Cost-benefit analyses of developmental crime prevention programmes.

BACKGROUND: Children and youth who are at risk of becoming early-onset life-course-persistent offenders often slip through the cracks of other systems in society (e.g., health, education, child welfare, substance use and mental health). When they do, they impose an enormous economic burden on society. Developmental crime prevention (DCP) programmes seek to reduce these costs through evidence-based interventions that target individual child and family risk and protective factors for antisocial behaviour. AIM: This study reviewed cost-benefit analysis studies of DCP interventions to identify whether they produced monetary benefits that exceeded programme costs. METHOD: We searched the literature for studies of interventions that were evaluated using high-quality research methods (i.e., experimental or quasi-experimental designs). Key characteristics of these evaluations are summarised and benefit-to-cost ratios (BCRs) are reported. RESULTS: Eleven cost-benefit analysis (CBA) evaluations met study criteria. The programmes varied in terms of who they targeted (e.g., pregnant mothers, at-risk youth), the age of participants (e.g., adults, children, older youth), the intervention duration (e.g., 10 weeks to 4 years), and the follow-up interval (e.g., 6 months to 50 years). Ten of the 11 studies produced favourable BCRs, ranging between 1.35 and 31.77, depending on the type and scope of outcomes that were monetised. CONCLUSION: There is strong evidence in support of DCP from a cost-benefit perspective. However, given the small number of studies for analysis, more prospective longitudinal CBA evaluations are needed, in addition to greater consistency in the scope and methods that are used to monetise outcomes.

Estimating the monetary cost of risk factors for crime in boys using the EARL-20B.

This study examined the relationship between early childhood risk factors for antisocial behavior and the monetary costs associated with criminal convictions for 379 clinic-referred boys. Participants were assessed using a structured risk assessment instrument, the Early Assessment Risk List for Boys (EARL-20B), intended for use with boys aged 6-11 with conduct problems. Criminal conviction data were used to calculate costs borne by victims, the correctional system, and other areas of the criminal justice system for participants between the ages of 12 and 20. For the total sample, the average cost per person was $580,181. Using the EARL-20B total score to derive quartile groups, the average lowest and highest risk quartile boys cost $361,581 and $878,460, respectively. Including estimates associated with undetected crimes increased per-person estimates to $1,058,854 and $3,536,441. For all risk groups, most of the costs occurred during mid-to-late adolescence, between the ages of 15-17. Analyses of individual EARL-20B items revealed that the three most expensive risk factors were manifesting antisocial attitudes ($920,657), poor coping ability ($768,416), and poor academic performance ($772,256). The results from this study show that it is possible to quantify childhood risk in monetary terms, and that substantial cost savings can be realized if developmental crime prevention programs are targeted at antisocial children before they reach the age of criminal liability. Psychologists play an important role in this pursuit by developing and using risk/needs assessment instruments, choosing and targeting interventions based on the results, developing new programs, training personnel, and evaluating the effectiveness of programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

System-wide implementation of ACT in Ontario: an ongoing improvement effort.

In the late 1990s, the government of Ontario undertook a province-wide implementation of Assertive Community Treatment (ACT). Capacity grew to 59 teams within 6 years. This paper describes the implementation process, focusing on three phases--start-up, or the enabling phase; feedback, or the reinforcement phase; and response, or the corrective action phase. Key implementation supports include an active oversight committee with representation from both the ministry and the field and the availability of the planning data on ACT performance. Three areas of underperformance were identified: lower than expected team caseloads, drift from the target client group, and significant under-staffing in the teams. Likely causes were suggested, and corrective actions developed, which centered on clarifying the ACT standards, especially related to intake criteria, rate of intake and staffing, increasing team funding, and establishing expectations for reporting and accountability. While these corrective responses are promising, implementation of infrastructure and mechanisms for providing systematic practice feedback is still underdeveloped.

Clinician perceptions of childhood risk factors for future antisocial behavior.

We asked 176 mental health clinicians to list factors that place a child at risk for engaging in future antisocial behavior. Participants were randomly assigned to do this in relationship to boys and girls. Listed factors were then coded into broad item categories using the Early Assessment Risk Lists (EARL). Of the 1,695 factors listed, 1,476 (87%) could be unambiguously classified under one discrete EARL factor category, providing support for the structure of the tools. Children's own antisocial behavior was seen as the most important factor, followed by experiencing abuse and having antisocial peers. In some cases, participants emphasized different risk factors for boys (e.g., having antisocial attitudes) and girls (e.g., low coping ability). The findings highlight the need to pay attention to client characteristics in developing risk assessment protocols and support continued efforts to bridge the gap between scientific research and clinical practice.

Prevalence and profile of people with co-occurring mental and substance use disorders within a comprehensive mental health system.

OBJECTIVE: To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology. METHOD: Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care. RESULTS: Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm. CONCLUSION: The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems.

Evaluation of a targeted cognitive-behavioral program for children with conduct problems--the SNAP Under 12 Outreach Project: service intensity, age and gender effects on short- and long-term outcomes.

This study tested the effectiveness of a multifaceted, cognitive-behavioral therapy (CBT) program for antisocial children--the SNAP Under 12 Outreach Project (ORP)--in relation to age, sex and indices of treatment intensity. Study participants were 80 clinic-referred children (59 boys and 21 girls) aged 6-11 years assigned to one of the following groups: control (CG; n = 14) who did not receive the ORP, matched (MG; n = 50) who received the ORP, and experimental (EG; n = 16) who received an enhanced version of the ORP. Results indicated significant pre-post changes for the EG and MG for Child Behavior Checklist (CBCL)-measured delinquency and aggression, but no improvement for the CG. Positive relationships between the number of individual ORP components (e.g. number of children's CBT sessions) received and CBCL change scores were also found. Statistical associations tended to be larger for girls and older children (i.e. 10-11 years old) who may have been more cognitively advanced. Also, the number of children's CBT sessions predicted later convictions, even after controlling for prior CBCL delinquency scores. Findings from this study support the effectiveness of the ORP, but also highlight the need to take into account client characteristics when offering clinical treatment.