Kendall Ashley D, Emerson Erin M, Hartmann William E, Zinbarg Richard E, Donenberg Geri R
University of Illinois at Chicago and Northwestern University, Evanston, IL.
University of Illinois at Chicago.
J Am Acad Child Adolesc Psychiatry. 2017 Dec;56(12):1053-1061. doi: 10.1016/j.jaac.2017.09.424. Epub 2017 Oct 5.
There is a largely unmet need for evidence-based interventions that reduce future aggression and incarceration in clinically aggressive juvenile offenders serving probation. We addressed this gap using a group randomized controlled trial. Offenders both with and without clinical aggression were included, enabling comparison of intervention effects.
Juveniles 13 to 17 years old (N = 310, mean = 16 years, 90% African-American, 66% male) on probation were assigned to a 2-week intervention targeting psychosocial factors implicated in risky behavior (e.g., learning strategies to manage "hot" emotions that prompt risk taking) or to an equally intensive health promotion control. Participants completed aggression measures at baseline, 6-, and 12-month follow-up and reported on incarceration at 12 months. Spline regression tested symptom change.
Among clinically aggressive offenders (n = 71), the intervention arm showed significantly greater reductions in aggression over the first 6 months compared with controls. Juveniles from the intervention no longer met clinical criteria, on average, but clinically significant symptoms persisted in the control group. By 12 months, participants from the intervention appeared to maintain treatment gains, but their symptom levels no longer differed significantly from those in the control. However, the intervention group was nearly 4 times less likely than controls to report incarceration. Intervention effects were significantly stronger for offenders with clinical than with nonclinical (n = 239) baseline aggression.
A 2-week intervention expedited improvements in aggression and reduced incarceration in clinically aggressive juvenile offenders. The findings underscore the importance of directing intervention resources to the most aggressive youth. Clinical trial registration information-PHAT Life: Preventing HIV/AIDS Among Teens in Juvenile Justice (PHAT Life); http://clinicaltrials.gov/; NCT02647710.
对于减少正在接受缓刑的具有临床攻击性的青少年罪犯未来的攻击行为和监禁率,基于证据的干预措施存在很大的需求缺口。我们通过一项群组随机对照试验来填补这一空白。纳入了有临床攻击行为和无临床攻击行为的罪犯,以便比较干预效果。
对13至17岁(N = 310,平均年龄 = 16岁,90%为非裔美国人,66%为男性)正在接受缓刑的青少年,分配到为期2周的针对涉及危险行为的心理社会因素的干预组(例如,学习管理促使冒险行为的“热”情绪的策略)或同等强度的健康促进对照组。参与者在基线、6个月和12个月随访时完成攻击行为测量,并报告12个月时的监禁情况。样条回归检验症状变化。
在有临床攻击行为的罪犯(n = 71)中,与对照组相比,干预组在最初6个月内攻击行为的减少更为显著。干预组的青少年平均不再符合临床标准,但对照组中仍存在具有临床意义的症状。到12个月时,干预组的参与者似乎维持了治疗效果,但他们的症状水平与对照组不再有显著差异。然而,干预组报告被监禁的可能性比对照组低近4倍。对于基线时有临床攻击行为的罪犯,干预效果比对无临床攻击行为(n = 239)的罪犯显著更强。
为期2周的干预加快了有临床攻击行为的青少年罪犯攻击行为的改善并减少了监禁率。研究结果强调了将干预资源导向最具攻击性的青少年的重要性。临床试验注册信息 - PHAT Life:预防青少年司法系统中青少年感染艾滋病毒/艾滋病(PHAT Life);http://clinicaltrials.gov/;NCT02647710。