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Beyond detention: The effectiveness of aftercare for juvenile and young adult offenders

James, C.

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Citation for published version (APA):James, C. (2015). Beyond detention: The effectiveness of aftercare for juvenile and young adult offenders.

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Download date: 24 Jul 2020

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Studies included in the meta-analysis are indicated with an asterisk.

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Summary

Beyond Detention. The effectiveness of aftercare for juvenileand young adult offenders

By Chrissy James

Crime rates among young offenders are high, as is recidivism, with the majorityof the juvenile and young adult offenders coming into contact with the criminaljustice system within a few years after release (Abrams et al., ; Wartna et al.,). The first period after release seems to be a critical phase, and the risk ofrecidivism is highest during the first few months post release (Snyder et al.,). It appears to be difficult for juvenile and young adult offenders to trans-late skills learned inside prison to real-world settings once back in the commu-nity (Abrams et al., ; Steinberg et al., ). Therefore, aftercare may be anessential component if institutional intervention programs are to have a lastingeffect (Inciardi et al., ; Kurlycheck et al., ).

Hence, during the past three decades various reentry and aftercare pro-grams have been developed to increase the chances of juvenile and young adultoffenders for successful reintegration and desistance from crime (Mears et al.,). The importance of aftercare is also recognized in The Netherlands, withthe development of the New Perspectives Aftercare Program (NPAP), which isan intensive aftercare program for serious juvenile and young adult offenders,aged to years, reentering society after a period of detention with a moderateto high recidivism risk. The goals of the aftercare program are the prevention ofrecidivism by reducing cognitive distortions and antisocial behavior and foster-ing prosocial behavior and improving coping skills (Vogelvang & Schut, ).

To ensure successful reentry and reduce future problematic and delinquentbehavior, it is important to gain insight into whether aftercare is effective, andfor which specific groups of juvenile and young adult offenders. A number ofstudies on the effectiveness of aftercare and re-entry programs for juvenile andyoung adult offenders have been carried out, showing mixed results, which un-derscores the need for additional research to identify effective aftercare modelsand strategies for delinquent youthful offenders, especially robust experimentalresearch in the form of a Randomized Controlled Trial (RCT).

Therefore, the aim of this dissertation was threefold:First, to provide an overview and analysis of the effectiveness of aftercare

programs for juvenile and young adult offenders, and to answer the important

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and practically relevant question of “what works for whom” (Fonagy, Target,Cottrell, Phillips, & Kurtz, ).

Second, to share information on conducting an experimental study in a ju-venile and adult criminal justice setting, so that lessons can be drawn that can beof use to fellow researchers planning to conduct an experimental study in theforensic youth care field.

And third, the effectiveness of the NPAP aftercare program was studiedthrough a multi-site RCT-design, with random assignment of the participants tothe experimental group (NPAP) and the control group (treatment as usual). Twostudies of this dissertation were dedicated to establish whether or not NPAP waseffective in decreasing risk factors, such as criminal thinking patterns and cogni-tive distortions, improving adequate coping and prosocial skills, and subse-quently in reducing recidivism compared to a control group that received ‘treat-ment as usual’.

The first study (chapter ) was a meta-analytic review on the effectiveness ofaftercare programs following detention. The study comprised studies, includ-ing participants, all of which had a (quasi-) experimental research design,with the control group receiving ‘care as usual’ or no treatment. Recidivism wasmeasured by re-arrests and/or reconvictions, and was based on official reports.Results showed that aftercare had a small and positive effect on recidivism, withan overall effect size of d = .. Moderator analyses indicated more substantialeffects, and showed that aftercare is most effective if it is well-implemented andconsists of individual instead of group treatment, and if it is aimed at older andhigh-risk youth. Whereas the treatment duration and moment of starting theaftercare program were not related to the program’s effectiveness, more intensiveaftercare programs were associated with lower recidivism rates.

In chapter the challenges and solutions that were encountered during theexperimental study examining the effectiveness of NPAP are discussed. Rando-mized Controlled Trials (RCT’s) studying the effectiveness of an intervention,such as ours, constitute only a small fraction of all research conducted in crim-inal justice settings (Farrington, ; Farrington & Welsh, ). Researchersare reluctant to carry out a RCT, because of the often encountered practical andethical barriers resulting from conflicting interests of the stakeholders involvedin the study (Lum & Yang, ; Welsh et al., ). Implementing the experi-mental study was a challenge, because it covered both the juvenile and adultjustice system, with offenders receiving aftercare mandated under criminal andcivil law, resulting in complex referral pathways complicating the system andmoment of randomization. Other matters were related to resistance to randomassignment and unforeseen conflicts between administrative and evaluation

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priorities of the different stakeholders, such as the city council and youth careorganizations. To overcome these barriers in future experimental studies, fundsand resources should be allocated by the governmental organizations on the con-dition of requiring rigorous evaluations of evidence-based programs.

The third study (chapter ) examined the effectiveness of the NPAP after-care program for serious juvenile and young adult offenders in The Netherlandswith an experimental intention- to-treat design. Participants (N = ) were ran-domly assigned to NPAP (n = ) or existing aftercare services (‘treatment asusual’, n = ). The aim was to determine whether NPAP was effective in de-creasing cognitive distortions and criminal thinking patterns and increasing pro-social and coping skills of the juveniles compared to a control group that re-ceived ‘treatment as usual’. The following moderators were examined toestablish whether NPAP was more or less effective for certain groups of youngoffenders: ethnic minority status, age, voluntary or mandatory aftercare, startingaftercare during or after confinement and whether or not the aftercare programwas successfully completed.

No direct intervention effects were found on any of the outcome measures:aggressive behavior, cognitive distortions, pro-criminal attitude, coping and pro-social skills. Moderator analyses, however, showed several interaction effects ofethnicity and coping skills for both NPAP and TAU youths. Furthermore, NPAPdropouts displayed significantly more indirect aggression at posttest comparedto youths dropping out from TAU, who showed no significant change in indirectaggression, suggesting that drop-out from the NPAP aftercare program has adetrimental effect.

Results showed that the moment of starting the aftercare intervention wasnot related to the aftercare program’s effectiveness, which is in line with themeta-analytic study (chapter ). These findings suggest that NPAP is not moreeffective when the intervention starts during the last phase of detention thanwhen started upon reentry. Additionally, the moderator analyses showed that itdoes not matter whether NPAP is provided on a mandatory or voluntary basis.

Finally, the fourth study (chapter ) examined whether NPAP was effectivein terms of official delinquency outcomes. Participants (N = ) were randomlyassigned to NPAP (n = ) or existing aftercare services (‘treatment as usual’, n =). Recidivism data were based on official delinquency records. Survival analysiswas used to obtain the cumulative survival curves for participants with an aver-age follow-up period of respectively M = . years (SD = .) for the NPAPgroup and M = . years (SD = .) for the TAU group. The results showed nostatistically significant differences between NPAP and TAU on any of the recidi-vism outcomes. The two conditions were compared in terms of time to re-con-viction, and frequency of re-arrests and violent or non-violent rearrests, using

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chi square-tests and univariate ANOVA tests. No evidence was found to supportthe claim that NPAP was more effective in reducing recidivism than treatment asusual.

Again, moderator analyses were carried out to determine whether the re-sults were different for specific client characteristics (ethnicity, age at first arrest,etc.). Indeed, NPAP participants with a younger age of onset had a slightly higherchance to recidivate compared to control group youths, and therefore may bepoor candidates for an intensive aftercare program such as NPAP (Moffitt, ).

Similar to results from a meta-analysis by Wilson and colleagues () anda recent study on the effectiveness of correctional programs with ethnically di-verse offenders (Usher & Stewart, ) no differences in treatment effects werefound for the various ethnic groups, indicating that NPAP does not seem to beculturally biased, because there was no differential impact on Dutch and ethnicminority youths.

Results showed that age of onset and number of prior offenses increased therisk for recidivism, regardless of whether they received NPAP or TAU. The otherpotential factors of influence on the effectiveness of the aftercare program - pro-gram retention and whether or not participants were referred to aftercare on amandatory or voluntary basis - did not have any impact on the recidivism out-comes when NPAP was compared with TAU, as was the case for the outcomes inchapter .

Despite the small, but encouraging findings of our meta-analysis, the RCT on theeffectiveness of the NPAP aftercare program showed that overall, the most pre-cise inference that we can make is that in the effectiveness studies included inthis dissertation (chapters and ) no evidence was found that receiving NPAPaftercare services provides any additional effect above and beyond what juvenileand young adult offenders released from detention facilities received elsewherein one form or another.

Why did both studies on the effectiveness of NPAP not produce more dis-cernable results? Unfortunately, it cannot be ruled out that the failure of theNPAP aftercare program to achieve a significant reduction in cognitive distor-tions, pro-criminal attitude and criminal behavior and increase of prosocial skillscompared to the TAU group was (partly) due to poor implementation of keycomponents of the program. This can lead to a Type II error: the erroneous con-clusion that NPAP is ineffective, when in fact, weaknesses in treatment imple-mentation impeded drawing conclusions on the program’s (in) effectiveness (Fa-gan, ). Yet, it should be recognized that treatment integrity is often not ashigh in effectiveness studies compared to efficacy studies (Van der Stouwe et al.,; Weisz, ), since they are conducted under clinically relevant conditions

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in which (external) factors are at play that cannot be controlled (e.g., great vari-ety in competence of therapists, staff turnover, unanticipated life events duringthe course of treatment, sudden changes in treatment motivation, low therapeu-tic alliance, lack of stringent use of inclusion/exclusion criteria, high comorbidityof mental disorders), and which may negatively impact both susceptibility totreatment of clients and treatment adherence of therapists (Shadish et al., ).

Furthermore, our meta-analytic review showed that aftercare yielded morepositive outcomes when the control group did not receive any intervention com-pared to when the control group received services otherwise available (‘care asusual’). Therefore, the absence of significant positive effects of NPAP could havebeen related to the lack of program differentiation (Durlak & DuPre, : ),since the level of standard treatment, supervision and guidance that may be pro-vided to ex-offenders in the control group, e.g., by other secondary preventionprograms in the various cities in The Netherlands that target criminogenic needssimilar to NPAP, may not be significantly different from NPAP. On the otherhand, as shown in the last study of this dissertation (chapter ), both the NPAPand control group showed substantial recidivism, indicating that neither NPAPnor treatment as usual seem to have been able to substantially reduce the recidi-vism rates and time to recidivism.

The main limitation was that program integrity was not included in thestudy as a potential moderator of the effectiveness of NPAP. Hence, it cannot beruled out that our findings were negatively influenced by lack of treatment integ-rity. Unfortunately, it was impossible to establish, for example, the intensity ofthe treatment, because the number and duration of face-to-face and phone con-tacts between participants and project staff were not systematically registered bythe youth care workers. Notably, treatment adherence had not been adequatelymonitored by the organizations responsible for the delivery of NPAP, which maybe regarded as a necessary condition for treatment adherence. It is also possiblethat certain parts or specific aspects of the intervention are more effective thanothers. Alas, we were unable to test these hypotheses, as sufficient informationon whether the juveniles met the critical inclusion criteria for NPAP did notbecome available.

In this dissertation it was examined whether the NPAP aftercare program pro-duces outcomes that are superior to the existing services (‘treatment as usual’) ina dynamic ‘real world’ forensic youth care setting. By comparing NPAP to thecare usually provided the results found are more realistic than when the studywould have been carried out in a clinically controlled setting. Therefore, the pro-spective and longitudinal effectiveness study included in this dissertation is more

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clinically relevant than its counterpart, efficacy studies, could be (Kendall, ;Weisz et al., ; ).

What policy consequences should the mostly null-results of this dissertationhave, especially considering that the NPAP program was one of the few thatactually was willing to participate in such a RCT? No direct conclusion can bedrawn from this study that one should stop delivering NPAP. For instance, moreinsight in implementation issues may help to improve the performance of theprogram, which in the long run may lead to positive outcomes. At least, youthcare organizations should ensure that a sufficient level of treatment integrity ismet, and that the right target group is reached.

Merely a few studies include treatment integrity and recognize it as a factorof influence on the outcome of the intervention (James et al., ; Goense,Boendermaker, Van Yperen, Stams, & Laar, ; Perepletchikova, Treat, & Kaz-din, ). Given that it cannot be completely ruled out that other factors, suchas a lack of program integrity, influenced the results, future effectiveness studieson aftercare interventions should pay more attention to the implementation andtreatment fidelity of the intervention.

The scarcity of rigorous effectiveness studies on the effectiveness of after-care programs for juvenile and young adult offenders is problematic, since it hasleft a lacuna in knowledge on what works for whom in aftercare. RandomizedControlled Trials provide the most unambiguous results concerning the efficacyand effectiveness of any treatment, since they can rule out most of the confound-ing factors (Boruch, Snyder, & DeMoya, ; Farrington, ; Lum & Yang,; Sherman, ; Weisburd, ).

The criminal justice system and youth care field could benefit from moreexperimental studies, such as included in this dissertation. An accumulation ofresearch could result in a more fine-grained identification of aftercare programsfor juvenile and young adult offenders that do and do not reliably outperformtreatment as usual (Weisz et al., ).

Therefore, funds and resources should be allocated by the governmentalorganizations on the condition of requiring an evaluation of evidence-based pro-grams through sound scientific research or public-private partnerships, such asSocial Impact Bonds (Asscher et al., ; National Juvenile Justice Network,; Rubin, ). This way, interventions can be implemented and scientificallyevaluated, and organizations can be compensated for their temporary lower pro-duction because of their involvement in the experimental research.

This dissertation aimed to establish whether or not aftercare contributes to thesuccessful integration of juvenile and young adult offenders after a period of in-carceration. Overall, no evidence was found to support the claim that NPAP was

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more effective in altering proximal outcome measures, or dynamic criminogenicfactors, compared to TAU. Moreover, recidivism proved to be high amongstboth groups, regardless of whether they received aftercare. The results of thestudies included in this dissertation show that aftercare programs still have along way to go before becoming superior to existing services otherwise available.

What possibly can be learned from the results of this dissertation is that forhigh-risk juvenile and young adult offenders with a long criminal record andmultiple criminogenic needs, such as the participants in this study, it might bedifficult to desist from crime, at least during the relatively short and turbulentperiod in which they receive aftercare.

Hence, although this study does not provide compelling evidence to supportthe claim

That NPAP is effective, one should be careful not to throw the baby outwith the bathwater. We should continue to provide aftercare to serious youngoffenders, at least regarding practical matters in the first crucial period after re-entry in the community.

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Samenvatting(Dutch Summary)

Beyond Detention. The effectiveness of aftercare for juvenileand young adult offenders

Door Chrissy James

Criminaliteit onder jeugdige delinquenten is hoog, evenals de recidivecijfers, ende meerderheid van de jeugdige en jongvolwassen daders komt binnen een paarjaar na vrijlating opnieuw in aanraking met justitie (Abrams et al., ; Wartnaet al., ). Met name de eerste periode na terugkeer in de samenleving blijkteen kritieke fase te zijn, waarbij het risico op recidive het hoogst blijkt tijdens deeerste paar maanden na de vrijlating (Snyder et al., ). Onderzoek wijst uitdat het voor jeugdige en jongvolwassen daders moeilijk blijkt te zijn om vaar-digheden geleerd in detentie toe te blijven passen zodra ze eenmaal teruggekeerdzijn in de gemeenschap (Abrams et al., ; Steinberg et al., ). Nazorg lijktdaarom een essentieel onderdeel te zijn van een sluitende aanpak willen de insti-tutionele interventieprogramma's een blijvend effect hebben (Inciardi et al.,;. Kurlycheck et al., ). Om deze reden zijn er in de afgelopen decenniadiverse nazorgprogramma's ontwikkeld om de kansen van jeugdige en jongvol-wassen daders op een succesvolle re-integratie te vergroten (Mears et al., ).Het belang van nazorg wordt ook erkend in Nederland, onder andere blijkenduit de ontwikkeling en implementatie van Nieuwe Perspectieven bij Terugkeer(NPT), een intensief nazorgprogramma voor ernstig delinquente jongeren enjongvolwassenen, in de leeftijd tot jaar, met een matig tot hoog risico oprecidive, die terugkeren in de samenleving na een periode van detentie of verblijfin een JeugdzorgPlus-instelling. De doelen van NPT zijn het voorkomen van re-cidive door het veranderen van cognitieve vertekeningen en criminele denkpa-tronen en het vergroten van prosociaal gedrag en positieve copingvaardigheden(Vogelvang & Schut, ).

Om de kans op een succesvolle terugkeer in de samenleving te vergroten entoekomstig problematisch en delinquent gedrag te verminderen, is het belangrijkom inzicht te krijgen in de vraag of de nazorg effectief is, en voor welke speci-fieke groepen jeugdige en jongvolwassen daders. Er is maar een beperkt aantalstudies naar de effectiviteit van nazorgprogramma's voor jeugdige en jonge vol-wassen daders uitgevoerd. De resultaten van deze studies waren niet eenduidig,hetgeen onderstreept dat meer onderzoek om effectieve nazorginterventies enstrategieën voor delinquente jeugdige delinquenten te identificeren noodzakelijkis, in het bijzonder robuust onderzoek in de vorm van een Randomized Con-trolled Trial (RCT).

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Het doel van dit proefschrift was dan ook drieledig:Allereerst was het doel om de effectiviteit van bestaande nazorgprogram-

ma’s voor jeugdige en jongvolwassen daders wereldwijd in kaart te brengen enanalyseren en daarnaast, om de belangrijke en praktisch relevante vraag te kun-nen beantwoorden: "wat werkt voor wie?" (Fonagy, Target, Cottrell, Phillips, &Kurtz, ).

Daarnaast beoogt dit proefschrift ook om informatie en ervaringen over hetimplementeren en uitvoeren van een experimentele interventiestudie gericht opjeugdige en jongvolwassen delinquenten te delen, hetgeen van nut kan zijn voorcollega-onderzoekers die overwegen om experimenteel interventieonderzoek uitte voeren op het gebied van de forensische jeugdzorg.

En ten derde beoogt dit proefschrift om de effectiviteit van het nazorgpro-gramma Nieuwe Perspectieven bij Terugkeer vast te stellen, door middel van eenmulti-site randomized controlled trial (RCT), met random toewijzing van dedeelnemers aan de experimentele groep (NPT) en de controlegroep die naar de‘gebruikelijke behandeling’ (TAU) werd doorverwezen. De twee laatste studiesvan dit proefschrift zijn dan ook gewijd aan het vaststellen of NPT effectief is inhet verminderen van risicofactoren, waaronder criminele denkpatronen en cog-nitieve vertekeningen, het verbeteren van adequate coping en prosociale vaar-digheden, en vervolgens in het verminderen van recidive in vergelijking met eencontrolegroep die ‘gebruikelijke behandeling’ kreeg aangeboden.

De eerste studie (hoofdstuk ) omvat een meta-analyse van de effectiviteit van denazorg programma’s na detentie of gesloten jeugdzorg. De meta-analyse bestaatuit studies, waaronder deelnemers, en alle studies hadden een (quasi)experimenteel onderzoeksdesign, met een controle groep die ‘care as usual’ ofgeen behandeling kreeg. Recidive werd gemeten aan de hand van nieuwe arresta-ties en/of de veroordelingen en was gebaseerd op officiële recidivecijfers. De re-sultaten toonden aan dat nazorg een klein positief effect had op recidive, met eentotale effectgrootte van d = .. Moderator analyses lieten meer substantiële effec-ten zien en toonden aan dat nazorg het meest effectief is wanneer het goed isgeïmplementeerd en bestaat uit individuele behandeling in plaats van groepsbe-handeling en wanneer het is gericht op oudere en hoog-risico jongeren. De duurvan de nazorginterventie en het moment van aanvang van het programma ble-ken niet gerelateerd te zijn aan de effectiviteit van de interventie, echter waren demeer intensieve nazorgprogramma’s wel geassocieerd met een lagere recidive.

Hoofdstuk bestaat uit een overzicht van de uitdagingen en oplossingen dietijdens het effectiviteitsonderzoek van NPT aan de orde kwamen. Evaluatiestu-dies met random toewijzing van de proefpersonen aan de interventie of controle-groep om de effectiviteit van een interventie te bestuderen, zoals de onze, vor-

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men slechts een klein deel van al het criminologische evaluatieonderzoek (Far-rington, ; Farrington & Welsh, ). Onderzoekers zijn terughoudend watbetreft het uitvoeren van een RCT vanwege de belemmeringen op praktisch enethisch vlak die vaak worden ondervonden en die voortvloeien uit tegenstrijdigebelangen van de bij het onderzoek betrokken partijen (Lum & Yang, ; Welshet al., ). De uitvoering van de experimentele studie naar de effectiviteit vanNPT was een uitdaging doordat het zowel jeugdige als (jong)volwassen delin-quenten betrof, vanuit zowel een strafrechtelijke als civielrechtelijk kader, watresulteerde in complexe verwijzingspaden die het moment van randomisatiecompliceerden. Andere zaken hadden betrekking op de weerstand tegen de will-ekeurige toewijzing van cliënten en onvoorziene conflicten tussen bestuurlijke,financiële en beleidsmatige prioriteiten van de verschillende belanghebbenden,zoals de betrokken gemeentes en jeugdzorgorganisaties. Om te voorkomen datdeze zaken barrières vormen voor toekomstige experimentele studies op het ge-bied van de forensische jeugdzorg, moeten middelen worden toegekend door debetrokken ministeries die gedegen evaluatieonderzoek van evidence-based inter-venties eisen en mogelijk maken.

De derde studie (hoofdstuk ) onderzocht de effectiviteit van NPT met een‘intention to-treat’ onderzoeksdesign aan de hand van de uitkomsten van zel-frapportage instrumenten. Participanten (N = ) werden willekeurig toegewe-zen aan NPT (n = ) of aan een controlegroep die een alternatieve vorm vannazorg kreeg aangeboden (TAU, n = ). Het doel van deze studie was om tebepalen of NPT effectief is in het verminderen van cognitieve vertekeningen enstrafrechtelijke denkpatronen en het vergroten van prosociaal gedrag en coping-vaardigheden van de jongeren in vergelijking met de controlegroep. Moderator-analyses werden uitgevoerd om vast te stellen of NPT meer of minder effectief isvoor bepaalde groepen jeugdige delinquenten, waaronder etniciteit, leeftijd, of denazorg in een vrijwillig of verplichte kader werd aangeboden, of nazorg begontijdens of na vrijlating en of het nazorgprogramma met succes werd afgerond.

Op geen van de uitkomstmaten werden directe interventie-effecten gevon-den, waaronder agressief gedrag, cognitieve vervormingen, pro-criminele atti-tude, coping en prosociale vaardigheden. Moderator-analyses toonden echtereen aantal interactie-effecten van etniciteit en coping vaardigheden voor zowelNPT als TAU jongeren. Bovendien bleken NPT drop-outs significant meer indir-ecte agressie te vertonen bij nameting in vergelijking met TAU jongeren dievoortijdig afhaakten en die geen significante verandering lieten zien in indirecteagressie. De resultaten toonden aan dat het moment van het starten van de na-zorg niet was gerelateerd aan de effectiviteit van NPT, wat overeenkomt met deresultaten van de meta-analyse (hoofdstuk ). Deze bevindingen suggereren datnazorgprogramma’s niet effectiever zijn wanneer deze starten tijdens de laatste

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fase van detentie dan wanneer deze beginnen op het moment dat de delinquentejongeren reeds zijn vrijgelaten. Daarnaast toonden de moderatoranalyses aan dathet niet uitmaakt of NPT wordt aangeboden in een verplicht kader of op vrijwil-lige basis.

Ten slotte is aan de hand van de vierde studie (hoofdstuk ) onderzocht ofNPT effectief is wat betreft de officiële gerapporteerde delinquentie. Survivalanalyses werden uitgevoerd om te bepalen of en op welk moment de participan-ten recidiveren, met een gemiddelde follow-up periode van respectievelijkM = . jaar (SD = .) voor NPT groep en M = . jaar (SD = ,) voor decontrolegroep. De resultaten toonden geen statistisch significante verschillen aantussen NPT en TAU op een van de recidive uitkomstmaten. De twee groepenwerden vergeleken ten aanzien van algemene, gewelddadige of niet-gewelddadigerecidive wat betreft de tijd tot recidive en de frequentie van gepleegde delicten,met behulp van Chi kwadraat-tests en univariate ANOVA’s. Uit de resultatenbleek niet dat NPT effectiever was in het terugdringen van recidive dan de ‘geb-ruikelijke behandeling’, die de controlegroep jongeren kreeg aangeboden. We-derom werden moderatoranalyses uitgevoerd om te bepalen of de resultatenverschillend waren wat betreft bepaalde cliënt specifieke kenmerken (etniciteit,leeftijd eerste delict, etc.).

In lijn met de resultaten van een meta-analyse van Wilson en collega's() en een recente studie naar de effectiviteit van intramurale interventiepro-gramma’s voor delinquenten (Usher & Stewart, ) zijn er geen verschillen ininterventie-effecten gevonden voor de verschillende etnische groepen. De resul-taten toonden verder aan dat de leeftijd van het eerste delict en het aantal voor-afgaande delicten het risico op recidive verhoogde, ongeacht of jeugdigen NPT ofTAU ontvingen. De groep jongere delinquenten is daarom mogelijk mindergeschikt voor nazorg dan de jongvolwassenen. De andere mogelijke factoren dievan invloed zijn op de effectiviteit van het nazorgtraject – drop-out van het na-zorgprogramma en het al dan niet worden doorverwezen naar nazorg op eenverplichte of vrijwillige basis – waren niet van invloed op de recidive-uitkomstenwanneer NPT werd vergeleken met TAU.

Ondanks dat de resultaten van de meta-analyse (hoofdstuk ) laten zien dat na-zorg een, weliswaar bescheiden, positief effect heeft, is de meest algemene con-clusie die we kunnen trekken op basis van de effectiviteitstudies (hoofdstukken

en ) dat er geen bewijs is gevonden dat het NPT nazorgprogramma effectiever isdan de ‘gebruikelijke behandeling’ die jeugdige en jongvolwassen daders elders ofin een andere vorm kregen aangeboden na een periode van detentie.

Daarmee rijst de vraag, waarom beide studies naar de effectiviteit van NPTniet meer positieve resultaten hebben laten zien? Helaas kan niet worden uitge-

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sloten dat het uitblijven van een positief effect van NPT in vergelijking met decontrolegroep, op het gebied van het verminderen van cognitieve vertekeningen,pro-criminele attitude en crimineel gedrag en een toename van prosociaal gedragen adequate copingvaardigheden (mede) het gevolg is van een onvoldoende uit-voering van belangrijke onderdelen van de interventie. Dit kan leiden tot eenType II fout: de onjuiste conclusie dat NPT niet effectief is, terwijl in feite tekort-komingen in de implementatie van de interventie het onmogelijk maken omconclusies te trekken over de (in)effectiviteit van het programma (Fagan, ).Ook moet worden erkend dat de behandelintegriteit vaak niet zo hoog is in effec-tiviteitsstudies als bij effectstudies (Van der Stouwe et al., ; Weisz, )doordat effectiviteitstudies plaatsvinden onder klinisch relevante omstandighe-den waarbij (externe) factoren een rol spelen die men niet in de hand heeft (bij-voorbeeld een verscheidenheid in professionaliteit van de jeugdzorgmedewer-kers, personeelsverloop, onverwachte levensgebeurtenissen tijdens de loop vande behandeling, plotselinge veranderingen in de motivatie voor behandeling,problematische cliënt-therapeutrelatie, het ontbreken van streng gebruik van in-en exclusiecriteria, hoge co-morbiditeit van psychische stoornissen), en die eennegatieve invloed kunnen hebben op zowel de behandelbaarheid van cliënten alsde behandelintegriteit van interventiewerkers (Shadish et al., ).

Bovendien bleek uit de meta-analyse dat nazorg meer positieve effecten lietzien indien de experimentele groep werd vergeleken met een controlegroep diegeen enkele vorm van nazorg kreeg in vergelijking met wanneer de controle-groep ‘gebruikelijke behandeling’ (‘care as usual’) kreeg aangeboden. De afwezig-heid van significante positieve effecten van NPT kan om deze reden dan ook inverband worden gebracht met het ontbreken van programma-differentiatie(Durlak & Dupré, ), aangezien het niveau van de behandeling, toezicht enbegeleiding die de controlegroep normaliter wordt geboden, bijvoorbeeld doorandere secundaire preventie-programma's in de verschillende steden in Neder-land, zich veelal op vergelijkbare criminogene factoren richt en niet significantverschillend is van NPT. Anderzijds, zoals uit de laatste studie van dit proefs-chrift (hoofdstuk ) blijkt, vertoonden zowel jongeren als jongvolwassenen uitde NPT als de controlegroep aanzienlijke recidive, wat aangeeft dat noch NPT ofgebruikelijke behandeling recidive uiteindelijk aanzienlijk weet te verminderen.

De voornaamste beperking van het onderzoek was dat de programma-in-tegriteit niet in de studie is opgenomen als een potentiële moderator van de ef-fectiviteit van NPT. Derhalve kan niet worden uitgesloten dat onze bevindingennegatief werden beïnvloed door gebrek aan behandelintegriteit. Het bleek in depraktijk helaas onmogelijk om, bijvoorbeeld, de intensiteit van de behandelingvast te stellen, omdat het aantal face-to-face en telefonische contacten en deduur hiervan door de betrokken jeugdzorginstellingen niet systematisch werden

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geregistreerd. Noemenswaardig is dat programma-integriteit niet consequent envoortdurend wordt geregistreerd door de NPT uitvoerende instanties, hetgeenals een noodzakelijke voorwaarde voor programma-integriteit kan wordenbeschouwd. Het is ook mogelijk dat bepaalde onderdelen of specifieke aspectenvan de nazorginterventie effectiever zijn dan andere. Deze hypothesen kondenhelaas niet worden getoetst, aangezien onvoldoende informatie beschikbaar wasom de vraag te kunnen beantwoorden of de jongeren voldeden aan alle in- enexclusiecriteria voor NPT, waaronder IQ en recidiverisico.

In dit proefschrift is onderzocht of het NPT nazorgprogramma positievere effec-ten laat zien dan de reeds bestaande mogelijkheden voor nazorg ('treatment asusual') binnen de forensische jeugdzorg. Door het vergelijken van NPT in deklinische praktijk met de ‘gebruikelijke behandeling’ (‘effectiveness’ studie) zijnde gevonden resultaten realistischer dan wanneer het onderzoek zou zijn uitge-voerd in een sterk gecontroleerde onderzoeksomgeving (‘efficacy’ studie). Daar-om is deze prospectieve en longitudinale effectiveness studie meer relevant voorde klinische praktijk dan haar tegenhanger, de efficacy studie, zou kunnen zijn(Kendall, ; Weisz et al., ; ).

Welke consequenties voor beleid zouden de - voornamelijk nul-resultaten -van dit onderzoek moeten hebben, zeker gezien het feit dat betrokkenen bij hetNPT nazorgprogramma een van de weinigen waren die daadwerkelijk bereidwaren om deel te nemen aan een dergelijk RCT onderzoek? Op basis van deonderzoeksresultaten mag niet worden geconcludeerd dat NPT volledig zoumoeten worden afgeschaft. Meer inzicht in de programma-integriteit van NPTkan helpen om de werkzaamheid van het programma te verbeteren, hetgeen opde langere termijn zou kunnen leiden tot meer significante positieve effecten.Jeugdzorgorganisaties moeten op zijn minst zorgen voor een voldoende niveauvan behandelintegriteit en dat met de interventie de beoogde doelgroep wordtbereikt.

Slechts een beperkt aantal effectiviteitstudies meet behandelintegriteit enherkent dit als een factor die van invloed kan zijn op de uitkomst van een inter-ventie (James et al, ; Goense, Boendermaker, Van Yperen, Stams, & Laar,; Perepletchikova, Treat, & Kazdin, ). Naast dat er behoefte is aan meergecontroleerde effectiviteitstudies op het gebied van nazorg, moeten toekomstigeeffectiviteitstudies dan ook meer aandacht besteden aan de mate waarin de inter-ventie programma-integer wordt uitgevoerd. Meer robuust effectiviteitsonder-zoek zou kunnen leiden tot een meer nauwkeurige identificatie van nazorginter-venties en specifieke programmaonderdelen voor jeugdige en jongvolwassendaders die meer effect sorteren dan de ‘gebruikelijke behandeling’ (Weisz et al.,). Er zullen door de overheid dan ook meer middelen moeten worden toege-

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wezen waarmee een evaluatie van evidence-based programma’s door middel vangedegen wetenschappelijk onderzoek kan worden geëist en mogelijk wordt ge-maakt (Asscher et al., ; Nationale Juvenile Justice netwerk, ; Rubin,). Op deze manier kunnen interventies wetenschappelijk worden geëva-lueerd en kunnen organisaties worden gecompenseerd voor hun (mogelijk) tijde-lijke lagere productie als gevolg van hun betrokkenheid bij een (RCT) onderzoek.

Dit proefschrift heeft zich gericht op de vraag of nazorg bijdraagt aan de succes-volle re-integratie van jeugdige en jongvolwassen daders na een periode van(jeugd)detentie of verblijf in een gesloten jeugdzorginstelling. Los van de bemoe-digende resultaten van de meta-analyse, is er uiteindelijk geen overtuigend bewijsgevonden voor de bewering dat het NPT nazorgprogramma effectiever is in hetveranderen van dynamische criminogene factoren in vergelijking met de groepdie ‘gebruikelijke behandeling’ krijgt aangeboden. Bovendien is de recidive hoogonder beide groepen, ongeacht of zij nazorg ontvangen. De resultaten van destudies in dit proefschrift laten dan ook zien dat nazorginterventies nog eenlange weg te gaan hebben voordat deze significant betere resultaten laten ziendan de reeds bestaande interventies voor jeugdige en jongvolwassen daders diegericht zijn op gedragsverandering en ook kunnen worden aangeboden.

Uit de resultaten van dit proefschrift kan worden afgeleid dat het voor ern-stig delinquente jongeren en jongvolwassenen met een lang strafblad, hoog risicoop recidive en meerdere aanwezige criminogene factoren, waaronder de deelne-mers aan dit onderzoek, erg moeilijk blijkt te zijn om te stoppen met het plegenvan delicten, althans, in ieder geval gedurende de relatief korte en turbulenteperiode na hun vrijlating waarin zij nazorg ontvangen.

Hoewel de effectiviteitsstudies in dit proefschrift geen overtuigend bewijsleveren voor de effectiviteit van NPT moet men ervoor waken om de baby nietmet het badwater weg te gooien. Er zal namelijk toch enige vorm van nazorgmoeten worden geboden aan ernstige jeugdige en jongvolwassen delinquenten,in ieder geval wat betreft ondersteuning bij praktische zaken in de eerste crucialeperiode na hun terugkeer in de samenleving.

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Curriculum Vitae

Chrissy James was born on July in IJsselstein, The Netherlands. She stud-ied at the Toneelacademie Maastricht before commencing at the VU Universityin Amsterdam in to study Psychology. Following her first year, she decidedto combine Psychology with one of her other fields of interest, Criminology.After completion of both her Bachelor Psychology and Bachelor Criminology,she continued her studies at the VU with a Master’s degree in Life Course Crim-inology and a Master’s degree in Clinical Psychology (Cum Laude). During herMaster’s in Criminology she studied at the University of Cape Town (UCT) inSouth Africa as an exchange student, followed by a Master’s program in CriminalJustice and Criminology at the University of Cape Town in , through a grantfrom the VSB Fund. After returning to The Netherlands in , she worked as aCriminology teacher at the VU Law Faculty before entering a PhD program atthe Department of Forensic Child and Youth Care Sciences of the University ofAmsterdam in . Besides her PhD project, Chrissy worked as a psychologistat juvenile treatment and detention center (JJI) Amsterbaken.

Currently, Chrissy James works a psychologist, in training to become a Health-care Psychologist (GZ-psycholoog), and researcher at GGZ inGeest in Amster-dam.

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List ofpublicationsincluded in thisdissertation

James, C., Stams, G. J. J. M, Asscher, J. J., De Roo, A. K. & Van der Laan, P. H. ().Aftercare programs for reducing recidivism among juvenile and young adult offen-ders: A Meta-Analytic Review, Clinical Psychology Review, , -. (Chapter )

James, C., Asscher, J. J., Dekovic, M., Van der Laan, P. H., & Stams, G. J. J. M. ().Endeavors in an Experimental Study on the Effectiveness of an Aftercare Program inthe Netherlands: Research Note. Criminal Justice Policy Review, , -. (Chapter)

James, C., Asscher, J. J., Stams, G. J. J. M., & Van der Laan, P. H. (). The effectivenessof aftercare for juvenile and young adult offenders. Journal of Offender Therapy andComparative Criminology. Advance online publication. (Chapter )

James, C., Asscher, J. J., Stams, G. J. J. M., & Van der Laan, P. H. The effectiveness of theNew Perspectives Aftercare Program for juvenile and young adult offenders: Recidi-vism outcomes. (submitted for publication) (Chapter )

In each of the listed publications the order of the co-authors reflects the declin-ing importance of their contribution to the paper.

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