00 3.67 1.85 0.00 7.00 3.73 1.77 (range 0-7) t = -.478; p = .633

Peer Relations 0.00 4.00 2.91 0.92 0.00 4.00 2.65 1.04 (range 0-4) t =3.885; p = .000

Substance Abuse 0.00 5.00 3.99 1.22 0.00 5.00 3.30 1.68 (range 0-5) t =6.910; p = .000

Leisure/Recreation 0.00 3.00 1.94 0.61 0.00 3.00 1.88 0.70 (range 0-3) t =1.238; p = .216

Personality & Behavior 0.00 7.00 3.58 1.66 0.00 7.00 3.78 1.80 (range 0-7) t = -1.757; p = .079

Attitudes & Orientations 0.00 5.00 2.00 1.12 0.00 5.00 1.74 1.34 (range 0-5) t =3.009; p = .003

Total 5.00 37.00 24.72 5.39 2.00 38.00 23.38 6.15 (range 0-42) t=3.463; p = .001

204

Table B5: Descriptive Statistics for How I Think Questionnaire – Time 1* Scale N Minimum Maximum Mean SD Cognitive Distortions

Anomalous Responding 299 1.00 4.25 3.67 .53 (range 1-6)

Self-centered 294 1.67 6.00 3.24 .61 (range 1-6)

Blaming Others 296 1.00 6.00 3.16 .63 (range 1-6)

Minimizing/Mislabeling 294 2.56 6.00 4.13 .58 (range 1-6)

Assuming the Worst 294 1.27 6.00 2.76 .67 (range 1-6)

Behavioral Referents

Opposition-Defiance 297 1.40 6.00 3.18 .68 (range 1-6)

Physical Aggression 294 2.00 6.00 3.34 .59 (range 1-6)

Lying 290 .25 6.00 3.44 .57 (range 1-6)

Stealing 297 1.91 6.00 3.23 .56 (range 1-6)

Summary Scores Covert 289 1.40 6.00 3.33 .50 (range 1-6)

Overt 294 1.80 6.00 3.27 .59 (range 1-6)

How I Think 284 1.91 6.00 3.31 .52 (range 1-6)

* Includes the scores that may be considered “suspect” because the AR scale is greater than 4.0 but less than 4.25.

205

Table B6: Descriptive Statistics for How I Think Questionnaire – Time 1* Scale N Minimum Maximum Mean SD Cognitive Distortions

Anomalous Responding 221 1.00 4.00 3.49 .51 (range 1-6)

Self-centered 217 2.22 6.00 3.38 .61 (range 1-6)

Blaming Others 219 2.00 6.00 3.32 .61 (range 1-6)

Minimizing/Mislabeling 217 2.56 6.00 4.21 .58 (range 1-6)

Assuming the Worst 218 1.45 6.00 2.92 .67 (range 1-6)

Behavioral Referents

Opposition-Defiance 220 2.10 6.00 3.34 .68 (range 1-6)

Physical Aggression 218 2.20 6.00 3.49 .57 (range 1-6)

Lying 214 2.13 6.00 3.55 .54 (range 1-6)

Stealing 219 1.91 6.00 3.36 .56 (range 1-6)

Summary Scores

Covert 213 2.29 6.00 3.45 .49 (range 1-6)

Overt 218 2.30 6.00 3.42 .58 (range 1-6)

How I Think 210 2.44 6.00 3.45 .51 (range 1-6)

* Does not include the scores that may be considered “suspect” because the AR scale is greater than 4.0 but less than 4.25.

206

Table B7: Independent Samples t-tests for the Client Self Rating Scale N for Time 1 N for Time 2 t-value Sig. Time 1 Mean Time 2 Mean

Anxiety 211 17.06 187 17.15 -.176 .860 (range 7-35)

Depression 215 12.72 188 13.04 -.791 .430 (range 6-30)

Self-esteem 212 22.69 187 22.49 .520 .604 (range 6-30)

Decision-making 211 31.40 184 31.51 -.198 .843 (range 9-45)

Risk-taking 211 21.15 190 21.36 -.407 .684 (range 7-35)

Hostility 210 20.19 185 20.26 -.119 .905 (range 8-40)

Self-efficacy 208 26.69 189 26.04 1.534 .126 (range 7-35)

Desire for Help 214 23.35 188 23.73 -.724 .469 (range 7-35)

Treatment Readiness 211 26.62 185 26.57 .087 .931 (range 8-40)

Time 1 = pretest only Time 2 = both pre and posttests

207

Table B8: The Effects of Time on Psychological and Social Functioning, With Controls for Pre-test Scores Anxiety Depression Self Esteem

Independent Variables b SE Beta b SE Beta b SE Beta

Time .012 .007 .118 .003 .005 .043 .000 .005 .010 Pre-test score .542 .067 .519* .243 .059 .299* .345 .068 .363* Constant 6.240 1.719* --- 8.604 1.225* --- 15.762 1.769* ---

F-value 34.992 8.734 12.913

R2 .29 .09 .13

Decision-making Risk-taking Hostility

Independent Variables b SE Beta b SE Beta b SE Beta

Time .005 .007 .050 .015 .006 .160* .021 .007 .203* Pre-test score .343 .072 .345* .546 .061 .552* .389 .060 .437* Constant 21.035 2.657* --- 7.325 1.660* --- 9.558 1.756* ---

F-value 11.690 45.489 27.899

R2 .12 .35 .25

* p = .05

Table B8: The Effects of Time on Psychological and Social Functioning, With Controls for Pre-test Scores (continued) Self-efficacy Desire for Help Treatment Readiness Independent Variables b SE Beta b SE Beta b SE Beta

Time -.001 .005 -.018 -.005 .006 -.054 -.014 .007 -.146* Pre-test score .368 .070 .371* .426 .062 .468* .282 .064 .318* Constant 17.138 2.181* --- 14.567 1.968* --- 21.542 2.244* ---

F-value 13.804 24.565 12.398

R2 .14 .23 .13

* p = .05

Table B9: Independent Samples t-tests for the How I Think Questionnaire Scale N for Time 1 N for Time 2 t-value Sig. Time 1 Mean Time 2 Mean Cognitive Distortions

Self-centered 154 3.25 113 3.30 -.772 .441 (range 1-6)

Blaming Others 154 3.17 115 3.23 -.814 .416 (range 1-6)

Minimizing/Mislabeling 155 4.14 113 4.18 -.683 .495 (range 1-6)

Assuming the Worst 155 2.76 112 2.85 -1.094 .275 (range 1-6)

Behavioral Referents

Opposition-Defiance 115 3.19 115 3.25 -.810 .419 (range 1-6)

Physical Aggression 154 3.34 113 3.41 -.942 .347 (range 1-6)

Lying 054 3.45 109 3.51 -.881 .379 (range 1-6)

Stealing 156 3.23 115 3.30 -.924 .356 (range 1-6)

Summary Scores

Covert 154 3.34 109 3.40 -1.013 .312 (range 1-6)

Overt 154 3.27 113 3.33 -.918 .360 (range 1-6)

How I Think 152 3.32 106 3.39 -1.134 .258 (range 1-6)

Time 1 = pretest only Time 2 = both pre and posttests

Table B10: The Effects of Time on How I Think Scales, With Controls for Pre-test Scores (includes suspect cases) Self-Centered Blaming Others Minimizing/ Mislabeling Independent Variables b SE Beta b SE Beta b SE Beta

Time .001 .001 .124 .002 .001 .132 .003 .001 .193* Pre-test score .272 .073 .336* .285 .072 .351* .491 .091 .450* Constant 2.007 .300* --- 1.974 .296* --- 1.616 .407* ---

F-value 8.685 10.379 5.765

R2 .14 .16 .27

Assuming the Oppositional Physical Worst Defiance Aggression Independent Variables b SE Beta b SE Beta b SE Beta

Time .002 .001 .124 .003 .001 .231* .002 .001 .169 Pre-test score .181 .077 .221* .247 .075 .290* .310 .076 .357* Constant 1.878 .334* --- 1.795 .330* --- 1.882 .311* ---

F-value 3.573 9.547 11.468

R2 .06 .15 .17

* p = .05

Table B10: The Effects of Time on How I Think Scales, With Controls for Pre-test Scores (includes suspect cases) Lying Stealing Overt

Independent Variables b SE Beta b SE Beta b SE Beta

Time .012 .001 .121 .001 .001 .079 .003 .001 .223* Pre-test score .235 .066 .335* .339 .074 .405* .282 .070 .351* Constant 2.376 .275* --- 1.951 .292* --- 1.841 .288* ---

F-value 8.095 11.874 12.786

R2 .14 .17 .18

Covert How I Think

Independent Variables b SE Beta b SE Beta

Time .001 .001 .111 .002 .001 .191* Pre-test score .289 .069 .385* .298 .070 .386* Constant 2.148 .269* --- 1.936 .276* ---

F-value 10.684 12.743

R2 .16 .19

* p = .05

Table B11: The Effects of Time on How I Think Scales, With Controls for Pre-test Scores (does not include suspect cases) Self-Centered Blaming Others Minimizing/ Mislabeling Independent Variables b SE Beta b SE Beta b SE Beta

Time .003 .002 .186 .004 .002 .262* .005 .002 .302* Pre-test score .257 .103 .300* .225 .097 .271* .521 .107 .486* Constant 1.942 .421* --- 1.885 .389* --- 1.048 .491* ---

F-value 5.733 7.634 20.929

R2 .13 .19 .38

Assuming the Oppositional Physical Worst Defiance Aggression Independent Variables b SE Beta b SE Beta b SE Beta

Time .003 .002 .170 .005 .002 .296* .003 .002 .238* Pre-test score .158 .105 .186 .253 .096 .296* .248 .101 .288* Constant 1.900 .442* --- 1.618 .417* --- 1.943 .398* ---

F-value 2.576 9.034 7.366

R2 .05 .19 .16

* p = .05

Table B11: The Effects of Time on How I Think Scales, With Controls for Pre-test Scores (does not include suspect cases) Lying Stealing Overt

Independent Variables b SE Beta b SE Beta b SE Beta

Time .023 .001 .194 .003 .002 .240* .004 .001 .296* Pre-test score .223 .100 .284* .277 .099 .326* .271 .089 .339* Constant 2.212 .392* --- 1.818 .396* --- 1.725 .354* ---

F-value 5.404 8.043 11.484

R2 .13 .18 .24

Covert How I Think

Independent Variables b SE Beta b SE Beta

Time .003 .001 .224 .003 .001 .290* Pre-test score .278 .100 .340* .287 .096 .357* Constant 1.935 .378* --- 1.758 .362* ---

F-value 8.082 10.946

R2 .19 .25

* p = .05