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Clinical Psychology Review 33 (2013) 448–459

Contents lists available at SciVerse ScienceDirect

Clinical Psychology Review

The impact of incarceration on juvenile offenders


Ian Lambie ⁎, Isabel Randell
Psychology Department, University of Auckland, New Zealand

H I G H L I G H T S

► Incarcerating youth in prison has little positive impact in reducing crime.


► The literature highlights this problem, particularly in adult facilities.
► There are many negative effects from incarcerating young people in prisons.
► Incarceration fails to address both the young person's developmental and criminogenic needs.

a r t i c l e i n f o a b s t r a c t

Article history: Increasingly, research points to the negative effects of incarcerating youth offenders, particularly in adult facilities.
Received 25 October 2011 Literature published since 2000 suggests that incarceration fails to meet the developmental and criminogenic
Received in revised form 26 December 2012 needs of youth offenders and is limited in its ability to provide appropriate rehabilitation. Incarceration often results
Accepted 19 January 2013
in negative behavioral and mental health consequences, including ongoing engagement in offending behaviors and
Available online 28 January 2013
contact with the justice system. Although incarceration of youth offenders is often viewed as a necessary means of
Keywords:
public protection, research indicates that it is not an effective option in terms of either cost or outcome. The severe
Juvenile offending behavioral problems of juvenile offenders are a result of complex and interactive individual and environmental fac-
Incarceration tors, which elicit and maintain offending behavior. Therefore, the focus of effective treatment must be on addressing
Rehabilitation such criminogenic needs and the multiple “systems” in which the young person comes from. Recent research dem-
Community treatment onstrates that in order to achieve the best outcomes for youth offenders and the general public, community-based,
empirically supported intervention practices must be adopted as an alternative to incarceration wherever possible.
© 2013 Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
2. Youth in the justice system—a special population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
2.1. Females . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
3. Outcomes of transfer and incarceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
3.1. Disruption of a natural “age out” of criminal behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
3.2. Behavior and iatrogenic effect of juvenile justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
4. Rehabilitative limitations and negative effects of juvenile incarceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452
4.1. Victimization within the criminal justice system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452
4.2. Mental health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
4.3. Suicidal behaviors and ideation within the criminal system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
4.4. Social relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454
4.5. Physical health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454
4.6. Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454
4.7. Reentry into the community and impact on adulthood wellbeing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454
5. What are the alternatives? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
6. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456

⁎ Corresponding author at: Psychology Department, University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel.: +64 9 3737599x85012; fax: +64 9 373 7000.
E-mail address: i.lambie@auckland.ac.nz (I. Lambie).

0272-7358/$ – see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.cpr.2013.01.007
I. Lambie, I. Randell / Clinical Psychology Review 33 (2013) 448–459 449

1. Introduction around 5% of all those held in correctional facilities in developed


countries (Sabol, West, & Cooper, 2009). In the United States, 263 ju-
This paper reviews literature published since 2000 (and earlier if venile offenders were in placement for every 100,000 in the general
of particular importance) concerning the outcomes of incarceration population in 2008 (Sickmund, 2010), and approximately 160,000
on youth offenders and the rehabilitative limitations of their incarcer- adolescent offenders are placed in residential facilities annually
ation, as well as evidence-based alternatives. For the purposes of this (Henggeler & Schoenwald, 2011). In 2007, 25% of delinquency cases
review, youth will be defined as any young person below the age of resulted in residential facility placement (Puzzanchera et al., 2010).
18, with adolescence occurring between the ages of 13 and 18. Increasingly, youth are also being placed in detention centers while
The United Nations Convention on the Rights of the Child they await trial or placement in another facility or program
(UNCRC) was established in 1989 to recognize the rights of children (Holman & Ziedenberg, 2006).
worldwide (Muncie, 2009). This legal framework advocates for Barry (2011) describes increased rates of youth custody in Scot-
the protection of any person under the age of 18, as it recognizes land as a result of the politicization of youth crime and a shift from
children warrant special attention due to their age and associated de- values of the juvenile justice system (which has jurisdiction over under-
velopmental needs (Independent Police Conduct Authority, 2012). age defendants) that prioritize the adolescent's best interests and
Thus, the UNCRC proposes 40 specific rights for children, in particular minimize intervention. Fagan (2010) argues that there is an inher-
advocating for the special protection of ‘children in conflict with the ent contradiction between the existence of a juvenile justice system
law’ (Muncie, 2009). Specifically relevant to this review, in all actions intended to provide more remedial interventions and increasingly
concerning children in conflict with the law, the best interests of punitive sanctions. A study of dispositional outcomes (i.e., proba-
the child shall be a primary consideration where the needs of persons tion vs. confinement) in Philadelphia and Phoenix juvenile court ju-
of his or her age need to be taken into account. In particular, risdictions found that legal factors such as having a higher number
every child deprived of liberty shall be separated from adults unless of court referrals, rather than factors such as developmental matu-
it is considered in the child's best interests not to do so (United rity and mental health, were predictive of dispositional outcomes
Nations, 1989). The UNCRC has been ratified by every recognized (Cauffman et al., 2007). This suggests that the juvenile court system
country in the world apart from the United States (Mildred & in these jurisdictions fail to prioritize an individual's intervention
Plummer, 2009). based on rehabilitative need over court processes (Cauffman et al.,
Although the ratification of the UNCRC highlights international 2007).
recognition of the protection of children and adolescents, a number of Although only around 1% of all formally processed delinquency
law reforms in recent decades, particularly in the United States, have cases in the United States are judicially transferred to criminal court
imposed harsher penalties on serious young offenders, and have conse- (Puzzanchera et al., 2010; Puzzanchera & Kang, 2011), transfer can
quently increased rates of incarcerated youth and made it easier for have serious consequences for the adolescents involved. While the
youth to be treated and incarcerated as adults within the justice system consequences of juvenile transfer differ between states, they can in-
(Redding, 2003; Snyder & Sickmund, 2006). In most states throughout clude being placed on the public record of convictions, the compulso-
the US, a juvenile is legally defined as anyone below 18 years of age ry reporting of the conviction on employment applications, being
(Siegel & Welsh, 2008). However, children as young as 14, and some- subject to criminal court jurisdiction for all subsequent offenses com-
times younger, may be transferred and sentenced in adult court, and mitted as a juvenile, registration in a state's sex offender registries,
incarcerated in adult prisons (Steinberg, 2009). and the potential to receive an adult sentence and incarceration in
Based on two recent court cases, namely Roper v. Simmons (2005) adult prison (Redding, 2003).
and Graham v. Florida (2010), the United States Supreme Court's cur- The Juvenile Justice and Delinquency Prevention Act (JJDPA) of
rent position on juvenile offenders is that mandatory life sentences 1974 requires that juvenile offenders be “sight and sound” separated
without the possibility of parole violates the Eighth Amendment from adult inmates when detained in a jail or lock-up facility. How-
ban on cruel and unusual punishment with regard to juvenile of- ever, juvenile offenders who have been waived to adult court no
fenders (Miller, 2012). Accordingly, juvenile offenders cannot receive longer fall under the jurisdiction of the JJDPA as they are thereby
the death penalty, or receive a life sentence without parole except in considered as adults in criminal court (Levitt, 2010; Sickmund,
the case of homicide. However, law reform in the United States has 2004). Consequently, juvenile offenders incarcerated in adult
greatly increased the chance of adolescents being transferred to the prisons are not protected separately from adult offenders by federal
criminal court, which has jurisdiction over criminal cases involving law (Levitt, 2010). While it is likely that some youth offenders are
adult defendants (Fagan, 2008). Consequently, many juvenile of- separated from the general population in some adult prisons, re-
fenders are tried as adults, resulting in a greater likelihood of incar- search suggests that in a majority of states (i.e., 31 states), youth of-
ceration and much harsher sentences than they would receive in fenders are housed with the general adult prison population (Bishop,
juvenile court (Carmichael, 2010). The changes have included lower- 2000). A minority of states allow for the segregation of juvenile and
ing the minimum age for transfer, expanding the list of crimes for adult offenders or graduated incarceration, whereby inmates under
which transfer is an option, vesting greater discretion in prosecutors, the age of 18 begin their sentences in juvenile facilities until they
and eliminating some of the factors judges must consider before trans- reach the age of 18 where they are then transferred to adult prisons
ferring youth (Redding, 2003). The number of delinquency cases that (Austin, Johnson, & Gregoriou, 2000; Storm, 2000). Subsequently,
were judicially transferred to criminal court in the United States peaked Storm (2000) also found that only 6 states in the US require separate
in 1994, then declined until 2001, and increased between 2001 and housing in state prisons for offenders under the age of 18. Due to
2007 (Puzzanchera, Adams, & Sickmund, 2010). Several authors suggest youth being more vulnerable because of their age, this puts youth
that the decline in the second half of the 1990s is likely to be a result of at greater risk of victimization from adult inmates within adult cor-
changes to the law, which enabled some serious young offenders to be rectional facilities (Fagen & Kupchik, 2011).
tried directly in the criminal court and for juvenile court to be bypassed The justifications for incarcerating juveniles range from rehabilita-
entirely (Puzzanchera et al., 2010). tion and punishment to providing a deterrent for future offending.
Despite growing numbers of incarcerated adolescents throughout However, a growing body of evidence suggests that there are numer-
the 1990s, in countries such as the United States, the United Kingdom ous negative psychological and behavioral consequences for young
and New Zealand, since 2000, there has been a general stabilization, people who are incarcerated, particularly for those incarcerated in
or decline, in both youth offending and incarceration (Sickmund, adult prisons and with adult offenders (Lane, Lanza-Kaduce, Frazier,
2010; Workman, 2011). It is estimated that adolescents comprise & Bishop, 2002; Tie & Waugh, 2001).
450 I. Lambie, I. Randell / Clinical Psychology Review 33 (2013) 448–459

2. Youth in the justice system—a special population disorders among youth offender populations are associated with signifi-
cantly poorer outcomes following release, including increased recidivism,
It is widely accepted that juveniles do not possess the same develop- suicidality, substance use problems, hospitalization and use of psychiatric
mental level of psychological maturity as adults (Steinberg, Cauffman, services (Vermeiren, Jespers, & Moffitt, 2006). Additionally, many female
Woolard, Graham, & Banich, 2009; Steinberg, Graham, O'Brien, Woolard, youth offenders present with more than one psychiatric disorder, which
Cauffman, & Banich, 2009; Steinberg & Scott, 2003) and can have difficul- is associated with even poorer outcomes following release (Russell &
ty regulating their moods, impulses, and behaviors (Spear, 2000). Marston, 2009). Furthermore, in comparison to male youth offenders, fe-
Anatomical and functional changes in the brain occur throughout devel- male youth offenders experience a significantly greater amount of physi-
opment and continue into early adulthood (Giedd, 2008). Such changes cal (e.g., abuse, chronic health problems, sexual assault) and sexual (e.g.,
involve self-regulation, reward processing, processing of social informa- sexually transmitted disease and engagement in high-risk sexual behav-
tion, and the development of psychosocial maturity, involving risk per- iors) health problems (Robins, Odgers, & Russell, 2009).
ception, lowered levels of sensation seeking and impulsivity, resistance Research suggests that the association between antisocial behavior
to peer influence, and anticipation of future consequences (Steinberg, and poor physical health is greater for female youth offenders following
2009; Steinberg, Cauffman, et al., 2009 and Steinberg, Graham, et al., a life-course persistent pathway of antisocial behavior (Moffitt, 1993).
2009). Additionally, and probably as a result of heightened reward This is a pathway characterized by high-risk family and social environ-
salience, particularly in relation to social rewards, involvement in ments, and early neurodevelopmental difficulty (Robins et al., 2009). In
sensation-seeking and risk-taking behaviors peaks during adolescence comparison to male youth offenders, female youth offenders are more
(Steinberg, 2008, 2009, 2010). Adolescents are more influence than adults likely to have experienced trauma, often linked to multiple forms of
by the presence of peers, social rewards and approval (Steinberg, 2010). maltreatment including sexual abuse and neglect, and suffer from
Immediate and concrete rewards, particularly those involving peer post-traumatic stress disorder (Moretti, Jackson, & Obsuth, 2009). As a
approval, greatly influence their behavior, and they are particularly special population, it seems rehabilitation for justice-involved female
susceptible to peer influence and impulsivity, provocation, and stressful youth may benefit from a particular focus on the appropriate assess-
situations (Steinberg & Scott, 2003). ment and treatment of the mental health needs in conjunction with
There are several implications of the psychosocial immaturity of assessing social welfare and ensuring stable community support follow-
adolescent offenders. Firstly, their vulnerability to peer influence, ing release (Moretti et al., 2009).
coercion, provocation, and immature decision making may mean
that culpability is mitigated, making incarceration in an adult pris- 3. Outcomes of transfer and incarceration
on an inappropriate sentence (Scott & Steinberg, 2008). Additionally,
incarceration is intended to support the major task of adolescent devel- Little is known about the effects of transferring juveniles into the
opment of achieving both social autonomy and social integration. justice system (Mears, 2003). However transfer to adult court increases
Instead, incarceration inhibits opportunities for successful prosocial the potential for harsher punishments (including victimization by other
development by restricting autonomy, thus limiting the young person's inmates) and long-term developmental costs (Mulvey & Schubert,
options for social interaction and preventing integration (Dmitrieva, 2012). There are inherent difficulties in studying the effects of transfer,
Monahan, Cauffman, & Steinberg, 2012). given the possible selection bias of higher-risk youth being transferred.
Youth offenders are a particularly disadvantaged population and However, a number of studies based in the United States that control for
often come from backgrounds of family dysfunction and maltreatment selection bias have found a null effect of transfer or indicate that youth
(Ou & Reynolds, 2010). Between 70% and 95% of detained youth offenders transferred to the criminal justice system exhibit heightened
offenders have at least one psychiatric diagnosis, along with coexisting levels of recidivism (Lanza-Kaduce, Lane, Bishop, & Frazier, 2005;
mental health problems (Lader, Singleton, & Meltzer, 2003; Robertson, Loughran et al., 2010; Myers, 2003). These findings suggest that the ju-
Dill, Husain, & Undesser, 2004). Rates of substance use are extremely venile justice system is likely to be more rehabilitative or less damaging
high among this population, with substance abuse and dependence af- than the adult system, and that all but the most serious juvenile of-
fecting 40%–70% of youth offenders (Aarons, Brown, Hough, Garland, & fenders should be kept out of the adult system (Myers, 2003).
Wood, 2001; McClelland, Elkington, Teplin, & Abram, 2004; Robertson The judicial transfer of youth offenders to adult court has resulted in
et al., 2004). Over a third of juvenile offenders have special education many juveniles being tried as adults in the criminal justice system.
needs (Cruise, Evans, & Pickens, 2011; Minor, Wells, & Angel, 2008), Consequently, youth offenders become susceptible to more severe
and many are below their chronological age level in terms of reading, sanctions by criminal court proceedings (Jordan & Myers, 2011;
spelling, comprehension, and cognitive abilities (Kroll et al., 2002). Due Kupchik, Fagen, & Liberman, 2003), and as a result the likelihood that
to high rates of smoking, alcohol, and drug use, as well as engagement a juvenile will be incarcerated increases (Myers, 2003).
in risky sexual and violent behavior, adolescent offenders are also at Because youth incarceration is aimed at decreasing the incidence of
high risk for numerous health concerns (Fazel & Baillargeon, 2011). crime as well as recidivism, it is important to examine how effective it is
in achieving these aims. Between 70% and 80% of juveniles who have
2.1. Females been in residential correction programs are subsequently rearrested
within a three-year period (Mendel, 2011), and research indicates
Recent years have seen a considerable increase in female juvenile that incarceration of juveniles generally is ineffective in reducing recid-
offending, such that girls comprise of approximately one third of all ivism and may maintain, or even increase, levels of engagement in anti-
juvenile arrests in the United States (Snyder & Sickmund, 2006). social behavior and criminal activity (Gatti, Tremblay, & Vitaro, 2009;
Although the majority of research regarding juvenile offending has Lane et al., 2002). Although some research suggests that longer stays
focused on male youth, and female youth offenders have previously in juvenile institutions are ineffective in reducing recidivism
been a neglected population both in terms of research and service deliv- (Loughran et al., 2009; Mulvey, 2011), other research found that youths
ery, there has been some recent research to suggest key differences who were incarcerated for longer periods of time, in either juvenile or
between boys and girls involved in juvenile justice (Odgers, Moretti, & adult facilities, were less likely to be rearrested following disposition
Reppucci, 2009). For example, rates of psychiatric disorders among than were offenders who were either not incarcerated or who were in-
detained youth are higher for female youth offenders than they are for carcerated for shorter time periods (Hjalmarsson, 2009; Myers 2003).
male youth offenders, with nearly 75% of incarcerated female youth meet- Due to the complexity of the issue, Myers comments that it is very
ing the diagnostic criteria for at least one psychiatric disorder (Cauffman, hard to determine what factors were operating in this study to bring
2004; Russell & Marston, 2009). Research also suggests that psychiatric about this effect. However, the divergent findings here may be due to
I. Lambie, I. Randell / Clinical Psychology Review 33 (2013) 448–459 451

differences in the follow-up period used. For example, Myers (2003) Loeber, Wei, Loeber, & Masten, 2004). A study that gathered information
measure of recidivism was taken after an 18 month follow-up period, on 14–18-year-old juvenile offenders 7 years after their conviction
whereas Loughran et al. (2009) used a follow-up period of 48 months. found that even the most serious adolescent offenders report a decrease
There is some indication, however, that there may be differential effects in offending over time (Mulvey, 2011). Only a small percentage of of-
of transfer for individuals, with research indicating that post-release fenders continued with high-level offending throughout the follow-up
outcomes were significantly related to charge type and other legal and period and a large percentage of the most severe offenders reported
risk-need factors (Loughran et al., 2010; Schubert et al., 2010). For ex- dramatic reductions in their offending. Based on these findings, the Path-
ample, Loughran et al. (2010) found that transferred adolescents ways to Desistance study (see Mulvey, 2011) concluded that even serious
charged with person crimes (e.g., assault) showed lower rates of youth offenders will not necessarily continue to offend into adulthood.
recidivism than transferred adolescents charged with property crimes Incarceration may, therefore, interfere with the reestablishment of a
(e.g., burglary & theft). Schubert et al. (2010) found that adolescents prosocial lifestyle and limit the likelihood of positive outcomes. Lane et
with fewer prior petitions to court and adolescents with less association al. (2002) reported that many juveniles who were incarcerated felt that
with antisocial peers showed lower rates of recidivism. their childhood and positive aspirations for the future had been taken
It seems important that youth offenders are not placed under higher away from them. It was also found that the pain and loss experienced
levels of security than is necessary. Low-level offenders appear to be par- during incarceration sometimes only increases the resentment and hostil-
ticularly at risk for increased rates of recidivism following institutional ity towards “the system”, which results in further antisocial behavior
placement (Mulvey, 2011). Although it is unclear whether such findings (Lane et al., 2002).
are able to be generalized to adolescents, research suggests that when The effect of incarceration inhibiting the ability to “age out” is espe-
adult offenders are placed into higher than necessary levels of security, cially the case following treatment in a secure setting, where the envi-
they are more likely to have higher rates of recidivism than if they were ronment is highly structured and predictable and thus not reflective
placed at the appropriate security level (Gaes & Camp, 2009). While of the realities of independent living. Research investigating percep-
there are situations in which higher security levels are likely to be neces- tions of boys in boot camp correctional facilities found that, due to the
sary, there is some evidence that low security levels may result in better extremely structured nature of the program, boys felt unprepared for
outcomes than high-security placements even for higher-risk inmates avoiding incarceration in the future and were uncertain to what extent
(Gaes & Camp, 2009). Gaes and Camp (2009) found that adult inmates they had acquired skills as a result of their inability to test and practice
with level 3 security classification who were randomly assigned to level them (Kilgore & Meade, 2004). The authors concluded that, although
3 placement (i.e., higher security placement) had a hazard rate of one aim of boot camp-type programs is to teach self-discipline and
returning to prison 31% higher than those assigned to a level 1 placement the ability to make wise choices, the extremely structured environment
(i.e., lower security placement). Johnson et al. (2011) found that, after (which removes all decision-making opportunity) is likely to be coun-
controlling for a number of variables, among repeat youth offenders, skip- terproductive to such a goal. In structured confinement settings, few
ping intermediate interventions into deep-end sanctions was related to opportunities exist for youth to learn new ways of forming and
greater recidivism, whereas experience of graduated interventions was maintaining appropriate social and sexual relationships. It is only possi-
associated with less recidivism. This finding suggests that negative effects ble for a young person to reliably “grow out” of deviance if he or she de-
of transfer may be due to a lack of graduated sanctions, which allow for velops alternative, more adaptive coping resources and strategies (Lane
appropriate intervention. et al., 2002). Such adaptive resources are not reliably or effectively
The existing literature concerning the outcomes of incarceration and taught to juvenile inmates and the acquisition of such skills is limited
transfer in terms of recidivism is somewhat mixed. Differences in these by the nature of the environment.
findings could most likely be explained by divergent experimental
methods used by the different studies. Nevertheless, a significant body 3.2. Behavior and iatrogenic effect of juvenile justice
of literature supports the contention that incarceration and transfer
have null or negative effects on later offending and that a more punitive There is much suggestion in the literature that increased contact with
approach is unlikely to be productive (Gatti et al., 2009; Lane et al., antisocial peers in a prison environment, as well as decreased contact
2002; Lanza-Kaduce et al., 2005; Loughran et al., 2010; Mulvey, 2011; with prosocial or less delinquent peers, is a contributing factor in negative
Myers, 2003). outcomes for incarcerated adolescents (Gatti et al., 2009). In an attempt to
Subjective outcome studies of incarceration have indicated similarly acculturate into the criminal environment and be accepted by older and
problematic experiences of those incarcerated as youth. Incarcerated more intimidating peers, juveniles spend time talking with more skilled
adults have been found to perceive the juvenile system as not particu- and experienced adult offenders (Woolard, Odgers, Lanza-Kaduce, &
larly helpful and ineffective in deterring other juveniles (Veneziano, Daglis, 2005). While it may be assumed that offenders with prior expo-
Veneziano, & Gill, 2000). Lane et al. (2002) interviewed 71 youths sure to antisocial peers are more likely to mingle with antisocial peers
who were transferred to adult court. The majority of them reported while incarcerated, Little (2006) found that youth offenders incarcerated
that incarceration with adults had no positive effect or a negative effect in out-of-home placements (adult or juvenile facilities) exhibited a much
on their attitudes and behavior. A number of youth attributed negative faster rate of exposure to antisocial peers than non-incarcerated youth of-
outcomes to adult sanctions, maintaining that they learnt more crime fenders regardless of baseline exposure to antisocial peers.
while incarcerated with adults. They found staff to be “mean” or apa- As well as providing exposure to antisocial behaviors and peers,
thetic, hope to be diminished, and the prison environment to be ex- incarceration disrupts community contact (Little, 2006). Thus, it se-
tremely unsafe and inappropriate for adolescents (Lane et al., 2002). verely limits reinforcement of societal norms and expectations, as
well as opportunities for youth to model adaptive interpersonal inter-
3.1. Disruption of a natural “age out” of criminal behavior actions, such as conflict resolution, or practice of interpersonal skills
and relationship management (Steinberg, Chung, & Little, 2004). It
As the sentence time progresses, adolescents become more deep- is difficult to practice prosocial forms of behavior while incarcerated
ly immersed in the criminal justice system and move further from (Lane et al., 2002); consequently, incarcerated juveniles become in-
prosocial involvement in society, thus limiting opportunity for the indi- creasingly detached from adaptive law-abiding society.
vidual to “age out” of their delinquent behavior. Research has demon- It has been hypothesized that the effect of peer contagion is stron-
strated that roughly a third of all juveniles will engage in some form of gest among those youths who are only moderately deviant or are still
serious delinquent behavior, but many will naturally grow out of this be- developing deviant behavior patterns (Dishion & Dodge, 2005). Mis-
havior as part of their maturation process (Elliot, 1994; Stouthamer- conduct is most common among young inmates, with age being the
452 I. Lambie, I. Randell / Clinical Psychology Review 33 (2013) 448–459

strongest predictor of prison misconduct, including violent misconduct Although it is possible that positive rehabilitative effects can be achieved
(Kuanliang, Sorensen, & Cunningham, 2008). Given that, over time, ju- in a confinement setting, the nature of confinement, as well as the
veniles have been found to exhibit shifts in levels of delinquency that negative impacts that it may have, can greatly limit the rehabilitative
are influenced by the relative deviance of their immediate peers potential of such placements. Incarceration environments are often
(McGloin, 2009), it is not surprising that juveniles in the adult system characterized by victimization, social isolation, and unaddressed or
are more likely to exhibit a developed set of offending behavior when exacerbated mental health, educational, and health needs. These factors
they leave the facilities. may limit rehabilitation and have damaging effects that contribute to
An increase in aggressive behavior has also been shown to be a re- recidivism and other unfavorable outcomes (Ashkar & Kenny, 2008).
sult of incarceration among confined youths. Prisons are dangerous Overcrowding is a concerning reality in facilities housing youth
places: they contain inmates with a propensity to behave aggressive- offenders, with 15% of facilities in the United States being over stan-
ly, and inmate norms frequently support violent behavior (Anderson dard bed capacity, according to Snyder and Sickmund (2006). The
& Ranckin, 2007). Exposure to violence and male-modeled antisocial same study found that 20% of youth offenders housed in such facili-
behavior is a risk factor for the development of sexual and non- ties were in facilities at capacity and an additional 14% were in facil-
sexual aggression and delinquency in juvenile offenders (Hunter, ities over capacity (2006). This indicates that resources supporting
2004; Shahinfar, Kupersmidt, & Matza, 2001), and a review of a num- rehabilitation are likely to be severely limited in such institutions.
ber of studies found that this contact with other aggressive inmates Additionally, removing youth from their community removes them
increases an individual's aggressive behavior (Anderson & Ranckin, from the environment in which their offending behavior occurs
2007). However, Little (2006) found that contact with antisocial peers and the contextual factors that contribute to and maintain this be-
did not solely predict increased aggression upon release, suggesting havior. As a result, incarceration limits the potential for the use of re-
that other variables are also likely to be involved in such a relationship. habilitative options that directly address these factors, and youth are
A study by Gatti et al. (2009), which examined a community sample less likely to receive intervention that targets their criminogenic
of boys in disadvantaged areas of Montreal, Canada, found that inter- needs. Accordingly, research suggests that longer stays in institu-
vention by the juvenile court had an overall iatrogenic effect on youth, tions for youth offenders does not reduce recidivism, while more in-
greatly increasing the likelihood of adult criminality. This study found volvement with community-based supervision is more effective in
that disadvantaged youths are more likely, for the same degree of reducing re-offending, particularly for youth who have committed
antisocial behavior, to undergo intervention by the juvenile court and serious offenses (Mulvey, 2011). Given the stark contrast between
that this then facilitates their initiation into a criminal career. Gatti the environment of a secure facility and that of a community setting,
and colleagues found that programs that place deviant youth together the transition of youth back into the community after a period of
and confine them to facilities separate from the rest of society are incarceration can be extremely difficult (Anthony et al., 2010).
most likely to have a negative effect. In a meta-analysis, Lipsey (2006)
found that treatments that placed deviant peers together were 30% 4.1. Victimization within the criminal justice system
less effective than individual programs and that 42% of group programs
had adverse effects, with behavior of participants worsening after Abuse is prevalent within adult prisons and both youth and adult
intervention. This could be explained by the peer contagion theory, offenders experience significant levels of victimization, involving ver-
which suggests that, given the important role that a peer group plays bal, physical, sexual, and emotional abuse (Tie & Waugh, 2001; Wolff,
in orienting adolescent behavior, any intervention that places youths Shi, & Siegel, 2009). Wolff et al. (2009) found that nearly 40% of male
within a deviant group consolidates their antisocial behavior (Dodge, and female inmates reported physical or sexual victimization over a
Dishion, & Lansford, 2006; Warr, 2002). Although peer contagion can 6-month period. Female inmates experienced lower rates of physical
occur in both residential and non-residential programs, it has been victimization by staff or other inmates than males (24% vs. 35%), but
argued that it is more likely and more intense in a residential regime, higher rates of sexual victimization (24% vs. 10%).
such as when young people are incarcerated (Osgood & Briddell, 2006). Juvenile offenders incarcerated in adult prisons may be at particu-
However, this notion of iatrogenic effects was challenged by Weiss lar risk of victimization (Tie & Waugh, 2001). When juveniles are
et al. (2005), who questioned both empirical and conceptual bases for incarcerated with adult prisoners, their age and developmental level
this theory. The authors reviewed the empirical evidence of 18 recent place them at high risk (Fagen & Kupchik, 2011). It is likely that
meta-analytic studies and concluded that 17 of them did not, in fact, adult inmates in the system may have greater physical strength, a
support iatrogenic effects. They also questioned the ideas that group longer criminal history, and more experience of incarceration than ju-
treatments are iatrogenic and that deviancy-training effects underlie venile offenders, suggesting some inherent risk to youth within adult
these iatrogenic effects. They argued that, given that negative peer correctional facilities.
associations are a strong predictor of delinquency, adolescents who Youths who are younger and from minority racial groups have
are chosen to participate in group treatment are likely to be already been shown to be at particular risk of victimization within the prison
associating with delinquent youth outside of treatment and that the system. A study concerning juveniles in a South African prison found
amount of time in therapy is a small portion of their waking hours, that, the younger respondents were, the more likely they were to ex-
thus limiting the impact of the peers within the treatment group. perience victimization (Kiessl & Wurger, 2002). Youths belonging to
They argued that consideration of potential negative aspects must be minority racial groups in society were also found to be at greater risk
balanced with consideration of potential positive aspects, such as of victimization within the adult prison setting (Kiessl & Wurger,
economy and convenience. However, these findings are limited by a 2002).
key gap in the literature on this topic, that is, the extent to which It is important to note, however, that victimization of juvenile
group therapy may magnify the effects of deviancy training or other iat- offenders is not limited to adult facilities. It is also a significant problem
rogenic processes (Weiss et al., 2005). within juvenile custody facilities. A recent nationwide survey of youth
in juvenile facilities in the United States (Beck, Harrison, & Guerino,
4. Rehabilitative limitations and negative effects of 2010) found that 12% had experienced one or more incidents of sexual
juvenile incarceration victimization by another youth or facility staff in the previous
12 months. Just over 10% of youth reported an incident of victimization
Youth offenders are a high-risk population and an extensive range of involving facility staff, with 4.3% reporting having had sexual contact
environmental and individual factors interact to contribute to their with staff as a result of some type of force. In facilities with the highest
maladaptive behavior (see Loeber, Burke, & Pardini, 2009, for a review). rates of sexual victimization, youth reported very high rates of
I. Lambie, I. Randell / Clinical Psychology Review 33 (2013) 448–459 453

victimization (20%–36%), even when limited to the most serious non- treatment following release, resulting in youth often returning to the
consensual acts. Youth with a sexual orientation other than heterosex- substance use problems and re-offending at higher rates (Henderson
ual reported significantly higher rates of sexual victimization by other et al., 2007).
youth inmates (12.5%), compared to heterosexual youth (1.5%). Addi- There is evidence that juveniles who are confined in an adult pris-
tionally, individuals who had previously been victims of assault were on environment may have particular difficulty in adjusting and that
at greater risk for experience of victimization in the current facility they may require specially targeted care (Kuanliang et al., 2008).
(Beck et al., 2010). Staff within the adult justice system lack knowledge and training in
child and adolescent development and, therefore, are ill equipped to
4.2. Mental health understand the needs of the youth (Soler, 2002).
A study by Murrie et al. (2009) of youths housed in Texas adult
A large proportion of incarcerated youth suffer from mental health correction facilities found that juveniles in adult facilities reported
problems such as depression, suicide attempts and ideation, as well as higher rates of mental health symptoms than those in juvenile correc-
drug and alcohol abuse (Domalanta, Risser, Roberts, & Risser, 2003; tion facilities. Although this research indicates that the mental health
Kiriakidis, 2008; Lader et al., 2003; Robertson et al., 2004), and the needs of youth incarcerated in adult prisons may be greater than
prevalence of emotional and behavioral problems among incarcerated the needs of those in juvenile prisons, it is unclear whether such
youth is greater than that within the general population (Thomas & differences reflect difficulties that existed prior to incarceration or
Penn, 2002). It is likely that these problems are exacerbated by the those that developed during the period of incarceration (Murrie,
adverse conditions experienced during incarceration; however, there Henderson, Vincent, Rockett, & Mundt, 2009). However, a more re-
is a lack of research investigating the factors that affect adolescents' psy- cent study, after controlling for other risk factors, found that youth of-
chological adaptation to the prison environment. fenders in Michigan who were placed in adult incarceration facilities
During incarceration, isolation, boredom, bullying, and victimiza- were 37 times more likely to be depressed than were serious youth
tion are pervasive stressors (Greve, 2001) and, given the permeable offenders in juvenile placements, despite having less severe psycho-
and transitory nature of adolescent identity and self-esteem, incarcer- social or offending backgrounds (Ng et al., 2011). This suggests that
ation can have a negative long-term effect on a young person's sense placing youths in adult prisons is likely to have significant negative
of self and self-worth (Lane et al., 2002). In addition to existing diffi- consequences in terms of creating or aggravating mental health prob-
culties and stressors associated with an incarceration environment, lems (Ng et al., 2011).
these youth also lose their lives outside of the facility, which adds to There is some research to suggest that mental problems experi-
their distress and deteriorating mental health (Ng et al., 2011). Men- enced by incarcerated youth may not be long-lasting and decrease
tal health problems are often not identified or addressed during pe- over time. Brown and Ireland (2006), in a study of male adolescent
riods of incarceration (Altschuler & Brash, 2004; Soler, 2002), and prisoners in the United Kingdom, found significant decreases in
mental health services and juvenile justice systems are often not both anxiety and depression during the six weeks following incarcer-
well integrated (Rapp-Paglicci, 2007). This suggests that in many ation. The authors explain that this could be a result of acculturation,
cases services are not equipped to cope with preexisting mental as incarcerated youth develop more adaptive strategies to incarcera-
health problems, nor those that may worsen or develop during tion over time (2006). Similar findings were reported by Shulman
incarceration. and Cauffman (2011), who found that symptoms of psychopathology
Despite high rates of substance abuse among youth offender declined over the first month of incarceration among male juvenile
populations, drug and alcohol treatment is only available in 36% of ju- offenders held in the California Department of Juvenile Justice correc-
venile correctional facilities in the United States, and of those incar- tional reception facility. However, both samples of youth offenders
cerated individuals who would benefit from treatment, only 16% involved in the research of Brown and Ireland (2006), and Shulman
receive it (National Center on Addiction & Substance Abuse, 2004). and Cauffman (2011) were confined to Juvenile Justice Facilities in
A study investigating needs and utilization of adolescents in the Illi- the England and the United States, which house juvenile offenders
nois corrections system found that two-thirds of youth were in alone. In contrast, the sample of youth offenders involved in the
need of treatment; yet under half of those in need reported receiving study conducted by Ng et al. (2011) were confined in adult prisons.
treatment (Johnson et al., 2004). Research suggests that there are 11 It may be likely that for youth offenders confined in adult prisons,
key elements involved in effective substance abuse programs includ- particularly if juvenile inmates are integrated with prison population,
ing integrating treatment across multiple systems of care; matching there is a heightened degree of stress and potential threat in compar-
assessment and treatment; recognizing co-occurring disorders; a ison to offenders imprisoned in juvenile justice settings. Juvenile
comprehensive treatment approach; having qualified staff; develop- offenders may find it more difficult to adapt to life inside an adult
mentally appropriate treatment; family involvement in treatment; prison, which may explain the negative effects of incarceration on
engagement and retention of teens in treatment; continuing care; juvenile mental health found by Ng et al. (2011).
assessment of treatment outcomes; and gender and cultural compe-
tence (Drug Strategies, 2005). 4.3. Suicidal behaviors and ideation within the criminal system
Although Henderson et al. (2007) found that there is variable imple-
mentation of a number of these elements in treatment programs, The rates of suicide, suicide ideation, and suicide attempts among
community-based services on average were using a greater number of incarcerated youths are particularly concerning. Although suicide
elements that institutional services. Some differences may be explained mortality rates in custody are typically lower than population rates,
by differences in treatment environment, for example, logistical limita- attempted suicides may be much higher (Kiriakidis, 2008). Research on
tions make it difficult to involve youth's families in treatment within an the Scottish juvenile population in custody reported that suicide
institutional setting compared to a community setting. However, sub- attempts among incarcerated youth are higher than are those in the
stance abuse treatment programs within institutional settings were general population, with 14.5% of the sample having reported suicide
also less likely to involve qualified staff and assessment of treatment attempts in comparison 8.8% of youth in the community (Kiriakidis,
outcomes compared to community settings likely indicating the accred- 2008). Another study of youths incarcerated in the United States found
itation of evidence-based practices needed by third-party organizations that 52% of incarcerated youth self-reported suicide ideation (Esposito
in community settings. Additionally, the findings suggest that there & Clum, 2002). Additionally, incarcerated youths reported high rates of
seems to be a disconnection between corrections and community- lifetime suicide attempts and ideation (Penn, Esposito, Schaeffer, Fritz,
based treatment services likely leading to a lack in the continuation of & Spirito, 2003). This suggests that, while prisons report low suicide-
454 I. Lambie, I. Randell / Clinical Psychology Review 33 (2013) 448–459

mortality rates, this is largely due to security, suicide screening, and incarcerated youth as a result of the sedentary lifestyle, which is likely
monitoring measures in incarceration environments. Therefore, rates of to be continued upon release back into the community (Griel & Loeb,
completed suicide, suicide attempts, and self-harming behaviors should 2009).
still be of concern. Research also suggests that youth in adult prisons are at particular
Research has identified a number of factors associated with high risk of negative health outcomes (Braverman & Murray, 2011; Griel &
levels of suicidal behavior in incarcerated juveniles. One of the key influ- Loeb, 2009). This is primarily because they are vulnerable to both
ences is likely to be the stressful conditions of confinement, suggesting physical and sexual assault, are more likely to be placed in “protec-
that youths attempt suicide when they are unable to cope with these tive” isolation for long periods, which has serious effects on health,
conditions (Bonner, 2006). It has also been hypothesized that imprisoned and little is offered in the way of health services, education, or recre-
youth are particularly vulnerable, as they experience increased expo- ation programs for juveniles (Soler, 2002).
sure to suicidal behavior by others (Hales, Davison, Misch, & Taylor,
2003). Victimization has also been identified as a key driver, with 4.6. Education
those who experienced being bullied in custody being over nine times
more likely to attempt suicide than those who were not (Kiriakidis, It is largely accepted that educational success can lead to a decreased
2008). likelihood of delinquency (Foley, 2001). A recent study by Blomberg et
In an attempt to address the incidence of both victimization and al. (2011) of incarcerated youth in Florida, found that youths who
suicide within prison settings, Tie and Waugh (2001) have devel- achieved educational success during incarceration were significantly
oped a Prison Youth Vulnerability Scale (PYVS) in New Zealand to more likely to return to school following release and to make a transi-
detect those youth offenders between the ages of 17–19 years who tion from delinquency. This is largely because education provides reha-
are vulnerable to harm from themselves and/or harm from others. bilitation in a number of ways including through benefits such as formal
This instrument can help minimize risk to vulnerable youth by certifications and concrete skills, as well as other skills such as improved
assessing whether placement in a specialized youth unit may be decision making (Brazzell, Crayton, Mukamal, Solomon, & Lindahl,
more suitable rather than being held in an adult prison facility. The 2009). When youth return to their communities without the necessary
PYVS is comprised of three primary subscales: “Vulnerability to Victim- literacy, vocational, and social skills, the risk of recidivism increases
ization” (Criminal history, social skills, perception of risk, history of vic- (Leone, Krezmien, Mason, & Meisel, 2005).
timization, offense type, and intellectual impairment), “Wellbeing” Despite this clear evidence of the importance of quality education
(Alcohol and drug use, social support, and psychological distress) and during incarceration, research suggests that incarcerated youth often
“Vulnerability to Suicide/Self Harm” (Suicidal ideation, previous attempts, receive a more fragmented and inferior education than that of their
family history). The PYVS has been found to have good internal consisten- peers in the community (Blomberg, Bales, Mann, Piquero, & Berk,
cy and a strong factorial structure with juvenile offenders in New Zealand 2011; Leone et al., 2005). Correctional programs fail to provide the
suggesting that it is both a valid and a reliable measure of youth vulnera- specialist education services that are often necessary for incarcerated
bility to victimization and self-harm. For example, the PYVS items togeth- youths, who are characterized by significant learning, behavioral, and
er explain 67.1% of the variance, and the Cronbach coefficient alpha scores cognitive problems (Blomberg et al., 2011).
of .68 (Victimization sub-scale), .66 (Wellbeing sub-scale), and .69
(Suicidality sub-scale) suggest a moderate level of internal consistency 4.7. Reentry into the community and impact on adulthood wellbeing
(Tie & Waugh, 2001).
The effects of incarceration continue to impact on juvenile of-
4.4. Social relationships fenders after they are released from prison, as time excluded from
the community as well as the criminal convictions that the individual
Incarceration has also been found to have a considerable negative has acquired result in challenges with reintegration. Any gains made
effect on social relationships, and this can be particularly damaging in treatment programs in confined settings are likely to be challenged
for adolescents who are still developing socially (Hartwell, Fisher, by the difficulties of reentering an antisocial peer group (Hartwell,
& Davis, 2010; Little, 2006). Among incarcerated youth, social rela- McMackin, Tansi, & Bartlett, 2010), and the potentially damaging
tionships and disconnectedness between significant people in their effects of incarceration on mental health, attitudes, and behavior as
lives emerge as key concerns (Biggam & Power, 2002). Even after mentioned may decrease the likelihood of successful outcomes.
accounting for individual differences, incarcerated adolescents The stigma associated with criminal convictions may limit access
have been found to lose access to adult support and contact with to conventional social networks, employment, and responsible re-
friends more rapidly than do their non-incarcerated counterparts engagement with the community (Mears & Travis, 2004). Experi-
(Little, 2006). Although it is developmentally normal for access to ences of exclusion from educational or work placements as a result
adult guidance and support to decline over time, incarceration of a criminal history can make it difficult for youth newly released
severely hastens this decline (Little, 2006). This is particularly into the community to meet requirements of probation (Gardner,
concerning as adult support is associated with decreased aggressive 2010). As well as these external factors, this social stigma also serves
offending (Little, 2006) and family contact while incarcerated is to reinforce their own negative self-worth. Having a criminal record
associated with decline in depressive symptoms (Monahan, Goldweber, can lead to internal strain and cause formerly incarcerated youths to
& Cauffman, 2011). doubt their own ability to experience success in their lives back in
the community (Mears & Travis, 2004).
4.5. Physical health The transition from incarceration back to the community is partic-
ularly complex and difficult for youth, as this transition often happens
Incarcerated juvenile offenders also have a higher rate of physical concurrently with the transition from adolescence to adulthood, put-
health problems than their counterparts in the general population ting such youth at increased risk for a number of negative outcomes,
(Griel & Loeb, 2009). In many cases, this may be the result of the in- including recidivism (Altschuler & Brash, 2004). Adolescents at the
creased risk-taking behavior that is often a feature of incarceration, end of their prison sentence are dealing, not only with the usual chal-
such as violence, substance abuse and sexual activity (American lenges associated with community reentry, but also often with added
Academy of Pediatrics, 2011). These behaviors increase their chance developmental tasks and first experiences (Anthony et al., 2010),
of contracting HIV, hepatitis and other sexually transmitted infec- such as living alone, employment, relationships, and parenthood.
tions. Obesity has also been identified as a growing issue among Steinberg et al. (2004) argue that psychosocial maturation is
I. Lambie, I. Randell / Clinical Psychology Review 33 (2013) 448–459 455

necessary for adolescents to successfully transition into adulthood 5. What are the alternatives?
and that incarceration limits opportunity for experiences conducive
to development, fails to address existing barriers to development, Factors that place juveniles at risk for offending and reoffending are
and exposes youth to harmful experiences that worsen existing broad and multisystemic in nature, involving complex interactions
problems. between individual, family, community, school, work, and peer group
In a qualitative study examining youth experiences of community systems (see Loeber et al., 2009, for a review). For any intervention to
reentry following juvenile justice placements, Hartwell, Fisher, et al. be effective, it must address all risk factors or criminogenic needs, and
(2010) and Hartwell, McMackin, et al. (2010) found that the primary thus be tailored to the specific aspects of an individual's “social ecology”
factors that were experienced by youth as barriers to avoiding in- that are key to their offending behaviors (Henggeler & Schoenwald,
volvement with crime were drugs, familial environment, lack of fi- 2011).
nancial resources, and antisocial peers. Often, incarceration fails to Empirical research also shows that effective treatments are focused
address these issues. In many cases, mental health and substance on the principles of risk, need, and responsivity (Andrews et al., 1990;
problems have not been sufficiently addressed during incarceration Dowden & Andrews, 1999). This approach posits that the level of risk
(Altschuler & Brash, 2004; National Center on Addiction & posed by an individual should match the intensity of treatment, that
Substance Abuse, 2004; Soler, 2002). Education has also often been criminogenic needs must be directly addressed, and that style of treat-
disrupted, and this makes returning to school or finding work diffi- ment must be matched to the client's learning style and be capable of
cult, which subsequently affects the extent to which formerly incar- addressing treatment targets. Interventions should be rehabilitative in
cerated youths can become financially independent (Anthony et al., nature, draw on behavioral techniques, maintain high-quality imple-
2010; Brazzell et al., 2009). This is especially true if learning difficul- mentation, and be multi-systemic focusing particularly on the environ-
ties have not been addressed. Altschuler and Brash (2004) comment ment in which the young person lives (Henggeler & Schoenwald, 2011;
that reentry is also made difficult when opportunities for developing Lipsey, 2009).
skills to navigate prosocial relationships have not been provided. It is Increasingly, authors are advocating the use of evidence-based
critical that incarcerated youth develop these skills, as it has been practice in the treatment of youth offenders (Henggeler & Schoenwald,
found that moving back into old peer networks is one of the greatest 2011). Community-based programs that use cognitive behavioral and
challenges youths face upon their transition back into the communi- social learning approaches are typically understood to incorporate these
ty and a primary obstacle to avoiding delinquency (Abrams, 2006). principles most effectively. Not surprisingly, research indicates that inter-
The high special education and mental health needs of youth ventions with philosophies of deterrence or discipline, such as boot
offending samples pose challenges to a successful community reinte- camps or “scared straight” programs, tend to have no effect or an adverse
gration including educational engagement (Cruise et al., 2011). While effect on recidivism rates (Lipsey, 2009) and should therefore be avoided.
engagement in education or employment is associated with desistance The empirically supported treatments that are predominantly advocated
of severe delinquent behaviors (Stouthamer-Loeber et al., 2004), only include Multisystemic Therapy (MST) (Henggeler, Schoenwald, Borduin,
around 30%–40% of incarcerated youth offenders gain employment Rowland, & Cunningham, 2009), Functional Family Therapy (FFT)
within one year following their release (Bullis & Yovanoff, 2006; (Alexander, Pugh, Parsons, & Sexton, 2000) and Multidimensional
Chung, Schubert, & Mulvey, 2007). Furthermore, the likelihood of Treatment Fostercare (MTFC) (Chamberlain, 2003) (see Henggeler &
being employed is significantly less for those with special education Sheidow, 2012, for a review of all three treatment approaches).
needs (Bullis & Yovanoff, 2006). The underlying concept of these interventions is that they are family
In order to overcome these challenges, aftercare programs in the centered and community based, and they provide a comprehensive
months following release, including engagement with community approach with collaboration between juvenile justice, mental health,
services and community supervision, are keys to successful transition and other services. Consequently these programs often involve family
and decreased risk for further contact with juvenile justice (Mulvey, systems approaches, as well as principles of cognitive behavior therapy
2011). Based on a comprehensive review of literature, Abrams et al. and social learning, and assist adolescents and their families in develop-
(2008) emphasized that, in order to achieve successful reintegration, ing the skills, competencies, and motivation to succeed in functioning
it is critical that not just surveillance-orientated probation services adaptively and prosocially within their natural environment. Interven-
are provided, but also programs that help youth to practice and main- tions that effectively reduce the incidence of offending behaviors
tain prosocial behaviors. Altschuler (2007) argues that bridging is among youth are not only positive for the at-risk individual, but also
also necessary to ensure that this aftercare is effective, and it should the community (Henggeler & Schoenwald, 2011). Henggeler (2003)
include integration of residential and aftercare services, continuity notes that, in addition to decreased crime and treatment costs, as well
of care, involvement of family, and community support planning. as increased functioning, there are a number of other advantages of
This is particularly important, given that requirements for success in evidence-based treatments, such as accountability through the rigorous
secure residential settings and in a community context can be vastly quality assurance systems, and the inclusion of clear operationalized
different and present differing environmental factors that shape be- goals that are benchmarks for progress. Additionally, evidence-based
havior in different ways (Altschuler, 2007). However, although bridg- treatments explicitly target key risk factors by helping to build prosocial
ing is crucial, it is difficult to achieve because residential and contexts in real-world settings, thus addressing the issue of treatment
community services are often largely independent of one another generalization (Henggeler, 2003).
(Altschuler, 2007; Soler, 2002). A number of recent studies have indicated the efficacy of MST on
The negative impacts of incarceration during adolescence have post-treatment measures of serious antisocial behavior (Curtis, Heiblum,
been found to have, not just a short-term effect, but also one that re- Ronan, & Crellin, 2009) and in comparison to usual community services
sults in negative outcomes in multiple domains during adulthood. (Borduin, Schaeffer, & Heiblum, 2009; Henggeler, Clingempeel, Brondino,
Drawing data from the Ohio life-course study, Lanctôt et al. (2007) & Pickrel, 2002; Henggeler et al., 2009; Letourneau et al., 2009; Ogden &
found that, even after controlling for self-reported delinquency, insti- Halliday-Boykins, 2004; Schaeffer & Borduin, 2005) over both short-
tutionalization was associated with several negative outcomes in and long-term follow-up periods (Sawyer & Borduin, 2011). For example,
early adulthood. Such negative outcomes included socio-economic in a meta-analysis of treatment studies, Curtis et al. (2004) found MST to
disadvantage, premature transitions into cohabitation and parent- have an average effect size of .55 mostly over short-term follow-up
hood, instability (involving shorter job tenures, conjugal instability, periods (i.e., up to 24 months), and that youths and their families who
and unintended pregnancies), and a perceived lack of caring and received MST were functioning better than 70% of youths and families
trust from both parents and peers. treated alternatively. Similarly, Sawyer and Borduin (2011) investigating
456 I. Lambie, I. Randell / Clinical Psychology Review 33 (2013) 448–459

long-term treatment efficacy found recidivism rates were significantly Huey et al., 2000; Ogden & Hagen, 2006; Timmons-Mitchell et al., 2006)
lower for participants receiving MST (34.8%) in comparison to individual suggest that there can be difficulties in optimizing effectiveness in real-
therapy (54.8%) at 21.9 year follow-up. One particular strength of MST is life community situations and indicate that there is a need to investigate
that it has an average completion rate of 86% (Curtis, Ronan, & Borduin, influences on outcomes in real-life settings (Henggeler, 2004).
2004), in comparison to the 50% dropout rate of other child and family There is a need, and a demand, for a balance between public safety
treatments (Nock & Ferriter, 2005). Such positive effects have also been and rehabilitation to be reached and, in some cases, for particularly
found in randomized trials in a real-world rather than clinical setting dangerous offenders, secure residential options are likely to be necessary.
(Ogden & Hagen, 2006; Timmons-Mitchell, Bender, Kishna, & Mitchell, Obviously, in the case of some serious offending, punishment by law is
2006). MST has been found to have a positive effect, not only on behavior also necessary. In such circumstances, incarceration maybe required.
and offending outcomes, but also on other measures of functioning, However, given that research points to community-based, empirically
specifically in the home, at school, and in the community, and concerning supported treatments as being the most effective option for youth
moods and emotions (Timmons-Mitchell et al., 2006). offenders, where possible, the retention of offenders in the community
Similarly, studies that have compared MTFC with services such as and provision of such interventions is likely to result in the most desirable
usual group care have found MTFC to be associated with less contact outcomes for both the offender and the community. Community-based
with delinquent peers (Leve & Chamberlain, 2005), less violent offending treatment with a focus on rehabilitation and principles of reparation are
(Eddy, Whaley, & Chamberlain, 2004) fewer criminal referrals and fewer not necessarily mutually exclusive. A restorative justice approach involv-
number of days in locked settings (Van Ryzin & Leve, 2012), lower anti- ing family group conferencing processes may provide a means of process-
social behavior scores, more positive family management scores, and ing juvenile criminal behavior whereby the needs and wishes of the
lower deviant peer association scores (Eddy & Chamberlain, 2000). Addi- victim are apparent, the rehabilitative needs of the offender considered,
tionally, one MTFC to residential group care found youth involved with and an acceptable outcome is settled that considers values of both repara-
MTFC (50%) had significantly lower rates of incarceration than youth tion and rehabilitation (Goren, 2001).
placed in residential group care (94%) during a 2 year follow-up period
(Chamberlain, 1990). 6. Conclusion
Interestingly, a number of studies have found that the positive
effects of evidence-based treatments on problem behaviors are mediat- Prisons are notoriously inadequate, even for adult inmates. For
ed by a lack of improvement in factors such as family cohesion and func- juveniles, incarceration, particularly with adult offenders, has been
tioning, caregiver supervision and discipline, adult–youth relationships shown to be more damaging than rehabilitative. This vulnerable popu-
and association with delinquent peers (Eddy & Chamberlain, 2000; lation suffers negative consequences when placed in an environment
Henggeler et al., 2009; Huey, Henggeler, Brondino, & Pickrel, 2000; that fails to address, and often heightens, existing mental health, learn-
Van Ryzin & Leve, 2012). Changes in family factors and delinquent ing, and behavioral problems. Not only are juveniles more at risk of
peer association are therefore key mechanisms in program efficacy suicide, victimization, and assaults in adult facilities, there is also a
and are likely to be hindered by group residential confinement settings, lack of health and mental health services, as well as education and
given the previously discussed family dislocation and negative peer recreation programs, for them. Incarceration impairs positive psychoso-
association that are likely to result from incarceration of adolescents. cial development and transition into adulthood, resulting in an impaired
In response to the high cost of incarceration, and the negative out- ability to reintegrate successfully into the community post-incarceration,
comes it produces, there is a need to examine the cost-effectiveness of and a number of negative adult outcomes. In an adult prison, to be accept-
incarcerating youth in comparison to alternatives for offending behavior. ed and escape the brutality and victimization, juveniles adopt the social
One study from the United States compared the cost-effectiveness of rules and norms of the more seasoned adult offenders. Rather than
incarcerating youths to that of alternate programs, such as diversion being deterred from crime, they receive instruction on how to commit
and mentoring, FFT, aggression replacement training, and MST (Aos, crimes and evade detection. Exposure to the adult inmate subculture,
2002). This study found that MST was the most cost-effective and that lack of rehabilitative support services that cater to their needs, and loss
detention was found to be the least cost-effective. Additionally, a of their normal life outside prison invariably lead juveniles to reoffend
cost-benefit analysis of MST (Klietz, Borduin, & Schaeffer, 2010) found on release. Incarcerated youth are removed from the environment in
that, in a sample of serious juvenile offenders in the state of Missouri, which the vast and complex factors that act to elicit and maintain behav-
because of lowered justice system expenses and fewer victims, ior exist. Therefore, the incarceration environment is highly limited in its
every dollar spent on MST provided taxpayers with approximately rehabilitative potential. The evidence clearly points to the need to keep
$9.50–$23.50 USD in savings. juveniles out of adult prisons and ensure that they undergo effective
Although a large body of psychological literature tends to agree on rehabilitation, which takes their developmental status and complex
evidence-based treatments as the most effective options for the rehabil- criminogenic needs into account.
itation of youth offenders, governmental policies and justice decisions
have yet to reflect such findings. Henggeler and Schoenwald (2011)
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