Promising - More than one study
Program Goals/Target Population
The Mendota Juvenile Treatment Center (MJTC) is a residential facility that provides mental health treatment to serious and violent juvenile offenders in secured correctional institutions. The program was established by the Wisconsin State Legislature in 1995 to meet the needs of youths who are too unruly, aggressive, or “treatment refractory” to be housed in the state’s traditional correctional centers. Youths are typically transferred to MJTC when they are unresponsive to customary rehabilitation services provided in correctional institutions. MJTC seeks to control and rehabilitate such youth by combining the security consciousness of a traditional correctional institution with the strong mental health orientation of a private psychiatric facility.The overarching goal of the program is to replace the antagonistic responses and feelings created by traditional correctional institutions with more conventional bonds and roles, which can encourage positive social development.
The treatment model is based on the notion that rebellious behavior can become cyclical when the defiant response to a sanction is itself sanctioned, resulting in more defiance and increasing sanctions (Sherman 1993). With each reiteration, the youth is further disenfranchised from conventional goals and values and is increasingly “compressed” into a defiant behavior pattern. The MJTC uses a decompression model (Monroe et al. 1988) that attempts to erode the antagonistic bond with conventional roles, expectations, authority figures, and other potential sanctioning agents, and replace them with conventional bonds. A fundamental concept of the decompression model is that treatment should do more than just provide juvenile offenders with needed skills. Treatment should also address the youth’s detachment from, and antagonistic defiance of, conventional behaviors and lifestyles.
Unlike most secured, state-funded correctional facilities, MJTC is housed on the grounds of a state mental health center. The staff consists of experienced mental health professionals rather than security guards or correctional officers. This organizational design allows for a clinical–correctional hybrid approach to treating violent juvenile offenders that addresses security concerns while promoting a core mental health philosophy.
There are several organizational and structural differences between MJTC and traditional juvenile correctional institutions. Program residents are housed in single bedrooms in small inpatient units with about 15 youths per unit (as compared to 50 double-bunked youths in conventional juvenile correctional institutions). There is 1 psychologist, 1 social worker, and a half psychiatry position for every 20 youths in MJTC, compared to about 1 psychologist for every 75 youths and 1 social worker for every 40 youths in traditional correctional settings. In addition, day-to-day administration of MJTC is the responsibility of a psychiatric nurse manager, while correctional institutions are generally run by experienced security staff.
Although youth in juvenile correctional institutions receive mental health services, treatment is less frequent and usually offered in weekly individual or group therapy sessions. Conversely, within a private, clinical setting, youth in MJTC undergo intensive individualized therapy designed to treat their underlying emotional problems and “break the cycle of defiance” triggered by typical institutional settings. Whenever youth in treatment act out or become unruly, they receive additional therapy as well as enhanced security.
Overall, the studies evaluating the impact of the Mendota Juvenile Treatment Center (MJTC) showed treatment had a significant impact on measures of felony and violent felony offenses, but did not impact misdemeanor offenses.
Prevalence of Offending
The evaluation by Caldwell and Van Rybroek (2005) showed that at the 2-year follow-up period, 52 percent of the treatment group had recidivated compared to 73 percent of the comparison group. With regard to more serious violence, 37 percent of the comparison group was charged with a violent felony (25 percent of which involved serious victim injury or death), while only 18 percent of the treatment group was charged with a violent felony (only 7 percent of which involved serious victim injury)—all significant differences. However, there were no significant differences between the groups on misdemeanor offenses.
Offense-Free Time in the Community
After controlling for the effects of nonrandom assignment to the treatment and comparison groups, results showed MJTC predicted longer survival time for misdemeanor offenses. Thus, although the MJTC treatment did not appear to affect the number of juveniles who reoffended with misdemeanor offenses, the treatment did appear to have contributed to longer periods of community adjustment before the first misdemeanor offense.
In addition, after controlling for the effects of nonrandom assignment, results showed MJTC predicted both lower rates of serious and violent recidivism and longer survival times in the community. Thus, MJTC treatment not only reduced the number of youths involved in serious and violent offenses, but also increased the time youths spent in the community before failure.
Of the 141 youths with psychopathy features included in the study by Caldwell and colleagues (2006), 10.6 percent were released directly to adult prison following treatment. For these youths, recidivism occurred in juvenile institutional settings after treatment. Therefore, the results were examined in two ways: 1) combined institutional and community recidivism, and 2) community recidivism only.
Results showed that youths treated in the MJTC were significantly less likely to recidivate in general. Within 2 years of release from custody, 57 percent of treatment youths had recidivated in the institution or community, compared with 78 percent of comparison youths. Considering only cases of youths who had some community access during the follow-up period, 56 percent of MJTC–treated youths had recidivated following release compared to 73 percent of comparison youtsh.
Youths treated in the MJTC were also significantly less likely to be involved in violence. Only 21 percent of MJTC–treated youths were involved in institutional or community violence within 2 years of release compared with 49 percent of comparison youths. Considering only cases of youth who had some community access during the follow-up period, 18 percent of treatment youths were involved in community violence compared to 36 percent of comparison youths.
In addition, 10.7 percent of MJTC youths were charged with a violent, injurious felony compared with 29.5 percent of comparison youths (a statistically significant difference). However, when considering only cases of youths who had some community access during the follow-up period, there were no significant differences between the groups on violent, injurious felony recidivism.
Offense-Free Time in the Community
After controlling for the effects of nonrandom assignment, results showed MJTC treatment had no reliable effect on general recidivism in the community. However, MJTC treatment did predict a slower rate of violent recidivism. Youths who completed MJTC treatment were 2.7 times less likely to become violent in the community than comparison youths. At the 2-year follow-up period, probability of community violence was approximately 16 percent for the MJTC group and 37 percent for the comparison group.
Caldwell and Van Rybroek (2005) examined the impact of the intensive treatment program by comparing the outcome results of 101 male youths treated to the point of recommended release at the Mendota Juvenile Treatment Center (MJTC) to 147 comparison male youths who were admitted to MJTC briefly for assessment or stabilization services and returned to a secured juvenile correctional institution. The treatment group consisted of youths who had been transferred to MJTC because they had failed to adjust to the correctional institution setting. They had been disruptive or aggressive enough to, in effect, have been “expelled” from traditional rehabilitation services. Staff from the secured correctional institution decided whether the youth would be returned to that facility. Youths in the comparison group were returned to the facility when it was believed they could benefit from conventional rehabilitation services in the institution.
The sample consisted of male juveniles. In total, 51 percent were African American, 38 percent were white, 9 percent were Hispanic, and 2 percent were Asian or Middle Eastern. The average age was 17 years and 1 month. For demographic and historical variables, there were no statistically significant differences between the treatment and control groups, except on race. The treatment group consisted of 59 percent African American males, and the comparison group consisted of 37 percent African American males. There were no significant differences on the clinical and diagnostic information about the treatment and comparison groups. There were also no significant differences on institutional and release characteristics, except for one: MJTC treatment youths were more likely to be granted early release and therefore spent fewer total days in incarceration.
The study looked at information about youths who were admitted over a 4 1/2-year period (when data was available). Recidivism outcome variables were drawn from public court records of filed charges. Data on the offenses included the type (nonviolent, misdemeanor, nonviolent felony, violent misdemeanor, violent felony with injury, and homicide); number of offenses in each category; and days at large before each offense type. All youths were followed from the date of their release from juvenile confinement to August 1, 2003. The average follow-up period was about 4 1/2 years (1,657 days). There were no significant differences between treatment and comparison groups on average days of follow-up.
Because of the nonrandom group assignment, there was a possibility that the true effect of MJTC was distorted due to sampling bias. To account for this possibility, a propensity score analysis was conducted. A propensity score representing the probability that each case would be in the treatment group was generated based on numerous variables (such as age of first arrest, number of Conduct Disorder Symptoms, academic achievement scores, and number of charged crimes against persons). The propensity scores were then used as one of two covariates to assess the association between MJTC treatment and recidivism. Survival analysis for each outcome variable was also conducted to determine the association between MJTC treatment and offense-free time in the community. Cox regression analysis was used, in which the propensity score was entered first, followed by the treatment group assignment.
Caldwell and colleagues (2006) examined the treatment responses of 141 juvenile male offenders with high scores on the Psychopathy Checklist: Youth Version (PCL: YV) [M total > 27]. Fifty-six of those offenders received intensive treatment in the MJTC and 85 received treatment as usual in conventional juvenile correctional institution settings. Study participants were consecutively released from MJTC between 1995 and 1997, after participating in either a brief evaluation or full treatment that was prompted by disruptive and unmanageable behavior. Youths were transferred at the discretion of staff at the juvenile correctional institution when they were found to be nonresponsive to rehabilitation services. They were returned to the correctional institution when they were found to be more amenable to the usual services.
Overall, the study sample was 59 percent African American, 31 percent white, and 10 percent Hispanic, Native American, Asian, or Arab. For demographic and historical variables, there were no statistically significant differences between the treatment and control groups, except on race. The treatment group was 41.1 percent African American, and the comparison group was 71.8 percent African American. There were no significant differences on the clinical and diagnostic information about the treatment and comparison groups. There were also no significant differences on institutional and release characteristics, except for one: MJTC treatment youths were more likely to be granted early release and therefore spent fewer total days in incarceration.
Recidivism outcomes of interest were measured as the number and type of charges filed in a state circuit court against the youth over the 2 years (730 days) following release from secured custody. Recidivism data was collected from a statewide computer database of circuit court records. The PCL: YV was used to assess youths’ psychopathy features. Scores were compiled at the time of admission to MJTC and based on an interview and review of youths’ records. The treatment group had an average PCL: YV score of 33.5; the comparison group had an average score of 33.8.
Again, propensity score analyses were conducted to correct for the effect of nonrandom assignment to the MJTC treatment group. The propensity score analyses supplemented the basic analyses of the relationship between treatment and recidivism outcomes.
Caldwell, Vitacco, and Van Rybroek (2006) analyzed the costs–benefits of intensive treatment provided in the Mendota Juvenile Treatment Center (MJTC) to treatment as usual. All figures were adjusted to 2001 costs. For each participant, the costs of treatment, prison, and criminal justice processing was calculated.
The analysis found that the cost for juvenile institutional treatment per youth for comparison group youth was $154,917.79, compared with $161,932.23 per youth who received treatment in MJTC (although the difference was not statistically significant). This results in an average marginal cost of treating a youth in MJTC of $7,014.44, an added cost of 4.5 percent over the mean costs for comparison group youth.
However, due to the lower reoffending rates of the MJTC treatment group, the costs of criminal justice processing was significantly lower than for the comparison group. Criminal justice processing costs were approximately $14,103.24 per comparison youth and $5,927.07 per treatment youth, meaning taxpayers saved $8,176.17 per treatment youth in avoided criminal justice costs. Prisons costs were also significantly less for the treatment group. Prisons costs were approximately $47,366.97 per comparison youth and $5,152.90 per treatment youth, amounting to a savings of $42,214.07 per youth.
In total, the mean per-youth costs for the comparison group across all three cost categories in the analysis was $216,388.00, whereas the per-youth costs for the MJTC treatment group was $173,012.20 across all three cost categories. The net treatment group costs averaged 20 percent less than the comparison group ($43,375.80 less in net costs) over 4½ years. MJTC had a cost–benefit ratio of 1 to 7.18, meaning the program produced benefits of $7.18 for every dollar of cost.
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1Caldwell, Michael F., and Gregory J. Van Rybroek. 2005. “Reducing Violence in Serious Juvenile Offenders Using Intensive Treatment.” International Journal of Law and Psychiatry 28:622–36.Study 2Caldwell, Michael, Jennifer Skeem, Randy Salekin, and Gregory Van Rybroek. 2006. “Treatment Responses of Adolescent Offenders With Psychopathy Features: A 2-Year Follow-Up.” Criminal Justice and Behavior 33(5):571–96.
These sources were used in the development of the program profile:
Caldwell, Michael F., Michael Vitacco, and Gregory J. Van Rybroek. 2006. “Are Violent Delinquents Worth Treating? A Cost–Benefit Analysis.” Journal of Research in Crime and Delinquency
Monroe, Craig M., Gregory J. Van Rybroek, and Gary J. Maier. 1988. “Decompressing Aggressive Inpatients: Breaking the Aggression Cycle to Enhance Positive Outcome.” Behavioral Sciences and the Law
Sherman, Lawrence. 1993. “Defiance, Deterrence, and Irrelevance: A Theory of the Criminal Sanction.” Journal of Research in Crime and Delinquency