A Cognitive-Behavioral Therapy Program for Youth Who Engage in Domestic Violence Against Their Parents

Thursday, 27 July 2017: 4:50 PM

Anthony J. Roberson, PhD
School of Nursing & Health Studies, University of Miami, Coral Gables, FL, USA

Purpose: The purpose of this oral presentation is to present the specifics and the results of an evidence-based, Cognitive-Behavioral Therapy intervention program developed for youth who engage in domestic violence against family members, and their parents.

Problem: Domestic violence by youth against family members, particularly their parents, is on the rise in the USA and in other countries (Imbusch, P., Misse. M., & Carrion, F., 2011; Martinez-Lanz, P., Gonzalez, A., & Ocampo, D.B., 2014; Zeoli, A.M., Rivera, E.A., Sullivan, C.M., Kubiak, S., 2013). Specifically, in Miami-Dade County (Miami, Florida, USA), the number of youth who engage in abusive behaviors (physical and verbal) against their family members has led to an increase of juvenile arrests and encounters with the juvenile justice system (JJS) (Jouriles, E.N., Rosenfield, D., McDonald, R., Mueller, V., 2013; Miami-Dade, 2016). Unfortunately, these arrests have led to incarceration of youth who otherwise had no previous encounters with the JJS. Further, data indicates that initial arrests among youth have resulted in a noticeable increase in subsequent arrests (for various reasons) upon release of the youth from the JJS back into the community (Miami-Dade, 2016). Because of the increase in domestic violence of youth against their parents and family members, and the unmanageable increase of youth who were being incarcerated for domestic violence, a judge within the Miami-Dade JJS sought the assistance of a research/advanced practice nurse, therapists, lawyers, probation officers, and social workers, to address this growing and seemingly uncontrollable epidemic. In collaboration with a representation of disciplines, this author (research/advanced practice nurse) led the development of a program that was implemented to divert youth who engaged in domestic violence from encountering the JJS, thereby avoiding incarceration when unnecessary and otherwise avoidable.

Intervention: The four week, four module program, solidly grounded in the tenets of Cognitive Behavioral Therapy (Clark, P., 2010; Townsend, E., Walker, D., Sargeant, S., Vostanis, P., Hawton, K., Stocker, O., & Sithole, J., 2010) was a collaboration between a School of Nursing, Coordinated Victims Assistance Center (CVAC), Miami, Florida, and the Miami-Dade County Juvenile Justice System (JJS). The target population was youth, male and female, age 13-17, who engaged in domestic violence against their parents and/or a family member, had a history of psychiatric mental health treatment, and who had limited previous encounters with the JJS. The latter criteria proved important, as research indicates that youth who are not fully involved in the JJS are more likely to change their behaviors and avoid further involvement in the system if interventions are implemented in the early stage(s) of their offenses (Jouriles, E.N., Rosenfield, D., McDonald, R., Mueller, V., 2013). In addition, because of the limited involvement of these youth in the JSS, the intervention program served as a diversion for the youth, as agreed upon by the judge; meaning that if youth successfully completed the program, s/he could avoid further incarceration, probation, and/or record of involvement in the JJS. Parents of the youth were also involved in the intervention program (Aos, S. & Drake, E., 2013).

Cognitive Behavioral Therapy (CBT) is the psychiatric mental health therapy approach that has proven exceptionally and consistently successful among various incarcerated populations, including offenders of drug paraphernalia, driving while intoxicated, and those who commit what are considered minor offenses, such as petty theft, vandalism, and battery/assault (Clark, P., 2010; Townsend, E., Walker, D., Sargeant, S., Vostanis, P., Hawton, K., Stocker, O., & Sithole, J., 2010). Further, CBT is a short-term, focused, and concise therapy approach, which is ideal for the youth population. Lastly, CBT approaches can easily be implemented in a group setting, thereby reducing costs associated with individual therapy approaches and casting a larger net in terms of treatment (WSIPP, 2015). Since domestic violence is defined for the most part as a minor offense (especially among youth), and a short-term, brief therapy approach was desired, a program with a strong CBT approach was created. The overall goal was to improve the lives of the youth who were enrolled in the program. Therefore, Transforming Our Youth (TOY) became the name of the program.

The content of the TOY program modules included anger assessment (identified through the administration of the GAIN-I and GAIN-SS), reviewing domestic violence concepts, understanding the profile of the batterer, and describing the cycle of violence. In addition, roles (present and desired) within the family were explored, which included a discussion related to the strong cultural component of domestic violence (especially relevant considering the strong Hispanic representation of youth in the program), and the communication between youth and their parents were evaluated (Macias, R.L., Rosales, A., Morales, A., Serrate, J., Perilla, J., 2013; Perilla, J., 2013). The program also included a component of self-evaluation which involved the youth considering the consequences of their abusive behaviors. Lastly, the program incorporated activities (homework) for the youth to begin adopting and implementing more effective and healthy communication and interactions with those in their family. The parent component of the program was similar in content to that of what was presented to the youth. However, parents were also encouraged to process their concerns with specific parenting issues, along with ways to better manage their youth in terms of setting limits in productive, healthy, and effective ways. The youth and parent groups, although facilitated in separate rooms at the JJS, were held at the same times, mainly for convenience, but most importantly so the youth and parents received the same information and worked on the same assignments between sessions. Each cohort of youth and parents completed the program over a consecutive four week period, completing one module of the program each week.

Results: Considering the nature and cycle of domestic violence, we defined initial success of the program as a youth who avoided encountering the juvenile justice system at least six (6) months after the initial domestic violence offense. The program continues to date, and is now being facilitated by youth and parents who completed the program. Nevertheless, for this presentation, the data from the first four cohorts of youth (n=45) and their parents (n=53) are included. Among the four cohorts, all have reached the six (6) month post-intervention date, and no youth have re-encountered the JJS since completing the TOY program. Based on the pre-intervention data provided by the Miami-Dade JJS youth domestic violence arrest record, the fact that no youth was arrested within the six month post-intervention period was a significant and promising finding.

Summary: A Cognitive Behavioral Therapy approach to address youth domestic violence against their parents and other family members was implemented as a component of a diversion program. Success in the program was measured if the youth never engaged in domestic violence six months post intervention. The first four cohorts of youth were included in the initial evaluation of the program. The results include no re-arrest of youth, which is significant considering the number of youth who were being arrested after their initial arrest for domestic violence.

Implications for Nursing Practice and Future Projects: As a researcher and advanced practice nurse with over 20 years of experience of service in the JJS, I recognize that the TOY intervention program can be implemented in a variety of juvenile justice settings, including the USA and other countries. As part of a global initiative, my goal is to introduce this program not only in other counties across Florida and the USA, but also in countries where domestic violence among youth is increasing (i.e. Latin American countries) (Martinez-Lanz, P., Gonzalez, A., & Ocampo, D.B., 2014). Further, the evaluation of the TOY program includes only the first four cohorts that completed the six-month evaluation period, which was the intent when the program was originally implemented. However, since that time, our interests have expanded to include evaluation of the long-lasting, and perhaps lifetime, effect(s) of the program. Therefore, longitudinal data collection and analysis, including arrest activity of youth who completed the TOY program, will be conducted and eventually presented in subsequent scholarly publications.