How Washington put therapy on the menu

How Washington put therapy on the menu
14 May 2009

It can be hard to get even seasoned practitioners to show much interest in individual proven programs, and, when they do, they often suffer from the zeal of the converted: they become obsessed with their discovery to the exclusion of all else.
 
The bigger and potentially more profitable challenge is to make sure a number of programs are recognized as the components of a coherent package with the capacity to accommodate different age groups and different types and severity of need.

One place to look for an all-in-one answer is Washington State where Mark Wirschem, Manager of Juvenile Treatment Services for King County, has been telling study tour participants about just such a package developed during the past ten years.
 
“If you go to a restaurant in Seattle you get a menu. Kids who come to juvenile court can’t get that. – But they can get this.” By “this” he means a menu of 12 evidence-based programs, with a particular emphasis on improving the behavior and employment prospects of those with severe problems. Every judge, every office, has a copy.

The Washington State menu also includes eligibility criteria for each program, such as the geographical areas where it is available, the age and risk level of the children who may receive it and appropriate family characteristics. Contact details for lead professionals and the intake capacity are shown, too.
 
What impact has it had? In the last decade crime has fallen by 50% and half as many students have been sent to state institutions. “We’re incarcerating fewer children, saving money and improving outcomes,” Wirschem says. 

Plainly, none of the programs in and of itself provides any panacea.

For example, the list includes Multisystemic Therapy (MST), a pragmatic, goal-oriented treatment that targets the factors in a young person’s social network most likely to be contributing to his or her antisocial behavior. 

Numerous randomized trials conducted with violent, chronic offenders have indicated lower long-term rates of criminal offending, reduced rates of out-of-home placements and extensive improvements in family functioning.

In Washington State, the recidivism rate after four years for MST completers is 22%. Taken on its own, that figure compares well with a rate of 74% for those who receiving the usual services, but it is the comprehensiveness of the approach that makes the difference.
 
So Wirschem stresses the need to give young people access to programs before they get into trouble. ”The concept of surrendering your liberty in order to access services is stupid to us,” he says.

But money is tight and getting tighter and decisions have to be made about what to provide and what to cut. So far Wirschem’s menu has escaped the knife. Despite the $9 billion cut in the state budget, the $5 million allocated for evidence-based programs in the juvenile courts has been protected – an important message in a time of belt-tightening.
 
And delivering evidence-based programs with quality is not easy. “Everyone says ‘evidence-based programs – great!’. But they don’t know how much work it takes.”
 
In Washington it all began 12 years ago with the Community Juvenile Accountability Act (CJAA), which legislated for funds to be given to the juvenile courts to establish evidence-based programs. The primary goal of the CJAA is to reduce juvenile crime cost-effectively, by establishing “research-based” programs in the state’s juvenile courts. The basic idea is straightforward: taxpayers are better off if their dollars fund programs that have been proven to be effective in key policy outcomes, in this case reduced re-offending.

In today's video, Seattle Multisystemic Therapy supervisor Joshua Leblang stresses the importance of community-wide "buy in".

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