New Perspectives on Aggression Replacement Training: Practice, Research and Application (Wiley Series in Forensic Clinical Psychology)

NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

WILEY SERIES IN

FORENSIC CLINICAL PSYCHOLOGY Edited by

Clive R. Hollin Department of Health Sciences, The University of Leicester, UK and

Mary McMurran School of Psychology, Cardiff University, UK Cognitive Behavioural Treatment of Sexual Offenders William L. Marshall, Dana Anderson and Yolanda Fernandez Violence, Crime and Mentally Disordered Offenders: Concepts and Methods for Effective Treatment and Prevention Sheilagh Hodgins and Rudiger ¨ Muller-Isberner ¨ (Editors) Offender Rehabilitation in Practice: Implementing and Evaluating Effective Programs Gary A. Bernfeld, David P. Farrington and Alan W. Leschied (Editors) Motivating Offenders to Change: A Guide to Enhancing Engagement in Therapy Mary McMurran (Editor) The Psychology of Group Aggression Arnold P. Goldstein Offender Rehabilitation and Treatment: Effective Programmes and Policies to Reduce Re-offending James McGuire (Editor) Offenders with Developmental Disabilities William R. Lindsay, John L. Taylor and Peter Sturmey (Editors) New Perspectives on Aggression Replacement Training: Practice, Research, and Application Arnold P. Goldstein, Rune Nens´en, Bengt Daleflod and Mikael Kalt (Editors)

NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Practice, Research, and Application Edited by

Arnold P. Goldstein Syracuse University, New York, USA

Rune Nens´en Barnhemmet Oasen, Aneby, Sweden

Bengt Daleflod Norra Rudbecksgatan 6, Uppsala, Sweden

Mikael Kalt Ungdomsalternativet, Malm¨o, Sweden

C 2004 Copyright


John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England Telephone

C 2004 Copyright


(+44) 1243 779777

Susan Striepling-Goldstein for material by Arnold P. Goldstein

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Library of Congress Cataloging-in-Publication Data New perspectives on aggression replacement training : practice, research and application/edited by Arnold P. Goldstein . . . [et al.]. p. cm. – (Wiley series in forensic clinical psychology) Includes bibliographical references and index. ISBN 0-470-85492-8 (cloth : alk. paper) – ISBN 0-470-85493-6 (pbk. : alk. paper) 1. Aggressiveness–Treatment. 2. Anger–Treatment. 3. Criminals– Rehabilitation. 4. Juvenile delinquents–Rehabilitation. I. Goldstein, Arnold P. II. Series. RC569.5.A34N39 2004 616.85′ 810651 – dc22 2004005511 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 0-470-85492-8 (hbk) ISBN 0-470-85493-6 (pbk) Typeset in 10/12pt Palatino by TechBooks, New Delhi, India Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall This book is printed on acid-free paper responsibly manufactured from sustainable forestry in which at least two trees are planted for each one used for paper production.

CONTENTS About the Editors List of Contributors Series Editors’ Preface Preface Acknowledgments

PART I THEORY AND PRACTICE 1 Aggression Replacement Training: The Cognitive-Behavioral Context Clive R. Hollin

page vii ix xi xv xvii

1 3

2 Skillstreaming: The Behavioral Component Arnold P. Goldstein

21

3 Current Issues in Anger Management Interventions with Youth Eva L. Feindler and Kristan Baker

31

4 Moral Reasoning Training: The Values Component John C. Gibbs

51

PART II ESTABLISHED APPLICATIONS

73

5 Application in an Inner-city Elementary School Rob DiFlorio

75

6 Collaboration with Human Services and Schools Mark Amendola and Robert Oliver

87

7 Ungdomsalternativet—The Youth Alternative Ivan Brilje, Mariusz Hermelin, and Mikael Kalt

105

vi CONTENTS

8 The Oasis—A Living Idea Rune Nens´en and Nikolai Hamstein

121

9 A National Dissemination Program James McGuire and Danny Clark

139

PART III ELABORATIONS, EXTENSIONS, AND EVALUATIONS

151

10 ART and Beyond: The Prepare Curriculum Arnold P. Goldstein

153

11 The Peace Curriculum: Expanded Aggression Replacement Training Sara Salmon

171

12 Aggression Control Therapy for Forensic Psychiatric Patients: Development and Preliminary Results Ruud H. J. Hornsveld

189

13 Aggression Replacement Training: A Learning Process for the Whole Family Robert Calame and Kim Parker

197

14 Evaluations of Effectiveness Arnold P. Goldstein

231

15 The ART Trainer as a Scientific Practitioner Bengt Daleflod

245

Epilogue Index

257 259

ABOUT THE EDITORS Arnold P. Goldstein was the Director of the Center for Research on Aggression at Syracuse University, Director of the New York State Task Force on Juvenile Gangs, and co-founder of the International Center for Aggression Replacement Training. He served on the American Psychological Association Commission on Youth Violence and on the Council of Representatives for the International Society for Research on Aggression. A prolific writer, he authored more than 55 books and 100 articles on violence, aggression, delinquency, abuse, and related topics. His work was honored with numerous awards, including the Career Achievement Award from the American Psychological Association’s Committee on Children, Youth, and Families (1996), the Senior Scientist Award from the APA Psychology Division (1996), and the 2002 Devereux Massachusetts Legacy of Caring Award. Just before his death in 2002, Professor Goldstein was nominated for a Nobel Prize. Rune Nens´en is the founder of The Oasis, a residential treatment facility for young people and their families, in Sweden. A qualified social worker, he has many years’ experience in the social services as both a supervisor and program director in cities in southern Sweden. Since 1990 he has primarily worked as the director and Program Director for The Oasis which, over the past decade, has served more than 80 cities in Sweden in offering services to families with young children. In 1997 Rune Nens´en successfully introduced ART at The Oasis as a program for both families and children. Bengt Daleflod is a psychologist specializing in cognitive-behavioral psychotherapy. He started his clinical career in the psychiatric care of children and adolescents, and since 1986 he has been working with incarcerated juvenile delinquents and involved in staff training and supervision. He works within SiS (The National Board of Institutional Care) and is now connected to Sundbo Youth Home in Sweden, where ART is one of the main interventions that has been introduced in working with young offenders. Bengt Daleflod is also an active member of the Swedish Behavioral Therapy Association with a special assignment to work out guidelines for treatment of various psychological disorders. Mikael Kalt was born in Warsaw but has been residing in the city of Malmo¨ in Sweden for the past 23 years. He has a long and extensive experience of working with aggressive and delinquent youth in different settings, ranging from

viii ABOUT THE EDITORS

institutions to community-based projects and schools. Mikael Kalt and his friends and associates Mariusz Hermelin and Ivan Brilje are the co-founders of Ungdomsalternativet (“The Youth Alternative”), a non-government organization working in Sweden with youth at risk in schools and the community and training teachers and youth workers in ART. He is a practicing ART trainer working on a regular basis with youth groups, and is an ART Master Trainer, training staff and new ART trainers.

LIST OF CONTRIBUTORS Mark Amendola 3825 Holly Drive, Erie, PA 16510, USA Kristan Baker 66-15 Thorton Place, #1A Rego Park, New York 11374, USA Ivan Brilje Ungdomsalternativet, Jacob Mollersgatan 3, 211 57 Malmo, ¨ Sweden Robert Calame Batshaw Youth and Family Centres, Dorval Campus, 825 Avenue Dawson, Dorval, Quebec, Canada H9S 1X4 Danny Clark National Probation Directorate, Horseferry House, Dean Ryle Street, London SW1P, UK Bengt Daleflod Norra Rudbecksgatan 6, 752 36 Uppsala, Sweden Rob DiFlorio 440 Brattle Rd, Syracuse, NY 13203, USA Eva L. Feindler Director, Psychological Services Center, Long Island University, C.W. Post Campus, 720 Northern Blvd, Brookville, NY 11548-1300, USA John C. Gibbs 1346 Murrell Ave., Columbus, OH 43212, USA

x LIST OF CONTRIBUTORS

Arnold P. Goldstein (Deceased) c/o Susan Striepling-Goldstein, 129 Nottingham Road, Syracuse, NY 13210, USA Nikolai Hamstein Barnhemmet Oasen, Box 199, Fasanstigen 17-25, 578 24 Aneby, Sweden Mariusz Hermelin Ungdomsalternativet, Jacob Mollersgatan 3, 211 57 Malmo, ¨ Sweden Clive R. Hollin University of Leicester, Arnold Lodge, Leicester LE3 0LE, UK Ruud H. J. Hornsveld Lange Dreef 52, 2285 LA Rijswijk, The Netherlands Mikael Kalt Ungdomsalternativet, Jacob Mollersgatan 3, 211 57 Malmo, ¨ Sweden James McGuire University of Liverpool, Department of Clinical Psychology, Whelan Building, Liverpool L69 3GB, UK Rune Nens´en Barnhemmet Oasen, Box 199, Fasanstigen 17-25, 578 24 Aneby, Sweden Robert Oliver 3951 Shamrock Ct, Erie, PA 16510, USA Kim Parker 1767 Cote St Garitel, Morin Heights, Quebec, Canada J0R lH0 Sara Salmon 430 Tynon Court, Erie, CO 80516, USA

SERIES EDITORS’ PREFACE ABOUT THE SERIES At the time of writing it is clear that we live in a time, certainly in the UK and other parts of Europe, if perhaps less so in other areas of the world, when there is renewed enthusiasm for constructive approaches to working with offenders to prevent crime. What do we mean by this statement and what basis do we have for making it? First, by “constructive approaches to working with offenders” we mean bringing the use of effective methods and techniques of behavior change into work with offenders. Indeed, this view might pass as a definition of forensic clinical psychology. Thus, our focus is the application of theory and research in order to develop practice aimed at bringing about a change in the offender’s functioning. The word constructive is important and can be set against approaches to changing behavior that seek to operate by destructive means. Such destructive approaches are typically based on the principles of deterrence and punishment, seeking to suppress the offender’s actions through fear and intimidation. A constructive approach, on the other hand, seeks to bring about changes in an offender’s functioning that will produce, say, enhanced possibilities of employment, greater levels of self-control, better family functioning, or increased awareness of the pain of victims. A constructive approach faces the criticism of being a “soft” response to the damage caused by offenders, neither inflicting pain and punishment nor delivering retribution. This point raises a serious question for those involved in working with offenders. Should advocates of constructive approaches oppose retribution as a goal of the criminal justice system as a process that is incompatible with treatment and rehabilitation? Alternatively, should constructive work with offenders take place within a system given to retribution? We believe that this issue merits serious debate. However, to return to our starting point, history shows that criminal justice systems are littered with many attempts at constructive work with offenders, not all of which have been successful. In raising the specter of success, the second part of our opening sentence now merits attention: that is, “constructive approaches to working with offenders to prevent crime.” In order to achieve the goal of preventing crime, interventions must focus on the right targets for behavior change. In addressing this crucial point, Andrews and Bonta (1994) have formulated the need principle:

xii SERIES EDITORS’ PREFACE Many offenders, especially high-risk offenders, have a variety of needs. They need places to live and work and/or they need to stop taking drugs. Some have poor self-esteem, chronic headaches or cavities in their teeth. These are all “needs.” The need principle draws our attention to the distinction between criminogenic and noncriminogenic needs. Criminogenic needs are a subset of an offender’s risk level. They are dynamic attributes of an offender that, when changed, are associated with changes in the probability of recidivism. Noncriminogenic needs are also dynamic and changeable, but these changes are not necessarily associated with the probability of recidivism. (p. 176)

Thus, successful work with offenders can be judged in terms of bringing about change in noncriminogenic need or in terms of bringing about change in criminogenic need. While the former is important and, indeed, may be a necessary precursor to offense-focused work, it is changing criminogenic need that, we argue, should be the touchstone in working with offenders. While, as noted above, the history of work with offenders is not replete with success, the research base developed since the early 1990s, particularly the metaanalyses (e.g. Losel, ¨ 1995), now strongly supports the position that effective work with offenders to prevent further offending is possible. The parameters of such evidence-based practice have become well established and widely disseminated under the banner of “What Works” (McGuire, 1995). It is important to state that we are not advocating that there is only one approach to preventing crime. Clearly there are many approaches, with different theoretical underpinnings, that can be applied. Nonetheless, a tangible momentum has grown in the wake of the “What Works” movement as academics, practitioners, and policy makers seek to capitalize on the possibilities that this research raises for preventing crime. The task now facing many service agencies lies in turning the research into effective practice. Our aim in developing this Series in Forensic Clinical Psychology is to produce texts that review research and draw on clinical expertise to advance effective work with offenders. We are both committed to the ideal of evidence-based practice and we will encourage contributors to the Series to follow this approach. Thus, the books published in the Series will not be practice manuals or “cook books”: they will offer readers authoritative and critical information through which forensic clinical practice can develop. We are both enthusiastic about the contribution to effective practice that this Series can make and look forward to continuing to develop it in the years to come.

ABOUT THIS BOOK This is the second book that Professor Goldstein has contributed to our Series. In the Preface to the previous book (Goldstein, 2002) we expressed our sorrow at Professor Goldstein’s untimely death. This book stands as one of Professor Goldstein’s last publications but it also marks the beginning of the continuation of his life’s work. Over his career Professor Goldstein’s work was concerned with understanding aggression and violence and, perhaps more importantly, in finding effective means to change violent behavior. His program Aggression Replacement

SERIES EDITORS’ PREFACE xiii

Training (ART; Goldstein, Glick, & Gibbs, 1998) represents a significant contribution to forensic practice and has influenced the efforts of practitioners all over the world. The growing worldwide use of ART led in 2001 to the formation of the International Center for Aggression Replacement Training (ICART). The beginning of ICART was marked with a conference in Malmo, ¨ Sweden, which attracted over 750 delegates from 20 countries. As noted on the ICART website (www.aggressionreplacementtraining.org), the tasks undertaken by ICART are to provide a forum for the exchange of ART-relevant experiences and data, create an active network of interested professionals, encourage high-quality practice in its use, promote its continued rigorous evaluation, and aid in ART’s growing dissemination as a useful intervention approach. In order to meet these goals ICART sponsors conferences, creates and disseminates the ICART Communicator practitioner–researcher newsletter, and serves as a clearing-house for creative ART practice innovations and developing research findings as they become available. The ICART newsletter is available at the website. The chapters in this book are intended to give a broad flavor of the theory and practice of ART. The opening chapters in the first section look at the broad theory that informs ART and the specifics of the three components— Skillstreaming, emotional control, moral values—of the ART program. Indeed, the latter three chapters bring together the trio of academics, Arnold Goldstein, Eve Feindler, and John Gibbs, who were the originators of the three interventions that currently constitute ART. The second section is then concerned with the application of ART across a range of settings and countries. There are two points that spring to attention when looking at the scope of these chapters and the style of work they encompass. The first point to note lies in the range of settings within which ART has found a home and hence the diversity of client groups with which ART is applied. It can be seen that the chapters build from a focus on the individual offender, then to a variety of settings such as local schools and residential facilities, and finally to the national use of ART in the English and Welsh Probation Service. The second point to note is the absence of a formal structure around the implementation of ART. This “hands-off” approach leads to an interesting clash in the philosophy of program management. The approach adopted by ART, strongly advocated by Professor Goldstein, is based on encouragement and facilitation of the work of practitioners. To engage practitioners and their clients in the ART program is the fundamental aim; once practitioners are engaged then their work can be supported by training, consultancy, and professional networks. This practitionerfriendly “bottom-up” approach can be contrasted with the “top-down” approach evident in some systems, such as the criminal justice system in England and Wales, in which the development and application of programs is very tightly managed. This latter approach is clearly seen in the intricacies of program accreditation (Lipton, Thornton, McGuire, Porporino, & Hollin, 2000) and in discussions of program management (Bernfeld, Farrington, & Leschied, 2001). It is evident that both approaches have their relative strengths and weaknesses: as ART is currently being used with both approaches, it may be that the data will eventually let us know which approach produces the best outcomes. In the third section of the book attention turns to new directions in the development of the ART program. As knowledge and experience accrue, so change should

xiv SERIES EDITORS’ PREFACE

follow: the Prepare and the Peace curricula exemplify this process of program modification and development. The real spirit of ART is that it is always work in progress, never the final word. In the same vein, it is also the case that violent behavior is not the province of any one group, and the extension and modification of ART to new populations, such as forensic patients, is an exciting development. The chapter by Robert Calame and Kim Parker illustrates how evaluation can be built into practice, and the penultimate chapter of the book considers what is currently known about the effectiveness of ART. The final chapter neatly brings the text full circle in looking to the scientist-practitioner model as the basis for progress. The work of researchers, as seen in the opening section, feeds into practice; the work of practitioners, as seen in the second section, tests and contributes to work of theorists and researchers; the culmination of the work of scientists and practitioners leads to increasingly effective practice. As noted above, this book marks an end and a beginning: we hope that readers will learn and benefit and be enthused to use ART in their practice. There will be more work and, as we hope and Arnie had planned, more books just like this one. Clive Hollin and Mary McMurran

REFERENCES Andrews, D. A. & Bonta, J. (1994). The psychology of criminal conduct. Cincinnati, OH: Anderson Publishing. Bernfeld, G. A., Farrington, D. P., & Leschied, A. W. (Eds) (2001). Offender rehabilitation in practice: Implementing and evaluating effective programmes. Chichester: John Wiley & Sons. Goldstein, A. P. (Ed.) (2002). The psychology of group aggression. Chichester: John Wiley & Sons. Goldstein, A. P., Glick, B., & Gibbs, J. C. (1998). Aggression Replacement Training: A comprehensive intervention for aggressive youth (rev. edn). Champaign, IL: Research Press. Lipton, D. S., Thornton, D. M., McGuire, J., Porporino, F. J., & Hollin, C. R. (2000). Program accreditation and correctional treatment. Substance Use and Misuse, 35, 1705–1734. Losel, ¨ F. (1995). Increasing consensus in the evaluation of offender rehabilitation? Psychology, Crime, and Law, 2, 19–39. McGuire, J. (Ed.) (1995). What works: Reducing reoffending. Chichester: John Wiley & Sons.

PREFACE In the mid-1970s, at the very beginning of the social skills training movement, my colleagues and graduate students and I developed our approach to teaching prosocial behaviors, Skillstreaming. Skillstreaming is the topic of Chapter 2. As efficacy studies of the earliest social skills approaches, including Skillstreaming, became available, it became clear that far too often results shared a quality held in common by all psychological interventions—that is, frequent inadequacy of generalization of gain. Skill acquisition generally did occur; skill transfer to out-of-training settings and skill maintenance over time were clearly less frequent outcomes. Around 1980, I had the good fortune of beginning a series of conversations with Barry Glick, who was at that time the director of an NY State facility for delinquent youth near Syracuse, NY. Our goal was to puzzle through what might optimally be added to Skillstreaming in order to enhance its outcome potency, particularly with regard to generalization. Two additional components seemed to be likely candidates. The first was Anger Control Training to provide trainees with competence in what not to do in the face of provocation. Back then, as now, we viewed Eva Feindler as the US’s leading expert on anger control and sought her out. With her characteristic wisdom and generosity, Eva fully shared her intervention approach and its evaluations with us, and we incorporated it as ART’s second component. Since aggression is so typically a richly rewarded, infrequently punished primarily learned behavior, trainees can know well what to do (from Skillstreaming) and what not to do (from Anger Control Training) and still choose to behave aggressively. We thus felt that a values intervention needed to be ART’s third component, providing in a sense the prosocial motivation to employ the other components’ skills. We first selected Kohlberg’s Moral Education for this purpose and, in later years, replaced this with John Gibbs’ especially well-grounded Social Problem Solving approach. Having thus constituted our intervention, Barry and I then set off on a 10 year multi-study journey to examine whether our hope for its potency matched its reality. Over the course of this period, a half-dozen other investigators at widely distributed locations also came to test the adequacy of ART. The combined results of these several studies, reported in detail in Chapter 14, point to ART as generally quite an effective intervention worthy of further application and continued evaluation. Largely in response to this stream of primarily positive outcomes, a number of developments have occurred. First, ART has been designated as a recommended

xvi PREFACE

program by the US Department of Education, a validated program by the NY State Department of Education, a model program by both the US Department of Justice and the American Correctional Association, and an accredited program by the UK Home Office Probation Unit. Second, a new ART organization has been formed: the International Center for Aggression Replacement Training (ICART). Its purpose is to promote competent application and rigorous evaluation of ART. We invite interested readers of the present book to join us as ICART members. The third result of the frequent demonstration of ART’s efficacy is the wide spread across Europe, North America, and elsewhere in its creative use, energetic training, and continued evaluation. Arnold P. Goldstein

ACKNOWLEDGMENTS Arnold Goldstein’s death was as much of a surprise to him as it was to his family, friends, and colleagues. Only a week before his death he was working on this book, as well as planning future works. Fate intervened, however. Clive Hollin, dear friend and colleague of Arnie’s, stepped in and took over the work of bringing this book to publication. Without his efforts, Arnie’s project would never have been completed. The contributors to this volume, as well as the whole of the ICART and ART communities, wish to thank him enormously and say, “Good job.” The pioneers of ART—Goldstein, Glick, and later, Gibbs—created an intervention they thought would be useful. Their own research and rigorous evaluation showed it to be so. Through their efforts and the work of many others, ART has spread far beyond its original test site in upstate New York. Over the years, Arnie began to envision an international ART community of researchers and academics, practitioners and administrators, which resulted in the founding of the International Center for Aggression Replacement Training. I would like to personally thank all of the contributors to this volume for their hard work and support on behalf of ART and ICART. It is as a result of their ongoing efforts that Arnie’s vision has been realized. Susan Striepling-Goldstein, Co-Chairperson, ICART

PART I

THEORY AND PRACTICE Contemporary practitioners—whether they are psychotherapists, educators, social workers, or other professionals—find themselves governed more and more in their work by the fact that we are in an “era of accountability.” Government and private agencies are increasingly and rightly insisting that we—the treatment and intervention professionals—firmly and unequivocally demonstrate that our interventions work. In fact, an ever growing number of such agencies now require such efficacy information in advance, as a precondition to selecting and starting to use any given intervention. Nowhere has the accountability movement taken root more strongly than in the UK, where the Prison Service and the National Probation Service have responded to 20 years of evidence showing clearly that the most effective interventions for chronically aggressive persons are those that seek to both alter aggression-promoting thinking patterns and provide new behaviors to aid the person to deal prosocially with previously provocative events—that is, cognitivebehavior interventions. The national initiatives in the UK have been informed by the author of our first chapter, a person considered to be the UK’s premier forensic psychologist working in the field of offender rehabilitation, who has reviewed in detail the existing evaluation literature on cognitive-behavioral approaches and has recommended those he felt to be of value. Clive Hollin is Professor of Criminological Psychology at the University of Leicester. His opening chapter provides us with the cognitive-behavioral context from which ART grew. The following three chapters bring together the three persons who were the originators of the three interventions that constitute ART. Arnold P. Goldstein and his colleagues at Syracuse University first constituted Skillstreaming; Anger Control Training was developed by Eva Feindler, Professor of Psychology and Director of the Psychological Services Center at Long Island University in New York; and ART’s Moral Reasoning Training—in the form of Social Problem Solving Intervention—was first formulated by John Gibbs, Professor of Developmental Psychology at Ohio State University.

Chapter 1

AGGRESSION REPLACEMENT TRAINING: THE COGNITIVE-BEHAVIORAL CONTEXT CLIVE R. HOLLIN Department of Health Sciences, University of Leicester, UK

INTRODUCTION Developed in the 1980s, the first complete publication of Aggression Replacement Training (ART) in 1987, by Arnold Goldstein and Barry Glick, saw the formulation of a multimodal approach to working with aggressive offenders. Utilized on an increasingly wide basis throughout the 1990s, the accumulated outcome evidence shows that ART is an effective method by which to reduce aggressive behavior (Goldstein & Glick, 1996). The latest text offering a revised edition of the program (Goldstein, Glick, & Gibbs, 1998) details and refines the three components that make up ART: these three components, delivered sequentially, are Skillstreaming, Anger Control Training, and Moral Reasoning Training. Skillstreaming involves the teaching of skills that serve to displace the out-ofcontrol destructive behaviors with constructive, prosocial behavior. The skills element of ART teaches constructive social skills in terms of step-by-step instructions to managing key social situations. In keeping with the principles of skills training, the skills are modeled by group leaders and then practiced by offenders. ART addresses a “core” set of social skills relevant to the target group in order to bring about change. Anger Control Training follows the established sequence of establishing Antecedent–Behavior–Consequence (A–B–C) sequences to determine triggers for anger. ART then uses the standard anger management techniques of enhancing self-awareness of internal angry cues, teaching coping strategies, skills training, self-instruction, and social problem solving. Moral Reasoning Training seeks to address issues concerned with a delay in maturing of moral reasoning and the associated egocentric bias. Thus, this part of the program seeks to enhance offenders’ moral reasoning skills and widen their social perspective taking. These aims are achieved through self-instruction training, New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


4 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

social problem solving, skills training, and guided peer group social decisionmaking meetings. The aim of this chapter is principally to describe the theoretical underpinnings for ART, then to consider the evidence that speaks to this theoretical base. In looking to theory, there are two dimensions to discuss: first, the broad theoretical position adopted by ART, and, second, the specific theoretical rationale for the three components.

ART: BROAD THEORY This section develops the theme of cognitive-behavioral theory as the bedrock theory on which ART is built. To achieve this aim, an overview of the broad extent of cognitive-behavioral theory is presented. The theme will be developed by suggesting that a cognitive-behavioral approach is one that seeks to locate behavior within a social context, with an emphasis on the reciprocity between the social context and an individual’s functioning. The dovetailing of ART and these theoretical principles will then become clear. There is no doubt that ART has its theoretical base in learning theory: “Aggression is primarily learned behavior, learned by observation, imitation, direct experience, and rehearsal” (Goldstein et al., 1998, p. 3). In its initial formulation as a theory of learning, traditional behavioral theory concentrated on the relationship between the environment and observable behavior (Skinner, 1974). The theoretical position articulated by Skinner was that given the right setting conditions or antecedents (A), then behavior (B) develops through the individual’s experience of the rewarding or punishing consequences (C) delivered by the environment following their actions. In an A–B–C model, the consequences may be rewarding, in which case they increase the frequency, or reinforce the behavior; or aversive, in which case they may decrease, or punish the frequency of the behavior. This deceptively simple model of behavior was applied to the explanation of criminal behavior in the form of Differential Reinforcement Theory (Jeffery, 1965). The use of A–B–C sequences to explain the development of extreme violence is seen in Gresswell and Hollin’s (1992) case study of attempted multiple murder. The advent of social learning theory added to the picture by incorporating more explicitly the role of cognition and emotion into a theoretical account of human aggression specifically (Bandura, 1973) and human functioning generally (Bandura, 1977, 1986). Social learning theory departed from the traditional behavioral position in that, while continuing to acknowledge the role of external reinforcement, it suggests that learning can also take place purely at a cognitive level. Further, Bandura also advanced the concept of “motivation” to supersede reinforcement as the force that develops and maintains behavior. In social learning theory terms, motivation is held to take three forms: external reinforcement in the traditional sense that the term is used in behavioral theory; vicarious reinforcement, where an individual’s actions are based on observing what happens to other people who behave in a particular way; and actions that produce self-reinforcement, as in a sense of personal pride or achievement.

THE COGNITIVE-BEHAVIORAL CONTEXT 5

Distal antecedents

Early indicators

Developmental processes

Maintenance variables

Biological precursors (e.g. brain dysfunction)

Conduct disorder

School failure

Peers

Psychological factors (e.g. impulsiveness)

Poor parenting

Cognitive style (e.g. hostile attributions)

Opportunities

Environmental factors (e.g. family functioning)

Early aggression

Substance abuse

Socioeconomic deprivation

Figure 1.1 Possible developmental sequence in the etiology of violent behavior (after Nietzel et al., 1999)

While social learning theory retains some degree of overlap with behavior analysis, theorists have increasingly turned their attention to the study of cognition. As social learning theory precipitated interest in the role of cognition within an overarching behavioral framework, the term cognitive-behavioral entered popular usage. Thus, cognitive-behavioral theory increasingly became a focus for a range of researchers, and cognitive-behavioral interventions became a focus for practitioners. With its mixed heritage, from the standpoint of both research and practice, it is difficult if not impossible to give a watertight definition of cognitive-behavioral theory or practice. Kendall and Bacon (1988) have previously noted the problems with attempts to define cognitive-behavioral therapy and to say precisely how it sits alongside traditional behavioral theory and practice. Indeed, Kendall and Bacon suggest that it is preferable to see a cognitive-behavioral approach to practice as a general perspective rather than a single unified theory. It is clear that models of human behavior based on learning have become increasingly complex. This theoretical complexity is seen in the behavioral model of violent conduct developed by Nietzel, Hasemann, and Lynam (1999). This model is based on four sequential stages across the life span (Figure 1.1). At the first stage, there are distal antecedents to violence: Nietzel et al. suggest that these are biological precursors, including genetic transmission and ANS lability, psychological predispositions including impulsivity and deficient problem solving, and environmental factors, such as family functioning and the social fabric of the neighborhood. At the second stage, there are early indicators of violence as the child develops. These first signs include features of childhood such as conduct disorder and poor emotional regulation. Third, as the child matures the developmental processes associated with the intensification of violent behavior come into effect: these processes include school failure, association with delinquent peers, and substance abuse. Finally, as the adolescent moves into adulthood there is a stage at which maintenance variables come into force. These maintaining variables include continued reinforcement for violent conduct, association with criminal peers, and social conditions. The type of model proposed by Nietzel et al. is an excellent example of the application of cognitive-behavioral principles. The model includes social factors,

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environmental forces, and cognitive processes, and is dynamic in speaking to progression and change over the life span. It is evident that ART has its theoretical base in similar territory. Goldstein (1994) described three levels of analysis in the physical ecology of aggression, all incorporating various levels of a person–environment interaction. The macrolevel refers to analysis of violence at a national or regional level; at the mesolevel the analysis of violence is at the level of the neighborhood; and microlevel analysis is at the level of the home, street, public house, and so on. The fundamental point to take from these complex models is that a cognitivebehavioral approach neither has an exclusive focus on the individual, nor does it neglect the possibilities of preventing violence through social and environmental means. However, for those charged with the responsibility of working with offenders, the focus of their day-to-day work lies with the individual. Reviews of the literature show that the history of working with offenders, including violent offenders, is dominated by a single-target approach (Hollin, 1990a). In other words, practice is dominated by trying to change one aspect of the offender’s functioning, such as their social skills or educational achievement. In contrast and in keeping with the more complex models, contemporary practice is concerned with multimodal programs that seek to change several aspects of the offender’s functioning. To its credit, ART was one of the first programs to adopt a multimodal perspective, seeking to change the individual’s thinking, emotion, and action. As discussed in the following sections on each specific component of ART, the theoretical base for this tripartite approach is well established.

SPECIFIC THEORY: SKILLSTREAMING The original social skills model (Argyle & Kendon, 1967) held that socially skilled behavior consists of three related components—social perception, social cognition, and social performance (Hollin & Trower, 1986c). Social perception refers to the ability to perceive and understand verbal and nonverbal social cues and signals; social cognition, in this sense, is analogous to social information processing; and social performance is, of course, observable social action. Thus, the socially competent individual will use all aspects of their social skills to function effectively in their interactions with others and so achieve their social goals. The application of this way of thinking about social behavior with respect to offender populations raises two issues: first, is there any evidence to indicate that offenders have particular difficulties in any specific areas of social ability? Second, is an offender’s level of social skills related to his or her offending?

Social Perception The ability to recognize, understand, and interpret interpersonal cues is central to all social behavior (Argyle, 1983). In a study of social perception in delinquents, McCown, Johnson, and Austin (1986) showed that young offenders had some difficulty in recognizing the emotion expressed in different facial expressions.

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Similarly, a body of evidence has accumulated to suggest that young people who struggle socially, particularly with respect to aggressive behavior, have difficulties in both the selection and interpretation of social cues (e.g. Dodge, Murphy, & Buchsbaum, 1984; Dodge & Tomlin, 1987; Akhtar & Bradley, 1991). Further, a study by Lipton, McDonel, and McFall (1987) suggested that sexually aggressive men may misperceive social cues in male–female social interactions. The misperception of social cues may in turn lead to misattribution of intent, so that the actions of other people are mistakenly seen as hostile or threatening (Slaby & Guerra, 1988; Lochman & Dodge, 1994; Crick & Dodge, 1996). The manner in which a social encounter is perceived will, in turn, influence the way in which the person deals with a given social encounter.

Social Cognition Following their perception and understanding of other people’s behavior, the individual must decide on a suitable response. This type of decision making requires the ability to generate feasible courses of action, consider potential alternatives and their likely consequences, and make plans towards achieving the desired outcome (Spivack, Platt, & Shure, 1976). Several studies have suggested that some offenders, perhaps particularly younger offenders, may experience difficulties in solving social interaction problems. For example, studies using the Adolescent Problem Inventory have shown that male young offenders typically gave less socially competent responses than non-offenders to a series of social problems (Palmer & Hollin, 1996, 1999). Offenders typically use a more limited range of alternatives to solve interpersonal problems, and rely more on verbal and physical aggression. A similar pattern has been reported for female offenders using the Problem Inventory for Adolescent Girls (Gaffney & McFall, 1981; Ward & McFall, 1986). It is clear that social cognition, including social problem solving, is related to offending behavior. There is a weight of research in the tradition illustrated above that strongly suggests that difficulties in setting social goals, solving social problems, and accurately perceiving social feedback on performance are critical factors in understanding antisocial, including aggressive, behavior (e.g. Ross & Fabiano, 1985; Hollin, 1990a, 1990b; Akhtar & Bradley, 1991; Demorest, 1992; Crick & Dodge, 1994).

Social Performance In a typical study, Spence (1981a) compared the social performance skills of young male offenders with non-delinquent controls matched for age, academic performance, and social background. The delinquents showed significantly less eye contact and speech, but more “fiddling” and gross body movements, behaviors shown to relate to poor observer ratings of social skill (Spence, 1981b). On global ratings of social skill, social anxiety, and employability the delinquent group were rated less favorably than the non-delinquents. In summary, the research suggests that some offenders do experience difficulties with social skills. However, it would be wrong to assume that this is a characteristic

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of all offenders: clearly offenders are a heterogeneous population with a wide distribution of social ability (Veneziano & Veneziano, 1988). Nonetheless, there are offenders with social difficulties and the hypothesis has been formed that there is a link between social ability and offending (e.g. Howells, 1986). If this hypothesis is true, in some cases at least, then remediation of these social difficulties, typically through the use of Social Skills Training (SST), may contribute to a reduction in offending.

SPECIFIC THEORY: ANGER CONTROL A second strand in ART is enabling participants to control their anger. Anger is the emotional state most frequently associated with violent behavior (Blackburn, 1993). Specifically, the concern here is with the experience and expression of dysfunctional anger. Anger is seen to be dysfunctional when the experience and expression of this emotion have a negative consequence for the individuals themselves (for example, dysfunctional anger is associated with poor physical and mental health) or for other people (Swaffer & Hollin, 2000, 2001). It is known that violent acts are committed by people in angry states (Zamble & Quinsey, 1997), and that levels of anger in violent offenders can be greater than those in nonviolent offenders (Hunter, 1993). However, it would be wrong to assume that anger is the main cause of violence or that all violent offenders must be angry. Indeed, some studies suggest that a propensity to anger, in and of itself, does not distinguish violent and nonviolent offenders (Loza & Loza-Fanous, 1999). The point is made that anger management should be seen as a component, rather than the main focus, of work with violent offenders. As with the term “cognitive-behavioral,” there are difficulties in defining the term anger: while anger is said to be an emotion, as Dodge and Garber (1991) state, “Emotion is like pornography: The experts have great difficulty defining it, but we all know it when we see it” (p. 3). Currently, the most influential theory of anger is that proposed by Novaco (1975, 1994). Novaco’s position is close to cognitive-behavioral theory in that anger is understood as a subjective emotional state, involving both physiological and cognitive activity, but which is clearly related to environmental circumstances. According to Novaco, for a person to become angry some environmental event triggers distinctive patterns of cognitive and physiological arousal. Most typically, this trigger lies in the individual’s perception of the words and actions of another person. The physiological processes associated with anger are increased autonomic nervous system activity, such as a rise in body temperature, perspiration, muscular tension, and increased cardiovascular activity. The cognitive processes are complex, beginning with the individual labeling their emotional state as “anger.” Novaco and Welsh (1989) suggest that labeling of an emotional state is a function of the individual’s pre-existing system of beliefs and knowledge, or “schemas.” Schemas serve the useful purpose of speeding up information processing, but have the disadvantage that increased speed can lead to faulty or biased judgments. Novaco and Welsh (1989) identified five information-processing biases in individuals prone to anger: (1) attentional cueing, (2) perceptual matching, (3) attributional

THE COGNITIVE-BEHAVIORAL CONTEXT 9

error, (4) false consensus, and (5) anchoring effects. These cognitive biases are all concerned with the encoding of external and internal cues and the interpretation and cognitive representation of those cues. Attentional cueing refers to the tendency of people who are prone to anger to see hostility and provocation in the words and actions of other people (Dodge, Price, Bachorowski, & Newman, 1990). Perceptual matching is found when an individual, regardless of the situation, bases their current behavior on how they behaved previously. Thus, if a person has found that a display of anger and violent behavior solves a problem, then when faced with another problem in another context they will become angry and violent. An attribution error occurs when the individual perceives their own behavior as situationally determined, but the behavior of other people as explained by their personality. Thus, I see that my behavior is caused by circumstances (external attribution): so, I hit you because you challenged me in front of my friends and they made me respond. On the other hand, I see that your behavior occurs because you are that type of person (internal attribution): you hit me because you are a bad and violent person. The notion of a false consensus is applied when individuals assume that more people agree with them than is actually the case. This, in turn, inhibits perception and appreciation of the other person’s point of view. Novaco and Welsh (1989) suggest that false consensus is found among those individuals who have problems with anger. Finally, there are anchoring effects so that once an individual has made an initial value judgment, they maintain this position even in the face of contrary evidence. Thus, triggering events precipitate cognitive and physiological process which the individual labels as “anger”; the processing biases noted above may play a role at this stage. The progression from anger to violence depends in large part upon the disinhibition of internal control: disinhibition can come about through a range of factors, including person-specific factors such as high levels of physiological arousal, perception of a low possibility of punishment, and the use of drugs or alcohol. Novaco (1993) advises that anger should be understood in context: that is, situational factors, both physical and social, can influence a person’s experience and expression of anger.

SPECIFIC THEORY: MORAL REASONING The third strand in ART lies in attending to the participant’s level of moral reasoning. The process of socialization is linked with moral development in the theories of both Piaget (1932) and Kohlberg (1964, 1978). In particular, Kohlberg has used his theory to develop an explanation for antisocial behavior and this is therefore of interest here. Kohlberg, like Piaget, argues that moral reasoning develops in a sequential manner as the individual attains maturity. Kohlberg describes three levels of moral development, with two stages at each level. As shown in Table 1.1, at the lower stages moral reasoning is concrete in orientation, becoming more abstract at the higher stages and involving concepts such as “justice,” “rights,” and “principles.”

10 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Table 1.1 Levels and stages of moral judgment in Kohlberg’s theory Level 1: Pre-morality Stage 1. Punishment and obedience: moral behavior is concerned with deferring to authority and avoiding punishment. Stage 2. Hedonism: the concern is with one’s own needs irrespective of others’ concerns. Level 2: Conventional conformity Stage 3. Interpersonal concordance: moral reasoning concerned with general conformity and gaining social approval. Stage 4. Law and order: commitment to social order for its own sake and hence deference to social and religious authorities. Level 3 : Autonomous principles Stage 5. Social contract: acknowledgment of individual rights and the role of the democratic process in deriving laws. Stage 6. Universal ethical principles: moral judgment determined by justice, respect, and trust and may transcend legal dictates.

Antisocial behavior, Kohlberg argues, is associated with a delay in the development of moral reasoning so that given the opportunity for offending, the individual does not have the internal processes to control and resist temptation. A number of recent reviews have examined this basic premise with respect to the empirical evidence (Blasi, 1980; Jurkovic, 1980; Jennings, Kilkenny, & Kohlberg, 1983; Nelson, Smith, & Dodd, 1990). The generally accepted position from the major reviews is that delinquents typically show lower levels of reasoning, i.e., Kohlberg’s Premorality Stages (1 and 2), than their non-delinquent peers. Thus, from a Kohlbergian perspective antisocial behavior is associated, in part, with sociomoral developmental delay. This developmental delay is seen in immature and hedonistic, self-centered, moral judgments. However, as Gibbs (1993) points out, moral reasoning does not function in a vacuum: the individual’s level of moral reasoning should be considered alongside other aspects of their cognition. Specifically, Gibbs suggests that the overlap between theories of social information processing (see above) and moral development are useful in understanding the totality of the processes involved. The bridge between moral reasoning and social information processing is argued to take the form of cognitive distortions (Gibbs, 1993; Goldstein et al., 1998). Cognitive distortions are taken to be “Nonveridical attitudes or beliefs pertaining to the self or one’s social behavior” (Gibbs, 1993, p. 165). These cognitive distortions can function both directly to support the attitudes consistent with sociomoral developmental delay and, in line with Sykes and Matza’s (1957) “techniques of neutralization,” to temper any resulting cognitive dissonance. An example of selfcentered moral reasoning is “If I want it, I take it”: Gibbs calls this type of reasoning a primary distortion. The distorted secondary cognitions that flow from such primary distortions may serve to rationalize the behavior, or to mislabel the behavior. Thus, the reasoning (primary cognitive distortion) that “If I want it, I take it” might be rationalized (secondary cognitive distortion) by blaming others: for example, if owners leave their cars unlocked then they deserve to have them stolen. In aggressive individuals the actions of other people may be seen in a distorted

THE COGNITIVE-BEHAVIORAL CONTEXT 11

way, typically as having hostile intent, with the inevitable conclusion that “they were asking for it” (Dodge et al., 1990). Mislabeling (secondary cognitive distortion) refers to biased interpretations of one’s behavior: for example, car theft can be explained away as “just a laugh” or “nothing serious.” Aggressive individuals may say that their victims “could have had it worse,” “were not too badly hurt,” or that “no real damage was done” (Gibbs, 1996). These powerful types of distorted thinking are often socially supported and reinforced by the offender’s peer group. The cognitive-behavioral theoretical basis of ART is seen in the techniques for behavior change that are used in the program.

COGNITIVE-BEHAVIORAL METHODS OF CHANGE As with the broader theory, it is possible to see various levels at which to bring about changes in violent behavior. Initiatives that change one or more components of the interaction between the individual and the environment may bring about changes in the target behavior. Thus, prevention and reduction of violence might be achieved at any of the three levels—macro, meso, and micro—described above. However, at the level of working with the violent individual, the focus is on ways of bringing about behavior change through working with the violent person. With its lineage in operant theory, behavior modification and behavior therapy (Martin & Pear, 1999), and skills training (Trower, Bryant, & Argyle, 1978; Hollin & Trower, 1986a, 1986b), so social learning theory (Bandura, 1977) and cognitive behavior modification (Meichenbaum, 1977) became what is now called cognitivebehavioral theory and cognitive-behavior therapy. A number of techniques have become associated with cognitive-behavioral practice: these techniques include modeling, skills training, self-instructional training, thought stopping, emotional control training, and problem-solving training (Sheldon, 1996). In practice, behavior change techniques are seldom used in isolation: it is more common to see amalgams of techniques in the form of multimodal programs (such as ART). Such multimodal programs might include elements such as problem-solving skills training, social skills training, and emotional control training. Thus, the model of change with such an individualized, cognitive-behavioral approach is that by bringing about change in internal (psychological and/or physiological) states and process, this covert change will, in turn, mediate change at an overt behavioral level. Such overt behavioral change will, in turn, elicit new patterns of reinforcement from the environment, so leading to maintenance of behavior change. What is the evidence that these methods of behavior change can be used to any effect with violent behavior?

COGNITIVE-BEHAVIORAL METHODS AND VIOLENT BEHAVIOR This section has two components: first, the applicability of cognitive-behavioral methods generally to violent populations; second, to consider specifically the three

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elements of ART—skills training, anger control, and moral development—with aggressive offenders.

General Applicability The issue of the application of cognitive-behavioral methods to offending behavior is amply supported by the meta-analyses (Garrett, 1985; Gottschalk, Davidson, Gensheimer, & Mayer, 1987; Gottschalk, Davidson, Mayer, & Gensheimer, 1987; Losel ¨ & Koferl, ¨ 1989; Whitehead & Lab, 1989; Andrews et al., 1990; Izzo & Ross, 1990; Lipsey, 1992; Antonowicz & Ross, 1994; Cleland, Pearson, Lipton, & Yee, 1997; Pearson, Lipton & Cleland, 1997; Redondo, Garrido, & Sanchez-Meca, 1999) and the syntheses of these meta-analyses (Gendreau & Andrews, 1990; Hollin, 1993, 1994, 1999; Lipsey, 1995; Losel, ¨ 1995a, 1995b, 1996; McGuire & Priestley, 1995; Gendreau, 1996; Cooke & Philip, 2001). Nietzel et al.’s (1999) behavioral model of violence discussed above drew on four sequential stages across the life span, encompassing a range of environmental and individual factors. This model is helpful at a conceptual level, although the developmental pathways themselves are less than fully understood (Loeber & Stouthamer-Loeber, 1998; Tolan & Gorman-Smith, 1998). Nietzel et al. conclude their piece with the comment that: “A major implication of this model is the need for preventative interventions that target multiple risk factors for violence” (p. 59). Similarly, Tate, Reppucci, and Mulvey (1995), in their review of treatment effectiveness for violent juveniles, comment that: “Social-cognitive interventions should be encouraged as a critical component of institutional and community-based programs” (p. 780). Tate et al. followed this comment with the note that “The empirical literature on interventions with seriously violent adolescents is rather limited” (p. 779). With reference to the state of the general literature, including juveniles and adults, Blackburn (1993) made the same point: “Investigations of the effects of behavioral methods on aggressive offending have been few” (p. 379). Lipsey and Wilson (1998) report the findings from a meta-analysis of 200 studies concerned with effective intervention for violent juvenile offenders. The metaanalysis included a wide range of interventions, ranging from restitution programs to wilderness programs, considered according to whether the programs were delivered to institutionalized or noninstitutionalized offenders. Lipsey and Wilson report that for noninstitutionalized offenders the types of intervention that consistently produced positive effects, in terms of a reduction in recidivism, were as follows. (The n is the number of studies included in the metaanalysis, with referenced examples as cited by Lipsey and Wilson: it will be seen that the research base is limited.) As indicated by the midpoint of estimated effect sizes, individual counseling produced a strong effect (n = 8: e.g. Moore, 1987; Bean, 1988; Borduin, Henggeler, Blake, & Stein, 1990), followed by interpersonal skills (n = 2: Chandler, 1973; Delinquency Research Group, 1986), and by behavioral programs (n = 7: e.g. Jesness, Allison, McCormic, Wedge, & Young, 1975; Gordon, Graves, & Arbuthnot, 1987). For institutionalized offenders, interpersonal skills (n = 3: Spence & Marzillier, 1981; Glick & Goldstein, 1987) were followed by teaching family homes

THE COGNITIVE-BEHAVIORAL CONTEXT 13

(community-based, family-style group homes) (n = 6: e.g. Wolf, Phillips, & Fixson, 1974; Kirigin, Braukmann, Atwater, & Worl, 1982), and by behavioral programs (n = 2: Schlicter & Horan, 1981; Guerra & Slaby, 1990). In summary, it can be seen that there is support from the literature for the use generally of cognitive-behavioral methods with aggressive populations.

Specific Applicability The methods used in ART are traditional cognitive-behavioral methods, based on anger control, problem-solving skills training, and social skills training. There is ample evidence that these methods have been used with good effect with violent offenders (Hollin & Courtney, 1983; Howells, 1986; Henderson, 1989; Marshall, Turner, & Barbaree, 1989; Guerra & Slaby, 1990; Bush, 1995; Hughes, 1996; Hollin & Palmer, 2001; Novaco , Ramm, & Black, 2001; Polaschek & Dixon, 2001; Polaschek & Reynolds, 2001). The development of Moral Reasoning Training, in keeping with Gibbs’ theory of moral functioning, to enhance moral development in violent populations has been reported in the literature (Gibbs, 1993, 1996; Gibbs, Potter, & Goldstein, 1995; Goldstein, Glick, & Gibbs, 1998). The point can be repeated that ART has a research base that supports its effectiveness. Goldstein et al. (1998) cover the range of centers in which ART has been applied, together with the positive outcome evidence from these centers of application (Goldstein & Glick, 1987; Goldstein, Glick, Irwin, & McCartney, 1989; Leeman, Gibbs, & Fuller, 1993; Goldstein, Glick, Carthen, & Blancero, 1994). It is clear that ART represents a major advance in work with violent offenders who have a history that includes a pattern of violence of an interpersonal nature. It can be said with confidence that it is possible to work with some violent offenders and reduce their rates of violent conduct. However, what we know now sets the future research agenda: how might ART develop over the next decade?

RESEARCH AGENDA The literature suggests that ART is at its strongest when used with offenders who have committed acts of interpersonal violence, typically with and against their peers. Such offenders are likely to be of medium to medium-high risk of reoffending and will have reasonable levels of cognitive functioning. Where might we go from here? Domestic violence continues to be an enduring problem and one to which the methods implicit in ART might gainfully be employed (Dobash, Dobash, Cavanagh, & Lewis, 2000). The research that suggests similar predictors of violence in mentally disordered and mainstream offender groups (Bonta, Law, & Hanson, 1998) further suggests that ART, suitably adapted, might well be appropriate for mentally disordered violent offenders. The extension of the target groups and modification of ART might also be widened to those of low intellectual ability who behave in a violent manner (Day, 2001). The configuration of programs for exceptionally high-risk violent offenders, such as those with psychopathic disorder,

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continues to be a challenge to researchers and practitioners (Wong, 2000). The possibilities of utilizing ART in this particular arena have yet to be explored. Finally, as contemporary criminological research begins to address issues specific to the female offender, specialist offender programs for women are being developed (Andrews & Dowden, 1999). The evolution of programs such as ART with respect to the special needs of women would be a welcome step for many practitioners (Bloom, 1999). While a great deal has been achieved in a short period of time, it is clear that much, much more remains to be done.

REFERENCES Akhtar, N. & Bradley, E. J. (1991). Social information processing deficits of aggressive children: Present findings and implication for social skills training. Clinical Psychology Review, 11, 621–644. Andrews, D. A. & Dowden, C. (1999). A meta-analytic investigation into effective correctional intervention for female offenders. Forum on Corrections Research, 11, 18–21. Andrews, D. A., Zinger, I., Hoge, R. D., Bonta, J., Gendreau, P., & Cullen, F. T. (1990). Does correctional treatment work? A clinically relevant and informed meta-analysis. Criminology, 28, 369–404. Antonowicz, D. H. & Ross, R. R. (1994). Essential components of successful rehabilitation programs for offenders. International Journal of Offender Therapy and Comparative Criminology, 38, 97–104. Argyle, M. (1983). The psychology of interpersonal behaviour (4th edn). Harmondsworth: Penguin. Argyle, M. & Kendon, A. (1967). The experimental analysis of social performance. In L. Berkowitz (Ed.), Advances in experimental social psychology, Vol. 3. New York: Academic Press. Bandura, A. (1973). Aggression: A social learning analysis. Englewood Cliffs, NJ: Prentice-Hall. Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall. Bandura, A. (1986). Social foundations of thought and action: A social-cognitive theory . Englewood Cliffs, NJ: Prentice-Hall. Bean, J. S. (1988). The effect of individualized reality therapy on the recidivism rates and locus of control orientation of male juvenile offenders. Doctoral dissertation, University of Mississippi. Dissertation Abstracts International, 49, 2370B (University Microfilms No. 88-18138). Blackburn, R. (1993). The psychology of criminal conduct: Theory, research and practice. Chichester: John Wiley & Sons. Blasi, A. (1980). Bridging moral cognition and moral action: A critical review. Psychological Bulletin, 88, 1–45. Bloom, B. (1999). Gender-responsive programming for women offenders: Guiding principles and practices. Forum on Corrections Research, 11, 22–27. Bonta, J., Law, M., & Hanson, R. K. (1998). The prediction of criminal and violent recidivism among mentally disordered offenders: A meta-analysis. Psychological Bulletin, 123, 123–142. Borduin, C. M., Henggeler, S. W., Blake, D. M., & Stein, R. J. (1990). Multisystemic treatment of adolescent sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 34, 105–113. Bush, J. (1995). Teaching self-risk management to violent offenders. In J. McGuire (Ed.), What works: Reducing reoffending. Chichester: John Wiley & Sons. Chandler, M. J. (1973). Egocentrism and antisocial behavior: The assessment and training of social perspective-training skills. Developmental Psychology, 9, 326–333.

THE COGNITIVE-BEHAVIORAL CONTEXT 15 Cleland, C. M., Pearson, F. S., Lipton, D. S., & Yee, D. (1997). Does age make a difference? A meta-analytic approach to reductions in criminal offending for juveniles and adults. Paper presented at the annual meeting of the American Society of Criminology, San Diego, CA, November. Cooke, D. J. & Philip, L. (2001). To treat or not to treat? An empirical perspective. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment. Chichester: John Wiley & Sons. Crick, N. R. & Dodge, K. A. (1994). A review and reformulation of social informationprocessing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74– 101. Crick, N. R. & Dodge, K. A. (1996). Social information-processing mechanisms in reactive and proactive aggression. Child Development, 67, 993–1002. Day, K. (2001). Offenders with mental retardation. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment. Chichester: John Wiley & Sons. Delinquency Research Group (1986). An evaluation of the delinquency of participants in the youth at risk program. Claremont, CA: Claremont Graduate School, Center for Applied Social Research. Demorest, A. P. (1992). The role of social cognition in children’s social maladjustment. Social Cognition, 10, 211–233. Dobash, R. E., Dobash, R. P., Cavanagh, K., & Lewis, R. (2000). Changing violent men. Thousand Oaks, CA: Sage. Dodge, K. A. & Garber, J. (1991). Domains of emotion regulation. In J. Garber & K. A. Dodge (Eds), The development of emotion regulation and dysregulation. New York: Cambridge University Press. Dodge, K. A. Murphy, R. R., & Buchsbaum, K. (1984). The assessment of intention-cue detection skills in children: Implications for developmental psychopathology. Child Development, 55, 163–173. Dodge, K. A., Price, J. M., Bachorowski, J.-A., & Newman, J. P. (1990). Hostile attributional biases in severely aggressive adolescents. Journal of Abnormal Psychology, 99, 385– 392. Dodge, K. A. & Tomlin, A. M. (1987). Utilization of self-schemas as a mechanism of interpretational bias in aggressive children. Social Cognition, 5, 280–300. Gaffney, L. R. & McFall, R. M. (1981). A comparison of social skills in delinquent and nondelinquent adolescent girls using a behavioral role-playing inventory. Journal of Consulting and Clinical Psychology, 49, 959–967. Garrett, C. J. (1985). Effects of residential treatment of adjudicated delinquents: A metaanalysis. Journal of Research in Crime and Delinquency, 22, 287–308. Gendreau, P. (1996). Offender rehabilitation: What we know and what needs to be done. Criminal Justice and Behavior, 23, 144–161. Gendreau, P., & Andrews, D. A. (1990). What the meta-analyses of the offender treatment literature tells us about “what works.” Canadian Journal of Criminology, 32, 173– 184. Gibbs, J. C. (1993). Moral-cognitive interventions. In A. P. Goldstein & C. R. Huff (Eds), The gang intervention handbook. Champaign, IL: Research Press. Gibbs, J. C. (1996). Sociomoral group treatment for young offenders. In C. R. Hollin & K. Howells (Eds.), Clinical approaches to working with young offenders. Chichester: John Wiley & Sons. Gibbs, J. C., Potter, G. B., & Goldstein, A. P. (1995). The EQUIP program: Teaching youth to think and act responsibily through a peer-helping approach. Champaign, IL: Research Press. Glick, B. & Goldstein, A. P. (1987). Aggression replacement training. Journal of Counseling and Development, 65(7), 356–362. Goldstein, A. P. (1994). The ecology of aggression. New York: Plenum Press. Goldstein, A. P. & Glick, B. (1987). Aggression Replacement Training: A comprehensive intervention for adolescent youth. Champaign, IL: Research Press. Goldstein, A. P. & Glick, B. (1996). Aggression Replacement Training: Methods and outcomes. In C. R. Hollin & K. Howells (Eds), Clinical approaches to working with young offenders. Chichester: John Wiley & Sons.

16 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Goldstein, A. P., Glick, B., Carthen, W., & Blancero, D. (1994). The prosocial gang. Thousand Oaks, CA: Research Press. Goldstein, A. P., Glick, B., & Gibbs, J. C. (1998). Aggression Replacement Training (rev. edn). Champaign, IL: Research Press. Goldstein, A. P., Glick, B., Irwin, M. J., McCartney, C., & Rubama, I. (1989). Reducing delinquency: Intervention in the community. New York: Pergamon Press. Gordon, D. A., Graves, K., & Arbuthnot, J. (1987). Prevention of adult criminal behavior using family therapy for disadvantaged juvenile delinquents. Manuscript, Ohio University, Athens, OH. Gottschalk, R., Davidson II, W. S., Gensheimer, L. K., & Mayer, J. (1987). Communitybased interventions. In H. C. Quay (Ed.), Handbook of juvenile delinquency. New York: John Wiley & Sons. Gottschalk, R., Davidson II, W. S., Mayer, J., & Gensheimer, L. K. (1987). Behavioural approaches with juvenile offenders: A meta-analysis of long-term treatment efficacy. In E. K. Morris & C. J. Braukmann (Eds), Behavioral approaches to crime and delinquency. New York: Plenum. Gresswell, D. M. & Hollin, C. R. (1992). Towards a new methodology for making sense of case material: An illustrative case involving attempted multiple murder. Criminal Behaviour and Mental Health, 2, 329–341. Guerra, N. G. & Slaby, R. G. (1990). Cognitive mediators of aggression in adolescent offenders: 2. Intervention. Developmental Psychology, 26, 269–277. Henderson, M. (1989). Behavioural approaches to violent crime. In K. Howells & C. R. Hollin (Eds), Clinical approaches to violence. Chichester: John Wiley & Sons. Hollin, C. R. (1990a). Cognitive-behavioral interventions with young offenders. Elmsford, NY: Pergamon Press. Hollin, C. R. (1990b). Social skills training with delinquents: A look at the evidence and some recommendations for practice. British Journal of Social Work, 20, 483–493. Hollin, C. R. (1993). Advances in the psychological treatment of criminal behaviour. Criminal Behaviour and Mental Health, 3, 42–57. Hollin, C. R. (1994). Designing effective rehabilitation programmes for young offenders. Psychology, Crime and Law, 1, 193–199. Hollin, C. R. (1999). Treatment programmes for offenders: Meta-analysis, “what works”, and beyond. International Journal of Psychiatry and Law, 22, 361–372. Hollin, C. R. & Courtney, S. (1983). A skills training approach to the reduction of institutional offending. Personality and Individual Differences, 4, 257–264. Hollin, C. R. & Palmer, E. J. (2001). Skills training. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment. Chichester: John Wiley & Sons. Hollin, C. R. & Trower, P. (Eds) (1986a). Handbook of social skills training, Vol. 1: Applications across the life span. Oxford: Pergamon Press. Hollin, C. R. & Trower, P. (Eds) (1986b). Handbook of social skills training, Vol. 2: Clinical applications and new directions. Oxford: Pergamon Press. Hollin, C. R. & Trower, P. (1986c). Social skills training: Critique and future development. In C. R. Hollin & P. Trower (Eds), Handbook of social skills training, Vol. 2: Clinical applications and new directions. Oxford: Pergamon Press. Howells, K. (1986). Social skills training and criminal and antisocial behaviour in adults. In C. R. Hollin & P. Trower (Eds), Handbook of social skills training, Vol. 1: Applications across the life span. Oxford: Pergamon Press. Hughes, G. V. (1996). Short and long term outcomes for a cognitive-behavioral anger management program. In G. Davies, S. Lloyd-Bostock, M. McMurran, & C. Wilson (Eds), Psychology, law, and criminal justice: International developments in research and practice. New York: Walter de Gruyter. Hunter, D. (1993). Anger management in the prison: An evaluation. Forum on Corrections Research, 5, 3–5. Izzo, R. L. & Ross, R. R. (1990). Meta-analysis of rehabilitation programs for juvenile delinquents: A brief report. Criminal Justice and Behavior, 17, 134–142. Jeffery, C. R. (1965). Criminal behavior and learning theory. Journal of Criminal Law, Criminology and Police Science, 56, 294–300.

THE COGNITIVE-BEHAVIORAL CONTEXT 17 Jennings, W. S., Kilkenny, R., & Kohlberg, L. (1983). Moral development theory and practice for youthful and adult offenders. In W. S. Laufer & J. M. Day (Eds), Personality theory, moral development, and criminal behavior. Toronto: Lexington Books. Jesness, C. F., Allison, F. S., McCormic, P. M., Wedge, R. F., & Young, M. L. (1975). An evaluation of the effectiveness of contingency contracting with delinquents. Sacramento, CA: California Youth Authority. Jurkovic, G. J. (1980). The juvenile delinquent as moral philosopher: A structuraldevelopmental approach. Psychological Bulletin, 88, 709–727. Kendall, P. C. & Bacon, S. F. (1988). Cognitive behavior therapy. In D. B. Fishman, F. Rotgers, & C. M. Franks (Eds), Paradigms in behavior therapy: Present and promise. New York: SpringerVerlag. Kirigin, K. A., Braukmann, C. J., Atwater, J. D., & Worl, M. M. (1982). An evaluation of teaching-family (Achievement Place) group homes for juvenile offenders. Journal of Applied Behavior Analysis, 15, 1–16. Kohlberg, L. (1964). Development of moral character and moral ideology. In M. Hoffman & L. Hoffman (Eds), Review of child development research, Vol. 1. New York: Russell Sage Foundation. Kohlberg, L. (1978). Revisions in the theory and practice of mental development. In W. Damon (Ed.), New directions in child development: Moral development. San Francisco, CA: Jossey-Bass. Leeman, L. W., Gibbs, J. C., & Fuller, D. (1993). Evaluation of a multi-component treatment program for juvenile delinquents. Aggressive Behavior, 19, 281–292. Lipsey, M. W. (1992). Juvenile delinquency treatment: A meta-analytic inquiry into the variability of effects. In T. D. Cook, H. Cooper, D. S. Cordray, H. Hartmann, L. V. Hedges, R. J. Light, T. A. Louis, & F. Mosteller (Eds), Meta-analysis for explanation: A casebook. New York: Russell Sage Foundation. Lipsey, M. W. (1995). What do we learn from 400 studies on the effectiveness of treatment with juvenile delinquents? In J. McGuire (Ed.), What works: Reducing reoffending. Chichester: John Wiley & Sons. Lipsey, M. W. & Wilson, D. B. (1998). Effective intervention for serious juvenile offenders. In R. Loeber & D. Farrington (Eds), Serious and violent juvenile offenders: Risk factors and successful interventions. Thousand Oaks, CA: Sage. Lipton, D. N., McDonel, E. C., & McFall, R. M. (1987). Heterosocial perception in rapists. Journal of Consulting and Clinical Psychology, 55, 17–21. Loeber, R. & Stouthamer-Loeber, M. (1998). Development of juvenile aggression and violence: Some common misconceptions and controversies. American Psychologist, 53, 242– 259. Lochman, J. E. & Dodge, K. A. (1994). Social-cognitive processes of severely violent, moderately aggressive and nonaggressive boys. Journal of Consulting and Clinical Psychology, 62, 366–374. Losel, ¨ F. (1995a). The efficacy of correctional treatment: A review and synthesis of metaevaluations. In J. McGuire (Ed.), What works: Reducing reoffending. Chichester: John Wiley & Sons. Losel, ¨ F. (1995b). Increasing consensus in the evaluation of offender rehabilitation? Lessons from recent research syntheses. Psychology, Crime and Law, 2, 19–39. Losel, ¨ F. (1996). Working with young offenders: The impact of the meta-analyses. In C. R. Hollin & K. Howells (Eds), Clinical approaches to working with young offenders. Chichester: John Wiley & Sons. Losel, ¨ F. & Koferl, ¨ P. (1989). Evaluation research on correctional treatment in West Germany: A meta-analysis. In H. Wegener, F. Losel, ¨ & J. Haison (Eds), Criminal behavior and the justice system: Psychological perspectives. New York: Springer-Verlag. Loza, W. & Loza-Fanous, A. (1999). The fallacy of reducing rape and violent recidivism by treating anger. International Journal of Offender Therapy and Comparative Criminology, 43, 492–502. Marshall, W. L., Turner, B. A., & Barbaree, H. E. (1989). An evaluation of life skills training for penitentiary inmates. Journal of Offender Counseling, Services and Rehabilitation, 14, 41–59.

18 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Martin, G. & Pear, J. (1999). Behavior modification: What it is and how to do it (6th edn). Upper Saddle River, NJ: Prentice-Hall. McCown, W. Johnson, J., & Austin, S. (1986). Inability of delinquents to recognize facial affects. Journal of Social Behavior and Personality, 1, 489–496. McGuire, J. & Priestley, P. (1995). Reviewing “what works”: Past, present and future. In J. McGuire (Ed.), What works: Reducing reoffending. Chichester: John Wiley & Sons. Meichenbaum, D. M. (1977). Cognitive behavior modification. New York: Plenum Press. Moore, R. H. (1987). Effectiveness of citizen volunteers functioning as counselors for highrisk young male offenders. Psychological Reports, 61(3), 823–830. Nelson, J. R., Smith, D. J., & Dodd, J. (1990). The moral reasoning of juvenile delinquents: A meta-analysis. Journal of Abnormal Child Psychology, 18, 709–727. Nietzel, M. T., Hasemann, D. M., & Lynam, D. R. (1999). Behavioral perspective on violent behavior. In V. B. Van Hasselt & M. Hersen (Eds), Handbook of psychological approaches with violent offenders: Contemporary strategies and issues. New York: Kluwer Academic/Plenum Press. Novaco, R. W. (1975). Anger control: The development and evaluation of an experimental treatment. Lexington, MA: D. C. Heath. Novaco, R. W. (1993). Clinicians ought to view anger contextually. Behaviour Change, 10, 208–218. Novaco, R. W. (1994). Anger as a risk factor for violence among the mentally disordered. In J. Monahan & H. Steadman (Eds), Violence and mental disorder. Chicago, IL: University of Chicago Press. Novaco, R. W., Ramm, M., & Black, L. (2001). Anger treatment with offenders. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment. Chichester: John Wiley & Sons. Novaco, R. W. & Welsh, W. N. (1989). Anger disturbances: Cognitive mediation and clinical prescriptions. In K. Howells & C. R. Hollin (Eds), Clinical approaches to violence. Chichester: John Wiley & Sons. Palmer, E. J. & Hollin, C. R. (1996). Assessing adolescent problems: An overview of the Adolescent Problem Inventory. Journal of Adolescence, 19, 347–354. Palmer, E. J. & Hollin, C. R. (1999). Social competence and sociomoral reasoning in young offenders. Applied Cognitive Psychology, 13, 79–87. Pearson, F. S., Lipton, D. S., & Cleland, C. M. (1997). Rehabilitative programs in adult corrections: CDATE meta-analyses. Paper presented at the annual meeting of the American Society of Criminology, San Diego, CA, November. Piaget, J. (1932). The moral judgement of the child. London: Kegan Paul. Polaschek, D. L. L. & Dixon, B. G. (2001). The Violence Prevention Project: The development and evaluation of a treatment programme for violent offenders. Psychology, Crime and Law, 7, 1–23. Polaschek, D. L. L. & Reynolds, N. (2001). Assessment and treatment: Violent offenders. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment. Chichester: John Wiley & Sons. Redondo, S., Garrido, V., & Sanchez-Meca, J. (1999). The influence of treatment programmes on the recidivism of juvenile and adult offenders: A European meta-analytic study. Psychology, Crime and Law, 5, 251–278. Ross, R. R. & Fabiano, E. A. (1985). Time to think: A cognitive model of delinquency prevention and offender rehabilitation. Johnson City, TN: Institute of Social Sciences and Arts. Schlicter, K. J. & Horan, J. J. (1981). Effects of stress inoculation on the anger and aggression management skills of institutionalized juvenile delinquents. Cognitive Therapy and Research, 5(4), 359–365. Sheldon, B. (1996). Cognitive-behavioral therapy. London: Routledge. Skinner, B. F. (1974). About behaviorism. London: Cape. Slaby, R. G. & Guerra, N. G. (1988). Cognitive mediators of aggression in adolescent offenders: I. Assessment. Developmental Psychology, 24, 580–588. Spence, S. H. (1981a). Differences in social skills performance between institutionalized juvenile male offenders and a comparable group of boys without offence records. British Journal of Clinical Psychology, 20, 163–171.

THE COGNITIVE-BEHAVIORAL CONTEXT 19 Spence, S. H. (1981b). Validation of social skills of adolescent males in an interview conversation with a previously unknown adult. Journal of Applied Behavior Analysis, 14, 159–168. Spence, S. H. & Marzillier, J. S. (1981). Social skills training with adolescent male offenders: Short-term, long-term and generalized effects. Behaviour Research and Therapy, 19, 349–368. Spivack, G., Platt, J. J., & Shure, M. B. (1976). The problem-solving approach to adjustment: A guide to research and intervention. San Francisco, CA: Jossey-Bass. Swaffer, T. & Hollin, C. R. (2000). Anger and impulse control. In R. Newell & K. Gournay (Eds), Mental health nursing: An evidence-based approach. Edinburgh: Churchill Livingstone. Swaffer, T. & Hollin, C. R. (2001). Anger and general health in young offenders. Journal of Forensic Psychiatry, 12, 90–103. Sykes, G. M. & Matza, D. (1957). Techniques of neutralization: A theory of delinquency. American Sociological Review, 22, 664–670. Tate, D. C., Reppucci, N. D., & Mulvey, E. P. (1995). Violent juvenile delinquents: Treatment effectiveness and implications for future action. American Psychologist, 50, 777–781. Tolan, P. H. & Gorman-Smith, D. (1998). Development of serious and violent offending careers. In R. Loeber & D. Farrington (Eds), Serious and violent juvenile offenders: Risk factors and successful interventions. Thousand Oaks, CA: Sage. Trower, P., Bryant, B., & Argyle, M. (1978). Social skills and mental health. London: Methuen. Veneziano, C. & Veneziano, L. (1988). Knowledge of social skills among institutionalized juvenile delinquents: An assessment. Criminal Justice and Behavior, 15 , 152–171. Ward, C. I. & McFall, R. M. (1986). Further validation of the Problem Inventory for Adolescent Girls: Comparing Caucasian and black delinquents and nondelinquents. Journal of Consulting and Clinical Psychology, 54, 732–733. Whitehead, J. T. & Lab, S. P. (1989). A meta-analysis of juvenile correctional treatment. Journal of Research in Crime and Delinquency, 26, 276–295. Wolf, M. M., Phillips, E. L., & Fixson, D. L. (1974). Achievement place: Phase II (Vol. 1). Rockville, MD: National Institute of Mental Health, Center for Studies of Crime and Delinquency. Wong, S. (2000). Psychopathic offenders. In S. Hodgins & R. Muller-Isberner ¨ (Eds), Violence, crime and mentally disordered offenders. Chichester: John Wiley & Sons. Zamble, E. & Quinsey, V. L. (1997). The criminal recidivism process. Cambridge: Cambridge University Press.

Chapter 2

SKILLSTREAMING: THE BEHAVIORAL COMPONENT ARNOLD P. GOLDSTEIN Syracuse University, New York, USA

I first entered into the domain of social skills training almost 30 years ago, as I wrote of Structured Learning Therapy (later re-christened Skillstreaming) as a useful intervention for adult psychiatric patients about to be deinstitutionalized after long mental hospital stays (Goldstein, 1973). As social skills training left the status of mere intervention, and became a veritable psychoeducational movement, my colleagues and students and I became more and more heavily involved in its conceptualization and implementation. Over the course of these three decades, we have developed Skillstreaming formats, curricula, and procedures for elderly adults (Goldstein, Hoyer, & Monti, 1979), child-abusing parents (Goldstein, Keller, & Ern´e, 1985), industrial managers (Goldstein & Sorcher, 1974), police officers (Goldstein, Monti, Sardino, & Green, 1978), substance abusers (Goldstein, Reagles, & Amann, 1990), preschool youngsters (McGinnis & Goldstein, 1990), elementary school students (McGinniss & Goldstein, 1984), and, most fully, aggressive, withdrawn, developmentally delayed, or otherwise skill-deficient adolescents (Goldstein & McGinnis, 1997). Across these diverse trainee populations, skill curriculum-delivery procedures have remained essentially constant, and consisted of: (1) modeling (the skill demonstration by the trainers), (2) role-playing (the skill rehearsal by the trainee), (3) performance feedback (by all trainees in the group and the trainers), and (4) generalization training (such as skill homework assignments, to enhance transfer and maintenance). Utilizing this sequence of procedures, Skillstreaming was first employed primarily as a “standalone” intervention and then increasingly as a procedure folded into ART and used as its behavior change, deficit-altering component. In doing so, the extended skill curriculum shown in (Table 2.1) is taught. All of the skills in the curriculum are broken down into their constituent behavioral steps. The steps are the skills. They are what is modeled by the trainers, role-played by trainees, and commented upon in giving feedback. Four adolescent New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


22 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Table 2.1 The Skillstreaming curriculum for adolescents Group I: Beginning social skills 1. Listening 2. Starting a conversation 3. Having a conversation 4. Asking a question 5. Saying thank you 6. Introducing yourself 7. Introducing other people 8. Giving a compliment Group II: Advanced social skills 9. Asking for help 10. Joining in 11. Giving instructions 12. Following instructions 13. Apologizing 14. Convincing others Group III: Skills for dealing with feelings 15. Knowing your feelings 16. Expressing your feelings 17. Understanding the feelings of others 18. Dealing with someone else’s anger 19. Expressing affection 20. Dealing with fear 21. Rewarding yourself Group IV: Skill alternatives to aggression 22. Asking permission 23. Sharing something 24. Helping others

25. Negotiating 26. Using self-control 27. Standing up for your rights 28. Responding to teasing 29. Avoiding trouble with others 30. Keeping out of fights Group V: Skills for dealing with stress 31. Making a complaint 32. Answering a complaint 33. Being a good sport 34. Dealing with embarrassment 35. Dealing with being left out 36. Standing up for a friend 37. Responding to persuasion 38. Responding to failure 39. Dealing with contradictory messages 40. Dealing with an accusation 41. Getting ready for a difficult conversation 42. Dealing with group pressure Group VI: Planning skills 43. Deciding on something to do 44. Deciding what caused a problem 45. Setting a goal 46. Deciding on your abilities 47. Gathering information 48. Arranging problems by importance 49. Making a decision 50. Concentrating on a task

curriculum skills are shown in Boxes 2.1–2.4 along with (1) their skill steps, (2) trainer notes provided to help trainers coach trainees, (3) suggested contents for each skill’s modeling displays, and (4) where appropriate, additional comments for trainer guidance. The sequence of procedures employed in carrying out the modeling, role-play, performance feedback, and generalization training processes that constitute Skillstreaming are listed in Table 2.2. Defining the skill is conducted briefly, usually in but a few minutes. Its purpose is orientation to both general meaning and concrete example. The youths who typically are the recipients of Skillstreaming—especially as part of ART—tend to be action-oriented youngsters who do not sit easily for lengthy or abstract lectures or discussions. Defining the skill quickly and with their participation gets them “on board” and ready for the more action-oriented processes of modeling. Trainers proceed to model the skill being taught, taking care to (1) select contents relevant to trainees’ real-life circumstances, (2) clearly depict all of the behavioral steps constituting the skill being modeled, and (3) display a positive outcome, as behaviors which “work” are more likely to be instated.

SKILLSTREAMING 23

Box 2.1 Skill 28: Responding to teasing Steps

Trainer notes

1. Decide if you are being teased. 2. Think about ways to deal with the teasing. 3. Choose the best way to do it.

Are others making jokes or whispering? Gracefully accept it; make a joke of it; ignore it. When possible, avoid alternatives that foster aggression, malicious counterteasing, and withdrawal.

Suggested content for modeling displays School or neighborhood: main actor ignores classmate’s comments when volunteering to help teacher after class. Home: main actor tells sibling to stop teasing about new haircut. Peer group: main actor deals with peer’s teasing about a girlfriend or boyfriend by making a joke of it.

Box 2.2 Skill 30: Keeping out of fights Steps 1. Stop and think about why you want to fight. 2. Decide what you want to happen in the long run. 3. Think about other ways to handle the situation besides fighting.

Trainer notes

What is the long-range outcome? You might negotiate, stand up for your rights, ask for help, or pacify the person.

4. Decide on the best way to handle the situation and do it. Suggested content for modeling displays School or neighborhood: main actor tells classmate that he/she wants to talk out their differences instead of being pressured to fight. Home: main actor resolves potential fight with older sibling by asking parent to intervene. Peer group: main actor goes for help when he/she sees peers fighting on school steps. Comments Prior to teaching this skill, it is often useful to review Skill 26 (Using self-control).

24 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

Box 2.3 Skill 32: Answering a complaint Steps

Trainer notes

1. Listen to the complaint. 2. Ask the person to explain anything you don’t understand. 3. Tell the person that you understand the complaint. 4. State your ideas about the complaint, accepting the blame if appropriate. 5. Suggest what each of you could do about the complaint.

Listen openly.

Rephrase; acknowledge the content and feeling.

You might compromise, defend your position, or apologize.

Suggested content for modeling displays School or neighborhood: main actor responds to neighbor’s complaint about noisy party. Home: main actor responds to parent’s complaint about selection of friends. Peer group: main actor responds to friend’s complaint about returning sporting equipment in poor condition.

Box 2.4 Skill 42: Dealing with group pressure Steps

Trainer notes

1. Think about what the group wants you to do and why.

Listen to other people; decide what the real meaning is; try to understand what is being said. Yield; resist; delay; negotiate. Give reasons; talk to one person only; delay; assert yourself.

2. Decide what you want to do. 3. Decide how to tell the group what you want to do. 4. Tell the group what you have decided.

Suggested content for modeling displays School or neighborhood: main actor deals with group pressure to vandalize neighborhood. Home: main actor deals with family pressure to break up friendship. Peer group: main actor deals with pressure to fight. Following skill definition and modeling, a brief “go-around” is conducted to establish concretely the circumstances constituting each trainee’s current need for the skill—with whom, where, when, and so forth. A role-player (the “main actor”)

SKILLSTREAMING 25 Table 2.2 Skillstreaming training steps 1. 2. 3. 4. 5. 6. 7. 8. 9.

Define the skill Model the skill Establish trainee skill need Select role-player Set up the role-play Conduct the role-play Provide performance feedback Assign skill homework Select next role-player

is then selected and, using the just-obtained need-for-skill information, an appropriate role-play scene is constructed. A co-actor is chosen and asked to portray the main actor’s real-world other figure; the physical scene is set. In order to facilitate the quality of post-role-play feedback, as well as to maximize group member attention during each role-play, the skill steps are assigned to various members, who are instructed to note how and how well the main actor carried out the given step. The role-play is then conducted, with trainers offering guidance as needed as it unfolds. Immediate re-role-plays are sometimes necessary to assure that each role-play (given that they are rehearsals) ends with a smooth portrayal of the given skill’s steps and in the proper sequence. Feedback by other trainees is provided, further “shaping up” the quality of the skill, and its readiness for real-world use. When such readiness is the case, the trainee is then asked to carry out the skill in his or her own real-world environment, with his/her actual significant others. To maximize the likelihood that homework will in fact be done, trainees are asked to complete a homework contract, called the Homework Report, a completed copy of which is shown in Figure 2.1. The training sequence for that trainee is thus completed, and the next role-player is then chosen. Given the not-infrequent proclivity for youths involved in Skillstreaming and ART programs to act up, not out, and display behavior management challenges during training sessions, I have long urged when possible that two trainers be used to run each session. Trainers optimally will be skilled not only in the Skillstreaming method, group management, and good pedagogy, but also be as acutely attuned as possible to the real-world cultural perspective of the participating youths. An ideal group size is often six to eight, as that is the approximate number of roleplays that can comfortably be completed within a session. Smaller groups, at least initially, are recommended for particularly aggressive trainees. When larger groups are unavoidable, seeking additional adult assistance for both feedback and group management purposes is advised. The frequency of sessions is variable—once per week, twice, or other. Crucial here is to make certain that trainees have ample time and opportunity to complete homework assignments. Since Skillstreaming programs have as their core goal to prepare youths for prosocially skilled real-life functioning, groups should be constituted in such a manner that their parallel to real-life relationships is maximized. The more they are a microcosm the better, which often concretely translates to peers, boys and girls, antagonists, family members, and so forth. Decisions about who should and should

26 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Skillstreaming the Adolescent HOMEWORK REPORT 1 Name:

Date:

Josh

September 15

FILL IN DURING THIS CLASS 1. What skill will you use? Dealing with Group Pressure 2. What are the steps for the skill? 1. Think about what the group wants you to do and why. 2. Decide what you want to do. 3. Decide how to tell the group what you want to do. 4. Tell the group what you have decided. 3. Where will you try the skill? At my locker 4. With whom will you try the skill? My friends 5. When will you try the skill? After school FILL IN AFTER DOING YOUR HOMEWORK 1. What happened when you did the homework?

My friends acted like they sort of understood. 2. Which skill steps did you really follow?

1, 2, and 4. 3. How good a job did you do in using the skill? (check one) Excellent

Good

Fair

Poor

4. What do you think should be your next homework assignment?

Try the skill again with the same friends.

Figure 2.1 Completed Homework Report. Reproduced from Goldstein and McGinnis (1997) Skillstreaming the adolescent—student manual. Champaign, IL: Research Press. Copyright (1997) Goldstein and McGinnis. Reprinted by permission.

not be included in the program at all rest in the final analysis on matters of skill proficiency and deficiency. Those already reasonably competent in the skills to be taught obviously are not in need of training. Those deficient, are. While several avenues of social skill assessment exist, we have relied primarily on behavioral observation (by the youth care worker, teacher, or other “front-line” person working with the youth much of the time) and our Skillstreaming Checklists. The forms shown in Figures 2.2 and 2.3 are segments from the Staff and Student forms of this assessment device.

SKILLSTREAMING 27 Skillstreaming the Elementary School Child TEACHER/STAFF SKILLSTREAMING CHECKLIST Student:____________________________ Class/age:___________________ Teacher/staff:________________________________ Date: _______________ INSTRUCTIONS:

Listed below you will find a number of skills that children are more or less proficient in using. This checklist will help you evaluate how well each child uses the various skills. For each child, rate his/her use of each skill, based on your observations of his/her behavior in various situations. Circle 1 if the child is almost never good at using the skill. Circle 2 if the child is seldom good at using the skill. Circle 3 if the child is sometimes good at using the skill. Circle 4 if the child is often good at using the skill. Circle 5 if the child is almost always good at using the skill.

almost never

seldom

sometimes

often

almost always

Please rate the child on all skills listed. If you know of a situation in which the child has particular difficulty in using the skill well, please note it briefly in the space marked "Problem situation."

1

2

3

4

5

2. Asking for Help: Does the student decide when he/she 1 needs assistance and ask for this help in a pleasant manner?

2

3 4

5

2

3

5

1.

Listening: Does the student appear to listen when someone is speaking and make an effort to understand what is said? Problem situation:

Problem situation: 3.

Saying Thank You: Does the student tell others he/she appreciates help given, favors, and so forth?

1

4

Problem situation:

Figure 2.2 Skillstreaming Checklist—Staff form. Reproduced from McGinnis and Goldstein (1997) Skillstreaming the elementary school child. Champaign, IL: Research Press. Copyright (1997) McGinnis and Goldstein. Reprinted by permission.

In addition to its value as a means of determining levels and locus of perceived skill proficiency and deficiency across the curriculum, the Student Checklist— on which trainees can indicate which skills they feel deficient in, has been used effectively by us to “negotiate the curriculum” with participating youths. Done for motivation-promoting purposes, this is a procedure (using Student Checklist tallies) for jointly determining with trainees which skills are to be taught. It is rare for youths to be empowered in this manner. It is our long-standing impression that such empowerment does indeed enhance trainee motivation to attend sessions, to participate actively, and to use the skills thus learned. Beginning with our earliest use of Skillstreaming, and continuing to the present, we have urged that its outcomes be rigorously evaluated. Several dozen evaluations

28 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Skillstreaming the Elementary School Child STUDENT SKILLSTREAMING CHECKLIST Name:_______________________________________ Date: ___________________ INSTRUCTIONS: Each of the questions will ask you about how well you do something. Next to each question is a number. Circle number 1 if you almost never do what the question asks. Circle number 2 if you seldom do it. Circle number 3 if you sometimes do it. Circle number 4 if you do it often. Circle number 5 if you almost always do it.

almost never

seldom

sometimes

often

almost always

There are no right or wrong answers to these questions. Answer the way you really feel about each question.

1

2

3

4

5

1

2

33

44 5 5

3. Do I tell people thank you for something they have done for me?

1

2

3

4

5

4. Do I have the materials I need for my classes (like books, pencils, paper)?

1

2

3

4

5

5. Do I understand what to do when directions are given, and do I follow these directions?

1

2

3

4

5

6. Do I finish my schoolwork?

1

2

3

4

5

7. Do I join in on class talks or discussions?

1

2

3

4

5

8. Do I try to help an adult when I think he/she could use the help?

1

2

3

4

5

9. Do I decide what I don't understand about my schoolwork and ask my teacher questions in a friendly way?

1

2

3

4

5

10. Is it easy for me to keep doing my schoolwork when people are noisy?

1

2

3

4

5

1. Is it easy for me to listen to someone who is talking to me? 2. Do I ask for help in a friendly way when I need help?

1

Figure 2.3 Skillstreaming Checklist—Student form. Reproduced from McGinnis and Goldstein (1997) Skillstreaming the elementary school child. Champaign, IL: Research Press. Copyright (1997) McGinnis and Goldstein. Reprinted with permission.

of Skillstreaming as a “standalone” intervention have been conducted, as well as now a dozen more as a component of ART. This quite substantial array of efficacy evaluations—conducted across time, venues, investigators, diverse trainees, and diverse cultures—reveals it to be an effective means for effecting skill acquisition. When (and often only when) the Skillstreaming program also sought to involve trainee peers or family, or used other techniques in the training itself which were explicitly designed to maximize transfer and/or maintenance of skill proficiency,

SKILLSTREAMING 29

outcomes beyond mere acquisition, but on to skill generalization, have also been reliably reported.

REFERENCES Goldstein, A. P. (1973). Structured learning therapy: Toward a psychotherapy for the poor. New York: Academic Press. Goldstein, A. P., Hoyer, W. J., & Monti, P. J. (1979). Police and the elderly. New York: Pergamon Press. Goldstein, A. P., Keller, H., & Ern´e, D. (1985). Changing the abusive parent. Champaign, IL: Research Press. Goldstein, A. P. & McGinnis, E. (1997). Skillstreaming the adolescent—student manual (rev. edn). Champaign, IL: Research Press. Goldstein, A. P., Monti, P. J., Sardino, T., & Green, D. (1978). Police crisis intervention. New York: Pergamon Press. Goldstein, A. P., Reagles, K. W., & Amann, L. L. (1990). Refusal skills: Preventing drug use in adolescents. Champaign, IL: Research Press. Goldstein, A. P. & Sorcher, M. (1974). Changing supervisor behavior. New York: Pergamon Press. McGinnis, E. & Goldstein, A. P. (1984). Skillstreaming the elementary school child: A guide for teaching prosocial skills. Champaign, IL: Research Press. McGinnis, E. & Goldstein, A. P. (1990). Skillstreaming in early childhood: Teaching prosocial skills to the preschool and kindergarten child—program forms. Champaign, IL: Research Press. McGinnis, E. & Goldstein, A. P. (1997). Skillstreaming the elementary school child: New strategies and perspectives for teaching prosocial skills—program forms (rev. edn). Champaign, IL: Research Press.

Chapter 3

CURRENT ISSUES IN ANGER MANAGEMENT INTERVENTIONS WITH YOUTH EVA L. FEINDLER AND KRISTAN BAKER Long Island University, New York, USA

INTRODUCTION In response to the oft presenting problems of angry outbursts and aggressive behavior in children and adolescents, anger management interventions were developed during the past 15 years by clinicians and educators (Nelson & Finch, 2000). Unhappy with traditional behavior modification approaches, which handle these problems via contingency management and punishment strategies, some looked towards the cognitive-behavioral self-control approach and developed a skills training program to help youth manage their anger experience and use more effective conflict resolution skills. After a brief description of the anger management approach (which is described elsewhere in more detail: see Feindler & Ecton, 1986; Feindler, 1995; Feindler & Scalley, 1998), this chapter will provide a review of more recent applications of anger management and will highlight both clinical and research issues.

The Development of Anger Management Interventions for Youth Across a variety of clinical, educational, and residential treatment settings, youth presenting with conduct and oppositional-defiant disorders have patterns of irritability, anger outbursts, and aggressive behavior that result in poor conflict resolution, poor interpersonal skills, and a host of compliance problems. Although behavior modification strategies have been successfully implemented to provide contingencies that can reduce occurrences of aggressive behavior, especially in a controlled setting, these approaches were somewhat limited. Often when the youth New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


32 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

returned to the natural environment or was beyond the control of these contingencies, aggressive behavior and conflict escalation would return. The aggressive behaviors of interest would occur outside of the purview of adults, making it difficult to implement either punishment or response cost strategies, usually part of a more comprehensive behavior management program. These problems with maintenance and generalization of behavior change indicated that self-control skills of aggression management were not being learned, nor were youth gaining skills in appropriate conflict resolution. In fact, children and adolescents merely learned that if you were caught being aggressive you might get in trouble but never learned what to do to manage anger appropriately. Struggling with both clinical and safety issues for those who work with aggressive youth, Feindler and her colleagues developed an approach to treatment that would focus on the emotional arousal often preceding an aggressive outburst. Based upon Novaco’s (1975) early work with adults, anger management technology focuses on teaching skills of arousal reduction with direct emphasis on the physiological and cognitive components of anger. Hypothetically, aggressive behavior is elicited by an aversive “trigger” stimulus which is followed by both physiological arousal and distorted cognitive responses that result in the emotional experience of anger. Children and adolescents who have impulsive, aggressive behaviors in their repertoire often react towards the trigger and fail to solve the interpersonal conflict in an appropriate fashion. Much of the research by both Crick and Dodge (1994) and Lochman and Dodge (1994), who have studied the cognitive reactions of aggressive children, concludes that aggressive cognitions, in particular hostile attributions and expectancies, influence the occurrence of behavioral responses to interpersonal situations. Aggressive youth seem to lack a cognitive processing of the interpersonal problem and instead engage in distorted thinking that intensifies their perceptions of injustice and fuels their rage (Harvey, Fletcher, & French, 2001). Further, these same youth, perhaps due to early family experiences or to an innate physiological dysynchrony, suffer from various aspects of emotion dysregulation (Keenan, 2000). They seem unable to cope with the lower levels of the affective experience of anger in a constructive way. The irritability or annoyance that results from goal blocking or mild interpersonal conflict often gives way to intensified anger and explosive rage. Before the work of Novaco (1975), little was understood about the components of the anger reaction that may be the precursor to the actingout behavior of children and adolescents without the capacity to either verbalize their experience or manage their internal arousal so as to prevent an aggressive episode.

Anger Management Interventions In order to prevent an aggressive response to a triggering stimulus, it is necessary for the youth to manage their anger arousal and process the interpersonal exchange such that a more prosocial response is exhibited (Nelson & Finch, 2000). The anger management treatment protocols focus on the three hypothesized components of the anger experience: physiological responses, cognitive processes, and behavioral responses (Novaco, 1975). If anger reactions comprise heightened physiological

ANGER MANAGEMENT INTERVENTIONS WITH YOUTH 33

arousal, cognitive distortions, impulsive thoughts, and aggressive responding, then the treatment approach must focus on helping young people develop self-control skills in each of these areas. For the physiological aspect, anger management first helps the client to identify the experience of anger, to label the various intensities of the emotion, and to recognize the early warning signs such as a flushed feeling or quickened heart rate. During this component the experience of anger is validated as a normal and frequently occurring emotion that has an intensity range under the youth’s control. Further, clients are asked to identify and track common triggers of their anger by using a self-monitoring assessment called the Hassle Log. Charting daily occurrences of anger (whether handled well or not) helps the youth to recognize idiosyncratic patterns of anger loss and control, and to increase awareness of external triggers and internal physiological and cognitive reactions. Finally, several arousal management skills such as deep breathing, imagery, and relaxation are taught to help the youth reduce the accumulated physiologic tension and to increase their capacity to think through the interpersonal event in a more rational fashion. The cognitive component of anger management emphasizes both cognitive deficiencies and distortions that are characteristic of those with aggressive and impulsive responding to perceived provocation. Specific cognitive problem-solving skills seem missing for aggressive youth. They generate few possible solutions to interpersonal problems as well as limited future consequences for their aggressive behavior. Further, their assumptions, expectancies, beliefs, and attributions are distorted in distinct ways that actually increase their anger experience. In particular, aggressive youth perceive triggering stimuli to be intentional and unjust acts on the part of others, which are direct insults and are meant to be hostile. Their belief is that an aggressive counteraction is the best in terms of outcome and in terms of ego protection and establishment of power in the eyes of others. They expect themselves and believe that others expect them to behave aggressively, but then they do not take responsibility for their actions. In fact, they blame others for their own misbehavior. All of these cognitive distortions combine to confirm that aggression is the only way to resolve a conflict and is therefore completely justified. Cognitive restructuring strategies are used to help the clients identify their distorted thinking styles and to encourage them to substitute a series of selfinstructions that will guide them through effective problem solving. Strategies that assist the youth in examining the irrationality and narrow focus of their cognitions help them to develop alternative causal attributions and a non-aggressive perspective. Youth are encouraged to engage in self-coaching of attributions that protect their sense of self, but also lead them to de-escalate conflict and create “mental distance” from the trigger. This type of cognitive work seems to be the most difficult for aggressive and impulsive youth, but it is probably the most critical element of the anger management intervention. Altering those internal processes will help the youth to better manage their anger experience, rethink their optional responses to provocation, and select a more prosocial behavioral response. The final component of the anger reaction is the behavioral one. Both verbal and nonverbal aggression as well as withdrawal patterns are the most typical responses to interpersonal conflicts and perceived provocation. However, once the youth has achieved competence at managing both their physiological arousal and

34 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

their cognitive process, they will still need to respond to the situation and achieve some level of social competence. What is needed then is training in problem solving, assertiveness, and communication skills related to effective conflict resolution. Certainly, the probability that these skills will be implemented is enhanced when the accompanying emotional arousal is managed effectively. Otherwise, the intense anger often experienced by those with patterns of aggressive responding will disrupt or perhaps prevent the execution of more prosocial skills. In sum, an effective anger management intervention must target each of the hypothesized anger reaction components (physiological, cognitive, and behavioral) and must teach to the skills deficiencies and cognitive distortions most characteristic. Although research has yet to evaluate the “best” sequence, it seems that the arousal management and cognitive restructuring aspects should precede the behavioral skills training. But if they are taken all together the youth will have increased self-control skills as well as more effective interpersonal problem-solving skills.

Training Strategies and Program Characteristics The anger control program originally described by Feindler and Ecton (1986) used a variety of training methods to reach the content objectives described above. The majority of anger management skills were modeled and rehearsed during extensive role-playing using scenarios generated from completed Hassle Logs. The roleplays should be arranged for the youth in such a fashion that graduated exposure to greater levels of provocation and conflict can be matched to better skill attainment. Each treatment session included a variety of graded homework assignments designed to have the clients practice newly acquired skills and to foster generalization to the natural environment. Many of the cognitive restructuring strategies have been transformed into games that participants in group treatment seem quite receptive to (Feindler & Scalley, 1998). Clients are able to learn aspects of problem solving, to develop alternative perspectives, and to generate non-hostile attributions in response to hypothetical conflict situations. Role-play with coaching then helps the youth to practice these improved cognitive responses to problem situations in which they themselves are provoked. Repeated practice once the “package” of skills has been taught seems necessary not only to reinforce the newly acquired responses but also to help the client make the social judgments required to match their response to the perceived trigger to maximize positive outcome. Although a number of anger management programs have been published in a curriculum format (Feindler & Ecton, 1986; Goldstein & Glick, 1994; Feindler & Scalley, 1998; Larson, 1998), there are several variables to consider which may require individualization of the program. Chronological age as well as cognitive level of the client group may determine the emphasis and the content of the cognitive interventions. Younger children and perhaps clients with developmental delays may struggle with the cognitive restructuring strategies and may need greater emphasis on the behavioral skills training. The setting for the anger management program will determine whether group or individual treatment is implemented as well as determine the length of sessions, the number of sessions, and the composition of

ANGER MANAGEMENT INTERVENTIONS WITH YOUTH 35

the group. Clinicians in mental health settings have different choices and different constraints than those working in residential or educational settings (see Feindler & Scalley, 1998 for a complete discussion). Personnel who will implement the program will also differ depending on the setting, thus bringing differing expertise and orientations to the intervention. Finally, in some settings, anger management may serve as an adjunct clinical intervention to other therapies received by clients, while for some it serves as the sole training program for the learning of anger management and aggression control. In some settings, family members may be involved (Feindler, 1995), while for most youth, the treatment is deemed solely for them. Although consideration of all of these program variables as well as the variety of treatment strategies may seem confusing, it certainly highlights the tremendous flexibility found in the anger management technology. Developed in response to critical clinical needs and sustained across 15 years, anger management interventions have evolved and extended to a variety of populations of youth in a variety of settings. A review of published studies in the area of anger management will underscore not just the utility of the approach but also the effectiveness in terms of aggression reduction in youth typically resistant to more traditional forms of therapy. The next section of this chapter will review developments in the anger management field and will highlight clinical issues and new applications.

DEVELOPMENTS IN ANGER MANAGEMENT INTERVENTIONS Assessment of Anger Program evaluation and research on anger management interventions for children and adolescents have been hampered by difficulties in securing reliable and valid assessment tools. Clinical decisions regarding appropriate youth for anger management interventions as well as youth at risk for anger- and aggression-related problems would be enhanced by the identification of relevant and comprehensive assessment strategies. This section will review assessment tools most frequently used and will suggest additional methods.

Self-Report Methods Many clinical researchers have relied on self-report inventories to determine significant change as a result of anger management. The State-Trait Anger Inventory has been used by several researchers (Moore & Shannon, 1993; Musante, Treiber, Davis, Waller, & Thompson, 1999; Whitfield, 1999) and it represents a psychometrically sound tool with a number of relevant subscales. In particular, the Anger Control and Anger Expression subscales seem sensitive to improved anger management skills learned by youth. Other researchers have used the Children’s Inventory of Anger (Sukhodolsky, Solomon, & Perine, 2000b), the Pediatric Anger Expression Scale (Musante et al., 1999) and the relatively new Aggression Questionnaire (Ruchkin & Eisemann, 2000). Snyder, Kymissis, and Kessler (1999) incorporated

36 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

the Anger Content subscale of the MMPI for adolescents in their short-term intervention in a psychiatric hospital setting. Finally, the Conflict Behavior Inventory (Stern, 1999), the Conflict in Relationships Inventory (Wolfe, Wekerle, Reitzel-Jaffe, & LeFebvre, 1998), and the Youth Self Report Inventory (Ruchkin & Eisemann, 2000) have also been included in the self-report assessment of youth with anger-related difficulties. A number of the anger management programs described have included a selfmonitoring assessment strategy as part of the treatment package. Modeled after Feindler and Ecton’s (1986) original Hassle Log, others have created an annoyance journal (Studer, 1996), a “Lost-It-Log” (Dwivedi & Gupta, 2000), an Anger Log (Kellner & Bry, 1999), and other forms of self-assessment. It is clear that selfmonitoring will increase the youth’s awareness of anger incidents and will allow for an inventory of cognitive, behavioral, and physiological components as well as an assessment of anger triggers. All of these are integral goals in the treatment of anger management difficulties. Yet, as an assessment tool, self-monitoring is highly unreliable and the validity of such assessments has yet to be established. Needless to say, the use of self-report methods with adolescent populations is always questionable given their predilection to respond in a socially desirable manner and their difficulties with self-reflective thought required to answer in an accurate fashion. Further, it seems plausible for angry youth to initially deny any experience with explosive behavior and intense anger at the outset of treatment. This mirrors their usual denial that they in fact have difficulties modulating their own emotions and their tendency to blame others for interpersonal problems they experience. In fact, anecdotal evidence from current research we are conducting indicates that only after several sessions of anger management, wherein their internal experience is validated and normalized, will adolescents self-report high levels of anger. Sometimes this results in elevated anger scores at post-treatment when using self-report inventories.

Reports by Others and Program Data To counter these difficulties with the use of self-report data, researchers and clinicians must search for other sources of information on the youth’s anger and aggression problems. Behavior problem checklists, in particular the Child Behavior Checklist (CBCL), have been completed by adults who have repeated contact with the youth. In the Larson, Calamari, West, and Frevert (1998) study, the CBCL was completed by direct care staff, as it was in the Nugent, Champlin, and Wiinimaki (1997) study. These authors note that staff members completing the CBCL knew which youths were receiving the treatment program, which surely influenced the results. Additionally, teachers and parents completed the Connors rating scale in the Kellner and Bry (1999) study and the CBCL in the Whitfield (1999) report. Other assessments completed by teachers (Hudley et al., 1998; Sukhodolsky et al., 2000b) and hospital staff (Snyder et al., 1999) have been used to assess the youth’s functioning in the natural environment. Researchers and clinicians are encouraged to incorporate assessment ratings by others in order to determine the generalization of anger management skills to the natural environment.

ANGER MANAGEMENT INTERVENTIONS WITH YOUTH 37

A number of published reports of youth anger management have used already existing program data to evaluate treatment outcome. Formal incident reports and daily rates of antisocial behavior were examined in several studies (Moore & Shannon, 1993; Larson et al., 1998; Nugent, Bruley, & Allen, 1999; Whitfield, 1999). Although these data are easy to collect, especially in residential treatment or special education settings, caution is suggested in the interpretation of changes as reflecting anger management success. Often, these data sources are unreliable as they are collected by a variety of personnel and they represent a wide variety of judgments on the part of paraprofessionals. Further, program data do not directly reflect youth behavior but rather the staff observation, assessment, and recording behaviors.

New Ideas in Anger Assessment There are several new developments in the assessment of youth anger and aggression that look promising in the evaluation of anger management interventions. The cognitive deficits and distortions as well as core beliefs that maintain aggressive behavior patterns require particular focus since the treatment strategies target this directly. Barriga and Gibbs (1996) describe the development and preliminary evaluation of the “How I Think” (HIT) questionnaire designed to assess cognitive distortions. This questionnaire has four subscales: self-centered, blaming others, minimizing/mislabeling, and assuming the worst. Reliability data (test–retest and internal consistency) for this 60-item self-report inventory were very good and the HIT correlated with appropriate subscales of the Youth Self Report Inventory (Externalizing, Aggressive, and Delinquent Behavior subscales). Although the authors report only partial success with the HIT in discriminating between male adolescents at a juvenile correctional facility and those in a public high school, it seems an important addition to the assessment of the cognitive component of anger. Another inventory, Normative Beliefs About Aggression (NOBAGS), was developed to assess cognitions about the acceptability of aggressive behaviors in a variety of social contexts (Huesmann & Guerra, 1997). This revised 20-item selfreport scale is more appropriate for elementary school children but is reliable for a range of ages, for both genders, and across ethnic groups. Research results indicate that children’s beliefs about the appropriateness of retaliation and about general interpersonal aggression correlate with teacher and peer ratings of actual aggressive behavior. Perhaps further development of the NOBAGS will include an adolescent version and future research on the effectiveness of the cognitive component of anger management can include this as an outcome measure. Clearly, a belief system that supports the use of aggression in interpersonal interactions is one of the main targets for intervention. Finally, Feindler and her colleagues (Feindler, Adler, Brooks, & Bhumitra, 1993) developed the Children’s Anger Response Checklist (CARC) to provide a multifocused assessment of each of the hypothesized components of an anger reaction: physiological, cognitive, emotional, and behavioral responses. This self-report measure consists of 10 hypothetical stories to which a child checks off how s/he would respond. Responses are coded according to the following subscales: cognitive aggression, cognitive assertion, cognitive self-blame, cognitive withdrawal,

38 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

behavioral aggression, behavioral assertion, and behavioral passivity. This type of checklist assessment allows for the categorization of a child’s typical response pattern to interpersonal situations, which may help to develop more individualized anger management interventions. Although developed for 8–11-year-olds, particular stories can be used for adolescents. Others have used hypothetical scenarios to assess children’s attributions. Hudley et al. (1998) presented three hypothetical scenarios which resulted in a negative outcome and involved an unnamed peer in accidental or ambiguous situations. Situations included destruction of property, physical harm, and social rejection, all fairly typical anger triggers. Following each scenario, elementary students responded to questions of judgment of intent as well as perceived anger and behavior options. Results from this assessment method suggested that improvements in behavior following an attribution retraining program for aggressive children were related to changes in attributions (Hudley et al., 1998). Finally, Crane-Ross, Tisak, and Tisak (1998) investigated social-cognitive beliefs and values regarding aggression and conventional rule violations in a large population of male and female adolescents (N = 398). Youth were presented with vignettes pertaining to aggressive behavior (e.g. using physical force to stop a classmate from taking the window seat on the bus) and to conventional violations (e.g. leaving the school grounds without permission). Following each of eight vignettes, participants were asked about the legitimacy of the acts, concern about negative self-evaluation, peer approval or rejection, expected rewards, and negative effects on others. These beliefs and values have been hypotheorized as critical in the social reasoning process and as representing the social-cognitive beliefs that mediate the decision to behave aggressively (Harvey, Fletcher, & French, 2001). Results indicate an influential role of each of these beliefs and values on self-reported and peer-reported aggression and rule violations. Again, this assessment method provides a creative way to tap into some of the cognitive correlates of aggressive behavior and should be used to evaluate the effects of cognitive anger management strategies. Lastly, new developments in online assessment of cognitions and emotions may prove helpful as a research tool. The “articulated thoughts during simulated situations” paradigm was used to assess mothers’ and sons’ emotional and cognitive process as they viewed videotaped interpersonal interactions in a study reported by O’Brien, Margolin, John, and Krueger (1991). This laboratory analog assessment method could be extended to the clinical environment if a standard set of angerinducing scenarios were developed and adolescents were required to disclose their thoughts and feelings while viewing the scenes. This online type of assessment allows for more specific evaluation of the cognitive processes evoked in the youth when an anger reaction is triggered. In summary, it is hoped that clinicians and researchers who seek to evaluate the effectiveness of anger management interventions develop a comprehensive assessment approach which includes data from multiple sources. It is recommended that methods other than self-report be used and that targets other than angry feelings be assessed. This will certainly help in our understanding of which components and formats of anger management treatment are effective across a variety of settings and populations.

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Interventions Across Environments School Contexts Anger management interventions for children and adolescents have become popular in a variety of settings in which a skills-based program is easily incorporated. There are few published research reports on anger management interventions in middle or senior high school settings (see Feindler & Scalley, 1998 for a program description at the high school level). One of the few examples beyond the original anger control program developed by Feindler and her colleagues is the Think First program (Larson & McBride, 1992). This program combines the elements of anger control and social problem solving specifically oriented towards school-related interpersonal aggression. The intervention procedures emphasize the use of prerecorded and in-group videotaping, which helps to demonstrate the use of each anger management skill during an interpersonal conflict. This 10-session program has been used extensively in high school settings, and students receiving treatment were found to manifest significantly fewer suspensions and administrative referrals for disruptive behavior than students in the control group (Larson, 1998). There are several examples in elementary school settings for boys. Sukhodolsky et al. (2000b) evaluated the effectiveness of a 10-session cognitive-behavioral program which focused on affective education about anger experiences, on cognitive and physiological elements of anger triggers and reactions, and on generating and practicing appropriate responses to provocation. The 33 participants between 9 and 11 years of age were referred by teachers and staff due to anger-related problems. Compared to boys receiving a no-treatment play group, the treatment subjects were rated as significantly less aggressive and disruptive by their teachers. However, only the results on the anger control scale from the Pediatric Anger Expression Scale showed change as a result of treatment. The other self-report subscales revealed no significant change, prompting the authors to conclude that the anger management intervention did not affect the phenomenology of angry feelings in the children (Sukhodolsky et al., 2000b) but did influence skills necessary to control aggressive behavior. The Brain Power Program (Hudley et al., 1998), a 12-session attribution retraining intervention, was implemented for aggressive and non-aggressive boys in four urban public schools. Based upon the link between faulty attributions and aggression, this program helps children to recognize accidental causes in peer interactions and to view negative outcomes as a result of accidental and non-hostile cues. Once the typical hostile attribution bias is reduced, the authors predict that subjects will display significantly lower levels of aggressive behavior. Results from the pre- and post-tests on the experimental, attentional, and control groups comprising 168 aggressive boys and 95 non-aggressive boys revealed that treatment subjects achieved and maintained improvements in teacher ratings of self-control. Further, subjects in the attributional intervention displayed reductions of judgments of hostile intent, although these changes were not maintained at follow-up. The authors are to be commended for their analyses of a specific component of the usual treatment package, namely attribution retraining, and for the large-scale evaluation. Unfortunately, the relationship of attributions and anger experiences

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was not evaluated, making this a limited contribution to the anger management literature. Others have reported the extension of anger management programs to special education settings. Dwivedi and Gupta (2000) report on the development and implementation of a “Keeping Cool” group for eight teenage boys with documented emotional and behavioral difficulties. The eight-session program was modeled after Feindler and Ecton (1986) and was implemented by the school psychologist and a special education teacher. Anecdotal feedback indicated that all of the participants became more aware of aggressive triggers and feelings. The only pre-/post-data comparison was on the self-report “Lost It” log, and at post-test students reported use of more appropriate anger management strategies and better self-ratings. Since there were no standardized assessment measures, nor ratings by others, this is just considered a case-study examination in a natural context. Whitfield (1999) reports on a multiple baseline single-subject design across subjects attending an adolescent day treatment program in a public school. Eight male students referred to the author for problems with self-control of disruptive behavior were matched to eight male control subjects. The five basic components of the Feindler and Ecton (1986) program—self-instruction, self-assessment, selfevaluation, arousal management, and adaptive skills development—were incorporated into 12 one-hour individual sessions. All subjects completed self-report measures each week (the Anger Control and Anger Expression subscales of the STAXI and the Self Control Rating Scale) and the staff completed a daily report on aggressive episodes and specific instances of rule violations. Results indicated that patterns of improvement on the self-report measures were noted for four treatment subjects while three students remained unchanged and one showed a pattern of deterioration. Staff daily report data indicated clear improvement for three experimental subjects, patterns of deterioration for three and ambiguous results for two subjects. The author reports that data from all sources were highly variable across the 12 weeks of the study, including the baseline phase, suggesting that many moderating and mediating variables were present and could not be controlled for (Whitfield, 1999). However, the implementation of anger management strategies in this setting using a multiple baseline design and multiple sources of data is to be applauded as an attempt to conduct meaningful clinical research in an applied setting without the assistance of a research team. Another extension of the anger management approach was reported by Kellner and Bry (1999), who worked with adolescents in a day school setting. Seven students (six male, one female) participated in 10 weekly two-hour group meetings. All of the students had received significant scores on the conduct subscale and Connors Teacher Rating Scale, and had multiple psychiatric diagnoses. The treatment program was based on Feindler and Ecton (1986) as well as Goldstein and Glick (1994) and was delivered by two social workers. Parents and teachers completed the Conduct subscale at pre- and post-treatment and results revealed a significant improvement following anger management training. Further, counts of the number of incidents of physical aggression by the subjects were compared for six months prior to and for six months after the intervention. Reductions in physical aggression approached a statistically significant change. Although there was no comparison group, nor did the authors examine changes in the subjects’ self-reported anger

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experiences, Kellner and Bry (1999) completed a clinically relevant replication of anger management with an adolescent population in need of increased arousal management skills. In summary, there are numerous clinicians in educational settings who are implementing anger management programs with some success. Although the research results are limited by the methodological inadequacies in the studies, all represent attempts at logical extensions of the intervention strategies in natural settings. One other creative use of anger management was a dissertation by Abrams (1999) in which he implemented a six-session program for junior varsity basketball players. This represents an interesting extension to the world of adolescent sports and his positive results may help other coaches to consider anger management skills as part of what their students need to exhibit both in the game and off the court. Of note is the absence of reported interventions in middle and high school settings or in clinical, outpatient settings. Sukhodolsky, Golub, Cromwell, and Orban (2000a) presented data on 26 elementary age boys referred to an outpatient setting for anger-related problems. In small groups, the boys completed either a 10-session cognitive skills or behavioral skills training program. Significant improvements on parent rating scales as well as anger self-report inventories provided evidence for the effectiveness of an anger management intervention in a clinic setting. It is hoped that other youth-based community organizations might incorporate such programming into the services offered for children and adolescents after school hours.

Residential Treatment Contexts The original anger control treatment package described by Feindler and Ecton (1986) was developed for use with adolescents in residential treatment. The effectiveness of an 18-session treatment package for adolescents in a long-term state psychiatric facility was evaluated and results indicated that adolescents receiving treatment increased their use of anger control skills and received fewer consequences for aggressive behavior on the treatment ward when compared to adolescents not receiving the anger management training (Feindler, Ecton, Kingsley, & Dubey, 1986). Synder, Kymissis, and Kessler (1999), faced with the treatment implementation limitations of a short-term psychiatric facility, condensed the anger management treatment into a four-session package to be given in a hospital setting within two weeks. Adolescents (both males and females; N = 50) selected for high levels of anger on the Trait Anger Subscale of the STAXI and based on chart review were randomly assigned to either an anger management or control group. In addition to self-report assessment, teachers and nursing staff completed behavior checklists while the adolescents were hospitalized, and parents completed assessments 4 to 6 weeks after the adolescents were discharged. Results indicated change on all measures, indicating that anger management skills can be acquired in a brief group format and can be generalized out of the treatment session to the general hospital and classroom contexts. Clearly, the “captive audience” factor on an inpatient unit will help adolescents learn the anger management skills quickly, but what will be crucial will be to determine the long-term maintenance of these new skills.

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The majority of published reports of anger management in residential environments focus on less restrictive settings and highlight the ease with which the treatment package can be adapted to the facility’s structure. Larson et al. (1998) examined the implementation of the Think First (Larson & McBride, 1992) program for residents on a unit designated for the treatment of disruptive behavior disorders. In addition to the unit’s behavioral contingency management program, male residents participated in weekly group skills training which included an instructional video to teach a standard set of anger management skills. Larson et al. (1998) also reported training unit staff in the program principles, including direct care staff in group sessions, and instructing staff to prompt residents to use their new skills in real-life situations. Results from a pre/post comparison of staffcompleted CBCLs revealed positive results on the Externalizing and Aggression subscales, although exact scores were not reported. Anecdotal evidence indicated that both residents and staff experienced the Think First program in a very positive way and that anger management skills were learned and reinforced in the natural environment. However, because of the extensive staff involvement and the lack of a comparison no-treatment group, it is difficult to evaluate the effectiveness of the program alone, but this is an example wherein practical issues take precedent over the methodological rigor of clinical research. Another interesting example which echoes the dilemmas inherent to program evaluation is reported by Moore and Shannon (1993). These authors examined the therapeutic impact of the addition of a third-party-delivered anger management program to an already existing behavioral contingency management program for youth living in residential care, Teaching-Family model group homes. The treatment subjects received weekly anger control therapy in a group format across 10 weeks. Unfortunately, results from pre-/post-administration of the STAXI and analyses of program data showed that both treatment and control groups improved over time with no significant differences between groups. The authors concluded that the addition of an expensive third-party-delivered treatment to the already existing program did not improve treatment outcomes for youth referred for anger and aggression (Moore & Shannon, 1993). It may well be that the anger management intervention was too brief to result in change on the dependent measures chosen for the program evaluation. Or perhaps the STAXI and the examination of program data are not appropriate measures of the acquisition of anger management skills. Further, it seems that groups of adolescents living together in congregate care more closely resemble a family dynamic and require a different therapeutic intervention which targets relationship issues in the home. Nugent et al. (1997) also evaluated the effects of anger control therapy with male adolescents living in a group home environment. Although an extremely small sample of boys completed the treatment, the single-case design approach revealed several treatment successes compared to boys not receiving the anger control therapy, which was modeled after Goldstein and Glick (1994). A number of practical issues prohibited this evaluation from meeting the methodological requirements of clinical research. The trainers were direct care staff with limited training in the implementation of anger management and the residents receiving treatment had frequent placement changes so that the group meetings were not standardized. Of

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note was the increase in acting-out behavior in the treatment group home following the cessation of anger management sessions. Thus, although there were treatment gains, they were not maintained across time (Nugent et al., 1997). Even though anger management intervention seems appropriate for adolescents in residential care, the available research has not yet shown the effectiveness of the treatment and future research with greater methodological rigor is suggested. More recently, Nugent et al. (1999) reported on a field study to test the effectiveness of Aggression Replacement Training on antisocial behaviors of adolescents in a runaway shelter where the average length of stay was three weeks. In a condensed fashion, all adolescents during a two-year period received daily ART sessions in groups ranging from 7 to 10 clients. The outcome data used to evaluate the effects of the program were daily rates of antisocial behavior culled retrospectively from chart review. Although the lack of an experimental design prohibits causal conclusions about ART, weekly rate of antisocial behavior for adolescents in residence decreased during the weeks of ART compared to pre-treatment weeks. Interestingly, there was a greater decrease for females residing at the shelter and they represented 54% of the total sample of 522 adolescents. In sum, the ART program was easily incorporated into this environment and again seems like a logical treatment component. However, further research with multi-component assessment is needed.

The Family Context Another appropriate arena for the application of anger management strategies is the youth’s family. There are numerous developmental influences which, beginning early in their lives, will shape the strategies a youth has to understand and process their experience of anger. Debaryshe and Fryxell (1998) present a model of the development of anger in family and peer contexts and suggests the family as the place where emotional socialization takes place. Family members may function as “emotional coaches” in that they provide models for regulation of anger arousal as well as direct instruction for recognizing and interpreting anger experiences. In addition to the shaping of a child’s behavioral, cognitive, and physiological reactivity to emotional states, the family also provides exposure to interpersonal conflict and experience in conflict resolution (Debaryshe & Fryxell, 1998). It is hoped that most families encourage the development of appropriate emotional control. However, many do not. The families of youth with anger and aggression problems indeed evidence a number of poor parenting practices related to later conduct problems. Clearly, the care-giving environment is crucial to the development of emotion regulation and appropriate anger control. From infancy, parental responsivity and the ability to facilitate the process by which a homeostatic internal state is achieved are critical to the development of self-regulatory skills (Keenan, 2000). Unresponsive parents or those who suffer from their own emotion dysregulation are less likely to assist their child in the development of healthy emotional control. Another oft described aspect of dysregulation of negative emotion is the “difficult temperament” child, who stresses and challenges the unprepared or unskilled parent. Early rating of difficult temperament appears to be related to the development

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of internalizing behavior problems of children (Pope & Bierman, 1999), further indicating that a necessary focus for intervention would be on parents of young and difficult children. Additionally, exposure to family conflict or perhaps maltreatment in the early years influences the development of anger and aggression problems. Howes, Cicchetti, Toth, and Rogosch (2000) conducted in-home observations of structured interactions with 42 maltreating families of preschool children. Families with documented histories of neglect, physical abuse, and sexual abuse were compared to 23 low-income families on indices of affect regulation. Observers coded positive affect, anger, fear, and sadness while the families engaged in a block building task. Results indicated that families with histories of sexual abuse displayed more angry feelings, were more chaotic and less organized around family roles, and had more rigid relationship skills compared to other families (Howes et al., 2000). Clearly, children growing up in this environment will not be able to freely express negative affect and be appropriately reassured. All aspects of affect dysregulation are thus modeled and shaped for the child. Other researchers have focused on the adjustment of adolescents who had experiences of maltreatment as children. Wolfe et al. (1998) examined peer and dating relationships of maltreated (n = 132) and non-maltreated (n = 227) 15-year-olds. Those youth exposed to family maltreatment were seen by teachers as engaging in higher frequencies of aggression and harassment and self-reported more frequent verbal and physical abuse in their current relationships. Wekerle and Wolfe (1998), in a survey of over 300 high school students, concluded that family maltreatment accounted for 13–18% of the variance in males who were physically, sexually, and verbally abusive behavior towards peers. However, this was not the case for female abusive behaviors. A subsequent study by Wolfe, Scott, Wekerle, and Pittman (2001) examined this differential pattern for a large sample of male and female high school students. One third of their sample were considered to have experienced maltreatment in their childhood. The authors examined three domains of current adjustment: emotional distress, delinquent behavior, and dating violence perpetration and victimization. Females who were maltreated displayed greater anger, depression, anxiety, and PTSD symptoms and had higher rates of delinquent behavior compared to non-maltreated females. In contrast, males from maltreating families reported higher rates of threatening and abusive behaviors towards their dates. Perhaps these results reflect gender-based modeling for teens having witnessed domestic violence although the increased delinquency rate for females remains curious. But clearly, exposure to family conflict and anger as well as parenting by adults with poor affect regulation influences the development of angerand aggression-related problems for youth. Eddy and Chamberlain (2000) examined other aspects of the relationship between parenting behaviors and youth aggression. In an investigation of factors mediating the effect of treatment on youth antisocial and delinquent behaviors, the authors examined the family management skills of adolescents in two types of residential care: group care and multidimensional treatment foster care. In particular, parenting behaviors of supervision, discipline, and positive reinforcement of foster parents were examined relative to the extent and context of association with deviant peers by the adolescents in their homes. Results indicated that parenting

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characterized by firm limit setting, consistent consequences for misbehavior, and close supervision of youths’ activities resulted in fewer antisocial peer contacts. Although this study did not examine the behavior of the youths’ natural parents, the results support the volumes of research already available on the role of parenting and the development of behavior problems. Patterson (1986) has long concluded that inept discipline practices interact with child coerciveness, create family conflict, and result in later patterns of antisocial behavior. DiLalla, Mitchell, Arthur, and Pagliocca (1998) examined 17 youths and their mothers on a number of problem behavior measures in a delinquency intervention program. Results indicated that the aggressive nature of the youths’ referring offenses was related to lax punishment by parents and that high parent ratings of youths’ aggressiveness were related to turmoil in the home and the youths’ positive opinion of delinquent peers. Perceptions of aggressive behaviors as well as delinquent behaviors are related to conflict in the home but not necessarily an overly aggressive style of parenting (DiLalla et al., 1998). In sum, exposure to intense negative affect in a family ill equipped to regulate emotional arousal, as well as exposure to domestic violence, seems to predispose a child to develop problems with anger and aggression. Additionally, there are numerous parenting behaviors that contribute to the development of conduct problems as well as a lack of discipline or parental monitoring (Griffin, Scheier, Botvin, Diaz, & Miller, 1999). But the family can also serve a protective role for the youth especially if family/parent intervention is possible. Interestingly, there are few examples of family anger control intervention in the published literature. Stern and Azar (1998) describe a parent training approach for abusive parents and parents of aggressive youth that incorporate a number of the cognitive strategies contained in anger control training. Their cognitive parenting model focuses on the identification of unrealistic expectations and negative attributional biases as well as on poor problem-solving skills which increase the likelihood of maladaptive and aggressive parenting responses. Their parents and families receive skills training in stress and anger management as well as communication and conflict resolution designed to prevent further aggressive parenting. Stern (1999) presents the first outcome investigation of the role of anger management in the reduction of parent–adolescent conflict. Parent–adolescent dyads (N = 18) experiencing problematic conflict at home were assigned to a conflict management (CM) and conflict resolution (CR) intervention or a CR intervention alone. The CM component was designed to address the affective and cognitive components of parent–adolescent conflict and enhance the likelihood of families avoiding escalating conflict through the use of anger management. The CR component focused more on calm communication, problem-solving, and negotiation skills needed to resolve a conflict. Results from pre/post evaluations on the Conflict Behavior Questionnaire and the Issues Checklist and comparisons on videotaped family discussions of “hot topics” indicated improvements for all dyads. The addition of the conflict management skills seemed only to make a difference in the videotaped discussions, coded for positive and negative intervention behaviors. With the addition of the anger control skills, parents in that condition reduced their negative and insulting behavior and rated their discussions as less emotionally intense. Although the lack of a control group limits the generalizability

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of these results, clearly parents and adolescents involved in angry and coercive conflict can learn to effectively resolve their issues and communicate more positively. Feindler (1995) reports a case study of anger management intervention with an adolescent girl and her family experiencing chronic conflict and temper outbursts. Results from parent measures indicated successful incorporation of anger control strategies by parents and child and represent a possible extension of the treatment methodology to the family context. Certainly, further clinical research on families with anger control difficulties and aggressive interaction styles is warranted. Perhaps the extension of anger management to both parents at risk for maltreatment as well as parents with angry and aggressive children will be an area explored by both clinicians and researchers in the future.

RESEARCH LIMITATIONS Research in the area of adult anger management has been prolific. Numerous studies have been published with college student populations by Deffenbacher and his colleagues. Their work has helped to separate the various components of an anger management cognitive-behavioral approach and has helped to determine which treatment strategies are most effective. Relaxation strategies, interpersonal skills training as well as emotional control strategies have been compared as treatment elements (Deffenbacher, Thwaites, Wallace, & Oetting, 1994). Only Sukhodolsky et al. (2000a) have attempted to conduct a component analysis. Elementary school boys (N = 31) referred for anger- and aggression-related problems received either of two treatment protocols developed to differentially represent cognitive and behavioral components of an anger control program. Following 10 weekly group sessions, results indicated that both protocols appeared effective in reducing selfreported anger and perceived aggression and in improving social competence. The cognitive protocol resulted in improvements in hostile attribution biases while the behavioral protocol resulted in greater anger control skills. Certainly, much more work needs to be done to evaluate the numerous components of any anger management package, and these authors are to be commended for starting work done for years with adult populations. Overall, the research on anger management with youth is quite limited. Most interventions include complete treatment packages in which individual components have not been evaluated and may not be necessary. Further, sequence effects of the various components have yet to be examined. The proliferation of published reports about anger control interventions in various settings underscores both the need for effective programming by those who work with angry and aggressive youth as well as the practicality and effectiveness of a skills-based anger management approach. However, the majority of these applied examples suffer from methodological inadequacies such that the generalization of their results is restricted. Few studies use either control or comparison groups. Most have small sample sizes based upon some clinical criteria never fully articulated. The choice of dependent measures seems somewhat random and the data sources are usually unreliable. Many authors report null results on self-report measures of angry

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feelings, and fail to include other methods of assessment. In only one study was a 12-month follow-up assessment completed (Hudley et al., 1998), and the treatment gains had disappeared. Clearly, the generalization and maintenance of the newly acquired anger control skills must be further evaluated. Additionally, gender issues in anger management with youth have yet to be addressed. There are few published reports that include female subjects. Except for the Nugent et al. (1999) study conducted at a runaway shelter and the Synder et al. (1999) study conducted at an inpatient psychiatric hospital in which half of the subjects were female, almost exclusively the focus has been on males. Certainly, common clinical knowledge indicates that males present more often with problems related to aggression. However, when we try to examine the links between anger and other emotions such as shame and depression, we may be overlooking a female population in need of anger management skills. Perhaps future researchers will begin to examine the variety of female populations available in clinical and educational settings for youth. Lastly, although many have implemented anger management treatment packages developed by others, few have described or standardized the mechanics of actual program implementation. Across the board, those professionals or paraprofessionals who implement treatment are largely an uncontrolled variable in any attempt at research or program evaluation. Teachers, social workers, guidance counselors, psychologists, and even direct care staff (Larson et al., 1998) have been involved in program implementation yet their training and their treatment methods remain undocumented. It may be time for a look at their training and supervision needs as well as at treatment fidelity across various anger management programs. In summary, the research results from anger management programs indicate that skills acquired lead to reductions in angry feelings, faulty thinking, and aggressive behavior patterns, and to improvements in social competence and problem solving. However, these results should be interpreted with caution as each study reviewed is limited by methodological flaws. Additional clinical research is certainly encouraged as anger management programs are clearly needed across populations and settings. Researchers should be encouraged to work through the obstacles inherent in doing research in applied settings so that the philosophy and technology of anger management can be empirically validated.

SUMMARY Anger management interventions are eagerly sought by a host of professionals who work with youth suffering from problems with anger and aggression. The recent focus on violence prevention, especially in light of school shootings and increases in bullying, encourages us to implement programs with high-risk children as well. And although the methodological deficiencies in the research evaluations of anger management may limit the confidence that some may have in the treatment components, the skills-based approach to assisting youth in gaining emotional control and in using more effective conflict resolution strategies is one of the most helpful approaches available.

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Future clinical application of anger management may focus on youth with other diagnostic impressions. Recent work is beginning to focus on family violence applications. Unregulated anger seems to be a characteristic of violent families (Howes et al., 2000), as is interpersonal aggression. Children who are exposed to family violence and those who are victims of abuse certainly need much education and intervention around the dynamics of conflict in relationships and the management of anger. The dating relationships that emerge during adolescence for these children are characterized by similar patterns of interpersonal anger and aggression (Wolfe et al., 1998). Further, other researchers have just begun to examine children’s experience of shame. Tangney, Wagner, Hill-Barlow, Marschall, and Gramzow (1996) explored the relationship between shame proneness and anger responses in a large sample of youth. Correlational results indicated that shame proneness was directly related to self-reported maladaptive responses to anger, which included malevolent intentions, aggressive thoughts, and self-directed hostility. For boys, shame proneness was also related to teacher reports of aggression. Exactly how the experience of shame may function to increase anger and aggression remains theoretical at this point, but it might be included as an important variable to address not only in the assessment phase but also in the cognitive treatment component. Perhaps shame-based self-statements or anticipation of the experience of shame functions as another type of cognitive distortion that requires interventions. Finally, there are many other clinical populations for whom anger management problems are a related symptom. Youth with obsessive-compulsive behavior patterns often find themselves in a “lock” with either themselves or their family members. This may result in angry outbursts which are much more motivated by anxiety and the need for ritualistic behaviors. Youth with Asperger’s syndrome or those with other developmental disabilities might benefit from the skills training involved in anger management. Although the cognitive strategies may need to be altered to match the developmental level of the client, many specific skills could be taught in a sequence to implement when feeling angry. There also are youth who suffer from various neurological deficits, in particular brain injury, who have an extremely difficult time managing their explosive outbursts. Perhaps anger management skills training could be as beneficial here as it has been for children and adolescents across the board.

REFERENCES Abrams, M. (1999). The effects of an anger management package on male athletes. Dissertation, Long Island University, New York. Barriga, A. Q. & Gibbs, J. C. (1996). Measuring cognitive distortion in antisocial youth: Development and preliminary validation of the “How I Think” questionnaire. Aggressive Behavior, 22, 333–344. Crane-Ross, D., Tisak, M. S., & Tisak, J. (1998). Aggression and conventional rule violation among adolescents: Social-reasoning predictions of social behavior. Aggressive Behavior, 24, 347–365. Crick, N. R. & Dodge, K. A. (1994). A review and reformulation of social information processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74–101. Debaryshe, B. D. & Fryxell, D. (1998). A developmental perspective on anger: Family and peer contexts. Psychology in the Schools, 35(3), 205–216.

ANGER MANAGEMENT INTERVENTIONS WITH YOUTH 49 Deffenbacher, J. L., Thwaites, G. A., Wallace, T. L., & Oetting, E. R. (1994). Social skills and cognitive-relaxation approaches to general anger reduction. Journal of Counseling Psychology, 41(3), 386–396. DiLalla, L. F., Mitchell, C. M., Arthur, M. W., & Pagliocca, P. M. (1998). Aggression and delinquency: Family and environmental factors. Journal of Youth and Adolescence, 17(3), 233–246. Dwivedi, K. & Gupta, A. (2000). “Keeping cool”: Anger management through group work. Support for Learning, 15(2), 76–81. Eddy, J. M. & Chamberlain, P. (2000). Family management and deviant peer association as mediators of the impact of treatment condition on youth antisocial behavior. Journal of Consulting and Clinical Psychology, 68, 857–863. Feindler, E. L. (1995). Ideal treatment package for children and adolescents with anger disorders. In H. Kassinove (Ed.), Anger disorders: Definition, diagnosis, and treatment (Chapter 10). Washington, DC: Taylor & Francis. Feindler, E. L., Adler, N., Brooks, D., & Bhumitra, E. (1993). The Children’s Anger Response Checklist (CARC). In L. VandeCreek, S. Knapp, & T. L. Jackson (Eds), Innovations in Clinical Practice: A source book. Sarasota, FL: Professional Resource Exchange. Feindler, E. L. & Ecton, R. B. (1986). Adolescent anger control: Cognitive behavioral techniques. New York: Pergamon Press. Feindler, E. L., Ecton, R. B., Kingsley, D., & Dubey, D. R. (1986). Group anger-control training for institutionalized psychiatric male adolescents. Behavior Therapy, 17, 109–112. Feindler, E. L. & Scalley, M. (1998). Adolescent anger-management groups for violence reduction. In K. C. Stoiber & T. R. Kratochwill (Eds), Handbook of Group Intervention for Children and Families (pp. 100–118). Boston, MA: Allyn & Bacon. Griffin, K. W., Scheier, L. M., Botvin, G. J., Diaz, T., & Miller, N. (1999). Interpersonal aggression in urban minority youth: Mediators of perceived neighborhood, peer, and parental influences. Journal of Community Psychology, 27(3), 281–298. Goldstein, A. P. & Glick, B. (1994). Aggression replacement training: Curriculum and evaluation. Simulation and Gaming, 25(1), 9–26. Harvey, R. J., Fletcher, J., & French, D. J. (2001). Social reasoning—a source of influence on aggression. Clinical Psychology Review, 21, 447–469. Howes, P. W., Cicchetti, D., Toth, S. L., & Rogosch, F. A. (2000). Affective, organizational, and relational characteristics of maltreating families: A systems perspective. Journal of Family Psychology, 14, 95–110. Hudley, C., Britsch, B., Wakefield, W. D., Smith, F., DeMorat, M., & Cho, S.-J. (1998). An attribution retraining program to reduce aggression in elementary school students. Psychology in the Schools, 35(3), 271–282. Huesmann, L. R. & Guerra, N. G. (1997). Children’s normative beliefs about aggression and aggressive behavior. Journal of Personality and Social Psychology, 72, 408–419. Keenan, K. (2000). Emotion dysregulation as a risk factor for child psychopathology. Clinical Psychology: Science and Practice, 7, 418–434. Kellner, M. H. & Bry, B. H. (1999). The effects of anger management groups in a day school for emotionally disturbed adolescents. Adolescence, 34, 645–652. Larson, J. D. (1998). Managing student aggression in high schools: Implications for practice. Psychology in the Schools, 35(3), 283–295. Larson, J. D., Calamari, J. E., West, J. G., & Frevert, T. A. (1998). Aggression management with disruptive adolescents in the residential setting: Integration of a cognitive-behavioral component. Residential Treatment for Children and Youth, 15(4), 1–9. Larson, J. D. & McBride, J. A. (1992). Think First: Anger and aggression management for secondary level students. Long Beach, CA: Long Beach Unified School District. Lochman, J. & Dodge, K. A. (1994). Social-cognitive processes of severely violent, moderately aggressive and non-aggressive boys. Journal of Counselling and Clinical Psychology, 62, 366– 374. Moore, K. J. & Shannon, K. K. (1993). Brief report: The development of superstitious beliefs in the effectiveness of treatment of anger: Evidence for the importance of experimental program evaluation in applied settings. Behavioral Residential Treatment, 8(2), 147–161.

50 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Musante, L., Treiber, F. A., Davis, H. C., Waller, J. L., & Thompson, W. O. (1999). Assessment of self-reported anger expression in youth. Assessment, 6(3), 225–233. Nelson III, W. M. & Finch, Jr, A. J. (2000). Managing anger in youth: A cognitive-behavioral intervention approach. In P. C. Kendall (Ed.), Child and Adolescent Therapy: CognitiveBehavioral Procedures, 2nd edn (Chapter 4). New York: Guilford Press. Novaco, R. W. (1975). Anger Control: The Development and Evaluation of an Experimental Treatment. Lexington, MA: D.C. Heath & Co. Nugent, W. R., Bruley, C., & Allen, P. (1999). The effects of aggression replacement training on male and female antisocial behavior in a runaway shelter. Research on Social Work Practice, 9(4), 466–482. Nugent, W. R., Champlin, D., & Wiinimaki, L. (1997). The effects of anger control training on adolescent antisocial behavior. Research on Social Work Practice, 7(4), 446–462. O’Brien, M., Margolin, G., John, R. S., & Krueger, L. (1991). Mothers’ and sons’ cognitive and emotional reactions to simulated marital and family conflict. Journal of Consulting and Clinical Psychology, 59, 692–703. Patterson, G. (1986). Performance models for antisocial boys. American Psychologist, 41, 432– 444. Pope, A. W. & Bierman, K. L. (1999). Predicting adolescent peer problems and antisocial activities: The relative roles of aggression and dysregulation. Developmental Psychology, 35, 335–346. Ruchkin, V. V. & Eisemann, M. (2000). Aggression and psychological problems in juvenile male delinquents versus controls in Russia: Alternative ways of “letting off steam”? Aggression and Violent Behavior, 5(2), 217–225. Snyder, K. V., Kymissis, P., & Kessler, K. (1999). Anger management for adolescents: Efficacy of brief group therapy. Journal of the American Academy of Child and Adolescent Psychiatry, 38(11), 1409–1416. Stern, S. B. (1999). Anger management in parent–adolescent conflict. American Journal of Family Therapy, 27, 181–193. Stern, S. B. & Azar, S. T. (1998). Integrating cognitive strategies into behavioral treatment for abusive parents and families with aggressive adolescents. Clinical Child Psychology and Psychiatry, 3(3), 387–403. Studer, J. (1996). Understanding and preventing aggressive responses in youth. Elementary School Guidance and Counseling, 30, 194–203. Sukhodolsky, D. G., Golub, M. A., Cromwell, E. N., & Orban, L. (2000a). Techniques that work best: Dismantling child anger-control interventions (preliminary data). Poster presented at the 108th annual convention of the American Psychological Association, Washington, DC. Sukhodolsky, D. G., Solomon, R. M., & Perine, J. (2000b). Cognitive-behavioral, anger-control intervention for elementary school children: A treatment-outcome study. Journal of Child and Adolescent Group Therapy, 10(3), 159–170. Tangney, J. P., Wagner, P. E., Hill-Barlow, D., Marschall, D. E. & Gramzow, R. (1996). Relation of shame and guilt to constructive versus destructive responses to anger across the lifespan. Journal of Personality and Social Psychology, 70, 797–809. Wekerle, C. & Wolfe, D. A. (1998). The role of child maltreatment and attachment style in adolescent relationship violence. Development and Psychopathology, 10, 571–586. Whitfield, G. W. (1999). Validating school social work: An evaluation of a cognitivebehavioral approach to reduce school violence. Research on Social Work Practice, 9(4), 399–426. Wolfe, D., Scott, K., Wekerle, C., & Pittman, A. L. (2001). Child maltreatment: Risk of adjustment problems and dating violence in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40(3), 282–289. Wolfe, D., Wekerle, C., Reitzel-Jaffe, D., & LeFebvre, L. (1998). Factors associated with abusive relationships among maltreated and nonmaltreated youth. Development and Psychopathology, 10, 61–85.

Chapter 4

MORAL REASONING TRAINING: THE VALUES COMPONENT JOHN C. GIBBS The Ohio State University, Columbus, Ohio, USA

Moral Reasoning Training is the values component of ART. Youth with moral values are more likely to choose to use prosocial or at least balanced social behaviors (Skillstreaming, behavioral component) and to inhibit the use of putdowns, threats, or assaults (Anger Control, affective component). But what does it mean to have moral values? I remember talking about values in the late 1980s with Joey, a 15-year-old at Clearbrook Middle School in Columbus, Ohio, a special school for juveniles with behavior problems. I was impressed with Joey’s apparent earnestness and sincerity as he emphatically affirmed the importance of moral values such as keeping promises, telling the truth, helping others, saving lives, not stealing, and obeying the law. “And why is it so important to obey the law?” I asked Joey. “Because, [pause] like in a store, you may think no one sees you, but there could be cameras!” he replied. His other explanations were similar: keeping promises to others is important because if you don’t they might find out and get even; helping others is important in case you need a favor from them later; and so forth. The more I heard Joey justify or explain his moral affirmations, the less impressed I became. If motivating the use of prosocial, self-controlled, and other moral behaviors were simply a matter of encouraging the favorable evaluation of moral values, Moral Reasoning Training would be the easiest component of ART. Like Joey, many behavior-problem youth—especially incarcerated youth who would like to impress a judge enough to secure an early release—evaluate moral values as important (Gregg, Gibbs, & Basinger, 1994). But “having” moral values means not only affirming them but also understanding the deeper reasons for their importance. Joey did not have moral values in this deeper sense. This chapter discusses Moral Reasoning Training for antisocial youths like Joey. “Not having moral values in a deeper sense” means developmental delay in moral reasoning. If you think Joey’s moral reasons sounded immature for a 15-year-old, New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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you are right. The moral judgment of many antisocial youths is developmentally delayed, especially in their conceptions of the law (Gregg et al., 1994; Barriga, Morrison, Liau, & Gibbs, 2001). Moral Reasoning Training remedies this developmental delay and thereby establishes the foundation for moral behavior. Moral Reasoning Training takes time, but it is fun partly because the youth especially like these meetings (at least that has been our experience). And there is evidence that Moral Reasoning Training does motivate the use of moral behaviors in the long run. In one study, we found a remarkable “sleeper effect”: incarcerated participants who gained the most in moral judgment were the ones least likely—twelve months after release—to have recidivated (Leeman, Gibbs, & Fuller, 1993)! The key to remedying developmental delay in this values component of ART lies in giving antisocial youth opportunities and encouragement to take the perspectives of other persons. Mature and accurate perspective-taking should help the youths not only directly but also indirectly by enhancing the social and moral climate of their peer group. I will highlight the perspective-taking opportunities entailed in Moral Reasoning Training procedures, and will conclude by describing a group-development tool that should be used to establish a climate of caring moral ideals for ART group work.

DEVELOPMENTALLY DELAYED MORAL JUDGMENT If moral judgment development has to do with taking the perspectives of others, then we should not be surprised that antisocial youths tend to be immature or delayed in moral judgment. One of our studies showed that homes low in nurturance and perspective-taking (that is, that use power-assertive rather than inductive discipline; Hoffman, 2000) have children who are low in empathy, empathy-based guilt, and prosocial behavior (Krevans & Gibbs, 1996). At its extreme, power assertion means erratic and senseless physical abuse, often accompanied by other forms of abuse as well as neglect. If you came from such a home, you might think only about protecting yourself and surviving instead of taking anyone else’s perspective. You might be quick to threaten and hit if that is what you saw all the time at home (see Kazdin, 1995). And you might start thinking that everybody “has it in for you” so you had better hit first (we will term such thinking “cognitive distortion”). Of course, not all aggression stems from home histories of abuse and neglect, with their attendant privations of perspective-taking, models of violence, and stimuli for distorted thinking. Also involved can be biological factors like volatile temperaments in the parent or child or both. Finally, despite these environmental, cognitive, and biological risk factors, the youth (and their parents) are still accountable for their decisions and behavior. These caveats noted, we will focus in this chapter on understanding and remedying the lack of social perspective-taking in aggression and other antisocial behavior. The paucity of perspective-taking opportunities leads to moral judgment developmental delay in two interrelated senses: first, delay means a prolonged immature or superficial moral judgment stage; and second, delay means a persistent and pronounced egocentric bias that consolidates into what we call self-serving thinking errors or cognitive distortion (e.g. Gibbs, Potter, & Goldstein, 1995; Barriga, Landau,

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Stinson, Liau, & Gibbs, 2000). First, let us consider delay as prolonged immaturity in stage of moral judgment. Antisocial youths’ reasons for the importance of moral values are often superficial. We interpret these superficial reasons in stagedevelopmental terms, following from Lawrence Kohlberg’s (1984) still-influential model of moral judgment development. Our (e.g. Gibbs, Basinger, & Fuller, 1992; Gibbs, 2003) adaptation of Kohlberg’s (1984) model of moral judgment development is depicted in Box 4.1. In our adaptation, Stages 1 and 2 moral judgment is immature or superficial, whereas Stages 3 and 4 moral judgment is mature or profound. To say that an early stage is superficial is to say that it is confounded, that it misses an underlying moral reality because that reality is confused with something else, something immediately salient or “on the surface.”

Box 4.1 The stages of moral judgment development Immature moralities: Stages 1 and 2 Stage 1: Power—“might makes right” r Morality is whatever big or powerful people say that you have to do. If you are big or powerful, whatever you say is right, and whatever you want to do or get is fair. r If you do not get punished for what you did or no one powerful saw it, whatever you did was OK. It is wrong if you do get punished; the punishment makes it wrong. r Physical damage or other obvious injury—but not psychological suffering—is noticed and acknowledged to be wrong. r Spouting of cliches (“You should never tell a lie”) without much understanding of them or obedience to them. r Critique: Does not understand the moral reasons for rules. Has trouble with reciprocity if it requires taking more than one perspective at a time. Best at taking the perspective of someone physically powerful.

Stage 2: Deals—“you scratch my back, I’ll scratch yours” r Morality is exchange of favors (“I did this for you, so you’d better do that for me”) or of blows (misunderstanding of the Golden Rule as “Do it to others before they do it to you,” or “pay them back” if they have done it to you). r You should ask or figure, “What’s in it for me?” before you help or obey others. r The main reason for not stealing, cheating, etc. is that you could get caught. r May assert that nobody (even those in legitimate positions of authority) should “boss anybody around.” People should mind their own business. Since everybody has their own point of view as to what is right, everybody should have the right to think and do whatever they want. r May suggest that you should “set things right” if somebody gets more than you do.

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r Critique: Has trouble understanding the ideal of mutuality in a relationship. Also, tends to be self-centered: better at detecting how others are unfair to him or do not do things for him than how he (or she) is unfair to others or does not do things for others. Mature moralities: Stages 3 and 4 Stage 3: Mutuality—“treat others as you would hope they would treat you”

r In r r r r

mutual morality, the relationship itself becomes a value: “trust” and “mutual caring,” although intangible, are real and important. People can really care about other people, can have trust in them, can feel part of a “we.” You should try to understand if your friend is acting hostile or selfish. You should try to make a good impression so that others understand you are a well-intentioned person and so that you can think well of yourself. Critique: Stage 3 thinking can entail caring about the preciousness of human life. However, Stage 3 thinkers can care so much about what others think of them that they turn into “moral marshmallows” in difficult situations.

Stage 4: Systems—“are you contributing to society?”

r Morality of interdependence and cooperation for the sake of society: society r r r r

cannot make it if people do not respect others’ rights and follow through on their responsibilities. Honoring your commitments is a sign of character. If you are in the position of a judge, teacher, or some other social authority, you should uphold consistent and fair standards (but also consider extenuating circumstances). In difficult situations, retaining integrity and self-respect may mean becoming unpopular. Critique: Stage 4 thinking can entail appeals to moral law and to respect for rights and responsibilities as the basis for society. However, Stage 4 societal morality should be considered more as a supplement to than a replacement for Stage 3 interpersonal morality.

Moral reality has to do with mutual caring, respect, or trust—what Piaget (1965) called “ideal reciprocity [or] do as you would be done by” (p. 323)—whether on the scale of interpersonal relationships (Stage 3) or social systems (Stage 4). The immature stages are superficial insofar as they confuse such moral ideals with physical power (Stage 1) or pragmatic deals (Stage 2). Stage 2’s pragmatism is illustrated in Joey’s prescription to obey the law against stealing because you might not be careful enough if you break it. Or, have you heard “Don’t do the crime if you can’t do the time”? That is also Stage 2, morality as pragmatic exchanges or deals. But again, the underlying, real, unconfounded, intrinsic morality is not a matter of deals but of ideals. The interpersonally mature, profound, or ideal thinker asks,

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“How would you feel if someone stole from you?” (Stage 3). The societally mature, profound, or ideal thinker suggests: “You’ve got to have certain understandings in things that everyone is going to abide by or else you could never get anywhere in society. . . . chaos will ensue, since each person will be following his or her own set of laws” (Colby et al., 1987, p. 375). Remember, the incarcerated youths in our study who started to develop that kind of deeper, ideal moral understanding were likely to be the ones who did not recidivate.

Delay as Persistent and Pronounced Egocentric Bias/Cognitive Distortions Besides being superficial, immature reasons are egocentric or self-centered. In fact, the superficial and egocentrically biased aspects of developmental delay are functionally related: after all, a superficial reason focuses on something immediately salient like jail or getting caught by a camera—and what could be more salient than the immediate desires or impulses of the one who is concerned about such possible consequences? As we would expect, these two aspects of moral developmental delay—superficial judgment and self-centered bias—are highly correlated (Barriga et al., 2001). This egocentric, me-first, me-only bias is a natural feature of thought and behavior in childhood. In distributive justice tasks, young children will often allocate the most candy bars for themselves, and if you ask them why, they may unabashedly explain, “because I want them,” or “because I like this kind of candy bar” (Damon, 1977). According to Thomas Lickona (1983), the young child thinks: “What’s fair is whatever I want.” Normally, egocentric bias declines with social experience and cognitive development as children’s understanding becomes more profound or ideal (as noted) and they increasingly see their self-interest in light of the welfare of others. “Declines” is the verb here, not “disappears”: all of us continue to have some egocentric bias. Socially balanced or coordinated perspectives are not always actualized in daily life. Even as mature adults, “we experience our own points of view more or less directly, whereas we must always attain the other person’s view in more indirect ways. . . . We are usually unable to turn our own viewpoints off completely when trying to infer another’s viewpoint” (Flavell, Miller, & Miller, 1993, p. 181). “Not turning one’s own viewpoint off completely” is an understatement in the case of antisocial youths, whose egocentric bias—given their paucity of perspectivetaking opportunities at home and elsewhere—typically remains at the pronounced levels characteristic of childhood. Egocentric bias for these youths tends to consolidate into a self-serving worldview or approach to life, in particular a cognitive distortion. Cognitive distortions are inaccurate ways of attending to or interpreting experience. They have been called “faulty beliefs” (Ellis, 1962, 1977) and “thinking errors” (Yochelson & Samenow, 1976, 1977). There is something faulty or erroneous about such thinking. After all, “fairness” is a balance between two or more people, not an imbalanced or self-focused view that says “whatever I want is what’s ‘fair.’”

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Box 4.2 Four categories of cognitive distortion (thinking errors) with examples Self-centered (primary) Self-centered thinking means that your opinion and feelings are more important than the opinions and feelings of other people. You may not even consider how another person might feel about things. Self-centered thinking can also mean that you think only about what you want right now and do not think about how your behaviors will affect you in the future. Examples: If I see something I like, I take it. Rules are mostly meant for other people. When I get mad, I don’t care who gets hurt. If I lie to people, that’s nobody’s business but my own. Minimizing/mislabeling (secondary) Minimizing means that you think your problems or behaviors are not as bad or wrong as they really are. You tell yourself and other people that your problems are not a big deal. Minimizing also means that you think your wrong behaviors are OK because a lot of other people do the same things. It also means that you think your bad actions do not cause any real harm to anyone (example: you do not think that selling drugs causes any harm to anyone even though it really does). Mislabeling means that you put a good label on your wrong behavior to try to make it look right (example: you describe making a drug delivery as “helping out a friend” when really it is against the law and can harm other people). Mislabeling can also mean that you describe other people with bad names so it will seem OK to hurt them (example: he was a “snitch” so he deserved to get “jumped”). Additional examples: Everybody lies. It’s no big deal. Laws are meant to be broken. People need to be roughed up once in a while. If you know you can get away with it, only a fool wouldn’t steal. Blaming others (secondary) Blaming others means that you do not take responsibility for your own behavior but instead you blame other people for your mistakes that are really your fault. It can also mean that you blame your behaviors on things such as drugs or alcohol or being in a bad mood. Examples: If someone is careless enough to lose a wallet, they deserve to have it stolen. People force me to lie when they ask me too many questions.

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I lose my temper because people try to make me mad. If people don’t cooperate with me, it’s not my fault if someone gets hurt. Assuming the worst (secondary) Assuming the worst means that you think that only bad things can happen to you and that you cannot do anything about what happens to you. It also means that you or other people will not be able to change and make improvements. Assuming the worst about other people means that you think everyone is always out to get you (example: if someone bumps into you in the hall you assume he did it on purpose instead of thinking it was an accident). Additional examples: If I don’t steal it, somebody else will. I might as well lie, people aren’t going to believe me anyway. I can’t help losing my temper a lot. You can’t trust anybody; hurt them before they hurt you. Note: Definitions courtesy of the Lubbock County, Texas Detention Center. Examples from Gibbs, Barriga, & Potter (2001).

We call the primary cognitive distortion “self-centered” (see Box 4.2). The selfcentered distortion has been called an attitude of entitlement, something like: “Because I want to do it, I am entitled to,” “Because I desire something, that makes it mine” (Yochelson & Samenow, 1976, 1977), or, simply, “the world owes me” (Redl & Wineman, 1957). (One common variant among violent offenders— something like “Because I was abused, the world owes me or I can abuse others”— is also a distortion.) Redl and Wineman gave as an example of self-centered distortion the responses of a youth who had stolen a cigarette lighter and was confronted: His only defense seemed to be, “Well, I wanted a lighter.” When further challenged, “Yes, you wanted a lighter but how about going to such lengths as to steal it from someone?” he grew quite irritated. “How the hell do you expect me to get one if I don’t swipe it? Do I have enough money to buy one?” . . . The act · · · was quite justifiable to him . . . “I want it, there is no other way, so I swipe it—just because I want it.” (pp. 154–155)

Self-centered distortion also comes up in the early weeks of Moral Reasoning Training. I remember one of our group members at a juvenile correctional facility who seemed to consider that he had sufficiently justified his having stolen a car with the explanation: “I needed to get to Cleveland.” Other group members, reflecting on their shoplifting and other offenses, have recollected that their thoughts at the time concerned whether they could do what they wanted and get away successfully. (The middle school student Joey was not locked up yet, but his concern with surveillance cameras fits right in here.) Note that the only perspective these juveniles took was their own; spontaneous references to the victims of the offenses were totally absent.

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The primary cognitive distortion of self-centered is especially clear in groups of aggressive male juveniles. Such youths have been described as “fixated at a level of getting their own throbbing needs met, regardless of the effects on others” (Carducci, 1980, p. 157). Their self-centered attitude comes out plainly when we use the following vignette (actually part of our version of Anger Control Training in our expanded version of ART called EQUIP): Gary is in the kitchen of his apartment. Gary’s girlfriend, Cecilia, is angry at him for something he did to hurt her. She yells at him. She pushes his shoulder. Thoughts run through Gary’s head. Gary does nothing to correct the errors in his thoughts. Gary becomes furious. He swears at Cecilia. A sharp kitchen knife is nearby. Gary picks up the knife and stabs Cecilia, seriously wounding her. (Potter, Gibbs, & Goldstein, 2001, p. 56)

We (Gibbs et al., 1995; Potter et al., 2001) ask the aggressive juveniles: “What thoughts do you think ran through Gary’s head?” Among the most popular answers are these, suggestive of self-centered distortion: “Who does she think she is? Nobody hits me. I wear the pants around here. I do what I want. How dare she touch me!” Such cognitive distortions correlate highly with actual assault (e.g., Barriga & Gibbs, 1996; Liau, Barriga, & Gibbs, 1998; Barriga et al., 2000). Real-life Cecilias are at risk for serious harm from real-life Garys.

Secondary Cognitive Distortions Especially when we ask about the thoughts that ran through Gary’s head after he stabbed her, we hear answers like: “I taught her!” “She hated me and was going to leave me!” and “She was the one who was careless enough to leave out that knife.” We call these distortions, respectively: minimizing/mislabeling (for example, the stabbing was an educational service), assuming the worst (for example, about Cecilia’s intentions), and blaming others (for example, a victim such as Cecilia). These distortions (see Box 4.2) are “secondary” to or supportive of the primary distortion (self-centered): specifically, after the Garys of this world stab the Cecilias, the Garys—unless they are outright psychopaths—often do begin to experience empathic distress, guilt, or negative self-evaluation. That negative affect is something they try to pre-empt, “neutralize” (Sykes & Matsa, 1957), or rationalize away. One 17-year-old delinquent, reflecting back upon his burglaries, said: “If I started feeling bad, I’d say to myself, ‘tough rocks for him. He should have had the house locked better and the alarm on’” (Samenow, 1984, p. 115). Well, at least he started to feel bad and had to do something about it. Redl and Wineman (1957) suggested that we find encouragement in delinquents’ use of such neutralizing distortions; after all, a youth truly without empathy or conscience would not need any neutralizations because there would be nothing to neutralize!

REMEDYING THE DEVELOPMENTAL DELAY The rationale for remedying antisocial youths’ moral developmental delay is straightforward. To the extent that their developmental delay and antisocial

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behavior stem from a paucity of social perspective-taking opportunities, then Moral Reasoning Training should provide an enriched, concentrated “dose” of such opportunities to stimulate them to “catch up” to an age-appropriate or mature level of moral judgment. As others’ perspectives are considered in their own right, superficial judgments give way to the construction of more ideal and intrinsically moral understanding, which can motivate moral behavior. At the same time, egocentrically biased or self-centered and rationalizing judgments give way to more balanced, non-defensive, accurate moral perceptions and interpretations. More accurate perception of others typically means more empathy for others. It can also mean more empathy-based guilt if one has harmed others, instead of getting rid of that guilt the way the 17-year-old burglar did by blaming his victims. And it means, in the future, more anticipatory empathy-based guilt when one thinks of aggressing against others (Hoffman, 2000). In short, perspective-taking promotes ideal reciprocity and empathy—and thereby the use of the Skillstreaming and Anger Control components in daily life.

Problem Situations in the Social Decision-Making Meeting Moral Reasoning Training provides concentrated social perspective-taking opportunities through “social decision-making” meetings. In these meetings, participants must give defensible reasons for their problem-solving decisions in the face of challenges from developmentally more advanced peers and group leaders (e.g., Gibbs, Arnold, Ahlborn, & Cheesman, 1984). A Stage 1- or Stage 2-thinking participant— who may usually dominate peers—may lose in a challenge from a more mature peer and may accordingly experience an inner conflict or “disequilibration” that could stimulate a more mature moral understanding. This challenge process is cultivated through certain structured questions and through the “phases” that characterize the course of a good meeting (to be discussed shortly). Although we may refer to the goal of the meeting as the making of mature moral decisions, remember that our concerns go deeper than the decisions per se. Just as “having moral values” means “understanding the deeper reasons for the importance of moral values,” “making moral decisions” means “making decisions based on mature moral reasons.” Although we are concerned of course that the group achieve responsible social decisions and values, we are more fundamentally concerned with the maturity of the reasons used by the group to support or justify those responsible decisions and values. In social decision-making meetings, the group strives to develop mature moral reasons, decisions, and values pertaining to specific problem situations. We depart from the common practice in moral education of using moral dilemmas, which can be genuinely problematic and may not have “right” answers. In contrast, our problem situations generally do have right or responsible answers—for instance, deciding to try to persuade a friend against stealing a car (see “Alonzo’s problem situation,” Box 4.3). The problem is that the right answer might not be immediately apparent (for example, resisting the car theft and ride may not be favored if the ride is mislabeled or misconstrued as “doing fun things with a friend”). Similarly, problem situations in which the right answer is to tell on a friend (for example, if

60 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

the friend is dealing in drugs or talking about plans to shoot people at school) may be experienced as dilemmas because the peer norm against “ratting” or “narking” is so strong. Box 4.3 Sample problem situation Date: Your name: Alonzo’s problem situation Alonzo is walking along a side street with his friend Rodney. Rodney stops in front of a beautiful new sports car. Rodney looks inside and then says excitedly, “Look! The keys are still in this thing! Let’s see what it can do! Come on, let’s go!” What should Alonzo say or do? 1. Should Alonzo try to persuade Rodney not to steal the car? should persuade/should let steal/can’t decide (circle one) 2. What if Rodney says to Alonzo that the keys were left in the car, that anyone that careless deserves to get ripped off? Then should Alonzo try to persuade Rodney not to steal the car? should persuade/should let steal/can’t decide (circle one) 3. What if Rodney says to Alonzo that the car’s owner can probably get insurance money to cover most of the loss? Then should Alonzo try to persuade Rodney not to steal the car? should persuade/should let steal/can’t decide (circle one) 4. What if Rodney tells Alonzo that stealing a car is no big deal, that plenty of his friends do it all the time? Then what should Alonzo do? should persuade/should let steal/can’t decide (circle one) 5. What if Alonzo knows that Rodney has a wife and child who will suffer if Rodney is caught, loses his job, and goes to jail? Then should Alonzo try to persuade Rodney not to steal the car? should persuade/should let steal/can’t decide (circle one) 6. Let’s say the car is your car. Alonzo is Rodney’s friend, but Alonzo is also your friend. Alonzo knows it’s your car. Then should Alonzo try to persuade Rodney not to steal the car? should persuade/should let steal/can’t decide (circle one) 7. In general, how important is it for people not to take things that belong to others? very important/important/not important (circle one)

MORAL REASONING TRAINING 61

8. Let’s say Alonzo does try to persuade Rodney not to take the car, but Rodney goes ahead and takes it anyway. Alonzo knows Rodney’s in bad shape from being high—he could have a serious accident and someone could get killed. Then what should Alonzo do? contact the police/not contact the police/can’t decide (circle one) Source: From Potter et al. (2001). EQUIP program implementation manual. Champaign, IL: Research Press. Copyright (2001) Potter, Gibbs, and Goldstein. Reprinted by permission

The 12 problem situations, derived from various sources, are used both in ART and in our expansion of ART, the EQUIP Program (Gibbs et al., 1995; Potter et al., 2001). The settings represented by the situations range from the home to the school or correctional facility to the workplace. The situations are designed to stimulate discussion helpful to promoting a more mature understanding of the reasons for moral values or decisions such as telling the truth, keeping promises, not stealing or cheating, having honest peer and family relationships, resisting drugs, and preventing suicide. Each situation depicts an adolescent with a problem, typically one created by someone else with a problem (an effective way to induce a non-defensive discussion). The problem situations’ potential to stimulate perspective-taking is promoted through their associated discussion questions. In Alonzo’s problem situation (see Box 4.3), question 6 stimulates the group participants to take the perspective of the prospective victim (“Let’s say the car is your car”)—a question that, ironically, recruits the self-centered bias against itself! Other questions stimulate group members to consider possible adverse consequences for the prospective thief (question 8) and his family (question 5). Still other questions stimulate the removal of impediments to perspective-taking by planting secondary cognitive distortions such as blaming others (question 2), and minimizing/mislabeling (questions 3, 4) for group members to identify and correct. By the way, we are often asked how youths can learn the cognitive distortion categories in the first place, and now we have a good answer. It is called EQUIPPED for Life (Horn, Shively, & Gibbs, 2001), a recently developed board game. We are finding that EQUIPPED for Life is a relatively easy and even fun way for participants to learn the four (one primary, three secondary) thinking error categories. Participants also learn the link between these errors and their destructive consequences, and how to replace the errors with accurate thoughts and constructive responses. Participants who have played the EQUIPPED for Life game seem to do particularly well in identifying and challenging the thinking errors planted in our problem situation probe questions.

Phases of the Social Decision-Making Meeting Besides the stimulation from discussion questions, challenges to take others’ perspectives are also cultivated through the format of the meeting, specifically its four

62 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

phases: Introducing the Problem Situation, Cultivating Mature Morality, Remediating Developmental Delay, and Consolidating Mature Morality. These four phases are described in the second edition of Aggression Replacement Training (Goldstein, Glick, & Gibbs, 1998) as well as in our EQUIP program publications (Gibbs et al., 1995; Potter et al., 2001). I will try to communicate some sense of these four phases, with an emphasis on how they promote perspective-taking. Before getting into the phases, however, I should note two things you can do to fully actualize the perspective-taking potential of the social decision-making meeting. First, you can obtain moral judgment stage scores for each participant; the best way to do this is to use our Sociomoral Reflection Measure—Short Form (SRM—SF; see Box 4.4; Gibbs, Basinger, & Fuller, 1992; Basinger, Gibbs, & Fuller,

Box 4.4 SRM—SF 1. Think about when you’ve made a promise to a friend of yours. How important is it for people to keep promises, if they can, to friends? Circle one: very important important not important Why is that very important/important/not important (whichever one you circled)? [This format is also used for the remaining questions.] 2. What about keeping a promise to anyone? How important is it for people to keep promises, if they can, even to someone they hardly know? 3. What about keeping a promise to a child? How important is it for parents to keep their promises to their children? 4. In general, how important is it for people to tell the truth? 5. Think about when you’ve helped your mother or father. How important is it for children to help their parents? 6. Let’s say a friend of yours needs help and may even die, and you’re the only person who can save him or her. How important is it for a person to save the life of a friend? 7. What about saving the life of anyone? How important is it for a person (without losing his or her own life) to save the life of a stranger? 8. How important is it for a person to live even if that person doesn’t want to? 9. How important is it for people not to take things that belong to other people? 10. How important is it for people to obey the law? 11. How important is it for judges to send people who break the law to jail?

1995). Second, you can have the prospective group members individually work through the given problem situation and its probe questions. As the group leader, you then collect the responses and organize them in a matrix or chart. Include a row at the bottom that lists the majority decisions. A sample chart for Alonzo’s problem situation, based on answers I collected some years ago, is provided in Figure 4.1. Note that most of the decisions are responsible (try to persuade not to steal), although some are “can’t decide,” and some are negative (let steal). Based on this pattern, you can prepare yourself with some helpful guesses: for example, that mature moral reasons will tend to go with responsible decisions; that Steve—a

MORAL REASONING TRAINING 63

Name

Question Number 1

2

3

4

5

6

7

8

Jay

a b

P

P

P

P

P

P

Ic

CDd

Vince

P

P

P

P

P

P

Ve

CD

Marty

P

P

CD

P

P

P

V

CD

Steve

P

P

P

P

P

P

V

C

Juan

CD

S

S

P

P

P

I

CD

P

P

I

C

P

P

I

D

S? P? P Group decision outcomes

P

I?

CD?

P

I

CD?

P

Bill

P

Mike

P

CD

Group decision

P?

S?

Group decision

P

P

P P

P

P P

P

P

Figure 4.1 Response to Alonzo’s problem situation. Notes: a Should let steal b Should try to persuade not to steal c Important d Can’t decide e Very important Where two answers are given, the second represents the participant’s changed decision following group discussion.

consistently responsible decider and who had scored Stage 3 in moral judgment— should especially be called on to help cultivate mature morality; that Jay may try to dominate with pragmatic reasons and irresponsible decisions; that Bill could go either way, etc. At the start of the meeting, it may be important to remind the group of certain ground rules, like: never put down or threaten anyone; listen to what others have to say; stay on the subject; and never talk to anyone outside the group about what is said in the meeting. At the close of the meeting, you should conduct an evaluation using our checklist (Box 4.5), which is organized according to the four phases.

Phase 1: Introducing the Problem Situation To have an effective social decision-making meeting, all group members must understand clearly what the problem situation is and how it relates to their lives. You can ask what the problem situation is, why it is a problem, whether problems like this actually happen, and so forth. In Florida several years ago, I watched appreciatively as a gifted teacher working with a group of mentally low-functioning, conduct-disordered boys communicated a problem situation by having some volunteers from the group act out the situation. I would recommend such a role-play if there is any question as to whether the group understands the problem situation.

64 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

Box 4.5 Equipper’s Review and Self-evaluation Form: Social Decision Making Equipper Session/problem situation

Date Group

In general
yes
no 1. Did group members follow the ground rules (concerning listening, confidentiality, etc.)?
yes
no 2. Were all group members interested and involved? If not, list the names of uninvolved group members:


yes
no 3. Did you find some constructive value in every serious comment made by a group member?
yes
no 4. Did you maintain a normal voice volume and speak in a respectful rather than threatening or demanding tone?
yes
no 5. Did you maintain a balance between criticism and approval by using the “sandwich” style of constructive criticism (in which a critical comment is preceded and followed by supportive ones)?
yes
no 6. Did you use the “ask, don’t tell” intervention as much as possible?

For the session In the various places, did you . . . Phase 1: Introducing the problem situation
yes
no 1. Make sure the group understood the problem situation (e.g., “Who can tell the group just what Jerry’s problem situation is? Why is that a problem?)?
yes
no 2. Relate this problem situation to group members’ everyday lives (e.g., “Do problems like this happen? Who has been in a situation like this? Tell the group about it”)? Phase 2: Cultivating mature morality
yes
no 3. Establish mature morality as the tone for the rest of the meeting (e.g., eliciting and listing on the easel pad reasons for each positive majority decision)?

MORAL REASONING TRAINING 65


yes
no 4. Support and relabel the “should” as strong (e.g., “Yes, it takes guts to do the right thing”)? Phase 3: Remediating moral developmental delay
yes
no 5. Use more mature group members and their reasons (Phase 2) to challenge the hedonistic or pragmatic arguments of some group members?
yes
no 6. Create role-taking opportunities in other ways as well (e.g., “What would the world be like if everybody did that?”, “How would you feel if you were Bob?”)? Phase 4: Consolidating mature morality
yes
no 7. Make positive decisions and mature reasons unanimous for the group (e.g., “Any objections if I circle that decision as the group decision/underline that reason as the group’s number one reason?”)?
yes
no 8. Praise the group for its positive decisions and mature reasons (e.g., “I’m really pleased that the group was able to make so many good, strong decisions and back them up with strong reasons”, “Would the group like to tape this sheet onto the wall?”)? Post-meeting
yes
no 9. Did you make notes regarding the session and individual group members? Source: From Potter et al. (2001) EQUIP program implementation manual. Champaign, IL: Research Press. Copyright (2001) Potter, Gibbs, and Goldstein. Reprinted by permission

Phase 2: Cultivating Mature Morality Once the group understands the problem situation and accepts it as relevant, Moral Reasoning Training proper can begin. Your aim in this phase is to cultivate a group atmosphere of mature morality comprising responsible decisions and mature moral reasons for those decisions. The makings of such a climate are typically available from the group members (at least from the majority). On Alonzo’s problem situation (Box 4.3), for example, note that a majority of the group decided responsibly on questions 1 and 4 through 7 (Figure 4.1). Your job is to actualize the group’s positive potential in order to render mature morality prominent and to set the tone for the remainder of the meeting. Ask group members (such as Steve, in the example) who indicated responsible decisions about their reasons for those decisions, and write down those reasons on an easel pad or chalkboard.

66 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

Persuade

Important

Help your friends not get in trouble

Put yourself in the other ’s position

Rodney needs to think about his family Bible says stealing is wrong Could be your car

You get locked up

Rodney might get caught, in trouble, shot, killed, or in a wreck

Hurts trust I ’ve been robbed— it sucks ‚ You d feel bad, scared, angry, guilty

Let steal, Not important It ’s not important for people not to steal You’d be a big shot Lots of fun Exciting Now you can drive, get money, booze, girls, whatever you want

Figure 4.2 Alonzo’s problem situation: reason for social decisions

In the example, Alonzo’s problem situation, then, you would ask Steve and other responsible-decision group members about the reasons for their decisions (“should try to persuade Rodney not to steal the car” for questions 1 and 4, 5 and 6, “important” or “very important” for question 7, and, if feasible, “contact the police” for question 8 [“contact the police” is such a difficult option for these kids that sometimes we have just skipped discussion of this question]). I wrote down a whole host of group members’ reasons for “Persuade” and “Important” (see Figure 4.2). As might be expected given developmental delay, the prevalent tone of these reasons is pragmatic and self-centered. But not entirely, however—notice the mature perspective-taking in some of the reasons: that Rodney should think about his family; that you should put yourself in the other’s position and not steal; that stealing hurts trust; and that you’d feel guilty if you stole. To cultivate a mature moral climate, I paid particular attention to these reasons for not stealing and trying to persuade Rodney not to steal the car. Without my even saying anything, one group member spotted the blaming others thinking error in question 2 and said: “Everyone’s careless at one time or another. That doesn’t mean you deserve to get your car stolen.”

MORAL REASONING TRAINING 67

Phase 3: Remediating Moral Developmental Delay Your having successfully cultivated a mature moral atmosphere means that you are in a position to take on directly the problem of developmental delay. In other words, the group focus on mature reasons for moral decisions provides a crucial bulwark against the pragmatic influence of negative-deciding group members. To some extent, you have already started dealing with the developmental delay problem simply by not emphasizing the pragmatic among the reasons for the responsible decisions and not calling on the negative deciders. These negative group members cannot be put off forever, however. Having built up the mature reasons of the positive deciders, it is now time to invite the negative deciders to explain their reasons. Record those reasons on a flip pad or chalkboard (see Figure 4.2 sample). The pragmatic group members will sometimes argue that their reasons and decisions are more realistic and honest and hence more compelling. For example, Alonzo’s joining Rodney to “see what this baby can do” and have fun is superior because, after all, that is what Alonzo is actually most likely to do. Invite members of the majority—especially the mature reasoners—to respond to this pragmatic argument. What do the group members in the majority think of it? When I asked this question in the meeting on Alonzo’s problem situation, several group members responded that the argument was self-centered, that those group members were not thinking of the people who would be hurt. There are at least two things you can do to help the group counter such attack and thereby remedy developmental delay. First, you can relabel—or, as my co-author and EQUIP implementation specialist Bud Potter (Potter et al., 2001) says, rightlabel—the pragmatic “would” and moral “should” arguments. That is, you can counterattack the euphemistic labeling of the antisocial would as “only realistic” and “what you want” with a positive characterization of the should: “That’s true, it would take real guts for Alonzo not to give in to what he feels like doing and instead do what a lot of people might not be strong enough to do—the right thing.” Second, you can recognize that part of the problem is that developmentally delayed youth tend to be mentally concrete. Accordingly, you can make moral ideals concrete for them by appealing to a place where people do try to do the right thing. I will describe this technique in my conclusion.

Phase 4: Consolidating Mature Morality Once mature morality has been cultivated and defended, it needs to be consolidated and made as inclusive as possible. The group’s mature morality is consolidated— and the group’s culture becomes more positive and cohesive—as you seek consensus for positive decisions and mature reasons. As the pragmatic group members— feeling positive pressure—begin to defer to and even embrace mature morality, it is time to invite them to join the majority position. The goal in this final phase is to convert as many of the positive majority positions as possible into official, even unanimous, group decisions. Refer to the bottom row of the chart and ask: “Is the group ready to all agree that Alonzo should try to persuade Rodney not to steal

68 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

the car? Any objections if someone comes up and crosses out the question mark and circles that as the group’s decision?” Some group members at this point may change their decision, which you or a group volunteer can indicate on the chart (see Figure 4.1). For example, without any prompting from me, Jay, Vince, and Bill made changes to responsible decisions, shifting the majority decision in the reponsible direction (see Figure 4.1). Similarly, identify several mature reasons and suggest that, unless there is an objection, the group may ask someone to underline those reasons as “the group’s top reasons” for their positive decisions (see the italics in Figure 4.2). If you are not entirely successful, don’t worry; a stalemate can be developmentally stimulating, too. In any event, the group should be praised or encouraged at the conclusion of the social decision-making session.

THE EQUIP PROGRAM Cultivating a Caring Group Cultivating a mature morality in the social decision-making meeting is part of the larger need to cultivate a culture of caring among the youth participating in the Moral Reasoning Training and other components of ART. With the concentrated dose of perspective-taking opportunities it offers for remedying moral developmental delay, Moral Reasoning Training does facilitate the capacity to experience greater empathy, have moral values in a deeper (ideal reciprocity) sense, and make mature moral decisions. As we noted at the beginning of the chapter, Moral Reasoning Training can motivate youth to choose to use prosocial and inhibitory skills. I do not think Moral Reasoning Training can fully make this motivational contribution, however, unless the youths participating in the ART group become a positive, caring “culture.” I learned this point back at Clearbrook, where I gradually realized that the students were not really motivated to change; their participation in (what we came to call) social decision-making meetings was often half-hearted and sometimes downright resistant. To turn this situation around, I did two things. First, I came up with a technique by which the group could grasp moral ideals and discover their common prosocial values (more on that shortly). Second, I discussed the motivational problem with a colleague in the field, Bud Potter. Through comparing notes with Bud, I came to realize that I was up against a youth “culture” in which caring for and helping others was considered “uncool” or sissy and actively discouraged. Curiously, Bud was having the opposite problem: As an expert in the Positive Peer Culture (PPC; Vorrath & Brendtro, 1985) group techniques, Bud was having success in motivating problem youth to try to help one another change, but was realizing that they did not have the skills to be effective at it. In other words, Bud needed ART just as I needed PPC! The upshot of this story is that Bud and I and Arnie Goldstein got together to adapt and integrate Positive Peer Culture, ART, and techniques to correct criminogenic thinking errors. The result was what we call the EQUIP Program (Gibbs et al., 1995; Potter et al., 2001). In our program, Moral Reasoning Training is called “Equipping with Mature Moral Judgment.”

MORAL REASONING TRAINING 69

It is hard to classify EQUIP. When I got together with Goldstein, we (Goldstein et al., 1998) called EQUIP an “ART Plus Significant Others” program, where the significant others can be peers or family. But then I must say that when Bud and I presented EQUIP at Larry Brendtro’s Positive Peer Culture conference in South Dakota a few summers ago, we went along with calling EQUIP the way Larry saw it, namely as a “PPC Plus Psychoeducation” program! And both are true: the two intervention approaches complement each other. EQUIP gives youth in PPC groups psychoeducational helping skills thanks to (our adaptation of) ART. Reciprocally, EQUIP gives ART groups a positive environment of significant others thanks to (our adaptation of) PPC. And EQUIP gives to both programs an emphasis on the correction of thinking errors, thanks to our adaptation of the work of cognitivebehaviorists like Aaron Beck (1999), Kenneth Dodge (e.g., Dodge & Schwartz, 1997), and Samuel Yochelson and Stanton Samenow (1976, 1977). You should definitely consider using EQUIP if you are implementing ART in a long-term residential facility where you have an opportunity to develop an effective culture of caring—as Arnie (Goldstein et al., 1998) put it, “to capture a major portion of the youth’s environment and turn it in a prosocial direction” (p. 203). If you can expand the prosocial context by including the youth’s post-release peer and family environment, so much the better. Outcome evaluation studies (see Goldstein et al., 1998, chapter 8) document that cultivating a caring social environment to whatever extent feasible results in an enhancement of ART’s effectiveness.

Concluding Comment Besides my exchange with Joey, I remember another meaningful exchange from my work in the late 1980s at Clearbrook. I directly asked a group member named Calvin (who was also 15, like Joey): “How should you feel when you steal something? Should you feel guilty?” Calvin emphatically rejected the question: “Man, you show me a thief who feels guilty,” he asserted, “and, man, I give you everything I own.” I was finding such concrete, pragmatic rejections of the “should” or moral ideals as irrelevant to be a distressingly common stance among antisocial youth and a major impediment in Moral Reasoning Training. Fortunately, thanks to a problem situation I had been developing with the group, I had an answer for Calvin: “But you could be on Planet B, Calvin,” I said. “Remember? Planet B people do care and feel bad when they hurt someone. It’s the planet most of the guys selected. And I know that this group has got the strength to be a group that cares, like the people on Planet B.” Other group members—and then even Calvin—assented: caring is not irrelevant, “out of this world,” or unrealistic if the world is like Planet B, a place we can grasp and remember through a story. We now call the Planet B exercise “The Martian’s Adviser’s Problem Situation,” and it sets the group tone for the EQUIP version of Moral Reasoning Training. It reads as follows: A man from Mars has decided to move to another planet. He has narrowed his search down to two planets, Planet A and Planet B. Planet A is a violent and dangerous place to live. People just care about themselves and don’t care when they hurt others. Planet B is a safer, more peaceful place. People on Planet B do

70 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING care about others. They still have fun, but they feel bad if they hurt someone. Planet B people try to make the planet a better place. You’re the Martian’s adviser. Which planet should you advise him to move to? Planet A/Planet B/can’t decide (circle one)

It is remarkable how much this one exercise can contribute to the motivation of an ART group to use its prosocial and inhibitory skills. Moving to the prosocial planet, Planet B, is typically the majority decision. In fact, when group members make their decisions on this problem situation individually and privately prior to the group meeting—the private circumstances reduce the salience of social norms against caring as “uncool”—the majorities approach unanimity. Hence, through this exercise, a group of cynical or antisocial youths can discover that they do after all share values of caring and prosocial behavior. When asked for reasons for their decision, many group members appeal to the respective planet descriptions: there’s not as much violence on Planet B, it’s safer, it’s more peaceful, people have fun without hurting others, and—especially pertinent to motivating youth to care—people want to help one another, work to make things better, and feel bad and apologize if they do hurt others. On one occasion, we found poignant a reason added pensively by one of the young group members for going to Planet B: “Parents spend more time with their kids.” Of course, given the pervasiveness of moral developmental delay, some group members do choose and argue for Planet A. On one occasion, some group members suggested that Planet B is a “goody goody” place, and that on Planet A “There’d be lots of drugs and booze and sex” and “Nobody’d be sticking their nose in your business.” A Planet B decider countered that there was still fun on Planet B, and that freedom on Planet A isn’t worth it if everybody minding their own business means that people are getting hurt and hurting others. You may find it easy to make Planet B the official group decision, and caring intentions the top reason. Be prepared to help the group, though, if it falters in responding to challenges such as that no one interferes on Planet A. Keeping in mind what Moral Reasoning Training is all about, you can provide a perspective-taking opportunity: “What if someone you did care about—say, a parent or brother or sister or close friend—was going to commit suicide? Would you just let them do it, because after all, don’t stick your nose in their business? And no one else would care, either. That’s what Planet A is like.” More briefly, you can ask what the basic thinking error is on Planet A. (The answer is: self-centered.) With this assistance, the group majority may prevail and even become unanimous in the choice of Planet B. These prosocial values are not just for the Martian, of course, but for the members of the group. You should encourage your group to make their group a Planet B. It is important to emphasize that every (or almost every) group member would prefer, not only for the Martian but for him- or herself, a world that is safer, more trusting, more caring. But because their common individual preference can easily be undone by that adolescent “caring is uncool” norm, you must work to “make caring fashionable,” as Vorrath and Brendtro (1985) put it. Remember “right labeling” and ask: “Where are the truly strong people? On planet A or on planet B?” Right labeling can support a “you can make it happen here” appeal to the group:

MORAL REASONING TRAINING 71 What kind of group do you want this group to be—Planet A or Planet B, negative or positive? If Planet B is what the group wants for itself, have group members been living up to it? The group can make it happen, but it will not unless the group practices what it preaches. That’s tough work, but this group has what it takes to make itself a Planet B.

Planet A and Planet B can become therapeutic tools or “handles” for the group. The terms provide handles for contrasting groups: Planet A as a shorthand term for a collection of self-centered, rationalizing, and superficial individuals who neither trust nor care about each other; or Planet B as a shorthand term for a community of mutually caring persons who have moral ideals and who are striving toward responsible thinking and acting. Such handles make it easier for youths who are otherwise concrete and pragmatic thinkers—like Calvin—to grasp moral ideals. The new vocabulary is quite useful in later ART group sessions. Instead of simply asking how things have been going, you can ask whether the group has slipped back toward Planet A or has continued to progress toward Planet B. I conclude with a hypothetical reply to Calvin: Dear Calvin, I did show you that day a thief who feels guilty, on Planet B. But you don’t have to give me everything you own. Yes, I “won” that day, but I wasn’t the only winner with my successful Planet B counter-challenge to you. You also won as you said Yes to caring. The group won as they discovered common positive values, corrected thinking errors, and gained moral ideals. The winners would include, over ten years later, practitioners who may now also help youth with Planet B and the positive skills of Aggression Replacement Training or EQUIP. The winners include all of us who can now make concrete our ideals of caring in advice to a Martian, and strive toward making Planet B our home, too, right here on this Earth. Thanks, John Gibbs

REFERENCES Barriga, A. Q. & Gibbs, J. C. (1996). Measuring cognitive distortion in antisocial youth: Development and preliminary validation of the “How I Think” questionnaire. Aggressive Behavior, 22(5), 333–344. Barriga, A. Q., Landau, J. R., Stinson, B. L., Liau, A. K., & Gibbs, J. C. (2001). Cognitive distortion and problem behaviors in adolescents. Criminal Justice and Behavior, 27, 36–56. Barriga, A. Q., Morrison, E. M., Liau, A. K., & Gibbs, J. C. (2000). Moral cognition: Explaining the gender difference in antisocial behavior. Merrill-Palmer Quarterly, 47, 532–562 Basinger, K. S., Gibbs, J. C., & Fuller, D. (1995). Context and the measurement of moral judgment. International Journal of Behavioral Development, 18, 537–556. Beck, A. T. (1999). Prisoners of hate: The cognitive basis of anger, hostility, and violence. New York: HarperCollins. Carducci, D. J. (1980). Positive Peer Culture and assertiveness training: Complementary modalities for dealing with disturbed and disturbing adolescents in the classroom. Behavioral Disorders, 5, 156–162. Colby, A., Kohlberg, L., Speicher, B., Hewer, A., Candee, D., Gibbs, J., & Power, C. (1987). The measurement of moral judgment, Vol. 2. Cambridge: Cambridge University Press.

72 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Damon, W. (1977). The social world of the child. San Francisco, CA: Jossey-Bass. Dodge, K. A. & Schwartz, R. (1997). Social information processing mechanisms in aggressive behavior. In D. M. Stoff, J. Breiling, & J. D. Maser (Eds), Handbook of antisocial behavior (pp. 171–180). New York: John Wiley & Sons. Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart. Ellis, A. (1977). Rational-emotive therapy: Research data that support the clinical and personality hypothesis of RET and other modes of cognitive-behavior therapy. Counseling Psychologist, 7, 2–42. Flavell, J. H., Miller, P. H., & Miller, S. A. (1993). Cognitive development (3rd edn). Englewood Cliffs, NJ: Prentice-Hall. Gibbs, J. C. (2003). Moral development and reality: Beyond the theories of Kohlberg and Hoffman. Thousand Oaks, CA: Sage. Gibbs, J. C., Arnold, K. D., Ahlborn, H. H., & Cheesman, F. L. (1984). Facilitation of sociomoral reasoning in delinquents. Journal of Consulting and Clinical Psychology, 52, 37–45. Gibbs, J. C., Barriga, A. Q., & Potter, G. B. (2001). The How I Think questionnaire. Champaign, IL: Research Press. Gibbs, J. C., Basinger, K. S., & Fuller, D. (1992). Moral maturity: Measuring the development of sociomoral reflection. Hillsdale, NJ: Lawrence Erlbaum Associates. Gibbs, J. C., Potter, G. B., & Goldstein, A. P. (1995). The EQUIP program: Teaching youth to think and act responsibly. Champaign, IL: Research Press. Goldstein, A. P., Glick, B., & Gibbs, J. C. (1998). Aggression Replacement Training: A comprehensive intervention for aggressive youth (rev. edn). Champaign, IL: Research Press. Gregg, V. R., Gibbs, J. C., & Basinger, K. S. (1994). Patterns of developmental delay in moral judgment by male and female delinquents. Merrill-Palmer Quarterly, 40, 538–553. Hoffman, M. L. (2000). Empathy and moral development. New York: John Wiley & Sons. Horn, M., Shively, R., & Gibbs, J. C. (2001). EQUIPPED for life [game]. Champaign, IL: Research Press. Kazdin, A. (1995). Conduct disorders in childhood and adolescence (2nd edn). Thousand Oaks, CA: Sage. Kohlberg, L. (1984). Essays on moral development: The psychology of moral development. San Francisco, CA: Harper & Row. Krevans, J. & Gibbs, J. C. (1996). Parents’ use of inductive discipline: Relations to children’s empathy and prosocial behavior. Child Development, 67, 3263–3277. Leeman, L. W., Gibbs, J. C., & Fuller, D. (1993). Evaluation of a multi-component group treatment program for juvenile delinquents. Aggressive Behavior, 19, 281–292. Liau, A. K., Barriga, A. Q., & Gibbs, J. C. (1998). Relations between self-serving cognitive distortions and overt vs. covert antisocial behavior in adolescents. Aggressive Behavior, 24, 335–346. Lickona, T. (1983). Raising good children. Toronto: Bantam. Piaget, J. (1965). Moral judgment of the child (M. Gabain, trans.). New York: Free Press (original work published 1932). Potter, G. B., Gibbs, J. C., & Goldstein, A. P. (2001). EQUIP program implementation guide. Champaign, IL: Research Press. Redl, F. & Wineman, D. (1957). The aggressive child. Glencoe, IL: Free Press. Samenow, S. E. (1984). Inside the criminal mind. New York: Random House. Sykes, G. M. & Matza, D. (1957). Techniques of neutralization: A theory of delinquency. American Sociological Review, 22, 664–670. Vorrath, H. H. & Brendtro, L. K. (1985). Positive Peer Culture (2nd edn). New York: Aldine. Yochelson, S. & Samenow, S. E. (1976). The criminal personality, Vol. 1: A profile for change. New York: Jason Aronson. Yochelson, S. & Samenow, S. E. (1977). The criminal personality, Vol. 2: The change process. New York: Jason Aronson.

PART II

ESTABLISHED APPLICATIONS ART appears to be an effective intervention with a variety of trainees and in a variety of contexts. From its initial applications in delinquency centers and then schools, it has since also found a comfortable home in a variety of community and family agencies. The chapters which follow share these diverse applications, nicely illustrating the manner in which creative clinicians, teachers, and others prescriptively shape their work in order to fit the particular, individualized needs of their ART trainees. Competent ART trainers know the ART procedures well, are skilled in delivering their content, are able to manage their (sometimes acting-out) trainee groups well, are comfortable with and even enjoy working with adolescents and younger children, are models of prosocial behavior themselves whenever they interact with trainees, and help ART’s benefits generalize. Who the ART trainers are (race, gender, professional credentials), in my view, matters very little. While we have long urged that the foregoing several competencies are necessary to make for a skilled ART trainer, just how those several competencies are to be acquired is and should remain an open matter. Stated otherwise, while we hope that all ART trainers will show high levels of knowledge of the method, good teaching and group management skills, and so forth, we also believe that such abilities can be acquired via a variety of trainer-training approaches. In the opening chapter of this section, Rob DiFlorio looks at the use of ART in a school. Rob is the vice-principal of a very challenging and unusually successful inner-city elementary school in Syracuse, NY. Those of us who have watched him in action a number of times have seen him turn challenge into opportunity, turn aggression into a positive learning experience. The use of ART in schools is also the concern of Mark Amendola and Robert Oliver from Erie, Pennsylvania. Mark directs a large, multi-site, and very successful community agency called Perseus House. Robert is the Principal of the Collegiate Academy, a very special school for special youngsters in Erie. Their community-based ART work is of such especially good quality that they frequently receive visitors from Europe, Australia, and elsewhere to see their exemplary efforts first hand. The widespread use of ART in community settings, together with training ART practitioners, has been the creative effort of Mikael Kalt, Mariusz Hermelin, and Evan Brilje and their fine organization, The Youth Alternative, which began in Malmo¨ and has since spread throughout Sweden and beyond. In their chapter they discuss the challenges of working across a range of settings. The chapter by Rune Nens´en and Nikolai Hamstein of Barnhammet Oasen, in Aneby, Sweden, describes

74 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

their very talented use of ART in a family center context, one in which the ART group is often all the members of a given family. The final chapter by Danny Clark of the UK Home Office and Professor James McGuire of the University of Liverpool reflects on the issues in organizing and delivering a national dissemination of ART by the National Probation Service in England and Wales.

Chapter 5

APPLICATION IN AN INNER-CITY ELEMENTARY SCHOOL ROB DIFLORIO Consultant, Syracuse, New York, USA

In today’s schools, it is not uncommon to hear conversations about raising students’ academic standards. The push for national and state assessments has bombarded parents, teachers, administrators, and all school personnel. In today’s fast-paced, multimedia, Internet society, it is essential to believe and stand behind the “ethos of raising the standards.” However, as we plunge into this next century of higher-order thinking and higher academic achievement, we must not forget the sole purpose of education; that is, creating democratic, peaceful human beings who will contribute to our society. The purpose of teaching our children reading, writing, and arithmetic is not to show how well we do or how well we are doing as a school or school district, but rather to instill the knowledge and values to assist our children to contribute in some positive form to our society.

DISCIPLINE AND DISRUPTIVE BEHAVIOR The challenge of continually increasing academic standards is never going to disappear. Unfortunately, this challenge will never be met until we face the most difficult task set in front of us each day, the task of teaching the aggressive and disruptive student. Susan Striepling summed up today’s schools when she stated that the days of children sitting quietly with hands folded in front of them, waiting for the lesson to begin, are long gone (Goldstein & Conoley, 1997). As many of us know, disruption and violence have invaded far too many of our schools. Fighting, cursing, name calling, pushing, shoving, assaults, beatings, insubordination, and weapons have become routine features in some of our schools. Interestingly, violence and disruptive behavior are no longer “urban problems” as evidenced by recent data that demonstrate major concerns in rural and suburban schools; nor are New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


76 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

they confined to any social, economic, cultural, or ethnic groups (Goldstein, 1996, 1999a; Goldstein & Conoley, 1997). Today, teachers nationwide are spending more time each day dealing with and controlling the “disruptive child.” Every day students, parents, educators, and others voice concerns about the hostility that plagues our society. While schools remain one of the safest havens for many students, the threat of disruption and violent acts is on everyone’s mind. Just the thought that something could happen in school not only distracts from the educational process, but also provokes fears. Recent school shootings have once again raised the resolve of parents and politicians to do something about these dreaded and horrific events. For many educators, there is nothing new in these demands. The Phi Delta Kappa/Gallup Polls (2000) throughout the years have established that the biggest problem facing public schools today is safety: lack of discipline, fighting, gangs, violence, and drugs have been at the top of the list year after year. Many public school educators have historically seen the conventional, mild misbehavior from the past turn into the aggressive, violent behavior of today. American public education has seen many changes in the twentieth century. In more recent years, one of the most shocking changes has been in elementary schools. Elementary schools are beginning to discover significant increases in the number of behavior violations that occur on a daily basis. However, as we are all aware, the intensity of discipline and behavioral problems has increased so dramatically that no comparisons can be made between what existed then and what exists today. The most frightening data note that the greatest increase in crime and inappropriate behavior is occurring at the elementary school level (Goldstein, Harootunian, & Conoley, 1994; Dahlberg, 1998). While today’s elementary schools are dealing with discipline and behavioral concerns on a much more concentrated and intensified level, the profound increase in social isolation and lack of a sense of belonging have placed intervention skills above those of academic achievement (McGinnis & Goldstein, 1997). The question then arises as to where this behavior comes from and what we should do about it. Some researchers link it to various aspects of a child’s life: from home, school, television, video games, or the street or play area. Goldstein (1999b) indicates that disruptive and aggressive behavior is learned from the child’s total environment and is no different from the learning of any other behavior, whether positive or negative. What then do elementary teachers do about the aggressive and disruptive child? Since anger is one of the most common and powerful emotions experienced by children and is often the culprit behind difficulties children have expressing feelings and controlling their impulses, they continue to find that it is easier to allow their anger to get control of them instead of controlling their anger (Stephens, 1995). Thus, when a teacher is confronted with this anger their most frequent response is reactive, by using what some practitioners call the “Pavilion method”: when you break our rules you will be sent to the Principal’s office. He or she will then send you to detention, to in-school suspension, or if the behavior was severe enough, you will be sent home for out-of-school suspension. Although this method of reactive school discipline may have worked in the past where spitballs and gum chewing were the most severe behavior, it has been proven to be ineffective where fistfights, assaults,

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verbal abuse, and other violent acts take place. There is a critical need to have a proactive school-wide approach that focuses on targeted aggressive behaviors and utilizes the strength of teachers and their teaching skills. Not only do school-wide approaches need to be consistent from year to year but a sense of resiliency needs to be instilled in every member of staff in order to prevent them from adopting a defeatist attitude when faced with the overwhelming task of changing behavior.

DELAWARE ACADEMY Delaware Academy is an N-6 elementary school located on the Westside of the City of Syracuse and has over 700 students attending. It is also located in one of the poorest sections of the city and was recognized in 1994 by US News and World Report as the 12th most impoverished neighborhood of the nation’s urban centers. In the 2000–01 school year, Delaware Academy had a diverse student population coming from various racial, ethnic, and cultural backgrounds: 75% constituted various minority groups, 32% had limited English-speaking skills, and 27% were identified as having a disability. Nearly all students at Delaware Academy received a free or reduced-cost lunch and resided in neighborhoods that have extremely high rates of poverty, drug abuse, violence in the streets, and one-parent families. During the 1999–2000 school year only 25% of Delaware students met state standards while the other 75% were considered to be academically at risk or students in need of highly specialized academic skill development. Delaware Academy has the highest suspension rate of all elementary schools in the Syracuse City School District. The number of out-of-school suspensions in the 1999–2000 school year was 690 and there were 586 in-school suspensions. The total number of instructional days lost during this 1999–2000 school year due to disciplinary action was 1,534. The major causes for suspension of students at Delaware Academy are disruptive behavior, such as disrespectful, uncooperative behavior, failure to comply with a reasonable request, use of verbal and abusive language, verbal harassment of a student, and verbal harassment of staff.

Aggression Replacement Training at Delaware Academy It was after the incident in Colombine, Colorado, where two students entered their high school and began killing and wounding classmates and others that American public schools really began to take a long hard look at what is occurring at home. Schools throughout the nation became seriously alarmed and no longer ignored the present status of their schools’ students’ behavior and the potential for violence. A dramatic revolution was occurring in America. Schools in the Syracuse City School District were no different than the nation’s schools. They too developed school committees and various organized groups, which alerted the Syracuse Board of Education to review and modify its security practices. The real problem, however, rested with the ever-growing incidence of aggression in schools.

78 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

Delaware Academy sprung into action by developing a special group of staff entitled the Social Emotional Committee (SEC). The charge of this committee was to find suitable ways on a school-wide basis to begin to decrease the significant increases in student disciplinary actions and to find suitable approaches that would have a lasting and impressionable effect throughout an elementary child’s school career. To further emphasize the importance of the task of the committee, Daniel Goleman’s books, Emotional Intelligence (1995) and Working with Emotional Intelligence (1998), became required reading and assisted in inspiring the committee to choose a simple, practical, organized approach in helping children control their aggressive behaviors. Further, the books primarily researched and substantiated that the emotional health and the necessity for children to receive instruction on social skills will eventually increase academic achievement. Goleman’s research on the importance of how to get along with others is a crucial element in the workplace today. According to Goleman (1998), “A survey of American employers reveals that more than half the people who work for them lack the motivation to keep learning and improving in their job. Four in ten are not able to work cooperatively with fellow employees, and just 19 percent of those applying for entry-level jobs have enough self-discipline in their work habits” (p. 12). In a national survey of employers, reported by Goleman, specific technical skills are now less important than the underlying ability to learn on the job. Of seven major traits that employers wanted in new employees, only the basic academic skills of reading, writing, and arithmetic were of importance. Listening, oral communication, adaptability, personal management, confidence, group and interpersonal effectiveness, cooperativeness, teamwork, and skills at negotiating disagreements were of paramount concern to the people who would eventually be hiring Syracuse City school graduates. Thus, Daniel Goleman’s work helped outline for the committee the reality in today’s fast-paced, multimedia society where children are being judged by different rules and regulations. The committee recognized that to enter our societal workplace requires more than just good academic skills but also depends on how well people can get along with others and accept criticism. While the Social Emotional Committee’s major goal was to look at the whole child in terms of their academic well-being, significant high-level forms of aggression were continuing to rise at Delaware Academy. During the school year 1998–1999, Delaware Academy implemented its first year of Success For All (www.successforall.net), a research-based reading program from Johns Hopkins University. This program had been successful in 48 states in both rural and urban areas, and the staff at Delaware opted to implement the program to begin to intervene in the cycle of academic failure. Along with Success For All, being a reading program focusing primarily on academics, it also has a component of social skills training called “Getting Along Together.” The program focuses on teaching the cooperative learning standards which, according to Success For All, are: practice active listening, help encourage each other, everyone participates, explain yourself and tell why, and complete tasks. The program, “Getting Along Together,” teaches the cooperative learning standards in a systematic way. One important component to this curriculum is the three hand signals that are used throughout the school. These hand signals are the zero noise signal, the active listening signal, and the 123 lining up signal. These

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signals were to be taught in every classroom so any staff member could use them in order to maintain good classroom, playground, and cafeteria control. While the three hand signals were presented in general form, the staff at Delaware Academy devised specific procedures on how to successfully implement the signals. Further, Delaware staff incorporated an added procedure entitled “resistance” into the existing procedures to assist teachers and other staff to respond successfully when students were being uncooperative and unruly. The three hand signal procedures were carefully and simply written so that any working staff at Delaware would be capable of meeting their expectations (Box 5.1). Box 5.1 Hand signal procedures “Zero noise” signal Steps: 1. Teacher raises full hand straight in the air without talking. 2. Students raise their hand with ZERO NOISE. Suggestion: Auditory signal to get students’ attention:

r Clapping r Counting r Bells/chimes etc. Resistance:

r Affirmation (catching them being good) r Re-teach r Reward system (stickers, points, stars, etc.) r Look at student r Teach students to give each other visual cues r Proximity “Active listening” signal Steps: 1. Teacher holds fingers straight up in the air in a V formation. 2. Students: a. Look at the speaker. b. Sit up straight. c. Hands on lap or table. d. No talking/mouth closed. Resistance:

r Affirmation (catching them being good) r Re-teach

80 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

r Reward system (stickers, points, stars, etc.) r Look at student r Teach students to give each other visual cues r Proximity “Lining up” Signal Steps: 1. Teacher holds one finger in the air and says “One, gather your things.” Students should gather material; put items in desk, etc. 2. Teacher holds two fingers in the air and says, “Stand and push in your chair.” Students stand up straight and push in their chairs. 3. Teacher holds three fingers in the air and gives directions of where the students should move to; SFA, line up at the door, etc. Students follow directions and move to their designated area. Resistance:

r Affirmation (catching them being good) r Re-teach r Reward system (stickers, points, stars, etc.) r Look at student r Teach students to give each other visual cues r Proximity It was evident after the first year of implementing Success For All that teachers were still finding difficulty in teaching the cooperative learning standards. The Social Emotional Committee concluded that even though the use of the Johns Hopkins’ “Getting Along Together“ curriculum was implemented, there was a greater need to focus more intensively on teaching social skills in order for the cooperative learning standards to be implemented effectively. The Social Emotional Committee, made up of 12 people and including an administrator, social workers, teachers, reading facilitators, and teaching assistants, decided to attend a workshop given by Dr Arnold Goldstein based on Aggression Replacement Training (ART). Upon completion of the conference, the Delaware committee returned to school with enthusiasm and confidence that ART would greatly assist by reducing the aggressive behaviors that existed in the school environment. This excitement was conveyed to other staff at the school and the seeds of integrating ART into the regular school day were planted at Delaware Academy. Thus, shortly after the ART conference with Dr Goldstein in February 2000, three of the teachers who attended the conference decided to implement and pilot skills training in their classroom. Each of these teachers chose various social skills from McGinnis and Goldstein (1997). After two months of using ART, the teachers returned to the Social Emotional Committee and explained their successes with their children. They further emphasized that by adopting ART social skills

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Skillstreaming (behavioral component) Teaches what to do the skills curriculum

Anger Control Training (emotional component) Teaches what not to do reduces anger, aggression

In all classrooms 30 minutes per week during classmeeting

Small groups 45 minutes per week

Moral Reasoning Training (the values component) Teaches why to use the skills increases prosocial motivation

Small groups 45 minutes per week

Figure 5.1 Aggression Replacement Training model for Delaware Academy

training school-wide, they could considerably change the behavioral climate of the school and teach students the social skills needed in order to implement the cooperative learning standards that are so important to Delaware’s Success For All reading program. At the same time a whole-school approach was being discussed, the Social Emotional Committee wanted to also provide an additional focus on those who were presenting severe behavior problems, particularly those who were aggressive in a physical, harmful manner. The committee suggested that teachers could identify small groups of students who fall in this category of high-level aggression to teach the Anger Control Training and Moral Reasoning part of ART. The groups were to be broken down by both age and gender. Students would be taught for 45 minutes with 6 students per group (Figure 5.1). It was determined that due to a lack of staff it would be very difficult for any teacher to commit their time to teach Anger Control Training and Moral Reasoning to the small groups of high-level aggressive students. However, with close-knit ties to the community at large, Delaware Academy staff made a connection with the Onondaga Pastoral Counseling Center and requested their assistance. The Center responded by providing a counselor with the purpose of teaching the groups of identified high-level aggressive students along with those having a long history of sexual, physical or emotional abuse. The majority of children in the Anger Control Training groups were often suspended for aggressive and violent behaviors such as destruction, throwing objects, fighting, hitting, punching, etc. Frankly and unfortunately, the students were easily identified. The children ranged from second to sixth grade. A Delaware teaching assistant was assigned to the group to assist the counselor in teaching, following up with students after sessions, and helping to transfer the learned skills into the everyday situations they faced. Maintenance of the sessions proved to be an integral and essential part of the small group sessions. In late spring 2000, the Social Emotional Committee provided the entire faculty with the pilot successes being attained in both the small groups using Anger Control Training and Moral Reasoning and the Skillstreaming being piloted in the three teachers’ classrooms. Recognizing the significance of what was occurring, the entire Delaware staff asked to speak with Dr Goldstein to gain a more comprehensive understanding of ART. Shortly after Dr Goldstein’s inclusive presentation of ART to the staff, the committee incorporated for the first time ART into the existing rules and regulations

82 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

of the pupil behavior code at Delaware Academy. In its deliberations to include ART in the existing behavior code, the staff selected 10 Skillstreaming skills that would not only reinforce the existing “Getting Along Together” curriculum, but also provide a structured framework and process for teaching social skills. The ten skills that were selected by the committee from the ART curriculum are listed in Box 5.2. Box 5.2 Ten selected Skillstreaming skills, 2000–01 school year 1 2 3 4 5 6 7 8 9 10

Listening Asking for help Saying thank you Following instructions Apologizing Expressing your feelings Showing understanding of another’s feelings Dealing with your anger Using self-control Responding to teasing

To further strengthen and support the implementation of ART, a summer 2000 training in-service was held for staff training. The session included all disciplinary data, in-school suspensions, out-of-school suspensions, and a common definition of aggressive behaviors that occur regularly in the school. The purpose of clarifying definitions of aggressive behavior was to establish a common language for all staff to communicate effectively. The rationale for giving teachers data on disciplinary behaviors was extremely important because it supported Delaware teachers’ personal beliefs that the amount of aggressive incidents occurring during the school year was extremely high for Delaware Academy. Furthermore, it validated the need for a sense of urgency that ART would be useful in helping them to start focusing more on teaching prosocial skills to students. During the summer training session, approximately 40 teachers attended the ART sessions. Data were reviewed for both academic achievement and behavioral information. There was always an emphasis on the importance of maintaining student control to accomplish student achievement. Model Skillstreaming lessons were taught and reviewed as well as teaching strategies for the social skills. A student video was made that demonstrated to students what all three hand signals meant and the importance of obeying the signal when a staff member gave it. The video was to be presented and demonstrated to students and, more importantly, to be used in the in-school suspension room as an additional tool for reinforcing the signal rules. The video was also to model to students a better approach to antisocial behavior and to teach the value of social skills instead of just accepting some type of punishment for misbehaving. The approach of taking reactive discipline such as in-school suspension or other school suspensions and turning it into a proactive and positive learning situation by teaching prosocial skills made for quality teaching and learning. The summer workshop also included a review of the 10 social skills

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selected to be taught in the 2000–01 school year, which were once again scrutinized for student adaptability. This summer training outlined for teachers an implementation plan that would occur during the 2000–01 school year. The implementation plan dictated that for the first 21/2 weeks of school, students would learn the first four Skillstreaming skills selected for at least a half-hour each day. The four skills selected were listening, asking for help, saying thank you, and following instructions. For the remainder of the school year teachers would then teach the remaining social skills at least a minimum of a half-hour per week. As the 2000–01 school year began and implementation of Skillstreaming skills was taught, teachers became more convinced that the teaching of social skills training in their classroom reduced the amount of aggressive behavior. In short, the more instruction in Skillstreaming skills, the greater reduction of aggressive behavior. For some teachers, the results were so profound that they began to teach Skillstreaming for the first 15 minutes every morning of every day. In these classrooms there was less aggressive behavior and more time being spent on instructional activities on a daily basis. During the month of March, a refresher was provided to all staff in order to maintain enthusiasm for the program, re-teach the Skillstreaming skills, and to continue to emphasize that achievement will not occur if social skills are not operating appropriately. Another aspect of the March workshop concentrated on making reactive discipline proactive using practical applications of ART. Since student discipline is generally reactive, ART uses the reactive situation as a proactive learning situation. For example, a child strikes another child, disrupts the classroom, and is sent out of the classroom for some type of disciplinary action. At Delaware Academy, whatever the antisocial behavior, a prosocial behavior will be taught utilizing a repertoire of Skillstreaming skill responses. For example, Roberto is a second grader who exhibits a high level of antisocial behavior and is often sent to a timeout room for interrupting the class by yelling and not following directions. While in the timeout room, Roberto would be taught the Skillstreaming skill, “Following Directions.” Roberto role-plays the skill with the timeout teacher and the next time Roberto is not following directions his teacher can remind Roberto to practice the skill before he starts to exhibit a higher level of aggression.

RESULTS The results of using ART to teach proactive disciplinary behaviors at Delaware Academy have proven the program to be effective. Teachers have incorporated and interwoven each curriculum into their daily teaching, with continued positive reinforcement being provided by all support and administrative staff. Quality time is being devoted to encouraging students to use more effective methods to control their anger and to behave in an appropriate manner. Efforts are beginning to pay off for the staff and administration at Delaware Academy. The number of out-of-school suspensions decreased dramatically, as did the number of instructional days lost in 2002 to disciplinary action. Table 5.1 demonstrates the results for 2000–2001 compared to 1999–2000.

84 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Table 5.1 Delaware Academy’s discipline record Disciplinary event In-school suspension days Out-of-school suspension days Out-of-school informal hearings Out-of-school formal hearings Total days lost

1999–2000

2000–2001

586 690 48 210

407 149 45 220

1534

821

Box 5.3 Anger control training—case study A 12-year-old girl had numerous out-of-school and in-school suspensions. After attending Anger Control Training classes she had no out-of-school or in-school suspensions that school year. This child reported that the Anger Control Training classes she attended had “changed her life.” She reported that as she gained more control over her anger, her life at home and in school improved. She stated that, “I get along with my brothers and sisters now, and my mother and me hardly even get mad at each other. When I feel like I’m getting mad I start doing all the things in my Anger Control Training class and things get better, not worse.”

The anger control training groups have also proven to be extremely successful. Box 5.3 is an example of a 12-year-old student who was on the verge of being excluded from school and began attending the anger control training groups. To enhance further our efforts to work with aggressive children, Delaware Academy has received a major grant from the State of New York Violence Prevention Program for a three-hour extended day program. The program serves 150 kindergarten through sixth grade students each school day and is composed of three equal, one-hour strands: one hour dedicated to academics, another to the arts, such as music, dance, drama, etc., and a third strictly dedicated to social skills, including Aggression Replacement Training. The academic strand, comprising three prominent faculty members from Syracuse University along with five graduate students and ten undergraduates, operates on a student–tutor ratio of 10 to 1. The social strand is under the direction of Syracuse University Center for Research on Aggression and is supported by business, community, and parent groups. The enrichment strand will vary and will include City School District personnel. The Office of Professional Development at Syracuse University will share administrative responsibilities and will design and consult on program professional development modules. While we are still far from our school goals, we nonetheless believe we have come a long way in reducing the number of aggressive incidents due to the efforts

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of the Aggression Replacement Training program. We also believe that future school years will show more promising and exciting results and will, we hope, meet our goal of providing children of Delaware Academy skills for success in life.

REFERENCES Dahlberg, L. (1998). Youth violence in the United States: Major trends, risk factors, and prevention approaches. American Journal of Preventative Medicine, 14, 259–272. Goldstein, A. P. (1996). Violence in America: Lessons on understanding the aggression in our lives. Palo Alto, CA: Davis Black. Goldstein, A. P. (1999a). Low level aggression: First steps on the ladder to violence. Champaign, IL: Research Press. Goldstein, A. P. (1999b). The Prepare Curriculum: Teaching prosocial competencies. Champaign, IL: Research Press. Goldstein, A. P. & Conoley, J. C. (1997). School violence intervention: A practical handbook. New York: Guilford Press. Goldstein, A. P. & Glick, B. (1987). Aggression Replacement Training: A comprehensive intervention for aggressive youth. Champaign, IL: Research Press. Goldstein, A. P., Harootunian, B., & Conoley, J. C. (1994). Student aggression: Prevention, management and replacement training. New York: Guilford Press. Goleman, D. (1995). Emotional intelligence. New York: Bantam Books. Goleman, D. (1998). Working with emotional intelligence. New York: Bantam Books. McGinnis, E. & Goldstein, A. P. (1997). Skillstreaming the elementary school child. Champaign, IL: Research Press. Rose, L. C. & Gallup A. M. (2000). The 32nd Annual Phi Delta Kappa/Gallup Poll of the public’s attitudes toward the public schools. Phi Delta Kappan, 82, 41–66. Stephens, A. B. (1995). Conflict resolution: Learning to get along. (Research report ISBN-0-87652215-0.) Arlington, VA: American Association of School Administrators.

Chapter 6

COLLABORATION WITH HUMAN SERVICES AND SCHOOLS MARK AMENDOLA AND ROBERT OLIVER Erie, Pennsylvania, USA

What does it take for a community and its human service providers to structure and engage in partnership relations? As we endeavor to design policy and implement programs that will effectively and cost-efficiently meet the needs of high-risk youth and their families, it is imperative to develop partnerships and relationships that transcend cooperation and become collaborative in nature. This chapter outlines the incorporation of Aggression Replacement Training in a community-based collaborative program in the USA. The collaboration is a county-wide effort with a local school district, a private provider, offices of juvenile probation and child welfare, and supported by the Office of Human Services. The National Assembly of National Voluntary Health and Social Welfare Organizations defines collaboration as: The process by which several agencies or organizations make a formal sustained commitment to work together to accomplish a common mission. Collaboration requires a commitment to participate in shared decision-making, and allocation of resources related to activities responding to mutually identified needs. (Bruner, 1990, p. 4)

While inter-agency cooperation has grown over the past two decades, it has often been limited by agency turf issues as well as the fear of who owns the “program” and ultimate accountability for measurable outcomes. Collaboration is set apart from both cooperation and coordination. Until recently the literature has provided little separation between coordination, cooperation, and collaboration. These terms have been, for the most part, ill defined and used interchangeably. In collaborative relationships, all partners own the project, and thus responsibility is shared. Cooperation has been typically an intra-agency function, while coordination and collaboration refer to inter-agency. Elder and Magrab (1980) offer a definition of

New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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coordination as cooperative efforts within an agency and collaboration as coordinated efforts across agencies. Webster’s New World Dictionary defines collaborate as “To work together, especially in some literary, artistic, scientific undertaking.” Kagan (1991) delivers a more specified definition and identifies collaborations as “Organizational and inter-organizational structures where resources, power, and authority are shared and where people are brought together to achieve common goals that could not be accomplished by a single individual or organization independently.” Risk-taking behaviors may occur with collaboration and a quality of apprehension may still exist between entities. The challenge of collaboration is to join together with like or unlike organizations for a common cause and to work toward goals that would not normally be achieved without the collective efforts of each other. As noted, and as consistent with our experience, Kagan (1991) emphasizes three dimensions as central to effective collaboration: 1. Resources: the ability to share resources and combine them into a concerted effort provides partners with the opportunity to be more efficient and effective in service delivery. Resource sharing is particularly advantageous in the areas of personnel, training, and operational strategies. The ability to make joint use of resources creates an environment conducive to improving the quality of service delivered, as resource limitations often restrict solo ventures to deliver services. 2. Power: power represents the ability to “do” something in a persuasive manner. People are the stronghold of organizations, and personalities that productively utilize power can create opportunities that enable collaborations to exist. A combination of individuals who are extraordinary in this capacity may form partnerships that are extremely powerful. In this regard, it is critical to develop relationships among those individuals who possess the skills creatively to anticipate the community environment and respond in a manner that is proactive. 3. Authority: authority is the state of having permission to take specific final actions within the framework of moral and ethical constraints. Authority that is shared permits a culture of consensus building. Communication with partners and staff is critical for daily operations. Toward this end, to the extent that they may hinder the development of effective collaboration, traditional hierarchical systems of vertical communication may have to be modified or even abandoned. This requires a paradigm shift of traditional organizational structures and engagement in a boundary-less (horizontal) system that permits free flow of communication from within and through each level (see Table 6.1). Effective communication is the main ingredient for success. The ability of partners effectively to express needs in an environment of trust is the primary step for collaborative viability. Also, communication that is connected among partners assists with breaking down communication barriers. Regularly scheduled management meetings may facilitate this process. Decisions should be made through consensus building which includes key personnel. This may take more time than the traditional process of organizational structures but assures staff involvement and compliance with policy and procedure through staff empowerment. Intraagency collaboration is encouraged to improve work processes and communication

COLLABORATION WITH HUMAN SERVICES AND SCHOOLS 89 Table 6.1 Organizational structure Boundary-less

Hierarchical

1. Communication is interconnected 2. Decisions are made through consensus building 3. Accountability is an expressed expectation 4. Intra-agency collaboration is encouraged 5. Training and skill development are critical for program integrity and performance appraisal

1. Communication is dictated top-down 2. Decisions are made by the “boss” 3. Fear of mistakes directs employee misperformance 4. Departmental competition breeds mistrust 5. Control and manipulation are used as motivators

patterns. Finally, attention to and implementation of staff training for skill development enhance facilitator confidence and proficiency. This collaborative process of maximizing resources of human service agencies and schools is best described through the application of concepts.

COLLABORATION WITH HUMAN SERVICES AND SCHOOLS A model example of collaboration is the Collaborative Intensive Community Treatment Program (CICTP) located in Erie, Pennsylvania. The CICTP is a collaborative effort that has incorporated numerous partners to achieve the ultimate goal of residential diversion of male and female adolescents within a community setting. Program ingredients will be reviewed in terms of agencies involved in the collaboration and staffing patterns. We also will describe the program interventions in terms of the types of activities and how they are delivered. This chapter will outline the development and structure of this project.

GUIDING PRINCIPLES OF COLLABORATION The application and implementation of collaborative principles, which will be outlined, were helpful in the development of collaborative continuum in Erie, Pennsylvania. 1. Mission and vision are the birth of any program. Erie county had been experiencing significant gaps in alternatives to residential treatment for adolescents. This created an opportunity to assess and critically evaluate the current delivery system of residential care in the community. The vision of the developers of the program was to create a system that would allow adolescents who were in need of residential care to remain in the community, and, most importantly, with their families. The vision was to create a service that would replicate residential care

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yet provide adequate supervision so they did not need 24-hour residential surveillance. This would also provide a mechanism for the early reintegration of those youth in facilities in need of aftercare support upon return to the community. 2. Strategic leadership forms and moulds successful measures. The need to have key strategic leaders involved in the formation of this project was critical. County representatives, who were able to make policy and administrative decisions, were solicited for their input from the initiation of the project. Their views and opinions helped shape the direction of the initiative. If we had not had their endorsement, it would have never moved forward. 3. Customer relationships are one of the most important factors in the project formation. All collaborators had professional relationships that were customer focused. Each trusted the integrity of the other and felt confident and comfortable that dialog shared was open and honest. Feedback was solicited and encouraged, as seen by continued meetings that focused on what goals were to be accomplished and how they were going to be implemented. 4. Alliance of partners creates a culture that solidifies lines of communication. As the project developed there was a need for frequent communication between key leaders. This created an alliance that assured program integrity. All partners served as quality control administrators as we problem-solved and reviewed alternatives on a daily basis. This process also fostered additional trust among partners. 5. Responsibility and accountability become the core of quality control. To develop a program that would be a viable alternative to residential placement, the supervisory team focused on team accountability and responsibility. Shared supervision assisted in multiple ownership of the program. No one group or agency owned the program but rather the collaborators were responsible for the project, which increased the opportunity for successful implementation. 6. Comprehensiveness of service is critical to produce a service that would meet the needs of referred individuals. To provide a program that would operate seven days a week was the request of county customers and truly in the best interest of the clients. 7. Decision making and consensus building involve all levels of staff. In order to make program decisions that were practical, it was important to involve staff at all levels. We met with supervisory staff in regularly scheduled meetings but we also met with program staff and collaborators to solicit their feedback and opinions regarding decision making. We then collated the data and evaluated central themes that could be used for continuous quality improvement. This process took time, but the final results were effective due to staff participation. 8. Accountability and responsibility are functions of all collaborators. All collaborators were involved in the delivery of the program and no one agency or group owned the project. This led to mutual ownership of the program and increased the investment of all collaborative partners. It also brought to the table different views of supervision and accountability that improved program maintenance. 9. Cross-system communication and consensus building originated and were sustained by the partners. The inclusion of multiple partners brought together multiple systems that in and of themselves communicated on a very superficial level. The cross-system communication efforts improved the communication patterns of all parties and helped develop an increased awareness of the barriers that each group experienced. What then transpired was an increased level of trust and

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respect that ultimately broke down any preconceived beliefs that may have been erroneous due to lack of communication. 10. Team performance of all members is interdependent. Roles were clearly defined and each partner understood the specific tasks that were to be achieved. The private provider was responsible for clinical implementation, the school district was responsible for fiscal administration, and the county partners were responsible for quality control. All collaborators were responsible for day-to-day program implementation and operation. 11. Program modification is critical to ongoing operations. The ability continuously to evaluate the program and develop modifications as necessary was key and continues to be vital to program development. We maintain open lines of communication to modify the program. Flexibility and creativity are concepts that all partners embrace. This continuous quality improvement is what assists in maintaining the program. 12. Collaboration increases problem solving through the expertise of the partners. By bringing to the table multiple partners with experience in multiple disciplines, we developed a leadership team that had well over 20 years of experience in their respective roles. This group was well versed in problem-solving techniques and strategies to eliminate barriers. This would not have been accomplished at this level if the program had been operated by one group. 13. Value congruence assisted the development of the project. It was necessary for the collaborators to reach consensus regarding professional values and belief systems. We did this by discussing initial program goals and objectives. It became evident that we generally agreed on what should be accomplished and how it should be done. If we could not have reached this agreement, it would have been extremely challenging to further the project. 14. Problem solving and conflict resolution should be incorporated into the team operation. Central leadership should take an active role in solving problems but needs to empower staff to independently resolve conflict. One method used is a suggestion box at each site that gives the staff the opportunity to submit suggestions and solutions to problems. A second, more formalized, method is the use of supervisory meetings to solicit feedback from staff. Consensus building is the preferred approach to problem solving. 15. Ease of delivery of service for staff and clients was important for program implementation. The ability to deliver a service that was user friendly for both the staff and clients was an agreed-upon value early in the project development. To meet comprehensively the needs of the clients, it became necessary to develop a competency-based model that would be practical and efficient. Goldstein’s Aggression Replacement Training model best met our needs.

DEVELOPMENT RATIONALE Conceptualization and Formation The rationale for the development of the CICTP was formulated in response to the county’s escalating costs associated with increased residential placements of youth. To complicate the matter, in 1996 the federal government determined that

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counties no longer would be eligible for federal Title IV-A dollars, which helped subsidize room and board for placements. In Erie County, this decreased amount totaled $2 million. This reduction created a projected deficit and a serious fiscal problem for county representatives. The School District of the City of Erie and Perseus House, Inc., a local not-for-profit organization, had developed coordinated and cooperative agreements but had not taken the risks that collaborative ventures assure. Administrators from both entities were impressed with the development of the Erie–Warren Project which had been implemented four years earlier. The Office of Mental Health/Mental Retardation (MH/MR) developed the Erie– Warren Project in response to escalating costs associated with state hospitalization of the chronically mentally ill. The county proposed to the state that if the state would allocate the same dollars to the county that it was expending for hospitalization, Erie County could replicate, for a majority of the population, similar services. The MH/MR office, in collaboration with numerous local providers, developed and implemented a viable plan for the transition of these clients to return to the community. This was a lesson learned regarding the redefinition of resources and the reallocation of existing dollars. The Erie School District and Perseus House, Inc. administrators had experience in both residential and community-based therapeutic settings for adolescents. They believed that there was a significant percentage of adolescents who could be diverted from residential care if similar supports were available in the community. They also felt strongly that there was a group of clients who were in placement who may have been able to reintegrate into the community earlier than anticipated if this service were available. Focus had to be on supervision, intervention, and the inclusion of the family in the treatment plan. This was the initial stage of collaborative conception and formation, which was dictated by both community crisis and a gap in service. The Erie School District and Perseus House, Inc. met on numerous occasions to develop the program curriculum. This process included a series of meetings that evolved over a period of two years. Perseus House, Inc.’s Executive Director and the Erie School District’s Supervisor of Student Assistance Programs explored issues relevant to the project, including financial restraints, clinical considerations, staffing patterns, educational requirements, supervision, and program structure. Vision, mission, and objectives were discussed fully. It is important to note that we had extensive dialog regarding the mission of the program—what we wanted to achieve, how we were going to move forward, and whom we needed to include in key discussions were reviewed. In regard to initial structural formation, Perseus House was responsible for fiscal administration and clinical supervision, and the School District was responsible for the physical plant site, transportation, and maintenance. Once a viable program description had been developed, both organizations met with local county representatives, including the Chief Probation Officer and the Director of Children and Youth Services. The first meeting was encouraging due to their response. The representatives felt that there was a need for such a program, but there was an air of apprehension and uncertainty. County officials suggested specific program modifications. They stated that this project would need the approval

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of the court. We discussed strategies that would assist in our presentation to the court. We also requested that the county utilize only existing dollars that were currently allocated for residential programming. If we could stem the tide of escalating placement costs, then the mission of the project would be fulfilled. In this first meeting we also discussed goals and objectives of the program. The two agreed-upon initial goals of the program were and continue to be: (a) reduction of the clinical and behavioral need for residential placement and (b) reduction of the escalating fiscal and administrative burden assumed by the referent agencies. Concern was also raised regarding “turf” issues and who would be responsible for each specific component of the project. There were and continue to be numerous providers of human services in Erie County. The question we needed to address was how we were going to access existing services. One method we used was to meet with numerous providers and engage in articulation agreements that would share case management and related ancillary services. Probably one of the toughest barriers we still continue to encounter is that of “turf” and the protective nature of human services. Our view is that there certainly are multitudes of problems to deal with and this is much too challenging for any one group to take on individually. Ultimately, we are all trying to achieve the same goal: to improve the lives of those with whom we are in daily contact. Not only did we review service delivery, but there was extensive dialog regarding types of clients eligible for this program. The further we discussed program mission, goals and objectives, the population that could benefit became clear. The population that would have normally entered residential placements and had some family resources was the best group to try as a pilot. Furthermore, by utilizing a resource management approach, there would also be a resource available in the community to provide early reintegration from residential facilities.

Collaborative Development The program description was reworked and presented to county officials once again. This was met optimistically as we moved into the stage of collaborative development. With the support of Family Court and the President Judge, we initiated the development of the program. Program collaborators included the Office of Juvenile Probation and Children and Youth, the County MH/MR Office, the Erie School District, and Perseus House, Inc. It is significant to note that this was not the first collaborative effort of this group. It was preceded by the development of School-Based Probation, After-School Student Support, the Family Center, Alternative Education Programming, and Delinquency Prevention Programming. The CICTP would be an important addition to this collaborative continuum. The intention of the program was not only to add to the continuum but to integrate with the extensive services offered by existing programs. As the collaborators initiated planning meetings, it became evident that there was a developing mutual bond. All partners discussed the potential merit of such a program, which fueled motivation. Ideas were brought to the table that were at least considered and discussed in an atmosphere of trust and confidence. Weekly meetings were held at rotating sites. We joined with a local university to conduct our

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literature search on similar programs. They were also involved in the determination of parameters for our outcome study. A primary issue was the qualifications of staff who would be hired. We agreed that the most qualified personnel would be hired. We then proceeded to identify and recruit those individuals we knew “fit the bill.” We also placed an advertisement in a local newspaper for case managers. We had 160 applications for 5 full-time positions and 70 part-time positions. Initial screenings were conducted and then a team comprising collaborators interviewed the final candidates.

Collaboration Implementation The next stage was implementation, which is the “how” of the partnership. It was vital to all partners that the program, as planned, be delivered in a consistent manner. Teams were developed with counselors, teachers, recreational therapists, and team leaders. Key collaborative administrators provided staff training regarding program delivery. The full-time case management staff, with the clinical director, developed and packaged the curriculum. The partners met with all staff who were new to the program. Upon the start of the program, administrative staff modeled the delivery of program services and provided feedback to administrative staff through direct observation. We also used general logs to communicate effectively from team to team.

PROGRAM PHILOSOPHY The CICTP provides intervention services for both delinquent and dependent youth. The program incorporates the philosophical framework of the Balanced Approach and Restorative Justice model developed by the Federal Office of Juvenile Justice and Delinquency. The focus of the model is on developing balanced, community-based systems that utilize restorative sanctions and processes and related approaches to effect change in the juvenile justice system. The four guiding objectives of the model are accountability, community protection, competency development, and balance. Over the past six years, the Erie County Office of Juvenile Probation has experienced increasing referrals for delinquent behaviors. The Chief Probation Officer and collaborators have embraced the Balanced Approach and Restorative Justice model. Antolik (1995) perceived the implementation of the Restorative model as essential to his department’s transition to a balanced and restorative justice approach. The Balanced and Restorative Justice Project of the Federal Office of Juvenile Justice and Delinquency Prevention has developed model systems for community supervision of delinquents based on the balanced approach mission (Bazemore, 1992; Maloney, Romig, & Armstrong, 1988) and the restorative justice philosophy (Umbreit, 1989; VanNess, 1990; Zehr, 1990). These model systems are viewed as catalysts for changing the current juvenile justice system. The balanced approach for the juvenile justice system differs from traditional approaches through prescribed outcomes, concrete performance measures, and

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evaluation through measurable improvements. Prescribed outcomes for competency development, accountability, and community protection are focused on the three primary clients of the juvenile justice system: offenders, victims, and the community. This conceptual framework emphasizes three programming priorities: 1. Accountability. Through restitution and community service, offenders gain awareness of the impact of their actions on victims; it requires offenders to make amends for their actions. 2. Community protection. A continuum of sanctions provides for consequences for noncompliance. 3. Competency development. Education, work experience, and community service promote the development of skills that demonstrate that offenders are capable of productive, competent behavior. The balanced approach is individualized and is based on the offense committed and the needs and risks of the offender. Restorative justice (Zehr, 1990) is based on three values and assumptions: 1. Offenders, victims, and the community roles are included in the response to crime. 2. The response has complementary roles for government and local communities. 3. Offenders are held accountable through accepting responsibility for their actions and repairing the harm caused by their offenses. Restorative justice is focused on the broad relationships between offenders, victims, and the community (Lawrence, 1991; Zehr, 1990). Zehr (1985) viewed this approach as a paradigm shift from retributive justice (punishment, vengeance, deterrence) to restorative justice (mediation, empowerment, reparation). Philosophically, restorative justice provides an alternative that is neither punitive nor lenient in its focus. This model was a driving force in program development. First, the CICTP emphasizes accountability through monitoring and providing opportunities for restitution to victims and through ongoing viable community service projects. Second, community protection is provided through a seven-dayper-week continuum of intermediate, community-based surveillance and sanctions. Third, competency development is the focus of all program components. The ultimate goal is to develop clients who are capable of productive, competent behavior. Finally, balance is achieved through the program by tangible benefits gained by the community, the victim, and the offender.

DESCRIPTION OF AGENCIES The School District of the City of Erie is an urban district that serves 12,500 students. The school population lives in one of the highest areas of poverty per capita. The district has been innovative and creative in the development of programming for at-risk youth. The primary benefit of the district’s participation in the partnership is related to fiscal concerns. When a student is court-ordered to a residential facility,

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the home district is responsible for the cost of education. Typically those costs are more than it would incur if the students resided at home. There would be cost savings if students could receive similar residential services and still remain in the community. Aside from the cost savings, the district has always been interested in the provision of services that may benefit their students. The Juvenile Probation Office is responsible for disposition of all referrals for delinquent behavior. The benefit for this office’s collaborative involvement is that this is a viable alternative to residential treatment, which would help with the escalating expense of residential placement. Perseus House, Inc. is a not-for-profit organization that provides residential and community-based programming for males and females, grades k-12, with drug and alcohol, mental health, and behavioral problems. The benefit to Perseus House, Inc. as a collaborative partner was development of the ability to increase and improve the agency’s continuum of services.

STAFFING PATTERNS The CICTP operates seven days a week with students who are engaged in clinical, educational, and behavioral intervention through two distinct programmatic structures. The first is the Deferred Placement option. At disposition, placement has been recommended and is deferred to the CICTP. The second option is Community Reintegration, where the adolescent returns from placement approximately 45 days earlier than the average residential stay. The training and program focus has been, and will continue to be, inclusion of the family in the prescribed treatment and implementation of Aggression Replacement Training. Twenty-five local social service agencies are represented with a variety of proficiencies. This multi-trained and talented group of staff truly reflects a melting pot of disciplines which enhanced the treatment team. It would be difficult for any non-profit organization to duplicate similar staffing patterns with full-time staff without significant expenditures. The staff configuration is a unique design not typical of residential or community-based programming. There is a total of 40 staff employed, 12 full-time and the remaining 28 employees part-time. The full-time staff includes three case managers, a community service coordinator, an aftercare specialist, and support staff. The case managers provide non-traditional case management, which entails non-traditional hours and group facilitation of Aggression Replacement Training. They provide supervision and sanctions throughout the week. The decision to hire part-time staff was developed through consensus building, and an effort to contain costs related to full-time benefits. It was determined that in order for the program to be successful, it would need to be staffed by the most seasoned veterans. We developed a schedule that would accommodate part-time positions and still maintain program continuity. We were also able to allocate hourly rates that were higher than typical per-diem rates, thus attracting qualified staff. It is important to note that key administrative staff from all collaborators participated in the development of the program. They also provided the primary supervision, which has increased investment in program success. Communication

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between partners occurs on a daily basis, which also improves attention to daily detail. All partners embrace a holistic approach to client intervention as the program provides a comprehensive multimodal treatment model. This agreed-upon vision was developed through consensus and mutually determined collaborative goals.

PROGRAM OBJECTIVES Program objectives were developed in conjunction with the consensus of all collaborators. We had lengthy dialog regarding specific short-term objectives designed to meet our long-range goals: 1. To provide an opportunity for youth to remain in the community. 2. To use community resources to address and reduce behavioral problems and therefore divert residential placement. 3. To provide an atmosphere through which problem solving and individualized treatment planning can be undertaken by the client, the family, and referring agency to reduce the possibility of further behavioral problems. 4. To increase the potential for successful completion of educational goals. 5. To increase involvement of the family with the client to address behavioral problems which could lead to residential placement. 6. To provide cost-efficient intervention other than residential placement, group homes or institutions. 7. To provide for early reintegration of youth currently in placement, reducing placement by an average of 45 days. 8. To reduce the potential for future referrals to the court and therefore reduce the rate of recidivism. The outcome measures chosen to evaluate the decided-upon goals have had a direct impact on cost savings for residential expenses. The following are measures that we have utilized to assess program effectiveness: 1. 2. 3. 4.

Stabilization of growth in Erie County residential placements. Shortening length of stay regarding residential days. Decrease in dollars spent on residential placements. Recidivism rate that is the same or lower than current residential treatment facilities utilized by Erie County.

PROGRAM INTERVENTIONS Case Management The program is designed to provide a continuum of services to clients seven days per week. Clients attend the Alternative Education Program (AEP) from 10:00 a.m.

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until 6:00 p.m. daily, Monday through Thursday. The Deferred clients attend a sitespecific class at a local educational institution. The Reintegration clients attend AEP at their home school. The therapeutic component for both Deferred and Reintegration clients occurs Friday from 3:30 p.m. until 8:00 p.m., Saturday from 10:00 a.m. until 7:00 p.m., and Sunday from 9:00 a.m. until 3:30 p.m. A key component of the program is case management services. Case managers are responsible for tracking each client throughout the week to coordinate services. The case managers are full-time employees who primarily focus on assisting the client and family attain treatment goals. They ensure client participation in programs from the continuum that meet their needs. The case managers facilitate the Skillstreaming curriculum to enhance program continuity. The case managers also act as brokers and link clients with necessary community resources. They are responsible for providing ongoing coordination of all required services at home, in school, and during the weekend components of the program. They are the glue that holds the program together. The case managers monitor compliance with the AEP and compliance with Individualized Treatment Plans (i.e. house arrest status, curfew, etc.) through home visits and phone contacts. Curfew phone checks are provided randomly seven days per week.

Clinical Components The clinical program was designed by a group of key program collaborators with the intent of replicating residential treatment services. The behavioral component was designed by a selected group of team leaders and collaborative administrative staff. This process occurred over a period of two months and a series of eight meetings. Two teams were divided up based on staff expertise and then developed the behavior management system for approval by the full group. The clinical component was evolved, with general agreement from the planning group, with a philosophical framework of the achievement of competency development for both clients and their families. The primary clinical focus is Aggression Replacement Training expounded by Goldstein, Glick, and Gibbs (1986).

AGGRESSION REPLACEMENT TRAINING (ART) ART was initiated in 1987 with three major components of Skillstreaming, the behavioral component, Anger Control Training, the emotion targeted component, and Moral Reasoning, the cognitive component. Goldstein and Glick (1987) describe the first of three underlying rationales that guide ART principles, which is the importance of multimodal interventions: Behavior change in our view may result from interventions which are explicitly targeted on overt behavior, or which seek to diminish emotional responses which inhibit use of behaviors already in the person’s behavioral repertoire, or which provide information about the consequences of alternative behaviors. Behavioral, affective and cognitive interventions each in these differing ways possess potential for altering overt behaviors. Which, and how many of

COLLABORATION WITH HUMAN SERVICES AND SCHOOLS 99 these alternative intervention routes will correspond to any given youngster’s channels of accessibility will obviously vary from youngster to youngster. We believe, however, that it generally will prove efficacious to take more than one route simultaneously. The source and maintainers of aggression are diverse and multi-channeled, so must the remediation be. Skillstreaming is our behavioral intervention; Anger Control Training is affective in its substance; Moral Education is cognitive in nature. Guided by our multimodal philosophy, it is our hypothesis that these interventions yield superior outcomes to those resulting from single-channel interventions. (p. 18)

The second rationale is the development and implementation of a constructive treatment strategy that is described by Kazdin (1975): The constructive treatment strategy refers to developing a treatment package by adding components to enhance therapy . . . With the constructive approach the investigator usually begins with a basic treatment component that is relatively narrow or circumscribed in focus. Research is conducted that adds various ingredients to the basic treatment to determine what enhances treatment effects. As research continues, effective components are retained and a large treatment package is constructed. (p. 87)

Finally, Goldstein and Stein (1976) describe the development, application, and evaluation of ART as incremental prescription building: An incremental prescriptive strategy [is] one in which partial or tentative prescriptions are replicated, combined, and empirically examined in such a manner that one can ascertain whether the percent of outcome variance accounted for is, as predicted, progressively increasing. Klett and Moseley (1963) champion a similar incremental strategy. They propose a prescription-building process in which (a) active treatment ingredients are identified, (b) their weighing visa` -vis outcome variance is determined, (c) ingredients are combined into new sets and combinations, and (d) the new prescriptive combinations are offered, reweighted and so forth. (p. 19)

This multi-pronged approach fits with the intention and goals of the CICTP regarding competency development. The collaborators were also already familiar with utilizing ART throughout a variety of programs ranging, with extremely positive outcomes, from intensive residential services to community-based programming. The ART curriculum is delivered weekly to both the clients and parents. (We will describe the parent component later in this chapter.) With the client we choose the skill of the week; however, with the parent group the curriculum is negotiated as a tool of engagement. The groups have open enrollment and are selected by clinical indication. The following is a list of the various program interventions that have been incorporated into the program. 1. Skillstreaming: intervention with specific skill curriculum of prosocial behaviors systematically implemented with small groups, utilizing: a. modeling; b. role-playing; c. performance feedback; d. transfer training.

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2. Anger Control Training: a 13-week curriculum that is designed to teach selfcontrol of anger. Each client is trained to respond to specific “hassles” with a chain of behaviors that include: a. identifying triggers; b. identifying cues; c. use of reminders; d. use of reducers; e. use of self-evaluation. 3. Moral Reasoning: a set of procedures designed to raise the young person’s level of fairness, justice, and concern with the needs and rights of others. 4. Psychoeducational: an intervention designed to provide psychoeducational curriculum (e.g. HIV/AIDS, hygiene, stress, etc.) to small groups. 5. Drug and alcohol education: an intervention designed to provide drug and alcohol education to develop each client’s understanding of educational themes, e.g. the disease concept, biological impact of addictive behaviors, self-esteem, etc. 6. Communication/peer feedback: an intervention designed to develop each client’s ability to communicate effectively with peers and adults. Peer feedback provides the opportunity for praise, reinstruction, and related feedback through the use of positive peer culture. 7. Recreational therapy/creative arts: an intervention designed to teach cooperative, non-competitive assertive skills in a social environment through the development of prosocial leisure-time skills. 8. Systematic progressive relaxation: an intervention involving the understanding and development of biophysical dimensions of problems and coping strategies. It incorporates muscle relaxation training and guided imagery as a strategy for stress and anger reduction. 9. Victim impact empathy training: an intervention designed to increase each client’s ability to understand and empathize with the human consequences of crime. 10. Cultural sensitivity: an intervention designed to assist clients in the development of awareness and respect for similarities and differences among diverse groups. 11. Life skills training: an intervention designed to teach basic skills that may be applicable in daily living. 12. Victim/offender mediation: provides a forum for victims to question the offender and reach a mutual agreement to determine how restitution will be paid. Both the case managers and clinical staff deliver all interventions throughout the week. 13. Parent training: the primary focus of treatment is inclusion of the family in the treatment plan. Community-based settings tend to increase the opportunity for parent engagement because of physical proximity of parents to the program. We have also requested that the judiciary order parents to participate in the program. We utilize a structural family approach as we help families identify boundaries, strengths, and behavioral strategies to address their children’s behavior. This approach also may help parents, in a non-threatening manner, to evaluate their interactions with their sons or daughters. Parents attend weekly parent training groups that are both educational and supportive in nature. A unique feature of the parent training

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program is that parents also participate in Skillstreaming, and, twice monthly, they role-play relevant skills with their children in the group. We have seen success utilizing this strategy and have received feedback that although parents were initially intimidated, they found the role-play and feedback extremely productive. The components of the Parent Training Program are as follows: 1. Skillstreaming with parent. 2. Skillstreaming with parent and child. 3. Parent-to-parent drug and alcohol awareness: a group intervention designed to train participants in the skills, attitudes, and abilities they may need to aid their children through the adolescent years without significant drug and alcohol use. 4. The Power of Choice (Michael Pritchard, 1997): a group intervention designed to help empower people to make healthy decisions in their lives. 5. Parent support: a group intervention designed to provide an opportunity for parents to share experiences and problems and to develop parenting strategies from open discussions and feedback. The weekend educational program also focuses on competency development, specifically in the areas of reading, math, technology, and study skills. Psychiatric assessment is available to all clients as well as psychological evaluation and diagnostic study.

COMMUNITY SERVICE Clients participate in viable community service projects to develop behavior that is productive and competent with the ultimate goal of community reparation. All projects are developed, implemented, and supervised by the Community Service Coordinator. The main goal is to develop empathy and understanding of the human consequence of victimization, utilizing community resources to develop competency, accountability, and community protection. Many of the clients are court-ordered to perform community service hours. Equipment and supplies are provided through public grants and private donations. We provide project sites seven days per week. Many of the projects include United Way’s Student Day of Caring, Neighborhood Watch Clean Ups, Nursing Home Visits, and Earth Day. The development of the Summer Earn and Learn Program has also flourished from the collaboration. It was initiated in 1996 as an effort to combine summer school with restitution and the community service program. Initial partners were the Erie School District and Erie County Juvenile Probation. In 1997, the concept expanded through collaboration with the Greater Erie Community Action Center and the CICTP.

AFTERCARE Each client has an individualized aftercare plan that is developed in conjunction with the client, family, and referring agent. The plan is implemented and supervised

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by the aftercare specialist. The aftercare specialists act as brokers, coordinators, and advocates for the client and the family. Their main focus is one of coordination and connection with the client and indicated community resources.

COLLABORATIVE DEVELOPMENT The development of the CICTP program was thought to be the culmination of collaboration in Erie County. Actually, it was a step in the collaborative development of services for youth. As services for youth increased, fragmentation became evident as providers operated in various directions. Through the leadership of the collaborators within the CICTP, a system was developed that would address the issues of incorrigibility and system fragmentation. Upon examination of resources available to youth in Erie County, it became evident that the population of youth usually described as incorrigible was being referred to programs within community-based and residential settings. Although this is a population of youth for which delinquency charges may or may not have been filed, they had engaged in behavior that was dangerous to themselves and others and out of the reasonable control of educators, their parents, and other responsible authorities. In addition to being harmful to themselves and others, their behavior undermined a sense of civility and good social order necessary for the community and its citizens to reach their potential. In the absence of an effective response to this population, their behavior will deteriorate, other youth may be pulled into their influence, and the sense of public order will be strained. In Erie County there was and continues to be a strong need to best serve the youth within a constellation of collaborative community services that are designed to achieve specific outcomes for each of the definable “incorrigible” populations: 1. Serious and repetitive delinquent youth: this group of youth receives services through the delivery of traditional delinquent services. Although this group is not merely incorrigible, they may require the services of the Community Youth Services Center at the time of re-entry to school and community. 2. Less serious delinquent youth: these groups of youths receive services in the traditional delinquent system and the collaborative community system. 3. Chronically incorrigible youth: this is the most directly specified target population for the Community Youth Services Center. These youths have violated school district policy, have chronic behavior problems, are often truant, have violated drug and alcohol policies, or have been expelled from school. 4. At-risk youth: this refers to elementary youth who are exhibiting behavior that places them at high risk for later delinquency, including early and persistent antisocial behavior, academic failure, ineffective parental supervision, association with antisocial delinquent peers, drug and alcohol use, or extreme economic deprivation. In response to this identified incorrigible population, Perseus House, Inc., in collaboration with the City of Erie School District, Sarah A. Reed Children’s Center,

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Erie County Offices of Juvenile Probation and Children and Youth, and the Erie County MH/MR Office, developed the Community Youth Service Center. The Center benefits youths from age 10 to 18 years, who typically fall into the category of either incorrigible or delinquent, and/or have a psychiatric diagnosis. The constellation is managed by a collaborative management team, which uses a results-based management model supported by objectively gathered fiscal information that is analyzed to assure that effective, cost-efficient, flexible, and responsive services are provided. The management committee includes a representative from each of the collaborative partners. Families of clients benefit as they have the opportunity for a single point of entry for referral, assessment, and parent training that previously had been fragmented. The Erie community has benefited as there are coordinated, cohesive, initiatives designed to refer, assess, and/or treat identified youth referred to the program. The collaborative management team developed goals, objectives, methods, and outcome measures. This process included assessment of the current system of service delivery and evaluation of community needs. Consensus building was a tool used to determine the need and appropriate measures to take to solve the problem of fragmentation. Program interventions were designed similar to the CICTP, which include a multi-pronged approach with extensive program evaluation. Howell (1997) echoes this approach in defining a comprehensive strategy towards juvenile justice and youth violence: Treatment programs found to be most effective were characterized by multimodal services, more intensive services (contact hours, duration, and intensity), and services more closely monitored by research teams, which resulted in better implementation. (p. 170)

SUMMARY The development of the CICTP was a process that focused primarily on relationship building. This included the fostering of trust with collaborators to develop solutions to community problems that broke the traditional mode of problem solving. To develop and maintain it, it was necessary to think beyond the traditional methods of analysis, identification, and solution building. Partners were able to shift from typical problem-solving paradigms to a creative model that focuses on resource reallocation. The Collaborative Intensive Community Treatment Program is a good example of how human service agencies and schools can collaborate and incorporate Aggression Replacement Training effectively to solve community problems.

ACKNOWLEDGMENTS The authors would like to acknowledge the work of Tom Antolik, Tom Gamble, Paula Laughlin, and Nick Viglione for their pivotal participation in the development and implementation of programming.

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REFERENCES Antolik, T. (1995). Erie County Juvenile Probation Annual Report. Erie, PA: Author. Bazemore, G. (1992). On mission statements and reform in juvenile justice: The case for the balanced approach. Federal Probation, 56(3), 24–34. Bruner, C. (1990). Improving children’s welfare: Learning from Iowa. Denver, CO: National Conference of State Legislatures. Elder, J. O. & Magrab, P. (1980). Coordinating services to handicapped children—A handbook for interagency ccollaboration. Baltimore, MD: Paul H. Brookes. Goldstein, A. P. & Glick B. (1987). Angry Youth—Reducing Aggression. Corrections Today, 49, 38–42. Goldstein, A. P., Glick B., & Gibbs, J. (1986). Aggression Replacement Training: A comprehensive intervention for aggressive youth. Champaign, IL: Research Press. Goldstein, A. P. & Stein, N. (1976). Prescriptive psychotherapies. New York: Pergamon Press. Howell, J. (1997). Guide for implementing the Comprehensive Strategy for Serious, Violent, and Chronic Juvenile Offenders. Washington, DC: US Department of Justice, Office of Juvenile Justice and Delinquency Prevention. Kagan, S. (1991). United we stand. New York: Teachers College Press. Kazdin, A. (1975). Behavior modification in applied settings. Homewood, IL: Dorsey. Klett, C. J. & Moseley, E. C. (1963). The right drug for the right patient. Report No. 54. Washington, DC: US Government Printing Office. Lawrence, R. (1991). Reexamining community corrections models. Crime and Delinquency, 37(4), 436–449. Maloney, D., Romig, D., & Armstrong, T. (1988). Juvenile probation: The balanced approach. Juvenile and Family Court Journal, 39(3), 23–32. Pritchard, M. S. (1997). Peace Talks [video]. San Francisco, CA: Heart Land Media (distributed by the Bureau for At-Risk Youth). Umbreit, M. S. (1989). Victims seeking fairness, not revenge toward restorative justice. Federal Probation, 53(3), 52–57. VanNess, D. W. (1990). Restorative justice. In B. Galaway & J. Hudson (Eds), Criminal justice, restitution, and reconciliation (p. 163). Monsey, NJ: Willow Tree Press. Zehr, H. (1985). Retributive justice, restorative justice. Akron, PA: Mennonite Central Committee. Zehr, H. (1990). Changing lenses: A new focus for crime and justice. Scottsdale, PA: Herald Press.

Chapter 7

UNGDOMSALTERNATIVET—THE YOUTH ALTERNATIVE IVAN BRILJE, MARIUSZ HERMELIN, AND MIKAEL KALT Ungdomsalternativet, Malm¨o, Sweden

Based upon many years of practical experience with aggressive youth and our reflection upon those experiences, we offer in this chapter the story of our professional and personal journey, a journey in which Aggression Replacement Training (ART) plays a major role. In 1997, we created Ungdomsalternativet (The Youth Alternative), as a way of helping young people find alternative ways of dealing with their problems. The primary intention in developing Ungdomsalternativet was to train the youth in alternatives to aggressive behavior and improve their ability to interact with others. The important goal was to provide the community’s social services with alternatives to expensive institution placements, and to actively involve youth at risk and positively influence their decisions and actions in order to promote a better future for themselves and the community. The schools in the community were also in need of new and effective methods of managing behavior. The best way to achieve all these goals was to work with research-based and effective methods such as ART, combined with long-time experience of working with aggressive youth in various settings. Promoting and implementing ART, not only by working directly with youngsters, but through information and training of trainers, as well as developing a simple and accessible system to make ART available to teachers and youth workers around the country, was also an important goal. The ultimate goal was, and still is, to integrate ART in early stages of education, making it a part of the primary school curriculum.

THE YOUTH INSTITUTIONS The three of us had worked previously with aggressive youngsters, particularly those so advanced in their violent, criminal careers that they have had to spend New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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time in the state youth institutions. We worked in one of the oldest and largest institutions in Sweden located in Lund in the south of the country, just across the bridge from Copenhagen. In recent years, there has been a significant shift in the institutional clientele towards more violent and aggressive youths. Some young people committed brutal and violent crimes; many were addicted to drugs or alcohol and their felonies were often committed under the influence. The majority of institutional clients (over 70%) were of the so-called “second generation immigrant” background. The majority of these “immigrant” youngsters were born and raised in Sweden, where the immigrant population is estimated at approximately 20% of the total populace. These adolescents were often difficult to handle within the confines of institutional walls. We worked with dedication and enthusiasm, trying to influence them as best we could. We explained to them what society expected, to help them make that all-important decision to change their lives and transform themselves into “good law-abiding citizens.” Unfortunately for both them and us, our efforts often failed. The methods we were using were not effective in teaching alternative behaviors. So the youths kept returning to the institutions after committing new crimes, showing an inability to adapt to the laws and rules of society, regardless of the amount of time spent in the institution and the efforts of caring people around them. The professional patience and tolerance of the staff and the lack of consequences, no matter how badly they behaved, made the time in the lock-up easy and predictable. The institutional therapy did not have a positive influence or teach the youth alternative ways of dealing with real-life problems. The majority of the young people were not motivated to change or to be “treated.” In the secure unit for extremely aggressive boys where we worked, an 18-year-old boy was admitted with a record of extreme violent crime and drug addiction. It was challenging to keep him from escaping and hurting himself or someone else: we relied on personal experience and the relationship that we were eventually able to establish. However, this youth brought forth something that changed the way we looked at our role in the lives of the young people we worked with. Whenever we attempted to persuade him to change or think about his future he would reply, “I must only do one thing— I must die. The rest I can do if I want to!” What we said or did mattered little as long as he was not ready and willing to listen. The best way to help him was to offer him alternatives to the violent behavior with the understanding that he had the power and control to make choices and also to accept consequences. Until recently, institutions in Sweden did not provide programs that actively offered these alternatives; indeed, the long stay in the institution could even reinforce the negative behavior. After the clients were released or went home on a short leave, the problems often started again as the young people were not able to resist the pressures or handle the situations of everyday life at school, home, or in the street. They simply did not know what alternatives there were, or they became so enraged they could not think of alternatives, so old, well-rehearsed patterns of behavior came to the fore. Many young people went through a number of consecutive placements over several years of their short lives, after which they were supposed to be “socially readapted.” There were few community-based programs offering them support and continuation of the “social training” once they re-entered society,

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but institutional therapy is costly and a burden to the limited financial resources of the social services. The teenagers are aware of this, saying: “If they gave me all the millions they spent on me here, I wouldn’t cause any more trouble.” Perhaps it is a shame no one ever considered this approach. Placing young delinquents in institutions for a limited period of time is, in many cases, unavoidable for the sake of their own security and well-being, as well as for society. A law has been introduced recently enabling Swedish courts to sentence young offenders (under the age of 18 years) to time-limited institutional therapy instead of prison terms. Once this law had been passed, the number of cases quickly soared higher than expected and is still growing, placing even more responsibility on youth institutions to provide treatment methods and effective ways of implementing them. The State Institution Board decided recently to include ART in the institutional therapy, which will not only improve the quality of youth treatment, but also increase the personal security and work satisfaction of the staff.

THE COMMUNITY PROJECTS Why do costly institution placements bring about so little change, and what, if anything, can be done differently? We felt frustrated with the results and conditions of our work, and many of our colleagues expressed similar feelings. The situation called for radical changes: either give in or do something different. The solution involved both! One of the strategies was to meet the youngsters earlier, when the first signs of trouble appeared and their young age left them more open to influence. It seemed also natural to meet them on their “home ground,” to experience the conditions they lived in, to meet their parents, siblings, and peers, and to watch them interact in everyday situations. Eventually we began to work for schools and the community-based projects administered by the social services in Malmo¨ and surrounding communities. Our job was to meet the youth at risk, keep in touch with their parents and teachers, and together provide increased control and guidance for our clients. The idea was to keep the youngsters occupied, help them develop new interests and hobbies, and find new friends and role models. We discovered that working to these new premises and in different environments was both challenging and rewarding. The youngsters “chose” to work with us, instead of being “forced” to do it. No one wanted to be sent away to an institution, so meeting with us became a last chance for many young people. Most cases worked out really well and we were able to help the youth avoid the trauma of leaving their friends and family. The social authorities and the parents saw advantages with our work in that they were able to fulfill obligations towards the clients, provide control and care, and save money on expensive institution placements. We developed a good working relationship with local police, school counselors, and social authorities in Malmo, ¨ which proved very useful. We also got to know all the “boys in the hood” and, even more importantly, they got to know us. Working in both youth institutions and in the community inspired new ideas about how the two should work together. The unavoidable institutional placements should be shorter and more meaningful, more resources and efforts should

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be invested in preventive work in schools and the community, and new intervention methods should be introduced in both institutions and the community. Further programs started in institutions should be continued in the community with, importantly, a unified approach from the different youth workers and authorities involved. A unified approach avoids young people taking advantage of professional differences and continuing their destructive behaviors without experiencing swift and serious consequences.

¨ SCHOOLS IN MALMO Working within the community also gave us an opportunity to observe what the young people experienced before they came to the youth institution. After working in a number of elementary schools in Malmo¨ we concluded that the problems there were serious and often started at a very young age. It seemed as if we had only seen the “tip of the iceberg” while working in the isolated environments of the institutions. The teachers were often overworked and frustrated; many expressed feeling “burned out” or said that they were on the verge of quitting the profession. In some schools there was a feeling of constant crisis and helplessness. The teachers spent most of their time in the classroom addressing disciplinary problems, while the academic achievements of the students were suffering. Some schools seemed to be taken over by young delinquents, terrorizing students and staff alike. These young people were not there to study, but to cause trouble, and to intimidate or impress their peers. Unfortunately, they often succeeded in being role models for younger children and were surrounded by a circle of “hangers-on.” At times the schools needed to call the police or hire security personnel to maintain order, and the social authorities became involved in order to send the troublemakers away to a special school or institution. Unfortunately the young people who did go away were quickly replaced by other pupils. Schools would therefore hire special educators or social workers to take care of the most disturbing students, and keep them occupied or separated from the rest of the school population. However, the long-term goals of such interventions were often not clearly defined and therefore seldom fulfilled expectations. These projects were expensive and, as a result, time limited and had no significant impact on the school-wide environment. However, it must be said that some of them were at times successful and provided both the troubled students and the ones remaining in their classes an opportunity to study in a more serene environment. The positive reinforcement of getting all the attention in the classroom was withdrawn and replaced by positive attention and support in smaller groups. The high adult to student ratio and matching the special qualifications of the staff with the problems of youth was a good, although costly, solution. In recent years, several primary schools in Malmo¨ decided to address these problems in a different, longer-term manner, sending teachers and counselors to ART trainer workshops and initiating school-based ART programs. The teachers and counselors, trained and supervised by ART master trainers from Ungdomsalternativet, work with age groups ranging from grade 4 to 9 years. The interest in these

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more permanent and effective solutions to school problems is increasing, and it is necessary to train many more trainers and secure the cooperation of the rest of the school staff in order to make ART a whole-school system of violence prevention. Currently, six elementary or special schools in Malmo¨ have finished their first year of working with ART and plan to expand the program into the next school year. All of them are satisfied with the results and have become models for similar efforts in Malmo¨ and around the country. It is important that these programs continue to receive the necessary long-term support and are well documented and evaluated. We are convinced that these efforts will be introduced to many other schools in Malmo¨ and elsewhere. We are prepared to train and coach many new ART trainers and participate in new ART projects in schools, where Aggression Replacement Training is certainly most needed and effective.

¨ MALMO—THE MULTICULTURAL CITY Malmo, ¨ Sweden’s third largest city, is also the most ethnically diverse. One in four inhabitants of the city are of an immigrant background; recent data indicate that 52% of youngsters aged 19 and under are of immigrant parents (41% in Stockholm). This ethnic and cultural mixture gives the city its multicultural identity and continental flavor appreciated by residents and visitors alike. The recently opened bridge connection to Copenhagen has influenced the character of the city even more, making it a part of a large city conglomeration. However, as is often the case, as well as the positive effects this development is also a source of growing social problems. In some districts of the city, the immigrant population today reaches 90%, with almost corresponding unemployment numbers. This ethnic diversity is reflected in the variety of cultures represented and languages spoken in local schools, and is often associated with problems such as school violence, high crime rate, and poor academic results. The clear over-representation of youth with immigrant backgrounds in youth institutions is also one of the consequences of the multiethnic infusions. The youngsters referred to as “second generation immigrants” present a challenge to the system of institutional care, schools, and social services. Society, represented by the police, social workers, teachers, and courts, is often looked upon with suspicion by these youngsters (as well as their parents), confirming the attitude common to antisocial youth. We frequently hear young people justifying their antics by saying “They (the establishment, teachers, police, etc.) are racists, they are my enemy and are responsible for my behavior.” The young people’s level of motivation to actively participate in “therapy programs” and to identify with available role models is consequently very low. The rewards that society “is supposed to provide” for improved social behavior, such as higher education, job opportunities, and high social status are not present or seem unachievable. Addressing these problems requires political, economic, and social changes as well as working directly with individuals and their families. Frequent media reports about youth violence, robberies, and gang-related fights, as well as the status of the city’s elementary schools (placing three of them on the top ten list of worst-performing schools in the country), initiated local discussions about how

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to improve the situation. Daily reports of youth violence have finally come to the attention of local politicians, and the discussions on how to make Malmo¨ a safer city will certainly continue. It was not a coincidence that the first international ART conference was held in Malmo¨ in September 2001.

OUR FIRST CONTACT WITH ART We owe much of our experience and knowledge of how to cope professionally with extremely aggressive and antisocial youth to our time in the youth institutions. This experience gave us the drive to search for alternative solutions and methods beyond the limitations of the institutional walls. ART was one such solution we found, a scientifically validated method that matched our own experiences. The first contact with Dr Goldstein was at a workshop in Sundbo, the youth institution north of Stockholm. Attending Dr Goldstein’s workshops in different locations in Sweden and in the USA provided us with information about the background, theory, applications, and results of the program. However, we could not picture ourselves working with ART as we lacked the skills, experience, and confidence. This initial experience later inspired us to develop our own ART trainer-training program in order to help others overcome the initial difficulties. The workshops in Sweden provided us with an opportunity to meet other people interested or working with ART, such as Rune Nens´en and the staff of Oasis in Aneby, and Bengt Daleflod, responsible for ART at the Sundbo Youth Instituion. These networks inspired and encouraged us to continue with our efforts, and to expand beyond Sweden in our professional links. In the USA we have links with Taberg, a state youth facility, and Aaron Gregory and his staff working with extremely aggressive boys. This residential facility, with 24 aggressive teenagers from tough New York neighborhoods, has not had one fight during the past three years. The proactive behavior, encompassed in a firm and respectful approach towards youth and each other, together with the ART program, had produced these impressive results. In Erie, Pennsylvania, we have links with Mark Amendola, director of the local youth agency, Perseus House, and with Bob Oliver, the head of a large school district in Erie. Perseus House has developed over the years and now works closely with the community, businesses, and schools within the district. It later became one of the models for establishing our own organization, Ungdomsalternativet. The ideals and models of behavior spread instantly through media channels: action movies, computer games, and hip-hop music are sources of inspiration to youth the world over. Unfortunately, fast and easily accessible communication does not only spread positive ideals or models of behavior. It has been said that European countries, including Sweden, follow in the footsteps of social problems and juvenile delinquency development in the United States. Moreover, the role models of antisocial behavior spread by mass media play a significant part in its development. A recent addition to the Swedish crime scene is the appearance of organized, criminal youth gangs such as the Original Gangsters and the Albans. The American

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gangs serve as role models for these organizations and their rivalry for territory and profits evolves into regular gang wars, terrorizing the population at large. This “unexpected” development has taken the Swedish police and authorities by surprise. These observations, together with documented experience of successful intervention strategies such as ART, made us confident that what worked in the United States should prove equally effective back home. Therefore we decided to dedicate time and effort to introducing ART in Malmo¨ schools and community youth projects. We have visited our friends in the United States on several occasions and through numerous workshops and extensive practice we have achieved the status of ART Master Trainers.

THE ALTERNATIVE SCHOOL PROJECTS One of the earliest ART projects we got involved in was the alternative school project Trappen in Roseng˚ard, Malmo. ¨ The primary schools of the district sent “difficult” students to Trappen for a period of time, but in some cases the schools were reluctant to take them back. We introduced ART to Trappen, and it soon became the most important part of their program alongside school education, sports, and other activities. Trappen was a unique and innovative project. It offered an opportunity not only for the twice-weekly ART sessions, but also for transfer coaching and facilitating the use of trained skills in real life. The teachers knew from their experience that clearly defined rules and consequences were needed, so that dealing with conflict situations provided an excellent opportunity for transfer coaching. Some youngsters, with problems outside of school, were assigned individual transfer coaches from Ungdomsalternativet, who were able to observe and monitor their behavior as well as assist them in transferring the trained skills. The transfer training and the “homework” were thus taking place not only throughout the whole school day, but also during the free-time activities. Further, contact between staff and parents was established. Our collaboration with Trappen as ART trainers, transfer coaches, and consultants has been rewarding and successful, and parents, teachers, and social authorities alike appreciate the project. Thanks to the competent and dedicated leadership and personnel, and to the well-run ART program, Trappen received publicity, hosted visitors, and is now a model for school projects elsewhere in the country. It plays a significant role in promoting ART in Sweden.

THE ART SCHOOL ALTERNATIVE The alternative schools are one of the solutions to the school problems described previously. The number of these special schools, at both the elementary and secondary level, is growing. However, the number of students who are in need of such programs is growing at an even faster rate. This increasing need not only opens the field to the emergence of many alternative schools, but also raises questions as to their role and primary objective. Are they to function as permanent solutions for

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some students? If so, we would need many more of these costly projects. Can we develop a routine of sending maladjusted children to these programs for a limited period of time and for a specific purpose? Such a purpose, for instance, could be to improve their social and problem-solving skills and their ability to control anger, so enabling them to re-enter mainstream education. However, some students show a significant improvement in their social skills level and overall behavior, but are still not able to rejoin their ordinary schools. The unchanged environment of the school and the lack of positive reinforcement provided for the newly trained skills mean a return to the previous role of a troublemaker. Our experiences from Trappen and the expertise and dedication of our new coworker David Kiliba helped us to develop our own alternative school project for aggressive boys. It consists today of five students and three teachers, and we plan to expand to the optimal number of eight students in the next school year (making it an ideal ART group). The teachers and ART trainers work continually on improving the program. It is based on ART and social training (transfer), combined with individual tutoring in chosen primary school subjects, sports, and other activities. It involves active fact-finding through visiting museums and libraries and using the Internet. The typical features of our approach are high teacher to student ratio, skillful ART trainers combining youth, flexibility, and experience, warm, respectful relations between the trainers and the trainees, rules that are few in number and clear and simple, respected by teachers and students alike, individual attention to students and immediate reinforcement of social skills, and close collaboration with parents and social authorities. The goal of the program is to prepare the students for reentering the mainstream school system, to prevent institution placements, and to train future junior ART trainers (the last being of special importance). The program is presented to youth as a possibility to become skillful, successful, and respected by becoming a role model and a junior ART trainer, not as a permanent exclusion, a punishment or therapy (an opportunity many of our students considered lost or unachievable at school). The average period of training in the ART school alternative varies from one school term to one full year. The students attending the school alternative are not only those causing problems in their classes but are also at risk for an institution placement. Therefore, the program is being co-financed by social services and the school districts from which the students come. We continually report the progress of our students to their respective parents, teachers, and social workers. This coalition decides on the duration and content of individual programs for each student. The schools also support providing teaching materials and professional advice. The waiting list for our alternative school is growing.

OUR OWN TRAINING: START ART in Trappen and our school alternative provide an opportunity to practice leadership and supervising skills, improve the procedures and routines of training, and deal with all kinds of disciplinary and motivational problems. These experiences

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helped us later develop our ART trainer-training program. Modeling and acting in the role-plays also made us realize our own personal social skills deficiencies, especially in the field of conflict resolution and anger management. Sometimes there was little difference in the behavior of the adults and the youth—both seemed to be in need of social training. (Recent research in Swedish primary schools indicates that 6% of students feel they are being bullied by the teachers whereas only 4% feel they are being bullied by other students!) “Live the way you teach” became our motto and the key to our successful ART approach. In order to achieve this goal we have regular START (Staff Training ART) once a week, during which we concentrate on our own social skills and anger control as well as resolve problems and conflicts. In the beginning of our ART implementation we became aware that Swedish translations and descriptions of social skills (the steps) were often too long and difficult for our youth, which inhibited their performance in role-playing and prevented active participation. We solved this problem by translating the steps together with our youth. The language used is familiar to the trainees and helps them understand the instructions. We use the first person to make the steps more personal and direct. For those with reading problems we read the instructions or ask questions while directing the role-plays. Simplifying the steps, without compromising their content, was important to the tempo and fluency of the training sessions. Translating the steps also made the participants feel involved and at the same time familiar with the social skills instructions. For moral reasoning, we used similar procedures, designing new moral dilemmas together with our students. The everyday-life situations reflect problems close to our young people’s reality. The more they recognize the situations and relate to them, the livelier the discussions. We recommend these and similar innovative procedures to ART facilitators in order to adapt ART to their particular youth groups, making training interesting, understandable, and involving. Active participation of the trainees, acknowledging their potential and ability to learn, and adjusting the program to the age and social skill levels of the group made a significant difference. Working with aggressive, hyperactive youngsters in various environments helped us also to realize the importance of group rules and routines. The rules we chose together with the trainees are simple and few in number, and the consequences of breaking them are clear and not negotiable. The rules are as follows: come on time; listen; raise your hand when you want to speak; and participate. These rules stand for showing respect, and the consequences of breaking them are explained and repeated at the beginning of every training session. For example, not coming on time results in non-attendance. We strictly enforce this rule, which supports the training of planning ahead skills and eliminates time-consuming explanations. Most of our youth are very skillful at creatively explaining the reasons for their behavior (coming late) and do not need additional training in this skills area. The consequences of breaking other rules vary from apologizing to the group, to showing respect by leaving the training. It is important to mention that all rules apply equally to the trainees and the trainers. This rigid and predictable structure helps reduce disruptive behavior and allows high levels of activity, tempo, and participation, so making ART an interesting and involving experience. The social skills sessions are also more efficient and interesting if they allow the trainees the

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freedom of “showing off” their social skills and improvising the role-plays based on recent events in their lives. ART may sometimes prove difficult to “sell” to the youth who require it the most. The obstacles appear in the form of low motivation and resistance. However, the problems can sometimes equally depend on our own lack of confidence, inexperience, fears or habits. Working with ART makes us aware that we need to re-examine and perhaps change the ways we act and react in our relationships with our respective colleagues and students. ART provides an excellent tool for these personal changes. We often use role-playing and feedback in resolving our own, “grown-up” conflicts and problems within the organization. It provides us with opportunities to improve our coaching skills and at the same time with the experience of being a trainee. The results of such training are indeed remarkable and definitely worth the effort. “START” with ART by living the way you teach! In addition to a respectful and trusting relationship between trainers and trainees, successful ART programs require safe environments. It is desirable that everyone involved in ART, especially the trainers and transfer coaches, is adequate at performing the social skills and displaying anger management, and not only during the training sessions, but also in real-life situations: this ability comes with time and training. The extreme youngsters we deal with are highly sensitive to our sincerity and credibility; if they sense we doubt what we teach, or fail to produce the skills in real life, there is no way we can convince them that ART is good for them. The more confident the trainer, the better the results. The trainertraining program provides an excellent start to building up such competence and confidence.

THE TRAINER-TRAINING/APPRENTICESHIP PROGRAM Our trainer-training program, developed in consultation with Dr Goldstein and in collaboration with colleagues and partners within ICART, is a six-month part-time course. It involves seven days of group training, two days of ART trainer-network meetings, and 15 training sessions practice (each session consists of two 45-minute classes). After completion of the course and passing the theoretical and practical exams, the ART Trainer Certificate is issued. The program is being used to train ART trainers in Sweden, Norway, and Poland, and is a part of a university postgraduate ART course at the Ragaland College in Norway. We hope that this program will become one of the models for training ART trainers elsewhere and set a standard for training programs across Europe. The sixmonth, part-time program is primarily designed for teachers, youth counselors, social workers, and personnel with experience of working with aggressive youth. It may, however, equally suit others without formal education, but with similar experience and leadership skills. The program for schools and youth agencies starts with a one-day workshop for the entire staff. Everyone involved plays an important role in ART, as a role model, trainer or a transfer coach. It is absolutely crucial that the skills acquired in training are reinforced when actually displayed in real-life situations. The workshop provides information about the goals, training procedures, and duration of

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the program together with instructions in how everyone can be supportive. It also makes the staff aware of what personal and professional skills and qualities are required to become a successful ART trainer. The one-day workshops provide an opportunity to discuss problems and, it is hoped, agree upon common solutions. It is our experience that these workshops are useful and appreciated, and result in several staff volunteering for our trainer-training program. The future ART coaches bring to our workshops their experiences and expertise. The practical exercises aim at training leadership skills and strengthening their competence and confidence to initiate and maintain ART programs. Someone once said, “Tell me and I will forget; show me and I will remember; let me do it and I will learn.” The trainer-training program is designed to let the participants do most of the learning and work, emphasizing practical skills and leadership training. The theoretical segment consists of self-studies of ART literature and answering related questions during the course and at the final exam. The program is a result of our trial and error experiences over the years and it has been tested in training ART coaches within our organization. The opinions and ideas of our young trainers together with our previous experiences have helped to develop the program and keep it up to date. We teach only what we have experienced first hand, either with youth groups or in coaching young trainers. The seven-day training program starts with a four-day get-together. (These first four days can sometimes be divided into two meetings within a fortnight, giving the participants a chance to digest new information and reflect on the practiced skills.) During these days we concentrate on leadership skills, presentation of ART to youth, and ways of motivating the participants, rules, training, and feedback procedures, modeling, role-playing, and documentation. We practice and conduct exercises in two of the ART components, social skills and anger control. After this initial meeting the training continues at home (workplaces), where each candidate is required to conduct 15 training sessions as a head coach and send the documentation to us for evaluation. This section of the program allows the participants time to gather valuable experience, and to initiate and evaluate ART programs as well as discuss them with colleagues and make plans for the future. These experiences are exchanged and discussed during the first day of the following two-day gathering, which is predominantly devoted to finding solutions to any problems that occurred and refreshing the role-playing and modeling skills. Trainees exchange their experiences with each other and receive coaching and advice from experienced master trainers. The trainer manual is our course literature (in addition to the ART book) and contains exercise instructions together with useful hints, based on our experience and reflecting our personal approach to ART. In some cases, this approach needs to be modified by trainers to suit their target groups, as for example with younger children, school classes, and large groups, or youth with lesser skill deficiencies. The training offers a solid foundation on which to build successful ART programs. The exercises aim to improve behavior management skills, to show what motivates the youth, how few rules are needed, what personal and professional qualities the ART trainer should display, and how to keep the tempo and flow in the role-plays and feedbacks. Thus, the exercises are designed to resemble the actual training procedure, with two participants acting as coaches and the rest playing the parts of trainees.

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One of the opening exercises is, for example, answering questions such as: Who am I? Why do I enjoy working with youth? Why do people like me? What am I good at? What would I like to train (develop) more? The participants receive feedback to help them become aware of their body language, overall impression, and what can be done differently. It makes the future ART trainers aware of how they can improve their skills by training and what level of active involvement and participation is required of them throughout the course. At the same time, it is an introduction to the training and evaluation procedures used during training. This and many other exercises have been designed to help participants feel at ease with performing in front of the group (modeling) and become familiar with training procedures (role-playing, feedback). The trainees team up in pairs for most of these exercises, preparing for the roles of main coach and assisting ART coaches. In some cases they have time to prepare, in others they have to improvise (a skill often needed in real-life ART), and comments from the observers are first allowed during the feedback. We attempt to play down our role as coaches throughout the workshop, limiting our engagement to instructing the exercises and giving feedback, thus modeling the trainer behavior we recommend in youth groups. Most of the training time is devoted to practicing skills, the same way as should be done in actual training. We call this important rule 25–75, meaning that the trainers should take no more then one-quarter of the training time for instructions, feedback, motivation or managing disciplinary problems. The remaining three-quarters of the time should be devoted to role-playing and feedback by the trainees, making them feel involved and maintaining their interest and energy levels. Our motto is: Of a good leader, who talks little, When his work is done, his aim fulfilled, They will say, “We did this ourselves” (Tao Te Ching)

We model this approach in our trainer workshops. Difficult as it may be at times, we practice giving short instructions and asking relevant questions, so encouraging and allowing the students to do all the talking and acting. Minimizing our active participation as coaches and role models has, in our experience, given the best results both with youth groups and in trainer training. We know from the positive feedback that this makes our trainer training an active and stimulating experience. The positive feedback confirms the even greater need for practical exercises in preparing for work with actual ART groups. The three criteria for successful completion of the trainer training are: (1) participation in seven days of group training and exercises, (2) 15 documented sessions as ART trainer (main coach), and (3) passing of a written test and demonstration of leadership skills during the final day. The trainer workshops inspire new ideas for our ART youth groups and vice versa. For example, we often switch roles of trainees and coaches in our youth groups (as we do in our trainer workshops), particularly when concentration and participation levels are low. The role changing provides a challenge and responsibility and is, in our experience, an efficient way of strengthening the motivation of participants and the efficacy of training. This strategy not only allows the youth to

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model the alternative behaviors for each other, but also increases the likelihood of these skills being used and accepted (transferred) in real-life situations. Over the years, Ungdomsalternativet has trained over 200 ART coaches in Sweden and a number of facilitators and master trainers in Poland. These coaches in turn develop and implement their trainer-training program on the basis of ours. We see a growing demand for ART trainers in schools and youth agencies, as well as qualified and experienced master trainers who can train new coaches and supervise the programs. Developing a master trainer program and standards for active trainers (with at least one year’s ART experience) will help further promote the method and maintain a high standard of trainer education. ART trainers who completed our training and have long experience of working with youth groups expressed a desire to partake in such master trainer courses. The majority of ART trainers who completed our training program are currently involved in different ART projects and are reporting positive results. We maintain close contact with them within the ART trainer network and encourage the exchange of ideas and experiences by organizing network meetings twice a year. We also act as consultants supervising several ART school projects currently in progress in Malmo’s ¨ primary schools. The Ungdomsalternativet coaches conduct workshops, seminars, and presentations on ART and related subjects for schools, youth care institutions, the mass media, and social authorities.

JUNIOR ART TRAINERS One of the obstacles new ART trainers encounter is persuading the young people they work with to participate in the training. To counter this apathy, talking about the young people’s personal development, respect for others, improved school results, making parents happy, and staying out of arguments are often successful. From our experience, presenting ART as an opportunity of becoming a junior ART trainer and a role model for others has proved to be most effective. This approach helps introduce new trainees to ART and gives those who have trained for some time the motivation to proceed, and it gives the most impatient or restless participants a chance to act, show off their skills, and model the behavior for others instead of initiating discussions that sometimes serve the purpose of avoiding the training. What is more, it allows them to start the training from their actual social competence level and train purposely to achieve concrete goals. The young people we work with are often better at doing things than talking about them, so that letting them take over the role of trainer both displays their ability to perform social skills and helps them accept critical feedback. This in turn increases their motivation to participate in training. ART provides young people with a second chance of becoming good at something positive. Becoming a junior ART trainer inspires motivation to work hard and is an important, achievable goal. At the end of the day, it does not matter if the goal is actually achieved; the benefits of training are still there. The youth at risk of going away to institutions often complain that they are forced to participate in ART, so their attitude toward training is consequently very negative. We respond to that situation by giving them positive motivation and describing

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tangible goals they can achieve through training, and becoming a junior ART trainer is one such important goal. It has helped many of our trainees stay with the program for over two years. The most experienced junior ART trainers conduct the training sessions as main or assisting coaches, act as positive role models and motivators, and help us present ART and train professionals during our trainer-training courses. Their feedback and modeling serve as an eye opener to many, and help relieve the doubts and anxieties sometimes displayed by future ART facilitators. The more competent the trainers are at displaying social skills and anger management in realistic situations, the more positive response they get in training. We believe that most of the youth are often just as skillful in displaying these qualities (at least in role-plays) as “professional trainers,” given the opportunity and encouragement. The young people’s modeling, role-playing, and respecting the rules is an example to others, enhances transferring of skills into real-life situations, and increases their acceptance among peers.

THE SIX-MONTH FULL-TIME ART TRAINING PROGRAM Both research and experience confirm that the more youth can identify with role models, the stronger their influence. The most significant role models for teenagers are often their peers, or older youngsters sharing similar backgrounds, experiences, and problems. Since the majority of the youth we work with are from ethnic minorities, it is also desirable and beneficial if we can match those minorities among our staff. By that we mean not only matching their nationality, language or religion, but even more importantly by sharing common experiences of being (or regarding themselves as) outsiders and underdogs in the society. Young role models that youth can look up to and identify with will make it easier to “sell” positive and prosocial ideas to their younger colleagues. It is important that we reach out and involve these role models, help them become skillful ART trainers and, via training and supervision, assist them in their work with youth at risk. By doing this, we also help these young people. Some of them, unemployed or undecided about their choice of vocation, find a meaningful and rewarding occupation and become aware of a myriad of possibilities in education and employment while at the same time developing their own qualities and helping others. Ungdomsalternativet has developed a six-month full-time training/apprenticeship program, offering young unemployed and motivated youth an opportunity to study and practice under supervision to become ART trainers. The schools and social services often express the need for people capable of working with difficultto-reach, aggressive youth. These young ART trainers and role models can help teachers and youth workers, hold ART sessions, and act as transfer coaches by positively influencing younger children at school and during free-time activities. From our personal experiences, they not only make the training more realistic and acceptable to the adolescents, but also increase the chances that the trained social skills will be used outside of ART classes. We have been very successful in working with young ART trainers within our organization and strongly believe in this model. The first two youth ART trainers who successfully completed our six-month program received employment as ART trainer and teacher assistant in one of the special

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schools in Malmo. ¨ This educational project is supported by the state employment agencies and received recognition and funds from the European Union supporting its development. The program effectively involves and influences both aggressive youth and the young people entering the workforce, helping in integration of both groups in society.

THE YOUTH ALTERNATIVES ART is about role-playing, modeling, positive reinforcement, and transfer, but most of all it is about choices and alternatives. “I didn’t have a choice, I had to hit him,” or “He made me so angry I didn’t know what to do”: how often do we hear these and similar explanations from our youth? In stressful situations, under group pressure from peers, responding to provocation, they often feel as if they have no choice. It’s about “respect,” “keeping face,” and teaching the provoker a lesson (“so he won’t do it again!”). “Do you really think that fighting is wrong?” “Didn’t you ever fight yourself?” “Wouldn’t you fight if someone attacked your family?” These are frequently asked questions. The best answer we can come up with is: “Yes, I did fight,” or “Yes, I would defend my family,” but in most everyday-life situations I have choices and alternatives. “Choice” and “alternative”—these two words are very often used in our ART groups. If someone gets into a fight (which happens now and then), they typically say, “I chose to hit him because I couldn’t control my anger and choose the right alternative!” not “I had to hit him because he made me mad!” The ART trainees also ask and discuss: “What can I do differently in a similar situation next time around?” The significant difference is not only in the choice of vocabulary, but also in understanding what is happening, analyzing the reasons as well as accepting the responsibility for the choice of action. Having a choice, being “in control,” and avoiding the same mistakes gives the youth a feeling of confidence and competence. Being “rewarded” for choosing the right alternatives further reinforces that feeling and, with time, it is hoped, makes “good behavior” a habit. Our youth coaches help the youngsters make these choices by providing alternatives through modeling and role-playing, being good role models, and reinforcing positive behavior. From our experience, it does not have to be more difficult than that! Realizing and confirming the youth’s potential, showing a good example, paying attention, reacting to antisocial behaviors, and rewarding changes works miracles. We often expect “well-trained” aggressive children to change quickly and permanently, but unfortunately in most cases this does not happen. The most important and lasting change we can accomplish is that our youngsters know and feel they have a choice. We have been involved in this work for almost four years now and the organization has gradually grown, attracting new co-workers and creating new ideas and projects. Today, we work directly with youth at risk in Malmo, ¨ through ART programs in schools and communities and in our special school project. We also work with older youth, training them to become ART trainers, supervising their work, and opening new possibilities of employment. We train and supervise professional youth workers and teachers throughout the country and abroad through our

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trainer-training workshops. Our training program is part of a postgraduate ART course at a university in Norway and is a model for similar courses in Sweden and Poland. We are involved in nationwide and international ART networks, exchanging experiences with our friends and colleagues in the United States and Europe. We are developing training procedures and educational materials, improving our methods of training, and sharing information about ART with others. We document and evaluate our own efforts and encourage evaluations of ART programs elsewhere. This has all happened in a short period of time, and motivating and rewarding ourselves has been a most important part of our experience. Working with often vulnerable young people stimulates our own personal and professional skills and “recharges” our energy reservoirs. Rewarding ourselves (a social skill that many of us need to practice!) and enjoying every little success (catching ourselves being good) are important components of that process. We strongly believe that we need to feel good, positive, and satisfied within our private and professional lives before we can help others and make a real difference. “Sacrificing” our own well-being for others seldom works in the long run. We would like to share this simple advice with our professional colleagues: take good care of yourselves and each other and make a serious attempt at “Living the way we teach!” ART has profoundly developed our personal and professional skills over these past years. Our performance as role models and trainers has improved dramatically since we started practicing as ART trainers. So has our ability to interact with others within and outside of the organization. We are more aware of our behavior towards each other and what influences it has on our young followers. Only by experiencing hands-on training can we be successful in changing the behavior of our youth. Only by living the way we teach can we ask and expect them to follow in our path.

Chapter 8

THE OASIS—A LIVING IDEA RUNE NENSE´ N AND NIKOLAI HAMSTEIN Barnhemmet Oasen, Aneby, Sweden

INTRODUCTION The Oasis, located in Aneby, southern Sweden, was founded by Rune Nens´en, a social worker with experience of public social services. For the past ten years, The Oasis has been a residential and treatment facility providing shelter and services for children aged 0–13 years, as well as for families with young children. Swedish law permits children to be removed from the home and placed in foster care when home/family conditions are deemed to be a threat to the children’s welfare. The Oasis offers an alternative to foster care, whereby children, and often the entire family, are invited to move to The Oasis for an extended period of evaluation and intervention. Beginning in 1991 with 13 beds, the organization has constantly grown and developed. Today The Oasis consists of a family unit and a children’s unit, with a total of 48 beds. The children’s unit is located on a beautiful farm five kilometers outside of Aneby. A preschool and primary school have also been founded within the framework of The Oasis organization; however, in some cases children attend the local public schools. Working in cooperation with the social services of more than 80 cities in Sweden, The Oasis has dealt with a large number of referrals with different needs and backgrounds. The Oasis has invested in highly competent personnel, with long experience of social evaluation and treatment. Fundamental to the daily work of The Oasis are a holistic approach to each individual, respect for each client, professional behavior, scientifically sound methods, and an adequate level of decisiveness.

PROGRAM DESCRIPTION The facility provides several different services, depending on the referring agency inquiry, such as assessments/investigations or more long-term treatment. An New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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individual treatment plan is always established for each child or family throughout the length of stay in The Oasis program. The assessment can be done from a social, medical, psychiatric, and/or psychological perspective according to the specifics of the referral. This may include a total responsibility for The Oasis to assess a child or parent/child, or it may mean that The Oasis provides parts of the assessment. The treatment takes place in a home-like setting with an emphasis on the holistic approach to the individual. A case manager is also assigned to the child, or family, throughout the length of stay. The goal is to improve the relationship between child and parent, or careprovider/fosterparent, i.e. an adult significant to the continued development of the child. In the effort to improve and strengthen relationships, as well as change behavior, ART, which includes Skillstreaming, anger control training, and moral reasoning, is a very successful tool. ART is therefore used both within the family and in parent groups. Criteria for placements vary. Common to all placements is that the relationship between parent and child is dysfunctional in some way, i.e. inability or social problems, with the result that the parents cannot adequately care for their child. Families with social and/or psychological problems, developmental disabilities, or young mothers with newborn babies have priority in The Oasis program. Thus, The Oasis is also a treatment facility for children aged 0–13 years without parents. Depending on the specifics of the referral, The Oasis program may include a period of assessment for a child as well.

PURPOSE OF THE OASIS PROGRAM The purpose of The Oasis program is to be a resource for agencies when they need a residential treatment program or a period of assessment within a residential program for children aged 0–13 or for a parent and child together. This is at times due to high-risk situations, and other times it is impossible to assess the situation unless a 24 hour/day observation takes place. The Oasis has “round-the-clock” staffing, which enables emergency placements. The purposes of The Oasis program for families and children are to:

r assist and support families with specific needs (in crises); r rehabilitate and establish a functioning and positive influence within the family relationship by utilizing ART, among other intervention methods;

r prevent families from separation when there are possibilities for them to stay together;

r during a period of assessment make sure that families with specific needs receive the most helpful treatment for a positive change of their life situation;

r provide agencies with a written report on issues which are included in the treatment plan and requested from referral agencies;

r work according to The Oasis ethical values and Swedish law; r work with parent and child during a process of separation when separation is necessary;

r establish a long-term treatment plan, emphasizing the ART curriculum, for children who are in The Oasis program without parents;

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r strive toward ART generalization by supporting and training foster parents when a child is ready to move from The Oasis to a foster home;

r work together with the foster parents during the time of change and separation for the child.

GOALS DESCRIPTION OF THE OASIS PROGRAM Service Concept The staff’s work shall be founded on a holistic approach to each individual, scientific theory, and tested experience. Evaluation shall be impartial, objective, and thorough, describing the individual’s needs in accordance with the holistic approach. Observation and treatment shall be carried out in such a way that the individual’s own resources and initiatives are put to use for the description of the individual’s need of help/support in accordance with the social services law. Evaluation always involves treatment, where ART has become a primary tool.

Scientific Theory The theoretical foundation for The Oasis evaluation and treatment is both a psychodynamic and cognitive perspective. The actual evaluation and treatment work is carried out in a home-like setting (environment therapy). Environment therapy is a model of society at large, but on a small scale and in safe and secure surroundings, which takes into consideration and develops the individual’s social, physical, and psychological needs.

Proven Experience The organization shall strive for constant development through regular continued education and work-related guidance. Continued education shall regard the organization’s field as well as current related laws.

Holistic Approach The total needs and resources of each individual shall be seen and identified. This approach is taken into consideration when employing personnel, so that relevant professional categories, such as social workers, nurses, child care workers, preschool teachers, teachers, office personnel, psychiatrists, child psychologists, and maintenance and housekeeping personnel are available.

Relationships The personnel shall make an effort to establish good relations with clients even in difficult situations. Personnel are obliged to professional secrecy. Clients shall

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Board Rune Nensén CEO and chairman of the board

Samuel Fransson

Ewa Jungbeck

Kajsa Samuelsson

Director, children’s unit

Director, family unit

Director, assessment

Figure 8.1 The organization of The Oasis

be informed that journals are kept and told how information is treated. Personnel shall actively inform clients of their rights. Personnel shall not in any way take advantage of clients’ dependent situation. Personnel shall respect and support the individual’s right to personal integrity and self-determination.

Locale An important goal for The Oasis has been to provide practical and pleasant locales for the work at hand. Provision of an environment which is as home-like as possible aids in achieving a positive treatment result.

ORGANIZATION The Oasis (Barnhemmet Oasen AB) was in 1991 officially granted permission to operate a private residential treatment facility for care and shelter. A board of professionals leads The Oasis, and Rune Nens´en is chairman of the board and CEO for The Oasis. As shown in Figure 8.1, there is a director for each unit, as well as a director for the evaluation work. The Oasis employs more than 80 personnel. The Oasis leadership group meets regularly in order to discuss relevant questions regarding the evaluation and treatment work. In addition, a morning meeting is held on a daily basis, where those in charge of different areas of the organization can discuss important issues and make relevant decisions. Service-mindedness and decisiveness characterize the work of The Oasis. The staff are The Oasis’ most important resource. The Oasis personnel are aided in their evaluation and treatment work by hired consultants within different areas of expertise. This enables the referring agency to receive service of higher competency according to the individual needs of each client and the specifics of the referral.

CLIENTELE During its first 10 years of existence, The Oasis received more than 200 families of varying sizes and backgrounds. Families with children, and preferably young children, make up The Oasis’ main target group. The following is a description

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of the families’ size, background, etc. based upon our data between 1991 and 2001. More than one-half of the families have only one parent (most often the mother), whereas the others consist of living-together relationships or marriage. Family size varies from one to seven children per family. More than 80% of the families are Swedish, while the others are immigrants or Swedes with immigrant backgrounds. The average age of adult clients is 35 years for men and 30 years for women. The average age of child clients is five years. The average treatment period since the Oasis began is four to five months. Contact with families may be voluntarily with the support of the social services law, or compulsory as families are legally required to take part in The Oasis program.

Diagnosis at the Time of Admission More than 50% of the clientele is made up of individuals with some form of social incapacity. Examples of other problems which have warranted treatment include physical and/or mental abuse, psychological illness, mental handicap, and sexual abuse.

Treatment Results Approximately one-half of the families have been able to move home with their children, with or without support in the home, after their stay at The Oasis. In nine out of ten cases, the social services and courts of law heed the recommendations of The Oasis evaluation.

INSTITUTIONAL CARE 2001 AND ONWARD It appears that the social services have a growing tendency to wait longer before placing clients in institutions. This delay means that The Oasis becomes involved in cases very late, when a family’s and/or a child’s problems have increased and become more complex. Beginning evaluation and treatment at a late stage always makes practical care more difficult, and achievement of good results takes much longer. Politicians and decision makers often have the incorrect notion that hesitating to make the decision to evaluate/treat a family in an institution can save money. The evaluation and treatment period simply becomes longer and more expensive for those families who are forced to wait. In the worst possible case, the failure to act promptly might mean that a family in crisis would have their children taken from them for social care or placement in a foster home, perhaps even for the rest of their life. Seen from this perspective, it is both more humane and economical to begin care and treatment as early as possible.

CASE MANAGEMENT During evaluation at The Oasis, the child’s and the family’s situation, both past and present, are described. This work can also be seen as a process whereby alternatives

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to earlier problem-solving methods are tested and evaluated. In this context, ART for families is an important method of intervention. Through ART, families are encouraged and supported in their attempt to use alternative, more successful ways to relate to themselves and others.The goal of the evaluation process with a holistic approach is to gain a clear understanding of the family’s/individual’s future possibilities. The holistic approach demands a broad competency. The development of the organization during the past ten years has been influenced by experience, which has created greater and new areas of competency. Certainly the future of the Oasis will be characterized by continued development through more finely tuned evaluation methods, increased competency, and use of relevant research material.

EVALUATION TASK The task of evaluation is formed by the referring agency at the start of the evaluation process and can vary from case to case. The planned evaluation tasks are often preceded by study visits and careful planning. Other evaluation tasks are acute, and admission to The Oasis happens before task planning can occur. The referring agency’s inquiry is always presented to The Oasis in writing. The most common subjects for evaluation of parents in The Oasis program regard parental capacity: this might involve which roles exist in the family, parents’ relationships to their children, the parents’ capacity for showing emotion or setting limits, interaction between parents and between parents and children, parental capacity to put children’s needs before their own needs, and suggestions for future solutions.

EVALUATION The treatment personnel’s gathering of data makes up an important part of the family’s/child’s social description. Moreover, a description of the parent’s own life history is written by the evaluator, using the K¨alvesten method while interviewing during the case evaluation. A social worker responsible for a given case coordinates other evaluation inputs in the case. Doctors and nurses at The Oasis take responsibility for the medical aspect of the evaluation. For each case, an examining psychiatrist at The Oasis also makes a report. Children are judged according to different tests performed by The Oasis child psychologist. Such judgments make up an important part of the foundation for a holistic approach to the case. Preschool teachers at The Oasis own preschool have unique opportunities to observe the children and thereby contribute to the evaluation process. An average evaluation takes approximately three months. A team of personnel with different areas of expertise meet each week in order to share information regarding each case. This eventually results in a comprehensive case picture and determination of how the case work should best continue. In order to gain a comprehensive understanding of each case, the different areas of expertise constantly interact with each other and communication in conjunction is of extreme importance to a successful evaluation period. Most of those who are being processed at The Oasis for an evaluation would rather not be there and parents

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are very aware of their grave situation. For these reasons, the situation demands great respect, but also complete honesty and unveiling of relevant problem areas. Continued openness and communication with parents and children regarding the evaluation process is important during the entire evaluation period.

ADMISSION An admission meeting is led by the social worker responsible for evaluation together with a case contact person, who will thereafter be the link between The Oasis personnel and the referring agency for the duration of the evaluation period. During the admission meeting parents are informed of the following: that parents remain responsible for their children during their stay at The Oasis; about the case contact person and how this system can be of assistance; the weekly and daily schedules; details about time off, visits, and possible restrictions; matters of privacy/professional secrecy; the evaluation process and any other information that is required. All information is also presented to the family in writing together with the names of the social worker responsible for their case and their contact person, as well as an invitation to an in-school meeting at the preschool if relevant. The most important part of the admission meeting is summed up by the question “Why did you come here?” In more than half of all cases the client’s answer is “I/we didn’t want to come here, but the social worker wanted us to.” The next question is naturally “Why do you think the social worker wanted you to come here?” Sometimes this question is answered very concretely, while in other cases the clients may need more detailed questions in order to give a clear answer. Some clients maintain that the evaluation and stay at The Oasis are unnecessary; others say that they have never understood how their parental capacity is deficient, even though they have had a long history of contact with different support personnel. In conjunction with this clarification it is often suitable to allow the referring agency to explain the situation and questions involved. Directness, honesty, and clarity regarding the case situation are important for the parents’ understanding, the prevention of later surprises or confusion, and the improvement of communication during the evaluation period. At this point, many parents are able to express their fears of parental insufficiency and loss of their children. Here it is important to maintain a professional stance, not making promises, but giving hope that improvement of parental capacity is always possible, and that The Oasis personnel are devoted to assisting in such an improvement. Parents are also informed that no evaluation report leaves The Oasis before it is thoroughly discussed by the responsible social worker together with the parents. This occasion provides an opportunity to correct possible misunderstandings or to add their own opinions about certain occurrences. The admission meeting therefore has the purpose of getting the family’s/child’s evaluation period at The Oasis off to a good start by creating personal contact, giving hope for the evaluation, clarifying the task ahead by asking questions, recognizing the parents’ own level of understanding regarding problems and possibilities, recognizing the parents’ own level of motivation, providing a foundation for how The Oasis personnel should plan the evaluation period, and determining

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the evaluation period’s duration, as well as planning treatment conferences. In the event that the admission meeting is preceded by an acute and/or chaotic event, the family/child should have the opportunity to receive crisis support before questions about the possible evaluation take shape.

ASSESSMENT STRUCTURE Social Content Everyday life at The Oasis provides unique possibilities to notice how parents and children deal with different situations. Besides support and counsel, the staff’s most important task is to observe what parents and/or children do, as well as how their personalities are expressed. The staff’s collective observation creates an understanding of the family/child and forms the basis for ideas about how a positive development can be achieved. Observations are made on a daily basis and noted in a diary. Personnel are provided with regular continued education regarding objective observational skills. It is extremely important that the theme of objectivity is kept in focus, since different personnel understandably do not have the same ideals of how parents should or should not behave. Observation of parents and/or children in different situations does not occur passively. In reality, the personnel contribute to the development of positive interaction and make observations thereby. Consequently, no evaluation visit is regarded to be entirely for evaluation, but also for interaction, influence, intervention, and a certain measure of personally tailored approach from the personnel. Typically, the observations would include the following: practical routines such as meals, sleep, bed times, good-night stories, and homework; expression of feelings within the family and individually; setting of limits within the family; predictability within the family; how interaction within the family functions; how identity, self-understanding, and defense mechanisms are expressed in the family; family patterns; and other subjects specific for the evaluation task. Daily routines at The Oasis are made up of a firm structure, the value of which cannot be over-emphasized. Relationships between clients and personnel are also established, with all the implications of making acquaintance, testing, and separation. Within the frames of these relationships, the client can regress, express himself/herself, imitate, and eventually relate to the personnel. Parallel to the daily routines, an inventory of parents’ lives and interaction is made by the social worker responsible for each case. Everyday situations become the topic of evaluation meetings, providing possibilities for greater understanding. Other practical problems, which arise during the program, can also be given immediate attention.

Psychiatric Content The Oasis psychiatrists meet with the parents as soon as possible after admission, which most often means during the clients’ first week at The Oasis. The psychiatric assessment is made after several meetings, based partially on the information

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regarding everyday behavior, which is presented each week during an overall treatment conference. Some parents show no personality disturbances, and assessment meetings are limited to one or two. The resulting psychiatric assessment contributes to the final overall assessment, and is presented as a separate attachment to the final evaluation report.

Medical Content The Oasis doctors examine parents and, if necessary, each child as a part of admission. In some cases, a doctor’s certificate is required for forced-care application. Other reasons for medical examination include suspected child abuse, anorexia, sexual abuse, allergies, and asthma. During the evaluation visit, The Oasis doctors are available three days per week for emergency care. The physician can either give medical care or refer clients to other medical experts. Nurses are also available every weekday. Maternity examinations are made at the local maternity clinic. The availability of medical professionals is also of great assistance in the case of psychosomatic illnesses. The medical assessment of possible illnesses, handicap, etc. and their consequences makes up an important part of the final overall assessment.

Child Psychological Content The Oasis child psychologists make developmental assessments, personal evaluation tests, family relations tests, etc., according to the inquiries of the referring agency. The child psychologist meets the youngest children together with their parents and explains the purpose of the meeting. When tests are completed (parents are present during tests) and results available, the child psychologist goes through the results together with the parents. Older children take tests in the absence of their parents. However, parents are kept informed both before and after testing. The child psychologist also performs therapy for the purpose of treatment.

School Content The Oasis preschool has its own local, experienced personnel, with preschool teachers and recreation leaders responsible for preschool activities. The preschool is open for three hours each morning all year round and comprises five rooms for different activities, such as arts and crafts, reading, playing, water games, and use of computers. The children mainly range in age from three to six years, and the number of children varies from three to eight, with an average of five. The preschool’s program is made up of personal development through the use of motor skills, language, and social, everyday behavior. We have noticed that children need limited stimulation in order to develop properly so the locales are simple and the activities limited and adjusted to a somewhat slower pace. The preschool teacher always writes a personal statement, which is attached to the main evaluation. This statement describes the child’s motor-skill development, language and speaking development, social skills, as well as parents’ contact with

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the preschool personnel. The preschool provides a good opportunity to see how the children interact with other children and adults. In each case, the parents have an in-school meeting before the child begins preschool. Parents are responsible for getting their child to preschool and providing suitable clothes and a snack. At the conclusion of the child’s preschooling, information is given to the parents regarding the preschool teacher’s statement for the main evaluation. Each child celebrates a “graduation ceremony” upon conclusion of their stay, and takes with them a folder full of their own creative work at the preschool. The Oasis preschool provides a unique opportunity for stimulation and development of children during their evaluation visit. The older children go to the local public schools, which are in the same neighborhood as The Oasis. After several years of cooperation with the public schools, parents and teachers of other children have learned that The Oasis children need this school as part of their routine, which remains stable, even when it seems difficult to gain a perspective on other parts of life. For school children aged 7–13 years and with special needs and/or learning disabilities, The Oasis provides, in cooperation with the city of Aneby, a small school located at the children’s unit, Karlsborg. There, a specialist teacher and two assistants are responsible for the work. In-school and conclusion meetings are conducted together with the parents and responsible evaluator. This often provides an opportunity for contact with former or future teachers. The schools’ specialist teachers meet with The Oasis evaluation personnel on a regular basis. Once per year the public schools’ teachers are invited to The Oasis where they are provided with relevant information and given the chance to discuss problems which may have arisen during the school year. Statements from the preschool and grade schools make up an important part of the final overall assessment.

THE FINAL PHASE OF THE EVALUATION When all areas of competency have contributed with their conclusions, results are discussed and woven together to form a clear understanding from a holistic point of view. Continued individual planning is based on this overall assessment. The final assessment is made approximately two weeks before the end of the threemonth period, which is the normal length of an assessment period. Parents in the program go through the assessment together with personnel from the different areas of competency, and in the final phase, together with the social worker responsible for the case. At this point parents are given the opportunity to clear up possible misunderstandings, add to the assessment, ask questions, or agree with the assessment. Once the parents have seen the assessment, it is sent to the responsible social worker from the referring agency, where all parties are prepared for the final assessment conference. In cases where the family moves back home, the social worker is given a short time to create resources for extra support if necessary. It is, however, important that the final assessment conference not only sums up the assessment period, but also serves as a hopeful new start regarding possibilities for change which lie ahead for the family. A special afternoon farewell party for the family is also of great importance.

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In cases where the final assessment recommends that the children be separated from the parents, entirely different processes are set in motion. This assessment recommendation almost always causes a crisis for the parents, typically expressed through tears, anger, despair, and chaotic questioning. Through years of experience, The Oasis personnel have gained a valuable understanding of crisis reactions, and the entire staff is thoroughly prepared when such assessment recommendations are presented. It is extremely important that the parents receive care, however, within reasonable limits. It can often be tempting to try to comfort a parent, since identification as a parent may be strong. Therefore, it is important to be there for the parents, but to keep reality in perspective. After a while, when the acute crisis phase has passed, parents begin to question the competency of the staff, accuse them of heartlessness, and finally ask, “What happens now?” For many parents the legal process is extremely difficult to understand. If the responsible social agency decides to sue for forced custody, The Oasis personnel assist the parents with legal information and support surrounding negotiations. In such difficult situations, it is important that where the family has older children, they are informed and given an informal opportunity to react and ask questions. It is not unusual for children to feel a great responsibility for their parents, and have strong bonds of loyalty to them. Smaller children can also show reactions when parents, for obvious reasons, cannot function normally. When the responsible social worker informs us that a foster home has been appointed, the foster parents and natural parents normally meet first in an attempt to introduce cooperation. The natural parents need a great deal of support for such a meeting. The in-school process continues for a couple of weeks, according to an individually tailored plan, which counts on the constant involvement of the parents. Cooperation between the foster and natural parents as well as good schooling are essential conditions if the child is to have a peaceful and secure experience in the foster home. Periods of school should be followed by a period of frequent visits, which can later be adjusted to a more normal, regular visitation. It is also important for many children that the natural parents are taken care of and receive different kinds of support, since the child can no longer take care of the parents him/herself. From the child’s point of view, it is important that the parents receive help. For some parents, an assessment recommendation of separation between parents and children comes as a combination of sorrow and relief. For a long time, they have lacked the strength to be good enough parents. They have given this signal themselves by refusing to respond to open care assistance. Some parents even feel more satisfied with themselves as parents when they are parents for limited periods of time. Assessment work can be done in many different ways, and each family is unique. Personnel at The Oasis are often amazed at the amount of support many parents, despite lack of resources, can give their children in a foster home.

ART AT THE OASIS ART was first introduced at The Oasis in 1997 and has since grown in importance as an intervention method in the daily treatment work. The entire Oasis staff has been thoroughly educated in ART’s procedures and theoretical foundation. However, only certain personnel are designated group trainers for interpersonal

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skillstreaming, anger control training, and moral reasoning. Group trainers have also taken the ART master course led by Professor Goldstein. ART is carried out in both the children’s unit for students enrolled in The Oasis school and in the daily treatment work, and in the family unit for families and for parent groups.

ART in the Family Unit Many of the families who come to The Oasis family unit arrive exhausted as a result of the situations they have been living in. The evaluation period is normally around three months in duration. However, most clients remain at The Oasis even after their evaluation period, while good feasible alternatives for the families are worked out. ART is a useful tool in both seeking the degree of change potential in the family, and in teaching new social skills. Many of the parents who have stayed with us at The Oasis have lacked clarity and limits in their own upbringing, which has in turn affected how they raise their own children. The goal of ART at the family unit is to give the clients new and better possibilities to mature and improve contact with their children and their surroundings. At the family unit we work with both adult/parent groups and with whole families. The parents begin in an ART group a week or so after admission and continue for their entire length of stay. Work with whole families begins within a few weeks of their admission. First it is important to observe the family for some time, gaining insight into how they function and what their needs are.

Family ART We have discovered that training with the whole family is a good forum for working with the problems specific to the family. During ART the family meets and works together with their own weaknesses and strengths. Before we start a group, the parents first fill out a checklist, estimating how adept they and the children are in using different social skills. Children can also fill out such checklists to the extent they are able to do so. Our starting point is then the family’s possibilities, and training begins in areas which the family is willing to change. Motivation to take part in the entire training session is increased, since they themselves have influenced the choice of social skill. After each training session participants are given a token, a star: accumulation of tokens after several ART sessions results in a reward for either the individual or the whole family.

BETTER COMMUNICATION One positive result of working with families is that they seem to discover a new language for communicating with each other. They gain knowledge of each others’ feelings, learn to wait their turn, and generally how to solve everyday conflicts. Training sessions with families vary a lot from family to family depending

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on specific conditions such as age, family size, and problem areas. However, the framework is the same and covers all three parts of ART, social skills training, anger control, and moral reasoning. Sessions take place regularly each week for the duration of the family’s stay at the family unit. Depending on the family’s situation, sessions range from a half-hour to an hour in length. In between sessions, families are given the task of practicing those skills which have been taught in the training sessions. This is done with the help of homework sheets. If the day’s session includes social skills training, then the session begins by going through the previous week’s homework. Secondly, the ART trainer introduces a new skill, and the family discusses its meaning, if they have heard of it, and how well they use it. The family and the ART trainer then discuss what they have done in different situations and how they can use the skill in order to do things differently. Role-playing is used in front of the trainer to practice for a similar situation. The whole family or relevant individuals take part in role-playing. Family members often play themselves, using the mode of expression that they would use in everyday situations. Afterwards the ART trainer goes through how well each step was used, giving feedback to all the participants.

ROLE-PLAYS ARE IMPORTANT Role-plays are made up almost entirely of situations from the family’s everyday life. Training to make a situation turn out differently and experiencing the resulting feelings and treatment is of great value for many families who are used to accumulated unsolved conflicts. At times some parents resist taking part in the training, wanting only the children, whom they consider to have the problem, to participate. We try to motivate the parents to be a part of the training by stressing the fact that the parents know the child best and can therefore influence the child to a high degree. The family is a living organism in which all parts affect each other. This means that if one part changes, something happens in the entire organism. It also means that families who make use of what they have learned in family ART become more dynamic. The father who learns to breathe deeply and find alternatives to his anger has an effect not only on himself, but the entire family. Taking part in ART as a family enables the family members to remind each other of what they have learned during the week, increasing the chances of generalization occurring in real life.

EXAMPLES OF FAMILY ART Some time ago we concluded family ART training with a family of five who had participated for approximately six months. The first sessions were concentrated on getting the three children, two of whom were boys diagnosed with DAMP (Deficits in Attention Motor Control and Perception) and ADHD (Attention Deficit Hyperactivity Disorder), to sit still with us in a circle on the floor. The parents were extremely tired of all the conflicts and outbursts of rage which had splintered the family. We began, therefore, with simple exercises which encouraged them to trust each other and relax and take time to think, in order to create unity in

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the group. After a few weeks, we began to present the fundamentals of anger control and Skillstreaming, all on a very basic and easy level. We practiced the same exercises week after week, adding new skills little by little, while training anger control. During one of these sessions the mother in the group told how she had one afternoon been very irritated with one of her sons for not obeying her. The boy then said, “You have to do ART now! You have to breathe deeply!” On another occasion one of the sons, after being provoked by his brother, ran out onto the balcony shouting “I can’t breathe! I need some air!” When he returned to the rest of the family, he was calm. During the period in which the family regularly participated in training, we could see how the frequency of negative, aggressive behavior decreased, while the family, and mostly the parents, learned to reward positive behavior, which in time became more common. Mattias (false name), eight years of age, arrived at The Oasis with both of his parents a year or so ago. The family was desperate, since Mattias, with a high level of aggression and DAMP, had taken over the family and steered it completely. At home he had made enemies of most people and had difficulties with the social codes. He was very smart and self-focused, and saw no need to learn anything when the ten-week anger-control program began for him and his family. Most important at the outset was to observe what caused Mattias’ extreme anger, how he dealt with it, and what the consequences were. At first, the boy could not see anyone but himself while having an outburst of rage. What he knew was that he became exhausted after the outbursts. Mattias turned out to be very sensitive to external triggers, and we spoke often about these in order to find anger reducers that suited him. The weeks passed and little by little Mattias began to be aware of those around him during his outbursts of rage. In order to keep the reminders available to Mattias and his parents, the family chose to cut them out and keep them in their pockets. Wherever they were, they could quickly produce the reminders in case an outburst of rage seemed to be on its way. After approximately seven weeks, Mattias began to respond to the training: he had learned alternatives to anger outbursts and was now and again successful in using them; he had also begun to notice that others around him reacted negatively to his anger, his friends left him, and his parents were tired and sad. This discovery also led in part to a reduction in the frequency of outbursts and his parents felt that they now had a calmer son. They too had learned how to help their son when outbursts of rage came. Due to the fact that the whole family had taken part in ART, the parents also had learned to communicate in a new way, rather than express anger toward one another.

Adult/Parent Groups At the family unit, all admitted adults participate in an ART group once per week. Each group consists of approximately six to eight parents. Since parents stay at The Oasis for a limited period, it is impossible to have “locked” or “closed” groups. In order to facilitate the participation of as many as possible in an ART group, The Oasis has chosen to allow new group members to enter existing groups. New members often adjust quickly in the group, and the other group members can explain

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what ART is and what it has meant to them. Parents who participate in the groups are often very different from each other; however, they do have in common the fact that they are parents. For this reason sessions often have to do with better communication with their children, and being a good role model. However, ART also gives training in how to handle situations which earlier were considered difficult: the ART sessions consist of three parts, skillstreaming, anger control training, and moral reasoning. Skillstreaming leads to good discussions and role-play illustrates the parents’ everyday life together with their children in their surroundings. On one occasion we practiced the skill “getting ready for a difficult conversation.” It had been requested by a woman who always walked away from meetings with her social worker when they did not agree. The woman role-played the skill during a session, and the group discussed how one could deal with difficult conversations. A week later the woman had a new meeting with her social worker, and due to her preparation in ART, she was able to remain throughout the entire one-hour meeting. Dynamics in a group often arise when parents dare to open themselves up and talk about difficulties and strengths within the family. In order for this to occur, there must be an atmosphere of security and trust within the group. Therefore, in parallel with the three components of ART, we work with alternative group exercises from Goldstein (1999). With the help of these exercises group members express their feelings about each other and practice encouraging one another, which in turn leads to a strengthened group feeling.

Moral Reasoning Many of the parents who come to The Oasis are morally immature in many ways. Moral judgment is motivated by selfish gain. The moral reasoning which is practiced as a part of ART therefore provides a good basis for improvement of morals among the adults. In the group context, each individual thinks through his/her own moral reasoning, examining dilemmas which often are relevant for them. The discussion leader tries to steer the conversation toward a collective conclusion, with the goal of decreasing egocentricity.

THE SOCIAL DEVELOPMENT OF CHILDREN AND FAMILIES We see a clear and concrete change of behavior in those children who are admitted to The Oasis. ART, as well as other types of social reinforcement, plays a large part in this change (see Box 8.1). For example, a child who has often had outbursts of rage, even resulting in physical violence, shows clear progress after a period of ART treatment. We have noted that a large majority of these children have fewer and less intensive outbursts. With the help of what ART “checklists,” we can compare and measure how the child’s social ability increases and how the child’s language improves. Indeed, swear words and vulgar sexual references decrease as the child learns alternative forms of expression. The word “respect” is a word

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that the children eventually learn to use in expressing their dissatisfaction with something. Box 8.1 Student examples Johan: Long-term progress Johan is 9 years old when he arrives at The Oasis children’s unit, Karlsborg, because of his very aggressive behavior in both the home and other contexts, such as in school and among friends. Johan’s behavior consists of regular outbursts of aggression as well as other types of aggressive actions which have resulted in considerable material damage. At Karlsborg Johan begins training in basic social skills, while also participating in a ten-week anger control course. Moral reasoning sessions also become a regular part of Johan’s training. At first only small steps of progress are noticed, and Johan has a tendency rather to increase his aggressive behavior. Johan’s trainer and other personnel work consistently to encourage him when he behaves correctly. The treatment strategy is to give as little attention as possible when Johan acts in a non-desirable way. Each day Johan is given reminders and encouragement to practice his training in skillstreaming, anger control, and moral reasoning. Step by step we are able to see progress and how the frequency and intensity of his aggressive behavior decrease. After two years of treatment at The Oasis, Johan moves to an institution. Reports from them indicate that Johan has continued to make use of much of what he learned in ART. In the first months after the move, Johan calls The Oasis every week, telling us how he is doing and his thoughts regarding continued use of ART. Mikael: Catching teachable moments (taken from ART trainer/personnel notes from an ART session) Mikael (false name) is 11 years of age and participates in the ART session and is very enthusiastic. In the session “Knowing your feelings” Mikael gives several suggestions as to which feelings one can experience, such as fear, worry, and sorrow. He begins to cry when the conversation begins to deal with parents and what we can feel toward them. Personnel comfort Mikael, who is allowed to leave the session for a while in order to talk in peace and quiet with one of the trainers. The trainer encourages Mikael, pointing out that what he has just done was to express his feelings. The trainer asks Mikael to reflect on what made him begin to cry. At this point Mikael describes what he is feeling. He also explains how it feels OK to cry in front of others, and that it is an adequate way to express what he is feeling in this situation. This is an example of how to catch teachable moments, and to carefully make use of ART components, even in emotionally tense situations. Martin: Exercising control Martin (false name) becomes angry due to a misunderstanding between himself and a staff member. The conflict gets out of hand, and Martin becomes

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violent. Personnel are forced to lay Martin on the ground to prevent him from hurting himself or others. Martin has participated in an anger control course and is well aware of what he should do in this situation. In other words, Martin has the knowledge of what to do; however, the question is whether or not he has the will to use it. With support from the personnel who are holding and speaking calmly to him, encouraging him to use what he has learned, the answer to this question is “yes.” After only five minutes, personnel suggest that Martin walk a few meters away, and that personnel will come and talk with him once he has calmed down. Martin walks to an apple tree a few meters away. Martin takes several deep breaths. After a few minutes personnel go to Martin, and together they speak calmly about the incident. Personnel encourage and commend Martin for so quickly gaining control over himself. Besides a reduction in aggression, we can also see progress in the following areas:

r Children lacking in self-confidence, who have not normally greeted by shaking hands, begin to do so, as well as introduce themselves.

r Personnel, social services workers, teachers, and parents have noticed that children have improved their ability to have eye contact in different situations.

r Children develop a greater ability to converse and exchange thoughts and feelings with others. learn to be more conscious of what they feel, and dare to describe different specific emotions. Children learn to better understand how others feel in certain situations. We have noted that children’s empathetic ability increases throughout ART training. We have also seen that children develop a greater ability to deal with stress. This leads in turn to increased patience and a capacity to deal with irritation.

r Children r r

ART and the rest of the program in the children’s unit is connected to a token economy. A token economy is a motivation system designed to encourage and reinforce desired behavior. It is based on the premise that behavior is primarily steered by its immediate consequences, and if the consequences can be changed, then the behavior will also be influenced. In the token economy, participants receive immediate feedback in the form of tokens when they exhibit desirable behavior. It is important in a token economy that the rules are clear and that expectations of participants are clear and specific, not unclear and diffuse.

GENERALIZATION Generalization means that we also work with the children’s parents and other networks, even when these are not admitted to The Oasis for treatment. This wider work is carried out in order to share knowledge and understanding of what the child is learning through the treatment. Visiting the child’s home or having the parents or contact persons visit The Oasis for training together with the child is how this is done concretely. Generalization provides a more lasting treatment result after the period at The Oasis.

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The child’s development is often a key to changing a destructive family pattern. Our starting point is always an individual treatment plan, which also implies taking into consideration the family’s/parents’ conditions, and training primarily with what the parents themselves wish to work on. ART in family or parent groups becomes dynamic, since all the individuals in a system are influenced when a child begins to change his or her behavior. A vitally positive change resulting from skillstreaming is when family members become better at listening to each other: communication within the family improves so that problems can be solved more easily using the new alternatives, which are practiced in the ART training sessions. The will and ability to change often exist within the individual, and with the new skills they have been taught, parents have tools with which they can influence their own and their children’s situations positively.

SUMMARY The Oasis offers specialist services for young people and their families. The use of ART within this setting has proved to be an important component of the work of the staff both in terms of their professional development and in terms of the effectiveness of the service they offer.

REFERENCE Goldstein, A. P. (1999). The Prepare Curriculum: Teaching prosocial competencies (rev. edn). Champaign, IL: Research Press.

Chapter 9

A NATIONAL DISSEMINATION PROGRAM JAMES MCGUIRE1 AND DANNY CLARK2 1 2

University of Liverpool, Liverpool, UK National Probation Directorate, London, UK

The focus on Aggression Replacement Training (ART) is happening at an opportune time, and there are several excellent reasons for this. First, there is a large volume of primary studies now available in the field of offender treatment. The general trends within it are such that we hope that the once dominant belief that “nothing works” to help offenders change and to reduce criminal recidivism can now be laid to rest. Second, work on a number of specific programs, of which ART is a prominent example, has consolidated to a remarkable degree. Many issues, from the nature of the program itself to aspects of delivery, implementation, and evaluation, have been solidly addressed, though we fully acknowledge that this is still only a beginning and much more work remains to be done. Third, the nature of practice in many services, including prisons, probation, and youth justice, has been significantly influenced by these types of developments. There are now new kinds of partnerships between researchers and practitioners that have been and will continue to be of considerable benefit to both. Finally, in a number of countries, including the UK, the development of structured programs has been adopted as an element of policy, with the result that new resources are available which even a few years ago were very difficult to obtain. In this chapter we would like to outline the way in which ART has been piloted, evaluated, and is now being disseminated in criminal justice services in the United Kingdom. To date, this has not occurred on a particularly large scale, but is now approaching a point that could be called “lift-off” in terms of level of interest and activity. But first we need to set this in a wider context, as it forms part of a larger-scale initiative and is one element of a major change in government policy, entitled the Crime Reduction Programme. This is a major strategy by HM Government working through the Home Office (the equivalent of a ministry of justice in other countries) to develop and implement an approach to crime prevention that is firmly evidence based.

New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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BACKGROUND RESEARCH It is beyond the scope of this chapter to carry out a review of relevant background evidence relating to what has been called “what works.” But recent integrative reviews of the field show that there are in the region of 2,000 primary studies in which some form of intervention, such as a structured program, has been compared with a no-treatment control group. Since 1985 there has been a total of 42 metaanalyses covering different portions of this literature (McGuire, 2001, 2004). There is also a general consensus among researchers concerning interpretation of the trends within it (Gendreau, 1996; Sherman, Farrington, Welsh, & MacKenzie, 2002; Hollin, 1999), though it is useful to be reminded that there are also limitations that should be constantly borne in mind (Losel, ¨ 2001). It is often forgotten, however, that some of the “treatments” that have been investigated do not consist of programs of education, training, or therapy of any type. They have been designed to test the expectation that additional sanctions— more intensive punishment—will reduce reoffending. That is a widespread lay view concerning how to change offenders’ behavior, based on the idea of deterrence. While this probably has an impact on some offenders, in some places at some times, there is no evidence that it works on a systematic basis as a central pillar of criminal justice (McGuire, 2002). Much more positive findings are obtained when the effects of interventions with certain ingredients are examined. These have loosely been called “programs” though precise definitions of these vary and there can be sizable diversity in the exact nature of the activities involved (McGuire, 2000). But with a fairly high level of consistency, certain identifiable features emerge as more likely to secure reductions in reoffending. Effective programs have a sound theoretical rationale based on evidence from psychology and criminology. They involve assessment and allocation of offenders in terms of risk levels. They focus on dynamic risk factors associated with reoffending, and they employ cognitive-behavioral methods adapted in a way that is responsive to the needs of a particular target group. However, as in any other applied field there are no guarantees of a successful outcome in any given case. It remains vitally important, therefore, that in every instance possible, the use of any program should be subject to monitoring and evaluation processes. One difficulty is that when reporting the average effects obtained from reviews of offender treatment, all these studies are often bundled together. The apparent overall mean effect size is reduced by the zero or negative effects from experiments on sanctioning. Even so, the impact of interventions on recidivism is still comparable with effect sizes found in many other areas, and which are firmly established as valuable courses of action (McGuire, 2002). Selection and implementation of programs containing the factors previously listed is usually linked to larger, and sometimes very impressive, outcomes.

IMPACT ON PRACTICE AND POLICY Many criminal justice agencies now have an expectation that the kinds of services they provide should be based on theory and evidence concerning the factors

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that influence offending behavior, and which if effectively addressed in intervention programs may be likely to reduce it (Vennard, Sugg, & Hedderman 1997; Goldblatt & Lewis, 1998). The move towards what is known as “evidence-based practice” has been occurring in parallel in a number of fields for more than a decade. In medicine and healthcare generally, the advent of an evidence-based approach is often traced to the influence of Cochrane (1979), a British epidemiologist who identified a marked need to examine whether medicine and related health research fields could genuinely claim to have sound empirical foundations. As he pointed out, even in medicine, where there is considerable investment in research, there was no systematic record of the outcomes of interventions: it simply did not exist. During the mid-1980s, a paper by Mulrow (1987) examined a series of review articles published in medical journals over a 12-month period (June 1985 to June 1986). Mulrow found major shortcomings in the manner in which reviews were conducted and reported. As a result of comments and findings such as these, the international Cochrane Collaboration was created in 1993. This is a worldwide network of researchers and reviewers coordinated through a series of sites in different continents. The task it has set itself is to locate, evaluate, and integrate the results of well-designed intervention studies (usually randomized controlled trials). The available set of outcome studies, assembled as the Cochrane Database of Systematic Reviews, contains more than a quarter of a million entries. These have been made accessible to researchers and other users through the Cochrane Library, accessible via the Internet. There is also now a parallel innovation, focused not on health but on the fields of educational and social interventions, including correctional services. The recently created Campbell Collaboration had its inaugural international gathering in February 2000 and its first conference in April 2001. Even prior to its formal launch, members of the Collaboration had assembled a sizable database, entitled the Social, Psychological, Educational and Criminological Trials Register (Petrosino, Boruch, Rounding, McDonald, & Chalmers, 1999). In summary, then, across many fields of endeavor there is now a standard philosophy, encapsulated in the phrase evidence-based practice, that is regarded as a cornerstone of the process of consolidating and synthesizing scientific knowledge. It has become a virtual prerequisite of the design and delivery of services and of consultation with practitioners and policy makers. It is also a benchmark for identifying unanswered research questions and for signaling the necessary next steps for research work.

DEVELOPMENTS IN THE UK In 1996, the prison service (England and Wales) embarked on a major initiative to increase the number of prison establishments providing programs and activities designed to reduce rates of recidivism following release. Prison service objectives have for some time been managed in terms of Key Performance Indicators (KPIs), which are measures of the achievement of core tasks of the service. The provision of programs designed to reduce recidivism has been included as an indicator of

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this kind (KPI-7). To establish a process for quality control of the programs that would be delivered as part of it, two independent specialist panels were appointed. One was given the job of accrediting programs for sex offenders, while the other dealt with general offending behavior programs. These panels published sets of Accreditation Criteria for evaluating the rationale, design, and delivery of prisonbased interventions. Programs designed to meet these criteria, and which have been accredited as doing so by the consultative panels, are now in use in more than 70 of the 150 penal institutions in England and Wales. The introduction of these processes into the prison service in England and Wales from 1996 onwards has been described in more detail by Lipton, Thornton, McGuire, Porporino, and Hollin (2000). Similar developments have occurred in the Scottish Prison Services and in the Correctional Services of Canada, and it may be that such initiatives will also be pursued by prison services in several other countries. To sustain an initiative of this kind is a substantial undertaking. It has involved the deployment of significant additional resources. It has entailed an extensive program of staff training events, creation of a system of monitoring and audit, and associated mechanisms for administration and information management, both within individual prisons and on a service-wide scale. For example, all sessions of cognitive-skills programs are to be videotaped for scrutiny by external assessors (on a sampling basis). Procedures have been put in place for the systematic evaluation of programs in both the short and longer term. The research findings outlined earlier have also had a marked impact on community agencies for offenders, principally the probation service (and, more recently, youth justice services too). During 1997–98 in England and Wales, the Probation Inspectorate, which monitors the working standards of probation nationally, conducted a focused or “thematic” inspection to examine the extent to which probation staff employed practices based on research evidence. The main report on this work (Underdown, 1998) proposed a series of new initiatives to extend the usage of evidence-based practice in probation work. This subsequently led to the selection of a number of programs designated as Pathfinder projects that were earmarked for further development. In late 1999, a new accreditation process was established to operate jointly for prison and probation services. It was envisaged that programs satisfactorily meeting pre-appointed criteria would be delivered at a large number of sites, and by the end of 2003 more than 10,000 offenders would have attended such programs. To have a program accredited for use in prison or probation settings, a proposal must be submitted to the Correctional Services Accreditation Panel, which, like its predecessor in the prison service, consists of independent experts and consultants. The submission should include copies of all relevant materials such as a description of the program’s theoretical rationale and evidence base, session manuals, staff training manuals, assessment and evaluation measures, and ideally, some preliminary indications of effectiveness. These are then judged against a pre-agreed set of accreditation criteria that define the minimal requirements for approval of a program (Home Office Probation Unit, 1999). The criteria stipulate that the following specifications must be met.

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1. Model of change. There should be a clear, evidence-based theoretical model underpinning the program which explains how it is proposed it will have an impact on factors linked to offending behavior. 2. Dynamic risk factors. Program materials should identify factors linked to offending, specified in the model, and which if changed will lead to a reduction in risk of reoffending. The program contents should reflect these objectives. 3. Range of targets. Multimodal programs with a range of treatment targets have yielded the largest effect sizes in research reviews. Program manuals specify an appropriate range of targets and the nature of their interrelationships. 4. Effective methods. The methods of change utilized in the program should have empirical support concerning effectiveness and be coordinated in an appropriate way. 5. Skills oriented. Programs targeting skills that will enable offenders to avoid criminal activities have yielded higher effect sizes in outcome studies. The skills targeted by the program should have explicit links to risk of reoffending and its reduction. 6. Intensity, sequencing, duration. The overall amount of programming (numbers of contact hours), the mode of delivery of sessions, and total program duration should be appropriate in the light of available evidence, the program’s objectives and contents, and the risk level of the targeted offender groups. 7. Selection of offenders. The population of offenders for whom the program is designed should be explicitly and clearly specified. There should be agreed and realistic procedures for targeting and selection, and for exclusion of inappropriate referrals. 8. Engagement and participation. This criterion refers to the principle of responsivity. Information should be provided concerning how this will be addressed, and how offenders will be encouraged and motivated to take part in and adhere to the program. 9. Case management. In prison settings, offenders are allocated a Personal Officer with responsibility for overseeing their individual sentence plans. On probation, they are supervised by a Case Manager. To be effective, programs should be inter-linked with these processes, and guidelines provided for implementation within services. 10. Ongoing monitoring. In order to safeguard the integrity of a program and the treatment methods used, procedures should be in place for collection of monitoring quality-of-delivery data, and systems established for review of this and for taking action on the basis of it. 11. Evaluation. Finally, program materials should include assessment and evaluation measures and a framework for evaluation of its overall delivery, and short-term and long-term impact. With regard to each criterion, a programme may score 0 (not met), 1 (partially met), or 2 (fully met). Some of the criteria (items 1, 2, 7, 9, 10, and 11) are mandatory: in other words, it is essential that the requirements be fully met. To be accredited, a program must achieve a minimum score of 19/22 points, including full marks on all mandatory items.

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In addition to program accreditation, each location in correctional services (such as an individual prison, probation office, or other unit) must also satisfactorily meet criteria for site accreditation. This is part of a process of certifying program and treatment integrity at that site. Systems for collecting information on quality of delivery (program integrity) must also be in place, and the data so collected made available for an annual site audit. Audit reports are then scrutinized by both correctional agency staff and members of the independent accreditation panel. The annual site audit itself is a time-consuming task. However, the fact that results of the site audit have a direct impact on KPIs through a system of weighting completions ensures that managers in correctional settings take the process seriously. The annual audit encompasses four areas: 1. Managerial commitment to program delivery. Are appropriate resources made available to run the program? Is the institution/setting supportive of program delivery? 2. Monitoring of attendance and completions. Are the right offenders selected for the program? Are the majority of offenders completing the program? 3. Staff training and support. Are all staff delivering the program competent and experienced? Is consistency of staff maintained within the program? 4. Program integrity. This is primarily checked through video monitoring. Staff are judged against a series of criteria related to adherence to the program content and to style of delivery, which should include prosocial modeling and Socratic questioning. In addition, all offenders attending the program complete a battery of psychometric tests before and after the program, which allows immediate response to the program to be monitored. Research is now demonstrating the value of this approach. A study by Rosie Travers of the Prison Service Long-Term Evaluation Unit compared establishments’ audit results with the mean levels of change offenders showed on the pre- and post-program psychometric tests. The study included over 75 prison establishments and covered a three-year period (Travers, 2001). It demonstrated there was a strong correlation between quality of program delivery judged from the videos and mean changes for offenders on the psychometric assessments. This proves the value of internal audit. There are also preliminary results from the prison service implementation of accredited programs. However, whilst one study found a 14% reduction in subsequent recidivism (Friendship, Blud, Erikson, & Travers, 2002), results from other evaluations to date have been less positive (Cann, Falshaw, Nugent, & Friendship, 2003; Falshaw, Friendship, Travers, & Nugent, 2003). Many of the programs which are currently being developed in both prison and probation settings employ methods of cognitive skills training, or other work along similar lines. The theoretical model they draw from is that of cognitive social learning theory or some variant of it, and the methods they employ can broadly be characterized as “cognitive-behavioral,” though this can cover a wide range of activities.

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ART AS AN ACCREDITED PROGRAM Some of the programs that have achieved accredited status through the foregoing process were developed by local practitioners in adult probation services; others have been imported. The most extensive usage of ART in England and Wales has occurred in Wiltshire, a predominantly rural county approximately 100 miles west of London, with a generally dispersed population in villages and medium-sized towns, and one larger center (Swindon) that is more industrial. The distinctive feature of ART, of course, is that it is an adapted version of the program initially developed by Arnold Goldstein for younger offenders. That work has been extensively documented in a number of publications since the late 1980s (Goldstein & Glick, 1987, 2001; Goldstein, Glick, Carthan, & Blancero, 1994). The program as implemented in Wiltshire entails 18 sessions, each in two parts lasting 55 minutes with a short break in between. The rate of delivery is one or two sessions per week. Program sessions are multimodal and combine the familiar three elements, Skillstreaming, self-control training, and training in moral reasoning, into an integrated design. Each of the elements constitutes eleven 55-minute sessions. There is a specially adapted program manual but, unlike the pattern with other programs, there are no hand-out materials or homework exercise worksheets. These are steadfastly avoided, apart from a credit-card-sized prompt of anger management for offenders to take away. The focus is on live, in-session activity. The program has now been running for almost four years and owes its origins to some internal reviews conducted by Wiltshire Probation Service in the period 1996–97. This followed an analysis of local Pre-Sentence Reports (PSRs), which are provided for courts in cases seen by probation staff. The review identified a need for new programs in several key areas focused on specific offending patterns. In particular, it was found that violent offences accounted for approximately one-third of all PSRs, indicating a need for a program focused on this type of offending. Development of the ART program followed attendance by Wiltshire probation staff at a workshop delivered by Professor Goldstein prior to the 1996 “What Works” conference held in Manchester. The program was then established in 1997. There was some correspondence and consultation with Professor Goldstein, and advice has also been obtained from Professor Gibbs regarding moral reasoning training. Given the North American origin of the original program and its content, cultural context and style, considerable work was required to adapt materials for use in the UK. Clearly, it would have been advantageous for the service to have been able to consult more extensively with the external experts, but this was not feasible. Wiltshire, in organizational terms one of the country’s smaller probation areas, allows the possibility of frequent and regular contacts between staff groups at different sites. In general, there have been no serious access problems between staff at different levels either upward or downward in the line management hierarchy. In addition, the staff group involved during the initial development period remained fairly stable with few changes of personnel. These patterns afforded a number of advantages for a service seeking to import a program from elsewhere. They are important elements identified by Gendreau, Goggin, and Smith (1999) contributing to effective implementation of new initiatives.

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The program is delivered at two sites in the towns of Swindon and Trowbridge at a rate of 6–10 deliveries per annum, with 6–8 offenders per group, predominantly in evening sessions as a high proportion of offenders are in employment. A maximum of eight participants is preferred to allow time for skills practice, which is a key ingredient of the program. The staff team includes four probation officers, three specialized group-work assistants, and four experienced part-time staff. All staff members are involved in program delivery. The service also runs a range of other programs. However, as the development sequence for programs unfolds, some may be discontinued, with additional staff being allocated to ART. There is an emphasis, in annual program planning, on both continuity of staff per program and adherence to a delivery timetable. Two practitioners per session are involved in running the program. Though not always feasible it is intended to achieve a gender balance and mixture of grades and prior experience among tutors. To ensure cohesiveness of delivery, as far as possible staff are also allocated as “reserves” for program sessions. There are regular supervision sessions for all staff, formal and informal debriefings, and material from live observation of sessions is utilized in supervisory work. There is also a review week twice per year which incorporates both training events and a review of staff competencies, and discussion of any issues arising from the program work, such as difficult incidents occurring in groups. One problem this has raised is the sizable number of program participants who have committed domestic violence. This is understood to be associated with a different pattern of risk factors from those targeted by ART. This had led the referral pattern to change with the advent of a program focused on this type of offense. Possibly the largest single drawback of this mode of adopting a program was that staff who instigated the process trained themselves to run it. This involved a thorough examination of materials provided for the program. Subsequently new staff were trained by existing staff. The team has also provided training externally, to practitioners in six other probation service areas. For each new member of staff there is a lengthy induction process evolving from observational work and limited experience of session input, through adoption of an increasingly active role, to coleadership. However, some staff saw this overall format as inadequate, and would have preferred more formal training and perhaps less emphasis on learning “on the job.” The staff team has more recently completed staff training manuals and other materials required for accreditation. The introduction of a new program in the manner we have described has not of course been without some difficulties. One of them is selection of offenders for the program, with only an estimated 60% of referrals viewed as genuinely appropriate. A large proportion of the remaining 40% have committed offenses of domestic violence, as mentioned above. Nevertheless, there is a significant waiting list for ART, and for this to be manageable it is envisaged that the frequency of programs may have to increase. One major problem faced by all community correctional services with respect to structured programs is that of attrition. Offenders are court-mandated to attend programs, which are made integral parts of a community sentence. The consequences of non-attendance may include being returned to court, which in turn might result in an offender being sent to prison. Despite this, on many programs

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the number of offenders who attend all sessions and make it through to the end is sometimes very low. However, completion rates for ART have varied between 65% and 75%, which in relative terms is perceived as very satisfactory. In different areas of the UK, the factors influencing program “drop-out” vary widely. In Wiltshire, travel problems in a large rural county play a part in this, as public transport facilities are limited, particularly in the evenings. Participants are brought to program sites by a combination of staff effort and the use of taxis. Although this program receives a high rate of referral for women offenders, given their much lower rate of violence, the absolute number of female clients remains low and they constitute only one or two members of some groups. As Wiltshire has a very low proportion of members of ethnic minorities, the number of black offenders seen is also very low. The Wiltshire ART program was considered by the then Joint Accreditation Panel in March 2000. Despite the fact that the program is based on work with a proven track record in North America, changes were required by the Joint Accreditation Panel before accreditation was finally achieved in March 2001. The revisions included:

r introduction of catch-up sessions for offenders who missed parts of the program; r identification of arrangements to practice skills outside the program, with family members, friends or, if necessary, with the case manager;

r individual pre- and post-group sessions with the case manager to provide motivational enhancement and reinforcement of the program work; selection criteria to ensure offenders attending the program were the most suitable, specifically excluding those with a history of domestic violence and those whose aggression was entirely instrumental; sequencing of ART with other cognitive-behavioral programs for high-risk generic offenders (e.g. those with multiple types of offenses and high risk of reconviction); revised arrangements for women offenders to avoid single placements and to make the material more responsive; teaching of core social skills for all offenders.

r tighter r r r

These changed requirements demonstrate the rigors of the accreditation process.

MONITORING AND EVALUATION The use of the ART program in Wiltshire, as well as in those other areas to which it is being “rolled out,” is being evaluated as part of a national research project (Hollin et al., 2001). The first phase of this activity involved preliminary visits to the probation areas and sites where programs are being implemented and this chapter has been partly based upon that work. The objectives of these visits were to conduct interviews with key staff, to assemble relevant documentation, and to specify and check upon the availability of a wide range of types of data to be collected and analysed as part of the project as a whole. The data being collected are both quantitative and qualitative, and focus both on the outcomes of programs as well as aspects of implementation and process. This is, therefore, a multi-layered

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approach in which evaluation is seen from a number of interrelated perspectives (Stecher & Davis, 1987; Posavac & Carey, 1997). Offenders’ participation in the Wiltshire ART program is closely monitored. Records are kept of all sessions attended and absences are communicated speedily to case managers. A final report is prepared on each participant, documenting levels of attendance, punctuality, and factors established as contributing to offending behavior, and requiring monitoring in terms of future risk. Reports are despatched efficiently and reliably to offenders’ case managers. For monitoring of program integrity, the program manager directly observes two sessions per program delivered. Staff retain written records of session planning and feedback, and these materials are used in supervision sessions, which occur four times per program. At the time of writing, resources were not available for videotape recording but this will be introduced gradually for all programs. Preliminary information is now available concerning the ART program’s impact on reoffending, after a follow-up period of one year. Sugg (2000) has provided some analysis of a series of 295 offenders who went through the program in the period up to September 1999. Of this group, a total of 230 could be traced through the Offenders Index, a national database of criminal history information, although a further 77 were excluded as they were still on probation orders. Of the 153 remaining, 113 (74%) completed their orders successfully. Their risk of reoffending was assessed using the Offender Group Reconviction Scale, Version 2 (OGRS-2). This is a static prediction instrument developed by Home Office researchers and validated on fairly large samples (Taylor, 1999). It yields a two-year predicted rate of reconviction, which for ART completers was 34.6%. The OGRS2 score of non-completers—the remainder of the sample whose probation orders were revoked or breached—was higher than for completers. This suggests that ART in the form adapted by Wiltshire is more suitable for medium-risk than high-risk offenders. Follow-up data are shown in Figure 9.1. The reconviction rate for program completers after one year was 20.4%. This compared with a figure of 65% for those whose probation order had been revoked. The ART group was also compared with a retrospective matched sample of offenders sentenced to other court disposals, including

Percent reconvicted

70 60 50 40

Predicted

30

Actual

20 10 0 ART

ART Revoked

Comparison

Figure 9.1 Reconvictions at one-year follow-up

Comparison Revoked

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community service orders and combination orders. The one-year reconviction rate for those who completed these orders was 34.5%. There were no differences between the reconviction rates of those who had these other types of order revoked, and those placed on ART whose orders were revoked (65% and 60%, respectively). Comparing the reconviction rates of those who completed their orders, however, shows a sizable reduction in favour of ART (20.4% as against 34.5%). Two caveats should be borne in mind when considering these results. First, the Offenders Index is known to have some internal inaccuracies (Friendship, Thornton, Erikson, & Beech, 2001), which are in a gradual process of being remedied. But it can be reasonably assumed that in the present case they would probably arise with corresponding frequency in both the ART and comparison samples. Second, in other research differences between experimental and control samples at one year have disappeared by the end of year two, and only further follow-up will resolve this issue in the case of the Wiltshire cohort. Overall, however, these results can be viewed as very positive, and if sustained will demonstrate a significant long-term impact of participation in ART. As the ART program is gradually disseminated to other areas, there are also additional developments within Wiltshire itself. They include an extension of structured learning materials to cover additional sessions, especially in a manner that can be used in a “booster” or follow-up format. In addition, there is a possibility in future of a program variant of involving significant others, which in Wiltshire’s case would entail sessions that included both offenders and their spouses or partners. In the future, we may be able to provide much larger-scale evidence of ART’s effectiveness.

REFERENCES Cann, J., Falshaw, L., Nugent, F., & Friendship, C. (2003). Understanding “What Works”: Accredited cognitive skills programmes for adult men and young offenders. Findings 226. London: Home Office Research, Development and Statistics Directorate. Cochrane, A. L. (1979). 1931–1971: A critical review, with particular reference to the medical profession. In Medicines for the Year 2000. London: Office of Health Economics. Falshaw, L., Friendship, C., Travers, R., & Nugent, F. (2003). Searching for “What Works”: An evaluation of cognitive skills programmes. Findings 206. London: Home Office Research, Development and Statistics Directorate. Friendship, C., Blud, L., Erikson, M., & Travers, R. (2002). An evaluation of cognitive-behavioural treatment for prisoners. Findings 161. London: Home Office Research, Development and Statistics Directorate. Friendship, C., Thornton, D., Erikson, M., & Beech A. R. (2001). Reconviction: A critique and comparison of two main data sources in England and Wales. Legal and Criminological Psychology, 6, 121–129. Gendreau, P. (1996). Offender rehabilitation: What we know and what needs to be done. Criminal Justice and Behavior, 23, 144–161. Gendreau, P., Goggin, C., & Smith, P. (1999). The forgotten issue in effective correctional treatment: Programme implementation. International Journal of Offender Therapy and Comparative Criminology, 43, 180–187. Goldblatt, P. & Lewis, C. (1998). Reducing offending: An assessment of research evidence on ways of dealing with offending behaviour. Home Office Research Study No.187. London: Home Office. Goldstein, A. P. & Glick, B. (1987). Aggression Replacement Training. Champaign, IL: Research Press.

150 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Goldstein, A. P. & Glick, B. (2001). Aggression Replacement Training: Application and evaluation management. In G. Bernfeld, D. P. Farrington, & A. Lescheid (Eds), Offender rehabilitation in practice: Implementing and evaluating effective programmes (pp. 121–148). Chichester: John Wiley & Sons. Goldstein, A. P., Glick, B., Carthan, M., & Blancero, D. (1994). The pro-social gang: Implementing aggression replacement training. Thousand Oaks, CA: Sage. Hollin, C. R. (1999). Treatment programmes for offenders: Meta-analysis, “What Works”, and beyond. International Journal of Law and Psychiatry, 22, 361–371. Hollin, C. R., McGuire, J., Palmer, E., Bilby, C., Hatcher, R., & Holmes, A. (2002). Introducing Pathfinder programmes into the Probation Service: An interim report. Home Office Research Study 247. London: Home Office. Home Office Probation Unit (1999). What Works Initiative: Crime Reduction Programme. Joint Prison and Probation Accreditation Criteria. London: Home Office. Lipton, D., Thornton, D., McGuire, J., Porporino, F., & Hollin, C. R. (2000). Programme accreditation and correctional treatment. Substance Use and Misuse, 35, 1705–1734. Losel, ¨ F. (2001). Evaluating the effectiveness of correctional programmes: Bridging the gap between research and practice. In G. Bernfeld, D. P. Farrington, & A. Lescheid (Eds), Offender rehabilitation in practice: Implementing and evaluating effective programmes (pp. 67– 92). Chichester: John Wiley & Sons. McGuire, J. (2000). Defining correctional programs. Forum on Corrections Research, 12, 5–9. McGuire, J. (2001). What works in correctional intervention? Evidence and practical implications. In G. Bernfeld, D. P. Farrington, & A. Lescheid (Eds), Offender rehabilitation in practice: Implementing and evaluating effective programmes (pp. 25–43). Chichester: John Wiley & Sons. McGuire, J. (2002). Criminal sanctions versus psychological interventions with offenders: A comparative empirical analysis. Psychology, Crime and Law, 8, 183–208. McGuire, J. (2004). Understanding psychology and crime: perspectives on theory and action. Buckingham: McGraw Hill/Open University Press. Mulrow, C. D. (1987). The medical review article: state of the science. Annals of Internal Medicine, 106, 485–488. Petrosino, A. J., Boruch, R. F., Rounding, C., McDonald, S., & Chalmers, I. (1999). A Social, Psychological, Educational and Criminological Trials Register (SPECTR) to facilitate the preparation and maintenance of systematic reviews of social and educational interventions. Background paper for the Cochrane Collaboration meeting, School of Public Policy, University College London, July. Posavac, E. J. & Carey, R. G. (1997). Programme evaluation: Methods and case studies (5th edn). Upper Saddle River, NJ: Prentice-Hall. Sherman, L. W., Farrington, D. P., Welsh, B. C., & MacKenzie, D. L. (Eds) (2002). Evidence-based crime prevention. London and New York: Routledge. Stecher, B. M. & Davis, W. A. (1987). How to focus an evaluation. Newbury Park, CA: Sage. Sugg, D. (2000). Wiltshire Aggression Replacement Therapy (ART): One-year reconvictons and targeting. Unpublished report, Research Development and Statistics Directorate, Home Office, London. Taylor, R. (1999). Predicting reconvictions for sexual and violent offences using the revised offender group reconviction scale. Research Findings No. 104. London: Home Office Research, Development and Statistics Directorate. Travers, R. (2001). A comparison of intermediate psychometric measures and programme delivery quality at HM Prison establishments. Paper presented to the Joint Prison and Probation Offending Behaviour Programmes Accreditation Panel, March, Oxford. Underdown, A. (1998). Strategies for effective offender supervision: Report of the HMIP What Works project. London: Home Office. Vennard, J., Sugg, D., & Hedderman, C. (1997). Changing offenders’ attitudes and behaviour: What works? Home Office Research Study No. 171. London: HMSO.

PART III

ELABORATIONS, EXTENSIONS, AND EVALUATIONS In this third and final part the theme of elaborations to ART is taken up with two chapters that look at ways in which the essentials of ART can be advanced. These are the Prepare Curriculum, by Arnold P. Goldstein, and the Peace Curriculum, by Sara Salmon, which both offer ways in which ART can be expanded and enhanced to reach a wider range of targets for change. Alongside elaborations of the program, some innovative practitioners have sought to extend ART into new areas of practice. Ruud Hornsveld works in The Netherlands and his creative format and evaluation of ART in a forensic setting prescriptively reflects the particular qualities and research requirements necessary when working with such clients. Robert Calame and Kim Parker describe their work at the Batshaw Youth and Family Centre in Quebec. Alongside their innovative practice, they have set up a field evaluation of their work. Outcome research in such a setting demands careful and rigorous attention to the unique characteristics which follow from a family focus. The work reported in this chapter does, indeed, reflect such a careful and rigorous attention to detail. It is through evaluation that programs such as ART will stand or fall. There are as of this date 16 completed evaluations of the effectiveness of ART, conducted at almost as many different locations by almost as many different investigators. In the penultimate chapter, Arnold P. Goldstein reviews this array of completed studies. Thus far, it appears that the overall effectiveness of ART appears to be robust, but many research questions remain, and the range, duration, and facilitators of such change need to be vigorously probed further. In the final chapter Bengt Daleflod, who was the first to bring ART to Sweden, writes about the importance of evaluation and how it interacts with practice.

Chapter 10

ART AND BEYOND: THE PREPARE CURRICULUM ARNOLD P. GOLDSTEIN Syracuse University, New York, USA

INTRODUCTION It has been convincingly demonstrated that aggressive behavior is in large part learned behavior. Not only is aggression primarily learned, but the manner in which such acquisition occurs has been shown in an extended series of social learning investigations to be no different from how all other behaviors—both antisocial and prosocial—are also learned. Thus, manipulation, cheating, teasing, bullying, as well as altruism, cooperation, sharing, and empathy—and aggression—appear to be learned largely by means of either observational, vicarious experiences (e.g. seeing others perform the behavior and receiving reward for doing so) or direct experiences (e.g. enacting the behavior oneself and receiving reward for doing so). Chronically aggressive youngsters are characteristically individuals with a life history in which, from their early years on, aggression was frequently used, and used successfully, by family, peers, media figures, and others constituting the youth’s real-world environment. Such aggression by others, increasingly learned and used by the youth himself, is very often richly, reliably, and immediately rewarded. It works; it pays off; it is reinforced, thus making it behavior which is quite difficult to change. The fact that such youths are often markedly deficient in prosocial alternative behaviors—that is, in achieving life satisfactions and effectiveness via prosocial, rather than antisocial, routes—makes their chronic aggressiveness all the more difficult to change. And prosocially deficient they are. A substantial body of literature has directly demonstrated that chronically aggressive youngsters display widespread interpersonal, planning, aggression management, and other prosocial skill deficiencies. Freedman, Rosenthal, Donahoe, Schlundt, and McFall (1978) examined the comparative skill competence levels of a group of such adolescents and a matched group (age, IQ, social background) of non-aggressive youth in response to a series of New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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standardized role-play situations. The aggressive adolescent sample responded in a consistently less skillful manner. Spence (1981) constituted comparable adolescent offender and non-offender samples, and videotaped their individual interviews with a previously unknown adult. The offender group evidenced significantly less (1) eye contact, (2) appropriate head movements, and (3) speech, as well as significantly more fiddling and gross body movement. Conger, Miller, and Walsmith (1965) add further to this picture of skill deficiency. They conclude from their evidence that juvenile delinquents, as compared to non-delinquent cohorts, Had more difficulty in getting along with peers, both in individual one-to-one contacts and in group situations, and were less willing or able to treat others courteously and tactfully, and less able to be fair in dealing with them. In return, they were less well-liked and accepted by their peers. (p. 442)

Patterson, Reid, Jones, and Conger (1975), also studying chronically aggressive youngsters, observe: The socialization process appears to be severely impeded for many aggressive youngsters. Their behavioral adjustments are often immature and they do not seem to have learned the key social skills necessary for initiating and maintaining positive social relationships with others. Peer groups often reject, avoid, and/or punish aggressive children, thereby excluding them from positive learning experiences with others. (p. 4)

As Patterson et al. (1975) appear to be proposing, the social competence discrepancy between aggressive youngsters and their non-aggressive peers has early childhood roots, according to evidence provided by Mussen, Conger, Kagan, and Gerwitz (1979). Boys who later became delinquent in their longitudinal study were appraised by their teachers as less well adjusted socially than their classmates as early as third grade. They appeared less friendly, responsible, or fair in dealing with others, and more impulsive and antagonistic to authority. Poor peer relations— less friendly toward classmates, less well liked by peers—were further developmental predictors of later delinquency. Thus, it may be safely concluded that prosocial skill deficiencies of diverse—especially interpersonal—types markedly characterized both the early development and adolescent behavior of delinquent and aggressive youngsters, to a degree that significantly differentiates them from their non-delinquent, non-aggressive peers. Teacher and school administration response to aggressive, disruptive, difficult youngsters in America’s secondary and elementary schools, as well as parental response to such behaviors in the home, have characteristically involved heavy reliance on one or another method designed to reduce or inhibit such negative behaviors, with relatively little companion effort explicitly directed toward increasing the frequency of alternative constructive behaviors. We have, in fact, become reasonably competent in, at least temporarily, decreasing or eliminating fighting, arguing, teasing, yelling, bullying, and similar acting-out, off-task behaviors. But, in a relative sense, we have attended rather little to procedures designed to teach negotiation skills, constructive responses to failure, management of peer group pressure, means for dealing effectively with teasing, rejection, accusations, anger, and so forth. Two of the most heavily relied upon decelerative approaches, and

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paradoxically two of the least effective in terms of the long term, are corporal punishment and verbal reprimands. Their effectiveness often is quite temporary, and is a complex function of a large number of considerations, including the likelihood, consistency, immediacy, duration, and severity of their occurrence, as well as a number of characteristics of the punishing agent. A central point with regard to the several means in use for reducing aggressive behavior in the classroom, home, or community—whether corporal punishment, reprimands, or such more benign punishments as extinction, time-out, and response cost—is that none teaches alternative constructive responses. At best, they suppress, but offer no substitutes. As we have commented elsewhere: A reprimand or a paddling will not teach new behaviors. If an aggressive youngster literally is deficient in the ability to ask rather than take, request rather than command, negotiate rather than strike out, all the scolding, scowling, spanking, and the like possible will not teach the youngster the desirable alternative behaviors. Thus, punishment, if used at all, must be combined with teacher efforts which instruct the youngster in those behaviors he knows not at all. (Goldstein & Keller, 1987)

Constructive alternatives to aggression can be effectively taught to chronically aggressive youngsters. The present chapter outlines our efforts in developing a comprehensive, prosocial curriculum for doing so.

PROSOCIAL INSTRUCTION: A HISTORICAL OVERVIEW Prosocial instruction in general, and the proposed Prepare Curriculum in particular, have their roots in both education and psychology. The notion of literally seeking to teach prosocial behaviors has often, if sporadically, been a significant goal of the American educational establishment. The Character Education Movement of the 1920s and the more contemporary Moral Education and Values Clarification programs are three prominent examples. Others include Beck’s Ultimate Life Goal approach (Beck, 1971), McPhail’s Learning to Care program (McPhail, UngoedThomas, & Chapman, 1975), the Public Issues Program (Newman & Oliver, 1970), Wilson’s Moral Components approach (Wilson, 1972), Psychological Education (Mosher & Sprinthall, 1971), the Classroom Meeting (Glasser, 1969), Identity Education (Weinstein & Fantini, 1970), and Social Problem Solving (Gibbs, 1994). In a broad context, in which the learning process has been psychology’s central concern for decades, its single most direct contribution to prosocial instruction comes from social learning theory and, in particular, from the work conducted and stimulated by Albert Bandura. Based upon the same broad array of modeling, behavioral rehearsal, and social reinforcement investigations which helped stimulate and direct the development of our own approach to interpersonal skills training, Bandura (1973) comments: The method that has yielded the most impressive results with diverse problems contains three major components. First, alternative modes of response are repeatedly modeled, preferably by several people who demonstrate how the new style of behavior can be used in dealing with a variety of . . . situations.

156 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Second, learners are provided with necessary guidance and ample opportunities to practice the modeled behavior under favorable conditions until they perform it skillfully and spontaneously. The latter procedures are ideally suited for developing new social skills, but they are unlikely to be adopted unless they produce rewarding consequences. Arrangement of success experiences, particularly for initial efforts at behaving differently, constitute the third component in this powerful composite method . . . Given adequate demonstration, guided practice, and success experiences, this method is almost certain to produce favorable results. (p. 253)

Both the spirit and substance of this earlier perspective by Bandura (1973) are thoroughly reflected in the teaching procedures and instructional goals of the first course presented below: Interpersonal Skills Training. Thus, both education and psychology have sought seriously to meet the challenge of developing means for enhancing positive behaviors. It is in this latter spirit that we began the development of the Prepare Curriculum and, in that spirit, we seek the opportunity for its further development and refinement.

THE PREPARE CURRICULUM: GENERAL CONSIDERATIONS There are a number of qualities of the Prepare Curriculum which we wish to comment briefly upon before considering its constituent courses, namely its planned comprehensiveness, relevance, complementarity of courses, prescriptiveness, and open-endedness.

Comprehensiveness Most interventions provided for aggressive, disruptive or even delinquent youth in school, clinic, community or incarceration settings are far too piecemeal in their impact. A youngster’s daily living experiences for ten or more years may have taught him such lessons as “aggression pays,” “might makes right,” and “take, don’t ask.” Surely, we are wearing blinders to hope that a weekly counseling session, or occasional use of time-out, or three days of in-school suspension can make a dent in altering such lifelong learning. To have even a chance of success, our interventions must be encompassing, long-term, and powerful. We intend that Prepare be a step in just such a comprehensive direction.

Relevance The curriculum’s constituent courses, it is our aspiration, will be functionally useful and valuable from the perspective of the youth to whom they will be taught, as well as to the major figures in their real-life environments. To maximize this quality of relevance, the prosocial competency areas developed into curriculum courses were selected based not only upon the relevant professional literature, but also on active and continuing consultation with both teachers and other youth-care professionals and, especially, with adolescent and younger child “consultants” themselves.

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Complementarity The several competencies which the curriculum seeks to teach are optimally used in the real-world functioning of its recipients in sets, subsets, patterns, or combinations. We designed its constituent courses with this patterning goal in mind, and will later point to specific examples of groupings and sequencing of courses in such a manner that their respective gains have the potential for building upon one another.

Prescriptiveness We believe strongly that offerings such as the proposed curriculum will yield maximal effectiveness when employed in a tailored, differential, prescriptive manner. Different courses, course combinations, and course sequencing for different youths are components of effective implementation. While such a goal is clearly as much a matter of assessment of deficit as the course offerings per se, preparation for prescriptive usage begins with attention to course development parameters. Thus, the courses developed vary not only in content or focus, but also on such dimensions as difficulty, abstractness/concreteness, immediacy of usage, media employed, and other prescriptiveness-permitting parameters.

Open-Endedness To plan and develop the Prepare Curriculum we have drawn upon the relevant bodies of professional literature, our own decades of curriculum building and evaluation experience, and that of a panel for real-world teachers and youth-care consultants, feedback from adolescent and younger child trainees themselves, as well as systematic evaluation research. While we are temporarily pleased with the comprehensiveness of the curriculum, we are well aware of the manner in which new research findings, emerging social needs, and developments in the pedagogy of curriculum delivery each may make desirable the addition to the curriculum of yet other courses, and the deletion from it of existing courses. Our intention, therefore, is decidedly open-ended, with a willingness and even eagerness to be responsive to such change considerations as our efforts progress.

Course Offerings The ten courses which constitute the Prepare Curriculum are listed in Table 10.1, and described below.

Course 1: Interpersonal Skills Training Via a sequence of didactic procedures we termed Skillstreaming, we have, since 1970, sought to teach an array of interpersonal prosocial competencies to aggressive youth and children (Goldstein, 1973, 1981; Goldstein, Carr, Davidson, & Wehr, 1981;

158 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Table 10.1 Prepare: a prosocial curriculum for aggressive youth Course 1 Course 2 Course 3 Course 4 Course 5 Course 6 Course 7 Course 8 Course 9 Course 10

Interpersonal Skills Training Anger Control Training Moral Reasoning Training Problem Solving Training Empathy Training Social Perception Training Anxiety Management Cooperation Training Building a Prosocial Support Group Understanding and Using Group Processes

Goldstein & McGinnis, 1997). In this approach, small groups of chronically aggressive youngsters with shared prosocial skill deficiencies are (1) shown several examples of expert use of the behaviors constituting the skills in which they are weak or lacking (e.g. modeling), (2) given several guided opportunities to practice and rehearse these competent interpersonal behaviors (e.g. role-playing), (3) provided with praise, reinstruction, and related feedback on how well their role-playing of the skill matched the expert model’s portrayal of it (e.g. performance feedback), and (4) encouraged to engage in a series of activities designed to increase the chances that skills learned in the training setting will endure and be available for use when needed in the school, home, community, institution, or other real-world setting (e.g. transfer training). By means of this set of didactic procedures, we have been able to teach such youngsters a 50-skill curriculum, organized into six groupings: 1. Beginning social skills, e.g. “starting a conversation,” “introducing yourself,” “giving a compliment.” 2. Advanced social skills, e.g. “giving instructions,” “apologizing,” “convincing others.” 3. Skills for dealing with feelings, e.g. “dealing with someone else’s anger,” “expressing affection,” “dealing with fear.” 4. Skill alternatives to aggression, e.g. “responding to teasing,” “keeping out of fights,” “helping others.” 5. Skills for dealing with stress, e.g. “dealing with being left out,” “responding to failure,” “dealing with an accusation.” 6. Planning skills, e.g. “setting a goal,” “arranging problems by importance,” “deciding what caused a problem.” We have conducted approximately 30 investigations evaluating the effectiveness of this interpersonal skills training approach. Skill acquisition (do they learn it?) is a reliable outcome, occurring in well over 90% of the aggressive adolescent and younger child trainees involved (Goldstein, 1981; Goldstein & McGinnis, 1997; McGinnis & Goldstein, 1997). Skill transfer (do they still use the skills in real-world settings?) is a less frequent outcome thus far, occurring in about half of the trainees involved. Of great importance here, however, is the manner in which we have

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been able to show that transfer can be and is increased to the degree that one’s training effort incorporates a series of transfer-enhancing techniques (Goldstein & Kanfer; 1979; Karoly & Steffan, 1980; Goldstein, 2000). Clearly, Interpersonal Skills Training is an established and valuable part of a prosocial instructional curriculum.

Course 2: Anger Control Training Anger Control Training was developed by Feindler and her research group (Feindler, Marriott, & Iwata, 1984) and modified by us in separate programs involving disruptive school children and incarcerated juvenile delinquents (Goldstein, Glick, Reiner, Zimmerman, & Coultry, 1986). In contrast to the direct facilitation of prosocial behavior in Interpersonal Skills Training, Anger Control Training facilitates indirectly, by teaching means for inhibiting anger and loss of self-control. Participating youngsters are taught, over a one-term span, how to respond to provocations to anger by (1) identifying their external and internal triggers, (2) identifying this own physiological/kinesthetic cues which signify anger, (3) using reminders, which are self-statements designed to function opposite to triggers (i.e. to lower this anger arousal level), (4) using reducers, to further lower anger via deep breathing, counting backwards, imagining a peaceful scene, or contemplating the long-term consequences of their anger-associated behavior, and (5) self-evaluation, in which they judge how adequately anger control worked, and reward themselves when it worked well. Our implementation of Anger Control Training was systematically evaluated for effectiveness as part of a three-course set, to be discussed below.

Course 3: Moral Reasoning Training Armed with both the ability to respond to the real world prosocially, and the skills necessary to stifle or at least diminish impulsive anger and aggression, will the chronically acting-out youngster in fact choose to do so? To enhance the likelihood that such will in fact be his/her frequent choice, one must enter, we believe, into the realm of moral values. In a pioneering series of investigations, Kohlberg (1969, 1973) has demonstrated that exposing youngsters to a series of moral dilemmas, in a discussion-group context which includes youngsters reasoning at differing levels of moral thinking, arouses an experience of cognitive conflict whose resolution will frequently advance a youngster’s moral reasoning to that of the higher-level peers in the group. While such moral reasoning stage advancement is a reliable finding, as with other single interventions, efforts to utilize it by itself, as a means of enhancing actual overt moral behavior, have yielded only mixed success (Arbuthnot & Gordon, 1983; Zimmerman, 1983)—perhaps, we would speculate, because such youngsters did not have in their behavior repertoires the actual skill behavior either for acting prosocially or for successfully inhibiting the antisocial. Consistent with our curriculum development goal of course complementarity, we thus reasoned, and have in fact been able to show, that Kohlbergian Moral Education, concretized in the latest revision of the Prepare Curriculum via the Social Problem Solving curriculum developed by Gibbs (see Goldstein, 1998), has marked

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potential for providing constructive directionality toward prosocialness and away from antisocialness in youngsters armed with the fruits of both Interpersonal Skills Training and Anger Control Training (Goldstein et al., 1986).

Course 4: Problem Solving Training Aggressive adolescents and younger children are frequently deficient not only in knowledge of and ability to use such prosocial competencies as the array of interpersonal skills and anger control techniques taught in Courses 1 and 2, but they may also be deficient in other ways crucial to the use of prosocial behavior. They may, as Ladd and Mize (1983) point out, be deficient in such problem-solving competencies as “(a) knowledge of appropriate goals for social interaction, (b) knowledge of appropriate strategies for reaching a social goal, and (c) knowledge of contexts in which specific strategies may be appropriately applied” (p. 130). An analogous conclusion flows from the research program on interpersonal problem solving conducted by Spivak, Platt, and Shure (1976). In early and middle childhood, as well as in adolescence, chronically aggressive youngsters were less able than more typical youngsters to function effectively in most problem-solving subskills, such as identification of alternatives, consideration of consequences, determining causality, means–end thinking, and perspective taking. Several programs have been developed already in an effort to remediate such problem-solving deficiencies with the types of youngsters of concern here (Giebink, Stover & Fahl, 1968; DeLange, Lanham & Barton, 1981; Sarason & Sarason, 1981). Such programs represent a fine beginning, but problem-solving deficiency in such youth is substantial (Chandler, 1973; Spivak et al., 1976; Selman, 1980), and substantial deficiencies require substantial, longer-term, more comprehensive interventions. The Prepare Curriculum course described here seeks to provide just such an effort. In our early pilot development of it, it is a longer-term (than existing programs) sequence of such graduated problem-solving skills as reflection, problem identification, information gathering, perspective taking, identification of alternatives, consideration of consequences, and decision making. Our initial evaluation of this sequence with an aggressive adolescent population has yielded significant gains in problem-solving skills thus defined, substantially encouraging further development of this course (Grant, 1986). These results give beginning substance to our assertion made earlier that: Individuals can be provided systematic training in problem solving skills both for purposes of building general competence in meeting life’s challenges, and as a specific means of supplying one more reliable, prosocial alternatives to aggression. (Goldstein, 1981)

Course 5: Empathy Training We were especially interested in the inclusion in the Prepare Curriculum of a course designed to enhance the participating youth’s level of empathy for two reasons. Expression of empathic understanding, it seems, can simultaneously serve as an inhibitor of negative interactions and a facilitator of positive ones. Evidence clearly

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demonstrates that: Responding to another individual in an empathic manner and assuming temporarily their perspective decreases or inhibits one’s potential for acting aggressively toward the other (Feshbach, 1982; Feshbach & Feshbach, 1969). Stated otherwise, empathy and aggression are incompatible interpersonal responses, hence learning to be more skilled in the former serves as an aid to diminishing the latter. (Goldstein et al., 1986, p. 309)

The notion of empathy as a facilitator of positive interpersonal relations stands on an even broader base of research evidence. Our review of the literally hundreds of investigations inquiring into the interpersonal consequences of empathic responding reveals such responding to be a consistently potent promoter of interpersonal attraction, dyadic openness, conflict resolution, and individual growth (Goldstein & Michaels, 1985). It is a most potent facilitator indeed. This same review effort led us to define empathy and its optimal training as a multi-stage process of perception of emotional cues, affective reverberation of the emotions perceived, their cognitive labeling, and communication, and, correspondingly, to develop a multi-stage training program by which these four constituent components could be taught.

Course 6: Social Perception Training Once armed with the interpersonal skills necessary to respond prosocially to others (Courses 1, 2, and 3), the problem-solving strategies underlying skill selection and usage (Course 4), and a fuller, empathic sense of the other person’s perspective (Course 5), the chronically aggressive youngster may still fail to behave prosocially because he or she “misreads” the context in which the behavior is to occur. A major thrust in psychology of the past 15 years has been this emphasis on the situation or setting as perceived by the individual, and its importance in determining overt behavior. Morrison and Bellack (1981) comment, for example: Adequate social performance not only requires a repertoire of response skills, but knowledge about when and how these responses should be applied. Application of this knowledge, in turn, depends upon the ability to accurately “read” the social environment: determine the particular norms and conventions operating at the moment, and to understand the messages being sent . . . and intentions guiding the behavior of the interpersonal partner. (p. 70)

Dil (1972), Emery (1975) and Rothenberg (1970) have each shown that emotionally disturbed youngsters, as well as those “socially maladjusted” in other ways are characteristically deficient in such social perceptiveness. Argyle, Furnham, and Graham (1981) observe: It has been found that people who are socially inadequate are unable to read everyday situations and respond appropriately. They are unable to perform or interpret nonverbal signals, unaware of the rules of social behavior, mystified by ritualized routines and conventions of self-presentation and self-disclosure, and are hence like foreigners in their own land. (p. 37)

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Argyle et al. (1981) and Backman (1979) have stressed this same social-perceptual deficit in their work with aggressive individuals. Yet, we believe that the ability to accurately “read” social situations can be taught, and we have sought to do so with this proposed course. Its planned contents are responsive to the valuable leads provided in this context by Brown and Fraser (1979), who proposed three salient dimensions of accurate social perceptiveness: (1) the setting of the interaction and its associated rules and norms, (2) the purpose of the interaction and its goals, tasks, and topics, and (3) the relationship of the participants, their roles, responsibilities, expectations, and group memberships.

Course 7: Anxiety Management We have oriented each of the preceding course descriptions toward either directly enhancing prosocial competency (e.g. Interpersonal Skills Training, Moral Reasoning, Social Perception Training), or reducing qualities that inhibit previouslylearned or newly acquired prosocial competency (e.g. Anger Control Training). The Prepare Curriculum course we now wish to describe is of this latter type. It has been demonstrated by Arkowitz, Lichtenstein, McGovern, and Hines (1975) and Curran (1977) that individuals may possess an array of prosocial skills in their repertoires, but not employ them in particularly challenging or difficult situations because of anxiety. A youth may have learned well the Interpersonal Skills Training skill “responding to failure” but his embarrassment at a failing grade in front of his teacher or missing a foul shot in front of his friends may engender a level of anxiety which inhibits proper use of this skill. A young woman may possess the problem-solving competency to plan well for a job interview, but perform poorly in the interview itself as anxiety, as it were, “takes over.” Such anxiety-inhibition as a source of prosocially incompetent and unsatisfying behavior may be especially prevalent in the highly peer-conscious adolescent years. A series of self-managed procedures exists by means of which such stressinduced anxiety may be substantially reduced. It is these procedures which form the contents of the stress management course. Participating youngsters are taught systematic deep muscular relaxation (Jacobson, 1964; Benson, 1975), meditation techniques (Naranjo & Ornstein, 1971; Assagioli, 1973), environmental restructuring (Anderson, 1978), exercise (Walker, 1975), and related means for the management, control, and reduction of stress.

Course 8: Cooperation Training Chronically aggressive youth have been shown to display a personality trait pattern often high in egocentricity and competitiveness, and low in concern for others and cooperation (Pepitone, 1985; Slavin et al., 1985). We include a course in Cooperation Training, not only because enhanced cooperation among individuals is a valuable social goal, but also because of the several valuable concomitants and consequences of enhanced cooperation. Research on cooperative learning reveals outcomes of enhanced self-esteem, group cohesiveness, altruism, and cooperation itself, as well

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as reduced egocentricity. As long ago as 1929, Maller commented: The frequent staging of contests, the constant emphasis upon the making and breaking of records, and the glorification of the heroic individual achievement . . . in our present educational system lead toward the acquisition of competitiveness. The child is trained to look at the members of his group as constant competitors and urged to put forth a maximum effort to excel them. The lack of practice in group activities and community projects in which the child works with his fellows for a common goal precludes the formation of habits of cooperativeness. (p. 163)

It was many years before the educational establishment responded concretely to this Dewey-like challenge, but when it did, it created a wide series of innovative, cooperation-enhancing methodologies, each of which deserves long and careful application and scrutiny both in general educational contexts as well as, in our instance, with particularly non-cooperative youth. We refer to the cooperative learning methods: Student Teams-Achievement Divisions (Slavin, 1980), Teams-Games-Tournaments (Slavin, 1980), Jigsaw Classrooms I (Aronson, 1978), Jigsaw Classrooms II (Slavin, 1980), Group-Investigation (Sharan & HertzLazarowitz, 1980), and Co-op Co-op (Kagan, 1985). Using shared materials, interdependent tasks, group rewards, and similar features, these methods (applied to any content area: mathematics, social studies, etc.) have consistently yielded the several interpersonal, cooperation-enhancing group and individual benefits noted above. In our course, we not only make use of the many valuable features of the cooperative learning approaches noted above but, in addition, responding to the physical action orientation typical of such youth, rely heavily on cooperative sports and games. Such athletic activity, while not yet popular in the United States, does exist elsewhere in both action and written document (Orlick, 1978a, 1978b, 1982; Fluegelman, 1981). Collective score basketball, no-hitting football, cross-team rotational hockey, collective fastest-time track meets, and other sports restructured to be what cooperative gaming creators term “all touch,” “all play,” “all positions,” “all shoot,” and cooperative in other playing and scoring ways may seem strange to the typical American youth, weaned on highly competitive, individualistic sports, but it appears to us to be a valuable additional channel to be utilized with aggressive youth toward the goal of cooperative enhancement.

Course 9: Building a Prosocial Support Group Aggressive youth, quite typically, are regularly exposed to highly aggressive models in their interpersonal worlds. Parents, siblings, and peers are quite frequently chronically aggressive individuals themselves (Knight & West, 1975; Robins, West & Herjanic, 1975; Osborn & West, 1979; Loeber & Dishion, 1983). Simultaneously, there tend to be relatively few countervailing prosocial models available to be observed and imitated. When there are, however, such prosocial models can apparently make a tremendous difference in the daily lives and development of such youth. In support of this assertion, we may turn not only to

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such community-provided examples of prosocial modeling as Big Brothers, Police Athletic League, Boy Scouts and the like, and not only to laboratory research consistently showing that rewarded prosocial behaviors (e.g., sharing, altruism, cooperation) are quite often imitated (Bryan & Test, 1967; Evers & Schwarz, 1973; Canale, 1977), but also to more direct evidence. For example, Werner & Smith (1982), in their impressive longitudinal study of aggressive and non-aggressive youth, Vulnerable But Invincible, clearly demonstrated that many youngsters growing up in a community characterized by high crime, high unemployment, high schooldrop-out levels and aggressive models were indeed able to sail on through, as it were, and develop into effective, satisfied, prosocial-oriented individuals if they had experienced sustained exposure to at least one significant prosocial model—be it parent, relative, peer, or other. Since such models are often scarce in the real-world environments of the youth Prepare is intended to serve, efforts must be made to help these youth identify, encourage, attract, elicit, and, at times perhaps, even create sources and attachments to others who not only (as models) function prosocially themselves, but who can also serve as sustained sources of direct support for the youths’ own prosociallyoriented efforts. Our course contents for teaching such identification, encouraging, attraction, elicitation, and creation skills rely, in part, on both the teaching procedures and certain of the interpersonal skills which constitute our Skillstreaming skills training curricula for adolescents (Goldstein, 1980) and younger children (McGinnis & Goldstein, 1997).

Course 10: Understanding and Using Group Processes Adolescent and pre-adolescent acute responsiveness to peer influences is a truism frequently expressed in both lay and professional literature on child development. It is a conclusion resting on a very solid research foundation (Baumrind, 1975; Rosenberg, 1975; Moriarty & Toussieng, 1976; Manaster, 1977; Field, 1981; Guralnick, 1981). As a curriculum designed to enhance prosocial competencies, it is especially important that Prepare include a segment giving special emphasis to group (especially peer) processes. Its title includes both “understanding” and “using,” because both are clearly its goal. Participating youth will be helped to understand such group forces and phenomena as peer pressure, clique formation and dissolution, leaders and leadership, cohesiveness, imitation, reciprocity, in-group versus out-groups relations, developmental phases, competition, within-group communication and its failure, and similar processes. For such understanding to have real-world value for participating youth (the “using” component of our course title), this course’s instructional format will consist almost exclusively of group activities in which, experientially, participants can learn means for effectively resisting group pressure when they elect to do so, for seeking and enacting a group leadership role, for helping build and enjoy the fruits of group cohesiveness, and so forth. Examples of specific activities of apparent value for such group-experiential learning include such group simulations, structured experiences, and gaming as “assessment of leadership style,” “committee

ART AND BEYOND: THE PREPARE CURRICULUM 165

meeting: demonstrating hidden agendas,” “process observation: a guide,” “top problems: a consensus-seeking task,” “dealing with shared leadership,” “conflict resolution,” “a collection of tasks,” “group on group,” “line-up and power inversion,” “polarization: a demonstration,” “not listening: a dyadic role play,” “towers: an intergroup competition,” and “peer perceptions: a feedback experience” (Pfeiffer & Jones, 1969; Thayer & Beeler, 1975).

CURRICULUM DELIVERY Substantial gains in prosocial competency will occur in youth receiving the proposed curriculum, not only if the contents of its constituent courses are creatively and prescriptively developed, but also if the delivery of the courses is conducted in a creative and trainee-targeted manner. Users of Prepare Curriculum courses in any given setting will need to be responsive to demand qualities of the setting and prescriptive qualities of the trainees. Thus, we recommend no fixed course sequence but instead suggest a variable arrangement to be determined largely by the prosocial deficiencies of participating trainees. However, as we have interacted with the many teachers, administrators, youthcare workers, and other change agents regularly employing the Prepare Curriculum since 1988, it has become clear that their goals in using it have generally been to reduce youth aggression, moderate youth stress levels, and/or lower the levels of youth ethnocentrism. Based upon such user history, we have grouped the curriculum’s component course into three subsets, dealing respectively with aggression reduction, stress reduction, and prejudice reduction. In its original format (Goldstein, 1988) the Prepare Curriculum consisted of 10 freestanding courses. We made several suggestions at that time regarding potentially effective combinations and sequences of two or more of these courses, but we possessed no data regarding the efficacy of our suggestions. The Prepare Curriculum revised (Goldstein, 1999) begins to provide more databased course grouping proposals. Our perspective in constructing Prepare Curriculum course combinations is colored particularly by our view that the three areas of possible impact— aggression, stress, and prejudice—are phenomena originated and sustained on behavioral, emotional, and cognitive bases. Aggression, for example, is an overt behavioral attempt to inflict injury that often arises from cognitive misperceptions of another’s intentions, as well as a behavior given energy by the emotional arousal of anger, which typically precedes and accompanies it. We suggest that a similar causal pattern of cognition, emotion, and behavior often underlies stress arousal and expression (e.g. appraisal, arousal, fight or flight), as well as the ethnocentrism at the heart of prejudice. Prejudice, for example, often rests upon a foundation of biased belief, emotional arousal, and discriminatory behavior. If we are accurate in perceiving these domains as causally following from the thoughts, feelings, and actions of the actors involved, it follows that the reduction of such inappropriate, antisocial, or maladaptive phenomena ought to be a similar combination of behavior-targeted, emotion-targeted, and cognition-targeted procedures. Such a curriculum has been demonstrated effective in the case of aggression

166 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Table 10.2 Grouping of Prepare Curriculum courses

Behavioral

Emotional Cognitive

Aggression

Stress

Prejudice

Interpersonal Skills Training Social Perception Training Anger Control Training Moral Reasoning Training

Building a Prosocial Support Group

Cooperation Training

Anxiety Management Problem Solving Training

Empathy Training Understanding and Using Group Processes

reduction. We refer here to data derived from a series of efficacy evaluations of the combination of Skillstreaming, Anger Control Training, and Moral Reasoning Training conducted by ourselves and others (Goldstein, Glick, & Gibbs, 1998). We hypothesize that a similar pattern of stress- and prejudice-reducing outcomes may well follow from future evaluations of Prepare Curriculum interventions of a combined behavioral, affective, and cognitive nature. Thus, based upon both solid data (for aggression reduction) and reasonable hypothesis (for stress and prejudice reduction), we have grouped the 10 Prepare Curriculum courses into three subsets, shown as Table 10.2. A second curriculum delivery strategy we have found useful responds to our impression that Problem Solving Training is a course best presented first, not only for its value as a skill per se but also for its usefulness as an organizer of decisions about which of the other courses to select from and employ. Skillstreaming is presented early on in the curriculum both for its demonstrated usefulness in a variety of life settings and for its relationship to another course, Social Perception Training. This course is an important companion of Skillstreaming. Interpersonal skill deficiencies occur because the youth does not know the skills and thus must be taught them, or does know them but is not competent in diagnosing when, where, and with whom to use them. Social Perception Training teaches such diagnostic skills. Therefore, one useful sequence of Prepare courses is Problem Solving Training, Interpersonal Skills Training, and Social Perception Training. Anger Control Training and Moral Reasoning Training, in combination with Skillstreaming, constitute Aggression Replacement Training and have been employed by our research group in a series of programs designed to alter the behavior of incarcerated and paroled juvenile delinquents, as well as chronically aggressive youths in school settings. Evaluations of these programs reveal outcomes including enhanced interpersonal skillfulness, diminished aggression, and improved community functioning (Goldstein et al., 1998). We therefore recommend that this triad of courses be offered together as a third curriculum delivery approach. Anxiety Management and Empathy Training seek to provide skills relevant to, respectively, the trainee’s own emotional world and the emotional world of others. These two courses are valuable in their own right. Because they bear importantly on facilitation of all other Prepare courses, they are also prerequisite to the next three courses in the curriculum.

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Building a Prosocial Support Group offers ways to teach youth to identify, seek out, establish, and maintain relationships with prosocially oriented adult or peer models. It is a course explicitly responsive to the research finding that having at least one such model differentiates youth from very difficult environments who survive and thrive as they develop from those who turn toward disturbed, antisocial, or asocial lives. Course content relies heavily on the lessons of Skillstreaming. Cooperation Training and Understanding and Using Group Processes complete the Prepare Curriculum. Both courses involve games, simulations, and group activities, all of which often have special motivational appeal to the action-oriented youth who constitute a significant portion of the Prepare Curriculum’s trainees. The Prepare Curriculum first appeared in 1988. Since then, evaluations in applied settings have demonstrated the real-world impact of several of its components, and substantial research has been conducted in the domains from which each course has been drawn. We have sought to bring the Prepare Curriculum, circa 1998, into line with this considerable applied and research progress. In addition to each of the 10 Prepare Curriculum courses, we have added a compilation of supplementary exercises. Drawn from many different sources, these exercises target the same overall goals as the Prepare Curriculum course to which they are attached (e.g. social skill development, anger control, problem solving, etc.). These supplements serve an array of curriculum-enhancing purposes. First, as a menu from which the trainer may draw to enhance and complement the given Prepare Curriculum course, each supplement contributes to curricular variety, flexibility, and program intensity (amount, level, dosage, duration). Because of their action-oriented quality, these exercises also add a measure of prescriptiveness to the overall curriculum, given their typical appeal for action-oriented youth. To a degree permitted by their content, the exercises are sequenced to parallel the sequence of the Prepare Curriculum course they supplement. Thus, the course and the supplementary exercises may profitably be employed together. These qualities add to the likelihood that the Prepare Curriculum will be successful in its diverse skill development goals. The prosocial skill development and evaluation program we have conducted for almost 30 years, and which has yielded Skillstreaming, Aggression Replacement Training, and the Prepare Curriculum, remains an effort in perpetual transition. We invite interested practitioners and researchers concerned with moderating aggressive behavior to join us on this development journey.

REFERENCES Anderson, R. A. (1978). Stress power. New York: Human Services Press. Arbuthnot, J. & Gordon, D. A. (1983). Moral reasoning development in correctional intervention. Journal of Correctional Education, 34, 133–138. Argyle, M., Furnham, A., & Graham, J. (1981). Social situations. Cambridge: Cambridge University Press. Arkowitz, H., Lichtenstein, E., McGovern, K., & Hines, P. (1975). The behavioral assessment of social competence in males. Behavior Therapy, 6, 3–13. Aronson, E. (1978). The jigsaw classroom. Beverly Hills, CA: Sage.

168 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Assagioli, R. (1973). The act of will. New York: Viking Press. Backman, C. (1979). Epilogue: A new paradigm. In G. Ginsburg (Ed.), Emerging strategies in social psychological research. Chichester: John Wiley & Sons. Bandura, A. (1973). Aggression: A social learning analysis. Englewood Cliffs, NJ: Prentice-Hall. Baumrind, D. (1975). Early socialization and adolescent competence. In S. E. Dragastin & G. H. Elder (Eds), Adolescence in the life cycle. Washington, DC: Hemisphere. Beck, C. (1971). Moral education in the schools: Some practical suggestions. Toronto: Ontario Institute for Studies in Education. Benson, H. (1975). The relaxation response. New York: Avon. Brown, P. & Fraser, C. (1979). Speech as a marker of situations. In K. Scherer & H. Giles (Eds), Social markers in speech. Cambridge: Cambridge University Press. Bryan, J. H. & Test, M. A. (1967). Models and helping: Naturalistic studies in aiding behavior. Journal of Personality and Social Psychology, 6, 400–407. Canale, J. R. (1977). The effect of modeling and length of ownership on sharing behavior of children. Social Behavior and Personality, 5, 187–191. Conger, J. J., Miller, W. C., & Walsmith, C. R. (1965). Antecedents of delinquency, personality, social class, and intelligence. In P. H. Mussen, J. J. Conger, & J. Kagan (Eds), Readings in child development and personality. New York: Harper & Row. Curran, J. P. (1977). Skills training as an approach to the treatment of heterosexual-social anxiety: A review. Psychological Bulletin, 84, 140–157. DeLange, J. M., Lanham, S. L., & Barton, J. A. (1981). Social skills training for juvenile delinquents: Behavioral skill training and cognitive techniques. In D. Upper & S. Ross (Eds), Behavior group therapy, 1981: An annual review. Champaign, IL: Research Press. Dil, N. (1972). Sensitivity of emotionally disturbed and emotionally non-disturbed elementary school children to emotional meanings of facial expressions. Doctoral dissertation, Indiana University. Emery, J. E. (1975). Social perception processes in normal and learning disabled children. Doctoral dissertation, New York University. Evers, W. L. & Schwarz, J. C. (1973). Modifying social withdrawal in preschoolers: The effects of filmed modeling and teacher praise. Journal of Abnormal Child Psychology, 1, 248– 256. Feindler, E. L., Marriott, S. A., & Iwata, M. (1984). Group anger control training for junior high school delinquents. Cognitive Therapy and Research, 8, 299–311. Feshbach, N. D. (1982). Empathy, empathy training and the regulation of aggression in elementary school children. In R. M. Kaplan, V. J. Konecni, & R. Novaco (Eds), Aggression in children and youth. Alphen den Rijn: Sythoff/Noordhoff. Feshbach, N. D. & Feshbach, S. (1969). The relationship between empathy and aggression in two age groups. Developmental Psychology, 1, 102–107. Field, T. (1981). Early peer relations. In P. S. Straini (Ed.), The utilization of classroom peers as behavior change agents. New York: Plenum Press. Fluegelman, A. (1981). More new games. Garden City, NY: Dolphin Books. Freedman, B. J., Rosenthal, R., Donahoe, C. P., Schlundt, D. G., & McFall, R. M. (1978). A social behavioral analysis of skill deficits in delinquent and nondelinquent adolescent boys. Journal of Consulting and Clinical Psycholoogy, 46, 1448–1462. Gibbs, J. C. (1994). Fairness and empathy as the foundation for universal moral education. Comenius, 14, 12–23. Giebink, J. W., Stover, D. S., & Fahl, M. A. (1968). Teaching adaptive responses to frustration to emotionally disturbed boys. Journal of Consulting and Clinical Psychology 32, 336–368. Glasser, W. (1969). Schools without failure. NY: Harper & Row. Goldstein, A. P. (1973). Structured learning therapy: Toward a psychotherapy for the poor. New York: Academic Press. Goldstein, A. P. (1980). Skillstreaming the adolescent: A structured learning approach to teaching prosocial skills. Champaign, IL: Research Press. Goldstein, A. P. (1981). Psychological skill training: The structured learning technique. Elmsford, NY: Pergamon Press. Goldstein, A. P. (1988). The Prepare Curriculum. Champaign, IL: Research Press.

ART AND BEYOND: THE PREPARE CURRICULUM 169 Goldstein, A. P. (1999). The Prepare Curriculum: Teaching prosocial competencies (rev. edn). Champaign, IL: Research Press. Goldstein, A. P. (2000). Lasting change. Champaign, IL: Research Press. Goldstein, A. P., Carr, E. G., Davidson, W. S., & Wehr, P. (1981). In response to aggression. New York: Pergamon Press. Goldstein, A. P., Glick, B., and Gibbs, J. C. (1998). Aggression Replacement Training: A comprehensive intervention for youth (rev. edn). Champaign, IL: Research Press. Goldstein, A. P., Glick, B., Reiner, S., Zimmerman, D., & Coultry, T. (1986). Aggression Replacement Training. Champaign, IL: Research Press. Goldstein, A. P. & Kanfer, F. H. (1979). Maximizing treatment gains: Transfer enhancement in psychotherapy. New York: Academic Press. Goldstein, A. P. & Keller, H. (1987). Aggressive behavior: Assessment and intervention. New York: Pergamon Press. Goldstein, A. P. & McGinnis, E. (1997). Skillstreaming the adolescent (rev. edn). Champaign, IL: Research Press. Goldstein, A. P. & Michaels, G. Y. (1985). Empathy: Development, training and consequences. Hillsdale, NJ: Lawrence Erlbaum Associates. Grant, J. (1986). An instructional training problem solving skill enhancement with delinquent youth. Doctoral dissertation, Syracuse University, New York. Guralnick, M. J. (1981). Peer influences on the development of communicative competence. In P. S. Strain (Ed.), The utilization of classroom peers as behavior change agents. New York: Plenum Press. Jacobson, E. (1964). Anxiety and tension control. Philadelphia, PA: Lippincott. Kagan, S. (1985). Co-op Co-op: A flexible cooperative learning technique. In R. Slavin, S. Sharan, S. Kagan, R. Hertz-Lazarowitz, C. Webb, & R. Schmuck (Eds), Learning to cooperate, cooperating to learn. New York: Plenum Press. Karoly, P. & Steffan, J. (1980). Improving the long term effects of psychotherapy. New York: Guilford Press. Knight, B. J. & West, D. J. (1975). Temporary and continuing delinquency. British Journal of Criminology, 15, 43–50. Kohlberg, L. (1969). Stage and sequence: the cognitive-developmental approach to socialization. In D. A. Goslin (Ed.), Handbook of socialization theory and research. Chicago, IL: Rand McNally. Kohlberg, L. (Ed.) (1973). Collected papers on moral development and moral education. Cambridge, MA: Center for Moral Education, Harvard University. Ladd, G. W. & Mize, J. (1983). A cognitive-social learning model of social skill training. Psychological Review, 90, 127–157. Loeber, R. & Dishion, T. (1983). Early predictors of male delinquency: A review. Psychological Bulletin, 94, 68–99. Maller, J. B. (1929). Cooperation and competition: An experimental study in motivation. New York: Teachers College, Columbia University. Manaster, G. J. (1977). Adolescent development and the life tasks. Boston, MA: Allyn & Bacon. McGinnis, E. & Goldstein, A. P. (1997). Skillstreaming the elementary school child (rev. edn). Champaign, IL: Research Press. McPhail, P., Ungoed-Thomas, J. R., & Chapman, H. (1975). Learning to care: Rationale and method of the lifeline program. Niles, IL: Argus Communications. Moriarty, A. E. & Toussieng, P. W. (1976). Adolescent coping. New York: Grune & Stratton. Morrison, R. L. & Bellack, A. S. (1981). The role of social perception in social skill. Behavior Theory, 12, 69–79. Mosher, R. & Sprinthall, N. (1971). Psychological education in the secondary schools. American Psychologist, 25, 911–916. Mussen, P. H., Conger, J. J., Kagan, J., & Gerwitz, J. (1979). Psychological development: A life-span approach. New York: Harper & Row. Naranjo, C. & Ornstein, R. E. (1971). On the psychology of meditation. New York: Viking Press. Newman, F. & Oliver, D. (1970). Clarifying public issues: An approach to reaching social studies. Boston, MA: Little, Brown.

170 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Orlick, T. (1978a). Winning through cooperation. Washington, DC: Acropolis Books. Orlick, T. (1978b). The cooperative sports and game book. New York: Pantheon Books. Orlick, T. (1982). The second cooperative sports and game book. New York: Pantheon Books. Osborn, S. G. & West, D. J. (1979). Conviction records of fathers and sons compared. British Journal of Criminology, 19, 120–133. Patterson, G. R., Reid, J. G., Jones, R. R., & Conger, R. E. (1975). A social learning approach to family intervention. Eugene, OR: Caralia. Pepitone, E. A. (1985). Children in cooperation and competition: Antecedents and consequences of self-orientation. In R. Slavin, S. Sharan, S. Kagan, R. Hertz-Lazarowitz, C. Webb, & R. Schmuck (Eds), Learning to cooperate, cooperating to learn. New York: Plenum Press. Pfeiffer, J. W. & Jones, J. E. (1969). A handbook of structured experiences for human relations training. LaJolla, CA: University Associates. Robins, L. N., West, P. A., & Herjanic, B. L. (1975). Arrests and delinquency in two generations: A study of black urban families and their children. Journal of Child Psychology and Psychiatry, 16, 125–140. Rosenberg, M. (1975). The dissonant context and the adolescent self-concept. In S. E. Dragastin & G. H. Elder (Eds), Adolescence in the life cycle. Washington, DC: Hemisphere Publishing Company. Rothenberg, B. B. (1970). Children’s social sensitivity and the relationship to interpersonal competence, interpersonal comfort, and intellectual level. Developmental Psychology, 2, 335–350. Sarason, J. G. & Sarason, B. R. (1981). Teaching cognitive and social skills to high school students. Journal of Consulting and Clinical Psychology, 49, 908–918. Sharan, S. & Hertz-Lazarowitz, R. (1980). A group-investigation method of cooperative learning in the classroom. In S. Sharan, P. Hare, C. D. Webb, & Hertz-Lazarowitz, R. (Eds), Cooperation in education. Provo, UT: Brigham Young University. Selman, R. L. (1980). The growth of interpersonal understanding: Developmental and clinical analyses. New York: Academic Press. Slavin, R. E. (1980). Cooperative learning. Review of Educational Research, 50, 315–342. Slavin, R. E., Sharan, S., Kagan, S., Hertz-Lazarowitz, R., Webb, C., & Schmuck, R. (Eds) (1985). Learning to cooperate, cooperating to learn. New York: Plenum Press. Spence, S. H. (1981). Differences in social skills performance between institutionalized juvenile male offenders and a comparable group of boys without offence records. British Journal of Clinical Psychology, 20, 163–171. Spivak, G., Platt, J. J., & Shure, M. B. (1976). The problem-solving approach to adjustment: A guide to research and intervention. San Francisco, CA: Jossey-Bass. Thayer, L. & Beeler, K. D. (1975). Activities and exercises for affective education. Washington, DC: American Educational Research Association. Walker, C. E. (1975). Learn to relax. Englewood Cliffs, NJ: Spectrum Books. Weinstein, G. & Fantini, M. (1970). Toward humanistic education: A curriculum of affect. New York: Praeger. Werner, E. & Smith, R. (1982). Vulnerable but invincible: A study of resilient children. New York: McGraw-Hill. Wilson, J. (1972). Practical methods of moral education. London: Heinemann. Zimmerman, D. (1983). Moral education. In Center for Research on Aggression (Ed.), Prevention and control of aggression (pp. 210–240). New York: Pergamon Press.

Chapter 11

THE PEACE CURRICULUM: EXPANDED AGGRESSION REPLACEMENT TRAINING SARA SALMON Center for Safe Schools and Communities, Erie, Colorado, USA

The roots of our expansion of the Aggression Replacement Training (ART) model developed out of a tremendous need during the early part of the 1990s in St Louis, Missouri. During that time, a change began to take place in St Louis that created program responses from those working in the public schools. The Ferguson Florissant School District is located in urban St Louis, Missouri and has consistently had an enrollment of around 12,000 students—three high schools, three middle schools, sixteen elementary schools, and an alternative school that was begun in the 1970s for students who did not tolerate the regime of the high school very well. In the late 1980s, the District began to experience rapid change in terms of student body, attitude, and demographics. Our once idyllic, rather middle class community began to attract a highly transient population and one that began to behave in increasingly aggressive ways. One day the Federal Bureau of Investigation (FBI) met with key members of the central office staff to advise that several gangs were on their way to district neighborhoods from Compton, California and Chicago, Illinois in order to set up a base for drug commerce. The FBI warned that these gangs would involve as many of the district students as they could and that we had better begin some programs to deal with this effectively. Central office staff are known to be somewhat unresponsive to this sort of thing so the warnings went unheeded. Very shortly after this meeting, it was apparent that the gang members had begun to enter district schools. Rival gangs displayed their colors—blue for the Crips, red for the Bloods, and black for the Gangster Disciples. With the gangs came increasing violence. The district experienced its first drive-by shooting in the early 1990s in front of Airport Elementary School where a 10-year-old child was killed by gang members. The elementary school was riddled with bullets. Soon after that, guns were found on a regular basis in the schools. Assaults on students and teachers increased, with New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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parents coming to the board hearing defending their children’s right to assault others. What a change from before, when parents took responsibility for helping their kids behave! Something had to be done immediately. One of the first things that developed was the formation of a community coalition called the North County Service Coalition that combined over 40 businesses and agencies with five school districts to assess the community need and start programs to increase school and community safety. The Coalition immediately began a gang task force, with the police departments and juvenile court meeting on a regular basis to create programs and seek funding. The Coalition was to become very successful at developing cooperation among agencies and was also to become effective at fundraising and obtaining grants. The District’s administration staff had been searching for the best way to help these students and families, and to do it with as little money as possible as the District was struggling financially. The decision was made to begin by starting a middle school program for violent and aggressive students, which was called the Positive Alternative Learning (PAL) program. Three of the best district teachers were interviewed and placed in the program. The PAL program began in the same building as the old alternative school program. The PAL staff were committed to helping the students on long-term suspension to change for the better. Many programs around the country were scrutinized in our search for the best model. One day a flyer arrived at the school district advertising Dr Arnold P. Goldstein, professor at Syracuse University, who would be speaking at DePaul Hospital in St Louis. His topic was Effective Strategies for Violent Youth. The staff remember his talk and how he stressed that behavior rehearsal is one of the few ways that juvenile offenders could change, and that teachers had to change their teaching modalities in order to be comfortable with role-playing. As he mentioned that his program worked effectively with tough kids from Harlem, New York, the staff knew immediately that it would be effective with kids in St Louis. Dr Goldstein was invited to come to the District and speak about the program. Soon after his speech at DePaul Hospital, Dr Goldstein spoke to a representative group from the school district and the North County Service Coalition, and the staff were given the Prepare Curriculum (Goldstein, 1999) and told to go forth and teach. The PAL program was designed for students on long-term suspension—in those days that was 90 days or over. The program required students to receive two hours of ART per day in the morning and their academics in the afternoon. A research design was created in collaboration with a local university to measure the success of the students. The researcher, Dr Bill Ahlbrand from Southern Illinois University, established the research design with pre-post variables of grade point average, attendance, office referrals, suspensions, scores on the Missouri State Test, parent observations, student observations, and teacher observations. Once the program started, the staff noticed that the students were making little or no improvement. In alarm, Dr Goldstein was called and asked to return to the District to observe and give feedback. He kindly did that and after observing for a brief period, reminded the teachers that these kinds of students could not learn the skills in an informal way through general discussion in class. Dr Goldstein suggested that role-playing of the social skills begin immediately. The somewhat

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frustrated staff challenged Dr Goldstein to role-play with the students. The scene was unforgettable—there was Dr Goldstein with tough students from St Louis, who by now had taken over the program, speaking to them with great sincerity and firmness, explaining that the only way they were going to be successful was to role-play the skills and the role-playing would proceed immediately. He looked the students in the eye and told them that he wanted them to live until a ripe old age even though he realized that they might not want that for themselves—yet! After continuing to explain the importance of role-playing, he asked for a student volunteer, and the rest is history. The staff has never looked back and this is 12 years later. Once the staff began to feel comfortable with role-playing, the students began to improve in both behavior and academics. After staying in the program a quarter, most students began to return to school with improved social skills. The students’ changed behavior was surprising to the middle-school staff back in the regular schools, and teachers wanted to learn more about ART. Ferguson Florissant received its first grant involving ART, which was a training grant to train teachers, counselors, nurses, social workers, and psychologists in order for them to begin to use the language of ART back in the home schools and also in order for staff to use the lessons in pull-out programs and in the classroom.

THE DEVELOPING CURRICULUM The staff in PAL noticed right away that most students were antisocial and extremely reluctant to learn skill rehearsal. It was decided to strengthen the empathy portion of the curriculum. The staff reasoned that students would participate more willingly in the social skills part of the curriculum once they had learned to listen and be compassionate toward others. Some of the grant money was devoted to hiring teachers from the schools to write a curriculum. Teachers wrote the curriculum after school on a weekly basis throughout the school year and during the summer months. Representative staff members from the Coalition schools collaborated on the curriculum and agreed that the empathy lessons were to be field tested with the students to determine whether or not the lessons would help students be more willing to learn social skills. The staff found that after focusing on empathy, especially when the students first arrived, the students were more willing to learn social skills. Once the curriculum-writing process began to become a part of our culture, the lessons became more thorough. The teachers wrote a lesson, an in-class activity, and a homework assignment. Soon, a secondary and elementary curriculum would be complete. Over the years, the staff from the Coalition schools and other staff from Iowa, Colorado, and Illinois have contributed to the curriculum, and it evolved into The Peace Curriculum—Expanded Aggression Replacement Training. As it is now, the curriculum includes Primary, Elementary, Middle School, Secondary, and Parent Empowerment Curricula. A grant was received in 2001 to add an additional component to each lesson—a school–home link, an activity that can be done with the child and parent together at home.

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EMPATHY The empathy component began to develop around key steps that would help students learn compassion. The staff developed the HEARS model: 1. 2. 3. 4. 5.

Hold the correct posture. Eye contact when someone is speaking. Assess the person’s feeling correctly. Respond appropriately with your face. Say the person’s feelings in your own words.

Students were given lessons that taught this model. First they practiced holding their bodies in a listening mode. The students were given practice in looking at another person with “soft eyes,” usually for three to five seconds at a time. Since violent students are fairly singular in terms of feelings—most of them feel one feeling: anger—many lessons were written about the development of a feeling vocabulary. We taught the students about William Pollack’s book, Real Boys (Pollack, 1999). This book talks about the United States being a country that does not legitimize feelings with boys. He coins a phrase that many boys, as a result of this practice, grow up to “cry bullets of tears.” He stresses that we need to allow students time to learn about feelings, and identify them correctly in themselves and in others; doing this can help to avoid many mistakes in relationships. So the empathy training began to emphasize the development of a feeling vocabulary. One of the lessons involves, for example, students brainstorming feeling words (they must be “g”-rated, of course, meaning our grandmother must feel comfortable with the language used in class). After the students have brainstormed their list, they are assigned the task of choosing a feeling word and acting it out nonverbally in class, with the rest of the class having to guess what the feeling is. Students are then given pictures to practice the identification of feelings; they look up emotions in magazines and books. As a result, the students learn to correctly identify their own feelings and those of others. Part of the HEARS model is learning to respond appropriately with facial expressions to someone who is expressing a feeling. Many of our students expressed inappropriate facial expressions in the presence of others. The curriculum evolved where lessons were taught to students to show them how to respond appropriately when someone was expressing a certain feeling. With happiness, the face needs to change for the positive; with sadness, the face needs to change to concern. We also stressed that if someone is expressing anger, the listener needs to express calm concern as anger tends to be a secondary reaction to the feeling of hurt. Once the students have learnt to sit or stand appropriately, look at someone when they are speaking, and exhibit the appropriate facial expression, they are given practice in the Truax and Carkhuff model popular in the 1970s (Carkhuff, 1969) and taught to summarize the content briefly and to make a guess at the appropriate feeling. Activities were taken from other sources such as the peer helping training manuals (Tindall & White, 1991). Students practice empathy continually until they are able to respond easily and genuinely to anyone who is expressing a feeling to them. In fact, such great results emerged from our HEARS model that the staff

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continued to emphasize the empathy part of our curriculum when the students first entered our program.

RECENT MODIFICATIONS OF EMPATHY TRAINING Several years ago, PAL teachers came across a wonderful book by Stephen Nowicki (1992). Nowicki conducted studies involving people who committed violent acts and concluded that a high percentage of violent criminals had a learning disability that he called “dyssemia”—a density of spatial intrusion. He describes these people as having a complete lack of perceptiveness with regard to spatial boundaries. These are people who speak in intrusive ways—nose to nose, so to speak. They may argue loudly, be “off” in terms of their rhythm, and may use inappropriate gestures that invade others’ space. The staff became very excited about this concept and added a section in the empathy curriculum about “space empathy.” For the first time, students were given activities where they practiced personal boundaries, appropriate gestures, getting in touch with others’ rhythm, and other spatial issues. This was a wonderful addition to the curriculum and students began to understand and behave with respect to others’ space needs.

EXPANSION OF THE PROGRAM As the first four years of PAL passed, we added an elementary component to the alternative school, and a “baby” PAL for young children, and finally changed the high-school program from the old “drop in and earn a few credits paradigm” to the more rigorous program where the students combined ART with their academics. That was a tough transition for many of the staff but the change was accomplished. A grant for the Coalition was received from the Missouri Department of Elementary and Secondary Education, which started an Elementary ReEntry Center for the most disruptive students from the five school districts. Staff were hired to conduct classes for these students in each school district.

THE RE-ENTRY CENTER The North County Service Coalition continued to meet and grow. The superintendents of the five school districts were interested in ART and suggested that a grant be written where ART could be used with the most violent students in all of the Coalition districts—students who had been expelled, or permanently removed, from our schools. The administrative staffs met for a year along with the police departments, juvenile courts and Division of Family Services, to come up with a model that could work. The US Department of Education opened up the first round of Safe and Drug Free Schools competitive funding for local school districts. The Coalition districts decided to apply for funding to start a Re-Entry Center where expelled students would come together in an alternative school and would receive ART three hours a day and their academics in the afternoon.

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The North County Service Coalition received approximately $1 million for a three-year grant to see if ART would work with students who were permanently expelled from school. A rigorous research design was established to measure the success of the program. The Boards of Education of the schools were contacted and persuaded to try the program. That meant that if a student were successful, the student’s expulsion would be rescinded by the Board and the student would be allowed to return to school. Each Board of Education was willing to try the Re-Entry Center Program—quite an accomplishment. The Missouri Department of Elementary and Secondary Education (DESE) also had to agree to the Re-Entry program and the new policies of the Boards of Education with regard to expelled students. DESE also gave its agreement and the program was begun. The staff were hired and trained in the Peace Curriculum as we had developed it. It was difficult to find a place to house the Re-Entry Center. The School District had originally found space in a local shopping center close to the regular schools. Once the neighborhood people found out that aggressive students would soon be attending school nearby, there was a tremendous protest. It took the administrative staff almost three months to find an appropriate space. A vacated Social Security Building in a shopping center was located for the Center. It was on the second floor with a huge central room and six classrooms surrounding the central room. There was a kitchen and bathroom and two additional rooms that were used as a meeting room and computer room for the students. A police department was located across from the building and a community center next to the building. The staff planned to work with these agencies and others close to the center so that students might have the opportunity to offer community service to these agencies. The Re-entry Center was opened in January of 1996. Students would receive three hours of ART each morning. Their academics would involve individual and smallgroup instruction, computer time, and individual instructional modules developed by the military and donated by the military for student use. Parents would be required to attend a parent program. Since these students would be in the program for a base time of one semester and some of them would need to stay a year or more, we continued to revise the curriculum and program.

PARENT EMPOWERMENT The staff knew that the parent component could be a critical part of the program’s success. We searched the country for an effective parent component. The PAL teachers met with parents weekly but with little or no success. They tried many agendas but none of them seemed to work. The staff were eager to find a program that would help the Re-Entry Center parents. At the annual Safe and Drug Free national conference in Washington, DC, in 1996, the FAST program was presented as both an exemplary and a nationally disseminated program (Wallace, 1999). The FAST program was designed for students with character disorders and sociopathy—disorders of social conscience. Educators in the state of Wisconsin studied the research carefully in order to create a program that would cause sociopathic families to bond, thus creating more socially adept families. A structure

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was developed from their research that used a sequence of activities that worked with the families together. The original plan involved regular schools, where invitations were sent out to large groups of students and their families and personal invitations were issued to the most needy. The program was found to be most successful, running once a week for only eight weeks for 11/2 hours each session. The entire family participated. That is how the original name developed—Families and Schools Together. As the staff searched for an effective parent program for the Re-Entry Center, the research results from the FAST program were exciting and promising and it was decided to incorporate the program into the Re-Entry Center. It was unknown at the time whether it would be effective with an aggressive population since the original program involved regular schools. When starting the program, the staff decided not to invite the entire family unless the family really could not find other care for the siblings. The staff were reluctant to face the entire family, so only the Re-Entry student and a parent were required to attend the weekly meeting. The FAST research found that parents would strive to come to the program. Nevertheless, sanctions were built in. For example, if the parents could not attend the Parent Empowerment session, they had to bring their child into school the next day. Teachers and administrators worked with employers, obtained bus passes and cab vouchers, and even arranged car pools when necessary. The program was named “Parent Empowerment” because it truly empowers the parent and gives the parent the skills and strength to lead the family. As we studied the FAST model, we decided to add an ART mini-lesson to each night’s session for approximately 15 minutes. Parent Empowerment was scheduled one evening per week for 11/2 hours per session—exactly the same as the model in Wisconsin (Box 11.1).

Box 11.1 Parent Empowerment schedule Group warm-up with entire group ART mini-lesson (involving parents) Family game time (under watchful eye of staff) Student recognitions Family snack time (students serve the parents) Closing circle (everyone shares one positive)

A couple of years into the program, the closing circle was added to the end of the session. That kept families from “eating and running” and provided closure to the evening and additional practice in focusing on the positive. Many wonderful things emerged from the Parent Empowerment program. The student success rate went up from 85% to 95%. Many students grew tremendously as they learned to express themselves positively, and parents improved as well. Visitors from Arkansas, Illinois, Iowa, Colorado, California, and New Mexico began

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to visit the program, and many were brought to tears when they saw the positive responses from the students and parents.

PARENT EMPOWERMENT APPLICATIONS Currently, many states in the USA have developed rigorous performance-based state tests. Missouri was no exception. Students in several grade levels are required to take this state-developed performance-based test with an emphasis on project development, speaking, and writing. As a result of this emphasis, the staff began brainstorming about how they could make the Parent Empowerment experience performance based. Several experiences were designed where the students would create a project that would require them to put together an event and implement it—an event that would benefit the family. The first experience was creating an authentic Thanksgiving dinner. The students would research Thanksgiving, create a budget, purchase the food, cook the food, make placemats and table settings, and learn enough about Thanksgiving to engage in table talk during the meal. The staff had to first determine which students could handle the knives(!) and create a plan that would involve all students in the process. The Thanksgiving dinner continued and was a great way for students to involve themselves in a positive family experience that could transfer to the home. Some of our toughest students were seen fretting over whether or not people would have enough food, whether the turkey would get done on time, and whether people would like the food and the event. This idea rapidly spread over many states, and other ideas were added. A teacher in Chicago added a dress-up component to the event with real china and silver and a hygiene lesson. An Albuquerque teacher added a Thanksgiving skit that students performed on cable television shown during the dinner. Other additions included a holiday cookie-baking session where cookies were made from scratch. Students gave their family one basket and took another basket to a charity. This continued with other events for Valentine’s Day and other holidays.

CURRENT APPLICATIONS OF PARENT EMPOWERMENT Two successful programs have begun in Denver, Colorado, where the expanded ART model has been combined with Parent Empowerment. Despite the fact that these programs were for suspended and expelled youth, these staff decided to invite the entire family, as in the original FAST program, and assess the results. Starting these programs was a challenge because most teachers were skeptical. Several teachers visited St Louis to see the Parent Empowerment in action but were worried that it would not work in Colorado. Nevertheless, several Parent Empowerment programs were started in Colorado. Six elementary schools started the program in Denver, and Parent Empowerment was started at the new high school PREP program for suspended and expelled youth. Three Parent Empowerment groups were started in Loveland, Colorado for

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suspended and expelled youth, two programs at the middle school and one for the high school. The staff were amazed at the continued l00% participation of the families. Teachers commented on the reaction of the younger siblings, who readily learned the ART skills. In all of these programs, each family member was personally interviewed and talked about how important the Parent Empowerment program was. A majority of parents said that they personally needed more ART skills. The Parent Empowerment program is so valuable that if it is possible to start this program, the benefits are certainly long term. This program is one of the federal government’s nationally disseminated field sites. The FAST research shows that the students’ behavior continues to improve up to two years after the eight-week program ends! There is little question that transfer occurs. And it makes a lot of sense—a routine of positive experiences over time seems to create more positive relationships within the home.

CONTINUED EVOLUTION OF THE CURRICULUM As we continued the program, the staff were committed to developing a strong curriculum, adding strategies that worked. In every grant written, money was set aside to pay teachers after school and in the summer to write the curriculum. The curriculum writers decided to name it The Peace Curriculum. Many teachers participated in the curriculum writing and continue to do so today. Originally, the teachers from the North County Service Coalition wrote most of the lessons. Currently, lessons are being developed by teachers from California, Colorado, Missouri, and Illinois.

ANGER CONTROL Teachers gave a good deal of thought to the anger control section of the curriculum. One of the first activities designed by the staff was the MELT, a two-minute relaxation technique where students practice deep breathing to tranquil music that is approximately 60 beats per minute. The students are taught that they are to empty out the negatives into a puddle on the floor. The MELT is one of the very first things taught to the students in the PAL program and Re-Entry Center. It is highly successful once the students become accustomed to it. The MELT is also used in the Gathering, an event that will be discussed in more detail later. Students ask for the MELT later when they feel angry or stressed, and the teacher can call for a MELT at any time that the students seem angry or frustrated. Students even came up with their own acronym for the MELT: M E L T

Mellowing out Emptying out the negatives Laid-back attitude Tranquillity

After the MELT was developed, with great success, the teachers refined the anger cycle and developed lessons around labeling the cycle while thinking and talking

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about the reducers. The lessons started with four main reducers: deep breathing, counting backwards, pleasant imagery, and positive self-talk. Students used a Hassle Log (Goldstein, 1999) and were given practice labeling the parts of the hassle log in front of the group while other students re-labeled. Students were asked to identify the external trigger, internal trigger, cues, reducers used, and the shortand long-term consequences that could occur if the anger was not controlled. We developed many unique lessons involving anger, including the PEACE acronym that students could also use to help control their anger: P E A C E

Pause Exhale Attach your fingers (at the exhalation) Change your thinking (neutralize that internal trigger) Exit to a social skill (students learn that once they reduce their anger they often have to use a social skill)

BRAIN GYM As part of anger control, the staff began to incorporate brain gym activities to help students relax their right brains so that their left brains could do required academic work. Several books have been published on the matter. One of the most prominent is authored by Carla Hannaford (1995). Hannaford describes brain gym activities as micro-neuronal movements that help students form a gestalt to improve learning. While learning these activities, members of the staff visited a court-school for seriously damaged children in San Diego, California, where brain gym activities were used with acting-out students. The teacher pointed out a rowdy bunch of 8–10-year-olds and conducted a particular brain gym activity that would help the students settle down and learn an abstract concept involving reading. This particular activity required the students to sit on the floor, make gentle circles on their foreheads while taking four deep breaths, followed by a cross-sweep five times— right hand sweeping up the left ankle, left hand sweeping up the right ankle, until the five sweeps were finished. The students completed this cycle then sat down and began to learn! The staff were excited to add brain gym to the curriculum. The students now are taught several basic brain gym activities in order for them to learn more easily. Later on the staff incorporated a basic brain gym activity into the MELT. The brain gym activity is called the “hookup.” The hookup goes like this—first, the right leg is crossed over the left. Then the arms are lifted up straight in front of the person, the left hand crosses over the right, the palms are clapped together and both hands turned under, holding them under close to the chest. This activity is calming and designed to help the student become more focused and ready to learn. Now students are given a choice with their MELT—they can do the MELT in the original sitting position or do it in the hookup position. Most prefer the hookup position.

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SKILL REHEARSAL A professor from Michigan State University attended one of our trainings where staff demonstrated their newly developed model for teaching social skills. Teachers called their model “Skill Rehearsal.” In this model, the teacher performs like a coach and “cuts the action” if students make mistakes in the role-play and redirects them until they are successful. Skill rehearsal developed into an active, theaterbased model where students role-play the skills on the “stage” of the classroom. The Michigan State professor commented that teachers were actually using an old theater model that is successful with training actors on stage. Her comment was that instead of creating characters in a play, we were developing socialized human beings through the use of key attributes that develop character—empathy and feelings, social skills and behaviors, cognitive thought processes and language, and a system of ethics. She sent several theater training books for the staff to see for themselves. Teachers were encouraged by this professor to continue using the model while reinforcing “baby steps” of student improvement as each skill was practiced. Two templates were developed for skill rehearsal. First the students are given the “Social Skill of the Day” step sheet (Figure 11.1). Students use this step sheet to complete while the instructor is teaching the skills. The step sheet reflects the template the instructor uses. The teacher fills out the template on the board while teaching the particular social skill.

Name of Skill

What: Why:

When/Where: Name

Example

1. 2. 3. 4. (until all students’ names are on the list with examples)

Figure 11.1 Skill rehearsal template

Steps

Icing

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Skill Rehearsal Lesson Students are asked for a brief definition of the skill, and the teacher writes this on the board under the “What” section. The teacher asks the students why the skill is important, and those reasons are written on the board under the “Why” section. An example of when and where the skill could be used is obtained from the teacher and each student, and also written on the board. The teacher’s example goes first since that is the person who will be doing the first role-play. Each student’s name needs to go up on the board with the specific example. This makes it much easier for the students to role-play without hesitation when it becomes time to do so. The middle section of the template is used to write the steps of the skill while explaining them one by one to the students. Brief examples are given of each step and the students write the steps on their step sheet. The teacher explains the concept of “icing,” and that icing provides finishing touches to a skill. The teacher provides examples. When introducing yourself, an example of icing would be a smile and good use of personal space. The teacher role-plays the skill for the students after assigning students the steps to watch. Students provide feedback. Each student then role-plays the skill. It is important for the teacher to assign the steps each time prior to the role-play and to vary which steps students watch. When the technique is used in a large regular education classroom, a small group of students can role-play or the room can be divided up into groups. In order to reinforce the skills, students participate in an in-class activity followed by a homework assignment. We have just added an additional part to the curriculum—a school– home link where the students and family members can do an activity together. The “Icing on the Cake” section was developed by one of our teachers a few years ago. The students and staff loved the idea and it gave everyone an opportunity during role-play to focus on the nuances of the skill. A class in Loveland, Colorado did a lesson on “Avoiding trouble with others.” As each student role-played, the teacher took some time discussing the importance of nonverbal behaviors as the students said “no” to a peer who was pressuring them to do something wrong. Students were able to practice some of those finishing touches to make their words sound even stronger. Our most violent and aggressive students enjoy role-playing. Generally, the teachers do not; role-playing is often difficult for them. As training occurs, teachers are strongly encouraged to become comfortable with role-playing. Teachers receive lots of practice until they can carry this off with confidence and aplomb.

CHARACTER EDUCATION Some years ago, Sandy McDonnell, vice president of McDonnell Douglas Corporation (now Boeing Corporation), came to the Ferguson Florissant School District to inform the central office staff that recent graduates were coming to work did not have good ethics—coming late to work, stealing from the company, and performing poorly. Mr McDonnell offered a small grant if Ferguson Florissant would

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take the leadership in developing a character education program for all district students. Ferguson Florissant staff agreed to his offer and embarked on a journey to create a program that would build a “culture of character.” Staff from Ferguson Florissant took one full year to build community consensus involving which traits to teach in schools, inviting every possible religious and other groups to meetings where character traits were selected to be defined and taught in schools. The school district completed the process with 13 traits and a curriculum was written around these traits. The program was named PREP—Personal Responsibility Education Program. Eventually, these 13 traits were adopted by all 23 school districts in St Louis, Missouri. The traits are: caring, courage, cooperation, goal setting, honesty, humanity, patience, perseverance, respect, responsibility, self-esteem, self-control, and service. PREP spread like wildfire. Sandy McDonnell visited other school districts, hosted fundraisers, gave speeches, and met with the media, and money became available to start system-wide character education programs. PREP committees were started in each school, reporting to a district PREP committee, reporting to a county-wide PREP committee led by Sandy McDonnell. PREP cards were made with definitions on them in a variety of bright colors and placed in every classroom, principal’s office, lunch room, church, and court. Teachers from all 23 school districts developed a wide array of PREP activities and curricula to be used with the students from kindergarten through grade twelve. The media joined in the effort by publishing the PREP traits on a regular basis, writing stories about the traits, and giving students from the school districts PREP awards. Alternative school students enrolled in PAL and Re-Entry were provided a basic PREP curriculum as part of the ART program. Many activities were developed for the students to focus on PREP. A three-minute writing assignment begins many of the classes each day, where students are given a theme involving one or more of the PREP traits. Rubrics for paragraph writing and essay writing were developed to encourage students to think and write about the character traits. Awards were given for PREP and year-end ceremonies involved PREP certificates and recognitions. The staffs from PAL and Re-Entry decided to change Goldstein’s original “moral reasoning” section of ART found in the Prepare Curriculum (Goldstein, 1999). That section of the curriculum involves students discussing moral scenarios in order for them to have the opportunity to make higher moral judgments during group discussion. Goldstein utilized Lawrence Kohlberg’s work on moral reasoning, popular during the 1970s and 1980s (Kohlberg, 1981). The original Kohlberg work had been somewhat damaged and misinterpreted by many individuals in schools during that time. Many discussions were held with the staff regarding the results of this misinterpretation. A whole movement of “values clarification” seemed to grow out of Kohlberg’s theory. Many schools in the United States during the 1970s and 1980s were teaching that to clarify values was a fine thing to do, but to “teach” values was not appropriate for schools. This led to right-wing conservatives storming the schools, forbidding them to hold any discussions of values and character—insisting that morals be taught in the home and not at school. Teachers and administrators grappled with this issue and wanted to do some more intense work with the students other than the basic PREP curriculum. As the staff had eliminated the moral reasoning part of the curriculum for a time, an

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interesting event occurred. A superintendent from Waukegan, Illinois, came to visit one of our high-school self-contained special education rooms where ART had just begun. The superintendent watched while a new counselor taught from an old “Moral Reasoning” curriculum that had been discarded by almost everyone. He watched this new counselor discuss a moral scenario with the students and during the questioning related to the scenario, the counselor asked which PREP trait the story was about. Through the discussion, students experienced the realization that “responsibility” was the topic of the story and that they could be responsible— they could change their behavior and become effective parents and spouses! Once this realization occurred, many of the students experienced an emotional reaction during this discussion. Students and the superintendent all came to tears as they realized that a “breakthrough” had occurred. The superintendent described later to the PAL staff that there was electricity in the air as the students experienced an “aha” moment when all the ART lessons had come together and students had internalized them as a group. Hearing about that experience from both the superintendent and the counselor, the staff reasoned that moral scenarios could be written with questions encouraging debate but students could also be asked to choose one or more PREP traits that the scenarios featured. After debate, the teacher would then begin to focus on those particular PREP traits and how they could be practiced in more effective ways. The staff designed in-class and homework activities that would help students think, talk, and practice that trait until it became part of the student’s ethical base. This change was highly successful and something the students began to enjoy very much. In fact, a recent Stanford study examined Kohlberg’s research and supported what the staff found in an intuitive way (Damon, 1999). Damon found after ten years of research that Kohlberg was right. Students will move up the Kohlberg Moral Reasoning Scale after debate—but it helps when there is the addition of an authoritative model as a base. Our PREP program is an example of an authoritative base, and students progress quite rapidly through discussion, debate, then come to consensus regarding the PREP trait that is important. Practice and homework are provided for students to help seal that PREP trait into their language, thinking, and behavior.

THE GATHERING One of the most recent additions to our program is the Gathering. The Gathering is a daily event that bridges the events from home to the focus on academics at school. Students today frequently come to school with tremendous conflicts, fears, and feelings of confusion and apprehension. We first saw a Gathering at the Eagle Rock School, an alternative school in the mountains of Estes Park, Colorado, funded by Honda Motor Corporation. All fifty plus students come to the Gathering in a central location for announcements and a song about character. This event was repeated every day. Prior to graduating from Eagle Rock, students were required to formulate their ethical system into a thesis where it was juried by representatives of the community.

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The staff were very excited about the potential of the Gathering. They saw it as a way to form a bridge from home life to school while focusing on character development. The Gathering schedule developed into the routine outlined in Box 11.2. Box 11.2 Gathering schedule MELT Announcements Recognitions Story or song about character What PREP traits does the story feature? How can you apply the traits to your life in school today? Staff from the PAL program in the Ferguson Florissant School District decided that they would do the Gathering with all 100 violent and aggressive students in grades kindergarten through twelve. Many of the administrators were apprehensive about this activity. There were worries that it was impossible for this many aggressive students representing such a variety of ages and grade levels to conduct themselves appropriately. They were certainly fearful for nothing. The Gathering works—and works very well. Students and their teachers participate in the Gathering together, and as students reach the highest level in the program, they are encouraged to lead the MELT. Last year, a kindergartner led the MELT and did an outstanding job. Gatherings are being done in many places now with great success. This is one of those ideas whose “time has come” because students today really do need the time to relax, refocus, and think about ethics prior to their school day. Stories, poems, songs, and sayings can be used for the Gathering experience.

DISCIPLINE STRUCTURE As the programs evolved, a good deal of time was spent establishing an infrastructure that makes it almost impossible for students to misbehave. Since there has been a consistent 95% success rate with the most violent and aggressive students, the discipline system becomes a key factor in helping students improve their behaviors. It is not easy creating this infrastructure. Staff have to be committed to the curriculum and to implement it on a continual basis. The discipline system contains the following elements:

r student contracts r student recognitions r positive reinforcement r rules and rules test r point system r levels system r re-entry hearing (presentation of skills)

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The rules were an aspect of the discipline system that was taken very seriously. Rules systems were studied and researched by the teachers, and an excellent system of rules was developed that actually has become a learning tool for the students. Rules are stated positively and include the rationale for the rule, what it means, behaviors that are not allowed, and behaviors that are allowed. There are five simple rules, including rules on safety, learning, and social appropriateness. In order to succeed in the levels system, students have to pass a rules test. Recognition is an important part of the discipline system. Students are recognized every day for positive behaviors and steps toward those behaviors. This happens in class, where they are given applause for role-plays, in Parent Empowerment, and during the Gathering. Students need recognition and also need to learn to accept it in a gracious manner. Positive reinforcement is also important in the system. Students experience positive reinforcement through the point system. The point system is simple and easy to manage. Students are given points for each class. Points are added up for each day to Outstanding, Satisfactory, or Unsatisfactory days. Students have to obtain so many “S” days to move up levels. There are four levels, and when students begin to earn their way to levels 3 and 4, they must have some outstanding days as well as satisfactory ones, and the days must be consecutive. The level system is rigorous and involves demonstrating mastery of the ART skills as well as academic success. During the many years of doing this program with students, the staff have learned that students will perform well in order to experience social contact with others. As students become more responsible, they earn the privileges of increased social contact as they move up the levels. This system is highly successful. It should be noted that students are required to master the ART skills in greater depth as they move up the level system. It is important to build those ART skills into any level and point system. By doing that, it is more apt to create an environment where students will learn the skills because they have to learn them in order to socialize with others. Students then have to create their presentation of skills in order to be re-admitted to their regular school. Students keep a portfolio of skills learned and design their presentation. Staff members, including a teacher, assistant principal or principal, participate in the re-entry hearing and make the decision to accept the student back. In the Thompson Valley School District in Loveland, Colorado, students are learning to use Power Point and are creating animated presentations for their Re-Entry Hearing Boards, with great success.

THE STAFF There are important things about the staff that must be implemented before students can achieve this great success. First of all, teachers need to be selected who believe that students can change and are able to reinforce that change sincerely. Teachers need to show their belief that students can change. Since the curriculum is divided up into manageable steps, teachers need to reinforce each step rather than expecting the students to “know” the skills immediately. Teachers need energy

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to do this program—they move from the “sage on the stage” to the “guide on the side.” That means no more teaching behind a desk—teachers must be up on their feet, standing close to the students who are role-playing, and redirecting them until the skills are mastered. The curriculum must be delivered in a professional manner with confidence and strength. All members of the staff working with these students need to search themselves on a regular basis to make sure that they are good role models and that they are practicing the ART skills themselves. Teachers need to be trained continually in order for the program to be successful. Teachers need an introduction to the curriculum and program, then continuous practice. They should receive training with the students until feeling confident, comfortable, and relaxed while delivering the curriculum. The teachers realize that establishing an ART curriculum is a good deal of work but once the structure is in place, a culture of appropriate social behavior begins to emerge almost immediately. The teachers are then placed in a role of supporting and refining the culture. This phenomenon makes it easier and more pleasant for teachers. A good example of this happened three weeks into the Denver Public Schools PREP Academy program for expelled students in January 2001. During an empathy lesson, one student asked the teacher, “What is the difference between empathy and empathic and can I use this when my friend is telling me a sad story about something that happened to me at home, and can I also use an ‘I’ message as a social skill with my friend?” That is what happens when the teachers continually teach the lessons—the students begin to put it all together and use the language and skills of the curriculum on a daily basis. Taking the time to allow students to talk, write, and think about the skills is an important precursor to the students actually using the skills in their daily behavior.

RESEARCH William Ahlbrand from Southern Illinois University found that students who participated in our program achieved a high rate of success using the variables of grade point average, office referrals, attendance, suspensions, parent perceptions, teacher perceptions, and student perceptions. John Mosher, a retired counselor from the Ferguson Florissant School District, interviewed students from the Re-Entry Center one and two years after they left the program. He reported success with these students, and all the students he interviewed reported that they use the ART skills every day. Michael Grady, a researcher from the University of Missouri, St Louis, found significant differences between the Re-Entry Center group and a control group on test performance using the Missouri MAP Test (Grady & Mosher, 1998). The research is being carried out with the Denver Public Schools population and the Thompson School District. Dr Myriam Baker from Denver, Colorado, is conducting the research and has gathered some exciting data showing increases in student attendance, improved grades, fewer office referrals and suspensions, and better attitude, measured by parents and teachers. Additional research with the program is being done in Albuquerque, New Mexico, Fayetteville, Arkansas, and San Diego, California.

188 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

CONCLUSION These are some of the developments that we have put in place over the past twelve years. Teachers are continuing to share their ideas, their songs, and their ART games with us as we all learn to build a culture of character in our own states and cities. There are many wonderful programs where the curriculum is being implemented. Some of these programs are in Danville, Illinois, Chicago, Illinois, Palatine, Illinois, Bridgeport, Connecticut, San Diego, California, Bakersfield, California, Jonesboro, Arkansas, Little Rock, Arkansas, Fayetteville, Arkansas, St Louis, Missouri, Denver, Colorado, Loveland, Colorado, Iowa City, Iowa, and Albuquerque, New Mexico. These districts are taking the leadership in providing this program to students who so desperately need structure, guidance, and love. By taking the time to allow students to learn the ART skills, we are empowering them with the skills they need to be successful in relationships and in life.

REFERENCES Carkhuff, R. R. (1969). Helping and human relations: A primer for lay and professional helpers, Vol. 2: Selection and training. Amherst, MA: Human Resource Development. Damon, W. (1999). The moral development of children. Scientific American, 73–78. Goldstein, A. P. (1999). The Prepare Curriculum. Champaign, IL: Research Press. Grady, M. & Mosher, J. (1998). Reducing aggressive behavior: A comprehensive approach. Missouri Educational Leadership, 9, 9–11. Hannaford, C. (1995). Smart Moves. Arlington, VA: Great Ocean Publishers. Kohlberg. L. (1981). Essays on moral development, Vol. 2: The psychology of moral development. San Francisco, CA: Harper & Row. Nowicki, S. (1992). Helping the child who doesn’t fit in. Atlanta, GA: Peachtree Press. Pollack, W. (1998). Real boys. New York: Henry Holt. Tindall, J. & White, S. (1991). Peer helping for the pre-adolescent. Atlanta, GA: Accelerated Development Press. Wallace, D. (1999). National report on Families Together with Schools, a.k.a. FAST. Milwaukee, WI: Family Service America.

Chapter 12

AGGRESSION CONTROL THERAPY FOR FORENSIC PSYCHIATRIC PATIENTS: DEVELOPMENT AND PRELIMINARY RESULTS RUUD H. J. HORNSVELD La Rijswijk, The Netherlands

INTRODUCTION In The Netherlands, treatment of forensic psychiatric patients was for a long time dominated by a psychoanalytic and client-centered approach. However, in the past five years more and more behavioral treatment programs have been implemented, especially for sexual offenders. But until a few years ago, a treatment program focusing directly on aggressive or violent behavior was lacking. As a result of the workshop given by Arnold P. Goldstein in May 2000, a Dutch version of Aggression Replacement Training (ART), called Aggression Control Therapy (ACT) (Hornsveld, Van Dam-Baggen, Leenaars, & Jonkers, 2004) has now been implemented in a number of Dutch institutions for forensic psychiatric in- and outpatients. In this chapter, the development and first evaluation of ACT for forensic psychiatric patients is described. To begin with, brief information about the Dutch forensic psychiatric population is provided, together with the problem behaviors of this population in relation to their use of violence. After that, the focus moves to the method of evaluation with a description of the measurement instruments and the framework of the therapy. Finally, preliminary results are discussed.

FORENSIC PSYCHIATRY IN THE NETHERLANDS Inpatients Placed at the Disposal of the Government The Dutch TBS law states that “a person is not punishable if he commits an act for which he cannot be responsible.” Placed at the disposal of the government means, New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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briefly, that following the advice of a psychiatrist and a psychologist, a person is placed in a specialized hospital until their risk of recidivism has been reduced to an acceptable level. Every one or two years a judge decides about the prolongation or termination of the TBS sentence. The average duration of TBS sentences is currently 65 months. For such a sentence it is necessary that: (a) there is a psychiatric disorder or an insufficient development of the mental faculties which makes the perpetrator less responsible for the committed acts; (b) there is an offence committed for which the offender can be sentenced for at least four years’ unconditional imprisonment; (c) the existing disorder and the committed offense are associated with each other; and (d) on the ground of the disorder there is a real risk of reoffending. To be placed at the disposal of the government is first of all a security measure; the offender is not forced to cooperate with the proposed treatment. Van Emmerik and Diks (1999) investigated the population of TBS hospitals during the period 1995–1997. The amount of (sexual) violence of the TBS offence could be described as follows (on January 1, 1998): material damage (5%), threat (20%), injury (50%), and mortal termination (25%). The most important DSM categories found in the population on Axis I were substance abuse related disorders (31%) and psychotic disorders (26%); and on Axis II personality disorder not elsewhere described (33%), and antisocial personality disorder (19%). Most of the TBS offenders (95% males, 5% females) had a disorder on both Axis I and Axis II, 16% had only an Axis I disorder and 24% had only a personality disorder (Axis II).

Outpatients with Conditional and Alternative Punishments In The Netherlands, the court can require juvenile and adult forensic psychiatric outpatients to undergo treatment as: (a) an added conditional punishment for offenses to which imprisonment for three years or less applies; (b) an alternative punishment for offenses to which imprisonment for six months or less applies; (c) a condition of suspension of detention while awaiting trial; (d) part of a penal programme; and (e) a supervision element for a youth protection agency. In most cases, the court has determined a link between “insufficient development or pathological disorder of mental faculties” and their offenses, based on examination by a psychiatrist and a psychologist.

PROBLEM BEHAVIORS OF FORENSIC PSYCHIATRIC PATIENTS From research and clinical experience there are numerous indications that violent forensic psychiatric patients have a range of problem behaviors. First of all,

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generally speaking, they do not observe social situations adequately, partly because of attention deficits (Lochman, White, & Wayland, 1991). Second, like most aggressive people, forensic patients are more likely than non-aggressive people to perceive the behavior of others as provocative (Dodge, Price, & Bachorowski, 1990), probably because of biased cognitive schemas (Beck, 1990). False interpretations of the behavior of others may result in a drastic increase of arousal, which is experienced as an extreme emotion such as anger or rage. Most of the time, aggressive persons cannot regulate their level of arousal when they are angry. They do not have sufficient capacity to place themselves in other positions and they have few problem-solving skills (Feindler & Ecton, 1986) and social skills (Hollin & Palmer, 2001) at their disposal. Above all, aggressive people pay attention to the short-term positive consequences of aggressive behavior, such as terminating provocation, acquiring the desired goods, and gaining a higher status among peers (Bandura, 1973). Negative long-term consequences have little effect, perhaps because of the insensitivity to punishment (Lykken, 1995) and a restricted awareness of current norms and values (Raine, 1993).

METHOD Patients Essentially, nearly all forensic psychiatric patients are indicated for ACT, since they are sentenced for violent crimes. However, there are contraindications for treatment which include acute psychosis, acute substance abuse (only for the outpatient and day treatment centers), insufficient knowledge of the Dutch language/very low IQ, and inability to participate adequately in a group of eight patients.

Measurement Instruments Self-report questionnaires, risk assessment, and observation scales for personality traits and various elements of aggressive and competent social behavior are used in the evaluation. The NEO-FFI and the PCL-R are scored at the start of the therapy. All other instruments are used at the start, at the end, and at the last follow-up session. (1) Self-report questionnaires r NEO Five Factor Inventory (NEO-FFI: Hoekstra, Ormel, & De Fruyt, 1996), for assessing personality traits according to the Big Five: Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. r Self-Analysis Questionnaire (ZAV: Van der Ploeg, Defares, & Spielberger, 1982), Dutch version of the Spielberger State-Trait Anger Scale (Spielberger, 1980) for assessing anger as a trait (ZAV-D). r Attribution Questionnaire (ATV: Hornsveld, Nijman, Lammers, Van DamBaggen, & Kraaimaat, 2002), an experimental questionnaire for assessing hostility using 17 pictures from the Rosenzweig Picture-Frustration Study (RPFS: Hormann ¨ & Moog, 1957).

192 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

r Agressie Vragenlijst (AVL: Meesters, Muris, Bosma, Schouten, & Beuving, 1996), the Dutch version of the Aggression Questionnaire (AQ: Buss & Perry, 1992) for assessing various types of aggressive behavior. r Novaco Anger Scale (NAS: Novaco, 1994), for assessing anger and rage. The psychometric properties of the Dutch version are still being evaluated. r Inventory of Interpersonal Situations (IOA: Van Dam-Baggen & Kraaimaat, 2000b), an inventory for assessing social anxiety and social skills. r Alexithymia Questionnaire (BVAQ: Bermond & Vorst, 1996), for assessing the ability to cope with emotions. A lower score is supposed to indicate a more adequate ability to cope with emotions than a higher score. (2) Risk assessment r Psychopathy Checklist—Revised (Vertommen, Verheul, De Ruiter, & Hildebrand, 2002), the Dutch version of the PCL—R (Hare, 1991) for identifying psychopathy with the following two factors: “egotistic, insensitive and remorseless use of others” (factor 1) and “chronically unstable and antisocial behaviour” (factor 2). (3) Observation scales r Observation Scale for Behavior in Conflict Situations (OGC; Hornsveld, Lammers, Kraaimaat, & Van Dam-Baggen, 2001), an experimental scale for measuring aggressive and socially competent behavior on the ward. In one hospital (FPI De Kijvelanden, Rotterdam) two observation scales are also completed every nine months for all patients:

r Rehabilitation Evaluation (REHAB; Baker & Hall, 1988; Van der Gaag & Wilken,

r

1994), for measuring the general functioning level of chronic psychiatric patients. Van der Gaag and Wilken (1994) translated and revised this instrument for the Dutch situation. MI Observation scale (Brand, Diks, & Van Emmerik, 1999). This scale was developed by the Dr F. S. Meijers Institute to determine the number of behaviors on a unit and has the following subscales: cooperative behavior, social skills, domestic skills, antisocial behavior, positive coping skills, and negative coping.

Procedure The evaluation has an explorative character as no control conditions could be included. Since most forensic institutions in the Netherlands only recently started with behavior-oriented treatment plans, indications for ACT are usually done in the course of the treatment. Therefore, is also not possible to use patients as their own control. All hospitals and the outpatient treatment centers use both the same study design and measurement instruments. Generally TBS hospitals are small (about 100 beds), with a long average duration of treatment (last year 65 months), and typically part of the population is contraindicated (e.g. acute psychosis) or refuses to participate in treatment. The number of patients in the outpatient centers who are sentenced

ACT FOR FORENSIC PSYCHIATRIC PATIENTS 193

to an alternative punishment is also relatively small. By combining the data from the hospitals and the outpatient centers, the sample size will possibly allow more reliable conclusions to be drawn from the study. The ACT assumes specific skills deficits in the population of forensic psychiatric patients, since prison inmates have received no psychiatric treatment in The Netherlands until now. However, the question is whether there are there differences in problem behaviors between forensic psychiatric inpatients and delinquents with long imprisonment. Therefore both groups were compared with each other in regard to aggressive and socially competent behavior.

Framework of the Aggression Control Therapy For the development of treatment scenarios for ACT, Aggression Replacement Training (Goldstein, Glick, & Gibbs, 1998) was a starting point. The following objectives were added: (a) (b) (c) (d)

more focus on the specific problem behaviors of forensic psychiatric patients; learning self-regulation skills for maximal generalization; part of a total treatment program in a forensic psychiatric hospital; and to be applicable in day treatment or outpatient settings. ACT consists of 15 weekly sessions and 3 follow-up sessions of 11/2 hours. The follow-up sessions take place at 5, 10, and 15 weeks after the end of the therapy.

The main goal of the therapy is that patients learn to deal better with conflict situations via the following behavior changes:

r Sessions 1–5: dealing adequately with feelings of irritation, anger, rage, and aggression (anger control).

r Sessions 6–10: improving or extending related social skills (social skills). r Sessions 11–15: becoming more knowledgeable of current Dutch norms and values and learning to resolve moral problems better (moral reasoning).

r Sessions 6–15: making programs for practicing new behaviors (self-regulation skills).

r Sessions 16–18: follow-up and evaluation. The modules for social skills and for self-regulation skills are largely based on the social skills therapy of Van Dam-Baggen and Kraaimaat (2000a). For therapists a detailed treatment scenario (Hornsveld, 2004a) has been developed and participants in the therapy receive a portfolio in which they can make homework assignments. The forms in the portfolio for making reports of the homework assignments are easy to complete; therefore patients with a low IQ can participate in ACT too. For the inpatients, special weekly interim sessions take place at the Education Department, so that they can carry out the homework assignments under supervision of this department.

194 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

PRELIMINARY RESULTS First of all, we compared pre-treatment measurements of 13 outpatients with the pre-treatment measurements of 39 inpatients and with the measurements of 20 delinquents with long imprisonment who did not receive treatment. No significant differences were found on the self-report questionnaires, with the exception of the AVL (Aggression Questionnaire). Remarkably, outpatients scored significantly higher on this questionnaire than the other two groups. Second, of the three therapy groups, we compared the pre-treatment measurements with the post-treatment measurements and with the follow-up measurements. The three groups consisted of two groups of 10 inpatients (3 drop-outs not included) and one group of 5 outpatients (3 drop-outs not included). For the two-inpatient groups, ward observation ratings were available. Although no significant differences were found, most trends were in the predicted direction. We also calculated correlations between scores on self-report questionnaires and the ratings from the observation scales, finding low to negative correlations.

DISCUSSION Although the sample size during this first evaluation in 2001 was small, and differences between pre-, post-, and follow-up measurements were not significant, we did find a positive trend in the data which suggests that the likelihood of significant results will increase when more treated patients are included in the study.1 This position is in accordance with the general findings in the literature about treatment programs for adult forensic patients: i.e. treatment effects turn out to be limited, even with larger sample sizes (Quinsey, Harris, Rice, & Cormier, 1998; Cooke & Philip, 2001). However, we have to realize that what is evaluated for the inpatients is not only the ACT. Since the evaluation concerns all interventions in which patients participate during a period of 30 weeks, the essential contribution of the therapy to a possible effect of all those interventions still needs to be demonstrated. The low correlations between scores and ratings on identical questionnaires and observation scales affirmed us in the choice of developing a more specific observation scale (OGC) for forensic psychiatric patients. By means of this observation scale, not only can different forms of aggressive behavior be registered, but also socially competent behavior. After all, the aim of the therapy is to reduce aggressive behavior by increasing prosocial behavior. We shall investigate if it is possible to combine inpatient groups with outpatient groups. The fact that we found a significant difference between the groups on an aggression measurement may suggest that this combination is not allowed. However, with a larger sample size we may be able to determine which personality characteristics predict treatment outcome. In this way we hope to find criteria for differentiating between positive and negative indications for ACT (e.g. the score on the PCL-R). More delinquents with long imprisonment will be asked to 1

At the end of the evaluation, in 2003, these significant results were for the most part confirmed (Hornsveld, 2004b).

ACT FOR FORENSIC PSYCHIATRIC PATIENTS 195

complete the self-report questionnaires in order to allow more reliable comparisons between measurements of forensic psychiatric patients and delinquents with long imprisonment. If we find few or no significant differences again, the conclusion may be that the two groups do not differ in aggressive and socially incompetent behavior after a long stay in hospital or prison. The critical question for the future is whether a different treatment policy for forensic psychiatric patients and delinquents with long imprisonment is warranted.

REFERENCES Baker, R. D. & Hall, J. N. (1988). REHAB: a new assessment instrument for chronic psychiatric patients. Schizophrenia Bulletin, 14, 97–111. Bandura, A. (1973). Aggression: A social learning analysis. Englewood Cliffs, NJ: PrenticeHall. Beck, A. T. (1990). Cognitive therapy of the personality disorders. New York: Guilford. Bermond, B. & Vorst, H. C. M. (1996). Alexithymia Vragenlijst [Alexithymia Questionnaire]. Amsterdam: Psychologisch Adviesbureau Bermond & Psychometric Services Interope. Brand, E. F. J. M., Diks, G. J. M., & Van Emmerik, J. L. (1999). Handleiding bij de MI-Rapportage Samenvatting Lijsten V2.0 [Manual for the MI-Report Summaries Lists V2.0]. Utrecht: Dr F. S. Meijers Instituut. Buss, A. H. & Perry, M. (1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452–459. Cooke, D. J., & Philip, L. (2001). To treat or not to treat? An empirical perspective. In C. R. Hollin (Ed.), Handbook of Offender Assessment and Treatment. Chichester: John Wiley & Sons. Dam-Baggen, C. M. J. van & Kraaimaat, F. W. (2000a). Sociaalvaardigheidstherapie: Een cognitief gedragstherapeutische groepsbehandeling [Social skills therapy: a cognitive-behavioral group therapy]. Houten/Diegem: Bohn Stafleu Van Loghum. Dam-Baggen, C. M. J. van & Kraaimaat, F. W. (2000b). Inventarisatielijst Omgaan met Anderen (IOA). Handleiding (2e druk) [Inventory of Interpersonal Situations (IOA). Manual (2nd rev. edn)]. Lisse: Swets Test Services. Dodge, K. A., Price, J. M., & Bachorowski, J. A. (1990). Hostile attributional biases in severely aggressive adolescents. Journal of Abnormal Psychology, 99, 385–392. Emmerik, J. L. van & Diks, G. J. M. (1999). De Terbeschikkingstelling in maat en getal. Deel A. Populatie-beschrijving [The TBS measure in numbers: Part A. Description of population]. Utrecht: Dr F. S. Meijers Instituut, afdeling Monitoring & Research. Feindler, E. A. & Ecton, R. B. (1986). Adolescent anger control: Cognitive-behavioral Techniques. New York: Pergamon Press. Gaag, M. van der & Wilken, J. P. (1994). Handleiding REHAB: Een maat van psychiatrische invaliditeit [Manual REHAB: assessment of psychiatric disablement]. Lisse: Swets Test Services. Goldstein, A. P., Glick, B., & Gibbs, J. C. (1998). Aggression Replacement Training: A comprehensive intervention for aggressive youth. Champaign, IL: Research Press. Hare, R. D. (1991). The Hare Psychopathy Checklist—Revised. Toronto: Multi-Health Systems. Hoekstra, H. A., Ormel, J., & de Fruyt, F. (1996). Handleiding NEO Persoonlijkheidsvragenlijsten [Manual NEO Personality Questionnaires]. Lisse: Swets Test Services. Hollin, C. R. & Palmer, E. J. (2001). Skills training. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment. Chichester: John Wiley & Sons. ¨ Erwachsene. Gottingen: Hormann, ¨ H. & Moog, W. (1957). Der Rosenzweig P-F test: Form fur ¨ Verlag fur ¨ Psychologie Dr C. J. Hogrefe. Hornsveld, R. H. J. (2004a). Held zonder Geweld; protocol voor de behandeling van jongens en mannen met agressieproblematiek [Hero without Violence: scenario for the treatment of boys and men with aggressive behaviour]. Amsterdam, NL: Boom.

196 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Hornsveld, R. H. J. (2004b). Rapportage deelonderzoek I, “Ontwikkeling en evaluatie van de Agressiehanteringstherapie (AHT) voor forensisch psychiatrische pati¨enten” [Report part I study, “Development and evaluation of the Aggression Control Therapy” for forensic psychiatric patients]. Nijmegen, NL: University of Nijmegen (unpublished manuscript). Hornsveld, R. H. J., Lammers, S. M. M., Kraaimaat, F. W., & Van Dam-Baggen, C. M. J. (2001). Observatie-schaal voor Gedrag in Conflictsituaties (OGC) [Observation Scale for Behaviour in Conflict Situations (OGC)]. Rijswijk, NL: eigen beheer [private edition]. Hornsveld, R. H. J., Nijman, H. L. I., Lammers, S. M. M., Van Dam-Baggen, C. M. J., & Kraaimaat, F. W. (2002). Attributie Vragenlijst [Attribution Questionnaire]. Rijswijk, NL: eigen beheer [private edition]. Hornsveld, R., Van Dam-Baggen, R., Leenaars, E., & Jonkers, Ph. (2004). Agressiehanteringstherapie voor forensisch psychiatrische pati¨enten met geweldsdelicten: ontwikkeling en praktijk [Aggression Control Therapy for forensic psychiatric patients with violent offenses: development and application]. Tijdschrift voor Psychotherapie [Dutch Journal of Psychotherapy], 30(1), 22–38. Lochman, J. E., White, K. J., & Wayland, K. K. (1991). Cognitive-behavioral assessment and treatment with aggressive children. In P. C. Kendall (Ed.), Child and adolescent therapy: Cognitive-behavioral procedures (pp. 25–66). New York: Guilford Press. Lykken, D. T. (1995). The antisocial personalities. Hillsdale, NJ: Lawrence Erlbaum Associates. Meesters, C., Muris, P., Bosma, H., Schouten, E. & Beuving, S. (1996). Psychometric evaluation of the Dutch version of the Aggression Questionnaire. Behaviour Research and Therapy, 34(10), 839–843. Novaco, R. W. (1994). Anger as a risk factor for violence among the mentally disordered. In J. Monahan & H. J. Steadman (Eds), Violence and mental disorder (pp. 21–59). Chicago, IL: The University of Chicago Press. Ploeg, H. M. van der, Defares, P. B. & Spielberger, C. D. (1982). Handleiding bij de ZelfAnalyse Vragenlijst, ZAV [Manual for the Self-Analysis Questionnaire, ZAV]. Lisse: Swets & Zeitlinger. Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. A. (1998). Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association. Raine, A. (1993). The psychopathology of crime: Criminal behavior as a clinical disorder. San Diego, CA: Academic Press. Spielberger, C. D. (1980). Preliminary Manual for the State-Trait Anger Scale (STAS). Tampa, FL: University of South Florida. Vertommen, H., Verheul, R., de Ruiter, C., & Hildebrand, M. (2002). De herziene versie van Hare’s Psychopathie Checklist (PCL-R) [The revised version of Hare’s Psychopathy Checklist (PCL-R)]. Lisse: Swets Test Publishers.

Chapter 13

AGGRESSION REPLACEMENT TRAINING: A LEARNING PROCESS FOR THE WHOLE FAMILY ROBERT CALAME1 AND KIM PARKER2 1 2

Batshaw Youth and Family Centres, Montreal, Quebec, Canada Main Heights, Montreal, Quebec, Canada

EVALUATION OF FAMILY ART AT BATSHAW YOUTH AND FAMILY CENTRES This is a discussion of the use of skills acquisition training, as it has been introduced and adopted at Batshaw Youth and Family Centres. The chapter will be examining how the institution uses a model based on instruction in anger control, social skills, and moral reasoning from a program known as Aggression Replacement Training (ART; Goldstein, Glick, & Gibbs, 1998). These programs, as well as other skill-building courses such as Problem Solving and Empathy Training from the Prepare Curriculum (Goldstein, 1999), are designed to assist maladjusted youth in the development of prosocial competencies. Specific emphasis is on the evaluation of ART, and in particular how parents and significant others participate in what we refer to in our agency as “Family ART” groups. During the 1970s, a change in focus began to occur with youth care professionals. Behaviorists noted that only treating problem youth was limiting, and that for lasting change to occur, interventions needed to include their families and environments: When you adopt the position that environmental and contextual information drive behavior, then it follows that treatment implies altering the environment. This environment includes both the physical (behavioral sequences) and the perceptual (cognition; beliefs) aspects. More formally, you must assume that the behavior is a consequence of genetic composition coupled with current family patterns and history. In turn, this composite is coupled with, and reacts to, the larger social environment. Finally, arching above the assumptions about context, perception, behavioral sequences, and change is the fundamental New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


198 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING assumption that families and relationships are the most potent change agents in an environment. (Griffin, 1993, pp. 2–3)

This growing belief is causing a shift in approach in the youth care field. Given the above rationale, many youth care agencies throughout the world have developed family-based practices. Batshaw Youth and Family Centres (Batshaw) can be included as one of these agencies. There is, of course, good reason for this shift in focus. Child and youth care, like most “helping” professions, has come to realize that the young person is a member of a social interacting system and that the development of the young person, and the young person’s thoughts, actions, values, beliefs, and experience of self occur within this system. We have come to realize that lasting change is only facilitated when helping professionals interested in the troubled young person are involved with the total family system. (Garfat & McElwee, 2001, pp. 237–238)

In that spirit, Batshaw employees are attempting, despite budget restrictions, to provide a “family-centered” approach in all services we offer to our clients. As a result, Family ART groups are being adopted as an integral part of the ART model. Our experiences at Batshaw have shown that one of the most effective ways to achieve sustained change with the use of ART is through the use of family work and follow-up. Below, we will look at evaluation results of ART and Family ART use to date, as well as developing strategies for evaluation of the project. Obstacles to running the ideal ART and Family ART program will be discussed in the following pages. As well, we will look at successful methods and recommendations for an optimally run Family ART program. ART enthusiasts are striving to have the ART program create lasting change in the life of a youth in their care. Thus, ART training must also include parents, family members, and significant others. These most important people are crucial to the youth’s successful generalization of the skills and techniques. It is clear, in this day and age, that parents are not always the principal caregivers in a child’s life. There can be step-parents, foster parents, friends or other significant persons that also fill this role. Their inclusion is essential in helping our ART trainees continue to use the skills learned in their daily lives. The goal is to have the trainee and family/significant others use the newly acquired skills long after the training has been completed and, it is hoped, permanently. Henceforth in this discourse, when the terms “family” and “parent(s)” of the trainee are referred to, please understand that the author is referring not only to biological, nuclear family members but also to step-parents, extended family members, peers, and any other significant person(s) directly implicated in the life and development of the child. It is our objective at Batshaw to provide the youth and parents with a common experience, developing interpersonal skills together so that parents can indeed become coaches for their children in the continued use of these acquired skills. According to Dr Goldstein: Research evaluations demonstrate that enhancing the ART skill levels of the significant people in ART trainees’ lives enhances in turn the maintenance of

A LEARNING PROCESS FOR THE WHOLE FAMILY 199 trainee ART skill use. We consider these research outcomes quite important and reflective of a belief long held by many who work with troubled youth. Serious attempts to alter antisocial behaviors for the better must be directed toward youth and toward significant people (e.g. parents, peers) in the youths’ lives. (Goldstein et al. 1998, pp. 169–170)

If we look at evaluative data on outcomes of ART training in Table 13.1, a clear picture of the importance of family involvement in ART quickly emerges. In considering rearrest frequencies of youth in three categories: 1. youth trained in ART plus parent/sibling trained in ART, 2. youth trained in ART only, 3. youth not involved in ART training, group 3 had a rearrest percentage of 43%, group 2 had a better rearrest ratio of 30%, and group 1 had the lowest level of rearrest, recorded at 15%. This is a concrete example of the effectiveness of having family involvement in rehabilitation strategies for our youth. This significant difference holds great promise for both youth care professionals and teachers hoping to provide programs to answer cries for help in dealing with aggressive youth in schools, youth rehabilitation centers, and at the community level. Table 13.2 shows more strong evidence of the effectiveness of having family/peer participation along with youth engaged in ART training. This table shows that three separate trials had additional similar results when reporting recidivism rates where no ART was offered to youth, in comparison to recidivism rates for youth who participated in ART training with involvement of family/peers. Briefly, Table 13.2 shows that with varying amounts of time passing since discharge from ART programming, ranging from 4 months to 12 months, rates of recidivism remain consistent with Table 13.1 . The no-ART control groups reported recidivism rates ranging from 40% to 52%. In sharp contrast were the significantly lower scores of youth who completed ART training together with family/peers who also received the training. The measures of reoffending rates in these groups ranged from 13% to 15%. This was strong evidence for the use of Family ART at Batshaw and at similar institutions worldwide. These figures suggest that ART and Family ART programming are a fundamental way to effect real, lasting change and can be effectively used anywhere youth care work is performed. Table 13.1 Frequency of rearrest by condition in the community-based evaluation Condition Youth ART plus parent/ sibling ART Youth ART only No ART control

Total N

Rearrested N

Rearrested (%)

13

2

15

20 32

6 14

30 43

Source: From Goldstein et al. (1998) Aggression Replacement Training, p. 201, Table 8.1. Champaign, IL: Research Press. Copyright (1998) Goldstein et al. Reprinted by permission.

200 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Table 13.2 Rearrest outcomes for delinquent youths plus significant others

Youth plus family (community-based evaluation)∗ Youth plus peers (gang intervention project)† Youth plus peers (positive peer culture)‡

Months following

Recidivism, ART+ (%)

Recidivism, no-ART control (%)

4

15

43

8

13

52

12

15

40

Source: From Goldstein et al. (1998) Aggression Replacement Training, p. 207, Table 8.2. Champaign, IL: Research Press. Copyright (1998) Goldstein et al. Reprinted by permission. ∗ Goldstein & Glick (1987), Goldstein, Glick, Irwin, Pask-McCartney, & Rubama (1989) † Goldstein, Glick, Carthan, & Blancero (1994) ‡ Leeman, Gibbs, & Fuller (1993)

FAMILY ART: PART OF THE TREATMENT PHILOSOPHY Batshaw Youth and Family Centres is a large child and youth care agency in Montreal, Canada. It is the largest anglophone institution of its kind in the province of Quebec. Its clientele ranges in age from 0 to 18 years. Services are rendered under the Health and Social Services Act, the Youth Protection Act and the Young Offenders Act. Batshaw has a treatment philosophy and a code of ethics which clearly state that parents and siblings, along with the youth in our care, form the client. The following are some of the guiding principles of how work is to be done with clients and family by Batshaw employees. These principles also govern the way we attempt to use the ART program. Excerpts from the Batshaw Youth and Family Centres’ Code of Ethics include the following statements: We encourage the fullest possible development of the child’s and family’s own potential by:

r drawing upon strengths of and contributions from parents, other family members and the larger community in the provision of care and services

r providing opportunities for success and positive reinforcement for what may appear to be even the smallest of achievements We promote responsibility and autonomy by:

r helping youth and families develop problem-solving abilities rather than automatically imposing our own solutions

r developing programs which focus on acquiring skills We promote a safe and secure environment by:

r working on conflict resolution in a manner which does not jeopardize the safety of those involved

r focusing on the prevention of aggression (Code of Ethics, Batshaw Youth and Family Centres, 1994, pp. 10, 13, 14)

For decades in the field of youth care work, teachers, childcare workers, and social workers have developed excellent skills in connecting with and teaching

A LEARNING PROCESS FOR THE WHOLE FAMILY 201

appropriate behaviors to youth. In residential care many of our troubled and extremely troubled youth have made amazing gains while in placement. Far too often, however, upon return to their own home and neighborhood environment, old problems begin to resurface. Unfortunately, large numbers of youth who did very well in placement revert to the old behaviors and problems which brought them into institutional care in the first place. Those cases which prove most successful in achieving a significant change are, time and time again, the cases in which parents and youth work together towards a solution to the presenting problem(s). When we teach new concepts and skills to youth without transmitting this information to their families, we can expect that the gains made in residential care will probably be lost. Consequently, in using ART at Batshaw, we are attempting to train parents to become coaches for their youth. In the process, parents may be learning the concepts or skills for the first time, but most importantly they are learning to support their children in the consistent use of their newly acquired skills. “Before I took this course with my son, we would always be talking to each other from a different room in the house. Now I stop what I’m doing and look at him and we are listening to what is being said.” (Mary, an ART mother) “I know all the steps, my problem is I just don’t use it. With my mom and I, though, I’ll tell you this. We haven’t got into a fight since starting this together. You can even check with the police.” (Mike, her son)

The positive response to ART youth and family groups has caused the agency to adopt the model throughout the system. Animators have begun to network with other ART established users and consult with institutions interested in becoming users across the city of Montreal and in surrounding areas in the province of Quebec. A Canadian network is in the beginning stages.

HISTORY The creation of Family ART groups at Batshaw had its beginnings in 1982 when a Parental Empathy group was developed for a pilot project being run at Centre de R´eadaption la Cit´e des Prairies. The Montreal francophone social service agency, Centres de Jeunesse de Montr´eal (Montreal Youth Centres) began a pilot project using the Prepare Curriculum and ART courses, when servicing Batshaw youth in their facilities at Cit´e des Prairies. The author developed a Parental Empathy group based on the premise we have previously discussed—that is, parental involvement in skills acquisition makes for a far more potent intervention, which is more likely to generalize than the same program with no family involvement. In the 1990s, Batshaw’s residential treatment facility at Pr´evost, Quebec campus experienced an extremely problematic rise in levels of violence and aggressive behavior. Youth were becoming more aggressive towards parents, teachers, peers and youth care staff. Interested parties (youth care workers, social workers, program managers and co-ordinators) began to look at Aggression Replacement Training . . . as one promising response to these issues of increasing violence. Management recognized the practical nature and potential of the

202 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING program, as well as the enthusiasm of their front line workers to take on such a program, and so supported a small number of staff to begin development of the ART project. With the success of some pilot projects, Batshaw has moved forward towards using ART on an agency wide basis. The project evolved on Pr´evost residential campus with seven units, 2 closed and 5 open units for adolescent boys. Inspired by “The Prepare Curriculum: Teaching prosocial competencies” . . . ’ and “Aggression Replacement Training—Revised edition . . . a group of child care professionals began working towards delivering [ART] on campus in both custody and intermittent custody situations in the mid 90s. In January 1999, after some pilot projects and an ART Intermittent Custody Program were completed, a full blown central ART program, open to all campus residents, finally began. This prosocial skills training program was offered to interested, voluntary youth and their parents. It was also offered to youth who were court-ordered to follow a program which teaches anger management. (Calame et al., 2001)

For behavioral change to occur, transfer and maintenance of ART skills are critical. Parents and family are the best change agents we have to ensure that skills taught to youth are effectively used, when youths leave residential treatment to return to their homes and communities. In April 2000, a budget was set aside to begin implementing ART at Batshaw on a more permanent basis, as well as to train animators to implement ART in 24 different residential programs. Alternative high-school settings, Young Offenders’ Services, a community-based pilot project, and foster care at Batshaw were also targeted as services to receive ART training and funding now and in the future.

RECRUITMENT OF PARENTS FOR FAMILY ART In Family ART training we are trying to put parents in the role of coaches for their youth and, at the same time, offer parents the opportunity to hone their own interpersonal skills. Then the youth, with parental support, can practice these skills on their own family members where it is most needed. An additional benefit is when parents realize that they can be more effective communicators as well. I have been having a lot of trouble with my foreman, at work. I decided to use the skill of “Making a Complaint” and he listened. We get along a lot better since. (Norman, an ART dad)

Getting parents involved in Family ART programs requires planning and skill. When families are living through a separation from their children, due to youths being incarcerated for offenses against the criminal code or due to residential placement under youth protection, there is often resentment directed at youth care workers/social workers who assume the interventionist roles. The first contact with these parents is therefore critical. If we are to be in a position to do Family ART and evaluate its progress, we must build an alliance with these parents. As Dr Goldstein prescribes, letters to parents from school teachers are an important opening for communication with parents. The same is true for youth care workers in all situations, especially in the implementation of ART programming.

A LEARNING PROCESS FOR THE WHOLE FAMILY 203

If we want to work with families and evaluate progress while intervening with the youth in our care, then we have to have excellent first-contact strategies. We have prepared ART introductory letters designed to inform parents about ART training being offered to their youth, and encouraging their participation in the Family ART group. An example is shown in Box 13.1. Box 13.1 Example introductory letter Dear Mr & Mrs Roy, My name is Robert Calame, Peter’s social worker [primary youth care worker, program manager, etc.]. I want to welcome you and your son to our program at DARA for the next few months. It is my job to be working personally with Peter and his family while he is here with us. I am looking forward to a positive stay for Peter and hope we can work together to help him as he builds a positive future for himself. At DARA we offer a full academic program, work programs, and many recreational programs. The Federal and Provincial governments mandate us to offer rehabilitative services to all our youth and we certainly do that here at DARA. One of our principal methods of fulfilling this mandate is by offering a skill building program known as Aggression Replacement Training. This type of programming is offered in schools, rehabilitation centers, and community centers across Canada. Aggression Replacement Training, known as ART, was developed by Dr Arnold Goldstein and is being used all over the world with good success. ART teaches three separate components: 1. Social Skills Training: how to behave in a positive manner. 2. Anger Control Training: how not to behave when dealing with anger. 3. Moral Reasoning Training: how to examine our own values to help us make better decisions about our behavior. We have learned at our Pr´evost campus, after over 85 years of existence, that three things make the difference in how well our clients do for themselves. One is time. As adolescents get older they begin to make better choices as to what to do in their lives. Second is hard work. If a teenager works hard at improving his situation in life, he is much more likely to succeed. Thirdly, it has become clear to us that youth in our care whose parents are involved with them have the best outcomes. We know the same is true for Peter. Over and over these three factors are those which determine the success of the youth we work with. For these next months the courts have given us the job of caring for Peter on your behalf. You are the experts on Peter and we need all the help you can give us to help him in the right direction. For that reason we offer a Family ART program where parents can join us in helping their children get their lives on the right path. Parents are the best possible coaches for our trainees to continue to use the techniques they learn in ART. We will be calling you soon to see when is a good time for you to come to

204 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

Family ART. Kim, Dave or myself will answer any of your questions if you call at 555-1515. One of the most important things we can do to make sure Peter does well at DARA is for us to stay in close contact to discuss how he is doing. We are looking forward to meeting you and working with you, coach. Please call us as soon as possible. Sincerely yours, Robert Calame Sending a letter, in our experience, is not sufficient to make all parents feel comfortable enough to become involved in Family ART groups. As a strategy, all parents are contacted by phone after the letter has been mailed, to make a more intimate kind of contact and to troubleshoot any restriction to attend that parents might face. Parents are surveyed as to the best time to meet (given two or three possibilities), offered transportation, baby-sitting, bus tickets, car pool arrangements, and help with any obstacles within our power to accommodate. We emphasize the importance of their presence and usually will make a second phone call prior to our first Family ART session. Again we emphasize that the outcome will not be as positive if they cannot participate. This show of interest in their presence usually helps us to connect well with parents and also to lay the foundation for good family involvement and good evaluation opportunities to occur. In Batshaw applications of Family ART, youth meet three times per week for one session each of anger control training, social skills training, and moral reasoning. Meanwhile parents meet with animators once weekly for three weeks, without their children, to receive basic ART training. The first week, parents receive an overview of the three components of the program. In the second half of this evening, they share the feelings they had when their child became troublesome and came into placement. Emotions run high and tears inevitably follow. Parents feel a great sense of relief when they realize that others are living the same experiences. They appreciate the opportunity ART gives them as they begin to take back their parenting role. This session ends with the sharing of a fond memory of their child. The following two sessions concentrate on role-playing and skills acquisition, in readiness for meeting with the trainees. When parents and youth begin meeting together in Family ART, they do some preliminary role-playing and then continue by working on the Angry Behavior Cycle. For the next five weeks youth and parents build their ART skills together. This methodology enables the ART techniques to be simultaneously learned and generalized by the parents and youth.

USING THE “ANGRY BEHAVIOR CYCLE” IN FAMILY ART: A GREAT TOOL FOR LINKING ART THEORY TO PRACTICE In the anger control portion of ART, there is a training session entitled the “Angry Behavior Cycle” (Goldstein et al., 1998, pp. 94–95). In this session, youth who have already been trained to use multiple techniques to reduce their anger are

A LEARNING PROCESS FOR THE WHOLE FAMILY 205

challenged to decrease conflict situations as much as is in their power. Avoiding conflict becomes another tool to control their anger. The premise is quite simple, the results very encouraging. We all do things to make others angry, whether deliberately or unintentionally. The session requires trainees to reflect on what they do to make others angry, to record these situations, and make a commitment to deliberately work at changing those specific behaviors. On Pr´evost campus, in the Central ART program, each ART trainee is given the task of giving the ART animators a list of five or six behaviors which, when they do them, cause others to become angry. In other words, each client recognizes their own Angry Behavior Cycle. Peers and animators often help in the creation of the list. Next the youth is contracted to attempt to stop using those behaviors and to observe the effect in their interpersonal interactions for the next few weeks. If the youth apply themselves to this task, they can significantly reduce the number of conflicts they have and feel more power over their own lives. At the same time they can demonstrate to themselves, family, and others that they are willing and earnestly trying to make permanent changes to their troubled lifestyle. The most powerful use of the Angry Behavior Cycle comes in Family ART training. When the Family ART group does the Angry Behavior Cycle session together, the youth presents his previously determined list of things he does that makes other people angry. Parents are asked to consider the list carefully. Next parents are encouraged to add things to the list which the youth does at home, which in turn cause parents or significant others to become angry. Upon completion of the youth’s list, parents go through the same exercise. Parents list the behaviors and things that they do that cause others to become angry. When parents have completed their list, we invite their children to add behaviors that they see parents doing which make others angry. This exercise frequently results in an overlap between the lists. Often, the recurring anger-creating behaviors the family needs to work on are in evidence on these lists. The results are absolutely amazing. Parents and youth begin to work on family issues such as lack of communication, curfew, disputes around household chores and responsibilities, and other typical situations of conflict that all too frequently cripple communication and understanding in the family. “Things are by no means perfect now, but they are a whole lot better. I can’t remember when we last had an out and out screaming match.” (Arthur, an ART father)

The use of the Angry Behavior Cycle at this juncture sets the stage for some real gains to be realized by families faced with negotiating the difficult family life cycle stages of launching and adolescence (Carter & McGoldrick, 1989).

EVALUATION PRACTICES: A WORK-IN-PROGRESS When evaluating a program, one can choose from a variety of approaches. We can consider rates of recidivism, behavioral change, skill acquisition, anecdotal

206 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

recounts of progress, and other measurable variables. All of these approaches are valuable and worthy of examination. Building an ART program at Batshaw Youth and Family Centres has been, and continues to be, work-in-progress. Much has been accomplished, but expansion of the program and fine tuning of existing programs will remain the major piece of work to be done for the coming years. However, it is strongly evident that new and existing programs need to include an evaluative component so that results are monitored, problems are solved, and training is improved. Methods of evaluation used by Batshaw Youth and Family Centres are also a work-in-progress. Currently, Batshaw most frequently uses process-oriented evaluations to determine if programs are being conducted as planned. This process enables identification and correction of problems related to the actual application and delivery of program and course material. Outcome evaluations can be extremely interesting and informative, and are essential to understand clearly the outcomes of training such as ART. These types of evaluations frequently require new recording tasks, large sample groups, and a well-organized method of collecting data. Performing these evaluative tasks implies time and by extension money so that the maximum benefits of ART can be experienced. Funding, or lack of it, is a major obstacle common to many youth care operations, not only in Montreal, Quebec but all across Canada and around the world. The ART program at Batshaw has an increasing recurring budget planned for the next two years. The budget will need to increase even more, and be sustained over subsequent years, in order to implement and evaluate this program across the entire agency and its services.

Evaluation of the Individual Client The current model being used at Batshaw’s Pr´evost Campus to evaluate ART training is an outcome type study based on observations of clients, parents, and youth care workers. The evaluation questions are to be completed prior to commencing the ART program, upon completion, and 6–8 weeks later in a booster session or follow-up. Future evaluations will attempt to include information gathered from the ART process recordings written after every session. Indeed, an effort to improve evaluation methods everywhere at Batshaw is an ongoing process.

Evaluation of the Program It is important that ART programs being delivered are monitored to make sure that all the steps, methods, and procedures of the Goldstein model are in place. To ensure that the objectives of the program are being met, a process evaluation questionnaire must be used to monitor the use of Goldstein’s prescribed methodology. In this tool, questions concerning animator use of training procedures, time allotted to preparation and debriefing, use of modeling and proper set-up of role-playing,

A LEARNING PROCESS FOR THE WHOLE FAMILY 207

Figure 13.1 Washington State ART Self Monitoring Tool—ACT

attempts to facilitate transfer training, use of performance feedback, etc. need to be tracked. The following are some excellent process evaluations which were published by the State of Washington and are available to the public because the ART work involved was publicly funded. Figures 13.1 and 13.2 are tools for animators to selfmonitor the animation techniques used in a Structured Learning workshop (SLT) and in an Anger Control workshop (ACT).

Outcome Evaluations At Batshaw, an ART pilot project for Young Offenders Services clients will be evaluated using an outcome study for the purpose of monitoring rates of recidivism for ART trainees. Youth receiving ART will be compared with youth not offered ART in terms of recidivism rates. Young offenders who are to receive probation as a result of crimes committed will be ordered to receive ART training as well. The

208 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

Washington State ART Self Monitoring Tool SLT County

Date

Trainer

Yes

No

Were any issues from last Structured Learning Group reviewed? Were Group Norms reviewed? Was Homework reviewed? Was Homework reinforced? Were visual aids used? (Skill Cards & Skill Title and Skill Steps displayed.) Was the Skill introduced, defined, steps read, and briefly explained? Was the Skill correctly modeled by the trainer and co-trainer? Were all the Skill Steps identified during the model? Was the modeling demonstration(s) relevant to the youth? (i.e. adolescent situation, etc.) Did the trainer conduct a discussion about each trainee’s need for the skill? Did each trainee correctly role-play the skill as the main actor? Were all trainees involved in providing performance feedback? Was the order of performance feedback correct? (co-actor, group members co-trainer, trainer, main actor) Were homework assignments given to each youth? Was behavior management an issue during the session? Comments

Figure 13.2 Washington State ART Self Monitoring Tool—SLT

study will require a random selection of trainees being placed into three groups: offenders receiving ART only, offenders receiving ART and Family ART, and a control group of clients who will not receive any ART training. The implementation of a risk/needs assessment tool and/or a psychosocial inventory will be used to identify the client’s need for the program. Upon completion of the program, the test could be re-administered to attempt to observe any change in terms of identifiable criminogenic need. In this group, rates of reoffending will be studied. Another useful evaluative tool for this group will be one that asks of youth, parents, and social/youth care workers the following question: Has ART made a difference for the ART trainee: at home, in school, in community, etc. ? Yes / No Please explain.

A LEARNING PROCESS FOR THE WHOLE FAMILY 209

EVALUATION QUESTIONNAIRE DESIGN ART animators at Pr´evost Campus developed a questionnaire to gather data to be used to evaluate improvement in skills acquisition, in the specific skills being taught in the Central and Unit-based programs. The questions were selected to provide an overview of trainees’ individual progress in the development of Skillstreaming, anger control, and moral reasoning techniques. The questionnaires were limited to 15 questions in order that response time be kept to a minimum. Most questions were adapted directly from the Student Skillstreaming Checklist found in Goldstein et al. (1998, pp. 284–287) targeting the following skills: Question 1: Listening Question 2: Expressing affection Question 3: Standing up for your rights Question 4: Dealing with group pressure Question 5: Dealing with an accusation Question 6: Using self-control Question 7: Dealing with anger (source: Dealing with fear) Question 8: Responding to teasing Question 9: Avoiding trouble with others Question 10: Keeping out of fights Question 11: Standing up for a friend Question 12: Helping others Question 13: Understanding the feelings of others Question 14: Form stages of moral reasoning (Goldstein, et al., 1998, pp. 100–101) Question 15: Created by ART team: if there is something I really want, do I (choose one) : (1) just take it? (2) con someone into giving it to me? (3) ask for it? (4) work for it? Questions 1–5 were chosen to specifically evaluate progress in Skillstreaming; questions 6–10 were chosen to specifically evaluate progress in Skillstreaming and anger control; questions 11–13 were chosen to specifically evaluate progress in Skillstreaming and moral reasoning; questions 14 and 15 were chosen to evaluate progress in moral reasoning. The questionnaire was adapted to evaluate progress of clients from three different perspectives: (1) clients (trainees), (2) family/significant others, and (3) youth care workers. They were administered at the beginning of the ART semester (pre), upon completion (post), and two months later at a booster session (follow-up).

EVALUATION DATA For the purposes of this chapter, upon compilation of all data, results were separated into three categories by family involvement:

r Group 1: clients with some ART family involvement but only one of three family questionnaires submitted by parents.

210 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

r Group 2: clients with ART family involvement allowing for comparison, two or three family questionnaires submitted by parents.

r Group 3: clients with no ART family involvement and consequently no family questionnaires submitted by parents. The three sets of three questionnaires each were:

r Clients (trainees) pre, post, and follow-up. r Parents (parents/significant others) pre, post, follow-up. r Worker (primary youth care worker) pre, post, follow-up. Client Self-Reporting Questionnaires Please note when considering results that groups 1, 2, and 3 do not reflect groups of youth who trained together. The groups have been put together by family involvement in order to appreciate the effects of Family ART on outcome.

Group 1: Some Family Involvement Seven clients were in the group and reported as follows:

r Six clients reported one questionnaire only; r One client reported an improvement of 4.3% between pre and post questionnaires. The one youth who did report an improvement was an average client who showed improvement typical of the majority of ART trainees.

Group 3: No Family Involvement There were 26 clients in the group, who reported as follows (Figure 13.3):

r 12 reported one questionnaire; r 11 reported two questionnaires; r 3 reported three questionnaires. In the post questionnaire 12 did not report and 14 reported as follows:

r 10 reported self-improvement. r 4 reported decreased scores. Of the 14 youth who did respond to the questionnaire 70% indicated an improvement in skill use. Reports from school personnel informed ART staff of improved behavior in ART trainees in general. A lower than ideal number of total responses is due to a general lack of success administering the questionnaires, or in tracking and collecting the data.

0

5

10

15

20

25

30

35

40

45

50

1

2

3

4

5 7

Totalpre

6 8 10 11

MAXPREC

9

13 14

15

Totalpst

Participant s number

12

Figure 13.3 Clients’ self-reported scores by family involvement, group 3

Scores and maximums possible

17

MAXPSTC

16

18

20

Totalfol

19

21

23

24 25

MAXFOLC

22

26

212 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

In the follow up-questionnaire 23 did not report and 3 reported as follows:

r 1 reported self-improvement; r 1 reported decreased scores; r 1 reported no change. The lack of response in the follow-up questionnaire reflects a lack of interest or follow-up in the use of the evaluation tool by youth and staff. Unfortunately, Group 3 youths do not benefit from any family involvement in ART training. It has been our experience that the majority of trainees whose families are not involved in ART are less enthusiastic about the curriculum than youths whose parents are invested in Family ART programs with them.

Group 2: With Family ART Involvement There were 17 clients in the group, who reported as follows (Figure 13.4):

r 4 reported one questionnaire; r 8 reported two questionnaires; r 5 reported three questionnaires. In the post questionnaire 7 did not report, or had no pre report for comparison and 10 reported as follows:

r 7 reported self-improvement; r 2 reported decrease in scores; r 1 reported no change. In Group 2 clients where parents were involved, 70% of the youth reported increased skill use upon completion of the program. This was consistent with selfrecorded results of the overall sample. In the follow-up questionnaire 9 did not report and 8 reported as follows:

r 5 reported self-improvement; r 3 reported a decrease in scores. Of the 13 clients in Group 2 who completed more than one questionnaire, 7 reported self-improvement, 4 reported no significant change, and only 2 reported a decrease in score. In other words, 54% of the group felt that they had benefited from their training. More importantly, they had chosen to use it with their parents!

Family Report of Client Progress: Group 2 There were 18 parents, who evaluated 17 youths as follows:

r 1 reported one questionnaire; r 9 reported two questionnaires; r 8 reported three questionnaires.

0

5

10

15

20

25

30

35

40

45

50

1

2

Totalpre

3 4

MAXPREC

5 7

Totalpst

6 8

9

10

MAXPSTC

Totalfol

Participant s number

Figure 13.4 Clients’ self-reported scores by family involvement, group 2

Scores and maximums possible

12

MAXFOLC

11

13

14

15

16

17

214 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

In the post questionnaire, 18 parents reported as follows:

r 11 reported client improvement; r 2 reported a decrease in score; r 5 had only one report to date. Eighteen parents attended the groups and results were very positive. Five parents reported only one questionnaire so no improvement could be gauged. Of the 13 parents who did report two or more questionnaires, 85% reported that their children improved and only 15% reported a decrease in score. In fact, almost all parents consistently expressed high satisfaction with the program and with their children’s progress. In the follow-up questionnaire nine parents reported as follows:

r three reported continued improvement; r one reported stable scores; r five reported a decrease in scores. In the follow-up questionnaire where nine parents responded, three parents, one full third of those who reported, indicated even more improvement in their son’s use of skills. Of the four parents who reported a decrease in their child’s skill use, three of these scores reflected no significant change between onset of the program and the follow-up evaluation. As you can see in Figure 13.5, the parent reported that participant no. 15’s scores reported a decrease in use of skills, but nonetheless had shown an overall improvement since the program began. It appears, in the graph, that the parent of participant no. 5 seems to report a significant decrease in skill use. A careful look, however, shows that this parent had answered less than half of the questions on the follow-up questionnaire. Of the questions answered, she in fact rated him quite well. Parents explained that their youths had learned the material well but were not always choosing to use it. When comparing parents’ questionnaires with the questionnaires of their children, youth consistently rated their use of prosocial skills higher than their parents rated them. Clearly parents see a positive change in their child’s behavior. Parents enthusiastically reported improved interactions between trainees and their family members. In fact, the data revealed that parents report a higher percentage of improvement in their youth than the youth report themselves. Also, when youth reported a decrease in their skill use, parents reported a lesser decrease in their questionnaire than did their child. In follow-up testing the difference between the youth’s rating of him/herself and the parent’s rating of their child was relatively equal (within 1% of each other). In all three groups, clients report beginning at nearly the same skill level. Once training is complete, however, the clients with family involvement demonstrate a greater increase in skill performance than the other two groups (Figure 13.6). In fact, in our experience as Family ART animators, parents and youth are doing much better interpersonally due to having worked together for two months. They have developed the skills designed to help them interact better with each other and the world around them. Our experience has been a positive one. At Batshaw, what

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remains is to do better work in implementing ART and to develop and improve our evaluative process.

OTHER MEANS OF EVALUATION ART animators at Batshaw’s Pr´evost campus have developed other means to evaluate our progress and improve our program. In the following pages we will look at some of these other evaluative methods and also at other ART programming offered at Batshaw.

Family ART Hotline After engaging parents in Family ART, or in a dialog about ART for those unable to attend, a call-in hotline service is offered by Family ART animators. This service is designed to support the practice of ART skills at home, when youth are on temporary release, or when parents are visiting or communicating by phone with their children. This helps youth and parents to resolve problems, using the framework of the ART program, and furthers the parent–animator relationship, thereby opening the door for the collection of further evaluative information. Indeed this hotline format creates strong relationships between youth and families, thereby improving the outcome of Family ART efforts.

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Family ART Newsletter For youth care workers, social workers, teachers, and especially parents not able to participate in Family ART, an ART newsletter is produced weekly. The letter reflects the curriculum covered by youth in the weekly sessions of anger control, social skills training, and moral reasoning. Parents are advised of the curriculum and then encouraged to give feedback to ART animators as to progress, or lack thereof, by their own youth. Again this provides more evaluative material to animators to be able to assess true progress outside the living unit or ART classroom.

Family ART Transportation It may seem strange to see the topic of transportation included in a subsection about different methods of evaluating Family ART groups. In reality, it is perhaps our most practical means of monitoring progress of both parents and youth participating in the ART program. In our Pr´evost campus ART operation, we have been blessed with two excellent ART animators being licenced to drive transport vehicles. Accompanied by another Family ART animator, they pick up the parents from a number of pick-up points around the city, and take them to the Family ART group location. The time spent on the transport inevitably becomes optimal evaluation time for both animators. This time is most often used to review with eager parents how the ART techniques have played themselves out in the family in the past week. Parents and animators also use the conversations to plan strategies for the coming Family ART session. As well, parents talk together and realize that they share many of the same problems. They begin to feel less guilty and can strategize together on better parenting techniques.

Informal Evaluations The old adage “Make hay while the sun shines” applies to successful evaluation and animation of Family ART groups. Experienced youth care workers/social workers take every opportunity to reinforce the progress their clients are making. It is no different with ART animators wanting to monitor progress of youth and families taking ART together. As well as during transport rides to Family ART sessions, there is time before the session, after the session, and even during breaks while the session is going on. The ART family group generates so much enthusiasm, hope, positive change, setbacks, struggle, and good hard family work that parents seek out animators once they are engaged in the program. For animators, these informal talks help them to quickly assess problems and progress. Also, the talks help animators to plan future sessions that will be focused and directly relative to the needs of individual families, as well as the entire Family ART group. During Family ART meetings, parents are given feedback on their child’s progress, trainees are asked how they feel family life is improving, parents are given support for providing clear guidelines for their child, and, as always, performance feedback is given when role-playing is complete.

218 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING “Doing ART has made me realize how inconsistent Bill’s father and I are. Bill agrees too. We all know how important it is to keep our word and will try hard to do this from now on.” (Dorothy, an ART mother)

Role-play as Evaluation Tool Probably the most effective tool for an ART animator is the assignment and observation of a role-play. A totally new situation is proposed to parent and youth to use as a role-play. Parent and son/daughter perform the role-play using a previously learned skill. When this is done masterfully, it is clear to animator and family members that the skill has been learned. The object then becomes choosing to use the skill from that point forward and changing the outcome of what previously may have been a disaster. Indeed, testing youth and families by having them role-play until the skill has been internalized, and not moving on until generalization of the skill has taken place, is a good strategy for animators to use as a rule rather than as an exception.

Anecdotes as Evaluative Information Weekly at family groups, anecdotes are shared on an informal basis. These stories illustrate setbacks, resistance, positive progress, increase in skill use, etc. Also, at the end of every Family ART semester, there is a graduation night where all parents and all youth are invited, whether in Family ART or ART for youth only. At this event youth are acknowledged with certificates of completion of ART, parents for completion of the Family ART program. Parents bring special food, the agency provides salads and a big cake, etc. The goal of the evening is to acknowledge youth and family progress but also to learn their perspective on the ART experience. All youth and parents are asked to give their feedback. The anecdotal illustrations by both youth and parents quickly reveal the powerful impact that ART can have on the lives of these troubled families. Changes can be huge for one family but small for others. Some families learn to work through conflicts that previously seemed hopeless. Often youth and parents who were estranged prior to ART family work regain more functional family relationships. The following are stories of specific youth or parents who left huge impressions on animators as to the effect ART and Family ART have had on their families or on youth trainees.

Frank and His Mom A young man who was a delinquent gang member type and his mother of Hispanic background were participating together in a Family ART program. They were known to have an explosive relationship where conversation between them turned frequently into disputes, which escalated into both mother and son using physical aggression with each other.

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At the end of the ART semester at graduation, the mother admitted that ART had been very effective for her and her son. The skill of listening made a major difference in their lives. The most fundamental of all of Goldstein’s 50 skills had the most impact and developed into a long-lasting change in the family. Mom reportedly had some significant problem of abuse of drugs and alcohol, and she and her son constantly fought, even to the point of serious physical abuse toward each other. Mom stated that she had learned to look at her son when they were talking and her son had learned to listen to her as well. Mom also stated that they both learned to wait their turn to talk and now they were not fighting so much. They learned the basic communication skill: “You talk and I listen and then I talk and you listen.” This represented a huge improvement in this very troubled family. Frank was in our program in 1999. He returned late summer of 2001. He informed us that he does not use ART much, but that since ART began in 1999 he and his mother do not fight anymore. The acquisition of the listening skill and Mom’s special investment in her son in ART brought them to a much more functional level of interaction that still exists. Now that’s lasting change!

No More “In Your Face” Jerry went through the ART program twice and so did his parents, Arthur and Natalie. Jerry’s parents were divorced and fortunately were still willing to work together to support their son’s rehabilitation. They faithfully attended Family ART for close to 20 weeks. The use of the previously mentioned Angry Behavior Cycle exercise (Goldstein et al., 1998, pp. 94–95) proved to be a key for powerful change to occur in Jerry’s life. The parents had two different styles of parenting: one perhaps a bit too controlling, the other perhaps not controlling enough. Nonetheless, they agreed on using the Angry Behavior Cycle to try to change family interactions. In this case it had nothing to do with style and everything to do with optimum interactions between Jerry and Dad. After Jerry, Arthur, and Natalie completed their lists of anger-producing behaviors, Jerry requested that his dad alter a way of interacting that constantly infuriated him. Dad worked at home on the computer and would not let anyone interrupt him when he was working. Jerry frequently needed to talk to Dad when he was working on the computer. When Jerry would approach, Dad would refuse to give him time. Jerry would soon become a nuisance and before the day was out, Dad and Jerry would be in a face-to-face shouting match. Arthur agreed that he would give his son a brief period to talk to him if Jerry would stop stealing cars. (Jerry would steal Mom’s car, Dad’s car, the neighbor’s car, etc. until finally he was charged and sentenced for this behavior.) They made a commitment to the change and Dad reported that after 18 months they still had not had one “in your face” shouting argument. Instead they were using the Listening skill, the Negotiating skill and Understanding the Feelings of Others skill. As a result of the progress the parents repeated the Family ART program and became a strong example for others as to how powerful Skillstreaming can be.

220 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

Switching Roles Pat’s father had legal custody of his son and together they went through a session of Family ART. The plan was for Pat to move back to his Dad’s after things didn’t work out at Mom’s house. Pat also had a close relationship with his mom, Stephanie, and especially his stepfather, Carl. Previously, when living with Stephanie and Carl, Pat got into some trouble that brought him to Batshaw’s Pr´evost campus. His mom and Carl wanted to work with Family ART to support their son and began to attend. Pat and Carl had become pretty close, so when Mom and Pat got into a dispute over Pat’s curfew, Carl joined in to try to support Stephanie, who was no match for her son in an argument. Pat was 17 and moving towards independent living. In the heat of the moment, Pat lashed out at Carl by saying, “You can’t tell me what to do, you’re not my real father!” The incident had hurt Carl badly and put up a wall between them. They had never talked about the poignant statement. After learning that curfew was an ongoing issue between Pat and his parents, the ART animators chose to use the curfew issue in a role-play. Working with the skill of Negotiation, the role-play was set up to be performed by Pat with Stephanie and Carl. Just as the role-play was about to begin, Carl and Pat were asked to switch roles. Later, when Pat was acting out Carl’s role of stepfather, the animator whispered in Carl’s ear to suggest he use Patrick’s poignant statement that had put a damper on a perfectly good relationship. When Carl suddenly used Pat’s words in the role-play, “You can’t tell me what to do, you’re not my real father!”, Pat’s jaw dropped and the entire room became totally hushed. Pat realized, now that he was playing Carl’s role, how the statement hurt and was embarrassed and sorry for what he had said. Pat and Carl were finally able to process the issue and return to their former positive relationship that had been marred by that hurtful statement. Communication was re-established and this part of the family became able to interact again without uneasy feelings. These stories confirmed to us that important progress could and was being made through the ART family program. Parents have also made it clear since Family ART began at Batshaw in 1992–93 that this was helpful for them and their children. Since that time at least one family in every parents’ ART group has asked if they can return for another session. We consider these kinds of anecdotes as powerful indicators of the success of Family ART, and the stories keep on coming.

EVALUATION AT BATSHAW’S INTERMITTENT CUSTODY PROGRAM The Intermittent Custody Program (ICP) has had ART at its core since its establishment in 1997. Youth spend 8–12 weekends doing ART and problem solving. As a program primarily for young offenders, it requires a court order with specific conditions. The program is used as an alternative, in an attempt to give offending youth who qualify one last chance to remain in their community, before the courts order full-time custodial care under the Young Offenders’ Act.

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1. Do you believe that you better understand anger and how it works?________ 2. Would you use anything you learned in the course in everyday life? ________ 3. Was the presentation/material clear and understandable? _________ 4. Would you add/change anything about the course? _________ If yes, what? ___________________________________________________ 5. Comments: ____________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ 6. How would you rate this course overall? Circle one: Very good

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Figure 13.7 ICP ART evaluation form. Devised by Leo Ferguson, Batshaw Youth and Family Centres. Reproduced by permission

The designers of the program also saw the absolute necessity of including families in the treatment afforded these youngsters. As a result the court order must specify that parents have agreed to attend an ART Parents’ Group on 10 of the maximum 12 weeks that the program runs. The parents show up to meet with their youth on week one and focus primarily on learning and practicing social skills training for the entire period. ICP has also shown itself to be effective and well appreciated by youth and especially parents. To monitor family satisfaction with ART and to find out how the program was affecting the trainees and parents, Leo Ferguson, the social worker on the ICP team, designed a questionnaire for ART and problem solving, the two training courses offered by the program (Figures 13.7 and 13.8). The ICP program has received positive responses to the questionnaires but Ferguson reports that the evaluation does not give them the suggestions for improvement or change that they are looking for. As well, this type of questionnaire does not reveal any data on long-term results or generalization of ART techniques. Consequently, the design for a new format of questionnaire for ART parent groups is on the table, another work-in-progress at Batshaw.

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1. Would you say that you are now better prepared to solve problems? ________ 2. Would you use anything you learned in the course in everyday life? _________ 3. Was the presentation/material clear and understandable? _________ 4. Would you add/change anything about the course? _________ If yes, what? ___________________________________________________ 5. Comments: ____________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

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Figure 13.8 ICP problem solving evaluation form. Devised by Leo Ferguson, Batshaw Youth and Family Centres. Reproduced by permission

ART PROGRAMS OFFERED AT BATSHAW YOUTH AND FAMILY CENTRES The following is a breakdown of the multiple applications of ART at Batshaw Youth and Family Centres which are at various stages in development. These different programs all need standardized and specific evaluation tools to monitor progress of ART youth and programs.

Pr´evost Campus: Central ART (Year Round; Boys Aged 13–18; Young Offenders/Youth Protection) Animators receive clients from four or five residential units and offer 8–10 weeks of ART training and Family ART programming. Problem solving and moral reasoning movie groups have also been offered. Animators from this group assist in training of animators, with Master Trainer.

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Intermittent Custody Program (Year Round; Boys Aged 15–18; Young Offenders Only) The ICP offers 8 weeks of ART and/or 4 weeks’ problem solving. It must be court ordered to qualify. A parent group meets once weekly for skills training with their youth. Parents must agree to attend the parents’ group. Clients must be interviewed to determine suitability prior to going to court. The total focus is using ART and problem solving.

Bridges (Back-Up Program) (Year Round; Boys Aged 13–18; Young Offenders/Youth Protection) Bridges is a closed custody residential program used for back-up purposes for 3– 8 days. Problem solving is the principal focus in response to referral issues. ART techniques, empathy training, situational perception training, substance abuse, and SMART goals training, etc. are used to solve problems. Follow-up is required upon discharge from Bridges.

Intensive Probation Program (Year Round; Boys and Girls Aged 13–18; Young Offenders Only) In lieu of custody or post-custody youth are required to meet curfew and usual probation conditions and are closely monitored. Youth are required to participate in a Victim Impact Program (VIP), which includes the use of Dr Goldstein’s Prepare Curriculum courses such as Moral Reasoning, Empathy Training, etc. This program uses a “family preservation” model and intensive work is done in the family setting.

Pr´evost Campus: Springfield (30 Weeks per Year; Boys Aged 15–18; Young Offenders/Youth Protection) This is an open placement/custody residential program based in a living unit environment. It currently offers all clients ART with 6 clients per semester, 10 weeks per session, and is to be expanded to 12 clients per semester. Family ART has been offered by Central ART animators. It is currently being taken over by unit-based youth care workers trained in ART animation.

Pr´evost Campus: Ste Rose (30 Weeks per Year; Girls Aged 13–18; Young Offenders/Youth Protection) This is an open placement/custody residential program based in a living unit environment for girls. It offers groups of between 4 and 9 trainees in ART and problem solving. A successful Family ART group has been run by Ste Rose youth care workers trained in ART. High-risk girls in the program present a major challenge.

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Cartier Campus: Jeanne Sauve (30 Weeks per Year; Girls Aged 13–18; Young Offenders/Youth Protection) This is a closed placement/custody residential program based in a living unit environment. ART is new in the program, which offers groups to 6–8 trainees at a time. Groups need to be completed in 30 days due to the average length of stay of clients in the program. A Family ART group is to be offered. The program is adapting to the quick turnover of youths.

Cartier Campus: Northview (30 Weeks to Year Round; Boys Aged 13–18; Young Offenders Only) This is a closed custody residential program based in a living unit environment. Skillstreaming is offered, and anger control and moral reasoning are to be added along with Family ART.

Community-Based Group Home: St James (30 Weeks per Year; Boys Aged 15–18; Young Offenders/Youth Protection) This is a residential group home offering ART in a living unit environment. ART is a basic unit expectation for all youths admitted into St James. Family ART complements the full ART program.

Community-Based Group Home: Addington (30 Weeks per Year; Girls and Boys Aged 13–18; Young Offenders/Youth Protection) This is a residential group home offering ART in a co-ed living unit environment. ART is a basic unit expectation for all youths admitted into Addington. Family ART is to be added to provide a full program.

Community-Based Group Home: Hawkins (30 Weeks per Year; Girls and Boys Aged 8–12; Youth Protection Only) This is a residential group home for pre-adolescents offering ART programming for all youth admitted into the program. Family ART and moral reasoning are to be added to provide a full program.

Community-Based Group Home: Tobin House (30 Weeks per Year; Girls and Boys Aged 8–12; Youth Protection Only) This is a residential group home for pre-adolescents offering ART programming for all youth admitted into the program. Family ART and moral reasoning are to be added to provide a full program.

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Community-Based Alternative School: Mountainview (South) (30 Weeks per Year; Girls and Boys High School; Youth Protection/ Young Offenders) This Montreal English School Board Alternative School was set up to service residential and community-based youths under the care of Batshaw Youth and Family Centres. Skillstreaming is offered on a voluntary basis and a full ART program, including Family ART, is to be added to provide a full program.

DIFFICULTIES IN THE EVALUATION PROCESS Gathering information to evaluate programs in the “helping” professions is a difficult task. There are time restrictions, lack of commitment, availability of subjects, financial constraints, etc. When reviewing literature on parent training groups, it was comforting to read that others experienced the same frustrations. This is why it is necessary to include the less formal, qualitative data in the evaluation process: One can and should still be concerned with the observable and measurable but this needs to be supplemented with techniques which reflect how people make sense of social adversity and experience any help they receive. For such experiences affect the way people behave and what we measure. (Gill, 1998)

It is, at times, discouraging to find that one’s sample group is too small, or that the results do not match the hypothesis, and especially that the success we feel is not backed up by data. It is important to turn that to one’s advantage and learn from the experience: “Behavior analysts . . . should encourage their fellow researchers to document and to analyze their apparent failures, rather than allowing them to slide into oblivion. A detailed and systemic understanding of generalization could result” (Stokes & Baer, 1977, pp. 351–352, in Goldstein & Martens, 2000, p. 28). The analysis of the Batshaw data revealed more than just results. This author learned that:

r Collecting data is time consuming. As well, it is difficult to track those who have

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been involved in the program due to early discharge, moving, etc. It is necessary to engage others, preferably university students, to focus on data collection and analysis. The use of stagi`eres (interns) for ART at Batshaw is planned for September 2001. Families are willing to continue attending groups; however, budget and resources are limited. We invite parents to return, as space and resources allow. Families deserve all the support we can afford. Funding must be found to continue family groups beyond the completion of their child’s ART training period. This implies moneys to cover for animators’ hours spent in Family ART, and moneys to support parents to attend sessions, e.g. taxi fare, bus tickets, babysitting costs, etc. This will help to further transference and generalization of the ART techniques learned.

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questionnaires did not always reflect the skills learned. A new processoriented system will be developed: the initial (pre) questionnaire is to be the Student Skillstreaming Checklist (Goldstein et al., 1998, pp. 284–287), with the post and follow-up having questions targeted at the specific skills learned. Although youth care workers were given questionnaires, very few were completed. This may be due to a lack of time, a feeling of being overwhelmed in their work, or some resistance to change. A more concentrated effort must be made to engage workers by convincing them of the benefits of the program, the necessity for its evaluation, and providing them with the time needed to complete the task. A training video for Family ART group animators was made during one of the family group sessions. It was an excellent tool and provided animators with clear examples of the fruits of their labors. The video camera should be used more often to evaluate both family and trainee sessions as well as to monitor animation skills.

Mark Amendola, the executive director of Perseus House in Erie, Pennsylvania, is a strong advocate for the use of video in both program and animator evaluations of ART classes. Perseus House runs a multi-faceted, award-winning ART operation complete with highly successful ART parent groups. In Erie, Perseus House evaluates not only skill acquisition use by their trainees, but also measures academic progress and other factors which contribute to the building of a strong young person on the path to success.

FUTURE ENDEAVORS As ART expands and develops at Batshaw new approaches must be used to build resources as well as new experiences. The following subsections delineate new undertakings offering promise to the Batshaw ART project.

Collaboration with Other ART Projects and Universities Although we have gained much important information about the work we are doing at Batshaw, the process has to become more effective through more formal approaches. As previously mentioned, efforts to evaluate ART programs have met with delays and setbacks due to budget restrictions, and the difficulties of introducing more tasks to already highly charged job descriptions. Nonetheless, in an effort to work smarter, as more and more ART programs become operational at Batshaw, the need for evaluation increases. As a result, a number of previously planned strategies was realized in 2001–2002. Networking with other successful ART operations such as Perseus House in Fort Erie, Pennsylvania, and others will be investigated by Batshaw in the immediate future. To evaluate ourselves effectively also requires learning from other ART enthusiasts about what they have accomplished. For any ART project to flourish, exchanges of successes, failures, and new approaches with other youth care professionals are paramount.

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Batshaw will work in partnership with Concordia University to develop better evaluation tools and methods of collecting and interpreting more useful results of ART programming. A Master’s Thesis from McGill University’s School of Social Work will look at the viability of the Batshaw ART project, including Family ART and its evaluation. Projects such as these, between youth care services and universities, are essential for the development of optimal practices for evaluating ART programming and other skill-building programs of this nature. Ideally, a good system of evaluation should be in place prior to any major implementation of ART. For that matter any ART programming, without some form of evaluation, is lacking in vital information critical for improvement and development. The implementation of ART and other Prepare Curriculum training programs is a constantly developing project.

Focus and YOS A new ART project is about to begin at Batshaw which offers an interesting opportunity for both application and evaluation. The program involved is called Focus and uses a family preservation model. This program is an alternative to residential care which operates by offering a school program for 32–44 youth. As well as an Alternative School approach with eight students maximum per class, the program offers the services of four youth care workers whose mandate is to work with these youth in the school and also with their families in the family setting. These youth care workers do regular work in the home and will add ART and Family ART to their program approach. Teachers will co-animate ART with youth care workers, during moral and religious education classes. With parents and youth also attending Family ART sessions, skill-building techniques should effectively improve an already successful family preservation program. New evaluation tools will be created to support the project’s development. The previously mentioned ART program for YOS with probation and alternative measures clients will require a clear evaluation process. Along with our Intensive Probation Program, which already uses ART and the Prepare Curriculum in what is referred to as the Victim Impact Program (VIP), an evaluation of effectiveness needs to be developed. The evaluation approach will parallel the previously described studies focusing on recidivism rates (see Tables 13.1 and 13.2) and also try to measure individual progress in learning of individual skills.

SUMMARY AND RECOMMENDATIONS For ART animators at Batshaw, the ART experience continues to be a rewarding one. Improving the program is challenging given the financial constraints we face. However, as a colleague always says, “It’s a job worth doing !” The experiences of Batshaw ART animators have been very rewarding. Needless to say, ART animators are feeling enthusiastic about teaching the program. In so doing, they are rejuvenated in their jobs. As clinical front line staff, they

228 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING are experiencing tangible returns for their efforts which come in the form of appreciative comments from parents and trainees. As well animators are seeing significant visible behavioral improvements in the ART youth. . . . [At] “Graduation” night . . . inevitably someone asks, “could we return next session, for more ART?”( Calame et al., 2001)

Family ART is a powerful approach for the enhancement of generalization of the ART program. Batshaw Youth and Family Centres have made a big commitment to skills acquisition through the use of these programs. This is a big step on the road to lasting change. Evaluation of ART, Family ART, and other Prepare Curriculum training programs, in as many forms as possible, can only strengthen the process. There are other techniques which show great promise as methods for the enhancement of generalization of gain. These emerging approaches include the use of relapse prevention, social networks, and other social support interventions to name a few (Goldstein & Martens, 2000, pp. 67–120). Those strategies, however, although essential to consider when working towards “lasting change” in intervention with troubled youth and families, are also part of a different discussion. Family ART is a potent intervention for work with maladjusted youth today. If we are to be truly helpful to these youth and their families we must employ every available strategy for change which is long term or permanent. Otherwise we employ “Band-Aid” youth care methodology. We must, as youth care professionals, use both the new and the old gain enhancement methods available to us. We must use the oldest God-given method proven over and over to be the most effective means for solving the problems of children. If we want our youth care interventions to be truly effective, we must train parents to be effective coaches, teachers, and trainers of the prosocial competencies their youth need, to live in peace with all men. As the proverb says, “Train up a child in the way he should go, and when he is old he will not depart from it”.

ACKNOWLEDGMENT Figures 13.1 and 13.2 were created with funds provided by Washington State Department of Social and Health Services as part of the Community Juvenile Accountability Act (2000).

REFERENCES Calame, R., Barile, S., Brown, D., Colantonio, M., Konopa, K., Maas, K., Parker, K., Potter, D., & Williams, C. (2001). Too angry to learn? Aggression Replacement Training for youth and their families in a residential treatment setting. Journal of Youth and Child Care Work, 15–16, 82–94. Carter, B. & McGoldrick, M. (1989). The changing family life cycle: A framework for family therapy (2nd edn). Boston, MA: Allyn & Bacon.

A LEARNING PROCESS FOR THE WHOLE FAMILY 229 Garfat, T. & McElwee, C. N. (2001). The changing role of family in child and youth care practice. Journal of Child and Youth Care Work, 15–16, 237–238. Gill, A. (1998). What makes parent training groups effective: Promoting positive parenting through collaboration. Unpublished PhD. Thesis, University of Leicester, Leicester, UK. Goldstein, A. P. (1999). The Prepare Curriculum: Teaching prosocial competencies (rev. edn). Champaign, IL: Research Press. Goldstein, A. P. & Glick, B. (1987). Aggression Replacement Training: A comprehensive intervention for aggressive youth. Champaign, IL: Research Press. Goldstein, A. P., Glick, B., Carthan. W., & Blancero, D. (1994). The prosocial gang. Thousand Oaks, CA: Sage. Goldstein, A. P., Glick, B., & Gibbs. J. C. (1998). Aggression Replacement Training: A comprehensive intervention for aggressive youth (rev. edn). Champaign, IL: Research Press. Goldstein, A. P., Glick, B., Irwin. M. J., Pask-McCartney. C., & Rubama, I. (1989). Reducing delinquency: Intervention in the community. New York: Pergamon Press. Goldstein, A. P. & Martens, B. K. (2000). Lasting change: Methods for enhancing generalization of gain. Champaign, IL: Research Press. Griffin, W. A. (1993). Family therapy: Fundamentals of theory and practice. New York: Brunner/Mazel. Leeman, L. W., Gibbs, J. C., & Fuller. D. (1993). Evaluation of a multi-component treatment program for juvenile delinquents. Aggressive Behavior, 19, 281–292.

Chapter 14

EVALUATIONS OF EFFECTIVENESS ARNOLD P. GOLDSTEIN Syracuse University, New York, USA

A substantial number of ART effectiveness evaluations have been conducted. The external validity of their combined outcomes is strengthened by the significant diversity in characteristics of their locations, investigators, ART trainers, ART trainees, and outcome measuring criteria. This chapter seeks to describe this multisite research program and its findings, as well as reflect upon their combined implications for the current and future utilization of ART.

ANNSVILLE YOUTH CENTER Our first evaluation of ART was conducted at a New York State Division for Youth facility in central New York State (Goldstein & Glick, 1987). Sixty youths at Annsville were included, most of them incarcerated at this limited-security institution for such crimes as burglary, unarmed robbery, criminal mischief, and various drug offenses. Twenty-four youngsters received a 10-week ART program (see Table 14.1). This program required them to attend three sessions per week, one each of Skillstreaming, anger control training, and moral reasoning training. An additional 24 youths were assigned to a no-ART, brief instruction control group. This group controlled for the possibility that any apparent ART-derived gains in skill performance were due not to ART per se, but to the youngsters’ enhanced motivation to display skills they already possessed but simply were not using. A third group, the no-treatment control group, consisted of 12 youths not participating in either ART or the brief instruction control group. The overall goal of this evaluation was to examine the effectiveness of ART for the purposes of: 1. Skill acquisition: Do the youngsters learn the 10 Skillstreaming skills in the ART curriculum? 2. Minimal skill transfer: Can the youngsters perform the skills in response to new situations similar in format to those in which they were trained? New perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A.P. Goldstein, R.Nensen, B.Date Fold, and M.Kalt.


Preparing for a stressful conversation 1. Imagine yourself in the stressful situation.

3

2. Think about how you will feel and why you will feel that way. 3. Imagine that other person in the stressful situation. Think about how that person will feel and why.

Responding to the feelings of others (empathy) 1. Observe the other person’s words and actions. 2. Decide what the other person might be feeling, and how strong the feelings are. 3. Decide whether it would be helpful to let the other person know you understand his or her feelings. 4. Tell the other person, in a warm and sincere manner, how you think he or she is feeling.

6. Come to an agreement on the steps to be taken by each of you.

5. Show that you understand his or her feelings.

Expressing a complaint 1. Define what the problem is, and who is responsible for it. 2. Decide how the problem might be solved. 3. Tell the person what the problem is and how it might be solved. 4. Ask for a response.

Skillstreaming

2

1

Week

3. Plagiarism

2. Booby trap

1. Shoplifting

1. The passenger ship 2. The case of Charles Manson 3. LSD

2. The dope pusher 3. Riots in public places

1. The used car

Moral reasoning

Table 14.1 Aggression Replacement Training core curriculum

3. Review of hassle logs.

Triggers 1. Identification of provoking stimuli: (a) Direct triggers (from others); (b) Indirect triggers (from self). 2. Role-play: triggers + cures + anger reducer.

3. Anger reducers: Reducer 1: deep breathing training; Reducer 2: refocusing, backward counting; Reducer 3: peaceful imagery.

Assessment 1. Hassle log: purpose and mechanics. 2. Anger self-assessment: physiological cues.

2. Rules: presentation and discussion. 3. Training procedures: presentation and discussion. 4. Contract for anger control training, initial history taking. 5. Antecedent provocations–behavioral response–consequences (A–B–C).

Introduction 1. Rationale: presentation and discussion.

Anger control

6

Keeping out of fights 1. Stop and think about why you want to fight. 2. Decide what you want to happen in the long run.

5

Helping others 1. Decide if the other person might need and want your help. 2. Think of the ways you could be helpful.

3. Think about other ways to handle the situation besides fighting. 4. Decide the best way to handle the situation and do it.

Responding to anger 1. Listen openly to what the other person has to say. 2. Show that you understand what the other person is feeling. 3. Ask the other person to explain anything you do not understand. 4. Show that you understand why the other person feels angry. 5. If it is appropriate, express your thoughts and feelings about the situation.

4

4. Imagine yourself telling the other person what you want to say. 5. Imagine what he or she will say. 6. Repeat the above steps using as many approaches as you can think of. 7. Choose the best approach.

3. Role-play: triggers + cues + reminders + anger reducer. 4. Homework assignments and review of hassle log.

3. Drugs

2. Perjury

1. The kidney transplant

3. Saving a life

(Continued)

Thinking ahead (anger reducer 5) 1. Estimating future negative consequences for current acting out. 2. Short-term versus long-term consequences.

Self-evaluation 1. Review of reminder homework assignment. 2. Self-evaluation of post-conflict reminders: (a) Self-reinforcement techniques; (b) Selfcoaching techniques. 3. Review of hassle log post-conflict reminders.

2. Modeling use of reminders under pressure.

2. Robin Hood case

1. Private country road 2. New York versus Gerald Young

Reminders (Anger reducer 4) 1. Introduction to self-instruction training.

1. Toy revolver

9

Dealing with group pressure 1. Think about what the other people want to do and why. 2. Decide what you want to do.

8

Expressing affection 1. Decide if you have good feelings about the other person.

3. Decide how to tell the other people what you want to do. 4. Tell the group what you have decided.

Dealing with accusation 1. Think about what the other person has accused you of. 2. Think about why the person might have accused you. 3. Think about ways to answer the person’s accusations. 4. Choose the best way and do it.

1. Defense of other persons

3. Discrimination

2. The stolen car

1. Noisy child

3. Doctor’s responsibility

2. Perjury

1. Lt. Berg

3. Worst to least consequences.

3. Misrepresentation

3. Ask the other person if he or she needs and wants your help. 4. Help the other person.

Full sequence rehearsal 1. Review of hassle logs.

2. Role-play: triggers + cues + reminders + anger reducers + self-evaluation + Skillstreaming skill.

Full sequence rehearsal 1. Review of hassle logs.

2. Identification of own anger-provoking behavior. 3. Modification of own anger-provoking behavior. 4. Role-play: triggers + cues + reminders + anger reducers + self-evaluation + Skillstreaming skill.

The angry behavior cycle 1. Review of hassle logs.

4. Role-play: “If . . . then” thinking ahead. 5. Role-play: triggers + cues + reminders + anger reducers + self-evaluation + Skillstreaming skill.

Anger control

Moral reasoning

Skillstreaming

7

Week

Table 14.1 (Continued)

10

3. Decide how you might do things differently if you tried again. 4. Decide if you want to try again. 5. If it is appropriate, try again, using your revised approach.

Responding to failure 1. Decide if you have failed. 2. Think about both the personal reasons and the circumstances that have caused you to fail.

4. Choose the right time and place to express your feelings. 5. Express affection in a warm and caring manner.

2. Decide whether the other person would like to know about your feelings. 3. Decide how you might best express your feelings.

3. Drunken driving

1. The desert 2. The threat

2. Lying in order to help someone 3. Rockefeller’s suggestion

Full sequence rehearsal 1. Review of hassle logs. 2. Role-play: triggers + cues + reminders + anger reducers + self-evaluation + Skillstreaming skill.

2. Role-play: triggers + cues + reminders + anger reducers + Skillstreaming skill.

236 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

3. Extended skill transfer: Can the youngsters perform the skills in response to new situations dissimilar in format and more “real-lifelike” than those in which they were trained? 4. Anger control enhancement: Do the youngsters actually demonstrate fewer altercations or other acting-out behaviors as reflected in weekly behavior incident reports, completed for all participating youths by the center’s staff? 5. Impulse reduction: Are the youngsters rated as less impulsive and more reflective and self-controlled in their interpersonal behaviors? 6. Moral reasoning level enhancement, as measured by Gibbs, Basinger, and Fuller’s (1992) Sociomoral Reflection measure. Analyses of study data revealed, first, that youths undergoing ART compared with youths in both control groups significantly acquired and transferred (minimal and extended) 4 of the 10 Skillstreaming skills: Making a Complaint, Getting Ready for a Difficult Conversation, Dealing with Someone Else’s Anger, and Dealing with Group Pressure. Similarly significant ART versus control group comparisons emerged on both the number and intensity of in-facility acting-out behaviors (as measured by behavior incident reports) as well as on staff-rated impulsiveness. Following completion of the projects post testing, in Week 11 new ART groups were formed for the 36 youths in the two control groups. As before, these sessions were held three times per week for 10 weeks and duplicated the first-phase ART sessions in all other major respects (curriculum, group size, materials, etc.). Our goal in this second phase was an own control test of the efficacy of ART, with particular attention to discerning possible reductions in acting-out behaviors by comparing, for these youths, their behavior incident reports during Weeks 11 thorough 20 (when in ART) with their behavior incident reports from the period when they had served as control group members (Weeks 1 through 10). Both of the statistical comparisons (number and severity) conducted to test this replication effect yielded positive results. No between-group differences emerged on the study’s measure of moral reasoning level. Real-world figures such as family and peers frequently express indifference or even hostility toward trainees’ use of newly learned prosocial skills. As a result, incarcerated delinquents experience considerable difficulty in effecting the transfer of skills from the more protective and benign training environment to the community environment. Family and peers frequently serve as reinforcers of antisocial behaviors, ignoring or even punishing constructive alternative actions. Our hope was that ART would serve as a sufficiently powerful intervention to effect at least moderate carry-over of in-facility ART gangs. In order to test for such possible transfer effects, we constructed a global rating measurement of community functioning. During the 1-year period following initiation of ART at Annsville, 54 youths were released from this facility. Of these 54, 17 had received ART; 37 had not. We contacted the Division for Youth team members (analogous to parole officers) around New York State to whom the 54 released youths regularly reported and, without informing the workers as to whether the youths had or had not received ART, asked the workers to complete global rating measurements for each of the Annsville youths. In four of the six areas—namely, home and family, peer, legal, and overall—ART youths were rated significantly

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higher with regard to in-community functioning than were youths who had not received ART. In the areas of school and work, no significant differences emerged.

MACCORMICK YOUTH CENTER Our second evaluation of the efficacy of ART was conducted at MacCormick Youth Center, a New York State Division for Youth maximum security facility for male juvenile delinquents between the ages of 13 and 21 (Goldstein & Glick, 1987). In essence, this second evaluation project sought to replicate the exact procedures and findings of the Annsville project and to include youths incarcerated for substantially more serious felonies. There were 51 youths in residence at MacCormick at the time of the evaluation. Crimes committed by these youths included murder, manslaughter, rape, sodomy, attempted murder, assault, and armed robbery. In all its procedural and experimental particulars, the MacCormick evaluation project replicated the effort at Annsville. It employed the same preparatory activities, materials, curriculum, testing, staff training, residential training, supervision, and data analysis procedures. On 5 of the 10 Skillstreaming skills, significant acquisition and/or transfer results emerged. These findings essentially replicate the Annsville Skillstreaming results. In contrast to the Annsville results, however, the MacCormick data also yielded a significant result on the Sociomoral Reflection measure (Gibbs et al., 1992). At MacCormick, but not at Annsville, youths participating in moral reasoning training sessions grew significantly in moral reasoning stages over the 10-week intervention period. Regarding overt, in-facility behavior, youths receiving ART, compared with those who did not, increased significantly over their base rate levels in their use of constructive, prosocial behaviors (e.g. offering or accepting criticism appropriately, employing self-control when provoked) and decreased significantly in their rated levels of impulsiveness. In contrast to the Annsville findings, MacCormick youths who received ART did not differ from controls in either the number or intensity of acting-out behaviors. Annsville, internally, is not a locked facility. Its 60 youths live in one dormitory, in contrast to the locked, single-room arrangement at MacCormick. MacCormick’s staff is twice the size of Annsville’s, and the facility operates under a considerably tighter system of sanctions and controls than does Annsville. Because of these operational differences, the opportunity for acting-out behaviors is lower across all conditions at MacCormick as compared with Annsville. A “floor effect” therefore seemed to be operating at MacCormick that made a decrease in acting-out at MacCormick less likely to be a direct result of ART participation than at Annsville. At Annsville, such behaviors were contextually more possible at base rate, and they could (and did) decrease over the intervention period. At MacCormick, all youths started with low base rates and, likely for these same contextual reasons (e.g. sanctions, controls, rich staffing, etc.), they remained low. Subjects’ use of prosocial behaviors, to which no floor or ceiling influences were relevant, did increase differentially as a function of the ART intervention.

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A COMMUNITY-BASED EVALUATION The findings of our first two investigations revealed ART to be a multimodal, habilitation intervention of considerable potency with incarcerated juvenile delinquents: it enhanced prosocial skill competency and overt prosocial behavior and reduced levels of impulsiveness. And, in one of the two samples studied, decreases (where possible) in the frequency and intensity of acting-out behaviors and enhancement of participants’ levels of moral reasoning were verified. Furthermore, some evidence provided independently revealed ART to lead to valuable changes in community functioning. In light of the general movement away from residential-based and toward community-based programming for delinquent youths, this possibility for community change led to our third evaluation of the efficacy of ART. This evaluation sought to discern the value of ART when provided to 65 youths on a post-release basis, while youths were living in the community (Goldstein, Glick, Irwin, Pask-McCartney, & Rubama, 1989). We were aware of the potent contribution to effective community functioning that parents and others make in the lives of delinquent youths. This belief led to our attempt to discern the effects of offering ART not only to the youths, but also to their parents and other family members. This community-based project was essentially a three-way comparison of ART provided directly to youths plus ART provided to youths’ parents or other family members (Condition 1), versus ART for youths only (Condition 2), versus a no-ART control group (Condition 3). For the most part, participating youths were assigned to project conditions on a random basis, with departures from randomization becoming necessary on occasion as a function of the five-city, multisite, time-extended nature of the project. Largely as a result of how long the New York State Division for Youth had after-care responsibility for youths discharged from their facilities, the ART program offered to project participants was designed to last 3 months, with sessions meeting twice per week, for a total of approximately 24 sessions. Each session, 11/2 –2 hours long, was spent in (a) brief discussion of current life events and difficulties, (b) Skillstreaming training of a skill relevant to the life events/difficulties discussed, and, on an alternating basis, (c) anger control training or moral reasoning training. Once weekly, an ART session was held for the parents and other family members of a sample of participating youths. Those parents selected to participate, but who did not appear, were provided ART in modified form via a weekly home visit or telephone call. Since the different ART groups comprising the project’s two treatment conditions chose which of the 50 Skillstreaming skills they wished to learn, different groups learned different (if overlapping) skills. We did not, therefore, examine in our statistical analyses participant change on individual skills. Instead, analyses focused on total skill change for the youths participating in ART (Conditions 1 and 2) versus each other and non-ART control group youths (Condition 3). Results indicated that, although results for the two ART conditions did not differ significantly, participants in each of these conditions increased significantly in their overall interpersonal skill competence when compared to Condition 3 (no-ART) youths. A similarly significant outcome emerged (both ART groups versus no-ART group)

EVALUATIONS OF EFFECTIVENESS 239

for decrease in self-reported anger levels in response to mild (e.g. minor nuisance, unfair treatment) but not severe (e.g. betrayal of trust, control/coercion, physical abuse) anger-provoking situations. A particularly important evaluation criterion in delinquency intervention work is recidivism. The majority of previously incarcerated youths who recidivate do so within the first 6 months following their release (Maltz, 1984). Thus, the recidivism criterion employed in this project, rearrest, was tracked during the first 3 months, in which youths received ART, and during the 3 subsequent no-ART months. Condition 3 youths, of course, received no ART during the entire tracking period. Analyses examining the frequency of rearrest by condition showed a significant effect for ART participation. Both Condition 1 and Condition 2 youths were rearrested significantly less than were youths not receiving ART. A substantial decrease in rearrest occurred when the youths’ families (i.e., parents and siblings) participated simultaneously in their own ART groups. Table 13.1 (see p. 199) represents the actual frequency and percentages of rearrests by condition. From this study it appears that teaching family members interpersonal skills and anger control techniques reciprocal to those the delinquent youths are learning may possibly provide the youths with a more responsive and prosocially reinforcing real-world environment—an environment in which prosocial instead of antisocial behaviors are supported, encouraged, and reinforced.

THE GANG INTERVENTION PROJECT Our research group’s fourth ART evaluation (Goldstein, Glick, Carthan, & Blancero, 1994), in which trainees were all gang members, also grew from a systems-oriented spirit. If our community-based effort captured that part of the delinquent youths’ interpersonal world made up of family members and possibly turned it, at least in part, toward a prosocially reinforcing direction, could the same be done with delinquent gang youths and their peer groups (i.e. other gang members)? Could we use ART not only to teach youths to behave more prosocially but also to increase the likelihood that their prosocial efforts in real life would be met by acceptance, support, and even praise from fellow gang members? This project was conducted in two Brooklyn, New York, community-based agencies: the Brownsville Community Neighborhood Action Center and Youth DARES of Coney Island. Each agency conducted three 4-month sequences of ART. Within each sequence, trainees were all members of the same gang. We constituted a control group for each sequence whose members were also from the same gang but from a gang different than the one to which the ART trainees belonged. Thus, across both agencies, twelve different gangs participated in the program—six receiving ART, six as no-ART controls. All the youths, ART and controls, received the same educational, vocational, and recreational services offered by the two participating agencies. Repeated measures analysis of variables crossing project conditions (ART versus control) with time of measurement (pre versus post study) revealed a significant interaction effect favoring ART participants for each of the following Skillstreaming

240 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

categories: Beginning Social Skills, Advanced Social Skills, Skills for Dealing with Feelings, Skill Alternatives to Aggressions, Skills for Dealing with Stress, Planning Skills, and a total skills score. None of the ANOVA comparisons of ART scores with control group scores for the study’s measure of anger control yielded significant differences. Of the five community domains, only work adjustment yielded a significant difference. This result accords well with (and no doubt largely reflects) the real-world employment pattern for project participants. For example, in the months immediately following their ART sequence, the majority of the participating Lo-Lives left their gang and took jobs in retail businesses. At an analogous point in time, following their own ART participation, a substantial minority of the participating Baby Wolfpack members obtained employment in the construction trades. Arrest data were available for the youths participating in our first two ART gang intervention sequences and their respective control groups. Five of the 38 ART participants (13%) and 14 of the 27 control group members (52%) were rearrested during the 8-month tracking period (chi square = 6.08, p < 0.01). Our primary rationale for working with intact gangs in this project was the opportunity afforded by such a strategy to capture a major portion of the youth’s environment and turn it in a prosocial direction. The question was, once trainees learned specific prosocial behaviors, would the transfer and maintenance of these skills be facilitated or discouraged by the people with whom the youths regularly interacted in the real-world environment? Our favorable outcome verified by rearrest rates implies the possibility that a more harmonious and prosocially promotive post-ART peer environment was created. While it is important for future research to examine the possibility more directly, it is of considerable interest to note that similar rearrest outcomes were obtained in our earlier attempt to create a prosocially reinforcing post-ART environment for delinquent youths by employing this intervention with them and their families. For these youths (ART for self and family), rearrest rates on follow-up were 15% for no-ART control group youths; the comparable figure was 43%. Both of these outcomes from the community-based project closely parallel the outcomes found here (13% and 52%, respectively) for the presence or absence of support from a rather different type of ”family”—fellow gang members. Our studies of the effectiveness of ART have yielded several promising findings, both proximal to the ART procedures (i.e. skill acquisition, anger control, enhanced moral reasoning) and distal to ART procedures but central to the program’s ultimate purposes (i.e. reduced rearrests, enhanced community functioning). But what of the independent findings of other investigators? Coleman, Pfeiffer, and Oakland (1991) evaluated the effectiveness of a 10-week ART program for behaviorally disordered adolescents in a Texas residential treatment center. Study results indicated improvement in participant skill knowledge but not in overt skill behaviors. Coleman et al. comment: The current study thus provides additional support for the contention that although cognitive gains can be demonstrated, the link to actual behavior is tenuous, especially with disturbed populations. (p. 17)

As our own previous discussion suggests, however, we believe that the likelihood for overt behavioral expression (performance) of newly acquired skills is less a

EVALUATIONS OF EFFECTIVENESS 241

function of the degree of trainee emotional disturbance than it is a matter of trainee motivation to perform, and staff or other significant persons’ perceived receptivity to and likely reward for such overt behaviors. Coleman et al. continue: Of the ten social skills that were taught, three accounted for the improvement in social skills knowledge: keeping out of fights, dealing with group pressure, and expressing a complaint. The fact that Goldstein and Glick (1987) also found these same skills to be improved in two separate studies suggests that these skills may be the most responsive to intervention. One plausible explanation is that these three skills may be construed as contributing to self-preservation, especially within the context of residential or institutional living. (p. 15)

Curulla (1990) evaluated (a) a 14-week ART program versus (b) ART without the moral education component versus (c) a no-ART control condition. Trainees were 67 young adult offenders participating in a community intervention setting in Seattle. Curulla reports: Tendency toward recidivism and actual recidivism were compared among the three groups. Tendency towards recidivism as measured by the Weekly Activity Record was significantly reduced in the dilemma group . . . The nondilemma . . . and control . . . groups showed no significant reduction. The dilemma group also had the lowest frequency of subsequent offense . . . However, the differences in actual recidivism among the three groups did not reach statistical significance due to the low incidence of recorded changes during the six-month followup. (pp. 1–2)

Unlike Coleman et al.’s (1991) result, in Curulla’s study—as in our own—overt acting-out behaviors were significantly reduced via ART participation. However, unlike our own results, post-ART recidivism was not. In a second effort to examine the impact of ART component procedures singly and in combination, Kennedy (1989) assessed the efficacy of Skillstreaming and anger control training with a sample of 37 adult incarcerated offenders, all of whom had a history of serious anger control difficulties. Outcome comparisons were made of the two procedures used in combination versus either Skillstreaming alone or anger control training alone. Kennedy states: The results of this study demonstrated that anger control training and structured learning therapy [Skillstreaming] are both effective treatment modalities for incarcerated adult male offenders with severe anger and aggressive behavioral problems. Subjects in all four active treatment conditions displayed the following changes. They self-reported less anger to a variety of provocations common to the prison setting. They self-reported decreases in the frequency, intensity, and duration of anger, more appropriate modalities of expression, and fewer consequences of anger reactions. Objective behavioral ratings of their verbal responses to laboratory role-played provocations indicated their responses were more appropriate, as were their self-reported reactions to these provocations. In addition, subjects demonstrated more prosocial attitudes following completion of the program. The overall findings from the followup measures provide strong support for the extended maintenance of treatment benefits. Subjects continued to demonstrate lower levels of anger arousal on cognitive indices of anger. (p. 3)

242 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING

Jones (1990) compared ART to moral education and a no-treatment control using a sample of aggressive male students in a Brisbane, Australia, high school. Her results were consistent and positive: Compared to the two control conditions, students completing the ART program: showed a significant decrease in aggressive incidences, a significant increase in coping incidences, and acquired more social skills. Students in condition 1 [also] improved on . . . self-control and impulsivity . . . ART appears to be an effective intervention for aggressive youth within a high school setting. (p. 1)

A further investigation, also affirming the efficacy of ART, takes this intervention in a new direction. Gibbs and his co-workers in the Ohio Department of Youth Services have for some years employed and evaluated a Positive Peer Culture approach in their work with delinquent youths. This technique, described as an “adult-guided but youth-run group approach,” places major responsibility upon the youth group itself for the management of the living environment as well as for changes in their own behaviors. Believing that youths are sufficiently motivated to conduct much of their own governance and direction but that they too frequently lack the skills and anger control to do so, Gibbs and his group combined the Positive Peer Culture approach with ART to yield a motivational, skills-oriented intervention they call EQUIP (Gibbs, Potter, & Goldstein, 1995). Leeman, Gibbs, and Fuller (1993) note: “In EQUIP, moral discussion, anger management, or social skills sessions are designated as ‘equipment meetings,’ i.e., meetings wherein the group gains ‘equipment’ for helping group members.” These investigators conducted an efficacy evaluation of EQUIP at a medium-security institution for juvenile felony offenders, the Buckeye Youth Center in Columbus, Ohio. Three conditions were constituted—EQUIP, a motivational control group, and a no-treatment group. Outcome results were significant and supportive of the EQUIP intervention on both proximal and distal criteria. The investigators comment that “institutional conduct improvements were highly significant for the EQUIP relative to the control groups in terms of self-reported misconduct, staff-filed incident reports, and unexcused absences from school.” The investigators also found that, whereas the recidivism rate of EQUIP subjects was low (15%) at both 6 and 12 months following release, the control group rates worsened from 6 through 12 months (25% to 35% for the motivational control, 30% to 40% for the simple passage-of-time control). This pattern suggests that the treatment result was maintained as a stable effect. Table 13.2 (see p. 200) shows the results of the Leeman et al. (1993) investigation as well as the findings of the community-based project (Goldstein et al., 1989) and the Gang Intervention Project (Goldstein et al., 1994). In all three studies, each of which yielded significant differences between the treatment versus control conditions, ART was offered both to the delinquent youths and to the other people (parents, fellow gang members, or fellow unit members) serving as arbitrators, reinforcers, or punishers of the youths’ behavior. As change agents of all types have noted for decades, the client’s system is as crucial a treatment target as is the client. As was the case for our community-based and gang ART evaluations, this investigation strongly confirms this assertion.

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Nugent, Bruley, and Allen (1999) conducted a field study to test the effect of male and female antisocial behavior in a runaway shelter. An interrupted time series design was used in this study. The case records of 522 11–17-year-olds who stayed in a runaway shelter over a 519-day period were reviewed and measures of antisocial behavior obtained. Results suggest that the implementation of ART was associated with a decrease in male and female antisocial behavior in the shelter. ART, they concluded, may be a useful component of a multicomponent approach to reducing juvenile antisocial behavior in a short-term residential setting. The ART participants in an investigation by Nodarse (1998) were adolescents with emotional handicaps. There were 25 participants in the experimental group and 25 in the control group. Gender and ages were matched as closely as possible. Ages for the experimental and controls groups ranged from 12 to 14 years. The participants in the experimental group received ART three times a week for one hour each session. Results indicate that after the ART 10-week program, significant decreases in overt aggression and significant increases in social skills were found. In one further study, in this instance targeted to generalization of effect, 40 juvenile delinquents who successfully completed an extensive ART program while institutionalized were examined by a series of semi-structured interviews and brief assessment instruments prior to discharge and again at 15 weeks post release. Multiple situations were identified in six adjustment areas of school, work, family life, peer relationships, drug and alcohol use, and trouble with the law. ART skills transferred to more than half of all situations. Certain skills, however, transferred more frequently that others and certain adjustment situations were more likely to have skills applied than others. Substantial skill maintenance was also discovered. Results of the field experiment found that the booster session was not significantly associated with improvement in community adjustment but was so with reduced frequency and seriousness of delinquent behavior and fewer arrests. Two additional efficacy evaluations, both quasi-experimental in design, complete our survey of efforts to examine the impact of ART on the functioning of chronically aggressive youths. The first, the collaborative Intensive Community Treatment Program, was conducted by Perseus House, a multisite community-based agency in Erie, Pennsylvania (M. Amendola, personal communication, November 17, 1997). ART lasted 13 weeks, for 7 days each week, and was presented to both youths and their parents. Participating youths, all referred by juvenile court, were assigned to the program on either a deferred placement basis (diversion to the program instead of incarceration) or on a community reintegration basis (following a period of incarceration). Youth ART sessions were conducted daily. Parent sessions were held on Saturdays and Sundays. Compared to pre-ART status, gain scores revealed significant increases in participant (both youth and parent) Skillstreaming skill scores, youth school attendance and achievement scores (in math but not in reading), and staff ratings of youth overall psychological and social functioning (American Psychiatric Association, 1997). The final evaluation was conducted by the Michigan Department of Social Services at five sites collectively constituting their Maxey Training School (S. White, personal communication, August 5, 1997). Participants, 44 youths sentenced to Maxey by juvenile court, underwent a 10-week ART program. Again, pre- and

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post-ART comparisons revealed significant growth in Skillstreaming skill competency. In all but one of the participating sites, there was also a significant decrease in within-institution acting-out behaviors. The efficacy evaluations described in this chapter combine to suggest that ART is an effective intervention. With considerable reliability it appears to promote skills acquisition and performance, improve anger control, decrease the frequency of acting-out behaviors, and increase the frequency of constructive, prosocial behaviors. Beyond institutional walls, its effects persist, less fully perhaps than when the youth is in the controlled institutional environment, but persist nonetheless. These effects are especially pronounced when significant others in the youth’s real-world environment are simultaneous recipients of ART. In general, the ART program’s potency appears more than adequate to warrant continued program implementation and evaluation with chronically aggressive youngsters.

REFERENCES American Psychiatric Association (1997). Diagnostic and statistical manual of mental disorders (4th edn). Washington, DC: American Psychiatric Association. Coleman, M., Pfeiffer, S., & Oakland, T. (1991). Aggression replacement training with behavior disordered adolescents. University of Texas. Curulla, V. L. (1990). Aggression replacement training in the community for adult learning disabled offenders. University of Washington. Gibbs, J. C., Basinger, K. S., & Fuller, D. (1992). Moral maturity: measuring the development of sociomoral reflection. Moral Education Forum, 17, 22–23. Gibbs, J. C., Potter, G. B., & Goldstein, A. P. (1995). The EQUIP program: Teaching youth to think and act responsibly through a peer-helping approach. Champaign, IL: Research Press. Goldstein, A. P. & Glick, B. (1987). Aggression Replacement Training. Champaign, IL: Research Press. Goldstein, A. P., Glick, B., Carthan, M., & Blancero, D. (1994). The prosocial gang: Implementing aggression replacement training. Thousand Oaks, CA: Sage. Goldstein, A. P., Glick, B., Irwin, M. J., Pask-McCartney, C., & Rubama, I. (1989). Reducing delinquency: Intervention in the community. New York: Pergamon Press. Jones, Y. (1990). Aggression replacement training in a high school setting. Center for Learning and Adjustment Difficulties, Brisbane, Australia. Kennedy, S. M. (1989). Anger management training with adult prisoners, doctoral dissertation, University of Ottawa, Canada. Leeman, L. W., Gibbs, J. C., & Fuller, D. (1993). Evaluation of a multi-component treatment program for juvenile delinquents. Aggressive Behavior, 19, 281–292. Maltz, M. D. (1984). Recidivism. Orlando, FL: Academic Press. Nodarse, M. V. (1998). The effects of Aggression Replacement Training on adolescents with an emotional handicap. Dissertation Abstracts International, May, 6242. Nugent, W. R., Bruley, C., & Allen, P. (1999). The effects of Aggression Replacement Training on male and female antisocial behavior in a runaway shelter. Research on Social Work Practice, 9, 466–482.

Chapter 15

THE ART TRAINER AS A SCIENTIFIC PRACTITIONER BENGT DALEFLOD Norra Rudbecksgatan 6, Uppsala, Sweden

INTRODUCTION This chapter emphasizes the importance of documentation and evaluation of Aggression Replacement Training (ART) work. ART is now spreading rapidly in many countries, especially at grassroots level, which is good news and something we have worked hard to achieve. However, we must not let slip the opportunity to demonstrate what we are doing: it is the case that far too many existing programs have never been tested or evaluated (Kazdin, 1998). The basic message is that we must establish systematic evaluation of ART programs on a larger scale, and that the major part of this task rests with the many experienced ART practitioners who work with ART training on a regular basis. Research can be a difficult subject to discuss since many practitioners for one reason or another seem to find it boring, frightening or even unnecessary, while most clinicians in fact believe that they manage very well without it (Cohen, Sargent, & Sechrest, 1986). In fact, it all depends on how we view science, on how we perceive the world of science. The word “science” perhaps tends to make some people think of advanced research which involves expensive, high-tech equipment; they visualize scientists in white overalls at work in a laboratory or a university clinic. The majority of people think of research as something exclusive, unrelated to daily practice, and something that other people do.

WHAT WE LEARN FROM RESEARCH In treatment work, our knowledge in most areas is continually enhanced by systematic research and evaluation, so that the information accumulated from research and evaluation makes it possible to spotlight and elaborate constructive treatment New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


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strategies (Target & Fonagy, 1996). A vital issue is therefore the development of guiding principles for treatment based on empirical evidence (Eddy, 2001). Research must inform practice: why should we waste time and energy on something that will not work? To be able to choose the most appropriate methods we must examine critically all related research literature. From a research perspective there is of course both good news and bad news (that is the whole point of research!). The not so good news indicates that the prevalence of aggression, conduct problems, and youth violence is on the increase (McMahon & Wells, 1998). This increase in problems is apparent over the whole range, from low-level aggression to more serious and lethal violence. Longitudinal studies show that early aggression is a very serious risk factor contributing to a range of problems in later life (Tolan & Gorman-Smith, 1998). Those young people who become chronically aggressive or delinquent are generally early starters (Patterson, Reid, & Dishion, 1992), so prevention of serious aggression means that we must plan to break the chain as early as possible. The good news is that we now know so much more about how aggressive and antisocial behavior patterns develop, about key risk factors and protective factors, and, last but not least, about successful interventions (Loeber & Farrington, 1998). The main stumbling-block is not a lack of knowing how or what to do, but in the process of the application of this knowledge. The research literature gives us useful guidelines as to what steps should be taken to prevent and reduce aggressive behavior. Efficient methods of working with defiance and conduct disorders have been developed, and ART is one such increasingly successful, empirically based approach. Kazdin states in his reviews that four approaches in particular are extremely promising in overcoming conduct problems (Kazdin, 1997; Kazdin & Weisz, 1998): (1) social and cognitive problem-solving skills training (e.g. ART), (2) parent management training (PMT), (3) functional family therapy (FFT), and (4) multisystemic therapy (MST). Efficiently delivered ART programs should include collaboration with the family and peers and take into account extra-familiar factors. ART emanates from a long tradition of research and has a solid scientific basis: every component of ART—skills training, anger control, and moral reasoning—is based in theory with empirical support. The three components combine to make ART a broad-based, multimodal intervention, precisely what current research suggests. The maintenance of newly acquired behaviours is enhanced if the program teaches a broad competence: an extension of ART is outlined in the Prepare Curriculum (Goldstein, 1999), in which additional components, for example, problem solving, empathy training, situational perception training, can be added to amplify the generalization of gain. Nonetheless, ART has empirical support on its own merits (Goldstein, Gibbs, & Glick, 1998): since the first evaluation in 1987, more than a dozen studies have in different ways pointed out positive outcomes. We have seen that young people on ART training programs have added new skills to their repertoire to better control anger arousal, to reason more maturely, to function better in society, and to have fewer relapses into criminal behavior. This is certainly a very encouraging start, but much remains to be done in the future.

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DIFFERENT RESEARCH OBJECTIVES There is of course a wide range of research designs, each with different aims (Reamer, 1998): we often want to know whether a particular intervention works, or would like to find out more about a certain issue, or perhaps assess the specific needs of a client group. Alternatively, the goal of research can be simply to describe changes over a period of time. Research can vary from highly sophisticated academic research to more applied surveys. Basically, most research is an attempt to answer questions. The hard part of research is to ask meaningful and measurable questions and to know how to identify success or failure, how to collect information, and finally how to analyse and interpret outcomes. Treatment itself has to be documented in a concrete and specific manner so that it can be replicated. Other vital issues involve guaranteeing valid conclusions and translating these findings to the real world. Perhaps the riskiest element of evaluation is excluding all possible alternative explanations of change in the targeted behavior. You can often demonstrate a correlation, but from there it is a far cry to declaring that treatment alone was responsible for change. Might there not be alternative interpretations of the results? You have to be very careful when drawing conclusions about causes and effects; many external factors can contribute to change. If we wish to rule out extraneous factors as the cause of change, we must have an evaluation design that includes controls of other possible explanations such as maturation, testing bias, and selection (see Cook & Campbell, 1979; Kazdin, 1998). What most interests us when working with ART is evaluating the effects of treatment and looking at the overall process. Everyone who works in treatment wants to help people improve their lives; we all would like to bring about important changes in our clients’ existence. So we must ascertain whether our work is actually producing results. Are the methods we are using effective? Are our clients making progress? Are we reaching our goals? McGuire (2001) points out that evaluation can also provide feedback to the program to create a positive development spiral. This kind of research must become an integral part of ART practice. So it is not enough to be skilled, experienced ART trainers; we must be at the same time scientists, since evaluation research is clearly part of effective treatment.

THE GAP BETWEEN RESEARCH AND PRACTICE A wide gap exists between research and practice. This imbalance has been discussed for a long time by many of the eminent figures (Goldfried, 2000; Kazdin, 2001), while Goldstein (1968) has discussed the friction that exists between practitioners and researchers. Goldstein suggests that the advancement of psychotherapy has been inhibited because of this discrepancy and lack of harmony. Researchers and practitioners can function as if the other was of little or no importance: treatment procedures often lag behind research findings, while it can take time before a promising treatment method attracts the attention of researchers. However, a great deal of research is obviously not being used fully: for example, research which indicates that it may be possible to produce major changes in antisocial behavior,

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including youth violence and delinquency, if research findings were put into practice (Lipsey & Wilson, 1998).

Distinctive Features of Effective Treatment Strategies There is a growing consensus that effective treatment of antisocial and delinquent behavior should encompass a number of strands to reduce offending (Lipsey & Wilson, 1998). 1. Complexity. Aggressive behavior has multiple causes, so treatment has to be complex. Effective programs are broad-based and multimodal. 2. Prescriptive programming. Treatment should be applied in an individualized or prescripted manner. A thorough individual behavioral assessment should be the starting point of all treatment. 3. Responsiveness to learning style. Impulsive youth responds best to active, concrete, and well-structured methods. 4. Cognitive-behavioral therapy (CBT). The CBT approach is “the treatment of choice” when working with aggressive and conduct-disordered individuals. 5. Situationality. The individual interacts with his or her social and physical environment; effective treatment tackles problems in their natural context. 6. Family and system approach. Family members and peers play a crucial role in the development and maintenance of antisocial and aggressive behavior. 7. Aggression is primarily a learned behavior. Aggression is learned through modeling and reinforcing consequences. The main focus should be on developing alternative social skills (cognitions, values, feelings, and overt behaviors). 8. Some approaches are ineffective. Classical psychotherapeutic models, punishment, deterrence, and cohabitation are strategies not recommended. 9. High “treatment integrity.” Intervention must be well delivered and of good quality. 10. Evaluation. Evaluation research shows that clients benefit from treatment and that intervention increases social adjustment and reduces recidivism. 11. Prevention. “Catch it low to prevent it high.” However, the community agencies working with young people have failed to assimilate this knowledge fully and clinicians do not make use of it. Why is this? Considering that aggression, violence, and delinquency are regarded by most people to be a serious social problem, this is strikingly contradictory. One main reason for this failure is that social work in most countries has in the past been governed by political ideologies and vague opinions and not at all by empirical findings. Social work has traditionally had a more overarching focus; the primary goal was to adjust social factors. Public institutions made no specific requirements as to carrying out research in this sector of society. It is striking that Sweden and other comparable countries, while leading the world in other public areas such as medicine, technology, and agriculture, have more or less ignored research into social work. Another obstacle to dissemination of research findings has to do with the fact that many people believe that solutions based on common sense are the right ones. Society, policy makers, and judges think that tougher sentences will

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alter the behavior patterns of delinquents. People believe that if they themselves were punished in this way, it would stop them from committing future criminal acts. Vast amounts of money have been squandered over the years on untested methods, and it was not until the late 1990s that it was suggested that treatment should be accountable for itself. Today there is a growing demand that intervention should be evaluated and proven to be effective; we frequently hear nowadays that practice should be evidence or research based (Macdonald, 1999). Another problem has to do with lack of information about what in fact works and limited access to empirical knowledge. For many years, successful interventions have been reported in academic literature and presented at conferences or in academic journals (Lipsey, 1992; Daleflod, 1993; Mulvey, Arthur, & Reppucci, 1993). The message was always addressed to other academics and this is probably one of the reasons that we have not seen a broader dissemination of promising methods. Society, legislators, judges, and program administrators in general know little or nothing about contemporary research findings. Research is often a long-drawn-out process. Designing and carrying out research studies takes time (Fitz-Gibbon & Morris, 1987) and eventually a scientific paper will be published in a professional journal and, it is hoped, be read by other members of the research community. Scientific reports are directed at other researchers and not at the public or practitioners. The recommendations from research clearly must become more accessible to the authorities and other potential users. In this area there have been some encouraging contributions lately. Research articles, reviews, and guidelines for different types of social and psychological disorders are beginning to become accessible on the Internet and in databased libraries. An important future source of collected knowledge in social work will be the international network, the Campbell Collaboration, whose main objective is to make it easier for practitioners and policy makers to access knowledge of effective interventions. A further problem is that a great deal of research lacks applicability or clinical relevance. Today the experimental study is the “gold standard” for deciding whether a treatment is effective and consequently evidence based. In an experimental study you compare a specific treatment method with one or more control groups under highly controlled conditions. The “efficacy study,” which applies randomized distribution to different experimental conditions, is undoubtedly the best method of drawing accurate conclusions about the effects of treatment (Kazdin, 1994). This latter design gives a high degree of internal validity, making it possible to rule out other plausible explanations. However, it is considerably more difficult to predict how the treatment will work under active service conditions, where the possibility of external control is much more limited. In most cases we cannot expect the ideal study: reality is complex and many factors are beyond our control. Conditions in an experimental study can also be different from what is going on in regular treatment (Seligman, 1995). Clinical treatment is more individual and flexible, often working with more than one problem at a time. Clients who seek therapy mostly do so by actively choosing the kind of treatment they want. The intervention continues until the client is markedly improved or decides to end the treatment, or if one technique does not work, another, or perhaps a whole package, is tried.

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Many experts claim that the efficacy study is perhaps not the only or even the best way to find out whether a treatment works in real life. Seligman (1995) argues: “I no longer believe that efficacy studies are the only, or even the best, way of finding out what treatments actually work in the field. I have come to believe that the ‘effectiveness’ study of how patients fare under the actual conditions of treatment in the field can yield useful and credible ‘empirical validation’ of psychotherapy and medication. This is the method that Consumer Reports pioneered.” Thus, experimental studies should be complemented with treatment in real-life situations. There is, in fact, a great demand for studies in clinical and real-life situations, and the present generation of psychotherapy research advocates closer links between research workers and practitioners (Goldfried & Wolfe, 1998). For most practitioners, however, the experimental study is not a realistic option, but it is possible to incorporate evaluation as a part of your program.

THE NEED FOR FIELD STUDIES ART is now experiencing a definitive breakthrough outside the USA and a rapid dissemination of ART in Sweden and other parts of Europe—official youth centers, correctional services, family homes, and schools are introducing ART training—is taking place. There is therefore an increased need for studies which shed light on different aspects of ART activities with different age groups, in a variety of settings, with various treatment focuses, with novel combinations of treatment components, and so on. If research is to be close to practice, the evaluation model must be simple and easy to use. It has been suggested that ART is “the poor man’s psychotherapy,” as it attempts to reach under-privileged youngsters from deprived backgrounds, is relatively inexpensive, and aims to make changes in the real world. The evaluation model should respond to this demand in the same spirit: it should be practical, “user-friendly,” inexpensive, and it should measure changes effected in the real world. The model for evaluation should be directly linked to practical activities and be of immediate significance. ART is a cognitive-behavioral intervention and research in the field has led to continued development and refinement of theories and methods (Clark & Fairburn, 1997). In spite of the fact that current CBT includes a range of theories and techniques, there are distinct common features. An outstanding hallmark of CBT is that the theory is scientifically based, its methods empirically validated, and evaluation is a natural part of practice.

COGNITIVE BEHAVIOR THERAPY Foundations and Features The defining features of CBT are shown in Table 15.1. The CBT model provides practitioners with a tool for collecting information, analysing problems, setting goals, intervening, and evaluating. This structured framework, with its roots in applied behavior analysis, is well established and only requires putting into practice

THE ART TRAINER AS A SCIENTIFIC PRACTITIONER 251 Table 15.1 Defining features of CBT 1. Behavior includes everything an organism is doing, saying, feeling, and thinking, together with bodily reactions. 2. Behavior (normal and abnormal) is primarily learned via social learning principles. The same learning principles can be used to change maladjusted and non-functional behavior. 3. Methodology is systematic, structured, and time-limited. 4. The principal objective is to increase the client’s freedom and self-control. 5. Treatment goals are explicit, specific, and measurable. 6. Goals and methods are decided in collaboration with the client. 7. The effects of treatment are scientifically evaluated. 8. The relationship between therapist and client is characterized by cooperation; the client takes an active part in the problem-solving process. 9. Treatment is preceded by behavior analysis of the interplay between the individual and his or her environment. Individual treatment programs are tailored to the client’s problem. 10. Focus is more directed on current controlling factors and the future than on the past. 11. Focus is on the problem behavior itself rather than on an assumed hidden cause. 12. Irrational beliefs and negative thoughts (cognitions) can cause psychological problems. 13. The client carries out home assignments between sessions. 14. Cooperation with significant others in order to influence behavior in the natural environment. 15. Methods and procedures are prescribed in a concrete, often stepwise manner. 16. Methods change and develop concurrently with new research findings.

(Hollin, Epps, & Kendrick, 1995). We have an obligation to evaluate our efforts in order to find out whether we are helping our clients and to improve our work. We also have to make the most rational use we can of the limited resources we have at our disposal, so an analysis of cost-effectiveness should also be a part of any evaluation. In plain terms, we have to assume more actively the role of the “scientific practitioner” (McGuire, 2001). Everyone who works with ART and other CBT approaches ought systematically to evaluate his or her treatments. Indeed, part of being a scientific practitioner is critically selecting the most effective methods. Which methods can reasonably be relied on? Do not choose a method simply because you have been to a workshop and listened to a charismatic lecturer saying that ART is a fantastic therapeutic innovation. Always be prepared to question, to look for sound evidence for the most effective approach.

EVALUATION SKILLS Too often practitioners lack the necessary knowledge and skills to carry out outcome research (Reamer, 1998). However, evaluation skills are learned behaviors and therefore can be taught and learned. These skills can be highly sophisticated and are demanding to master, but they can often be quite simple and straightforward. There is a large number of books, articles, and other resources available that can help you plan and carry out evaluations (Berk & Rossi, 1999; Wolfe &

252 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Table 15.2 Skill 51: evaluating your ART program Steps

Trainer’s notes

1. Identify and describe target behavior(s)

Be specific and state behavior excesses and deficits in concrete, observable terms. Measure the strength of target behaviors by measuring their frequency, duration or intensity. You can also use standardized questionnaires and scales. Establish explicit and measurable objectives to be used as criteria for evaluation of treatment. Apply the techniques and procedures prescribed in the ART manual. Document treatment process to ensure treatment quality. Continuous and follow-up registration of multiple targets including real-life measures and evaluation by the program’s consumers. Do clients and society judge the results of treatment to be effective and important? Compare strength of target behaviors before, during, and after ART program. Communicate your findings to policy makers, researchers, and practitioners in the ART community. Publish your report on www.AggressionReplacementTraining.org.

2. Obtain baseline information

3. Formulate behavioral change goals

4. Start ART program

5. Continue data collection

6. Evaluate level of goal attainment 7. Report and disseminate your results

Miller, undated). Within ART the Skillstreaming curriculum consist of 50 different skills: perhaps you have wondered what the 51st skill is. I have designed a new skill that covers the basic components of clinical evaluation: this new skill is called “Evaluating your ART program.” It has seven steps that constitute an excellent way of evaluating the effects of ART training (Table 15.2). Skill 51 roughly follows the outline of applied behavior analysis (Sundel & Sundel, 1999) and its format is a single-subject design (or experimental case study). The various steps in the research methodology are basically similar to the procedure for the problemsolving framework used in clinical behavioral therapy. The single-subject design is the most suitable when you want to check on a client through a treatment process (for larger groups of people there are group designs). The use of multiple baseline designs, with several target behaviors, individuals or situations, increases accuracy and confidence in the conclusions you can draw about the effects of treatment. As is standard procedure in skills training, I will start by defining, explaining and going through the steps which make up the skill. When you feel confident about carrying out the evaluation procedure, make use of the skill and implement it in your ART practice.

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Skill 51: Evaluating Your ART Program Begin in the assessment phase by identifying and defining the target behaviors that you want to change, bearing in mind that behaviors can be both private and overt. As outcome indicators, you should mainly look for real-life incidents. The purpose of ART is to increase the use of social skills and to decrease aggressive and antisocial behaviors. At this stage it is important to be specific and state behavior in a concrete, observable way. Before you begin your intervention, you must obtain some baseline information. Now is the time to measure and quantify the target behaviors. If you are doing a behavior analysis, you will also look for stimuli (antecedents and consequences) that influence and maintain the problem behavior. To keep a record of your observations, you may simply use paper and pencil, although you can also make use of modern technology: there are computer programs available that can assist you in keeping track of treatments. There is also a wealth of reliable checklists, questionnaires, and scales you can include in your evaluation kit. You will also need descriptive data and background information on your clients. The next step is to formulate goals that you and your client would like to achieve. Ideally, you do this with your client, which also increases their motivation for participation and change. Goals must be very concrete and specific to be measurable and useful in later evaluation: SMART (Specific, Measurable, Achievable, Realistic, Time-limited) is a useful rule of thumb for stating goals. The more accurately you can define your objectives as measurable criteria, the better you can evaluate them. You should now have a baseline, goals, and a treatment plan, and be ready to start the ART program. Deliver the treatment by following the procedures in the ART manual. It is as simple as that! However, it is critically important to ensure high quality of treatment, and the process of program implementation is essential. You may start a program enthusiastically, but after a while perhaps you find yourself doing something else: you are no longer giving homework assignments, you skip the modeling display, the structure of each session is crumbling, and suddenly you find you are drinking coffee and having discussions about the latest movie. Maybe you are having a great time, but you are not doing ART any more. So you must have a built-in system of quality checks. After every session you and your co-trainer should go through a checklist, and every now and then you should videotape a session and have a supervisor look at it. We must not focus on the outcome of treatment alone; it is equally important to keep a record of the treatment process and to see that delivery of treatment is satisfactory. Step 4 is what many practitioners are already doing and are good at: this is what you really enjoy doing! Now you must continue to collect data: it is vital to register multiple targets before, during, and after treatment. Most programs aim at influencing aspects of functioning, such as cognitions, attitudes, problem-solving skills, and social skills, which are assumed to mediate between the treatment and the actual problem behavior. However, it is not enough to rely on clinical measures alone: for example, a large number of studies show that treatment with delinquents can be successful from a clinical point of view, but has no effect whatsoever on recidivism (Hollin, 1990). At this point in the history of ART, we recommend that you rely heavily on

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real-life behavioral activities and evaluation by the consumers. Do clients, family members, and the community see the treatment as worthwhile and cost-effective? It is essential to make treatment as clinically and ecologically valid as possible. Trying out a program in its real context is the best test of effectiveness and usefulness, and is one way of bridging the gap between research and practice, a real demand of the present generation of psychotherapeutic research. When you have formulated explicit goals, you can now assess the level of goal attainment simply by comparing the strength of target behaviors before, during, and after the ART program. Did your client benefit from the intervention? Is he or she better adjusted to society? Progress can be illustrated very dramatically by a graph and very often clients are surprised by the progress they have made when seen pictorially. Another way to increase reliability in a single-case design is to use multiple baselines: here you focus treatment on either one target behavior or one client at a time. Systematic work of this type is a vital part of a scientific practitioner’s job. It is finally time to share your findings and communicate them to policy makers, practitioners, and researchers in the ART community. We strongly recommend that you make your report public. One option is to publish it on the ICART homepage. An ambition we have at ICART is to bridge the gap between therapy research and clinical practice. We would like to make research, especially regarding ART, more easily accessible to practitioners, policy makers, and other stakeholders. Another of our aspirations is to develop a user-friendly guide for evaluating ART programs, including suggestions on relevant and useful instruments.

CONCLUDING REMARKS Aggressive and antisocial children and young people, generally speaking, have a very negative prognosis. These children and young people are going to get into a lot of trouble on their own, they will create fear and suffering for other people, and they will cost society a lot of money. A pressing task is the application of appropriate methods to prevent this from happening. It is strongly argued here that these methods must be based on actual knowledge and currently available research. All of us who work with ART know that this intervention can be effective and lasting. In fact, we are convinced of its effectiveness, since we have personally witnessed its wonderful results, especially when ART training is extended to include the young person’s home environment. But it is not enough to be dedicated and believe that what you are doing is important; almost everyone who practices a particular method thinks he or she is doing the right thing. More than 250 different therapies for young people with behavior disorders are described in the related literature (Kazdin, 1998), very few of which have been tested or have produced documented outcomes. We must demonstrate in a reliable way that ART training does produce favorable outcomes for those involved. There is an ever-increasing demand for evidence-based social work and psychological treatment, which implies that it is more than ever necessary for us to evaluate what we do. If we can establish the evaluation of ART on a larger scale, we have so much to gain. We will be in a position to develop ART, improve its

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procedures and manuals, find ways of enhancing the generalization of gain, develop strategies to stimulate motivation and readiness to change, and, last but not least, work out agreed standards to ensure quality of treatment. There is always an evident risk that treatment programs become shallow and over time slide into something other than what they were intended to be. We now come to the crucial ethical question: are our endangered and deprived clients getting the best possible help? If we take action from an empirical standpoint, we can with a clear conscience offer our clients the best possible help for their problems and needs, instead of using arbitrary methods, which may even be harmful. We hope that our message will reach a wide audience and that more practitioners will begin to evaluate their programs and share their findings with the general public and policy makers, with a view to informing them about effective and appropriate interventions.

REFERENCES Berk, R. A. & Rossi, P. H. (1999). Thinking about program evaluation (2nd edn). Thousand Oaks, CA: Sage. Clark, D. M. & Fairburn, C. G. (Eds) (1997). Science and practice of cognitive behaviour therapy. Oxford: Oxford University Press. Cohen, L. H., Sargent, M. M., & Sechrest, I. B. (1986). Use of psychotherapy research by professional psychologists. American Psychologist, 41, 198–206. Cook, T. D. & Campbell, D. T. (1979). Quasi-experimentation: Design and analysis issues for field settings. Boston, MA: Houghton Mifflin. ¨ Daleflod, B. (1993). Stagnation eller Evolution? Oversikt av hoppingivande forskning med relevans for ¨ ungdomsv˚arden. Scandinavian Journal of Behavior Therapy, 22, 89–117. Eddy, J. M. (2001). Aggressive and defiant behavior; The latest assessment and treatment strategies for the conduct disorders (2nd edn). Kansas City, KA: Dean Psych Press. Fitz-Gibbon, C. T. & Morris, L. L. (1987). How to design a program evaluation. Newbury Park, CA: Sage. Goldfried, M. R. (2000). Consensus in psychotherapy research and practice: Where have all the findings gone? Psychotherapy Research, 10, 1–16. Goldfried, M. R. & Wolfe, B. E. (1998). Toward a more clinically valid approach to therapy research. Journal of Consulting and Clinical Psychology, 66, 143–150. Goldstein, A. P. (1999). The Prepare Curriculum: Teaching prosocial competences. Champaign, IL: Research Press. Goldstein, A. P. (1968). Psychotherapy research and psychotherapy practice: Independence or equivalence? In S. Lesse (Ed.), An evaluation of the results of the psychotherapies. Springfield, IL: C. C. Thomas. Goldstein, A. P., Gibbs J. C., & Glick, B. (1998). Aggression Replacement Training: A comprehensive intervention for aggressive youth. Champaign, IL: Research Press. Hollin, C. R. (1990). Cognitive-behavioral interventions with young offenders. Syracuse, NY: Pergamon Press. Hollin, C. R., Epps, K. J., & Kendrick, D. J. (1995). Managing behavioural treatment: Policy and practice with delinquent adolescents. London: Routledge. Kazdin, A. E. (1994). Methodology, design and evaluation in psychotherapy research. In A. E. Bergin & S. L. Garfield (Eds), Handbook of psychotherapy and behavior change (4th edn). New York: John Wiley & Sons. Kazdin, A. E. (1997). Practitioner review: Psychosocial treatments for conduct disorder in children. Child Psychology and Psychiatry, 38, 161–178.

256 NEW PERSPECTIVES ON AGGRESSION REPLACEMENT TRAINING Kazdin, A. E. (1998). Research design in clinical psychology (3rd edn). Needham Heights, MA: Allyn & Bacon. Kazdin, A. E. (2001). Bridging the enormous gap of theory with therapy research and practice. Journal of Clinical Child and Psychology, 30, 59–66. Kazdin, A. E. & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66, 19–36. Lipsey, M. W. (1992). Juvenile delinquency treatment: A meta-analytic inquiry into the variability of effects. In T. D. Cook, H. Cooper, D. S. Cordray, H. Hartmann, L. V. Hedges, R. J. Light, T. A. Louis, & F. Mosteller (Eds), Meta-analysis for explanation: A casebook. New York: Russell Sage Foundation. Lipsey, M. W. & Wilson, D. B. (1998). Effective intervention for serious juvenile offenders: A synthesis of research. In R. Loeber & D. P. Farrington (Eds), Serious and violent juvenile offenders: Risk factors and successful interventions. Thousand Oaks, CA: Sage. Loeber, R. & Farrington, D. P. (Eds) (1998). Serious and violent juvenile offenders: Risk factors and successful interventions. Thousand Oaks, CA: Sage. Macdonald, G. (1999). Evidence-based social care: Wheels off the runaway? Public Money and Management, 19, 25–32. McGuire, J. (2001). Development of a program logic model to assist evaluation. In L. Motiuk & R. C. Serin (Eds), Compendium 2000 on effective correctional programming. Ottawa: Correctional Services of Canada. McMahon, R. J. & Wells, K. C. (1998). Conduct problems. In E. J. Mash & R. A. Barkley (Eds), Treatment of childhood disorders (2nd edn). New York: Guilford Press. Mulvey, E. P., Arthur, M. W., & Reppucci, N. D. (1993). The prevention and treatment of juvenile delinquency: A review of the research. Clinical Psychology Review, 13, 133–167. Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). Antisocial boys. Eugene, OR: Castalia. Reamer, F. G. (1998). Social work research and evaluation skills: A case-based, user-friendly approach. New York: Columbia University Press. Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50, 965–974. Sundel, S. S. & Sundel, M. S. (1999). Behavior change in the human services: A systematic introduction to concepts and applications (4th edn). Thousand Oaks, CA: Sage. Target, M. & Fonagy, P. (1996). The psychological treatment of child and adolescent psychiatric disorders. In A. Roth & P. Fonagry (Eds), What works for whom? New York: Guilford Press. Tolan, P. H. & Gorman-Smith, D. (1998). Development of serious and violent offending careers. In R. Loeber & D. P. Farrington (Eds), Serious and violent juvenile offenders: Risk factors and successful interventions. Thousand Oaks, CA: Sage. Wolfe, B. L. & Miller, W. R. (undated). Program evaluation. A do-it yourself manual for substance abuse programs. Department of Psychology, University of New Mexico, Albuquerque.

EPILOGUE As one of the Series Editors I have taken the liberty of adding an Epilogue to this book. I have just finished reading and editing the text and several thoughts occurred to me on which I would like to reflect. It is plain that the development of ART is firmly based in theory and evidence. As discussed in the opening chapters, ART has a strong grounding in social learning theory and there is a body of associated research evidence that speaks to its efficacy. It is also clear from the chapters in this book that the impact of ART is to be keenly felt in both America and a number of European countries, while there are initiatives in other parts of the world. However, this widespread interest and use of ART should not mask the fact that the driving force behind ART originates in the work of a small group of people. ART has not become popular just because it is grounded in theory and evidence; its increasingly widespread use also owes a great deal to the pioneers of ART, Arnold Goldstein, Barry Glick, and later John Gibbs. The clarity and accessibility of the published texts that have informed ART over the years (Goldstein & Glick, 1987; Goldstein, Glick, & Gibbs, 1998) are important factors, but these texts are also the springboards from which Goldstein and his colleagues could engage the field. They understood that if they wanted ART to be widely used then they had to get out there and convince people to use it. There is little doubt that professional skills needed to engage administrators and practitioners are different in large part to the skills required by successful academics and researchers. To connect with those administrators and policy makers responsible for the delivery of services, it is necessary to have high-level communication skills and to understand the realities of funding and resources; to connect to practitioners it is necessary to appreciate and understand the difficulties faced every day by those who work face to face with troubled and troublesome young people. Anyone concerned with the delivery of treatment to delinquent groups will be aware that there is more to the delivery of effective services than a good program. The interplay between organizational policies and procedures, the training and skills of those delivering the treatment, and provision of support and supervision for treatment staff are critically important. If you want your program to be used, you have to work with the system that will use it. The chapters in this book written by those responsible for the organization and delivery of services show that ART has been successfully incorporated into working New Perspectives on Aggression Replacement Training: Practice, Research, and Application. C 2004 John Wiley & Sons, Ltd. Edited by A. P. Goldstein, R. Nens´en, B. Daleflod, and M. Kalt.


258 EPILOGUE

practices across a variety of settings. It is interesting to read in these chapters how the authors describe their efforts to engage their wider communities and other agencies in order to introduce ART in a constructive and accepted manner. This preparatory work is often painstaking, involving hours spent in committees and piles of horrendous paperwork, to plan the smooth introduction of a new style of working. Those involved in this level of work need support, and the chapters hint at the efforts made by the developers of ART, particularly Goldstein, to be there personally to train and run workshops, to encourage practitioners to try ART for themselves, to talk to politicians and policy makers, and to offer words of counsel. If ever there was a case study of the hero-innovator then ART provides all the material one could need. While hero-innovators can start a project and quickly attract attention, as Goldstein knew, it takes solid commitment by a group of people to keep a project going over time. Further, once established, the project itself cannot stand still; it must change and develop with new advances and in learning from its own history. The closing chapters in this book have taken this theme of development and show how those who understand and are familiar with ART can use their knowledge to push at the boundaries of practice in terms of both content and application. Indeed, the force pushing this book into the public domain is the International Center for Aggression Replacement Training (ICART). The founding of ICART, masterminded by Arnold Goldstein, is really a means he devised by which to maintain the gains made with ART and to ensure generalization when the time of the hero-innovator has passed. In gathering together a strong group of academics, senior managers and administrators, and practitioners, ICART seeks to move the use of ART to the next level of sophistication. However, there are principles about which Arnie was firm and which ICART must heed: first, progress should be thought thorough and incremental in its application, and cautious in its claims for what can be achieved. Those of us who knew Arnie will doubtless recall his maxim, “We are in the business of small gains, always small gains.” Second, we must also be in the business of encouraging and supporting practitioners—it is our role to make their lives easier, not harder: if we want people to use ART we have to help, not hinder. I would like to think that this book captures something of what Arnie was striving to achieve in setting up ICART. In their chapters those involved in ART have drawn on their knowledge and experience to help bring ART to a wider audience and to pass on their enthusiasm and commitment to others who work in the field. It is hoped that this is a small but significant gain as the work started by Arnie and his colleagues gathers yet more momentum. Clive Hollin

REFERENCES Goldstein A. P. & Glick, B. (1987). Aggression Replacement Training: A comprehensive intervention for aggressive youth. Champaign, IL: Research Press. Goldstein, A. P., Glick, B., & Gibbs, J. C. (1998). Aggression Replacement Training: A comprehensive intervention for aggressive youth (rev. edn). Champaign, IL: Research Press.

INDEX Note: Aggression Replacement Training = ART A–B–C model 3, 4 ACT see Aggression Control Therapy Adolescent Problem Inventory 7 Aggression Control Therapy (ACT) 189–95 Aggression Questionnaire (AQ) 35, 192 Agressie Vragenlijist (AVL) 192, 194 Alexithymia Questionnaire (BVAQ) 192 anchoring effects 9 anger, definition 8 anger assessment 35–8 anger control 8–9 Anger Control Training 58, 81, 159, 166 Anger Log 36 anger management interventions 3, 31–48 across environments 39–46 anger assessment 35–8 development 31–2 in family context 43–6 research limitations 46–7 in residential treatment contexts 41–3 in school contexts 39–41 training strategies and program characteristics 34–5 Annsville Youth Center, NY 231–7 Antecedent–Behavior–Consequence (A–B–C) sequences 3, 4 Anxiety Management 162, 166 applied behavior analysis 250 AQ see Aggression Questionnaire arousal management skills 33 “articulated thoughts during simulation situations” 38 Asperger’s syndrome 48 assuming the worst 57 attentional cueing 8, 9 Attribution Questionnaire (ATV) 191 attributional error 8–9 ATV see Attribution Questionnaire AVL see Agressie Vragenlijist Balanced Approach and Restorative Justice Project 94

Batshaw Youth and Family Centres, family ART 197–200 behavior model of violent conduct 5–6 biological precursors of violence 5 blaming others (secondary) 56–7 Brain Power Program 39 BVAQ see Alexithymia Questionnaire Campbell Collaboration 141, 249 CARC see Children’s Anger Response Checklist CBCL see Child Behavior Checklist Character Education Movement 155 Child Behavior Checklist (CBCL) 36, 42 Children’s Anger Response Checklist (CARC) 37–8 Children’s Inventory of Anger 35 Classroom Meeting 155 Cochrane Collaboration 141 Cochrane Database of Systematic Reviews 141 Cochrane Library 141 cognitive-behavioral interventions 5 methods of change 11 and violent method 11–13 cognitive-behavioral therapy 248 defining features 250–1 definition 5 development of 4–5 models 5–6 cognitive distortions (thinking errors) 10–11, 52 categories 56–7 cognitive restructuring strategies 33 collaboration definition 87–8 dimensions of 88 guiding principles 89–91 with human services and schools 89 organizational structure 89 Collaborative Intensive Community Treatment Program (CICTP), Erie, Pennsylvania 89–103 aftercare 101–2 agencies description 95–6 ART in 98–101 collaborative development 93–4, 102–3

260 INDEX CICTP (cont.) collaborative implementation 94 community service 101 conceptualization and formation 91–3 development rationale 91–4 guiding principles 89–91 interventions 97–8 objectives 97 philosophy 94–5 staffing patterns 96–7 community-based evaluation of ART 238–9 conduct disorder 5 Conflict Behavior Inventory 36 Conflict Behavior Questionnaire 45 Conflict in Relationships Inventory 36 Connors rating scale 36 Connors Teacher Rating Scale 40 Co-op Co-op 163 cooperation, definition 87 Cooperation Training 162–3 coordination, definition 87–8 Crime Reduction Programme 139 criminal justice system, UK, applications in 139–149 Delaware Academy, Syracuse ART at 77–85 Social Emotional Committee (SEC) 78, 80–1 developmental processes 5 Differential Reinforcement Theory 4 distal antecedents to violence 5 effectiveness of ART, evaluation of 231–44 efficacy study 249–50 Empathy Training 160–1, 166 environmental factors 5 EQUIP program 58, 61, 68–71, 242 Equipped for Life 61 evaluation, effectiveness 231–44 see also research and evaluation evidence-based practice 141 external reinforcement 4 false consensus 9 Family Aggression Replacement Training 197–228 anecdotes as evaluative information 218–20 “Angry Behavior Cycle” in 204–5 ART programs 222–5 difficulties in evaluation 225–6 evaluation at Batshaw Youth and Family Centres 197–200 evaluation data 209–16 evaluation of individual client 206 evaluation of program 206–7 evaluation questionnaire design 209 family ART hotline 216 family ART newsletter 217 family ART transportation 217 future endeavors 226–7 history 201–2

informal evaluations 217–18 Intermittent Custody Program (ICP) 220–2 outcome 207–8 recruitment of parents 202–4 role-play as evaluation tool 218 treatment philosophy 200–1 work-in-progress 205–8 family context, anger management interventions in 43–6 FAST program 176–7, 178–9 faulty beliefs 55 forensic psychiatry in the Netherlands 189–95 framework 193 inpatients 189–90 measurement instruments 191–2 method 191–4 outpatients 190 problem behaviors of patients 190–1 procedure 192–3 functional family therapy (FFT) 246 gang intervention project 239–44 “Getting Along Together” program 78–82 “Active listening” hand signal 79–80 “Lining up” hand signal 80 “Zero noise” hand signal 79 Group-Investigation 163 Hassle Log 33, 34, 36, 180 HEARS model 174 Homework Report 25 “How I Think” questionnaire 37 Identity Education 155 indicators, early, of violence 5 Intensive Community Treatment Program, Erie, PN 243 International Center for Aggression Replacement Training (ICART) 258 Interpersonal Skills Training 155–6, 157–9, 166 Inventory of Interpersonal Situations (IOA) 192 IOA see Inventory of Interpersonal Situations Issues Checklist 45 Jigsaw Classrooms I and II 163 Joint Prison Probation Accreditation Panel 142 “Keeping Cool” group 40 Key Performance Indicators (KPIs) 141–2 learning theory 4 Learning to Care program (McPhail) 155 “Lost-It-Log” 36, 40 MacCormick Youth Center, NY 237 maintenance variables 5 MI Observation scale 19 minimizing/mislabeling (secondary) cognitive distortion 56

INDEX 261 Missouri MAP Test 187 MMPI 36 Moral Components approach (Wilson) 155 Moral Education (Kohlberg) 159 Moral Education program 155 moral functioning, theory of 13 moral judgment development delayed 52–8 egocentric (self-centered) bias/cognitive distortions 55–8 EQUIP Program 68–71 primary cognitive distortions 55–8 remedying 58–68 secondary cognitive distortions 58 stages of 53–5 superficial judgment and self-centered bias 55 social decision-making meetings 59–69 moral reasoning 9–11, 81 Moral Reasoning Scale (Kohlberg) 184 Moral Reasoning Training 3–4, 13, 51–71, 159–60, 166 developmentally delayed moral judgment 52–8 motivation 4 MST see multisystemic therapy multimodal programs 11 multisystemic therapy (MST) 246 NAS see Novaco Anger Scale NEO Five Factor Inventory (NEO-FFI) 191 NOBAGS see Normative Beliefs About Aggression Normative Beliefs About Aggression (NOBAGS) 37 Novaco Anger Scale (NAS) 192 Oasis (Aneby, Sweden), The 121–38 admission 127–8 adult/parent groups 134–5 ART at 131–2 assessment structure 128–30 case management 125–6 child psychological content 129 clientele 124–5 communication 132–3 evaluation 126–7 evaluation task 126 family ART 132, 133–5 final phase of evaluation 130–1 generalization 137–8 goals of program 123–4 institutional care from 2001 125 medical content 129 moral reasoning 135 organization 124 program description 121–2 psychiatric content 128–9 purpose of program 122–3 role-play 133 school content 129–30 social content 128 social development of children and families 135–7

Observation Scale for Behaviour in Conflict Situations (OGC) 192, 194 Offender Group Reconviction Scale, Version 2 (OGRS-2) 148 Offenders Index 149 OGC see Observation Scale for Behaviour in Conflict Situations OGRS-2 see Offender Group Reconviction Scale, Version 2 parent management training 246 Pathfinder projects 142 Pavilion method 76 PEACE Curriculum—Expanded Aggression Replacement Training 171–88 anger control 179–80 brain gym 180 character education 182–4 discipline structure 185–6 Gathering, the 184–5 MELT 179–80 PREP 183–4 research 187 Skill Rehearsal 181–2 staff 186–7 Pediatric Anger Expression Scale 35, 39 perceptual matching 8, 9 person–environment interaction, levels of 6 Positive Alternative Learning (PAL) program 172 developing curriculum 173 empathy 174–5 expansion 175 parent empowerment 176–9 Re-Entry Center 175–6, 177 see also PEACE Curriculum Positive Peer Culture (PPC) 68–9 PREP—Personal Responsibility Education Program 183–4 Prepare Curriculum 155, 156–65, 172, 183, 246 Anger Control Training 159, 166 Anxiety Management 162, 166 complementarity 157 comprehensiveness 156 Cooperation Training 162–3 course offerings 157–65 curriculum delivery 165–7 Empathy Training 160–1, 166 Interpersonal Skills Training 157–9, 166 Moral Reasoning Training 159–60, 166 open-endedness 157 prescriptiveness 157 Problem Solving Training 160, 166 Prosocial Support Group 163–4, 167 relevance 156–7 Social Perception Training 161–2, 166 Understanding and Using Group Processes 164–5 Pre-Sentence Reports (PSRs) 145 primary cognitive distortion 10 prison service, applications in 141–9

262 INDEX Problem Inventory for Adolescent Girls 7 Problem Solving Training 160, 166 prosocial instruction 155–6 Prosocial Support Group 163–4, 167 Psychological Education 155 psychological predispositions to violence 5 Psychopathy Checklist-Revised 192 Public Issues Program 155 Rehabilitation Evaluation Hall And Baker (REHAB) 192 research and evaluation benefits of 245–6 effective treatment strategies 248–50 evaluation skills 251–4 field studies 250 gap between research and practice 247–50 objectives 247 residential context, anger management interventions in 41–3 residential setting, ART in 43 Rosenzweig Picture-Frustration Study (RPFS) 191 schemas 8 schools anger management interventions in 39–41 discipline and disruptive behavior in 75–7 secondary cognitive distortion 10, 11 Self-Analysis Questionnaire (ZAV) 191 ZAV-D 191 self-centered (primary) distortion 56, 57–8 Self Control Rating Scale 40 self-reinforcement 4 self-serving thinking errors 52 Skillstreaming 3, 6–8, 21–9, 82–3 curriculum for adolescents 22–9 Homework reports 26 skill definition 22–3 Student Checklist 27, 28 Teacher/Staff Checklist 27 training steps 25 SMART 253 social cognition 6, 7 social cues, misinterpretation of 7 social decision-making meetings Consolidating Mature Morality 67–8 Cultivating Mature Morality 65–6 Introducing the Problem Situation 63–5 phases 61–9 problem situations 59–61 Remediating Moral Developmental Delay 67

social learning theory 4–5 social perception 6–7 Social Perception Training 161–2, 166 social performance 6, 7–8 Social Problem Solving 7, 155, 159 Social, Psychological, Educational and Criminological Trials Register 141 social skills therapy 193 Social Skills Training (SST) 8 Sociomoral Reflection Measure—Short Form (SRM—SF) 62 State-Trait Anger Inventory 35 STAXI 40, 41, 42 Structured Learning Therapy see Skillstreaming Student Skillstreaming Checklist 209, 226 Student Teams-Achievement Divisions 163 Success for All 78–80, 81 Teaching-Family model group 42 Teams-Games-Tournaments 163 Think First program 39, 42 thinking errors see cognitive distortion Ultimate Life Goal approach (Beck) 155 Understanding and Using Group Processes 164–5 Values Clarification program 155 vicarious reinforcement 4 Victim Impact Program (VIP) 223, 227 Vulnerable But Invincible 164 Wiltshire ART program 145–8 Youth Alternative, The (Ungdomsalternativet), Malmo, ¨ Sweden 105–20 alternative school projects 111 ART school alternative 111–12 ART training program 118–19 community projects 107–8 junior ART trainers 117–18 Malmo¨ as multicultural city 109–10 schools in Malmo¨ 108–9 Staff Training ART (START) 112–14 trainer-training/apprenticeship program 114–17 use of ART 110–11 youth alternatives 119–20 youth institutions 105–7 Youth Self Report Inventory 36, 37 ZAV see Self-Analysis Questionnaire