Criminal Justice Section
Criminal Justice Magazine
Volume 20 Number 1
NIH Report Critical of "Get Tough" Programs
By Robert E. Shepherd, Jr.
Robert E. Shepherd is emeritus professor of law at the University of Richmond School of Law in Virginia. He is also a contributing editor to Criminal Justice magazine and former chair of the Section’s Juvenile Justice Committee.
In October 2004, the National Institutes of Health (NIH) convened an independent “state-of-the-science” panel for a conference to address the important issues of preventing violence and related risky social behaviors in adolescents. The panel of 13 distinguished experts from a variety of disciplines issued a significant report of importance to all those who practice in the juvenile justice system or make policy governing juvenile programs. The panel concluded that “get tough” programs that rely on “scare tactics” for the purpose of preventing children and adolescents from engaging in violent behavior are not only ineffective, but may actually make the problem worse.
Criticism of common juvenile programs
The panel found that many residential “get tough” programs, including group detention centers and boot camps, often exacerbate existing problems among adolescent youths by grouping those with delinquent tendencies together, where “the more sophisticated instruct the more naive.” Similarly, the panel concluded that the recent practice of transferring increasing numbers of juveniles to the adult criminal justice system also can be counterproductive, resulting in greater violence among incarcerated youths and increased recidivism when they are ultimately released. (National Institutes of Health, State-of-the-Science Conference Draft Statement (Oct., 2004), http://consensus.nih.gov (the final version also will be posted at this address).) Dr. Robert L. Johnson, chair of the Department of Pediatrics at the University of Medicine and Dentistry of New Jersey, who chaired the panel, explained some of its findings in a press notice announcing the release of the report, which followed the two-day conference. The conference itself was sponsored by several federal agencies.
Johnson’s report also stated that “the good news is that a number of intervention programs have been demonstrated to be effective through randomized controlled trials. We were pleased to find several programs that work, and we hope that communities will adopt them and continue to develop other interventions that incorporate the features common to successful programs.”
Programs that work
The panel spotlighted two particular programs that it found are clearly effective in reducing arrests and out-of-home placements: Functional Family Therapy and Multisystemic Therapy. Among the significant characteristics that these two programs shared are a focus on developing social competency skills, a long-term approach rather than a “simple” short-term “fix,” and the involvement of the family as well as the youth in the program. The two programs maintained positive results for nearly four years after the treatment ended.
Several other programs were identified that were classified as “effective with reservation,” meaning that they had only internal rather than external randomized controlled trials: Big Brothers/Big Sisters (reductions in hitting), Multidimensional Treatment Foster Care, Nurse Family Partnership (reduction in incarceration), Project Towards No Drug Abuse (reduction in weapon carrying), Promoting Alternative Thinking Strategies (reduction in peer aggression), and Brief Strategic Family Therapy (reduction in conduct disorder, socialized aggression). The reductions in violent behavior demonstrated by these programs were obviously important.
Recommendations for research
The panel also identified strengths and weaknesses in the field of violence prevention research, and made a number of recommendations to help inform and direct future efforts. Among these, the panel advocated a national population-based adolescent violence registry, and a much greater emphasis on research into the cost-effectiveness of intervention to prevent violence.
The panel was independent of any of the sponsoring agencies, and its report was not a policy statement of the NIH or the federal government. The NIH Consensus Development Program, of which the conference leading up to the release of the report is a part, was established in 1977 as a mechanism to judge controversial topics in medicine and public health in an unbiased, impartial manner. The conference was sponsored by the Office of Medical Applications of Research and the National Institute of Mental Health, of the NIH. Cosponsors included the Office of Behavioral and Social Sciences Research, the National Institute of Alcohol Abuse and Alcoholism, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, National Institute of Nursing Research, the National Library of Medicine, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the United States Department of Education, and the U.S. Department of Justice.
Members of the panel included practitioners and researchers in community and family medicine, pediatrics, nursing, psychiatry, behavioral health, economics, juvenile justice, outcomes research, and a public representative. The panel reviewed an extensive collection of scientific literature related to youth violence prevention, including a systematic literature review prepared by the Southern California Evidence-Based Practice Center, under contract with the Agency for Healthcare Research and Quality (AHRQ). To obtain a free copy of the voluminous report summarizing the research, call AHRQ Publications Clearinghouse at (800) 358-9295 and ask for “Evidence Report/Technology Assessment No. 107.” The report itself, Preventing Violence and Related Health-Risking Social Behaviors in Adolescents, also may be downloaded at www.ahrq.gov. The report contains probably the most extensive bibliography of the existing literature on violence prevention and treatment with a useful analysis of the studies and programs.