The effectiveness of Forensic Outpatient Systemic Therapy in the treatment of juvenile antisocial behavior: A study protocol of a Multiple Case Experimental Design

BACKGROUND

Juvenile antisocial behavior can have long-lasting and devastating effects for juveniles themselves, victims, and society. Evidence-based treatment is vital. Forensic Outpatient Systemic Therapy (Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles showing severe antisocial behavior including aggression, (domestic) violence, and delinquent behavior. FAST has a flexible intensity and length, addresses individual and systemic risk and protective factors, and is responsive to the abilities of the client (system), intervention characteristics all considered crucial for effective treatment. The current study will investigate whether FAST is effective in reducing aggression of the juvenile, reaching client formulated subgoals, and improving family functioning. Processes of change will be examined, as well as mediation by reaching client formulated subgoals and improved family functioning.

METHODS

A Multiple Case Experimental Design (MCED) with an ABC design will be performed (A = baseline, B = intervention, and C = follow-up). Juveniles with primary aggression and/or anger problems (N = 15) and their caregiver(s) will be recruited. Data collection will consist of self-report questionnaires and case file analysis. Participants fill out frequent short self-report questionnaires (twice a week during phase A, every other week during phase B, and every week during phase C) and two main questionnaires at the start of the intervention and immediately after intervention end, thereby covering a period of 5 to 11 months. Both visual and statistical analyses will be performed.

DISCUSSION

This study will generate robust knowledge and inform clinical practice on the effectiveness, processes of change, and mediating mechanisms of FAST, aiming to improve the treatment of future families within youth forensic care.

TRIAL REGISTRATION

This trial was registered at ClinicalTrials.gov on 28/08/2023, protocol ID 60-63600-98-1138a.

The effectiveness of blended versus regular Forensic Outpatient Systemic Therapy in the treatment of juvenile antisocial behavior: a study protocol of a randomized controlled trial

BACKGROUND

Antisocial behavior during adolescence can have long-lasting negative effects and leads to high societal costs. Forensic Outpatient Systemic Therapy (Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles aged 12-21 showing severe antisocial behavior. The intensity, content and duration of FAST can be adjusted to the needs of the juvenile and their caregiver(s), which is considered crucial for effective treatment. Next to the regular version of FAST (FASTr), a blended version (FASTb) in which face-to-face contacts are replaced by minimally 50% online contacts over the duration of intervention was developed during the Covid-19 pandemic. The current study will investigate whether FASTb is equally effective as FASTr, and through which mechanisms of change, for whom, and under which conditions FASTr and FASTb work.

METHODS

A randomized controlled trial (RCT) will be carried out. Participants (N = 200) will be randomly assigned to FASTb (n = 100) or FASTr (n = 100). Data collection will consist of self-report questionnaires and case file analysis, and include a pre-test at the start of the intervention, a post-test immediately after the intervention, and a six month follow-up. Mechanisms of change will be investigated using monthly questionnaires of key variables during treatment. Official recidivism data will be collected at two-year follow-up.

DISCUSSION

This study aims to improve the effectiveness and quality of forensic mental health care for juveniles with antisocial behavior by studying the effectiveness of blended care, which has not been studied before in treatment of externalizing behavior. If found to be at least as effective as face-to-face treatment, blended treatment can help meet the urgent need for more flexible and efficient interventions in this field. In addition, the proposed study aims to unravel what works for whom, knowledge urgently needed in mental health care for juveniles with severe antisocial behavior.

TRIAL REGISTRATION

This trial was registered at ClinicalTrials.gov on 07/11/2022, registration number NCT05606978.

Gender Differences Between Domestic Violent Men and Women: Criminogenic Risk Factors and Their Association With Treatment Dropout

Although many studies have concluded that men and women engage in domestic violence at equal levels, existing studies have hardly focused on gender specific risk factors for domestic violence perpetration. Therefore, this study aimed to examine gender differences in criminogenic risk factors between Dutch male and female forensic outpatients who were referred to forensic treatment for domestic violence. Clinical structured assessments of criminogenic risk factors were retrieved for 366 male and 87 female outpatients. Gender differences were not only found in the prevalence and interrelatedness of criminogenic risk factors, but also in associations between criminogenic risk factors and treatment dropout. In men, risk factors related to the criminal history, substance abuse, and criminal attitudes were more prevalent than in women, whereas risk factors related to education/work, finances, and the living environment were more prevalent in women. Further, having criminal friends, having a criminal history, and drug abuse were associated with treatment dropout in men, whereas a problematic relationship with family members, housing instability, a lack of personal support, and unemployment were associated with treatment dropout in women. Finally, network analyses revealed gender differences in risk factor interrelatedness. The results provide important insights into gender specific differences in criminogenic risk factors for domestic violence, which support clinical professionals in tailoring treatment to the specific needs of male and female perpetrators of domestic violence.

The Role of Control in Intimate Partner Violence: A Study in Dutch Forensic Outpatients

Johnson argued that coercive control is crucial in explaining heterogeneity in intimate partner violence, with such violence being more frequent, less reciprocal, and more often male-to-female aggression when it serves to exercise control over the partner. We assessed 280 Dutch forensic outpatients who had recently engaged in intimate partner violence on nonaggressive coercive control. Control showed significant, small to moderate, associations with more frequent past year acts of psychological aggression, physical assault, and sexual coercion and more frequently resulted in partner injury. Control was unrelated to reciprocity of partner violence. High controlling violence was enacted mostly, but not exclusively by men. Overall, while perhaps not having a uniquely strong association, our findings provide partial support for the role of coercive control in intimate partner violence and suggest it may benefit intimate partner violence risk assessment.

Arsonists and Violent Offenders Compared: Two Peas in a Pod?

Arsonists are considered a type of violent offender by some and a distinct group of offenders by others. Assuming the latter could be beneficial to offer tailor-made psychotherapeutic treatment to these offenders. The present study investigated whether arsonists ( n = 55) and violent offenders ( n = 41) are differentiable regarding several demographic and personal characteristics, and criminal career. Results indicated that arsonists were significantly more often diagnosed with a Diagnostic and Statistical Manual of Mental Disorders ( DSM) Axis II disorder, and more socially isolated and lacking coping skills. Violent offenders, on the other hand, demonstrated more drug abuse/dependence, a younger age at the first manifestation of antisocial behavior, a more extensive criminal history and higher percentage of recidivism. In light of these results, it is conceivable that arsonists could benefit from a slightly different treatment approach, for example, with more attention to relational and emotion regulation skills.

Incarcerated Dutch juvenile sex offenders compared with non-sex offenders

There is some debate about whether or not sex offenders are similar to non-sex offenders with regard to family background (parental characteristics), personality, and psychopathology. The central aim of this study focused on the comparison of juvenile sex offenders and non-sex offenders. The sample consisted of incarcerated juvenile male sex (n = 30) and non-sex (n = 368) offenders. It appeared that sex offenders resembled non-sex offenders with respect to most of the offender and parental characteristics. Results demonstrated some differences between both groups, while the majority of characteristics were similar. Limitations of the study are discussed, especially the low number of sex offenders, followed by suggestions for further research.

Juvenile sex offenders: a group on its own?

There is some debate about whether sex offenders are similar to non-sex offenders. It is known that sex and non-sex offenders are heterogeneous groups. Comparative studies must take this heterogeneity into account. Based on an aggregated database, a study was conducted among adjudicated juvenile (sex) offenders. The sample consisted of juvenile male sex and non-sex offenders who had been subjected to a psychological assessment at the request of the judge or district attorney. The central question focused on the differences between juvenile sex offenders, in particular rapists and sexual assaulters (n = 57), child molesters (n = 55), and non-sex offenders: violent (n = 85) and nonviolent offenders (n = 80). The results demonstrated that sex offenders differ from non-sex offenders with regard to demographic characteristics, problem behavior, and personality traits. Some reference is made regarding future research.