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Program Profile: Risk Detection/Executive Function Intervention

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 21, 2016

Program Summary

This is a program for adolescent females with a history of violence/abuse and involvement in the child welfare system. The goal of the program was to reduce re-victimization in teen dating situations. The program used mindfulness-based, cognitive interventions to build skills for responding to risky situations and improving executive function (including reasoning and problem solving). The program is rated Promising. The intervention was shown to reduce sexual and physical re-victimization.

Program Description

Program Goals
The Risk Detection/Executive Function (RD/EF) program set out to reduce sexual and physical re-victimization in girls who had previously been exposed to maltreatment. Research has found that youths with histories of re-victimization have impaired abilities to detect threats or risky situations in intimate relationships (an ability known as risk detection [RD]). Research has also shown an important link between youths who experience child abuse and deficits in executive function (EF). EF refers to those cognitive skills that allow an individual to respond to risks of danger in a relationship (DePrince et al. 2013). Based on this research, the RD/EF intervention not only focused on improving girls’ ability to perceive risky and dangerous situations, but also on improving their ability to respond to those situations. 
 
Target Population/Eligibility
The RD/EF program focused on adolescent females between the ages of 12–19. The participants were referred to the program (by their caseworkers, service providers, or legal guardians) because they were currently or previously involved with the child welfare system and had a history of maltreatment exposure. They were also eligible for the study if they 1) did not report current suicidal ideation; 2) were receiving current treatment services for reported suicide attempts or psychiatric hospitalizations within the last 3 to 6 months; and 3) were receiving current treatment services for reported self-harm behavior or psychosis (DePrince et al. 2013).
 
Program Theory
Risk detection (RD) requires that an individual notice and respond to danger cues (both external, such as a dating partner’s threatening behaviors, and internal, such as one’s own feelings of fear or discomfort) in intimate relationships (DePrince 2006). A range of cognitive skills, called executive functions (EFs), are required for one to notice and respond to danger cues. These skills include the ability to shift, inhibit, and focus attention; maintain focus in the face of distracting information; update new information to the working memory system; think flexibly about potential solutions; and plan and initiate actions (DePrince et al. 2013, p. 14). In potentially dangerous situations, teens with compromised EF, due to previous victimization, may have trouble noticing potential danger cues and may not be able to figure out how to respond to threats. The authors theorized that teaching teens the EF skills needed to notice and respond to danger cues would result in decreased re-victimization. 
 
Program Activities
To create the Risk Detection/Executive Function intervention, DePrince and colleagues (2013) modified a risk detection program, which had been developed by Marx and colleagues (2001) for college students. Additionally, they adapted a mindfulness-based intervention, originally developed by DePrince and Shirk (2013), to target alterations in executive functioning. They integrated the mindfulness-based program with Marx’s risk detection curriculum and made it age-appropriate and engaging.
 
The program was implemented outside of school, in a community-based location, and included 12 sessions, each with a detailed session theme. The sessions each lasted 1.5 hours and were provided weekly. Using mindfulness-based, cognitive interventions, the program helped adolescents become more aware of both internal (e.g., feelings of shame, fear) and external (e.g., a partner’s threatening behaviors or the presence of nearby danger) cues for risky situations and ways to respond to risks. Sessions included the following:
  1. Introduction to the group (meeting other members, establishing rules)
  2. Consequences of violence/abuse: Going on auto-pilot
  3. What is violence and aggression?
  4. Getting on active pilot: Noticing the world around us
  5. Getting on active pilot: Noticing our bodies and physical sensations as guides
  6. Getting on active pilot: Noticing our thoughts as guides
  7. Getting on active pilot: Noticing our reactions as guides
  8. Active pilot in dating situations: What is risky?
  9. Responding to risk: Figuring out what to do
  10. Responding to risk: Knowing what to do and asserting what I want
  11. Responding to risk: Knowing where to get help
  12. End of group celebration 
Key Personnel
Two co-facilitators covered the content of the program, using the program manuals. The co-facilitators were graduate-level trainees and received weekly supervision from the program developer.  The program developer also served as a co-facilitator.

Evaluation Outcomes

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Study 1
Sexual Revictimization
DePrince and colleagues (2013) found that 6 months after the treatment, the girls who participated in the Risk Detection/Executive Function program were nearly five times more likely not to be sexually re-victimized, compared with the girls in the comparison group.
  
Physical Revictimization
In addition, 6 months after the treatment, the girls who participated in the Risk Detection/Executive Function program were more than three times more likely not to be physically re-victimized, compared with the girls in the comparison group.
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Evaluation Methodology

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Study 1
DePrince and colleagues (2013) used a quasi-experimental design study to assess the effects of the Risk Detection/Executive Function (RD/EF) intervention on physical and sexual re-victimization. The program took place in Denver and the surrounding areas. Adolescent girls between 12 and 19 were referred to participate in the Healthy Adolescent Relationship Project (HARP) by their caseworkers, foster parents, or service providers. Referred adolescents were assessed prior to being randomized into a treatment condition. Eligible participants were randomly assigned into two different treatment groups (i.e., the RD/EF intervention, described here, and the Social Learning/Feminist intervention, described in a separate program description).The sample also comprised a non-random comparison group of eligible individuals who did not participate in either group. 
 
There were no significant pre-treatment differences between the groups. The RD/EF group consisted of 67 adolescent girls. Of the 57 girls who shared race data, 42 percent were white, 31 percent were black, 2 percent were Asian/Asian American, 11 percent were American Indian/Native Alaskan/Native American, and 14 percent were other races. The comparison group consisted of 42 individuals, 34 of whom provided race information. The comparison group was 35 percent white, 32 percent black, 3 percent Asian/Asian American, 6 percent American Indian/Native Alaskan/Native American, 21 percent other races, and 3 percent unknown (declined to answer).
  
Participants in the study engaged in four, 2-hour assessments. These occurred prior to the intervention (Time 1), immediately after the intervention (Time 2), and again 2 and 6  months after the intervention (Times 3 and 4). The presence/absence of re-victimization was measured using a combination of data gathered from The Traumatic Events Screening Inventory-Child Version (TESI), which gauged previous trauma exposure, and the Conflict in Adolescent Dating Relationship Inventory (CADRI), which assessed dating violence. Linear contrast analysis on estimates from a repeated measures, generalized estimating equation (GEE) approach was used to determine the effects of the program on sexual and physical re-victimization in Times 2, 3, and 4.
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Cost

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There is no cost information available for this program.
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Implementation Information

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DePrince and colleagues (2013) developed a checklist to assess fidelity to the Risk Detection/Executive Function intervention curricula.
 
For example, for Session 3 (“What is violence and aggression?”), implementation should include a mindfulness exercise and the session should cover facts about violence against women, personal rights, and the connection from personal rights to attention.
 
Further examples of specific items assessed in the checklist are provided in the original report, available at https://www.ncjrs.gov/pdffiles1/nij/grants/244086.pdf.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
DePrince, Anne P., Ann T. Chu, Jennifer Labus, Stephen R. Shirk, and Cathryn Potter. 2013. Preventing Revictimization in Teen Dating Relationships. Technical Report. Washington, D.C.: U.S. Department of Justice.

https://www.ncjrs.gov/pdffiles1/nij/grants/244086.pdf
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Additional References

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These sources were used in the development of the program profile:

DePrince, Anne P. 2006. “Cognitive Correlates of Trauma Exposure.” Paper presented at the Neuroscience Research Group, University of Denver, Denver, Colo.


DePrince, Anne P., and Stephen R. Shirk. 2013. “Adapting Cognitive-Behavioral Therapy for Depressed Adolescents Exposed to Interpersonal Trauma: A Case Study With Two Teens.” Cognitive and Behavioral Practice, 20, 198–201.


Marx, B.P., K.S. Calhoun, A.E. Wilson, and L.A. Meyerson. 2001. “Sexual Revictimization Prevention: An Outcome Evaluation.” Journal of Consulting and Clinical Psychology, 69, 25–32.

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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

School-Based Interventions to Reduce Dating and Sexual Violence
This practice includes universal-level prevention and intervention programs in schools that aim to reduce or prevent teen dating violence perpetration and victimization. The practice is rated Effective for reducing perpetration of teen dating violence and improving dating violence knowledge and attitudes. The practice is rated No Effects for reducing teen dating violence victimization.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Crime & Delinquency - Violent offenses
Effective - One Meta-Analysis Attitudes & Beliefs - Teen Dating Violence Knowledge
Effective - One Meta-Analysis Attitudes & Beliefs - Teen Dating Violence Attitudes
No Effects - One Meta-Analysis Victimization - Domestic/intimate partner/family violence
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Program Snapshot

Age: 12 - 19

Gender: Female

Race/Ethnicity: Black, American Indians/Alaska Native, Asian/Pacific Islander, Hispanic, White, Other

Geography: Suburban, Urban

Setting (Delivery): Other Community Setting

Program Type: Classroom Curricula, Conflict Resolution/Interpersonal Skills, Crisis Intervention/Response, Gender-Specific Programming, Group Home, Victim Programs, Children Exposed to Violence, Violence Prevention

Targeted Population: Females, Victims of Crime, Children Exposed to Violence

Current Program Status: Not Active

Listed by Other Directories: Model Programs Guide

Researcher:
Anne DePrince
Professor
Department of Psychology, University of Denver
2155 S. Race Street
Denver CO 80208
Email