A Meta-Analysis on Differences and Associations between Alliance Ratings in Child and Adolescent Psychotherapy.

OBJECTIVE: The alliance in child and adolescent psychotherapy is widely recognized as an important factor in therapy. Studies on the alliance have increasingly focused on assessment of the alliance as a dyadic construct, measuring both client and therapist alliance ratings. However, cross-informant reports of the alliance in child psychotherapy have not yet been subjected to meta-analysis. Therefore, the present meta-analysis aims to increase knowledge on the degree of convergence and divergence between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. METHODS: A series of three-level meta-analyses of 78 studies was conducted to investigate differences and associations between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. RESULTS: Findings indicated that children and parents in general rated the alliance more positively than their therapists (d = 0.35, d = 0.72, respectively), and that child-therapist and parent-therapist alliance ratings were moderately correlated (r = .32, r = .23, respectively). Associations between child and therapist ratings and observer ratings were moderate to large (r = .43, r = .53, respectively). CONCLUSIONS: It can be concluded that children and parents generally report more positively on the alliance compared to their therapists, which is consistent with research on the alliance in adult populations. The small to moderate associations between alliance ratings indicate that individuals to some extent have a shared perspective on their alliance, and that the various perspectives on alliance should be acknowledged when dealing with children and parents in therapy. Implications for future research are discussed.

A Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy.

Previous meta-analyses have found small to moderate associations between child-therapist alliance and treatment outcomes. However, these meta-analyses have not taken into account changes in alliance (i.e., alliance shifts), alliance agreement (i.e., congruence or discrepancies between child-therapist ratings), and the role of alliance as a moderator in relation to treatment outcomes (i.e., an interaction effect of alliance and treatment condition on treatment outcomes). A series of multilevel meta-analyses of 99 studies was conducted to investigate several types of alliance-outcome associations in child and adolescent psychotherapy. Associations between child-therapist alliance and child outcomes (r = 0.17), changes in child-therapist alliance and child outcomes (r = 0.19), child-therapist alliance as a moderator of outcomes (r = 0.09), and parent-therapist alliance and child outcomes (r = 0.13) were small. Associations between child-therapist alliance agreement and outcomes (r = 0.21) and between parent-therapist alliance and parent outcomes (r = 0.24) were small to moderate. This meta-analysis provides the most updated and comprehensive overview of the alliance-outcome association in child and adolescent psychotherapy, showing that the alliance continues to show impact on treatment outcomes. Alliance research in youth psychotherapy has increasingly focused on several complex aspects of the alliance-outcome association, such as the role of changes in alliance, alliance discrepancies, client and therapist variability, and the reciprocal association between alliance and prior symptom change in relation to treatment outcomes. Implications for future research and clinical practice are discussed.

Childhood adversity and vagal regulation: A systematic review and meta-analysis.

Childhood adversity (CA) is associated with increased risk for physical and mental health problems, with alterations in vagal regulation (an aspect of autonomic functioning indexed by vagally-mediated heart rate variability [vmHRV]) implicated as a mechanism. Three-level meta-analyses were conducted to synthesize research on the relationship between CA and 1) baseline vagal activity, and 2) vagal reactivity to challenges including stress tests, emotion-eliciting tasks and cognitive tasks. No significant overall association was found between CA and vagal activity (r = -.015; p = .11) or vagal reactivity (r = -.017; p = .13). However, analyses controlling for moderator interrelatedness revealed an association between CA and lower baseline vagal activity in samples including participants diagnosed with a psychiatric disorder, and for direct adversities such as maltreatment. For vagal reactivity, CA was associated with lower reactivity if the adversity was experienced less recently, and for studies operationalizing reactivity using task mean levels of vmHRV. These findings indicate that small alterations in vagal functioning occur for specific CA subtypes and subgroups of individuals.

The Role of Personal Resilience and Interpersonal Support in Building Fulfilling and Prosocial Lives: Examining the Good Lives Model among Young Women Four Years after Youth Detention.

Despite growing interest in strength-based rehabilitation frameworks, relevant internal/external resources that are likely to facilitate the rehabilitation of detained female adolescents (DFA) have been understudied. This study aims to fill this gap by studying the role of young women's personal resilience and interpersonal support in building fulfilling and prosocial lives 4 years after youth detention, thereby examining the strength-based good lives model (GLM). Forty-nine former DFA (Mage = 20.75) completed questionnaires about resilience, support, Quality of Life (QoL), and offending. Hierarchical multiple regression analyses showed that young women with more resilience displayed higher QoL and less offending, while more support was associated with higher QoL only. The relationship between resilience and QoL/offending did not depend upon the level of support. Overall, our results support the applicability of the GLM to former DFA, showing evidence for the importance of both internal and external resources in building fulfilling and prosocial lives.

Heart-wired to be cold? Exploring cardiac markers of callous-unemotional traits in incarcerated offenders.

Elevated callous-unemotional (CU) traits have been repeatedly identified in a subgroup of offenders that displays severe antisocial behavior; establishing physiological markers may help improve early identification and treatment efforts. This study examines to what extent baseline-resting heart rate (HR) and heart rate variability (HRV) can be used as markers of CU in incarcerated juvenile and adult offenders. CU traits were assessed using the Inventory of Callous-Unemotional traits. Results of the multiple hierarchical regression tests indicated that there was a small yet significant positive association between baseline HR and CU and negative association between HRV and CU in juvenile offenders with medium model effect sizes (R2 = 0.115 for HR-CU; R2 = 0.126 for HRV-CU). The cardiac markers were unrelated to CU in adult offenders. These findings are important because they demonstrate that impaired cardiac autonomic activity is related to CU traits in juveniles, suggesting that socioemotional processing difficulties should be considered in understanding these deficits. Future research should be conducted in large samples, under reactive and static conditions, while including cardiac covariates, to get more clarity on the interplay between biological systems and behavioral expression.

A Quasi-Experimental Study on the Effectiveness of Dutch Cell Dogs in Incarcerated Youth.

This study examined the effectiveness of Dutch Cell Dogs (DCD), a prison-based dog training program that aims to improve socioemotional functioning of incarcerated youth by giving them the opportunity to train a shelter dog. Primary (aggression and institutional infractions) and secondary (wellbeing and therapeutic functioning) outcomes were assessed for the intervention (n = 61) and comparison group (n = 77) before the start of DCD, after 4 weeks, and after 8 weeks at posttest. Overall, DCD participation was not effective. Compared to the comparison group, institutional infractions decreased in DCD participants with an immigrant background and increased in DCD participants with a native Dutch background. In addition, DCD participation reduced the quality of the therapeutic alliance for younger participants and those in secure residential facilities. The current study demonstrated heterogeneity in DTP responsiveness. Future research with robust designs and sufficiently large samples is needed to further identify who benefits from DTPs.

Effects of Awareness Programs on Juvenile Delinquency: A Three-Level Meta-Analysis.

Juvenile awareness programs, such as Scared Straight, remain in use despite the finding that these programs provoke rather than prevent delinquency. The aim of this study was to examine what program components are associated with program effectiveness, which is important for improving these programs. A three-level meta-analysis was conducted. A literature search yielded 13 independent studies (N = 1,536) from which 88 effect sizes could be extracted. A nonsignificant overall effect was found (d = 0.10), indicating that juvenile awareness programs have no effect on offending behavior and other outcomes that are related to delinquency. No significant moderator effects were found for program components. The moderator analyses revealed that juvenile awareness programs are effective in reducing antisocial attitudes (d = 0.46), which has not been meta-analytically studied before. Furthermore, larger effects were found as follow-up length increased. These results show a more nuanced view on the effectiveness of juvenile awareness programs is necessary.

Risk factors for child sexual abuse victimization: A meta-analytic review.

Experiencing child sexual abuse (CSA) is a major public health problem with serious consequences for CSA victims. For effective assessment and (preventive) intervention, knowledge on risk factors and their effects is crucial. Here, the aim was to synthesize research on associations between (putative) risk factors and CSA victimization. In total, 765 (putative) risk factors were extracted from 72 studies, which were classified into 35 risk domains. A series of three-level meta-analyses produced a significant mean effect for 23 of the 35 risk domains ranging from r = .101 to r = .360. The strongest effects were found for prior victimization of the child and/or its family members, such as prior CSA victimization of the child and/or siblings (r = .360), prior victimization of the child other than child abuse (r = .340), prior or concurrent forms of child abuse in the child's home environment (r = .267), and a parental history of child abuse victimization (r = .265). Other identified risks were related to parental problems (e.g., intimate partner violence, r = .188), parenting problems (e.g., low quality of parent-child relation, r = .292), a non-nuclear family structure (e.g., having a stepfather, r = .118), family problems (e.g., social isolation, r = .191), child problems (e.g., having a mental/physical chronic condition, r = .193), and other child characteristics (e.g., being female, r = .290). Moderator analyses suggested that contact CSA victimization may be better predicted than noncontact CSA victimization. It was concluded that an ecological perspective on preventing CSA victimization is necessary. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effectiveness of Dutch Cell Dogs in correctional facilities in the Netherlands: a study protocol of a quasi-experimental trial.

BACKGROUND: Many former inmates recidivate, resulting in high costs for societies worldwide. Evidence based treatment practices may not work in prisons, due to detainees' lacking motivation, impaired well-being, and an unsafe group environment. One attempt to improve social group climate and well-being is the use of Prison-based Animal Programs (PAP). Using a quasi-experimental design, the aim of the current study is to examine the effectiveness of one such PAP in the Netherlands: Dutch Cell Dogs (DCD). METHODS/DESIGN: Participants (N = 256) from 12 justice centers, including psychiatric, juvenile and adult facilities, will be recruited. Half of the sample (n = 128) will receive DCD training after voluntarily signing up (intervention group); The other half (n = 128) will be recruited to participate in the research and receive treatment-as-usual (TAU/Ccomparison group). Factors related to psychosocial functioning (e.g., self-esteem, empathy, self-control, life satisfaction, attention) and general therapeutic factors (i.e., therapeutic alliance, treatment motivation), expected to contribute to treatment success, will be assessed to measure the effectiveness of DCD. In addition, behavioral problems will be measured as well as recidivism rates. Questionnaires and neuropsychological tests will be employed to measure aforementioned outcome variables. Moreover, physiological data, based on heart rate and cortisol measures, will be collected to provide insight into the functioning of participants' physiological stress response and to determine whether stress reduction occurs over time. Multimethod data collection will occur at pre-training (T1), at 1-month (halfway training/T2), at 2-months (end training/T3), and 6-months after the end of the training (follow up/T4). DISCUSSION: This is the first study to examine the effectiveness of a widely implemented PAP in the Netherlands. Challenges associated with conducting the proposed study are typical for practice based research in correctional settings (e.g., a demanding workload of staff, lack of motivation to participate in research). Study results on the effects of a PAP will have an impact on inmates, justice centers, and municipalities across the Netherlands. TRIAL REGISTRATION: Retrospectively registered. The Netherlands National Trial Register TC = 6894 .

The Long-Term Effects of the Youth Crime Prevention Program "New Perspectives" on Delinquency and Recidivism.

New Perspectives (NP) aims to prevent persistent criminal behavior. We examined the long-term effectiveness of NP and whether the effects were moderated by demographic and delinquency factors. At-risk youth aged 12 to 19 years were randomly assigned to the intervention group (NP, n = 47) or care as usual (CAU, n = 54). Official and self-report data were collected to assess recidivism. NP was not more effective in reducing delinquency levels and recidivism than CAU. Also, no moderator effects were found. The overall null effects are discussed, including further research and policy implications.

The Influence of Treatment Motivation on Outcomes of Social Skills Training for Juvenile Delinquents.

This study examined the influence of treatment motivation on posttreatment effectiveness of an outpatient, individual social skills training for juvenile delinquents imposed as a penal sanction. Propensity score matching was used to match a control group of juveniles receiving treatment as usual ( n = 108 of total N = 354) to a treatment group of juveniles receiving Tools4U, a social skills training with a parental component ( N = 115). Treatment motivation was examined as a moderator and predictor of treatment effects on impulsivity, social perspective-taking, social problem-solving, lack of critical reasoning, developmental task-related skills, and parenting skills. Treatment effects were mostly consistent across juveniles with different levels of treatment motivation. Only one moderating effect was found on active tackling (i.e., actively addressing problems), and predictive effects were found on seeking social support, cognitive empathy, hostile intent attribution, and self-centeredness. Implications for further research are discussed.

Research Review: The effectiveness of multidimensional family therapy in treating adolescents with multiple behavior problems - a meta-analysis.

BACKGROUND: Multidimensional family therapy (MDFT) is a well-established treatment for adolescents showing both substance abuse and/or antisocial behavior. METHOD: The effectiveness of MDFT in reducing adolescents' substance abuse, delinquency, externalizing and internalizing psychopathology, and family malfunctioning was examined by means of a (three-level) meta-analysis, summarizing 61 effect sizes from 19 manuscripts (N = 1,488 participants). RESULTS: Compared with other therapies, the overall effect size of MDFT was significant, albeit small in magnitude (d = 0.24, p < .001), and similar across intervention outcome categories. Moderator analysis revealed that adolescents with high severity problems, including severe substance abuse and disruptive behavior disorder, benefited more from MDFT than adolescents with less severe conditions. CONCLUSIONS: It can be concluded that MDFT is effective for adolescents with substance abuse, delinquency, and comorbid behavior problems. Subsequently, it is important to match specific characteristics of the adolescents, such as extent of impairment, with MDFT.

Quality of life in relation to future mental health problems and offending: Testing the good lives model among detained girls.

Detained girls bear high levels of criminal behavior and mental health problems that are likely to persist into young adulthood. Research with these girls began primarily from a risk management perspective, whereas a strength-based empowering perspective may increase knowledge that could improve rehabilitation. This study examines detained girls' quality of life (QoL) in relation to future mental health problems and offending, thereby testing the strength-based good lives model of offender rehabilitation (GLM). At baseline, 95 girls (Mage = 16.25) completed the World Health Organization QoL instrument to assess their QoL prior to detention in the domains of physical health, psychological health, social relationships, and environment. Six months after discharge, mental health problems and offending were assessed by self-report measures. Structural equation models were conducted to test GLM's proposed (in)direct pathways from QoL (via mental health problems) toward offending. Although we could not find support for GLM's direct negative pathway from QoL to offending, our findings did provide support for GLM's indirect negative pathway via mental health problems to future offending. In addition, we found a direct positive pathway from detained girls' satisfaction with their social relationships to offending after discharge. The current findings support the potential relevance of addressing detained girls' QoL, pursuing the development of new skills, and supporting them to build constructive social contacts. Our findings, however, also show that clinicians should not only focus on strengths but that detecting and modifying mental health problems in this vulnerable group is also warranted. (PsycINFO Database Record

Adolescent-Parent Attachment and Externalizing Behavior: The Mediating Role of Individual and Social Factors.

The aim of this study was to test whether the associations between adolescent-parent attachment and externalizing problem behavior of adolescents were mediated by adolescent cognitive distortions, self-esteem, parental monitoring and association with deviant peers. A total of 102 adolescents (71 % male; aged 12-19 years) at risk for developing delinquent behaviors reported on attachment, parental monitoring, aggressive and delinquent behavior and peers. Mediation effects were tested by using structural equation modeling. Different pathways were found depending on the type of externalizing behavior. The association between attachment and direct and indirect aggressive behavior was mediated by cognitive distortions. The relation between attachment and delinquency was mediated by deviant peers and parental monitoring. We argue that clinical practice should focus on the attachment relationship between adolescent and parents in order to positively affect risk and protective factors for adolescents' aggressive and delinquent behavior.

Risk factors for persistent delinquent behavior among juveniles: A meta-analytic review.

Multiple risk domains have been identified for life-course persistent (LCP) offending, but a quantitative review of the effect of different risk domains was not yet available. Therefore, we performed a series of multilevel meta-analyses to examine the effect of several risk domains for LCP offending relative to adolescence-limited (AL) offending. We included 55 studies reporting on 1014 effects of risk factors, and classified each factor into one of 14 risk domains. The results revealed a significant effect for 11 domains ranging from d=0.200 to d=0.758. Relatively large effects were found for the criminal history, aggressive behavior, and alcohol/drug abuse domains, whereas relatively small effects were found for the family, neurocognitive, and attitude domains. The physical health, background, and neighborhood domains yielded no effect. Moderator analyses showed that effects of sibling-related risk factors were larger than effects of mother-related risk factors, and that the effect of the relationship domain was largest during childhood. We conclude that most risk domains contribute to the development of LCP offending and that differences between AL and LCP offenders may be quantitative rather than qualitative. Implications of the present results for risk assessment and the prevention/treatment of LCP offending are discussed.

The association between childhood maltreatment, mental health problems, and aggression in justice-involved boys.

The link between childhood maltreatment and adolescent aggression is well documented; yet, studies examining potential mechanisms that explain this association are limited. In the present study, we tested the association between childhood maltreatment and adolescent aggression in boys in juvenile justice facilities (N = 767) and examined the contribution of mental health problems to this relationship. Data on childhood maltreatment, mental health problems, and aggression were collected by means of self-report measures and structural equation models were used to test mediation models. We found that mental health problems mediated the link between maltreatment and aggression. Results demonstrated different pathways depending on the type of aggression examined. The association between childhood maltreatment and reactive aggression was fully mediated by a variety of mental health problems and for proactive aggression the association was partially mediated by mental health problems. We also found that reactive and proactive aggression partially mediated the association between maltreatment and mental health problems. These findings suggest that a transactional model may best explain the negative effects of childhood trauma on mental health problems and (in particular reactive) aggression. In addition, our findings add to the existing evidence that reactive and proactive aggression have different etiological pathways.

Practitioner review: Effective ingredients of prevention programs for youth at risk of persistent juvenile delinquency--recommendations for clinical practice.

BACKGROUND: There is a lack of knowledge about specific effective ingredients of prevention programs for youth at risk for persistent delinquent behavior. The present study combines findings of previous studies by examining the effectiveness of programs in preventing persistent juvenile delinquency and by studying which particular program, sample, and study characteristics contribute to the effects. Information on effective ingredients offers specific indications of how programs may be improved in clinical practice. METHOD: A literature search in PsychINFO, ERIC, PubMed, Sociological Abstracts, Criminal Justice Abstracts, and Google Scholar was performed. Only (quasi)experimental studies and studies that focused on adolescents at risk for (persistent) delinquent behavior were included. Multilevel meta-analysis was conducted on 39 studies (N = 9,084). Participants' ages ranged from 6 to 20 years (M = 14 years, SD = 2.45). RESULTS: The overall effect size was significant and small in magnitude (d = 0.24, p < .001). Behavioral-oriented programs, focusing on parenting skills training, behavioral modeling, or behavioral contracting yielded the largest effects. Multimodal programs and programs carried out in the family context proved to be more beneficial than individual and group-based programs. Less intensive programs yielded larger effects. CONCLUSIONS: Prevention programs have positive effects on preventing persistent juvenile delinquency. In order to improve program effectiveness, interventions should be behavioral-oriented, delivered in a family or multimodal format, and the intensity of the program should be matched to the level of risk of the juvenile.

A systematic review of financial debt in adolescents and young adults: prevalence, correlates and associations with crime.

Financial debt in young people has increased in recent years. Because debt may have severe consequences, and it may enhance criminal behavior, insight into the prevalence and determinants of debt and its association with crime is important. We conducted a systematic review and meta-analysis of 36 manuscripts to examine the prevalence of financial debt (k = 23), correlates and risk factors of debt (k = 16), and associations between debt and criminal behavior in adolescents and young adults (k = 8). Findings revealed that the prevalence of debt is substantial among young people; on average, 49% reported to have at least some debt, 22% had financial problems. Older participants and ethnic minorities were found to have higher levels of debt than younger and indigenous counterparts. Females had more financial problems and higher student loans. Low self-esteem, a pro-debt attitude (of young people and their parents), lack of perceived control towards financial management, poor social functioning, financial stress and external locus of control were found to have the strongest associations with debt. Studies reported strong associations between debt and crime. Particularly, strong associations were found between serious and persistent crime in young people and later (young adult) debt or financial problems.

Differences between juvenile offenders with and without substance use problems in the prevalence and impact of risk and protective factors for criminal recidivism.

BACKGROUND: Little is known about the needs of substance-using juveniles in treatment aimed at reducing criminal recidivism. Therefore, we aimed to examine treatment needs of substance-using juvenile offenders. METHODS: Differences were examined between juvenile offenders who abstain from substance use (ASU; n=1974) and substance-using juvenile offenders without (SU; n=7000) and with substance use problems (SUP; n=3317), in the prevalence of risk/protective factors for criminal recidivism and strength of associations between risk/protective factors and criminal recidivism. We conducted secondary data analysis on recidivism risk assessments, collected with the Washington State Juvenile Court Assessment, and re-offending data. Analyses of variance and Partial correlations, adjusted for age, gender and ethnicity were applied, as well as Fisher's z tests and logistic regression analyses. RESULTS: Results showed that substance-using offenders, especially those with substance use problems, had more risk factors and less protective factors than ASU youths in the domains of school, use of free time, relationships, family, attitude, aggression and skills. The associations between most of the risk/protective factors and recidivism were stronger in the ASU group than in the SUP group. Substance use uniquely predicted recidivism, net of risk factors. CONCLUSIONS: These results suggest that general interventions for juvenile offenders addressing risk and protective factors with the aim to reduce recidivism may be less effective for offenders with substance use problems, and that substance use (problems) should be addressed, too.

Service referral for juvenile justice youths: associations with psychiatric disorder and recidivism.

Secondary multiple regression analyses related disorder profile, probation officers' mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receive service referrals. Substance disordered youths with service referrals had lower recidivism risk compared to counterparts without referrals; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk.