86 Chapter 7
for violence? Does his father come home drunk and hit him? There are a
number of instruments to help assess risk, as noted above.
Management
Most effort is directed at the 25% of offenders who repeatedly break
the law. There is little evidence for the effectiveness of punishments
such as prison or other judicial approaches, and beliefs in ‘short, sharp
shocks’ at one extreme and prolonged individual therapy at the other
owe more to fashion and political ideology than empirical evidence. Three
treatment approaches have been reasonably well evaluated and shown
to be effective: (1) Functional Family Therapy; (2) Multisystemic Therapy
(MST); and (3) Multidimensional Treatment Foster Care (MTFC).
1 Functional Family Therapy, developed by James Alexander, is the least
intensive, involving an individual therapist who works with each family
in their home over 10–12 weeks. It has three phases: the first is designed
to motivate the family to change, the second teaches the family how
to change a specific problem, and the final phase helps the family
generalise their problem-solving skills. There have been six trials in
the world, including two independent ones in Europe. Reoffending was
reduced by 20-40%.
2 Multisystemic Therapy (MST),developed by Scott Henggeler, also lasts
for about three months. It is based on sound developmental research
that shows that multiple factors determine serious antisocial behaviour,
and that many of these are in the immediate environment of the
young person. It therefore makes no sense temporarily to isolate the
young person from these factors, increase the level of one of the most
potent aggravating factors, and then return him to the old criminogenic
surroundings that have not been changed at all. Yet this is what the
current juvenile justice system does by jailing young offenders with
other highly antisocial peers. MST takes the opposite tack, and instead of
pouring resources into incarceration, puts them into trying to alter the
environment around the youth. MST has six elements that are flexibly
applied according to the needs of the young person (see Box 7.3). It has
been shown in replicated studies in the USA to reduce re-offending rates
by a third to a half, and to increase sociable behaviour. However, quality
assurance is key, and to address this, there needs to be a team of staff
to ensure adequate ongoing support and supervision of the therapists;
there is good evidence that in centres where treatment fidelity is not
upheld, outcomes worsen. Also the good results in the USA are helped
by two factors. First, if the young person and family do not attend, the
youth typically has to go straight to jail, whereas in Europe they remain
in the community. This helps compliance! Secondly, management as
usual, in the control arm, is usually better in countries with more public
services, and, for example, a large trial in Canada and a small one in