School of Occupational Therapy Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

Critically Appraised Topic Project
Name: Sydney Carnevale and Faith Wilkins

Date: October 8, 2015

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

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

Articles were excluded if they were: Level IV, V, or quantitative, written in another language, and published before 2005. Articles
about incarcerated persons over the age of 18 were excluded. Pharmacological interventions were excluded in order to address
treatment options within the scope of practice of occupational therapy. Systematic review articles were excluded in order to prevent
duplicate research.

Author/

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study Limitations

Implications for
OT

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

Level II

Intervention:

Statistically
Significant:

Lack of
randomization

Clinical and
Community based
practice of OT:

Year
Barnett,
Himelstein,
Herbert,
GarciaRomeu, &
Chamberlai
n, 2013

Design:
Mixed Methods
Cohort

10 week mindfulness
program and one day,
7 hour retreat
compared to a 10 week
mindfulness program.

Subjects:

Outcome Measures:

N=29; Control
group (N=16);
experimental
group (N=13); All
incarcerated males
with the majority
identifying as
Latino

Mindfulness Attention
Awareness Scale Adolescent Version

Healthy Self-Regulation
Scale

Teen Conflict Survey Impulsiveness Subscale

Perceived Stress Scale

10

Paired T-Test
showed
significant
increase in selfregulation
amongst all in
participants in the
experimental
group

Small sample size

Lack of objective
behavioral measures

Lack of a true
control group

Occupational
therapy is deeply
rooted in mental
health and
addressing
psychosocial
deficits through the
use of occupation.
Mindfulness
addresses the need
for nonpharmacology
programs to aid in
the development of
positive coping
strategies and selfregulation.
Special training is
necessary to
perform
mindfulness based

interventions.
Objective Behavioral
Assessment (Behavior
Points)

Focus Group Data

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

Societal needs:
Rates of depression
and anxiety
continue to grow as

our fast paced

world continues to
expand.
Mindfulness is a
technique that all
people can try to
alleviate feelings of
hopelessness,
anger, depression,
fear, and pain. This
also provides an
alternative or
supplement to
pharmacological
interventions.

Health care
delivery and
policy:
These results
should be
considered
preliminary in
regard to directing
funds for policy, as
the sample size of
this study is still

relatively small and

subjective
measures may have
influenced results.

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

Refinement,
revision, and

advancement of
factual knowledge
or theory:
Further studies
should include
more stringent
study criteria in
order to eliminate
covariable effects.
Programs should
aim to determine
curriculum that
best suits various
populations.

Cuellar,
McReynold
s, &
Wasserman
(2006)

Measures the
effectiveness of
youth diversion
programs for youth
with mental health
disorders in
comparison to
incarceration and the
impact of these
programs on
reduction of
recidivism,
lengthened time
between arrests, and

Level I

Design:
Randomized
Control Trial

Population:
N=299 (n=148
experimental;

Intervention:
The Special Needs
Diversion program
focuses on individual
therapy, medication
monitoring, crisis
management, selfadvocacy and service
planning. Average length
of the program was 4.5
months.

Statistically
Significant:
57.2% of
participants of the
total sample were
re-arrested at least
one time within the
last year. 68.2% of
that total was of the
control group with
45.9% being the
experimental

Limited geographical
demographics of
participants

Results not
generalizable to
incarcerated youth
who are serving
harsher sentences

Co-intervention may

Clinical and
Community based
practice of OT:
Youth diversion
programs have
greater effects in
reducing
recidivism rates
amongst youth
when compared to
traditional social

crime severity.

n=151 control)
from 6 counties in
Texas on formal
probation or
community
supervision.

Diagnoses
included substance
abuse disorder
(38.8%), followed
by disruptive
disorder (38.1%),
anxiety disorder
(32.1%), and
affective disorder
(18.4%).

group.
Measures:
Voice Diagnostic
Interview Schedule for
Children (used for
demographics)

Arrest records

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

have occurred in the

control group during
the one year period
after the study

work services.

Influence of probation
monitoring leading to
decreases in crime rate

Specific aspects of
the program,
specifically the
focus on skill
development such
as medication and
financial
management,
should be
incorporated into
other programs.

Lack of specificity
regarding which
aspects of the program
reduced recidivism
rates

Non-generalizability
of results to
mandatory programs
as SNDP was
voluntary

Program
development:

Societal needs:
Diversion
programs increase
the choices youth
have regarding
treatment.
Effective
programming
could decrease the

financial impact of
recidivism.

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

Education and
training for OT
students:

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

Refinement,
revision, and
advancement of
factual knowledge
or theory:
Future studies
should have results
that are more
generalizable.

Helmond,
Overbeek,
&
Brugman,
(2012)

Evaluate the
program integrity
of EQUIP.

Level II

Design:
Measure changes in
moral judgement,
social skills, and
cognitive distortion

QuasiExperimental PrePosttest design

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

Statistically
Significant:

Small control group

sample size,

There was a
statistically
Lack of
significant
randomization
increase in moral
value amongst the
control group.
Significant

Clinical and
Community based
practice of OT:
Given the limited
statistically
significant
information, this
program should not
be implemented in

amongst
incarcerated youth
participating in the
EQUIP program.

Population:

Outcome Measures:

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

Observation Checklist
Program Integrity
EQUIP (constructed by
researchers) **

Observation Forms
(adherence - constructed
by researchers) **

How I Think
Questionnaire

Inventory of Adolescent
Problems Short Form

Sociomoral Reflection
Measure (SF)

development of
social skills noted
in experimental
group but not the
increase in
positive social
skills.

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

Selection bias

OT practice.

Limited training of
leaders

Program
development:

Transient nature of
incarcerated youth

Inconsistent EQUIP
trainers

Per the results of

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

Societal needs:
There is a great
need to help
incarcerated,
paroled, and at-risk
youth in the
development of
self-efficacy and
reducing cognitive
distortions.

Health care
delivery and
policy:
Due the limitation
of the results, the
findings of this
study are not
conducive to the
development of
mental health
programming.

Education and
training for OT
students:
OT students should
be trained in how
to deliver a specific
program to a
group. OT students
should receive
sound background
in adolescent
mental health
conditions and the

effect of
occupational
performance.

Refinement,
revision, and
advancement of
factual knowledge
or theory:
More randomized
studies should be
conducted to
determine program
efficacy.

Himelstein,
2010

The objectives of
this study: Can
mindfulness based
substance use
intervention
feasibly be
implemented with
incarcerated
adolescents, what is
the effect of a
mindfulness - based

Level II

Design:
Mixed Methods
Cohort

Population:

Intervention:
8-week mindfulness
based substance use
treatment. Weekly
sessions for 1.5 hours
with 8-12 participants.
Based on a curriculum
for mindfulness based
substance use
intervention. Focused on
drug education and
development of self-

Statistically
Significant:
Changes in preand post-test
scores for Teen
Conflict Survey
and the
Monitoring the
Future
Assessment.
Significant

Small sample size

Institutional
limitations that limited
the study from having
a control group

Participant resistance
to treatment

Clinical and
Community based
practice of OT:
The use of
mindfulness for
children is an
emerging tool that
is showing great
uses with minimal
harm. The use of
this technique

substance use
intervention on
impulsiveness, selfregulation, and
perceived risk of
illegal substances
with a group of
incarcerated youth,
and how was the
program viewed
and received by the
participating youth.

N=60
Three groups of two
cohorts given the
intervention over a
7 month period.
Juvenile male
incarcerated inmates
from Northern
California with
substance abuse
problems who were
required attendance
to the mindfulness
group. Between the
ages of 15-18 years
of age primarily
identifying as
Latino.

awareness. Role of
facilitators not
thoroughly described.

Outcome Measures:
Teen Conflict Survey

Monitoring the Future

Healthy Self-Regulation

decrease in
impulsiveness
and significant
increase in
perceived drug
risk was
measured.

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

Court ordered
participation of
participants

Many confounding
variables

could lead to
positive behavioral
changes, especially
amongst at-risk and
delinquent youth.
Special training is
necessary to
perform
mindfulness based
interventions.

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

interventions.

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

Health care
delivery and
policy:
These results
should be

considered
preliminary in
regard to directing
funds for policy, as
the sample size of
this study is still
relatively small.

Education and
training for OT
students:
OT students should
be trained in how
to run a group as
well as lead a
mindfulness
intervention.
Students should be
encouraged to
practice
mindfulness on
their own to bolster
their own ability to
teach others.
Students need to be
educated in the
nuances of the

justice system as
well as have a
strong background
in mental health
and the effects of
trauma.

Refinement,
revision, and
advancement of
factual knowledge
or theory:
Future studies
should focus on the
difference in
clinical outcomes
between those who
are court ordered to
participate and
those who
voluntarily
participate.

Himelstein,
Hastings,
Shapiro, &
Heery, 2012.

Test the feasibility of

a 10 week
mindfulness based
intervention for

Level II

Intervention:
10 week Mind Body
Awareness course that

There was a
statistically
significant
difference between

Lack of written data

due to pencil bans on
unit

Clinical and
Community based
practice of OT:

incarcerated youth,
and its effect on the
individuals levels of
self-regulation,
perceived stress and
mindfulness.

Design:
Cohort

Subjects:
N=47 incarcerated
males from San
Francisco

met for one hour a week

to practice formal
mindfulness meditation,
experiential activities,
group processing and
discussion.

Outcome Measures:
Perceived Stress Scale
10

Mindfulness Attention

pre and post test

scores for the
Perceived Stress
Scale and the
Healthy SelfRegulation Scale.

No control group

Small sample size

Mindfulness can be
an effective tool for
developing selfregulation and selfawareness
especially among
youth with mental
health disorders.
Mindfulness may
improve functional
outcomes once the
adolescent is
released from the
juvenile justice
system.

Awareness Scale

Healthy Self-Regulation
Scale

Special training is
necessary to
perform
mindfulness based
interventions.

Program
development:
Mindfulness
should be a core
standard to any
mental health

program as it
develops positive
coping strategies
that increase the
clients
independence and
functional abilities.
Special training is
necessary to
perform
mindfulness based
interventions.

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

Health care

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

Education and
training for OT
students:
OT students should
be trained in
mindfulness
techniques as well
as be well-versed
in youth mental
health disorders.
OT students should
feel comfortable
running groups for
individuals with
behavioral
problems in a
juvenile detention

center.

Refinement,
revision, and
advancement of
factual knowledge
or theory:
More studies need
to be done to
determine the
effects of
mindfulness when
compared to
traditional or other
methods of
intervention.

Himelstein,
Saul, &
GarciaRomeu,
2015

Determine the
effectiveness of
mindfulness
meditation with
adolescents who are
incarcerated
specifically within
the realms of selfesteem, attitudes
toward substance

Level 1

Intervention:

Design:

Two groups received

group therapy and 45-60
minute one on one
psychotherapy sessions
for 8-12 weeks.

Randomized
Control Trial

Experimental group

Statistical
Significance:
Improvement in
decision making
skills and selfesteem in both
groups.

Limitations:
Small sample size

Contamination

Clinical and
Community based
practice of OT:
Mindfulness can be
an effective tool for
developing selfesteem, sense of
control, decision
making and

use, locus of control,

decision-making,
mindfulness and
behavioral
regulations.

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

received one on one 4560 minute psychotherapy

with a focus on
mindfulness based
training. The first 6
weeks the therapist
taught a specific form of
meditation. For the
remainder, participants
were encouraged to
choose a meditation of
which they gravitated to.

The control group

received one on one 4560 minute psychotherapy
with an emphasis on
motivational
interviewing, goal
planning and successful
reentry back into the
community once
released from detention.

Outcome Measures:
Mindfulness Attention
Awareness Scale

Self-esteem
higher in
experimental
group.

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

No regression in
self-esteem,
attitudes, towards
substance abuse,
locus of control,
decision-making,
mindfulness and
behavioral
regulations for the
individuals that
received

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

Societal needs:
Youth with
substance abuse
disorders is a
pertinent societal
matter that needs to
be addressed. This

Prison Locus of Control

Scale
Decision-Making Skills

Rosenberg Self-Esteem
Scale

Attitude Toward Drugs

Behavioral Regulation
Reports

mindfulness based
psychotherapy.

Individuals
psychotherapy
without
mindfulness had a
decline in behavior
reports.

study and similar

programs aim to
provide supportive
services for youth
who are
incarcerated.

Health care
delivery and
policy: This area
would need to be
explored as policy
for therapeutic
services for youth
who are
incarcerated is not
clearly established
or defined.

Education and
training for OT
students: This
study reiterates the
concept that OT
students should be
receiving training
in mindfulness

based
interventions.

Refinement,
revision, and
advancement of
factual knowledge
or theory:
Psychotherapist are
addressing this
population, and it
is time the OT
profession consider
forming models to
address this
population in great
need.
Latourneau
et al., 2009

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

Level I

Design:
Randomized
control trial

Population:

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

Outcome Measures:

Statistically
Significant:
Reduction in
deviant sexual
interests self report
& caregiver report

Reduction in sexual
risk and misuse

Need for longer

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

More valid and

Clinical and
Community based
practice of OT:
There are a high
number of juvenile
sexual offenders
that are a result of
cyclical familial
violence. By
including the

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

Adolescent Sexual
Behavior Inventory
Self-Report Delinquency
Scale (moderate
reliability and validity)*

self-report &
caregiver report

reliable measures of
delinquent behaviors

Reduction in
delinquent behavior

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

Personal Experience
Inventory
Reduction in
substance abuse
Externalizing and
Internalizing scales from
the Child Behavior
Checklist

Youth Self-Report (poor

to moderate validity)*

Services Utilization
Tracking form

Clinically
Significant:
Decreases in
internalization of
negative emotion
and increases in
externalizing
positive emotion
was found however
it was not
statistically
significant

family in
treatment, the OT
can address
dynamics and skill
development
within a natural
context.

Program
development:
MST should be
included into core
programming as it
addresses the
intrinsic and
extrinsic factors
related to
delinquent
behavior. Requires
specialized training
of healthcare
professionals to
uphold
standardized
protocols

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

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

Education and
training for OT
students:

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

Refinement,
revision, and
advancement of
factual knowledge
or theory:
Future studies
should not utilize
parole or juvenile
justice staff to help
collect data as it
may skew the

results.

Ogden &
Hagen
(2006)

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

Level I

Intervention:

Design:

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

Randomized
Control trial

Participants:
Investigate whether
MST was successful
in preventing out of
home placement and
examine trends in
reductions of
behavioral problems
such as delinquency.

75 youth. Average
age of 15.07 years
at intake. Most
(74/75) identified as
Norwegian. s.
Inclusion criteria
included: problem
behaviors, age
between 12-17, and
parents motivated to
start MST

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

Length of treatment
ranges between 3-5
months however there is
no specific length of
service. Intervention
reflects the nine goals of
the MST program

Statistically
Significant
Significant
decrease in
problematic
behavior amongst
the youth that
received the MST
treatment as per
their parents
reports. MST youth
reports of
delinquency
behaviors also
showed a
statistically
significant decrease
over the two year
period (15%) as
compared to their
peers receiving RS
(7%). Reduction in
out of home
placement

Measures:
Self-report delinquency
scale

Clinically

Limited participant
demographic

Clinical and
Community based
practice of OT:

MST is a highly
effective and most
researched type of
youth program.
MST should
provide alternative
No juvenile justice
treatment means
system in Norway
(home and community for incarcerated
based diversion
and delinquent
programs)
youth.
Implementation of
this program may
Site differences in the
lead to large
implementation of
reductions in
MST
recidivism rates
amongst youth
offenders with
Inconsistent manner of mental health
data collection
disorders.
Not long enough to
determine recidivism
rates

between groups and

sites

Requires
specialized training
of healthcare

Out of Home Placement

Survey** (created by the
researchers)

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

Social Skills Rating

Systems

Family Adaptability and

Cohesion Evaluation
Scales - III (FACES-III)

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

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

professionals to
uphold
standardized
protocols

Limited insight
regarding youth selfefficacy and selfperception

Program
development:

Limited
generalizability to
incarcerated and
paroled youth

MST should be a
core part of
programming as it
seems to be highly
effective and
standardized.

Societal needs:
This intervention
can help to
decrease recidivism
rates, in turn
decreasing the
burden of cost of
recidivism on local
communities.

Health care
delivery and
policy:
Policy should focus
on the
implementation of
alternative and
diversion
programming for
youth offenders,
especially those
with mental health
disorders, in order
to promote health
lifestyles and
decrease criminal
behavior.

Education and
training for OT
students:
Students should be
given in depth
instruction
regarding the
standardized and
specific protocol of

MST.

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

Ramadoss
& Bose
(2010)

Examine the
effectiveness of the
Yoga-Based
Transformative Life
Skill program on
decreasing the
number of
recurrences of
violence behavior by
incarcerated youth

Level III

Design:
One group pretest/post-test

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

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

Increase in self-

Lack of control group

High dropout rate

Reliance on staff of
juvenile justice center
to collect data

Clinical and
Community based
practice of OT:
Implementation of
yoga programs
should be done in
conjunction with
one on one skill
development. Yoga

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

sequence of yoga poses

and breathing exercises,
and a final checkout.

control was
measured from pretest to post-test
(p=.02).

Measures:
Perceived Stress Scale

Tangneys Self-Control
Scale

Clinically
Significant:
Use of the TLS
program causes
positive and
significant changes
in self-control and
perceived stress

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

can be a great way

to reinforce learned
skills.

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

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

increasing selfefficacy and

quality of life.

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

Education and
training for OT
students:
OT students should
be highly familiar
with yoga practices
and how to lead

groups safely and

effectively. OT
students should
have a firm grasp
on how yoga can
impact
psychosocial wellbeing as well an
understanding of
youth mental
health disorders.

Refinement,
revision, and
advancement of
factual knowledge
or theory:
Future studies
should utilize more
rigorous study
designs.

TimmonsMitchell,
Bender,
Kishna, &

Independent clinical
study examining the
effectiveness of an
MST program for
youth with diagnosed

Level I

Intervention:
No specific details
regarding the MST
intervention were given

Statistically
Significant:
Youth within the
MST group had

Small sample size

Small budget reduced

Clinical and
Community based
practice of OT:
MST may improve

Mitchell
(2006)

severe behavior
problems within the
juvenile justice
system in the
reduction of
recidivism and
increase in social
functioning.

Design:
2x3 mixed
factorial
randomized
control trial

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

as the protocol is
copyrighted

MST is provided at
home and the intensity is
dependent on the needs
of the family. Length of
treatment ranges
between 3-5 months
however there is no
specific length of
service. Intervention
reflects the nine goals of
the MST program

Outcome Measures:
Arrest Records

Child and Adolescent

Functional Assessment
Scale (CAFAS)

significant fewer
offenses at the 18
month follow up
with a 66.7%
reduction in
recidivism rates.
TAU group was 3.2
times more likely
to be rearrested
within that 18
month period.

MST group scored

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

Clinically
Significant:
Average time
between rearrest
was longer in the
MST group (135

amount of measures
used to test treatment
fidelity

Limited information
regarding the TAU
procedures

Selection bias

Focus on one county

that had an already
established MST
Program

Limited
generalizability to
larger counties and
courts

self-efficacy and
social functioning
amongst youth
with mental health
disorders.
Improvements in
positive behaviors
will lead to lower
recidivism rates
and lower violent
crime rates.
Requires
specialized training
of healthcare
professionals to
uphold
standardized
protocols

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

days) versus the

TAU group (117
days).

of treatment.

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

This intervention
could potentially
lead to decreases in
healthcare and
judicial costs as
youth recidivism
rates decline.

Health care
delivery and
policy:
Larger studies with
more funding
should be done to
determine
diversion program
effectiveness in
reducing
recidivism rates
amongst youth
offenders with
mental health

disorders.

Education and
training for OT
students:
OT students should
be well trained in
the standardized,
specific protocols
of MST as well as
how to effectively
treat clients in a
home setting.
Refinement,
revision, and
advancement of
factual knowledge
or theory:
Future studies
should have a
greater sample size
with a more
heterogenous
population.
Trupin,

Evaluate the impact

on the Family

Level II

Intervention:

Statistically

County variations and

Clinical and

Kerns,
Walker,
DeRobertis,
& Stewart
(2011)

Integrated
Transitions(FIT)
program on juvenile
recidivism for youth
with co-occurring
mental health and
substance use
disorders in
comparison to usual
care

Design:
Cohort Design

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

2 to 3 months phase
while the youth are in
custody and a follow up
4 to 6 month phase postrelease. Families in the
FIT program received an
average of 2.01 hours
per week within the
families homes and
community. Families
also have access to a FIT
coach 24/7. No further
information was given
regarding the specifics of
the FIT program due to
copyright laws.

Significant

coach variations

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

Lack of
generalizability other
regions

Clinically
Significant

Limited information
regarding the specific
interventions used in
the usual model

Decrease in
misdemeanor
recidivism rates
especially among
female offenders.

Measures:
Arrest Records

Decrease in
recidivism rates
among violent
felony offenders

Limited parameters
regarding subject
participation in
program

Single outcome
measure

Community based
practice of OT:
FIT programs are
effective tools in
increasing familial
input and
disrupting cycles of
violence amongst
youth offenders.
The benefits of
home based
interventions is that
transportation and
time become less
of a factor.Requires
specialized training
of healthcare
professionals to
uphold
standardized
protocols

Program
development:
FIT can be used to
develop strong
community based

interventions that
focus on the
development of
positive coping
strategies, life
management, and
healthy life choices
that not only
impact the youth
but all members of
the family who are
involved.

Societal needs:
There is a need to
develop family
based and
community based
interventions for
youth offenders in
order to increase
effectiveness in
skill development.
Youth offenders
often engage in
crime patterns that
are close to home

and therefore
effective
programming
could improve
local communities.

Health care
delivery and
policy:
More programs
need to be
developed for
youth offenders
that incorporate the
family within the
local community in
order to promote
healthier lifestyles.

Education and
training for OT
students:
OT students should
be trained in
dealing with family

dynamics and how

to develop group
based
interventions.

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