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mental health conditions, and limited life skill sets. The U.S. Department of Justice has
repeatedly examined current programs aimed at reducing recidivism rates among youth offenders
with mental health disorders, and they have found that most facilities are inadequately prepared
to address the mental health needs of the youth (U.S. Department of Justice, 2005). Many
programs utilize one on one psychotherapy as the basis of treatment to address intrinsic
motivating factors of criminal behaviors. These psychotherapeutic programs are aimed at the
individual who is incarcerated only and addresses their concerns in a vacuum. A series of
investigative reports examined the influence of familial involvement in recidivism and crime
rates among youth offenders and found that an overwhelming amount of children, approximately
94%, wish to be in more contact with their families while incarcerated (Sedlack & McPherson,
2010). Despite this evidence, many programs are still utilizing an individualized psychotherapy
approach to treatment rather than an approach involving the adolescent and their support network
(i.e. family, caregiver, teachers, etc.). However, there has been a recent push to have incarcerated
youth with mental health disorders placed in community based settings in order for them to have
greater access to evidence-based treatments aimed at reducing criminal behaviors and addressing
life skills development. This paradigm shift is a major contributor to increased funding in
research and host treatment for this population in attempts to develop effective skill-based
programming.
The average cost of incarceration within a juvenile detention facility is between $32,000
and $65,000 per year (Juvenile Detention Alternatives Initiative, 2007). The estimated total cost
resulting from long-term outcomes of ineffective intervention treatments could cost taxpayers
between $8 billion to $21 billion a year nationwide (Justice Policy Institute, 2014). The
development of alternative programming can address not only the needs of the youth, but can
significantly reduce the financial burden on prisons within the United States. Research has
shown through the use of programming such as Multisystemic Therapy (MST), every $1 spent
will have a $13 return. Programs focused on reducing recidivism rates through the development
of positive coping skills, social skills, and life skills can save the public almost $5.7 million in
costs over the childs lifetime (Cohen & Piquero, 2007). During the 2014 fiscal year in Nevada,
the cost of incarcerating a juvenile offender was approximately $150,000 (Justice Policy
Institute, 2014).
Effective programming that encompasses symptom and behavioral management, coping
strategies, and the development of useful life skills is necessary to address the multifaceted needs
of incarcerated youth with mental illness. The implementation of occupational therapy services
with this population could help decrease recidivism rates and involved costs. Occupational
therapists can help to create programming that focuses on building positive social networks,
developing independent living and vocational skills, and addressing psychosocial factors often
associated with incarceration and crime. Occupational therapists can help incarcerated youth
with mental illness identify vocational and leisure opportunities that could improve the
Level II:
Mindfulness based interventions have a statistically significant impact on levels of selfregulation, perceived stress, and incidence of mindful behaviors. The use of group
discussion and reflection allowed for the youth to process mindfulness teachings and
learn how to apply them to their daily life (Himelstein, Hastings, Shapiro, & Heery,
2012; Barnett, Himelstein, Herbert, Garcia-Romeu & Chamberlain, 2013).
Psychotherapy alone is not as effective as skill based intervention strategies targeting
incarcerated youth with substance abuse disorders. A mindfulness program tailored to
address self-regulation and perceived risk can lead to the youth having a greater
understanding of susceptibility to drug use and control over ones impulses (Himelstein,
2010).
Family and community based programs are more effective in decreasing recidivism
rates among youth with mental health conditions than psychotherapy alone. Current
programs-as-usual are not equipped to deal with co-occurring substance abuse and
mental health disorders in relation to reducing criminal behaviors (Trupin, Kerns,
Walker, DeRobertis, & Stewart, 2011).
Level III:
Yoga interventions can be a highly effective method for decreasing perceived stress
levels and increasing self-control (Ramadoss & Bose, 2010).
Skills learned through yoga based interventions, such as mindful movement, slow
breathing, and self-reflection, can be readily generalized and applied to daily life
activities (Ramadoss & Bose, 2010).
Incidence of violent behaviors was found to decline among incarcerated youth who
participated in the Yoga Based Transformative Life Skill Program. Findings related to
violent behaviors had good clinical significance; however, the results were not
statistically significant.
one study without flaws; however, meaningful implications can be drawn from each study such
as the importance of considering the youth and their family, contextual factors, and the
importance of promoting self-efficacy, self-esteem and a sense of control amongst the
individuals. Individually tailored programming is difficult, and near impossible, to implement in
a juvenile justice center, however the basic tenets of programs can be adapted in order to meet
the unique needs of all those who participate. Programs focusing on familial involvement,
communication, self-regulation, self-efficacy, and the establishment of positive coping skills had
the greatest impact on recidivism rates. Facilitating social abilities, life skills, and emotional
regulation skills needed to cope with prison life all fall under occupational therapys scope of
practice. Occupational therapists can assist in the development of the capacity for successful
community reintegration through meaningful and skill-based interventions that promote
occupational engagement and improved self-efficacy.
Program development:
None of the studies reviewed incorporated occupational therapy services; however, future
programs would benefit from implementing occupational therapy services. Occupational
therapist are skilled in providing client-centered evaluations and interventions that consider
pertinent intrinsic and extrinsic client factors along with factors that improve clients
independence and functional abilities. Program protocols must relate to the needs of the youth
and address them as occupational beings, rather than as inmates. Further program refinement
should be done to adapt the program for on-site and community based implementation.
Regardless of health care discipline, all professionals delivering services must be well versed in
the methodologies of the program and intervention.
Societal Needs:
It is imperative youth be given opportunities to be successful in life despite legal system
involvement. Further information needs to be provided regarding program protocols and
standards in order for the research to be beneficial for treatment. The current programming
provided for this population is scarce and often ineffective in reducing recidivism rates.
Recidivism costs, legal costs, and costs payed to harmed parties still make up a large portion of
taxpayer dollars every year. Society could benefit financially, civically and communally by
developing therapeutic programs for this population. All parties included youth, their families,
and their communities would benefit from more effective programming aimed at the
development of positive life skills.
Review Process:
The focus question was developed to explore current programming options offered for
incarcerated youth with mental health conditions that could fall under the scope of practice of
occupational therapy.
Given the variety of programming available, the authors chose to hone in on programming aimed
at reducing recidivism rates. These programs also had to include skill based interventions rather
than psychotherapy alone.
The focus question was then amended to encompass all important aspects of the authors search:
Do skill-based interventions reduce recidivism rates amongst youth with mental health
disorders?
The focus question was reviewed and approved by Dr. Donna Costa.
A comprehensive literature review was conducted utilizing key terms in various databases in
order to exhaust available research studies.
A total of 34 articles were found as a result of the comprehensive literature search.
The articles were reviewed by both authors in order to determine their fit with the inclusion
criteria.
23 out of the 34 articles were eliminated based on the inclusion criteria. The eliminated articles
focused on the use of psychotherapy or pharmacological treatments to address the needs of
incarcerated youth with mental health disorders.
11 articles met the inclusion criteria and were analyzed in the evidence table.
The evidence table was reviewed by Dr. Donna Costa for accuracy.
Upon approval of the evidence table, appraised articles were compiled and evaluated as a
critically appraised topic.
Exclusion Criteria:
Participants > 18 y/o
Physical disability only
House arrest
Pharmacological treatment
Studies conducted before 2006
Studies with less than Level III evidence
Search Strategies:
Categories
Patient/Client Population
Intervention
Outcomes
Google Scholar, CINAHL, hand searching through articles, EBSCO Host, OTSearch
Quality Control/Peer Review Process:
The focus question was reviewed and approved by Dr. Donna Costa.
Both researchers made revisions to the focus questions to include skill based interventions.
The researchers identified key terms to conduct a comprehensive literature review.
A comprehensive literature review was completed by both authors.
The focus question was again amended and approved by Dr. Donna Costa following literature
review feedback.
The inclusion and exclusion criteria were amended by both authors in response to changes in the
focus question.
Both researchers reviewed each article and agreed upon the inclusion of each article.
Both researchers worked together to complete critical review forms for quantitative studies for
each article.
Information from each critical review form was compiled into an evidence table.
Dr. Donna Costa reviewed this evidence table for accuracy and rigor.
CAT was completed based on revisions and consultations between authors and Dr. Donna Costa.
Results of Search:
Summary of Study Designs of Articles Selected for Appraisal:
Level of
Evidence
Number of Articles
Selected
II
III
IV
Other
Qualitative Studies
0
TOTAL:
11
Level II Limitations:
Court ordered versus voluntary participation in both experimental treatment and
treatment as usual conditions may have skewed results (Himelstein, 2010).
Small sample size limited generalizability to more heterogenous populations
(Himelstein, 2010); (Trupin, Kerns, Walker, DeRobertis, & Stewart, 2011); (Himelstein,
Hastings, Shapiro, & Heery, 2012); (Helmond, Overbeek, & Brugman, 2012); (Barnett,
Himelstein, Herbert, Garcia-Romeu, & Chamberlain, 2013).
Inconsistent training and professional backgrounds of treatment administrators limited
the findings (Helmond, Overbeek, & Brugman, 2012).
Limited information regarding specific treatment protocols impacted analysis and
comparison (Trupin, Kerns, Walker, DeRobertis, & Stewart, 2011).
Levels IV and V:
No Level IV or IV studies were appraised.
Other:
No qualitative studies were appraised.
Other References:
Cocozza, J. & Skowyra, K. (2000). Youth with mental health disorders: Issues and emerging
responses. Office of Juvenile Justice and Delinquency Prevention Journal, 7(1), 3-13.
Cohen, M. & Piquero, A. (2007). New evidence on the monetary value of saving a high risk
youth. Vanderbilt Law and Economics Research Paper No. 08-07. Retrieved from:
http://ssrn.com/abstract=1077214.
Juvenile Detention Alternatives Initiative. (2007). Detention reform brief 1: Detention reform: A
cost-saving approach, Annie E. Casey Foundation. Retrieved from:
http://www.aecf.org/upload/PublicationFiles/jdai_facts1.pdf.
Juvenile Justice Institute. (2014). Sticker shock: Calculating the full price tag for youth
incarceration. Retrieved from: http://www.justicepolicy.org/research/8477
Office of Juvenile Justice and Delinquency Prevention. (2014). Juvenile offenders and victims:
2014 national report. Retrieved from:
http://www.ojjdp.gov/ojstatbb/nr2014/downloads/NR2014.pdf
Sedlack, A., & McPherson, K. (2010). Conditions of confinement: Findings from the survey of
youth in residential placement. Washington, DC: U.S. Department of Justice, Office of
Justice Programs, Office of Juvenile Justice and Delinquency Prevention