The Integration of Family and Group Therapy as an Alternative to Juvenile Incarceration: A Quasi‐Experimental Evaluation Using Parenting with Love and Limits

• Author: Eli A. Karam,Lynn Kiaer,Emma M. Sterrett
• DOI: http://doi.org/10.1111/famp.12187
• Date: 01 June 2017
• Published date: 01 June 2017

The Integration of Family and Group Therapy

as an Alternative to Juvenile Incarceration: A

Quasi-Experimental Evaluation Using Parenting with

Love and Limits

ELI A. KARAM*

EMMA M. STERRETT*

LYNN KIAER

†

The current study employed a quasi-experimental design using both intent-to-treat and

protocol adherence analysis of 155 moderate- to high-risk juvenile offenders to evaluate the

effectiveness of Parenting with Love and Limitsâ(PLL), an integrative group and family

therapy approach. Youth completing PLL had significantly lower rates of recidivism than

the comparison group. Parents also reported statistically significant improvements in

youth behavior. Lengths of service were also significantly shorter for the treatment sample

than the matched comparison group by an average of 4 months. This study contributes to

the literature by suggesting that intensive community-based combined family and group

treatment is effective in curbing recidivism among high-risk juveniles.

Keywords: Community- based; Juvenile offender; Recidivism; Attrition rates; Family

therapy; Group therapy; Fidelity measures; Readjudication; Parenting with Love and

Limits; Propensity score matching; Intervention; Delinquency; Program effectiveness

Fam Proc 56:331–347, 2017

FAMILY THERAPY RESEARCH: TWO PATHWAYS FOR INTERVENTION FOR

JUVENILE OFFENDERS AND THEIR PARENTS

The use of community-based interventions has grown in the last two decades as more

states seek alternatives to incarceration or other costly placements for juvenile offend-

ers (Darwiche & de Roten, 2014; Sexton & Datachi, 2014; Von Sydow, Retzlaff, Beher,

Haun, & Schweitzer, 2013). A large and robust evidence base now also supports the

effectiveness of systemic interventions for conduct disordered adolescents (Sprenkle,

2012). Historically reviewing effectiveness research, the family therapy prof ession has

classified evidence-based practice (EBT) with oppositional defiant and conduct disordered

youth into two distinct categories: (1) multiple family groups and (2) traditional family

therapy (Sprenkle, 2002, 2012).

*University of Louisville, Louisville, KY.

†

Hornby Zeller Associates, LLC, Troy, NY.

Correspondence concerning this article should be addressed to Eli A. Karam, Ph.D., Associate Professor,

University of Louisville/Kent School of Social Work/Family Therapy Program, Louisville, KY 40292.

E-mail: eli.karam@louisville.edu

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Family Process, Vol. 56, No. 2, 2017 ©2015 Family Process Institute

doi: 10.1111/famp.12187

Multiple Family Groups

Multiple family groups (MFG) is a modality facilitated by a treatment provider and

includes youth, parents or caregivers, and other youth and family members with shared

experiences (Nahum & Brewer, 2004). The goal of this modality is to bring families

together to interact, build empathy, and ultimately produce change in family systems.

Within the groups, families work on improving community safety, improving supervision

of youth, teaching offenders the concept of delayed gratification, developing empathy,

instilling values of hope, and hard work. A group context is also beneficial for hearing

stories, sharing with others, developing empathy for others, expressing emotions, and

receiving practical feedback. Moreover, groups are an efficient method by which families

can share growth and progress with others; in this way, both teens and parents are role

models and leaders for peers (Marshall & Burton, 2010). Some activities in groups include

homework, didactic instruction, videos, discussion, and role-modeling activities (Rich &

Longo, 2003).

There is an emerging body of research that demonstrates the efficacy and effectiveness

of a MFG approach with populations related to juvenile offenders (Lucksted, McFarlane,

Downing, & Dixon, 2012). Multiple family groups have been employed to address

numerous populations, including the homeless (Davey, 2004), urban children with condu ct

difficulties (McKay et al., 2011; McKay, Harrison, Gonzales, Kim, & Quintana, 2002),

persons with schizophrenia (Kaslow, Broth, Smith, & Collins, 2012; McFarlane, 2002),

juvenile firestarters (Barreto, Boekamp, Armstrong, & Gillen, 2004), and dually diagnosed

adolescents (Kaslow et al., 2012; Kymissis, Bevacqua, & Morales, 1995).

Family Therapy

A number of community-based, family therapy treatment models have been used as

front-end, diversionary, or probation interventions with sustained clinical outcomes and

real-world demonstration of effectiveness. Among these “gold standard” empirically sup-

ported approaches, based on criteria developed by the American Psychological Association

Task Force on the Promotion and Dissemination of Psychological Procedures (Chambles s

et al., 1998) and the Office of Juvenile Justice and Delinquency Prevention Blueprints for

Violence Prevention (Elliott, 1998), are Functional Family Therapy (FFT) (Sexton &

Turner, 2010), Multi-Systemic Therapy

â

(MST) (Henggeler, Schoenwald, Borduin,

Rowland, & Cunningham, 2009), Multidimensional Treatment Foster Care

â

(MTFC)

(Chamberlain, Saldana, Brown, & Leve, 2010), Multidimensional Family Therapy

(MDFT) (Liddle, 2014), and Brief Strategic Family Therapy (BSFT) (Szapocznik, Hervis,

& Schwartz, 2003).

Although each approach uses model-specific language and is unique in its organization,

there are core similarities between these four treatments (Sprenkle, 2012). All have

expanded systemic foci and tend to be strength-based with the goal of empowering parents

and teens to affect changes in their own lives. They focus upon improving parent–child

communication and relationships, and especially upon parental functions that include

monitoring, limit-setting, and discipline. These intermediate goals are aimed toward miti-

gating family risk factors and reducing antisocial behavior resulting in arrest, detention,

and court involvement.

In their recent extensive review, Henggeler and Sheidow (2012) concurred that commu-

nity-based treatment programs that incorporate aspects of these two components (MFG

and family therapy) are superior to institution-based programs. Although some youth who

have complex mental health treatment needs may require out-of-home treatment, many

more can be appropriately served in the community, where youth behavior can be

addressed in its social and familial context.

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