Early Outcomes from a Girl-Specific Tertiary Prevention Program in Juvenile Justice: An Integrated Care Approach

Introduction: This paper describes early results from an affordable, gender-specific, indicated prevention program for justice-involved girls. Girl Only Active Learning (GOAL) is a girl-specific, complex adaptation of Aggression Replacement Training that is based on a cognitive-behavioral model of emotion regulation, problem-solving and moral reasoning used by other CBT based interventions for offenders (Goldstein & Glick, 1994). ART is demonstrated to reduce delinquency (Caldwell et al., 2006; Barnoski, 2004) and is rated as cost-beneficial by the Washington State Institute of Public Policy (www.wsipp.wa.gov). However, lower completion success rates (73% boys, 64% girls) and mixed outcomes-based results with girls suggest adaptation is needed to increase effectiveness with this population (Cleare, 2001; Nugent et al., 1999). Consequently, the adaptation draws from the risk pathways literature with four primary adjustments: 1) Expands emotional targets for regulation to internalizing symptoms; 2) Expands cognitive restructuring to address negative self-thoughts and peer acceptance; 3) Uses relationship-based scenarios for skill generalization; and 4) Uses technology to increase parenting skills and maintain parent engagement through text and email messages in addition to other effective outreach strategies.  Additionally, the project evaluates the feasibility of implementing GOAL in juvenile justice service settings using frontline staff as facilitators, a model that will achieve considerable cost benefit if successful. Our proposal is the first to propose the innovative integration of technology, court-embedded group facilitators, and girl-responsive treatment components.

 

Methods: The study is on track to enroll 120 girls (13-17 years)  in the research study by August 2017. Girls involved in the project are rated as moderate or high risk on a standard, validated risk assessment used by Washington State Juvenile courts (PACT). The quasi-experimental design assigns girls to treatment or control based on first-served capacity, with overflow being assigned to usual court programming. In the majority of cases girls not receiving GOAL receive  Aggression Replacement Training. This paper will report on the preliminary findings of the first 50 girls (30 GOAL, 20 comparison) to complete the study as well as the process of developing a real-world intervention with the intended service deliverers, in this case probation counselors.

Results:  Differences between treatment and control will be examine with between subjects tests, potentially controlling for site differences if intraclass correlations within sites are found to exceed 20%. The paper will report on differences in emotional regulation skills (Difficulties in Emotional Regulation Scale), substance use patterns (frequency, type, context), family conflict and subsequent court involvement. 

Conclusions: To date, significant barriers to widespread implementation of evidence-based practice have included cost and perceived applicability to special groups. This study examines the  feasibility of an integrated care model in which probation counselors are the intended service delivery staff for a group specific (girls) program.