Kathryne B. Brewer

A meta-analysis of experimental studies of diversion programs for juvenile offenders

OBJECTIVE Research to establish an evidence-base for the treatment of conduct problems and delinquency in adolescence is well established; however, an evidence-base for interventions with offenders who are diverted from the juvenile justice system has yet to be synthesized. The purpose of this study was to conduct a meta-analysis of experimental studies testing juvenile diversion programs and to examine the moderating effect of program type and implementation quality. METHOD A literature search using PsycINFO, Web of Science, and the National Criminal Justice Reference Service data-bases and research institute websites yielded 28 eligible studies involving 57 experimental comparisons and 19,301 youths. RESULTS Recidivism was the most common outcome reported across all studies. Overall, the effect of diversion programs on recidivism was non-significant (k=45, OR=0.83, 95%CI=0.43-1.58). Of the five program types identified, including case management (k=18, OR=0.78), individual treatment (k=11, OR=0.83), family treatment (k=4, OR=0.57), youth court (k=6, OR=0.93), and restorative justice (k=6, OR=0.87), only family treatment led to a statistically significant reduction in recidivism. Restorative justice studies that were implemented with active involvement of researchers led to statistically significant reductions in recidivism (k=3, OR=0.69). Other outcomes, including frequency of offending, truancy, and psycho-social problems were reported infrequently and were not subjected to meta-analysis. CONCLUSIONS High levels of heterogeneity characterize diversion research. Results of this study recommend against implementation of programs limited to case management and highlight the promise of family interventions and restorative justice.

Adaptation and translation of mental health interventions in Middle Eastern Arab countries: A systematic review of barriers to and strategies for effective treatment implementation:

Aim: All too often, efficacious psychosocial evidence-based interventions fail when adapted from one culture to another. International translation requires a deep understanding of the local culture, nuanced differences within a culture, established service practices, and knowledge of obstacles and promoters to treatment implementation. This research investigated the following objectives to better facilitate cultural adaptation and translation of psychosocial and mental health treatments in Arab countries: (1) identify barriers or obstacles; (2) identify promoting strategies; and (3) provide clinical and research recommendations. Methods: This systematic review of 22 psychosocial or mental health studies in Middle East Arab countries identified more barriers (68%) than promoters (32%) to effective translation and adaptation of empirically supported psychosocial interventions. Results: Identified barriers include obstacles related to acceptability of the intervention within the cultural context, community and system difficulties, and problems with clinical engagement processes. Whereas identified promoter strategies centre on the importance of partnering and working within the local and cultural context, the need to engage with acceptable and traditional intervention characteristics, and the development of culturally appropriate treatment strategies and techniques. Conclusions: Although Arab cultures across the Middle East are unique, this article provides a series of core clinical and research recommendations to assist effective treatment adaptation and translation within Arab communities in the Middle East.

Prevalence of Mental Health and Behavioral Problems Among Adolescents in Institutional Care in Jordan

OBJECTIVES This study aimed to establish the prevalence rates of mental health and behavioral problems of Arab youths residing in Jordanian care centers due to family disintegration, maltreatment, or abandonment and to examine how functioning varies by child characteristics and placement history. METHODS Child Behavior Checklist and case history data were collected for 70 youths across four Jordanian care centers. RESULTS Approximately 53% of the adolescents were identified as experiencing mental health problems, and 43% and 46% had high internalizing and externalizing scores, respectively. Ordinary least-squares regression models examining mental health functioning showed that male gender, care entry because of maltreatment, time in care, and transfers were the most significant predictors of problems. CONCLUSIONS Paralleling international research, this study found high levels of mental health needs among institutionalized youths. The impact of transfers on functioning is particularly worrisome, given the standard practice of transferring youths to another facility when they reach age 12. Improving the institutional care model by requiring fewer transfers and offering family-based community alternatives may ameliorate risks of developing mental and behavioral problems.

Stigma and adolescents with psychosis in the Middle East: implications for engaging in mental health treatment.

Abstract Stigma is a fundamental barrier to individuals seeking out mental health treatment in the Middle East. The impact of stigma may be amplified if the engagement in and utilization of mental health services for psychosis further stigmatizes individuals and their families. One hundred four Jordanians (N = 104) participated in an experimental vignette survey examining stigma perceptions and social exclusion related to adolescents with psychosis, with the vignettes varying in sex of the youth and whether their family had sought mental health services. The results found that seeking treatment did not add to perceived stigma, and both the male and female adolescents receiving mental health treatment were viewed as significantly more likely to be helped than those not in treatment (p < 0.001). Therefore, receiving mental health treatment did not further stigmatize these Arab youth with psychosis. In addition, seeking out and engaging adolescents and their family in mental health treatment were positively perceived and may help to improve the youth’s prognosis and outcomes.

Foster care as a viable alternative to institutional care in the Middle East: community acceptance and stigma across type of placement in Jordan.

Objective: Utilizing an experimental vignette design, this study assessed attitudes in the Hashemite Kingdom of Jordan toward the implementation of foster care as an alternative to institutions for children in need of care and protection. Methods: A sample of 111 adults were surveyed in Amman and presented with a vignette describing a 14-year-old boy who came into the care of the Ministry of Social Development when he was a baby after being placed by the grandfather because of shame surrounding the mother being unwed. The vignettes systematically varied as to whether the child was described as raised in an orphanage, with a relative in a kinship foster placement, or with a nonkin foster family. Participants were then asked a series of questions about their acceptance of the child, stigma that the community might attach to the child, and potential outcomes for the child. Results: We found no differences across the acceptance and stigma questions between the kinship and nonkin foster conditions. The 2 foster care options were at least as acceptable as current institutional models across all domains, and participants were more likely to accept the child going to school with or being friends with their child if they were in foster care rather than an institution. Conclusions: These results represent the first evidence of public acceptance of foster care as a model of care in Jordan and may inform the process of local stakeholders implementing alternatives to institutional care on a meaningful and sustainable scale in the Kingdom and regionally.

Child mental health in Jordanian orphanages: effect of placement change on behavior and caregiving

BackgroundTo assess the mental health and behavioral problems of children in institutional placements in Jordan to inform understanding of current needs, and to explore the effects of placement change on functioning and staff perceptions of goodness-of-fit.MethodsAn assessment was completed of 134 children between 1.5–12 years-of-age residing in Jordanian orphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and internalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with each child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time since last move, and an anticipation clock measuring time to next move.Results28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing domain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive developmental disorder, and conduct problems. Internalizing problems were found to decrease with time in placement as children adjust to a prior move, whereas externalizing problems increased as the time to their next age-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the change clocks were predictive of staff perceptions of goodness-of-fit with the children under their care.ConclusionsThese findings add to the evidence demonstrating the negative effects of orphanage rearing, and highlight the importance of the association between behavioral problems and child-caregiver relationship pathways including the timing of placement disruptions and staff perceptions of goodness-of-fit.

Prevalence and correlates of depression, posttraumatic stress disorder, and suicidality in Jordanian youth in institutional care.

Abstract Youth in institutional care centers have higher mental illness rates compared with community populations. Research examining mental illness among youth in institutional care in the Middle East is lacking. This study examines the prevalence and correlates of depression, posttraumatic stress disorder (PTSD), and suicidality of youth in institutional care in Jordan. Data were collected through youth interviews, staff-caregiver surveys, and administrative files. Prevalence rates and logistic regressions were used to model suicidality across depression, PTSD, and comorbid depression/PTSD, controlling for youth characteristics, case history, and social support factors. Institutionalized youth endorsed high rates of mental illness (45% depression, 24% PTSD, 17% depression/PTSD, 27% suicidality). The odds of suicidality for depressed youth were 3.6 times higher. Abuse was significant, with the odds of suicidality for abused youth 4 times higher. Elevated rates of mental illness and suicidality indicate the importance of addressing these needs within institutions. Developing institutional programs that foster peer relationships is recommended.

Public perceptions of adolescent mothers in need of care and protection in Jordan: Could community-based alternatives to institutional placement reduce stigma?:

Adolescent girls who become pregnant outside of marriage in the Middle East experience increased stigma, risk of social exclusion, and family violence. This study examined whether community-based foster care has the potential to reduce the stigma attached to pregnant girls placed in protective institutional care within an Arab context. Using data from a public survey of adults in Jordan, this study found that stigma was significantly lower when the pregnant girl was described as placed in foster care rather than institutional care. Findings indicate that foster care models may have the potential to lessen the stigma attached to these girls.