WINNER 2017 Abell Award in Urban Policy Juvenile Crime and the Heat of the Moment: A proposal to pilot cognitive behavioral therapy interventions to reduce youth crime and recidivism in Baltimore City George Wayne Zuo University of Maryland at College Park Stephanie Wang Zuo, M.D. Johns Hopkins School of Medicine July 2017 The Abell Foundation www.abell.org Suite 2300 Phone: 410-547-1300 111 S. Calvert Street @abellfoundation Baltimore, MD 21202-6174 WINNER 2017 Abell Award in Urban Policy TABLE OF CONTENTS Executive Summary.........................................................................................1 Introduction.....................................................................................................1 Theory and Application of CBT ......................................................................3 CBT and the Psychology of Juvenile Crime .............................................4 Youth Violence and CBT-Based Interventions in Baltimore City .........5 Becoming a Man (BAM) and Cook County Juvenile Temporary Detention Centers: Results from the Heller et al. study ......................6 Crime and Juvenile Detention in Baltimore City .........................................10 Observations of Overall Crime in Baltimore City ..................................10 Youth Crime and Detention .....................................................................11 Policy Recommendations and Approach .....................................................14 Obstacles, Limitations, and Mitigating Factors ..........................................20 References........................................................................................................26 Abell Foundation www.abell.org @abellfoundation P: 410-547-1300 July 2017 1 Juvenile Crime and the Heat of the Moment: A proposal to pilot cognitive behavioral therapy interventions to reduce youth crime and recidivism in Baltimore City Executive Summary 1. Use CBT to channel youth out of the school-to-prison pipeline: To For youth from distressed communities, reduce the likelihood of youth recidivating the gateway into the juvenile justice system back into the juvenile or adult criminal can be the beginning of a treacherous road justice systems, we propose implementing to adulthood. Recent studies have causally elements of the JTDC intervention linked juvenile incarceration with higher in the Baltimore City Juvenile Justice high school dropout and adult incarceration Center. These elements can largely rates, which have subsequently reduced be incorporated leveraging existing labor market and social engagement infrastructure and staff. outcomes for a population that is overwhelmingly represented by minorities. 2. Emphasize local high-risk schools as Despite extensive investment and planning key partners in delivering CBT-based by public and private stakeholders in violence prevention methods: In-school Baltimore City, the battle to curb youth CBT interventions have been shown to crime and recidivism has been an uphill substantially reduce arrests for violent one; even with boosts from aggressive city- crimes while simultaneously reducing and statewide initiatives, juvenile crime and dropout rates. In this paper, we propose a recidivism rates have remained relatively framework for developing and delivering steadfast over the past five years. Clearly, a pilot in-school CBT intervention in a fresh approach is needed to tackle the Baltimore City that emphasizes feasibility unique complexities of youth crime and and local impact. incarceration in Baltimore. Introduction In this paper, we propose introducing CBT- based interventions in select Baltimore There are few life events that can shape City Public Schools and the Baltimore the trajectory of a child’s future as much City Juvenile Justice Center (BCJJC). The as an early incarceration. One recent study CBT-based interventions would mimic establishes a causal link between juvenile the two Chicago interventions in content incarceration and increased high school and implementation, subject to several dropout and adult incarceration rates, with key adjustments that we have identified estimated increases of approximately 13 1 through conversations with various local percent and 22 percent, respectively. Youth stakeholders. In addition, we propose a of color are disproportionately exposed to “demonstration and evaluation” of CBT this phenomenon: In 2013, black youth were in Baltimore City, enabling us to focus 4.6 times more likely than white youth to be 2 resources on the highest areas of need. Our incarcerated, and certain estimates suggest proposal has two primary goals: that as many as one in three black men will be imprisoned at some point in their lifetime.3 2 Once incarcerated, nearly half of federal and education services and $2 million on mental state prisoners return to prison within five years,4 health services, resulting in a comprehensive creating a cycle of incarceration and rehabilitation per diem cost of $640.9 By comparison, the that has quickly become an enormous economic Justice Policy Institute reports that nationally, burden to society. Annually, more than $265 “the average costs of the most expensive billion is spent on the U.S. criminal justice system, confinement option for a young person [were] with over $60 billion spent on judicial and legal $407.58 per day.”10 In 2014, $3 million was proceedings alone.5 allocated by the Office of the Mayor specifically for youth violence prevention programs.11 Unfortunately, we have little evidence on what Clearly, financial resources alone have not been works for reducing youth crime and recidivism. enough to stem this problem. Despite the best intentions of policymakers and administrators, most interventions Recently, two Chicago-based interventions have either been ineffective (no statistically have laid the groundwork for replicable, significant improvements), inefficient (high cost-effective, and impactful youth crime/ per capita expenditures), or unreliable (serious violence prevention programs,12 thanks to the methodological issues in measuring student pioneering research of Heller, Shah, Guryan, outcomes). For example, of the more than Ludwig, Mullainathan, and Pollack (hereinafter 1,400 programs reviewed by Blueprints for referred to as Heller et al.),13 and the visionary Violence,6 less than 10 were identified as “model programming implemented by Youth Guidance programs,” based on program evaluation (YG) and the Cook County Juvenile Detention quality, intervention impact and specificity, and Center (JTDC). The novel aspect of these dissemination readiness. interventions is the integration of “cognitive behavioral therapy” (CBT), a technique that has The lack of scalable, evidence-based interventions been utilized for decades in the medical field has been a stumbling block for Baltimore to treat mental health disorders. In the context City, which has been fighting an uphill battle of youth violence, many adolescents have been against youth violence for many years. In the conditioned over time to instinctively resort to section entitled, “Crime and Juvenile Detention aggressive behaviors when confronted with in Baltimore City,” we show that Baltimore high-risk situations. Although these behaviors possesses one of the highest per capita rates may be appropriate in certain situations (e.g., of violent crime among comparably sized cities, protecting oneself “on the streets”), they are along with a disproportionate number of murders maladaptive in others (e.g., being reprimanded per violent crime. Moreover, Baltimore is also one by a teacher). CBT ultimately conditions and of the nation’s most racially segregated cities,7 empowers adolescents to identify and reduce with stark residential and racial divides in poverty the “automaticity” of such behaviors via and crime rates.8 The recent local backlash simulation, reflection, and reinforcement of following the death of Freddie Gray in 2015 techniques and exercises adapted from the use has only served to heighten tensions between of CBT in psychiatry. In the following section, local communities and institutions, further we review the theory and current application of complicating efforts to invest in youth who live in CBT with respect to youth violence. distressed neighborhoods. Heller et al. partnered with YG and JTDC to This has not been for lack of emphasis on juvenile commission two large-scale randomized delinquency. In 2016, $22.4 million was spent on control trials that measured the impact of CBT the operation of the Baltimore City Juvenile Justice interventions when applied to in-school and Center, with approximately $400,000 spent on juvenile detention center settings. The first of Abell Foundation www.abell.org @abellfoundation P: 410-547-1300 July 2017 3 Given the complexity of the issue at hand, the key to our approach is a focus on feasibility and prioritization of communities with high concentrations of youth living in crime-dense environments. these programs, “Becoming a Man” (BAM), concentrations of youth living in crime-dense was a series of weekly in-school coaching environments. Our intervention specifically sessions designed to engage youth through focuses on the Baltimore City Juvenile Justice immersive group activities and reflection. Center (operated by the Maryland Department Among the program’s successes were a of Juvenile Services), as well as select low- decrease in total arrests by 28 percent to 35 performing Baltimore City Public Schools in percent, a decrease