Interventions Flashcards
MST strengths
- Holistic and Individualized Approach:
- Evidence-Based Outcomes:
- Family-Centered Approach:
- Cost-Effectiveness:
- Cultural Adaptability:
MST limitations
- Dependency on Family Participation
- Inconsistent Long-Term Outcomes
- Challenges in Implementation
- Effectiveness in severe cases
- Potential for Practitioner Burnout
MST vs CBT
MST is broader in scope than CBT, which focuses primarily on individual cognitive and behavioral patterns.
While CBT is effective for specific behavioral issues, MST addresses systemic influences, making it more comprehensive for complex cases.
MST vs Intensive Fostering
MST works within the youth’s existing family and community systems, unlike intensive fostering programs, which remove the youth from their environment.
This may make MST less disruptive but potentially less effective for youth whose home environments are highly criminogenic.
CBT strengths
- Empirical Support:
- Focus on Cognitive Distortions:
- Structured and Goal-Oriented:
- Adaptability:
- Cost-Effectiveness:
- Skill Development:
CBT limitations
- Limited Address of Environmental Factors:
- Motivational Challenges:
- Effectiveness in High-Risk Populations:
- Focus on Present Issues:
- Potential for Group Dynamics Issues:
Staffordshire Intensive Fostering Programme Strengths
- Focus on Behavioural and Emotional Development
- Alternative to Custodial Sentences
- Structured Environment
- Trained Foster Carers
- Potential for Long-Term Benefits
- Avoidance of Criminogenic Effects
SIFP Limitations
- High Costs and Resource Intensity:
- Limited Accessibility:
- Challenges with Foster Placements:
- Short-Term Focus:
- Potential Emotional Impact:
- Mixed Evidence on Effectiveness:
Holistic and Individualised approach (S) - what intervention is this related to and how
MST integrates multiple perspectives and addresses the ecological systems, increases the likelihood of identifying and addressing the root cause.
It tailors interventions to the specific needs of the individual and their environment, ensuring relevance and effectiveness.
Evidence based outcomes (S) - what intervention is this related to and how
Numerous studies demonstrate MST’s effectiveness in reducing recidivism rates among youth offenders. A meta-analysis by van der Stouwe et al. (2014) found MST to be associated with significant reductions in reoffending compared to other treatment modalities.
Similarly, Borduin et al. (2009) reported long-term reductions in antisocial behavior and improvements in family functioning.
Family Centered Approach (S) - what intervention is this related to and how
MST engages families as key agents of change. It equips parents with skills to manage their child’s behaviour and strengthens family cohesion, his element is critical given the strong link between family dysfunction and youth offending (Huey et al., 2000).
Cultural adaptability (S) - what intervention is this related to and how
MST’s framework allows for cultural sensitivity by tailoring interventions to the unique cultural contexts of the youth and their families.
Dependency on family participation (L) - what intervention is this related to and how
MST heavily depends on family participation and cooperation. Families with high levels of dysfunction or resistance to intervention may struggle to engage effectively, limiting the intervention’s success (Lundahl et al., 2006).
Challenges in implementation (L) - what intervention is this related to and how
MST is a resource-intensive approach requiring highly trained therapists and close supervision to maintain fidelity to the model. This makes it difficult to implement in resource-constrained settings or rural areas.
Inconsistent long term outcomes (L) - what intervention is this related to and how
While some studies show sustained reductions in offending, others suggest that the effects diminish over time, particularly if ongoing support is not provided (Curtis et al., 2004). This raises questions about the sustainability of behavioural changes facilitated by MST.
Effectiveness in severe cases (L) - what intervention is this related to and how
MST has shown less success with extremely high-risk youth, such as those with severe mental health issues or entrenched criminal behavior, as these may require more specialized or additional interventions (Littell et al., 2005).
CBT empirical support (S)
CBT has strong empirical backing, meta-analyses showing it effective in reducing recidivism in youth offenders. Lipsey et al. (2007) CBT significantly reduces reoffending rates compared to non-therapeutic approaches.
Reduction from the .40 mean recidivism rate of the control groups to a mean rate of .30 for the treatment groups, a 25% decrease.
Focus on cognitive distortions (S) - what intervention is this related to and how
Youth offenders often exhibit cognitive distortions, such as minimization of harm or justification of criminal behaviour. CBT directly addresses these distortions, helping offenders develop prosocial thinking patterns and emotional regulation.
Structured and goal orientated (S) - what intervention is this related to and how
CBT provides a clear framework for identifying problematic behaviours and implementing practical strategies for change particularly useful for young individuals who benefit from structure and tangible goals.
Adaptability (S) - what intervention is this related to and how
CBT can be tailored to individual needs, addressing specific risks and protective factors. i.e trauma-focused CBT for group-based CBT for correctional settings.
CBT cost effectiveness (S)
Compared to Multisystemic Therapy (MST), CBT is generally more affordable and can be delivered in group, reducing costs while maintaining effectiveness.
Limited Address of Environmental Factors (L) - what intervention is this related to and how
CBT focuses primarily on individual cognition and behaviour, often neglecting systemic issues such as poverty. Youth offenders frequently operate within challenging environments that are not directly addressed by CBT.
Motivational Challenges (L) - what intervention is this related to and how
Youth offenders may lack motivation or insight to engage meaningfully with CBT. Resistance to change or denial of wrongdoing can undermine the effectiveness of the intervention.
Effectiveness in High-Risk Populations (L) - what intervention is this related to and how
While CBT is effective for many, it may be less impactful for high-risk youth with severe behavioural issues or co-occurring mental health conditions. These individuals may require more intensive, multimodal interventions.
Focus on present issues (L) - what intervention is this related to and how
Traditional CBT primarily targets current cognitive and behavioral patterns, potentially overlooking deeper, unresolved traumas or long-term developmental issues.
Potential for Group Dynamics Issues (L) - what intervention is this related to and how
Group-based CBT, commonly used in correctional settings, can be negatively influenced by antisocial peers, leading to reinforcement of delinquent attitudes rather than change (Dishion et al., 1999).
Alternative to Custodial Sentences (S) - what intervention is this related to and how
SIFP - The programme offered a rehabilitative alternative to custody, which often exacerbates criminal behaviour by exposing youth to more hardened offenders and removing them from prosocial influences. Evidence from the Youth Justice Board (YJB) evaluation (2008) indicated that participants in IF programs were less likely to reoffend compared to those serving custodial sentences.
Structured Environment (S) - what intervention is this related to and how
This approach aligns with evidence showing that structured, predictable environments reduce antisocial behaviour among at-risk youth (Leve et al., 2005).
Trained Foster Carers (S) - what intervention is this related to and how
Foster carers received specialized training to manage the complex needs of youth offenders, ensuring a consistent and therapeutic approach. Evidence from the MTFC model suggests that trained carers are critical for achieving positive outcomes (Rhoades et al., 2014).
Avoidance of Criminogenic Effects (S) - what intervention is this related to and how
Unlike incarceration, which can reinforce antisocial behaviours through negative peer influences, IF placements reduced exposure to delinquent peer groups, a significant risk factor for reoffending (Dishion et al., 1999).
High Costs and Resource Intensity (L) - what intervention is this related to and how
The programme required substantial financial investment for foster carer training, therapy, and ongoing support. The YJB (2009) evaluation noted that these costs, while potentially justified by reductions in reoffending, limited scalability.
Limited Accessibility (L) - what intervention is this related to and how
The program served a narrow demographic of offenders. It primarily targeted youth deemed suitable for fostering, excluding high-risk offenders.
Potential Emotional Impact (L) - what intervention is this related to and how
Removing youth from their families, even temporarily, could cause emotional distress or reinforce feelings of abandonment. Critics argue that interventions like MST, which work directly within family systems, may be less disruptive and equally effective (Henggeler et al., 2009).
Mixed Evidence on Effectiveness (L) - what intervention is this related to and how
The YJB (2009) evaluation found that the programme did not outperform all alternatives consistently in reducing reoffending rates.
How does CBT work
How and what we think shapes behaviour (Beck)
Tackles distorted cognition (deficient moral reasoning, schemas of dominance and entitlement)
Change perception of benign situations as threats, demand instant gratification, and confuse wants with needs.
“Tackles “victim stance” with offenders viewing themselves as unfairly blamed
Average effect of MST
.55 (Curtis, 2004)
efficacy studies showed more effect than effectiveness studies
Critique of Curtis
Effectiveness of SIFP
Rates of reoffending = 33% as opposed to 66% YJB (2009)
Who developed MST and when?
Henggeler et al in the late 70s with the first clinical trial in 1986
Who developed CBT and when?
Aaron Beck in the 1960s and 1970s
MST study limitations
Littell et al 2005 - many studies exclude youth with sever psychiatric disorders, may inflate effectiveness
Curtis et al 2004 - meta analysis often combine small studies, potentially masking inconsistencies in individual trials
CBT study limitations
Over-reliance on quantative data
Losel and Beelman 2003 found limited long-term follow up, CBT reduces antisocial behaviour but inconclusive on enduring behavioural changes
Lipsey 2007 crit ev
CBT
Strengths:
Focus on Juvenile Offenders:
Provides a targeted analysis of CBT’s impact on youth, rather than generalizing from adult studies.
Large Evidence Base:
Includes diverse studies, enhancing the representativeness of findings.
Quantifiable Effect Sizes:
Reports a significant average reduction in recidivism rates, offering actionable data for policymakers.
Critiques:
Limited Diversity in Outcomes:
Focuses primarily on recidivism, neglecting broader outcomes like education or mental health improvements.
Variability in Quality:
Some included studies lack rigorous designs, such as randomized controlled trials (RCTs).
Cultural and Contextual Gaps:
Most studies are U.S.-based, limiting the applicability to other justice systems or cultural contexts.
Littell 2005 crit ev
Strengths:
High-Quality Review: Conducted under Cochrane guidelines, ensuring rigorous evaluation of included studies.
Comprehensive Analysis: Evaluates a wide range of outcomes and study designs.
Critiques:
Criticism of Study Quality:
Identified significant methodological issues in many included studies, such as small sample sizes and lack of blinding.
Short-Term Bias:
Most studies reviewed focus on short-term outcomes, limiting conclusions about sustained effects.
Curtis et al 2004 crit ev
Strengths:
Comprehensive Approach: The meta-analysis synthesizes findings from multiple studies, providing a robust evidence base.
Consistent Findings: Across studies, MST showed significant reductions in recidivism and out-of-home placements.
Diverse Settings: Studies included in the meta-analysis were conducted in various settings, enhancing generalizability.
Critiques:
Selection Bias:
The included studies may not represent all MST research, as only studies with certain outcomes or methodologies were chosen.
Publication Bias:
Positive findings are more likely to be published and included in meta-analyses, potentially skewing results.
Variability in Quality:
Some included studies had methodological weaknesses, such as small sample sizes or inadequate controls.
Homogeneity Assumptions:
Aggregating data assumes uniformity in implementation and population characteristics, which may not reflect real-world variability.
Henggeler 1997
MST participants showed significantly lower rates of rearrest (22.1%) compared to the control group (71.4%) over a one-year follow-up.
Family Functioning: Improvements in parental supervision and reduced family conflict were observed in the MST group.
Psychosocial Outcomes: MST participants exhibited reductions in drug use and antisocial behaviors.
Strengths:
Rigorously controlled design ensures internal validity.
Measured a range of outcomes, including recidivism, family dynamics, and individual behavior.
Limitations:
Conducted by MST developers, potentially introducing bias.
Follow-up limited to one year, leaving long-term effects uncertain.
