Kevin S. Armstrong

Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy.

OBJECTIVE A randomized trial assessed the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. METHOD A 2 x 2 design encompassing 14 rural Appalachian counties included 2 factors: (a) the random assignment of delinquent youth within each county to a multisystemic therapy (MST) program or usual services and (b) the random assignment of counties to the ARC (for availability, responsiveness, and continuity) organizational intervention for implementing effective community-based mental health services. The design created 4 treatment conditions (MST plus ARC, MST only, ARC only, control). Outcome measures for 615 youth who were 69% male, 91% Caucasian, and aged 9-17 years included the Child Behavior Checklist and out-of-home placements. RESULTS A multilevel, mixed-effects, regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a nonclinical level and significantly lower than in other conditions. Total problem behavior was equivalent and at nonclinical levels in all conditions by the 18-month follow-up, but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate (16%) than youth in the control condition (34%). CONCLUSIONS Two-level strategies that combine an organizational intervention such as ARC and an evidence-based treatment such as MST are promising approaches to implementing effective community-based mental health services. More research is needed to understand how such strategies can be used effectively in a variety of organizational contexts and with other types of evidence-based treatments.

School Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Objectives School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors. Methods We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners. Results Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49–0.78, p<0.001), self-efficacy related to refusing sex or condom use (Hedges g = 0.25, 95% CI: 0.14–0.36, p<0.001), condom use (OR = 1.34, 95% CI: 1.18–1.52, p<0.001), fewer sexual partners (OR = 0.75, 95% CI:0.67–0.84, p<0.001) and less initiation of first sex during follow-up (OR = 0.66, 95% CI: 0.54–0.83, p<0.001). Conclusions The paucity of abstinence-only or abstinence-plus interventions identified during the review made comparisons between the predominant comprehensive and less common abstinence-focused programs difficult. Comprehensive school-based sex education interventions adapted from effective programs and those involving a range of school-based and community-based components had the largest impact on changing HIV-related behaviors.

Recidivism rates for registered and nonregistered juvenile sexual offenders.

The primary purpose of this study is to examine the effects of South Carolinas comprehensive registration policy on recidivism of juveniles who sexually offend. Registered and nonregistered male youth are matched on year of index offense, age at index offense, race, prior person offenses, prior nonperson offenses, and type of index sexual offense, for a total of 111 matched pairs. Recidivism is assessed across a mean 4.3-year follow-up (SD = 2.5). The sexual offense reconviction rate is too low (2 events) to support between-group analyses. Cox regression results indicate no significant between-group differences with respect to new nonsexual person offense convictions but significant between-group differences with respect to new nonperson offense convictions. Specifically, registered youth are more likely than nonregistered youth to have new nonperson offense convictions across follow-up. Public policy implications of these findings are discussed.

Effects of South Carolina's sex offender registration and notification policy on adult recidivism

Some sex offender registration and notification (SORN) policies subject all registered sex offenders to Internet notification. The present study examined the effects of one such broad notification policy on sex crime recidivism. Secondary data were analyzed for a sample of 6,064 male offenders convicted of at least one sex crime between 1990 and 2004. Across a mean follow-up of 8.4 years, 490 (8%) offenders had new sex crime charges and 299 (5%) offenders had new sex crime convictions. Cox’s relative risks and competing risks models estimated the influence of registration status on risk of sexual recidivism while controlling for time at risk. Registration status did not predict recidivism in any model. These results cast doubt on the effectiveness of broad SORN policies in preventing repeat sexual assault. Policy implications, particularly with respect to the federal Adam Walsh Child Protection and Safety Act, which requires broad notification, are discussed.

Failure to Register as a Sex Offender: Is it Associated with Recidivism?

The purpose of this study is to investigate the relationship between failure to register (FTR) as a sex offender and subsequent recidivism (N = 2,970). No significant differences were found between the sexual recidivism rates of those who failed to register and compliant registrants (11% vs. 9%, respectively). There was no significant difference in the proportion of sexual recidivists and nonrecidivists with registration violations (12% vs. 10%, respectively). FTR did not predict sexual recidivism, and survival analyses revealed no significant difference in time to recidivism when comparing those who failed to register (2.9 years) with compliant registrants (2.8 years). Results fail to support the supposition that sexual offenders who fail to register are more sexually dangerous than those who comply with registration requirements. The punitive emphasis on registration enforcement may not be justified and might divert limited resources away from strategies that would better facilitate public protection from sexual violence.

Effects of South Carolina’s Sex Offender Registration and Notification Policy on Deterrence of Adult Sex Crimes

This study examined whether South Carolina’s sex offender registration and notification (SORN) policy was associated with a general deterrent effect on adult sex crimes. Using adult arrest data from 1990 through 2005, trend analyses modeled the intervention effects of 1995 (the year South Carolina’s SORN policy was initially implemented) and 1999 (the year the policy was revised to include online registration). Results supported a significant deterrent effect for the 1995 intervention year, with an approximately 11% reduction in first-time sex crime arrests in the post-SORN period (1995-2005) relative to the pre-SORN period (1990-1994). This decline equated to averting approximately three new sex crime arrests per month. Comparison analyses with serious nonsex offenses against persons (assault and robbery) failed to identify similar effects, suggesting that the 1995 effect is attributable to sex offense—specific legislation. Findings are compared with the existing literature on general deterrent effects of SORN and discussed in the context of research examining other effects of SORN.

Two-year follow-up of a randomized effectiveness trial evaluating MST for juveniles who sexually offend.

Building on prior efficacy trials (i.e., university-based, graduate students as therapists), the primary purpose of this study was to determine whether favorable 12-month outcomes, obtained in a randomized effectiveness trial (i.e., implemented by practitioners in a community mental health center) of multisystemic therapy (MST) with juveniles who had sexually offended (JSO), were sustained through a second year of follow-up. JSO (n = 124 male youth) and their families were randomly assigned to MST, which was family based and delivered by community-based practitioners, or to treatment as usual (TAU), which was primarily group-based cognitive-behavioral interventions delivered by professionals within the juvenile justice system. Youth averaged 14.7 years of age (SD = 1.7) at referral, were primarily African American (54%), and 30% were Hispanic. All youth had been diverted or adjudicated for a sexual offense. Analyses examined whether MST effects reported previously at 1-year follow-up for problem sexual behaviors, delinquency, substance use, and out-of-home placement were sustained through a second year of follow-up. In addition, arrest records were examined from baseline through 2-year follow-up. During the second year of follow-up, MST treatment effects were sustained for 3 of 4 measures of youth problem sexual behavior, self-reported delinquency, and out-of-home placements. The base rate for sexual offense rearrests was too low to conduct statistical analyses, and a between-groups difference did not emerge for other criminal arrests. For the most part, the 2-year follow-up findings from this effectiveness study are consistent with favorable MST long-term results with JSO in efficacy research. In contrast with many MST trials, however, decreases in rearrests were not observed.

The Influence of Sex Offender Registration on Juvenile Sexual Recidivism

This study examines the influence of South Carolinas sex offender registration policy on juvenile offender recidivism risk. Juvenile male sexual offender (N = 1,275) risk of recidivism was examined with an average 9-year follow-up. Survival analysis was used to examine the influence of covariates, including the primary time-dependent covariate registration status at time, on risk of new sexual offense charges and adjudications. A competing risks model was used to explain the effects of covariates on different types of recidivism events (sexual, assault, and other). Registration status at time had a significant effect on risk of new “other” offense charges and a marginal (p < .10) effect on risk of sexual offense charges (survival analysis) but no statistical evidence of affecting risk of new adjudications. Results suggest a surveillance effect leading to unnecessary charges for registered (vs. nonregistered) youth. State and national policy implications are discussed.

Effects of Sex Offender Registration Policies on Juvenile Justice Decision Making

This study examines effects of sex offender registration policies on juvenile judicial decision making. Prosecutor decisions and disposition outcomes are examined across a 15-year period. Results indicate that prosecutors are significantly less likely to move forward on both serious sexual and assault offense charges after registration implementation, with the estimated effect nearly twice as large for sexual offenses. There also is increased likelihood of guilty findings for sexual and assault offenses over time. As new policies legislate harsher consequences for juvenile offenses, prosecutors become less likely to move forward on sexual and assault charges. This effect is especially strong for juvenile sexual offenders, who face reforms targeting both violent and sexual crimes. Results suggest that state and national policies requiring long-term public registration of juveniles might unintentionally decrease the likelihood of prosecution. If replicated, the results indicate a need to reform registration policies as applied to juveniles.

Do Sex Offender Registration and Notification Requirements Deter Juvenile Sex Crimes

This study examined whether South Carolina’s sex offender registration and notification (SORN) policy was associated with a general deterrent effect on juvenile sex crimes. Using juvenile justice data from 1991 through 2004, trend analyses modeled the intervention effects of 1995 (the year South Carolina’s SORN policy was initially implemented) and 1999 (the year the policy was revised to include online registration). Initial results suggested a significant deterrent effect of SORN on first-time juvenile sex crimes. However, comparison analyses with nonsex offenses identified a similar effect on first-time robbery crimes. Follow-up analyses indicated that the apparent declines identified for first-time sex and robbery offenses were due to another legislative change, also enacted in 1995, that moved the prosecution of 16-year-old defendants from juvenile to adult court. When these cases were included in the database, follow-up analyses indicated no significant effect for the 1995 intervention year. Thus, South Carolina’s SORN policy was not associated with a general deterrent effect on juvenile sex crimes. Specific policy changes are suggested regarding the application of registration and notification requirements to juveniles.