Psychiatr Q (2014) 85:295301

DOI 10.1007/s11126-014-9296-4
ORIGINAL PAPER

Juvenile Delinquency Treatment and Prevention:

A Literature Review
Jessica May Kristina Osmond Stephen Billick

Published online: 9 March 2014

Springer Science+Business Media New York 2014

Abstract In the last three decades there has been ample research to demonstrate that
instituting Multisystemic Therapy for serious juvenile offenders, keeping them in the
community with intensive intervention, can significantly reduce recidivism. When there is
recidivism, it is less severe than in released incarcerated juveniles. Multisystemic Therapy
provides 24 h available parental guidance, family therapy, individual therapy, group
therapy, educational support and quite importantly a change of peer group. In New York
City, there is the new mandate through the Juvenile Justice Initiative to implement
interventions to keep juvenile offenders in the community rather than sending them to be
incarcerated. However, this paper aims to examine how teaching prosocial values in early
childhood can reduce the incidence of first-time juvenile delinquency. Programs such as
the Perry School Project will be discussed to demonstrate that although somewhat
expensive, these innovative programs nonetheless are quite cost-effective as the cost to
society of adjudication, incarceration and victim damages are significantly greater. Along
with teaching prosocial 0020 values, there has been renewed interest in early identification
of youth at risk for developing Antisocial Personality Disorder. An update is given on the
status of both promising approaches in early intervention to prevent serious juvenile
delinquency and hence adult criminality.
Keywords Juvenile delinquency
Multisystemic Therapy
Perry preschool
project
Early childhood intervention programs

J. May
Hofstra NSLIJ School of Medicine, Hempstead, NY, USA
K. Osmond
Mt. Sinai Medical Center, New York, NY, USA
S. Billick (&)
NYU School of Medicine, 901 5th Avenue, New York, NY 10021, USA
e-mail: Stephen@billick.com

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Current Treatment of Delinquency and Historical Development

Recognizing the developmental aspect of juveniles as distinct from adults, the first juvenile
justice system was established in 1899 in Illinois and which then led to the creation of the
first child and adolescent psychiatry clinic in 1909, in Chicago. This clinic was specifically
created to aid the newly formed family courts in their adjudication of wayward youth.
Eventually all 50 states adopted these special courts to handle juvenile delinquency outside
of the adult criminal courts. The goal of these courts was to help the youth return to a
healthy path of development. Hence, there was no sentencing, only adjudication of the
youth for their betterment. Until In re Gault, children and adolescents in family court had
few of the safeguards afforded to adults charged with crimes. They now have all of legal
rights except for a jury of their peers. Since the 1970s, with the dramatic rise in violent
crime committed by adolescents, many juveniles have been returned to the jurisdiction of
adult criminal courts. Society was outraged to see juveniles murder and rape and be
released from custody at the age of 21 years, and further to have the juvenile records
sealed. In some jurisdictions, the juvenile may begin in family court and be waived up to
adult criminal court. In other states, such as New York, adolescents who commit specific
crimes of violence or with a weapon are immediately sent directly to adult criminal court.
Society has sought to reduce juvenile crime with longer incarceration in juvenile detention
facilities and some in adult prisons, with only modest success. Unfortunately when
released, incarcerated juveniles have been fully educated to be better criminals. Spending
time with more experienced criminals provides an unwanted fertile environment for
teaching adolescents exactly that which we do not want them to learn [1].

Prediction of Delinquency and Recidivism

Multiple studies show that the best predictor for delinquent behavior in the future is
delinquent behavior in the past. These youths continue their delinquency with no guide to
change their behavior, thus there is no break in the chain. A study by Abram et al.
highlights this point. His study follows almost 2,000 juvenile delinquents who were
interviewed and assessed 3 years after being detained at the Cook County Juvenile
Temporary Detention Center. Interviewers used the Child and Adolescent Functional
Assessment Scale (CAFAS) to determine the functionality of the participants based on
their responses during the semi-structured interview. Participants received scores in eight
different categories, including; their home, work/school, community, behavior, mood, selfharm behavior, substance use, and thinking. The participants scores then indicated the
level to which they were impaired or not at all impaired. Based on these interviews, almost
30 % of juvenile delinquents had marked or severe impairment across all domains. Almost
all participants had severe impairments in at least one domain [1].

Restorative Justice
In an article by Bergseth and Bouffard, these researchers explain another type of treatment
for juvenile delinquents, called Restorative Justice (RJ) [2]. RJ lies in the middle of two
competing theories for juvenile delinquent treatment, which are punishment and restoration. One of this programs main goals is to restore justice to the victim as well as the
community. Crimes committed by the juvenile delinquent are revisited, and many times the

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victim must be confronted. This structure does do some therapeutic work for the juvenile
delinquent; including taking responsibility for the wrongs they have committed, and
learning how to be held accountable. However, as documented below, when RJ is compared to Multisystemic Therapy (MST), RJ is one-dimensional. The duration of this
program is very short, with each participant receiving at least one session with a program
facilitator. Consequently, the juvenile delinquent learns much less about becoming prosocial in this short time frame. RJ only involves one factor of the delinquents life, which is
their crime. RJ had a large focus on the victim, which may be an important aspect, but is
certainly not the only factor requiring being addressed in understanding the complexity of
delinquent behavior. One of the critical complaints of RJ is that it may not significantly
decrease juvenile delinquent recidivism rates for all types of offenders. Analysis revealed
that the RJ program only yields a significant reduction in future criminality amongst male,
first-time offenders who were under the age of 14. Bergseth and Bouffard state that the
younger age that the delinquents are when referred to and treated with RJ, the longer the
time frame will be before reoffending. However, when it comes to more serious offenders,
who are generally older juveniles who have committed more serious crimes, RJ may not be
as successful in producing change in the juvenile delinquents themselves. Thus, more
lengthy treatment programs which address more dysfunctional aspects of the juvenile
delinquents life are essential when treating juvenile delinquency. However, research
shows that RJ is better than detention.

Stop Now, Act Later

SNAP (Stop Now, Act Later) is a study on delinquent adolescent boys ages 611 years old
in Ontario, Canada. The program was 12 weeks long and had two components. The first
was the Transformer Club, which was for the delinquent boys. The main goal was to help
participants through the group therapy process by identifying their bad behavior and
helping to control and manage their anger. The second component was the SNAP meeting,
group therapy intended for the parents. Positive feedback from the groups included positive
communication with other parents and separately with the delinquent boys, and the
increased feeling of support for both the parents and the boys from their peer groups. In
SNAP all of the family members are seen separately in their appropriate groups, without
specific family therapy. The SNAP program may be detrimental as it can promote delinquent behavior by putting the boys together during Transformer Club where inadvertently,
a delinquent may receive social support for his past delinquency. The SNAP program took
place at the delinquents school instead of their family home. This may limit both convenience and adherence to the therapy. Upon completion of the program, qualitative
interviews conducted with each family revealed an overall improvement in anger management and social skills amongst participants [6]. It is important to note however, that this
study had a relatively high attrition rate, as only 37 % of the original SNAP participants
consented to the final interview assessment of the program.

Scared Straight
Scared Straight represents a distinct contrast to the previously mentioned intervention
programs. Unlike the other programs, which strive to prevent the reoccurrence of delinquency through therapy and parental support, Scared Straight attempts to deter adolescents

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from initial delinquent behavior by exposing them to the harsh realities of life as a prison
inmate. The program hypothesized that these adolescents will be scared into leading a life
free from future criminal activity. The delinquent is brought to an adult prison, given tours,
and receives direct exposure and interpersonal interactions with currently convicted felons.
However, from a meta-analysis of the current literature concerning the effects of Scared
Straight on juvenile delinquency [9], concluded that programs of this nature do not successfully prevent future delinquency. Unfortunately, this exposure actually appears to
increase the likelihood of future criminal behavior.

Evidence-Based, Researched Multisystemic Therapy

In the last three decades there has been ample research to demonstrate that instituting MST
for serious juvenile offenders, keeping them in the community with intensive intervention,
significantly reduces recidivism. When there is recidivism, it is less severe than in released
incarcerated juveniles. According to a study by Borduin et al. [3] 4 years after juvenile
delinquents were treated with either MST or an individual therapy plan, MST participants
had a significantly lower recidivism rate. MST participants had a rate of recidivism of
22.1 %. This is significant, especially when compared to the individual therapy group
which had a recidivism rate of 71.4 %. Interestingly, even those that participated only
temporarily in the MST program also had a reduced recidivism rate of 46.6 % compared to
the control delinquent group. Based on findings such as these, in New York City, there is
the new mandate through the Juvenile Justice Initiative to implement interventions, like
MST, which keep juvenile offenders in the community rather than sending them to be
incarcerated (New York City) [7].
When taking into account all the experiences and systems involved in creating or
producing delinquency, it makes sense that the treatment must also be multifactorial. In the
literature, one is not able to pinpoint a single universal MST rigid treatment plan. This is
due to MSTs commitment to the individual and their family, school, problems, behaviors,
and the therapists recognition that each case may be handled differently. MST is an
intensive therapy program which focuses on numerous aspects of the delinquents life;
family, school, social and any other unique factors which may relate to the individual
delinquents behaviors [8]. MST focuses on prosocial activity and less association with
deviant peers. It has been implemented and researched in dozens of research trials and case
studies, and repeatedly received significant ratings in both effectiveness and efficacy [4].
According to a study by Tighe et al. [11], one of the main goals of MST is to decrease the
juvenile delinquents association with other delinquent youths, while facilitating familial
support through communication and guided problem solving. Some of the main praises of
MST are highlighted in Tighes qualitative study. Insights from participants included
appreciation that the family finally had time to talk with each other as well as for the nonblaming approach taken by the therapist. Delinquent individuals also stated they were more
clearly able to see and recognize how their behaviors were affecting their family. Both
family members and delinquents reported a decrease in delinquent behavior, improved
familial relationships, and an increased interest and understanding of the delinquents role
in creating their own future, and taking responsibility for their actions [11]. Despite these
positive results from MST research, it has proven difficult to implement it as a treatment
plan into standard practice and policy today due to comparative ease of other methods,
potential higher initial cost, increase of commitment on state and individual levels and
failure to see future community gains.

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Early Interventions for Delinquency and Adult Criminality Prevention

However as certain studies appear to show, preventing juvenile delinquency is far superior
to trying to correct it later. As with other commonly used preventative public health
measures, early intervention for children at high risk for delinquency may prove key. By
focusing proactive efforts on adolescents with specific risk factors for juvenile delinquency, including antisocial behavior, society would be spared the financial burden of
incarceration, victim damages and alternative treatments for reducing delinquency recidivism. The quality of life for the youth at risk for delinquency and the quality of life of
individuals in society would both be greatly improved. Additionally, applying proactive
programs to at-risk populations of a younger age has been shown to be even better. One
such long term study has been the Perry Preschool Project which teaches children prosocial
values and provides their families with support from the community during the childs
early, formative years.
Early childhood interventions can include center-based education for the child, support
programs for the family members or they include elements of both. The systematic literature review conducted by Hirokazu Yoshikawa in 1995 succeeded in creating a consolidated list of 40 early childhood programs [12]. However, of these 40 programs only 11
investigated the effects of early intervention on the subjects future delinquency and
antisocial behavior. Although of all of these eleven programs, which evaluated the effects
on juvenile delinquency and antisocial behavior, only four of these programs examined the
results in the long term and incorporated both family support and educational efforts. As it
has been previously observed, children exposed to multiple risk factors face a heightened
risk for future delinquency [5]. Therefore, it is suggested that intervention programs that
target multiple risk factors may yield superior results [12].
The first program to meet these criteria was the Perry Preschool Program, mentioned
above, which involved 123 3 and 4 years old children. Each child received approximately
12 h of preschool education per week for seven and a half months each year for 2 years.
The teachers were also required to conduct weekly home visits. Lasting ninety minutes,
these home visits involved both the child and their mother. Follow ups were conducted
with the children at the ages of 14, 19, 27 and 40 years. When compared with non-program
participants, children enrolled in the Perry Preschool Program exhibited a significant
reduction in adult and lifetime criminality at all time points studied. Upon follow up at age
40, it was found that only 28 % of the Perry Preschool Program participants had served jail
time versus 52 % of the control participants [10].
Additionally, the Perry Preschool Program model has become one of the most commonly used curriculums in the Head Start program offered to low-income families. It is
important to note that Head Start does not directly evaluate the effect of their programs on
juvenile delinquency or antisocial behavior. Instead, Head Start strives to assess each
participants school readiness. However, as they begin to integrate educational pre-K
childcare and family support services, an effect on reducing juvenile delinquency would be
an expected favorable by-product. Preliminary results from Head Starts assessment show
positive effects on the social-emotional and cognitive development, as well as parenting
practices. However, follow up was only conducted at the 1st grade time point and longer
term follow up would be necessary to properly assess the lasting effects of the Head Start
programs. Additionally, although support programs were made available to each parent it
was unclear if every parent did in fact take advantage of these classes. This study also did
not contain a no-program control group. Children who were not selected for the Head

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Start program were permitted to enroll in a non-Head Start childcare program or preschool,
which may or may not have offered some similar integrative experience for the child.
Another program, the Syracuse University Family Development Program featured 108
families and also featured high quality daycare and weekly home visits. However, unlike
the Perry Preschool Program model, parents were offered very early support beginning
prenatally and continuing into elementary school. Follow up was conducted at 13 and
16 years of age and yielded comparable results to the Perry Preschool Program, with a
significant reduction in future delinquency. At follow up only 6.2 % of program youths
were in probation versus 22 % of control participants. These results suggest that prenatal
care for families, especially for those with certain identified risks for juvenile delinquency
development such as low socioeconomic status, should prove advantageous. Unfortunately,
longer term follow up data has not yet been obtained to assess how the Syracuse project
may have affected adult criminality amongst the participant children.
Unlike the first two early intervention projects, The Yale Child Welfare Project represents a significantly smaller scale program. With only 17 families participating in the
study, each family received a personal team of professionals to assist, beginning during
the pregnancy and ending at 2.5 years of age. Families were paired with a pediatrician,
home visitor, childcare worker and developmental examiner to assist the parents
throughout the course of the program. When behavior was assessed at a 10 years follow up,
program children were depicted as well adjusted for school and male children exhibited
less antisocial behavior than their non-program counterparts [12].

Cost Effective Savings to Society with MST and Early Intervention Prevention
Programs
When comparing the cost to society, it has been shown that both MST and the Perry
Preschool Program yield substantial returns on the initial investment. According to Osher
et al. [8], the net program cost for MST was near $4,743 for each participant. However, this
investment eventually goes on to save taxpayers and crime victims $131,918 for each MST
participant. A similar projection is made with the Perry Preschool Program, which costs
$14,716 and yields $105,000 per participant in savings [8]. Results from the Syracuse
University Family Development Program found a heightened cost to the criminal justice
system for non-program participants. Based on data collected at their longer term follow
up, researchers found the costs totaled $186 per program participant versus $1,985 per
control individual. These programs represent a stark contrast to other intervention programs such as Scared Straight programs and juvenile boot camps, which yield respectively
a cost of $24,531 and $3,587 instead of providing a savings to society as did the previously
discussed programs [8].
A review of the literature shows that in the past there have been a variety of methods for
treating juvenile delinquency. However, it becomes apparent that only a select few are
successful at reducing recidivism and producing positive changes for society. MST has
become the research-documented gold standard for treating juvenile delinquents in a
highly cost effective manner. MST successfully reduces recidivism and the severity of
recidivism. However, the ultimate goal for society should be to prevent juvenile delinquency altogether. Studies, such as the Perry Preschool Program suggest that early intervention programs produce positive effects on reducing future delinquency and are highly
cost effective for society. By combining early education programs with support programs,
the Perry Preschool Program is able to target multiple risk factors, including antisocial

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behavior, for future delinquency. Therefore the Perry Preschool Program serves as the most
promising investment for reforming societys treatment of youth most at risk for delinquent
behavior.

A rational and Logical Approach to Prevention and Treatment of Delinquency

Based on this established evidence-based research, society would be wise to institute
widespread prevention programs modeled on the Perry Preschool Program. Additionally,
for those youths who do commit delinquent acts, MST should be the widespread treatment
of choice.

References
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Years after Detention. Journal of Adolescent Health 44(6):528535, 2009.
2. Bergseth KJ, Bouffard JA. Examining the effectiveness of a restorative justice program for various
types of juvenile offenders. International Journal of Offender Therapy and Comparative Criminology.
http://ijo.sagepub.com/content/early/2012/07/16/0306624x12453551. 2012.
3. Borduin CM, Mann BJ, Cone LT, Henggeler SW, Fucci BR, Blaske DM, Williams RA. Multisystemic
treatment of serious juvenile offenders: long-term prevention of criminiality and violence. Journal of
Consulting and Clinical Psychology 63(4):569-578, 1995.
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qualitative results of a multi-component intervention. BMC Public Health 11:364, 2011.
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effectiveness, and cost-benefit data to reduce minority youth incarceration. New Directions for Youth
Development 99:91120, 2003.
9. Petrosino A, Turpin-Petrosino C, Buehler J. Scared Straight and other juvenile awareness programs for
preventing juvenile delinquency. Cochrane Database of Systematic Reviews 2:CD002796, 2009.
10. Schweinhart LJ, Montie J, Xiang Z, Barnett WS, Belfield CR, Nores M. The high/scope perry preschool
study through age 40 summary, conclusions, and frequently asked questions. High/Scope Educational
Research Foundation, pp. 194215, 2005.
11. Tighe A, Pistrang N, Casdagli L, Baruch G, Butler S. Multisystemic Therapy for young offenders:
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12. Yoshikawa H. Long-term effects of early childhood programs on social outcomes and deliquency. The
Future of Children 5(3):5175, 1995.

Jessica May, BA is a current first year medical student enrolled at Hofstra NSLIJ School of Medicine. She
has received her BA in Neuroscience and Behavior from Columbia University.
Kristina Osmond, MSN is a practicing nurse at Mt. Sinai Medical Center working in the NICU.
Stephen Billick, MD is a child, adolescent and adult clinical and forensic psychiatrist currently practicing in
New York City. He is a clinical professor of psychiatry at NYU School of Medicine.

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