Managing risky behavior reduces future incarceration among aggressive juvenile offenders

Clinically aggressive juvenile offenders on probation in Cook County, Illinois, who participated in a two-week intervention program focusing on reducing risky behavior were four times less likely to be incarcerated in the 12 months after the intervention than their peers who participated in an information-based health promotion program.

The findings, by researchers at the University of Illinois at Chicago, are published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Mounting evidence suggests that incarceration frequently exacerbates psychiatric conditions, including aggression, among youth and leads to further incarceration.

“Most juvenile offenders are released back into the community following arrest, but without new skills for coping with the environmental triggers that may have prompted behaviors leading to arrest, and they are at high risk for incarceration,” said Ashley Kendall, postdoctoral fellow in the UIC School of Public Health and first author on the paper.

Kendall and her colleagues wanted to measure the efficacy of a two-week psycho-social intervention for juvenile offenders serving probation on future aggression and incarceration. They worked closely with the Cook County Department of Juvenile Probation to evaluate the efficacy of PHAT Life (Preventing HIV/AIDS among Teens), which focuses on recognizing triggers that lead to risky behavior, be it sexual or aggressive in nature, and guide youth through envisioning ways to cope with “hot” feelings that prompt risk taking. PHAT Life was developed by Geri Donenberg, professor of medicine in the UIC College of Medicine and senior author on the paper.

The researchers compared participation in PHAT Life to an equally intensive health information program among 310 participants, ages 13 to 17 years old, residing in Cook County and on probation. In this randomized, controlled study, the average age of participants was 16 years old; about 30 percent of participants were female and 90 percent were black.

Participants were asked to complete aggression surveys before the start of the intervention programs, and again six months and 12 months after the intervention. Each time they took the surveys, they were asked to reflect back on their aggression levels over the previous six months.

Prior to the beginning of the interventions, 71 participants reported clinically significant aggression in the surveys. “This means that these participants reported levels of aggressive behavior that typically have significant negative impact on their lives,” Kendall said. “These youth reported they did things like physically attack people, destroy others’ property and yell often.”

The PHAT Life program focused on factors involved in risky behaviors, including unhealthy relationships, substance use, emotional regulation and peer influence. Youth identified unique people, places, situations or moods that triggered high-risk behavior and developed specific plans for addressing the triggers.

The control group participated in a program that provided information on nutrition, substance use, violence and HIV/AIDS. Participants also reviewed tips for preventing interpersonal conflicts from becoming violent.

The programs consisted of eight sessions lasting 90 to 120 minutes each over the course of two weeks. They were delivered at detention alternative programs run by the Cook County Department of Juvenile Probation called evening reporting centers, or ERCs. These centers provide after-school supervision as part of probation.

PHAT Life, the researchers found, seemed to have the most impact on reducing aggressive behavior in those who reported clinical aggression at the beginning of the intervention, compared with those who were not clinically aggressive at the start.

Among clinically aggressive participants, those enrolled in PHAT Life showed meaningful reductions in aggression over the first six months compared with participants in the control group. By 12 months after the intervention, participants in PHAT Life appeared to maintain reductions in aggressive behavior, but the control group had equally low levels.

“We think that aggression was probably elevated for most offenders at the time of arrest, so we’d expect to see everyone ‘cool down’ over the following year,” said Kendall. “That PHAT Life expedited improvements is likely still important, given how costly even six months of aggressive behavior can be.”

Clinically aggressive participants in PHAT Life were also nearly four times less likely to report incarceration in the last six months on their 12 month post-program surveys compared with those in the control group.

“We are currently expanding the delivery of PHAT Life to youth on probation in Cook County by training probation staff and youth who were previously involved in the justice system to deliver the program to their peers,” said Donenberg. “We hope this sets to stage for a better long-term trajectory for all justice-involved youth.”

Erin Emerson and William Hartmann, UIC, and Richard Zinbarg, Northwestern University, are co-authors on the paper.

This research was supported in part by grant R01 MD005861 from the National Institute of Minority Health and Health Disparities.