Ammar Cephas Plumber

Expanding therapeutic care to prevent delinquency and heal traumatized youths

May 20, 2021

Abstract

Juvenile delinquency is a significant problem for the Dallas County. First time offenders are more likely than not to become chronic offenders, and pre-existing, reactive policies have proven inadequate. In this paper, we propose expanding access to free therapy to at-risk adolescent populations—specifically those with reported conduct problems in school. Conduct problems are both a predictor of future crime and a proxy for prior trauma. Because psychologies have deep causal significance in the phenomenon of delinquency, we propose that a behavioral health intervention would be particularly effective, and many prior studies support this position. Our intervention administers three different kinds of therapy to random samples from this target population. Our proposed recruitment strategy attempts to address stigma by utilizing peer mentors from similar cultural backgrounds as our subjects. Metrics of intervention success include first offense rates, persistent conduct problems in school, risk of violence, and psychological symptomatology. Dallas stands to gain millions of dollars in costs of detainment, communal safety, policing resources, and direct/intangible costs to victims. Projected costs are minimal, as behavioral clinic partnerships are already in place, and similar programs have been affordably conducted in the past. 

Motivation

The proposed intervention focuses on the problem of youth crime in Dallas. In general, crime poses substantial costs to society, violent crime incurring the steepest costs. Shapiro and Hassett (2012) estimate that a 10 percent reduction in violent crimes in Dallas “could save $7 million per year, reduce the direct costs to victims by nearly $15 million per year, and avert more than $140 million in annual, intangible costs to victims—reducing total government costs by an average of $138 per resident per year.” Such a drop in crime would also raise Dallas housing prices by an estimated $2.4 billion, which generates additional tax revenues. There are multiple reasons to target youth. First, age of first crime is one of the strongest predictors of repeat criminality (Katsiyannis and Archwamety, 1997). A study of 9,945 criminals in Philadelphia showed that half of all crimes and three-fourths of serious offenses were committed by 627 men, a small subset of the group (Wolfgang et al., 1972). Indeed, recidivism rates in Dallas mirror this pattern; 85.4% of first-time juvenile offenders are later charged again with similar crimes (Hunt, 2017). The recidivism rate approaches 50% for juvenile homicide offenders specifically (Trulson and Caudill, 2017). Targeting youth, therefore, has a multiplier effect in bringing down overall crime rates, and the city stands to save millions in doing so.

Besides crime, there are unique costs to youth detention. In 2015, there were an average of 215 youths detained per day in Dallas—2,950 total (Hunt, 2017). Each youth was detained for an average of 23 days. The cost of youth detainment is estimated at $7.8 million dollars. Not included in this estimate are the costs to school districts for accommodating these circumstances, the emotional and practical costs to families of not having their children present, and the intangible and long-term costs of trauma to the detainee. With regard to this last consideration, it has been shown that the majority of youth reported at least one violent victimization while in detention. An additional 23% also reported sexual assault (Evans-Chase, 2014).

We are focused on prevention of delinquency rather than remediation in the aftermath of crime. Remedial efforts are certainly necessary; previous offenders can be groomed into valuable community members. However, we believe that Dallas devotes inordinate attention to this stage of the pipeline, and, in so doing, perhaps allows criminality take root in the first place. We will review some specific remedial programs Dallas has implemented in the next section. For now, suffice it to note some key institutions involved in these efforts: the Dallas Police Department, the nonprofit sector (United Way), and the Dallas County Juvenile Department.

In designing an intervention, our target population is adolescent children with recorded conduct problems in school. Regarding the demographic features of our target population, disciplinary measures have predominantly been leveled against Black students, but, due to concerns about racial bias in enforcement, it seems that reforms were passed this year (Dallas ISD News Hub, 2021). However, these reforms only affected the punishment of conduct problems rather than how conduct problems are defined.

We target students with conduct problems for two reasons. First and foremost, conduct problems in school (CPS) strongly predict criminality. A longitudinal study of children showed that CPS males are 2.6 times as likely as males at the same schools with no conduct problems (NCP) to become adult offenders, and CPS females are 4.4 times as likely as NCP females to become adult offenders (Kratzer and Hodgins, 1997). Second, conduct problems are a proxy for trauma, which implies therapy may be uniquely valuable (McCabe et al., 2010). Trauma is both the outcome of youth detention and one of its strongest predictors. Between 75% and 93% of youth in the justice system have experienced trauma compared to just 25%-34% of the general population (Evans-Chase, 2014). Among those traumatized, the violent crime rate is almost triple the rate of those without trauma (Peltonen et al., 2020).

In addition to trauma, there are other noteworthy psychological drivers of crime, which make a behavioral approach essential. Neurophysiology is one consideration; youths have underdeveloped prefrontal cortices, which yields high present bias and insufficient risk aversion (Mills et al., 2014). This also makes them highly sensitive to peer evaluation and fearful of exclusion (Dumontheil, 2016). As such, youth are particularly vulnerable to gang influences. Socioeconomic status and poverty are relevant as well. Scarcity has been shown to promote high present bias, impulsivity, and overstretched cognitive resources (Zhao and Tomm, 2018). We think that because drivers of crime are at some level behavioral, behavioral health interventions are essential to any holistic policy solution. Conversely, without therapeutic intervention, juvenile delinquency rates will remain high. We discuss the efficacy of specific treatments in the following section. The proposed therapeutic intervention is cost-effective, and the benefits are immense. While a specific cost estimate was not publicly provided, Dallas has offered therapy to schoolchildren previously. The Friends and New Places Program administered therapy in Dallas schools to 1,100 students displaced by Hurricane Katrina (Jaycox et al., 2006). Moreover, non-expert facilitators can be trained in the therapeutic protocols being administered, as was successfully accomplished in Liberia and Chicago (Blattman et al., 2017; Heller et al., 2017). Finally, because there are behavioral health clinics already partnered with the Dallas Juvenile Department, some of the same facilities and staff can be allocated to this intervention as well, and additional overhead expenses may therefore be minimized. Economic costs include the $7.8 million each year spent on detention and the savings of reduced crime more generally, which are potentially tens of millions of dollars in direct costs with even greater indirect costs. The local housing market is likely to see gains from this intervention as well, which yields additional tax revenues. Political and sociological benefits are numerous. Juvenile delinquency predicts more violent forms of political expression in the long-term, and coercive measures such as detention have been shown to worsen this phenomenon (Schichor and Kelly, 1980). Also, healthy individuals are essential for familial and communal well-being. The effects of trauma and crime are intergenerational, so reducing violence among today’s youth may help to protect the youth of tomorrow (Hjalmarsson and Lindquist, 2012).

Background

A number of interventions have already been attempted in Dallas. In 2007, Texas spent the sixth greatest share of its budget on corrections among all fifty states while embracing a strategy that targets recidivism and seeks alternatives to imprisonment for low-risk offenders (Pew Center on the States, 2008). Yet, nearly a decade later, youth recidivism rates remain above eighty percent (Hunt, 2017).

I will review some previous interventions and note some of their shortcomings. United Way, a nonprofit in Dallas, runs two projects that target recidivism. Café Momentum, a casual fine dining restaurant, employs adjudicated teens for 12-month paid internships and provides job training (McCarthy, 2020). Though it was opened in 2011, no data has been published on the outcomes for those employed, but the program is publicly acclaimed. A second project, called the Prison Entrepreneurship Program, trains ex-convicts in business, general life skills, and character building. This program began in 2004 and has been tremendously successful; the recidivism rate is nearly 8.3% compared to the national average of 50%. Nearly all graduates remain employed today (Prison Entrepreneurship Program). However, this program is for adults, not adolescents. Despite these programs’ purported success at decreasing recidivism, there are several aspects of the problem that they fail to address. First and foremost, they do not prevent the first crime. It is impossible to assess the counterfactual of how much greater these people’s societal contribution had imprisonment been altogether avoided. Though recidivism is low, programs like this cannot recover peoples’ fullest potential; they can only salvage decency from lives that have already been marred by imprisonment and its concomitant traumas. Second, they do not themselves address trauma and its various non-crime costs, including effects on family and long-term health predispositions—drug addictions, high blood pressure, ulcers, etc. (Forman-Hoffman et al., 2016).

The Dallas County Juvenile Department also offers other diversion programs that serve as alternatives to detainment while rehabilitating youth offenders. Mental Health Court diverts youth with prior psychiatric diagnoses from further justice system involvement while offering therapy at home or at a partnered behavioral health clinic. A similar program is available for youths with drug addictions. No longitudinal data is available on the outcomes for program participants, but previously referenced data indicates that these programs have not done enough. Despite their existence for nearly a decade, youth recidivism remains at 85% (Hunt, 2017). But, recidivism aside, it is worth reiterating that prevention of the first offense is intrinsically desirable. Even if admitted to diversion programs, these youths will now carry a criminal record in all their life pursuits, though expungement is possible in certain cases. Also, what predicts future crimes is not detainment but the commission of the offense. As such, diversion programs are helpful but not sufficient for addressing the crime cycle.

Given the insufficiency of these reactive programs in Dallas, we propose that a proactive solution may be in order. In 2003, the US Department of Justice published a report on child delinquency which argued that prevention is a better goal than remediation, and 71% of practitioners agreed (Loeber et al., 2003). The preventative efforts in Dallas are almost nonexistent, with only one noteworthy program—the Police Athletic League, which uses recreational activities to create trust between police officers and youth. No data has been released on the efficacy of this program, but, even if it is effective, it does nothing to combat the psychological drivers of crime such as trauma, fear of peer exclusion, and emotional dysregulation. Perhaps this program would be an effective complement to the proposed intervention.

Now, we summarize literature on the promise of therapy in reducing crime. Here, our focus is on the success of previous interventions rather than on the content of each treatment; each treatment’s protocols and emphases will be described in the design section. Many studies show the efficacy of standard cognitive behavioral therapy (CBT) in reducing crime. Three randomized control trials (RCTs) in Liberia showed that CBT reduced criminality and increased graduation rates among at-risk youth (Blattman et al., 2017). This effect was greater when therapy was coupled with cash grants, but cash grants had no independent effect. In the US, a Chicago-based NGO Youth Guidance delivered CBT to at-risk male youths. This program was called Becoming a Man (BAM). Arrests decreased by 12 percent, and on-time graduation rates increased by 9 percent for the treatment group relative to control group members (Cook et al., 2014; Heller et al., 2017). In addition to standard CBT, other treatments have also shown promise. Partnered with the University of Chicago Crime Lab, which ran the BAM study, ideas42 developed a revised CBT curriculum that is designed to specifically target behavioral drivers of delinquency. This program targeted detainees and reduced the readmission rate by 21 percent relative to the control group (ideas42, 2017). Finally, Dr. Ricky Greenwald developed a new therapy called Motivation-Adaptive Skills-Trauma Resolution (MASTR), which he administered in an open trial in Hawaii. All evidence thus far is anecdotal, and nothing resembling an RCT has been conducted. However, sizable drops were observed in patients’ trauma scores, family lives became calmer, and school discipline problems decreased (Greenwald, 2002). Furthermore, features inherent to MASTR’s design make the treatment seem particularly promising, which warrants further research. Beyond highlighting results, we will properly characterize each of these therapeutic paradigms in the next section.

Stigma represents a major obstacle to recruiting students for therapy. This is especially true for people of color, as studies have found that Black Americans are more likely than non-Black counterparts to associate mental illness with shame and embarrassment or to hide the illness (Ward and Heldrich, 2009). Blacks and Hispanics have half the utilization rate of mental health services relative to Caucasian Americans (McLean Hospital, 2021). Likely explanations include economic accessibility, fear of social judgment, normative beliefs, and cultural mistrust (Taylor and Kuo, 2019). We aim to address each of these in our recruitment design.

Design

A pilot intervention will require three treatment groups—one for each therapeutic paradigm—and one control group. Out of a selection of students in Dallas County schools with reported conduct problems, one fourth will be randomly chosen to be part of the control group. The remaining students will be offered free therapy and randomly allocated into three treatment groups administering different types of therapy. These groups should be similar in gender, racial, age, and socioeconomic makeup. The therapeutic paradigms offered are as follows: standard cognitive-behavioral therapy (CBT), a specialized delinquency-focused CBT paradigm developed by ideas42 and the University of Chicago Crime Lab (DF-CBT), and Motivation-Adaptive Skills-Trauma Resolution (MASTR), which was pioneered by Dr. Ricky Greenwald. Most clinicians have standard training in CBT, but the other two therapeutic paradigms will require specific training. Therapeutic timelines will be decided on an individual basis, depending on severity of behavioral problems, trauma, risk of violence, overall symptomatology, and, of course, the preferences of the patient. Before describing each of the therapies and training required, I will elaborate on the recruitment stage.

We will utilize two avenues for recruiting families: parent-teacher conferences and phone calls. We avoid using texts, emails, and letters because they are impersonal, and we believe this would render recruitment ineffective in the face of stigma. Parent-teacher conferences would be the optimal means of introducing the topic because it directly concerns the child’s conduct problems, a topic that requires discretion. If the parent(s) agree to be contacted again, we will have a “peer specialist” from a similar cultural background call the family to discuss the benefits of therapy and to alleviate any fears that the family might have. Ideally, peer specialists will have pursued therapy themselves and can speak to its benefits. We believe hiring culturally similar peer advocates to place follow-up phone calls is necessary because effective messaging requires repeated contact from someone who is relatable to the subject (National Academies of Sciences, 2016). The same source has argued that peer support can help to overcome self-stigma and to change the subject’s empirical/normative expectations about seeking therapy. Having peer specialists from a similar racial/cultural background will help to alleviate cultural mistrust, as will having a culturally sensitive team of therapists. Data from 2017 indicates that only 4% of US therapists in 2018 were black (Lin et al., 2018). Because minority psychologists are in short supply, we can also conduct racial sensitivity training in addition to hiring diversely. Dr. Theopia Jackson of the Association of Black Psychologists indicated that white therapists often see boisterous black people as unstable, so implicit bias training is helpful in making therapists more likable and effective in treating other racial groups (Day, 2015).

The economic accessibility constraint will be addressed by making therapy free. One minor concern is that such an offer may cause decisionmakers to subconsciously devalue therapy. To deal with this, during all communications, we will state the usual cost of therapy but note that it is being offered for free. Note that it has been shown that free products are valued above and beyond the difference between costs and benefits—a phenomenon referred to as the zero-price effect (Shampanier et al., 2007). Second, this strategy helps to reduce missed appointments. A study in England found that emphasizing the monetary value of the appointment is more effective in deterring no-shows than social norms messaging or the “easy call” strategy, in which a link is sent to make cancellation as easy as possible (Hallsworth et al., 2015).

Upon intake and at the start of every fourth session, clinicians will administer two questionnaires. First, patients will complete the Structured Assessment of Violence Risk in Youth (SAVRY), which is the best predictor of juvenile violence as shown by a 68 study meta-analysis involving 25,980 participants (Singh et al., 2011). Because SAVRY materials are a paid resource, sample questions could not be provided, but, Appendix A provides a brief description and items that are assessed. Thus, violence risk can be longitudinally assessed over the course of treatment and compared across treatment groups. We hypothesize that therapy generally will reduce risk of violence and that MASTR and DF-CBT will be more effective than standard CBT in this regard. Second, subjects will complete the Symptom Checklist-10 (SCL-10), a shortened self-report symptom inventory that broadly measures psychological distress—with anxiety and depression as key dimensions (Nguyen et al., 1983; Strand et al., 2009). A meta-analysis showed this assessment to achieve the optimal blend of diagnostic strength, breadth and concision (Müller et al., 2010). SCL-10 is shown in Appendix B. This will allow us to test, 1) whether our treatments generally confer mental health benefits and 2) whether one of our treatment types differentially affects particular symptoms. We surmise that standard CBT will substantially reduce depression symptomatology while DF-CBT and MASTR will have the greatest effects on anger and emotional dysregulation.

Now, we describe each type of therapy being offered. Cognitive-behavioral therapy is a general framework that typically includes four steps: identification of circumstances causing trouble; awareness of thoughts, emotions, and beliefs about these problems; identification of negative or inaccurate thinking patterns; and reshaping of these perceptions (Mayo Clinic). Therapists trained in CBT are typically trained to recognize a common set of “cognitive distortions,” including all-or-nothing or black-and-white thinking, overgeneralization, emotional reasoning, personalization (blaming oneself exclusively), and a few others (Burns, 1999). In hearing about the patients’ thoughts and experiences, the therapist aims to help the patient recognize and correct these patterns. The goal is that patients will eventually be able to do so on their own upon completing therapy. In preventing delinquency, where CBT potentially falls short is in its generality. Therapists trained in CBT are not necessarily attuned to the specific biases that drive youth to crime. These will be highlighted in our descriptions of the other two paradigms.

The delinquency-focused CBT curriculum developed by ideas42 and the UChicago Crime Lab has several promising features. It utilizes the same basic structure as standard CBT, but the cognitive distortions and behavioral biases it focuses on are precursors to violence, drug use, and other criminal activities. The curriculum aims to inculcate three basic skillsets: sensitivity to one’s community, recognition of automatic thoughts, and managing responses to triggers. Teaching the civic sensitivity skill involves teaching the importance of relationships and the role that accountability plays in sustaining them. Further, therapists draw patients’ attention to the ripple effects that good and bad actions have on one’s close and distant relations. Several moral decision-making scenarios are presented to help subjects apply their new ways of thinking. The automatic thoughts phase seeks to train subjects to recognize the psychological effect of salient triggers. Patients are asked to reflect on experiences that arouse feelings of anger, fear, humiliation, or anxiety. Finally, various adaptive and maladaptive responses are considered with the aim of teaching deliberate thinking before acting, healthy risk aversion, and counteracting present bias even in emotionally charged circumstances. Sample DF-CBT exercises can be found in Appendix C, along with a link to the full curricular materials published by ideas42.

Relative to the other two methods, the Motivation-Adaptive Skills-Trauma Resolution (MASTR) therapeutic framework is quite under-studied; thus far, the only evidence for it is anecdotal. However, its inventor Dr. Ricky Greenwald touts its efficacy in ameliorating conduct problems, something that very few therapeutic paradigms are designed for. As such, we think that including it as a third treatment group is a great opportunity to test its promises. In the supporting literature, Dr. Greenwald argues convincingly that CBT techniques fail to work through traumatic material, and designated trauma therapies work through trauma but fail to impart “interpersonal, educational, and vocational competence” (Greenwald, 2002). Furthermore, trauma therapies can take a long time depending on the scope of trauma and can be extremely distressing to undergo. MASTR is in principle designed to incorporate non-troublesome elements of trauma therapies into a cognitive-behavioral framework. It works through the three phases denoted in the name: motivation, adaptive skills, and trauma resolution. The motivation stage of treatment focuses on short-term and long-term goal-setting using a visualization technique called Future Movies, wherein the client imagines a movie of the next ten years of his/her life. Subsequent stages of the treatment build on the client’s envisioned outcomes. Next, the adaptive skills stage teaches awareness of internal feelings, recognition of triggers, consideration of consequences during challenging moments, and reducing reactivity to teasing/provocation. Along with the goals identified in the first stage, this stage helps to combat present bias, emotionally charged decision-making, and risk intolerance during heated moments. The trauma resolution stage applies Eye Movement Desensitization and Reprocessing (EMDR) techniques to relatively recent, minor, upsetting experiences to give patients a track record with trauma processing should they decide to pursue it further. I will not elaborate on EMDR for brevity’s sake, but a thorough description of these techniques is available on the American Psychological Association’s website (see references). Greenwald notes three reasons it is better to acquaint clients with trauma processing rather than making it a focus. First, as noted earlier, adolescents may be averse to digging up the most salient memories; it may be overwhelming. Second, resolving all traumas may take too long. In the meantime, patients may drop out, cognitive-behavioral issues are not being dealt with, and conduct problems may persist. Third, the subject may experience additional traumas after treatment, in which case teaching the skill of trauma resolution is better than exhaustively undertaking it.

Analysis

The sampling protocol will be as follows. After instructing the school district to keep a record of conduct problems, they will be regularly reported to our team for a period of at least several months to guarantee a sufficiently large sample size of prior conduct and students. After enough students are obtained (at least 10,000 out of the 75,000 combined middle and high schoolers), one-fourth will be randomly allocated into a control group, which will not be offered therapy (Dallas Independent School District, 2020). The remaining three-fourths will be randomly allocated into the three treatment groups and recruited for therapy by our team. We will run tests to confirm that each of the groups have similar distributions of gender, race, socioeconomic status, and age.

Concerning outcomes of our proposed intervention, we will track five variables: recruitment success rate, first offense rates, conduct problem reports, SAVRY scores, and psychological symptom remission. Let us define each of these.

Recruitment success rate is defined as the percentage who attend an initial appointment out of the total number of students to whom therapy is offered. If recruitment success rate is abysmally low, future studies can be designed to optimize recruitment. Note that recruitment strategy will not differ across treatment groups. For the remaining analyses, we want to isolate the effect of each therapy from the success of recruitment. As such, for each of the foregoing regression models, we will exclude participants who were recruited for therapy but did not pursue it. Comparison of therapeutic benefit cannot be achieved we separately group those who received therapy of each kind and those who did not receive therapy (the control group).

First offense rates refer to the percentage of students who commit an initial offense within three years from the start of our intervention. By tracking this variable for the control group and all three treatment groups (CBT, DF-CBT, and MASTR), we can determine which, if any, treatment is best for reducing delinquency. Specifically, we can encode a set of dummy variables indicating which, if any, treatment was administered, and run a logistic regression with first offense commission within three years as the dependent variable to estimate the effect of each treatment on the probability that a student will commit a crime.

Conduct problem reports will inform us of the number of suspensions, detentions, or other disciplinary actions students incur while in school. We will ask Dallas County schools to record and transmit this data to us (should it be legally viable), and, accordingly, we will be able to track whether behavioral patterns show longitudinal improvements in each group. For this variable, we will conduct a difference-in-difference analysis. We will produce a simple linear regression. The dependent variable will be the difference in average number of conduct problems per month before and after the start of treatment. The regressors will be the type of therapy given (with no therapy as the intercept). Again, we will see whether one of the therapy paradigms is more efficacious than the others in this regard.

Next, as mentioned before, Structured Assessment of Violence Risk in Youth (SAVRY) is administered during the intake appointment and every fourth session thereafter. Because SAVRY cannot be easily administered outside of the therapeutic context, it likely cannot be given to control group members. Thus, SAVRY will be primarily used to compare the efficacy of different therapy paradigms in reducing the risk of violence. As with conduct problems, we will conduct difference-in-difference analysis to compare SAVRY score reductions over time for different treatments. Because SAVRY scores are being collected at four-week intervals, we can determine whether there is an inflection point—a specific number of weeks after which a significant reduction in violence risk is achieved.

Finally, we will assess psychological symptom reduction for each patient. Like SAVRY, the Symptom Checklist-10 (SCL-10) cannot be easily given outside of the treatment context, and we will employ difference-in-difference analysis to assess the effects of different treatments over time on psychological distress. Because there are only ten questions, this analysis can be conducted on a symptom-by-symptom basis.

Discussion and Limitations

This study is designed to assess the efficacy of three therapeutic paradigms in reducing youth criminality, with a specific focus on violent crime. Substantial literature points to the promise of therapy in addressing conduct problems, and similar interventions have been successful in other places. However, no studies thus far have explicitly compared the strengths and weaknesses of different paradigms using the randomized design we have proposed. Prior interventions have explored therapies sequentially, not in parallel.

From a city-planning standpoint, the intervention promises substantial benefits for the city and for its residents. The costs are reasonable, as some facilities and staff are already available. And, in any case, the costs of juvenile crime are surely far greater—in the millions. With a well-timed intervention, students with behavioral troubles can successfully manage their cognitive distortions, namely present bias, risk insensitivity, fear of peer exclusion, and emotional thinking. We believe that therapy will improve outcomes for schools, reduce the long-term incidence of crime, uplift the housing market, reduce log-term healthcare costs, and make policing easier.

Needless to say, there are a few limitations and future directions that must be noted. While we could administer questionnaires to assess the effect of therapy on various cognitive biases, for the purposes of our analyses, biases in and of themselves are not outcome variables; correcting them is only instrumentally valuable as a means of improving subjective well-being and reducing the risk of delinquency. Thus, we focus our analyses on violence risk, psychological symptoms, and behavioral outcomes. We assume that DF-CBT and MASTR, in emphasizing different biases, are successful in curtailing them. Prior research supports this assumption (ideas42, 2017; Greenwald, 2002). If we find that one of these treatments is superior, we can infer that the cognitive distortions it targets are relevant drivers of delinquency. Future studies may consider better ways to target those distortions.

Though our recruitment strategy is designed with stigma in mind, we might find that pre-existing stigma is too pervasive for our design elements to confront it adequately. As much literature attests, interventions are needed that target stigma on multiple levels—intrapersonal, interpersonal, and communal—and over multiple decades (National Academies of Sciences, 2016). These might include financial subsidies/incentives, education campaigns, faith-based supports, familial interventions, media coverage, and/or political messaging. By tracking recruitment success rates, we will be able to ascertain whether efforts are needed at other levels over the course of our intervention, and additional design features can be incorporated as needed.

The basic framework of this study potentially has even broader applicability. One could extend the treatment to younger age groups including elementary school students. Perhaps children who do not attend school can be recruited for treatment as well so that they are more likely to find jobs than to partake in crime. Other cities that lack a therapy program like this one may wish to adapt the therapy curricula to focus on circumstances peculiar to its communities (ex. opioid addiction, gang violence, racism, etc.). The possibilities are broad. Free school lunches were once an uncommon policy measure, but now, such programs are pervasive. An intervention like the one we propose could vault free therapy for schoolchildren into the mainstream.

References

Abram, K.M., Teplin, L.A., Charles, D.R., Longworth, S.L., McClelland, G.M., & Dulcan, M.K. (2004), Posttraumatic stress disorder and trauma in youth in juvenile detention, Archives of General Psychiatry 61(4), 403-410.

American Psychological Association, Eye Movement Desensitization and Reprocessing (EMDR) Therapy, https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing.

Blattman, C., Jamison, J. C. and Sheridan, M. (2017). Reducing crime and violence: Experimental evidence from cognitive behavioral therapy in Liberia. American Economic Review 107, 4, 1165-1206.

Burns, D. D. (1999), Feeling good: the new mood therapy, New York: Morrow.

Child Poverty Action Lab, A Guide to Reducing Childhood Poverty in Dallas.

Dallas Independent School District (2020), Dallas ISD Fact Sheet, https://www.dallasisd.org/Page/2609.

Dallas ISD News Hub (2021), Approved 2021-2022 budget includes $50.5 million in salary increases and funding for discipline reform, https://thehub.dallasisd.org/2021/06/25/approved-2021-2022-budget-includes-50-5-million-in-salary-increases-and-discipline-reform/.

Day, L. (2015), Could more black therapists mean better outcomes?, Center for Health Journalism, https://centerforhealthjournalism.org/fellowships/projects/could-more-black-therapists-mean-better-outcomes.

Dumontheil, I. (2016), Adolescent brain development, Current Opinion in Behav Sci 10, 39-44.

Evans-Chase, M. (2014), Addressing trauma and psychological development in juvenile justice involved youth, Laws 3, 744-758.

Fang, X., Brown, D., Florence, C., & Mercy, J. (2012), The Economic Burden of Child Maltreatment in the United States And Implications for Prevention, Child Abuse Negl 36(2), 156-165.

Forman-Hoffman, V. L., Bose, J., Batts, K. R., Glasheen, C., Hirsch, E., Karg, R. S., Huang, L. N., & Hedden, S. L. (2016), Correlates of Lifetime Exposure to One or More Potentially Traumatic Events and Subsequent Posttraumatic Stress among Adults in the United States: Results from the Mental Health Surveillance Study, 2008-2012, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, https://www.samhsa.gov/data/sites/default/files/CBHSQ-DR-PTSDtrauma-2016/CBHSQ-DR-PTSDtrauma-2016.htm.

Greenwald, R. (2012), Motivation-Adaptive Skills-Trauma Resolution (MASTR) Therapy for Adolescents with Conduct Problems: An Open Trial, from Trauma and Juvenile Delinquency: Theory, Research, and Interventions.

Hallsworth, M., Berry, D., Sanders, M., Sallis, A., King, D., Vlaev, I., & Darzi, A. (2015), Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled Trials, PLOS ONE 10(10).

Heller, S. B., Shah, A. K., Guryan, J., Ludwig, J., Mullainathan, S., Pollack, H. A. (2017), Thinking, Fast and Slow? Some Field Experiments to Reduce Crime and Dropout in Chicago, The Quarterly Journal of Economics 132(1), https://doi.org/10.1093/qje/qjw033.

Hjalmarsson, R., & Lindquist, M. J. (2012), Like godfather, like son exploring the intergenerational nature of crime, Journal of Human Resources 47(2), 550-582.

Hunt, W. (2017), Recidivism and Juvenile Justice Youth: A Study on Recidivism Rates for Youth Awaiting Adjudication, University of Texas at Arlington.

Ideas42 (2017), Reducing Recidivism Rates for Juveniles: CBT in the Juvenile Justice System in Chicago.

Jaycox, L. H., Morse, L. K., Tanielian, T., & Stein, B. D. (2006), How Schools Can Help Children Recover from Traumatic Experiences, RAND Corporation, https://www.rand.org/pubs/research_briefs/RB9229.html.

Katsiyannis, A., & Archwamety, T. (1997), Factors Related to Recidivism Among Delinquent Youths in a State Correctional Facility, Journal of Child and Family Studies 6, https://doi.org/10.1023/A:1025068623167.

Kratzer, L., & Hodgins, S. (1997), Adult outcomes of child conduct problems: A cohort study. Journal of abnormal child psychology 25(1), 65-81. Lin, L., Stamm, K., & Christidis, P. (2018), How diverse is the psychology workforce?, Monitor on Psychology 49(2), http://www.apa.org/monitor/2018/02/datapoint.

National Academies of Sciences (2016), Ending discrimination against people with mental and substance use disorders: the evidence for stigma change.

Nguyen, T. D., Attkisson, C. C., & Stegner, B. L. (1983), Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire, Evaluation and program planning 6(3-4), 299-313.

Mayo Clinic, Cognitive behavioral therapy, https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610. McCabe, K.M., Hough, R.L., Yeh, M., Lucchini, S.E. & Hazen, A. (2005), The Relation Between Violence Exposure and Conduct Problems Among Adolescents: A Prospective Study, American Journal of Orthopsychiatry, 75: 575-584, https://doi.org/10.1037/0002-9432.75.4.575.

McCarthy, A. (2020), Cafe Momentum Built a Restaurant to Revolutionize Juvenile Justice in Dallas. Now, It’s Going National., Dallas Eater, https://dallas.eater.com/2020/11/9/21546388/dallas-restaurant-cafe-momentum-expansion-juvenile-justice-reform-nonprofit.

McLean Hospital (2021), Deconstructing Stigma, https://deconstructingstigma.org/facts.

Mills, K., Goddings, A., Clasen, L., Giedd, J., & Blakemore, S. (2014), The Developmental Mismatch in Structural Brain Maturation during Adolescence, Dev Neurosci 36, 147-160.

Müller, J. M., Postert, C., Beyer, T., Furniss, T., and Achtergarde, S. (2010). Comparison of eleven short versions of the Symptom Checklist 90-Revised (SCL-90-R) for use in the assessment of general psychopathology, Journal of Psychopathology and Behavioral Assessment, 32(2), 246–254. https://doi.org/10.1007/s10862-009-9141-5.

Peltonen, K., Ellonen, N., Pitkänen, J., Aaltonen, M., & Martikainen, P. (2020), Trauma and violent offending among adolescents: a birth cohort study, J Epidemiol Community Health, 74(10), 845-850.

Pew Center on the States (2008), One in 100: Behind Bars in America 2008, https://www.pewtrusts.org/en/research-and-analysis/reports/2008/02/28/one-in-100-behind-bars-in-america-2008.

Prison Entrepreneurship Program (2020), Results, https://www.pep.org/pep-results/.

Shichor, D., & Kelly, D. H. (1980), Critical issues in juvenile delinquency, Lexington Books, Retrieved from https://proxy.library.upenn.edu/login?url=https://www-proquest-com.proxy.library.upenn.edu/books/critical-issues-juvenile-delinquency/docview/38119599/se-2?accountid=14707.

Shampanier, K., Mazar, N., & Ariely, D. (2007), Zero as a special price: The true value of free products, Marketing Science 26(6), 742–757.

Shapiro, R., & Hassett, K. (2012), The Economic Benefits of Reducing Violent Crime, Center for American Progress.

Singh, J., Grann, M., & Fazel, S. (2011), A comparative study of violence risk assessment tools: A systematic review and metaregression analysis of 68 studies involving 25,980 participants, Clinical Psych Review 31(3), 499-513.

Strand BH, Dalgard OS, Tambs K, Rognerud M (2003), Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36), Nord J Psychiatry 57(2), doi: 10.1080/08039480310000932. PMID: 12745773.

Taylor, R. E., & Kuo, B. C. H. (2019), Black American psychological help-seeking intention: An integrated literature review with recommendations for clinical practice, Journal of Psychotherapy Integration 29(4), https://doi.org/10.1037/int0000131.

Trulson, C., & Caudill, J. (2017), Juvenile homicide offender recidivism, Journal of criminal psychology.

Ward, E. C., & Heidrich, S. M. (2009), African American women’s beliefs about mental illness, stigma, and preferred coping behaviors. Res Nurs Health 32(5), doi:10.1002/nur.20344.

Wolfgang, M., Figlio, R., & Sellin, J.T. (1972), Delinquency in a Birth Cohort, University of Chicago Press. Zhao, J., & Tomm, B. M. (2018), Psychological responses to scarcity, Oxford Research Encyclopedia of Psychology.

Appendix A: Structured Assessment of Violence Risk in Youth (SAVRY)

Description: SAVRY is a professional judgment tool used for assessing the risk of violence for adolescents. It provides a framework for structured inquiry that will allow professionals to generate a score that reflects the severity and probability of subject’s violence risk.

Items Assessed:

Historical Risk Factors

Social/Contextual Risk Factors

Individual/Clinical Risk Factors

Protective Factors

Appendix B: Symptom Checklist-10 (SCL-10)

All scored zero to four. 0 = Not at all. 1 = A little bit. 2 = Moderately. 3 = Quite a bit. 4 = Extremely.

How much were you distressed by feeling lonely?

How much were you distressed by feeling no interest in things?

How much were you distressed by feeling afraid in open spaces or on the streets?

How much were you distressed by feeling weak in part of your body?

How much were you distressed by feeling blue?

How much were you distressed by heavy feelings in your arms or legs?

How much were you distressed by feeling afraid to go out of your house alone?

How much were you distressed by feeling tense or keyed up?

How much were you distressed by feelings of worthlessness?

How much were you distressed by feeling lonely even when you are with people?  

Appendix C: Sample exercises from ideas42 delinquency-focused cognitive behavioral therapy (DF-CBT)

Link to full handbook: http://www.ideas42.org/wp-content/uploads/2017/01/CBTCurriculum.pdf

Sensitivity to one’s community sample exercises:

Place a check next to the following statements that you have thought or still think:

__ The people in my community are strangers; I could care less what happens to them.

__ No one really cares about anyone else—they are just in it for themselves.

__ I am not responsible for anyone but myself.

__ I don’t have anything in common with members of my community.

Scenario - Amy’s Problem

Ashley and her mom had an argument because Ashley wanted to go out with friends but her mom said no. Ashley already agreed to stay home and help her mother by cleaning and babysitting, and her mom depended on her help. Ashley became furious and ran away from home later that night. Because Ashley was on probation, her mother called her Probation Officer to report her missing. The next day a warrant was issued for her arrest. It was cold outside and Ashley was hungry, so she went to her friend Amy’s house. When she arrived there she explained the situation to Amy and asked if she could stay there. Amy knows she can get into trouble with the police and her parents if she allows Ashley to stay in her home.

Choose the answer that you agree with for each question.

  1. Should Amy allow Ashley to stay in her home? Yes, No, Can’t Decide
  2. Should Amy call the police and tell them her friend’s location? Yes, No, Can’t Decide
  3. Should Amy call Ashley’s mom? Yes, No, Can’t Decide
  4. Would it be a good idea to give Ashley food and blankets, but tell her she cannot stay at her house? Yes, No, Can’t Decide
  5. What kind of things could Amy say to Ashley in this situation?
  6. Have you ever been in a situation like Amy’s? Like Ashley’s?

Recognition of automatic thoughts sample exercises:

AFROG Framework

A – Alive: Does my self-talk keep me alive by keeping me safe and secure?

F – Feelings: Does my self-talk make me feel better?

R – Reality: Is my self-talk true, real, and rational?

O – Others: Does my self-talk help me get along with others?

G – Goals: Dos my self-talk help me reach my goals?

Managing responses to triggers sample exercises:

Learning to relax

  1. Focus On Your Body
    • Slowly scan your body; tighten and then relax each of your muscles, starting with your feet and moving slowly up to your face muscles
    • Tell yourself to let go of the tension as you focus on each area of your body
    • When you have finished, think of yourself as relaxed and comfortable
  2. Focus On Your Breathing
    • Breathe out through your mouth
    • Breathe in slowly—feel it all the way down into your abdomen as your lungs fill up with air
    • Breathe out slowly through your mouth, feeling your abdomen deflate like a balloon
    • Try this with your hand on your upper abdomen to be more aware of your breathing
  3. Focus On Images
    • Picture a calm, peaceful scene
    • Imagine yourself sitting or lying on a beach feeling the warmth of the sun; in a park, a place with a gentle breeze, watching clouds pass in the sky
    • Think of yourself as completely relaxed and enjoy the sensation
  4. Do Some Other Things:
    • Say the word relax or calm to yourself as you breathe out; or count 1-2-3 to yourself as you slowly breathe out.
    • Stretch
    • Tense your muscles, then let go (e.g., shrug your shoulders up, hold for a few seconds, then let go and notice the difference)
    • Remember a time you felt relaxed and recall the feeling

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