School of Occupational Therapy Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

Critically Appraised Topic Project
Name: Sydney Carnevale and Faith Wilkins

Date: October 8, 2015

Focus Question: Do skill-based interventions reduce recidivism rates amongst youth with mental health disorders?

Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table:
Articles were included if they were: Level I, II or III evidence, written in English, published after 2005, included skilled based
treatments and contained all aspects of the PICO question. The inclusion and exclusion criteria was chosen to address more pertinent
research articles that may provide information regarding effective treatment options for incarcerated youth. We chose to expand our
inclusion criteria to not only include incarcerated youth, but to capture information regarding youth who may have been previously
incarcerated.

Articles were excluded if they were: Level IV, V, or qualitative, written in another language, and published before 2006. Articles about
incarcerated persons over the age of 18 were excluded as emphasis was placed on youth. Pharmacological interventions were excluded
in order to address treatment options within the scope of practice of occupational therapy. Systematic review articles were excluded in
order to prevent duplicate research.

Author/

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

Evaluate the
effectiveness of a
mindfulness based
intervention and
one day retreat for
incarcerated youth.

Level II

Intervention:

Statistically
Significant:

Lack of
randomization

Clinical and Community based practice of OT:

Paired T-Test showed

significant increase in
self-regulation
amongst all in
participants in the
experimental group

Small sample
size

Year
Barnett,
Himelstein,
Herbert,
GarciaRomeu, &
Chamberlain (2013)

Design:
Mixed Methods
Cohort
Subjects:
N=29; Control
group (N=16);
experimental
group (N=13);
All incarcerated
males with the
majority
identifying as
Latino

10 week mindfulness
program and one day,
7 hour retreat
compared to a 10
week mindfulness
program.
Outcome Measures:
Mindfulness Attention
Awareness Scale Adolescent Version

Healthy SelfRegulation Scale

Teen Conflict Survey Impulsiveness

Subscale

Perceived Stress Scale

10

Objective Behavioral

Clinical
Significance:
Use of mindfulness
for youth in juvenile
justice systems can
have potential
positive effects on
self-regulation and
impulsivity with
limited risk of
negative side effects

Lack of
objective
behavioral
measures

Lack of a true
control group

Occupational therapy is deeply rooted in

mental health and addressing psychosocial
deficits through the use of occupation.
Mindfulness can be used as a nonpharmacological program to aid in the
development of positive coping strategies and
self-regulation.

Program development:
More programs, especially those which are
conducted in a group setting, can integrate
mindfulness as an effective tool for clients to
deal with emotion and physical pain. Special
training is necessary to perform mindfulness
based interventions.

Societal needs:
Rates of depression and anxiety continue to
grow as our fast paced world continues to
expand. Mindfulness is a technique that all
individuals can use in attempts to alleviate
feelings of hopelessness, anger, depression,
fear, and pain. This may also provides an
alternative or supplement to pharmacological
interventions.

Assessment (Behavior
Points)

Health care delivery and policy:

These results should be considered preliminary
in regard to directing funds for policy, as the
sample size of this study is still relatively small
and subjective measures may have influenced
results.

Focus Group Data

Education and training for OT students:

OT students will need to be trained in what
mindfulness is as well as learn how to
effectively run a group. Students should be
encouraged to practice mindfulness themselves
in order to have a better understanding and
grasp of its effects. Special training is
necessary to perform mindfulness based
interventions

Refinement, revision, and advancement of

factual knowledge or theory:
Further studies should include more stringent
study criteria in order to eliminate covariable
effects. Programs should aim to determine
curriculum that best suits various populations.
Cuellar,
McReynold
s, &
Wasserman

Measure the
effectiveness of
youth diversion
programs for youth

Level I

Intervention:
The Special Needs
Diversion program

Statistically
Significant:
57.2% of participants

Limited
geographical
demographics of

Clinical and Community based practice of OT:

Youth diversion programs have greater effects
in reducing recidivism rates amongst youth

(2006)

with mental health

disorders in
comparison to
incarceration and
the impact of these
programs on
reduction of
recidivism,
lengthened time
between arrests,
and crime severity.

Design:
Randomized
Control Trial

Population:
N=299 (n=148
experimental;
n=151 control)
youth from 6
counties in Texas
on formal
probation or
community
supervision.
Diagnoses
included
substance abuse
disorder (38.8%),
followed by
disruptive
disorder (38.1%),
anxiety disorder
(32.1%), and
affective disorder
(18.4%).

focuses on individual
therapy, medication
monitoring, crisis
management, selfadvocacy and service
planning. Average
length of the program
was 4.5 months.

of the total sample

were re-arrested at
least one time within
the last year. 68.2%
of that total was of
the control group
with 45.9% being the
experimental group.

Measures:

Clinically
Significant:

Voice Diagnostic
Interview Schedule for
Children (used for
demographics)

Arrest records

Clinically significant
differences were
found between the
control and
experimental group
in overall rates of
recidivism, types of
crime and length of
time between arrests

participants

Results not
generalizable to
incarcerated
youth who are
serving harsher
sentences

Co-intervention
may have
occurred in the
control group
during the one
year period after
the study

Influence of
probation
monitoring
leading to
decreases in
crime rate.

Lack of
specificity
regarding which
aspects of the
program reduced

when compared to traditional social work

services.

Program development:
Specific aspects of the program, specifically
the focus on medication and financial
management skills, should be incorporated into
future programs.

Societal needs:
Diversion programs increase the choices youth
have regarding treatment. Effective
programming could reach more youth and
decrease the financial impact of recidivism.

Health care delivery and policy:

The results of this study lend to the reasoning
why diversion programs are more effective
than incarceration in regards to reducing
recidivism rates. More funding should be given
to determine best practice techniques for
working with this population.

Education and training for OT students:

OT students should be educated in how to
effectively run groups and how to teach life

recidivism rates

skills to adolescents.

Nongeneralizability
of results

Refinement, revision, and advancement of

factual knowledge or theory:
Future studies should have results that are more
generalizable.

Only two
measures were
used to
quantitatively
collect the data
Helmond,
Overbeek,
&
Brugman,
(2012)

Evaluate the
program integrity
of EQUIP.

Level II

Design:
Measure changes in
moral judgement,
social skills, and
cognitive distortion
amongst
incarcerated youth
participating in the
EQUIP program.

QuasiExperimental
Pre-Posttest
design

Population:
115 incarcerated
youth in Belgium
(n=89
experimental,
n=26 control).
69% male; 61%
identify as ethnic

Intervention:
10 week program
focused on anger
management, social
skills training and
social problem
solving. 1.5 hour
meetings run by
trained leaders.

Outcome Measures:
Observation Checklist
Program Integrity
EQUIP (constructed
by researchers).

Statistically
Significant:
There was a
statistically
significant increase in
moral value amongst
the control group.
Significant
development of
social skills noted in
experimental group,
but there was not an
increase in positive
social skills.

Small control
group sample
size,

Lack of
randomization

Selection bias

Clinical and Community based practice of OT:

Given the limited statistically significant
information, this program should not be
implemented in OT practice.

Program development:
Per the results of this study, the EQUIP
program is not an effective method for teaching
positive social and moral development amongst
youth.

Limited training
of leaders
Societal needs:

Clinically
Significant:

Transient nature
of incarcerated

There is a great need to help incarcerated,

paroled, and at-risk youth in the development
of self-efficacy and reducing cognitive

minority

Observation Forms
(adherence constructed by
researchers).

How I Think
Questionnaire

Lack of statistically
significant data
shows the
ineffectiveness of the
EQUIP program in
developing moral
value, judgement,
and positive social
skills.

youth

distortions.

Inconsistency
amongst EQUIP
trainers

Health care delivery and policy:

Inventory of
Adolescent Problems
Short Form

Due to the limitations of these results, the

findings of this study are not conducive for the
development of future mental health
programming.

Education and training for OT students:

OT students should be trained in how to deliver
a specific program to a group. OT students
should receive sound background in adolescent
mental health conditions and the effect of
occupational performance secondary to mental
health conditions.

Sociomoral Reflection
Measure (SF)

Refinement, revision, and advancement of

factual knowledge or theory:
More randomized studies should be conducted
to determine program efficacy.
Himelstein
(2010)

Evaluate the
feasibility of
mindfulness based
substance use
interventions for
adolescents who
are incarcerated

Level II

Design:
Mixed Methods

Intervention:
8-week mindfulness
based substance use
treatment. Weekly
sessions for 1.5 hours
with 8-12 participants.
Based on a curriculum

Statistically
Significant:

Small sample
size

Changes in pre-and
post-test scores for
Teen Conflict Survey
and the Monitoring
the Future

Court ordered
participation

Clinical and Community based practice of OT:

The use of mindfulness for children is an
emerging tool that has impacted youth with
minimal harm. The use of this technique could
lead to positive behavioral changes, especially
amongst at-risk and delinquent youth.
Mindfulness can address the cognitive and

Cohort
Test the
effectiveness of a
mindfulness based substance
use intervention on
impulsiveness, selfregulation, and
perceived risk of
illegal substances
with a group of
youth who were
incarcerated

Assess the
reception and
perception of the
mindfulness based
intervention
according to the
participating youth.

Population:
N=60
Three groups of
two cohorts were
given the
intervention over
a 7 month period.
15-18 year old
male inmates
who primarily
identified as
Latino from
Northern
California with
substance abuse
problems were
court mandated
to attend the
mindfulness
group.

for mindfulness based

substance use
intervention. Focused
on drug education and
development of selfawareness. The role of
facilitators was not
thoroughly described.

Outcome Measures:
Teen Conflict Survey

Monitoring the Future

Healthy SelfRegulation

Assessment were
statistically
significant.
Significant decrease
in impulsiveness and
significant increase in
perceived drug risk
was measured.

Clinical
Significance:
Use of mindfulness
for individuals with
substance abuse
disorders can lead to
greater understanding
of susceptibility to
drug use and control
of ones impulses. By
addressing both of
those concepts, a
possible treatment
outcome may be
lower recidivism
rates amongst
incarcerated youth.

Institutional
limitations that
limited the study
from having a
control group

Participants were
resistant to
treatment

Numerous
confounding
variables

emotional facets of substance abuse and guide

the development of coping strategies.

Program development:
Mindfulness should be considered as a core to
many programs as it addresses deep,
psychosocial workings and their effects on
functional abilities. Special training is
necessary to perform mindfulness based
interventions.

Societal needs:
More programming needs to be developed to
address the rising number of incarcerated youth
and adults. Prisons are overpopulated, and
recidivism rates are high. This underlies the
need for more effective skill based
programming.

Health care delivery and policy:

These results should be considered preliminary
in regard to directing funds for policy, as the
sample size of this study was still relatively
small.

Education and training for OT students:

OT students should be trained in how to run a

group as well as lead a mindfulness
intervention. Students should be encouraged to
practice mindfulness on their own to bolster
their own ability to teach others. Students need
to be educated in the nuances of the justice
system as well as have a strong background in
mental health and the effects of trauma. Special
training is necessary to perform mindfulness
based interventions.

Refinement, revision, and advancement of

factual knowledge or theory:
Future studies should focus on the difference in
clinical outcomes between those who are court
ordered to participate and those who
voluntarily participate.
Himelstein,
Hastings,
Shapiro, &
Heery
(2012)

Test the feasibility

of a 10 week
mindfulness based
intervention for
incarcerated youth,
and its effect on the
individuals level
of self-regulation,
perceived stress
and mindfulness.

Level II

Design:
Cohort

Subjects:
N=47
incarcerated
males from San
Francisco

Intervention:
10 week Mind Body
Awareness course that
met for one hour a
week to practice
formal mindfulness
meditation,
experiential activities,
group processing and
discussion.

Statistical
Significance:
There was a
statistically
significant difference
between pre and post
test scores for the
Perceived Stress
Scale and the Healthy
Self-Regulation
Scale.

Lack of written
data due to
pencil bans on
unit

No control group

Clinical and Community based practice of OT:

Mindfulness can be an effective tool for
developing self-regulation and self-awareness
especially among youth with mental health
disorders. Mindfulness may improve functional
outcomes once the adolescent is released from
the juvenile justice system. Youth may be able
to better regulate their behaviors in order to
avoid future incarceration.

Small sample
size
Program development:

Outcome Measures:
Clinical

Mindfulness should be a core standard to any

Perceived Stress Scale

10

Mindfulness Attention
Awareness Scale

Healthy SelfRegulation Scale

Significance:
The results proved
that youth who are
incarcerated do have
the ability to decrease
perceived stress and
increase selfregulation skills with
mindfulness
interventions.

mental health program as it develops positive

coping strategies that increase the clients
independence and functional abilities.

Societal needs:
Mindfulness is a beneficial intervention
strategy with minimal costs and minimal
opportunities to cause harm.

Health care delivery and policy:

These results should be considered as
preliminary findings in regards to funding
policy.

Education and training for OT students:

OT students should be trained in mindfulness
techniques as well as be well-versed in youth
mental health disorders. OT students should
feel comfortable running groups for individuals
with behavioral problems in a juvenile
detention center. Special training is necessary
to perform mindfulness based interventions

Refinement, revision, and advancement of

factual knowledge or theory:

More studies need to be done to determine the

effects of mindfulness when compared to
traditional or other methods of intervention for
youth with criminal backgrounds.
Himelstein,
Saul, &
GarciaRomeu
(2015)

Determine the
effectiveness of
mindfulness
meditation with
adolescents who
are incarcerated
specifically within
the realms of selfesteem, attitudes
toward substance
use, locus of
control, decisionmaking,
mindfulness and
behavioral
regulations.

Level I

Design:
Randomized
Control Trial

Population:
N=35; 44
incarcerated
adolescents in the
San Francisco
Bay area. Ages
14-18. Met DSMV criteria for
either PSTD,
ADHD, mood
disorders, anxiety
disorders, or
learning
disorders.

Intervention:
Two groups received
group therapy and one
hour one on one
psychotherapy
sessions for 8-12
weeks.

Experimental group
received one on one
hour long
psychotherapy with a
focus on mindfulness
based training. The
first 6 weeks the
therapist taught a
specific form of
meditation. For the
remainder, participants
were encouraged to
choose a meditation in
which they gravitated
to.

The control group

received one on one
hour long

Statistical
Significance:
Improvement was
measured in decision
making skills and
self-esteem for both
groups.
Self-esteem was
higher in the
experimental group.

Clinical
Significance:
Cost effective
intervention for youth
who are incarcerated.

Limitations:

Clinical and Community based practice of OT:

Small sample
size

Mindfulness can be an effective tool for

developing self-esteem, sense of control,
decision making and behavioral regulation in
youth with substance abuse disorders.
Mindfulness can guide interventions focused
on the development of problem solving and
decision making skills.

Contamination

Behavioral
Regulation
Reports were
subjective
measures made
by the facility
staff

Program development:
While OTs are not included in this study, OTs
have the capabilities to implement similar
programs. A background in mindfulness and
working with at risk youth would be essential
to starting a similar program.

Societal needs:
No regression in selfesteem, attitudes,
towards substance
abuse, locus of
control, decisionmaking, mindfulness
and behavioral
regulations for the

Youth with substance abuse disorders is a

pertinent societal matter that needs to be
addressed. This study and similar programs
aim to provide supportive services for youth
who are incarcerated.

psychotherapy with an
emphasis on
motivational
interviewing, goal
planning and
successful reentry
back into the
community once
released from
detention.

Outcome Measures:
Mindfulness Attention
Awareness Scale

Prison Locus of
Control Scale
Decision-Making
Skills

Rosenberg SelfEsteem Scale

Attitude Toward
Drugs

individuals that
received mindfulness
based psychotherapy.

The group with

individual
psychotherapy
without mindfulness
had a decline in
behavior reports.

Health care delivery and policy: This area

would need to be explored as policy for
therapeutic services for youth who are
incarcerated is not yet clearly established or
well defined.

Education and training for OT students: This

study reiterates the concept that OT students
should be receiving training in mindfulness
based interventions. Special training is
necessary to perform mindfulness based
interventions.

Refinement, revision, and advancement of

factual knowledge or theory: Psychotherapist
are addressing this population. The time has
come for the OT profession consider forming
models to address this population in great need.

Behavioral Regulation
Reports
Latourneau
et al.
(2009)

Evaluate the
effectiveness of
Multisystemic
therapy services
compared to
traditional mental
health services for
juvenile sexual
offenders.

Level I

Intervention:

Statistically
Significant:

Design:
Randomized
Control Trial

12 Month follow- up
to a Multisystemic
therapy program
adapted for juvenile
sexual offenders

Population:

Outcome Measures:

n=127 juvenile
sexual offenders;
Control (n=63);
MST (n=68)

Adolescent Sexual
Behavior Inventory

Reduction in sexual
risk and misuse selfreport and caregiver
report

Self-Report
Delinquency Scale
(moderate reliability
and validity)

Reduction in
delinquent behavior

Reduction in deviant
sexual interests self
report and caregiver
report

Personal Experience
Inventory

Reduction in
substance abuse

Externalizing and
Internalizing scales
from the Child
Behavior Checklist

Clinically
Significant:

Youth Self-Report

Decreases in
internalization of
negative emotion and
increases in
externalizing positive

Need for longer

longitudinal
study to see if
reductions in
criminal sexual
behavior is
decreased or
eliminated

Clinical and Community based practice of OT:

There are a high number of juvenile sexual
offenders that are a result of cyclical familial
violence. By including the family in treatment,
the OT can address dynamics and skill
development within a natural context.

Program development:
More valid and
reliable measures
of delinquent
behaviors

Selection bias
causing a lack of
generalizability
to serious
juvenile sexual
offenders

Limited
information
regarding MST
protocols

MST should be included into core

programming as it addresses the intrinsic and
extrinsic factors related to delinquent behavior.
Requires specialized training of healthcare
professionals to uphold standardized protocols

Societal needs:
This intervention could help to disrupt the
cycle of violence in some homes, especially
amongst those who are open to the program.

Health care delivery and policy:

The results of this study helped to warrant
future investments in youth mental health
services that include families and communities.

(poor to moderate
validity)

emotion was found

however it was not
statistically
significant

Education and training for OT students:

OT students should receive education regarding
the sensitive nature of sexual assault and
violence, especially within the context of the
home. OT students should receive training in
how to conduct treatment with a group as well
as how to follow up with in home visits.

Services Utilization
Tracking form

Refinement, revision, and advancement of

factual knowledge or theory:
Future studies should not utilize subjective
parole or juvenile justice staff to help collect
data as it may skew the results.
Ogden &
Hagen
(2006)

Evaluate the
effectiveness of
Multisystemic
treatment (MST)
compared to
regular services
(RS) for youth with
severe behavior
problems in
diversion
programs.

Investigate whether
MST was
successful in

Level I

Intervention:

Design:

No specific details
regarding the MST
intervention were
given as the protocol
is copyrighted.

Randomized
Control Trial

Participants:
75 youth.
Average age of
15.07 years.
74/75 identified
as Norwegian.

MST is provided at
home and the intensity
is dependent on the
needs of the family.

Length of treatment

Statistically
Significant
Significant decrease
in problematic
behavior amongst the
youth that received
the MST treatment as
per parent report.
MST youth reports of
delinquency
behaviors also
showed a statistically
significant decrease
over the two year
period (15%) as
compared to their

Limited diversity
amongst
particpants

Not long enough

to determine
recidivism rates

No juvenile
justice system in
Norway (home
and community
based diversion

Clinical and Community based practice of OT:

MST is a highly effective and most researched
type of youth program. MST should provide
alternative treatment means for incarcerated
and delinquent youth. Implementation of this
program in OT may lead to large reductions in
recidivism rates amongst youth offenders with
mental health disorders by guiding
development of life skills.
Program development:
MST should be a core part of programming as
it seems to be highly effective and
standardized.

preventing out of
home placement
and examine trends
in reductions of
behavioral
problems such as
delinquency.

Inclusion criteria
included:
problem
behaviors, age
between 12-17,
and parents
motivated to start
MST

ranges between 3-5

months however there
is no specific length of
service. Intervention
reflects the nine goals
of the MST program

peers receiving RS
(7%). There was a
reduction in out of
home placement.

Clinically
Significant
Measures:
Self-report
delinquency scale

Out of Home
Placement Survey**
(created by the
researchers)

Child Behavioral
Checklist
(self-report; may not
be valid)

Social Skills Rating

Systems

Family Adaptability
and Cohesion
Evaluation Scales - III

Decrease in
behavioral problems,
increase in social
competence, and
increase in family
adaptability over the
two year period from
both groups. Youth
receiving MST had a
greater increase in
positive behaviors
but both groups
showed improvement
in all behavioral
measures and fell
within the normal
range of the CBCL

programs)
Societal needs:
Site differences
in the
implementation
of MST

This intervention can help to decrease

recidivism rates, in turn decreasing the burden
of cost of recidivism on local communities.

Health care delivery and policy:

Inconsistent
manner of data
collection
between groups
and sites

School behavior
reports were
dropped because
of high rates of
missing data

Limited insight
regarding youth
self-efficacy and
self-perception

Limited
generalizability
to incarcerated

Policy should focus on the implementation of

alternative and diversion programming for
youth offenders, especially those with mental
health disorders, in attempts to promote health
lifestyles and decrease criminal behavior.

Education and training for OT students:

Students should be given in depth instruction
regarding the implementation of standardized
protocols. Instruction on MST would also
compliment student knowledge.

Refinement, revision, and advancement of

factual knowledge or theory:
Future studies should examine and compare the differences
between recidivism rates amongst youth who are currently
incarcerated.

(FACES-III)

and paroled
youth

Limited
information
regarding MST
protocols
Ramadoss
& Bose
(2010)

Examine the
effectiveness of the
Yoga-Based
Transformative
Life Skill (TLS)
program, and on its
ability to decrease
the number of
recurrences of
violent behavior by
incarcerated youth

Level III

Design:
One group pretest/post-test

Population:
70 residents
resulting from a
67% drop out
rate. 56% were
women, 44%
were men.

Intervention:
TLS program was
given over an 18
month period, five
days a week for 60
minutes. Class was
separated by gender.
The program included:
an initial moment of
silence, a check in, a
sequence of yoga
poses and breathing
exercises, and a final
checkout.

Measures:
Perceived Stress Scale

Tangneys SelfControl Scale

Statistically
Significant:

Lack of control
group

Decrease in
perceived stress
found from pre-test
to post-test (p=.04).

High dropout
rate

Increase in selfcontrol was measured

from pre-test to posttest (p=.02).

Reliance on staff
of juvenile
justice center to
collect data

Clinically
Significant:

High prevalence
of mental health
disorders that the
yoga staff was
not prepared to
deal with in the
sessions.

n/a

Clinical and Community based practice of OT:

Implementation of yoga programs should be
done in conjunction with one on one skill
development. Yoga can be a great way to
reinforce learned behavioral and processing
skills.

Program development:
Yoga programs aimed at this population should
take into consideration the cultural norms of
the youth as well take into account familiarity
with the practice.

Societal needs:
Yoga provides individuals with a way that they
can self-regulate and increase positive health
outcomes on their own, thereby increasing selfefficacy and quality of life.

Health care delivery and policy:

Yoga programs are fairly inexpensive to
implement into existing mental health
programs as long as there is qualified staff to
teach the proper and safe techniques.

Education and training for OT students:

OT students should be highly familiar with
yoga practices and how to lead groups safely
and effectively. OT students should have a firm
grasp on how yoga can impact psychosocial
well-being as well an understanding of youth
mental health disorders.

Refinement, revision, and advancement of

factual knowledge or theory:
Future studies should utilize more rigorous
study designs.
TimmonsMitchell,
Bender,
Kishna, &
Mitchell
(2006)

Examine the
effectiveness of an
MST program for
youth with
diagnosed severe
behavior problems
within the juvenile
justice system
specifically with in
the domains of
reducing

Level I

Intervention:

Design:

No specific details
regarding the MST
intervention were
given as the protocol
is copyrighted

2x3 mixed
factorial
Randomized
Control Trial

MST is provided at
home and the intensity

Statistically
Significant:

Small sample
size

Youth within the

MST group had
significantly fewer
offenses at the 18
month follow up with
a 66.7% reduction in
recidivism rates.
TAU group was 3.2

Small budget
reduced amount
of measures used
to test treatment
fidelity

Clinical and Community based practice of OT:

MST may improve self-efficacy and social
functioning amongst youth with mental health
disorders. Improvements in positive behaviors
will lead to lower recidivism rates and lower
violent crime rates. This treatment is especially
effective for those youth with severe behavioral
problems which makes it very different than
other programs currently being offered.

recidivism and
increasing social
functioning.

Population:
N=93. Randomly
assigned to MST
group (n=48) and
treatment as
usual (n=45).
Mean age 15.1
years. Inclusion
criteria included:
(1) felony
conviction, (2)
suspended
commitment to
the incarcerating
facility, and (3)
family consent
for participation.

is dependent on the
needs of the family.
Length of treatment
ranges between 3-5
months however there
is no specific length of
service.

Intervention reflects
the nine goals of the
MST program

Outcome Measures:
Arrest Records

Child and Adolescent

Functional Assessment
Scale (CAFAS)

times more likely to

be rearrested within
that 18 month period.

MST group scored

higher on four out of
the six subscales of
the CAFAS when
compared to the TAU
group at the 6 month
follow up.

Clinically
Significant:
Average time
between rearrests was
longer in the MST
group (135 days)
versus the TAU
group (117 days).

Decreased substance
abuse noted in both
groups but more
significant among the
MST group.

Limited
information
regarding the
TAU procedures

Selection bias

Focus on one
county that had
an already
established MST
Program

Limited
generalizability
to larger counties
and courts

Limited
information
regarding MST
protocols

Program development:
Programs should include MST as a core aspect
of the curriculum as it is a client-centered and
researched method of treatment.

Societal needs:
This intervention could potentially lead to
decreases in healthcare and judicial costs as
youth recidivism rates decline. And potentially
allow for greater awareness of mental health
disorders on a spectrum rather than just
providing a one-size fits all treatment for all
incarcerated youth.

Health care delivery and policy:

Larger studies with more funding should be
done to determine diversion program
effectiveness in reducing recidivism rates
amongst youth offenders with mental health
disorders.

Education and training for OT students:

OT students should be well trained in the
standardized, specific protocols of MST as well
as how to effectively treat clients in a home

setting.

Refinement, revision, and advancement of

factual knowledge or theory:
Future studies should have a greater sample
size with a more heterogeneous population.
Trupin,
Kerns,
Walker,
DeRobertis
, & Stewart
(2011)

Evaluate the impact

on the Family
Integrated
Transitions(FIT)
program on
juvenile recidivism
for youth with cooccurring mental
health and
substance use
disorders in
comparison to
usual care

Level II

Design:
Cohort Design

Population
N=274 youth
with co-occurring
mental health and
substance use
disorders within
Washington State
Juvenile
Rehabilitation
Facilities (n=105
experimental;
n=169 control).
Mean age =
16.35.

Intervention:
2 to 3 months phase
while the youth are in
custody and a follow
up with a 4 to 6 month
phase post-release.
Families in the FIT
program received an
average of 2 hours per
week within the
familys homes and
community. Families
also have access to a
FIT coach 24/7. No
further information
was given regarding
the specifics of the
FIT program due to
copyright laws.

Measures:
Arrest Records

Statistically
Significant
30% decreased rate
of recidivism rates
for felony offenders
over a 36 month
period

Clinically
Significant
Decrease in
misdemeanor
recidivism rates
especially among
female offenders.

Decrease in
recidivism rates
among violent felony
offenders

County
variations and
coach variations

Lack of
generalizability
to other regions
of the country

Limited
information
regarding the
specific
interventions
used in the
usual model

Limited
information
regarding FIT
protocols

Clinical and Community based practice of OT:

FIT programs are effective tools in increasing
familial input and disrupting cycles of violence
amongst youth offenders. The benefits of home
based interventions is that transportation and
time become less of a factor. FIT effectiveness
on developing positive strategies to address
substance abuse disorders.

Program development:
FIT can be used to develop strong community
based interventions that focus on the
development of positive coping strategies, life
management, and healthy life choices that not
only impact the youth but all members of the
family who are involved.

Societal needs:
There is a need to develop family based and
community based interventions for youth
offenders in order to increase effectiveness in

Limited
parameters
regarding subject
participation in
program

Single outcome
measure

skill development. Youth offenders often

engage in criminal patterns that are close to
home and therefore effective programming
could improve local communities.

Health care delivery and policy:

More programs need to be developed for youth
offenders that incorporate the family within the
local community in order to promote healthier
lifestyles.

Education and training for OT students:

OT students should be trained in dealing with
family dynamics and how to develop group
based interventions.

Refinement, revision, and advancement of

factual knowledge or theory:
Future studies using the FIT model should
incorporate more outcome measures in order to
determine program effects on multiple
behavioral patterns.