Intensive Supervision Program (ISP)

Multisystemic Therapy in WA Juvenile Justice

Causal Models of Delinquency & Drug Use

Condensed Longitudinal Model

Family

School

DelinquentPeers

DelinquentBehavior

Prior DelinquentBehavior

Low Parental MonitoringLow AffectionHigh Conflict

Low School InvolvementPoor Academic Performance

Elliott, Huizinga & Ageton (1985)

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What is ISP? One of a number of new DoJ initiatives to reduce

juvenile offending Intensive, community based approach to target

known causes of juvenile offending Branch of JCS, based in community alongside CJS –

Mirrabooka, Cannington, Midland Each team consists of Supervisor, 3 Clinicians,

Aboriginal Team Advisor. The ATA role is unique to MST but vital to the

Australian model Based on Multisystemic Therapy (MST), data

supports it as best treatment model for serious, repeat young offenders - Licensed by MST Services

About ISP: Target Group

Young people aged 10–17 who are engaged in JJ and meet all/some of the following:

Are at risk of placement in detention/remand due to delinquent behaviour

Are returning to the community following placement in detention/remand

Are placed on high end orders Have a history of chronic or violent offences Exhibit seriously disturbed anti social

behaviours Known to engage in substance misuse

About ISP: Exclusionary Criteria

No identified primary caregiver Young people in suicidal, psychotic or

homicidal states Young people who engage exclusively in

serious sexual offences Behaviour is more directly attributable to

organic factors rather than environmental factors

Issues faced by ISP Clients• Sub-standard housing, no electricity or heating,

lack of food, overcrowding, vandalism.

• Lack of positive male role models, drug use/selling, high debts, direct or vicarious violence.

• No phone or car in case of emergency.

• Removed from home community

• Young person and parents not in education or working.

• Intergenerational involvement with justice system

About MSTThe program treats known causes of juvenile

offending behaviour:

The program uses the strengths in all these systems to facilitate change

Families As The Solution

• MST focuses on families as the solution.• Families are full collaborators in treatment

planning and delivery with a focus on family members as the long-term change agents.

• Giving up on families, or labeling them as “resistant” or “unmotivated” is not an option.

• MST has a strong track record of client engagement, retention, and satisfaction.

About MST: Aims

Reduce offending and anti social behaviour Improve caregiver discipline practices Enhance family relationships Emphasis on parental empowerment Decrease youth association with deviant

peers Increase youth association with pro social

peers Improve youth school or vocational

performance Develop a support network to help caregivers

achieve and maintain changes Reduce substance misuse Target practical/welfare needs when

presenting as barriers to intervention

Researched MST Outcomes 25 –70% lowering in recidivism in serious and

violent young offenders at 1,2 and 4 year follow up

Fewer arrests, fewer offences, and less detention

Decreased behavioural problems at home and school

Improved family relations and functioning Increased mainstream school attendance Excellent cross cultural validity Cost reductions: Custody is significantly

more expensive per child than the MST program.

Research

• Henggeler, Rodick, Borduin, Hanson, Watson & Urey (1986). Multisystemic treatment of juvenile offenders: Effects on adolescent behaviour and family interactions. Developmental Psychology, 22, 132-141.

Results• Conducted from 1978-1983 – MST versus

usual community services; MST more effective in decreasing adolescent behavioural problems and improving family relations

Research

• Brunk Henggeler & Whelan (1987). A comparison of MST & parent training in brief treatment of child abuse & neglect. J of Consulting & Clinical Psych, 55, 311-318.

Results• Randomly allocated families to home-based

MST Vs parent training; parents reported decreased psychiatiric symptomatology, reduced overall stress & a reduction in the severity of identified problems; observational measures favoured MST condition – parents controlled their children’s behaviour more effectively, less passive noncompliance, parents more responsive

Research

• Borduin, Henggler, Blaske & Stein (1990). Multisystemic treatment of adolescent sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 35, 105 – 114.

Results• Randomly assigned to MST Vs office-

based, individual, outpatient counseling (200 chronic juvenile offenders); self-report, other-report, family assessment sessions, recidivism at 4 yr follow up

Research

Continued• Significantly fewer participants re-arrested

for sexual crimes (1/8 Vs 6/8)• Mean frequency of rearrest for nonsexual

crimes also lower - MST (0.62) outpatient counseling (2.25)

• Family members who received MST reported increased family cohesion & adaptability

• Observations indicated increased supportiveness & decreased conflict-hostility

• Parents in MST showed greater reductions in psychiatric symptomatology

About MST: In Practice Low caseloads, 3-6 families per clinician,

allows intensive service to be delivered (2-15 hrs each family per week)

Treatment occurs daily to several times a week, with sessions decreasing as treatment progresses

Treatment time limited, lasts 4-6 months, depends on seriousness of problems & success of interventions

Treatment delivered in families natural environment, including SCHOOL and other community places

About MST: In Practice

Works with linked family issues (marital counselling, child management strategies)

Clinicians are accountable for intervention activities

Clinicians available 24-hours a day, 7 days – flexible family friendly schedule

Involves all relevant stakeholders Adheres to principles & analytic process Uses CBT, Behaviour Therapy, pragmatic

family therapy Quality assurance processes

About MST: Principles

1. Primary purpose of assessment is to understand the fit between identified problems and their broader systemic context

2. Therapeutic contacts emphasise the positive and use systemic strengths as levers for change

3. Interventions are designed to promote responsible behaviour

4. Interventions are present focused and action oriented, targeting specific and well-defined problems

About MST: Principles

5. Target sequences of behaviour6. Interventions are developmentally

appropriate 7. Interventions are designed to require

daily or weekly effort by family members8. Continuous evaluation from multiple

perspectives9. Promote treatment generalisation & long-

term maintenance of therapeutic change by empowering caregivers

About MST: Supervision & Quality Assurance

Principles Do Loop guides analysis to keep

intervention systematic Weekly team supervision Weekly Supervisor consult with MST

Services Weekly Team consult with MST Services Paperwork Client feedback (TAMS) Supervision feedback (SAMS) ATA feedback

Desired OutcomesOf Family and Other

Key Participants

Desired OutcomesOf Family and Other

Key Participants

ReferralBehaviour

ReferralBehaviour

OverarchingGoals

OverarchingGoals

MST ConceptualizationOf “Fit”

MST ConceptualizationOf “Fit”

IntermediaryGoals

IntermediaryGoals

InterventionDevelopment

InterventionDevelopmentIntervention

Implementation

InterventionImplementation

Assessment ofAdvances & Barriers to

Intervention Effectiveness

Assessment ofAdvances & Barriers to

Intervention Effectiveness

MST: The Do-Loop

Examples of Referral BehavioursPrimary reasons for referral to the ISP.

• Offending Behaviour – aggravated burglary x 15; also facing charges for fire lighting and assaulting a public officer

Truancy – mum reported that since son moved to father’s residence, he had been truanting and hadn’t attended school fro five weeks.

Misbehaviour at School – The school reported that son often misbehaved in class, e.g., rude & aggressive toward teachers, refused to work, climbed out of windows & put no effort into his work.

Aggressive Behaviours – mum stated that son was regularly physically & emotionally aggressive toward her & brother, e.g., yelling, swearing, pushing, hitting, bullying, throwing objects, name calling & intimidating.

Substance Misuse – son has admitted sniffing substances in the past. Also alcohol and cannabis daily. Occasional speed use.

Examples of Concurrent Interventions

Reducing aggression at home by increasing level and consistency of consequences by both parents

Reducing substance misuse by increasing parental monitoring, reducing parental drug use and increasing engagement in pro-social activities

Reducing offending by increasing contact with pro-social peer network.

Examples of Overarching Goals

Are specific, include key indicators of achievement & are operationalised.

1. Reduce Aggressive Behaviours - son will reduce his aggressive behaviours (physical, verbal, intimidation) as evidenced by: – NO incidents of violence including NO yelling, swearing,

hitting (with/without objects), pushing, threatening others, bullying, name calling, put downs, throwing things.

– NO new offences (in particular NO violence toward mum, brother, dad).

– Complying with parents’ requests without becoming aggressive.

– Not blaming others for his behaviour – accepting responsibility for it.

Examples of Overarching Goals

2. Improve Behaviour & Performance at School: son will improve his behaviour & performance at school as evidenced by:– Attending school 5x per week unless sick– NO truanting– NO disruptive behaviour including NO: talking out of

turn, calling out to others, rushing work & putting in no effort, being rude/aggressive to students (swearing, bullying) or teachers (backchatting), refusing to do work, getting detentions, climbing out of classrooms, or always getting out of his seat.

Example of Conceptualisation of Fit

Examines the fit of the behaviour in the environment & looks

at what “drives” the behaviour at various systems levels:

Individual Family Peer School Community- eliciting evidence for each.

Problem behaviours are obtained from the overarching goals

Example- son’s truanting behaviours

Example of Fit Circle

Dean’s Truancy

Dean dislikes attending certain classes as they are too difficult for him (individual)

Friends were frequently truanting & displaying antisocial behaviours (peers)

Dean doesn’t like catching the bus (individual)

No serious consequences given at home (family)

Parents unaware of the extent of Dean’s truanting due to low communication with the school (family)

Dean able to access privileges at home when truanting (family)

Example of Intermediary Goals

Intermediary goals are developed from the prioritised drivers.

Prioritised Drivers:1. No serious consequences are given at home (family)2. Parents unaware of the extent of son’s truanting due to

low communication with the school (family)3. son dislikes attending certain classes as they are too

difficult for him (school).

Related Intermediary Goals:• Develop a behaviour management plan with dad and

mum related to truancy (increasing parental alignment).• dad and mum to increase their communication with the

school by making an appointment to meet with the teachers.

• dad/mum to organise meeting with Deputy & son to look at changing his subjects/using a teacher’s aide.

Example of Developing Intervention

Involve family, specific (who/ what/when/where) & use MST principles.

Driver: No serious consequences given at home.IG: Develop Behaviour Management Plan (BMP).

parents to compile list of behaviours they’d like son to adhere to in/out of the home.

Son to complete Reward List to determine which rewards/activities are most desirable/undesirable to him (to inform BMP).

parents write rules for the BMP based on behaviours they’d like to see/not see using rewards/consequences from the list.

Parents practice/Role play introducing BMP to son, preparing parents for likely negative reaction from him.

Principles – Action oriented, present focused, responsible behaviour, generalisation, daily effort.

Example of Intervention Evaluation

Some Advances: parents met with the Deputy principal and son’s 2

teachers.

School was able to change son’s optional classes to those he liked, and tailored the work to suit his level

mum phones school daily to check son’s attendance

parents began rewarding Dean for attending school.

son’s truancy decreased (during first week, only missed 3 classes).

Variables of Evaluating ISP• Age• Prior Education• Family Function• Drug Use Prior to Treatment• Parental Forensic History• Prior Accommodation• Psych• Parent/child Conflict• Parental Monitoring• Number of Offences• Court Appearance• Past legal involvement (eg

orders, bond)

• Success in Achieving Overarching Goals

• Treatment Strategies• ISP Hours Contact/Times

contacted• Offending During

Treatment• Offend Post 3 Month• Drug Use Post Treatment• Employ/training• Improved

Parenting/monitor

Research Directions: Evaluation